Clinical experience with ultrasound guided angioplasty for vascular access

Abstract

BackgroundThe use of ultrasound guided percutaneous transluminal angioplasty (UG-PTA), which use ultrasound as an imaging modality, is an evolving strategy. But, in Korea, this method is rarely used. We report our experiences with UG-PTA with respect to technical success rates and complication rates compared to conventional PTA (C-PTA), performed between 2010 and 2015 at Samsung Changwon Hospital, Korea.MethodsIn our series, 53 cases of UG-PTA and 90 cases of C-PTA were reviewed, respectively. Cases of central vein stenosis, cephalic arch stenosis, arterial stenosis and thrombosis were excluded. However, cases of juxta-anastomotic stenosis and outflow vein stenosis were included.ResultsTechnical success was achieved in 96.2% (51 of 53) of cases in the UG-PTA group and in 93.3% (84 of 90) of cases in the C-PTA group, respectively (P = 0.710). Technical failure was experienced in a total 8 cases (UG-PTA group: 2/53, 3.8%; C-PTA group: 6/90, 6.7%). No differences were observed in complications.ConclusionDuplex ultrasound-guided angioplasty for dialysis access in the outpatient setting is feasible, safe, and effective for peripheral venous stenotic lesions. It offers many advantages over conventional angiographic procedures, and, in the future, it has great potential to play a significant role in the management of these challenging patients.

Feasibility of routine ultrasound-guided percutaneous transluminal angioplasty in the treatment of native arteriovenous fistula dysfunction

“…Early technical success occurred in 95.6% of cases, and primary patency was 84% and 69.8% at 6 and 12 months, respectively; complication rate was 13.5% with no major complication requiring transition to surgery or fluoroscopic guidance. These results are in line with those recently published by other authors; 16,[19][20][21][22][23][24] however, some differences regarding the study design and the typology of treated AVF (native vs prosthetic) and of devices used for PTA limit their comparability. Our study has the advantages to be prospective with a large sample size and long follow-up.…”

Central venous disease in hemodialysis patients

“…Problems related to HD VA affect the survival rate of ESRD patients. Various techniques of endovascular therapy resulted in a breakthrough development in the treatment of HD VA [11–13]. However, the lesion of CV is much less responsive to endovascular therapy than that of a peripheral location.…”

Ultrasound in dialysis access: Opportunities and challenges

“…39 The use of intra-vascular ultrasound (IVUS) in addition to conventional angiography for dysfunctional grafts in a recently published pilot study altered management plans in a majority of the patients and doubled the median time to reintervention or graft abandonment. 40 US-guided interventions are also increasingly being used internationally [41][42][43] and may soon replace fluoroscopic procedures, with their concomitant risks of contrast and radiation exposure. The advantage of minimizing contrast exposure with US guidance is enhanced in pre-dialysis patients, and patency rates are equivalent to those performed under conventional fluoroscopic techniques.…”