Diagnosis and Treatment of Insufficient Dialysis Vascular Access

Abstract

A wide variety of diagnostic and minimally invasive modalities is currently available to radiologists for providing sufficient medical care for dialysis patients. In addition to clinical examination, ultrasound is the first line imaging method in suspected dialysis vascular access dysfunction. The percutaneous approach is the primarily recommended therapeutic option in many cases. This article reviews the current diagnostic and therapeutic methods in dialysis vascular access insufficiency. Key Points: ??Vascular access dysfunction is often elicited by stenosed vessels, which are regularly associated with concomitant thrombosis. ??Stenoses are commonly observed in the anastomosis, vascular access vein and also in the central venous system. ??Beside the clinical examination, sonography is the diagnostic method of first choice. ??Percutaneous balloon dilatation frequently is the first treatment option. Citation Format: ??Kamper L, Faizy TD, Haage P. Diagnosis and Treatment of Insufficient Dialysis Vascular Access. Fortschr R?ntgenstr 2015; 187: 360???371

Benefits of Long Versus Short Thrombolysis Times for Acutely Thrombosed Hemodialysis Native Fistulas

“…Recently, access ruptures have been reported as a major complication in approximately 8% of cases. 25 These data are consistent with the presented results after STT. Finally, another reason for the reduced IT after LTT could be the performance of the stenosis treatment during regular working hours, which guarantees the presence of highly trained interventional radiologists and assistants, whereas the presence of these personnel cannot be guaranteed at night or during the weekend.…”

Systematic Review of Drug Eluting Balloon Angioplasty for Arteriovenous Haemodialysis access Stenosis

“…Access options are limited and further diminish with each fistula failure. With conventional dilatation and local drug delivery for NIH, drug eluting balloon (DeB) angioplasty has been proposed as an alternative to reduce time to restenosis in AV access intervention (10, 14, 15).…”

Endovascular treatment to boost AV fistula maturation

“…1) should be addressed by endovascular treatment. PTA is the suggested first-line treatment in stenotic outflow veins (9), especially in short lesions. Surgical vein transposition is a potential alternative for longer stenoses.…”

“…Surgical vein transposition is a potential alternative for longer stenoses. Stents should only be considered in patients with repeated PTA failure and the venous confluences and the cannulation segment should be avoided (9). Covered stents were recently suggested for patients with dialysis-grafts and stenosed venous anastomosis since these may decrease the restenosis rate (17).…”

“…Failed maturation is associated with puncture-related complications and/or insufficient dialysis, which can lead to permanent loss of the fistula. Further diagnostic examinations should be performed if fistula maturation is not completed within eight weeks to enable prompt diagnosis and treatment (6, 9, 10). Frequent underlying causes of non-maturation are venous, arterial or anastomotic stenosis (11, 12).…”