Abstract: Objective To explore the surgical approaches for management of postoperative stenosis of ateriovenous fistula (AVF)
in patients with end-stage renal disease (ESRD). Methods Of the 415 patients with ESRD receiving radial-cephalic end-to-side
anastomosis during the last 3 years, 29 developed postoperative AVF stenosis (of type Ia in 5 cases, type Ib in 17 cases, type II
in 3 cases, and type II in 2 cases). A proximal anastomosis was created between the radical artery and cephalic vein for type Ia
stenosis. In the 17 cases with type Ⅰb stenosis, 5 were managed by interception of suitable segments from the accessory
cephalic veins for cephalic vein reconstructions, and 12 by transposition of the accessory cephalic veins. Of 3 cases with type II
stenosis, 1 was managed by interception of the accessory cephalic vein for interposing into the cephalic vein, 1 by interception
of the distal great saphenous vein for interposing into the cephalic vein, and 1 by transposition of the forearm basilic vein for
end-to-side anastomosis with the radial artery. The 2 cases with type III were managed by end-to-side anastomosis between
the forearm basilic vein and the radial artery or by conversion to AVF repair on the contralateral forearm. Results Twenty-eight
of the 28 patients finally received surgical repair of AVF stenosis and the surgeries were completed successfully. Thrombosis of
the outflow vein occurred 12 h after the repair in 1 case to require emergency embolectomy and anastomosis; restenosis
occurred in 2 cases at 9 months postoperatively, for which progressive percutaneous transluminal angioplasty (PTA) was
performed. The rate of restenosis was 7.1% (2/28). All the 28 patients undergoing AVF stenosis repair had successful HD for 12
months after the operation. Conclusion Reconstructing the arteriovenous anastomosis, replacing the stenosis segment with an
accessory cephalic vein or great saphenous vein graft, or altering the outflow with the forearm basilic vein can be surgical
options for repairing postoperative AVF stenosis