Brachiobasilic arteriovenous fistula for hemodialysis access: experience at King Hussein Medical Center

Objective: To evaluate the [one, two, three] year primary and secondary patency of brachiobasilic arteriovenous fistula [BBAVF] as hemodialysis vascular access and procedure complications at King Hussein Medical Center

Methods: A retrospective single-center study, analyzing the patency of 129 BBAVF procedures for hemodialysis vascular access and associated complications. Follow up patency was assessed by adequacy of BBAVF for hemodialysis over 3 years' period

Results: [One, two, three] year primary patency was [75, 62, 47] % respectively and [one, two, three] year secondary patency was [77, 64, 50] % respectively. Failure of maturation was seen in 16 patients [12%]. Hematoma developed in 5 patients [3.9%]. Bleeding related to infection developed in 3 patients [2.3%]. Wound infection developed in 13 patients [10.1%]. Arterial steal developed in 14 patients [10.9%]. Venous hypertension developed in 12 patients [9.3%]. Ischemic monomelic neuropathy developed in 2 patients [1.6%]. Pseudoaneurysm at puncture sites developed in 12 patients [9.3%]. Thrombosis developed in 24 patients [19%]. There was no procedure related mortality

Conclusion: BBAVF is an important and effective option in KHMC for chronic renal failure patients requiring hemodialysis with acceptable patency and complication rates

Treatment of venous outflow stenosis in hemodialysis arteriovenous fistulae using percutaneous transluminal angioplasty: our experience at King Hussein medical center

To evaluate the technical success and primary patency of percutaneous transluminal angioplasty as a modality of treatment for outflow venous stenosis in arteriovenous fistulae used as hemodialysis access. This is a retrospective, single center review which was conducted between August 2008 to August 2009, analyzing the results of percutaneous transluminal angioplasty used to treat 49 patients with short segment venous outflow stenosis. Patency was assessed by clinical examination and Doppler ultrasound scanning over a follow up period of one year. The immediate technical success rate of percutaneous transluminal angioplasty was 98%. The primary patency at six months, and one year were 83% and 53% respectively. One patient developed rupture of the vein at the site of angioplasty. Six patients died during the follow up period. The deaths were not related to the procedure or access failure. Percutaneous transluminal angioplasty is an effective method for treatment of venous outflow stenosis in surgically created arteriovenous fistulae, with excellent technical success, acceptable one year primary patency, and low complications rate

Result of supra-genicular femoropoliteal bypass done for critical limb ischemia

To report our experience with supra-genicular femoropopliteal bypass performed for critical limb ischemia. This is a retrospective review of supra-genicular femoropopliteal bypass were performed at our vascular surgery unit in King Hussein Medical Center, Amman, Jordan, between March 2008 and March 2010. Sixty three patients [49 male, 14 female] had 67 procedures [bilateral in 4 patients]. Fifty seven procedures done in 53 patients for critical limb ischemia were followed up for twelve months. During this period eight patients were lost to follow-up and were also excluded from the analysis. Records of the remaining 45 patients [35 male, 10 female] with 49 procedures were analyzed for operative details, patient risk factors, primary patency rates, complications, limb salvage rates. The surgical technique was uniform. Follow-up was clinical and by duplex scanning at six weeks, three and six months, and one year. Graft patency was considered terminated if the patient had an occluded graft or needed further procedures to keep the graft patent. In 31 [63.3%] limbs the indication for the procedure was tissue loss, while in 18 [36.7%] it was rest pain. The primary end point was primary graft patency calculated as 69.4% [reversed long saphenous vein 83.3%, prosthetic 61.3%]. The limb salvage rate was 83.7% [reversed long saphenous vein 88.9%, prosthetic 80.6%]. Five major limb amputations were done for non-healing wounds and three for prosthetic graft infections. Procedure related complications included surgical wound problems,[5] and nerve injuries.[4] The most ominous complication was prosthetic graft infection as three out of four resulted in graft occlusion and removal and eventual limb loss while one was replaced by saphenous vein. Perioperative 30 day mortality was two [3.8%] patients while another six [11.3%] died during the one year follow up period. Supra-genicular femoropopliteal bypass performed for critical ischemia has an acceptable patency rate at one year and is an effective mean of limb salvage. Prosthetic graft infections are a main cause of limb loss. The use of vein conduits should be aggressively pursued

Results of vascular clip closure device at King Hussein medical center

To assess the results of vascular clip closure devices used following percutaneous transfemoral endovascular procedures. This is a retrospective review of 69 patients who were managed with vascular clip closure device following transfemoral peripheral endovascular interventions during the year 2009, at King Hussein Medical Center. The success of the device in achieving hemostasis, as well as the associated complications were evaluated. Technical success defined as successful deployment of the device was achieved in 65 patients. Two minor complications and one major complication occurred following the deployment of the device. Femoral arterial access clip closure devices are both safe and effective, and are advised to be used in patient at high risk of bleeding at the arterial access site

Percutaneous transluminal angioplasty of popliteal artery steno-occlusive atherosclerotic disease at the king Hussein medical center: two year primary patency

To evaluate the two year primary patency following the percutaneous transluminal angioplasty [PTA] used to treat popliteal artery steno-occlusive atherosclerotic disease in the King Hussein Medical Center [KHMC]. A retrospective single-center study, analyzing the patency of 92 PTA procedures of the popliteal artery performed in 86 patients. Follow up patency was assessed by clinical examination, the ankle-brachial pressure index, and color duplex scanning over two years. Two year primary patency following popliteal artery PTA was 76% for stenotic lesions versus 37% for occlusive lesions. There was no procedure related periprocedural mortality. Popliteal artery PTA is performed effectively in the KHMC for patients with disabling intermittent claudication and critical lower limb ischemia with better results in stenotic lesions in comparison to occlusive lesions