الفهرس 
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Abstract
The aim of this study was to evaluate the safety and efficacy and to determine the predictors of technical success and patency of different endovascular management options to treat dysfunctional hemodialysis arteriovenous fistulas. This was a prospective study that was conducted on 30 patients presented with dysfunctional hemodialysis AVF to Vascular and Endovascular Surgery Department, Tanta University Hospitals during the period between July 2022 and July 2023. Patients were divided into two groups: ➢ group I (DCB): that included 11 patients. ➢ group (II) PBA: that included 19 patients. The Results were summarized as the following: ➢ There was no significant difference between both groups in all lesions related data except for the presence of a history of ipsilateral CVC, in only (27.3% vs 73.7%) in DCB vs PBA groups respectively with (P value =0.02). ➢ Patients in DCB group had AVF dysfunction after a median of 8 (range: 3-26) months whereas in PBA group the AVF dysfunction accessed after a median of 3 (range: 1-42) months starting from the date of access creation. ➢ The dysfunction was clinically diagnosed through patients’ complication of inadequate dialysis, aspiration of clots during cannulation, or dialysis, or new cannulation difficulties. On examination, most patients had abnormal thrill/bruit on the AVF vein. ➢ As the access of the venoplasty was chosen according to the site of the stenosis and its location relative to the anastomosis, most patients were managed by retrograde venous access (22/30) 73.3%. There was no significant statistical difference between both groups with regard to operative or, fluoroscopy time. ➢ In DCB group, each of the 11 patients had a single significant stenosis, while in PBA group, 2 patients had 2 significant stenosis each and only one patient had 3 stenosis. Most of the stenosis treated in the DCB group were in the mid-vein segment (55%), whereas a more even distribution was present in PBA group. ➢ A trend towards a larger stenotic segment was present in DCB group and a significantly higher PSV ratio was shown in the same group (P value = 0.02). ➢ Follow-up time was significantly higher in DCB group than in PBA group (P value=0.04). The follow-up index was non-significant between both groups. ➢ The Stenosis percentage was non-significantly different at 1 day, 1 month, 3 months, 6 months and 1 year between both groups. ➢ PSV ratio was non-significantly different at 1 day, 3 months, 6 months and 1-year between both groups while was significantly higher at 1 month in DCB group than in PBA group (P value=0.001). ➢ FV ratio was non-significantly different at 1 day, 3 months, 6 months and 1-year between both groups. ➢ The primary patency at 6 months 72.7% vs 78.9% in DCB vs PBA groups, respectively with non-statistically significant difference. The primary patency at 1 year was 63.6% vs 55.6% in DCB vs PBA groups, respectively with non-statistically significant difference. ➢ The 2ry patency at 6 months 90.9% vs 89.5% in DCB vs PBA groups, respectively with non-statistically significant difference. The secondary patency at 1 year 72.7% vs 66.7% in DCB vs PBA groups, respectively with non-statistically significant difference. ➢ In univariate regression, gender, diabetes mellitus, hypertension, IHD, dyslipidemia, anti-platelet therapy, prior ipsilateral AVF, HD duration, AVF type, side, creation-to-cannulation time, creation-to-dysfunction time, no. of stenotic segments, site of stenotic segment, length of stenotic segment, diameter of stenotic segment, stenosis percentage, PSV ratio, FV ratio and procedure were not predictors of treatment outcome.