The endovascular treatments of dysfunctional dialysis access with a stenotic lesion seen during diagnostic fistulography typically include percutaneous transluminal angioplasty (PTA) using a balloon and stent placement. The 2006 KDOQI guidelines established that PTA represents the first-line treatment for a stenosis in the dialysis access circuit [4]. Technical success for the treatment of a stenosis is defined by the SIR as <30% residual narrowing of the lumen in a treated segment. Clinical success is defined as at least 1 successful session of hemodialysis following treatment [7]. PTA is the first-line endovascular treatment of a hemodynamically significant stenosis [3,7]. Repeated PTA on stenotic lesions can be performed on dialysis access to maintain patency [43]. Technical failure of PTA on a stenotic lesion is associated with loss of AVF patency [44]. An untreated anatomic stenosis within the dialysis access circuit is the leading cause of a thrombosed access. The SIR guidelines suggest that surgical revision should be considered if 2 to 3 interventions are required within a 1-to-3-month period [7]. Clinical success of restoring patency in grafts with hemodynamically significant stenoses without thrombosis that are treated primarily with balloon angioplasty is 85% to 98%. Reported cumulative patency at 6-month (primary), 12-month (primary), and 12-month (secondary) interval was 38% to 63%, 23% to 44%, and 81% to 82%, respectively [45]. In addition to the use of conventional balloons for PTA, high-pressure balloons (>20 atm), cutting balloons, and drug-eluting balloons have been used typically for stenoses resistant to conventional PTA. There has been mixed evidence to support the use of cutting balloons. One prospective randomized study found higher patency rates with cutting balloon angioplasty of venous anastomotic stenoses in a graft compared to conventional angioplasty [46]. However, another prospective randomized study showed no significant change in patency between
Dialysis Fistula Malfunction. The endovascular treatments of dysfunctional dialysis access with a stenotic lesion seen during diagnostic fistulography typically include percutaneous transluminal angioplasty (PTA) using a balloon and stent placement. The 2006 KDOQI guidelines established that PTA represents the first-line treatment for a stenosis in the dialysis access circuit [4]. Technical success for the treatment of a stenosis is defined by the SIR as <30% residual narrowing of the lumen in a treated segment. Clinical success is defined as at least 1 successful session of hemodialysis following treatment [7]. PTA is the first-line endovascular treatment of a hemodynamically significant stenosis [3,7]. Repeated PTA on stenotic lesions can be performed on dialysis access to maintain patency [43]. Technical failure of PTA on a stenotic lesion is associated with loss of AVF patency [44]. An untreated anatomic stenosis within the dialysis access circuit is the leading cause of a thrombosed access. The SIR guidelines suggest that surgical revision should be considered if 2 to 3 interventions are required within a 1-to-3-month period [7]. Clinical success of restoring patency in grafts with hemodynamically significant stenoses without thrombosis that are treated primarily with balloon angioplasty is 85% to 98%. Reported cumulative patency at 6-month (primary), 12-month (primary), and 12-month (secondary) interval was 38% to 63%, 23% to 44%, and 81% to 82%, respectively [45]. In addition to the use of conventional balloons for PTA, high-pressure balloons (>20 atm), cutting balloons, and drug-eluting balloons have been used typically for stenoses resistant to conventional PTA. There has been mixed evidence to support the use of cutting balloons. One prospective randomized study found higher patency rates with cutting balloon angioplasty of venous anastomotic stenoses in a graft compared to conventional angioplasty [46]. However, another prospective randomized study showed no significant change in patency between