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Dialysis Access Maintenance: Plain Balloon Angioplasty
Lakshmi Ratnam1,2, Narayan Karunanithy3,4, Leto Mailli5,6
1Department of Interventional Radiology, St George's University Hospitals NHS Foundation Trust, London, UK. lakshmi.ratnam@stgeorges.nhs.uk.
Cardiovascular and Interventional Radiology
|May 8, 2023
Summary
Plain balloon angioplasty is the primary treatment for dialysis access stenosis. Outcomes are better for arteriovenous fistulae (AVF) than arteriovenous grafts (AVG), with success influenced by stenosis severity and patient factors.
Area of Science:
- Nephrology
- Vascular Surgery
- Interventional Radiology
Background:
- Dialysis access stenosis is a common complication.
- Plain balloon angioplasty is the standard initial treatment.
Purpose of the Study:
- To review the outcomes of plain balloon angioplasty for dialysis access stenosis.
- To compare outcomes between arteriovenous fistulae (AVF) and arteriovenous grafts (AVG).
Main Methods:
- Review of cohort and comparative studies.
- Analysis of primary patency rates and complication rates.
Main Results:
- Primary patency at 6 months is higher for AVF (42-63%) than AVG (27-61%).
- Forearm fistulae show better outcomes than upper arm fistulae.
- Outcomes are negatively impacted by severe stenosis, older patient age, and prior interventions.
Conclusions:
- Plain balloon angioplasty is effective but outcomes vary by access type and patient factors.
- Repeat treatments and adjuncts like drug-coated balloons and stents can improve long-term patency.
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