Richard Baer for Department of Nephrology Murty Mantha, John Paul - - PowerPoint PPT Presentation

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Nov 20, 2023 122 likes •310 views

Richard Baer for Department of Nephrology Murty Mantha, John Paul Killen, Richard Baer Cairns Base Hospital Cairns , Australia Case history 47 yr female ESRF [Diabetic nephropathy+ stone disease] Haemodialysis 5 yr Underlying

SLIDE 1

Richard Baer

for Department of Nephrology Murty Mantha, John Paul Killen, Richard Baer

Cairns Base Hospital Cairns , Australia

SLIDE 2

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

SLIDE 3

5 MONTHS – Long stenosis proximal to Juxta-anastomotic area

SLIDE 4

Successful PTA [6X4 AND 8X4 CONQUEST BALLOON]

6x4 PTA Site 6x4 PTA Site 8x4 PTA Site

SLIDE 5

2 MONTHS LATER - RECURRENCE

SLIDE 6

2ND INTERVENTION [6x4 POWERFLEX, 8x4 CONQUEST PTA]

SLIDE 7

7 MO LATER PTA- 3RD PTA [ CONQUEST 8X4]

POST-PROCEDURE DSA

SLIDE 8

3 WEEKS LATER- RAPI DLY ENLARGI NG ANEURYSM

SLIDE 9

SLIDE 10

I NI TI AL FI STULOGRAPHY

SLIDE 11

How should this be managed?

1. Surgical ligation- sacrifices the site
2. Surgical ligation- bridge graft brachial –

proximal cephalic

3. Endovascular approach
4. Other

SLIDE 12

ROUTI NE MEASUREMENTS

SLIDE 13

1ST COVERED STENT [ FLUENCY 12X6, BARD]

SLIDE 14

ACERTAIN DISTAL ARTERIAL FLOW

SLIDE 15

2ND COVERED STENT TELESCOPED [FLUENCY 12X6 BARD]

SLIDE 16

POST PROCEDURE DSA

SLIDE 17

CTA-- 2 WEEKS LATER

SLIDE 18

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