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Abstract: PO1034

A Novel Method for Ligation of Accessory Veins: A Case Series of Eight Patients

Session Information

Category: Dialysis

  • 703 Dialysis: Vascular Access

Authors

  • Boubes, Khaled, The Ohio State University, Columbus, Ohio, United States
  • Haddad, Nabil J., The Ohio State University, Columbus, Ohio, United States
  • Agarwal, Anil K., VA Central California Health Care System, Fresno, California, United States
Introduction

Accessory veins are a common cause for decreased blood flow through the body of arteriovenous fistulae (AVF). A common practice is to have these ligated surgically through a cut-down procedure. Alternatively, these can be blocked by coiling, embolization, or by percutaneous ligation. We present a case series where accessory veins were ligated percutaneously under direct ultrasound (US) visualization.

Case Description

A total of 8 patients underwent percutaneous accessory vein ligation from Dec 2020 through May 2021. None had any immediate complications. Cessation of blood flow through the accessory vein was confirmed by color doppler ultrasonography and by angiography.

Technique description:
After identifying the accessory vein on angiography and its impact on the flow through the AVF, the vein is then identified using the US. The location to ligate the vein is then chosen as close as possible to the vein “take-off”. Using a 4-0 absorbable suture and under direct US visualization, the needle is inserted from one side of the vein and passed underneath to come out from the other side. Then, the needle is flipped and inserted back subcutaneously, passing above the vein to come out eventually next to the initial insertion site. The suture is then tied firmly. Depending on the size and location of the vein, another suture can be done in a similar fashion a few millimeters away. Color doppler is then used to detect any flow through the vein. Confirmation of the cessation of flow can also be achieved by repeat angiography.

Discussion

Percutaneous ligation of the accessory veins is a technique that saves the patients from undergoing an open surgical intervention. Utilizing the US for direct visualization of the needle during the procedure enhances its safety and efficiency.

Flow through the accessory vein before the ligation.

Cessation of the blood flow through the accessory vein after the ligation.