ABSTRACT
The accurate anatomic mapping and determination of the severity of arterial disease, an important health problem of the elderly, is of great significance. We aimed to determine the diagnostic value of 64-multislice CT angiography [MSCTA] in run-off and cut-off sites of arterial disease. Throughout the study, MSCTA followed by an operative intervention was carried out on a total of 38 patients with clinical signs and symptoms suggestive of arterial disease [AD] all of whom had the indication for vascular surgery. The mean age of patients was 34 +/- 15.86 [range, 23 to 93] years. MSCTA was executed using a 64-slice CT scanner, during the arterial phase of injecting the nonionic, contrast medium with a power injector at the rate of 5 ml/sec into the antecubital vein and exploration and revascularization of peripheral arterial disease was performed intraoperatively. Atherosclerosis and arterial disease, the most common causes of vascular occlusion, were more common in the lower extremities. According to MSCTA findings, the most frequent site of stenosis was the superficial femoral artery. Spearman's correlation coefficient showed a high degree of agreement amongst the raters. The sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV] and the accuracy of MSCTA compared to surgery were 83.8%, 96%, 96.8%, 81.3% and 89%, respectively. MSCTA findings were compared with surgery as a standard of reference, which showed concordance in the majority of cases [81.6%]. Cut-off sites were correctly identified by MSCTA in 97.3% of the patients and the most common sites of discordance were the run-off sites [18.2%]. MSCTA angiography as a novel diagnostic modality may be a suitable alternative and a viable choice for routine clinical diagnosis
ABSTRACT
The rate of end stage renal disease [ESRD] has changed dramatically after innovation of hemodialysis in 1942. Introduction of arteriovenous fistula [AVF] made a new and comfortable vascular access, and since then function and complications of it became a matter of concern. In this study all hemodialysis patients in two referral hospitals [Imam Khomeini and Dr Shariati] were assessed for function and complications of their fistulas. In 108 patients with AVF, the average length of function was 3 years which was positively related to interval between surgery and beginning of dialysis via the fistula [P<0.03], and negatively related to history of dual catheter insertion [P<0.05] and diabetes mellitus [P<0.02]. The mean flow of fistulas was 245 ml/s. Most common complications were aneurysmal degeneration of fistula and venous site punctures which were related to length of using the fistula and diabetes [P<0.02].Among other complications,paresthesia, coldness of fingers and edema had a higher prevalence. Despite earlier convictions,proximal AVFS did not have markedly significant complications compared to distal fistulas. We concluded that after the diagnosis of ESRD is established, AVF operation should be done before the patient needs to central venous access for hemodialysis. Antecubital area can he used in patients with poor distal vessels without concern about more complication rate. Finally diabetes is an important and determining negative factor in both aspects function and complications