LASER ANGIOPLASTY OF INSUFFICIENT HEMODIA LYSIS ACCESS FISTULAS

Patients with end-stage renal failure frequently develop venous stenos es or occlusions in their haemodialysis access fistulas caused by inti mal fibrosis. A complete dilation with high pressure balloons up to 20 atm may be unsuccessful in such cases. We investigated two pulsed dye laser devices for the ablation of obstructions, which were not adequa tely treatable with a previous balloon angioplasty. From 11/90 to 4/92 a total amount of 154 PTAs of haemodialysis access fistulas were perf ormed. In 23 of them additive laser angioplasty was necessary. 20 pati ents with Cimino fistulas presented 28 stenoses and two occlusions, wh ereas all the three patients with Goretex loops presented with occlusi ons. Two pulsed dye laser devices emitted at the wavelengths 504 nm (g reen) and 595 nm (red). Technical success was achieved in 22/23 cases, but clinical success was obtained in only 20/23 patients, due to two early reocclusions caused by thrombosis. 5 restenoses occurred two, th ree, 10, and twice 14 months after angioplasty with a mean follow-up p eriod of 13.5 (5-18) months. Pulsed dye laser ablation in haemodialysi s access fistula lesions due to intimal fibrosis greatly enriches radi ological recanalisation techniques and is a valuable alternative to su rgery if stand-alone balloon PTA fails.