Percutaneous balloon occlusion of surgical arteriovenous fistulae following venous thrombectomy

Abstract

We describe a percutaneous method of balloon occlusion of surgically created femoral arteriovenous fistulae (AVF) after thrombectomy for acute iliofemoral venous thrombosis. The technique was successful in permanent obliteration of the AVF in 25 of 27 patients. Complications were few, minor, and limited to the developmental period of the procedure. No patient required surgical intervention. The procedure provides an opportunity to angiographically evaluate the results of previous thrombectomy.

Surgical Management of Iliofemoral Venous Thrombosis

“…Through a contralateral femoral artery retrograde percutaneous access, a catheter is inserted and positioned at the AVF level. 25 Before occlusion of the AVF with a detachable balloon or coil, an arteriovenogram is performed to evaluate the patency of the iliac veins and cava. In more than 10% of patients a residual significant iliac vein stenosis will be demonstrated despite initially successful surgery.…”

Management of Ilio-Femoral Deep Vein Thrombosis: A Hybrid Approach

“…While some researchers have reported closure of the AVF by percutaneous balloon occlusion [50][51][52], most patients do not require closure as flow through the small AVF diminishes with time because of neo-intimal fibroplasia [49]. If closure of the AVF is necessary, it is commonly performed after 4-8 weeks [46,47].…”

The Role of Kuwait in the Development of Early Thrombus Removal in Patients with Acute Iliofemoral Vein Thrombosis: In Memory of Dr. Nael Al-Naqeeb

“…A new percutaneous technique for fistula closure was developed by Endrys et al [ 8 ] in Kuwait. Through a puncture of the femoral artery on the opposite, surgically untouched side, a catheter is inserted and positioned at the fistula level.…”

“…The surgical technique was refined during this period. A fruitful collaboration with Jiri Endrys, a Czech interventional cardiologist at the Chest Hospital, led to the development of percutaneous closure of the AVF and postoperative angioplasty of the remaining iliac vein obstruction [ 8 ]. Six weeks after TE, the femoral artery on the contralateral nonoperated side was catheterized and the tip of the catheter was placed at the level of the AVF.…”