Hemodialysis vascular access dysfunction and its endovascular treatment

Czech version

Authors: Martin Vorčák ¹; Kamil Zeleňák ¹; Ján Sýkora ¹; Alena Ježíková ²; Marián Mokáň ²
Authors‘ workplace: Rádiologická klinika JLF UK a UN Martin, Slovenská republika ¹; I. Interná klinika JLF UK a UN Martin, Slovenská republika ²
Published in: Vnitř Lék 2020; 66(6): 14-18
Category:

Overview

Hemodialysed patients with end stage renal disease are reliant to proper function of vascular access – mostly arterio-venous fistula (AVF). AVF patency is jeopardized by stenosis formation, which needs to be treated before thrombosis. Angioplasty is primarily indicated and prolongs vascular access patency. High pressure balloons and cutting balloons aid to high technical success rate. Angioplasty needs to be repeated in order to maintain long term patency. Drug-eluting balloons prolong long term patency. Stents and stentgrafts are seldom used in inoperable patients and in selected locations. Technical advances allowed endovascular treatment in AVF thrombosis followed by angioplasty of culprit lesion. Vascular access endovascular occlusion is alternative for surgery in inoperable patients. In patients with residual renal function or iodine allergy, intervention could be ultrasound guided or carbon dioxide could be used without the need of iodine contrast.

Keywords:

Angioplasty – arterio-venous fistula stenosis – central venous stenosis – endovascular treatment – hemodialysis

Sources

1. Rychlík I, Lopot F. Statistická ročenka dialyzační léčby v České republice, 2018. Česká nefrologická společnost. (cit. 2019-10-17). Dostupné z WWW: http://www.nefrol.cz/odbornici/dialyzacni-statistika

2. Pisoni RL, Young EW, Dykstra DM, et al. Vascular access use in Europe and the United States: results from the DOPPS. Kidney Int 2002; 61: 305–316.

3. Pajek J, Malovrh M. Preoperative ultrasound still valuable for radio-cephalic arteriovenous fistula creatio. J Vasc Access 2017; 18: 5–9.

4. Medkouri G, Aghai R, Anabi A, et al. Analysis of vascular access in hemodialysis patients: a report from a dialysis unit in Casablanca. Saudi J Kidney Dis Transpl 2006; 17: 516–520.

5. Nikolic B. Hemodialysis Fistula Interventions: Diagnostic and Treatment Challenges and Technical Considerations. Tech Vasc Interv Radiol 2008; 11: 167–174.

6. Roček M. Obnovení funkce hemodialyzačního cévního přístupu. In: Krajina A, Peregrin J et al. Intervenční radiologie: miniinvazívní terapie. Olga Čermeková: Hradec Králové 2005: 258–268.

7. Lockhart ME, Robbin ML, Needleman L, et al. ACR-AIUM-SRU Practice Parameter for the Performance of Vascular Ultrasound for Postoperative Assessment of Dialysis Access. J Ultrasound Med 2014; 33: 1321–1332.

8. Al Shakarchi J, Inston N. Early cannulation grafts for haemodialysis: An updated systematic review. J Vasc Access 2019; 20: 123–127.

9. Vazquez-Padron RI, Allon M. New Insights into Dialysis Vascular Access: Impact of Preexisting Arterial and enous Pathology on AVF and AVG Outcomes. Clin J Am Soc Nephrol 2016; 11: 1495–1503.

10. Vascular Access 2006 Work Group. NKF-DOQI clinical practice guidelines for vascular access, update 2006. Am J Kidney Dis 2006; 48: 176–306.

11. Bent CL, Sahni VA, Matson MB. The radiological management of the thrombosed arteriovenous dialysis fistula. Clinical Radiology (online) 2011; 66: 1–12.

12. Leon C, Orozco-Vargas LC, Krishnamurthy G, et al. Accuracy of physical examination in the detection of arteriovenous graft stenosis. Semin Dial 2008; 21: 85–88.

13. Tordoir J, Canaud B, Haage P, et al. EBPG on Vascular Access. Nephrol Dial Transplant 2007; 22: 88–117.

14. Argyriou C, Schoretsanitis N, Georgakarakos EI, et al. Preemptive open surgical vs. endovascular repair for juxta-anastomotic stenoses of autogenous AV fistulae: a meta-analysis. J Vasc Access 2015; 16: 454–458.

15. Macrae JM, Dipchand C, Oliver M, et al. Arteriovenous Access Failure, Stenosis, and Thrombosis. Can J Kidney Health and Dis 2016; 3.

16. Trerotola SO, Stavropoulos SW, Shlansky-Goldberg R, et al. Hemodialysis-related venous stenosis: treatment with ultrahigh-pressure angioplasty balloons. Radiology 2004; 231: 259–262.

17. Kennedy SA, Mafeld S, Baerlocher MO, et al. Drug-Coated Balloon Angioplasty in Hemodialysis Circuits: A Systematic Review and Meta-Analysis. J Vasc Interv Radiol 2019; 30: 483–494.

18. Thomas SD, Peden S, Crowe P, et al. Interwoven Nitinol Stents to Treat Radiocephalic Anastomotic Arteriovenous Fistula Stenosis. J Endovasc Ther 2019; 26: 394–401.

19. Bachleda P, Janeckova J, Xinopulos P, et al. New hybrid procedures in treating occluded arteriovenous hemodialysis grafts. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2016; 160: 149–152.

20. Nassar GM, Beathard G, Rhee E, et al. Management of transposed arteriovenous fistula swing point stenosis at the basilic vein angle of transposition by stent grafts. J Vasc Access 2017; 18: 482–487.

21. Miller GA, Preddie DC, Savransky Y, et al. Use of the Viabahn stent graft for the treatment of recurrent cephalic arch stenosis in hemodialysis accesses. J Vasc Surg 2018; 67: 522–528.

22. Jones RG, Willis AP, Jones C, et al. Long-term results of stent-graft placement to treat central venous stenosis and occlusion in hemodialysis patients with arteriovenous fistulas. J Vasc Interv Radiol 2011; 22: 1240–1245.

23. Verstandig AG, Berelowitz D, Zaghal I, et al. Stent grafts for central venous occlusive disease in patients with ipsilateral hemodialysis access. J Vasc Interv Radiol 2013; 24: 1280–1287.

24. Surowiec SM, Fegley AJ, Tanski WJ, et al. Endovascular management of central venous stenoses in the hemodialysis patient: results of percutaneous therapy. Vasc Endovascular Surg 2004; 38: 349–354.

25. Agarawal A. Endovascular interventions for central vein stenosis. Kidney Res Clin Pract 2015; 34: 228–232.

26. Buriánková E, Köcher M, Bachleda P, et al. Endovascular treatment of central venous stenoses in patients with dialysis shunts. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2003; 147: 203–206.

27. Nassar GM, Rhee E, Khan AJ, et al. Percutaneous thrombectomy of AVF: immediate success and long-term patency rates. Semin Dial 2015; 28: 15–22.

28. Quencer KB, Oklu R. Hemodialysis access thrombosis. Cardiovasc Diagn Ther 2017; 7: 299–308.

29. Powell S, Narlawar R, Odetoyinbo T. Early experience with the Amplatzer Vascular Plug II for occlusive purposes in arteriovenous hemodialysis access. Cardiovasc Intervent Radiol 2010; 33: 150–156.

30. Schmidli J, Widmer MK, Basile C, et al. Editor’s Choice - Vascular Access: 2018 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2018; 55: 757–818.