To investigate the efficacy, safety and long-term patency of transfemoral and brachial artery percutaneous transluminal angioplasty (PTA) combined with thrombolysis in the treatment of completely occlusive autologous arteriovenous fistula (AVF).

From March 2016 to June 2018, 53 patients with AVF occlusion who underwent PTA combined with thrombolysis via arterial approach were analyzed retrospectively. The baseline data, surgical outcome, complications, radiation dose and fluoroscopy time were analyzed, and the patency time and patency rate of AVF were observed.

Among the53 patients with AVF occlusion, 48 cases were successful and 5 failed, with an overall technical success rate of 90.6%. The power of brachial artery approach was better than that of femoral artery approach with significant difference (P<0.05), but there were no significant differences in complications and primary patency rate between the two groups. The fluoroscopy time in the femoral artery approach group was (2 601.5 ±1 803.9) s, which was much longer than that in the brachial artery approach group [(1 191.8±844.5) s] with significant difference (P<0.05), and the radiation dose in the brachial artery approach group [(25.15 ±26.06) s] was significantly lower than that in the femoral artery approach group [(97.58 ±69.85) s](P< 0.05).

PTA combined with thrombolysis via femoral artery and brachial artery approach can effectively treat completely occlusive AVF, and postoperative AVF has good long-term patency during continuous follow-up. The brachial artery approach group is significantly better than the femoral artery approach group in terms of radiation dose and fluoroscopy time during operation.