Cutting balloon angioplasty for resistant venous anastomotic stenoses

Conventional angioplasty of stenoses at the venous anastomosis has been demonstrated to be an important endovascular adjunct to mechanical thrombectomy of clotted arteriovenous dialysis grafts. In some cases, however, severe venous anastomosis stenosis is resistant to angioplasty. Cutting balloon angioplasty may have an advantageous role in these difficult situations in order to avoid surgical revision. In this series of 350 patients receiving percutaneous, endovascular declotting procedures, 9 patients had high-grade venous anastomotic stenoses (opening less than 2 mm) that could not be remedied with either conventional or high-pressure noncompliant peripheral angioplasty balloons. These nine patients had the lesions opened with the use of 4 mm x 10 mm cutting balloons and placement of self-expanding nitinol stents at the venous anastomosis during the same angiography procedure. Patients were followed for patency and functionality of the graft. In all cases, immediate technical success occurred. Among these patients, the vessels have remained patent for as long as 20 months of follow-up and grafts have remained functional. Cutting balloon angioplasty may have a potential therapeutic role in resistant venous anastomotic stenoses.