title: Transradial approach for percutaneous intervention of malfunctioning arteriovenous accesses.
abstract: OBJECTIVE
  Interventions on arteriovenous (AV) access are typically performed with a direct puncture into the fistula. An alternative is the transradial approach (TRA), which offers the advantage of visualizing both the arterial and venous limbs as well as any juxta-anastomotic stenosis, all through one access.
  
  
  METHODS
  From September 2010 to 2013, 511 fistulograms were performed on 322 patients, 55 of which were TRA procedures in 40 patients (50% male; mean age, 60.4 ± 16.5 years). Of these, 37 of 40 accesses (92.5%) were AV fistulas, and 54 of 55 interventions (98%) were performed for stenotic lesion(s). There were 37 initial interventions, 13 secondary inventions, and five diagnostic fistulograms through the TRA. Stenotic lesions were juxta-anastomotic in 28, venous in 11, or both in 11. Mean follow-up was 14.3 months in 37 of 40 patients. Outcomes included technical and clinical success, complications, functional patency, and flow rate changes.
  
  
  RESULTS
  All TRA punctures were successful, with no radial artery thromboses or hand ischemia. Technical success was 88% (44 of 50). Functional patency rates were 88.5% (23 of 26), 84.2% (16 of 19), and 83% (10 of 12) at 1, 6, and 12 months, respectively. The complication rate was 1.8% (one of 55), consisting of AV fistula rupture after angioplasty. The average flow rate in the 20 juxta-anastomotic stenosis increased from 637 mL/min to 1094 mL/min (P = .01) after the procedure.
  
  
  CONCLUSIONS
  The TRA is a practical option with functional patency rates that are comparable to traditional approaches when intervening on a malfunctioning dialysis access in the appropriately selected patient. No hand ischemia was noted. This approach may be particularly attractive for treatment of juxta-anastomotic stenoses in a variety of AV accesses and offers unique practical advantages for the maintenance of AV accesses.
authors.affiliation: Section of Vascular and Endovascular Surgery, Department of Surgery, Ochsner Clinic, New Orleans, La. Electronic address: le.linda25@yahoo.com.
authors.forename: Linda
authors.initials: L
authors.lastname: Le
authors.affiliation: Section of Vascular and Endovascular Surgery, Department of Surgery, Ochsner Clinic, New Orleans, La.
authors.forename: Ashton
authors.initials: A
authors.lastname: Brooks
authors.affiliation: Section of Vascular and Endovascular Surgery, Department of Surgery, Ochsner Clinic, New Orleans, La.
authors.forename: Melissa
authors.initials: M
authors.lastname: Donovan
authors.affiliation: Section of Vascular and Endovascular Surgery, Department of Surgery, Ochsner Clinic, New Orleans, La.
authors.forename: Taylor A
authors.initials: TA
authors.lastname: Smith
authors.affiliation: Section of Vascular and Endovascular Surgery, Department of Surgery, Ochsner Clinic, New Orleans, La.
authors.forename: W Charles
authors.initials: WC
authors.lastname: Sternbergh
authors.affiliation: Section of Vascular and Endovascular Surgery, Department of Surgery, Ochsner Clinic, New Orleans, La.
authors.forename: Hernan A
authors.initials: HA
authors.lastname: Bazan
mesh_terms: D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D001783:Blood Flow Velocity; D003251:Constriction, Pathologic; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011677:Punctures; D017534:Radial Artery / Q000000981:diagnostic imaging; D011859:Radiography; D012039:Regional Blood Flow; D006435:Renal Dialysis; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency