Failure of a new arteriovenous fistula (AVF) may be defined as an unsuitable access site 3 months after creation. While most commonly this may be treated by balloon angioplasty, collateral vein embolization (CVE) is touted to promote maturation of a non-maturing AVF. Researchers from the University of Chicago evaluated 56 embolizations in 42 patients. The majority of patients treated by collateral vein embolization (76%) progressed to fistula maturity. In 79% of patients, this was done without angioplasty, contradicting the argument that collateral veins reflect venous outflow obstruction and do not, by themselves, indicate a true 'accessory' venous pathway. In addition, the study showed a trend toward higher rates of fistula failure in patients treated with radiocephalic fistulas undergoing CVE and PTA; however, the results were not statistically significant. Of note, fistula age, vessel, size, and number of collaterals did not correlate with the rate of fistula failure or success.
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(a) Digital subtraction angiogram in a 67-year-old man with new brachiocephalic fistula referred for fistula immaturity. Angiogram of the fistula demonstrates a large collateral vein arising from the primary venous outflow (arrow) without other diagnostic abnormality. This vessel was subsequently selected, and embolization was performed with four 0.035-inch, 8-mm pushable coils. (b) Postembolization image after CVE no longer demonstrates opacification of the collateral vessel.
Citation: Ahmed O, Patel M, Ginsburg M, Jilani D, Funaki B. Effectiveness of Collateral Vein Embolization for Salvage of Immature Native Arteriovenous Fistulas. J Vasc Interv Radiol 2014.
Post author: Luke Wilkins, MD