Dialysis access grafts: anatomic location of venous stenosis and results of angioplasty.

Kanterman, R Y; Vesely, Thomas M.; Pilgram, T K; Guy, Bethany; Windus, David W.; Picus, Daniel

doi:10.1148/radiology.195.1.7892454

Cited by 339 publications

(191 citation statements)

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“…For the past 4 decades, neointimal graft hyperplasia has been a well-known entity (5), and it is generally considered the leading cause of pVA stenosis (6), mainly observed at the prosthetic-venous anastomosis (in 58% of cases) (7). Finally, it is well documented that pVAs are more prone to thrombosis than autogenous vascular access (8).…”

Section: Discussionmentioning

confidence: 99%

A New Computerized Program for Surveillance of Prosthetic Arteriovenous Fistulas

Tozzi

Franchin

Formica³

et al. 2015

Nephrology @ Point of Care

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Stenosis and thrombosis are common causes of prosthetic vascular access (pVA) failure. The role of arteriovenous fistula (AVF) surveillance is widely debated. The aim of this paper is to present a new real-time application designed for AVF surveillance called SPIDER. Surgical staff and hemodialysis nurses are responsible for data entry. SPIDER automatically analyses data and generates alerts in case of abnormal trends. Surgical evaluation and duplex Doppler ultrasonography are then immediately performed to confirm presence of stenosis or other possible pVA defects. Surgery can be performed if required. A preliminary analysis of results will be completed at 12 months after the program begins and subsequently after 24 months. Primary assisted patency will be compared with historical using multivariate analysis. Expected results are an improvement in primary assisted pVA patency and reduction of hospitalizations. Simultaneous management of a high number of patients can become difficult due to the large amount of data required for surveillance. We want to demonstrate whether a real-time automated system could help to prevent thrombosis and graft loss.

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Section: Discussionmentioning

confidence: 99%

A New Computerized Program for Surveillance of Prosthetic Arteriovenous Fistulas

Tozzi

Franchin

Formica³

et al. 2015

Nephrology @ Point of Care

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“…Early studies reported low incidence of inflow artery stenosis, and it is venous problems that have drawn most of the attention in the treatment of access dysfunction. 1,4 More recent studies have suggested that the incidence of inflow stenoses can be substantially high, from 28% to 35%. However, most of the inflow stenoses reported were located at the arteriovenous anastomosis rather than in the native artery.…”

Section: Discussionmentioning

confidence: 99%

An occult cause of hemodialysis vascular access dysfunction

Kuo

Chen

2010

Renal Failure

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Although hemodialysis vascular access dysfunction is often caused by venous stenosis, stenosis can occur anywhere in the circuit. Herein, we report a 75-year-old woman who received repeated percutaneous angioplasty due to insufficient flow. Finally, a culprit stenosis at the subclavian artery was found and treated. Subclavian artery stenosis is often atherosclerotic in origin and is usually delayed to be diagnosed because of caveats in the care of vascular access. This case highlights important clues that can assist in the early discovery of inflow problems and reminds the physician that inflow stenosis may be hidden at a site far from the anastomosis.

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“…Stenosis plagues both types of arteriovenous conduits, although PTFE grafts are more prone to such complication. In PTFE grafts, stenosis develops commonly around the graft-venous anastomosis, and less frequently at the graftarterial anastomosis [1]. In native fistulae, stenosis occurs in both the outflow vein as well as the inflow artery.…”

Section: Pathology Of Neointimal Hyperplasia In Vascular Accessmentioning

confidence: 99%

“…In hemodialysis arteriovenous grafts, the patency rate diminishes progressively over time with each angioplasty procedure. In one study, the 360-day primary patency rate of forearm PTFE loop grafts was 40% following the first angioplasty, but dropped to 25% after the second angioplasty [1]. The 180-day patency rate following the third angioplasty was 0%.…”

Section: Pathogensis Of Neointimal Hyperplasia In Vascular Accessmentioning

confidence: 99%

Pathogensis and Local Drug Delivery for Prevention of Vascular Access Stenosis

Cheung

Terry

2008

Journal of Renal Nutrition

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Native fistulae and polytetrafluoroethylene (PTFE) grafts are preferred over intravenous catheters as hemodialysis vascular access. Stenosis plagues both types of arteriovenous conduits, although PTFE grafts are more prone to such complication. In PTFE grafts, stenosis develops commonly around the graft-venous anastomosis, and less frequently at the graftarterial anastomosis [1]. In native fistulae, stenosis occurs in both the outflow vein as well as the inflow artery. An incidence as high as 40% of inflow arterial stenosis has been reported in a study of chronic dialysis patients referred for vascular access intervention [2].The pathology of neointimal hyperplasia associated with arteriovenous PTFE grafts has been well characterized [3.4]. The lesion is comprised of smooth muscle-like cells in disarray, extracellular matrices and neovasculature. There is substantial adventitial angiogenesis and a large number of macrophages lining the peri-graft region. Also present are various growth factors, such as platelet-derived growth factor, vascular endothelial growth factor and basic fibroblast growth factor. Pathogensis of neointimal hyperplasia in vascular accessA number of factors contribute to the development of neointimal hyperplasia in vascular access. The local trauma produced by the surgical procedure of creating the anastomoses, altered hemodynamics and the bioincompatibility of the graft material are likely to be important contributing factors for the hyperplasia at the anastomoses. In distinct contrast to the coronary or peripheral arterial grafts, the dialysis graft is repeatedly punctured by large-bore needles as part of the hemodialysis procedure. This trauma induced by the needle puncture attracts and activates platelets and various leukocytes, leading to a sequence of pro-inflammatory and proliferative events.It is highly likely that the trauma of angioplasty of the stenotic lesion of the native fistulae or PTFE grafts further promotes neointimal hyperplasia formation, because of injury to the endothelium and medial layer. Neointimal hyperplasia is a well-recognized and frequent complication following angioplasty of the coronary artery. This complication and its early

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Dialysis access grafts: anatomic location of venous stenosis and results of angioplasty.

Abstract: Performance of serial venous angioplasty procedures may help prolong the life of a graft, but the patency rates diminish with subsequent interventions.

Cited by 339 publications

References 0 publications

A New Computerized Program for Surveillance of Prosthetic Arteriovenous Fistulas

A New Computerized Program for Surveillance of Prosthetic Arteriovenous Fistulas

An occult cause of hemodialysis vascular access dysfunction

Pathogensis and Local Drug Delivery for Prevention of Vascular Access Stenosis

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