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Gadolinium-Enhanced Digital Subtraction Angiography of Hemodialysis Fistulas: A Diagnostic and Therapeutic Approach

Alain-Ferdinand Le Blanche1,2, Marc Tassart1, Jean-François Deux1, Jérôme Rossert3, Jean-Michel Bigot1 and Frank Boudghene1

1 Department of Radiology, Tenon University Hospital, 4, rue de la Chine, F-75970 Paris Cedex 20, France.
2 Department of Radiology, Charles Foix University Hospital, 7, ave. de la République, F-94205 Ivry-sur-Seine Cedex, France.
3 Department of Nephrology B, AP-HP, Tenon University Hospital, F-75970 Paris Cedex 20, France.



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  		Fig. 1A. —80-year-old woman with end-stage renal disease. Gadolinium-enhanced digital subtraction angiogram after retrograde puncture of patient's brachiocephalic fistula shows severe stenosis of lower third of cephalic vein (arrow). Because of preferential shunt flow, basilic vein is poorly opacified. Contrast density is adequate. Numbers indicate diameter measurements.

 


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  		Fig. 1B. —80-year-old woman with end-stage renal disease. Angiogram shows status of fistula immediately after percutaneous transluminal angioplasty. Favorable outcome was later assessed at 2-month follow-up.

 


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  		Fig. 1C. —80-year-old woman with end-stage renal disease. Gadolinium-enhanced digital substraction angiogram of thoracic veins shows that as contrast agent passes from smaller to larger lumen and is accompanied by unopacified inflow from left jugular and then right brachiocephalic veins, proximal subclavian vein appears patent, but innominate vein and superior vena cava do not completely opacify.

 

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