CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A terapia de reperfusÃo coronariana com angioplastia coronariana transluminal percutÃnea e colocaÃÃo de stent constitui, atualmente, o tratamento preferencial ao paciente acometido por infarto agudo do miocÃrdio. No perÃodo pÃs-angioplastia, o paciente infartado exige cuidados da equipe de enfermagem peculiares devido ao comprometimento cardÃaco e dependÃncia fÃsica. A identificaÃÃo dos diagnÃsticos de enfermagem direciona as aÃÃes de enfermagem assistidas e delegadas pelo enfermeiro. O objetivo do estudo foi analisar os diagnÃsticos de enfermagem em pacientes com infarto agudo do miocÃrdio submetidos à angioplastia transluminal percutÃnea primÃria com uso de stent coronariano. Estudo transversal de natureza descritivo-exploratÃria, realizado em um hospital pÃblico de Fortaleza-Ce. A populaÃÃo constou de 51 pacientes em seu primeiro episÃdio de infarto que realizaram angioplastia com sucesso na colocaÃÃo de stent e internados nas enfermarias cardiolÃgicas. Os dados foram coletados por meio de entrevista, exame fÃsico e consulta ao prontuÃrio do paciente durante os meses de janeiro a agosto de 2006. Os resultados mostraram predominÃncia de homens, pardos, com mÃdia de idade de 54 anos e baixa escolaridade. Identificou-se maior freqÃÃncia de infarto anterior, com artÃria descendente anterior esquerda culpada pela isquemia e classificaÃÃo de killip I. Foram encontrados, em mÃdia, 11 diagnÃsticos de enfermagem, 28 caracterÃsticas definidoras, 6 fatores relacionados e 5 fatores de risco por paciente. Os diagnÃsticos de enfermagem de maior freqÃÃncia foram: Risco de infecÃÃo, DentiÃÃo prejudicada, IntolerÃncia à atividade, DÃficits no autocuidado para banho/higiene, higiene Ãntima e vestir-se/arrumar-se, PadrÃo de sono perturbado, DeambulaÃÃo prejudicada e Mobilidade fÃsica prejudicada. A variÃvel nÃmero de diagnÃsticos apresentou associaÃÃo estatisticamente significativa com os diagnÃsticos de dÃficit no autocuidado, deambulaÃÃo e mobilidade prejudicadas. Houve associaÃÃo estatisticamente significativa entre os diagnÃsticos relacionados ao autocuidado, mobilidade e locomoÃÃo, e destes com os fatores relacionados restriÃÃes de movimentos prescritas, limitaÃÃo imposta pela retirada da bainha e estado de mobilidade prejudicada. Os dados revelaram predominÃncia de fenÃmenos relacionados à ordem biolÃgica e importÃncia na identificaÃÃo dos diagnÃsticos de enfermagem na clientela especÃfica de modo a embasar um plano de atividades de enfermagem voltadas ao atendimento das necessidades fisiolÃgicas de autocuidado e dependÃncia fÃsica. / The coronary reperfusion therapy with percutaneous transluminal coronary angioplasty and stent placement constitutes, now, the preferential treatment to the patient attacked by acute myocardial infarction. In the period after to angioplasty, the patient with infarct demands peculiar cares of the nursing team due cardiac compromising and physical dependence. The identification of the nursing diagnoses addresses the actions attended and delegated by the nurse. The objective of the study was to analyze the nursing diagnoses in patients with acute myocardial infarction submitted to the primary percutaneous transluminal coronary angioplasty with use of coronary stent. Cross sectional study of descriptive-exploratory character, accomplished in a public hospital of Fortaleza-Ce. The population consisted of 51 patients in their first infarct episode that they accomplished angioplasty with success in the placement stent and interned in the cardiac infirmaries. The data were collected by means of interview, physical exam and it consults to the recordsâ patient during the months of January to August of 2006. The results showed predominance men, brown, with average of 54 year-old age and it lowers education level. It identified high frequency of previous infarct, with artery descending previous left accused by the ischemia and Killip Classification I. They were found, on the average, 11 nursing diagnoses, 28 defining characteristics, 6 related factors and 5 risk factors for patient. The nursing diagnoses of larger frequency were: Risk for infection, Altered dentition , Activity intolerance, Bathing/hygiene self-care deficit, Toileting self-care deficit, Dressing/grooming self-care deficit, Sleep pattern disturbance, Impaired walking and Impaired physical mobility. The variable number of diagnoses presented statistic association with the diagnoses self-care deficits, Impaired walking and Impaired physical mobility. There was significant association between the diagnoses related to the self-care, mobility and locomotion, and of these with the factors related prescribed restrictions of movements, limitation imposed by the retreat of the hem and state of harmed mobility. The data revealed predominance of phenomenons related to the biological order and importance in the identification of the nursing diagnoses in the specific clientele in way to base a nursing care plan of activities returned to the attendance of the physiologic needs of self-care and physical dependence.

Introdução: O transplante renal é a terapia substitutiva de escolha para a insuficiência renal crônica. O número absoluto de transplantes renais vem aumentando mundialmente e consequentemente as complicações deste procedimento têm sido evidenciadas com maior recorrência, dentre elas a estenose na artéria renal transplantada. A técnica endovascular vem mostrando bons resultados iniciais, com boa taxa de perviedade e baixa taxa de complicações pósoperatórias quando comparadas a técnica aberta para tratamento da estenose. O objetivo deste estudo foi avaliar os resultados primários da angioplastia da artéria renal do rim transplantado secundário a processo de re-estenose. Métodos: Realizado estudo retrospectivo no período de setembro de 2009 a outubro de 2015, baseado em protocolos de seguimento pós-transplante com perfil dos pacientes submetidos a tratamento por estenose em artéria de rim transplantado e o seguimento em curto prazo com critérios clínicos, laboratoriais e ultrassonográficos. Resultados: Dentre um total de 391 transplantes, 19 pacientes foram diagnosticados com Estenose na Artéria renal transplantada. Evidenciado um tempo médio entre o transplante e o diagnóstico de 172,6 dias. As estenoses ou acotovelamentos com alterações hemodinâmicas foram evidenciadas na anastomose (47%), no terço proximal (35%) e terço médio (18%) da artéria transplantada. Todos os pacientes foram submetidos a angioplastia com balão e posicionamento de stent metálico com sucesso técnico de 94,7 %. A creatinina média evoluiu de 3,63 mg/dl para 2,69 mg/dl em 24h e para 1,81 mg/dl em 30 dias (p<0.05). A taxa de filtração glomerular melhorou de 32,66 ml/min para 41,61 ml/min após 24 horas e 51,05 ml/min após 30 dias (p<0.05). Os critérios ultrassonográficos avaliados de velocidade da artéria renal e índice reno-iliaco (368,9 cm/seg e 3,71 pré angioplastia) normalizaram e se estabilizaram durante o período estudado (211,45 cm/seg e 1,69 90 dias pós angioplastia; p<0.05). Conclusão: A abordagem endovascular utilizando de angioplastia primária e colocação de stent metálico foi segura com boa uma taxa de sucesso técnico. O procedimento foi efetivo na melhora da função renal do enxerto transplantado e na correção das alterações ultrassonográficas evidenciadas no pré-operatório. / Introduction: Renal transplantation is the substitutive therapy of choice for chronic renal failure. The absolute number of renal transplants has increased worldwide and consequently the complications of this procedure have been evidenced with greater recurrence, among them stenosis in the transplanted renal artery. The endovascular technique has shown good initial results, with good patency rate and low rate of postoperative complications when compared to the open technique for stenosis treatment. The aim of this study was to evaluate the primary results of ATP from the renal artery of the transplanted kidney secondary to the restenosis process. Methods: A retrospective study was carried out from September 2009 to October 2015, based on post-transplant follow-up protocols with a profile of patients submitted to stenosis in a transplanted kidney artery and a short-term follow-up with clinical, laboratory and ultrasonographics criteria. Results: Out of a total of 391 transplants, 19 patients were diagnosed with transplanted renal artery stenosis. An average time between transplantation and the diagnosis of 172.6 days was evidenced. Stenting or flexing with hemodynamic changes were evident in the anastomosis (47%), in the proximal third (35%) and the middle third (18%) of the transplanted artery. All patients underwent balloon angioplasty and metallic stent placement with technical success of 94.7%. Mean creatinine increased from 3.63 mg / dL to 2.69 mg / dL in 24 hours and to 1.81 mg / dL in 30 days (p <0.05). The glomerular filtration rate improved from 32.66 ml / min to 41.61 ml / min after 24 hours and 51.05 ml / min after 30 days (p <0.05). The ultrasound criteria evaluated for renal artery velocity and reno-iliac index (368.9 cm / sec and 3.71 pre angioplasty) normalized and stabilized during the study period (211.45 cm / sec and 1.69 Angioplasty, p <0.05). Conclusion: The endovascular approach using primary angioplasty and stent placement was safe with good technical success rate. The procedure was effective in improving the renal function of the transplanted graft and in correcting the ultrasound changes evidenced in the preoperative period.

Abstract The purpose of this prospective, clinical longitudinal survey was to describe, explain and understand the subjective quality of life and life course of patients with coronary artery disease. The study subjects' quality of life was assessed at the time of the onset of coronary artery disease, during the treatment process and during rehabilitation. Altogether 280 patients participated, of whom 80 were treated with medication, 100 with transluminal angioplasty, and 100 with bypass surgery. The study population consisted of 189 men and 91 women. At the baseline, the study subjects' self-care agency was measured with the Self-As-Carer Inventory (SCI). The subjects health-related quality of life was assessed with the Nottingham Health Profile (NHP) at the baseline as well as at 6 and 12 months after the procedure. The qualify of life of coronary artery disease patients was compared to the quality of life of an age- and sex-matched Finnish adult population (N = 3600) by using a previous standardisation of the NHP instrument. One year after the treatment, 19 patients who had undergone either bypass surgery or angioplasty attended thematic interviews at their homes. Triangulation of methodologies, methods and data collection was used in the study. The qualitative analysis of personal experiences was carried out using the method of phenomenological psychology described by Amedeo Giorgi based on Husserl's descriptive phenomenology. Before the treatment procedures, the quality of life of the coronary artery disease patients was significantly poorer than that of the age-matched adult population on the dimensions of energy, pain, emotional reactions, sleep and mobility. Moreover, the female patients with coronary artery disease had poorer health-related quality of life than the corresponding male patients, especially on the dimensions of energy, sleep, emotional reactions and mobility. The quality of life of the patients who had undergone angioplasty or bypass surgery was statistically significantly better one year after surgery on the dimensions of energy, pain and mobility. Their quality of life had, however, deteriorated on the dimensions of emotional reactions and social isolation. The thematic interviews revealed two kinds of life course: one with an active attitude towards treatment and a re-orientation of life course and another with a passive attitude towards treatment and a maintenance of the old principles in one's life course. A need for rehabilitation was indicated by an onset of the illness suddenly at a relatively young age, termination of an active working career, financial problems, dissatisfaction with the outcome of treatment, problems in family relations, and a desolate view of the future. An increased need for psychosocial support was especially common among women, subjects with recurrence and both male and female subjects in the youngest age group. According to the subjects, after-care failed to meet their needs or to address their problems. No continuous and confidential therapeutic relationships emerged. The problems included inadequate knowledge of one's condition and a lack of detailed instructions concerning the permissible degree of exertion after treatment. The patients felt they needed rehabilitation groups with coronary artery disease patients similar to themselves. The study yielded new knowledge about the health-related quality of life of coronary artery disease patients, the connections between the treatment methods and the changes in the patients' quality of life during one year and the patients' experiences at the time of the diagnosis and during the periods of treatment and after-care. This evidence-based knowledge can be used to develop the treatment and rehabilitation of coronary artery disease patients and to plan further research.

Orientador: Ana Terezinha Guillaumon / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T11:44:57Z (GMT). No. of bitstreams: 1 Oliveira_GermanodaPaz_M.pdf: 4750891 bytes, checksum: 517650637fcacb4ffebc12ad859189bb (MD5) Previous issue date: 2014 / Resumo: Objetivos: Analisar a distribuição temporal de sinais de microembolias (SM) ao longo de diferentes estágios da endarterectomia carotídea (EC) e da angioplastia carotídea (AC) e as variáveis associadas com a ocorrência destes sinais, além de avaliar as mudanças na velocidade média aferida na artéria cerebral média (ACM) durante os dois tipos de intervenção. Material e métodos: Trinta e três pacientes com estenose carotídea foram submetidos ou a EC (17) ou a AC (16). Os SM bem como as velocidades médias na ACM foram adquiridas utilizando o US doppler transcraniano (DTC) e esses dados então analisados e associados a diferentes estágios cirúrgicos (pré-proteção, durante a proteção e pós-proteção), tipos de intervenção (EC ou AC) e diferentes variáveis para encontrar potenciais fatores de risco para embolização. Para análise estatística, foram usados os testes de Qui-quadrado, de Fisher e de Mann-Whitney, além de análise por medidas repetidas das variâncias com transformação por postos (ANOVA), seguido de teste de perfil por contrastes e análise de regressão linear múltipla ajustada para o grupo. Resultados: Uma diferença significativa foi encontrada para o número de SM em ambos os grupos. Houve, em média, 89,8 (± 171,4) sinais por procedimento no grupo EC, enquanto a média no grupo AC foi de 597,5 (± 343,3) sinais por procedimento. A média da velocidade média na ACM foi, em ambos os grupos, significantemente menor no estágio durante a proteção. Anestesia local correlacionou-se positivamente (p=0,003) com aumento dos SM, e, associado a isso, o histórico de tabagismo importante (desde que houvesse a cessação do vício há mais de um ano) correlacionou-se negativamente (0,014) com a ocorrência de SM. Conclusão: EC por semi-eversão, à luz do DTC, provocou uma menor incidência de SM por procedimento do que AC com filtro distal, em todos os estágios cirúrgicos. A média da velocidade média na ACM se comportou de maneira similar em ambos os grupos (EC e AC). Anestesia geral e histórico de tabagismo importante (desde que o paciente houvesse cessado por menos um anos antes da intervenção) foram as únicas duas variáveis no estudo que se correlacionaram significativamente (negativamente) com a ocorrência de SM / Abstract: Objectives: To analyze the temporal distribution of microembolic signals throughout the different stages of both the semi-eversion carotid endarterectomy (CEA) and the carotid artery stenting (CAS) procedures and the variables associated with occurrence of them and to evaluate changes in mean blood flow velocity, for both CAS and CEA, within the ipsilateral middle cerebral artery (MCA). Methods: Thirty three patients with carotid stenosis underwent either a CEA (17) or a CAS (16). Microembolic signals, as well as mean blood flow velocity, were acquired using a Transcranial Doppler scan (TCD) and these data were then analyzed and associated to different surgical stages (pre-protection, during protection, and post-protection), types of procedure (CAS or CEA) and different variables to find potential risk factors. To statistical analysis, chi-squared test, Fisher test, Mann-Whitney test, repeated measures analysis of variance with rank transformation (ANOVA) followed by contrast test and multiple linear regression analysis were used. Results: A significant difference was found for the number of microembolic signals in both groups. There were, on average, 89.8 (± 171.4) signals per procedure in the CEA group, while the average in the CAS group was 597.5 (± 343.3) signals per procedure. The average blood flow in the MCA was, in both groups, significantly lower during the stage of protection. Local anesthesia correlated positively (p= .003) with increase in microembolic signals and history of prolonged tobacco use having dropped the addiction for over a year correlated negatively (p= -.014) with the frequency of microembolic signals. Conclusion: Semi-eversion CEA, in light of our TCD findings, evoked a smaller incidence of hyperintense microemboli per procedure than CAS with a distal filter in all the protection stages. The average of the mean blood flow velocity within the MCA has behaved similarly between both groups (CAS and CEA). General anesthesia and the history of tobacco use (as long as the patient had quit for a year or more prior to surgery) were the only two variables in the study that correlated significantly (negatively) with the frequency of microembolic signals / Mestrado / Fisiopatologia Cirúrgica / Mestre em Ciências

Introdução. A elevação dos marcadores inflamatórios e de necrose miocárdica, após intervenção coronária percutânea, pode interferir nos resultados clínicos. No entanto, pouco se conhece sobre a terapia com estatinas pré-procedimento na redução destes marcadores em pacientes estáveis de baixo risco. Objetivo. Avaliar se o uso de estatina, antes do implante eletivo de stent coronário (ISC), reduz os níveis plasmáticos de marcadores inflamatórios e de necrose miocárdica, em pacientes com doença arterial coronária (DAC), estáveis e de baixo risco. Métodos. Neste estudo observacional prospectivo, 100 pacientes (n=50 em uso de estatina vs n=50 sem uso de estatina) com DAC estável foram submetidos à implante eletivo de stent coronário. Marcadores inflamatórios (proteína C reativa [PCR], interleucina[IL] -6, fator de necrose tumoral- e matrix metaloproteinase-9) e marcadores de necrose miocárdica (troponina I e CK-MB ) foram dosados antes e 24 horas após o implante eletivo de stent coronário. Resultados. Todos os pacientes apresentaram um aumento significativo de PCR e IL-6, após ISC. No entanto, esse aumento foi anulado em pacientes que faziam uso de estatina antes de ISC em relação àqueles que não tomavam estatina: 75% vs 150% (p <0,001) e 192% vs 300% (p <0,01) respectivamente. Os outros marcadores pró-inflamatórios foram semelhantes para os dois grupos de pacientes. Troponina I e CK-MB não se alterou, após ISC, independentemente, da terapia com estatina anterior ou não. Conclusão. O pré-tratamento com estatina reduz a magnitude da inflamação após ISC, demonstrada por aumentos significativamente menores de PCR e IL-6, em pacientes com DAC, estável e de baixo risco. Lesão miocárdica periprocedimento foi irrelevante e não foi afetada pela terapia com estatina pré-procedimento nesta população / Background. The elevation of markers of inflammatory and myocardial necrosis after percutaneous coronary intervention may interfere on clinical outcome. However, little is known concerning preprocedural statin therapy on the reduction of these markers in stable patients at low-risk. Objective. To evaluate if statin therapy prior to elective coronary stent implantation (CSI) reduces the plasma levels of markers inflammatory and myocardial necrosis in patients with low-risk stable coronary artery disease (CAD). Methods. In this prospective, observational study, 100 patients (n=50 on statin therapy vs n=50 not on statin) with stable CAD underwent elective CSI. Inflammatory (C-reactive protein [CRP], interleukin [IL]-6, tumor necrosis factor-a and matrix metalloproteinase-9) and myocardial necrosis markers (troponin I and CK-MB) were determined before and 24 hours after CSI. Results. All patients presented a significant increase of CRP and IL-6 after CSI. However, this increase was blunted in patients on statin therapy prior to CSI than those without statin therapy: 75% vs 150% (p<0.001), and 192% vs 300% (p<0.01), respectively for PCR and IL-6. The other pro-inflammatory markers were not affected in both sets of patients. Troponin I and CK-MB did not change after CSI regardless of previous statin therapy or not. Conclusions. Previous treatment with statins reduces the magnitude of procedural inflammation, denoted by markedly lower increases of CRP and IL-6 levels, in elective CSI on stable CAD patients. Periprocedural myocardial injury was not significant in this population

Introdução: Estudos clínicos e epidemiológicos têm revelado aumento do risco de doença coronária nos pacientes portadores de diabetes mellitus. A progressão da aterosclerose coronária documentada angiograficamente é identificada e utilizada com freqüência na prática clínica. Entretanto, o seu significado prognóstico ainda é pouco conhecido. Neste estudo, analisamos o significado dessa progressão em uma amostra de pacientes diabéticos e não diabéticos, portadores de doença arterial coronária e submetidos ao tratamento clínico, angioplastia ou cirurgia. Métodos. Foram avaliados 392 pacientes com cineangiocoronariografia inicial e após cinco anos de seguimento. A progressão foi definida como o surgimento de uma nova lesão ou o aumento em cerca de 20% de uma lesão prévia. A identificação da progressão foi realizada em pacientes submetidos previamente aos tratamentos clínico, cirúrgico e angioplastia. A progressão da doença foi analisada nos territórios correspondentes das artérias descendente anterior, circunflexa e coronária direita. A amostra englobou um grupo de 138 pacientes diabéticos e 254 pacientes não diabéticos. Dos 392 pacientes da amostra, formaram-se os seguintes grupos de intervenção: RCM (n=136) - 57 diabéticos e 79 não diabéticos; ATC (n=146) - 42 diabéticos e 104 não diabéticos; TM (n=110) - 38 diabéticos e 72 não diabéticos. Também se analisou também o percentual de progressão da doença, correlacionando-a com os fatores de risco e com a necessidade de novas intervenções. Resultados. Não se observou nenhuma diferença entre os grupos diabéticos e não diabéticos quanto à idade, sexo, HAS, tabagismo e distúrbios lipídicos. Além disso, não se demonstraram diferenças de progressão nesta amostra, quando comparados o grupo dos diabéticos e o de não diabéticos; entretanto, quando estratificados por intervenção, observou-se menor progressão da doença nos pacientes do grupo cirúrgico com diabetes mellitus (69,7%, p=0,014). Por outro lado, observou-se maior progressão no território das artérias descendente anterior (71,5%) e coronária direita (64,3%) dos pacientes diabéticos submetidos à angioplastia (p=0,024, p=0,047). Conclusão. Os resultados deste estudo permitiram concluir que, em cinco anos, o diabetes mellitus não impôs maior progressão angiográfica da doença aterosclerótica quando se compararam os grupos de pacientes diabéticos e de não diabéticos. Entretanto, a análise dos pacientes diabéticos submetidos a ATC revelou significativo aumento da progressão da doença nos territórios da coronária direita e da descendente anterior. Por outro lado, os pacientes diabéticos do grupo cirúrgico apresentaram menor progressão da doença. / Background: Epidemiologic and clinical studies have shown an increased risk of coronary artery disease (CAD) among patients with diabetes mellitus (DM). Angiographic progression of coronary atherosclerosis is frequently observed in clinical practice and is used as an end-point in clinical trials; however, its prognostic significance is unclear. In this study, we prospectively analyzed the angiographic progression in diabetic and nondiabetic patients treated by medication, angioplasty or surgery. Methods: At baseline and 5- year follow-up angiograms were obtained in 392 randomized patients. Progression was defined as an increase in diameter of stenosis by >20% of at least one coronary lesion. We tried to assess the coronary disease progression in the clinical, surgical, and angioplasty groups in the LAD, LCX, and RCA arteries in diabetic (n=138) and nondiabetic patients (n=254). A total of 392 subjects randomly assigned to CABG (n=136), 57 diabetic and 79 non diabetic, PCI (n=146),42 diabetic and 104 non diabetic or medical treatment(n=110) 38 diabetic and 72 non diabetic Also, we analyzed the relation of the rate of progression with morbidity and the need for an additional intervention. Results: No significant differences in relation to age, sex, hypertension, smoking, or lipid disorders were observed between the groups. Furthermore, no differences concerning CAD progression were shown when diabetic and nondiabetic subject were compared. However, when the type of treatment was stratified, the surgery group had less progression in the diabetic group (69.7% p =0.014). On the other hand, more progression in the PCI group was observed in RCA (64.3 %) and LAD (71.5%) territories in diabetic group (p=0.047; p=0.024). No relation was found between progression and the rate of events in both groups. Conclusion: Diabetes was not associated with greater progression of CAD in patients with stable CAD and preserved ventricular function during 5-year follow-up. However, the diabetic patients who underwent PCI had more progression of CAD compared with nondiabetic subjects in RCA and LAD territories.The surgery group shown less progression of the disease in the diabetic group.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第18878号 / 医博第3989号 / 新制||医||1008(附属図書館) / 31829 / 京都大学大学院医学研究科医学専攻 / (主査)教授 坂井 義治, 教授 坂田 隆造, 教授 平岡 眞寛 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Perkutane transluminale Angioplastie komplexer infrapoplitealer Gefässläsionen bei kritischer chronischer Extremitätenischämie: Restenoserate und klinische Ergebnisse

No description available.

Purpose. The primary objective was to compare primary and secondary patency, number of percutaneous transluminal angioplasty (PTA) interventions and cost-effectiveness among PTA, deployment of a stent, or a stent graft in the treatment of failing arteriovenous dialysis grafts. The secondary objective was to compare the residual diameter at the site of dialysis shunt stenosis using sonography and digital subtraction angiography (DSA). Methods. Sixty patients were randomly assigned to either PTA, placement of a stent or stent graft. Follow-up angiography was scheduled at 3, 6, and 12 months or when requested by the physician. Residual diameter of a dialysis shunt stenosis was measured in 20 patients with significant stenosis by ultrasonography and on an angiogram from DSA. Results. During a median follow-up of 22.4 months patients with PTA, stent, or stent graft required 3.1±1.7, 2.5±1.7, or 1.7±2.1 (P=0.031) secondary PTA interventions. The primary patency rates were 0%, 18%, and 65% at 12 months and 0%, 18%, and 37% at 24 months in the PTA, stent, and stent graft group respectively (P<0.0001). The cost of the procedures was €7,900±€3,300 in PTA group, €8,500±€4,500 in stent group, and €7,500±€6,200 in stent graft group (P=0.45). The mean residual diameter measured by ultrasonography and DSA was...