Percutaneous Transluminal Angioplasty for Obstructive Lesions of Arteriovenous Dialysis Fistulas

摘要

Percutaneous transluminal angioplasty (PTA) is the percutaneous, fluoroscopically guided use of balloon-tipped catheters to remove or relieve stenotic or occlusive lesions of the vascular system. Since its introduction in 1964, PTA has been widely used to treat atherosclerotic occlusive disease of the coronary, renal, iliac, and femoral arteries. However, dilation of failing arteriovenous access fistulas has been only rarely performed due to the newness of this application of PTA. Maintenance of a patent vascular access is one of the most vexing and frequent problems facing the physician who cares for patients on maintenance hemodialysis. While several authors have reported the successful use of PTA in these vessels, their experience, so far, with series of small numbers of patients, suggests a promising application of PTA with a low complication rate when careful selection of patients is made and the angioplasty is performed by an experienced individual. The treatment of patients with obstructive lesions of AV dialysis access fistulas with PTA is a relatively new procedure that lacks adequate experience. Substantially more experience with PTA in failing AV dialysis fistulas and shunts is needed in controlled studies to better define the safety and clinical effectiveness of the procedure.