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Related Concept Videos

Hemodialysis I: Introduction01:25

Hemodialysis I: Introduction

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Hemodialysis (HD) is a medical treatment that artificially removes waste products, excess fluids, and toxins from the blood when the kidneys are no longer able to perform these functions effectively. In this process, blood is filtered through a semipermeable membrane, allowing for the selective removal of waste while preserving necessary components like blood cells and proteins. Hemodialysis is typically performed in patients with end-stage renal disease (ESRD) or severe kidney...
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Restoring arteriovenous access: Pilot study using a scoring balloon in 50 patients.

J R Ross1

  • 1Dialysis Access Institute, Orangeburg, SC, USA.

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|September 17, 2020
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Summary

The AngioSculpt scoring balloon effectively reduced stenosis in hemodialysis access. This pilot study shows promising results for treating arteriovenous fistula and graft stenosis, with 81% of patients remaining free from re-intervention at six months.

Keywords:
Arteriovenous accessaccess restorationarteriovenous fistulaarteriovenous grafthemodialysis accessscoring balloon

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Area of Science:

  • Vascular Surgery
  • Interventional Nephrology
  • Medical Devices

Background:

  • Arteriovenous access failure, often caused by neointimal hyperplastic stenoses, is a common complication in hemodialysis.
  • Balloon angioplasty is the standard endovascular treatment for hemodialysis access stenosis.
  • Scoring balloon technology offers a novel approach to disrupt atheromatous plaque, but its impact on long-term patency requires further investigation.

Purpose of the Study:

  • To evaluate the safety and efficacy of the AngioSculpt scoring balloon for treating stenosed arteriovenous fistulas and grafts in hemodialysis patients.
  • To assess the primary endpoint of target lesion primary patency at 2 and 6 months, defined as freedom from re-intervention.

Main Methods:

  • A prospective, single-arm study involving 50 patients with stenosed hemodialysis fistulas/grafts.
  • Treatment utilized the AngioSculpt scoring balloon (Philips).
  • Patients were followed for 6 months to determine freedom from re-intervention.

Main Results:

  • Successful reduction in stenosis from 78% to 7.2% post-treatment with the scoring balloon.
  • No procedural complications such as slippage or dissection were reported.
  • At 6 months, 19% of patients required re-intervention, with a 6-month freedom from re-intervention rate of 81% overall. Patency rates were higher for fistulas (83.3%) than grafts (71.4%) and decreased with an increasing number of prior interventions.

Conclusions:

  • The AngioSculpt scoring balloon demonstrates potential as a safe and effective treatment for stenosed arteriovenous access in hemodialysis patients.
  • This pilot study suggests the AngioSculpt device is a viable option for endovascular intervention in this patient population.
  • Further research is warranted to confirm long-term patency rates and compare outcomes with existing therapies.