The role of stents in hemodialysis vascular access

2021 ◽  
pp. 112972982110150
Author(s):  
Aisha Shaikh ◽  
Alian Albalas ◽  
Brinda Desiraju ◽  
Amy Dwyer ◽  
Nabil Haddad ◽  
...  
Keyword(s):  
Vascular Access ◽  
Neointimal Hyperplasia ◽  
Transluminal Angioplasty ◽  
Hemodialysis Vascular Access ◽  
Clinical Scenarios ◽  
Anatomic Locations ◽  
End Stage ◽  
Percutaneous Transluminal ◽  
Stenotic Lesions

Vascular access is the Achilles’ heel of dialysis therapy among patient with end stage kidney disease. The development of neointimal hyperplasia and subsequent stenosis is common in vascular access and is associated with significant morbidity. Percutaneous transluminal angioplasty using balloon inflation was the standard therapy of these lesions. However, the balloon-based approaches were associated with poor vascular access patency rate necessitating new inventions. It is within this context that different types of stents were developed in order to improve the overall dialysis vascular access functionality. In this article, we review the available literature regarding the use of stents in treating dialysis vascular access stenotic lesions. Further, we review the major clinical trials of stent use in different anatomic locations and in different clinical scenarios.

Feasibility of routine ultrasound-guided percutaneous transluminal angioplasty in the treatment of native arteriovenous fistula dysfunction

2020 ◽  
pp. 112972982094307
Author(s):  
Antonio Granata ◽  
Rosario Maccarrone ◽  
Luca Di Lullo ◽  
Walter Morale ◽  
Giovanni Giorgio Battaglia ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Percutaneous Transluminal Angioplasty ◽  
Neointimal Hyperplasia ◽  
Transluminal Angioplasty ◽  
Primary Patency ◽  
Ultrasound Guided ◽  
Dialysis Unit ◽  
Percutaneous Transluminal ◽  
Vascular Access Stenosis

Background: Stenosis is the main cause of arteriovenous fistula failure and is due to neointimal hyperplasia. Percutaneous transluminal angioplasty is the gold standard for patients with vascular access stenosis. The aim of the study was to evaluate the efficacy and safety of ultrasound-guided percutaneous transluminal angioplasty in the treatment of native arteriovenous fistula venous stenosis. Methods: The need for intervention was determined by physical examination and duplex ultrasound in 162 patients. All patients with failing or not maturing arteriovenous fistula were treated in the outpatient setting under ultrasound guidance. Procedural success was assessed with repeated post-procedural ultrasound examinations. All procedures were performed under local anesthesia by a single nephrologist and were performed in a single vascular laboratory, while follow-up ultrasound was performed in the dialysis unit of destination. Results: Early technical success was obtained in 95.6% of cases (154 of 162). Complications occurred in 22 patients (13.5%) with no major complication requiring surgical or fluoroscopic endovascular intervention. Primary patency at 6 and 12 months was 84% and 69.8%, respectively. Risk factors for arteriovenous fistula failure/secondary percutaneous transluminal angioplasty were vascular access low blood flow rate and vintage, as well as the need for thrombolysis during the first percutaneous transluminal angioplasty. Conclusion: Ultrasound-guided percutaneous transluminal angioplasty is a valuable tool to treat vascular access stenosis.

scholarly journals Role of Hypoxia and Metabolism in the Development of Neointimal Hyperplasia in Arteriovenous Fistulas

2019 ◽  
Vol 20 (21) ◽  
pp. 5387 ◽  
Author(s):  
Nirvana Sadaghianloo ◽  
Julie Contenti ◽  
Alan Dardik ◽  
Nathalie M. Mazure
Keyword(s):  
Vascular Access ◽  
Neointimal Hyperplasia ◽  
Vasa Vasorum ◽  
Wall Thickening ◽  
Arteriovenous Fistulas ◽  
Flow Parameters ◽  
Stage Renal Disease ◽  
End Stage ◽  
Venous Wall

For patients with end-stage renal disease requiring hemodialysis, their vascular access is both their lifeline and their Achilles heel. Despite being recommended as primary vascular access, the arteriovenous fistula (AVF) shows sub-optimal results, with about 50% of patients needing a revision during the year following creation. After the AVF is created, the venous wall must adapt to new environment. While hemodynamic changes are responsible for the adaptation of the extracellular matrix and activation of the endothelium, surgical dissection and mobilization of the vein disrupt the vasa vasorum, causing wall ischemia and oxidative stress. As a consequence, migration and proliferation of vascular cells participate in venous wall thickening by a mechanism of neointimal hyperplasia (NH). When aggressive, NH causes stenosis and AVF dysfunction. In this review we show how hypoxia, metabolism, and flow parameters are intricate mechanisms responsible for the development of NH and stenosis during AVF maturation.

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 796-1 Non Surgical Revascularization in Carotid Arteries: Role of Percutaneous Transluminal Angioplasty

1995 ◽  
Vol 25 (2) ◽  
pp. 380A
Author(s):  
Alfredo E. Rodríguez ◽  
Mario Fernández ◽  
Eduardo Mele ◽  
Ernesto Peyregne ◽  
Néstor A. Pérez Baliño
Keyword(s):  
Percutaneous Transluminal Angioplasty ◽  
Carotid Arteries ◽  
Transluminal Angioplasty ◽  
Surgical Revascularization ◽  
Percutaneous Transluminal

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.

Abstract 466: CX3CR1 Down Regulation Reduces Venous Neointimal Hyperplasia Formation in a Murine Hemodialysis Vascular Access Model

2017 ◽  
Vol 37 (suppl_1) ◽  
Author(s):  
Binxia Yang ◽  
Sreenivaslisu Kilari ◽  
Deborah L McCall ◽  
John Broadwater ◽  
Steven Kerr ◽  
...  
Keyword(s):  
Cell Density ◽  
Vascular Access ◽  
Jugular Vein ◽  
Neointimal Hyperplasia ◽  
Genetically Engineered ◽  
Vehicle Group ◽  
Immunohistochemistry Analysis ◽  
Hemodialysis Vascular Access ◽  
Histology And Immunohistochemistry ◽  
Hemodialysis Arteriovenous Fistula

Introduction: Venous neointimal hyperplasia (VNH) is a major cause of hemodialysis arteriovenous fistula (AVF) vascular access failure. CX3CR1 mediates macrophage infiltration into the vasculature. Mice were used which had been genetically engineered to knock in the human CX3CR1 gene. Hypothesis: The hypothesis to be tested is that increased CX3CR1 gene expression results in VNH formation associated with AVF. Methods: We used 50 CX3CR1 knock in mice which were divided into 2 groups: 1. CX3CR1 antibody (30 mg/kg administered intraperitoneally two times per week) or vehicle (equal amount of volume used for CX3CR1 antibody administered intraperitoneally). AVFs were created by connecting the carotid artery to ipsilateral jugular vein 28 days after nephrectomy was performed to induce chronic kidney disease. Histology and Immunohistochemistry analysis at the outflow vein of AVF were performed to assess the pathological changes. Results: There was a significant decrease in neointima area in the outflow veins of AVF in CX3CR1 antibody group compared to the vehicle group at day 28 (43085 ± 12678 vs. 58963.4 ± 9273 μm 2 , P<0.05). There was a significant decrease in the ratio of neointima/media+adventitia area in the outflow veins of AVF in CX3CR1 antibody group compared to the vehicle group at day 28 (0.34 ± 0.1 vs. 0.61 ± 0.1, P<0.05). Cell density in neointima area in CX3CR1 group outflow veins was significantly lower than the vehicle group at day 14 (9600 ± 1000 vs. 13000 ± 3000 /mm 2 , P<0.01). There was a significant decrease in the average CD68-positive cell density in the CX3CR1 group outflow veins compared to the vehicle group (0.96 ± 0.34 vs.15.9 ±10, P<0.001) at day 14. Conclusion: Decreasing CX3CR1 significantly reduces macrophages infiltration and results in a significant reduction in VNH. This study provides a rationale for using CX3CR1 antibody in reducing VNH formation.

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