Pseudoaneurysm formation is known to complicate arteriovenous haemodialysis access. Ultrasound guided thrombin injection is a recognised treatment option, but is not possible in pseudoaneurysms with no measurable neck. Balloon assisted techniques have been described in such cases, which transiently obstruct flow out of the pseudoaneurysm and thereby prevent non-target embolization during ultrasound guided percutaneous thrombin injection. We describe a balloon assisted technique for the treatment of a radial artery pseudoaneurysm, via retrograde access from the draining cephalic vein of an arteriovenous fistula. A 61-year-old male with a radio-cephalic fistula was found on duplex ultrasound to have a large radial artery pseudoaneurysm with no measurable neck, as well as a juxta-anastomotic cephalic vein stenosis. Endovascular treatment was selected over open surgery. Retrograde cephalic venous access was established, which allowed for concurrent treatment of both the venous stenosis and the arterial pseudoaneurysm. After balloon dilation of the juxta-anastomotic stenosis, a percutaneous transluminal angioplasty balloon catheter was advanced across the arteriovenous anastomosis and inflated across the neck of the radial artery pseudoaneurysm, to transiently obstruct blood flow. This allowed for safe injection of thrombin into the pseudoaneurysm by direct ultrasound guided sac puncture; thereby achieving thrombosis. Balloon assisted ultrasound guided thrombin injection is an endovascular treatment option that can obviate the need for open surgery in cases involving pseudoaneurysms with no measurable neck. The technique described allowed both concurrent treatment of a juxta-anastomotic venous stenosis and treatment of an arterial pseudoaneurysm from a single venous puncture. This technique avoided arterial access and its inherent complications.

中文翻译：

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球囊辅助、超声引导下经皮凝血酶注射大桡动脉假性动脉瘤，经同侧动静脉瘘经静脉入路

已知假性动脉瘤的形成使动静脉血液透析通路复杂化。超声引导的凝血酶注射是公认的治疗选择，但在没有可测量颈部的假性动脉瘤中是不可能的。在这种情况下已经描述了球囊辅助技术，该技术会暂时阻碍假性动脉瘤的流出，从而防止在超声引导的经皮凝血酶注射过程中出现非目标栓塞。我们描述了一种用于治疗桡动脉假性动脉瘤的球囊辅助技术，通过从动静脉瘘的引流头静脉逆行进入。一名 61 岁男性患有放射性头颅瘘，在双重超声检查中发现有一个大的桡动脉假性动脉瘤，没有可测量的颈部，以及近吻合头静脉狭窄。选择血管内治疗而不是开放手术。建立了逆行头静脉通路，允许同时治疗静脉狭窄和动脉假性动脉瘤。在对近端吻合口狭窄进行球囊扩张后，将经皮腔内血管成形术球囊导管穿过动静脉吻合口并充气穿过桡动脉假性动脉瘤的颈部，以暂时阻碍血流。这允许通过直接超声引导的囊穿刺将凝血酶安全注射到假性动脉瘤中；从而达到血栓形成。球囊辅助超声引导的凝血酶注射是一种血管内治疗选择，可以避免在涉及无法测量颈部的假性动脉瘤的情况下进行开放手术。所描述的技术允许同时治疗近端吻合口静脉狭窄和通过单次静脉穿刺治疗动脉假性动脉瘤。这种技术避免了动脉通路及其固有的并发症。