PMC3482083_01
A fistulogram obtained just after the creation of the RCF revealed diffuse stenosis of the juxta-anastomotic cephalic vein (arrowhead) (a). Balloon angioplasty was applied to the stenotic lesion, and patency was confirmed by final fistulography. Note that there is an artifact defect induced by a Pean forceps (*) in the contrast image of the radial artery (arrow) (b). A scale bar is shown in each panel.
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F1
Next, the stenotic lesion of the juxta-anastomotic radiocephalic vein was crossed with a 0.018-inch hydrophilic guide wire, and a 3-mm (40 mm long) balloon catheter (Sterling Balloon Dilatation Catheter, Boston Scientific, Natick, Mass., USA) was inflated to 6 atm for at least 1 min, with one overlapping angioplasty under direct visualization (fig. 1).
A fistulogram on day 20 (a). The hydrophilic straight guide-wire was passed through the cephalic vein, and balloon angioplasty was applied to the radial artery, anastomotic region, and juxta-anastomotic region. The final fistulogram (b) shows the widely dilated vasculature (arrowheads). A scale bar is shown in each panel.
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F2
Balloon angioplasty was performed under radiological guidance on day 20, with a retrograde radial arterial approach using a 0.018-inch platform combined with a 4-mm balloon catheter for the radial artery (inflated to 4 atm for 10 s), anastomotic region (inflated to 6 atm for 20 s), and the juxta-anastomotic region (inflated to 8 atm for 20 s; fig. 2).
Follow-up fistulography performed at three months after the third angioplasty (day 60), when the RCF had become functional and the tunneled cuffed catheter was removed, thus revealing the matured radial artery (arrowheads) and cephalic vein (arrows). The scale is indicated.
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F3
Follow-up fistulography was performed 3 months later, when the RCF became functional and the tunneled cuffed catheter was removed, revealing the matured radial artery and cephalic vein (fig. 3).