2. Introduction
• 300 – 400: 1 000 000 worldwide
• CRD in Bulgaria is nearly twice
higher than the average for the EU -
almost 26%
Morbidity of Chronic Renal
Disease:
4. Complications of the AVF:
• hemodynamically significant stenosis;
• infection of the PVA;
• thrombosis;
• pseudoaneurism;
• rupture of the PVA.
Introduction
6. Introduction
Hemodynamically significant stenosis is
present when the normal vascular
diameter is reduced by 50% or more.
• increased static or dynamic pressure;
• decreased blood capacity;
• groundless dialysis cleansing;
• swallowing of the extremity.
7. Introduction
Stenosis found before it thromboses is
easier to be treated than post-
thrombotic one and shows 79%
reliability. Reliability of post-
thrombotic treatment of the stenosis
decreases to 40%.
8. PTA
The preferred method of treatment for
either arterial or venous stenosis of PVA is
Percutaneous Transluminal Angioplasty
(PTA).
9. PTA
Indicator of dysfunction:
• greater than 25% decrease in flow over
3-4 month period;
• elevated urea recirculation;
• arm swelling;
• poor thrill/pulsatile;
• poor maturation of fistula.
13. PTA
The typical endpoint is restoration of
normal trill to the fistula. A successful
angioplasty will have complete effacement
of the balloon waist and result in 0 - 30%
residual narrowing.
14. PTA
Contraindications:
• Infected AVF;
• Uncorrectable severe coagulopathy;
• Severe allergy to iodinated contrast
agents;
• Percutaneous intervention on a
newly placed graft.
15. Treatment of clotted AVF is either
endovascular thrombectomy (ET)
or thrombolysis.
16. Sweeping thrombus from the occluded
graft into the central venous circulation
Pulmonary circulation embolization
ET Balloon-Sweep
17. Contraindications:
• Patients with cardiopulmonary
compromise;
• Known right-to-left intracardiac shunt,
especially with pulmonary hypertension.
ET Balloon-Sweep
18. Endovascular thrombectomy is most
commonly performed by using
thromboaspiration, combined with
angioplasty. It is most useful with
fresh thrombus .
ET Thromboaspiration
24. Thrombolysis is taken in consideration
mainly in combination with other methods
of endovascular treatment of PVA and
especially during the first couple of hours
after thrombosis.
Thrombolysis
26. Results
Long-term patency of vascular access is
dependent on the identification and
successful treatment of all significant
stenoses.
Long-term Results:
27. Long-term results should be considered
only when angioplasty with/without
stenting is performed.
Results
28. Endovascular therapy requires qualified
medical team and adequately equipped
operating room. The medical supplies
needed for these procedures are expensive
and in this sense endovascular treatment
of AVF in Bulgaria is financially
compromised.
Conclusion
29. References
1. Handbook of Angioplasty and Stenting
Procedures, Techniques in IR series, Lee
Watkinson;
2. Съдов достъп. Перитонеална диализа, проф.
Д-р Здравко Краев;
3. Dialysis Access: A Multidisciplinary Approach,
Richard James Gray,Jeffrey J. Sands;
Endovascular Interventions: A Case-Based
Approach, Robert S. Dieter,Raymond A. Dieter,
Jr.,Raymond A. Dieter, III,Aravinda
Nanjundappa
4. Vascular Surgery, SIXTH EDITION, Robert B.
Rutherford MD, FACS, FRCS (Glasg.)
5. Haimovici's Vascular Surgery, 6th Edition
