Hemodialysis-related Venous Stenosis: Treatment with Ultrahigh-Pressure Angioplasty Balloons

Abstract

The authors retrospectively reviewed the use of ultrahigh-pressure angioplasty balloons at atmospheric pressures at or above the manufacturer recommended burst pressure (30 atm) for the treatment of resistant hemodialysis-related venous stenosis at their institution. In seven of 87 procedures, high-pressure angioplasty (up to 27 atm) was unsuccessful. By coupling new balloon technology with aggressive inflation pressures, 100% technical success was achieved in the treatment of stenoses that were resistant to high-pressure angioplasty in these seven procedures. This approach could potentially offer cost savings compared with the costs of other previously described treatment methods for resistant lesions, such as atherectomy devices and cutting balloons.

Angioplasty of Obstructed Homograft Conduits in the Right Ventricular Outflow Tract With Ultra-Noncompliant Balloons

“…These balloons were initially developed for angioplasty of resistant stenosis in prosthetic renal dialysis fistulas, for which they have shown success. 11 In a previous study of our early experience using UNC balloons to dilate resistant branch PA stenosis within or near a previously placed stent, we found this approach to be highly effective and generally safe. 12 However, there are no published data specifically concerning UNC balloons for angioplasty of RV-PA conduits.…”

Guidelines for basic techniques in vascular access intervention therapy (VAIVT)

“…51,69,76 For lesions expected to have poor expandability, such as in cases of recurrence of previous lesions with poor expandability or lesions located in AVG venous anastomosis sites, the use of ultrahigh pressure-resistant balloon catheters designed to withstand up to 30 atm or cutting balloon catheters may be considered. 1,19,20,29 However, since balloon catheter dilation straightens the blood vessel, use on lesions that have pronounced curves is contraindicated.…”

“…Since the approached lesions often follow a highly circuitous and complex course and have non-physiologically sharp branch angles at the site of anastomosis, VAIVT needs to be performed using balloon catheters that are highly pressure resistant, that are thin and thus have a low profile, and that are highly trackable, with high ability to traverse such a complex route. 51,76 It is preferable to use semi-compliant balloon catheters on lesions that curve in the juxta-anastomotic site since they cause less straightening of the blood vessel when dilated.…”

Ultra-High-Pressure Balloon Angioplasty for Treatment of Resistant Stenoses Within or Adjacent to Previously Implanted Pulmonary Arterial Stents

“…They have rated burst pressures ranging from 18 to 27 atm, but can be inflated to substantially higher pressures without rupturing. 11 The type of balloon was determined on the basis of size (the only diameter at which there is overlap between the 2 balloons is 12 mm). Balloon size was determined at the operator's discretion, typically, in part, on the basis of information from previous unsuccessful attempts to expand the stent with other balloons of known diameter, and from measured waist, lesion, and/or adjacent PA diameters.…”

“…11 UHMWPE is a very long-chain form of polyethylene with a high tensile strain modulus and toughness. The woven UHMWPE that coats the Conquest and Atlas balloons is applied with the fibers aligned orthogonally in the long-axis and true circumferential directions.…”