Percutaneous Transluminal Angioplasty as Best Treatment in Stenosis of Vascular Access for Hemodialysis

Nephron ◽  
1989 ◽  
Vol 51 (2) ◽  
pp. 192-196 ◽  
Author(s):  
J.C. Rodriguez-Perez ◽  
M. Maynar ◽  
A. Rams ◽  
C. Plaza ◽  
N. Vega ◽  
...  
Keyword(s):  
Vascular Access ◽  
Percutaneous Transluminal Angioplasty ◽  
Transluminal Angioplasty ◽  
Percutaneous Transluminal

Arterial percutaneous angioplasty in hemodialysis access: Endovascular treatment of hand ischemia

2020 ◽  
pp. 112972982094665
Author(s):  
Gabriela Teixeira ◽  
Paulo Almeida ◽  
Luís Loureiro ◽  
Inês Antunes ◽  
Duarte Rego ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Vascular Access ◽  
Percutaneous Transluminal Angioplasty ◽  
Clinical Success ◽  
Invasive Procedure ◽  
Transluminal Angioplasty ◽  
Arterial Stenosis ◽  
Low Flow ◽  
Hemodialysis Access ◽  
Percutaneous Transluminal

Background: Hemodialysis access–induced distal ischemia consists of symptomatic extremity malperfusion after vascular access creation. It is usually caused by discordant vascular resistance, with arteriovenous shunting of a high blood volume from arterial into venous system and subsequent hand hypoperfusion. Less often, hemodialysis access–induced distal ischemia is caused by arterial stenosis. In these cases, access frequently has normal/low flow, radial pulse is usually absent and not recoverable with vascular access digital compression, diabetes is often present, and percutaneous transluminal angioplasty can be critical for access and limb salvage. Methods: Retrospective study conducted between June 2011 and February 2018 of patients with vascular access submitted to arterial percutaneous transluminal angioplasty for limb-threatening ischemia. Results: Twenty-nine patients were referred for arterial angiography after hemodialysis access–induced distal ischemia diagnosis and physical examination or ultrasound findings suggestive of arterial disease. In 11 patients, percutaneous transluminal angioplasty was not technically feasible. Among 18 treated patients, 83.3% had diabetes and 60% had skin ulcerations. Target arteries were radial (11), brachial (7), axillar (2), ulnar (2), and subclavian (1). Clinical success, defined as arteriovenous maintenance and wound healing/pain resolution, was observed in 12 patients (66.7%). Concomitant procedures included adjuvant banding ( n = 2) and finger amputation ( n = 1), and one reintervention was performed. No intra- or postoperative complications were reported. Conclusion: Hemodialysis access–induced distal ischemia is a serious complication of hemodialysis vascular access, with multifactorial etiology. Correct and timely diagnosis is crucial for maintaining access and limb salvage. Percutaneous transluminal angioplasty is a minimally invasive procedure that may be effective and long-lasting in carefully selected patients with ischemic complaints.

Percutaneous transluminal angioplasty (PTA) and venous stenting in hemodialysis patients with vascular access-related venous stenosis or occlusion

Radiography ◽  
2006 ◽  
Vol 12 (2) ◽  
pp. 127-133 ◽  
Author(s):  
Fotini P. Christidou ◽  
Vasilios I. Kalpakidis ◽  
Kostas D. Iatrou ◽  
Ioannis A. Zervidis ◽  
Gerasimos I. Bamichas ◽  
...  
Keyword(s):  
Vascular Access ◽  
Percutaneous Transluminal Angioplasty ◽  
Hemodialysis Patients ◽  
Transluminal Angioplasty ◽  
Venous Stenting ◽  
Venous Stenosis ◽  
Percutaneous Transluminal

scholarly journals Current state of dialysis treatment and vascular access management in Japan

2019 ◽  
Vol 20 (1_suppl) ◽  
pp. 10-14 ◽  
Author(s):  
Takashi Sato ◽  
Hiroshi Sakurai ◽  
Kentaro Okubo ◽  
Risa Kusuta ◽  
Takeshi Onogi ◽  
...  
Keyword(s):  
Vascular Access ◽  
Percutaneous Transluminal Angioplasty ◽  
Japanese Society ◽  
Transluminal Angioplasty ◽  
Access Management ◽  
Dialysis Therapy ◽  
Arteriovenous Fistulae ◽  
First Choice ◽  
Dialysis Outcomes ◽  
Percutaneous Transluminal

According to the data from the Japanese Society for Dialysis Therapy, the number of dialysis patients was about 330,000 at the end of 2016. The mean age of newly initiated patients was 69.4 years and that of maintenance was 68.2 years. And, diabetic nephropathy is the most common primary disease, with an incidence rate of 43.2%. These results mean that the systemic vascular condition is getting worse. In spite of these backgrounds, the patients of 97.3% were treated by hemodialysis; therefore, careful management of vascular access is essential to better maintain the condition of patients. The Dialysis Outcomes and Practice Patterns Study shows that vascular access modalities are an important factor in determining prognoses of patients and that prognosis in Japan is one of the best worldwide. In Japan, the use of arteriovenous fistulae accounts for 95% of vascular access modalities. However, a statistic by Japanese Society for Dialysis Therapy suggests that the use of arteriovenous graft has been increasing. In 2005, Japanese Society for Dialysis Therapy Guidelines recommended percutaneous transluminal angioplasty be the first choice for the treatment of vascular access stenosis. Since then, percutaneous transluminal angioplasty has become an important procedure for long-term maintenance of the morphology and function of vascular access. In Japan, approximately 60% of percutaneous transluminal angioplasty are conducted by nephrologists and urologists; in addition, arteriovenous fistulae creation procedures are also performed by them. According to my private opinion, such conditions above show that even in the absence of standardized training on vascular access management, doctors on site perform their duties in an appropriate manner. However, the problems of how we evaluate the specificity in Japan and pass it down the generations still remain.

scholarly journals A case series of favorable vessel dilatation using a nitinol scoring element–equipped helical balloon catheter (AngioSculpt®)

2018 ◽  
Vol 20 (1_suppl) ◽  
pp. 93-96 ◽  
Author(s):  
Ryo Sato ◽  
Tetsuhiko Sato ◽  
Yuichi Shirasawa ◽  
Chika Kondo ◽  
Masao Tadakoshi ◽  
...  
Keyword(s):  
Vascular Access ◽  
Percutaneous Transluminal Angioplasty ◽  
Venous Pressure ◽  
Balloon Catheter ◽  
Case Series ◽  
Hemodialysis Patients ◽  
Transluminal Angioplasty ◽  
Stenosis Rate ◽  
Percutaneous Transluminal ◽  
Vascular Access Stenosis

Objective: Although percutaneous transluminal angioplasty is an effective therapy against vascular access failure in hemodialysis patients, recurrent stenosis imposes enormous burden for hemodialysis patients. A nitinol scoring element–equipped helical balloon catheter (AngioSculpt®) has been altered the landscape for treating several vascular diseases. It is not, however, fully elucidated whether AngioSculpt for advanced vascular access stenosis, difficult to expand by conventional balloons, successfully provides bailout angioplasty. Here, we report our cases whose intradialytic venous pressure significantly improved after percutaneous transluminal angioplasty without any serious adverse complications using AngioSculpt. Patients and Methods: Among patients undergoing hemodialysis in Masuko Memorial Hospital, 16 cases with resistant and recurrent vascular access stenosis underwent AngioSculpt (diameter 6 mm, total length 4 cm) angioplasty. We simultaneously measured the average venous pressures during hemodialysis before and after percutaneous transluminal angioplasty. Results: The average outflow vessel stenosis rate was 73.0 ± 11.3% before AngioSculpt intervention. Fully enlarged vessels were observed by expanding vessels at maximum pressure of 14 atm in all cases without any complications including vascular ruptures. Their intradialytic venous pressures decreased from 181.8 ± 39.2 mmHg to 150.5 ± 39.3 mmHg ( p < 0.0001). Conclusion: AngioSculpt may provide a promising option for treating hemodialysis patients with severely advanced vascular access stenosis, who would otherwise need repeated vascular access surgeries and/or conventional percutaneous transluminal angioplasties.

scholarly journals Different risk factors are associated with vascular access patency after construction and percutaneous transluminal angioplasty in patients starting hemodialysis

2020 ◽  
pp. 112972982095993
Author(s):  
Mahoko Yoshida ◽  
Shigehiro Doi ◽  
Ayumu Nakashima ◽  
Yasufumi Kyuden ◽  
Toru Kawai ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Vascular Access ◽  
Percutaneous Transluminal Angioplasty ◽  
Patency Rate ◽  
Transluminal Angioplasty ◽  
Primary Patency ◽  
Secondary Patency ◽  
Primary Patency Rate ◽  
Percutaneous Transluminal

Background: The objective of this multicenter, prospective observational study was to determine the factors related to patency rates after construction of vascular access (VA) and the first percutaneous transluminal angioplasty (PTA). Methods: The 24-month primary and secondary patency rates after construction of a radiocephalic arteriovenous fistula (RC-AVF) and arteriovenous graft (AVG) were evaluated using the Kaplan–Meier method and log-rank test. The 12-month post-PTA patency rate was also investigated. A Cox proportional hazard model was used to identify clinical parameters associated with the primary patency rate and the post-PTA patency rate. Results: A total of 611 patients were enrolled in the study. The primary patency rate after VA construction was lower in hemodialysis (HD) patients with an AVG than in those with an AVF. Aging (hazard ratio [HR], 1.02 per 1 year; p < 0.001), female sex (HR, 1.41; p = 0.03), diabetes mellitus (HR, 1.37; p = 0.03), low serum albumin (HR, 0.76 per 1-g/dL decrease; p = 0.02), and use of an erythropoietin-stimulating agent (HR, 1.62; p = 0.02) were risk factors for VA problems. The post-PTA patency rate was associated with aging (HR, 1.02; p < 0.001), diabetes mellitus (HR, 1.49; p = 0.02), polycystic kidney disease (HR, 2.14; p = 0.01), temporary catheter use for initiation of HD (HR, 1.60; p = 0.02), and period from VA construction to use (HR, 0.99; p = 0.04). Conclusion: Although a poor patency rate is commonly associated with advanced age and diabetes, different risk factors affect patency between VA construction and the first PTA.

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

2020 ◽  
pp. 112972982094307
Author(s):  
Antonio Granata ◽  
Rosario Maccarrone ◽  
Luca Di Lullo ◽  
Walter Morale ◽  
Giovanni Giorgio Battaglia ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Percutaneous Transluminal Angioplasty ◽  
Neointimal Hyperplasia ◽  
Transluminal Angioplasty ◽  
Primary Patency ◽  
Ultrasound Guided ◽  
Dialysis Unit ◽  
Percutaneous Transluminal ◽  
Vascular Access Stenosis

Background: Stenosis is the main cause of arteriovenous fistula failure and is due to neointimal hyperplasia. Percutaneous transluminal angioplasty is the gold standard for patients with vascular access stenosis. The aim of the study was to evaluate the efficacy and safety of ultrasound-guided percutaneous transluminal angioplasty in the treatment of native arteriovenous fistula venous stenosis. Methods: The need for intervention was determined by physical examination and duplex ultrasound in 162 patients. All patients with failing or not maturing arteriovenous fistula were treated in the outpatient setting under ultrasound guidance. Procedural success was assessed with repeated post-procedural ultrasound examinations. All procedures were performed under local anesthesia by a single nephrologist and were performed in a single vascular laboratory, while follow-up ultrasound was performed in the dialysis unit of destination. Results: Early technical success was obtained in 95.6% of cases (154 of 162). Complications occurred in 22 patients (13.5%) with no major complication requiring surgical or fluoroscopic endovascular intervention. Primary patency at 6 and 12 months was 84% and 69.8%, respectively. Risk factors for arteriovenous fistula failure/secondary percutaneous transluminal angioplasty were vascular access low blood flow rate and vintage, as well as the need for thrombolysis during the first percutaneous transluminal angioplasty. Conclusion: Ultrasound-guided percutaneous transluminal angioplasty is a valuable tool to treat vascular access stenosis.

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