Diagnostic and Interventional Radiology of Arteriovenous Accesses for Hemodialysis Luc Turmel-Rodrigues • Claude J Renaud Diagnostic and Interventional Radiology of Arteriovenous Accesses for Hemodialysis With contributions by Bernard Beyssen, Jean-Jacques Godier, Albert Mouton, Josette Pengloan, and Richard Shoenfeld Luc Turmel-Rodrigues Department of Vascular Radiology Clinique Saint-Gatien Tours France Claude J Renaud Department of Medicine Khoo Teck Puat Hospital Singapore Translation from the French language edition ‘Radiologie diagnostique et interventionnelle des accès artério-veineux pour hémodialyse’ by Luc Turmel, © Springer-Verlag France, Paris, 2012; ISBN: 978-2-8178-0265-7 ISBN 978-2-8178-0365-4 ISBN 978-2-8178-0366-1 DOI 10.1007/978-2-8178-0366-1 Springer Paris Heidelberg New York Dordrecht London (eBook) Library of Congress Control Number: 2012951701 © Springer-Verlag France 2013 This work is subject to copyright All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifically for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher’s location, in its current version, and permission for use must always be obtained from Springer Permissions for use may be obtained through RightsLink at the Copyright Clearance Center Violations are liable to prosecution under the respective Copyright Law The use of general descriptive names, registered names, trademarks, service marks, etc in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made The publisher makes no warranty, express or implied, with respect to the material contained herein Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) Contents Endovascular Repair of Dialysis Fistulas and Grafts: Strengths and Weaknesses References Role of the Nephrologist, Interventional Radiologist, and Vascular Access in the Treatment of End-Stage Renal Disease References Access Creation Strategy References 11 14 Natural History of Vascular Access References 15 17 Radiological Anatomy and Preoperative Imaging of Upper Limb Vessels 5.1 Arterial Anatomy 5.2 Venous Anatomy 5.3 Preoperative Radiological Imaging 5.3.1 Indications 5.3.2 Techniques of Venography 5.3.3 Interpretation of Venograms 5.3.4 What Use Is Venous Mapping to Surgeons? 19 19 22 28 28 29 32 34 Indications and Imaging Modalities in Dialysis Access 6.1 Indications 6.2 Clinical Abnormalities 6.3 Thrombosis Prevention 6.4 Which Type of Image Modality? References 35 35 35 36 36 38 v vi Contents Psychological and Clinical Issues 7.1 Psychology of Patients Referred for Intervention 7.2 Clinical Presentations of Patients and Dialysis Accesses 7.2.1 Patients 7.2.2 The Hand 7.2.3 The Normal Vascular Access 7.2.4 The Flat Fistula 7.2.5 The Hyperpulsatile Fistula 7.2.6 The Falsely Normal Fistula 7.2.7 The Inappropriately Needled Fistula 7.2.8 Hyper Flow 7.2.9 Arm and/or Facial Edema 7.2.10 Collateral Veins 7.2.11 Cutaneous Necrosis 7.2.12 Aneurysms 7.2.13 The Painful Vascular Access 39 39 40 40 40 41 41 42 43 43 43 43 44 45 46 47 Patient Preparation Prior to Angiography and Endovascular Interventions 8.1 Background 8.2 Essential Patient Data 8.3 Sedation 8.4 Allergies 8.5 Anticoagulation 8.6 Acute Access Thrombosis 49 49 49 50 50 51 51 Angiography (Fistulography) 9.1 Role of Angiography 9.2 Angiography Suite 9.3 Contrast Agents 9.4 Angiography Techniques 9.4.1 Background 9.4.2 Low Flow Forearm AVFs 9.4.3 Low Flow Upper Arm AVF 9.4.4 Venous Hypertension 9.4.5 Distal Ischemia 9.4.6 Hyper Flow AVFs 9.4.7 Prosthetic Grafts 9.4.8 Entrapment 9.5 Interpretation of Angiograms 9.5.1 Background 9.5.2 Arteries 9.5.3 The Veins 53 53 54 54 55 55 55 56 56 57 57 57 57 58 58 58 59 Contents vii 9.6 Sites of Stenoses 9.7 Rarities 9.8 Postoperative Imaging References 61 62 63 63 10 Dilation and Stent Placement 10.1 Dilation (or Percutaneous Transluminal Angioplasty) 10.1.1 Reading Angiograms 10.1.2 Contraindications to Dilation 10.1.3 Indications for Dilation 10.1.4 Basic Techniques of Angioplasty 10.1.5 Technical Details 10.1.6 Dilation of Stenosis Based on Anatomical Location and Access Type 10.2 Stents 10.2.1 Description 10.2.2 Deployment 10.2.3 Potential Drawbacks 10.2.4 Indications 10.3 Restenosis 10.4 Which Strategy: To Redilate or Give Up? References 65 65 65 66 67 70 86 11 Hand Ischemia 11.1 Background 11.2 An Atypical Form of Acute Ischemia: Ischemic Monomelic Neuropathy (IMN) 11.3 Chronic Ischemia 11.3.1 Diagnosis 11.3.2 Noninvasive Work-Up 11.4 Arteriography 11.4.1 Technique 11.4.2 Principles of Reading Arteriograms 11.4.3 Interpretation of Arteriograms and Concomitant Treatment 11.5 Surgical Treatment 11.5.1 Indications and Principles of Surgical Treatment 11.5.2 Upper Arm Hyper Flow AVFs 11.5.3 Hyper Flow Forearm AVFs 11.5.4 Normal Flow Upper Arm Accesses 11.5.5 Normal Flow Forearm AVFs 11.6 Conclusion References 92 122 122 123 123 124 127 128 128 131 131 136 136 136 137 139 139 142 142 148 148 149 150 150 151 153 153 viii Contents 12 Treatment of Thrombosed Accesses 12.1 Introduction 12.2 History 12.3 The Clinical Problem 12.4 Contraindications to Percutaneous Thrombectomy 12.4.1 Temporary Contraindications 12.4.2 Absolute Contraindications 12.4.3 Relative Contraindications 12.5 Patient Preparation 12.6 Percutaneous Thrombectomy by Thromboaspiration: Basic Technique 12.6.1 General Principles 12.6.2 “Venous” Access 12.6.3 “Arterial” Access 12.6.4 Venous Outflow Thromboaspiration 12.6.5 Arterial Inflow Thromboaspiration 12.6.6 Arterial Plug 12.6.7 Dilation 12.6.8 Arterial Embolism 12.6.9 Completion Angiography and Device Removal 12.7 Special Considerations and Challenges 12.7.1 The Non-flowing but Non-thrombosed AVF 12.7.2 Working with a Single Introducer-Sheath 12.7.3 Segmental Thromboses 12.7.4 Isolated Painful Thrombosed Aneurysms 12.7.5 Difficult Venous Access 12.7.6 Failure to Cross the Venous Outlet 12.7.7 Central Vein Occlusions 12.7.8 Risks Associated with Intervening on Brachial accesses 12.7.9 Failure to Cross the Arteriovenous Anastomosis 12.7.10 Proximal Artery Thrombosis 12.7.11 Distal Radial Artery Thrombosis 12.7.12 Aneurysms 12.7.13 Old AVFs 12.7.14 Looped Grafts 12.7.15 Lower Limb Accesses 12.7.16 Kinks and Traps 12.7.17 Cluttering 12.7.18 Alternative Thrombectomy Techniques 12.7.19 Early Rethrombosis 155 155 155 157 158 158 158 159 160 161 161 162 169 172 173 174 175 176 178 178 178 180 181 182 182 182 183 183 185 185 187 187 190 192 192 192 192 193 193 Contents ix References 194 13 Therapeutic Occlusion of Dysfunctional Accesses 197 Reference 197 14 Complications During and After Vascular Access Endovascular Procedures 199 15 Vascular Access Intervention Outcomes 203 References 204 Appendices The Anesthetist and Vascular Access Endovascular Procedures Treatment of Hyperkalemia in End-Stage Kidney Disease Patients During Vascular Access Procedures Introduction Definition, Causes, and Risk Stratification of Hyperkalemia Treatment Conclusion References Basic Tools Required to Perform Endovascular Dilation, Stenting, and Thrombectomy Procedures A Typical Request Form Template for Vascular Access Endovascular Procedure 207 207 209 209 209 210 211 212 213 215 .. .Diagnostic and Interventional Radiology of Arteriovenous Accesses for Hemodialysis Luc Turmel-Rodrigues • Claude J Renaud Diagnostic and Interventional Radiology of Arteriovenous Accesses for. .. C.J Renaud, Diagnostic and Interventional Radiology of Arteriovenous Accesses for Hemodialysis, DOI 10.1007/978-2-8178-0366-1_2, © Springer-Verlag France 2013 Role of the Nephrologist, Interventional. .. Diagnostic and Interventional Radiology of Arteriovenous Accesses for Hemodialysis, DOI 10.1007/978-2-8178-0366-1_5, © Springer-Verlag France 2013 19 20 Radiological Anatomy and Preoperative Imaging of