Percutaneous transvenous angioplasty in the treatment of vascular access stenosis.

This study was undertaken to evaluate percutaneous transvenous angioplasty (PTVA) for the treatment of all types of vascular access stenosis in a large population of dialysis patients. Stenoses were identified by venography in patients who met a set of clinical criteria indicating the need for evaluation. The lesions were classified by location and type. Data were collected prospectively and analyzed separately for each lesion type. A total of 536 PTVA procedures was performed in 285 patients. This included 107 cases of long venous stenosis (> 6 cm) and 149 cases of mid-graft stenosis. In the total group, an initial success rate of 94% was obtained (80% or greater dilatation). A decrease in VPm (venous pressure measured on dialysis) of 35.9%, 32.4%, and 22.6% was seen at one week, one month, and three months, respectively. At 90 days, 180 days, and 360 days 90.6%, 61.3%, and 38.2%, respectively, of the treated grafts were continuing to be patent and functional with no need for repeat PTVA treatment. Repeat treatments for recurrent lesions were as successful as the initial treatment. It is concluded that vascular access stenosis can be easily diagnosed and that all categories of stenotic lesion can be effectively treated with PTVA.