Keywords:
Interventional vascular, Kidney, Veins / Vena cava, Fluoroscopy, Percutaneous, Ultrasound-Colour Doppler, Angioplasty, Catheters, Venous access, Dilatation, Fistula, Obstruction / Occlusion
Authors:
M. Salsano1, S. Matthew2, R. ross2, A. Khawaja1, J. Weir-McCall2, G. Houston2; 1Birmingham/UK, 2Dundee/UK
DOI:
10.1594/ecr2018/C-2644
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,
microvessel formation,
and cytokine expression) with neointimal hyperplasia as final result (1)(2).
Native AVFs are the recommended option for permanent vascular access as they have relatively low rates of thrombosis and infection,
and require fewer interventions to maintain patency (3)(4).
Costs for creation and maintenance of AVF are lower than other types of vascular access (VA) and the overall life-span is longer compared to other kind of VA (3) (5). Percutaneous transluminal angioplasty (PTA) is the recommended treatment of choice for stenosis (6) (7).
Some stenoses can prove resistant to conventional PTA,
due to the presence of dense fibrous strands incorporated into the venous neointimal layer,
or from scar tissue resulting from recurrent puncture trauma to the venous wall (8).
An alternative to standard balloon PTA is the use of cutting balloon,
incorporated with 3 or 4 fine cutting blades capable of cutting and disrupting the fibroelastic continuity of this ring of neointimal hyperplasia.
They can prevent elastic recoil and enable dilation to occur by separating the intact plates of intima with little or no barotrauma (9).
Recent literature has shown conflicting results concerning the patency rates of native access after treatment with conventional and cutting balloon PTA (10)(11)(12).