Endovascular Options for Nonmaturing Fistulas due to Collateral Flow
- DOI:
- 10.1093/med/9780199986071.003.0050
The “failing to mature” arteriovenous fistula (AVF) is a surgically created AVF that fails to properly dilate to become usable for hemodialysis within 8–12 weeks after its creation. Difficult cannulation and inadequate AVF flow are the clinical manifestations of the “failing to mature” fistula. Early thrombosis of a newly created fistula is a possible cause of a “failing to mature” AVF. Early AVF thrombosis has similar underlying derangements as the immature fistula and both can be salvaged using endovascular techniques, including embolization of collateral veins via coils or endovascular plugs. Complications of collateral vein embolization include local hematoma formation, inadvertent coiling of the outflow vein, pain, erythema at the site of collateral vein embolization, migration of the coils, and, rarely, skin erosion at the site of the embolized superficial collateral vein. Patients need to be followed up with a fistulagram within 1 month of embolization.
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