Dingli Assistance | Prof. Tang Li's Team: Management of Recurrent Hyperplastic Stenotic Lesions in AVF
DK Medtech
Vascular Interventional Balloon Product Developer
With the vigorous development of China's peripheral vascular intervention market, ordinary peripheral balloons have entered a stage of full competition. However, for the increasing number of highly resistant stenotic lesions, ordinary balloons can easily cause complications such as excessive vascular injury, flow-limiting dissections, and hematomas. On the other hand, pressure-focused balloons utilize cutting/notching elements positioned between the inner wall of the blood vessel and the outer diameter of the balloon during expansion, which enhance localized pressure and enable efficient directional expansion. This reduces vascular elastic recoil and represents a new direction in the development of vascular intervention balloons.
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DK Medtech Special Release[Professor Tang Li's Team: Management of Recurrent Hyperplastic Stenotic Lesions in AVF] Case Presentation, demonstrating the meticulous operation of each case and the clinical application of advanced equipment and instruments. From the formulation of treatment strategies for different cases, standardized intraoperative procedures and technical applications, complication prevention, to perioperative management, etc., the aim is to promote the standardization of diagnosis and treatment for vascular stenosis and occlusive diseases, strengthen technical exchanges and experience sharing among doctors, with the hope of providing new ideas and methods for future diagnosis and treatment, benefiting more clinical patients.
Management of Recurrent Stenotic Lesions in AVF
Tang Li, Lu Tianzhuo from the Third People's Hospital of Zigong City
Patient Information
Basic Information:The patient is a middle-aged male.
Chief Complaint:Regular hemodialysis for 1 year, poor function of internal fistula for 20 days.
History of Present Illness:One year ago, the patient visited a local hospital due to high serum creatinine levels (900+ μmol/L). After completing relevant tests and examinations, the patient was diagnosed with "Stage 5 Chronic Kidney Disease, Type 2 Diabetes, Diabetic Nephropathy, and Renal Hypertension." The patient was then treated with hemodialysis (twice a week) and underwent native arteriovenous fistula formation surgery on the left forearm. The condition remained relatively stable; however, during dialysis, the patient underwent balloon angioplasty twice due to fistula stenosis. Twenty days ago, during dialysis, decreased blood flow in the fistula was detected, prompting the patient to visit our hospital. The outpatient department admitted the patient to our department with a diagnosis of "Stage 5 Chronic Kidney Disease." Since the onset of the disease, the patient has maintained good mental status, normal appetite, normal sleep, regular bowel movements, anuria, and no weight loss.
Past Medical History:Generally healthy, denies history of or contact with hepatitis, tuberculosis, etc., diabetes for 10 years.+ years, currently using Aspart insulin 10-10-10u in the morning, afternoon, and evening. Denies history of coronary heart disease; previously underwent balloon angioplasty due to poor fistula function. Denies history of trauma or blood transfusion, denies history of drug or food allergies. Vaccination history is unclear.
Physical Examination:A longitudinal scar, approximately 3cm in length, is visible 2cm above the transverse wrist crease on the left forearm. Two puncture scars with pigmentation are also present on the forearm. Palpation reveals a distinct pulse above the scar near the wrist, accompanied by a mild thrill. Auscultation of the left forearm detects a blowing murmur.
Admission Diagnosis:Stenosis of autologous arteriovenous fistula in the left forearm, chronic kidney disease stage 5, on hemodialysis.
Previous interventional treatment
Time | Main Treatment Process |
2022-10 | Left Forearm Autologous Arteriovenous Fistula Formation Surgery |
2023-4 | Balloon dilation using a standard balloon |
2023-7 | Balloon dilation using a standard balloon |
Preoperative Analysis
Preoperative Analysis:The patient has experienced repeated stenosis of the arteriovenous fistula in the left forearm, with a history of two previous PTA treatments. A decline in blood flow occurred shortly after each treatment. This time, balloon dilation is planned again, and it is recommended to change the treatment plan to improve outcomes. The use of the DK Medtech scoring balloon is being considered for this procedure.
Surgical Goal:
Main Objectives:Increase vascular diameter and augment fistula flow through PTA treatment with a scoring balloon.
Secondary Objectives:Slow down the speed of intimal hyperplasia and improve the patency rate of arteriovenous fistulas.
Surgical Strategy/Plan:Percutaneous transluminal angioplasty of arteriovenous fistula in the left forearm under color Doppler ultrasound and DSA guidance.
Significant preoperative stenosis with decreased flow.
Surgical Procedure
Preoperative Angiography
Intraoperative color Doppler ultrasound indicated significant stenosis of the fistula.
Intraoperative DKutting High-Pressure Scoring Balloon Dilation with DK Medtech 6mm*40mm
Significant improvement in postoperative stenosis
Significant improvement in postoperative stenosis
Follow-up
Discharge Status:The patient's postoperative examination showed good thrill of the internal fistula, no abnormal pulsation was palpated, and the blood flow rate during hemodialysis was 280ml/min without any abnormal manifestations during the process.
Case Summary
Case Characteristics:The patient underwent dialysis using an autologous arteriovenous fistula in the left forearm, with recurrent intimal hyperplasia and fistula stenosis, and the interval between stenoses was relatively short.
Preoperative Assessment Key Points:Preoperative comprehensive evaluation of the stenosis and intimal hyperplasia of the patient's fistula vessels, combined with the patient’s surgical history, to formulate a reasonable surgical plan.
Surgical Strategy/Technical Key Points:The patient has recurrent stenosis with significant intimal hyperplasia. The surgery requires thorough intimal tearing, and the use of a scoring balloon offers distinct advantages.
Device Features/Usage Tips:First, inflate to 4 atm, then slowly increase the pressure to 20 atm and maintain the pressure for 2 minutes, allowing the scoring element to open the severely narrowed section. If the lumen gain is still unsatisfactory, deflate the system, rotate the push rod by 60°, then reinflate to 20 atm and hold the pressure for 1-2 minutes.
Expert Introduction
Director Tang Li
Surgeon of This Case
Director of the Nephrology Department, Third People's Hospital of Zigong City, Associate Chief Physician, Master's Degree;Member of the Sichuan Provincial Medical Association's Nephrology Professional Committee;Member of the Nephrology Physicians Branch of the Sichuan Provincial Medical Association;Member of the Youth Committee of the First Professional Committee of Nephrology, Sichuan Provincial Medical and Health Promotion Association;Member of the Vascular Access Group, Branch of Nephrology Physicians, Sichuan Province Medical Doctor Association;First Committee Member of the Vascular Access Group under the Kidney Disease Special Committee of Chengdu High-tech Zone Medical Association;Secretary of the Nephrology Special Committee of Zigong City;Outstanding Health Talent of Zigong City;Yandu Science and Technology Elite of Zigong City.
Principal Investigator of 1 scientific research project from the Sichuan Provincial Medical Association, multiple municipal-level scientific research projects, awarded the Third Prize of the Zigong City Science and Technology Progress Award 4 times, published over 10 papers in core journals, including 2 SCI papers.
Proficient in the diagnosis and treatment of various acute and chronic kidney diseases, as well as the management of complications in hemodialysis patients. Particularly skilled in the establishment and maintenance of vascular access. Experienced in the creation and bypass of artificial vascular fistulas, diagnosis and treatment of artificial vascular complications, resection of aneurysms, endovascular intervention for fistula stenosis or thrombosis, central venous balloon dilation, and stent placement.
Dr. Tianzhuo Lu, Attending Physician
The Surgeon of This Case
The Third People's Hospital of Zigong City, Department of Nephrology, Attending Physician;Trainee at Sir Run Run Shaw Hospital, Zhejiang University.Participated in multiple provincial medical association and municipal scientific research projects.Long-term engagement in the establishment and maintenance of hemodialysis access, proficient in the creation and maintenance of autologous arteriovenous fistulas and prosthetic arteriovenous fistulas, as well as balloon angioplasty of fistulas under ultrasound and DSA.
Department Introduction
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