Percutaneous trans-jugular mechanical thrombectomy for the treatment of thrombosed upper arm fistulas

A 50-year-old woman was referred with acute thrombosis of a brachio-basilic haemodialysis fistula, located in the right upper arm. The access had been created 5 years previously and several percutaneous transluminal angioplasties (PTA) had been performed, the last one performed 3 months previously. The patient had a renal transplantation 15 days ago. The fistula had been thrombosed for the last 24 h. Ultrasound (US) examination disclosed a thrombosis of the venous portion of the fistula. The vessels were very deeply located; we then decided to obviate a difficult puncture using the jugular vein in order to approach the thrombosed tract. We used a micropuncture set (Cook Europe, Bjaeverskov, Denmark) and US guidance to puncture the ipsilateral internal jugular vein; once canalized in retrograde fashion, the subclavian vein by using a 5-French cobra C2 catheter (Glidecath, Terumo Europe) and a 0.035 inch curved stiff type hydrophilic guidewire (Radifocus guidewire M; Terumo, Europe), we inserted a 8-French, 24 cm long sheath (Arrow Europe) up to the axillary vein. We confirmed the thrombosis of the venous portion of the fistula. Then we began performing a manual thromboaspiration by using an 8-French guiding catheter (Cordis Europe, Roden, The Netherlands). Once the flow was completely restored, PTA of the underlying stenosis was successfully carried out by means of balloon catheters of 5mm diameter (BostonScientific/Europe, Buülach, Switzerland). No immediate complications occurred. The patient did not need any haemodialysis. The fistulas remain objectively patent with normal thrill up to the date of this report (follow-up 5 months).