Novel technique for arteriovenous fistula stenosis using a nitinol-caged balloon: a case report

Introduction and Importance: End-stage renal disease patients rely heavily on arteriovenous fistulas (AVFs) for hemodialysis access, but vascular access-related complications such as stenosis frequently compromise long-term patency. Percutaneous transluminal angioplasty (PTA) remains the primary intervention, yet resistant lesions pose significant clinical challenges. Case Presentation: This case report describes the use off-label of a nitinol-caged balloon (NCB) for treating refractory AVF stenosis that remains unresponsive to standard high-pressure angioplasty. An 85-year-old patient with a juxta-anastomotic stenosis underwent initial balloon dilation with conventional and drug-eluting balloons, which failed to achieve sustained patency. Subsequently, the NCB was employed, providing uniform and controlled expansion while minimizing vascular trauma. The procedure successfully resolved the stenosis, with the patient maintaining long-term fistula patency at 1-year follow-up and no complications. Clinical Discussion: The patency of an AVF is vital for dialysis patients, but stenosis and occlusion are common complications often caused by neointimal hyperplasia. Standard balloon angioplasty is the first-line treatment; however, resistant cases may benefit from high-pressure or ultra-high-pressure balloons. The NCB device has shown promise for refractory stenosis. Conclusion: These findings suggest that the NCB may offer a promising alternative for managing resistant AVF stenosis, potentially reducing restenosis rates and preserving vascular access. Further studies are warranted to validate its efficacy and safety in larger patient cohorts.