Upper extremity fistulogram and intervention: Benefits of internal jugular venotomy approach
Lavi Nissim, Bernadette Peralta and Chad Brooks
Imaging Advantage, USA
Abrazo Health Care, USA
: J Clin Exp Oncol
Fistulogram with intervention is traditionally performed via direct access into the graft or the fistula outflow vein in the patient's upper extremity. Repeated direct intervention places the fistula/graft at increased risk for pseudoaneurysm, infection, stenosis, or other complications, which may ultimately lead to access site failure. Furthermore, if the intervention fails, there is added cost and risk when a second procedure and access is required for placement of a dialysis catheter. Here we advocate an alternative approach to performing upper extremity fistulogram, using the internal jugular vein as the access site for intervention on both the fistula and the central venous system. This method results in less risk for injury or infection to the access site related to direct puncture, obviates the need for a second venotomy, and potentially may result in less radiation exposure and discomfort to the patient.