RSS-Feed abonnieren
DOI: 10.1055/s-2004-833681
Declotting, Maintenance, and Avoiding Procedural Complications of Native Arteriovenous Fistulae
Publikationsverlauf
Publikationsdatum:
13. September 2004 (online)
![](https://www.thieme-connect.de/media/sir/200402/lookinside/thumbnails/10.1055-s-2004-833681-1.jpg)
Native arteriovenous fistulae are the best form of hemodialysis access. Every effort should be made to preserve and maintain these valuable access sites. The typical fistula is created from the distal radial artery to an adjacent forearm vein. Thrombosis is a relatively rare occurrence but when it occurs, surgical declotting is not as successful as percutaneous approaches. Thus, the interventional radiologist needs to be prepared to evaluate and declot fistulae. As the percentage of fistulae increases in the general dialysis population, radiologists expect to see the demand for percutaneous declotting increase. This article reviews approaches to declotting and maintaining fistulae. Common procedural complications and their treatment or follow-up are also reviewed.
KEYWORDS
Arteriovenous fistula - dialysis - shunts - veins - transluminal angioplasty
REFERENCES
- 1 Brescia M J, Cimino J E, Appel K, Hurwich B J. Chronic hemodialysis using venipuncture and a surgically created arteriovenous fistula. N Engl J Med. 1966; 275 1089-1092
- 2 Chazan J A, London M R, Pono L M. Long-term survival of vascular accesses in a large chronic hemodialysis population. Nephron. 1995; 69 228-233
- 3 Stevenson K B, Hannah E L, Lowder C A et al.. Epidemiology of hemodialysis vascular access infections from longitudinal infection surveillance data: predicting the impact of NKF-DOQI clinical practice guidelines for vascular access. Am J Kidney Dis. 2002; 39 549-555
- 4 Aruny J E. Dialysis access shunt and fistula recanalization. In: Kandarpa K, Aruny JE Handbook of Interventional Radiology Procedures. Boston; Little, Brown 1996: 122-124
- 5 Vorwerk D, Schurmann K, Muller-Leisse C et al.. Hydrodynamic thrombectomy of haemodialysis grafts and fistulae: results of 51 procedures. Nephrol Dial Transplant. 1996; 11 1058-1064
- 6 Overbosch E H, Pattynama P M, Aarts H J et al.. Occluded hemodialysis shunts: Dutch multicenter experience with the hydrolyser catheter. Radiology. 1996; 201 485-488
- 7 Turmel-Rodrigues L, Sapoval M, Pengloan J et al.. Manual thromboaspiration and dilation of thrombosed dialysis access: mid-term results of a simple concept. J Vasc Interv Radiol. 1997; 8 813-824
- 8 Zaleski G X, Funaki B, Kenney S et al.. Angioplasty and bolus urokinase infusion for the restoration of function in thrombosed Brescia-Cimino dialysis fistulas. J Vasc Interv Radiol. 1999; 10 129-136
- 9 Haage P, Vorwerk D, Wildberger J E et al.. Percutaneous treatment of thrombosed primary arteriovenous hemodialysis access fistulae. Kidney Int. 2000; 57 1169-1175
- 10 Turmel-Rodrigues L, Pengloan J, Rodrigue H et al.. Treatment of failed native arteriovenous fistulae for hemodialysis by interventional radiology. Kidney Int. 2000; 57 1124-1140
- 11 Rocek M, Peregrin J H, Lasovickova J et al.. Mechanical thrombolysis of thrombosed hemodialysis native fistulas with use of the Arrow-Trerotola percutaneous thrombolytic device: our preliminary experience. J Vasc Interv Radiol. 2000; 11 1153-1158
- 12 Schmitz-Rode T, Wildberger J E, Hubner D et al.. Recanalization of thrombosed dialysis access with use of a rotating mini-pigtail catheter: follow-up study. J Vasc Interv Radiol. 2000; 11 721-727
- 13 Liang H L, Pan H B, Chung H M et al.. Restoration of thrombosed Brescia-Cimino dialysis fistulas by using percutaneous transluminal angioplasty. Radiology. 2002; 223 339-344
- 14 Rajan D K, Clark T W, Simons M E et al.. Procedural success and patency after percutaneous treatment of thrombosed autogenous arteriovenous dialysis fistulas. J Vasc Interv Radiol. 2002; 13 1211-1218
- 15 Schon D, Mishler R. Pharmacomechanical thrombolysis of natural vein fistulas: reduced dose of TPA and long-term follow-up. Semin Dial. 2003; 16 272-275
- 16 Berman S S, Gentile A T. Impact of secondary procedures in autogenous arteriovenous fistula maturation and maintenance. J Vasc Surg. 2001; 34 866-871
- 17 Turmel-Rodrigues L. Regarding “impact of secondary procedures in autogenous fistula maturation and maintenance. J Vasc Surg. 2002; 36 867-868
- 18 Zaleski G X, Funaki B, Gentile L, Garofalo R S. Purse-string sutures and miniature tourniquet to achieve immediate hemostasis of percutaneous grafts and fistulas: a simple trick with a twist. AJR Am J Roentgenol. 2000; 175 1643-1645
- 19 Manninen H I, Kaukanen E T, Ikaheimo R et al.. Brachial arterial access: endovascular treatment of failing Brescia-Cimino hemodialysis fistulas-initial success and long-term results. Radiology. 2001; 218 711-718
- 20 Haage P, Vorwerk D, Wildberger J et al.. Percutaneous treatment of thrombosed primary arteriovenous hemodialysis access fistulae. Kidney Int. 2000; 57 1169-1175
- 21 Simons M E, Rajan D K, Clark T W. The Woggle technique for suture closure of hemodialysis access catheterization sites. J Vasc Interv Radiol. 2003; 14 485-488
- 22 Konner K. The anastomosis of the arteriovenous fistula-common errors and their avoidance. Nephrol Dial Transplant. 2002; 17 376-379
- 23 Turmel-Rodrigues L A, Bourquelot P, Pengloan J. Hemodialysis arteriovenous fistula maturity: US evaluation Radiology. 2003; 227 906-907
- 24 Turmel-Rodrigues L, Mouton A, Birmele B et al.. Salvage of immature forearm fistulas for haemodialysis by interventional radiology. Nephrol Dial Transplant. 2001; 16 2365-2371
- 25 Beathard G A, Settle S M, Shields M W. Salvage of the nonfunctioning arteriovenous fistula. Am J Kidney Dis. 1999; 33 910-916
- 26 Faiyaz R, Abreo K, Zaman F et al.. Salvage of poorly developed arteriovenous fistulae with percutaneous ligation of accessory veins. Am J Kidney Dis. 2002; 39 824-827
- 27 Corpataux J M, Haesler E, Silacci P et al.. Low-pressure environment and remodelling of the forearm vein in Brescia-Cimino haemodialysis access. Nephrol Dial Transplant. 2002; 17 1057-1062
- 28 Ene-Iordache B, Mosconi L, Antiga L et al.. Radial artery remodeling in response to shear stress increase within arteriovenous fistula for hemodialysis access. Endothelium. 2003; 10 95-102
- 29 Beathard G A, Arnold P, Jackson J, Litchfield T. Physician Operators Forum of RMS Lifeline. Aggressive treatment of early fistula failure. Kidney Int. 2003; 64 1487-1494
- 30 Robbin M L, Chamberlain N E, Lockhart M E et al.. Hemodialysis arteriovenous fistula maturity: US evaluation. Radiology. 2002; 225 59-64
- 31 Trerotola S O, Vesely T M, Lund G B. Treatment of thrombosed hemodialysis access grafts: Arrow-Trerotola percutaneous thrombolytic device versus pulse-spray thrombolysis. Arrow-Trerotola Percutaneous Thrombolytic Device Clinical Trial. Radiology. 1998; 206 403-414
- 32 Trerotola S O, Johnson M S, Shah H, Namyslowski J. Backbleeding technique for treatment of arterial emboli resulting from dialysis graft thrombolysis. J Vasc Interv Radiol. 1998; 9 141-143
- 33 Funaki B, Szymski G X, Hackworth C A, Rosenblum J D. Vascular or interventional procedures in patients with diabetes. J Vasc Interv Radiol. 1997; 8 1080
- 34 Zaleski G X, Funaki B, Rosenblum J et al.. Metallic stents deployed in synthetic arteriovenous hemodialysis grafts. AJR Am J Roentgenol. 2001; 176 1515-1519
- 35 Turmel-Rodrigues L, Pengloan J, Rodrigue H et al.. Treatment of failed native arteriovenous fistulae for hemodialysis by interventional radiology. Kidney Int. 2000; 57 1124-1140
- 36 Rajan D K, Clark T W, Patel N K et al.. Prevalence and treatment of cephalic arch stenosis in dysfunctional autogenous hemodialysis fistulas. J Vasc Interv Radiol. 2003; 14 567-573
George ZaleskiM.D.
All Saints Medical Imaging
3801 Sping Street
Racine, WI 53405
eMail: george-zaleski@mindspring.com