Fluoroscopy Fistulography Hemodialysis Access with Intervention Employing diagnostic fistulography to support endovascular treatment of a CVS is indicated when a stenosis >50% of the endoluminal diameter is detected, when there is hemodynamic compromise in the dialysis vascular access circuit or when the AVF is nonmaturing. A determination to perform endovascular treatment of central venous stenoses is based on the presence of compelling clinical parameters, which include debilitating arm swelling or the presence of increased frequency of failing accesses [7,116]. Angioplasty for asymptomatic stenoses is not ideal as it is associated with increased progression to symptomatic stenosis [5,110,117]. The KDOQI guidelines 2019 state that an endovascular approach with transluminal balloon Dialysis Fistula Malfunction angioplasty is the first-line treatment of a symptomatic CVS [5,116]. The SIR Standards and Practice Committee guidelines and the KDOQI 2019 guidelines suggest that the use of a stent or stent graft should be considered in the setting of failed angioplasty after employing high-pressure balloons, marked by the presence of a refractory or persistent stenosis, abnormal hemodynamic findings that persist postangioplasty, or elastic venous recoil after angioplasty resulting in a reduction in the normal vessel caliber >50%, or stenosis recurrence within 3 months postangioplasty [5,7]. Yan et al [112] noted that balloon angioplasty of the central venous stenoses were seen to yield little benefit on AV access blood flow but resulted in effective relief of associated symptoms. One retrospective study by Bakken et al [118] reports a primary patency of 76% as equivalent between angioplasty versus angioplasty with stenting at 30 days. 12-month rates of 29% versus 21% for angioplasty and stenting, respectively, were noted.
Dialysis Fistula Malfunction. Fluoroscopy Fistulography Hemodialysis Access with Intervention Employing diagnostic fistulography to support endovascular treatment of a CVS is indicated when a stenosis >50% of the endoluminal diameter is detected, when there is hemodynamic compromise in the dialysis vascular access circuit or when the AVF is nonmaturing. A determination to perform endovascular treatment of central venous stenoses is based on the presence of compelling clinical parameters, which include debilitating arm swelling or the presence of increased frequency of failing accesses [7,116]. Angioplasty for asymptomatic stenoses is not ideal as it is associated with increased progression to symptomatic stenosis [5,110,117]. The KDOQI guidelines 2019 state that an endovascular approach with transluminal balloon Dialysis Fistula Malfunction angioplasty is the first-line treatment of a symptomatic CVS [5,116]. The SIR Standards and Practice Committee guidelines and the KDOQI 2019 guidelines suggest that the use of a stent or stent graft should be considered in the setting of failed angioplasty after employing high-pressure balloons, marked by the presence of a refractory or persistent stenosis, abnormal hemodynamic findings that persist postangioplasty, or elastic venous recoil after angioplasty resulting in a reduction in the normal vessel caliber >50%, or stenosis recurrence within 3 months postangioplasty [5,7]. Yan et al [112] noted that balloon angioplasty of the central venous stenoses were seen to yield little benefit on AV access blood flow but resulted in effective relief of associated symptoms. One retrospective study by Bakken et al [118] reports a primary patency of 76% as equivalent between angioplasty versus angioplasty with stenting at 30 days. 12-month rates of 29% versus 21% for angioplasty and stenting, respectively, were noted.