A one-sheath inverse method in vascular access intervention therapy for hemodialysis patients

Takashima, Tsuyoshi; Nonaka, Yasunori; Nakashima, Yui; Nonaka, Eriko; Ikeda, Yuki; Fukuda, Makoto; Jinnouchi, Hiroshi; Rikitake, Shuichi; Miyazono, Motoaki; Ikeda, Yûji

doi:10.1016/j.ijscr.2018.11.067

Cited by 4 publications

(6 citation statements)

References 10 publications

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“…Although rare, both sites may be stenosed [2,14]. Dilating both stenoses usually requires placing two sheaths in opposite directions or performing an anterograde angioplasty via brachial arterial access [15].…”

Section: Discussionmentioning

confidence: 99%

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Single-Sheath Inverse Technique via Vertical Puncture in Hemodialysis Arteriovenous Fistula Angioplasty

Hasegawa,

Tsuboi,

Takahashi

et al. 2024

Preprint

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Background: Transvenous percutaneous transluminal angioplasty for dialysis access stenosis is sometimes for both the upstream and downstream side of the approach site. A single sheath inversion has been used in some cases, but there are few reports in the literature. The purpose of this study was to retrospectively evaluate the feasibility of the sheath inverse technique using the vertical puncture approach in PTA for stenosis of arteriovenous fistulas for hemodialysis. Materials and Methods: Twenty patients (26 cases; 13 males; median age, 74 [range: 50–89] years) who underwent percutaneous transluminal angioplasty using the sheath inverse technique for native arteriovenous fistula stenosis between April 2019 and June 2023 were included. A 4-cm sheath (4Fr, 4 cases; 5Fr, 19 cases; 6Fr, 3 cases) was inserted by vertical puncture through a cutaneous vein in the forearm (20 cases) or upper arm (6 cases). After treating one side of the lesion, the sheath was reversed to treat the lesion on the opposite side. The vessel diameter at the sheath insertion site, the success rate of sheath inversion, the number of percutaneous transluminal angioplasty balloon catheters used, the percutaneous transluminal angioplasty success rate, and adverse events were evaluated. Results: The median diameter at the sheath indwelling site was 5.2 (range: 3.6–9.5) mm, and sheath inversion was successful in all cases. The number of balloon catheters used was oneand two in 17 (65%) and eight cases (31%), respectively, and three in one case wherein a drug-coated balloon was used. Major complications were not observed. However, in one case wherein a sheath had to be placed at the arterial needle puncture site, the skin was hard, leading to difficulty in inversion, and transient venous spasm occurred post-inversion. Conclusion: The single-sheath inverse technique for arteriovenous fistulas was feasible without sheath withdrawal.

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Section: Discussionmentioning

confidence: 99%

“…The sheath inverse technique is not di cult to perform. However, there are only two case reports of the sheath inverse technique [14,16], and only one case of PTA for hemodialysis access [14]. Takashima et al [14] stated that the advantages are "pain reduction, shortened operation time, and cost-savings."…”

Section: Discussionmentioning

confidence: 99%

Single-Sheath Inverse Technique via Vertical Puncture in Hemodialysis Arteriovenous Fistula Angioplasty

Hasegawa,

Tsuboi,

Takahashi

et al. 2024

Preprint

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“…We inverted the sheath direction from cranial to caudal. The one-sheath inverse method has been used for vascular access in hemodialysis patients whose stenotic lesions are located upstream and downstream from the approach site [9] . The technique is relatively easy for experienced operators, as vascular access is typically located superficially.…”

Section: Discussion/conclusionmentioning

confidence: 99%

“…Takashima et al. described the advantages of the technique, including optimization of the procedure, reduced invasiveness, and cost-savings [9] . In our patient, the one-sheath inverse method was useful for embolization of the hepatic and pelvic sides of the paraumbilical shunt; it contributed to the reduced risk of complications due to puncture.…”

Section: Discussion/conclusionmentioning

confidence: 99%

Embolization of a paraumbilical shunt by the transparaumbilical venous approach and one-sheath inverse method: A case report

Kamada

Ota

Seiji

et al. 2020

Radiology Case Reports

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We describe treatment of a 53-year-old man with chronic hepatic encephalopathy. Contrast-enhanced computed tomography demonstrated a recanalized paraumbilical vein as a portosystemic shunt connecting the left branch of the portal vein and bilateral iliac veins. Percutaneous embolization was performed. The paraumbilical vein was punctured under ultrasonographic guidance; a 7-Fr sheath was inserted in the cranial direction. The hepatic side of the shunt was embolized with a vascular plug. The sheath direction was inverted to the caudal side; the pelvic side of the shunt was then embolized with another vascular plug. This report demonstrates that the percutaneous transparaumbilical venous approach is useful and safe for portosystemic shunt intervention. Moreover, the one-sheath inverse method was useful for embolization of upstream and downstream sides of the puncture site.

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“…Autologous arteriovenous endovascular fistula (AEF) is the primary means of vascular access for patients undergoing maintenance hemodialysis, and vascular access patency affects treatment efficacy [4]. The long-term application of AEFs, combined with the weakened physical status of the patients, leads to a high incidence of thrombosis in arteriovenous fistula, which is a major cause of primary AV fistula failure [5,6]. Therefore, it is important to reduce the incidence of arteriovenous fistula (AVF) thrombosis, so as to improve the clinical outcomes of hemodialysis.…”

Section: Introductionmentioning

confidence: 99%

Effect of the combination of percutaneous transluminal angioplasty and pharmacological thrombolysis on hemodialysis patients

Yang¹,

Tang²,

Zhong³

2022

Trop. J. Pharm Res

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Purpose: To examine the efficacy of percutaneous transluminal angioplasty (PTA), combined withpharmacologic thrombolysis (PT) on thrombosis of autologous arteriovenous fistulas (AVFs),inflammatory factors, and β2 microglobulin (β2-MG) levels in hemodialysis patients.Methods: Seventy-eight patients with AVF thrombosis allocated randomly into a control group (CG) received PTA, and a study group (SG) received PTA combined with PT (n = 39 in each). The patency, vascular condition, inflammatory factors, viz, interleukin-6 (IL-6), high-sensitivity C-reactive protein (hs-CRP)), β2-MG levels, vascular-related factors (VEGF-A and MCP-1), complications, and quality of life were determined.Results: At three and six months after surgery, t SG exhibited a higher vascular patency than CG (p <0.05). Serum levels of IL-6, hs-CRP, β2-MG, VEGF-A, and MCP-1 of t SG were lower than those of CG(p < 0.05). The SG showed higher cross-sectional area, inner diameter at the site of fistula, and better quality of life scores than CG (p < 0.05).Conclusion: The combination of PTA and PT enhances efficacy, increases vascular patency, reduces inflammatory response, lowers the level of β2-MG, and improves quality of life in patients with AVFs without increasing complications. Thus, the combination treatment has potentials for the management of hemodialysis patients.

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A one-sheath inverse method in vascular access intervention therapy for hemodialysis patients

Cited by 4 publications

References 10 publications

Single-Sheath Inverse Technique via Vertical Puncture in Hemodialysis Arteriovenous Fistula Angioplasty

Single-Sheath Inverse Technique via Vertical Puncture in Hemodialysis Arteriovenous Fistula Angioplasty

Embolization of a paraumbilical shunt by the transparaumbilical venous approach and one-sheath inverse method: A case report

Effect of the combination of percutaneous transluminal angioplasty and pharmacological thrombolysis on hemodialysis patients

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