Bidirectional angioplasty with single vascular access in autogenous arteriovenous fistula

Salvage of a Radiocephalic Arteriovenous Hemodialysis Fistula by Percutaneous Angioplasty to Increase Retrograde Flow from the Palmar Arch in Patients with an Occluded Radial Artery

This brief report presents 12 patients who underwent percutaneous transluminal angioplasty (PTA) to increase the retrograde blood flow from the palmar arch. All the patients had radiocephalic arteriovenous fistulas with occluded feeding arteries. The technical success rate was 100%. Three patients (25.0%) underwent surgical repair for restenosis, 2 patients (16.6%) underwent surgical repair for other reasons, 5 patients (41.8%) underwent repeated PTAs for restenosis, and 2 patients (16.6%) had no further treatment. The target lesion primary patency rates at 6, 12, 36, and 60 months were 90.9%, 54.5%, 36.4%, and 18.2%, respectively.

Balloon catheter looping technique for entry site angioplasty during endovascular management of thrombosed arteriovenous grafts by single access

PURPOSE

This study was designed to evaluate the feasibility of balloon catheter looping technique for angioplasty of entry site lesions of stenosis or thrombi that could not be aspirated during endovascular treatment of thrombosed arteriovenous grafts by single access.

METHODS

Balloon catheter looping technique was used for angioplasty of entry site lesions in 13 sessions of treatment of thrombosed arteriovenous grafts by single access in 11 patients (M:F = 7:4, mean age: 70.7 years, 9 brachio-axillary straight and 2 brachio-antecubital loop grafts) and were retrospectively evaluated. Middle equator of the graft was punctured and a 7F Desilets-Hoffman introducer sheath was inserted for aspiration thrombectomy and angioplasty. For entry site angioplasty, the balloon catheter was positioned 4-5 cm beyond the tip of the sheath. The sheath was retrieved to the entry site and was redirected into the contralateral limb, so the balloon catheter would form a loop. The introducer sheath was advanced to pull the balloon back to cover the entry site for angioplasty. Radiological images and medical records were evaluated for feasibility, success rate, and complications.

RESULTS

Technical success of treatment of thrombosed graft and balloon catheter looping for entry site angioplasty could be achieved in all 13 cases (100%), without requiring second access. Completion fistulography revealed no access complication. Patency rate at 3 and 6 months were 80 and 68.6%, respectively.

CONCLUSIONS

Balloon catheter looping technique for angioplasty of entry site lesions during endovascular treatment of thrombosed arteriovenous graft is a feasible alternative technique to obtaining a second access.