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dialysis shunt [keywords]
- Endovascular management of thrombosed axillary artery to right atrium hemodialysis graft. [JOURNAL ARTICLE]
- Clin Imaging 2014 Jun 19.
To describe the salvage of a left axillary artery to right atrium hemodialysis graft using endovascular techniques.A 54-year-old man with multiple arteriovenous graft failures presented with a thrombosed left axillary artery to right atrium Gore-tex hemodialysis graft. The graft was salvaged using rheolytic catheter thrombectomy, mechanical thrombectomy, balloon angioplasty, and stenting.This single case report suggests that when axillary to right atrium grafts fail, various endovascular techniques can be employed to salvage the graft and maintain dialysis access.
- Abdominal pseudocyst development in a peritoneal dialysis patient with a ventriculoperitoneal shunt: an indication for switch to hemodialysis? [Letter]
- Perit Dial Int 2014 Jun; 34(4):470-1.
- Bilateral central vein stenosis in a dialysis patient with a pacemaker. [JOURNAL ARTICLE]
- Asian Cardiovasc Thorac Ann 2013 Oct 16.
Central vein stenosis is not uncommon in hemodialysis-dependent patients as a result of mechanical damage to the vessel walls from prior cannulation. It can cause ipsilateral upper limb swelling and pain, resulting in suboptimal hemodialysis. It is unfortunate for bilateral central vein stenosis to develop concomitantly, and rare in the setting of an in-situ pacemaker. This case illustrates the successful ligation of a nondependent left arteriovenous fistula and stenting of the right subclavian vein with functioning ipsilateral arteriovenous fistula, to overcome the problem of symptomatic bilateral upper limb swelling.
- Vascular access management: ongoing challenges and strategies for success. [Journal Article]
- Nephrol News Issues 2014 Mar; 28(3):26, 28, 30-3.
- Tube banding to correct steal syndrome after arteriovenous fistula construction for hemodialysis. [Journal Article]
- Am Surg 2014 Mar; 80(3):E71-3.
- Distal revascularization and interval ligation (DRIL) procedure requires a long bypass for optimal inflow. [Journal Article]
- Can J Surg 2014 Apr; 57(2):112-5.
Distal revascularization and interval ligation (DRIL) is commonly used to treat ischemic steal syndrome caused by arteriovenous hemodialysis access and has been associated with good outcomes. However, the literature lacks technical details of a successful intervention. We tested the hypothesis that a brachial-level arteriovenous fistula (AVF) generates a zone of low arterial blood pressure in the brachial artery near the AVF origin.We identified patients with ischemic steal syndrome caused by an AVF originating from the brachial artery level who were eligible for the DRIL procedure. All patients were studied with invasive pressure monitoring in the brachial artery at the time of digital subtraction angiography. We measured systolic, diastolic and mean arterial blood pressure at 5 cm intervals from a point in the arterial circulation 5 cm distal to the origin of the AVF and continuing proximally into the subclavian artery.Our series involved 10 patients with a mean age of 66.5 (range 53-81) years. Four patients were women and 8 had diabetes. All patients had grade 3 ischemic steal syndrome with ischemic rest pain and/or ischemic tissue loss. Mean systolic, diastolic and arterial pressures increased from the level of the AVF until central pressures were reached. Systolic blood pressure was significantly lower than central blood pressure until a level 20-25 cm proximal to the AVF.The benefits of the DRIL procedure in alleviating ischemic steal syndrome associated with hemodialysis access are best achieved with a DRIL bypass for which inflow originates at least 20-25 cm proximal to the origin of the AVF.
- 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.