ABSTRACT
The incidence of treated end-stage renal disease (ESRD) in the United States is 180 per million and it continues to rise at a rate of 7.8% per year (1). A majority of patents with ESRD require hemodialysis for survival. In such patients, the creation and maintenance of an arteriovenous (AV) access are two of the most difficult issues associated with their hemodialysis treatment. Hemodialysis vascular access dysfunction is a major clinical problem. Although current options for vascular access include an arteriovenous fistula (AVF), an arteriovenous graft (AVG), a venous catheter, or a totally subcutaneous catheter-based access system, approximately 70% of permanent dialysis vascular access in the United States is a polytetrafluoroethylene (PTFE) AVG. In general, such AVGs have dismal unassisted primary patency rates-50% at 1 year and 25% at 2 years-and require interventions for maintenance of adequate flow (2). Endovascular interventions, including balloon or percutaneous angioplasty (PTA) (intraluminal balloon dilatation), stent deployment (placement of a self-expanding or balloon expandable stent), pharmacological thrombolysis (catheter-directed infusion of thrombolytic agents), mechanical thrombolysis and thrombectomy (fragmentation, maceration, or mobilization of thrombus by mechanical means or devices), and pharmacomechanical thrombolysis (mechanical disruption of thrombus by fragmentation, maceration, or mobilization accompanied by catheter-directed administration of an agent that results in pharmacological thrombolysis) are the current standards of practice for AV access maintenance.
