ABSTRACT
Objectives: To report our experience of angioplasty with Lutonix (Bard Peripheral Vascular, Inc., Tempe, AZ) drug-coated balloon (DCB) for the treatment of failing arteriovenous fistulas (AVF).Materials and methods: Retrospective, single-center analysis consisting of 14 patients treated with Lutonix paclitaxel DCBs in the period from July 2015 through April 2017. We analyzed technical success, clinical success, primary patency of the target lesion, primary patency of the dialysis circuit, and the rate of complications. Regular follow-up of AVF patency was realized by clinical examination and duplex ultrasonography. The Kaplan-Meier survival method was applied to determine the cumulative primary patency of the target lesion and the dialysis circuit.Results: Technical success was 100% and clinical success 92.9%. There were no major or minor complications. Cumulative target lesion primary patency after DCB was 69.2% at 6 months and 31.6% at 12 months. Cumulative vascular circuit primary patency was 61.5% at 6 months and 31.6% at 12 months.Conclusion: Compared to results reported in literature with plain old balloon angioplasty (POBA), Lutonix paclitaxel DCB angioplasty proved a short-term patency benefit in treatment of dialysis AVF stenosis.
Subject(s)
Angioplasty, Balloon/instrumentation , Antineoplastic Agents, Phytogenic/administration & dosage , Arteriovenous Shunt, Surgical , Coated Materials, Biocompatible , Kidney Failure, Chronic/therapy , Paclitaxel/administration & dosage , Aged , Aged, 80 and over , Constriction, Pathologic , Female , Humans , Male , Middle Aged , Renal Dialysis , Retrospective StudiesABSTRACT
The early diagnosis of incompetence of the sapheno-femoral junction is made possible by combined ultrasonography/Doppler. Thus when the great saphenous vein is not too dilated and is not the site of severe ectasia, ligation of the junction may be sufficient to deal with malfunction of the latter. This is an outpatient procedure. Following local anesthesia (lidocaine 0.25%), a 4 cm incision is made in the inguinal fold between the femoral artery and the tendon of gracilis muscle. Dissection of the great saphenous exposes a lake distal to the collaterals of the sapheno-femoral junction and--by traction--obtains maximal exposure of the junction. A wide Weck hemoclip is used to interrupt reflux in the incompetent junction. We ligate the pudendal veins entering the femoral vein separately. This procedure neutralizes a major perforator under local anesthesia by an out-patient technique free of morbidity. Varicose veins are removed subsequently using the technique of Dr. R. Müller.
Subject(s)
Femoral Vein/surgery , Saphenous Vein/surgery , Ambulatory Surgical Procedures , Humans , Ligation , Methods , Venous Insufficiency/surgeryABSTRACT
Pelvic arteriovenous fistulas are rare. They may be defined as arteriovenous communications developing in the pelvis from the internal iliac artery, the origin of its posterior trunk or branches of its anterior trunk. Congenital arteriovenous malformations, more common in women, and posttraumatic arteriovenous fistulas are the two main etiological forms. Diagnostic problems include appreciation of visceral extension in arteriovenous malformations and precise localization of fistulas especially when they affect the internal iliac artery itself. Therapy is aimed at complete closure of arteriovenous communications using interventional radiologic methods or surgery. Although indications are difficult to assess, complete, one-stage therapy is preferable due to surgical difficulties following failed or incomplete radiological or surgical attempts.
