One-hundred twenty-five cases of upper extremity internal arteriovenous and graft fistulas were reviewed. Clinical problems requiring study were poor fistula flow during dialysis, difficulty in cannulation, diminished graft pulsations, extremity edema or varicosities, the appearance of pulsatile or nonpulsatile masses in the graft or fistula, and distal ischemia. Angiography demonstrated venous occlusion (13 cases), venous stenosis at or near the anastomotic site (32 cases), thrombi within shunts (9 cases), venous aneurysms or pseudoaneurysms related to either proximal obstruction or traumatic dialysis (23 cases), distal venous overdistention due to proximal obstruction or overcirculation (15 cases), and radial artery steal of blood from the distal extremity (15 cases). The causes and predisposing factors leading to the complications are presented along with a discussion of the angiographic techniques that were used.
Eighty-four balloon dilatations of dialysis-access fistulas have been performed over a five year period. Fifty-two were done with polyethylene balloons and the last 32 with high-pressure Olbert balloons. Initial success was significantly greater with the high-pressure balloons, but long-term patency rates were similar. Use of high-pressure balloons and long inflation times is the method of choice for dilating venostenotic lesions in access fistulas.
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