Drainage in a Fistula


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Transonic HD01 on fistulas submitted by Donald Schon, M.D.

Dear Nephrolors':

Last week we had a discussion on the use of the Transonic HD01 on fistulas. I made the point that fistulas with BF < 500 cc/min. invariably have problems. A couple of days ago I did three fistulas in our lab where the referring presentation was low BF. I think that graphically they may make it easier to understand the point I was trying to make. The last time I did this several members e-mailed me with suggestions to make the photos easier to understand. I have tried to incorporate these and would appreciate any feedback.

In each of these cases, the fistula may not have clotted for months to years later. However, the patients dialysis will be markedly improved by the procedures. This is how we use the Transonic.
I hope that this is useful and understandable,

Donald Schon, MD
Arizona Kidney Disease and Hypertension Center
ASC and Vascular Laboratory
Phoenix, Az

(To View Original Image Click on Thumbnail)

X-rays 1 - 4 are a man with a 10 year old forearm fistula who presents with low flow.

Figure 1 demonstrates the lesion: the radial artery is barely seen because of a tight stensosis. This is a reflux injection done from the venous side. The area just on the venous side of the anastomosis we call the post arterial anastomotic area (PAAS) which is also in bad shape. The artifact refers to the tourniquet used to reflux contrast into the artery

Figure 2 demonstrates the balloon in the arterial anastomosis, the artery and the radial (cephalic) vein at the same time and the tight waist (compression) on the balloon.

Figure 3 demonstratrates the lesion in the PAAS

Figure 4 demonstrates what the fistula looks like when we are done. Note that the radial artery (to the right of the arrow at the arterial anastomosis), the anastomosis and the PAAS now all have a uniform diameter.

X-rays 5 - 7 are a similar case. This patient also had a well established fistula and surveillance with HD01 demonstrated BF < 500 cc/min.

Figure 1 demonstrates the lesion. This time the arterial anastomosis is ok and the two lesions are in the PAAS and the radial (cephalic) v. central (downstream) from the PAAS.

Figure 2 demonstrates the balloon in the PAAS lesion and the waist (compression) on the balloon as it is inflated.

Figure 3 demonstrates what the fistula looks like after we are done.

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