Clinical Significance of Fistulography by Brachial Artery Approach in Hemodialysis Patients

Won, Yoo Dong; Kim, Young Ok; Kim, Young Soo; Yoon, Sun Ae; Kim, Ki Tae; Kim, Suk Young; Choi, Euy Jin; Chang, Yoon Sik; Bang, Byung Kee

Abstract

BACKGROUND
Fistulography is usually performed through transvenous approach in hemodialysis patients. We preformed this study to evaluate the clinical significance of the brachial arterial approach for the fistulography from the hemodialysis patients. METHODS: This study included 13 cases from 12 hemodialysis patients who had the fistulogram or percutaneous transluminal angioplasty through brachial arterial approach between November 2003 and June 2005. We investigated the indication, the radiologic finding, the complication and the outcome of the fistulography and the percutaneous transluminal angioplasty. RESULTS: Indication of transbrachial artery approach was immaturation of the arteriovenous fistula or poor visualization of venous route. The brachial artery puncture was successfully performed in all patients. For 10 cases, the stenoses or occlusions were observed in the arteriovenous anastomosis site, distal radial artery or proximal cephalic vein. Four patients had severe arterial stenosis. Additionally, the percutaneous transluminal angioplasty were performed in 8 cases of 13 cases. The procedure-related complication demonstrated focal pseudoaneurysm formation at brachial artery puncture site, resulting in transient radial nerve palsy in only one case. CONCLUSION: Tranbrachial artery approach is considered as effective in the immaturation of hemodialysis arteriovenous fistulas or arterial vascular problem. However, we should give attention to the brachial arterial approach because of its significant complication.