Feasibility and Safety of Coronary Procedures via an Arteriovenous Graft Approach in Patients on Maintenance Hemodialysis.
BACKGROUND
Traditionally, a radial or brachial arterial approach is unadvisable in hemodialysis patients. Consequently, coronary angiography or angioplasty is usually performed via a femoral artery approach in these patients, who carry a higher risk of vascular access complications. In hemodialysis patients, arteriovenous grafts (AVG) are created for repeated punctures; however, the feasibility and safety of a trans-AVG approach for coronary angiography or angioplasty remains unclear.


METHODS
In our institution, cardiac catheterizations were attempted via AV grafts in hemodialysis patients with a U-shaped forearm AVG. We retrospectively identified coronary angiography or angioplasty procedures in hemodialysis patients from a computer-based database in our hospital. The procedure details and outcomes were obtained from review of the clinical, angiographic and hemodialysis records.


RESULTS
From 2008 to 2013, 167 procedures in hemodialysis patients were identified from 2866 diagnostic or interventional coronary procedures in our institution. Out of these, 24 procedures in 17 patients were performed via a trans-AVG approach. In all AVG procedures, a 6F 16-cm or 7F 10-cm sheath was placed from the AVG into the brachial artery. All diagnostic procedures were successfully performed. In 14 procedures, the patients also underwent angioplasty and all of the angioplasty procedures were successful. There was no arterial spasm, arterial dissection, puncture site hematoma, or acute thrombosis of the AVG during or after the procedures.


CONCLUSIONS
A trans-AVG approach appears to be a feasible and safe route for coronary angiography or angioplasty in hemodialysis patients with a U-shaped forearm AVG. However, further studies with a larger patient number are necessary.


BACKGROUND
Arteriovenous graft; Hemodialysis; Percutaneous coronary intervention.
Division of Cardiology, Department of Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu;
Rye-Cheng
RC
Ko
Division of Cardiology, Department of Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu;
Min-Tsun
MT
Liao
Division of Cardiology, Department of Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu;
Lin
L
Lin
Division of Cardiology, Department of Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu;
Mu-Yang
MY
Hsieh
Division of Cardiology, Department of Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu;
Pei-Shan
PS
Lin
Division of Cardiology, Department of Medicine, Miao-Li General Hospital, Miao-Li;
Kuei-Chin
KC
Tsai
Division of Cardiology, Department of Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu; ; College of Medicine, National Taiwan University;
Chia-Lun
CL
Chao
Division of Cardiology, Department of Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu; ; College of Medicine, National Taiwan University; ; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Chih-Cheng
CC
Wu