A Meta‐analysis of Stent Placement vs. Angioplasty for Dialysis Vascular Access Stenosis

Fu, Ning; Joachim, Emily; Yevzlin, Alexander S.; Astor, Brad C.; Chan, Micah R.

doi:10.1111/sdi.12314

Cited by 20 publications

(13 citation statements)

References 33 publications

(46 reference statements)

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“…One prospective multicenter randomized trial tested self-expanding nitinol stents covered with PTFE and showed a higher 6-month patency rate in the stent graft group compared to balloon angioplasty alone (51% vs. 23%, p<0.001); there was also greater freedom from subsequent interventions (32% vs. 16%, p=0.03) and less restenosis (28% vs. 78%, p<0.001) [196]. A meta-analysis of 10 studies suggested there was improved primary patency at 6 months in those treated with nitinol stents compared to angioplasty; however, bare metal stents showed no significant increase in patency [197]. Covered stents can also be used to treat pseudoaneurysms that develop within the access [198].…”

Section: Future Approaches To Treatmentmentioning

confidence: 99%

Future research directions to improve fistula maturation and reduce access failure

Patel

Hänisch

et al. 2016

Seminars in Vascular Surgery

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With the increasing prevalence of end stage renal disease there is a growing need for hemodialysis. Arteriovenous fistulae (AVF) are the preferred type of vascular access for hemodialysis but maturation and failure continue to present significant barriers to successful fistula use. AVF maturation integrates outward remodeling with vessel wall thickening in response to drastic hemodynamic changes, in the setting of uremia, systemic inflammation, oxidative stress and preexistent vascular pathology. AVF can fail due to both failure to mature adequately to support hemodialysis, as well as development of neointimal hyperplasia (NIH) that narrows the AVF lumen, typically near the fistula anastomosis. Failure due to NIH involves vascular cell activation and migration and extracellular matrix remodeling with complex interactions of growth factors, adhesion molecules, inflammatory mediators, and chemokines, all of which result in maladaptive remodeling. Different strategies have been proposed to prevent and treat AVF failure, based on current understanding of the modes and pathology of access failure; these approaches range from appropriate patient selection and use of alternative surgical strategies for fistula creation, to the use of novel interventional techniques or drugs to treat failing fistulae. Effective treatments to prevent or treat AVF failure requires a multidisciplinary approach involving nephrologists, vascular surgeons and interventional radiologists, allowing careful patient selection and the use of tailored systemic or localized interventions to improve patient-specific outcomes. This review provides contemporary information on the underlying mechanisms of AVF maturation and failure and discusses the broad spectrum of options that can be tailored for specific therapy.

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Section: Future Approaches To Treatmentmentioning

confidence: 99%

Future research directions to improve fistula maturation and reduce access failure

Patel

Hänisch

et al. 2016

Seminars in Vascular Surgery

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“…Several stent grafts are approved by the US Food and Drug Administration and may be advantageous over balloon angioplasty for treating venous graft anastomotic stenoses as well as achieving primary patency of dialysis circuit stenoses (58,(62)(63)(64)(65). Stent grafts also provide better primary patency rates compared with angioplasty alone in treating cephalic arch stenosis (63).…”

Section: Introductionmentioning

confidence: 99%

Quality Improvement Guidelines for Percutaneous Image-Guided Management of the Thrombosed or Dysfunctional Dialysis Circuit

Dariushnia

Walker

Silberzweig

et al. 2016

Journal of Vascular and Interventional Radiology

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AR = access recirculation, AVF = arteriovenous fistula, AVG = arteriovenous graft, DHIS = distal hypoperfusion ischemia syndrome, KDOQI = Kidney Disease Outcomes Quality Initiative, NKF = National Kidney Foundation, Qa = blood access flow rate PREAMBLE The membership of the Society of Interventional Radiology (SIR) Standards of Practice Committee represents experts in a broad spectrum of interventional procedures from both the private and the academic sectors of medicine. Generally, Standards of Practice Committee members dedicate the vast majority of their professional time to performing interventional procedures; as such, they represent a valid broad expert constituency of the subject matter under consideration for standards production. Technical documents specifying the exact consensus and literature review methodologies as well as the institutional affiliations and professional credentials of the authors of this document are available upon request from SIR, 3975 Fair Ridge Dr, Ste 400 North, Fairfax, VA 22033. METHODOLOGY SIR produces its Standards of Practice documents using the following process. Standards documents of relevance and timeliness are conceptualized by the Standards of Practice Committee members. A recognized expert is identified to serve as the principal author for the standard. Additional authors may be assigned depending on the magnitude of the project. An in-depth literature search is performed using electronic medical literature databases. Then a critical review of peer-reviewed articles is performed with regard to the study methodology, results, and conclusions. The qualitative weight of these articles is assembled into an evidence table, which is used to write the document such that it contains evidence-based data with respect to content, rates, and thresholds. When the evidence of literature is weak, conflicting, or contradictory, consensus for the parameter is reached by a minimum of 12 Standards of Practice Committee members using a Modified Delphi Consensus Method (Appendix A). For purposes of these documents, consensus is defined as 80% Delphi participant agreement on a value or parameter. The draft document is critically reviewed by the Revisions Subcommittee members of the Standards of Practice Committee, either by telephone conference calling or by face-to-face meeting. The finalized draft from the Committee is sent to the SIR membership for further input or criticism during a 30-day comment period. These comments are discussed by the Subcommittee, and appropriate revisions are made to create the finished standards document. Before its publication, the document is endorsed by the SIR Executive Council.

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“…В ряде случаев баллонная дилатация дополняется имплантацией стента [23,[55][56][57]. Есть подтверждения тому, что использование стентов сопряжено с большей выживаемостью сосудистого доступа по сравнению с традиционной ангиопластикой при лечении дисфункции сосудистых протезов, а также нативных АВФ [58][59][60].…”

Section: методы лечения стенозов периферических отделов фистульной веныunclassified

Open and endovascular surgery for stenosis of the peripheral regions of arteriovenous fistula

Карданахишвили

Зулькарнаев

2019

Bûll. sib. med.

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Vascular access is the cornerstone of hemodialysis. With vascular access dysfunction, the results of treatment of patients with stage 5 chronic kidney disease significantly deteriorate. One of the most common causes of vascular access failure is peripheral venous stenosis. Despite the variety of initiating factors, the morphological substrate of stenotic damage to the arteriovenous fistula (or arteriovenous anastomosis) in most cases is neointimal hyperplasia. Stenotic lesions of the arterivenous fistula are strongly associated with an increased risk of thrombosis and loss of vascular access. There are 4 typical localizations of stenosis: arteriovenous or arteriograft anastomosis, stenosis of the juxta-anastomotic segment of the fistula, stenosis of the functional segment of the fistula, and stenosis of the cephalic arc.The most common indication for surgical treatment is vascular access failure; less common indications are clinical symptoms of venous insufficiency.There are various methods of open reconstruction of the stenotic segment of the fistula vein: resection, prosthetics with a synthetic vascular graft, prosthetics or plastic repair of the autologous vein wall, complete or partial drainage of the prestenotic segment of the vein, etc. Currently an alternative method of stenosis repair using endovascular interventions is gaining popularity. In contrast to central vein stenosis, where endovascular interventions are the gold standard, in peripheral vein stenosis it is only an adjuvant method. Complications of endovascular interventions are extremely rare.Despite the fact that endovascular interventions have almost absolute probability of technical success, the primary patency is not high and is about 50% in six months. The use of bare stents is not accompanied by an increase in primary patency. The use of stent-grafts can increase the primary patency, especially in the plastic repair of challenging stenoses of the graft-vein anastomosis or cephalic arch.Many issues related to endovascular interventions remain unresolved, which requires further research.

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A Meta‐analysis of Stent Placement vs. Angioplasty for Dialysis Vascular Access Stenosis

Cited by 20 publications

References 33 publications

Future research directions to improve fistula maturation and reduce access failure

Future research directions to improve fistula maturation and reduce access failure

Quality Improvement Guidelines for Percutaneous Image-Guided Management of the Thrombosed or Dysfunctional Dialysis Circuit

Open and endovascular surgery for stenosis of the peripheral regions of arteriovenous fistula

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