Bidirectional Angioplasty with Single Vascular Access in Autogenous Arteriovenous Fistula

Purpose In autogenous arteriovenous (AV) fistulas with multiple stenoses at extreme ends, one option for treatment of the stenoses with angioplasty is dual access directed toward both ends of the fistula. The present study is a retrospective evaluation of experiences with an alternative access technique, bidirectional angioplasty with a single vascular access. Materials and Methods A total of 124 bidirectional angioplasty procedures with a single vascular access performed in 96 autogenous AV fistulas (48 men and 48 women; mean age, 58 years) were evaluated. After fistulography, a dilated segment of the draining vein located between the proximal and distal stenoses, with its course straight or convex toward the interventional radiologist, was punctured with an 18-gauge needle. The needle was directed antegrade and an introducer sheath was inserted for angioplasty of the proximal or central venous stenoses. Then, with a safety guide wire in place, the introducer sheath was withdrawn and redirected retrograde for angioplasty of the distal stenoses. Results Technical success rates of redirection of the introducer sheath and angioplasty were 100% and 96.8%, respectively. The failures of angioplasty were related to elastic recoil ( n = 3) and inability to pass the guide wire through an occluded distal vein ( n = 1). Overall procedure times were 7–70 minutes (mean, 31 min). One pseudoaneurysm was the only access-related complication. Conclusions Bidirectional angioplasty with a single vascular access is a feasible method of access in angioplasty of autogenous AV fistulas with stenoses at extreme ends.