title: Failing and failed hemodialysis access sites: management with percutaneous catheter methods.
abstract: Chronic dialysis access is plagued with the formation of stenoses and access thrombosis, with a thrombosis rate of 0.5 to 0.8 episodes per year. Surgical management of thrombosed accesses, including thrombectomy, patch angioplasty, and bypass, has been the traditional treatment for thrombosed grants. Percutaneous catheter-directed thrombolysis of thrombosed accesses, coupled with angioplasty of underlying stenoses, offers comparable results to surgical revascularization. The technical success of thrombolysis is between 75% and 92%, similar to surgical results, with the advantage of sparing vein as potential conduit for future access sites. Surgical therapy may successfully reestablish access function for those stenoses that fail angioplasty. Long-term patencies after a single revascularization procedure are poor (median patency, < 90 days) for both catheter-directed and surgical procedures, and repeat maintenance procedures are necessary. Access surveillance using various means with timely fistulography coupled with angioplasty of stenoses has been shown to decrease the rate of access thromboses by a factor of 3 and to increase patency of grafts. A combined approach with catheter-directed therapies and surgical interventions leads to maximal longevity of each access site.
authors.affiliation: Department of Radiology, University of Colorado Health Sciences Center, Denver, USA.
authors.forename: J
authors.initials: J
authors.lastname: Krysl
authors.forename: D A
authors.initials: DA
authors.lastname: Kumpe
mesh_terms: D002404:Catheterization / Q000379:methods*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000628:therapy*; D006801:Humans; D006435:Renal Dialysis / Q000009:adverse effects*; D017131:Thrombectomy / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome; D014654:Vascular Patency