Interrupting Rivaling Access-flow with Nonsurgical Image-guided ligation: the "IRANI" Procedure.
The presence of collateral veins is one of the most common causes of fistula failure to mature. The traditional approach to eliminate collateral vessel flow is coil embolization under fluoroscopy or surgical cut down and branch vessel ligation. However, both approaches are expensive and time consuming. Here, we described an image-guided nonsurgical method to ligate collateral veins. The collateral veins were ligated using Hawkins-Akins needle under ultrasound guidance. The average time for one ligation procedure was 17 minutes. There was a significant increase of blood flow in the venous outflow postligation procedure. Four weeks postprocedure ultrasound demonstrated occlusion of the target vessels. This procedure was well tolerated without major complications. In summary, the novel procedure described here offers an image-guided nonsurgical approach for collateral vein occlusion.
Nephrology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Jie
J
Cui
Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Robert
R
Freed
Division of Interventional Radiology, Chinese People's Liberation Army General Hospital, Beijing, China.
Fengyong
F
Liu
Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Zubin
Z
Irani
D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D003097:Collateral Circulation; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008026:Ligation / Q000379:methods; D008297:Male; D008875:Middle Aged; D012039:Regional Blood Flow / Q000502:physiology*; D006435:Renal Dialysis; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013536:Suture Techniques / Q000295:instrumentation*; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D014680:Veins / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*