Adaptive remodeling of hypoplastic hemodialysis fistulas salvaged with angioplasty

Objectives: The aim of this study was to determine whether immature hemodialysis fistulas undergo flow‐induced adaptive remodeling after successful percutaneous angioplasty. Background: Approximately 50% of radiocephalic fistulas remain immature after surgery and cannot be used for hemodialysis. Small fistulas with anastomotic inflow stenoses may undergo salvage angioplasty, but the time course of outward remodeling after successful treatment has not been defined. Methods: Thirty‐two of 39 patients (82%) with inaccessible, hypoplastic radiocephalic fistulas underwent attempted salvage angioplasty of inflow stenoses involving the arteriovenous anastomoses. Twenty patients experienced salvage of their fistulas and successfully underwent hemodialysis (51%). Results: Eleven patients had serial angiographic procedures, which allowed paired sequential quantitative angiographic measurements of the fistulas to be made during a median follow‐up of 200 days (range 5–2,298 days). Fistula diameters increased from 4.5 ± 1.3 mm to 8.0 ± 2.5 mm (mean ± S.D.). The mean growth of the fistulas was 1.0 ± 0.9 mm per year. Conclusions: The mechanism of adaptive remodeling transforms nonmaturing hypoplastic autogenous fistulas into functioning accessible dialysis accesses after successful percutaneous transluminal angioplasty of inflow anastomotic stenoses. © 2009 Wiley‐Liss, Inc.