Document Detail

Restoration of thrombosed Brescia-Cimino dialysis fistulas by using percutaneous transluminal angioplasty.
MedLine Citation:
PMID:  11997535     Owner:  NLM     Status:  MEDLINE    
PURPOSE: To evaluate the authors' experience with a technique for management of thrombosed Brescia-Cimino arteriovenous fistula. MATERIALS AND METHODS: Forty patients with 42 thrombosed arteriovenous fistulas were percutaneously treated. Thrombosis occurred within 24 hours of attempted angioplasty in five fistulas, between 24 and 72 hours in 27, and longer than 72 hours in 10. Thrombosed fistulas were approached in a retrograde fashion followed by direct balloon dilation with 5-8-mm balloon catheters. If retrograde catheterization failed to cross the arterial anastomosis, an antegrade puncture directly into the thrombosed drainage vein close to the anastomosis was performed with ultrasonographic guidance, as an aid to catheterize the arterial inflow. Thrombolytic therapy with infusion of urokinase directly into the thrombus was performed in selected patients with visible thrombus that had compromised blood flow in the partially restored vascular access. Postintervention primary and secondary patency was calculated by using Kaplan-Meier analysis. Patency rates between patients without and with urokinase infusion were examined by using the log-rank test. RESULTS: Anatomic success was achieved in 39 (93%) of 42 fistulas; and clinical patency, in 38 (90%) of 42 fistulas. Postintervention primary and secondary patencies (including initial technical failure) at 6, 12, and 18 months were 81% and 84%, 70% and 80%, and 63% and 80%, respectively. No significance of patency rate between patients without and with urokinase infusion was found (P =.912). Three patients died of unrelated causes at 1, 2, and 5 months after the procedures. No major complications were encountered. CONCLUSION: High anatomic success and excellent clinical patency can be achieved in the salvage of thrombosed arteriovenous fistulas. Percutaneous restoration of arteriovenous fistulas should be attempted before surgical recreation to optimize outcome in patients undergoing hemodialysis.
Huei-Lung Liang; Huay-Ben Pan; Hsiao-Min Chung; Luo-Ping Ger; Hua-Chang Fang; Tung-Ho Wu; Ming-Ting Wu; Ping-Hong Lai; Clement K-H Chen; Chien-Fang Yang
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Radiology     Volume:  223     ISSN:  0033-8419     ISO Abbreviation:  Radiology     Publication Date:  2002 May 
Date Detail:
Created Date:  2002-05-08     Completed Date:  2002-06-13     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0401260     Medline TA:  Radiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  339-44     Citation Subset:  AIM; IM    
Copyright Information:
Copyright RSNA, 2002
Department of Radiology, Kaohsiung Veterans General Hospital, National Yang-Ming University, 386 Ta-Chung 1st Rd, Kaohsiung, Taiwan 813, Republic of China.
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MeSH Terms
Aged, 80 and over
Angioplasty, Transluminal, Percutaneous Coronary*
Arm / blood supply
Arteriovenous Shunt, Surgical*
Middle Aged
Thrombosis / therapy*,  ultrasonography
Treatment Outcome
Vascular Patency
Comment In:
Radiology. 2003 Mar;226(3):925; author reply 926-7   [PMID:  12616027 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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