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dialysis shunt [keywords]
- The aneurysmal arteriovenous fistula - morphological study and assessment of clinical implications. A pilot study. [JOURNAL ARTICLE]
- Vascular 2014 Oct 29.
Aneurysmal dilation of arteriovenous fistulae used for haemodialysis is a recognised complication but its clinical significance is a contentious issue. Our aims were to describe aneurysmal fistulae morphologically and clinically. Sixty patients underwent duplex scanning to measure the maximum diameter and skin thickness of their fistula. Haemodialysis function and bleeding risk were assessed clinically. The 75th percentile of maximum diameter was 2.05 cm. In addition to conventional diameter measurement, we describe a novel volume measurement technique which may be of value. No relationship was found between maximum diameter or volume and function, skin thickness or bleeding. Some studies define aneurysm at 2 cm (75th percentile); however, this definition and other arbitrary definitions lack clinical significance. This work suggests that fistula dilation should be considered together with clinical issues when determining the clinical significance of an aneurysm. Our finding that haemodialysis function, skin thickness and bleeding were not associated with diameter needs further study.
- Treatment Strategy for Distal Radius Fractures With Ipsilateral Arteriovenous Shunts. [JOURNAL ARTICLE]
- J Hand Surg Am 2014 Sep 17.
To describe our management of 3 patients with chronic renal failure who sustained distal radius fractures in limbs containing dialysis shunts.The 3 patients were 48-61 years old, and 2 of them were men. Because the injured limbs contained arteriovenous shunts, tourniquets were not used. Volar locking plate fixation was applied via the Henry approach. The patients' grip strength; visual analog scale scores; Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores; modified Mayo scores; and their range of wrist joint motion were assessed during the final follow-up examination. In addition, complications and the presence/absence of dysfunction of the forearm shunt were also investigated.The mean duration of the postoperative follow-up period was 9 months (range, 7-10 mo), and the subjects' mean wrist motion values were 75°, 79°, 78°, and 87° during flexion, extension, pronation, and supination, respectively. Grip strength on the affected side as a percentage of that seen on the healthy side ranged from 71% to 90%. The patients' visual analog scale; QuickDASH; and modified Mayo scores were all excellent, and bone union was achieved in all 3 cases. No shunt dysfunction or skin soft tissue complications were noted.Volar locking plate fixation via the Henry approach might be useful for treating distal radius fractures in cases in which an arteriovenous shunt is present in the same limb. Shunt dysfunction and hemorrhaging are of concern during open surgery, but these were not issues in our patients.Therapeutic IV.
- Aneurysmal Degeneration of the Inflow Artery after Arteriovenous Access for Hemodialysis. [JOURNAL ARTICLE]
- Eur J Vasc Endovasc Surg 2014 Sep 12.
After arteriovenous fistula creation, the arterial flow increase can lead to aneurysmal degeneration, even increased after fistula ligation or renal transplant immunosuppression. The aim of this study is to describe the therapeutic options and outcomes of true aneurysms of the inflow artery after arteriovenous fistula for hemodialysis.Prospectively collected data of patients with true aneurysmal degeneration of the inflow artery after fistula creation (excluding pseudoaneuryms, anastomotic or infected aneurysms, or surgical complications), surgically repaired between January 2010 and February 2014 (cohort study) have been included. Patient demographics and access characteristics, symptoms, treatment, and follow-up have been reviewed.12 patients (75% men, median age 63 years) were treated for aneurysmal degeneration of the axillary (1), brachial (6), or radial (5) artery. They had had a previous distal arteriovenous fistula (7 radiocephalic, 3 brachiocephalic, 2 brachiobasilic) created 15.6 years before (range 9.9-28.5) and the majority of them were currently ligated or thrombosed. Most patients were symptomatic (pain , distal embolization ). They were treated by means of a bypass (using the cephalic , basilic , or saphenous vein ), direct ligature (2), or excision with end-to-end reconstruction (1). No major complications or ischemic symptoms occurred before discharge. After a median follow-up of 8.6 months (3.1-36.5), one patient needed re-operation for new proximal brachial aneurysmal degeneration, and another presented with an asymptomatic post-traumatic thrombosis of the proximal axillary artery and brachial bypass. No other complications, bypass dilatation or ischemic symptoms occurred during follow-up.Inflow artery aneurysmal degeneration can occur after long-term arteriovenous access. Surgical treatment by autogenous bypass exclusion in most cases (or ligation or end-to-end reconstructions in selected cases) is a safe and effective option.
- Fistula first offers new tools to improve outcomes. [Journal Article]
- Nephrol News Issues 2014 Jul; 26(8):23.
- Renal dysfunction in patients with cirrhosis: Where do we stand? [Journal Article, Review]
- World J Gastrointest Pharmacol Ther 2014 Aug 6; 5(3):156-68.
Patients with cirrhosis and renal failure are high-risk patients who can hardly be grouped to form precise instructions for diagnosis and treatment. When it comes to evaluate renal function in patients with cirrhosis, determination of acute kidney injury (AKI), chronic kidney disease (CKD) or AKI on CKD should be made. First it should be excluded the prerenal causes of AKI. All cirrhotic patients should undergo renal ultrasound for measurement of renal resistive index in every stage of liver dysfunction and urine microscopy for differentiation of all causes of AKI. If there is history of dehydration on the ground of normal renal ultrasound and urine microscopy the diuretics should be withdrawn and plasma volume expansion should be tried with albumin. If the patient does not respond, the correct diagnosis is HRS. In case there is recent use of nephrotoxic agents or contrast media and examination shows shock, granular cast in urinary sediment and proteinuria above 0.5 g daily, acute tubular necrosis is the prominent diagnosis. Renal biopsy should be performed when glomerular filtration rate is between 30-60 mL/min and there are signs of parenchymal renal disease. The acute renal function is preferable to be assessed with modified AKIN. Patients with AKIN stage 1 and serum creatinine ≥ 1.5 mg/dL should be at close surveillance. Management options include hemodynamic monitoring and management of fluid balance and infections, potentially driving to HRS. Terlipressin is the treatment of choice in case of established HRS, administered until there are signs of improvement, but not more than two weeks. Midodrine is the alternative for therapy continuation or when terlipressin is unavailable. Norepinephrine has shown similar effect with terlipressin in patients being in Intensive Care Unit, but with much lower cost than that of terlipressin. If the patient meets the requirements for transplantation, dialysis and transjugular intrahepatic portosystemic shunt are the bridging therapies to keep the transplant candidate in the best clinical status. The present review clarifies the latest therapeutic modalities and the proposed recommendations and algorithms in order to be applied in clinical practice.
- Radiological diagnosis of dialysis-associated complications. [Journal Article]
- Insights Imaging 2014 Oct; 5(5):603-17.
In daily clinical practice, the radiologist in the context of diagnosis often faces dialysis-associated complications. The complications are numerous and range from infections, catheter dysfunctions, haematomas, cardiovascular diseases, digital ischaemia, and pseudoaneurysms to shunt stenosis. In this pictorial essay, we take a close look at the imaging diagnostics of the most common complications in dialysis patients. Teaching Points • The occurrence of venous stenosis in haemodialysis patients is up to 41 %. • Catheters usually have a fibrin sheath that can be rinsed but not aspirated. • The steal phenomenon occurs in 75-90 % of patients with a shunt system. • Arterial pseudoaneurysms can cause a number of complications.
- [Hemodialysis vascular access]. [Journal Article, Review]
- Dtsch Med Wochenschr 2014 Aug; 139(31-32):1562-4.
- 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.
- Vascular access team collaboration to decrease catheter rates in patients on hemodialysis: utilization of Kotter's change process. [Journal Article]
- Nephrol Nurs J 2014 May-Jun; 41(3):283-7; quiz 288.
Long-term central venous catheter (CVC) use among patients on hemodialysis increases the risk of infection, morbidity, and mortality. This article describes the use of Kotter's process of change to establish a multidisciplinary vascular access team to facilitate the replacement of CVCs with long-term accesses. Through the implementation of vascular access teams and the execution of Kotter's eight-step process for leading change, hemodialysis clinics will have the tools needed to reduce CVC utilization rates and improve patient healthcare outcomes.
- Invited commentary. [Comment, Journal Article]
- J Vasc Surg 2014 Aug; 60(2):461.