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dialysis shunt [keywords]
- Risk factors of sensitization to human leukocyte antigen in end-stage renal disease patients. [JOURNAL ARTICLE]
- Hum Immunol 2014 Mar 6.
Pre-sensitization to human leukocyte antigen (HLA) is closely related to the prognosis of renal transplantation. Concerning the risk factors for HLA sensitization, most studies focused only on selected transplant candidates.All patients with end-stage renal disease (ESRD) in a single teaching hospital and a group of healthy subjects were enrolled for the tests of panel-reactive antibodies (PRA).A total of 1177 subjects were recruited, including 289 ESRD patients (140 hemodialysis, 98 peritoneal dialysis, and 51 pre-dialysis) and 888 healthy volunteers. The prevalence of PRA positivity (for either type I or II HLA) for ESRD patients was higher than for healthy subjects (23.2% vs. 12.8%, p=0.000). Only pregnancy and transfusion showed independent correlations with PRA positivity, and not ESRD itself. The PRA-positive ESRD patients were prone to be female, have histories of pregnancy, transfusion, no hepatitis B, and use of graft shunt for dialysis. Multivariate analyses showed that pregnancy and time interval of the latest transfusion had independent correlations with PRA positivity. The time interval of less than 1year had the highest odds ratio 10.06 (p=0.000).Pregnancy and recent transfusion, not ESRD itself or dialysis modality, remain the independent risk factors for HLA sensitization.
- Arteriovenous fistula patency: some answers but questions remain. [Comment, Editorial]
- Am J Kidney Dis 2014 Mar; 63(3):384-6.
- Blood circulation in the fingers is aggravated after creating a vascular access for dialysis: assessment using skin perfusion pressure. [JOURNAL ARTICLE]
- J Plast Surg Hand Surg 2014 Feb 10.
Abstract Internal vascular shunts for haemodialysis can cause different complications. One of the most serious complications is steal syndrome, which can result in disturbed peripheral circulation causing finger necrosis and lead to amputation. Thus, prevention of these complications is important. Measurement of skin perfusion pressure (SPP) has been used in various clinical settings, including wound-healing management, and its usefulness has been increasingly unveiled. The present study was undertaken to evaluate changes in haemodynamics after internal shunt creation by measuring SPP of the thumb and the little finger before and after surgery in five patients undergoing shunt surgery using the radial artery and the cephalic vein. The study revealed average changes of -22.8 mmHg in thumb SPP. The change in the thumb was statistically significant (p < 0.05). If the effect of surgery and the threshold for wound healing are taken into account, the present results indicate the necessity to pay extra attention to fingers with extremely low preoperative SPP values. For the prevention of serious disturbances of peripheral circulation (e.g. steal syndrome), routine preoperative SPP measurement seems effective for screening of high-risk patients.
- Traditional versus early-access grafts for hemodialysis access: a single-institution comparative study. [Comparative Study, Journal Article]
- Am Surg 2014 Feb; 80(2):155-8.
In those patients requiring urgent hemodialysis, the use of early-access grafts may reduce the need for temporary hemodialysis catheters and their resultant complications such as infection and central venous stenosis. We review a consecutive group of patients undergoing placement of a traditional polytetrafluoroethylene (PTFE) graft as compared with a cohort of patients who underwent insertion of a trilaminate PTFE vascular graft (TPVG). During the period from January 2008 to December 2009, 65 sequential patients received a traditional PTFE graft with 78 subsequent patients having a TPVG inserted. Factors examined included use of temporary hemodialysis catheters during the period of graft maturation, incidence of infection, and primary and secondary graft patency. For all patients, incidence was reported as observed during the first year after graft insertion. With the use of the TPVG, need for temporary hemodialysis catheters was reduced from 91 to 32 per cent, and 1-year overall graft patency was improved from 36 to 77 per cent (P < 0.01). We report that the use of a trilaminate PTFE graft allowed early access, reduced the need for temporary hemodialysis catheters, decreased overall graft complication rates, and significantly improved 1-year patency.
- Ruptured aneurysm at the fenestration of the middle cerebral artery detected by magnetic resonance angiography in a patient with systemic lupus erythematosus and renal failure: a case report. [Journal Article]
- J Med Case Rep 2014; 8(1):30.
A cerebral aneurysm arising at the fenestration of the middle cerebral artery is extremely rare, with one report describing subarachnoid hemorrhage due to this type of lesion. There have been no reports of this type of lesion occurring in a patient with systemic lupus erythematosus.A 47-year-old Japanese woman with 23 years' history of systemic lupus erythematosus and chronic renal failure had sudden onset of subarachnoid hemorrhage. We avoided using contrast medium due to her chronic renal failure. Magnetic resonance angiography showed her ruptured aneurysm arising at the site of fenestration of her middle cerebral artery. Successful clipping, perioperative management avoiding the cerebral vasospasm, renal dialysis initiated after the acute phase and placement of a ventriculoperitoneal shunt were performed, and she was discharged home with no complications.This is the first report of ruptured aneurysm associated with middle cerebral artery fenestration in a patient with systemic lupus erythematosus as detected by magnetic resonance angiography. The presence and anatomical relationship of fenestration accompanied by aneurysm could be noninvasively and accurately evaluated preoperatively using three-dimensional time-of-flight magnetic resonance angiography with the volume rendering method in a case in which contrast medium was contraindicated.
- Superficialization of brachial artery as effective alternative vascular access. [JOURNAL ARTICLE]
- J Vasc Surg 2014 Jan 15.
The Japanese Society for Dialysis Therapy recommends superficialization of the brachial artery (BA) as an alternative vascular access (VA) technique in patients for whom a conventional internal shunt (arteriovenous fistula [AVF] or arteriovenous graft) cannot be created. Although 2% to 3% of Japanese hemodialysis patients undergo this procedure, it is not well recognized worldwide. We report here our experience with the procedure, as well as indications, durability, and morbidity.The technique involves exposure of the BA and ligation of the side branches, then fixing it beneath the skin at the upper arm. Cannulation of the BA is performed 2 weeks or more after surgery, and it is used as an outflow route, with any vein in an upper extremity utilized for blood return, including the hand if sites in the arm are not accessible. We retrospectively reviewed our cases of superficialization of the BA for VA.From 2005 through 2008, a total of 24 patients (11 females [46%]; average age, 69 years [range, 39-84 years]) underwent superficialization of the BA, of whom eight (33%) had diabetes. The indications were (1) impaired cardiac function (n = 13); (2) no other prospect for AVF or patient refused prosthetic graft implantation (n = 5); (3) severe upper extremity arterial disease or ischemic steal syndrome requiring AVF closure (n = 3); (4) venous hypertension with central vein occlusion (n = 2); and (5) repeated AVF thrombosis due to heparin-induced thrombocytopenia (n = 1). The mean follow-up period was 28 months. Serious complications were seen in one patient with an infected pseudoaneurysm formation associated with a BA puncture, which necessitated BA ligation, while two patients required an aneurysmectomy with reconstruction and one had occlusion of the superficialized BA, though no clinical symptoms of hand ischemia developed. We also had difficulty finding a vein for blood return in five patients. The rate of superficialized BA patency as a functioning VA was 95% and 66% at 1 and 3 years, respectively.Superficialization of the BA was found to be a simple and safe technique, with acceptable durability and complication rate in selected Japanese hemodialysis patients. We consider that this shuntless VA permits adequate blood flow and has theoretical advantages for some patients, particularly those with impaired cardiac function, though the availability of a return vein is a prerequisite for a functioning VA.
- JAAD grand rounds quiz. Hand ischemia in a hemodialysis patient. [Case Reports, Journal Article]
- J Am Acad Dermatol 2014 Feb; 70(2):393-5.
- Factors affecting the maturation of arterio-venous fistula in patients with end-stage renal disease. [Letter]
- Saudi J Kidney Dis Transpl 2014 Jan; 25(1):161-5.
- Effect of Arteriovenous Hemodialysis Shunt Location on Cardiac Events in Patients Having Coronary Artery Bypass Graft Using an Internal Thoracic Artery. [JOURNAL ARTICLE]
- Ther Apher Dial 2014 Jan 14.
The possibility of developing coronary steal in patients having coronary artery bypass graft (CABG) using internal thoracic artery (ITA) and ipsilateral upper extremity arteriovenous (AV) hemodialysis shunt has been reported. The impact of this phenomenon on clinical outcomes is uncertain. The aim of this study was to investigate an association between the AV dialysis shunt location regarding the side of the ITA CABG and clinical outcomes. This retrospective cohort study included chronic hemodialysis patients having ITA CABG and upper extremity AV shunt. The patients were divided into two groups: those with ipsilateral and those with contralateral location of ITA CABG and AV shunt. The outcomes were: death from any cause, cardiac death and a first cardiac event. In a group of 112 chronic hemodialysis patients having CABG, 32 had an ipsilateral and 25 had a contralateral location of ITA CABG and an upper extremity AV shunt. Significantly more cardiac events occurred in the group with an ipsilateral compared to a contralateral location of ITA CABGs and dialysis AV shunts (hazard ratio, 2.16 [95% CI, 1.11 to 4.19], P = 0.023). There was no difference between the groups in the all cause mortality risk (hazard ratio, 1.005 [95% CI, 0.43 to 2.37], P = 0.990) or the risk of cardiac death (hazard ratio, 2.43 [95% CI, 0.64 to 9.17], P = 0.191). The ipsilateral location of a CABG with the use of ITA and upper extremity AV hemodialysis shunt may be associated with increased risk of cardiac events.
- Buttonhole cannulation technique as the cannulation method of choice. [Comment, Letter]
- Am J Kidney Dis 2014 Jan; 63(1):165.