Balloon catheter looping technique for entry site angioplasty during endovascular management of thrombosed arteriovenous grafts by single access.
OBJECTIVE
This study was designed to evaluate the feasibility of balloon catheter looping technique for angioplasty of entry site lesions of stenosis or thrombi that could not be aspirated during endovascular treatment of thrombosed arteriovenous grafts by single access.


METHODS
Balloon catheter looping technique was used for angioplasty of entry site lesions in 13 sessions of treatment of thrombosed arteriovenous grafts by single access in 11 patients (M:F = 7:4, mean age: 70.7 years, 9 brachio-axillary straight and 2 brachio-antecubital loop grafts) and were retrospectively evaluated. Middle equator of the graft was punctured and a 7F Desilets-Hoffman introducer sheath was inserted for aspiration thrombectomy and angioplasty. For entry site angioplasty, the balloon catheter was positioned 4-5 cm beyond the tip of the sheath. The sheath was retrieved to the entry site and was redirected into the contralateral limb, so the balloon catheter would form a loop. The introducer sheath was advanced to pull the balloon back to cover the entry site for angioplasty. Radiological images and medical records were evaluated for feasibility, success rate, and complications.


RESULTS
Technical success of treatment of thrombosed graft and balloon catheter looping for entry site angioplasty could be achieved in all 13 cases (100%), without requiring second access. Completion fistulography revealed no access complication. Patency rate at 3 and 6 months were 80 and 68.6%, respectively.


CONCLUSIONS
Balloon catheter looping technique for angioplasty of entry site lesions during endovascular treatment of thrombosed arteriovenous graft is a feasible alternative technique to obtaining a second access.
Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea, astarte@yuhs.ac.
Sung Il
SI
Park
Il Jung
IJ
Kim
Shin Jae
SJ
Lee
Man Deuk
MD
Kim
Jong Yun
JY
Won
Do Yun
DY
Lee
Shin-Wook
SW
Kang
Kyu Hun
KH
Choi
D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000379:methods*; D000818:Animals; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D002415:Cats; D015331:Cohort Studies; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011859:Radiography; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D017131:Thrombectomy / Q000379:methods; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000628:therapy; D016896:Treatment Outcome; D062666:Vascular Access Devices / Q000009:adverse effects*; D014654:Vascular Patency / Q000502:physiology