**7. Conclusion**

*Cardiac Diseases - Novel Aspects of Cardiac Risk, Cardiorenal Pathology and Cardiac Interventions*

**(%)**

Diagnostic angiography 83 55 45 Angioplasty 92 60 45 Thrombolysis + angioplasty (AVG) 86 51 40

*Primary patency in our VAC at 30, 90, and 180 days, in line with most literature in the field.*

**At 90 days (%)**

**At 180 days (%)**

In intervening in a nAVF, use when available ultrasound localization of stenosis to plan the best place and

In intervening in a AVG, always puncture close to the arterial anastomosis in the direction of the flow toward

Use a 7F sheath and a hydrophilic guide wire. It allows balloons up to 14 mm to be inserted more than once Do not miss any step even when it seems unnecessary. Always check AV anastomosis in nAVFs and arterial

Do not accept incomplete balloon dilation. If necessary, use high-pressure balloons or cutting balloons

In AVG thrombolysis, after dealing with the venous anastomosis, even if the graft is already working, do

Always test flow at the end of a procedure. An eyeball test as the TIMI for cardiologists. If flow does not look

The technical details of all procedures we perform in our VAC are thoroughly

The National Kidney Foundation (KDOQI) guidelines [65] define a successful angioplasty a residual stenosis <30%, with return to acceptable levels of the parameters used to place the indication for angioplasty. Initial success rates using anatomical criteria ranged from 80 to 98%, but in some reports, 20–30% of these patients with anatomical success fail to increase blood flow (residual stenosis, a missed lesion, or elasticity). Primary patency rates are 41–76% at 6 months and 31–45% at 1 year. Long-term primary patency rates for thrombectomy are not as good as for angioplasty; therefore every effort should be made to prevent thrombosis by the

In a thrombosed access, the treatment must be timely to avoid catheters, done as an outpatient, venous stenosis must be detected and corrected, hemodynamic parameters should return to baseline, and patient should be evaluated for a secondary arteriovenous native fistula, created using upper arm veins that have become

In 2019, 139 surgical thrombectomies were performed in 127 patients (69 in nAVF and 70 in AVG). In 49.6%, no new intervention was required, and the average time until a new intervention was 46.7 days. Primary patency at 1 month was 66%, at 3 months 54.4%, and at 6 months 17.5%. In that same period, the angiography suite received 134 patients for 179 procedures (171 in AVGs, 8 with a nAVF), there was immediate success in 159 patients, the average time until a new intervention was 58.1-day, and primary patency at 1 month was 71.6% and at 6 months 42.5%. In our case, Qa average improvement is >50%, and we expect a

described in a recent textbook [63, 64].

approach with a Fogarty the arterial anastomosis

great, it is because there is something else to fix

direction to puncture the access

Avoid stents, only as a last resort

**Table 2.**

**Table 1.**

*Clinical pearls to take home.*

the venous anastomosis

dilated because of the functioning graft.

prospective diagnosis and treatment of venous stenosis.

and venous anastomosis in AVGs, as well as central venous drainage

**Procedures At 30 days** 

**196**

Kt/V above 1.4.

In conclusion, we are still dealing with quite a number of known unknowns. There has been no RCT to elucidate which percentage of lumen compromise should dictate the indication for angioplasty, and most operators choose 50%. Not all stenotic plaques were created equal, and some will never progress, but we cannot guess which ones. We also have no proof that a successful PTA in a graft improves longterm patency rate [14], angiographic criteria to assess the success of angioplasty are not predictive of changes in blood flow, and there is no correlation between changes in blood flow and changes in the percent of stenosis post-PTA [66]. In an era characterized by less is more, under the imperative of being useful for our patients, creating long-term solutions at sustainable costs, we feel a desperate need for robust scientific evidence to support our decision process and the procedures we perform. Just because it can be done, does not mean it should be done, our intervention is no more a question of know-how, but of know-when.
