Case Gallery

Hemodialysis Access, Case 6. Ken U. Ekechukwu, MD, MPH, FACP.

Clinical problem: A  43-year-old male patient with end-stage renal disease was referred to the interventional radiology service for a new dialysis access and relief of signs of superior vena cava syndrome. He had had many failed autogenous and non-autogenous arteriovenous accesses, and recently reverted to tunneled dialysis catheters as he waited for new arteriovenous access. Most recently, he […]

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Hemodialysis Access, Case 5. Ken U. Ekechukwu, MD, MPH, FACP.

Clinical problem: 44-year-old man who had had multiple failed arteriovenous accesses in the past. His new left forearm non-autogenous brachiobrachial access did not work well at his most recent hemodialysis session. Findings at imaging: The angiogram shows a loop arteriovenous graft connecting the distal left brachial artery to the proximal left brachial vein. The artery, the […]

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Hemodialysis Access Maintanance, Case 4. Ken U. Ekechukwu, MD, MPH, FACP.

Clinical problem: Failed right brachiobrachial fistula. Angiographic findings: A high-grade juxta-anastomotic venous stenosis. 2 upstream venous aneurysms between which is sandwiched  a 2nd high-grade venous stenosis. A 3rd venous stenosis, also high-grade, distal to the distal aneurysm. Venous collaterals around the right axillary vein due to chronic total occlusion of the right subclavian vein. Challenges: […]

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Hemodialysis Access Maintenance: Case 3. Ken U. Ekechukwu, MD, MPH, FACP.

I use this case to illustrate when to end an intervention and avoid harming the patient. “Better is the enemy of good” is a truism among interventional radiologists. In trying to improve the outcome of an intervention by doing more, terrible things may happen and foul earlier efforts. This was a patient with a failed arteriovenous […]

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Hemodialysis Access Management: Case 2 Ken U. Ekechukwu, MD, MPH, FACP.

These 3 images are diagnostic angiograms of a left arm arteriovenous fistula (AVF) between the brachial artery and the brachial vein. The end of the proximal left brachial vein (the part of the vein closer to the elbow) was anastomosed to the side of the distal left brachial artery at the creation of the fistula […]

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