Iatrogenic arterial injuries

This study includes 148 patients who sustained arterial injuries during various diagnostic and therapeutic procedures. Cardiac catheterization and angiography were responsible for the majority of cases [77%]. Surgical procedure came next and were responsible for 16.2% of cases. the commonly affected arteries were the brachial 48.7% and femoral 38.5% These injuries were managed surgically once diagnosed without the need of prior arteriography. The latter was reserved only to cases received late. The management depended upon the causative injury and the artery affected. Lateral suture was done in the majority of cases of injuries following diagnostic catheterization. On the other hand injuries following surgical procedures were managed by an interposition graft [saphenous vein or prosthetic] depending upon the size of the affected artery. Extra-anatomical by passes were reserved to cases with potential risks of infection. The results of management were satisfactory 12.2% morbidity and 1.3% mortality

Techniques of construction of a brachial basilic arteriovenous fistula

This study included 73 patients mainatined on regular hemodialysis and in whom the standard radial cephalic arteriovenous fistula cannot be constructed [26 cases] or failed [47 cases]. Two methods were used in these situations namely superficialization of the basilic vein [45 cases] and side to side brachial - basilic vein with valvulotomal destruction of the venous valves of the basilic vein in the forearm [28 cases]. The one year patency rates were 82.05% and 82.6% respectively. The overall complications of the two procedures were acceptable. Infections with aneurysmal dilatation and/or secondary hemorrhage occured in 4.1%, venous hypertension in 4.1% and distal ischemia in 1.36%. No cases of heart failure were observed in this series