ABSTRACT
PURPOSE: To report technical success and clinical outcomes of transfemoral venous access for upper extremity dialysis interventions. MATERIALS AND METHODS: A total of 15 patients underwent a transfemoral venous approach for fistulography (n = 4; 27%) or thrombectomy (n = 11; 73%) over a 14-month period. Access characteristics, sheath size, thrombectomy method, angioplasty site, fluoroscopy time, radiation dose, technical and clinical success, complications, and post-intervention primary and secondary patency rates were recorded. RESULTS: Access type included arteriovenous fistulas (n = 10; 67%) and grafts (n = 5; 33%). The most common configuration was brachio-brachial (n = 6; 38%). Mean age of access was 37 months. Mean prior interventions were 4. Right CFV access was used in all patients using 6-8-French (most common: 7-French [n = 10; 67%]) sheaths. Most thrombectomies (n = 11; 73%) required both pharmacologic and mechanical maceration (n = 9; 82%). All accesses required angioplasty to treat underlying stenosis at the outflow vein (n = 12; 80%) or arteriovenous anastomosis (n = 9; 90%). Mean fluoroscopy time was 26.43 min. Air kerma and dose area product were 178.06 ± 225.77 mGy and 57,768.83 ± 87,553.29 µGym2, respectively. Procedural and clinical success rates were 93% and 80%, respectively. Technical failure was due to persistent stenosis in one patient. Clinical failure was due to unsuccessful dialysis immediately following intervention in three patients. Mean post-intervention primary patency and secondary patency durations were 2.8 and 4.8 months, respectively. Primary patency rates at 1 and 3 months were 50% and 35%, respectively. Secondary patency rates at 1 and 3 months were 58% and 30%, respectively. CONCLUSION: A transfemoral venous approach for intervention of upper extremity dialysis accesses may be a valuable adjunct to traditional approaches.
Subject(s)
Arteriovenous Shunt, Surgical/methods , Endovascular Procedures/methods , Femoral Vein , Renal Dialysis/methods , Upper Extremity/blood supply , Vascular Patency/physiology , Adult , Aged , Aged, 80 and over , Female , Fluoroscopy , Humans , Male , Middle Aged , Radiation Dosage , Retrospective Studies , Time Factors , Treatment OutcomeABSTRACT
Ferumoxytol is a promising non-gadolinium-based contrast agent with numerous varied magnetic resonance imaging applications. Previous reviews of vascular applications have focused primarily on cardiac and aortic applications. After considering safety concerns and technical issues, the objective of this paper is to explore peripheral applications for ferumoxytol-enhanced magnetic resonance angiography (MRA) and venography (MRV) in the upper and lower extremities. Separate searches for each of the following keywords were performed in pubmed: "ferumoxytol," "ultrasmall superparamagnetic iron oxide," and "USPIO." All studies pertaining to MRA or MRV in humans are included in this review. Case-based examples of various peripheral applications are used to supplement a relatively scant literature in this space. Ferumoxytol's unique properties including high T1 relaxivity and prolonged intravascular half-life make it the optimal vascular imaging contrast agent on the market and one whose vast potential has only begun to be tapped.
Subject(s)
Blood Vessels/diagnostic imaging , Contrast Media , Ferrosoferric Oxide , Magnetic Resonance Angiography/methods , Humans , Peripheral Vascular Diseases/diagnostic imaging , Transcatheter Aortic Valve Replacement/methodsABSTRACT
Lymphangiography, despite advances in cross-sectional imaging, remains a useful tool in the diagnosis and therapeutic intervention of lymphatic vessel damage, such as high output chylothorax. This article describes our technique for this procedure.
