The new frontier in endovascular treatment of arteriovenous fistula stenosis: the role of ultrasound-guided percutaneous transluminal angioplasty

Abstract

Native arteriovenous fistula is the preferred vascular access because of it does not usually cause infections and seems to be closely related with prolonged patient survival, compared to prosthetic grafts and central venous catheters; it also is cost effective. Venous stenosis is one of the main causes of AVF failure. It is caused by a number of upstream and downstream events. The former group comprises hemodynamic and surgical stressors, inflammatory stimuli and uraemia, while downstream events involve the proliferation of smooth muscle cells and myofibroblasts and the development of neo-intimal hyperplasia. Percutaneous transluminal angioplasty is the gold standard for arteriovenous fistula stenosis. It allows the visualization of the whole vascular circuit and the immediate use of the vascular access for the next dialysis session. Ultrasound-guided percutaneous endovascular angioplasty is a feasible and safe alternative to conventional fluoroscopic technique: it is equally effective in treating arteriovenous fistula stenosis, but it presents the advantage of not using contrast media or ionizing radiation. The aim of this review is to report the latest evidence on cellular and molecular mechanisms that contribute to the development of neo-intimal hyperplasia, as well as the current and future therapeutic perspectives, especially concerning the use of anti-proliferative drugs, and the efficacy of the ultrasound-guided angioplasty in restoring and maintaining the vascular access patency over time.

Key words: Percutaneous angioplasty, ultrasound, arteriovenous fistula, hemodialysis, stenosis.

Sorry, this entry is only available in Italian. For the sake of viewer convenience, the content is shown below in the alternative language. You may click the link to switch the active language.

Introduzione

La prevalenza della malattia renale cronica terminale aumenta di anno in anno. Nel 2010, il numero dei pazienti sottoposti a terapia emodialitica in tutto il mondo era pari a 2,618 milioni e, secondo alcune recenti stime, è destinato a crescere fino a 5,439 milioni entro il 2030 [1]. A livello nazionale, i dati estrapolati dal Report 2015 del Registro Italiano di Dialisi e Trapianto evidenziano un’incidenza e una prevalenza di 154 pazienti/pmp e di 770/pmp rispettivamente [2]. Indipendentemente dalla metodica utilizzata, il buon funzionamento dell’accesso vascolare (AV) rappresenta un requisito irrinunciabile per una ottimale adeguatezza dialitica. 

La visualizzazione dell’intero documento è riservata a Soci attivi, devi essere registrato e aver eseguito la Login con utente e password.

Management of the incidental renal masses

Abstract

The diagnosis of renal masses has increased in the last decades owing to the widespread use of imaging (ultrasound, computed tomography and magnetic resonance).

Majority of the renal masses are detected incidentally on routine ultrasound examination.

Solid masses detected on ultrasound require further imaging evaluation with CT and/or MRI for suitable characterization. US-guided renal biopsy is a safe, effective and accurate method for evaluating the small renal masses with ambiguous radiologic findings.

Navigation technology and multimodality image fusion represent an important development in interventional radiology, especially for performing difficult percutaneous biopsies and ablations of small renal masses.

Multidisciplinary approach is required which results from experience and knowledge and in hard cases the use of serial imaging can be helpful.

 

Keywords: renal masses, imaging, ultrasound, renal biopsy, active surveillance

Sorry, this entry is only available in Italian. For the sake of viewer convenience, the content is shown below in the alternative language. You may click the link to switch the active language.

Introduzione

Il riscontro di masse renali durante gli ultimi trent’anni è andato via via aumentando (1) grazie alla diffusione delle tecniche di imaging, in primo luogo l’ecografia (US), ma anche la tomografia assiale computerizzata (TC) e la risonanza magnetica nucleare (MRI).

 

La visualizzazione dell’intero documento è riservata a Soci attivi, devi essere registrato e aver eseguito la Login con utente e password.