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Dilation and Stent Placement

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Diagnostic and Interventional Radiology of Arteriovenous Accesses for Hemodialysis

Abstract

The only absolute contraindication to dilation is access infection. Stenoses can be categorized into 3 groups: those that should be perfectly dilated, left untreated, or deliberately underdilated. The arterialized vein is preferably accessed for dilation since it is meant for cannulation in the first place. Heterogeneous stenoses should be crossed with a 0.014-in. guidewire. About 20 and 10 % of native fistula and prosthetic grafts stenoses, respectively, require an inflation balloon pressure above 20 atm for full effacement with a remaining few being resistant even to 30 atm inflation pressures. In nonmaturing radial–cephalic fistulas, the best results are obtained when juxta-anastomotic vein and feeding artery stenoses are dilated with 6- and 4-mm balloons, respectively. Subclavian and brachiocephalic vein stenoses require 10- to 14-mm and 12- to16-mm dilation balloons, respectively. Stents are a necessary evil. Almost all stents used in dialysis accesses are self-expanding. They are essential in the management of complications like severe venous ruptures and may also be useful in major post-dilation residual stenosis. They can, however, encroach on bifurcating normal veins and hence compromise the vein capital required for future access creation.

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Authors and Affiliations

  1. Department of Vascular Radiology, Clinique St-Gatien, 8 place de la cathédrale, 37000, Tours, France

    Luc Turmel-Rodrigues M.D.

  2. Department of Vascular Radiology, Clinique Ambroise Paré, 25 boulevard Victor Hugo, 92200, Neuilly-sur-Seine, France

    Luc Turmel-Rodrigues M.D. & Bernard Beyssen M.D.

  3. Department of Vascular Radiology, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015, Paris, France

    Bernard Beyssen M.D.

  4. Department of Medicine, Khoo Teck Puat Hospital, Alexandra Health, 90 Yishun, Central, Singapore, 768828, Singapore

    Claude J. Renaud M.D.

Authors
  1. Luc Turmel-Rodrigues M.D.
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  2. Bernard Beyssen M.D.
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  3. Claude J. Renaud M.D.
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Correspondence to Luc Turmel-Rodrigues M.D. .

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Turmel-Rodrigues, L., Beyssen, B., Renaud, C.J. (2013). Dilation and Stent Placement. In: Diagnostic and Interventional Radiology of Arteriovenous Accesses for Hemodialysis. Springer, Paris. https://doi.org/10.1007/978-2-8178-0366-1_10

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  • DOI: https://doi.org/10.1007/978-2-8178-0366-1_10

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  • Publisher Name: Springer, Paris

  • Print ISBN: 978-2-8178-0365-4

  • Online ISBN: 978-2-8178-0366-1

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