Percutaneous balloon cryoplasty: a new therapy for rapidly recurrent anastomotic venous stenoses of hemodialysis grafts?
Vascular access dysfunction is a major source of morbidity for end-stage renal disease patients on hemodialysis. The arteriovenous graft is a common access type for many of these patients. Frequent stenosis formation and thrombosis complicate this form of access. Patients may have a rapidly forming and recurrent venous stenosis at the graft-vein anastomosis that has been seen in both animal models and end-stage renal disease patients to be the result of neointimal hyperplasia. This venous lesion is particularly resistant and sometimes intractable to conventional angioplasty. As a result, new therapies have been developed to reduce the formation and/or recurrence of neointimal hyperplasia. These include special cutting balloons, drug-eluting stents, and endovascular brachytherapy. The authors present the cases of 5 patients with rapidly recurrent venous lesions at the graft-vein anastomosis that derived benefit from angioplasty with the cryoballoon. The time to stenosis or thrombosis in the arteriovenous grafts was increased from a mean of 3 weeks to more than 16 weeks with this technology. Cryotherapy with the cryoballoon (cryoplasty) may represent a useful therapy for patients with intractable stenoses at or near the venous anastomosis of arteriovenous grafts.
Rifkin
Brian S
BS
Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, CT 06520, USA.
Brewster
Ursula C
UC
Aruny
John E
JE
Perazella
Mark A
MA
D000368:Aged; D000800:Angioplasty, Balloon / Q000379:methods*; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D003251:Constriction, Pathologic / Q000601:surgery*; D017679:Cryotherapy / Q000379:methods*; D005260:Female; D006083:Graft Occlusion, Vascular / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods