Cutting balloon angioplasty for primary treatment of hemodialysis fistula venous stenoses: Preliminary results

PURPOSE: To assess the efficacy of the cutting balloon as the primary tool in percutaneous transluminal angioplasty of hemodialysis access stenoses. MATERIALS AND METHODS: A prospective study of symptomatic patients with stenoses of 50% or more in their hemodialysis accesses was undertaken. Provided that no contraindication to the use of cutting balloons existed, the stenoses were treated with the cutting balloon with use of a maximum of a 1:1.1 ratio between expected vessel diameter and balloon diameter. In cases in which dilation to the full diameter of the cutting balloon left a greater than 30% residual stenosis, postprocedural dilation with conventional balloons was carried out. Patient access function was followed. Twenty-nine patients with 42 stenoses have now reached 6 months of follow-up after cutting balloon angioplasty. RESULTS: Technical and clinical success rates were 100%. Slight local extravasation occurred in three cases: two had continued pain after the balloon was deflated and were therefore treated with balloon compression with resolution of symptoms and angiographic findings. In two cases, elastic recoil required stent placement to correct the stenosis. At 6 months, 22 patients (76%) remain in the primary patency category. Inclusion of those with primary assisted patency yields 26 patients (90%), and an additional patient had secondary patency, for a total of 93%. Two patients died of causes not directly related to dialysis. CONCLUSION: The high degree of technical and clinical success likely reflects the lack of major complications. The 6-month follow-up results match those of other series. Further follow-up will show whether this technique produces better results over the long term.