Dingli Assistance | Prof. Tang Li's Team: Management of Recurrent Hyperplastic Stenotic Lesions in Arteriovenous Fistulae
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-focusing balloons utilize cutting/notching elements positioned between the inner wall of the blood vessel and the outer diameter of the balloon during expansion to enhance localized pressure and achieve efficient directional dilation, thereby reducing vascular elastic recoil. This 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 precise operation of each case and the clinical application of advanced equipment and instruments. From the formulation of treatment strategies for different cases, standardized procedures during surgery, 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, enhance technical exchange 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 received balloon angioplasty twice due to fistula stenosis. Twenty days ago, during dialysis, the patient experienced decreased blood flow in the fistula and subsequently came to 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, noon, 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 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 pulsation 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 recurrent stenosis of the arteriovenous fistula in the left forearm, with a history of two previous PTA treatments, after which there was a decrease in flow within a short period. This time, balloon dilation is planned again, and it is recommended to change the treatment plan to improve the therapeutic effect. The use of the DK Medtech scoring balloon is being considered for this procedure.
Surgical Objective:
Main Objectives:Increase vascular diameter and augment fistula flow through PTA treatment with a scoring balloon.
Secondary Objective:Slow down the speed of intimal hyperplasia and improve the patency rate of arteriovenous fistulas.
Surgical Strategy/Plan:Percutaneous transluminal angioplasty of left forearm arteriovenous fistula under color Doppler ultrasound and DSA guidance.
Significant preoperative stenosis with reduced flow.
Surgical Procedure
Preoperative Angiography
Intraoperative color Doppler ultrasound indicated significant stenosis of the fistula.
Intraoperative DK Medtech 6mm*40mm DKutting High-Pressure Scoring Balloon Dilation
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 was 280ml/min during hemodialysis, with no abnormal manifestations during the process.
Case Summary
Case Characteristics:The patient underwent dialysis using an autologous arteriovenous fistula in the left forearm, with repeated occurrences of intimal hyperplasia and fistula stenosis, and the interval between stenoses was relatively short.
Preoperative Assessment Key Points:Preoperative thorough evaluation of the patient's stenosis and intimal hyperplasia in the arteriovenous fistula, 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.
Features/Usage Tips of the Device:First, inflate to 4 atm, then slowly increase pressure to 20 atm, maintaining the pressure for 2 minutes until the scoring element opens up the severely narrowed section. If the lumen gain is still unsatisfactory, deflate and rotate the push rod by 60°, then reinflate to 20 atm, holding the pressure for 1-2 minutes.
Expert Introduction
Director Tang Li
Surgeon of This Case
Director of the Department of Nephrology, 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 Association;First Committee Member of the Vascular Access Group under the Kidney Disease Specialty Committee of Chengdu High-tech Zone Medical Association;Secretary of the Nephrology Committee of Zigong City;Outstanding Health Talent of Zigong City;Elite of Yandu Science and Technology in Zigong City.
Principal Investigator of 1 research project from the Sichuan Provincial Medical Association, multiple municipal 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
Surgeon of This Case
Zigong Third People's Hospital, 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
