Can angioplasty help with Dialysis Access Management? [Dr. Spinowitz]

Q: Can angioplasty help with Dialysis Access Management?

A: When you have narrowing of the vein, and sometimes of the artery, the flow will be disturbed. Either you won’t have enough blood flow coming in or you won’t have the ability to have all the blood flow go back out towards the heart. To remedy this situation, we could use angioplasty. Angioplasty is a small balloon that we insert past the area of narrowing. The balloon will then be inflated. After the balloon is inflated for approximately five seconds, we deflate the balloon, remove it, and take a picture to ensure that the vein is back to its original size.

The narrowing that occurs in the venous part of the fistula is usually intimal hyperplasia, which is scar tissue building up. The creation of the fistula is very unnatural. We are asking the body to have your veins act as arteries because now we have arterial flow going through the veins. The veins get irritated and try to scar down to protect themselves. We want the veins to be wide open to allow the blood flow to get past. It is a battle between us and your veins to keep the veins open and allow for adequate blood flow so that your blood can get clean at dialysis.

Angioplasty can, and usually is enough to, improve the blood flow past this area. Just because we do it once doesn’t mean that you will never need angioplasty again. In fact, scar tissue can very frequently return. For every patient it will be a different amount of time; some patients it will take three months, some six months, and some are lucky enough that the scar tissue doesn’t return at all. The angioplasty balloon that we use to open up and expand the areas of stenosis, areas of narrowing, very often will be successful.

However, in the cases that there is an area of elastic recoil lesion, where the force keeps pushing back into the vein, causing the vein to be narrow, we have to place what’s called a stent. A stent is like a spring, almost like on the inside of a ballpoint pen. It is a curved spring made of nitinol that we are able to deploy at the area of narrowing. If the forces are pushing against the vein and making the vein smaller, the stent can actually give structure to the vein and push those forces back. This allows for adequate flow back to the heart.

More videos from the interview with Dr. Spinowitz of the Queens Endovascular Center as he describes the details of Dialysis Access Management:

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