Aneurisma venoso yuxta-anastomótico en fístula arterio-venosa para hemodiálisis / Juxtaanastomotic venous aneurysm in arteriovenous fistula for hemodialysis

Introducción: A pesar del gran avance técnico que representan las fístulas arterio-venosas internas para la hemodiálisis, estas no están exentas de complicaciones que comprometen su durabilidad. Entre ellas se encuentran los aneurismas venosos yuxta-anastomóticos. Objetivo: Presentar el tratamiento quirúrgico utilizado para reparar los aneurismas venosos yuxta-anastomóticos. Presentación del caso: Paciente de 54 años, de género femenino y color de piel negra. Presentó antecedentes de padecer insuficiencia renal crónica de 12 años de evolución, con transplante renal fallido, la cual tuvo un aneurisma venoso yuxta-anastomótico, localizado en una fístula arterio-venosa húmero-cefálica en miembro superior izquierdo, que fue confirmado por eco-doppler. Se emplearon como tratamiento quirúrgico la aneurismectomía y el injerto por sustitución con prótesis vascular expandible de poli-tetrafluoretileno. Finalmente, se preservó la fístula arterio-venosa, así como su permeabilidad. Conclusiones: La evolución fue satisfactoria en cuanto a su durabilidad y utilización como vía de acceso para la hemodiálisis(AU)

Introduction: Despite the great technical advance represented by internal arterio-venous fistulas for hemodialysis, these are not exempt from complications that compromise their durability. Among them are juxtaanastomotic venous aneurysms. Objective: Present the surgical treatment used to repair juxtaanastomotic venous aneurysms. Case presentation: 54-year-old patient, female and black skin color. She presented a history of chronic renal failure of 12 years of evolution, with failed kidney transplant, which had a juxtaanastomotic venous aneurysm, located in a humerus-cephalic arterio-venous fistula in the left upper limb, which was confirmed by Doppler echo. Aneurysmectomy and replacement grafting with expandable polytetrafluorethylene vascular prostheses were used as surgical treatment. Finally, the arterio-venous fistula was preserved, as well as its permeability. Conclusions: The evolution was satisfactory in terms of durability and use as an access route for hemodialysis(AU)

Percutaneous intervention for symptomatic central vein stenosis in patients with upper limb arteriovenous dialysis access

Central venous stenosis is an important hindrance to long-term maintenance of arteriovenous access in the upper extremities in dialysis patients. Aim The present study was done to determine feasibility and clinical success of endovascular approach for the treatment of symptomatic central venous stenosis associated with significant ipsilateral limb edema in dialysis patients with vascular access in the upper limb. Methods A database of hemodialysis patients who underwent endovascular treatment for central venous stenosis from January 2014 to January 2017 at our institute was retrospectively reviewed. Follow-up was variable. Results The study included ten patients (6 men and 4 women) with a mean age of 45.2 years, who underwent thirteen interventions during a period of 3 years. The technical success rate for endovascular treatment was 100%. One patient underwent primary PTA (percutaneous transluminal angioplasty). Seven patients underwent primary PTA and stenting. Three patients underwent secondary PTA. One among these patients underwent secondary PTA twice along with fistuloplasty. One patient underwent secondary PTA with stenting. No immediate complications were encountered during the procedure. Our study shows a primary patency rate of 67% and 33% at 6 months and 12 months for PTA with stenting. Our study also shows secondary or assisted primary patency of 75% at 6 months of follow-up. Conclusions Endovascular therapy (PTA) with or without stenting for central venous stenosis is safe, with low rates of technical failure. Multiple additional interventions are the rule and long-term patency rate is not very good.

Fístulas arterio-venosas trombosadas para hemodiálisis y su tratamiento / Thrombosed hemodyalisis arteriovenous fistulae and their treatment

Introducción: La trombosis constituye la principal causa de disfunción y pérdida de las fístulas arterio-venosas para hemodiálisis. Objetivo: actualizar los aspectos relacionados con los principales tratamientos de las fístulas arterio-venosas trombosadas. Fuente de los datos: Se realizó la búsqueda de artículos sobre el tema en la base de dato Medline, artículos publicados en páginas web y revistas líderes en la publicación de estudios sobre fístulas arterio-venosas para hemodiálisis. Síntesis de los datos: La trombosis es la complicación más frecuente de las fístulas arterio-venosas, su principal causa lo constituyen los errores técnicos en la trombosis precoz y las estenosis en las tardías. Conclusiones: La repermeabilización precoz de las fístulas arterio-venosas y tratar las estenosis en el mismo acto quirúrgico, es lo que se recomienda. Para tales fines se cuenta con las técnicas quirúrgicas identificadas como el gold standard y las endovasculares, con resultados alentadores(AU)

Introduction: Thrombosis is the most frequent cause of dysfunction and loss of hemodyalisis arteriovenous fistula. Objective: To update knowledge on the epidemiology, the characteristics and the main treatments of the thrombosed hemodyalisis arteriovenous fistulae. Data source: A literature research about the topic was made in Medline, in articles published in different web pages and in leading journals in the publication of studies about hemodialysis arteriovenous fistula. Data synthesis: Thrombosis is the most frequent complication of the arteriovenous fistula, being the technical errors the main cause of premature thrombosis and the stenosis in the late thrombosis. Conclusions: It is recommended to use early repermeabilization of the arteriovenuos fistulae and to treat stenosis in the same surgical act; for that purpose the surgical treatment identified as the "standard gold" and the endovascular technique achieve encouraging results(AU)

Are Brain Natriuretic Peptide Levels Related To Flow Through Autologous Ateriovenous Fistulae For Chronic Haemodialysis

Formation of arterio-venous-fistulae (AVF) may exacerbate cardiac failure in the ever increasing, elderly population on haemodialysis. Brain Natriuretic Peptide (BNP) may prove a useful marker of cardiac failure in this population. We aimed to determine effect of creation of an AVF and flow in AVF on BNP levels. Ten patients undergoing primary formation of an upper limb autologous AVF (pre-dialysis), were recruited. Serum BNP (pg/ml) and flow in AVF (cm3/s) were documented pre-operatively, and then 2, 6 and 12 weeks post-operatively. The relationship between flow and BNP levels was assessed. Ten patients (6 male), mean age of 66yrs were recruited. Five patients had a radio-cephalic and 5 had a brachio-cephalic AVF formed. There was no correlation between BNP levels and flow within the AVF (r=0.34, p=0.28) at any time point. There was a general trend towards increased flow in the AVF over time, with only the change between flow at 2-weeks and 3-months postoperatively reaching significance, p=0.043. There was a general trend for BNP to fall over time in the postoperative period, with no significant change between the postoperative sampling time points. BNP levels do not correlate with flow across an AVF.

Persistent Trigeminal Artery with a Cerebellar Branch and Trigeminal-Cavernous Fistula from Ruptured Aneurysm: Transarterial Coil Embolization / 신경중재치료의학

We report a case of persistent trigeminal artery (PTA) with a cerebellar branch supplying the posterior inferior cerebellar arterial territory, combined with a trigeminal-cavernous fistula resulting from rupture of an aneurysm at proximal trunk of the PTA. The fistula was successfully treated by transarterial coil embolization with preservation of PTA.

New Operative Treatment of Hyperfunctioning Arteriovenous Fistula for Hemodialysis: A Case Report

Hyperfunctioning fistulas are rare complications of hemodialysis access. They give rise to devastating complications, including a steal syndrome with reduced perfusion to the dependent limb and cardiac insufficiency caused by the high shunt volume. Numerous techniques such as fistula ligation, banding, plication, T-banding and distal revascularization with interval ligation have been developed. However, each technique bears the potential for its own complications, such as failure to resolve symptoms, recurrence and technical difficulty. Herein, we report a new technique that remedies the shortcomings of the other procedures. All the patients first underwent partial aneurysmal resection and lateral aneurysmorrhaphy of the enlarged vein from just distal to the anastomosis using a 6-0 prolene running sutures and then external wrapping with an 8 mm expanded polytetrafluoroethylene graft was done for a length of approximately 5 cm. Two patients with hyperfunctioning brachiocephalic arteriovenous fistula were treated this way. Doppler measurement of the fistula flow showed a mean flow reduction of about 60%. The procedure was effective and safe, with a mean follow up of 2 months.

Scalp Edema and Insufficient Maturation of Arteriovenous Fistula Due to Cephalic Vein Variation in Patient with End Stage Renal Disease / 대한신장학회잡지

Vascular access is the prerequisite and mainstay of extra-corporeal renal replacement therapy and its management is central to maintain the health and quality of life of end-stage renal disease (ESRD) patients. Success of maturation of AVF depends on the quality and size of the vessels and anatomic structure. There have been several reports on non-maturation by vascular stenosis or small vascular size after AVF procedure, but reports demonstrating that AVF non-maturation is due to by latent vessel variation are uncommon. We report a rare case of scalp edema and insufficient maturation of AVF due to cephalic vein variation in a 27 year-old female patient with ESRD on hemodialysis. Conclusively, meticulous observation on not only vessels used for AVF but also its proximal connection to other vessels should be considered.

Delayed Superficial Transposition of Cephalic Vein for Salvage of Brachiocephalic FIstula

The small diameter and sclerosis of the veins are the main causes of failure of autogenous arterio-venous fistula(AVF) for hemodialysis. In addition, the deep location of veins prevents adequate access postoperatively, as exemplified by the frequent requirement of transposition of basilic veins either primarily or delayed. As for the cephalic veins, superficial transposition was not emphasized. We report a case of brachiocephalic AVF which required delayed superficial transposition for access. We emphasize that the depth of veins should be considered for adequate creation of AVF.

Functioning Paraganglioma Manifested Cerebral Hemorrhage and Combined with Coronary Arterio-Venous Fistula

Extra-adrenal pheochromocytomas, also called functioning paragangliomas are uncommon retroperitoneal tumor, manifesting with similar symptoms and signs to adrenal pheochromocytoma. In this report, we present a case of a 46-year-old women who had had paroxysmal hypertension and palpitation for four years. An abdominal mass, the size of an adult fist, was noted, with symptom of a cerebral hemor rhage and cardiac ischemia caused by a coronary arterio-venous fistula. The cerebral hemorrhage symptoms were improved spontaneously. The abdominal mass determined to be a functioning paraganglioma by complete resection. The coronary arterio-venous fistula was surgically corrected a month after resection of the tumor. The patient was freed from the symptoms and signs of a pheochromocytoma, including palpitations and hypertension. There has been norecurrence for a year and half following the removal of the mass.

Tinnitus Caused by Traumatic Posterior Auricular Artery-Internal Jugular Vein Fistula / 대한이비인후과학회지

A patient suffering from arteriovenous fistula which developed after a traffic accident was recently treated. The patient noticed pulsatile tinnitus in the right orbital region two months after the accident. On the first visit, clinical impression of this case was diagnosed as a carotid-cavernous fistula. But the angiography documented a fistula between the posterior auricular artery and internal jugular vein. Although rare, this arteriovenous fistula should have been included in the differential diagnosis of pusatile tinnitus in the orbital region. An arteriovenous fistula between the posterior auricular artery and internal jugular vein has not previously been reported.

Valuation of MR Imaging for Diagnosis of Carotid-cavernous Sinus Fistulae / 实用放射学杂志

Objective To discuss the diagnostic value of MR in carotid-cavernous sinus fistulae(CCF). Methods Conventional MRI and 3D TOF MRA were performed in 23 cases of CCF confirmed by DSA. The MRI and MRA appearances of CCF were reviewed. Results The main MRI and MRA findings of CCF included enlargement of cavernous sinus, distortion and dilatation of the superior ophthalmic vein in the involved side in all cases.Dilatation of the inferior ophthalmic vein in 3 cases, superficial cerebral veins in 5 cases,dilatation of pterygoid venous plexus in 2 cases, superior petrosal sinus in 3 cases, and inferior pertrosal sinus in 2 cases. In the counterside, dilatation of cavernous sinus were found in 3 cases. Opening of posterior communicating artery in the circle of Willis happened in 17 cases. Conclusion MRI combined with MRA is able to make a reliable diagnosis of CCF, and is also able to demonstrate the condition of compensatory blood supply in brain, which is useful in the decision of the theraputic plan.

A case of Delayed Renavascular Hypertension in Stab Injury Induced Renal Artery-IVC Fistula and Its Renal Artery Aneurysm / 대한신장학회잡지

Renovascular hypertension is the most common cause of curable hypertension. The exact prevalence of renovascular hypertension is not known, and the diagnosis is probably missed in many patients. It is important to recognize this condition in clinical practice, first, because it is a correctable form of secondary hypertension, and second, it is a reversible cause of renal failure in some patients. The Basic lesion of renovascular hypertension is stenosis of the renal artery caused usually by either one of the two most common etiologies, atherosclerosis or fibromuscular dysplasia. Other known causes of renovascular hypertension include aneurysm, embolism, arterio venous fistula, neurofibromatosis, tumor, hematoma, foreign body induced compression, and trauma. Its treatment can be divided into surgical intervention, percutaneous transluminal balloon angioplasty, and medical therapy. Recently, selective embolization has been introduced as a useful alter native therapeutic modality in the management of arterio venous fistula and aneurysm. We report a case of delayed renovascular hyper-tension in stab injury induced renal artery-IVC fistula and its renal artery aneurysm in a 20 year-old man. Embolization of the renal arterio venous fistula was achieved by inserting a detachable balloon, and embolization of the renal aneurysm and lumbar artery pseudoaneurysm was performed using micro-eo-ils. Arteriogram immediately after embolization con- firmed complete occlusion of the ancurysm and closure of the arterio venous fistula. After the procedure, improvement of blood pressure was noted in the patient who is currently being followed-up on an out-patient basis.

A case of congenital renal arterio-venous malformation with huge venous dilatation / 대한비뇨기과학회지

A 45-years-old woman complained mild right flank pain and easy fatigability. Right abdominal bruit was heard by auscultation. CT and angiography revealed a huge venous dilatation in renal sinus measuring 10.2cm in diameter. And similar findings were shown in MRI. We performed nephrectomy and confirmed arteriovenous fistula in main renal artery and vein.