Percutaneous Transluminal Dilatation for Vascular Access

Abstract

The application of percutaneous transluminal angioplasty to vascular access stenosis is described. These access problems were discovered by the technique of retrograde venous fistulography. 13 dilatations were attempted in 12 patients. Functional success was achieved in seven attempts. This resulted in a significant prolongation of access survival in these patients. Angioplasty is recommended as a nonsurgical approach to vascular access stenosis.

Recirculation: Review, Techniques for Measurement and Ability to Predict Hemoaccess Stenosis before and after Angioplasty

“…Hemoaccess thrombectomy or replace ment is the leading reason for hospital ad mission among hemodialysis patients [5,6], It has been well documented that the most common cause of late access failure (after 6 months of hemodialysis) is distal venous ste nosis at or beyond the anastomotic site [7][8][9][10][11][12][13][14]. Angiography and transluminal angio plasty can be used to identify and treat this problem when symptoms and signs such as high venous pressures, inadequate dialysis, and extremity pain and edema occur [8,9,12,[15][16][17].…”

“…Angiography and transluminal angio plasty can be used to identify and treat this problem when symptoms and signs such as high venous pressures, inadequate dialysis, and extremity pain and edema occur [8,9,12,[15][16][17]. Often, recirculation testing can detect a stenosis before symptoms occur and before the stenosis becomes too severe for successful treatment with transluminal an gioplasty [1,2,4,18,19].…”

Intraoperative Stent Implantation for Venous Anastomotic Stenoses of Hemodialysis Grafts

“…Cl Discussion PTA of shunt vein stenoses has been reported with increasing frequency since the early 1980s.20-24 Later on the method was modified for intraoperative use following Fogarty balloon thrombectomy.25-27 Despite high initial success rates, long-term results of venous PTA have been disappointing because of frequent restenoses and occlusions. 20,21,24,28,29 Surgical repair of venous anastomotic stenoses (patch angioplasty or graft prolongation) results in equally low patency rates (20% to 40%) after one year.25 '30 When PTA of central veins is combined with stent implantation, better immediate and longterm results can be achieved than by PTA alone.16'31 Cumulative patency rates have been reported to range from 77% to 100% after a followup between fifteen and twenty-four months after implantation of flexible, self-expanding stents15-18 into various locations and for various indications. There are, however, only a few reports concerning stent implantation into venous anastomotic stenoses of vascular access grafts.32-36 To our knowledge, there is only a single prospective trial evaluating the effectiveness of Gianturco stent implantation in preserving graft patency following PTA.37 The results were disappointing with a primary one-year patency of 17% in the stent group when compared with 28% in the PTA group.…”

PTA Plus Stent Implantation Versus PTA Alone for Central Venous Stenoses

“…16,[18][19][20] Despite high initial success rates, long-term results of venous PTA have been disappointing because of frequent restenoses and occlusions. 10,13,16,17,19,[21][22][23][24] Consequently, percutaneously implantable vascular endoprostheses, originally developed for treatment of arterial stenoses, were investigated as to their efficacy within the venous system. Recently, different stent models have been used in small patient series for stenoses of varying etiology throughout the venous system.31-4° Longterm results have been published by only a few investigators.…”