Ten filiform stenoses and 1 complete occlusion of the venous anastomoses of 11 hemodialysis grafts were diagnosed during operative revision for shunt thrombosis. After Fogarty balloon thrombectomy, the lesions were treated by intraoperative balloon angioplasty and stent implantation (IAS). All grafts could be used for hemodialysis immediately after IAS. The patients could be followed up for six to twelve months. Within 2 stents, restenoses causing rethromboses of the shunts occurred after three and seven months, respectively. In 1 case another intraoperative dilation was successful, and the other was treated by graft prolongation. All other stents were widely patent at the last examination as demonstrated by color duplex sonography. IAS proved an effective alternative to surgical revision of the stenosed anastomosis. It may be applied without difficulty to patients with multiple preceding revisions and provides excellent success rates.
Get full access to this article
View all access options for this article.
References
1.
1. Etheredge EE, Haid SD, Maeser MN, et al: Salvage operations for malfunctioning polytetrafluoroethylene hemodialysis access grafts. Surgery94:464-470,1983.
2.
2. Lilly L, Nghiem D, Mendez-Picon G, et al: Comparison between bovine heterograft and expanded PTFE grafts for dialysis access. Am Surg46:694-696,1980.
3.
3. Munda R, First R, Alexander JW, et al: Polytetrafluoroethylene graft survival in hemodialysis. JAMA249:219-222,1983.
4.
4. Palder SB, Kirkman RL, Whittemore AD, et al: Vascular access for hemodialysis. Patency rates and results of revision. Ann Surg202:235-239,1985.
5.
5. Raju S: PTFE grafts for hemodialysis access. Techniques for insertion and management of complications. Ann Surg206:666-673,1987.
6.
6. Swedberg SH, Brown G, Sigley R, et al: Intimal fibromuscular hyperplasia at the venous anastomosis of PTFE grafts in hemodialysis patients. Circulation80:1726-1736,1989.
7.
7. Clowes AW, Kirkman TA, Reidy MA: Mechanisms of arterial graft healing. Am J Pathol123:220-230.1986.
8.
8. Zacharias RK, Kirkman TR, Clowes AW: Mechanisms of healing in synthetic grafts. J Vasc Surg6:429-436,1987.
9.
9. Kinley CE, Marble AE: Compliance: A continuing problem with vascular grafts. J Cardiovasc Surg21:163-170,1980.
10.
10. Seifert KB, Albo D, Knowlton H, et al: Effect of elasticity of prosthetic wall on patency of small diameter arterial prostheses. Surg Forum30:206-208,1979.
11.
11. Walden R, L'Italien GJ, Megerman J, et al: Matched elastic properties and successful arterial grafting. Arch Surg115:1166-1169,1980.
12.
12. Fillinger MF, Reinitz ER, Schwartz RA, et al: Beneficial effects of banding on venous intimal-medial hyperplasia in arteriovenous loop grafts. Am J Surg158:87-94,1989.
13.
13. Fillinger MF, Reinitz ER, Schwartz RA, et al: Graft geometry and venous intimal-medial hyperplasia in arteriovenous loop grafts. J Vasc Surg11:556-566,1990.
14.
14. Oblath RW, Buckley FO, Green RM, et al: Prevention of platelet aggregation and adherence to prosthetic vascular grafts by aspirin and dipyridamole. Surgery84:37-44,1978.
15.
15. Antonucci F, Salomonowitz E, Stuckmann G, et al: Placement of venous stents: Clinical experience with a self-expanding prosthesis. Radiology183:493-497,1992.
16.
16. Mickley V, Storck M, Friedrich JM, et al: PTA plus stent implantation versus PTA alone for central venous stenoses. Vascular Surgery28:505-512,1994.
17.
17. Shoenfeld R, Hermans H, Novick A, et al: Stenting of proximal venous obstructions to maintain hemodialysis access. J Vasc Surg19:532-539,1994.
18.
18. Vorwerk D, Gunther RW, Bohndorf K, et al: Selbstexpandierende Endoprothesen als Erganzung zur Ballondilatation komplizierter Himodialyseshunts. Angio Arch22:96-99,1991.
19.
19. Scholz A, Schubeus P, Langer R, et al: Primare femorale Rekanalisation mit einem langsam rotierenden Kathetersystem. Akt Radiol3:295-297,1993.
20.
20. Glanz S, Gordon DH, Butt KMH, et al: Stenotic lesions in dialysis access fistulas: Treatment by transluminal angioplasty using high pressure balloons. Radiology156:236-236,1985.
21.
21. Hunter DW, Castaneda-Zuniga WR, Coleman CE, et al: Failing arteriovenous dialysis fistulas: Evaluation and treatment. Radiology152:631-635,1983.
22.
22. Hunter DW, So SKS, Castaneda-Zuniga WR, et al: Failing or thrombosed Brescia-Cimino arteriovenous dialysis fistulas. Radiology149:105-109,1983.
23.
23. Lawrence PF, Miller FJ, Mineau DE: Balloon catheter dilatation in patients with failing arteriovenous fistulas. Surgery89:439-442,1981.
24.
24. Spinowitz BS, Carsen G, Meisell R, et al: Percutaneous transluminal dilatation for vascular access. Nephron35:201-204,1983.
25.
25. Dapunt O, Feurstein M, Rendl KH, et al: Transluminal angioplasty versus conventional operation in the treatment of haemodialysis fistula stenosis: Results from a 5-year study. Br J Surg74:1004-1005,1987.
26.
26. Kistler D, Bohndorf K, Gunther RW: Kombiniert chirurgisch radiologisches Vorgehen beim Verschluf eines Hamodialyse-Shunts. Chirurg61:84-86,1990.
27.
27. Smith TP, Hunter DW, Darcy MD, et al: Thrombosed synthetic hemodialysis access fistulas: The success of combined thrombectomy and angioplasty (technical note). Am J Radiol147:161-163,1986.
28.
28. Glanz S, Gordon DH, Butt KMH, et al: Dialysis access fistulas: Treatment of stenoses by transluminal angioplasty. Radiology152:637-642,1984.
29.
29. Glanz S, Gordon DH, Butt KMH, et al: The role of percutaneous angioplasty in the management of chronic hemodialysis fistulas. Am Surg206:777-781,1987.
30.
30. Brooks JL, Sigley RD, May KJ, et al: Transluminal angioplasty versus surgical repair for stenosis of hemodialysis grafts. Am J Surg153:530-531,1987.
31.
31. Landwehr P, Lackner K, Götz R, et al: Angioplastie zentralvenoser Dialyseshunt-Obstruktionen: Ergebnisse von Ballon-Dilatation und Palmaz-StentImplantation. Angio Arch22:100-103,1991.
32.
32. Gunther RW, Vorwerk D, Bohndorf K, et al: Venous stenoses in dialysis shunts: Treatment with self-expanding metallic stents. Radiology170:401-405,1989.
33.
33. Henry M, Mentre B, Morizot D, et al: Endoprothese de type Palmaz-Schatz au decours de l'angioplastie pour stenose d'une fistule arterio-veineuse chez un hemodialyse'. Presse Med20:1289-1289,1991.
34.
34. Quinn SF, Schuman ES, Hall L, et al: Venous stenoses in patients who undergo hemodialysis: Treatment with self-expandable endovascular stents. Radiology183:499-504,1992.
35.
35. Rousseau H, Morfaux V, Joffre F, et al: Treatment of haemodialysis arterio-venous fistula stenosis by percutaneous implantation of new intravascular stent. J Intervent Radiol4:161-167,1989.
36.
36. Zollikofer CL, Antonucci F, Stuckmann G, et al: Use of the Wallstent in the venous system including hemodialysis-related stenoses. Cardiovasc Intervent Radiol15:334-341,1992.
37.
37. Beathard GA: Gianturco self-expanding stent in the treatment of stenosis in dialysis access grafts. Kidney Int43:872-877,1993.
38.
38. Turmel-Rodrigues L, Pengloan J, Blanchier D, et al: Insufficient dialysis shunts: Improved long-term patency rates with close hemodynamic monitoring, repeated percutaneous balloon angioplasty, and stent placement. Radiology187:273-278,1993.
