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dialysis shunt [keywords]
- 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.
- 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.
- 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.
- [Hemodynamic abnormalities in different kind of arteriovenous access for hemodialysis]. [Comparative Study, English Abstract, Journal Article]
- Vestn Khir Im I I Grek 2013; 172(4):44-8.
On the basis of examination of 35 dialytic patients, who had clinical findings of progressed chronic cardiac insufficiency against the background of the large arteriovenous shunt through existing vascular access, the authors show the complications. The volume of blood circulation along the arteriovenous fistula, which was more than 30% of cardiac output, caused dilatation of heart cavities with cardiac decompensation. If the largest potency to volume remodeling of native proximal arteriovenous fistulas is taken into account, this kind of access could cause hemodynamic abnormalities more often than others (in 22 (62.9%) of patients). The best primary survival was demonstrated by arteriovenous shunts (87.1%) during 2 years. However, long-term survival of native arteriovenous fistulas dramatically outperformed the other kinds of accesses. The choice of constant vascular access for hemodialysis is an important and difficult task in chronic renal disease of V degree patients.
- [Optimization of policy aimed at forming a permanent access based on ultrasonographic duplex scanning for programmed dialysis]. [Comparative Study, English Abstract, Journal Article]
- Angiol Sosud Khir 2013; 19(3):53-4, 56-8.
The study was aimed at optimizing the policy of forming a permanent vascular access (PVA) by means of preoperative colour duplex scanning (CDS) of vessels in patients on programmed haemodialysis. The study included 420 patients undergoing from September 2003 to September 2011 a total of 595 PVAs. The Study Group (Group I) patients (351 PVAs) were subjected to preoperative PVA of vessels of limbs accompanied by assessing velocity parameters of the venous blood flow. The comparison group (Group II) patients (244 PVAs) underwent clinical examination only. The end point of the study was early diagnosis of incompetence of the PVA. Using preoperative PVA of vessels improved the outcomes of forming the PVA, significantly increasing the number of native arteriovenous fistulas (AVF) as a whole: (88.0% for Group I and 65.6% for Group II; p<0.01), their variants: radial-cephalic (I - 57.5%, II - 32.2%; p<0.01) and secondary radial-cephalic variants (I - 8.3%, II - 3.7%; p<0.01), leading to decreased frequency of using synthetic prostheses both totally (I - 12.0%, II - 34.4%; p<0.01) and in all positions (p<0.01) taken apart. Also decreased the frequency of the development of incompetence of all PVAs (I - 10.8%, II - 29.9%; p<0.01), AVFs as a whole (I - 7.4%, II - 18.0%; p<0.01) and accesses with a synthetic prosthesis both as a whole (I - 1.7%, II - 11.9%; p<0.01) and in all positions separately (p<0.01). Determining the velocity parameters of venous blood flow made it possible to exclude the development of significant proximal venous obstruction and to refuse phlebography. We consider it obligatory to perform CDS of vessels prior to forming a PVA.
- Hemodialysis in children: eleven years in a single center in Egypt. [Journal Article]
- Iran J Kidney Dis 2013 Nov; 7(6):468-74.
The objective of this study was to report the clinical characteristics and outcomes of children with end-stage renal disease under regular hemodialysis in a dialysis unit in Egypt.Ninety children with end-stage renal disease were included in this study and their charts over the past 11 years (from January 2001 to January 2012) were reviewed.The mean age of the patients at the start of hemodialysis was 5.6 +/- 1.4 years. The main causes of end-stage renal disease were glomerular diseases (35.6%), unknown etiology (33.3%), and urological problems (17.8%). Hospital admissions were due to hypertensive attacks, cardiac problems, arteriovenous shunt complications, and infections. Only 3 children received a kidney transplant and 24 (26.7%) died during the 11-year follow-up. Eight patients died of heart failure, 5 due to sepsis, and 4 due to unexplained causes.Maintaining an appropriate care for children with end-stage renal disease is quite difficult in developing countries due to factors such as late referral, poor medical service utilization, limitation of financial resources, and limitations to transplantation. As a result, maintaining on hemodialysis for long periods imposes a high risk of complications.
- Dialysis access technology, the next generation. [Letter]
- Saudi J Kidney Dis Transpl 2013 Nov; 24(6):1250-1.
- Amplatzer vascular plug for occlusion or flow reduction of hemodialysis arteriovenous access. [Journal Article]
- J Vasc Surg 2014 Jan; 59(1):260-3.
Use of the Amplatzer vascular plug (AVP; St. Jude Medical Inc, St. Paul, Minn) for percutaneous occlusion of a hemodialysis arteriovenous access (AVA) is an emerging practice, and only a few reports by radiologists have been published. We report here a multidisciplinary experience of this technique not only for AVA occlusion but also for flow reduction in selected patients.This preliminary study includes a series of 20 plugs of different generations (I, II, and IV) used in 19 hemodialysis patients (two children, 17 adults). Of these, 15 AVAs were autologous fistulas located at the elbow, 4 were autologous forearm fistulas, and 1 was a brachial-basilic polytetrafluoroethylene graft. AVP deployment was through a 4F to 8F sheath, with oversizing from 30% to 50% to reduce the risk of migration. AVA occlusion (n = 14), by placing the AVP in the vein at its origin, was performed for central vein occlusion after unsuccessful percutaneous recanalization (n = 4), high flow (n = 2), hand ischemia (n = 3), successful kidney transplant (n = 1), and brachial-basilic or brachial-brachial fistula second-stage superficialization technical failure (n = 4). Vein/polytetrafluoroethylene grafts were not removed. AVA flow reduction (n = 6), by placing the AVP in the radial artery, was performed for well-tolerated high flow (n = 3) or high flow associated with distal ischemia (n = 3). All patients underwent a postoperative evaluation at 6-month intervals that included a clinical examination and duplex scan.AVA occlusion or flow reduction was successfully achieved in all patients. Ischemia persisted in one patient and a revascularization with a distal bypass was necessary. Mean follow-up was 1.2 ± 0.8 years (range, 2 months-2.9 years). No plug migration, access revascularization, or other complication was observed.The results of this short preliminary study suggest that plug insertion for occlusion or for flow reduction in a hemodialysis AVA constitutes a reasonable alternative to coil insertion or to open surgery in selected patients.