Comparison of the one-year patency rates of radiocephalic arteriovenous fistulas created using no-touch versus conventional technique.

BACKGROUND: This study aims to compare the patency rates of radiocephalic arteriovenous fistulas prepared preserving the perivenous vascular tissues versus those prepared using the conventional technique. METHODS: A total of 169 patients (107 males, 62 females; mean age 59.5 years; range, 39 to 87 years) who underwent a radiocephalic arteriovenous fistula construction were included in this study. In 95 patients, the tissues surrounding the cephalic vein were stripped off as per the conventional method, while the no-touch technique preserving the perivenous vascular tissues was utilized for vein harvesting in 74 patients. Patients were followed-up to compare primary and secondary patency rates of the arteriovenous fistulas at one year. RESULTS: Fistula failure developed in 22 patients within the first year resulting in primary patency rates of 90.5% versus 84.2% for the no-touch and the conventional groups, respectively (p=0.225). Likewise, secondary patency rates were 94.6% versus 93.7% for the no-touch and the conventional groups, respectively (p=0.803). The two groups did not differ with regards to primary or secondary patency rates. CONCLUSION: Findings of this study were not in favor of the no-touch technique compared to the conventional methods in terms of arteriovenous fistula patency at one year.

Proximal Aortic Surgery: Upper "J" or Conventional Sternotomy?

BACKGROUND: While minimally invasive procedures are being used in cardiac surgery, experience with minimally invasive proximal aortic surgery has been limited to certain centers. METHODS: Between January 2010 and March 2015, 54 patients with an upper "J" hemi-sternotomy and 75 patients with a conventional sternotomy due to proximal aortic pathology were included in this study. Forty-five patients from the "J" hemi-sternotomy group were matched with 45 patients from the conventional sternotomy group with respect to age, sex, ejection fraction, diabetes, hypertension, smoking history and operative type. Perioperative variables were in-hospital mortality, surgery for revision, amount of blood loss, requirement for blood transfusion, cardiopulmonary bypass (CPB), aortic cross-clamp and unilateral cerebral protection times, duration of ventilation, and length of intensive care unit (ICU) and total hospital stay. RESULTS: Patients were between 21-76 years with a mean age of 58.14 ± 11.06 years; 73.3% (n = 66) were male and 26.7% (n = 24) were female. Of all the cases included, 36.7% (n = 33) had isolated ascending aortic replacement, 41.1% (n = 37) had concomitant aortic valve replacement and ascending aortic replacement, and 22.2% (n = 20) had a Bentall procedure. Statistically, the amount of bleeding (P = .026), length of ventilation (P = .001), ICU (P = .001) and total hospital stay (P = .004) in the "J" hemi-sternotomy group were all found to be significantly lower than those in the conventional group. CONCLUSIONS: Minimally invasive techniques like an upper "J" hemi-sternotomy can be safely performed without prolonging the aortic clamp time, and with less blood loss, less ventilatory support, and shorter ICU and total hospital stays when compared to conventional methods.

Double J ureteral stent displaced through the right ventricle.

We report a 59-year old patient with a double J ureteral catheter displaced out of the ureter through the inferior vena cava and right ventricle. The catheter was removed successfully under cardiopulmonary bypass.