Percutaneous transluminal angioplasty (PTA) and venous stenting in hemodialysis patients with vascular access-related venous stenosis or occlusion

Objective: To evaluate the treatment success rate of percutaneous transluminal angioplasty (balloon angioplasty) for peripheral and central venous stenosis in hemodialysis patients. Study Design: Retrospective/observational study. Place and Duration of Study: Department of Cardiology, Shaikh Zayed Hospital Lahore from 1st January 2018 to 30th June 2018. Methods: Thirteen patients of both genders presenting during from two years of hemodialysis failure and ipsilateral arm and neck swelling followed by peripheral and central venous stenosis were included in this study. Patients ages were ranging from 25 to 70 years. Patient’s detailed history including hemodialysis treatment, age, sex, socio-economic status was examined after taking informed consent from the patients. Percutaneous transluminal angioplasty (PTA) was performed at all the patients. Procedural success rate was examined. Results: There were 9 (69.23%) patients were men and rest (13.77%) were women. 5 (38.46%) patients were ages between 25 to 45 years, 6 (46.15%) patients had an ages 46 to 65 years and 2 (15.38%) patients were ages greater than 65 years. 10 (76.92%) had rural residency. 40 % patients had income >30000 PKR. Location and severity of lesions was examined as brachiocephalic vein, subclavian vein, Axillary vein, basilica, cephalic and median cubtal vein in 1,3,2,3,3 and 1 patients respectively. We determine priority patency rate in central lesion PTA was 82.7%, 62% and 38% at 3, 6 and 12 months and priority patency rate in peripheral lesions PTA was 87%, 79.5% and 67.8% at 3, 6 and 12 months. Conclusion: It is concluded that percutaneous transluminal angioplasty (balloon angioplasty) procedure for treatment of central and peripheral venous stenosis in hemodialysis patients was safe and effective with no procedural complications.

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The Primary Patency of Percutaneous Transluminal Angioplasty in Hemodialysis Patients With Vascular Access Failure

Korean Circulation Journal ◽

10.4070/kcj.2011.41.9.512 ◽

2011 ◽

Vol 41 (9) ◽

pp. 512 ◽

Cited By ~ 15

Author(s):

Woo Shin Kim ◽

Wook Bum Pyun ◽

Byung Chul Kang

Keyword(s):

Vascular Access ◽

Percutaneous Transluminal Angioplasty ◽

Hemodialysis Patients ◽

Transluminal Angioplasty ◽

Primary Patency ◽

Percutaneous Transluminal

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A case series of favorable vessel dilatation using a nitinol scoring element–equipped helical balloon catheter (AngioSculpt®)

The Journal of Vascular Access ◽

10.1177/1129729818757978 ◽

2018 ◽

Vol 20 (1_suppl) ◽

pp. 93-96 ◽

Cited By ~ 2

Author(s):

Ryo Sato ◽

Tetsuhiko Sato ◽

Yuichi Shirasawa ◽

Chika Kondo ◽

Masao Tadakoshi ◽

...

Keyword(s):

Vascular Access ◽

Percutaneous Transluminal Angioplasty ◽

Venous Pressure ◽

Balloon Catheter ◽

Case Series ◽

Hemodialysis Patients ◽

Transluminal Angioplasty ◽

Stenosis Rate ◽

Percutaneous Transluminal ◽

Vascular Access Stenosis

Objective: Although percutaneous transluminal angioplasty is an effective therapy against vascular access failure in hemodialysis patients, recurrent stenosis imposes enormous burden for hemodialysis patients. A nitinol scoring element–equipped helical balloon catheter (AngioSculpt®) has been altered the landscape for treating several vascular diseases. It is not, however, fully elucidated whether AngioSculpt for advanced vascular access stenosis, difficult to expand by conventional balloons, successfully provides bailout angioplasty. Here, we report our cases whose intradialytic venous pressure significantly improved after percutaneous transluminal angioplasty without any serious adverse complications using AngioSculpt. Patients and Methods: Among patients undergoing hemodialysis in Masuko Memorial Hospital, 16 cases with resistant and recurrent vascular access stenosis underwent AngioSculpt (diameter 6 mm, total length 4 cm) angioplasty. We simultaneously measured the average venous pressures during hemodialysis before and after percutaneous transluminal angioplasty. Results: The average outflow vessel stenosis rate was 73.0 ± 11.3% before AngioSculpt intervention. Fully enlarged vessels were observed by expanding vessels at maximum pressure of 14 atm in all cases without any complications including vascular ruptures. Their intradialytic venous pressures decreased from 181.8 ± 39.2 mmHg to 150.5 ± 39.3 mmHg ( p < 0.0001). Conclusion: AngioSculpt may provide a promising option for treating hemodialysis patients with severely advanced vascular access stenosis, who would otherwise need repeated vascular access surgeries and/or conventional percutaneous transluminal angioplasties.

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Percutaneous transluminal angioplasty procedure for central venous stenosis inpatient undergoing hemodialysis in Pelni Hospital: case series

Journal of Indonesia Vascular Access ◽

10.51559/jinava.v1i1.8 ◽

2021 ◽

Vol 1 (1) ◽

pp. 19-23

Author(s):

Muhammad Zaini Azwan ◽

Anak Agung Ngurah Nata Tresnawan Putra

Keyword(s):

Arteriovenous Fistula ◽

Vascular Access ◽

Percutaneous Transluminal Angioplasty ◽

Transluminal Angioplasty ◽

Central Venous ◽

Central Venous Stenosis ◽

Venous Stenosis ◽

Kidney Impairment ◽

Percutaneous Transluminal ◽

Percutaneous Transluminal Angiography

Introduction: Many causes leads to kidney impairment. This does not rule out the increasing number of patients undergoing hemodialysis. The common vascular access used during hemodialysis is an arteriovenous fistula (AVF). The arteriovenous fistula was preferred because it lasts longer and has a lower risk of infection for vascular access, meanwhile central venous stenosis or occlusion in the vein that carries the blood from the extremities to the heart often occur. If vascular access is still used during hemodialysis in which central venous stenosis is formed, it needs to make a new vascular access option. Percutaneous transluminal angiography (PTA) main objectives are to dilate the venous lesion that has occlusion more than 50% and extending the lifespan of arteriovenous fistula. In this case, we report six patients hemodialysis with central venous stenosis treated with percutaneous transluminal angiography. This procedure has benefits that are arteriovenous fistula can be used again to reach hemodialysis adequacy optimally and reduce pain and swelling in the arms. Case description: There six cases who were 45,48,57.58,63 and 66 years old who underwent percutaneous transluminal angioplasty procedures for central venous stenosis. Several past illnesses of the patients underlying the kidney impairment such chronic hypertension, chronic coronary heart complications, and/or diabetes. Several patients felt AVF swollen and/or painful. Minimal residual stenosis after balloon angioplasty was performed. Conclusion: According to our cases, patients that underwent the hemodialysis felt swollen or/and pain due to stenosis ballooning angioplasty help minimize the residual stenosis.

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Arterial percutaneous angioplasty in hemodialysis access: Endovascular treatment of hand ischemia

The Journal of Vascular Access ◽

10.1177/1129729820946654 ◽

2020 ◽

pp. 112972982094665

Author(s):

Gabriela Teixeira ◽

Paulo Almeida ◽

Luís Loureiro ◽

Inês Antunes ◽

Duarte Rego ◽

...

Keyword(s):

Limb Salvage ◽

Vascular Access ◽

Percutaneous Transluminal Angioplasty ◽

Clinical Success ◽

Invasive Procedure ◽

Transluminal Angioplasty ◽

Arterial Stenosis ◽

Low Flow ◽

Hemodialysis Access ◽

Percutaneous Transluminal

Background: Hemodialysis access–induced distal ischemia consists of symptomatic extremity malperfusion after vascular access creation. It is usually caused by discordant vascular resistance, with arteriovenous shunting of a high blood volume from arterial into venous system and subsequent hand hypoperfusion. Less often, hemodialysis access–induced distal ischemia is caused by arterial stenosis. In these cases, access frequently has normal/low flow, radial pulse is usually absent and not recoverable with vascular access digital compression, diabetes is often present, and percutaneous transluminal angioplasty can be critical for access and limb salvage. Methods: Retrospective study conducted between June 2011 and February 2018 of patients with vascular access submitted to arterial percutaneous transluminal angioplasty for limb-threatening ischemia. Results: Twenty-nine patients were referred for arterial angiography after hemodialysis access–induced distal ischemia diagnosis and physical examination or ultrasound findings suggestive of arterial disease. In 11 patients, percutaneous transluminal angioplasty was not technically feasible. Among 18 treated patients, 83.3% had diabetes and 60% had skin ulcerations. Target arteries were radial (11), brachial (7), axillar (2), ulnar (2), and subclavian (1). Clinical success, defined as arteriovenous maintenance and wound healing/pain resolution, was observed in 12 patients (66.7%). Concomitant procedures included adjuvant banding ( n = 2) and finger amputation ( n = 1), and one reintervention was performed. No intra- or postoperative complications were reported. Conclusion: Hemodialysis access–induced distal ischemia is a serious complication of hemodialysis vascular access, with multifactorial etiology. Correct and timely diagnosis is crucial for maintaining access and limb salvage. Percutaneous transluminal angioplasty is a minimally invasive procedure that may be effective and long-lasting in carefully selected patients with ischemic complaints.

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