Juxta-anastomotic stenting with aggressive angioplasty will salvage the native radiocephalic fistula for dialysis John Swinnen, MBChB, FRACS (General),

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Presentation transcript:

Juxta-anastomotic stenting with aggressive angioplasty will salvage the native radiocephalic fistula for dialysis John Swinnen, MBChB, FRACS (General), FRACS (Vascular), DDU (Vascular), Kia Lean Tan, CSAMM, Richard Allen, FRACS, David Burgess, FRACP, Irwin V. Mohan, FRCS, RACS Journal of Vascular Surgery Volume 61, Issue 2, Pages 436-442 (February 2015) DOI: 10.1016/j.jvs.2014.05.097 Copyright © 2015 Terms and Conditions

Fig 1 The juxta-anastomotic (JXA) segment and the steps in JXA stenting (JXAS). a, JXA stenosis; b, scouting balloon angioplasty; c, predilatation; d, JXAS; e, postdilatation; f, completion. Journal of Vascular Surgery 2015 61, 436-442DOI: (10.1016/j.jvs.2014.05.097) Copyright © 2015 Terms and Conditions

Fig 2 Technique for going “around-the-corner.” Step 1: Perform retrograde imaging of the juxta-anastomotic (JXA) segment through the sheath (with occlusion of the outflow), to get a road map for negotiating “around-the-corner” and visualize the stenoses. Step 2: Pass an angled hydrophilic wire and 4F hydrophilic catheter with a torque device into the radial artery. Journal of Vascular Surgery 2015 61, 436-442DOI: (10.1016/j.jvs.2014.05.097) Copyright © 2015 Terms and Conditions

Fig 3 The juxta-anastomotic (JXA) stenting (JXAS) sequence. Journal of Vascular Surgery 2015 61, 436-442DOI: (10.1016/j.jvs.2014.05.097) Copyright © 2015 Terms and Conditions

Fig 4 Interventions before juxta-anastomotic (JXA) stenting (JXAS). Journal of Vascular Surgery 2015 61, 436-442DOI: (10.1016/j.jvs.2014.05.097) Copyright © 2015 Terms and Conditions

Fig 5 Stent-assisted maturation. Journal of Vascular Surgery 2015 61, 436-442DOI: (10.1016/j.jvs.2014.05.097) Copyright © 2015 Terms and Conditions

Fig 6 Kaplan-Meier curves show patency for fistula and juxta-anastomotic stenting (JXAS). Journal of Vascular Surgery 2015 61, 436-442DOI: (10.1016/j.jvs.2014.05.097) Copyright © 2015 Terms and Conditions