Imaging and Endovascular Management of Complications of Dialysis Arteriovenous Fistula

Patients with end-stage renal disease depend on maintenance hemodialysis when a renal transplant is not an option. However, the increasing number of patients undergoing dialysis through arteriovenous fistulas (AVFs) has brought about a noticeable increase in fistula-related complications. AVFs are prone to a lack of maturation, anastomotic stenosis, thrombosis, venous pseudoaneurysms, and central vein obstruction. These complications can be effectively addressed with various endovascular techniques, such as balloon angioplasty, stenting, embolization of early-draining collaterals, thrombolysis, and central vein recanalization, all aimed at extending the lifespan of vascular access sites. It is essential for endovascular interventionalists to be highly knowledgeable in the types of AVFs, their potential complications, and the available endovascular options. This article aims to review the different AVF types, their complications, clinical presentations, ultrasound imaging, and endovascular treatment options, providing a comprehensive guide for clinicians involved in the care of patients with AVFs.