ASDIN white paper: Management of cephalic arch stenosis endorsed by the American Society of Diagnostic and Interventional Nephrology.

Brachiocephalic arteriovenous fistulas (AVF) makeup approximately one third of prevalent dialysis vascular accesses. The most common cause of malfunction with this access is cephalic arch stenosis (CAS). The accepted requirement for treatment of a venous stenosis lesion is ⩾50% stenosis associated with hemodynamically abnormalities.

A Prospective, Randomized Study of an Expanded Polytetrafluoroethylene Stent Graft versus Balloon Angioplasty for In-Stent Restenosis in Arteriovenous Grafts and Fistulae: Two-Year Results of the RESCUE Study.

Purpose: To assess the safety and efficacy of an expanded polytetrafluoroethylene stent graft versus balloon angioplasty for the treatment of in-stent restenosis in the venous outflow of hemodialysis access grafts and fistulae.

Materials And Methods: Two hundred seventy-five patients were randomized at 23 US sites to stent-graft placement or percutaneous transluminal angioplasty (PTA). Primary study endpoints were access circuit primary patency (ACPP) at 6 months and safety through 30 days; secondary endpoints were evaluated through 24 months.

A Randomized Prospective Study Comparing Outcomes of Angioplasty versus VIABAHN Stent-Graft Placement for Cephalic Arch Stenosis in Dysfunctional Hemodialysis Accesses.

Purpose: To determine if postintervention cephalic arch stenosis (CAS) primary patency and access circuit patency are superior with the VIABAHN stent graft compared with angioplasty at 3, 6, and 12 months.

Materials And Methods: All patients presenting with dysfunctional hemodialysis accesses with CAS over a 4-year period were assessed for inclusion in a randomized prospective study. A total of 14 patients were recruited across three centers.

Suggested guidelines for performing procedures in patients with chronic kidney disease in outpatient centers.

Maintenance of hemodialysis vascular access is increasingly performed on an outpatient basis by physicians trained in interventional techniques. The adoption of guidelines by national reputable organizations will help identify patients eligible for such outpatient treatments and help optimize the safety and efficacy of their procedures in the outpatient setting.

Optimizing hemodialysis arteriovenous fistula maturation.

Purpose: To review why hemodialysis fistulas fail to mature and how percutaneous techniques can salvage them.

Methods: A review of the medical literature was performed, with specific attention to the location of the lesions, the types and the numbers of procedures performed, salvage and patency rates.

Results: Using balloon angioplasty of the arteries and/or veins with sequential dilation if needed and ligation or embolization of collateral side branches the fistula that has failed to mature can be salvaged.

Optimizing arteriovenous fistula maturation.

Autogenous arteriovenous fistulas are the preferred vascular access in patients undergoing hemodialysis. Increasing fistula prevalence depends on increasing fistula placement, improving the maturation of fistula that fail to mature and enhancing the long-term patency of mature fistula. Percutaneous methods for optimizing arteriovenous fistula maturation will be reviewed.

The natural history of tunneled hemodialysis catheters removed or exchanged: a single-institution experience.

Purpose: To track the natural history of tunneled hemodialysis catheters requiring removal or exchange at a single institution.

Materials And Methods: Over a 2-year period, tunneled hemodialysis catheters that presented to interventional radiology for removal or exchange were entered into this retrospective study. Patient demographics, catheter location, dwell time, and indication for removal were recorded.

Use of the femoral vein as insertion site for tunneled hemodialysis catheters.

Purpose: To determine the outcome of tunneled hemodialysis catheters inserted through the common femoral vein.

Materials And Methods: From April 2000 to June 2003, 33 consecutive patients had 86 tunneled hemodialysis catheters inserted through the femoral vein. There were 14 male and 19 female patients with a mean age of 56 years.

Use of the brachiocephalic vein for placement of tunneled hemodialysis catheters.

Objective: The purpose of this study was to evaluate the use of the brachiocephalic vein as an alternative access site for the insertion of tunneled hemodialysis catheters in patients with occluded jugular veins.

Conclusion: Placement of brachiocephalic catheters for central venous access is safe and provides an alternative access in patients with internal and external jugular vein occlusion.

Maintenance and salvage of arteriovenous fistulas.

Purpose: To describe the number and type of percutaneous interventions required to promote maturation and maintain patency of hemodialysis fistulas.

Materials And Methods: One hundred fifty-four hemodialysis fistulas were created in 146 patients by a single surgeon between August 2001 and March 2005. There were 88 male patients (60%), and the median age of the group was 66 years.

Conversion of temporary hemodialysis catheters to permanent hemodialysis catheters: a retrospective study of catheter exchange versus classic de novo placement.

Many clinicians believe that de novo access is required when converting temporary hemodialysis (HD) catheters to long-term or permanent catheters. However, since vascular access sites are at a premium in the dialysis patient, it is important to preserve existing central venous catheters and conserve future access sites. In this retrospective study, data from 94 patients referred to interventional radiology for placement of long-term, tunneled HD catheters between July 2001 and September 2002 were reviewed.

Tenecteplase in the treatment of thrombosed hemodialysis grafts.

A pilot study was carried out to prospectively evaluate the efficacy and safety of Tenecteplase (TNKase) using a modified 'lyse and wait" technique with percutaneous transluminal angioplasty (PTA) to treat thrombosed hemodialysis arteriovenous grafts (AVG)s. Seven patients with eight hemodialysis AVGs were treated and followed up to 1 year. Dosing included 1 mg TNKase and 3,000-4,000 U of heparin.

The multidisciplinary approach to hemodialysis vascular access at the Mount Sinai Hospital.

A majority of the quarter of a million end-stage renal disease patients nationwide are treated with hemodialysis. Important and frequent causes of morbidity and mortality, when they undergo this procedure, include vascular access infection and thrombosis associated with the use of catheters and, to a lesser extent, grafts. Therefore, an arteriovenous (AV) fistula is the preferred hemodialysis access.

Revascularization of aortic arch branches and visceral arteries using minimally invasive endovascular techniques.

Minimally invasive techniques as the first line of management in vascular reconstruction are beginning to replace older surgical techniques. General and specific approaches in the endovascular reconstruction of branches off the aortic arch (innominate and subclavian arteries) and the visceral branches off the abdominal aorta (renal and mesenteric arteries) are described. The branches of the aortic arch and the visceral arteries are discussed together because of the similarity in the interventional techniques used for revascularization.

Venous access: women are equal.

Background: Arteriovenous fistulae (AVFs) are the preferred method of vascular access for hemodialysis patients; however, the current rate of AVF placement is only 25% to 30% in the United States. This prevalence is even smaller among women and attributed to their perceived inadequate vasculature. This commonly held view that women have less adequate vasculature for AVF placement than men has not been shown objectively in the literature.

Thoracic duct injury associated with left internal jugular vein catheterization: anatomic considerations.

Ultrasound (US)-guided cannulation of the internal jugular vein (IJV) has become the preferred approach for venous access as a result of its higher success rate and lower incidence of complications. This report describes a case of thoracic duct injury during US-guided left IJV catheterization. The normal and variant anatomy of the thoracic duct in the neck is illustrated.