Endovascular intervention for the failing vascular access.

Endovascular interventions have replaced surgical repair as the primary treatment of the failing or thrombosed vascular access. However, endovascular and surgical techniques are complementary: the limitations of one are the strengths of the other. Endovascular management of access-related problems is a critical component of a successful vascular access monitoring program. The identification and early treatment of developing stenoses, before access thrombosis are essential roles that are ideally suited to percutaneous, image-guided techniques. Despite recent advances in endovascular techniques and devices, angioplasty continues to be the primary method for treatment of access-related stenoses. When appropriate lesions are treated, angioplasty is a fast, easy, and safe procedure that can extend to patency of a hemodialysis graft or fistula. Copyright 2002 by the National Kidney Foundation, Inc.