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Abstract
Purpose
This study was designed to evaluate the technical feasibility and clinical outcome of endovascular intervention using the retrograde transradial approach to treat dysfunctional hemodialysis shunts of the upper arms.
Materials and Methods
During the last 3 years, sixteen procedures were performed by the transradial approach in 13 patients with dysfunctional hemodialysis shunts of the upper arms. The radial artery was ac-cessed with the use of 20-gauge needle and a 6-Fr sheath. Angiography was performed using a 5-Fr catheter placed in the brachial artery, and then the interventional procedure was performed. The technical and clinical success rates, complications and patency rates were evaluated.
Results
Fistulography and percutaneous transluminal angioplasty via the transradial approach were performed in 16 cases of the 13 patients. Fistulography demonstrated stenosis in 7 cases and occlusions in 9 cases. Lesion multiplicity was identified in 9 out of 16 cases. Balloon angioplasty was performed in all cases and a stent was placed to overcome restenosis or to treat venous rupture in two cases. The technical success rate of balloon angioplasty was 87.5% (14/16) and the technical success rate with including stent insertion was 100%(16/16). The clinical success rate was 93.8%. There was one procedural-related complication. The primary patency rates at 6 and 12 months were 84.6% and 74%, respectively.
Index words
Dialysis, Angioplasty, Transluminal, PercutaneousgREFERENCES
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Fig. 1.
Transradial approach for thrombosed brachiocephalic fistula with partial graft interposition. A. Angiography that was performed above the arterial anastomosis shows complete occlusion of the arterial anastomosis of the graft. B. After advancement of the catheter across the arterial anastomosis of the graft, angiography shows diffuse venous limb stenosis (arrows) distal to the venous anastomosis of graft and thrombosis within the outflow vein. C. After thrombus removal and PTA with the use of a 6 × 40 mm balloon, angiography shows flow restoration without significant residual stenosis. A partially thrombosed pseudoaneurysm (arrow) was demonstrated at the arterial anstomosis.
Fig. 2.
Stent placement by means of the transradial approach for residual junctional stenosis of the cephalic vein due to elastic re-coil after PTA. A. Fistulography performed above the arterial anastomosis shows two tight stenoses at the cephalic vein (arrows). B. After PTA at the diseased venous segment with a 7 × 40 mm balloon, fistulography shows significant residual stenosis (arrow) with faint contrast opacfication at the junction of the cephalic vein in spite of repeated angioplasty (arrow). C. After placement of an 8 × 40 mm self-expandable stent by means of the transradial approach (arrows), fistulography shows flow restoration without residual stensosis at the junction of the cephalic vein.
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