Percutaneous ecoguided endovascular lithotripsy to recruit failed-to-mature arteriovenous fistula due to completely calcified radial artery.

The first-choice vascular access for starting dialysis is autogenous distal forearm arteriovenous-fistula (AVF); the increasing demand to create more fistulas may lead to their creation in borderline vessels and, in this setting, the early failure (EF) and failure of maturation (FTM) remain the main issues. The size of vessels or preexisting stenotic lesions of artery or vein are no longer considered absolute exclusion criteria for the creation of distal AVF, but huge arterial calcification still represents an indication to create upper arm AVF. A novel approach to treat arterial calcifications is represented by intravascular lithotripsy (IVL).

CEUS-guided PTA on stenotic AVF: Morphological and functional point of view.

Background: Stenosis represents the main cause of hemodialysis fistula malfunction. The ultrasound-guided angioplasty with ecographic contrast (CEUS) could provide further advantages to the classical ultrasound guided method improving the morphological characterization of the stenosis and providing quantitative data with the creation of time intensity curves (TIC) collecting functional data comparable between pre and post procedure.

Methods: A total of 10 CEUS-guided angioplasties were performed on malfunctioning fistulas.