CVIR’s September issue has a special focus on dialysis access interventions curated by three world-renowned experts in the field: Kiang Hiong Tay, Scott Trerotola and Bien Soo Tan.
This special section provides a clinical review of the current hot topics in the dialysis access creation and management arena and also revisits traditional topics with updates from experts in the field.
We sat down with the guest editors to find out more on this project.
CIRSE: How did you choose which topics within dialysis access creation and management to focus on?
Bien Soo: The three guest editors met together virtually and debated on which key topics IRs should be updated on in 2023, bearing in mind foundational as well as emerging issues.
CIRSE: To Prof. Kiang Hiong – how did you become involved in the paper on role of drug-coated balloon in haemodialysis arteriovenous fistula stenosis management included in the series? What would you like to highlight to readers about its contents?
Kiang Hiong: Our centre conducted a randomised control trial (RCT) comparing DCB versus conventional angioplasty for treatment of haemodialysis arteriovenous fistula stenosis, (DEBAPTA trial, Radiology 2018; 289(1):238-247) and performed a patient level meta-analysis of RCTs comparing DCB vs conventional angioplasty in dysfunctional haemodialysis access (EJVES 2021; 62(4):610-621), so I was quite happy to be involved in writing a review paper on this topic.
While early studies have suggested DCB angioplasty is better than conventional angioplasty, large scale RCTs have had mixed results. The review paper dove deep into the major RCTs to distil the differences between the various trials as well as highlight factors that could explain why some RCTs are positive while others are negative. I hope readers will be better informed after reading the review and take home salient points that can help them optimize patient outcomes when using DCBs for management of haemodialysis arteriovenous fistula stenosis.
CIRSE: What are some of the highlights from this series?
Scott: Both papers I co-authored address areas of haemodialysis access intervention we feel are less well understood by IR MDs. Knowing something about alternative options, in this case surgical ones, is essential to being a good consultant and knowing when to refer. There is increasing recognition, including a large series from our group soon to be published in JVIR, that this is an area where IRs have a lot to offer, yet many IRs are unaware of it.
Bien Soo: I would advise the reader to soak in all the other nine equally wonderfully written reviews, they are all important
CIRSE: If given an opportunity to expand on this special selection in the future, what would you like to moderate, add, or emphasize?
Bien Soo: We would have liked to include dialysis catheters, but this topic would have been too wide for one special issue, perhaps a part two is something to think about.
Scott: As Bien Soo said, adding catheters and other HD related interventions such as PD catheter placement and management would be a natural extension.
CIRSE: How do you see the future of dialysis access creation and management? What could motivate young IRs to specialise in dialysis access creation and management?
Bien Soo: This area of intervention will definitely grow, and IRs have a unique opportunity to continue to expand in this arena, but only if we are immersed in all aspects of dialysis intervention, keep up with the knowledge, get involved in the clinical management, and lead the research.
Scott: This is an area of great opportunity; yet, for decades it has languished as something IR MDs do yet don’t seem to get excited about, with some obvious exceptions (such as the present company!). Recognizing that we have so much to offer to an underserved population should be enough to inspire any IR at any age. The growth of the technology will only make this area more and more appealing.
Please enjoy this special section and share it with your colleagues!
Dialysis Access Creation and Management: A Clinical Paradigm
Kiang Hiong Tay, Scott O. Trerotola & Bien Soo Tan
Percutaneous Creation of Hemodialysis Fistulas
Dheeraj K. Rajan
Management of Immature Arteriovenous Fistulas
Jinoo Kim, Yohan Kwon, Tae Won Choi & Je Hwan Won
Dialysis Access Maintenance: Plain Balloon Angioplasty
Lakshmi Ratnam, Narayan Karunanithy, Leto Mailli, Athanasios Diamantopoulos & Robert A. Morgan
The Role of Drug-Coated Balloon in Haemodialysis Arteriovenous Fistula Stenosis Management
Kun Da Zhuang, Farah Gillan Irani, Apoorva Gogna, Chow Wei Too, Bien Soo Tan & Kiang Hiong Tay
Hemodialysis Access Stent Graft Trials: Past, Present, and Future
Ziv J Haskal & Bart L. Dolmatch
Management of Thrombosed Dialysis Access Circuits
Geert Maleux
Dialysis Access-Associated Steal Syndrome and Management
Jordan B. Stoecker, Xin Li, Timothy W. I. Clark, Mark P. Mantell, Scott O. Trerotola & Ansar Z. Vance
Management of Central Venous Stenoses and Occlusions
Panagiotis Kitrou, Konstantinos Katsanos & Dimitrios Karnabatidis
Surgical Referral for Hemodialysis Access Maintenance
Xin Li, Mark D. Mantell & Scott O. Trerotola
