1/31/2024 0 Comments Angioplasty ultra balloon![]() Greater than 80% of Americans undergo HD via these two options 65% with a fistula and 17% with a graft ( 3).ĪVFs and AVGs are prone to dysfunction, most commonly due neointimal hyperplasia (NIH) and subsequent stenosis. Under this recommendation, the majority of patients remain best served by an arteriovenous fistula (AVF), followed by an arteriovenous graft (AVG), both of which are preferred over a dialysis catheter. The 2019 Kidney Disease Outcomes Quality Initiative (KDOQI) clinical practice guidelines emphasized an individualized approach to HD access options as part of a patient’s ESRD life plan, encouraging “the right access, in the right patient, at the right time, for the right reason” ( 2). The majority of the nearly 4 million people with end-stage renal disease (ESRD) receiving renal replacement therapy worldwide do so via hemodialysis (HD) ( 1). Keywords: Hemodialysis (HD) fistula graft stenosis angioplasty Part two of this review will discuss the evolving role of DCBs, which seek to improve angioplasty outcomes. While initially successful, patency rates remain non-durable. Additional treatment considerations must be taken into account when treating specific lesions, including cephalic arch and swing point stenoses in fistulas and graft-vein anastomotic stenoses in grafts, amongst others.Ĭonclusions: High-quality plain balloon angioplasty, performed utilizing the available evidence-basis regarding technique and considerations for specific lesion locations, is successful in treating the large majority of AV access stenoses. The large majority of stenotic lesions can be treated utilizing high-pressure balloon angioplasty, with the addition of ultra-high pressure balloon (UHPB) angioplasty for resistant lesions and prolonged angioplasty with progressive balloon upsizing for elastic lesions. ![]() Key Content and Findings: NIH, and subsequent stenoses, develop via a combination of upstream events, causing vascular damage, and downstream events, representing the subsequent biologic response. The highest available level of evidence regarding stenosis pathophysiology, angioplasty techniques, and approaches to treating different types of lesions within fistulas and grafts were included as part of this narrative review. Methods: An electronic search was performed on PubMed and EMBASE to identify relevant articles from 1980 to 2022. In part one of this two-part review, we aim to provide a comprehensive overview of the mechanisms of arteriovenous (AV) access stenosis, the evidence behind their treatment with high-quality plain balloon angioplasty techniques, and treatment considerations for specific stenotic lesions. ![]() Recent research has sought to improve patency rates utilizing antiproliferative drug-coated balloons (DCBs), however, their role in treatment has not yet been fully determined. Percutaneous balloon angioplasty using plain balloons is the first line treatment for clinically-significant stenosis, with excellent initial response rates, however, with poor long-term patency and need for frequent reintervention. Both of these accesses are complicated by dysfunction related to neointimal hyperplasia (NIH) and subsequent stenosis. Background and Objective: The majority of patients with end-stage renal disease (ESRD) requiring hemodialysis (HD) do so via an arteriovenous fistula (AVF) or graft.
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