Overview of the treatment of stenosis and thrombotic complications of hemodialysis arteriovenous grafts and fistulas
- Michael Allon, MD
Michael Allon, MD
- Professor of Medicine
- University of Alabama at Birmingham
- Ivan D Maya, MD, FACP
Ivan D Maya, MD, FACP
- Associate Professor of Medicine
- University of Central Florida
Hemodialysis requires access to blood vessels capable of providing rapid extracorporeal blood flow. These requirements are currently best met by both primary arteriovenous (AV) fistulas and synthetic grafts. (See "Arteriovenous fistulas and grafts for chronic hemodialysis access".)
A discussion of the treatment of venous stenosis and thrombotic complications of hemodialysis AV grafts is presented in this topic review. Issues surrounding clinical monitoring and surveillance of AV grafts to prevent thrombosis are presented in detail separately. (See "Monitoring and surveillance of hemodialysis arteriovenous grafts to prevent thrombosis".)
TREATMENT OF STENOSIS
Underlying stenosis of the vascular access circuit is an important predictor of graft or fistula thrombosis. Therefore, angioplasty of a stenotic lesion has been advocated as the treatment of choice to prevent graft or fistula thrombosis and/or failure of the vascular access.
In general, preemptive angioplasty of the stenotic lesion in grafts is not a permanent treatment due to its short primary and secondary patency (defined as time to next radiologic or surgical intervention and time to complete failure of the access, respectively). Even after an excellent technical success (visual inspection at time of the angioplasty), which is close to 100 percent, the low rates of access patency at three, six and twelve months are discouraging [1-7].
In fistulas, the treatment can be divided into two arms. One is the use of angioplasty as a form of treatment to salvage immature fistulas, and the second is the angioplasty of a stenotic lesion on a matured fistula.
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- TREATMENT OF STENOSIS
- - Percutaneous angioplasty
- - Surgical revision
- - Others
- TREATMENT OF THROMBOSES
- AV grafts
- - Percutaneous thrombectomy
- - Surgical thrombectomy
- - Thrombolysis
- - Mechanical disruption
- - K/DOQI goals
- AV fistulas
- TREATMENT OF DIALYSIS CATHETER THROMBOSIS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS