Treatment of stenosis and thrombosis in haemodialysis fistulas and grafts by interventional radiology

Turmel-Rodrigues, Luc; Pengloan, J; Baudin, Serge; Testou, Didier; Abaza, M. A.; Dahdah, Georges; Mouton, Albert; Blanchard, Didier

doi:10.1093/ndt/15.12.2029

Cited by 338 publications

(316 citation statements)

References 17 publications

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“…As previously reported, the approach to dysfunctional AVFs is more difficult than grafts (6). The reasons can be listed as follows: a thin and moving venous wall, anatomical irregularities that make the clinical and radiological identification of the anastomosis difficult, an underlying stenosis located between the feeding artery and superior vena cava, a stenosis that is tight and makes passage difficult, the presence of venous collaterals that make anatomic identification of the fistula difficult, and acute angulation that makes passage at the anastomotic level difficult.…”

Section: Discussionmentioning

confidence: 81%

“…Despite proven advantages of AVF over PTFE, both types of access eventually fail and contribute to multiple hospital admissions, radiological and surgical interventions, and overall morbidity associated with chronic hemodialysis. Significant stenosis causing access dysfunction is a frequent complication in hemodialysis and requires repeated percutaneous transluminal balloon angioplasty (PTA) to maintain patency (6)(7)(8)(9). The patency of PTA is limited, however, with first year primary patency rates ranging between 26% and 62% (6)(7)(8).…”

mentioning

confidence: 99%

“…Significant stenosis causing access dysfunction is a frequent complication in hemodialysis and requires repeated percutaneous transluminal balloon angioplasty (PTA) to maintain patency (6)(7)(8)(9). The patency of PTA is limited, however, with first year primary patency rates ranging between 26% and 62% (6)(7)(8). Many factors influencing the patency rate have been studied in previously reported series (7,8).…”

mentioning

confidence: 99%

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Percutaneous transluminal balloon angioplasty in stenosis of native hemodialysis arteriovenous fistulas: technical success and analysis of factors affecting postprocedural fistula patency

Aktaş

Bozkurt²,

Aktaş³

et al. 2015

Diagn Interv Radiol

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RESULTSA total of 330 stenoses were found in 228 patients. PTA was technically successful in 96.3% of the stenoses (n=319). Clinical success was achieved in 97.2% (n=321). Early dysfunction (within six months) was positively correlated with patient age (P < 0.001) and diabetes (P < 0.005). Older age (P < 0.001) and diabetes (P = 0.002) were associated with a lower primary patency rate. Patient age (P < 0.001), presence of diabetes (P = 0.023), length of stenosis (P = 0.003), early recurrence (P = 0.003) and presence of residual stenosis (P = 0.014) were associated with a lower secondary patency rate. CONCLUSION Patency of dysfunctional hemodialysis fistulas can be maintained safely with continuous follow-up and repeated interventions without shortening the venous segment by surgical revision. Percutaneous approach to hemodialysis access stenosis is an alternative to the conventional surgical approach and PTA is an effective treatment method for dysfunctional AVF.H emodialysis, and therefore patent hemodialysis access, is of great importance to patients with end-stage renal disease (ESRD). The preferred type of access in patients undergoing hemodialysis is an arteriovenous fistula (AVF) (1). The Kidney Disease Outcomes Quality Initiative provides evidence-based clinical practice guidelines for all stages of ESRD and reports autogenous AVF as the reference standard for primary vascular access, due to their longevity and low infection rates (2, 3). Sands et al. (4) and Schwab et al. (5) demonstrated a 10-fold increase in thrombosis rate of synthetic polytetrafluoroethylene (PTFE) accesses when compared to AVFs. Despite proven advantages of AVF over PTFE, both types of access eventually fail and contribute to multiple hospital admissions, radiological and surgical interventions, and overall morbidity associated with chronic hemodialysis. Significant stenosis causing access dysfunction is a frequent complication in hemodialysis and requires repeated percutaneous transluminal balloon angioplasty (PTA) to maintain patency (6-9). The patency of PTA is limited, however, with first year primary patency rates ranging between 26% and 62% (6-8). Many factors influencing the patency rate have been studied in previously reported series (7,8). Our study is the first to investigate the effect of early recurrence on secondary patency. MethodsThe records of 228 patients (129 men, 99 women; mean age, 56.8±14.6 years) who underwent first time PTA for a dysfunctional native AVF between January 2007 and January 2011 were retrospectively reviewed. Inclusion criteria were presence of a dysfunctional native AVF referred for fistulography and treatment, no previous history of stenosis or thrombosis, and only stenosis of the AVFs on fistulography. Patients who had synthetic dialysis, composite grafts, or autogenous fistulas that were already thrombosed were excluded from our study. Indications for fistulography included decreased flow rate, difficult cannulation, increased venous pressure, edema of the upper extremity, or pain during dialy...

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Section: Discussionmentioning

confidence: 81%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Percutaneous transluminal balloon angioplasty in stenosis of native hemodialysis arteriovenous fistulas: technical success and analysis of factors affecting postprocedural fistula patency

Aktaş

Bozkurt²,

Aktaş³

et al. 2015

Diagn Interv Radiol

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“…Stenoses of the efferent arm vein in forearm fistulas are treated via primary PTA [66,67]. Upper arm fistulas are typically stenosed in the region of the confluence of the superficial vein (typically the cephalic vein or the basilic vein) with the deep vein system [67] and should also be treated via primary PTA.…”

Section: Stenosis Of the Vascular Access Veinmentioning

confidence: 99%

“…Upper arm fistulas are typically stenosed in the region of the confluence of the superficial vein (typically the cephalic vein or the basilic vein) with the deep vein system [67] and should also be treated via primary PTA. In principle, vascular access vein stenoses in the forearm are accessible for interventional treatment ( • " Fig.…”

Section: Stenosis Of the Vascular Access Veinmentioning

confidence: 99%

Diagnosis and Treatment of Insufficient Dialysis Vascular Access

Kamper

Faizy²,

Haage³

2015

Fortschr Röntgenstr

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A wide variety of diagnostic and minimally invasive modalities is currently available to radiologists for providing sufficient medical care for dialysis patients. In addition to clinical examination, ultrasound is the first line imaging method in suspected dialysis vascular access dysfunction. The percutaneous approach is the primarily recommended therapeutic option in many cases. This article reviews the current diagnostic and therapeutic methods in dialysis vascular access insufficiency. Key Points: ??Vascular access dysfunction is often elicited by stenosed vessels, which are regularly associated with concomitant thrombosis. ??Stenoses are commonly observed in the anastomosis, vascular access vein and also in the central venous system. ??Beside the clinical examination, sonography is the diagnostic method of first choice. ??Percutaneous balloon dilatation frequently is the first treatment option. Citation Format: ??Kamper L, Faizy TD, Haage P. Diagnosis and Treatment of Insufficient Dialysis Vascular Access. Fortschr R?ntgenstr 2015; 187: 360???371

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Doppler of the Hemodialysis Fistula

Lockhart¹,

Robbin²

2005

Essentials of Vascular Laboratory Diagnosis

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Treatment of stenosis and thrombosis in haemodialysis fistulas and grafts by interventional radiology

Cited by 338 publications

References 17 publications

Percutaneous transluminal balloon angioplasty in stenosis of native hemodialysis arteriovenous fistulas: technical success and analysis of factors affecting postprocedural fistula patency

Percutaneous transluminal balloon angioplasty in stenosis of native hemodialysis arteriovenous fistulas: technical success and analysis of factors affecting postprocedural fistula patency

Diagnosis and Treatment of Insufficient Dialysis Vascular Access

Doppler of the Hemodialysis Fistula

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