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CardioVascular and Interventional Radiology

, Volume 30, Issue 6, pp 1166–1170 | Cite as

Primary Cutting Balloon Angioplasty for Treatment of Venous Stenoses in Native Hemodialysis Fistulas: Long-Term Results from Three Centers

  • Rajesh Bhat
  • Kieran McBride
  • Sam Chakraverty
  • Raghunandan Vikram
  • Alison Severn
Clinical Investigation

Abstract

Aim

To evaluate the technical success and patency rates following primary cutting balloon angioplasty for venous stenoses in native dialysis fistulas.

Methods

Forty-one patients (26 men, 15 women; age range 26–82 years, average age 59 years) underwent 50 (repeat procedures in 9 patients) primary cutting balloon (PCB) angioplasty procedures in three institutions by three primary operators. The indication was primary stenosis in 21 patients, recurrent lesions in 15, and immature fistulas in 5. A PCB was used alone in 17 cases, but was followed by a larger standard balloon in 33 cases. Follow-up included ultrasound, flow analysis and urea reduction ratio, and ranged from 2 to 30 months (mean 14 months).

Results

The technical success rate was 98%. All procedures were relatively painless. Two PCBs burst and 4 leaked, but without causing any morbidity. Nineteen fistulas were still working at last follow-up. Primary patency rates at 6, 12, and 24 months using Kaplan-Meier analysis were 88%, 73%, and 34%, respectively, and the primary assisted patencies were 90%, 75%, and 50%, respectively.

Conclusion

PCB angioplasty has high technical success and low complication rates. The long-term patency rates are favorable for PCB angioplasty and compare favorably with other series.

Keywords

Angioplasty Cutting balloon Dialysis fistula 

References

  1. 1.
    Brescia MJ, Cimino JE, Appel K, et al. (1966) Chronic haemodialysis using venepuncture and a surgically created arteriovenous fistula. N Engl J Med 275:1089–1092PubMedCrossRefGoogle Scholar
  2. 2.
    NKF-K/DOQI (2001) Clinical practise guidelines for vascular access: Update 2000. Am J Kidney Dis 37(Suppl 1):S137–S181Google Scholar
  3. 3.
    Funaki J (2005) Cutting balloon angioplasty in arteriovenous fistulas. J Vasc Interv Radiol 16:5–7PubMedGoogle Scholar
  4. 4.
    Schwab SJ, Raymond JR, Saeed M, Bollinger RR, et al. (1989) Prevention of haemodialysis fistula thrombosis: Early detection of venous stenosis. Kidney Int 36:707–711PubMedCrossRefGoogle Scholar
  5. 5.
    Turmel-Rodrigues L, Pengloan J, Baudin S, et al. (2000) Treatment of stenosis and thrombosis in haemodialysis fistulas and grafts by interventional radiology. Nephrol Dial Transplant 15:2029–2036PubMedCrossRefGoogle Scholar
  6. 6.
    Trerotola SO, Stavropolous SW, Schlansky-Goldberg, et al. (2004) Haemodialysis related venous stenosis: Treatment with ultrahigh pressure angioplasty balloons. Radiology 231:259–262Google Scholar
  7. 7.
    Zemel G, Katzen BT, Dake MD, et al. (1990) Directional atherectomy in the treatment of dialysis fistulas. J Vasc Interv Radiol 1:35–38PubMedCrossRefGoogle Scholar
  8. 8.
    Arnold WP, Guilarte P (2002) Infiltration and perforation PTA for resistant venous stenosis in haemodialysis access. J Vasc Interv Radiol 13(Suppl):S38Google Scholar
  9. 9.
    Indolfi C, Esposito G, Di Lorenzo, et al. (1995) Smooth muscle proliferation is proportional to the degree of balloon injury in a rat model angioplasty. Circulation 92:1239–1235Google Scholar
  10. 10.
    Lee MS, Singh V, Nero TJ, Wilentz JR (2002) Cutting balloon angioplasty. J Invas Cardiol 14:552–556Google Scholar
  11. 11.
    Bejarano J (2004) The cutting balloon for instent restenosis: A review. J Interv Cardiol 17:203–209PubMedCrossRefGoogle Scholar
  12. 12.
    Vorwerk D, Gunther RW, Scurmann K, et al. (1995) Use of a cutting balloon for dilatation of a resistant venous stenosis of a haemodialysis fistula. Cardiovasc Interv Radiol 18:62–64CrossRefGoogle Scholar
  13. 13.
    Vorwerk D, Adam G, Muller-Liesse C, et al. (1996) Cutting balloon angioplasty for undilatable venous stenoses causing dialysis graft failure. Radiology 201:864–867PubMedGoogle Scholar
  14. 14.
    Bittl JA, Feldman RL (2003) Cutting balloon angioplasty for undilatable venous stenoses causing graft failure. Catheter Cardiovasc Interv 58:524–526PubMedCrossRefGoogle Scholar
  15. 15.
    Ryan JM, Dumbleton SA, Smith TP (2003) Technical innovation: Using a cutting balloon to treat resistant high grade dialysis graft stenosis. AJR Am J Roentgenol 180:1072–1074PubMedGoogle Scholar
  16. 16.
    Song HH, Kim KT, Chung SK, Kim YO, Yoon SA (2004) Cutting balloon angioplasty for resistant venous stenoses of Brescia-Cimino fistulas. J Vasc Interv Radiol 15:1463–1467PubMedGoogle Scholar
  17. 17.
    Chakraverty S, Meier MA, Aarts JC, Ross RA, Griffiths GD (2005) Cutting-balloon-associated vascular rupture after failed standard balloon angioplasty. Cardiovasc Intervent Radiol 28:661–664PubMedCrossRefGoogle Scholar
  18. 18.
    Castellan D, Miotta D, Savastano S, et al. (1994) The percutaneous transluminal angioplasty of Brescia-Cimino arteriovenous fistulae: An evaluation of the results. Radiol Med (Torino) 87:134–140Google Scholar
  19. 19.
    Lay JP, Ashleigh RJ, Tranconi L, et al. (1994) Result of angioplasty of Brescia-Cimino haemodialysis fistulae: medium-term follow-up. Clin Radiol 1998 53(8):608–611Google Scholar
  20. 20.
    Singer-Jordan J, Papura S (2005) Cutting balloon angioplasty for primary treatment of haemodialysis fistula venous stenosis: Primary results. J Vasc Interv Radiol 16:25–29Google Scholar
  21. 21.
    Clark WI, Hirsch DA, Jindal K, et al. (2002) Outcome and prognostic factors of restenosis after percutaneous treatment of native haemodialysis fistulae. J Vasc Interv Radiol 13:51–59PubMedCrossRefGoogle Scholar
  22. 22.
    Vesely TM, Siegel JB (2005) Use of peripheral cutting balloon to treat haemodialysis-related stenosis. J Vasc Interv Radiol 16:1593–1603PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Rajesh Bhat
    • 1
  • Kieran McBride
    • 2
  • Sam Chakraverty
    • 1
  • Raghunandan Vikram
    • 1
  • Alison Severn
    • 1
  1. 1.Department of Clinical RadiologyNinewells HospitalDundeeUK
  2. 2.Queen Margaret HospitalDunfermlineUK

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