PURPOSE: Salvage procedures for a dysfunctional arteriovenous fistula (AVF) are defined as operation or percutaneous balloon angioplasty (PTA) for the AVF is inadequate for performing hemodialysis. This retrospective study was performed in order to identify the appropriate salvage treatment modality. METHODS: From April 2001 to October 2007, 132 salvage procedures in 100 patients were performed. We analyzed the overall cumulative patency rates of both the procedures and we compared them according to the type of primary AVF and the site and distribution of the stenoses. RESULTS: Fifty eight patients underwent operation, and 74 patients underwent PTA. The initial success rate was 77.59% for operation and 83.78% for PTA. The one year cumulative patency rates of operation and PTA were 46.11% and 21.62%, respectively (P=0.00). For the patients whose AVF had been created using autogenous vein, the one year cumulative patency rates of operation and PTA were 49.72% and 21.15%, respectively (P=0.04). According to the location and distribution of the stenoses, 56 patients (64.4%) with an autogenous AVF had juxta-anastomotic lesion. Among them, 23 patients underwent operation and 33 patients underwent PTA. The 1 year cumulative patency rates for these patients were 66.63% and 12.12%, respectively (P=0.00). For the treatment of the diffuse and multiple stenoses of the autogenous vein, PTA (n=14) showed a better patency rate than that of operation (P=0.00). CONCLUSION: Salvage therapy for a dysfunctional fistula prolonged their life span. Operation was superior to PTA for a juxta-anastomotic lesion of an autogenous AVF, but PTA had benefit over operation for the cases with diffuse and multiple stenoses.
Angioplasty, Balloon ; Arteriovenous Fistula ; Constriction, Pathologic ; Fistula ; Humans ; Renal Dialysis ; Retrospective Studies ; Salvage Therapy ; Veins

We report a case of an iatrogenic arteriovenous fistula complicated by catheter-directed thrombolytic therapy in a patient with acute deep vein thrombosis of a lower extremity. To the best of our knowledge, this is the first report of an arteriovenous fistula between the sural artery and popliteal vein in that situation. As the vessels have a close anatomical relationship, the arteriovenous fistula seems to be a potential complication after endovascular thrombolytic therapy of acute deep vein thrombosis.
Arteries ; Arteriovenous Fistula ; Catheterization ; Fistula ; Humans ; Lower Extremity ; Organic Chemicals ; Popliteal Vein ; Thrombolytic Therapy ; Venous Thrombosis

OBJECTIVE: To evaluate the efficacy of ultrasound or fluoroscopic-guided percutaneous transluminal angioplasty (PTA) combined with thrombolysis for the treatment of acutely thrombosed arteriovenous fistula (AVF) or grafts (AVG). METHODS: One hundred and ninety-two hemodialysed patients, in whom the thrombosed arterio-venous AVF or AVG developed less than 72 h and there were no contraindications for thrombolysis and PTA, underwent PTA combined with thrombolysis therapy in Sir Run Run Shaw Hospital of Zhejiang University from October 2014 to October 2017. Under ultrasound and/or fluoroscopic guidance, balloon catheter was introduced to thrombosis sites along a guide wire. Then the balloon was inflated and normal saline mixed with urokinase and heparin was injected for thrombolysis. After blood flow was restored, angioplasty was performed on vascular stenosed sites. RESULTS: A total of 274 endovascular interventional operations were performed for 192 patients. The procedure success rate was 98.2%, clinical success rate was 93.8%and complication rate was 1.46%. The post-intervention primary patency rates for AVF group were 87.4%, 76.7%and 63.9%at 3, 6 and 12 months, respectively; while the post-intervention secondary patency rates were 93.7%, 91.6%and 83.0%, respectively. The post-intervention primary patency rates for AVG group were 60.7%, 51.5%and 43.1%at 3, 6 and 12 months, while the post-intervention secondary patency rates were 82.7%, 77.1%and 70.8%, respectively. CONCLUSIONS PTA combined with thrombolysis is an effective and safe therapeutic option for AVF and AVG thrombosis, which would prolong hemodialysis access and save vascular resources for hemodialyzed patients.
Angioplasty ; Arteriovenous Fistula ; Arteriovenous Shunt, Surgical ; Humans ; Renal Dialysis ; Retrospective Studies ; Thrombolytic Therapy ; Thrombosis ; surgery ; Treatment Outcome ; Ultrasonography

Adequate care of patients with end-stage renal failure on hemodialysis requires permanent vascular access. Arteriovenous fistula obstruction due to venous thrombosis is commonly observed complication, contributing significantly to morbidity and hospitalization of dialysis patients. Percutaneous intervention using angioplasty and thrombolysis has become an accepted treatment of thrombosed vascular access and demonstrates comparable technical results and patency rates with those of surgery. Recently developed percutaneous mechanical thrombectomy (PMT) uses mechanical energy to clear thrombus percutaneously in combination with mechanical dissolution, fragmentation, and aspiration. PMT offers fast thrombus removal without complications related to thrombolytic therapy. We report a case of thrombosed hemodialysis native fistula which was successfully treated with percutaneous angioplasty and mechanical thrombolysis using newly introduced Arrow-Trerotola percutaneous thrombolytic device.
Angioplasty ; Arteriovenous Fistula ; Dialysis ; Fistula* ; Hospitalization ; Humans ; Kidney Failure, Chronic ; Mechanical Thrombolysis* ; Renal Dialysis* ; Thrombectomy ; Thrombolytic Therapy ; Thrombosis ; Venous Thrombosis

Arteriovenous Fistula ; therapy ; Child ; Embolization, Therapeutic ; Humans ; Male ; Pulmonary Artery ; abnormalities ; Pulmonary Veins ; abnormalities

Arteriovenous Fistula ; diagnosis ; therapy ; Humans ; Male ; Middle Aged ; Recurrence ; Spinal Cord ; blood supply ; Thoracic Vertebrae

Arteriovenous Fistula ; complications ; Embolization, Therapeutic ; methods ; Gastrointestinal Hemorrhage ; etiology ; therapy ; Humans ; Male ; Young Adult

We present a case of developmental venous anomaly associated with arteriovenous fistula supplied by a single arterial feeder adjacent to a large acute intracerebral hemorrhage. The arteriovenous fistula was successfully obliterated by superselective embolization while completely preserving the developmental venous anomaly. Two similar cases, including superselective angiographic findings, have been reported in the literature; however, we describe herein superselective angiographic findings in more detail and demonstrate the arteriovenous shunt more clearly than the previous reports. In addition, a literature review was performed to discuss the association of a developmental venous anomaly with vascular lesions.
Adolescent ; Arteriovenous Fistula/*radiography/*therapy ; Cerebral Angiography ; Cerebral Hemorrhage/*radiography/*therapy ; Diagnosis, Differential ; Embolization, Therapeutic/*methods ; Humans ; Intracranial Arteriovenous Malformations/*radiography/*therapy ; Male ; Tomography, X-Ray Computed/*methods

Arteriovenous Fistula ; therapy ; Brain Ischemia ; therapy ; Carotid-Cavernous Sinus Fistula ; therapy ; Cerebrovascular Disorders ; therapy ; Dura Mater ; blood supply ; Embolization, Therapeutic ; methods ; Humans ; Intracranial Aneurysm ; therapy ; Intracranial Arteriovenous Malformations ; therapy ; Stents

Adolescent ; Arteriovenous Fistula ; therapy ; Catheter Ablation ; methods ; Coronary Artery Disease ; therapy ; Female ; Heart Defects, Congenital ; therapy ; Humans ; Male ; Middle Aged