Snuffbox Versus Wrist Radiocephalic Arteriovenous Fistulas: 10 Years Experience.

Background The wrist radiocephalic arteriovenous fistula (RCAVF) is the initial suggested procedure for establishing hemodialysis vascular access (HVA) in the most distal site of the upper limb. The anatomical snuffbox arteriovenous fistula (SBAVF) is barely utilised, despite its remote location. In this study, we aimed to analyse and compare the results of SBAVF and RCAVF in terms of their maturity, patency, and failure rates. Methodology This descriptive, retrospective study compared outcomes between SBAVF and RCAVF in terms of maturation, patency, and failure. All patients with chronic kidney disease who attended and underwent either procedure at Betsi Cadwaladr University Health Board between 2013 and 2023 were studied. Results In a period of 10 years, 179 patients were included. Overall, 102 (57%) were male and 77 (43%) were female, with a male-to-female ratio of 1.3:1. Wrist radiocephalic fistula was the dominant type of surgery done in 76% (n = 136), while the snuffbox radiocephalic fistula was done in fewer than 24% (n = 43) of patients. Most patients underwent a successful arteriovenous (AV) fistula (n = 105, 58.7%), in contrast to 67 patients whose fistulas failed. There was a significant relationship between fistula failure and complications (p = 0.000). There was no significant effect of the fistula site, hypertension, diabetes, cardiac diseases, smoking, peripheral vascular disease, or central vein stenosis on the failure of the AV fistula (p = 0.127, 0.534, 0.510, 0.397, 0.017, 0.68, and 0.371, respectively). Conclusions The snuffbox AV fistula is a suitable and feasible first choice for patients on hemodynamic therapy.

Retaining a nonfunctional synthetic arterial bypass graft as a tunnel for future bypass using a vein graft: technical note.

Reoperation after infrainguinal arterial bypass may be difficult because of scar tissue from the previous bypass operation and usually involves removal of the old synthetic bypass graft. The authors describe a novel method of retaining the old thrombosed, externally reinforced polytetrafluoroethylene graft and using it as a tunnel for redo bypass using a vein.

[Unusual revascularization in acute mesenteric ischemia (a case report and review of the literature)]. / Umines mezenterines isemijos neiprasta revaskulizacija (klinikinio atvejo aprasymas ir literaturos apzvalga).

Acute-on-chronic mesenteric ischemia is rare, symptomatic manifestation of arteriosclerosis, and there are important gaps in our knowledge and recognition of this potentially lethal condition. Careful exploration of anamnestic history and angiography remain cornerstones of early diagnosis. Prognosis crucially depends on rapid diagnosis and surgical management, to prevent, or at least to minimize bowel infarction. Delay in surgical intervention is associated with increasing mortality that is still high and varies from 60 to 100%. The prognosis dramatically improves if revascularization can be achieved prior to intestinal infarction. Patients surviving extended intestinal resection may develop short gut syndrome. Case rapport of acute-on-chronic mesenteric ischemia with extraordinary approach for superior mesenteric artery revascularisation is described. Literature review is presented.