Endovascular hemodialysis AVF care is no longer only a rescue technique: the mapped evidence shows a full access-life-cycle strategy, from percutaneous creation and assisted maturation to repeated salvage of stenosed, immature, or thrombosed fistulas. The full SAIMSARA evidence map gives a structured, reference-linked view of which techniques work, where patency fails, how often reintervention is needed, and which patient or lesion phenotypes may benefit most.
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Abstract: To map and synthesize studies evaluating endovascular creation, maintenance, salvage, complication management, imaging support, procedural access routes, analgesia, and comparative outcomes for hemodialysis AVFs. The review uses 133 references and builds its evidence map from 167 original studies with 171348 total participants (topic-deduplicated ΣN). The mapped evidence supports a role for endovascular management as a feasible, repeatable, and increasingly central strategy across the hemodialysis fistula life cycle, spanning percutaneous creation, assisted maturation, and salvage of stenosed or thrombosed access. Technical success was consistently high across endoAVF creation platforms, with 24-month cumulative patency reaching 91.7% in a multicenter WavelinQ cohort, while salvage of immature and thrombosed fistulas achieved technical success of 93%–97%. The literature indicates that durable access often depends on accepting repeated interventions rather than treating reintervention as failure, and that outcomes are strongly modulated by lesion location, anatomy, and timing. Heterogeneous designs, retrospective predominance, and inconsistent patency definitions limit certainty about comparative device superiority. Future randomized comparative trials using harmonized maturation, patency, and reintervention endpoints are needed to clarify which endovascular strategies provide the most durable, cost-effective access for specific patient and lesion phenotypes.
Final search date and database lock: 2026-05-12 13:39:38 CEST
Plan: Pro (expanded craft tokens; source: PubMed)
Source: PubMed
Total Abstracts/Papers: 400
Downloaded Abstracts/Papers: 400
Included original and non-original Abstracts/Papers (all): 188
Included original Abstracts/Papers (Vote counting by direction of effect): 167
Reference Index (links used in paper): 133
Total participants (topic deduplicated ΣN): 171348
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The Evidence Object JSON is a separate machine-readable evidence product: a concentrated synthesis of results, topic-level evidence, and discussion across original and non-original studies. It can be directly input into your LLM, agent, or RAG workflow.
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[100] Oversized balloon angioplasty for endovascular maturation of arteriovenous fistulae to accelerate cannulation and to decrease the duration of catheter use. — https://doi.org/10.1177/11297298211029558
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[102] Multi-Center Two-Year Patency Outcomes of Endovascular Arteriovenous Fistulas (endoAVF) Created with a 4 French System. — https://doi.org/10.1007/s00270-024-03754-5
[104] Intervention with selution SLR™ Agent Balloon for Endovascular Latent Limus therapy for failing AV Fistulas (ISABELLA) Trial: Protocol for a pilot clinical study and pre-clinical results. — https://doi.org/10.1177/11297298211020867
[106] The use of experimental preclinical models in evaluating endovascular interventions for vascular access stenosis: A review. — https://doi.org/10.1177/11297298251362928
[110] Factors Associated with Secondary Functional Patency After Percutaneous Transluminal Angioplasty of the Early Failing or Immature Hemodialysis Arteriovenous Fistula. — https://doi.org/10.1007/s00270-018-2083-0
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[116] Repeated Endovascular Interventions Are Worthwhile, Even After Thrombosis, to Maintain Long-Term Use of Autogenous Dialysis Fistulas. — https://doi.org/10.1177/15385744211026452
[124] Cleaner XT Rotational Thrombectomy: An Efficacious Endovascular Technique for Salvage of Thrombosed Arteriovenous Access and a 12 Month Outcome Analysis. — https://doi.org/10.1177/15266028221083222
[125] Combined Endovascular Treatment with Distal Radial Artery Coil Embolization and Angioplasty in Steal Syndrome Associated with Forearm Dialysis Fistula. — https://doi.org/10.1007/s00270-016-1368-4
[126] A Multicenter Retrospective Study Evaluating Distal Radial Access vs. Conventional Transradial or Transvenous Access for Endovascular Treatment of Malfunctioning Dialysis Fistulas. — https://doi.org/10.3390/life14111382
[127] The efficacy of percutaneous transluminal angioplasty for the endovascular management of arteriovenous fistula dysfunction: a retrospective analysis in patients with end-stage renal disease. — https://doi.org/10.23736/s0392-9590.20.04334-5
[129] Anesthetic effect of ultrasound-guided block of the musculocutaneous nerve during endovascular treatment of dysfunctional radiocephalic arteriovenous fistulas. — https://doi.org/10.1177/11297298221075178
[130] Clinical Efficacy of the Transradial Approach in Percutaneous Intervention for a Malfunctioning Arteriovenous Fistula. — https://doi.org/10.3348/jksr.2021.0086
[137] Plain versus drug-eluting balloon angioplasty in the treatment of non-thrombotic hemodialysis arteriovenous fistula stenosis: results from a single center comparative retrospective analysis. — https://doi.org/10.1080/00015458.2025.2503647
[139] Endovascular salvage of non-maturing autogenous arteriovenous fistulas by using angioplasty and competitive vein embolization. — https://doi.org/10.1177/1129729819895185
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