Mechanisms of angioplasty in hemodialysis fistula stenoses evaluated by intravascular ultrasound

Davidson, Charles J.; Newman, Glenn E.; Sheikh, Khalid H.; Kisslo, Katherine B.; Stack, Richard S.; Schwab, Steve J.

doi:10.1038/ki.1991.185

Cited by 112 publications

(65 citation statements)

References 16 publications

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“…Moreover, angioplasty of asymptomatic CVS greater than 50% was associated with more rapid stenosis progression as compared with a non-treatment approach (19). Finally, intravascular ultrasound study showed immediate recoil after angioplasty in >50% of lesions (20). These findings are in concordance with clinical observations, that maintaining long patency after angioplasty or stenting requires frequent and repetitive interventions (12,13,16,17).…”

Section: Discussionsupporting

confidence: 78%

New Method of Forced Implantation of Permanent Catheters for Hemodialysis into Critically Stenosed or Occluded Central Veins

Przywara¹,

Iłżecki²,

Terlecki³

et al. 2014

Polish Journal of Surgery

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Abstractwas to report a novel technique of forced implantation of catheters for hemodialysis into critically stenosed or occluded central veins, without preceding angioplasty or stenting.Sixteen patients with central venous occlusive disease, requiring urgent hemodialysis underwent this procedure. Catheterization of stenosis - occlusion was initially performed with soft guidewire, subsequently exchanged to stiff guidewire. Forced insertion of dilators, peel-off sheath throughout the stenosis or occlusion and finally implantation of the catheter completed the procedure. Our technique does not require pre-procedural angioplasty or stent deployment.In all patients postoperative hemodialysis was managed with satisfactory adequacy. No early or late complications related to the procedure occurred. We did not observe any clinically significant aggravation of symptoms of central vein stenosis or occlusion. Complications, not-related to the procedure included one, late skin entry site infection and one, late catheter thrombosis. These were managed without the necessity of catheter exchange.Our technique of forced implantation of catheters for hemodialysis into critically stenosed or occluded central veins without previous balloon predilatation or stenting is simple and diminishes the total cost of the procedure. Provides quick vascular access for hemodialysis in life threatening situations.

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Section: Discussionsupporting

confidence: 78%

New Method of Forced Implantation of Permanent Catheters for Hemodialysis into Critically Stenosed or Occluded Central Veins

Przywara¹,

Iłżecki²,

Terlecki³

et al. 2014

Polish Journal of Surgery

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“…This is why percutaneous methods (PTA, stents) have supplanted surgery for management of central venous stenoses. Furthermore, Davidon et al have suggested that the central vasculature may be more susceptible to elastic recoil than the peripheral vasculature (46). Despite these observations, no conclusive patency benefit for stent insertion has been found compared with angioplasty alone.…”

Section: Stents and Central Venous Stenosismentioning

confidence: 63%

Stent Placement in Hemodialysis Access

Yevzlin

Asif

2009

Clinical Journal of the American Society of Nephrology

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Vascular access stenosis in patients undergoing chronic hemodialysis is a major issue that is associated with increased morbidity, mortality, and cost of medical care. Recent data have emphasized that endovascular stents could be used in the treatment of central as well as peripheral stenotic lesions. In general, a peripheral or central vein lesion that is elastic or recurs within a three-month period after an initially successful balloon angioplasty or a stenosis where surgical revision is not possible are some indications for intravascular stent placement. Recent reports have expanded the role of stents in the management of pseudoaneurysms associated with dialysis access. In this context, the utilization of these devices must take into account a fair comparison with the traditional (surgical) approaches regarding effectiveness as well as costs. This report describes the role of stents in arteriovenous dialysis access. In addition, some of the recent advances in the structure and complicating issues such as stent fracture, migration, and infection, as well cannulation through the stent, are discussed.

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“…Second, unlike PTFE grafts, stenosis might affect flow patterns through native vessel conduits (2,12,13), which might interfere with the transmission of a saline bolus that is necessary to perform UDT (7). Finally, the ideal frequency of screening might differ in individuals with previous stenosis, either because of more rapid progression of stenosis or recoil of the native vessels after angioplasty (14). Despite these theoretical considerations, the Qa Ͻ 500 ml/min and fall of 20% from baseline parameters both performed well and detected more first and recurrent lesions together than either used alone.…”

Section: Discussionmentioning

confidence: 99%

Access Flow Monitoring of Patients with Native Vessel Arteriovenous Fistulae and Previous Angioplasty

Tonelli¹,

Hirsch²,

Clark

et al. 2002

Journal of the American Society of Nephrology

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Abstract. Screening strategies based on measurement of access blood flow (Qa) allow detection and angioplasty of subclinical stenosis in native vessel arteriovenous (AV) fistulae. However, little is known about the efficacy of Qa measurements for detecting recurrent stenoses in fistulae and that of angioplasty for correcting them. A total of 303 patients were studied over 30 mo; 69 (23%) of these had stenoses, of whom 53 underwent angioplasty. Of those undergoing angioplasty, 30 patients had 46 episodes of recurrent positive studies and underwent repeat fistulography. In 31 of these episodes (19 patients), stenosis was again identified and treated successfully with angioplasty. Overall positive predictive values for stenosis were similar in first and subsequent episodes of stenosis (71% versus 67%), and angioplasty was associated with sustained increases in Qa for both first and subsequent episodes. Assisted patency in fistulae that required repeat angioplasty was 87% (median follow-up 10 mo after the second angioplasty). In conclusion, Qa is effective for detecting first and subsequent lesions in patients with AV fistulae, and angioplasty of first or subsequent lesions is associated with sustained increments in Qa. Continued screening after correction of first stenoses appears reasonable, because of both the frequency of recurrent stenosis and the success of repeat intervention.Ultrasound dilution measurement of access blood flow (Qa) has been shown to accurately identify first episodes of subclinical stenosis in native vessel fistulae (1). Most such stenoses, once identified, are amenable to percutaneous angioplasty, which is associated with short-term improvements in Qa and dialysis delivery. Although access screening programs have been shown to prolong the use-life of polytetrafluoroethylene (PTFE) grafts (2) and cohorts of mixed access type (3), little data exists on the effect of such programs on native arteriovenous dialysis fistulae (4 -6).The diagnostic performance of Qa in native vessel fistulae that have previously undergone angioplasty for stenosis is unknown. The positive predictive value of screening might differ substantially in this population compared with unselected fistulae, both because of the prevalence of stenosis and because of mechanical effects of angioplasty on the native vessel conduit. Finally, the effectiveness of angioplasty for correcting recurrent stenoses in fistulae is unclear. These data will become increasingly relevant as access screening programs are implemented in more dialysis centers and the prevalence of fistulae with previously angioplastied stenosis increases.There were two objectives for the current study. The first was to determine the positive predictive value of ultrasound dilution techniques (UDT) for the detection of subclinical stenoses in fistulae that have previously undergone angioplasty. The second was to document the efficacy of angioplasty at correcting stenoses in fistulae that have previously undergone angioplasty. In both cases, results from those with ...

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Mechanisms of angioplasty in hemodialysis fistula stenoses evaluated by intravascular ultrasound

Cited by 112 publications

References 16 publications

New Method of Forced Implantation of Permanent Catheters for Hemodialysis into Critically Stenosed or Occluded Central Veins

New Method of Forced Implantation of Permanent Catheters for Hemodialysis into Critically Stenosed or Occluded Central Veins

Stent Placement in Hemodialysis Access

Access Flow Monitoring of Patients with Native Vessel Arteriovenous Fistulae and Previous Angioplasty

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