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A thrombosed dialysis access can be declotted either through an open surgical procedure or a percutaneous one. In choosing how the access should be managed, a nephrologist should balance the experience and outcomes of local providers to ensure the efficient and safe salvage of the vascular access. Percutaneous procedures often offer less disruption to the schedule of the patient and dialysis clinic, give more information about the central vasculature, are less invasive, and ultimately are preferred. Nephrologist should encourage local vascular surgeons and interventional radiologists to become proficient in these procedures to avoid unnecessary open cases., (© 2016 Wiley Periodicals, Inc.)

Vascular access dysfunction is a major source of morbidity for end-stage renal disease patients on hemodialysis. The arteriovenous graft is a common access type for many of these patients. Frequent stenosis formation and thrombosis complicate this form of access. Patients may have a rapidly forming and recurrent venous stenosis at the graft-vein anastomosis that has been seen in both animal models and end-stage renal disease patients to be the result of neointimal hyperplasia. This venous lesion is particularly resistant and sometimes intractable to conventional angioplasty. As a result, new therapies have been developed to reduce the formation and/or recurrence of neointimal hyperplasia. These include special cutting balloons, drug-eluting stents, and endovascular brachytherapy. The authors present the cases of 5 patients with rapidly recurrent venous lesions at the graft-vein anastomosis that derived benefit from angioplasty with the cryoballoon. The time to stenosis or thrombosis in the arteriovenous grafts was increased from a mean of 3 weeks to more than 16 weeks with this technology. Cryotherapy with the cryoballoon (cryoplasty) may represent a useful therapy for patients with intractable stenoses at or near the venous anastomosis of arteriovenous grafts.