Highlights
  • Endovascular treatment is useful in cases with dialysis-access troubleshoots.

  • Drug coated balloons reduce the rate of reintervention in failed dialysis access.

  • Reintervention is highest in previously stented central veins.

Abstract

Background and Objectives: Dialysis-access troubleshoots cause a large number of admissions and impose a considerable amount of cost on both patients and health care systems. The reasons for late access-site failure include neointimal hyperplasia, outflow tract remodeling and fibrosis, and multiple catheterizations via the central veins. Drug-coated balloons (DCBs), high-pressure balloons, high radial force self-expanding stents, and covered stents have been shown to have good long-term access failure-free survival after the first intervention in previous studies. This study aimed to evaluate the effect of endovascular treatment on dialysis-access durability in the era of DCBs.

Methods: Patients who underwent endovascular treatment for the failure of any dialysis-access type—including arteriovenous fistulae, arteriovenous grafts, and central vein catheters—between October 2016 and March 2018 were recruited in the present study. Procedural and follow-up data were gathered and analyzed.

Results: Within 17 months, 47 endovascular procedures were performed. Among them, 37 (78.7%) procedures were conducted as de novo procedures and the rest were reinterventions. All reinterventions were conducted on cases with central vein stenoses or occlusions (10 [21.3%] procedures).

Conclusion: The reintervention rate is higher in central vein obstruction among patients with dialysis access. Higher rates of flow and previous catheterizations cause intimal hyperplasia and vascular remodeling. Newer devices, including larger DCBs, may reduce the rate of reintervention in these lesions.

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