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Kidney Week

Abstract: FR-PO648

Arteriovenous Fistula (AVF) Pseudo-Stenosis

Session Information

  • Trainee Case Reports - IV
    October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Trainee Case Reports

  • 704 Dialysis: Vascular Access

Authors

  • Valleau, Robert, Loyola University Medical Center, Maywood, Illinois, United States
  • Leehey, David J., Hines VA Hospital, Hines, Illinois, United States
  • Rahman, Mohamed A., Nephrology Associates of Northern IL, Elk Groove Village, Illinois, United States
  • Natarajan, Aparna, Loyola University Medical Center, Maywood, Illinois, United States
  • Schneider, Julia, Loyola University Medical Center, Maywood, Illinois, United States
Introduction

Pseudo-stenosis of an AVF has not yet been described in the literature, though it has been noted in the coronaries. It is the false visual appearance of stenosis seen during interventions involving the use of guidewire.

Case Description

Patient 1. 81-year-old male with a brachio-basilic AVF was referred for a fistulogram for high venous pressures noted during dialysis. A fistulogram with guidewire insertion and contrast injection showed multiple areas of apparent stenosis of the basilic vein. After retraction of the guidewire and repeat contrast injection, these areas of apparent stenosis were no longer observed.
Patient 2. 83-year-old male with a brachio-cephalic AVF was referred for a fistulogram because of arm pain. A fistulogram with guidewire insertion and contrast injection showed high-grade stenosis at the cephalic arch which was sucessfully dilated with a balloon. Distal to the area of stenosis, the cephalic vein appeared tortuous with multiple areas of stenosis seen while the guidewire was in place (Fig1). Once the guidwire was removed and contrast re-injected, these areas of apparent stenosis were absent (Fig2).

Discussion

Pseudo-stenosis (accordion effect) is well-described in the coronary arteries and is characterized by pseudo-narrowing of the coronary vessels which disappears after guidewire withdrawal. Although the exact mechanism is unclear, the theory is that advancing a guidewire, thereby shortening a tortuous artery, induces folds of the vessel wall which creates the false impression of narrowing. This phenomenon has not previously been reported in an AVF. It is important to recognize this phenomenon to avoid unnecessary interventions.