ABSTRACT
BACKGROUND: We evaluated restenosis rates at the cephalic arch after percutaneous angioplasty and stenting procedures in patients with brachial artery to cephalic vein arteriovenous fistula (BCAVF) hemodialysis access. METHODS: We used data from adult hemodialysis patients treated at a national network of 44 outpatient interventional facilities during Oct 2011-2015. We included data from patients with BCAVF who received an exclusive angioplasty, or stent with angioplasty, for treatment of cephalic arch stenosis and had ≥1 subsequent evaluation of the cephalic arch. Median percent restenosis per month at cephalic arch and days between encounters was calculated from the 1st index to 2nd procedure, and for up to 4 subsequent encounters. Analyses were stratified by intervention and device types. RESULTS: We identified a cohort of 3301 patients (mean age 62.2 ± 13.9 years, 58.5% male, 33.2% white race) with a BCAVF who had an angioplasty, or stent, at the cephalic arch for an index and ≥ 1 follow-up procedure. Between the 1st index to 2nd procedure, patients who received an angioplasty (n = 2663) or stent (n = 933) showed a median decrease of 18.9 and 16.5% in luminal diameter per month and a median time of 93 and 91 days between encounters, respectively. Restenosis and day rates were similar for standard versus high-pressure angioplasties. Bare metal stents showed 10.1 percentage point higher restenosis rate compared to stent grafts. Restenosis rates and time to restenosis were relatively consistent across subsequent encounters. CONCLUSIONS: Findings suggest hemodialysis patients with a BCAVF who require an angioplasty or stent to treat a stenosis at the cephalic arch will have stenosis reformed at a rate of 18.9 and 16.5% per month after the first intervention, respectively. Findings suggest patients are at risk of having significant lesions at the cephalic arch within 3 months after the previous intervention.
Subject(s)
Arteriovenous Shunt, Surgical , Fistula , Adult , Aged , Arteriovenous Shunt, Surgical/adverse effects , Constriction, Pathologic/etiology , Constriction, Pathologic/surgery , Female , Fistula/etiology , Graft Occlusion, Vascular/epidemiology , Graft Occlusion, Vascular/etiology , Humans , Male , Middle Aged , Renal Dialysis , Retrospective Studies , Treatment Outcome , Vascular PatencyABSTRACT
We present a case of a 57-year-old African American man with systemic sarcoidosis, who initially presented with cervical spinal cord disease. Initial MRI showed an elongated intramedullary area of increased signal intensity on T2 and inversion recovery sequences within the cervical spinal cord with minimal contrast enhancement after gadolinium administration. Further radiologic evaluation led to a chest CT, which showed bilateral hilar lymphadenopathy. Thoracic lymph node biopsy revealed systemic sarcoidosis. Post treatment MRI showed improvement of the cervical spinal cord lesion, further supporting the diagnosis of systemic sarcoidosis.
ABSTRACT
We present the case of a 35 year-old male with pain and swelling in his right thigh. By CT and sonography, an abscess was localized to the deep, anteromedial, mid-thigh within the quadriceps muscle, along with a 1.3 cm loose body. The infected loose body was removed under ultrasound guidance without complications.
