Salvage of autogenous dialysis access with balloon-assisted thrombin injection

Lin, Mary S.; Drucker, Charles B.; Tolaymat, Besher; Jinwala, Felecia; Nagarsheth, Khanjan H.

doi:10.1016/j.jvscit.2020.09.013

Cited by 3 publications

(2 citation statements)

References 17 publications

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“…On the other side, complications of a stent graft encompass possible migration, fracture, rupture, erosion, and shortening of the available cannulation area. 6 Therefore, there is a need for additional minimally invasive technique that could be performed as outpatient, limiting the need for open repair.…”

Section: Introductionmentioning

confidence: 99%

Treatment of arteriovenous access pseudoaneurysms using ultrasound guided balloon assisted thrombin injection: Two cases and systematic review of the literature

et al. 2023

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Background: Arteriovenous fistula pseudoaneurysm (AVF-PSA) is a common complication, usually caused during dialysis cannulation, which traditionally has been treated with open and less frequently endovascular techniques. Thrombin injection, although established in the treatment of arterial pseudoaneurysms, has barely been used in the treatment of AVF-PSA, due to concerns for AVF thrombosis or proximal embolization. Methods: A systematic review was performed according to the PRISMA 2020 guidelines. PubMed and Cochrane Central databases were reviewed and all clinical reports on AVF-PSA balloon assisted percutaneous thrombin injection through July 2022 were included. The electronic search yielded five case reports. Due to between-study differences and small sample size, the findings were summarized from each report, but the results were not pooled. Additionally, we present our own experience on two patients with AVF-PSA that were treated with balloon assisted percutaneous thrombin injection Results: A total of five case reports (no of patients: 7, including ours) were included for review. Most of the patients were male ( n = 6) and the mean age was 65.9 years. The average size of the PSA was 1.6 cm. In all cases a balloon was inflated to prevent thrombin and thrombotic material intrusion into the fistula lumen, prior to thrombin injection. In one patient n-butyl cyanoacrylate and Lipiodol were used, due to thrombin non availability. Recurrence was reported in only one patient, and average follow-up is 16 months. Conclusions: Thrombin injection with concomitant balloon inflation seems to be a safe and effective treatment for arteriovenous fistula pseudoaneurysms. Future studies should be aimed at evaluating the long-term outcomes of such minimally invasive techniques.

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Section: Introductionmentioning

confidence: 99%

Treatment of arteriovenous access pseudoaneurysms using ultrasound guided balloon assisted thrombin injection: Two cases and systematic review of the literature

et al. 2023

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“…Endovascular, balloon-assisted techniques transiently reduce blood ow across wide necked pseudoaneurysms, facilitating safe UGTI. This technique is usually employed for femoral artery pseudoaneurysms [4], but may also be used to treat pseudoaneurysms complicating dialysis access [5,6].…”

Section: Introductionmentioning

confidence: 99%

Balloon Assisted, Ultrasound Guided Percutaneous Thrombin Injection of a Large Radial Artery Pseudoaneurysm Using a Trans-Venous Approach via an Ipsilateral Arteriovenous Fistula.

Gregory

Guest

Abdeen

et al. 2021

Preprint

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Background: Pseudoaneurysm formation is known to complicate arteriovenous haemodialysis access. Ultrasound guided thrombin injection is a recognised treatment option, but is not possible in pseudoaneurysms with no measurable neck. Balloon assisted techniques have been described in such cases, which transiently obstruct flow out of the pseudoaneurysm and thereby prevent non-target embolization during ultrasound guided percutaneous thrombin injection. We describe a novel balloon assisted technique for the treatment of a radial artery pseudoaneurysm, via retrograde access from the draining cephalic vein of an arteriovenous fistula. Method: A 61 year old male with a radio-cephalic fistula was found on duplex ultrasound to have a large radial artery pseudoaneurysm with no measurable neck, as well as a juxta-anastomotic cephalic vein stenosis. Endovascular treatment was selected over open surgery. Retrograde cephalic venous access was established, which allowed for concurrent treatment of both the venous stenosis and the arterial pseudoaneurysm. After balloon dilation of the juxta-anastomotic stenosis, a percutaneous transluminal angioplasty balloon catheter was advanced across the arteriovenous anastomosis and inflated across the neck of the radial artery pseudoaneurysm, to transiently obstruct blood flow. This allowed for safe injection of thrombin into the pseudoaneurysm by direct ultrasound guided sac puncture; thereby achieving thrombosis. Conclusions: Balloon assisted ultrasound guided thrombin injection is an endovascular treatment option that can obviate the need for open surgery in cases involving pseudoaneurysms with no measurable neck. The novel technique described allowed both concurrent treatment of a juxta-anastomotic venous stenosis and treatment of an arterial pseudoaneurysm from a single venous puncture. This technique avoided arterial access and its inherent complications.

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Balloon assisted, ultrasound guided percutaneous thrombin injection of a large radial artery pseudoaneurysm using a trans-venous approach via an Ipsilateral Arteriovenous Fistula

et al. 2021

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Background Pseudoaneurysm formation is known to complicate arteriovenous haemodialysis access. Ultrasound guided thrombin injection is a recognised treatment option, but is not possible in pseudoaneurysms with no measurable neck. Balloon assisted techniques have been described in such cases, which transiently obstruct flow out of the pseudoaneurysm and thereby prevent non-target embolization during ultrasound guided percutaneous thrombin injection. We describe a balloon assisted technique for the treatment of a radial artery pseudoaneurysm, via retrograde access from the draining cephalic vein of an arteriovenous fistula. Method A 61-year-old male with a radio-cephalic fistula was found on duplex ultrasound to have a large radial artery pseudoaneurysm with no measurable neck, as well as a juxta-anastomotic cephalic vein stenosis. Endovascular treatment was selected over open surgery. Retrograde cephalic venous access was established, which allowed for concurrent treatment of both the venous stenosis and the arterial pseudoaneurysm. After balloon dilation of the juxta-anastomotic stenosis, a percutaneous transluminal angioplasty balloon catheter was advanced across the arteriovenous anastomosis and inflated across the neck of the radial artery pseudoaneurysm, to transiently obstruct blood flow. This allowed for safe injection of thrombin into the pseudoaneurysm by direct ultrasound guided sac puncture; thereby achieving thrombosis. Conclusions Balloon assisted ultrasound guided thrombin injection is an endovascular treatment option that can obviate the need for open surgery in cases involving pseudoaneurysms with no measurable neck. The technique described allowed both concurrent treatment of a juxta-anastomotic venous stenosis and treatment of an arterial pseudoaneurysm from a single venous puncture. This technique avoided arterial access and its inherent complications.

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Salvage of autogenous dialysis access with balloon-assisted thrombin injection

Cited by 3 publications

References 17 publications

Treatment of arteriovenous access pseudoaneurysms using ultrasound guided balloon assisted thrombin injection: Two cases and systematic review of the literature

Treatment of arteriovenous access pseudoaneurysms using ultrasound guided balloon assisted thrombin injection: Two cases and systematic review of the literature

Balloon Assisted, Ultrasound Guided Percutaneous Thrombin Injection of a Large Radial Artery Pseudoaneurysm Using a Trans-Venous Approach via an Ipsilateral Arteriovenous Fistula.

Balloon assisted, ultrasound guided percutaneous thrombin injection of a large radial artery pseudoaneurysm using a trans-venous approach via an Ipsilateral Arteriovenous Fistula

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