ABSTRACT
In those patients requiring urgent hemodialysis, the use of early-access grafts may reduce the need for temporary hemodialysis catheters and their resultant complications such as infection and central venous stenosis. We review a consecutive group of patients undergoing placement of a traditional polytetrafluoroethylene (PTFE) graft as compared with a cohort of patients who underwent insertion of a trilaminate PTFE vascular graft (TPVG). During the period from January 2008 to December 2009, 65 sequential patients received a traditional PTFE graft with 78 subsequent patients having a TPVG inserted. Factors examined included use of temporary hemodialysis catheters during the period of graft maturation, incidence of infection, and primary and secondary graft patency. For all patients, incidence was reported as observed during the first year after graft insertion. With the use of the TPVG, need for temporary hemodialysis catheters was reduced from 91 to 32 per cent, and 1-year overall graft patency was improved from 36 to 77 per cent (P < 0.01). We report that the use of a trilaminate PTFE graft allowed early access, reduced the need for temporary hemodialysis catheters, decreased overall graft complication rates, and significantly improved 1-year patency.
Subject(s)
Arteriovenous Shunt, Surgical/methods , Catheterization, Central Venous/methods , Kidney Failure, Chronic/therapy , Renal Dialysis/methods , Adult , Aged , Arteriovenous Shunt, Surgical/adverse effects , Catheterization, Central Venous/adverse effects , Cohort Studies , Female , Follow-Up Studies , Graft Rejection , Graft Survival , Humans , Kaplan-Meier Estimate , Kidney Failure, Chronic/diagnosis , Male , Middle Aged , Polytetrafluoroethylene , Renal Dialysis/adverse effects , Retrospective Studies , Risk Assessment , Time Factors , Treatment Outcome , Vascular Access Devices , Vascular Patency/physiology , Young AdultABSTRACT
Endovascular stents are being used with increasing frequency for various problems of the venous system, but they have been associated with numerous complications. We report the case of an 88-year-old woman who presented with persistent, progressive dyspnea. Imaging revealed a migrated stent lodged in the tricuspid valve and extending into the right ventricle, causing severe tricuspid regurgitation. After a failed attempt at endovascular retrieval, emergent surgical removal was successful. During surgery, the stent was found to be embedded in the tricuspid leaflets, and part of the stent had also perforated the right ventricle. Review of the patient's records revealed that 2 WALLSTENT venous endoprostheses had been placed 6 months earlier to treat stenosis of the left brachiocephalic vein and, further, that the migrated stent had been visible on outpatient chest radiography performed 4 months after the stent placement. This case emphasizes the need to consider the possibility of stent migration in patients who present with unusual symptoms.
Subject(s)
Endovascular Procedures/adverse effects , Endovascular Procedures/instrumentation , Foreign-Body Migration/etiology , Heart Injuries/etiology , Stents , Tricuspid Valve Insufficiency/etiology , Vascular Diseases/therapy , Aged, 80 and over , Brachiocephalic Veins , Cardiac Surgical Procedures , Constriction, Pathologic , Device Removal , Echocardiography, Doppler, Color , Female , Foreign-Body Migration/diagnosis , Foreign-Body Migration/surgery , Heart Injuries/diagnosis , Heart Injuries/surgery , Heart Ventricles/injuries , Humans , Prosthesis Design , Severity of Illness Index , Tomography, X-Ray Computed , Treatment Outcome , Tricuspid Valve Insufficiency/diagnosis , Tricuspid Valve Insufficiency/surgeryABSTRACT
PURPOSE: To evaluate the safety and patterns of use of targeted renal therapy (TRT) with the Benephit system. TRT, the delivery of therapeutic agents directly to the kidneys by renal arterial infusion, has the advantage of providing a higher local effective dose with potentially greater renal effects, while limiting systemic adverse effects due to renal first-pass elimination. METHODS: The Benephit System Renal Infusion Therapy (Be-RITe!) Multicenter Registry was a post-market registry following patients treated using the Benephit systems for TRT. The registry enrolled 501 patients (332 men; mean age 72.2+/-9.5 years) at high risk for contrast-induced nephropathy (CIN) during coronary or peripheral angiography/intervention or cardiovascular surgery. The Mehran score was used to compare the actual to predicted incidence of CIN within 48 hours post procedure. RESULTS: Bilateral renal artery cannulation was successful in 94.2%, with a mean cannulation time of 2.0 minutes. Either fenoldopam mesylate, sodium bicarbonate, alprostadil, or B-type natriuretic peptide (BNP) was infused for 184+/-212 minutes. Mean creatinine levels did not change significantly (baseline, 24, and 48 hours post procedure: 1.95, 1.99, and 1.98 mg/dL, respectively; p = NS). In 285 patients who received TRT with fenoldopam and were followed for at least 48 hours, the incidence of CIN was 71% lower than predicted (8.1% actual CIN versus 28.0% predicted; p<0.0001). Only 4 (1.4%) patients required dialysis (versus the 2.6% predicted rate, p = NS). CONCLUSION: The Benephit system and TRT during coronary and endovascular procedures in patients at high risk for renal failure is simple to use and safe. With the infusion of intrarenal fenoldopam, the incidence of CIN was significantly lower than predicted by risk score calculations.
