Sharp Needle Recanalization: A Salvage Procedure for Failing Arteriovenous Fistula Due to Tight Uncrossable Venous Stenosis

A 33-year- old male presented with malfunctioning brachiobasilic arteriovenous fistula (AVF) due to short tight juxta anastomotic stenosis ([Fig. 1]). Access was gained into the AVF draining vein, and multiple trials to cross the tight stenosis using catheter and wire failed ([Fig. 2]). Sharp needle recanalization was performed under ultrasound guidance, using 21G needle and wire to cross this tight stenosis ([Fig. 3a,b]). Wire passed into the AVF draining vein and snared through the already placed vascular sheath. Balloon angioplasty was performed using 6-mm, high-pressure balloon and inflated for 3 minutes. Postangioplasty venogram showed successful result ([Fig. 4]). Patient had follow-up fistulogram and angioplasty every 6 months for 2 years, and fistula remained patent ([Fig. 5]).

Fig. 1 Ultrasound of arteriovenous fistula (AVF) showing a juxta anastomotic tight stenosis and aneurysmal dilatation.

Fig. 2 Fistulogram showing patent arteriovenous fistula (AVF) with uncrossable tight stenosis.

Fig. 3 (a and b) Ultrasound-guided sharp needle recanalization using 21G needle and wire.

Fig. 4 Postballoon angioplasty fistulogram showing successful angioplasty without contrast extravasation.

Fig. 5 Follow-up fistulogram after 2 years showing patent arteriovenous fistula (AVF).

Sharp needle recanalization is a well-known technique for central venous occlusion.[1] This technique is rarely used in peripheral veins.[2] Jump graft is a salvage technique used to bridge stenotic/thrombotic venous segment of AVF. Jump graft is created surgically or percutaneously by a mean of stent graft for failing AVF.[3] Sharp needle recanalization is a minimally invasive alternative salvage technique to surgical jump graft in tight uncrossable AVF peripheral venous stenosis.[4]

Conflicts of Interest

None declared.

Financial Support and Sponsorship

Nil.

• References

• 1 Arabi M, Ahmed I, Mat'hami A, Ahmed D, Aslam N. Sharp central venous recanalization in hemodialysis patients: a single-institution experience. Cardiovasc Intervent Radiol 2016; 39 (06) 927-934
• 2 Miller GA, Koh E, Khariton A. et al. Sharp needle recanalization for salvaging hemodialysis accesses with chronically occluded peripheral outflow. J Vasc Access 2012; 13 (01) 22-28
• 3 Timpone VM, Gover DD. Percutaneous creation of a jump bypass graft in a native arteriovenous hemodialysis fistula. J Vasc Interv Radiol 2011; 22 (05) 734-736
• 4 Noh SY, Goo DE, Kim YJ, Yang SB, Lee JM, Lee WH. Sharp needle recanalization technique for peripheral hemodialysis arteriovenous fistula occlusion. Cardiovasc Intervent Radiol 2021; (e-pub ahead of print)

Publication History

Article published online:
22 December 2021