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Stenotic lesions in vascular access: treatment with transluminal angioplasty using high-pressure balloons
1Department of Internal Medicine, Nagoya Kyoritsu Hospital.
Insights
Balloon angioplasty effectively treats stenotic vascular access lesions, achieving 87% initial success. While long-term patency is limited, repeated procedures can maintain fistula function.
Area of Science:
- Vascular Surgery
- Interventional Radiology
Background:
- Vascular access stenosis is a common complication in hemodialysis patients.
- Percutaneous transluminal angioplasty (PTA) is a minimally invasive treatment option.
Purpose of the Study:
- To evaluate the efficacy and safety of high-pressure balloon angioplasty for stenotic vascular access lesions.
- To assess the patency rates of balloon angioplasty in maintaining vascular access function.
Main Methods:
- Retrospective analysis of 164 balloon dilatations performed since November 1991.
- Procedures included primary PTA and PTA following thrombectomy or surgical revision.
- High-pressure balloon catheters were utilized for all interventions.
Main Results:
- Initial technical success rate was 87% (142 out of 164 stenoses).
- Primary patency rates were 68% at 3 months, 42% at 6 months, and 25% at 1 year.
- No serious adverse reactions were reported during the study period.
Conclusions:
- High-pressure balloon angioplasty is a safe and effective procedure for managing stenotic vascular access.
- While long-term patency rates are modest, repeated dilatations can be performed to prolong fistula functionality.
- This technique offers a minimally traumatizing approach for maintaining long-term vascular access in selected patients.
Abstract:
In our institute, one hundred sixty-four balloon dilatations of stenotic lesions in vascular access have been performed since November 1991. All of these procedures were done with high-pressure balloon catheters. In addition to seventy-four cases treated with only percutaneous transluminal angioplasty, there were thirty-four cases which were treated by thrombectomy and/or surgical revision with subsequent intraoperative balloon angioplasty. These angioplastic procedures were initially successful in 142 (87%) of 164 stenoses. The patency rate after 3 months was 68%; after 6 months, 42%; and after 1 year, 25%. There were no serious adverse reactions in our series. This procedure can be safely done with minimal traumatization and, although long-term patency rates are low, repeated dilatations can be performed with ease, when restenosis occurs, to keep a fistula functioning for a long time in appropriate patients.