Role of intravascular ultrasound imaging during endovascular interventions of failing hemodialysis access grafts

Ross, John; Franga, Dion L.; Gallichio, M; Patel, Ankur J.; Ouriel, Kenneth

doi:10.1016/j.jvs.2016.10.115

Cited by 11 publications

(5 citation statements)

References 11 publications

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“…While this frequency is not insignificant, even more dramatically, a similar study by Ross et al published in 2017 demonstrated that IVUS results changed treatment plan in up to 76% (44/58) of patients. 18 While median time to first re-intervention was notably higher in the DSA + IVUS cohort (61 days) as compared to the DSA-alone cohort (30 days), this difference did not reach statistical significance. The use of IVUS appeared to have a numerically appreciable impact on the 2-year composite study endpoint (freedom from re-PTA, surgical AV access revision, and/or access thrombosis; Table 4), but like the findings seen by Ross et al, statistical significance was not achieved.…”

Section: Discussionmentioning

confidence: 84%

A prospective randomized feasibility trial comparing angiography and angiography with intravascular ultrasound for treatment of hemodialysis access failures

Shutze

Rendon

Lee³

et al. 2021

Vascular

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Objective Hemodialysis accesses suffer from limited primary patency requiring frequent interventions, revisions, or even abandonment. Prolongation of access life and usability with minimization of these adverse events is paramount. Endovascular methods are established first-line interventions for failing arteriovenous access and treatment of venous outflow stenoses. The Primary goal of this feasibility study was to evaluate intravascular ultrasound (IVUS) during interventional treatments on outcomes in those undergoing angiography for failing hemodialysis access. Secondary goals were to determine differences between IVUS and angiography on vessel and lesion characteristics and impact on treatment. Methods In this prospective, randomized controlled trial, patients scheduled for angiography to evaluate and treat a failing hemodialysis access were randomized to use of angiography (DSA) alone or angiography plus IVUS (DSA + IVUS). Patients were treated by a standardized protocol and seen in follow-up at 2 weeks, and every 3 months for 2 years or until a study endpoint was reached. Measurement of vessel diameters, % stenosis, lesion length, and study endpoints (AV access thrombosis, re-intervention, or surgical revision) were recorded. Results A total of 55 subjects were enrolled, 27 in the DSA cohort and 28 in the DSA + IVUS cohort. There were 41 treated lesions in each group. Freedom from the composite endpoint of AV access thrombosis or re-intervention was 46.3% in the DSA cohort and 61.0% in the DSA + IVUS cohort ( p = 0.27). Diameter measurements matched between the two imaging modalities only 9 times out of 41 total comparison measures. In pre-treatment lesions with >80% stenosis, IVUS had a greater tendency than DSA to underestimate the severity of stenosis, whereas in pre-treatment lesions with 50–80% stenosis, DSA was more likely than IVUS to underestimate the severity of stenosis. Post-treatment % stenosis had mean difference of −7.5% between DSA versus DSA + IVUS cohorts. In five lesions with <30% stenosis measured by angiogram, IVUS led to treatment escalation. Conclusion In the interventional treatment of failing angioaccess, IVUS and angiography differ in the vast majority of cases in measurement of vessel diameter. A significant number of patients were found to have suboptimal therapeutic response by IVUS only, which led to an escalation in treatment, and in over one-third of cases, the IVUS results led to a change in treatment plan. The improved patency rates in the IVUS group was not statistically significant in this small population but should be further investigated in a larger trial.

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Section: Discussionmentioning

confidence: 84%

A prospective randomized feasibility trial comparing angiography and angiography with intravascular ultrasound for treatment of hemodialysis access failures

Shutze

Rendon

Lee³

et al. 2021

Vascular

View full text Add to dashboard Cite

show abstract

“…However, in the meta-analysis of these two studies, the benefit was no longer observed. Based on personal experiences in CVD intervention, an elastic recoil phenomenon is frequently noted, and it has been suggested that insufficient luminal gain is achieved by PTA based on IVUS [19,29]. Therefore, the benefit of DCB in CVD seems limited.…”

Section: Treatmentmentioning

confidence: 99%

Central venous disease in hemodialysis patients

Park

Choi

Baik

2019

Kidney Res Clin Pract.

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Central venous disease (CVD) is difficult to treat and often resistant to treatment. In CVD, hemodialysis vascular access should sometimes be abandoned, or in serious cases, the patient's life may be threatened. Therefore, prevention is ideal. However, as the prevalence of chronic kidney disease (CKD) has increased steadily with population aging, CKD patients with a peripherally inserted central catheter (PICC) are encountered frequently. PICCs can cause CVD, and the basilic vein, which is regarded as the important last option for native arteriovenous fistula (AVF) creation in end-stage renal disease (ESRD) patients, is destroyed frequently after its use as the entry site of PICC. The most well-established risk factors for CVD are a history of central venous catheter (CVC) insertion and its duration of use. Therefore, to reduce the incidence of CVD, catheterization in the central vein (CV) should be minimized, along with its duration of use. In this review, we will first explain the basic territories of the CV and introduce its pathophysiology, clinical features, and advanced treatment options. Finally, we will emphasize prevention of CVD.

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“…24 More recently, a pilot study demonstrated that adding intravascular ultrasound to digital subtraction angiography changed management plans in 76% of the patients and increased the median time to reintervention or graft abandonment from 30 days in the control group to 61 days in the test group. 25 To evaluate the benefits and limitations of angioplasty using only ultrasound guidance, a recent prospective study evaluated 132 failing or non-maturing arteriovenous accesses that underwent 189 ultrasound-guided balloon angioplasties. The authors designated a procedure technically successful if the entire procedure was performed using ultrasound alone.…”

Section: Role Of Ultrasound In Dialysis Access Evaluationmentioning

confidence: 99%

Clinical Aspects of Dialysis Interventions: Physical and Sonographic Findings

Niyyar

Agarwal

Salman

2022

Semin intervent Radiol

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Physical examination (PE) of arteriovenous access remains of high clinical value and continues to be recommended by leading societies and guidelines. PE is easy to learn and perform. Once learned, examiners can provide a comprehensive arteriovenous (AV) access examination in 20 to 30 seconds. Therefore, we continue to advocate that AV access PE should be part of the training for all dialysis care providers. Similarly, ultrasound can provide important AV access evaluation and provide key information. It is relatively cheap and can be readily available at the bed side. Additionally, it is well accepted by patients, as it is not expected to be associated with pain or discomfort during the examination. We present in this review the key components of PE, signs and symptoms of AV access dysfunction, and the role of ultrasound in AV access evaluation as a complementary tool to PE.

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Role of intravascular ultrasound imaging during endovascular interventions of failing hemodialysis access grafts

Cited by 11 publications

References 11 publications

A prospective randomized feasibility trial comparing angiography and angiography with intravascular ultrasound for treatment of hemodialysis access failures

A prospective randomized feasibility trial comparing angiography and angiography with intravascular ultrasound for treatment of hemodialysis access failures

Central venous disease in hemodialysis patients

Clinical Aspects of Dialysis Interventions: Physical and Sonographic Findings

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