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Endovascular tools for vascular access stenosis: Flow-chart proposal
Marco Taurisano1, Andrea Mancini1, Cosma Cortese2
1Department of Nephrology, Hospital "Di Venere," Bari (BA), Apulia, Italy.
Insights
Stenosis is a key issue in arteriovenous fistulas (AVFs) for hemodialysis patients. This review details devices for treating AVF stenosis, aiming to improve outcomes for end-stage renal disease patients.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Nephrology
Background:
- Stenosis is the primary pathology affecting arteriovenous fistulas (AVFs), impacting end-stage renal disease (ESRD) patients requiring hemodialysis.
- Effective correction of vascular access stenosis is crucial for patient survival and quality of life.
Purpose of the Study:
- To review current literature on devices used for treating AVF stenosis.
- To provide evidence-based guidance on selecting and utilizing various treatment tools for different stenosis types and locations.
- To propose a treatment algorithm for managing AVF stenosis.
Main Methods:
- Literature review of scientific evidence on AVF stenosis treatment devices.
- Analysis of device materials, technologies, and applications for resistant lesions and recurrence reduction.
- Development of flow-chart treatment proposals based on literature evidence.
Main Results:
- Percutaneous transluminal angioplasty (PTA) is a primary treatment for AVF stenosis with immediate positive results.
- Technological advancements have introduced diverse devices to manage resistant stenotic lesions and minimize recurrence.
- Guidelines lack specific recommendations for individual treatment choices.
Conclusions:
- A comprehensive understanding of available devices and their appropriate application is essential for effective AVF stenosis management.
- This review offers specific information to guide clinicians in selecting the best tools for AVF stenosis treatment.
- Implementing a structured approach, potentially using flow-charts, can optimize treatment strategies and improve patient outcomes.
Abstract:
Stenosis represents the most relevant arteriovenous fistula (AVF) pathology and can affects the entire conduit forming the fistula, from afferent artery to central venous vessels. Correction of vascular access stenosis significantly affects the survival and quality of life for end stage renal disease patients (ESRD) dependent on hemodialysis. Guidelines consider the procedure of percutaneous transluminal angioplasty (PTA) relevant for the primary treatment of these lesions with excellent results in restoring AVF immediately at the end of the procedure. From first AVF angioplasty in 1981 to now, wide scientific innovation has led to development of new devices, composed by different materials and technologies, specific for the site and the type of stenosis to be treated, able to manage resistant stenotic lesion and to reduce stenosis recurrences. International guidelines do not clearly specify all treatment possibilities in the individual case. In this review the authors want to provide specific information on most used devices for stenosis treatment based on literature evidence, showing when and where to use the various tools available with flow-chart treatment proposal.
