Hemodynamic assessement of surgically created arteriovenous fistula for hemodialysis

Fifty patients with chronic renal failure were involved in this study. A radiocephalic fistula of the Brescia-Cimino type was newly created for hemodialysis in 45 patients. Nine of these 45 patients, showed an immediate fistula failure. Several hemodynamic parameters were found to be of important prognostic values to ensure a successful fistula outcome with a flow rate of >200 ml/min. A preoperative subclavien vein flow of >300 ml/min. and an arterial inflow of >/40 ml/min. were associated with a high fistula success rate. Besides, a postoperative decrease in resistively index [RI] of the inflow artery of >/0.1 resulted in a 100% success rate. Flow measurements were done by utilizing color flow duplex imaging. Therefore, the use of duplex imaging is beneficial during the evaluation of patients, who are candidates for an arteriovenous fistula operation. The remaining five patients had an already cerated arteriovenous fistula. They were studied with high output fistulas. This category of patients underwent banding correction of the existing fistulas. The banding technique resulted in reduction of fistula flow rates by a mean value of more than 60%

Diabetic foot: risk factors and surgical management

52 patients with diabetic foot were divided into five groups according to the degree of foot affection. They were studied to identify the risk factors for their affection and the different surgical procedures for management. It was found that smoking, duration of diabetes, poor diabetic control, hypoproteinemia, hypoalbuminemia, heavy proteinurea, high blood urea and serum creatinine, had significant relation with the degree of foot affection. Plain radiography demonstrated gas formation in 44.2% of patients and bone affection in 32.7%. Arteriography showed that 14.3% of patients had atheromatous plaques and lumenal irregularity of the femoral artery, while popliteal occlusion was found in 25.7% and occlusion of the remaining foot and leg vessels was found in 45.7%. Aneurysmal dilatation of the small vessels of the leg was found in 8.6% of cases. The mean Doppler pressure and the mean ankle to brachial supine systolic index showed significant decrease [P <0.001] with the increased severity to foot affection. Doppler curve affection also showed a significant correlation [P <0.02] with the degree of foot affection. Photoplethysmographic changes of the small vessels of the big toe correlated significantly with the degree of foot affection. The various surgical procedures are presented and discussed

Retrospective study of 100 cases of created arterio-venous fistulae for chronic renal failure

One hundred cases with chronic renal failure have benefited from creation of arterio-venous fistula [AVF]. Original Brescia technique was applied in 71 cases with excellent results. Other techniques used were as follows: end cephalic vein to side radial artery in 19 cases, brachial antecubital AVF in 5 cases, basilic vein transposition fistula in one case, end-to-end [cephalic vein to radial artery] in one case, venous loop of autogenous great saphenous vein in two cases and preserved allograft of great saphenous vein in one case. Complications were encountered in 14 percent of cases. They included thrombosis, infection and secondary hemorrhage. Avoidance of repeated venipunctures in the forearm before creation of AVF maintains patent foream veins and allows for creation of a successful AVF

Arterial aneurysms [a review of 28 cases]

28 cases having arterial aneurysms were revised, three carotid, 5 aortic, 8 at the upper limb vessels and 12 affecting the lower limb vessels. 46% were atherosclerotic, 32% traumatic, 11% anastmotic, and 11% mycotic. Atherosclerotic aneurysms were common after the age of 50, other occurred in younger age groups. They were presented by different clinical manifestations according to site and nature of aneurysm. All cases were subjected to plain X-ray, ultrasonography and angiographic study. C.T. were done for three cases. Twenty-four cases were operated upon with success reaching 83.3%. Failures were due to bad general condition of the patients, bad distal run-off and over anticoagulation. Two patients died before surgery by rupture and two refused operation