This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Marks, N. Articles by Hingorani, A. P. Search for Related Content PubMed PubMed Citation Articles by Marks, N. Articles by Hingorani, A. P. Social Bookmarking                         What's this?

Duplex-Guided Repair of Failing or Nonmaturing Arterio-venous Access for Hemodialysis

Maimonides Medical Center, Division of Vascular Surgery, Brooklyn, New York, nmarks{at}maimonidesmed.org

Enrico Ascher, MD

Maimonides Medical Center, Division of Vascular Surgery, Brooklyn, New York

Anil P. Hingorani, MD

Maimonides Medical Center, Division of Vascular Surgery, Brooklyn, New York

Diagnostic arteriography and balloon angioplasty of failing or nonmaturing arterio-venous (AV) access is based upon using nephrotoxic contrast. Patients not yet on dialysis with borderline renal function with nonmaturing AV accesses or ones with an allergy to contrast media present a therapeutic challenge. We have used duplex scanning as an alternative imaging modality to guide endovascular therapy in 10 cases (9 autologous and 1 prosthetic). Six target AV accesses (60%) were used for dialysis. Number of stenoses ranged from 1 to 5 per AV access. Short access sheath insertion, wire and balloon passage, and inflation were guided by duplex only. Balloon size (5-8 mm in diameter) was chosen based on duplex measurements. Cutting balloons (4 x 20 mm and 5 x 20 mm) were used for dilatation of recoiling lesions in 4 cases. One patient had a self-expanding stent placed under duplex-guidance for recoiling lesion in the junction of the brachial and axillary veins.

Angioplasty of failing AV access can be performed under duplex guidance alone. Duplex guidance offers very important advantages of hemodynamic evaluation for recoiling lesions and need for stenting. Avoidance of contrast use for repair of nonfunctioning AV access can be a useful option in patients with renal failure not yet on dialysis or in cases of allergy.

Key Words: duplex-guided • renal failure • hemodialysis access • failing AV access • nonmaturing AV access • AV access angioplasty

Perspectives in Vascular Surgery and Endovascular Therapy, Vol. 19, No. 1, 50-55 (2007)
DOI: 10.1177/1531003506298144


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				N. Patel, A. Hingorani, and E. Ascher Office-Based Surgery for Vascular Surgeons Perspectives in Vascular Surgery and Endovascular Therapy, December 1, 2008; 20(4): 326 - 330. [Abstract] [PDF]