Chih-Cheng Wu1, Szu-Chi Wen. 1. Department of Medicine, Hsinchu General Hospital and School of Medicine, Yang-Ming University, Taipei, Taiwan.
Abstract
OBJECTIVES: To evaluate the technical success, safety and patency of cutting balloon angioplasty for the treatment of resistant dialysis access stenoses. BACKGROUND: Cutting balloon angioplasty has been proposed to be useful in treating resistant dialysis access stenoses. However, they are based on experience with very limited cases and formal patency data is insufficient. METHODS: The author retrospectively reviewed 896 percutaneous transluminal angioplasty (PTA) procedures for the treatment of dysfunctional or thrombotic dialysis access. Thirty-seven of 623 patients with native fistulas and 23 of 273 patients with synthetic grafts had residual stenoses of more than 30% after conventional PTA at an inflation pressure of 24 atm for 60 sec. In these 60 patients, additional cutting balloon PTA was performed. RESULTS: The overall technical success rate was 96.7% and clinical success rate was 98.3%. Only one patient experienced mild local extravasation. The postintervention primary patency rates for native fistula group (N = 37) were 100%, 86.4%, and 67.5% at 1-month, 3-month, and 6-month; the postintervention primary patency rates for synthetic graft group (N = 23) were 87.0%, 60.9%, and 34.2% at 1-month, 3-month, and 6-month respectively. CONCLUSIONS: For resistant venous stenoses of dialysis access, cutting balloon PTA is effective, safe, and seems to provide comparative primary patency as suggested by guidelines. Copyright 2008 Wiley-Liss, Inc.
OBJECTIVES: To evaluate the technical success, safety and patency of cutting balloon angioplasty for the treatment of resistant dialysis access stenoses. BACKGROUND: Cutting balloon angioplasty has been proposed to be useful in treating resistant dialysis access stenoses. However, they are based on experience with very limited cases and formal patency data is insufficient. METHODS: The author retrospectively reviewed 896 percutaneous transluminal angioplasty (PTA) procedures for the treatment of dysfunctional or thrombotic dialysis access. Thirty-seven of 623 patients with native fistulas and 23 of 273 patients with synthetic grafts had residual stenoses of more than 30% after conventional PTA at an inflation pressure of 24 atm for 60 sec. In these 60 patients, additional cutting balloon PTA was performed. RESULTS: The overall technical success rate was 96.7% and clinical success rate was 98.3%. Only one patient experienced mild local extravasation. The postintervention primary patency rates for native fistula group (N = 37) were 100%, 86.4%, and 67.5% at 1-month, 3-month, and 6-month; the postintervention primary patency rates for synthetic graft group (N = 23) were 87.0%, 60.9%, and 34.2% at 1-month, 3-month, and 6-month respectively. CONCLUSIONS: For resistant venous stenoses of dialysis access, cutting balloon PTA is effective, safe, and seems to provide comparative primary patency as suggested by guidelines. Copyright 2008 Wiley-Liss, Inc.