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ABSTRACT: PURPOSE: To describe a single institutional experience with translumbar tunneled dialysis catheters (TDC) and compare outcomes between patients with normal and abnormal body mass index (BMI). MATERIALS AND METHODS: Translumbar TDCs placed between January 2002 and July 2011 were reviewed retrospectively. There were 33 patients; 18 had a normal BMI<25, and 15 had an abnormal BMI>25. Technical outcome, complications, indications for exchange or removal, and BMI were recorded. Catheter dwell time, catheter occlusion rate, frequency of malposition, and infection rates were collected. RESULTS: There were 92 procedures (33 initial placements) with 7,825 catheter days. The technical success rate was 100%. Two minor (2.2%) and three major (3.3%) complications occurred. The complication rate did not differ significantly between patients with a normal BMI and patients with an abnormal BMI. Median catheter time in situ (interquartile range) for all patients was 61 (113) days, for patients with normal BMI was 66 (114) days, and for patients with abnormal BMI was 56 (105) days (P = .9). Primary device service intervals for all patients, patients with normal BMI, and patients with abnormal BMI were 47 (96) days, 63 (98) days, and 39 (55) days (P = .1). Secondary device service intervals for all patients, patients with normal BMI, and patients with abnormal BMI were 147 (386) days, 109 (124) days, and 409 (503) days (P = .23). Catheter-related central venous thrombosis rate was 0.01 per 100 catheter days (n = 1). CONCLUSIONS: Translumbar TDC placement can provide effective hemodialysis in patients with limited venous reserve regardless of the patient's BMI. An abnormal BMI (>25) does not significantly affect complication rate, median catheter time in situ, or primary or secondary device service interval of translumbar TDCs.
Journal of vascular and interventional radiology: JVIR 05/2013; · 1.81 Impact Factor
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ABSTRACT: PURPOSE: To determine whether the inpatient versus outpatient status of patients at the time of port placement affects the infection rate. MATERIALS AND METHODS: Through a quality assurance database, all patients undergoing port insertion by interventional radiology personnel at a single institution between 2001 and 2010 were identified (N = 2,112). From this cohort, 1,030 patients with a known reason for port removal were retrospectively analyzed. All ports were of the same design. Data were analyzed according to inpatient/outpatient status at insertion and indications for port placement, including solid or hematologic malignancy and access for total parenteral nutrition or pheresis. Effects of inpatient/outpatient status on the reason for, and total time until, catheter removal were determined. Infections were defined as culture-positive bacteremia or clinically suspected port pocket infection. RESULTS: No significant differences were seen in age (P = .32), sex (P = .4), or access site (P = .4) between groups. There was a significant difference in total infection-free catheter days between groups, with means of 241 days for inpatients and 305 for outpatients (P<.001). Inpatients had a significantly higher infection rate per 1,000 catheter-days versus outpatients (0.72 vs 0.5; P = .01). Similarly, there was a significant difference between inpatients and outpatients in time to port removal for infection or dehiscence, with the hazard of inpatients needing removal 45% greater than that of outpatients (P = .03). The increased hazard of inpatients needing port removal was significant even after accounting for placement indication (P = .02). CONCLUSIONS: Port placement in an outpatient setting results in longer infection-free survival for a wide variety of placement indications.
Journal of vascular and interventional radiology: JVIR 04/2013; · 1.81 Impact Factor
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ABSTRACT: The use of rigid endobronchial forceps has been described for the percutaneous retrieval of tip-embedded retrievable inferior vena cava filters, especially when retrieval with the use of traditional devices has failed. The present report describes retrieval of a tip-embedded retrievable filter from the superior vena cava with the use of this technique.
Journal of vascular and interventional radiology: JVIR 04/2013; 24(4):592-5. · 1.81 Impact Factor
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ABSTRACT: PURPOSE: To investigate retrospectively the use of catheter-based intraaccess blood flow measurements as an adjunct to physical examination and fistulography in hemodialysis access interventions. MATERIALS AND METHODS: Among 1,540 dialysis interventions performed at a single institution in a 2.5-year period, 104 qualifying catheter-based flow measurements were made in 70 mature native fistula interventions in 55 patients and 34 graft interventions in 31 patients. The flow rate threshold prompting intervention was generally 600 mL/min, but some variation existed depending on the clinical setting. RESULTS: The most common indication for measurement of blood flow was to determine the hemodynamic significance of a fistula inflow stenosis (n = 25), of which only four had subsequent intervention. Other common indications included decision-making resulting in further angioplasty or stent implantation of noninflow lesions (fistulas, n = 10; grafts, n = 23) versus termination of the procedure (n = 23), problem-solving in cases in which there was no visible lesion to explain the clinical indicator of access failure (n = 17), evaluation for high-flow-related cardiac risk in aneurysmal fistulas (n = 13), suboptimal evaluation of the inflow (n = 8), and suboptimal physical examination (n = 6). Overall, flow measurements supported a decision to perform angioplasty (n = 11) or stent placement (n = 3) in 17% of fistula interventions and 35% of graft interventions. CONCLUSIONS: The major benefit of flow measurement was to support a decision to withhold further angioplasty or stent placement.
Journal of vascular and interventional radiology: JVIR 03/2013; · 1.81 Impact Factor
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ABSTRACT: PURPOSE: To assess the risk of developing contrast-induced nephropathy (CIN) and to evaluate the technical success of adrenal venous sampling (AVS) in patients with chronic kidney disease (CKD). MATERIALS AND METHODS: AVS was performed in 25 patients with primary hyperaldosteronism and concurrent CKD to distinguish between unilateral and bilateral adrenal disease. One of the 25 patients underwent repeat AVS, for a total of 26 samplings. All patients received a hydration protocol before and after the procedure. Acute kidney injury (AKI) (increase in creatinine of 0.5 mg/dL or>25% above baseline) and diagnostic yield were determined. RESULTS: CKD was stage III in 20 patients (80%), stage IV in 4 patients (16%), and stage V in 1 patient (4%). Median contrast volume was 25 mL (range, 10-250 mL). Of 26 studies, 25 (96%) were diagnostic; the one nondiagnostic AVS was repeated with success. Despite their elevated risks, only 2 of 25 patients (8%) developed AKI, and neither patient required treatment. CONCLUSIONS: AVS can be performed safely with a high degree of technical success and low risk of CIN in patients with primary hyperaldosteronism and concurrent advanced CKD.
Journal of vascular and interventional radiology: JVIR 03/2013; · 1.81 Impact Factor
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ABSTRACT: PURPOSE: To complement prior studies have shown that arteriovenous fistula (AVF) thrombectomies require more time and equipment than arteriovenous graft (AVG) thrombectomies by measuring work using established instruments to determine if there is also a difference in maintenance percutaneous transluminal angioplasty (PTA) of nonthrombosed AVFs versus AVGs. MATERIALS AND METHODS: PTA procedures performed on a consecutive cohort of 42 patients with AVFs and 27 patients with AVGs were prospectively compared. To quantify resource utilization, procedure time and disposable equipment were measured. Established instruments developed by the American Medical Association for Current Procedural Terminology code valuation were used to measure subjective "physician work," including mental effort and judgment, technical skill, physical effort, and psychological stress. These items were scored by 1 of 12 attending interventional radiology physicians performing the procedure. RESULTS: Mean PTA procedure time was 74 minutes (range, 18-183 minutes) for AVFs and 71 minutes (range, 28-204 minutes) for AVGs; hemostasis time was 12 minutes for AVFs and 11 minutes for AVGs. There was no significant difference in equipment use between groups. "Physician work" for AVFs scored significantly higher in four categories (P≤ .05). CONCLUSIONS: Using established subjective instruments, maintenance PTA of AVFs was scored as more cognitively, physically, and psychologically demanding than maintenance PTA of AVGs. However, there was no significant difference in resource utilization between maintenance PTA of AVFs versus AVGs, as has been previously shown with thrombectomy of thrombosed AVFs and AVGs.
Journal of vascular and interventional radiology: JVIR 03/2013; · 1.81 Impact Factor
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ABSTRACT: Purpose:To examine filter characteristics at preretrieval computed tomography (CT) that are associated with complicated inferior vena cava (IVC) filter retrieval procedures.Materials and Methods:This study was HIPAA compliant, and informed consent was waived. Institutional review board-approved retrospective review of IVC filter retrievals between January 2002 and July 2011 was performed to identify patients with preretrieval CT in whom a complicated retrieval was performed, as defined by use of nonstandard techniques, filter fracture, filter tip incorporation into the IVC wall, and retrieval failure. Age- and sex-matched control subjects with standard IVC filter retrieval were used for comparison. Preretrieval CT images were evaluated for tilt angle in mediolateral and anteroposterior directions, CT appearance of tip embedding, degree of filter strut perforation, and distance of filter tip from the nearest renal vein. Dwell time was also recorded. Statistical analysis was performed by using the Fisher exact test, Student t test, and Wilcoxon signed-rank test, depending on the variables being evaluated, as well as multivariate logistic regression.Results:Forty-eight patients with complicated retrievals and 48 control subjects with uncomplicated retrievals were evaluable for preretrieval CT characteristics. Mediolateral and anteroposterior tilt angle, degree of perforation, and dwell time were higher for the complicated versus noncomplicated retrieval group (P < .01). Odds of complicated retrieval were increased 129-fold with CT appearance of tip embedding (P < .0001), with an odds ratio of 33 with a tilt angle of more than 15° in any direction (P < .0001), while perforation and dwell time increased risk of a complicated retrieval by 10.7 (P < .0001) and 2.3 (P < .05) times, respectively. Distance from renal veins was noncontributory.Conclusion:CT appearance of tip embedding, increased tilt angle, higher-grade perforation, and longer dwell times are associated with complicated IVC filter retrieval. Therefore, preretrieval CT may be warranted in select patients for identification of these characteristics to tailor retrieval approach or to arrange a referral to a tertiary center if necessary.© RSNA, 2012.
Radiology 10/2012; · 5.73 Impact Factor
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ABSTRACT: The objective of our study was to assess outcomes after evaluation of immature hemodialysis arteriovenous fistulas (AVFs) via 3-French brachial artery access and to identify the incidence of arterial and venous puncture site spasm.
One hundred twenty-three outpatients (82 men, 41 women; mean age, 58 years; age range, 20-90 years) with immature AVF were identified retrospectively in whom diagnostic fistulography was performed via 3-French retrograde brachial artery puncture. Percutaneous transluminal angioplasty was performed via a separate venous puncture during the same visit in 95 patients. Patient age and sex, fistula age and type, and technical success and complications were recorded. Images were reviewed for lesion location, potentially competing vessels, and arterial and venous puncture-related spasms.
The mean fistula age was 99 days (range, 21-639 days). There were 49 AVFs in the left forearm; 30 in the left upper arm; 26 in the right forearm; and 18 in the right upper arm. Twenty-eight AVFs were transposed. Angioplasty was technically successful in 81 of 95 patients (85%; mean diameter, 7 mm; range, 4-10 mm). Brachial artery puncture caused no major complication. Arterial spasm occurred in 19 patients (15%) and was severe in one patient. There were two hematomas (1.6%). Venous spasm, ranging from mild (four patients) to occlusive (8 patients), occurred in 38 patients (40%) at the site of venipuncture for intervention. Nitroglycerin (mean, 325 mcg; range, 100-600 mcg) was used in 26 procedures (21%). Venous spasm was more common with forearm (50%) than upper arm (24%) fistulas (p = 0.02) and with decreasing vein diameter (p = 0.02).
Evaluation of immature AVFs based on 3-French micropuncture of the brachial artery can be safely performed on an outpatient basis. Spasm is more common in forearm AVFs and in smaller veins.
American Journal of Roentgenology 09/2012; 199(3):683-90. · 2.78 Impact Factor
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Journal of vascular and interventional radiology: JVIR 03/2012; 23(3):433-4; author reply 434. · 1.81 Impact Factor
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ABSTRACT: Purpose: Fistulae between an arteriovenous hemodialysis graft (AVG) or fistula (AVF) and an adjacent vein are an unusual complication of hemodialysis access. Such fistulae may theoretically cause steal syndrome, extremity edema, or access dysfunction. We sought to use our experience and existing literature to develop a management algorithm for this access complication. Methods: Twelve patients with AVG/AVF to adjacent vein fistulae found on fistulography were identified using a quality assurance database. Indications for fistulography, treatment rendered for both the fistulae and access stenosis, and outcome of treatment were determined. AVG/AVF to adjacent vein fistulae, when identified and considered to be significant, were treated with embolization. Results: Five out of twelve patients had successful embolization of their AVG/AVF to adjacent vein fistulae. Reasons for treatment included partial thrombosis of the access to the level of the fistula (n=1), contribution to bleeding during dialysis (n=1), and concern for competing flow causing thrombosis (n=5). No recurrence was identified. Seven patients did not undergo embolization either because of failure to recognize the fistula (n=3) or determination that treatment was not indicated (n=4). Two untreated fistulae were found occluded at follow-up. Additional access treatment included angioplasty (n=11), covered stent (n=1), and mechanical thrombectomy (n=3). Conclusions: The significance of AVG/AVF to adjacent vein fistulae remains unclear; some resolve spontaneously, possibly related to PTA of outflow stenosis. Embolotherapy is an effective treatment for such fistulae when determined to be significant.
The journal of vascular access 02/2012; 13(3):374-80. · 1.09 Impact Factor
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ABSTRACT: Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disorder of vascular development resulting in direct connections between the arterial and venous systems, bypassing capillaries. Symptoms and signs can appear throughout life and marked intrafamilial variability confounds diagnosis based purely on clinical criteria. We set out to determine the impact of genetic testing on the cost of screening for HHT in at-risk relatives.
We performed economic modeling of idealized pedigrees following two scenarios: repeated clinical screening until an HHT diagnosis could be either affirmed or excluded, and mutation testing in the proband, followed by genetic testing of at-risk relatives and clinical monitoring of only those relatives who test positive for the familial mutation.
Based on actual reimbursement data from our region's largest health insurer, the molecular diagnostic model saved over $22,000 for a family with four relatives at risk for the initial diagnostic work-up. For a cohort of 100 probands, the total savings for the molecular diagnostic model over a reasonable period of follow-up was greater than $9 million.
In this idealized setting in which all probands and at-risk relatives accepted molecular testing, the economic advantages of genetic screening over repeated clinical screening are substantial.
Genetics in medicine: official journal of the American College of Medical Genetics 01/2012; 14(6):604-10. · 3.92 Impact Factor
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ABSTRACT: To examine the feasibility and outcomes of removing retrievable inferior vena cava (IVC) filters that have fractured.
Retrospective review of IVC filter retrievals over an 8-year period identified patients in whom there was an attempt to retrieve fractured filters and struts. Patient medical records were evaluated for filter type, recovery method for filter body and struts, removal attempt results, and complications.
Between January 2002 and December 2010, 148 IVC filters were retrieved, 15 of which were fractured. All 15 fractured filter bodies were successfully retrieved. Nine of 15 fractured filters (60%) were removed in their entirety by using endobronchial forceps to retrieve the filter body and/or fractured struts. In three cases, forceps were used to retrieve the filter body and the fractured strut was removed with a snare. In six patients (40%), only the filter body could be removed, three with the Recovery Cone and three with endobronchial forceps. Failed attempts to remove fractured struts were made in three cases, with no attempt made in the remaining three. These struts were incorporated in the right ventricle, embedded in the IVC wall, or extraluminal. Minor caval defect was identified in five of 15 retrievals (33%); mild hemoptysis was noted in one case in which the strut was snared from a pulmonary artery. No major complications occurred.
Fractured IVC filter bodies can be safely removed. Fractured filter struts can be removed when accessible, but are often in a position that makes retrieval not possible.
Journal of vascular and interventional radiology: JVIR 12/2011; 23(2):181-7. · 1.81 Impact Factor
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ABSTRACT: Thoracic duct (TD) embolization (TDE) has become a universally accepted treatment of chylous pleural effusion. However, the long-term sequelae of occlusion of the TD are unknown. The objective of the present study was to determine the rate of delayed complications after technically successful TDE.
A total of 169 patients underwent TDE for symptomatic chylous effusion between January 1, 1994, and June 11, 2010. In 106 of 169 cases (63%), TDE embolization was technically successful. Retrospective review of these charts was performed, and patients were interviewed to determine the development of lower-extremity edema, diarrhea, abdominal swelling, and other symptoms.
Follow-up information was available in 78 of 106 patients (73.6%). Mean length of follow-up was 34 months. During follow-up, 32 patients (41%) died of causes unrelated to TDE, and 46 (59%) were alive at the end of follow-up. The families of three deceased patients were available for interview. Four of 49 patients (8%) had chronic leg swelling that was probably related to the procedure, three (6%) had abdominal swelling, and six (12%) had chronic diarrhea. In four of these six cases, diarrhea was considered "probably related" to the procedure. Overall, a 14.3% rate of probably-related long-term complications after TDE was recorded.
Chronic diarrhea and lower-extremity swelling may be related to TDE and should be part of informed consent before the procedure. A prospective follow-up study is needed to further establish these relationships.
Journal of vascular and interventional radiology: JVIR 11/2011; 23(1):76-9. · 1.81 Impact Factor
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ABSTRACT: To evaluate retrospectively the sequelae of fibroid expulsion (FE) after uterine artery embolization (UAE).
From a population of 759 UAE procedures performed from July 1999 to June 2009, 37 patients were found to have a uterine fibroid communicating with the endometrial cavity resulting in "bulk" FE with the passage of large fragments or an entire tumor or "sloughing" FE with shedding or "melting" of the tumor. Medical records and magnetic resonance images were evaluated for clinical information and tumor characteristics, respectively.
The mean age of patients with FE was 43 years ± 5 (SD), with 12 nulliparous and 25 parous. Expulsion took place a mean of 14.8 weeks ± 17.7 after UAE (range, 1.6-105.9 wk). FE was asymptomatic in 5% of cases (n = 2) and symptomatic in 95% (n = 35). Among symptomatic cases, 89% (n = 31) had bulk expulsion and 11% (n = 4) had sloughing expulsion. Forty-nine percent of patients (n = 18) had tumor expulsion at home or had an office/emergency room transvaginal myomectomy (TVM), 27% (n = 10) underwent operative TVM, and 8% (n = 3) had hysteroscopic resection. Urgent and elective hysterectomies were performed in 11% (n = 4) and 5% of cases (n = 2), respectively. Nulliparous women showed a trend toward undergoing hysterectomy compared with parous women (33% vs 8%; P =.07, Fisher exact test).
Most women tolerate FE well, with approximately half needing no operative intervention, but some may need to undergo hysteroscopy, operative TVM, or even hysterectomy. Nulliparous women are potentially at greater risk to require hysterectomy.
Journal of vascular and interventional radiology: JVIR 11/2011; 22(11):1586-93. · 1.81 Impact Factor
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Journal of vascular and interventional radiology: JVIR 10/2011; 22(10):1493-4. · 1.81 Impact Factor
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ABSTRACT: Over-the-wire exchange of tunneled dialysis catheters is the standard of care per K/DOQI guidelines for treating catheter-related bacteremia. However, Gram-positive bacteremia, specifically with staphylococcus species, may compromise over-the-wire exchange due to certain biological properties. This study addressed the effectiveness of over-the-wire exchange of staphylococcus-infected tunneled dialysis catheters compared with non-staphylococcus-infected tunneled dialysis catheters.
Patients who received over-the-wire exchange of their tunneled dialysis catheter due to documented or suspected bacteremia were identified from a QA database. Study patients (n = 61) had positive cultures for Staphylococcus aureus, Staphylococcus epidermidis, or coagulase-negative staphylococcus not otherwise specified. Control patients (n = 35) received over-the-wire exchange of their tunneled dialysis catheter due to infection with any organism besides staphylococcus. Overall catheter survival and catheter survival among staphylococcal species were assessed.
There was no difference in tunneled dialysis catheter survival between study and control groups (P = 0.46). Median survival time was 96 days for study catheters and 51 days for controls; survival curves were closely superimposed. There also was no difference among the three staphylococcal groups in terms of catheter survival (P = 0.31). The median time until catheter removal was 143 days for SE, 67 days for CNS, and 88 days for SA-infected catheters.
There is no significant difference in tunneled dialysis catheter survival between over-the-wire exchange of staphylococcus-infected tunneled dialysis catheters and those infected with other organisms.
CardioVascular and Interventional Radiology 05/2011; 34(6):1230-5. · 2.09 Impact Factor
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ABSTRACT: To examine the overall durability and breakage rates of dual-lumen silicone catheters in comparison with power-injectable dual-lumen polyurethane catheters.
Patients who received a 10-F dual-lumen silicone catheter or 9.5-F dual-lumen polyurethane catheter between January 2002 and July 2009 were identified through a quality assurance database. Medical records were reviewed retrospectively. A total of 117 silicone and 94 polyurethane catheters were identified in 192 patients. Reasons for catheter placement and removal were recorded, as were cases of breakage and repairs. Catheter durability was compared; survival analysis was also performed.
Breakage occurred in nine of 117 silicone catheters (8%) and none of 94 polyurethane catheters (P = .005). Most catheters were placed for malignancy (162 of 211; 77%); nonmalignant indications such as total parenteral nutrition accounted for 49 out of 211 catheters (23%). The mean silicone catheter dwell time was 99 days (11,612 total catheter-days), and the mean polyurethane catheter dwell time was 78 days (7,362 total catheter-days). There was no significant difference in overall duration of function (ie, survival) between silicone and polyurethane catheters (P = .12). The infection rates were 3.6 per 1,000 catheter-days for silicone catheters and 3.5 per 1,000 catheter-days for polyurethane catheters (P value not significant).
There were fewer catheter fractures with the polyurethane catheter compared with the silicone catheter, although there was no difference in the total access site service interval for the two catheter types.
Journal of vascular and interventional radiology: JVIR 05/2011; 22(5):638-41. · 1.81 Impact Factor
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ABSTRACT: To compare the safety and effectiveness of over-the-wire catheter exchange (catheter-exchange) with catheter removal and replacement (removal-replacement) at a new site for infected or malfunctioning tunneled infusion catheters.
Using a quality assurance database, 61 patients with tunneled infusion catheters placed during the period July 2001 to June 2009 were included in this study. Patients receiving hemodialysis catheters were excluded. Catheter-exchange was performed in 25 patients, and same-day removal-replacement was performed in 36 patients. Data collected included demographic information, indication for initial catheter placement and replacement, dwell time for the new catheter, and ultimate fate of the new device. Statistical comparisons between the two cohorts were analyzed using the Kaplan-Meier technique and Fisher exact test.
Catheters exchanged over the wire remained functional without infection for a median of 102 days (range, 2-570 days), whereas catheters removed and replaced were functional for a median 238 days (range, 1-292 days, P = .12). After catheter replacement, there were 11 instances of subsequent infection in the catheter-exchange group and 7 instances in the removal-replacement cohort, accounting for infection rates of 4.4 and 2.3 per 1,000 catheter days (P = .049). Patients in the catheter-exchange group had 3.2 greater odds of infection compared with patients in the removal-replacement group. Five malfunction events occurred in each group, accounting for 2.0 and 1.7 malfunctions per 1,000 catheter days in the catheter-exchange and removal-replacement groups (P = .73).
Catheter-exchange of tunneled infusion catheters results in a higher infection rate compared with removal-replacement at a new site. The rate of catheter malfunction is not significantly different between the two groups. Catheter-exchange is an alternative for patients with tunneled infusion catheters who have limited venous access, but this technique should not be expanded for use in all patients. Because of the size of this initial study, further investigation is needed to verify the results in a larger sample size.
Journal of vascular and interventional radiology: JVIR 05/2011; 22(5):642-6; quiz 646. · 1.81 Impact Factor
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ABSTRACT: To evaluate the use of the inferior accessory hepatic vein (IAHV) as an anatomic marker for the right adrenal vein (RAV) for adrenal vein sampling (AVS) and the use of a renal double curve (RDC) catheter to sample the RAV.
In 73 patients undergoing AVS, an RDC catheter was first directed laterally and withdrawn from the hepatic vein confluence inferiorly. If the catheter engaged the IAHV, this location was documented. A search for the RAV was conducted using the standard technique. If the IAHV was present, its distance from the RAV was measured. Alternate catheters and ultimately successful shape were recorded. A sequential poststimulation technique was used in all patients.
The IAHV was found in 42 of 73 patients (58%). The mean RAV to IAHV distance was 4.4 mm ± 4.7 (range 0-20 mm); it was 5 mm or less in 30 of 42 patients (71%) with an IAHV or 30 of 73 (41%) patients overall. In patients with an IAHV, RAV sampling was successful in 40 of 42 (95%). In 61 of 73 patients (84%), the RDC catheter was successful in localizing the RAV. In those patients, the RAV sample was adequate in 60 of 61 (98%) versus 9 of 12 (75%) in the remainder (P = .013). Overall, AVS was technically successful in 67 of 73 patients (92%).
The IAHV, when present, may help localize the RAV; this knowledge could help increase diagnostic yield for less experienced operators. The RDC catheter has a high yield in RAV sampling.
Journal of vascular and interventional radiology: JVIR 04/2011; 22(9):1306-11. · 1.81 Impact Factor
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ABSTRACT: Percutaneous declotting is usually not offered for hemodialysis access grafts clotting < 30 days after placement because of concerns regarding safety of percutaneous transluminal angioplasty in fresh anastomoses, potential need for surgical correction of the underlying cause, and poor outcomes. The authors sought to determine acute and long-term outcomes of declotting of grafts with early failure.
Of 860 percutaneous mechanical thrombectomies performed between July 2001 and June 2007, 23 were performed in grafts < 30 days after initial placement. In addition, 16 percutaneous thrombectomies performed in grafts 31-60 days after placement were identified. Data collected included medical history, graft characteristics, immediate technical and clinical success, complications, and subsequent graft patency and survival. Kaplan-Meier analysis compared outcomes in grafts < 30 days (U30) versus those 31-60 days (U60) old.
There was no difference between the U30 and U60 groups in primary patency (13 vs 19 days, respectively, P = 0.17) or in postintervention access patency (38 vs 189 days, respectively, P = 0.63). A strong trend toward shorter secondary patency in U30 grafts was observed (17 vs 73 days, P = 0.06). Underlying lesions not amenable to percutaneous treatment were found in 62% of U30 grafts and 33% of U60 grafts (P = 0.18). Neither group achieved the K/DOQI Guidelines' recommended 85% technical success or 40% 90-day primary patency; in the U30 group it was 0% and in the U60 group 17%.
Percutaneous declotting of grafts yields poor outcomes, well below the K/DOQI threshold not only within 30 days but also within 60 days of placement.
Journal of vascular and interventional radiology: JVIR 03/2011; 22(3):317-24. · 1.81 Impact Factor
