Hemodialysis fistulas and grafts: use of cutting balloons to dilate venous stenoses.

Abstract

To evaluate percutaneous transluminal angioplasty (PTA) with a cutting balloon performed in stenosed hemodialysis fistulas and grafts, 19 venous lesions in 15 patients were treated with a cutting balloon with an inflated diameter of 3-6 mm. The grade of stenosis ranged from 40% to 90% (mean, 65% +/- 15 [standard deviation]). Cutting PTA was performed before conventional PTA in seven patients and was followed with conventional PTA with larger balloons in seven patients. The balloon expanded completely in all patients, and no balloon waist remained. The mean grade of stenosis decreased to 14% +/- 9. Cutting PTA increased the technical success of balloon dilation of hemodialysis fistulas and grafts.

Percutaneous transluminal angioplasty of malfunctioning Brescia-Cimino arteriovenous fistula: analysis of factors adversely affecting long-term patency

“…Providing successful vascular access for hemodialysis remains one of the most challenging problems [1,2,3,4,5,6,7,8,9,10,11]. Many investigators have reported that Brescia-Cimino arteriovenous fistulas have several advantages to polytetrafluoroethylene grafts, especially for a longer lifetime [1,2,3,4,5,8,9,10].…”

“…Many investigators have reported that Brescia-Cimino arteriovenous fistulas have several advantages to polytetrafluoroethylene grafts, especially for a longer lifetime [1,2,3,4,5,8,9,10]. Despite the increased reliability, however, Brescia-Cimino arteriovenous fistulas often require radiological or surgical interventions frequently to maintain their function [1,2,3,4,5,8,9,10].…”

“…Percutaneous transluminal angioplasty (PTA) has been widely recognized as a suitable technique for maximizing the function of vascular access [1,2,3,4,5,6,7,8,9,10,11]. While many investigators have described high initial success rates, the long-term patency rates reported remain unsatisfactory [1,2,3,4,5,6,7,8,9,10,11,15,16,17].…”

“…While many investigators have described high initial success rates, the long-term patency rates reported remain unsatisfactory [1,2,3,4,5,6,7,8,9,10,11,15,16,17]. As a solution to this problem, endoluminal metallic stents have been developed in the salvage of failed hemodialysis access recanalization attempts in recent years [12,13,14,15,16,17]; however, three recent prospective randomized studies found no statistical significance in the long-term patency between lesions in which self-expanding metallic stents were placed and those treated only with PTA [15,16,17].…”

Novel Therapies for Hemodialysis Vascular Access Dysfunction

“…The use of cutting balloons for treatment of high-pressure balloon-resistant stenotic lesions in AVGs and AVFs has been described in clinical reports and small studies (50)(51)(52)(53)(54). A multicenter randomized clinical trial of 340 patients with venous outflow stenoses reported equivalent 6-month patency rates between PTA alone and cutting balloon angioplasty, but the cutting balloon approach experienced a greater number of device-related complications, including venous rupture and dissections (55).…”