scholarly journals Current state of dialysis treatment and vascular access management in Japan

2019 ◽  
Vol 20 (1_suppl) ◽  
pp. 10-14 ◽  
Author(s):  
Takashi Sato ◽  
Hiroshi Sakurai ◽  
Kentaro Okubo ◽  
Risa Kusuta ◽  
Takeshi Onogi ◽  
...  
Keyword(s):  
Vascular Access ◽  
Percutaneous Transluminal Angioplasty ◽  
Japanese Society ◽  
Transluminal Angioplasty ◽  
Access Management ◽  
Dialysis Therapy ◽  
Arteriovenous Fistulae ◽  
First Choice ◽  
Dialysis Outcomes ◽  
Percutaneous Transluminal

According to the data from the Japanese Society for Dialysis Therapy, the number of dialysis patients was about 330,000 at the end of 2016. The mean age of newly initiated patients was 69.4 years and that of maintenance was 68.2 years. And, diabetic nephropathy is the most common primary disease, with an incidence rate of 43.2%. These results mean that the systemic vascular condition is getting worse. In spite of these backgrounds, the patients of 97.3% were treated by hemodialysis; therefore, careful management of vascular access is essential to better maintain the condition of patients. The Dialysis Outcomes and Practice Patterns Study shows that vascular access modalities are an important factor in determining prognoses of patients and that prognosis in Japan is one of the best worldwide. In Japan, the use of arteriovenous fistulae accounts for 95% of vascular access modalities. However, a statistic by Japanese Society for Dialysis Therapy suggests that the use of arteriovenous graft has been increasing. In 2005, Japanese Society for Dialysis Therapy Guidelines recommended percutaneous transluminal angioplasty be the first choice for the treatment of vascular access stenosis. Since then, percutaneous transluminal angioplasty has become an important procedure for long-term maintenance of the morphology and function of vascular access. In Japan, approximately 60% of percutaneous transluminal angioplasty are conducted by nephrologists and urologists; in addition, arteriovenous fistulae creation procedures are also performed by them. According to my private opinion, such conditions above show that even in the absence of standardized training on vascular access management, doctors on site perform their duties in an appropriate manner. However, the problems of how we evaluate the specificity in Japan and pass it down the generations still remain.

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

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.

scholarly journals Prospects for Vascular Access Education in Developing Countries: Current Situation in Cambodia

2017 ◽  
Vol 44 (Suppl. 1) ◽  
pp. 52-54
Author(s):  
Toshihide Naganuma ◽  
Yoshiaki Takemoto
Keyword(s):  
Developing Countries ◽  
Vascular Access ◽  
Medical Personnel ◽  
Transluminal Angioplasty ◽  
Dialysis Therapy ◽  
International University ◽  
Development And Management ◽  
Percutaneous Transluminal ◽  
And Training ◽  
Stable Development

We report our activities training doctors on vascular access procedures at International University (IU) Hospital in Cambodia through a program facilitated by Ubiquitous Blood Purification International, a nonprofit organization that provides medical support to developing countries in the field of dialysis medicine. Six doctors from Japan have been involved in the education of medical personnel at IU, and we have collectively visited Cambodia about 15 times from 2010 to 2016. In these visits, we have performed many operations, including 42 for arteriovenous fistula, 1 arteriovenous graft, and 1 percutaneous transluminal angioplasty. Stable development and management of vascular access is increasingly required in Cambodia due to increased use of dialysis therapy, and training of doctors in this technique is urgently required. However, we have encountered several difficulties that need to be addressed, including (1) the situation of personnel receiving this training, (2) problems with facilities, including medical equipment and drugs, (3) financial limitations, and (4) problems with management of vascular access.

scholarly journals The Reconstructions for Vertebral Artery Stenosis at the Origin

2000 ◽  
Vol 6 (1_suppl) ◽  
pp. 237-242 ◽  
Author(s):  
K. Yoshino ◽  
Y. Terai ◽  
S. Fujimoto ◽  
I. Kamata ◽  
K. Kinugasa ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Percutaneous Transluminal Angioplasty ◽  
Transluminal Angioplasty ◽  
Surgical Reconstruction ◽  
Invasive Treatment ◽  
First Choice ◽  
Long Term Follow Up ◽  
Percutaneous Transluminal

To date in our hospital, surgical reconstructions and percutaneous transluminal angioplasty (PTA) were carried out in 168 patients with vertebral artery (VA) stenosis at the origin. In this article, we discuss the comparison between surgical reconstructions and PTA, especially regarding long term follow up, patency and complications. PTA is a less invasive treatment for VA stenosis at the origin than surgical reconstructions. However, restenosis after PTA occurred in 20% of the patients. On the other hand, restenosis after surgical reconstructions did not emerge even in long term follow up. An embolism after PTA occurred in 2.6% of the cases. However, the embolism occurred in only the first 10 patients of our series, after that there was no embolism. We concluded that PTA was the first choice for VA stenosis at the origin, if the angiogram did not reveal any PTA difficulty. If restenosis after PTA was performed, we selected surgical reconstruction for VA stenosis at the origin.

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

Radiography ◽  
2006 ◽  
Vol 12 (2) ◽  
pp. 127-133 ◽  
Author(s):  
Fotini P. Christidou ◽  
Vasilios I. Kalpakidis ◽  
Kostas D. Iatrou ◽  
Ioannis A. Zervidis ◽  
Gerasimos I. Bamichas ◽  
...  
Keyword(s):  
Vascular Access ◽  
Percutaneous Transluminal Angioplasty ◽  
Hemodialysis Patients ◽  
Transluminal Angioplasty ◽  
Venous Stenting ◽  
Venous Stenosis ◽  
Percutaneous Transluminal

Percutaneous Transluminal Angioplasty as Best Treatment in Stenosis of Vascular Access for Hemodialysis

Nephron ◽  
1989 ◽  
Vol 51 (2) ◽  
pp. 192-196 ◽  
Author(s):  
J.C. Rodriguez-Perez ◽  
M. Maynar ◽  
A. Rams ◽  
C. Plaza ◽  
N. Vega ◽  
...  
Keyword(s):  
Vascular Access ◽  
Percutaneous Transluminal Angioplasty ◽  
Transluminal Angioplasty ◽  
Percutaneous Transluminal

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

2018 ◽  
Vol 20 (1_suppl) ◽  
pp. 93-96 ◽  
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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