Efecto del catéter de hemodiálisis en la permeabilidad de fístulas arteriovenosas / The impact of hemodialysis catheter on arteriovenous fistula permeability

Resumen Objetivo: Evaluar el impacto que tiene el uso de catéteres de hemodiálisis en la permeabilidad de fístulas arteriovenosas. Materiales y Método: Estudio observacional, analítico, tipo cohorte retrospectiva. Se calculó un tamaño muestral de 195 pacientes, seleccionados aleatoriamente a partir del total de pacientes diagnosticados con enfermedad renal crónica (ERC) terminal, a quienes se les realizó su primera fístula arteriovenosa (FAV) entre enero de 2014 y diciembre de 2018. Como variables resultado se consideraron la trombosis de FAV y el tiempo de permeabilidad. Para el análisis inferencial se utilizaron las pruebas de Chi cuadrado; RR (IC 95%); curvas Kaplan-Meier; regresión de Cox; considerando un valor de p significativo < 0,05. Resultados: El 52,3% utilizó catéter de hemodiálisis, de los cuales el 49,5% presentó trombosis de su FAV versus el 17,7% del grupo sin este antecedente (p < 0,001); estimándose en el análisis univariado un riesgo de trombosis 2,7 veces mayor en pacientes con catéter previo a la confección de su FAV (IC 95% 1,7 a 4,4). En el análisis multivariado, se identificó como único factor significativo el antecedente de catéter de hemodiálisis, estimándose que los pacientes usuarios de catéter previo a la confección de su FAV tienen 2,8 veces más riesgo de trombosis en el tiempo que quienes no utilizaron catéter (IC 95% 1,6 a 4,9), quienes además presentaron un tiempo de permeabilidad significativamente menor (p < 0,001) en comparación con pacientes sin antecedente de catéter (28,1 vs 43,9 meses). Conclusión: Identificamos el uso del catéter de hemodiálisis como un factor de riesgo de trombosis de fístulas arteriovenosas, afectando significativamente su permeabilidad en el tiempo.

Objective: To evaluate the effects of hemodialysis catheter on arteriovenous fistula (AVF) permeability. Materials and Method: We conducted a retrospective cohort study, including 195 patients randomly selected from all patients diagnosed with chronic renal failure, who had their first arteriovenous fistula between January 2014 and December 2018. The outcomes were arteriovenous fistula thrombosis and permeability. For data analysis we used Chi-square test; Relative-Risk (CI 95%); Kaplan-Meier analysis and Cox regression; p value less than 0.05 were considered as significant. Results: The 52.3% of the patients used hemodialysis catheter, from this group, the 49.5% had AVF thrombosis versus the 17.7% of the group without history of hemodialysis catheter (p < 0.001), estimating in the univariate analysis a risk of thrombosis 2.7 times higher in patients with catheter before the creation of their AVF (CI 95% 1.7 a 4.4), as well as, in the multivariate analysis the risk of AVF thrombosis was 2.8 times higher in this group of patients, being identified the history of hemodialysis catheter as the only significative risk factor for thrombosis. Additionally, the AVF permeability time in this group was significantly less (p < 0.001) than patients without history of hemodialysis catheter (28.1 vs 43.9 months). Conclusion: We identified the hemodialysis catheter as a risk factor of arteriovenous fistula thrombosis, decreasing significantly its permeability time.

Clinical factors that influence the occurrence of symptomatic pseudoaneurysms and arteriovenous fistulas after partial nephrectomy: multi-institutional study of renal function outcomes after one year of selective arterial embolization

ABSTRACT Purpose: Renal artery pseudoaneurysms (RAPs) and arteriovenous fistulas (AVFs) are rare but potentially life-threatening complications after partial nephrectomy (PN). Selective arterial embolization (SAE) is an effective method for controlling RAPs/AVFs. We assessed the clinical factors affecting the occurrence of RAPs/AVFs after PN and the effects of SAE on postsurgical renal function. Materials and Methods: Four hundred ninety-three patients who underwent PN were retrospectively reviewed. They were placed in either the SAE or the non-SAE group. The effects of clinical factors, including R.E.N.A.L. scores, on the occurrence of RAPs/AVFs were analyzed. The influence of SAE on the estimated glomerular filtration rate (eGFR) during the first postoperative year was evaluated. Results: Thirty-three (6.7%) patients experienced RAPs/AVFs within 8 days of the median interval between PN and SAE. The SAE group had significantly higher R.E.N.A.L. scores, higher N component scores, and higher L component scores (all, p <0.05). In the multivariate analysis, higher N component scores were associated with the occurrence of RAPs/AVFs (Odds ratio: 1.96, p=0.039). In the SAE group, the mean 3-day postembolization eGFR was significantly lower than the mean 3-day postoperative eGFR (p <0.01). This difference in the eGFRs was still present 1 year later. Conclusions: Renal tumors located near the renal sinus and collecting system were associated with a higher risk for RAPs/AVFs after PN. Although SAE was an effective method for controlling symptomatic RAPs/AVFs after PN, a procedure-related impairment of renal function after SAE could occur and still be present at the end of the first postoperative year.

Fístula arteriovenosa dural espinal: a propósito de un caso / Spinal dural arteriovenous fistula: a case report

Las fístulas arteriovenosas durales medulares son malformaciones vasculares adquiridas que constituyen una causa muy infrecuente de mielopatía progresiva (5-10 casos por millón de habitantes por año). La resonancia magnética es el estudio por imágenes de elección para su diagnóstico. A continuación presentamos el caso de una paciente femenina de 89 años, que consultó a la guardia de nuestra institución por un cuadro de paraparesia moderada asociada a parestesias e incontinencia urinaria posterior a esfuerzo físico. Se le diagnosticó una fístula arteriovenosa dural medular como causante de su cuadro. (AU)

Spinal dural arteriovenous fistulas (SDAVF) are acquired spinal vascular malformations and a rare cause of progressive myelopathy (5-10 new cases per year and per 1 million inhabitants). Magnetic resonance imaging is the diagnosis modality of choice. We present a case of a 89-year-old female patient who consulted the emergency department of our institution because of paraparesis and lower extremities paresthesias associated with urinary incontinence post physical effort. With the final diagnosis of spinal dural arteriovenous fistula, as a cause of the clinical symptoms. (AU)

Gradual treatment of arteriovenous fistula in femoral vessels as a complication of coronary angiography

Abstract Arteriovenous fistula due to coronary angiography intervention is rarely seen. Arteriovenous fistulas may be asymptomatic according to the size of the shunt, as well as to the heart failure. In this case report, we aimed to share gradual transition from endovascular methods to surgery and why surgical treatment is required for a patient who developed arteriovenous fistula after coronary angiography.

Síndrome de Ehlers-Danlos vascular: complicaciones vasculares graves en enfermos con hipermovilidad articular / Vascular Ehlers-Danlos syndrome: severe vascular complications in patients with articular hypermobility

El Síndrome de Ehlers-Danlos Vascular es una de las Alteraciones Hereditarias del Tejido Conectivo. Es poco frecuente, pero es de alta morbilidad y mortalidad. Se debe a una mutación del gen COL3A1, que da debilidad del tejido colágeno, por lo que se pueden producir complicaciones graves afectando a la piel, tubo digestivo, hígado, pulmón y sistema vascular. Se pueden producir rupturas intestinales, neumotórax espontáneo, dilatación o ruptura aortica y anuerismas, lo que puede llevar a la muerte súbita del paciente.

The Vascular Ehlers-Danlos is one of Hereditary Diseases of Connective Tissue. Has low prevalence, but high morbidity and mortality. It is due to a COL3A1 gene mutation, producing tissue fragility, which can produce serious complications in the skin, digestive tract, liver, lungs and in the vascular system. It is frequently associated to intestinal ruptures, spontaneous pneumothorax, dilation or rupture of the aorta anuerism, which can lead to sudden death.

Traumatic arteriovenous fistula associated to pseudoaneurysm of the superficial temporal artery in a child: case report and literature review / Fístula arteriovenosa traumática associada a pseudoaneurisma da artéria temporal superficial em uma criança: relato de caso e revisão da literatura

As fístulas arteriovenosas (FAVs) e os pseudoaneurismas traumáticos extracranianos são malformações incomuns e, em sua maioria, estão associadas a traumatismo craniano fechado com lesão contusa de forte intensidade. O diagnóstico em geral é clínico, porém o exame de escolha para o diagnóstico definitivo é a angiografia. Nos casos em que a lesão é pequena, é possível abordá-la com embolização via endovascular com sucesso. A excisão cirúrgica, no entanto, ainda é o método de escolha para o tratamento. É relatado um caso de um paciente do sexo masculino, com 9 anos de idade, diagnosticado com FAV, acometendo o ramo frontal da artéria temporal superficial, secundária a trauma craniano contundente ocorrido três anos antes do diagnóstico.

The arteriovenous fistulae (AVFs) and the extracranial traumatic pseudoaneurysms are uncommon malformations and in the majority of the cases are associated to closed head trauma with high intensity blunt lesion. The diagnosis is generally clinical, though the exam of choice for definitive diagnosis is an angiography. In minor lesion cases it's possible to successfully approach it with endovas-cular embolization. The surgical excision though, is the method of choice for the treatment. Here is reported a case of a 9-year-old male patient, diagnosed with AVF involving the frontal branch of the superficial temporal artery, secondary to blunt head trauma occurred three years before diagnosis.

A novel endoscopic treatment for renal arteriopelvic fistula post-percutaneous nephrolithotomy (PCNL)

Main findings We describe the use of a novel endoscopic approach in the management of unremitting gross hematuria following post-percutaneous nephrolithotomy (PCNL) in a 65-years-old male. This approach proved successful and cost-effective in managing haemorrhage post-PCNL when renal angiography failed to localize the source of bleeding. Case hypothesis The recommended treatment modality for renal calculi ≥ 2cm is PCNL. It is essential that clinicians are aware of the various complications that can arise from PCNL, including arteriovenous fistula, which is typically managed with renal angio-embolization. The development of a renal arteriopelvic fistula (APF) is an extremely rare complication, and accounts of haemorrhage from renal APF and its treatment have not been well-described in the literature. We successfully hypothesized that the ureteroscopic localization, fulguration, and closure with a fibrin sealant at the site of the arterial bleed results in optimal treatment for this clinical presentation. We report this case in detail. Promising Future Implications The successful and cost-effective endoscopic approach described here for treatment of post-PCNL renal APF and unremitting gross hematuria ought to be considered as an adjunct to renal angiography and embolization when the source of bleeding cannot be accurately identified using traditional imaging modalities. .

Revisão de literatura e relato de caso de fístula arteriovenosa craniana cutânea pós-traumática / Post traumatic cutaneous cranial fístula: case report and literature review

Os autores descrevem o caso de um doente de 34 anos que, após agressão sofrida em 2008, detectou o surgimento de tumoração no mesmo local em que sofrera a agressão, onde surgiu uma fístula arteriovenosa cutânea pós-traumática, documentada por meio de angiografia digital. Tanto o doente quanto a equipe médica optaram por conduta não cirúrgica, e o doente segue assintomático no seguimento ambulatorial, sem modificação da fístula desde seu diagnóstico.

The authors describe a 34 years old men with cutaneous vascular disorder after a cranial injury suffered three months ago. Subsidiary investigation by angiography showed a cutaneous arteriovenous malformation. The men asymptomatic, have a non-surgical conduct and he is very well after three years.

Improved severe hepatopulmonary syndrome after liver transplantation in an adolescent with end-stage liver disease secondary to biliary atresia

Hepatopulmonary syndrome (HPS) is a serious complication of end-stage liver disease, which is characterized by hypoxia, intrapulmonary vascular dilatation, and liver cirrhosis. Liver transplantation (LT) is the only curative treatment modality for patients with HPS. However, morbidity and mortality after LT, especially in cases of severe HPS, remain high. This case report describes a patient with typical findings of an extracardiac pulmonary arteriovenous shunt on contrast-enhanced transesophageal echocardiography (TEE), and clubbing fingers, who had complete correction of HPS by deceased donor LT. The patient was a 16-year-old female who was born with biliary atresia and underwent porto-enterostomy on the 55th day after birth. She had been suffered from progressive liver failure with dyspnea, clubbing fingers, and cyanosis. Preoperative arterial blood gas analysis revealed severe hypoxia (arterial O2 tension of 54.5 mmHg and O2 saturation of 84.2%). Contrast-enhanced TEE revealed an extracardiac right-to-left shunt, which suggested an intrapulmonary arteriovenous shunt. The patient recovered successfully after LT, not only with respect to physical parameters but also for pychosocial activity, including school performance, during the 30-month follow-up period.

N-Butyl Cyanoacrylate Embolization with Blood Flow Control of an Arterioportal Shunt That Developed after Radiofrequency Ablation of Hepatocellular Carcinoma

We present a case of a patient with rapid deterioration of esophageal varices caused by portal hypertension accompanied by a large arterioportal shunt that developed after radiofrequency ablation of hepatocellular carcinoma. We used n-butyl cyanoacrylate (NBCA) as an embolic material to achieve pinpoint embolization of the shunt, because the microcatheter tip was 2 cm away from the shunt site. Under hepatic arterial flow control using a balloon catheter, the arterioportal shunt was successfully embolized with NBCA, which caused an improvement in the esophageal varices.

Fístula arteriovenosa traumática de arteria temporal superficial: un caso infrecuente / Traumatic arteriovenous fistula of the superficial temporal artery: a rare case

La arteria temporal superficial es particularmente vulnerable al trauma debido a su largo trayecto en el cuero cabelludo y relativa vulnerabilidad sin embargo las fístulas arteriovenosas del cuero cabelludo son una patología infrecuente. Presentamos un caso de una paciente femenina quien 2 años posterior a un trauma lacerante del cuero cabelludo presenta una fístula arteriovenosa traumática de la arteria temporal superficial, tratada de manera exitosa mediante la extirpación quirúrgica, se realiza una revisión de la literatura con respecto a la etiología, manifestaciones clínicas, patogenia, diagnóstico y su tratamiento.

The superficial temporal artery is particularly vulnerable to trauma because of its long journey in the scalp and relative vulnerability butth escalp arteriovenous fistulas arean uncommon finding. We report a case of a female patient who 2 years after a shearing trauma of the scalp has a superficial temporal artery (STA) traumatic arteriovenous fistula (TAVF), treated successfully by surgical removal. We review the literature regarding the etiology, clinical manifestations, pathogenesis, diagnosis and treatment.

Fístula aortocava como complicación de aneurisma aórtico abdominal / Aortocaval fistula as a complication of abdominal aortic aneurysm

Aortocaval fistula (ACF) is an infrequent complication of abdominal aortic aneurysm (AAA). Diagnosis is suspected by the presence of a continuous abdominal bruit and pulsatile abdominal mass, with variable signs of venous congestion and acute heart failure. Multislice computed tomography (MSCT) is useful in establishing the diagnosis, showing early enhancement of inferior vena cava and, in some cases, identifying the arteriovenous comunication. Surgical treatment is usually complex, with high morbidity and mortality rates. Endovascular treatment seems to be a promising alternative for the management of these patients. We report a case of ACF treated with open surgery and a literature review of this rare condition.

La fístula aortocava (FAC) es una complicación infrecuente del aneurisma aórtico abdominal (AAA). El diagnóstico se sospecha por la detección de un soplo continuo en el hemiabdomen inferior, asociado a masa abdominal pulsátil y signos variables de congestión venosa e insuficiencia cardíaca. La tomografía computada multicorte (TCM) permite confirmar el diagnóstico, evidenciando contraste de la vena cava inferior en fase arterial e identificando la zona anatómica de la comunicación arteriovenosa, en algunos casos. La reparación quirúrgica suele ser compleja, reportándose una alta morbi-mortalidad asociada. El uso de técnicas endovasculares pareciera mejorar el pronóstico de esta entidad. Reportamos un caso de FAC tratado mediante cirugía abierta. Se incluye una revisión de la literatura respecto a esta rara condición.

Aneurisma de la vena de Galeno / Vein of Galen aneurysm

Caso clínico luego de realizarse una ecografía en la semana 31 de gestación, en el que se detectó una dilatación aneurismática de la vena de Galeno.

Fístula traumática entre tronco braquiocefálico e veia braquiocefálica por arma de fogo / Traumatic fistula between the brachiocephalic trunk and the brachiocephalic vein due to gunshot wound

Descrevemos caso de paciente do sexo masculino, 49 anos, que sofreu ferimento por arma de fogo no tórax, transfixando o mediastino médio. Apresentava-se estável hemodinamicamente, contudo taquicárdico e taquipnéico. Ele foi submetido à propedêutica armada com radiograma de tórax, ecocardiografia transtorácica, tomografia computadorizada de tórax e arteriografia do arco aórtico. Evidenciou-se fístula traumática do tronco braquiocefálico com a veia braquiocefálica. Realizou-se correção cirúrgica com a utilização de circulação extracorpórea e hipotermia profunda com parada circulatória total. O paciente evolui bem com alta no quinto pós-operatório.

We describe the case of a 49-year old male patient who suffered a gunshot wound in the chest which transfixed the medial mediastinum. He was hemodynamically stable, but had tachycardia and tachypnea. He was submitted to integrated work-up with chest radiogram, transthoracic echocardiography, computerized chest tomography, and arteriography of the aortic arch. A traumatic fistula was evidenced between the brachiocephalic trunk and the brachiocephalic vein. Surgical repair was performed using extracorporeal circulation and deep hypothermia with total circulatory arrest. The patient progressed well and was discharged on the fifth day postoperatively.

Endovascular Stent-Graft Treatment of a Traumatic Vertebral Artery Pseudoaneurysm and Vertebrojugular Fistula

An endovascular intervention is a feasible alternative to the technically challenging conventional surgery for the treatment of traumatic vertebral arterial lesions. This report describes a rare case involving a 22-year-old patient with a traumatic vertebral arterial pseudoaneurysm and multiple arteriovenous fistulas which were successfully sealed using the endovascular stent-graft technique.

Transarterial Embolization of an Inferior Genicular Artery Pseudoaneurysm with Arteriovenous Fistula after Arthroscopy

Arthroscopic meniscectomy of the knee is generally a safe and effective procedure with a low rate of vascular complications. We report here on a unique case of a 55-year-old man with a lateral inferior genicular artery pseudoaneurysm and a concomitant arteriovenous fistula that developed after arthroscopic meniscectomy; this was successfully treated with selective angiographic embolization. This case illustrates the effectiveness of an endovascular approach as a minimally invasive treatment for this uncommon complication that occurs after an arthroscopic procedure.