Optimal Timing of Percutaneous Intervention in Non-maturing Dialysis Fistulas
Optimal Timing of Percutaneous Intervention in Non-maturing Dialysis Fistulas
Arteriovenous fistulas (AVFs) are the preferred type of vascular access for dialysis, but
 many of them fail to mature. The optimal timing of intervention to salvage immature AVFs is
 unknown.The study proposes a randomized clinical trial comparing the clinical and economic
 impact of early vs late angioplasty in non-maturing AVFs.

 The study proposes a RCT to test the hypothesis that, as compared to early angioplasty of
 non-maturing AVFs, late angioplasty results in a lower proportion of AVFs being used at 6
 months, but a greater long-term AVF patency , lower requirement of subsequent interventions
 to maintain AVF patency for dialysis, and lower overall cost of access maintenance.
The optimal timing of intervention in non-maturing AVFs remains controversial, and can only
 be definitively addressed by a randomized clinical trial (RCT) comparing early (6 weeks) vs
 late (3 months) angioplasty of non-maturing AVFs. The investigators will perform a
 single-center, prospective RCT. The investigators will recruit 112 patients who initiated
 hemodialysis with a CVC, then had a new AVF created after commencing dialysis, and then had a
 6-week postoperative ultrasound that revealed an immature AVF (diameter < 4 mm diameter or
 blood flow < 500 ml/min). These patients will be randomized to one of two groups: an early
 intervention group that will undergo a routine PTA at 6 weeks after AVF creation, or a late
 intervention group in which early PTA will be avoided and subsequently be performed only if
 the 3-month ultrasound indicates persistent AVF immaturity. These patients will be followed
 for 2 years.
Inclusion Criteria:

 -  Patients with End stage renal disease (ESRD).

 -  Patients on hemodialysis.

 -  Patients using central venous catheter (CVC).

 -  Patients who had a new AVF created after commencing dialysis.

 -  Patients who had immature fistula ( 6-week postoperative ultrasound that revealed an
 immature AVF (diameter < 4 mm diameter or blood flow < 500 ml/min).

 Exclusion Criteria:

 • Children with Age below 18