In recent years, the advent of endovascular techniques has made possible the treatment of high-risk surgical patients. Nevertheless, the risk of short- and long-term complications is not insignificant. A surveillance program is therefore required to identify any possible complications and to monitor the efficacy of the treatment over time. In the various studies concerning follow-up after endovascular treatment for aortic aneurysm, computed tomography angiography is considered the “gold-standard.” Duplex ultrasonography provides accurate information regarding the patency of the stent graft and the evolution of the aneurysm sac size but is characterized by low sensitivity and specificity in the identification of endoleaks, which ranges from 70% to 90%. The use of contrast agents seems to increase the sensitivity in the identification of endoleaks. We evaluated the efficacy of contrast agents in the follow-up of patients after endovascular treatment and to compare results obtained from computed tomography angiography.

We report a case of a lady affected by autosomal dominant polycystic kidney disease who had been on hemodialyis for 24 years. She has exhausted all options for arterious-venous fistula. The presence of an acquired anatomical abnormality was an obstacle in order to get appropriate blood flow from standard tunnelled femoral catheters. The enlarged right kidney was pushing the inferior vena cava to the left side of the abdomen, and the abnormality was demonstrated by phlebography. Only after placing a cuffed catheter 53 cm long in her left femoral vein we could dialyze efficiently. Venography is mandatory before placing a cuffed catheter especially in uremic patients with long history of access failure, because it saves costs.