Ultrasound appearances and histological correlation of native arteriovenous fistula stenoses – A retrospective case series

Abstract

Failure of maturation of native autologous arteriovenous fistulae (AVFs), fistula thrombosis and dialysis access dysfunction are most often caused by arteriovenous (AV) access stenosis. 1 The pathophysiology of AVF stenosis and mechanisms of restenosis are not yet fully understood.Venous neointimal hyperplasia is a recognised cause of vascular access stenosis and fistula failure. 2 Failure of fistula maturation and early fistula failure have been shown to be due to both neointimal hyperplasia and adverse adventitial remodelling or a failure of venous dilatation resulting in AVF stenosis. 2 Ultrasound is a non-invasive, readily available diagnostic tool used in the assessment of AVF dysfunction and failure of fistula maturation. Doppler ultrasound has a high sensitivity and specificity in the diagnosis of vascular access stenosis. 3,4 The technique, in the hands of an experienced operator, has high accuracy and reproducibility in detecting more than 90% of significant stenosis. 4 Ultrasound can also be used to assess neointimal hyperplasia by measuring intimal-medial thickness (IMT) at the site of a stenosis. 5 Carotid intima-media thickness (CIMT) measurements are made

Effect of local anti-vascular endothelial growth factor therapy to prevent the formation of stenosis in outflow vein in arteriovenous fistula

“…IMT% = (outer to outer vessel wall diameter − luminal diameter)/outer to outer wall vessel diameter ×100%. [ 26 , 27 ]…”

Editor's Choice – Paclitaxel Coated Balloon Angioplasty vs. Plain Balloon Angioplasty for Haemodialysis Arteriovenous Access Stenosis: A Systematic Review and a Time to Event Meta-Analysis of Randomised Controlled Trials

“…Sonographic and histopathological evidence suggests that AV access stenosis is a heterogeneous entity with different pathophysiology. 44,45 patency outcome up to 12 months. Considering the moderate quality of evidence, further accumulation of evidence from ongoing trials will be helpful in guiding clinical practice.…”

Paclitaxel-Coated Balloon Angioplasty for Dysfunctional Arteriovenous Fistulas

“…In addition, there has been evidence to demonstrate stenosis without intimal hyperplasia, especially in de novo lesions, which may limit the efficacy of DCB. [8] Lookstein et al also showed that the effect difference of DCB vs. HPB was larger in restenotic compared to de novo lesions (26.5% vs 15.1%). [6] A larger sample size is therefore needed to show a difference in target lesion patency in de novo lesions.…”