Percutaneous transvenous angioplasty in the treatment of vascular access stenosis

Beathard, Gerald A.

doi:10.1038/ki.1992.431

Cited by 383 publications

(257 citation statements)

References 26 publications

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“…1,[15][16][17][18][19][20][23][24][25][26][27][28] Additionally, also in common with other authors, 20,21 we did not observe superior patency in angioplasties with stents. Notwithstanding, our results differ with …”

Section: Discussionsupporting

confidence: 69%

“…Rates of immediate technical success of angioplasties conducted with a balloon alone can vary from 70 to 90%. 1,[15][16][17][18][19][20] In a study conducted by Kovalik et al, 16 in 1994, the authors observed that there were two types of central venous injuries: non-elastic lesions, which respond well to angioplasty, and elastic lesions, which do or do not respond to angioplasty. Therefore, elastic lesions tend to maintain less patency in relation to non-elastic lesions.…”

Section: Discussionmentioning

confidence: 99%

“…There are reports of primary patency at 6 months, varying from 23 to 55%. 1,[15][16][17][18][19][20] In 2007, in one of the largest studies of angioplasties for COVD undertaken to date, Bakken et al 20 studied 47 patients and demonstrated a technical success rate of 77%, with primary patency at 3 months of 58%, at 6 months of 45% and at 12 months of 29% (Table 2).…”

Section: Discussionmentioning

confidence: 99%

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Endovascular treatment of occlusive central venous disease: one center's experience

Silvestre¹,

Trevisan²,

Sardinha³

et al. 2014

J. vasc. bras.

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Introduction: The majority of cases of stenosis or occlusion of central veins are the result of central catheters, arteriovenous fistulas, neoplasms or traumas and these conditions can cause severe cases of venous hypertension or reduce the flow through fistulas. The objective of this study is to analyze the results of central venous angioplasties conducted at our hospital. Methodology: We conducted a retrospective and descriptive study to analyze the results of central venous angioplasties conducted from 2010 to 2012 at a university hospital run by the Universidade Estadual de Londrina, Brazil. We calculated primary and secondary success rates and analyzed whether or not stents were used and complications occurred during a 6-month follow-up period. Results: A total of 25 central venous angioplasties were conducted. Twenty-four (96%) of these were because of catheter-related intimal hyperplasia and one was to treat the effects of compression by a tumor. Fifteen (60%) angioplasties were to correct stenosis and ten (40%) were because of occlusions, with a one-hundred percent success rate for all stenosis-related procedures. However, none of the cases of occlusion could be treated endovascularly. Patency during the 6-months follow-up period was 80% after reinterventions. Conclusions: Despite good results observed after primary interventions for stenoses, it must be accepted that all current treatment options for chronic occlusive venous disease will, sooner or later, lead to restenosis or occlusion. Venous occlusions constitute a challenge demanding the development of new techniques and new materials. Prevention is paramount, through avoidance of central catheterization and early creation of arteriovenous fistulas.

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Section: Discussionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Endovascular treatment of occlusive central venous disease: one center's experience

Silvestre¹,

Trevisan²,

Sardinha³

et al. 2014

J. vasc. bras.

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“…The feeding artery, arteriovenous anastomosis, draining vein(s) and central veins up to the right atrium were visualized. After identification of the stenoses, angioplasty was performed using a standard technique (10,11). …”

Section: Pretreatment Fistulography and Ptamentioning

confidence: 99%

Percutaneous transluminal balloon angioplasty in stenosis of native hemodialysis arteriovenous fistulas: technical success and analysis of factors affecting postprocedural fistula patency

Aktaş

Bozkurt²,

Aktaş³

et al. 2015

Diagn Interv Radiol

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RESULTSA total of 330 stenoses were found in 228 patients. PTA was technically successful in 96.3% of the stenoses (n=319). Clinical success was achieved in 97.2% (n=321). Early dysfunction (within six months) was positively correlated with patient age (P < 0.001) and diabetes (P < 0.005). Older age (P < 0.001) and diabetes (P = 0.002) were associated with a lower primary patency rate. Patient age (P < 0.001), presence of diabetes (P = 0.023), length of stenosis (P = 0.003), early recurrence (P = 0.003) and presence of residual stenosis (P = 0.014) were associated with a lower secondary patency rate. CONCLUSION Patency of dysfunctional hemodialysis fistulas can be maintained safely with continuous follow-up and repeated interventions without shortening the venous segment by surgical revision. Percutaneous approach to hemodialysis access stenosis is an alternative to the conventional surgical approach and PTA is an effective treatment method for dysfunctional AVF.H emodialysis, and therefore patent hemodialysis access, is of great importance to patients with end-stage renal disease (ESRD). The preferred type of access in patients undergoing hemodialysis is an arteriovenous fistula (AVF) (1). The Kidney Disease Outcomes Quality Initiative provides evidence-based clinical practice guidelines for all stages of ESRD and reports autogenous AVF as the reference standard for primary vascular access, due to their longevity and low infection rates (2, 3). Sands et al. (4) and Schwab et al. (5) demonstrated a 10-fold increase in thrombosis rate of synthetic polytetrafluoroethylene (PTFE) accesses when compared to AVFs. Despite proven advantages of AVF over PTFE, both types of access eventually fail and contribute to multiple hospital admissions, radiological and surgical interventions, and overall morbidity associated with chronic hemodialysis. Significant stenosis causing access dysfunction is a frequent complication in hemodialysis and requires repeated percutaneous transluminal balloon angioplasty (PTA) to maintain patency (6-9). The patency of PTA is limited, however, with first year primary patency rates ranging between 26% and 62% (6-8). Many factors influencing the patency rate have been studied in previously reported series (7,8). Our study is the first to investigate the effect of early recurrence on secondary patency. MethodsThe records of 228 patients (129 men, 99 women; mean age, 56.8±14.6 years) who underwent first time PTA for a dysfunctional native AVF between January 2007 and January 2011 were retrospectively reviewed. Inclusion criteria were presence of a dysfunctional native AVF referred for fistulography and treatment, no previous history of stenosis or thrombosis, and only stenosis of the AVFs on fistulography. Patients who had synthetic dialysis, composite grafts, or autogenous fistulas that were already thrombosed were excluded from our study. Indications for fistulography included decreased flow rate, difficult cannulation, increased venous pressure, edema of the upper extremity, or pain during dialy...

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“…Success rates are dismal (11,21,(52)(53)(54) because vessel injury to the endothelium and smooth muscle cells within the media that occurs after the PTA leads to further development of neointimal hyperplasia and restenosis (13,55). This suggests that although PTA may be important to treat stenosis in AVF and AVG, drug therapies may need to be applied to the site of angioplasty and endothelial injury to promote vascular healing and prolong vascular access patency.…”

Section: Endovascular Therapiesmentioning

confidence: 99%

Novel Paradigms for Dialysis Vascular Access

Lee

2013

Clinical Journal of the American Society of Nephrology

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SummaryVascular access dysfunction is a major cause of morbidity and mortality in hemodialysis patients. The most common cause of vascular access dysfunction is venous stenosis from neointimal hyperplasia within the perianastomotic region of an arteriovenous fistula and at the graft-vein anastomosis of an arteriovenous graft. There have been few, if any, effective treatments for vascular access dysfunction because of the limited understanding of the pathophysiology of venous neointimal hyperplasia formation. This review will (1) describe the histopathologic features of hemodialysis access stenosis; (2) discuss novel concepts in the pathogenesis of neointimal hyperplasia development, focusing on downstream vascular biology; (3) highlight future novel therapies for treating downstream biology; and (4) discuss future research areas to improve our understanding of downstream biology and neointimal hyperplasia development.

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Percutaneous transvenous angioplasty in the treatment of vascular access stenosis

Cited by 383 publications

References 26 publications

Endovascular treatment of occlusive central venous disease: one center's experience

Endovascular treatment of occlusive central venous disease: one center's experience

Percutaneous transluminal balloon angioplasty in stenosis of native hemodialysis arteriovenous fistulas: technical success and analysis of factors affecting postprocedural fistula patency

Novel Paradigms for Dialysis Vascular Access

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