title: Percutaneous interventions in subclavian artery-to-contralateral subclavian vein "necklace" hemodialysis grafts: experience in five patients.
abstract: OBJECTIVE
  To describe clinical outcomes of endovascular interventions in the setting of thrombosis or dysfunction of anterior chest wall ("necklace") arteriovenous (AV) hemodialysis grafts.
  
  
  METHODS
  Eight percutaneous interventions (balloon angioplasty, pharmacologic thrombolysis, and mechanical thrombectomy) were performed in five patients with anterior chest wall AV grafts. Primary, assisted, and secondary patencies, as well as technical success and complication rates, were determined.
  
  
  RESULTS
  The technical success rate of percutaneous interventions in re-establishing a normal blood flow pattern within the AV grafts was 100%. Primary patency ranged from one to 23 months (median, 5 months). Primary assisted patency and secondary patency were 36 months and 8 months, respectively, in two patients who underwent more than one intervention. Postintervention access patency ranged from 5 to 36 months (median, 9 months), whereas graft lifetime ranged from 12 to 45 months (median, 24 months). There were no complications related to revascularization procedures.
  
  
  CONCLUSIONS
  Percutaneous interventions can be performed safely and effectively in anterior chest wall AV grafts. Technical success and long-term patency rates appear to be similar to those of percutaneous interventions in upper-extremity hemodialysis AV grafts.
authors.affiliation: Department of Radiology, University of California, San Francisco, 505 Parnassus Ave, Rm M-361, San Francisco, CA 94143, USA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Fidelman
authors.forename: Derrick
authors.initials: D
authors.lastname: Allen
authors.forename: Allan I
authors.initials: AI
authors.lastname: Bloom
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: LaBerge
authors.forename: Geoffrey S
authors.initials: GS
authors.lastname: Hastings
authors.forename: Robert K
authors.initials: RK
authors.lastname: Kerlan
authors.forename: Roy L
authors.initials: RL
authors.lastname: Gordon
authors.forename: Mark W
authors.initials: MW
authors.lastname: Wilson
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D000800:Angioplasty, Balloon; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D006435:Renal Dialysis; D012189:Retrospective Studies; D013348:Subclavian Artery / Q000601:surgery*; D013350:Subclavian Vein / Q000601:surgery*; D017131:Thrombectomy; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000209:etiology / Q000628:therapy*
chemical_list: D005343:Fibrinolytic Agents