The lesion-slip phenomenon in vascular access stenosis

Abstract

At present, VAIVT (vascular access intervention therapy), in which a balloon is used to achieve vasodilation, is widely performed for vascular stenosis that occurs in arteriovenous fistulas or arteriovenous grafts in hemodialysis patients. When the balloon cannot be fully expanded at the stenotic lesion during VAIVT, the so-called dog bone change is observed, which might result in incomplete dilation of the lesion and residual stenosis. In this study, we experimentally examined the lesion dynamics at dilation sites for dog bone changes, and whether the blood vessels at the dilation site and in the surrounding tissues gathered together at the time of the balloon dilation, resulting in resistance to balloon dilation. We confirmed that such changes occurred, which we named the lesion-slip phenomenon. In clinical studies, it was suggested that the lesion-slip phenomenon might require dilation to be performed at a higher pressure or might cause vascular dissection or the development of new lesions in the depopulated peripheral areas as a result of the concentration of tissues. The angioplasty vasodilator balloon, which has an inhibitory effect on the lesion-slip phenomenon, might allow the complete dilation of lesion sites at a lower pressure and reduce the risk of vascular injuries.