Day-1 Procedure: Right upper limb angiography, right brachiocephalic fistulography, venoplasty, fistuloplasty , mechanical thrombectomy and EKOS Thrombolysis
Description:
using US guidance, access was gained into the left CFV, 6 F sheath was introduced.
US guidance access into the right upper limb fistula, 0.018'' wire was introduced.
the short sheath from the left CFV was changed to 6 F x 90 cm and then to 7 F x 65 cm.
wire and catheter were manipulated into the right brachiocephalic vein and then into the fistula graft.
venoplasty was performed with 8 mm x 100 mm Drug coated balloon and 5 mm x 120 mm Drug coated balloon.
EKOS catheter 50 cm was introduced.
3 mg actilyse was adminstered stat.
Actilyse 0.6 mg per hour infusion for 10 hours.
heparinised infusion through the coolant port at 40ml per hour
Day-2 Procedure: check venography, venoplasty, fistuloplasty and stenting of right subclavian vein
Description:
Using the existing access in left CFV, the sheath was exchanged to new 8 F sheath x 65 cm.
wire and balloon were manipulated throught the anastomosis.
Fistulography showed reconstitution of flow through the fistula. mild narrowing noted at the anastomosis site, further narrowing noted at the graft-venous anastomsis site and in the proximal brachial and subclavian veins.
Fistuloplasty at the arterial anastomosis was performed using 5 mm x 100 mm balloon then 5 mm x60 mm Drug coated balloon (Paclitaxel). further fistuloplasty of the graft-venous anastomosis with 8 mm x 80 mm Drug coated balloon (paclitaxel).
Tight stenosis of the brachial vein proximally was noted and despite using different balloons including 8 mm x40 mm drug coated balloon (sirolimus) this did not respond fully and patient was complaining of pain.
10 mm x 80 mm balloon was used for the subclavian vein-brachiocephalic stenosis.
14 mm x 80 mm sinus venous stent was deployed and post dilated with 10 mm x 80 mm balloon.
as the patient complained of pain while the balloon was inflated, check angiography was performed.
angiography showed good flow through the fistula into the right subclavian vein and through the stent into the SVC.
Description:
using US guidance, access was gained into the left CFV, 6 F sheath was introduced.
US guidance access into the right upper limb fistula, 0.018'' wire was introduced.
the short sheath from the left CFV was changed to 6 F x 90 cm and then to 7 F x 65 cm.
wire and catheter were manipulated into the right brachiocephalic vein and then into the fistula graft.
venoplasty was performed with 8 mm x 100 mm Drug coated balloon and 5 mm x 120 mm Drug coated balloon.
EKOS catheter 50 cm was introduced.
3 mg actilyse was adminstered stat.
Actilyse 0.6 mg per hour infusion for 10 hours.
heparinised infusion through the coolant port at 40ml per hour
Day-2 Procedure: check venography, venoplasty, fistuloplasty and stenting of right subclavian vein
Description:
Using the existing access in left CFV, the sheath was exchanged to new 8 F sheath x 65 cm.
wire and balloon were manipulated throught the anastomosis.
Fistulography showed reconstitution of flow through the fistula. mild narrowing noted at the anastomosis site, further narrowing noted at the graft-venous anastomsis site and in the proximal brachial and subclavian veins.
Fistuloplasty at the arterial anastomosis was performed using 5 mm x 100 mm balloon then 5 mm x60 mm Drug coated balloon (Paclitaxel). further fistuloplasty of the graft-venous anastomosis with 8 mm x 80 mm Drug coated balloon (paclitaxel).
Tight stenosis of the brachial vein proximally was noted and despite using different balloons including 8 mm x40 mm drug coated balloon (sirolimus) this did not respond fully and patient was complaining of pain.
10 mm x 80 mm balloon was used for the subclavian vein-brachiocephalic stenosis.
14 mm x 80 mm sinus venous stent was deployed and post dilated with 10 mm x 80 mm balloon.
as the patient complained of pain while the balloon was inflated, check angiography was performed.
angiography showed good flow through the fistula into the right subclavian vein and through the stent into the SVC.