Abstract
Objective
To compare the efficacy and safety of ultrasound-guided sharp recanalization (USR) with those of conventional percutaneous transluminal angioplasty (PTA) in the treatment of venous valve-related stenosis (VVRS) in arteriovenous fistulas (AVFs).
Methods
This single-center retrospective cohort study included patients treated between January 2023 and June 2024. Seventy-eight patients met the inclusion criteria; after excluding 13 patients lost to follow-up, 65 were analyzed (USR n = 33; PTA n = 32). One-to-one propensity score matching generated 32 matched pairs (USR n = 32; PTA n = 32). The primary outcome was 12-month primary patency; secondary outcomes included technical success, time to restenosis, and complications.After propensity score matching, 32 matched pairs were analyzed.
Results
In the matched cohort, 12-month primary patency was higher with USR than with PTA (62.5% vs. 25.0%; HR = 0.36, 95% CI 0.18–0.70; P = 0.002). Mean time to restenosis was longer in the USR group (8.25 ± 3.42 vs. 4.48 ± 2.87 months; P = 0.021). Complications were not significantly different between groups (USR 11/32 vs. PTA 5/32), and none required open surgical intervention.
Conclusion
USR may improve 12-month primary patency in VVRS compared with PTA without an observed increase in complications. Larger multicenter prospective studies are needed to confirm these findings.
Keywords: Rteriovenous fistula, Venous valve stenosis, Sharp recanalization, Ultrasound-guided intervention, Percutaneous transluminal angioplasty
Introduction
Arteriovenous fistula (AVF) is the “lifeline” for hemodialysis in patients with end-stage renal disease (ESRD) [1, 2]. Advanced age, hypertension, diabetes, repeated punctures, and long-term medication use contribute to a high incidence of AVF stenosis. Effective vascular access is essential for adequate dialysis, and stenosis remains the most common cause of access dysfunction [3, 4]. Among AVF stenoses, venous valve-related stenosis (VVRS) is a distinct and underrecognized pathology that can lead to access dysfunction [5]. Importantly, VVRS differs from intimal-hyperplasia–driven stenosis; the key issue is valve-structure–related recoil after balloon deflation, which may limit the durability of PTA alone [5].Conventional PTA often yields suboptimal durability in VVRS because the thickened valve base and mobile leaflets can recoil immediately after balloon deflation, resulting in early restenosis and repeated interventions [5, 6]. Currently, there is no established treatment for complex, refractory VVRS, and the evidence is limited to small studies or case series [7].
Sharp recanalization creates a controlled channel using a puncture needle or a stiff-tipped guidewire to cross otherwise uncrossable refractory stenotic or occlusive lesions [8–10]. Its application has expanded in recent years, particularly for central venous occlusions (CVOs), with reported technical success rates exceeding 90% [1, 11–15]. However, its application in venous valve-related stenosis (VVRS) remains rarely reported.Given the rarity of VVRS and the challenges of conducting prospective randomized trials, we performed a retrospective cohort study comparing ultrasound-guided sharp recanalization (USR) with percutaneous transluminal angioplasty (PTA) for AVF-related VVRS.
Materials and methods
Study design
This single-center, retrospective cohort study was approved by the Ethics Committee of Chengdu Integrated Traditional Chinese and Western Medicine Hospital (No. 2024-KT-023).
Study population
Consecutive AVF-VVRS patients from January 2023 to June 2024 were identified in the database. Physical examination revealed a reduced or absent thrill and low dialysate flow. All cases were confirmed by duplex ultrasound.
VVRS was diagnosed on duplex ultrasound as a valve-centered focal stenosis characterized by thickened venous valve/valve base, often with a membranous component and/or a mobile leaflet element protruding into the lumen; color Doppler shows focal acceleration with aliasing, and spectral Doppler demonstrates increased velocity (with elevated resistance indices when applicable) [5]. These features help distinguish VVRS from intimal hyperplasia (IH), which typically presents as non–valve-centered concentric wall thickening without a membranous/valvular structure or mobile leaflet component. Figure 1A–B illustrate the stenotic lesion.Ultrasound assessment process: All ultrasound examinations were performed using a standardized protocol. VVRS classification and stenosis measurements were confirmed by a second reviewer who was blinded to treatment group whenever feasible.
Fig. 1.
Technical procedure of ultrasound-guided sharp recanalization for valve-related stenosis in arteriovenous fistulas (A-F). A: Ultrasonographic B-mode image demonstrating valve-related stenosis. B: Ultrasonographic color Doppler image illustrating valve-related stenosis. C: Schematic representation of sharp intraoperative dissection. D: Ultrasound-guided sharp incision of the valve using a puncture needle. E: Penetration of the intraluminal solid structure (venous valve) via a sharp device. F: Restoration of luminal patency following valve body incision/tearing, with improved hemodynamics and a remodeled flow channel
Inclusion and exclusion criteria
The inclusion criteria were as follows: (1) presence of a mature autogenous AVF for ≥ 4 weeks (defined as successful routine two-needle cannulation for hemodialysis with adequate prescribed blood flow prior to VVRS diagnosis); (2) ultrasound-confirmed VVRS (luminal stenosis ≥ 50% and peak systolic velocity ratio ≥ 2.5); (3) USR or PTA as the first intervention; and (4) ≥ 12 months of follow-up.
The exclusion criteria were as follows: (1) lower extremity AVF; (2) acute thrombosis; (3) active infection; and (4) loss to follow-up.
Propensity score matching
One-to-one nearest-neighbor matching was performed on the basis of age, sex, dialysis vintage, and stenosis percentage (caliper = 0.2), yielding 32 matched pairs.
Prior failed PTA was defined as restenosis at the same lesion location within 3 months after PTA.
Procedural technique
USR: venous access via the fistula vein; under real-time ultrasound guidance, an 18-G sharp needle penetrates the valve body. After channel creation, a 0.035-inch guidewire was advanced, and high-pressure balloon (≥ 18 atm) dilation was completed to disrupt the valve.
PTA: standard balloon angioplasty, balloon-to-vessel diameter ratio of 1.1–1.2, inflation pressure of 12–20 atm.
Definitions
Technical success was defined as successful crossing and treatment of the target lesion with restoration of luminal patency and < 30% residual stenosis on immediate post-procedure imaging, without the need for immediate surgical conversion. Complications were recorded per patient during the index procedure and within 30 days.
All procedures in both the USR and PTA groups were performed by the same specialized clinical team, which consisted of three senior interventionalists with extensive experience in vascular access intervention. To ensure technical consistency and mitigate the potential impact of the learning curve or individual operator bias on the study outcomes, patients were assigned to these three operators randomly.
Postprocedural Follow-up
Duplex ultrasound was scheduled at 1, 3, 6, and 12 months to assess restenosis, thrombosis, and dialysis flow.The 3-month follow-up interval was determined based on recommendations from relevant clinical guidelines, together with our institutional clinical practice and experience [16].This frequency also represents the standard surveillance protocol at our institution to detect early restenosis and guide timely reintervention.
Statistical analysis
Continuous variables are expressed as the means ± SDs or medians (IQRs); categorical variables are expressed as percentages. Comparisons were performed via t tests, Mann‒Whitney U tests, or χ² tests. Survival analyses employed Kaplan‒Meier curves and Cox proportional hazards regression, reporting hazard ratios (HRs) with 95% confidence intervals (CIs). Two-sided P < 0.05 indicated statistical significance. All analyses were performed according to the initial treatment strategy (intention-to-treat). Python 3.11 was used for all analyses.
Results
Baseline characteristics
Seventy-eight patients fulfilled the criteria. After 13 patients who were lost to follow-up were excluded, 65 patients were analyzed (USR = 33, PTA = 32). After propensity score matching, 32 matched pairs were included (USR = 32, PTA = 32), and baseline variables were well balanced (all P > 0.05; Table 1). Within this matched USR cohort, 14 patients had a history of prior failed PTA at the target VVRS lesion, defined as restenosis within 3 months at the same location.
Table 1.
Patient baseline characteristics
| Variable | PTA Group (Mean ± SD) |
USR Group (Mean ± SD) |
P value |
|---|---|---|---|
| Age (years) | 59.59 ± 8.23 | 57.59 ± 10.45 | 0.39 |
| Gender | 0.47 | ||
| Male | 23 | 20 | |
| Female | 9 | 12 | |
| BMI | 22.66 ± 3.12 | 22.84 ± 3.45 | 0.73 |
| Dialysis vintage (months) | 64.63 ± 15.21 | 62.21 ± 14.78 | 0.52 |
| Stenosis rate (%) | 83.79 ± 9.56 | 83.58 ± 10.32 | 0.93 |
Technical success and complications
The technical success rate was 100% in the USR group and 96.9% in the PTA group; one case in the PTA group crossed over to USR after failure to achieve lesion crossing. All analyses were performed according to the initial treatment assignment.The overall complication rate did not differ significantly between the groups (15.6% vs. 34.4%, P = 0.15) (Table 2).
Table 2.
Technical success and complication rates
| Variable | PTA Group | USR Group | P value |
|---|---|---|---|
| Pain | 3 (9.4%) | 6 (18.8%) | 0.47 |
| Puncture-site bleeding | 1 (3.1%) | 2 (6.2%) | 1.00 |
| Venous rupture/swelling | 2 (6.2%) | 4 (12.5%) | 0.67 |
| Thrombosis | 0 (0.0%) | 1 (3.1%) | 1.00 |
| Technical Success | 96.9% (31/32) | 100% (32/32) | 1.00 |
| Complications | 15.6% (5/32) | 34.4% (11/32) | 0.15 |
Note: Complications are reported per patient. A patient could experience more than one complication; therefore, the sum of individual complications may exceed the number of patients with any complication
Primary patency
USR demonstrated superior 12-month primary patency (62.5% vs. 25.0%; HR = 0.36, 95% CI 0.18–0.70, P = 0.002) (Table 3; Fig. 2).
Table 3.
Primary patency rates at the stenosis site
| Time Point | PTA Group | USR Group | P value |
|---|---|---|---|
| 1 month | 96.88% | 100% | 0.49 |
| 3 months | 65.62% | 96.88% | 0.001 |
| 6 months | 37.50% | 84.38% | < 0.0001 |
| 12 months | 25.00% | 62.50% | 0.002 |
Fig. 2.
Kaplan‒Meier curves comparing primary patency rates between the PTA and USR groups
Restenosis and morphological subgroups
The mean time to restenosis was 8.25 ± 3.42 months in the USR group and 4.48 ± 2.87 months in the PTA group (P = 0.021). Analyses of recurrence time and its association with baseline stenosis severity were restricted to patients who developed restenosis during follow-up. Higher baseline stenosis (> 85%) predicted earlier recurrence; this association remained present in both groups; whether USR modifies the effect of stenosis severity requires stratified or interaction analyses in larger cohorts (Tables 4 and 5).
Table 4.
Time to recurrence
| Group | N | Recurrence Time (months, Mean ± SD) | P value |
|---|---|---|---|
| PTA Group | 23 | 4.48 ± 2.87 | 0.021 |
| USR Group | 12 | 8.25 ± 3.42 |
Note: P < 0.05 indicates statistical significance
Note: N represents patients who developed restenosis during follow-up (event cases only)
Table 5.
Spearman correlation analysis: stenosis rate vs. recurrence time
| Group | N | ρ (95% CI) | P value |
|---|---|---|---|
| PTA Group | 23 | -0.412 (-0.692, -0.032) | 0.047 |
| USR Group | 12 | -0.581 (-0.853, -0.142) | 0.048 |
| Total | 35 | -0.503 (-0.721, -0.221) | 0.002 |
Note: P < 0.05 indicates statistical significance
N represents patients who developed restenosis during follow-up (event cases only)
Discussion
Clinical dilemma of VVRS
In our clinical workflow, the choice between USR + PTA and PTA alone was primarily guided by duplex ultrasound assessment of lesion etiology. When ultrasound demonstrated a typical valve-related stenosis pattern—i.e., stenosis centered at a venous valve site with a mobile echogenic leaflet protruding into the lumen “floating leaflet”, focal narrowing at the valve base, and color Doppler aliasing/turbulence suggesting a recoil-prone obstruction—we preferentially selected USR as an adjunct to balloon angioplasty to disrupt the valve/leaflet complex and reduce immediate elastic recoil. In contrast, lesions without valve-centered morphology and without leaflet mobility more consistent with intimal hyperplasia were generally treated with standard PTA as first-line endovascular therapy.
Prior treatment history also informed escalation. In the USR group, 14 patients had a documented history of prior failed PTA at the same VVRS site. In this study, PTA failure was defined as restenosis at the same lesion location within 3 months after PTA. These patients were considered to have a higher likelihood of early recurrence or inadequate luminal gain with repeated balloon angioplasty alone, and thus were managed with USR + PTA as an escalation strategy. From a broader management perspective, open surgical options (e.g. revision or valve-related surgical correction) remain important when endovascular patency cannot be maintained, and we view USR + PTA as a step-up option within a multidisciplinary algorithm rather than a replacement for surgery.
Although the incidence of arteriovenous fistula (AVF) valve-related stenosis (VVRS) is low, it is an important cause of access failure [5]. Current reports on the treatment of VVRS are scarce. Drug-coated balloons (DCBs) have shown good efficacy for non-VVRS lesions [17]. This study highlights the significant limitations of conventional PTA in treating lesions with thickened valve bases and floating leaflets. The immediate valve recoil after balloon withdrawal leads to recurrent luminal obstruction under the impact of blood flow, creating a “dilation‒recoil” cycle that fails to alleviate stenosis. The 12-month primary patency rate for the conventional PTA group was only 25.0%, with a mean recurrence time of 4.48 months, which is highly consistent with previous literature [7]. These findings suggest that PTA alone struggles to maintain sustained vascular remodeling and often requires repeated procedures. However, these results differ significantly from those of Suemitsu [18], who reported that PTA alone was effective for treating valve-like stenosis, resulting in superior 6-month primary patency compared with the intimal hyperplasia and luminal contraction types. The ultrasound morphology of the valve-like stenosis in Suemitsu’s study (anterior and posterior walls gathering toward the lumen) differed from the “floating leaflet” type observed here. This morphological difference might explain the heterogeneity in efficacy and warrants further investigation.
Technical advantages and efficacy of sharp recanalization
Sharp recanalization employs a three-step process—“puncture-tearing-high-pressure balloon assistance”—to physically destroy valve integrity, converting the elastic recoil structure into an irreversible fissure and thereby eliminating the stenotic barrier. While the application of sharp recanalization has been frequently reported in the peripheral and central veins [19–21], most existing evidence focuses on the pulmonary artery and aortic stenosis [22, 23], with limited reports on its safety and long-term outcomes in other valvular pathologies. Sharp recanalization often serves as a safe salvage strategy after conventional PTA failure, with minor complications. Reports by Xu [24] suggest that sharp needles play an important role in reconstructing peripheral outflow tracts. Combining sharp needles with PTA can enable minimally invasive reconstruction of outflow tracts, offering a new strategy for lesions resistant to conventional dilation. Our findings are consistent with Xu’s results. This study demonstrated that sharp recanalization improved the 12-month primary patency rate to 62.5% and extended the recurrence time to 8.25 months, significantly outperforming PTA. We propose that the mechanisms of sharp recanalization may include the following: (1) real-time ultrasound guidance ensures accurate needle penetration of the valve body, avoiding excessive vascular wall damage through precise targeting; (2) the synergistic effect of sharp cutting and high-pressure balloon dilation, rendering the valve incompetent and definitively resolving stenosis; and (3) immediate restoration of laminar flow, reducing the risk of shear stress-induced neointimal hyperplasia. These results align with the > 90% success rate reported by Chen et al. [14] for central venous occlusions, suggesting that the sharp recanalization strategy is also applicable to peripheral VVRS.
Safety profile of sharp recanalization
Both sharp recanalization and conventional PTA exhibit high success rates and safety profiles in treating vascular stenosis or occlusion [21, 25, 26]. The overall complication rates observed in our study were consistent with previous findings, and no statistically significant difference was found between the two groups. The complications were predominantly minor and included pain, puncture site bleeding, venous rupture, and local swelling. No severe events, such as acute AVF occlusion, limb ischemia, or infection, occurred. Under continuous ultrasound monitoring, the process of needle cutting of the valve can be observed in real time, confirming that the safety of sharp recanalization is comparable to that of conventional PTA [27].
Limitations and future perspectives
This study is a single-center investigation with a small sample size. Since the selection was limited to high-grade valve-like stenosis, potential selection bias may exist. Furthermore, the follow-up period was only 12 months; a longer period is needed to verify long-term patency and valve remodeling. Although propensity score matching was performed to balance key baseline characteristics, residual confounding may remain. In particular, prior failed PTA history was not included in the matching model, and in routine practice USR may have been selected as a step-up strategy in some patients, which could have influenced comparisons of patency outcomes. Additionally, the discrepancy between our study and that of Suemitsu might be related to differences in valve morphology. However, the study did not include stratified analyses based on morphological characteristics such as valve thickness and angle, and it did not formally test whether USR modifies the effect of baseline stenosis severity using stratified or interaction analyses. The analyses of recurrence time and its association with stenosis severity were limited to patients who developed restenosis, which may reduce generalizability. Subsequent studies could incorporate IVUS and 3D ultrasound to further refine patient characteristics. Future multicenter, prospective randomized controlled trials are warranted. Maclean [28] reported that combining sharp recanalization with thrombolytics and direct thrombin inhibitors could increase recanalization rates from less than 30% to 50% and reduce rethrombosis. This suggests that for patients with valve stenosis complicated by thrombosis, sharp recanalization should be combined with antithrombotic therapy to optimize outcomes. Additionally, Russo [29] emphasized that individualized anatomy in calcified lesions might increase procedural difficulty, necessitating personalized device and strategy selection. Therefore, future research will explore the synergistic effects of combining sharp recanalization with drug-coated balloons or bioabsorbable stents to achieve personalized and precise treatment for VVRS. Finally, open surgical options remain an important component of VVRS management. In patients with recurrent restenosis or inadequate luminal gain after endovascular therapy, surgical valve excision and segmental reconstruction or revision can be considered as complementary salvage strategies within a multidisciplinary pathway.
Conclusion
Ultrasound-guided sharp recanalization may improve mid-term patency in VVRS compared with PTA, without an observed increase in complications. Larger multicenter prospective studies are needed to confirm these findings and to explore combination strategies with drug-coated technologies.
Acknowledgements
Not applicable.
Abbreviations
- USR
Ultrasound-guided sharp recanalization
- PTA
Percutaneous transluminal angioplasty
- VVRS
Venous valve-related stenosis
- AVFs
Arteriovenous fistulas
- ESRD
End-stage renal disease
- VVRS
Venous valve-related stenosis
- CVOs
Central venous occlusions
- IH
Intimal hyperplasia
- HRs
Hazard ratios
- CIs
Confidence intervals
- AVF
Arteriovenous fistula
- DCBs
Drug-coated balloons
Author contributions
All authors have read and approved the manuscript. Y.H. and H.D. conceived the research project, critically revised the manuscript for important intellectual content, and approved the final version. Y.H. and Y.L. supervised the research work. Z.Z. and S.P. collected and managed the data, and contributed to drafting the Methods section. S. R. and Y.L. performed the data analysis, interpreted the data, and drafted the remaining sections of the manuscript.
Funding
This work was supported by the “2023 Nephrology-Hemodialysis Special Project” of the Chengdu High-Tech Zone Medical Association (Grant No. 202303).
Data availability
The raw data supporting the conclusions of this article will be made available by the authors without undue reservation.
Declarations
Ethics approval and consent to participate
This study was approved by the Ethics Committee of Chengdu Integrated Traditional Chinese and Western Medicine Hospital (No. 2024-KT-023) and complied with the Declaration of Helsinki. Informed consent was obtained from all participants. The study’s purpose and significance were explained to the participants who met the inclusion criteria. Participants were informed that they could withdraw from the study at any time without affecting their treatment plan, should they wish to do so. All methods were carried out in accordance with relevant guidelines and regulations aligned with the Declaration of Helsinki.
Consent for publication
All authors reviewed the draft and approved the final version for submission.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Yi Hu and Heli Duan contributed equally to this work.
References
- 1.Vachharajani TJ, Taliercio JJ, Anvari E. New devices and technologies for Hemodialysis vascular access: A review. Am J Kidney Dis. 2021;78(1):116–24. [DOI] [PubMed] [Google Scholar]
- 2.Malovrh M. Approach to patients with end-stage renal disease who need an arteriovenous fistula. Nephrol Dial Transpl. 2003;18(Suppl 5):v50–2. [DOI] [PubMed] [Google Scholar]
- 3.Allon M. Vascular access for Hemodialysis patients: new data should guide decision making. Clin J Am Soc Nephro. 2019;14(6):954–61. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Kukita K, Ohira S, Amano I, Naito H, Azuma N, Ikeda K, Kanno Y, Satou T, Sakai S, Sugimoto T, et al. 2011 update Japanese society for Dialysis therapy guidelines of vascular access construction and repair for chronic Hemodialysis. Ther Apher Dial. 2015;19(Suppl 1):1–39. [DOI] [PubMed] [Google Scholar]
- 5.Chen B, Chen L, Yang Q, Gao X, Lai Q, Tu B, Wan Z. Long-Term efficacy of Ultrasound-Guided percutaneous transluminal angioplasty for arteriovenous fistula outflow stenosis caused by venous valve. Kidney Dis-Basel. 2024;10(2):89–96. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Xiong Y, Gao X, Cui L, Lyu Q, Tu B, Chen B, Wan Z. Assessment of sonographic parameters for predicting primary patency rate in hemodialysis patients with venous valve-related stenosis. J Endovasc Ther. 2024;779335576. [DOI] [PubMed]
- 7.Ma X, Chen J, Yang T, Gao L, Xia Y. Treatment strategies for refractory Catheter-Related central venous occlusive disorders: review. Hemodial Int. 2025;29(3):255–61. [DOI] [PubMed] [Google Scholar]
- 8.Fitzgerald KM, Newell KR, Shin DS, Monroe EJ, Abad-Santos M, Bertino F, Sailer A, Chick JFB. Thoracic central vein obstruction endovascular recanalization and reconstruction. Radiographics. 2025;45(11):e240178. [DOI] [PubMed] [Google Scholar]
- 9.Rinfret S, Henry GA, Khatri JJ, Mashayekhi K, Alaswad K, Azzalini L, Ybarra LF, Vijayaraghavan R, Frizzell JD, Avran A, et al. Knuckle guidewires to create dissections in chronic total occlusion percutaneous coronary intervention: position statement. Jacc-Cardiovasc Inte. 2024;17(20):2411–24. [DOI] [PubMed] [Google Scholar]
- 10.Patel JD, Mandhani M, Gray R, Pettus J, Mccracken CE, Thomas A, Bauser-Heaton H, Kim DW, Petit CJ. Transcatheter recanalization of atretic pulmonary veins in infants and children. Circ-Cardiovasc Inte. 2022;15(6):e011351. [DOI] [PubMed] [Google Scholar]
- 11.Silbiger JJ. Mitral annular calcification and calcific mitral stenosis: role of echocardiography in hemodynamic assessment and management. J Am Soc Echocardiog. 2021;34(9):923–31. [DOI] [PubMed] [Google Scholar]
- 12.Noh SY, Goo DE, Kim YJ, Yang SB, Lee JM, Lee WH. Sharp needle recanalization technique for peripheral Hemodialysis arteriovenous fistula occlusion. Cardiovasc Inter Rad. 2021;44(11):1809–16. [DOI] [PubMed] [Google Scholar]
- 13.Chen B, Lin R, Dai H, Li N, Tang K, Yang J, Huang Y. Sharp recanalization for treatment of central venous occlusive disease in Hemodialysis patients. J Vasc Surg-Venous L. 2022;10(2):306–12. [DOI] [PubMed] [Google Scholar]
- 14.Rizk T, Gayed A, Stringfellow S, Younan Y, Yamada R, Guimaraes M. Review of Sharp recanalization techniques in central venous occlusions. Cardiovasc Inter Rad. 2024;47(12):1626–41. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Sohail MA, Vachharajani TJ, Anvari E. Central venous catheters for Hemodialysis-the myth and the evidence. Kidney Int Rep. 2021;6(12):2958–68. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Lok CE, Huber TS, Lee T, Shenoy S, Yevzlin AS, Abreo K, Allon M, Asif A, Astor BC, Glickman MH, et al. KDOQI clinical practice guideline for vascular access: 2019 update. Am J Kidney Dis. 2020;75(4 Suppl 2):S1–164. [DOI] [PubMed] [Google Scholar]
- 17.Kundu S. Review of central venous disease in Hemodialysis patients. J Vasc Interv Radiol. 2010;21(7):963–8. [DOI] [PubMed] [Google Scholar]
- 18.Suemitsu K, Shiraki T, Iida O, Oka K, Ota N, Izumi M. Ultrasound-assessed lesion morphology and drug-coated balloon treatment for de novo dysfunctional arteriovenous fistula in hemodialysis patients. J Endovasc Ther. 2023;769280121. [DOI] [PubMed]
- 19.Suemitsu K, Shiraki T, Iida O, Kobayashi H, Matsuoka Y, Izumi M, Nakanishi T. Impact of lesion morphology on durability after angioplasty of failed arteriovenous fistulas in Hemodialysis patients. J Endovasc Ther. 2018;25(5):649–54. [DOI] [PubMed] [Google Scholar]
- 20.Yin X, Shen X, Zhou Z, Chen Q, Zhou L, Cui T. Efficacy and safety of recanalization with transseptal needle for chronic total occlusion of the brachiocephalic vein in Hemodialysis patients. Ann Transl Med. 2020;8(18):1141. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Mcdevitt JL, Srinivasa RN, Gemmete JJ, Hage AN, Srinivasa RN, Bundy JJ, Chick JFB. Approach, technical Success, Complications, and stent patency of Sharp recanalization for the treatment of chronic venous occlusive disease: experience in 123 patients. Cardiovasc Inter Rad. 2019;42(2):205–12. [DOI] [PubMed] [Google Scholar]
- 22.Korosoglou G, Schmidt A, Lichtenberg M, Torsello G, Grozinger G, Mustapha J, Varcoe RL, Zeller T, Blessing E, Langhoff R. Crossing algorithm for infrainguinal chronic total occlusions: an interdisciplinary expert opinion statement. Jacc-Cardiovasc Inte. 2023;16(3):317–31. [DOI] [PubMed] [Google Scholar]
- 23.Adhikari R, Shiwakoti S, Ko J, Dhakal B, Park S, Choi IJ, Kim HJ, Oak M. Oxidative stress in calcific aortic valve stenosis: protective role of natural antioxidants. Antioxidants-Basel. 2022;11(6). [DOI] [PMC free article] [PubMed]
- 24.Xu Y, Zhu S, Li Y, Liu X, Zhang H, Wang L. Sharp needle reconstructs peripheral outflow for patients with malfunctional arteriovenous fistula. Ren Fail. 2024;46(1):2353351. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Dammers R, de Haan MW, Planken NR, van der Sande FM, Tordoir JH. Central vein obstruction in Hemodialysis patients: results of radiological and surgical intervention. Eur J Vasc Endovasc. 2003;26(3):317–21. [DOI] [PubMed] [Google Scholar]
- 26.Yu H, Chi Y, Wang B. The efficacy of percutaneous transluminal angioplasty and arteriovenous fistula reconstruction for immature arteriovenous fistula. Bmc Nephrol. 2023;24(1):304. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.Hu Y, Zhang T, Fang W, Wei M, Luo Y, Liu Y. Application of Ultrasound-Guided stent placement in the treatment of autologous arteriovenous fistula stenosis. Chin J Ultrasound Med. 2025;41(10):1191–4. [Google Scholar]
- 28.Maclean JAA, Tomkins AJ, Sturgeon SA, Hofma BR, Alwis I, Samson AL, Schoenwaelder SM, Jackson SP. Development of a carotid artery thrombolysis stroke model in mice. Blood Adv. 2022;6(18):5449–62. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 29.Russo G, Tang GHL, Sangiorgi G, Pedicino D, Enriquez-Sarano M, Maisano F, Taramasso M. Lifetime management of aortic stenosis: transcatheter versus surgical treatment for young and Low-Risk patients. Circ-Cardiovasc Inte. 2022;15(11):915–27. [DOI] [PubMed] [Google Scholar]
Associated Data
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Data Availability Statement
The raw data supporting the conclusions of this article will be made available by the authors without undue reservation.