Fístula arteriovenosa con elevación de la vena basílica. Reporte de casos / Arteriovenous fistula with basilic vein elevation. Case series

RESUMEN Las fístulas arteriovenosas (FAV) se requieren para hemodiálisis permanente. Las recomendaciones de acceso preferidas son radio cefálica, braquiocefálica, braquio-basilica con elevación o transposición y tunelización. El objetivo de este trabajo fue presentar la experiencia con la creación de FAV con vena basílica elevada. Entre junio 2017 y marzo 2020, se realizaron trece FAV braquio-basílicas con técnica de elevación de acuerdo al registro de cirugías realizadas por la Unidad, siete hombres y seis mujeres. La edad media fue 65,7 años. En el post operatorio temprano hubo hematomas de antebrazo en dos casos, infección de herida en dos casos, así como un caso de edema. En el periodo de seguimiento, tres no maduraron, y tres pacientes fallecieron; mientras que las FAV restantes aún están funcionando. En conclusión, la FAV braquio-basilica con vena elevada es una alternativa en pacientes que ya han agotado otras opciones.

ABSTRACT Arteriovenous fistula (AVF) is necessary for hemodialysis access. The preferred configurations are radial-cephalic, brachial-cephalic, and brachial-basilic with elevation or transposition and tunneling. The purpose of this study was to present our experience for creating arteriovenous fistulae using the elevation of the basilic vein technique. Between June 2017 and March 2020, thirteen brachial-basilic fistulae with elevation of the basilic vein were performed in seven male and six female subjects. Their mean age was 65.7 years. During the early post-op period, there were two cases of forearm hematoma, wound infection in two cases, and edema in one case. During the follow-up period, three fistulae did not have a good progression, and three patients died; the remaining AVFs are still working. In conclusion, brachial-basilic AVF with elevation of the basilic vein is an alternative in patients who have already exhausted other access options.

Nursing care with surgical arteriovenous shunt in renal dialysis: a validation study / Cuidado de enfermería con la derivación arteriovenosa quirúrgica en la diálisis renal: estudio de validación / Cuidado de enfermagem com a derivação arteriovenosa cirúrgica na diálise renal: estudo de validação

ABSTRACT Objectives: to validate a care protocol for the monitoring and prevention of arteriovenous fistula complications. Methods: a validation methodological study with a quantitative approach, developed in a university hospital in the city of Rio de Janeiro. Results: scientific evidence was gathered from 20 researches. A care protocol was developed, composed of 15 items and divided into 3 sessions. The protocol was validated by a group of 11 experts, obtaining a content validity index of 0.95. Conclusions: the protocol proposes nursing care capable of preventing and monitoring arteriovenous fistula complications, punctured with a traditional technique, taking into account the actions implemented from patients' entry into the machine until the end of therapy.

RESUMEN Objetivos: validar un protocolo asistencial para monitoreo y prevención de complicaciones de fístula arteriovenosa. Métodos: estudio metodológico de validación con abordaje cuantitativo, desarrollado en un hospital universitario de la cuidad de Río de Janeiro. Resultados: se extrajeron evidencias científicas de 20 encuestas. Fue elaborado un protocolo asistencial compuesto por 15 ítems divididos en 3 sesiones. El protocolo fue validado por un grupo de 11 expertos, obteniendo un índice de validez de contenido de 0.95. Conclusiones: el protocolo propone cuidados de enfermería capaces de prevenir y monitorear las complicaciones de la fístula arteriovenosa, puncionada con técnica tradicional, tomando en consideración las acciones implementadas desde la entrada del paciente en la máquina hasta el final de la terapia.

RESUMO Objetivos: validar um protocolo assistencial para monitoramento e prevenção de complicações de fístula arteriovenosa. Métodos: estudo metodológico de validação com abordagem quantitativa, desenvolvido em um hospital universitário do Rio de Janeiro. Resultados: foram extraídas evidências científicas de 20 pesquisas. Foi elaborado um protocolo assistencial composto por 15 itens divididos em 3 sessões. O mesmo foi validado por um grupo de 11 especialistas, obtendo um índice de validade de conteúdo de 0.95. Conclusões: o protocolo propõe cuidados de enfermagem capazes de prevenir e monitorar as complicações da fístula arteriovenosa, puncionada com técnica tradicional, levando em consideração as ações implementadas desde a entrada do paciente na máquina até o final da terapia.

Effect of contralateral saphenous vein bypass in the treatment of chronic femoral vein obstruction / 国际外科学杂志

Objective To study the feasibility and practicability of contralateral saphenous vein bypass in the treatment of chronic femoral vein obstruction.Methods A retrospective analysis was consisted of 33 patients who received contralateral great saphenous vein bypass during the period of June 2013 to June 2017 in the Deperrtment of Biloary Vascular Surgery of Shengjing Hospital of China Medical University.All patients after operation were followed up of 2 months deadline to August 2017 by telephone or outpatient,the follow-up content including lower limb activity after resting and subjective sensation,lower limb swelling degree and so on.The measurement data was expressed by mean standard deviation ((x) ± s),paired samples t test was used for comparison among groups.Linear correlation coefficient was used to describe the difference between ankle circumference and the time to maintain anticoagulation therapy after acute thrombosis,then we explored the effect and advantages of this surgical methods.Results Compared with the preoperative index,the activated partial thromboplastin time [(21.93 ± 3.36) svs(18.11 ±2.24)s,P＜0.05],the thrombus elastic map R value[(5.45 ±0.73)min vs(4.20 ± 0.39) min,P ＜ 0.05],the D-dimer [(3 502.79 ± 4 028.02) μg/L vs (5127.76 ± ± 4722.42) μg/L,P ＜ 0.05] and the ankle circumference [(22.23 ± 1.28) cm vs (25.38 ± 0.78) cm,P ＜ 0.05] were improved,and the prothrombin time [(12.63 ± 1.74) s vs (12.32 ± 1.14),P ＞0.05] showed no difference before and after the operation (P ＞ 0.05).With the extension of time,the effect of bypass on the treatment of lower limb edema weakened.Postoperative follow-up indicated that 33 cases of patients were unobstructed and returned to normal state,21 cases could tolerated normal physical activity and had no or mild swelling,12 cases occasional had moderate swelling while the swelling could disappear after lying down for a rest,symmetric of double lower limbs in all patients returned to acceptable degree and did not affect the clothing or appearance.Conclusion The contralateral saphenous vein bypass operation has better effect and less trauma,it can improve the lower limb edema and endogenous coagulation system of chronic obstructive iliac vein disease,and the effect is better after conservative treatment for half a year.

Treatment of Hemodialysis Vascular Access Rupture Irresponsive to Prolonged Balloon Tamponade: Retrospective Evaluation of the Effectiveness of N-Butyl Cyanoacrylate Seal-Off Technique

OBJECTIVE: The current study retrospectively evaluated whether the percutaneous N-butyl cyanoacrylate (NBCA) seal-off technique is an effective treatment for controlling the angioplasty-related ruptures, which are irresponsive to prolonged balloon tamponade, during interventions for failed or failing hemodialysis vascular accesses. MATERIALS AND METHODS: We reviewed 1588 interventions performed during a 2-year period for dysfunction and/or failed hemodialysis vascular access sites in 1569 patients. For the angioplasty-related ruptures, which could not be controlled with repeated prolonged balloon tamponade, the rupture sites were sealed off with an injection of a glue mixture (NBCA and lipiodol), via a needle/needle sheath to the rupture site, under a sonographic guidance. Technical success rate, complications and clinical success rate were reported. The post-seal-off primary and secondary functional patency rates were calculated by a survival analysis with the Kaplan-Meier method. RESULTS: Twenty ruptures irresponsive to prolonged balloon tamponade occurred in 1588 interventions (1.3%). Two technical failures were noted; one was salvaged with a bailout stent-graft insertion and the other was lost after access embolization. Eighteen accesses (90.0%) were salvaged with the seal-off technique; of them, 16 ruptures were completely sealed off, and two lesions were controlled as acute pseudoaneurysms. Acute pseudoaneurysms were corrected with stentgraft insertion in one patient, and access ligation in the other. The most significant complication during the follow-up was delayed pseudoaneurysm, which occurred in 43.8% (7 of 16) of the completely sealed off accesses. Delayed pseudoaneurysms were treated with surgical revision (n = 2), access ligation (n = 2) and observation (n = 3). During the follow-up, despite the presence of pseudoaneurysms (acute = 1, delayed = 7), a high clinical success rate of 94.4% (17 of 18) was achieved, and they were utilized for hemodialysis at the mean of 411.0 days. The post-seal-off primary patency vs. secondary patency at 90, 180 and 360 days were 66.7 +/- 11.1% vs. 94.4 +/- 5.4%; 33.3 +/- 11.1% vs. 83.3 +/- 8.8%; and 13.3 +/- 8.5% vs. 63.3 +/- 12.1%, respectively. CONCLUSION: Our results suggest that the NBCA seal-off technique is effective for immediate control of a venous rupture irresponsive to prolonged balloon tamponade, during interventions for hemodialysis accesses. Both high technical and clinical success rates can be achieved. However, the treatment is not durable, and about 40% of the completely sealed off accesses are associated with developed delayed pseudoaneurysms in a 2-month of follow-up. Further repair of the vascular tear site, with surgery or stent-graft insertion, is often necessary.

Utilização da técnica do varal para angioplastia de estenose de veia central com stent-graft / Utilization of the through-and-through technique for central vein angioplasty using stent-graft

A estenose de veia central é uma das situações mais frequentes em pacientes com insuficiência renal crônica em hemodiálise. A angioplastia com o uso de stent-graft tem obtido bons resultados nestes casos. O sistema de liberação dos stents é de calibre maior, podendo dificultar sua navegabilidade em áreas de estenose ou tortuosidade acentuadas. A técnica do varal é comumente utilizada para o tratamento endovascular do aneurisma de aorta, permitindo atingir bom mecanismo de estiramento e facilitando a navegação do sistema de entrega da endoprótese. Descrevemos o caso de uma angioplastia de veia central com stent-graft na qual foi utilizada a técnica do varal para permitir a transposição da área de estenose.

The central vein stenosis is one of the most common conditions in patients with chronic kidney failure in a hemodialysis program. In these cases, angioplasty using stent-grafts has obtained good results. The stent-graft delivery system is generally of large diameter what can hinder its navigability in very severe stenosis or tortuosities. The through-and-through technique is commonly used for endovascular treatment of aortic aneurysms, making possible to achieve a good mechanism of stretch and easy navigation of the endograft delivery system. We report a case of a central venous stenosis in wich a stent-graft was inserted using the through-and-through technique in order to cross the lesion.

Interleukin-10 and Tumor Necrosis Factor-alpha Polymorphisms in Vascular Access Failure in Patients on Hemodialysis: Preliminary Data in Korea

Neointimal hyperplasia causes vascular stenosis and subsequent thrombosis, which result in vascular access failure in patients undergoing hemodialysis. Interleukin-10 (IL-10) and tumour necrosis factor-alpha (TNF-alpha) are involved in this inflammatory process. The aim of this study was to investigate the relationship between vascular access failure and various inflammatory markers including the genetic polymorphisms of IL-10 and TNF-alpha. Seventy-five patients on hemodialysis with an arteriovenous fistula in place or an artificial graft (18 with vascular access failure and 82 without failure) and 98 healthy individuals were genotyped for IL-10 and TNF-alpha single nucleotide polymorphisms. Clinical and laboratory data including serum IL-10 and TNF-alpha levels were compared. Stimulated IL-10 levels, from in vitro incubation of blood with lipopolysaccharide, were also obtained and compared. Female gender, hypoproteinemia, and hypertriglyceridemia were associated with vascular access failure. The basal TNF-alpha level was significantly higher in patients with access failure. The distribution of IL-10 and TNF-alpha genotype did not differ among patients with or without access failure. This study could not demonstrate a relationship between genetic polymorphisms and vascular access failure. However, an altered immune response and inflammation might contribute to vascular access failure.

Intravascular interventional therapy combined with convention surgery for treatment of lower extremity multilevel atherosclerotic occlusive disease / 中国医师进修杂志

Objective To study the treatment effect of multilevel atherosclerotic occlusive disease of lower extremity. Methods From July 2004 to January 2008,intraoperative iliac balloon angioplasty and stenting combined with blood vassel prosthesis or autogenous reversed great saphenous vein bypass were performed on 32 patients suffering from lower extremity multilevel atheresclerotic occlusive disease. Results Surgical procedures were technically successful in all patients. The effect was good,intermittent claudication disappear, and rest pain improved. Preoperative vs postoperative ABI was 0.28±0.14 vs 0.65±0.18 (P<0.05 ).Thirty patients were followed up,the mean following period was 18 months (range of 3-36 months).Conclusions Simultaneous intravaseular interventional therapy combined with vascular bypass are effective in the treatment for patients with severe and multilevel atheroselerotie occlusive disease of lower extremity, the operation is less traumatic and the procedures are easy to do.The result is satisfactory.

Venous Backflow in a Patent Polytetrafluoroethylene Arteriovenous Graft: A case report / 대한흉부외과학회지

We report a case of a 48-year-old woman with end-stage renal failure who had a Polytetrafluoroethylene graft for hemodialysis and who had developed complications of venous outflow stenosis and venous backflow. Although venous backflow is an harbinger of graft failure, it is not enough reason to abandon the graft immediately. The patient was able to utilize her graft for 6 further months.

Snuffbox Arteriovenous Fistula Formation for Hemodialysis / 대한흉부외과학회지

BACKGROUND: The arteriovenous fistula (AVF), which maintains satisfactory blood flow, is necessary to the patients of end-stage renal disease for the long term hemodialysis. We performed the snuffbox fistula as the first operation for hemodialysis vascular access. This study was performed to investigate the patency rates, complications, risk factors for occlusion of the AVF, and the types of reoperations. MATERIAL AND METHOD: We performed 146 snuffbox fistulas from Jun. 1994 to Dec. 2001. The records of the patients except six patients who were lost from follow up were analyzed retrospectively. Mean age and male:female ratio were 52+/-15 years (range, 17~79 years) and 80:60 respectively. Diabetes mellitus and hypertension were combined in 47 patients and 101 respectively. Preoperative levels of creatinine and potassium were 9.09+/-3.68 mg/dL (range, 2.55~20.09 mg/dL) and 4.7+/-0.9 mmol/L (range, 2.3~8.1 mmol/L). One hundred thirteen cases of the snuffbox fistulas were done at left side hand and the others at right hand. RESULT: Mean follow up period of the patients was 41.8+/-31.0 months (range, 0.2~108.8 months). During the follow up period, 35 occlusions of AVF occurred and these AVFs were patent for 9.8+/-10.1 months (range, 0.1~40.4 months). The patency rates of 1 month, and 1, 2, 3, 5 years were known as 92.8, 80.2, 73.8, 71.3, 69.6% respectively. Right sided snuffbox fistulas (p-value=0.045) and old age (p-value=0.048) were revealed as significant risk factors for occlusion of AVF. The postoperative complications consisted of occlusions of AVF caused by intimal hyperplasia of vein in 24, thrombosis in nine, stenosis of anastomosis site in three, and venous hypertensions in two. After the first operation 37 patients underwent 86 reoperations. CONCLUSION: The snuffbox fistulas showed acceptable patency rates and low complication rates. The snuffbox fistulas as the first operation for AVF formation can be a good option for the patients with end-stage renal disease.

The clinical study of combined vein rearterization for treating thromboangiitis obliterans / 中国普通外科杂志

Twenty seven patients with obstruction of three branches below popliteal artery were divided into three groups and treated with three different kinds of arterioveinous reversal randomly. The results show that it is better to rebuild ischemic limb circulation with original vein rearterization on the femoral and popliteal planes than to do on the lower deep groups and original great saphenous rearterization for improving symptoms immediately and blood flow at future. It provides a new operation for obstruction of three branches below popliteal artery caused by thromboangiitis obliterans,arteriosclerosis obliterans and other diseases.

Clinical analysis of staged arteriovenous shunts for the treatment of arterial occlusive disease of the limbs / 中国普通外科杂志

Objective To evaluate the result of staged arteriovenous shunts for the treatment of thromboangiitis obliterans(TAO) and arterial sclerosis obstruction (ASO). MethodsData of 176 cases undergoing this procedure were retrospectively reviewed. ResultsIn this group, 147 cases (83 5%) were followed up with a median of 9 8 years. Pain and/or claudication disappeared in 86 out of 90 cases (95 5%) treated by low positioned shunt one week postoperatively, with a limb salvage rate of 100%. Among 57 cases treated by high positioned shunts of the lower limbs, pain and claudication disappeared in 43 cases (75 4%) 2~3 weeks postoperatively. Postoperative amputation has to be performed in 5 cases with a limb salvation rate of 91%. ConclusionsThe clinical result of this staged arteriovenous shunts is satisfactory for the treatment of thromboangiitis obliterans(TAO) and arterial sclerosis obstruction (ASO).