HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Liang, H.-L. Articles by Yang, C.-F. Search for Related Content PubMed PubMed Citation Articles by Liang, H.-L. Articles by Yang, C.-F.

Restoration of Thrombosed Brescia-Cimino Dialysis Fistulas by Using Percutaneous Transluminal Angioplasty¹

¹ From the Departments of Radiology (H.L.L., H.B.P., M.T.W., P.H.L., C.K.H.C., C.F.Y.), Internal Medicine (Nephrology) (H.M.C., H.C.F.), Education and Research (L.P.G.), and Surgery (Cardiovascular) (T.H.W.), Kaohsiung Veterans General Hospital, National Yang-Ming University, 386 Ta-Chung 1st Rd, Kaohsiung, Taiwan 813, Republic of China. Received April 20, 2001; revision requested May 31; revision received August 24; accepted September 28. Address correspondence to C.F.Y. (e-mail: cfyang@isca.vghks.gov.tw).

View larger version (28K): [in a new window]   Figure 1. Schematic illustration of two-puncture technique restoring a thrombosed AVF. Arrow indicates second antegrade puncture site. Cross-hatched area indicates the stenotic segment in the thrombosed AVF. A guide wire was inserted in the thrombosed lumen in an antegrade fashion with its soft tip in the lumen of the vascular sheath. av = accessory vein, mdv = main drainage vein, ra = radial artery.

View larger version (65K): [in a new window]   Figure 2. With US guidance, a needle (arrows) punctured the thrombosed lumen (TL) distal to the anastomosis in antegrade fashion. Small scale (right) = 5 mm.

View larger version (138K): [in a new window]   Figure 3. Venograms obtained in a 69-year-old woman who had AVF occlusion of 4 days duration. A, Road-map image shows many side branches (accessory veins) in the thrombosed AVF. The tip of a paper clip (arrowhead) indicates the superficial location of the arteriovenous anastomosis, which failed to be crossed in a retrograde fashion. B, A small amount of contrast medium was injected after the second puncture. Arrow points to stenotic segment of main drainage vein. Arrowhead points to entry site of second puncture. C, A guide wire was advanced into the thrombosed AVF in an antegrade fashion. D, Arterial inflow was crossed in a retrograde fashion. E, Follow-up venogram obtained after direct balloon dilation demonstrates well reestablished vascular access. No thrombolytic agent was administered in this patient.

View larger version (182K): [in a new window]   Figure 4. Arteriovenous anastomosis crossed by using the one-puncture technique. A, Fistula angiogram shows occlusion of the vascular access distal to the anastomosis. B, Fistula angiogram obtained after direct balloon dilation shows the vascular access is partially restored. There is a filling defect (arrow) in the slightly dilated aneurysmal segment. C, US scan confirms the residual thrombus (arrow) in the dilated segment of the vascular access. D, US scan shows the residual thrombus is completely dissolved after direct infusion of urokinase through a 22-gauge cannula sheath. E, Doppler US scan. The flow volume was estimated to be around 867 mL/min (flow volume = TAV [115 cm/sec] x 2 [3.14 x 4 mm2] x 60 sec/100).

View larger version (19K): [in a new window]   Figure 5. Graph shows primary (P, dashed line) and secondary (S, solid line) patency rates of thrombosed AVFs after percutaneous restoration.