Stent-graft arteriovenous fistula: an endovascular technique in hemodialysis access.

PURPOSE: To determine the feasibility and safety of a new endovascular technique for creating an arteriovenous (AV) fistula utilizing catheter-directed techniques and stents. METHODS: Stent-graft AV fistulas were offered on an experimental basis to 8 patients who had a history of multiple failed access procedures or very small arm veins unsuitable for standard vascular access techniques. The device consisted of a balloon-expandable Palmaz stent attached to the designated venous end of a polytetrafluoroethylene graft. The balloon-mounted stent-graft was inserted into the brachial vein through an arteriotomy and advanced over a guidewire into the axillary vein. After the stent-graft was deployed, the arterial anastomosis was completed in standard surgical fashion using an end-to-side anastomosis of the graft to the brachial artery. RESULTS: The stent-graft was inserted successfully in all patients, but there were two early failures. The first resulted from a steal phenomenon secondary to high flows through the stent-graft, necessitating ligation of the fistula. Another stent-graft was placed too peripherally in the upper arm, and the stainless steel stent was crushed by external compression. Three of the 6 remaining grafts were patent for over 1 year, and 2 grafts are still functioning at 22 and 13 months. CONCLUSIONS: Endoluminal stent-grafts can be successfully inserted into the axillary vein for creation of an AV fistula and remain patent for 2 years or more. This method may be most useful in patients with very small, unusable arm veins or multiple failed AV grafts.

1994 update on phlebography and varicography.

BACKGROUND: Appropriate management of venous disease requires definitive diagnosis. The place of phlebography and varicography in acute and chronic venous disease is to complement other less invasive and less expensive tests of venous function. OBJECTIVE: This paper will address the present indications for phlebography and present the techniques of ascending and descending phlebography and of varicography practiced in our environment. METHODS: The technique of each type of phlebography are outlined. These include ascending phlebography at the foot, popliteal and femoral levels, varicography, and descending phlebography. Complications are discussed briefly. RESULTS: The advantages and complications of each method are discussed with the description of the procedures. CONCLUSION: The most frequent uses of phlebography in acute venous thrombosis are to define deep vein thrombosis isolated to the calf or to the iliac veins, or to clarify findings from duplex scan examinations. In chronic venous disease, phlebography is used to clarify problem cases of superficial venous disease and to study patients with advanced deep vein disease who are potential candidates for deep vein reconstruction.

Mediastinal duplication cyst. Percutaneous aspiration and cystography for diagnosis and treatment.

Needle aspiration and metrizamide cystography of a mediastinal duplication cyst is described. The technique is a reasonable alternative to surgery for both the diagnosis and the treatment of asymptomatic benign mediastinal cysts.