Use of distal venous limb as a conduit for intra operative confirmation of arteriovenous fistula flow

Thrombosis due to low blood flow in Arterio Venous Fistulas [AVF] created in extremities of Chronic Renal Failure [CRF] patients is a common cause of primary failure of AVF. Thrombosis commonly occurs primarily in inflow arterial limb or outflow venous limb during anastomosis caused by proximal and distal vessels control. Spasm of the supplying artery can accelerate this phenomenon. In this clinical trial, we used distal venous limb as a conduit for revision and reconfirmation of blood flow in AVF at the end of operation. University Hospitals of Imam Khomeini and Sina during 1994 to 2002. Three hundred seventy eight CRF patients were operated on the upper extremities by this technique. We revived AVF blood flow by washing with a catheter and proximal arterial limb dilatation through distal venous conduit. Two hundred sixty [68.8%] out of 378 patients had inadequate blood flow in AVF at the end of operation. Using distal venous conduit we could successfully reestablish acceptable blood flow with good thrill in 242[93%] of them. Use of distal venous limb as an intraoperative conduit for revision and reconfirmation of blood flow of AVF can prevent primary thrombosis and failure of AVFs

Hydatid disease in children: a different pattern than adult

Hydatidosis is endemic in Iran. We studied hydatid cyst pattern in children, compared it with adults and present our experience. In 40 children, 76 cyst were found. There were multiple large lung cysts unilateral or bilateral in children. In the liver, the chief complaint was abdominal pain and in the lung it was chest pain and asthma-like symptoms. Lung cysts were operated first and liver cysts were postponed for 3-6 months in patients who had both liver and lung involvement. All patients were prescribed albendazole for 10 days before surgery and continued for three months. The patients were followed up by abdominal ultrasonography and chest-X- Ray every 3 months. We didn't use any scolicidal agents intraoperatively. Contrary to adults, incidence of involvement is equal in lung and liver [41% and 43%]. Combined lung and liver involvement is more frequent in children than adults [16% vs. 4%]. However, surgical complications are less frequent in children and their outcome is better

Factors responsible for fistula failure in hemodialysis patients

There are multiple factors in failure of Arterio Venous Fistula [AVF] in patients with Chronic Renal Failure [CRF] that require periodic hemodialysis. Out of technical errors, hypotension, site of insertion, size of vessels, diabetes and atherosclerosis are the common causes of failure in AVFs. In this study failure of 100 AVFs in 70 patients was evaluated during four years. Seventy five cases of CRF patients who were referred for AVF during January 1996 to December 2000 [1375-1379] were selected and operated upon AVF by a given surgeon with the same technique [end-to-side] and followed for two years regularly, In addition to underlying disease such as diabetes mellitus, atherosclerosis and inappropriate vessels another factors such as hypotension and bleeding of aneurismal vessels were recorded when AVF failed. Five out of 75 patients were excluded from this study because of impossible insertion of AVF due to severe damage and thrombosis of peripheral vessels, One hundred AVFs were inserted in 70 patients, 53 in snuff box of left hand, 26 in distal of left forearm, 17 cases in left arm and 4 ones in snuff box of right hand. Thirty percent failed primarily [before dialysis] commonly due to drop in blood pressure and among the remaining 70%, 47 patients had functional AVF for at least 20 months and 23 of them 7.5 months functioned for then failed monthly due to hypotension during hemodialysis [p=0.006]. Hypotension was the cardinal cause of failure of AVFs in CRF patients. We can reduce failure rate of AVFs by monitoring and controlling the blood pressure during hemodialysis and prevent hypotension by salted regimen intake