The Pipeline Technique: A Simple Endovascular Technique for Creation of a Jump Graft Bypass

Abstract

We describe an endovascular bypass technique using a sheath-dilator set and two angiographic catheters to salvage a thrombotic hemodialysis graft.

Percutaneous Costoclavicular Bypass for Thoracic Outlet Syndrome and Cephalic Arch Occlusion in Hemodialysis Patients

“…Extravascular stent grafts have been used to salvage thrombosed arteriovenous grafts (11,12) and to cover sharp recanalization sites that have potential extravascular wire passage (13). In this study, the Viabahn stent graft achieved a hemostatic seal at the fistula outflow and the jugular vein anastomosis in all cases.…”

Endovascular bypass for salvage of vascular access in hemodialysis catheter-consigned patients

“…A long endovascular bypass (>10 cm) can be created by making two small skin incisions and embedding two manually cut angiographic catheters along the vascular access site between the access stump and the recipient vein. The technique was performed as reported by Chen et al 3 For thrombosed vascular access sites without a recanalizable outflow vein, the access flow was redirected to a new outflow conduit vein through the bypass (Figure 2(d), white arrowheads). For access sites affected by peripheral venous hypertension (Figure 1(a)) without suitable veins for graft interposition surgery, we created a bypass to decompress the intra-access high pressure by diverting the access flow to a low-resistant deep or superficial vein (Figure 1(e)) through a stent graft, causing occlusion of the arterialized retrograde collateral veins immediately after deployment.…”

“…The intervascular tunnel was created using the tunnel-boring technique, 2 one-step tunnel creation technique, and pipeline technique. 3 If a bypass was estimated to be longer than 10 cm, the pipeline technique was used; if the needle trajectory angle was approximately 160°–180°, the one-step tunnel creation technique was used; in all other cases, the tunnel-boring technique was chosen.…”

“…A long endovascular bypass (>10 cm) can be created by making two small skin incisions and embedding two manually cut angiographic catheters along the vascular access site between the access stump and the recipient vein. The technique was performed as reported by Chen et al 3…”

“…In addition to having higher infection and dysfunction rates than other types of vascular access, hemodialysis catheters may be inconvenient. 1 With recent advances in endovascular techniques, [2][3][4][5] these abandoned vascular access sites with selected access anatomy can be salvaged with the creation of an intervascular tunnel. We herein report the results of endovascular bypass for the treatment of 16 patients whose vascular access sites were abandoned because of (1) poor or no outflow veins characterized by thrombosis and hand swelling or (2) a deeply seated cannulation vein after inadequate elevation surgery.…”