Aims and objectives
The failure of haemodialysis access,
in particular autogenous fistulas (AVFs) and prosthetic grafts (AVGs),
increases morbidity and healthcare costs in patients with end stage renal disease (1).
One of the main causes of this failure is the development of venous stenosis and subsequent thrombosis of the access.
The development of a stenosis involves similar mechanisms in both AVFs and AVGs (cellular proliferation,
and cytokine expression) with neointimal hyperplasia as final result (1)(2).
Native AVFs are the recommended option for permanent vascular access as...
Methods and materials
This retrospective study was approved by the local ethics committee .
We reviewed all PTAs performed on upper limb dialysis access at our center in the period between August 2011 and March 2017.
These totalled 436 interventions out of which 114 were excluded from the analysis because these were abandoned during the procedure (VA considered failed/not salvageable or technical failure as unable to cross lesion). Angioplasty performed on the arterial side of the access were also excluded (n=2).
Sixteen PTA were excluded (two...
A total of 281 PTA procedures were recorded,
207 performed using standard balloons and 74 using cutting angioplasty balloons
The demographic characteristics of the population are presented in Table 1.
There were no significant differences in characteristics between the two treatment groups.
The characteristics of the fistulas are presented in Table 2.
Cutting balloon showed a better PP,
SP and APP compared to standard balloons (p=0,046; 0,002 and 0,001 respectively).
Kaplan-Meier graphs of PP,
SP and APP are provided in Figure 1.
Technical success was...
Vorwerk et al reported the first use of a cutting balloon,
in 1995 for coronary dilation,
for the treatment of venous hemodialysis fistulas.
several studies have been published comparing the primary and secondary outcome of cutting and standard balloon venoplasty.
A recent meta-analysis by Agarwal et al,
aiming to assess the safety and efficacy of cutting balloon angioplasty in comparison with conventional and high pressure balloon angioplasty in the treatment of vascular access stenosis,
showed a significantly higher patency rate of cutting balloon...
Do Nascimento MM,
Do Nascimento DE,
Riella MC Stenosis in hemodialysis arteriovenous fistula: evaluation and treatment.
Hemodial Int 2006;10:152–61.
Cheung AK Hemodialysis vascular access dysfunction: a cellular and molecular viewpoint.
J Am Soc Nephrol 2006;17:1112–27.
Vascular access use in Europe and the United States: Results from the DOPPS.
Kidney Int 2002;61:305–16.
Pandey CM Role of vascular...