Author/Editor     Šurlan, Miloš; Popovič, P
Title     The role of interventional radiology in management of patients with end-stage renal disease
Type     članek
Source     Eur J Radiol
Vol. and No.     Letnik 46, št. 2
Publication year     2003
Volume     str. 96-114
Language     eng
Abstract     The aim of the paper is to review the role of interventional radiology in the management of hemodialysis vascular access and complications in renal transplantation. The evaluation of patients with hemodialysis vascular access is complex. It includes the radiology/ultrasound (US) 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 hemodynamically-sound dialysis fistula. Clinical and radiological detection of the hemodynamically 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. Thrombosed fistula and grafts can be declotted by purely mechanical methods or in combination with a lytic drug. The success rate of the technique is 89-90%. Primary patency rate is 8-26% per year and secondary 75% per year. The most frequently radiologically evaluated and treated complications in renal transplantation are perirenal and renal fluid collection and abnormalities of the vasculature and collecting system. US is often the method of choice for the diagnostic evaluation and management of the percutaneous therapeutic procedures in early and late transplantation complications. Computed tomography and magnetic resonance are valuable alternatives when US is inconclusive. (Abstract truncated at 2000 characters)
Descriptors     KIDNEY FAILURE, CHRONIC
KIDNEY TRANSPLANTATION
GRAFT OCCLUSION, VASCULAR
ARTERIOVENOUS SHUNT, SURGICAL
RADIOLOGY, INTERVENTIONAL
ANGIOPLASTY, BALLOON
LYMPHATIC DISEASES
LYMPHOCELE
POSTOPERATIVE COMPLICATIONS
HEMODIALYSIS
THROMBOLYTIC THERAPY
UROLOGIC DISEASES
VASCULAR DISEASES