Diagnostic and Interventional Radiology of Arteriovenous Accesses for Hemodialysis by Luc Turmel-Rodrigues & Claude J. Renaud

Author:Luc Turmel-Rodrigues & Claude J. Renaud
Language: eng
Format: epub
Publisher: Springer Paris, Paris

10.1.6.5 Superficialized Radial–Cephalic AVFs

Veins superficialized by either tunneling or transposition techniques develop stenoses at their terminal segment near the elbow. These skeletonized arterialized veins, devoid of their vasa vasorum, are more fragile and prone to rupture. Dilation of stenoses located in the cannulation zone carries a higher risk of skin rupture, and, therefore, deliberate underdilation with a 6-mm balloon should be the rule.

10.1.6.6 Ulnar–Basilic AVFs

These fistulas are not so common and typically develop stenoses at their peri-anastomotic and elbow areas [31]. Cannulation may be challenging in view of their posteromedial location in the forearm. The arm often needs to be flexed at the elbow in order to cannulate retrogradely new AVFs just like the nurses do during dialysis. Older fistulas are well developed enough to be cannulated at the wrist or elbow with the forearm kept extended and supinated (Fig. 7.3). Very exceptionally, the distal ulnar artery can be cannulated retrogradely. The arterialized basilic veins easily develop spasms in new fistulas and aneurysmal degeneration after a few years.

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