Management of autogenous arteriovenous (AV) fistula stenosis part 4

Juxta-anastomotic stenosis most common. Photo courtesy of L. Spergel, MD.

 

Balloon angioplasty

In order to visualize the stenosis, angiography is performed by retrograde puncture of the brachial artery, in case of anastomotic problems, or by direct antegrade puncture of the vein above the anstomosis if an outflow problem is suspected. It is controversial, wether long-segment stenosis should be treated radiologically or surgically. While some authors recommend surgical intervention, either by graft interposition or vein transposition, others recommend radiological intervention. Studies proving the superiority of one of two treatment options for the treatment of long-segment obtructions are not available. However, percutaneous transluminal angioplasty of short-segment stenosis  (<2cm) has a better outcome compared with long -segment stenosis (>2cm)

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