ABSTRACT
A Minimally Invasive Limited Ligation Endoluminal-assisted Revision (MILLER) banding procedure has been used for treating patients with dialysis access-related steal syndrome (DASS) and high-flow vascular access-related pulmonary hypertension (PHT) and heart failure (HF).We performed a retrospective analysis of patients undergoing the MILLER procedure performed for DASS, HF, and PHT from our Vascular Access Database from September 2017 to October 2019. Outcomes included primary patency of banding, primary assisted patency, and secondary patency, using time-to-event analyses with Kaplan-Meier curves and life tables to estimate 6- and 12-month rates.A total of 13 patients (6 men and 7 women, mean age 60 ± 14 years) underwent the MILLER procedure, 6 patients for DASS and 7 patients for pulmonary hypertension and heart failure (PHT/HF). Technical success was achieved in all patients. The longest duration of follow-up was 28 months (median 12 months [IQR 7, 19]). One patient died at 1 month after the intervention due to stroke. One patient developed access thrombosis of the graft 3 days after the procedure. Repeat banding was required in 1 patient 8 months after the first procedure. The 6-month primary patency rate of banding following this procedure was 83% while the 12-month rate was 66%. The 6- and 12-month secondary patency rates were 87% and 75%, respectively.The MILLER procedure can be performed for DASS and PHT/HF with improvement of symptoms and good long-term patency rates. Additional interventions to maintain patency and efficacy are required on long-term follow-up.
Subject(s)
Arteriovenous Shunt, Surgical , Heart Failure , Hypertension, Pulmonary , Male , Humans , Female , Middle Aged , Aged , Hypertension, Pulmonary/etiology , Hypertension, Pulmonary/surgery , Retrospective Studies , Treatment Outcome , Arteriovenous Shunt, Surgical/adverse effects , Renal Dialysis , Syndrome , Heart Failure/etiology , Heart Failure/surgery , Vascular Patency , Graft Occlusion, VascularABSTRACT
PURPOSE: To report the technique and acute technical results associated with the PowerWire Radiofrequency (RF) Guidewire used to recanalize central vein occlusions (CVOs) after the failure of conventional endovascular techniques. MATERIALS AND METHODS: A retrospective study was conducted from January 2008 to December 2011, which identified all patients with CVOs who underwent treatment with a novel RF guide wire. Forty-two symptomatic patients (with swollen arm or superior vena cava [SVC] syndrome) underwent RF wire recanalization of 43 CVOs, which were then implanted with stents. The distribution of CVOs in central veins was as follows: six subclavian, 29 brachiocephalic, and eight SVC. All patients had a history of central venous catheter placement. Patients were monitored with regular clinical evaluations and central venography after treatment. RESULTS: All 42 patients had successful recanalization of CVOs facilitated by the RF wire technique. There was one complication, which was not directly related to the RF wire: one case of cardiac tamponade attributed to balloon angioplasty after stent placement. Forty of 42 patients (95.2%) had patent stents and were asymptomatic at 6 and 9 months after treatment. CONCLUSIONS: The present results suggest that the RF wire technique is a safe and efficient alternative in the recanalization of symptomatic and chronic CVOs when conventional endovascular techniques have failed.
Subject(s)
Brachiocephalic Veins , Catheter Ablation/instrumentation , Endovascular Procedures/instrumentation , Subclavian Vein , Superior Vena Cava Syndrome/therapy , Vena Cava, Superior , Adult , Aged , Brachiocephalic Veins/diagnostic imaging , Catheterization, Central Venous/adverse effects , Constriction, Pathologic , Equipment Design , Female , Humans , Male , Middle Aged , Phlebography/methods , Radiography, Interventional , Retrospective Studies , South Carolina , Stents , Subclavian Vein/diagnostic imaging , Superior Vena Cava Syndrome/diagnostic imaging , Superior Vena Cava Syndrome/etiology , Time Factors , Tomography, X-Ray Computed , Treatment Failure , Vena Cava, Superior/diagnostic imagingABSTRACT
Isoflavone levels in Glycine max (soybean) were increased via metabolic engineering of the complex phenylpropanoid biosynthetic pathway. Phenylpropanoid pathway genes were activated by expression of the maize C1 and R transcription factors in soybean seed, which decreased genistein and increased the daidzein levels with a small overall increase in total isoflavone levels. Cosuppression of flavanone 3-hydroxylase to block the anthocyanin branch of the pathway, in conjunction with C1/R expression, resulted in higher levels of isoflavones. The combination of transcription factor-driven gene activation and suppression of a competing pathway provided a successful means of enhancing accumulation of isoflavones in soybean seed.
