Dear Nephrolers': 

I now have the capability of transferring images directly from my fluoroscopy unit to the computer.  I thought I would post an interesting case I just had.  If people like this, I can post other cases and if anyone has a particular interest I can post an example when I get one (I cannot transfer my old film library as they are kept only on cut film). Just a warning, these images take a large amount of space if you elect to download them.

This is a four year old radial artery fistula which presented to our LifeLine Vascular Lab clotted for less than 48 hrs.
In order to access the anastomotic area of the fistula I had to go through the brachial artery. 

The first image is of the anastomosis from the arterial side.  To the left you see the artery.  The beaded portion near the wrist (the clips mark the anastomosis) is the stenosis and it is in the radial artery itself extending into the anastomosis.  What the film demonstrates is the clot which extended from the anastomosis to the elbow.

The second image demonstrates the fistula after thrombolysis with a total dose of 1.25 mg of tPA.  The clot is gone and the anatomy of the forearm portion of the fistula is clear.

The third image is of the fistula after PTA of the radial arterial stenosis to 6 mm (the normal portion of radial artery measured 5mm prior to PTA).  The post arterial anastomotic section of the fistula (PAAS) distal to the anastomosis is about 6 mm and the narrowest area of the fistula itself distal to this is 8mm so it required no further dilatation.

Please give me feed back if you find this valuable.

Thanks

Donald Schon, MD, FACP
LifeLine Vascular Lab
Phoenix, AZ

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