Author/Editor		Šurlan, Miloš; Popovič, Peter
Title		Interventional radiology in haemodialysis fistulae and grafts
Translated title		Intervencijska radiologija pri hemodializnih fistulah
Type		članek
Source		Radiol Oncol
Vol. and No.		Letnik 38, št. 4
Publication year		2004
Volume		str. 299-308
Language		eng
Abstract		Background. The aim of the paper is to review the role of interventional radiology in the management of haemodialysis vascular access. The evaluation of patients with haemodialysis vascular access is complex. It includes the radiology/ultrasound evaluation of the peripheral veins of the upper extremities with venous mapping and the evaluation of the central vein prior to the access placement and radiological detection and treatment of the stenosis and thrombosis in misfunctional dialysis fistulas. Preoperative screening enables the identification of a suitable vessel to create a haemodynamically-sound dialysis fistula. Clinical and radiological detection of the haemodynamieally significant stenosis or occlusion demands fistulography and endovascular treatment. Endovascular prophylactic dilatation of stenosis greater than 50% with associated clinical abnormalities such as flow-rate reduction is warranted to prolong access patency. The technical success rates are over 90% for dilatation. One-year primary patency rate in forearm fistula is 51%, versus graft 40. Stents are placed only in selected cases; routinely in central vein after dilatation, in ruptured vein and elastic recoil. Conclusions. Thrombosed fistula and grafts can be deelotted by purely mechanical methods or in combination with a lytic drug. The success rate of the technique is 89-90%. Primary patency rate is 8% to 26% per year and secondary 75% per year.
Summary		Izhodišča. Namen članka je podati pregled vloge intervencijske radiologije pri obravnavanju hemodializnih žilnih pristopov. Obravnava bolnika, preden oblikujemo žilni pristop za hemodializo, vključuje radiološko ali ultrazvočno diagnostiko perifernega žilja zgornje okončine in ugotavljanje prehodnosti centralne vene. Kasneje pa vključuje odkrivanje in zdravljenje zožitev ali tromboz v slabo delujočih dializnih fistulah. Predoperacijski pregled omogoča izbiro ustreznih žil za oblikovanje dobro delujoče dializne fistule. Klinično in radiološko odkrivanje hemodinamsko pomembnih zožitev ali zapor vključuje fistulografijo, ki ji po potrebi sledi endovaskularno zdravljenje. Razširitev zožitev, ki so večje od 50%, je upravičena, ker podaljšuje prehodnost žilnega dostopa. Tehnični uspeh razširitve je 90%. Enoletna primarna prehodnost razširjene fistule na podlahti znaša 51%, pri graftih pa 40%. Žilne opornice postavljamo le v izbranih primerih; rutinsko pa v centralno veno po razširitvi, v primeru raztrganja vene ali prekomerne elastične zožitve po razširitvi. Zaključki. Prehodnost tromboziranih fistul ali graftov lahko zagotovimo z mehaničnimi postopki ali v kombinaciji s trombolitičnim zdravljenjem. Tehnični uspeh dosežemo v 89% - 90%, primarno enoletno prehodnost pa le v 8% - 26%, vendar sekundarna prehodnost dosega 75%.
Descriptors		RADIOLOGY, INTERVENTIONAL HEMODIALYSIS KIDNEY FAILURE, CHRONIC CATHETERS, INDWELLING VASCULAR PATENCY CATHETERIZATION, CENTRAL VENOUS THROMBOSIS ARTERIOVENOUS SHUNT, SURGICAL ANGIOPLASTY, BALLOON THROMBECTOMY