Coil Embolization in Dialysis Access Intervention: A Case Series

Arteriovenous (AV) dialysis access intervention aims to improve or maintain flow by treating underlying stenosis and/or thrombosis with thrombectomy/thrombolysis, angioplasty, and/or stent placement. However, in some scenarios, coil embolization may be effective and necessary to improve fistula/graft function. Here we present a case series of 20 patients who underwent coil embolization in the course of their dialysis access intervention for indications such as AV fistula creation, aneurysm formation, poor fistula maturation, and poor venous outflow due to venous collaterals. We will also highlight the technique of obtaining 3 French brachial artery access as the initial step of the intervention for accurate diagnosis, therapeutic intervention choice, and monitoring of treatment throughout the intervention.

Materials and Methods: A retrospective chart review of the EMR was performed for patients who had coil embolization performed as part of their dialysis access intervention from November 2016 through May 2024. Twenty patients were identified, and their records were reviewed for fistula type, methods of access, type/number of coils, reason for intervention, concurrent angioplasty, subsequent dialysis interventions, and dialysis access function post procedure.

Results: 20 patients (aged 32-86) underwent AV dialysis access intervention involving coil embolization from November 2016 - May 2024. The most common reason for coil embolization was venous hypertension due to poor venous outflow and venous collaterals. In 45% of cases, concurrent angioplasty was performed while in 55% of cases coil embolization alone was performed. In the vast majority of cases (18/20) brachial artery access was obtained as the initial access. Treatment was performed via the radial artery in 7 cases and via direct puncture of the competing outflow vein in 6 cases. After coil embolization, 80% of fistulas/grafts had adequate function and did not require subsequent intervention.  Number/type of coils used, fistula type, and concurrent angioplasty did not significantly affect the outcome after coil embolization.  

Conclusion: Coil embolization is a safe and effective technique during AV dialysis access intervention for indications such as collateral veins impeding maturation or flow, percutaneous access creation, aneurysm formation, and venous hypertension. Initially obtaining 3 French brachial artery access in these cases facilitated accurate diagnosis, guided therapeutic intervention choice, and allowed for monitoring of treatment during intervention.