Use of antegrade wire guidance for retrograde transjugular/transfemoral venous access in the treatment of dysfunctional hemodialysis access: A retrospective analysis

Abstract

Background: Transvenous access for endovascular treatment of dysfunctional hemodialysis (HD) access can be technically difficult in the retrograde selection of the HD access. This study aims to evaluate the efficacy of primary antegrade wire guidance in assisting transvenous access. Methods: A total of 41 transvenous access procedures (17 with and 24 without antegrade wire guidance), performed between March 2019 and February 2023, were included. Electronic medical records and procedural images were retrospectively reviewed. Results: Of the 41 procedures, 17 performed primary antegrade wire guidance (group A) and 24 did not (group B). The technical success rate was 100% in group A and 95.8% (23/24) in group B. The mean retrograde selection time was 16.7 min in group A, whereas it was 30.9 min in group B ( p = 0.014). Additional intraprocedural fistulography was not performed in group A, while it was performed at an average of 1.5 times (range: 0–4) in group B ( p = 0.001). One patient in group B experienced venous dissection as a minor complication; however, no major complications were observed in either of the groups. Conclusions: Using primary antegrade wire guidance in endovascular treatment of dysfunctional HD access via alternative transvenous access is safe and time-saving.