Dialysis Access Interventions (Arteriovenous Fistulas and Grafts)
This section provides a comprehensive procedural report for dialysis access interventions (arteriovenous fistuals and grafts) procedure with up-to-date explanatory notes, synopsis of the indications and contraindications, and potential complications in an
- PDF / 113,399 Bytes
- 5 Pages / 504.567 x 720 pts Page_size
- 38 Downloads / 219 Views
134
Divya Sridhar, David H. Hoffman, Nicole A. Lamparello and Mehrzad Zarghouni
Abbreviations
AVF: AVG: PTA: VA:
Arteriovenous fistula Arteriovenous graft Percutaneous transluminal angioplasty Vascular access
INTRODUCTION The prevalence of chronic kidney disease and the need for hemodialysis are increasing in the United States [1, 2]. A careful program of vascular access (VA) surveillance and monitoring is
D. Sridhar (&) M. Zarghouni Department of Radiology, Division of Vascular and Interventional Radiology, New York University Langone Medical Center, 660 1st Ave, 7th Floor, Suite. 742, 10016 New York, NY, USA e-mail: [email protected] M. Zarghouni e-mail: [email protected] D.H. Hoffman N.A. Lamparello Department of Radiology, New York University Langone Medical Center, 660 1st Ave, 10016 New York, NY, USA e-mail: [email protected]
essential for maintaining a functional arteriovenous fistula (AVF) or graft (AVG) [1, 3, 4] and maximizing its usable life. AVF and AVG dysfunction most commonly occurs due to thrombosis, stenosis along the venous outflow path, and/or stenosis at the arterial anastomosis. Thrombosis related to an underlying stenotic lesion is the most common cause of VA failure [1]. Stenosis is defined as greater than 50 % reduction in luminal diameter, and most frequently results from neointimal hyperplasia. Stenosis is more common in grafts than in fistulas, and more frequently affects the venous outflow than the arterial anastomosis. Hemodynamic and clinical findings of VA compromise, detailed below, include loss of palpable thrill or pulse, increased venous pressures at dialysis, arm swelling, and prolonged bleeding after needle removal. Non-maturation of a fistula, graft pseudoaneurysm formation, and development of steal syndrome are additional indications for VA interventions [1, 5, 6]. Endovascular approaches are typically the preferred first-line intervention for VA
N.A. Lamparello e-mail: [email protected] © Springer International Publishing Switzerland 2016 B. Taslakian et al. (eds.), Procedural Dictations in Image-Guided Intervention, DOI 10.1007/978-3-319-40845-3_134
617
618
dysfunction. Compared to surgical intervention, endovascular procedures demonstrate decreased morbidity, increased patient comfort, and comparable results in many situations [5]. Initial sonographic evaluation and angiography are performed to define the graft or fistula anatomy and identify the cause of dysfunction. If a thrombus is present, pharmacomechanical thrombolysis is commonly performed, using thrombolytic agents. If a stenosis is identified in the outflow vein, central vein, or arterial anastomosis, percutaneous transluminal angioplasty (PTA) is typically performed, with the goal of restoring luminal diameter to less than 30 % residual stenosis [7, 8]. With the increasing availability of high-pressure and cutting balloons, PTA alone is often an effective treatment. In selected cases, stent placement may be indicated; although somewhat controversial, commonly accepted indications for
Data Loading...
