Korean J Radiol.  2005 Sep;6(3):185-195. 10.3348/kjr.2005.6.3.185.

Endovascular Management of Immediate Procedure-Related Complications of Failed Hemodialysis Access Recanalization

• Kim DH
• Goo DE
• Yang SB
• Moon C
• Choi DL

• KMID: 1102716
• DOI: http://doi.org/10.3348/kjr.2005.6.3.185

Abstract

Endovascular procedures are becoming the standard type of care for the management of hemodialysis vascular access dysfunction. As with any type of medical procedure, these techniques can result in procedure-related complications, although the expected number of complications is low. The clinical extent of these complications varies from case to case. Management of these cases depends on the clinical presentation. Major complications such as vein rupture, arterial embolism, remote site bleeding or hematoma, symptomatic pulmonary embolism and puncture site complications necessitating treatment require major therapy. Minor complications such as non-flow compromising small puncture site hematoma or pseudoaneurysms require little or no therapy. It is essential that the interventionist be prepared to manage these complications appropriately when they arise.

Keyword

Hemodialysis; Transluminal angioplasty

MeSH Terms

Veins
Stents
Rupture, Spontaneous
Retrospective Studies
Renal Dialysis/*methods
Postoperative Complications/therapy
Middle Aged
Male
Humans
Female
Extravasation of Diagnostic and Therapeutic Materials/therapy
Embolism/therapy
*Arteriovenous Shunt, Surgical
Aged
Adult

Figure

• 

  Fig. 1 58-year-old woman with a left radiocephalic fistula. A. Diffuse stenosis of the distal cephalic vein is shown. B. Contrast extravasation after ballooning is shown at the proximal diffuse stenotic lesion. C. Blood flow is blocked by a balloon catheter for five minutes. D. Postprocedural angiography shows restoration of the lumen.

• 

  Fig. 2 47-year-old woman with a left radiobasilic graft. A. Diffuse tight stenosis is shown at the venous anastomosis (arrows). B. Extravasation after ballooning causing vein rupture. C. Blood flow was blocked by a balloon catheter for five minutes. However, fistulography shows continuous extravasation and persistent residual stenosis by severe tears and ruptures of the vein. Endovascular stents were successfully used to stop the bleeding and preserve the access. D. Follow-up angiography shows good patency of the lumen and no leakage.

• 

  Fig. 3 68-year-old woman with a right upper arm brachiobasilic graft. A. Abrupt cutoff in the ulnar artery means an arterial embolus. B. 7F Desilet-Hoffman sheath was advanced through the artery near the embolus. C. Angiography after retraction of the embolus in the sheath demonstrates a successful retrieval resulting in the restoration of the arterial lumen. D. The retracted embolus is shown.

• 

  Fig. 4 55-year-old man with a left radiocephalic fistula. A. Extravasation from the distal radial artery is shown. B. Blood flow is blocked by an angioplasty balloon for five minutes. C. A follow-up angiography shows no blood leaking. There are no hemodynamically significant complications.

• 

  Fig. 5 56-year-old woman with a left upper arm brachiobrachial graft. A. Tight stenosis at the venous anastomosis (arrow). B. An angioplasty was attempted, but the balloon ruptured abruptly. C. Fragmented balloon is shown in contrast filled vascular lumen. The fragmented balloon was removed by open surgery. D. Fragmented balloon specimen, removed.

• 

  Fig. 6 48-year-old woman with a right upper arm brachiojugular graft. A. Intragraft filling defects means thrombi (arrows). B. Thrombi aspiration with Desilets-Hoffman sheath was performed. During the procedure the patient experienced chest discomfort and dyspnea. The final fistulography shows no abnormal filling defect. C. Perfusion defect is shown in upper left lobe. The patient was managed by conservative treatment with anticoagulant.

• 

  Fig. 7 29-year-old woman with a left upper arm brachiocephalic fistula. A. 20×20 mm-stent migration into superior vena cava is shown (arrow). B. 6F-Goose neck snare (arrows) and 5 F-catheter were inserted into SVC (displaced stent) via a 12 F-sheath of the femoral vein. C. Guide wire through the 5 F-catheter was snared. The displaced stent, "Wire-loop" made by pulled Goose neck snare and guide wire is removed via the femoral vein sheath.

• 

  Fig. 8 63-year-old man with an infected graft and stenosis of the venous anastomosis. A. The patient had a focal infection in the arterial limb of the graft. Angiography shows focal stenosis at the venous anastomosis (arrow). B. Angioplasty was performed successfully. After one day, the patient experienced high fever and petechiae in the phalanges. C. After two weeks, multiple nodules were seen in the periphery of both lung fields. Yersinia Enterocolitica was confirmed microbiologically in pleural effusion and blood.

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