The Effect of Cutting Balloon Angioplasty on Vascular Access Dysfunction in Hemodialysis Patients

Won, Yoo Dong; Kim, Ki Tae; Kang, Hyun Hee; Shin, Mi Jung; Kim, Young Soo; Yoon, Sun Ae; Kim, Yong Soo; Chang, Yoon Sik; Bang, Byung Kee; Kim, Young Ok

Abstract

BACKGROUND
When angioplasty is performed using conventional balloon to treat arteriovenous fistula stenosis, treatment failure frequently occurs in case stenosis is very seve or tight. Cutting balloons were made to overcome these disadvantages. The purpose of this study is to evaluate the clinical effectiveness of cutting balloon angioplasty (CBA).
METHODS
Twenty-four patients treated with CBA were included in this study. We evaluated clinical signs of venous stenosis, fistulographic findings, indications of CBA, procedure outcomes, and its complications.
RESULTS
Out of the total 24 patients, the most common indication for fistulogram was increased negative arterial pressure (n=8). The stenotic lesions were juxta-anastomotic vein (n=19), graft-venous anastomosis (n=3), artery-venous anastomosis (n=1), and axillary vein (n=1), retrospectively. Conventional angioplasty had been attempted but failed in all 24 patients who were treated with CBA. The initial success rate of CBA was 100%, and the follow-up patency rate at 6, 12, 24 month after the procedure were 73.1%, 65.8%, and 49.3%, respectively. Procedure- related complications were minimal leakage of contrast media (n=3), partial rupture of vessel wall (n= 3), and vessel dissection (n=2). Three partial ruptures and one severe dissection were successfully treated only with balloon inflation without surgical operation. And leakages and one mild dissection spontaneously improved without specific treatment.
CONCLUSION
This study suggests that cutting balloon angioplasty is relatively safe and effective in treating failed stenotic lesions when compared with conventional angioplasty in hemodialysis patients.