Cutting balloon angioplasty for resistant venous stenoses in hemodialysis patients

Abstract

Purpose: To report our initial experience of using cutting balloons angioplasty in the treatment of resistant venous stenoses of Brescia‐Cimino fistulas. Materials and Methods: Forty‐eight patients with Brescia‐Cimino fistulas underwent percutaneous transluminal angioplasty (PTA) of 62 venous stenoses. Of these 48 patients, we encountered 8 venous stenoses (8/62, 12.9%) in 7 patients that were not successfully dilated with 6–8 mm high‐pressure balloons inflated up to 24 atm. In each of 8 stenoses, peripheral cutting balloons with diameters of 5–8 mm were employed to dilate resistant stenoses. Results: The locations of stenoses were 3 at the surgical vein mobilization site (“swing point”), 4 at the cephalic vein downstream from the anastomosis, and 1 at the cephalic arch. The grade of stenosis after high‐pressure balloon angioplasty ranged from 57% to 87%(mean, 76%). Cutting balloons expanded completely in all stenoses and the residual stenosis after cutting balloon PTA ranged from 0% to 24%(mean, 7%). Residual stenosis was virtually nonexisistent at the 3 stenoses of “swing point.” A focal rupture with a large hematoma occurred at the cephalic arch stenosis, which was treated by a stent placement. One minimal rupture that did not require any treatment occurred at the stenosis of downstream cephalic vein. No repeat angioplasty has been needed during follow‐up period (range, 74–249 days). Conclusion: Our early experience demonstrated that when high‐pressure balloons fail to dilate stenoses of Brescia‐Cimino fistulas, peripheral cutting balloons with diameters of 5–8 mm can be effectively used to overcome the resistance of stenoses.