title: Sharp needle recanalization for salvaging hemodialysis accesses with chronically occluded peripheral outflow.
abstract: OBJECTIVE
  To assess the effectiveness of sharp needle recanalization (SNR) for treatment of chronically occluded venous outflow in hemodialysis access.
  
  
  METHODS
  A retrospective analysis of patient records from January 2006 to March 2010 was conducted. Forty-four hemodialysis patients (31 fistulas, 13 grafts) were referred for arm swelling (18%), excessive bleeding after dialysis (29%), and thrombosis (53%). All patients had chronic occlusion of the outflow vein which failed conventional recanalization techniques. A new outflow pathway was established by advancing a 21g needle and dilating the subcutaneous tract to bridge the fistula body to a juxtaposed patent vein. If necessary, uncovered or covered stents were utilized to maintain patency of the newly formed subcutaneous tract.
  
  
  RESULTS
  Forty-four patients underwent 45 SNR procedures, with restoration of normal function and complete relief of symptoms in 40 (91%) patients. The average tract length was 15 mm (range, 1 to 32) and the average dilatation diameter was 8 mm. During the initial SNR procedure, bare metal (n=21) or covered (n=5) stents were inserted in 26 patients. The average follow-up was 18.4 months (range, 0.2 to 48 months). No major complications were observed with the procedure. At 12 months, the primary access, primary tract, and secondary access patencies were 10%, 51%, and 92%, respectively. Percutaneous thrombectomy procedures were performed at a rate of 1.16 per access-year and the number of interventions within the tract was 0.94 per access-year.
  
  
  CONCLUSIONS
  Sharp needle recanalization is an effective percutaneous treatment for restoring function to hemodialysis accesses with chronically occluded venous outflow pathways.
authors.affiliation: American Access Care of Brooklyn, Brooklyn, NY 11215, USA. vascular1@att.net
authors.forename: Gregg A
authors.initials: GA
authors.lastname: Miller
authors.forename: Elsie
authors.initials: E
authors.lastname: Koh
authors.forename: Aleksandr
authors.initials: A
authors.lastname: Khariton
authors.forename: Dean C
authors.initials: DC
authors.lastname: Preddie
authors.forename: Wayne W
authors.initials: WW
authors.lastname: Hwang
authors.forename: Yevgeny
authors.initials: Y
authors.lastname: Savransky
authors.forename: Israel
authors.initials: I
authors.lastname: Schur
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects* / Q000295:instrumentation; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D002908:Chronic Disease; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009518:New York; D011677:Punctures; D015641:Radiography, Interventional; D020127:Recovery of Function; D006435:Renal Dialysis; D012189:Retrospective Studies; D016879:Salvage Therapy; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*; D014654:Vascular Patency; D020246:Venous Thrombosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D055815:Young Adult