Endovascular Treatment of Dialysis Access–Induced Hand Ischemia Using a Flared Stent-Graft

2017 ◽  
Vol 24 (5) ◽  
pp. 743-745 ◽  
Author(s):  
Chien Yi M. Png ◽  
William E. Beckerman ◽  
Peter L. Faries ◽  
David J. Finlay
Keyword(s):  
Stent Graft ◽  
Brachial Artery ◽  
Dialysis Access ◽  
Dialysis Patients ◽  
Hybrid Surgery ◽  
Hand Ischemia ◽  
Guide Catheter ◽  
Arterial Anastomosis ◽  
Endovascular Approach ◽  
Antegrade Flow

Purpose: To report an investigation of a purely endovascular procedure to address access-induced hand ischemia in dialysis patients. Case Report: Two dialysis patients presented with stage III steal syndrome consisting of severe pain and numbness in their fingers. Preoperative fistulograms distal to the anastomosis showed alternating antegrade and retrograde flow. Under ultrasound guidance, the fistula was accessed and a 4-F micropuncture sheath placed. An angled guidewire was then advanced proximally into the brachial artery. A 6-F short sheath with marker was placed followed by a 4-F straight guide catheter inserted into the proximal brachial artery. A 9-F Flair endovascular stent-graft was advanced over a 0.035-inch stiff angled Glidewire into the fistula just distal to the arterial anastomosis and deployed. Postoperatively, pain and numbness resolved in both patients immediately. Postoperative fistulograms documented antegrade flow. Access flow velocity readings decreased significantly and pulse oximetry readings increased significantly in both patients, who were followed for >6 months with no reported complications. Conclusion: These 2 cases suggest that this endovascular approach to access-induced hand ischemia may be a viable alternative to open/hybrid surgery.

A new endovascular technique for the treatment of dialysis-associated steal syndrome

Vascular ◽  
2017 ◽  
Vol 26 (3) ◽  
pp. 335-337 ◽  
Author(s):  
Enrico Ascher ◽  
Jacob E. Mandel ◽  
Natalie A. Marks ◽  
Anil P. Hingorani
Keyword(s):  
Arteriovenous Fistula ◽  
Stent Graft ◽  
Brachial Artery ◽  
High Risk Patient ◽  
Arterial System ◽  
Dialysis Access ◽  
Endovascular Technique ◽  
Steal Phenomenon ◽  
Endovascular Approach ◽  
Steal Syndrome

Background Dialysis access-associated steal syndrome is a major complication of arteriovenous fistula creation whereby the low-resistance venous conduit shunts arterial inflow through the anastomosis, resulting in clinically significant distal artery insufficiency. Herein, we describe a case of severe steal phenomenon with gangrene of a digit following placement of an arteriovenous fistula that was treated with a novel, entirely endovascular technique. To our knowledge, this was the first totally endovascular approach to dialysis access-associated steal syndrome. Methods Catheterization of the right subclavian, axillary, and brachial arteries was performed. A short 5-Fr sheath was exchanged for a long destination 6-Fr sheath and placed in the proximal brachial artery. An arteriogram showed no stenosis of the arterial system, but did show substantial steal phenomenon with inflow to the arteriovenous fistula, instead of the forearm. We placed a stent graft in the brachial artery across the anastomosis such that the graft covered 3/4 of the length of the opening of the anastomosis. Results Immediately after placement of the stent graft the clinical picture improved dramatically. Patient was followed for 15 months after this procedure until her demise for unrelated causes without ever experiencing dialysis access-associated steal syndrome and with a patent and functional arteriovenous fistula. Conclusion We present a patient with severe dialysis access-associated steal syndrome complicated by third fingertip gangrene, which was successfully treated using a completely endovascular technique. This novel endovascular approach enabled a high-risk patient to avoid open surgery, preserve her limb, and maintain the function of her arteriovenous fistula.

scholarly journals Current status of vascular access in Japan—from Dialysis Access Symposium 2017

2019 ◽  
Vol 20 (1_suppl) ◽  
pp. 38-44
Author(s):  
Mizuya Fukasawa
Keyword(s):  
Vascular Access ◽  
Current Status ◽  
Good Survival ◽  
Chronic Glomerulonephritis ◽  
Dialysis Access ◽  
Dialysis Patients ◽  
Survival Prognosis ◽  
Access Methods ◽  
Number Of Patients ◽  
Wide Range

At the second Dialysis Access Symposium held in Nagoya, Japan, a proposal was made to investigate the differences in vascular access methods used in different countries. In this article, we describe the management of vascular access in Japan. The Japanese population is rapidly aging, and the proportion of elderly patients on dialysis is also increasing. There were 325,000 dialysis patients in Japan at the end of 2015, of whom 65.1% were aged 65 years or above. The number of patients with diabetic nephropathy or nephrosclerosis as the underlying condition is also increasing, whereas the number with chronic glomerulonephritis is steadily decreasing. The Japanese health insurance system enables patients to undergo medical treatment at almost no out-of-pocket cost. Percutaneous transluminal angioplasty suffers from a severe device lag compared with other countries, but although there are limitations on permitted devices, the use of those that have been authorized is covered by medical insurance. One important point that is unique to Japan is that vascular access is performed and managed by doctors involved in dialysis across a wide range of disciplines, including nephrologists, surgeons, and urologists. This may be one factor contributing to the good survival prognosis of Japanese dialysis patients.

Skin perfusion pressure for predicting access-related hand ischemia following arteriovenous fistula surgery based on the brachial artery

2021 ◽  
pp. 112972982199398
Author(s):  
Miju Bae ◽  
Sung Woon Chung ◽  
Chung Won Lee ◽  
Up Huh ◽  
Moran Jin ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Sensitivity And Specificity ◽  
Brachial Artery ◽  
Perfusion Pressure ◽  
Characteristic Curve ◽  
Major Complication ◽  
Clinical Predictors ◽  
Skin Perfusion ◽  
Hand Ischemia ◽  
Skin Perfusion Pressure

Background: Access-related hand ischemia (ARHI) is a major complication of arteriovenous fistula (AVF). This study aimed to assess the predictive efficacy of skin perfusion pressure (SPP) measurement for ARHI by examining the relationship between SPP and ARHI development and progression after AVF surgery. Methods: Twenty-five patients (16 men and 9 women) who underwent AVF surgery based on the brachial artery between January 2018 and December 2018 were included. The pre- and postoperative SPP values were measured on the day of surgery. ARHI occurrence and severity were measured within 3 days and at 6 months after surgery. Receiver operating characteristic curve analysis was used to evaluate the prediction model of ARHI, and the cutoff points for the calculated coefficients were determined. Results: There was a significant correlation between the occurrence of immediate ARHI and the SPP gradient ( p = 0.024). An SPP gradient value >50 mmHg had sensitivity and specificity values of 53.85% and 91.67%, respectively, in predicting the occurrence of immediate ARHI. A postoperative SPP <48 mmHg was significantly correlated with the occurrence of 6-month ARHI ( p = 0.005), with sensitivity and specificity values of 71.43% and 83.33%, respectively. Conclusion: The SPP gradient and postoperative SPP values may be effective clinical predictors of ARHI occurring immediately and 6 months after surgery, respectively, with high specificity. These findings could allow clinicians to diagnose and begin early interventions to help prevent ischemic tissue damage in hemodialysis patients following AVF surgery.

Giant brachial artery aneurysm as a rare complication of a dialysis shunt

2019 ◽  
Vol 21 (5) ◽  
pp. 799-802 ◽  
Author(s):  
Elisa Maria Schilling ◽  
Malte Weinrich ◽  
Thomas Heller ◽  
Sebastian Koball ◽  
Andreas Neumann
Keyword(s):  
Brachial Artery ◽  
Rare Complication ◽  
Artery Aneurysm ◽  
Giant Aneurysm ◽  
Magnetic Resonance Imaging Scan ◽  
Dialysis Access ◽  
Large Tumor ◽  
Arteriovenous Fistulas ◽  
Arteriovenous Shunts ◽  
Ongoing Care

Our patient exhibited a large tumor on his right upper arm where his former dialysis access site had been. X-ray, Doppler ultrasound, and magnetic resonance imaging scan could not fully reveal the nature of that tumor. Eventually, a surgical approach showed a giant aneurysm of the inflowing brachial artery to a partially obliterated arteriovenous fistula. This case highlights the importance of ongoing care for patients with arteriovenous shunts. Even arteriovenous fistulas, that are obliterated or no longer in use, can, especially when immunosuppressant therapy and other vascular risk factors are added to the overall cardiovascular risk, transform and endanger the health of our patients.

scholarly journals Acute Upper Limb Ischemia Due to Delayed Presentation of a Brachial Artery Pseudoaneurysm Post-Venipuncture

2019 ◽  
Vol 54 (1) ◽  
pp. 80-84 ◽  
Author(s):  
Adele H. H. Lee ◽  
Sara D. Qi ◽  
Nathaniel Chiang
Keyword(s):  
Median Nerve ◽  
Upper Limb ◽  
Brachial Artery ◽  
Limb Ischemia ◽  
High Morbidity ◽  
Delayed Presentation ◽  
Artery Pseudoaneurysm ◽  
Hand Ischemia ◽  
Iatrogenic Trauma ◽  
Median Nerve Neuropathy

Brachial artery pseudoaneurysms (BAPs) are rare but could lead to complications of high morbidity. We report a case of a BAP presenting with hand ischemia and median nerve neuropathy nearly a decade after the inciting iatrogenic trauma, successfully treated with excision and direct repair. This report highlights that untreated pseudoaneurysms can be indolent and present late with both symptoms of embolization and local compression.

Covered Stent-graft Repair of the Brachiocephalic Arteries: Technical Note

Neurosurgery ◽  
2002 ◽  
Vol 51 (1) ◽  
pp. 247-253 ◽  
Author(s):  
Arun Paul Amar ◽  
George P. Teitelbaum ◽  
Steven L. Giannotta ◽  
Donald W. Larsen
Keyword(s):  
Carotid Artery ◽  
Stent Graft ◽  
Neurological Complications ◽  
Covered Stent ◽  
Technical Note ◽  
Parent Vessel ◽  
Vessel Patency ◽  
Stent Graft Repair ◽  
Antegrade Flow ◽  
Covered Stent Graft

Abstract OBJECTIVE The use of a covered stent-graft to repair disruptions of the cervical carotid and vertebral arteries is described. This device maintains vessel patency while effectively excluding pseudoaneurysms, arteriovenous fistulae, and other breaches in the integrity of the arterial wall. METHODS Patient 1 bled from a large rent in the proximal common carotid artery as a result of tumor invasion. Patient 2 developed a vertebral arteriovenous fistula after a stab injury to the neck. Patient 3 developed cerebral infarction and an enlarging pseudoaneurysm of the internal carotid artery, also after a stab wound to the neck. RESULTS All three patients were treated with the Wallgraft endoprosthesis (Boston Scientific, Watertown, MA). In each case, the vessel wall defect was repaired while antegrade flow through the artery was preserved or restored. No neurological complications occurred as a result of stent-graft deployment. CONCLUSION Covered stent-grafts offer an alternative to endovascular occlusion of the parent vessel, thereby expanding the therapeutic options for patients with extracranial cerebrovascular disease. These three cases highlight the usefulness and versatility of these devices for endoluminal reconstruction of the brachiocephalic vasculature.

scholarly journals Estimation of brachial artery volume flow by duplex ultrasound imaging predicts dialysis access maturation

2015 ◽  
Vol 61 (6) ◽  
pp. 1521-1528 ◽  
Author(s):  
Sae Hee Ko ◽  
Dennis F. Bandyk ◽  
Kelley D. Hodgkiss-Harlow ◽  
Andrew Barleben ◽  
John Lane
Keyword(s):  
Ultrasound Imaging ◽  
Brachial Artery ◽  
Duplex Ultrasound ◽  
Volume Flow ◽  
Dialysis Access
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