Ask Dr. Z

Just when I think I get these I always question myself and get confused.  Would you consider this a venous or arterial angioplasty?  Is there an easy way to “get these”  no matter how much I read on these I still get confused.

Thanks!!

TECHNIQUE: The risks, benefits and goals of dialysis fistula/graft evaluation with possible stent placement and possible angioplasty under conscious sedation were discussed with the patient prior to the procedure. The patient desired to proceed and signed informed consent. The patient was placed supine on the angiography table. The right upper extremity was prepared and draped in the usual sterile fashion. 2% lidocaine with epinephrine was used as a local anesthetic. Access to the fistula was obtained using US guidance and micropuncture technique directed toward the arterial inflow. Evaluation of the fistula outflow was performed with digital subtraction venography to the level of the superior vena cava. A 6 Fr short sheath was inserted over a Bentson wire which was positioned into the brachial artery. Over the wire, a Bern catheter was inserted and positioned in the brachial artery. Digital subtraction angiography was performed to evaluate the arterial anastomosis and the perianastomotic region of the fistula.

Multiple segments of moderate-length narrowing were noted in the perianastomotic region.


A 5 x 4 angioplasty balloon was inserted and positioned such that multiple, overlapping angioplasties of the perianastomotic region were performed to treat the stenoses. The balloon was then positioned at the arterial anastomosis and angioplasty of the arterial anastomosis was performed. Post-angiography DSA was performed through a Bern catheter inserted into the brachial artery, demonstrating a good angiographic result with brisk flow centrally through this fistula. The catheter and wire were withdrawn. Hemostasis was obtained with manual compression. The patient tolerated the procedure well and exited the angiography suite in stable condition. FINDINGS: There is brisk flow through the fistula. There are multiple segments of 30-50 % narrowing in the perianastomotic region of the fistula, as well as at the arterial anastomosis. The outflow the brachio-cephalic fistula is otherwise unremarkable. IMPRESSION: Successful venous angioplasty of the peri-anastomotic region and arterial anastomosis of the right brachial artery-cephalic vein fistula. PLAN: The fistula can be used immediately.