Dr. Yu Junchao's Team: A Case of Percutaneous Transluminal Angioplasty for HIV-Positive Patient with Autogenous Arteriovenous Fistula Occlusion
DK Medtech
Vascular Interventional Balloon Product Developer
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DK Medtech Special Release[Professor Junchao Yu's Team: A Case of Percutaneous Angioplasty for Autologous Arteriovenous Fistula in HIV] Case Presentation, demonstrating the precise operations of each case and the clinical application of advanced equipment and instruments. From the formulation of treatment strategies for different cases, standardized intraoperative procedures and technical applications, complication prevention, to perioperative management, etc., the aim is to promote the standardization of diagnosis and treatment for vascular stenosis and occlusive diseases, strengthen technical exchanges and experience sharing among doctors, with the hope of providing new ideas and methods for future diagnosis and treatment, benefiting more clinical patients.
A Case of Percutaneous Angioplasty for Autologous Arteriovenous Fistula in an HIV Patient
Kunming First People's HospitalYu Junchao,Wang Ye
Kunming Third People's HospitalWei Sha Zhou
Patient Information
Basic Information:The patient is a 46-year-old male.
Chief Complaint:More than 1 year of maintenance hemodialysis, autologous arteriovenous fistula occlusion for 1 day.
History of Present Illness:The patient was diagnosed with HIV infection in 2004 and has been on antiviral therapy with "Abacavir + Kaletra" since 2005. Four years ago, the patient discovered elevated serum creatinine levels. From March 2022 to the present, the patient has been undergoing regular maintenance hemodialysis at Kunming Third People's Hospital due to "1. Chronic renal failure, 2. Renal anemia, 3. AIDS." During this period, the patient underwent multiple femoral vein catheterizations, one long-term right internal jugular vein catheterization, and one autologous arteriovenous fistula formation procedure. On January 4, 2024, the patient reported the absence of thrill in the left upper limb autologous arteriovenous fistula. Ultrasound examination revealed thrombosis and occlusion of the fistula. To address vascular access issues, the patient sought medical attention on January 5. The patient complained of swelling and pain in the left upper limb but had no other specific discomfort.
Past Medical History:HIV Infection。
Physical Examination:General condition is fair. Chronic disease appearance, facial edema, jugular vein distention and expansion, no jaundice of skin or sclera, regular heart rhythm, coarse breath sounds in both lungs, no dry or wet rales heard, abdomen flat and soft, no tenderness or rebound tenderness, negative ascites sign. No edema in both lower limbs. Autologous arteriovenous fistula visible on the left upper limb, no thrill palpable, no vascular murmur heard.
Admission Diagnosis:
Chronic Renal Failure
Hemodialysis Status
Renal Anemia
Renal Hypertension
AIDS
Dysfunction of Autologous Arteriovenous Fistula (Thrombotic Occlusion)
Previous interventional treatment
Time | Main Treatment Process |
March 22, 2022 | Right Femoral Vein Catheterization |
May 19, 2022 | Long-term Catheter Placement in the Right Internal Jugular Vein |
June 10, 2023 | Left Femoral Vein Catheterization |
July 3, 2023 | Left Upper Limb Autologous Arteriovenous Fistula Formation |
January 4, 2024 | Right Femoral Vein Puncture and Catheterization |
January 5, 2024 | Percutaneous Balloon Angioplasty of Autologous Arteriovenous Fistula in Left Upper Limb |
Preoperative Analysis
Preoperative Analysis:The patient is an HIV-infected individual with chronic renal failure who has undergone multiple temporary femoral vein catheterization procedures and a long-term right internal jugular vein catheterization procedure during nearly one year of maintenance hemodialysis. Subsequently, the patient developed facial edema, jugular vein distention, and poor blood flow, suggesting possible superior vena cava stenosis. Currently, within less than half a year after the formation of an autologous arteriovenous fistula in the left upper limb, the patient has experienced thrombotic occlusion of the autologous arteriovenous fistula. Ultrasound examination revealed incomplete occlusion of the radial artery. To continue hemodialysis treatment, percutaneous balloon angioplasty of the autologous arteriovenous fistula is required.
Surgical Objective:
Main Objectives:Continue hemodialysis treatment for the patient and maintain vascular access;
Secondary Objective:Addressing the stenosis and occlusion of autologous arteriovenous fistulas in patients.
Surgical Strategy/Plan:Under ultrasound guidance, perform percutaneous arteriovenous fistula formation at the radial artery puncture site of the left upper limb wrist.
Surgical Procedure
Ultrasound Examination of the Left Upper Limb Autologous Arteriovenous Fistula in the ForearmStenosis and thrombosis occlusion of the anastomosis of the internal fistula, cephalic vein of the forearm, median vein of the forearm, and median cubital vein, with a length of approximately 20 cm; radial artery stenosis of the forearm, with the narrowest inner diameter of 1.4 mm and a length of approximately 16 cm.
Under ultrasound guidance, the radial artery was punctured at the left wrist. After puncture, a guidewire was inserted, followed by the placement of a vascular sheath over the guidewire. Under B-mode ultrasound guidance, a hydrophilic-coated guidewire (RF*GA35153M 150CM) was advanced to the stenotic thrombotic occlusion segment of the vessel.
DK Medtech Scored Peripheral Balloon Dilatation Catheter 6mm*40mm.
Under ultrasound guidance, a 6mm*40mm peripheral balloon dilation catheter was inserted along the guidewire to progressively dilate the stenotic thrombotic occlusion segment of the blood vessel.
Occluded and stenotic vascular segments
Thrombosed vessel segment
Guidewire passes through the stenotic occlusion segment
Place a 6mm*40mm scored peripheral balloon dilation catheter along the guidewire.
Peripheral Balloon Dilation Catheter for Stenosis Expansion
Peripheral balloon expansion pressure 4-20 atm, each lasting 1 minute
Improved waist-like stenosis compared to before.
Significant improvement in vascular stenosis waist
After dilation, blood flow significantly improved, and the diameter of the stenotic segment of the forearm cephalic vein fistula increased to 4.2mm.
The diameter of the radial artery in the forearm improved to 2.8mm after dilation.
After using a 6mm*40mm peripheral balloon dilation catheter to dilate the stenotic and thrombotic occlusion segments of the anastomosis of the internal fistula, the cephalic vein of the forearm, the median vein of the forearm, and the median cubital vein, the blood flow of the brachial artery was measured to be 399ml/min.
After the expansion of the left venous stenosis occlusion segment, a 4mm*40mm peripheral balloon dilation catheter was used to dilate the radial artery stenosis segment of the forearm, and the brachial artery flow was measured at 1025ml/min.
Significant Increase in Blood Flow at the Anastomosis of the Internal Fistula
Withdrawal of peripheral balloon dilation catheter, balloon dilation procedure completed.
Follow-up
Discharge Status:The patient is an outpatient and did not report any special discomfort. The sutures were removed one day after the surgery. During the ward round on January 7, the patient's autologous arteriovenous fistula was palpable with a thrill and auscultated with prominent vascular murmur. The hemodialysis treatment proceeded smoothly with a blood flow rate of approximately 250ml/min.
Case Summary
Case Characteristics:
AIDS patients with poor economic conditions;
Poor vascular condition;
Multiple deep venous catheterizations in a short term;
Stenosis and thrombotic occlusion of autologous arteriovenous fistula occurred within six months after the formation procedure.
Preoperative Assessment Key Points:The patient's autologous arteriovenous fistula did not show thrill, and was occluded by thrombosis. The cephalic vein and radial artery in the forearm had narrow diameters, but the radial artery was palpable and not completely occluded.
Surgical Strategy/Technical Key Points:
Under ultrasound guidance, perform percutaneous arteriovenous fistula formation via radial artery puncture at the left upper limb wrist.
Radial artery selects DK Medtech 4mm*40mm peripheral dilation balloon;
The anterior forearm cephalic vein was selected for the DK Medtech 6mm*40mm peripheral balloon dilation catheter.
Device Features/Tips for Use:DK Medtech Scoring Balloon Dilation Catheter, with three nitinol scoring elements fixed on the balloon working section, creates pressure focusing at the lesion site, offering excellent cutting performance. The balloon slowly rebounds during deflation and withdrawal, and exits without damage after dilation, demonstrating good malleability.
Expert Introduction
Yu Junchao, Associate Chief Physician
The Surgeon of This Case
With 17 years of experience in blood purification, skilled in vascular access establishment and maintenance, and rich expertise in critical care blood purification and complex vascular access.
Academic Positions:Vice Chairman of the Kunming Blood Purification Branch of the Chinese Medical Association;Member of the Vascular Access Group, Yunnan Branch of the Chinese Society for Vascular Surgery;Standing Committee Member of Nephrology and Hemodialysis Specialty in Non-public Hospitals of Yunnan Province;Director and Lecturer of the Yunnan Hemodialysis Vascular Access Training Base, under the Vascular Surgery Expert Committee of the Cross-Straits Medicine and Health Exchange Association.Lecturer at Kunming Medical University.
Dr. Wang Ye, Attending Physician
The Surgeon of This Case
Attending Physician and Surgeon, Blood Purification Center, Kunming First People's Hospital.
January 2012 - June 2013 Engaged in specialized interventional treatment in cardiovascular internal medicine; From June 2013 to January 2014, advanced study on "Kidney Disease Treatment and Establishment and Maintenance of Vascular Access Related to Blood Purification" was conducted at the Kidney Disease Center of the First Affiliated Hospital of Zhejiang University. Since 2020, specialized in the establishment and maintenance of vascular access for blood purification treatment.
Dr. WeiSha Zhou, Attending Physician
The Surgeon of This Case
Attending Physician and Surgeon, Blood Purification Center, Kunming Third People's Hospital.
Engaged in blood purification and artificial liver-related technologies for infectious diseases in 2017, and studied vascular access-related technologies at the Blood Purification Center of Kunming First People's Hospital in November 2023.
Department Introduction
Introduction to the Blood Purification Center of the North Campus of Kunming First People's Hospital
Department Introduction:
In July 2015, the Blood Purification Center of the North Campus of the First People's Hospital of Kunming City officially opened. After more than eight years of hard work and dedication, it has now become a blood purification clinical research institution in our province that integrates medical treatment, scientific research, and teaching. It is the chairman unit of the Blood Purification Branch of the Kunming Medical Association, as well as the Yunnan Province Hemodialysis Vascular Access Training Base, the Nipro Dialysis Yunnan-Guizhou-Sichuan Training Base, the Bard Vascular Access Establishment and Maintenance Training Center, and the CRRT Yunnan Province Training Base. Equipment and staff allocation of the department:
Currently, there are more than 80 blood purification devices of 15 different brands and models. There are 51 medical staff, including 2 deputy chief physicians, 5 attending physicians, and 43 specialized nurses, of which 4 are national specialized nurses.
Department Technology Development:
The current treatment projects carried out by our center include HD, HDF, HD+HP, HFR, CRRT, PE, bilirubin adsorption, DPMAPS, CPFA, DFPP, and IA. Our center serves over 400 regular dialysis outpatients, with an annual total of more than 50,000 dialysis sessions and participation in approximately 1,000 emergency critical care cases within the hospital each year.
Our department has formed a multidisciplinary team in collaboration with the Hepatobiliary Vascular Surgery, Thyroid and Breast Surgery, Interventional Suite, and Ultrasound Department. We have been the first in the province to carry out various new vascular access technologies, such as arteriovenous grafts in the upper and lower limbs, PTA of peripheral blood vessels under ultrasound/DSA guidance, PTA/stent placement for central venous lesions under DSA guidance, secondary parathyroidectomy, radiofrequency ablation, and more. These techniques place us at a leading level within the province. To date, we have provided hemodialysis access and parathyroid surgeries for thousands of renal failure patients from various cities, prefectures, counties, and medical institutions across the province.
Outpatient Address: 3rd Floor, Inpatient Department, North Campus of Kunming First People's Hospital
Department Contact Number: 0871-67390558
