Endovascular treatment of nonfunctional vascular access through retrograde arterial access: A single-center experience with midterm follow-up



Retrograde arterial access, Vascular access, Transradial access, Interventional radiology, Arteriovenous fistula


Background/Aim: Nonfunctional vascular access is treated through venous or brachial artery access traditionally. However, each route has its drawbacks. This study aimed to evaluate the feasibility, safety, and effectiveness of retrograde arterial access (RAA) in the treatment of nonfunctional vascular access with mid-term results. Methods: Patients with nonfunctional vascular access who were treated through RAA between January 2019 and December 2020 were included in this cohort study. Patient demographics, lesion characteristics, procedural details, technical and clinical outcomes were noted. Results: Thirty-six interventions were performed on 30 patients. Twenty-nine occlusions and seven long segment stenoses were treated. The radial artery was accessed in 34 cases, the interosseous and ulnar arteries were accessed in one case each. The technical and clinical success rates were 100% and 97.2%, respectively (35/36). Venous rupture was encountered in three patients. No puncture-site complication was observed. The mean follow-up time was 14.3 (range: 6-24) months. None of the patients showed signs of hand ischemia and the accessed arteries were patent at Color Doppler Ultrasound examinations. Post-intervention primary patency rates were 100%, 73.3%, 47.5% at 1, 6 and 12 months, respectively. Post-intervention secondary patency rates were 100%, 93.3%, 84.8% at 1, 6 and 12 months, respectively. Conclusion: RAA is effective and safe in the treatment of nonfunctional vascular access with comparable outcomes to traditional routes. The low access-site complication rates make this access site an attractive salvage route when traditional approaches are not feasible.


Download data is not yet available.


Lok CE, Huber TS, Lee T, Shenoy S, Yevzlin AS, Abreo K, et al. KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update. Am J Kidney Dis. 2020;75(4 Suppl 2):S1-s164.

Güven C, Üçkardeş F. Our arteriovenous fistula experiences with grafts in hemodialysis patients. J Surg Med. 2020;4(7):550-4.

Manninen HI, Kaukanen ET, Ikaheimo R, Karhapaa P, Lahtinen T, Matsi P, et al. Brachial arterial access: endovascular treatment of failing Brescia-Cimino hemodialysis fistulas--initial success and long-term results. Radiology. 2001;218(3):711-8.

Natario A, Turmel-Rodrigues L, Fodil-Cherif M, Brillet G, Girault-Lataste A, Dumont G, et al. Endovascular treatment of immature, dysfunctional and thrombosed forearm autogenous ulnar-basilic and radial-basilic fistulas for haemodialysis. Nephrol Dial Transplant. 2010;25(2):532-8.

Wu CC, Wen SC, Chen MK, Yang CW, Pu SY, Tsai KC, et al. Radial artery approach for endovascular salvage of occluded autogenous radial-cephalic fistulae. Nephrol Dial Transplant. 2009;24(8):2497-502.

Anderson SG, Ratib K, Myint PK, Keavney B, Kwok CS, Zaman A, et al. Impact of age on access site-related outcomes in 469,983 percutaneous coronary intervention procedures: Insights from the British Cardiovascular Intervention Society. Catheter Cardiovasc Interv. 2015;86(6):965-72.

Kiemeneij F, Laarman GJ, Odekerken D, Slagboom T, van der Wieken R. A randomized comparison of percutaneous transluminal coronary angioplasty by the radial, brachial and femoral approaches: the access study. J Am Coll Cardiol. 1997;29(6):1269-75.

Ukaigwe A, Baquero G, Shrestha P, Karmacharya P, Gilchrist I. Efficacy And Safety Of Transulnar Compared To Transradial Arterial Access In Patients Undergoing Coronary Angiography: A Systematic Review And Meta-Analysis. J Am Coll Cardiol. 2017;69(11 Supplement):1162.

Jo KW, Park SM, Kim SD, Kim SR, Baik MW, Kim YW. Is Transradial Cerebral Angiography Feasible and Safe? A Single Center's Experience. Journal of Korean Neurosurgical Society. 2010;47(5):332-7.

Alli O, Mathew V, From AM, Barsness G, Misra S, Gulati R. Transradial access for renal artery intervention is feasible and safe. Vasc Endovascular Surg. 2011;45(8):738-42.

Wu T, Sun R, Huang Y, Wang Z, Yin X, Zhu Z, et al. Transradial arterial chemoembolization reduces complications and costs in patients with hepatocellular carcinoma. Indian J Cancer. 2015;52 Suppl 2:e107-11.

Omary RA, Bettmann MA, Cardella JF, Bakal CW, Schwartzberg MS, Sacks D, et al. Quality improvement guidelines for the reporting and archiving of interventional radiology procedures. J Vasc Interv Radiol. 2002;13(9 Pt 1):879-81.

Sidawy AN, Gray R, Besarab A, Henry M, Ascher E, Silva M, Jr., et al. Recommended standards for reports dealing with arteriovenous hemodialysis accesses. J Vasc Surg. 2002;35(3):603-10.

Hsieh MY, Lin L, Tsai KC, Wu CC. Radial artery approach to salvage nonmaturing radiocephalic arteriovenous fistulas. Cardiovasc Intervent Radiol. 2013;36(4):957-63.

Chen SM, Hang CL, Yip HK, Fang CY, Wu CJ, Yang CH, et al. Outcomes of interventions via a transradial approach for dysfunctional Brescia-Cimino fistulas. Cardiovasc Intervent Radiol. 2009;32(5):952-9.

Gracz KC, Ing TS, Soung LS, Armbruster KF, Seim SK, Merkel FK. Proximal forearm fistula for maintenance hemodialysis. Kidney Int. 1977;11(1):71-5.

Coroleu SF, Burzotta F, Fernandez-Gomez C, Tommasino A, Giammarinaro M, Coluccia V, et al. Feasibility of complex coronary and peripheral interventions by trans-radial approach using large sheaths. Catheter Cardiovasc Interv. 2012;79(4):597-600.

Aminian A, Iglesias JF, Van Mieghem C, Zuffi A, Ferrara A, Manih R, et al. First prospective multicenter experience with the 7 French Glidesheath slender for complex transradial coronary interventions. Catheter Cardiovasc Interv. 2017;89(6):1014-20.

Uglietta JP, Kadir S. Arteriographic study of variant arterial anatomy of the upper extremities. Cardiovasc Intervent Radiol. 1989;12(3):145-8.

Palit S, Kendrick J. Vascular calcification in chronic kidney disease: role of disordered mineral metabolism. Curr Pharm Des. 2014;20(37):5829-33.

Wang HJ, Yang YF. Percutaneous treatment of dysfunctional Brescia-Cimino fistulae through a radial arterial approach. Am J Kidney Dis. 2006;48(4):652-8.

Le L, Brooks A, Donovan M, Smith TA, Sternbergh WC, 3rd, Bazan HA. Transradial approach for percutaneous intervention of malfunctioning arteriovenous accesses. J Vasc Surg. 2015;61(3):747-53.

Rahmatzadeh M, Vijayan V, Ritter CJ, Hockley J, Leong BD, Sandford M, et al. Transradial approach for challenging vascular access interventions. Vascular. 2015;23(4):374-81.

Kawarada O, Yokoi Y, Nakata S, Morioka N, Takemoto K. Transradial intervention for native fistula failure. Catheter Cardiovasc Interv. 2006;68(4):513-20.

Lin YS, Lin PC, Hsu JT, Chang ST, Yang TY, Cheng HW, et al. Feasibility of trans-radial approach in percutaneous intervention for upper arm dialysis access. Seminars in dialysis. 2008;21(6):567-74.

Hull J, Workman S, Heath JI. Snuff box radial artery access for arteriovenous fistula intervention. J Vasc Access. 2019:1129729819871434.

Clinical practice guidelines for hemodialysis adequacy, update 2006. Am J Kidney Dis. 2006;48 Suppl 1:S2-90.

Miyayama S, Matsui O, Taki K, Minami T, Shinmura R, Ito C, et al. Occluded Brescia-cimino hemodialysis fistulas: endovascular treatment with both brachial arterial and venous access using the pull-through technique. Cardiovasc Intervent Radiol. 2005;28(6):806-12.

Miquelin DG, Reis LF, da Silva AAM, de Godoy JMP. Percutaneous transluminal angioplasty in the treatment of stenosis of arteriovenous fistulae for hemodialysis. Int Arch Med. 2008;1(1):16.

Rashid M, Kwok CS, Pancholy S, Chugh S, Kedev SA, Bernat I, et al. Radial Artery Occlusion After Transradial Interventions: A Systematic Review and Meta-Analysis. J Am Heart Assoc. 2016;5(1).

Pancholy SB, Patel TM. Effect of duration of hemostatic compression on radial artery occlusion after transradial access. Catheter Cardiovasc Interv. 2012;79(1):78-81.

Bernat I, Bertrand OF, Rokyta R, Kacer M, Pesek J, Koza J, et al. Efficacy and safety of transient ulnar artery compression to recanalize acute radial artery occlusion after transradial catheterization. Am J Cardiol. 2011;107(11):1698-701.






Research Article

How to Cite

Öğüşlü U, Gümüş B. Endovascular treatment of nonfunctional vascular access through retrograde arterial access: A single-center experience with midterm follow-up. J Surg Med [Internet]. 2022 Jan. 1 [cited 2024 Apr. 14];6(1):53-8. Available from: https://jsurgmed.com/article/view/994217