Ultrasound‐guided percutaneous transluminal angioplasty for the treatment of cephalic arch stenosis in hemodialysis arteriovenous fistulas

The aim of our study is to report the results of two types (type A, type B) paclitaxel drug-coated balloon compared with standard percutaneous transluminal angioplasty in the treatment of juxta-anastomotic stenoses of mature but failing distal radiocephalic hemodialysis arteriovenous fistulas. Two groups of 26 and 44 patients treated with two different drug-coated balloon are compared with a control group of 86 treated with standard percutaneous transluminal angioplasty. A color Doppler ultrasound was performed to evaluate stenosis and for treatment planning. We assess primary patency, defined as the absence of dysfunction of the arteriovenous fistulas, patent lesion or residual stenosis < 30% and no need for further reintervention of target lesion. Primary patency and secondary patency are evaluated after 12 months with color Doppler ultrasound for the whole arteriovenous fistulas, defined as absolute (absolute primary patency, absolute secondary patency) and target lesion. Postprocedural technical and clinical success was 100%. After 12 months, absolute primary patency is 81.8% for type A, 84.1% type B, and 54.7% for standard percutaneous transluminal angioplasty; target lesion primary patency is 92% type A, 86.4% type B, and 62.8% standard percutaneous transluminal angioplasty; absolute secondary patency is 95.4% type A, 95.5% type B, and 80.7% standard percutaneous transluminal angioplasty; target lesion secondary patency is 100% type A, 97.7% type B, and 80.7% standard percutaneous transluminal angioplasty. All the patients treated with drug-coated balloon (type A + type B) have an absolute primary patency of 83.3%, a target lesion primary patency of 87.9%, an absolute secondary patency of 95.5%, and a target lesion secondary patency of 98.4%. Our study confirms that the use of drug-coated balloon, indiscriminately among different brands, improves primary patency with statistically significant difference in comparison with standard percutaneous transluminal angioplasty and decreases reintervention of target lesion in juxta-anastomotic stenoses of failing distal arteriovenous fistulas maintaining the radiocephalic fistula as long as possible.

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A retrospective comparison analysis of results of drug-coated balloon versus plain balloon angioplasty in treatment of juxta-anastomotic de novo stenosis of radiocephalic arteriovenous fistulas

The Journal of Vascular Access ◽

10.1177/1129729819893205 ◽

2019 ◽

Vol 21 (5) ◽

pp. 596-601

Author(s):

Cemal Kocaaslan ◽

Ahmet Oztekin ◽

Mehmet Senel Bademci ◽

Emine Seyma Denli Yalvac ◽

Nurgul Bulut ◽

...

Keyword(s):

Percutaneous Transluminal Angioplasty ◽

Target Lesion ◽

Transluminal Angioplasty ◽

Primary Patency ◽

Anastomotic Stenosis ◽

Arteriovenous Fistulas ◽

Study Results ◽

Significant Difference ◽

Percutaneous Transluminal ◽

Drug Coated Balloon

Background: Juxta-anastomotic stenosis is a common issue of arteriovenous fistulas. We aimed to evaluate the results of percutaneous transluminal angioplasty with drug-coated balloon versus plain balloon for the treatment of juxta-anastomotic stenoses of mature but failing distal radiocephalic arteriovenous fistulas. Methods: A total of 80 patients with a juxta-anastomotic stenosis of distal radiocephalic arteriovenous fistula in our clinic between January 2016 and September 2017 were retrospectively analyzed. Patients were divided into two groups according to the type of treatment as drug-coated balloon – percutaneous transluminal angioplasty (n = 44) and plain balloon – percutaneous transluminal angioplasty (n = 43). Intra- and post-procedural data were recorded. Target lesion primary patency rate was evaluated at 6 and 12 months. Of all patients, 48 were females and 39 were males with a mean age of 56.3 ± 10.4 (range, 24–75) years. Both groups had mature fistulas, and the mean age of fistula was 11.3 ± 9.1 months in the drug-coated balloon – percutaneous transluminal angioplasty group and 10.3 ± 8.8 months in the plain balloon – percutaneous transluminal angioplasty group (p = 0.24). Results: There was no significant difference in the target lesion stenosis rate and the median lesion length between the groups. Technical and clinical success were achieved in both groups. Target lesion primary patency was similar at 6 months between the two groups (93.1% vs 81.3%, respectively; p = 0.14) but significantly higher for the drug-coated balloon – percutaneous transluminal angioplasty group at 12 months (81.8% vs 51.1%, respectively; p = 0.01). Conclusion: Our study results suggest that the use of drug-coated balloon combined with percutaneous transluminal angioplasty is an effective treatment for juxta-anastomotic stenoses of mature but failing distal radiocephalic arteriovenous fistulas with significantly improved target lesion primary patency rates and reduced need for juxta-anastomotic reinterventions.

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FP662NATIVE ARTERO-VENOUS FISTULA DYSFUNCTION: ROLE OF ULTRASOUND-GUIDED PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY IN THE TREATMENT OF OUTFLOW STENO-THROMBOSIS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfz106.fp662 ◽

2019 ◽

Vol 34 (Supplement_1) ◽

Author(s):

Antonio Granata ◽

Rosario Maccarrone ◽

Luca Zanoli ◽

Matthias Zeiler ◽

Lillo Pace ◽

...

Keyword(s):

Percutaneous Transluminal Angioplasty ◽

Transluminal Angioplasty ◽

Ultrasound Guided ◽

Venous Fistula ◽

Percutaneous Transluminal

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Periodic Duplex Ultrasonography Screening Together with Elective Percutaneous Transluminal Angioplasty in the Management of Graft Arteriovenous Fistulas for Hemodialysis

Surgery Today ◽

10.1007/s00595-006-3252-3 ◽

2006 ◽

Vol 36 (9) ◽

pp. 775-778 ◽

Cited By ~ 6

Author(s):

Naoki Toya ◽

Tetsuji Fujita ◽

Hiromichi Hagiwara ◽

Makoto Sumi ◽

Koji Kurosawa ◽

...

Keyword(s):

Percutaneous Transluminal Angioplasty ◽

Transluminal Angioplasty ◽

Duplex Ultrasonography ◽

Arteriovenous Fistulas ◽

Percutaneous Transluminal

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Objective and Subjective Assessment of Physician Labor and Resource Utilization in Maintenance Percutaneous Transluminal Angioplasty of Nonthrombosed Hemodialysis Arteriovenous Fistulas versus Arteriovenous Grafts

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2013.01.498 ◽

2013 ◽

Vol 24 (5) ◽

pp. 722-725 ◽

Cited By ~ 1

Author(s):

Lee Coryell ◽

Richard D. Shlansky-Goldberg ◽

Michael C. Soulen ◽

Jeffrey I. Mondschein ◽

S. William Stavropoulos ◽

...

Keyword(s):

Resource Utilization ◽

Percutaneous Transluminal Angioplasty ◽

Subjective Assessment ◽

Transluminal Angioplasty ◽

Arteriovenous Fistulas ◽

Arteriovenous Grafts ◽

Percutaneous Transluminal

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Ultrasound guided interventional procedures on arteriovenous fistulae: An Italian experience

The Journal of Vascular Access ◽

10.1177/1129729820977380 ◽

2021 ◽

pp. 112972982097738

Author(s):

Marcello Napoli ◽

Giuseppe Bacchini ◽

Luisa Scarpati ◽

Giuliana Loizzo ◽

Anna Zito

Keyword(s):

Hemodialysis Patients ◽

Transluminal Angioplasty ◽

Ultrasound Guided ◽

New Techniques ◽

Indwelling Catheters ◽

Arteriovenous Fistulas ◽

Italian Experience ◽

Reduced Costs ◽

Percutaneous Transluminal

Autogenous (AVF) and prosthetic (AVG) arteriovenous fistulas are the vascular accesses (VA) of choice for hemodialysis thanks to their improved patency, reduced costs, and lower rate of infections relative to catheters. In an effort to maximize the number of primary AVF and AVG, shorten maturation times for AVF, and reduce the number of indwelling catheters, several new techniques have been developed within the context of an overall program designed to optimize access care. This approach includes: (a) Primary Intraoperative Balloon Angioplasty on the vessels selected for AV creation whether small-sized or altered by pre-existing lesions; (b) Percutaneous Transluminal Angioplasty (PTA) on AVF and AVG stenosis, performed under ultrasonographic (UG) or fluoroscopic guide (FG). We report the experience of two Center in performing the above mentioned procedures on even complex VA. The wise adoption of these techniques may avail to meet the stringent demands for reliable VA placement as defined by KDOQI and, thereby, expand the duration and quality of life for hemodialysis patients.

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