A 34-year-old male patient had been treated by HD in the last 3 years via left brachiocephalic AVF. He presented with gradually increasing painful swelling of the left upper limb, a sign of VH. He was evaluated with CT angiography and documented to have stenosis at IJV and left brachiocephalic vein. Under local anesthesia, the right common femoral artery access was secured with a 5 French sheath. Using 5 French H1 catheter and hydrophilic guide wire, left brachial artery angiogram was performed. The left common femoral venous access secured. However, H1 catheter could not be negotiated into left brachiocephalic vein (the angiogram also confirmed the presence of an occlusion in left brachiocephalic vein. Echelon – 10 and traxcess for guide wire was placed within the venous side of AVF. A 6 × 20 microplex 18 coil was placed in the venous side. Subsequently 5 × 15 (GDC – 18) and 4 × 10 (GDC – 10) coils were placed within the venous side of a fistula, followed by introduction of fibrin glue, 1 ml (1:2 dilution). Final check angiogram revealed closure of AVF. Right lower limb was immobilized for 6 h and left upper limb raised. Limb edema disappeared in 48 h [].
A 63-year-old male patient had been treated by HD in the last 5 years via left brachiobasilic AVF. He presented with gradually increasing painful swelling of the left upper limb, a sign of VH. CT angiography documented left brachiobasilic vein stenosis with extensive collaterals in the upper limb. Under local anesthesia, the right common femoral artery access was obtained with 8 french arterial sheath. This was followed by 5 french micro venous sheaths in left basilic vein, distal to stenosis site via left common femoral venous access. Then a Swan-Ganz catheter was placed in the left brachial artery just proximal to fistula site, followed by inflation of the balloon, check angiogram showed patent fistula site with stenosis of basilic vein. Through dilator of 5 French sheath – 6, 8 cm × 5 cm pushable coils were placed in venous side just distal to fistula, followed by introduction of fibrin glue, 1 ml (1:2). Final check angiogram documented successful embolization. Also, in this case, a rapid disappearance of the edema occurred with a progressive resolution of the elephantiasis [].