title: Ipsilateral jugular access to treat an otherwise inaccessible puncture-related arteriovenous fistula pseudoaneurysm: a technical note.
abstract: BACKGROUND
  The standard approach for the endovascular treatment of a dysfunctional or occluded hemodialysis access in the upper limbs includes a direct intervention through the access itself or alternatively, when not feasible, through the brachial or radial artery access. Nonetheless, there are certain circumstances in which these approaches are not easily achieved.
  
  
  METHODS
  An 89-year-old male with end-stage renal disease developed a pseudoaneurysm after an hemorrhagic complication of a recently transposed native basilic arteriovenous fistula secondary to a needle puncture. Dehiscence of the injured access with spontaneous arterial bleeding evolved as a consequence of the upper limb swelling, rendering therapeutic intervention of the access through a conventional route impossible. A fistulogram through puncture of the common femoral artery was performed to obtain an accurate diagnosis. However, this approach was insufficient to advance the covered stent with the intention of excluding the pseudoaneurysm, as the stent delivery system could not reach the desired site. Given that the covered stent insertion required a 9 Fr introducer, the radial artery approach was ruled out. Therefore, we chose a venous access via the ipsilateral internal jugular vein, which was punctured under ultrasound guidance.
  
  
  RESULTS
  This strategy was useful to advance the stent and exclude the pseudoaneurysm successfully.
  
  
  CONCLUSIONS
  This technique should be considered for those individuals in whom conventional routes of approach for repairing dialysis accesses are not feasible or are extremely risky.
authors.affiliation: Department of Angiography and Endovascular Therapy, Hospital Italiano de Buenos Aires, Buenos Aires - Argentina.
authors.forename: Martin
authors.initials: M
authors.lastname: Rabellino
authors.forename: Guillermo
authors.initials: G
authors.lastname: Rosa-Diez
authors.forename: Oscar
authors.initials: O
authors.lastname: Peralta
authors.forename: Sergio
authors.initials: S
authors.lastname: Shinzato
authors.forename: Maria Soledad
authors.initials: MS
authors.lastname: Crucelegui
authors.forename: Diego
authors.initials: D
authors.lastname: Serra
authors.forename: Ricardo
authors.initials: R
authors.lastname: Garcia-Monaco
mesh_terms: D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D002405:Catheterization, Central Venous / Q000379:methods*; D057510:Endovascular Procedures / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D011237:Predictive Value of Tests; D011677:Punctures; D006435:Renal Dialysis; D015607:Stents; D018084:Ultrasonography, Interventional; D034941:Upper Extremity / Q000098:blood supply*