A Multicenter Retrospective Study Evaluating Distal Radial Access vs. Conventional Transradial or Transvenous Access for Endovascular Treatment of Malfunctioning Dialysis Fistulas
Roberto Minici,
Massimo Venturini,
Giuseppe Guzzardi,
Federico Fontana,
Andrea Coppola,
Filippo Piacentino,
Marco Spinetta,
Davide Costa,
Maria Chiara Brunese,
Pasquale Guerriero,
Biagio Apollonio,
MGJR Research Team,
Nicola De Rosi,
Raffaele Serra,
Domenico Laganà
Affiliations
Roberto Minici
Radiology Unit, University Hospital Dulbecco, 88100 Catanzaro, Italy
Massimo Venturini
Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy
Giuseppe Guzzardi
Imagerie Vasculaire et Interventionnelle, Centre Hospitalier Princesse Grace, 98000 Monaco City, Monaco
Federico Fontana
Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy
Andrea Coppola
Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy
Filippo Piacentino
Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy
Marco Spinetta
Radiology Unit, Maggiore della Carità University Hospital, 28100 Novara, Italy
Davide Costa
Department of Law, Economics and Sociology, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy
Maria Chiara Brunese
Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy
Pasquale Guerriero
Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy
Biagio Apollonio
Radiology Unit, San Timoteo Hospital, 86039 Termoli, Italy
MGJR Research Team
Radiology Unit, University Hospital Dulbecco, 88100 Catanzaro, Italy
Nicola De Rosi
Radiology Unit, University Hospital Dulbecco, 88100 Catanzaro, Italy
Raffaele Serra
Vascular Surgery Unit, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Dulbecco University Hospital, 88100 Catanzaro, Italy
Domenico Laganà
Radiology Unit, University Hospital Dulbecco, 88100 Catanzaro, Italy
Background: This study aims to evaluate the feasibility, efficacy, and safety of distal transradial access (dRA) for the endovascular management of malfunctioning dialysis fistulas. This study also compares dRA with conventional access techniques, such as proximal radial and transvenous access, focusing on technical success, clinical outcomes, and vascular access site complications (VASCs). Methods: A retrospective multicenter study was conducted across four hospitals, including 292 patients treated between January 2019 and June 2024. Of these, 57 patients underwent dRA, and 235 received proximal radial or transvenous access. Key outcomes included technical success (successful completion of the procedure), clinical success (restoration of functional dialysis access), and complication rates. Data were collected on procedure times and complication profiles. Results: Technical success was achieved in 96.5% of patients undergoing dRA, compared to 98.3% in those receiving conventional access (p = 0.388). Clinical success was similar between groups (96.5% vs. 97%, p = 0.835). The overall complication rate was 10.5% for dRA and 8.5% for conventional access (p = 0.632). Cannulation time was longer for dRA (109.1 vs. 91.9 s, p < 0.001), but total procedure duration was comparable between the groups. No major complications were observed in either cohort, and improved post-procedure access flow rates were recorded in all patients. Conclusions: Distal transradial access is a feasible and effective approach for the endovascular management of malfunctioning dialysis fistulas, with outcomes comparable to conventional access techniques. It provides a safe alternative, particularly for patients with complex fistulas, while maintaining a low complication profile.
