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Percutaneous intervention for the treatment of stenosis in the arteriovenous access

Gerald A Beathard, MD, PhD
Section Editors
Steve J Schwab, MD
John F Eidt, MD
Joseph L Mills, Sr, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS


Dialysis facilities should have the capability and expertise to prospectively diagnose and, when indicated, refer the patient for treatment of venous and arterial stenosis associated with hemodialysis arteriovenous (AV) access. Different modalities and/or criteria have been promoted to screen for and diagnose angiographic and hemodynamically significant venous stenosis. (See "Clinical monitoring and surveillance of the mature hemodialysis arteriovenous fistula" and "Monitoring and surveillance of hemodialysis arteriovenous grafts to prevent thrombosis".)

The 2006 National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF-K/DOQI or K/DOQI) hemodialysis access working group recommend that a hemodynamically significant stenosis requiring intervention should display a ≥50 percent stenosis (determined radiographically) and evidence of a clinical or physiologic abnormality (eg, elevated venous pressure, decreased blood flow) [1]. The K/DOQI clinical practice guidelines for hemodialysis vascular access, as well as other K/DOQI guidelines, can be accessed online at the National Kidney Foundation website.

Since the early reports of success, percutaneous angioplasty has been demonstrated to be safe and effective and has become the standard treatment for stenotic lesions in both AV fistulas and AV grafts using techniques that have become relatively standardized [2-7].

Lesions affecting hemodialysis AV access, the rationale and indications for early intervention, and patency rates related to intervention are reviewed here. Issues surrounding monitoring and diagnosis of stenosis and specific techniques for intervention are reviewed elsewhere. (See "Monitoring and surveillance of hemodialysis arteriovenous grafts to prevent thrombosis" and "Clinical monitoring and surveillance of the mature hemodialysis arteriovenous fistula" and "Techniques for angioplasty of the arteriovenous hemodialysis access".)


Percutaneous intervention includes balloon dilation (angioplasty) with or without adjunctive stenting.


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