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Angioplasty ultra balloon1/27/2024 Multiple treatments including angioplasty and thrombectomy may be included in secondary patency. Patency until access is surgically de-clotted, revised or abandoned. Interval following intervention that the lesion requires reintervention. Lesions where < 30% residual stenosis following dilation with a standard high-pressure balloon is not achieved. Rebound of the vessel wall after undergoing PTA that results in recurrent narrowing. Studies with mixed data were excluded if sufficient detailed breakdown was not provided to enable extraction of the relevant patient cohort (number of AVF versus AVG, number of patients receiving stents, location of access, patency rates at 6 and 12 months) (Table 1).ĥ0% luminal narrowing compared with the normal vascular segment located adjacent to the stenosis. Studies of central venous stenosis, thrombosed access circuits, immature fistulae, and studies where more than 20% of patients underwent adjuvant stent procedures were excluded. Cohort studies describing outcomes of PBA, comparative studies with more than 30 patients treated with drug-coated balloons (DCB) versus PBA with up to 1 year outcomes data, and stent graft versus PBA were included for analysis to review the outcomes of PBA. Search terms used were haemodialysis, dialysis, access maintenance, arteriovenous fistula, balloon dilation, angioplasty, and percutaneous transluminal angioplasty. These were supplemented with citation searches from identified studies. The aim of this article is to summarise the evidence for the use of PBA in maintaining functional access circuits.Ī narrative review of the literature was performed using Medline and Embase via Ovid to include studies published from 1980 to 2022. In keeping with the latest KDOQI guidelines, the use of PBA must be factored in as part of the overall, individual patient’s pathway and long-term care of each patient (the ESKD (End Stage Kidney Disease) Life Plan). Angioplasty also has the added advantage of allowing treatment of synchronous lesions. Although the outcomes of surgical revision have been shown to be comparable to angioplasty, the use of angioplasty can prolong the life of a fistula whilst preserving the option of surgical revision. Clinical manifestation of access dysfunction manifest broadly as disorders of inflow (needling difficulty, inability to achieve adequate dialysis flow speed, and poor fistula maturation) or outflow (arm swelling and prolonged bleeding). Plain balloon angioplasty (PBA), typically with high-pressure balloons, is considered to be the mainstay of treatment for dialysis access circuit stenoses and is indicated when there is an angiographically significant stenosis associated with clinical dysfunction. These outcomes all lead to significant morbidity and result in substantial economic cost. Stenosis can develop in the access circuit due to multiple factors and if untreated, can lead to reduced effectiveness of dialysis, progressive loss of function and thrombosis of the access circuit. However, preserving the patency of these accesses remains challenging. ![]() These are the most established means of long-term haemodialysis. This was followed by the introduction of expanded polytetrafluorethylene (ePTFE) grafts into clinical practice in 1976. ![]() Subcutaneous arteriovenous fistulae were developed by Brescio and Cimino in 1966, providing vascular access for haemodialysis.
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