Abstract
There are no data regarding the feasibility and safety of a radial arterial approach with adjunctive urokinase for treating occluded autogenous radial-cephalic fistulas. We retrospectively examined 54 transradial interventions performed to treat occluded autogenous radial-cephalic fistulas within 72 h of occurrence. Urokinase was used in patients with a large thrombus burden. A total of 92 lesions in 54 consecutive patients (27 males, 27 females; mean age, 61.8 ± 12.3 years) were treated via radial access. All radial punctures were successful except in one patient. Most thrombotic lesions were located within 1 cm of the radiocephalic anastomosis (79.6%). The mean length of treated thrombotic lesions was 10.3 ± 5.4 cm (range, 4–32 cm). Twenty-five patients (46.3%) received urokinase (mean dose, 96,000 ± 30,000 U). After transradial intervention, systolic, diastolic, and mean pressures in the radial artery decreased from 179 ± 41, 77 ± 17, and 111 ± 22 mm Hg to 71 ± 29, 36 ± 15, and 48 ± 19 mm Hg (all p’s < 0.001), respectively. Four radial interventions were unsuccessful. The anatomic and clinical success rates of the radial approach were both 92.6%; postinterventional primary patency rates were 65% at 6 months and 40% at 12 months. Two minor vascular complications were noted, one caused by guidewire-induced contrast extravasation and the other by balloon-induced contrast extravasation. No patient developed clinical signs of pulmonary embolism. In conclusion, the radial approach with adjunctive urokinase is an effective and safe approach to treat occluded autogenous radial-cephalic fistulas.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Turmel-Rodrigues L, Raynaud A, Shapoval M, Beyssen B (2000) Interventions in dialysis fistulas. In: Dyet JF, Ettles DF, Nicholson AA, Wilson SE (eds) Textbook of endovascular procedures. Churchill Livingstone, London, pp 441–451
Vorwerk D (2002) Non-traumatic vascular emergencies: management of occluded hemodialysis shunts and venous access. Eur Radiol 12:2644–2650
Haage P, Vorwerk D, Wildberger J et al (2000) Percutaneous treatment of thrombosed primary arteriovenous hemodialysis access fistulae. Kidney Int 57:1169–1175
Turmel-Rodrigues L, Pengloan J, Rodrigue H et al (2000) Treatment of failed native arteriovenous fistulae for hemodialysis by interventional radiology. Kidney Int 57:1124–1140
Manninen HI, Kaukanen ET, Ikäheimo R et al (2001) Brachial arterial access: endovascular treatment of failing Brescia-Cimino hemodialysis fistulas—initial success and long-term results. Radiology 218:711–718
Liang HL, Pan HB, Chung HM et al (2002) Restoration of thrombosed Brescia-Cimino dialysis fistulas by using percutaneous transluminal angioplasty. Radiology 223:339–344
Miyayama S, Matsui O, Taki K et al (2005) Occluded Brescia-Cimino hemodialysis fistulas: endovascular treatment with both brachial arterial and venous access using the pull-through technique. CardioVasc Interv Radiol 28:806–812
Overbosch EH, Pattynama PM, Aarts HJ et al (1996) Occluded hemodialysis shunts: Dutch multicenter experience with the hydrolyser catheter. Radiology 201:485–488
Shatsky JB, Berns JS, Clark TW et al (2005) Single-center experience with the Arrow-Trerotola Percutaneous Thrombectomy Device in the management of thrombosed native dialysis fistulas. J Vasc Interv Radiol 16:1605–1611
Sahni V, Kaniyur S, Malhotra A et al (2005) Mechanical thrombectomy of occluded hemodialysis native fistulas and grafts using a hydrodynamic thrombectomy catheter: preliminary experience. CardioVasc Interv Radiol 28:714–721
Rajan DK, Clark TW, Simons ME et al (2002) Procedural success and patency after percutaneous treatment of thrombosed autogenous arteriovenous dialysis fistulas. J Vasc Interv Radiol 13:1211–1218
Wang HJ, Yang YF (2006) Percutaneous treatment of dysfunctional Brescia-Cimino fistulae through a radial arterial approach. Am J Kidney Dis 48:652–658
Aruny JE, Lewis CA, Cardella JF et al (2003) Quality improvement guidelines for percutaneous management of the thrombosed or dysfunctional dialysis access. J Vasc Interv Radiol 14:S247–S253
Kawarada O, Yokoi Y, Nakata S et al (2006) Transradial intervention for native fistula failure. Catheter Cardiovasc Interv 68:513–520
Zaleski GX, Funaki B, Kenney S et al (1999) Angioplasty and bolus urokinase infusion for the restoration of function in thrombosed Brescia-Cimino dialysis fistulas. J Vasc Interv Radiol 10:129–136
Schon D, Mishler R (2000) Salvage of occluded autologous arteriovenous fistulae. Am J Kidney Dis 36:804–810
Trerotola SO, Turmel-Rodrigues LA (2001) Off the beaten path: transbrachial approach for native fistula interventions. Radiology 218:617–619
Vorwerk D, Schurmann K, Müller-Leisse C et al (1996) Hydrodynamic thrombectomy of haemodialysis grafts and fistulae: results of 51 procedures. Nephrol Dial Transplant 11:1058–1064
Swan TL, Smyth SH, Ruffenach SJ et al (1995) Pulmonary embolism following hemodialysis access thrombolysis/thrombectomy. J Vasc Interv Radiol 6:683–686
Kinney TB, Valji K, Rose SC et al (2000) Pulmonary embolism from pulse-spray pharmacomechanical thrombolysis of clotted hemodialysis grafts: urokinase versus heparinized saline. J Vasc Interv Radiol 11:1143–1152
Author information
Authors and Affiliations
Corresponding author
Additional information
Li-Chuan Hsieh and Huang-Joe Wang contributed equally to this work.
Rights and permissions
About this article
Cite this article
Hsieh, LC., Wang, HJ., Chen, YP. et al. Radial Arterial Approach with Adjunctive Urokinase for Treating Occluded Autogenous Radial-Cephalic Fistulas. Cardiovasc Intervent Radiol 32, 1202–1208 (2009). https://doi.org/10.1007/s00270-009-9709-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00270-009-9709-1