Impaired maturation of distal radio-cephalic fistula for haemodialysis: a review of treatment options

Distal radio-cephalic arteriovenous fistula is the 'gold standard' vascular access for chronic hemodialysis. Its main drawback is early failure, which can complicate up to 50 % of this surgical procedure. Two scenarios of failure are possible: early post-operative thrombosis or impaired maturation. The first is mainly due to a defective preoperative evaluation or poor surgical procedure. The latter is a patent angioaccess unable to deliver adequately hemodialysis due to a persistently low blood flow or difficult cannulation. In this article, the causes of impaired maturation will be reviewed, ranging from the stenosis causing low flow to the deep location of the vein in the obese. Treatment options will be described in thorough technical detail, in order to allow the angioaccess team to master them in daily practice.