PMC5240806_01
Angiogram results showing arteriovenous fistula (AVF) stenosis predominantly at the Juxta-Anastomosis Mid-fistula. (A) Angiography showing 70-90% long segment stenosis (arrows) at the Juxta-Anastomosis and Mid-fistula. (B-E) Percutaneous transluminal angioplasty with 8mm x 8cm balloon and increasing pressure from nominal pressure to rated burst pressure of 18 atm (at which full effacement is achieved). (F) AVF showing resolution of the vascular stenosis after angioplasty.
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F2
Retrograde cannulation and AVF angiogram was performed, which showed long stenotic lesions at the juxta anastomotic area and mid fistula (Figure 2). PTA with a 6mm x 4cm followed by an 8mm x 8cm access angioplasty balloons (Bard Peripheral Vascular, Inc.) was performed for all lesions. Post PTA angiogram showed complete resolution of the stenosis (Figure 2) with significant improvement on physical examination, normal pulse and continuous (systolic-diastolic) thrill.
Vascular wall changes and intimal hyperplasia in matched-paired vein and arteriovenous fistula (AVF). Representative of a two-stage brachial-basilic AVF matched-pair. (A-C) vein collected before anastomosis with mild NIH and (D-F) AVF at the time of superficialization with mild to moderate NIH. Sections were (A, D) Hematoxilin and Eosin stained, (B, E) Smooth Muscle cell stained and (C, F) Mason Trichrome stained. Scale bars denote 200mum.
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F3
The loss of medial smooth muscle cell and increased medial fibroses in the AVF wall was noticeable (Figure 3).