INSUFFICIENT HEMODIALYSIS ACCESS FISTULAS - 18 MONTHS EXPERIENCE IN LASER-SUPPORTED DILATION

Patients with end-stage renal failure disease frequently develop venou s stenoses or occlusions in their hemodialysis access fistulas caused by intimal fibrosis. A complete dilation with high pressure balloons u p to 20 atm may be unsuccessful in those cases. We investigated two ne w pulsed dye laser devices for the ablation of obstructions, which wer e not adequately treatable with a previous balloon angioplasty. From N ovember 1990 to April 1992 a total of 154 percutaneous transluminal an gioplasties (PTAs) of hemodialysis access fistulas were performed. In 23 of them an additive laser angioplasty was necessary. Twenty patient s with Cimino fistulas presented 28 stenoses and two occlusions, and t hree Goretex loops presented all occlusions. Two pulsed dye laser devi ces emitting at 504 nm and 595 nm wavelength were tested. Technical su ccess was achieved in 22/23 cases, but clinical success was obtained i n 20/23 patients because two early reocclusions caused by thrombosis a ppeared. Five restenoses occured 2, 3, 10, and in two cases 14 months after angioplasty with a mean follow-up period of 13.5 (5-18) months. Pulsed dye laser ablation in hemodialysis access fistula lesions due t o intimal fibrosis is a valuable enrichment of radiological recanaliza tion techniques and an alternative to surgery if stand alone balloon P TA fails.