for department of nephrology murty mantha, john … 2010...richard baer for department of nephrology...
TRANSCRIPT
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Richard Baerfor Department of Nephrology
Murty Mantha, John Paul Killen, Richard Baer
Cairns Base HospitalCairns , Australia
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Case history• 47 yr female ESRF [Diabetic nephropathy+
stone disease]• Haemodialysis 5 yr• Underlying disseminated vascular disease
– Significant systemic clinical events• Chequered h/o vascular access • Current access- Brachial-cephalic AVF [15
months old], nil alternative sites available
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5 MONTHS – Long stenosis proximal to Juxta-anastomotic area
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Successful PTA [6X4 AND 8X4 CONQUEST BALLOON]
6x4 PTA Site6x4 PTA Site
8x4 PTA Site
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2 MONTHS LATER - RECURRENCE
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2ND INTERVENTION [6x4 POWERFLEX, 8x4 CONQUEST PTA]
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7 MO LATER PTA- 3RD PTA [ CONQUEST 8X4]
POST-PROCEDURE DSA
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3 WEEKS LATER-
RAPIDLY ENLARGING ANEURYSM
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INITIAL FISTULOGRAPHY
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How should this be managed?
1. Surgical ligation- sacrifices the site
2. Surgical ligation- bridge graft brachial –proximal cephalic
3. Endovascular approach
4. Other
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ROUTINE MEASUREMENTS
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1ST COVERED STENT [ FLUENCY 12X6, BARD]
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ACERTAIN DISTAL ARTERIAL FLOW
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2ND COVERED STENT TELESCOPED [FLUENCY 12X6 BARD]
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POST PROCEDURE DSA
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CTA-- 2 WEEKS LATER
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FOLLOW-UP• Aneurysm regressed completely• No symptoms or signs of steal syndrome• Uninterrupted, uneventful, adequate dialysis• Fistula cannulated away from covered stents• 6 months later died as a result of acute
coronary event and VF arrest