title: Percutaneous transluminal angioplasty of a non-mainstream venous route to restore an occluded hemodialysis fistula.
abstract: OBJECTIVE
  To report the usefulness of percutaneous transluminal angioplasty (PTA) of a non-mainstream venous route in an occluded native hemodialysis fistula when a mainstream outflow vein could not be traversed.
  
  
  METHODS
  This cohort included seven patients with an occulted hemodialysis fistula with difficulty in traversing via a mainstream route. A non-mainstream vein near the occluded portion was traversed until it connected with a proximal large-sized vein and the route was dilated using a 4- or 5-mm balloon catheter. Metallic stent placement was performed, if necessary. Technical aspects and long-term patency was evaluated.
  
  
  RESULTS
  PTA could be performed in all patients; however, stent placement was required in two because of residual stenosis and clotting. The clinical success rate of fistula restoration was 100 %. Fistula dysfunction recurred in six patients 17-668 days (mean ± standard deviation 229.3 ± 225.0) later. PTA was repeated in four patients, but not in two. The mean duration of the primary patency was 336.6 ± 417.2 days (range 17-1,190) and that of the secondary patency was 897.1 ± 801.4 days (range 17-2,230).
  
  
  CONCLUSIONS
  PTA of a non-mainstream venous route is useful for restoring an occluded hemodialysis fistula when the mainstream outflow vein cannot be traversed.
authors.affiliation: Department of Diagnostic Radiology, Fukuiken Saiseikai Hospital, 7-1 Funabashi, Wadanaka-cho, Fukui, 918-8503, Japan, s-miyayama@fukui.saiseikai.or.jp.
authors.forename: Shiro
authors.initials: S
authors.lastname: Miyayama
authors.forename: Masashi
authors.initials: M
authors.lastname: Yamashiro
authors.forename: Masaya
authors.initials: M
authors.lastname: Ikuno
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Okumura
authors.forename: Miki
authors.initials: M
authors.lastname: Yoshida
authors.forename: Tamayo
authors.initials: T
authors.lastname: Kato
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Ushiogi
mesh_terms: D000328:Adult; D000368:Aged; D017130:Angioplasty / Q000379:methods*; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D006435:Renal Dialysis / Q000009:adverse effects*; D016896:Treatment Outcome; D014654:Vascular Patency