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Kwak J, Cho SB, Jun H, Chung HH, Park SJ, Seo TS, Yang WJ. Transjugular approach in aspiration thrombectomy and angioplasty of a thrombosed straight arteriovenous graft compared to the direct hemodialysis access approach. Hemodial Int 2024; 28:162-169. [PMID: 38481062 DOI: 10.1111/hdi.13142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 02/17/2024] [Accepted: 02/20/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE To evaluate the efficacy and outcome of the transjugular approach in endovascular recanalization of a thrombosed straight arteriovenous graft (AVG) compared to those of the direct hemodialysis access approach (conventional approach). MATERIALS AND METHODS We retrospectively assessed patients who underwent aspiration thrombectomy and percutaneous transluminal angioplasty for thrombosed straight AVG performed at a single institution between October 2006 and October 2021. A total of 138 thrombosed AVGs in 83 patients (39 male and 44 females) were divided into the transjugular approach group (Group A) and the conventional approach group (Group B). Technical and clinical success, postintervention primary patency, cumulative patency, and periprocedural complications were compared. RESULTS There was no statistical difference in demographic data between groups A and B. The technical success rate of group A and B was 96.4% (80/83) and 98.2% 54/55, respectively (p > 0.05). The mean procedure time was 61.4 min (Group A) and 70.5 min (Group B) (p > 0.05). There was no statistically significant difference between the two groups in postintervention primary patency. The cumulative patency of Groups A and B was 911.9 days (range 122-6277) and 1062.3 days (range 72-2302 days), respectively (p > 0.05). One patient in Group B experienced a major graft rupture. Pseudoaneurysm formation at the sheath insertion site occurred in two patients in Group B. No cases of stenosis or thrombosis of the IJV or hematoma at the puncture site were observed in Group A. CONCLUSION The transjugular approach is as safe and effective as the conventional approach for aspiration thrombectomy and percutaneous transluminal angioplasty of thrombosed straight AVGs.
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Affiliation(s)
- JungWon Kwak
- Department of Radiology, Anam Hospital, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Sung Bum Cho
- Department of Radiology, Anam Hospital, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Heungman Jun
- Department of Surgery, Anam Hospital, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Hwan Hoon Chung
- Department of Radiology, Ansan Hospital, College of Medicine, Korea University, Ansan-si, Gyeonggi-do, Republic of Korea
| | - Sung-Joon Park
- Department of Radiology, Ansan Hospital, College of Medicine, Korea University, Ansan-si, Gyeonggi-do, Republic of Korea
| | - Tae-Seok Seo
- Department of Radiology, Guro Hospital, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Woo Jin Yang
- Department of Radiology, Guro Hospital, College of Medicine, Korea University, Seoul, Republic of Korea
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Lee DK, Cho SB, Kwak JW, Min HJ, Chung HH, Lee SH, Song MG, Sung DJ. Transjugular approach: comparison with conventional endovascular treatment of native arteriovenous fistulas. Br J Radiol 2024; 97:221-227. [PMID: 38263816 PMCID: PMC11027325 DOI: 10.1093/bjr/tqad013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 05/24/2023] [Accepted: 11/06/2023] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVES The aim of this study was to compare the outcomes of the transjugular approach with those of the conventional approach for endovascular treatment of arteriovenous fistulas (AVFs). METHODS Between May 2015 and July 2019, 112 patients with endovascular treatment of dysfunctional or immature AVFs were included and divided into the transjugular (n = 46) and conventional (n = 66) groups. Electronic medical records and angiography of the patients were retrospectively reviewed to assess technical and clinical success rates, time to first fistulography, total procedure time, primary and secondary patency, and complications in both groups. RESULTS There were no significant differences in technical success rate (87.0% vs 97.0%; P = .062), clinical success rate (80.4% vs 90.9%; P = .109), or total procedure time (60.2 vs 57.9 min; P = .670) between the groups. Cox proportional hazards models showed that the cumulative primary patency was significantly higher in the transjugular group than in the conventional group (P = .041; 6-month patency rates, 93.8% vs 91.5%). Also, a statistically significant difference was found between the cumulative secondary patency of the groups (P = .014; 6-month patency rates, 91.4% vs 86.5%). No major complications were observed. CONCLUSIONS Transjugular endovascular treatment of AVFs was successful and effective. Longer patency periods were observed when treated via transjugular access. ADVANCES IN KNOWLEDGE This article compared the outcomes of transjugular approaches with those of conventional approaches in the endovascular treatment of native AVFs and showed higher patency periods/rates in the transjugular group than in the conventional group.
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Affiliation(s)
- Dong Kyu Lee
- Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea
| | - Sung Bum Cho
- Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea
| | - Jung Won Kwak
- Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea
| | - Hyeon Jin Min
- Department of Nephrology, Chunggoo Sungsim Hospital, Seoul 03330, Republic of Korea
| | - Hwan Hoon Chung
- Department of Radiology, Ansan Hospital, Korea University College of Medicine, Ansan 15355, Republic of Korea
| | - Seung Hwa Lee
- Department of Interventional Radiology (Angiography Center), Andong Medical Group Hospital, Andong 36743, Republic of Korea
| | - Myung Gyu Song
- Department of Radiology, Guro Hospital, Korea University College of Medicine, Seoul 08308, Republic of Korea
| | - Deuk Jae Sung
- Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea
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Lee CH, Gwon JG, Jung CW, Cho SB. Efficacy of the transjugular approach in endovascular intervention for hemodialysis access comparing with conventional approach. J Vasc Access 2020; 21:1003-1010. [PMID: 32390541 DOI: 10.1177/1129729820920105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Compared with the conventional approach, the benefits of the transjugular approach in endovascular intervention for hemodialysis access avoids complications due to direct puncture and reduces direct radiation exposure to the hands of operator. The aim of this non-inferiority study was to evaluate the efficacy of the transjugular approach in endovascular intervention for hemodialysis access comparing with conventional approach. METHODS We retrospectively assessed endovascular intervention for hemodialysis access performed in our hospital from 2012 to 2016, divided into the conventional approach group and the transjugular approach group. The hemodialysis access survival rate, re-intervention survival rate, and lesion characteristics were comparatively evaluated. RESULTS We included 223 cases in 118 patients (146 cases with conventional approaches and 77 cases with transjugular approaches). There was a higher incidence of thrombosis with the conventional approach (p < 0.001), however, no significant difference in the hemodialysis access type or main lesion location. The transjugular approach showed either a better hemodialysis access survival rate (p = 0.017) and a trend toward improved re-intervention survival rate (p = 0.098) than the conventional approach. Following classification according to the presence of thrombus, there was no significant difference in either the hemodialysis access survival rate or the re-intervention survival rate between the approaches with or without thrombus. CONCLUSION The transjugular approach could be performed in most cases and was similar to the conventional approach in terms of outcomes. The transjugular approach should be considered as an alternative to either replace or use in combination with the conventional approach in endovascular intervention for hemodialysis access.
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Affiliation(s)
- Chang Hun Lee
- Department of Transplantation and Vascular Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Jun Gyo Gwon
- Department of Transplantation and Vascular Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Cheol Woong Jung
- Department of Transplantation and Vascular Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Sung Bum Cho
- Department of Radiology, Korea University College of Medicine, Seoul, South Korea
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Wang JW, Padia SA, Lee EW, Moriarty JM, McWilliams JP, Kee ST, Plotnik AN, Sayre JW, Srinivasa RN. Transfemoral Venous Access Facilitates Upper Extremity Dialysis Interventions: Procedural Success and Clinical Outcomes. Cardiovasc Intervent Radiol 2019; 42:460-465. [PMID: 30603971 DOI: 10.1007/s00270-018-02154-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 12/21/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE To report technical success and clinical outcomes of transfemoral venous access for upper extremity dialysis interventions. MATERIALS AND METHODS A total of 15 patients underwent a transfemoral venous approach for fistulography (n = 4; 27%) or thrombectomy (n = 11; 73%) over a 14-month period. Access characteristics, sheath size, thrombectomy method, angioplasty site, fluoroscopy time, radiation dose, technical and clinical success, complications, and post-intervention primary and secondary patency rates were recorded. RESULTS Access type included arteriovenous fistulas (n = 10; 67%) and grafts (n = 5; 33%). The most common configuration was brachio-brachial (n = 6; 38%). Mean age of access was 37 months. Mean prior interventions were 4. Right CFV access was used in all patients using 6-8-French (most common: 7-French [n = 10; 67%]) sheaths. Most thrombectomies (n = 11; 73%) required both pharmacologic and mechanical maceration (n = 9; 82%). All accesses required angioplasty to treat underlying stenosis at the outflow vein (n = 12; 80%) or arteriovenous anastomosis (n = 9; 90%). Mean fluoroscopy time was 26.43 min. Air kerma and dose area product were 178.06 ± 225.77 mGy and 57,768.83 ± 87,553.29 μGym2, respectively. Procedural and clinical success rates were 93% and 80%, respectively. Technical failure was due to persistent stenosis in one patient. Clinical failure was due to unsuccessful dialysis immediately following intervention in three patients. Mean post-intervention primary patency and secondary patency durations were 2.8 and 4.8 months, respectively. Primary patency rates at 1 and 3 months were 50% and 35%, respectively. Secondary patency rates at 1 and 3 months were 58% and 30%, respectively. CONCLUSION A transfemoral venous approach for intervention of upper extremity dialysis accesses may be a valuable adjunct to traditional approaches.
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Affiliation(s)
- J W Wang
- Department of Radiology, Division of Vascular and Interventional Radiology, University of California at Los Angeles, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - S A Padia
- Department of Radiology, Division of Vascular and Interventional Radiology, University of California at Los Angeles, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - E W Lee
- Department of Radiology, Division of Vascular and Interventional Radiology, University of California at Los Angeles, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - J M Moriarty
- Department of Radiology, Division of Vascular and Interventional Radiology, University of California at Los Angeles, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - J P McWilliams
- Department of Radiology, Division of Vascular and Interventional Radiology, University of California at Los Angeles, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - S T Kee
- Department of Radiology, Division of Vascular and Interventional Radiology, University of California at Los Angeles, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - A N Plotnik
- Department of Radiology, Division of Vascular and Interventional Radiology, University of California at Los Angeles, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - J W Sayre
- Department of Biostatistics, UCLA School of Public Health, Los Angeles, CA, 90095, USA
| | - R N Srinivasa
- Department of Radiology, Division of Vascular and Interventional Radiology, University of California at Los Angeles, 757 Westwood Plaza, Los Angeles, CA, 90095, USA.
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Kim JH, Cho SB, Kim YH, Chung HH, Lee SH, Sung DJ. Transjugular percutaneous endovascular treatment of dysfunctional hemodialysis access. J Vasc Access 2018; 20:488-494. [PMID: 30520334 DOI: 10.1177/1129729818815327] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To evaluate the feasibility and the outcomes of transjugular percutaneous endovascular treatment of dysfunctional hemodialysis access in patients with chronic kidney disease. METHODS A total of 50 transjugular treatments in 38 patients with arteriovenous fistulas or arteriovenous grafts from September 2011 to May 2015 were included in this study. Medical records and angiographies were retrospectively reviewed. Success rate, patency rate, procedure time, and complications including internal jugular vein stenosis were evaluated. RESULTS A total of 50 sessions of transjugular treatments were performed in 38 patients. There were 31 native arteriovenous fistulas including 10 immature cases and 19 arteriovenous grafts. Among the 50 cases, technical success was achieved in 45 and clinical success was achieved in 44; 37 cases (74%) with multiple stenotic sites were treated by the transjugular approach without placement of cross-sheaths. The mean time from puncture of the internal jugular vein to first fistulography was 10 min, and the mean total procedure time was 64 min. The primary patency rate at 6 months was 77%, while the secondary patency rate at 6 months was 97%. Perforation occurred in two cases during conventional percutaneous transluminal angioplasty after failure of the transjugular approach. One dissection occurred during the transjugular approach. There was no newly developed internal jugular vein stenosis during a mean follow-up period of 19.3 months. CONCLUSION For the treatment of dysfunctional or immature hemodialysis access, the transjugular approach is a feasible and effective option that avoids injury to the graft or draining vein, especially in immature fistulas.
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Affiliation(s)
- Jin Ho Kim
- Korea University Anam Hospital, Seoul, Republic of Korea
| | - Sung Bum Cho
- Korea University Anam Hospital, Seoul, Republic of Korea
| | - Yun Hwan Kim
- Korea University Anam Hospital, Seoul, Republic of Korea
| | | | - Seung Hwa Lee
- Korea University Anam Hospital, Seoul, Republic of Korea
| | - Deuk Jae Sung
- Korea University Anam Hospital, Seoul, Republic of Korea
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Transjugular Venous Approach for Endovascular Interventions in Hemodialysis Grafts and Fistulas of the Upper Extremities. AJR Am J Roentgenol 2017; 210:W86-W91. [PMID: 29112475 DOI: 10.2214/ajr.17.18442] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This article describes the use of a transjugular venous access for interventions in upper extremity hemodialysis arteriovenous fistulas (AVFs) and grafts. This access is used in selected patients in whom direct puncture of the hemodialysis access is considered to be difficult or cumbersome. Technical success was achieved in 96.7% of patients. If an intervention is unsuccessful, the transjugular access offers the possibility of placement of a dialysis catheter for temporary or long-term hemodialysis. CONCLUSION The transjugular approach for hemodialysis access endovascular interventions is technically successful and safe. Initially described as an intervention to treat malfunctioning arteriovenous grafts, we have used it successfully in AVF interventions. In our opinion, this approach is a safe and effective alternative that may prove useful in selected patients.
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Ferral H, Alonzo MJ. Transjugular venous approach for endovascular intervention in upper-extremity dialysis access fistulae and grafts. Semin Vasc Surg 2017; 29:206-211. [PMID: 28779788 DOI: 10.1053/j.semvascsurg.2017.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A transjugular venous access is an alternative approach for endovascular intervention in upper-extremity dialysis arteriovenous fistulae and grafts. The transjugular access is recommended for patients who have an unfavorable anatomy for the direct arm access approach. Ultrasound evaluation of the arteriovenous access is essential before intervention and includes evaluation of the inflow artery and outflow vein diameters, arteriovenous anastomosis, and the entire outflow vein, specifically looking into potential problem areas. Patency of the ipsilateral internal jugular vein needs to be assessed. If patency of the ipsilateral internal jugular vein is confirmed, it can be used for access. Retrograde access into the outflow vein is obtained with a reverse-curve catheter and a Glidewire. In some cases, puncture of the outflow vein is necessary along with the use of snares to direct the catheter system into the outflow vein. The techniques for intervention are described. Successful access into the outflow vein is possible in >95% of cases. The technique is useful for fistula maturation, declotting procedure, and arteriovenous fistula and graft maintenance. If intervention is unsuccessful, the transjugular access offers the possibility of placement of a dialysis catheter for temporary or long-term dialysis.
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Affiliation(s)
- Hector Ferral
- Section of Interventional Radiology, Department of Radiology, NorthShore University Health System, 2650 Ridge Avenue, Evanston, IL 60201.
| | - Marc J Alonzo
- Section of Interventional Radiology, Department of Radiology, NorthShore University Health System, 2650 Ridge Avenue, Evanston, IL 60201
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Ipsilateral jugular access to treat an otherwise inaccessible puncture-related arteriovenous fistula pseudoaneurysm: a technical note. J Vasc Access 2013; 15:61-4. [PMID: 24043325 DOI: 10.5301/jva.5000175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2013] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The standard approach for the endovascular treatment of a dysfunctional or occluded hemodialysis access in the upper limbs includes a direct intervention through the access itself or alternatively, when not feasible, through the brachial or radial artery access. Nonetheless, there are certain circumstances in which these approaches are not easily achieved. METHODS An 89-year-old male with end-stage renal disease developed a pseudoaneurysm after an hemorrhagic complication of a recently transposed native basilic arteriovenous fistula secondary to a needle puncture. Dehiscence of the injured access with spontaneous arterial bleeding evolved as a consequence of the upper limb swelling, rendering therapeutic intervention of the access through a conventional route impossible. A fistulogram through puncture of the common femoral artery was performed to obtain an accurate diagnosis. However, this approach was insufficient to advance the covered stent with the intention of excluding the pseudoaneurysm, as the stent delivery system could not reach the desired site. Given that the covered stent insertion required a 9 Fr introducer, the radial artery approach was ruled out. Therefore, we chose a venous access via the ipsilateral internal jugular vein, which was punctured under ultrasound guidance. RESULTS This strategy was useful to advance the stent and exclude the pseudoaneurysm successfully. CONCLUSIONS This technique should be considered for those individuals in whom conventional routes of approach for repairing dialysis accesses are not feasible or are extremely risky.
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Soulen MC. Mechanical Thrombolysis of Dialysis Access Grafts. Semin Dial 2007. [DOI: 10.1111/j.1525-139x.1998.tb00396.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Packer J. An alternative approach to a totally occluded subclavian vein in a malfunctioning arteriovenous fistula. Semin Dial 2007; 20:365-9. [PMID: 17635831 DOI: 10.1111/j.1525-139x.2007.00298.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Endovascular therapy is useful in the treatment of a malfunctioning or nonmaturing arteriovenous (AV) fistula. When a standard trans-access approach fails, alternative approaches can be attempted. A patient with a malfunctioning fistula is presented describing the use of a successful transjugular approach after an unsuccessful trans-fistula attempt. The merits of this alternative method are discussed. An alternative means of treating a malfunctioning dialysis AV fistula may help increase the prevalence of AV fistulae in the hemodialysis population.
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Affiliation(s)
- Jeffrey Packer
- Arizona Kidney Disease and Hypertension Center, Phoenix, Arizona 85012, USA.
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Kim BM, Goo DE, Park SI. Bidirectional angioplasty with single vascular access in autogenous arteriovenous fistula. J Vasc Interv Radiol 2007; 18:868-74. [PMID: 17609446 DOI: 10.1016/j.jvir.2007.04.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
PURPOSE In autogenous arteriovenous (AV) fistulas with multiple stenoses at extreme ends, one option for treatment of the stenoses with angioplasty is dual access directed toward both ends of the fistula. The present study is a retrospective evaluation of experiences with an alternative access technique, bidirectional angioplasty with a single vascular access. MATERIALS AND METHODS A total of 124 bidirectional angioplasty procedures with a single vascular access performed in 96 autogenous AV fistulas (48 men and 48 women; mean age, 58 years) were evaluated. After fistulography, a dilated segment of the draining vein located between the proximal and distal stenoses, with its course straight or convex toward the interventional radiologist, was punctured with an 18-gauge needle. The needle was directed antegrade and an introducer sheath was inserted for angioplasty of the proximal or central venous stenoses. Then, with a safety guide wire in place, the introducer sheath was withdrawn and redirected retrograde for angioplasty of the distal stenoses. RESULTS Technical success rates of redirection of the introducer sheath and angioplasty were 100% and 96.8%, respectively. The failures of angioplasty were related to elastic recoil (n = 3) and inability to pass the guide wire through an occluded distal vein (n = 1). Overall procedure times were 7-70 minutes (mean, 31 min). One pseudoaneurysm was the only access-related complication. CONCLUSIONS Bidirectional angioplasty with a single vascular access is a feasible method of access in angioplasty of autogenous AV fistulas with stenoses at extreme ends.
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Affiliation(s)
- Byung Moon Kim
- Department of Diagnostic Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University, Gyeonggi-Do, Korea
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Medina JG, Basile A, Saura-Luján I, Andreu A, Alvarez G. Percutaneous trans-jugular mechanical thrombectomy for the treatment of thrombosed upper arm fistulas. Nephrol Dial Transplant 2005; 20:2872-3. [PMID: 16169867 DOI: 10.1093/ndt/gfi130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Sofocleous CT, Schur I, Koh E, Hinrichs C, Cooper SG, Welber A, Brountzos E, Kelekis D. Percutaneous treatment of complications occurring during hemodialysis graft recanalization. Eur J Radiol 2003; 47:237-46. [PMID: 12927669 DOI: 10.1016/s0720-048x(02)00087-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION/OBJECTIVE To describe and evaluate percutaneous treatment methods of complications occurring during recanalization of thrombosed hemodialysis access grafts. METHODS AND MATERIALS A retrospective review of 579 thrombosed hemodialysis access grafts revealed 48 complications occurring during urokinase thrombolysis (512) or mechanical thrombectomy (67). These include 12 venous or venous anastomotic ruptures not controlled by balloon tamponade, eight arterial emboli, 12 graft extravasations, seven small hematomas, four intragraft pseudointimal 'dissections', two incidents of pulmonary edema, one episode of intestinal angina, one procedural death, and one distant hematoma. RESULTS Twelve cases of post angioplasty ruptures were treated with uncovered stents of which 10 resulted in graft salvage allowing successful hemodialysis. All arterial emboli were retrieved by Fogarty or embolectomy balloons. The 10/12 graft extravasations were successfully treated by digital compression while the procedure was completed and the graft flow was restored. Dissections were treated with prolonged Percutaneous Trasluminal Angioplasty (PTA) balloon inflation. Overall technical success was 39/48 (81%). Kaplan-Meier Primary and secondary patency rates were 72 and 78% at 30, 62 and 73% at 90 and 36 and 67% at 180 days, respectively. Secondary patency rates remained over 50% at 1 year. There were no additional complications caused by these maneuvers. DISCUSSIONS AND CONCLUSION The majority of complications occurring during percutaneous thrombolysis/thrombectomy of thrombosed access grafts, can be treated at the same sitting allowing completion of the recanalization procedure and usage of the same access for hemodialysis.
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Affiliation(s)
- Constantinos T Sofocleous
- Department of Radiology Vascular and Interventional, University of Medicine and Dentistry of New Jersey, University Hospital, C320 150 Bergen Street, Newark, NJ 07103-2406, USA.
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Sofocleous CT, Hinrichs CR, Weiss SH, Contractor D, Barone A, Bahramipour P, Brountzos E, Kelekis D. Alteplase for hemodialysis access graft thrombolysis. J Vasc Interv Radiol 2002; 13:775-84. [PMID: 12171980 DOI: 10.1016/s1051-0443(07)61985-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To evaluate the efficacy and safety of alteplase, a recombinant tissue plasminogen activator, in hemodialysis access graft thrombolysis. MATERIALS AND METHODS From November 1999 to May 2001, 68 episodes of occlusion in 50 grafts (in 49 patients) were included in the study. Occlusion was treated with pulse-spray (n = 41) or lyse-and-wait (n = 27) thrombolysis with use of alteplase. Balloon angioplasty of all identified stenoses was performed. The arterial plug was mobilized with the Fogarty maneuver. RESULTS Procedural success was achieved in 64 of 68 episodes (94%) with a dose of 2-10 mg (mean = 4.13 mg) of alteplase, allowing successful hemodialysis within 24 hours. Failures (6%) were the result of PTA perforation (one of 68), nonnegotiable outflow occlusion (one of 68), delayed bleeding (one of 68), and balloon bursting and shearing becoming occlusive within the graft (one of 68). Primary and secondary patency rates were 72% and 87% at 30 days, 57% and 80% at 90 days, and 44% and 72% at 180 days, respectively. Arterial emboli (two of 68) were treated by Fogarty balloon retrieval and alteplase infusion locally over the course of 20 minutes. One of two PTA perforations was controlled by balloon tamponade. CONCLUSION Alteplase can be used successfully for hemodialysis graft thrombolysis.
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Abstract
The article summarizes the role of vascular radiology in the imaging and salvage of hemodialysis fistulas and in the placement and maintenance of tunneled dialysis access catheters.
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Sofocleous CT, Cooper SG, Schur I, Patel RI, Iqbal A, Walker S. Retrospective comparison of the Amplatz thrombectomy device with modified pulse-spray pharmacomechanical thrombolysis in the treatment of thrombosed hemodialysis access grafts. Radiology 1999; 213:561-7. [PMID: 10551242 DOI: 10.1148/radiology.213.2.r99nv32561] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To retrospectively evaluate the Amplatz thrombectomy device (ATD) in the treatment of thrombosed hemodialysis grafts and compare it with modified pulse-spray pharmacomechanical thrombolysis (PPT). MATERIALS AND METHODS During a 4-month period, 79 patients presented with 126 episodes of graft occlusion. Percutaneous recanalization was performed by using the ATD (n = 57) or the modified PPT technique (n = 69). Evaluation included the technical success, complications, and primary patency rates. RESULTS Technical success was achieved in 93% (53 to 57) of the cases treated with the ATD and in 96% (66 of 69) of the cases treated with modified PPT (P = .70). Complications occurred in 6% (four of 69) of modified PPT procedures and 16% (nine of 57) of ATD procedures. This difference was not statistically significant (P = .08); however, there were significantly more local complications in the ATD group (P = .04). The primary patency rates at 30, 90, and 180 days were 65% and 65%, 36% and 50%, and 26% and 33% for modified PPT and ATD, respectively. Survival curves were found not to differ significantly (P = .49). CONCLUSION The ATD and modified PPT were similarly successful in the recanalization of thrombosed hemodialysis access grafts and achieved comparable primary patency rates. The higher rate of local complications and technical difficulties encountered with use of the 8-F ATD limit its usefulness for this indication.
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Affiliation(s)
- C T Sofocleous
- Division of Vascular and Interventional Radiology, St Luke's-Roosevelt Hospital Center, New York, NY 10019, USA
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Hathaway PB, Vesely TM. The apex-puncture technique for mechanical thrombolysis of loop hemodialysis grafts. J Vasc Interv Radiol 1999; 10:775-9. [PMID: 10392946 DOI: 10.1016/s1051-0443(99)70113-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- P B Hathaway
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
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Turmel-Rodrigues L. Percutaneous mechanical declotting of dialysis grafts using a central approach: a summation of risks not acceptable in 1998. J Vasc Interv Radiol 1999; 10:375-6. [PMID: 10102206 DOI: 10.1016/s1051-0443(99)70046-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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