Use of a novel tapered, scoring balloon to treat juxta-anastomotic stenosis in AV fistula

BACKGROUND

Juxta-anastomotic stenosis, the most common lesion in arteriovenous fistula, creates a dilemma for optimal balloon size choosing during PTA.

OBJECTIVES

To descript the effect of a novel tapered scoring balloon catheter (DK Medtech, Suzhou, China) which has a conical shape with an increasing diameter from the front part of the balloon to the end, and three non-slip elements attached on the surface of the balloon.

RESEARCH DESIGN

Case series of 10 patients used this balloon catheter was retrospectively analyzed.

SUBJECTS

Patients with juxta-anastomotic stenosis.

MEASURES

A retrospective review of 10 cases using the novel tapered, scoring balloon catheter in our center was performed.

RESULTS

All cases were clinical technique success. The average total procedure time was 16.7 min with 2:14 of fluoroscopy time. No complications such as vascular rupture or dissection occurred. The primary patency rates at 6 and 12 month were 80% and 50% separately.

CONCLUSIONS

This tapered scoring balloon provides an economical, safe, and efficient management for juxta-anastomotic stenosis.

A prospective randomized feasibility trial comparing angiography and angiography with intravascular ultrasound for treatment of hemodialysis access failures

OBJECTIVE

Hemodialysis accesses suffer from limited primary patency requiring frequent interventions, revisions, or even abandonment. Prolongation of access life and usability with minimization of these adverse events is paramount. Endovascular methods are established first-line interventions for failing arteriovenous access and treatment of venous outflow stenoses. The Primary goal of this feasibility study was to evaluate intravascular ultrasound (IVUS) during interventional treatments on outcomes in those undergoing angiography for failing hemodialysis access. Secondary goals were to determine differences between IVUS and angiography on vessel and lesion characteristics and impact on treatment.

METHODS

In this prospective, randomized controlled trial, patients scheduled for angiography to evaluate and treat a failing hemodialysis access were randomized to use of angiography (DSA) alone or angiography plus IVUS (DSA + IVUS). Patients were treated by a standardized protocol and seen in follow-up at 2 weeks, and every 3 months for 2 years or until a study endpoint was reached. Measurement of vessel diameters, % stenosis, lesion length, and study endpoints (AV access thrombosis, re-intervention, or surgical revision) were recorded.

RESULTS

A total of 55 subjects were enrolled, 27 in the DSA cohort and 28 in the DSA + IVUS cohort. There were 41 treated lesions in each group. Freedom from the composite endpoint of AV access thrombosis or re-intervention was 46.3% in the DSA cohort and 61.0% in the DSA + IVUS cohort (p = 0.27). Diameter measurements matched between the two imaging modalities only 9 times out of 41 total comparison measures. In pre-treatment lesions with >80% stenosis, IVUS had a greater tendency than DSA to underestimate the severity of stenosis, whereas in pre-treatment lesions with 50-80% stenosis, DSA was more likely than IVUS to underestimate the severity of stenosis. Post-treatment % stenosis had mean difference of -7.5% between DSA versus DSA + IVUS cohorts. In five lesions with <30% stenosis measured by angiogram, IVUS led to treatment escalation.

CONCLUSION

In the interventional treatment of failing angioaccess, IVUS and angiography differ in the vast majority of cases in measurement of vessel diameter. A significant number of patients were found to have suboptimal therapeutic response by IVUS only, which led to an escalation in treatment, and in over one-third of cases, the IVUS results led to a change in treatment plan. The improved patency rates in the IVUS group was not statistically significant in this small population but should be further investigated in a larger trial.