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Drug eluting balloon angioplasty for assisted maturation of failing fistulae

Abstract

Objective

To present our experience of balloon-assisted maturation with drug-eluting balloon dilation in patients with recurrent failing arteriovenous fistulae.

Case series

Three patients (all males, mean age 71 years) with a complex history of failed attempts at native fistula creation underwent surgical creation of arteriovenous fistulae. Two patients had a two-stage brachio-brachial fistula and 1 had a brachio-cephalic fistula that also required subsequent elevation. After a few weeks of preserved patency with a thrill detected clinically, all patients had a gradual deterioration of flow manifested with loss of thrill and multiple severely stenotic lesions of neo-intimal hyperplasia seen on duplex ultrasound. All 3 non-maturing native arteriovenous fistulae had 1 or more angioplasties with regular balloons that were initially successful; however, they rapidly deteriorated with a loss of thrill and a recurrence of multiple stenosis. Drug-eluting balloon dilation was used subsequently as a last resort to save these failing fistulae. All procedures were successful with the preservation of patency and adequate fistula flow (>600 mL/min) during the follow-up period (4-8 months, mean 6 months), and all patients received successful dialysis with 2-needle cannulation of their fistulae. There were no adverse events during the study period.

Conclusions

Drug-eluting balloon angioplasty was to salvage nonmaturing fistulae with durable results in complex patients where conventional treatment had previously failed. Drug-eluting balloons may provide a useful treatment option for patients prone to multiple access failures due accelerated neo-intimal hyperplasia.

Post author correction

Article Type: CASE REPORT

Article Subject: Dialysis

DOI:10.5301/jva.5000819

Authors

Alexandros Mallios, Jeffrey Hull, Benoit Boura, Alessandro Costanzo, Myriam Combes

Article History

Disclosures

Financial support: None.
Conflict of interest: None.

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Authors

Affiliations

  • Department of Vascular Surgery, Institut Mutualiste Montsouris, Paris - France
  • Richmond Vascular Center, Radiology Associates of Richmond, North Chesterfield, Virginia - USA

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