ABSTRACT
Aneurysmatic transformation of a fistulous vein is one of the most frequently encountered complications in patients on programmed dialysis. This complication increases the risk of dysfunction of an arteriovenous fistula. However, there are no common approaches to correction of this complication. This study was aimed at assessing the results of aneurysmorrhaphy for treating aneurysms of fistulous veins in patients on programmed dialysis. For this purpose, we carried out a retrospective analysis of the results of operations in a total of 87 patients with aneurysmatic transformation of an arteriovenous fistula. All patients were subjected to aneurysmorrhaphy supplemented, if necessary, by plasty of stenosis with the use of the tissue of the wall of the resected aneurysm. The vein was placed into a new subcutaneous channel (transposition with transection of the vein) or a pocket formed by the separated subcutaneous tissue (transposition without transection). Secondary patency after 1 year amounted to 95.3%, after 2 years to 91.4%, and after 3 years to 87.6%. At 4.8 years, 69% (95% CI 44.9-84.2) of the arteriovenous fistulas proved patent. CONCLUSION: Aneurysmorrhaphy supplemented with correction of concomitant complications of aneurysms of fistulous veins is an effective and safe operation making it possible to maintain the function of an arteriovenous fistula for a long period of time.
Subject(s)
Arteriovenous Shunt, Surgical , Arteriovenous Shunt, Surgical/adverse effects , Humans , Renal Dialysis/adverse effects , Retrospective Studies , Treatment Outcome , Vascular PatencyABSTRACT
This study presents results of extracorporeal photochemotherapy (EPCT) application in 24 renal allograft recipients (RAR), who suffered chronic kidney disease (CKD) caused by urological diseases. The comparison group treated only with chemical immunosuppression comprised 24 recipients who received transplants from the same donors as intervention group patients. It was found that EPCT reduces not only the number of RAR rejections, but also the incidence of infectious complications. The effectiveness of EFHT was confirmed by clinical, laboratory and immunological data, and by protocol biopsy results. Possible mechanisms of preservation of anti-infectious protection in the setting of chemical immunosuppression when using EPCT are discussed.
Subject(s)
Graft Rejection , Kidney Transplantation , Photopheresis , Graft Rejection/prevention & control , Humans , Immunosuppression Therapy , Tissue DonorsABSTRACT
Kidney transplant is inevitably subjected to ischemic and reperfusion injury. In many cases, this is due to a violation of intraorgan hemodynamics. Severity of such damage can be reduced using different methods of extracorporeal hemocorrection. The aim of the study was to examine the intraorgan blood flow of kidney transplant and assess the impact of plasmapheresis on its primary function in the early postoperative period. Plasmapheresis with replacement from 1,25 to 3,5 liters of plasma was applied in 40 recipients of the Group 1; in 40 recipients of Group 2 plasmapheresis was not performed. High resistance index (Ri > 0,9) at low flow velocities in the interlobular arteries at the first day after surgery is an informative criterion for the diagnosis of acute tubular necrosis and indicates the inadequate blood supply of kidney. Plasmapheresis has promoted the normalization of renal hemodynamics. Immediate graft function in patients of Group 1 was observed in 36 patients, whereas only in 19 patients of Group 2. In the Group 1, there were no patients with primary non-functioning graft, while there were three such patients in Group 2. Thus, plasmapheresis in the early postoperative period, no later than 3-5 h after reperfusion of the graft, has a positive effect on the functional status of the transplanted kidney.
Subject(s)
Kidney Transplantation , Kidney/blood supply , Plasmapheresis , Renal Circulation/physiology , Reperfusion Injury/prevention & control , Transplants/blood supply , Adult , Female , Glomerular Filtration Rate/physiology , Humans , Kidney/physiopathology , Male , Plasmapheresis/methods , Postoperative Period , Reperfusion Injury/pathology , Reperfusion Injury/physiopathology , Time Factors , Transplants/physiopathology , Treatment Outcome , Ultrasonography, DopplerABSTRACT
The review of literature presents the current view of domestic and foreign authors on the frequency of infectious complications after kidney transplantation, their etiology, timing of emergence, and the spectrum of bacterial pathogens. Data on the effects of bacterial complications on the function of renal transplant and recipient survival are also demonstrated.
Subject(s)
Bacterial Infections , Kidney Transplantation , Transplants , Bacterial Infections/diagnosis , Bacterial Infections/etiology , Bacterial Infections/mortality , Bacterial Infections/therapy , Female , Humans , MaleABSTRACT
This review highlights current concepts of sepsis pathogenesis and the efficacy of modern methods of extracorporeal hemocorrection.
Subject(s)
Plasmapheresis/methods , Sepsis/therapy , Humans , Inflammation Mediators/metabolism , Sepsis/etiology , Sepsis/metabolism , Sepsis/physiopathology , Systemic Inflammatory Response Syndrome/metabolism , Systemic Inflammatory Response Syndrome/physiopathology , Treatment OutcomeABSTRACT
A review of literature reveales the current conception of Russian and foreign authors on the cellular and humoral pathogenetic mechanisms of ischemic and reperfusion injury of kidney transplant.
