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Katheterinterventionen und interventionelle Shuntanlagen

Catheter interventions and interventional shunt placement

  • Leitthema
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Der Nephrologe Aims and scope

Zusammenfassung

Hintergrund

Das Leben der Dialysepatienten hängt unbestritten vom vaskulären Zugang ab. Standard ist die chirurgische Schaffung eines Shunts (arteriovenöse Fistel, AVF), was besondere Vorbereitung und Expertise erfordert. Eine besondere Herausforderung sind die Shuntreifung und die Versorgung der shuntassoziierten Probleme mit dem Ziel, den Patienten eine möglichst reibungslose Dialyse langfristig zu ermöglichen und zentrale Venenkatheter zu ersparen. Dies erfordert die Versorgung mittels endovaskulärer Techniken und chirurgischer Revisionen. Es existieren multiple Instrumente, die für die AVF-Versorgung zur Verfügung stehen. Des Weiteren wurden über die letzten Jahre Instrumentation und Techniken entwickelt, die eine endovaskuläre AVF-Anlage ermöglichen.

Ziel der Arbeit

Darstellung aktuell genutzter Katheterinterventionen und Beleuchtung verfügbarer Methoden der endovaskulären Shuntanlage.

Material und Methoden

In diesem Übersichtsartikel werden die Katheterinterventionen, Techniken, Komplikationen und Erfolge der jeweiligen Verfahren dargestellt.

Ergebnisse

Perkutane Angioplastien (PTA) mit verschiedenen Ballons, Stent- und Stentgraftanlage sowie endovaskuläre Thrombektomie mittels verschiedener Methoden haben das Armamentarium der Shuntversorgung über die letzten Jahre erweitert und verbessert und sind eine wertvolle Addition zu den bisherigen chirurgischen Verfahren zur Behandlung der Shuntdysfunktion. Die Möglichkeit der endovaskulären Shuntanlage eröffnet eine ganz neue Perspektive in der Kreierung des Dialysezugangs und weist bereits gute Früherfolge auf.

Diskussion

AVF-Anlage und -Versorgung sind ein zentrales und longitudinales Problem für Dialysepatienten. Es erfordert eine multidisziplinäre Zusammenarbeit. Kenntnis aller Verfahren und sorgfältige Selektion einer Methode für den individuellen Patienten bleiben von immenser Bedeutung.

Abstract

Background

It is undisputed that the life of dialysis patients depends on the vascular access and on the problems associated with it. The standard procedure is the surgical creation of a shunt (arteriovenous fistula, AVF). Careful preoperative diagnostic imaging and surgical expertise are needed to successfully create an AVF. In addition, shunt maturation and long-term care require endovascular and surgical revision procedures in order to enable patients to undergo short and long-term dialysis and to avoid central venous catheters. There are several endovascular devices available, which enable treatment of AVF dysfunction and thrombosis. In addition, new devices and techniques have been developed that enable endovascular creation of an AVF.

Objective

The goal of this paper is to present an overview of current endovascular, catheter-based techniques used in the care of AVFs and a description of available methods for an endovascular shunt.

Material and methods

In this review the catheter interventions, techniques, complications and success of each procedure are presented.

Results

Percutaneous transluminal angioplasty (PTA) with various balloons, stents, stent grafts and devices utilized for endovascular thrombectomy have widened and improved the spectrum and success of care of shunts. They are a valuable addition to the surgical procedures used so far for treatment of shunt dysfunction and complications. Endovascular shunt devices enable non-surgical creation of AVF and are exciting new developments that create new alternatives for dialysis access creation with very promising early results.

Conclusion

The creation and care of an AVF are a central and longitudinal problems for dialysis patients, which require close cooperation in a multidisciplinary approach. Knowledge of all technical and surgical procedures and careful selection of a method for the individual patient remain the key to success and are of immense importance.

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Danksagung

Wir bedanken uns für das Zurverfügungstellen des Bildmaterials für die Abb. 4 bei der Firma Becton, Dickinson and Company sowie für die Abb. 5, 6 und 7 bei Frau Dr. med. Seher Kücükköylü (Klinik für Nephrologie, Universitätsklinik Düsseldorf).

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Authors and Affiliations

  1. Interventional Nephrology, Brigham Health, BWFH, 1153 Center Street/Suite 4G, 02130, Boston, MA, USA

    A. S. Voiculescu & D. M. Hentschel MD, Assistant Professor, Harvard Medical School

Authors
  1. A. S. Voiculescu
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  2. D. M. Hentschel MD, Assistant Professor, Harvard Medical School
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Corresponding author

Correspondence to A. S. Voiculescu.

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Interessenkonflikt

D.M. Hentschel hat Beratungsvereinbarungen mit Bard, BioSurfaces, BlugrassVascular, Laminate Medical, Proteon Therapeutics und SurModics. A.S. Voiculescu gibt an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Redaktion

C. Erley, Berlin

D. Fliser, Homburg/Saar

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Voiculescu, A.S., Hentschel, D.M. Katheterinterventionen und interventionelle Shuntanlagen. Nephrologe 14, 348–358 (2019). https://doi.org/10.1007/s11560-019-0353-8

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