Some stenosis cannot be dilated by conventional balloon angioplasty. These “hard” stenosis can be treated with cutting ballons or ultra high pressure balloon (up to 32 atm)
Recurring stenosis can be treated radiologically, with or without stent placement, or surgically. The strategy for treatment should be made considering the individual condition of the patient in relation to the invasiveness of the surgical treatment. In spite of complete opening of the percutaneous transluminal angioplasty balloon of sufficient diameter, the dilated vessel wall may collapse immediately after removal of the balloon. This elastic recoil can be prevented by stent implantation, especially in central veins. Stent placement in the needling areas of forearm fistula should be avoided except for percutaneous transluminal angioplasty-induced ruptures not controllable by protracted balloon inflation.