Patency and Functional outcomes of Endovascular Treatment in Juxta-Anastomotic Venous Stenosis of Native Arteriovenous Fistulas

Introduction: Juxta-anastomotic venous stenosis is a frequent cause of dysfunction in native arteriovenous fistula (AVFs), compromising both maturation and long-term patency. Endovascular treatment has emerged as a minimally invasive alternative to surgical revision. We evaluated short-term patency and functionality outcomes and temporal patterns following endovascular treatment of juxta-anastomotic venous stenosis. Materials and methods: We conducted a retrospective single-center observational study including adult patients with native AVFs who underwent endovascular treatment for juxta-anastomotic venous stenosis between January 2020, and June 2024. Analyses were performed at the patient level using the first (index) intervention. Assisted primary patency was assessed using Kaplan–Meier survival analysis. Exploratory associations with 6-month failure were evaluated using penalized logistic regression. Results: Fifty patients were included. Median age was 72 years [IQR: 65–76], and 72% of patients were male, with a high burden of cardiovascular comorbidity. At intervention, 72% were on hemodialysis and 28 % were followed in advanced chronic kidney disease (ACKD). Delayed AVF maturation accounted for 46% of cases. The median time from AVF creation to stenosis detection was 112.5 days (IQR 60.5–511), indicating heterogeneous temporal presentation. Stenosis was detected significantly earlier in AVFs treated for delayed maturation compared with established accesses (median 68.5 vs 388.5 days; p=0.001). Conventional balloon angioplasty was performed in 98% of index procedures, with selective use of cutting balloons and drug-coated balloons. During 6-months of follow-up, 8 access failures occurred. Kaplan–Meier estimates of assisted primary patency were 90% at 90 days (95% CI 0.78–0.96) and 84% at 180 days (95% CI 0.71–0.92). Functional success at 6-months was 90% of patients. Conclusions: In this single-center retrospective cohort, endovascular treatment was associated with high short-term assisted primary patency and functional success. These results represent real-world descriptive data and require confirmation in prospective studies with longer follow-up and comparative designs.