Ultrasound-guided transbrachial arterial access: A safe approach for hemodialysis arteriovenous fistula intervention

Abstract

CONTEXT: Endovascular interventions for hemodialysis arteriovenous fistula (AVF) can be performed through transfistula, transradial, and transbrachial artery access (TBA), but many interventionists consider TBA a risky approach and thus avoid using it.AIMS: We conducted a retrospective review to report the safety and applications of TBA for AVF interventions.SETTINGS AND DESIGN: Consecutive endovascular procedures for AVFs with TBA applied during a 2-year period were retrospectively reviewed.SUBJECTS AND METHODS: All brachial artery cannulations were performed under ultrasound guidance, either for fistulogram (20G cannula) only or for both angiogram and therapeutic purposes (4–6 Fr sheath). Demographics, comorbidities, antiplatelet and anticoagulant usage, indications of procedure, lesion sites, treatment outcome, and complication were reported.STATISTICAL ANALYSIS USED: Excel version 2010.RESULTS: One hundred AVF procedures that adopted TBA were performed for 73 patients during the study period (4 diagnostic fistulogram and 96 therapeutic interventions). Indications were dysfunctional AVF (n = 82), acute fistula thrombosis (n = 9), failure-to-mature (n = 8), and steal syndrome (n = 1). In 61 and 5 procedures, the patients were on long-term antiplatelet and anticoagulant agents, respectively. In 69 procedures, more than one lesion were identified in the AVF circuit. Stenosis over the anastomosis, juxta-anastomosis, and cannulation zone was found in 40.6%, 74%, and 67.7% of the AVFs, respectively. Thirty-two procedures had transbrachial 20G cannula inserted and 68 procedures had 4–6 Fr introducer sheath inserted. Technical success of the therapeutic interventions was 98.9%. Two patients developed limited hematoma at TBA site after the procedure and resolved with conservative management. No major complication (hemorrhage, nerve injury, pseudoaneurysm, and dissection) was noted from all the TBA procedures.CONCLUSIONS: TBA is a safe approach for AVF endovascular therapy.