title: Percutaneous Creation of Bare Intervascular Tunnels for Salvage of Thrombosed Hemodialysis Fistulas Without Recanalizable Outflow.
abstract: OBJECTIVE
  This study aimed to retrospectively assess the efficacy of a bare intervascular tunnel for salvage of a thrombosed hemodialysis fistula. We examined the clinical outcomes and provided follow-up images of the bare intervascular tunnel.
  
  
  METHODS
  Eight thrombosed fistulas lacked available recanalizable outflow veins were included in this study. These fistulas were salvaged by re-directing access site flow to a new outflow vein through a percutaneously created intervascular tunnel without stent graft placement. The post-intervention primary and secondary access patency rates were calculated using the Kaplan-Meier method.
  
  
  RESULTS
  The procedural and clinical success rates were 100%. Post-intervention primary and secondary access patency at 300 days were 18.7 ± 15.8 and 87.5 ± 11.7%, respectively. The mean follow-up period was 218.7 days (range 10-368 days). One patient died of acute myocardial infarction 10 days after the procedure. No other major complications were observed. Minor complications, such as swelling, ecchymosis, and pain around the tunnel, occurred in all of the patients.
  
  
  CONCLUSIONS
  Percutaneous creation of a bare intervascular tunnel is a treatment option for thrombosed hemodialysis fistulas without recanalizable outflow in selected patients.
authors.affiliation: Department of Interventional Radiology, Yuan's General Hospital, No.162, Cheng-gong 1st Rd., Lingya District, Kaohsiung, 802, Taiwan, jjychen@gmail.com.
authors.forename: Matt Chiung-Yu
authors.initials: MC
authors.lastname: Chen
authors.forename: Yen-Chi
authors.initials: YC
authors.lastname: Wang
authors.forename: Mei-Jui
authors.initials: MJ
authors.lastname: Weng
mesh_terms: D000368:Aged; D001164:Arteriovenous Fistula / Q000150:complications / Q000601:surgery*; D005260:Female; D006083:Graft Occlusion, Vascular / Q000150:complications / Q000601:surgery*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D013927:Thrombosis / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome; D014654:Vascular Patency