Duplex-Guided Angioplasty of Failing or Nonmaturing Arteriovenous Access

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Objective Patients not yet on dialysis with nonmaturing arterio-venous (AV) accesses present a therapeutic problem. Because the standard treatment with balloon angioplasty requires nephrotoxic contrast use for diagnosis and treatment, we have sought an alternative therapy. Methods Five consecutive patients with chronic renal insufficiency and failing arteriovenous (AV) access underwent duplex-guided balloon angioplasties at our institution. These were 3 women and 2 men with age ranging from 70 to 85 years (mean 77 ± 7 years). All patients were hypertensive, 4 (80%) were diabetics, and 3 (60%) had coronary artery disease. Three patients (60%) had target AV access used for dialysis. Preoperative volume flows (VF) measured by duplex ranged from 200 mL/min to 1160 mL/min (mean 755 ± 358 mL/min). Peal systolic velocity obtained at the most significant stenosis preoperatively ranged from 428 cm/sec to 656 cm/sec (mean 555 ± 87 cm/sec). Technique All procedures were performed via short sheath inserted under duplex guidance. Wire and balloon passage and inflation were performed under duplex surveillance as well. Results None of these procedures required use of fluoroscopy or contrast material. One patient had a stent placed for recoiling lesion. Postoperative VF ranged from 520 mL/min to 1750 mL/min (mean 1272 ± 486 mL/min). Peal systolic velocity obtained at the most significant stenosis postoperatively ranged from 142 cm/sec to 321 cm/sec (mean 233 ± 64 cm/sec). Conclusions Angioplasty of failing AV access can be performed under duplex guidance alone. Duplex guidance offers advantages of hemodynamic evaluation for recoiling lesions and need for stenting.