The diagnostic value of duplex ultrasound in detecting the presence and location of a stenosis in an autologous arteriovenous fistula.

OBJECTIVE: To determine the value of duplex ultrasound in the detection of significant (⩾50%) stenosis and the location of the stenosis in arteriovenous fistula, compared to angiography. METHODS: Patients who underwent construction of an autologous arteriovenous fistula between January 2007 and December 2013 in Treant Care Group, hospital location Emmen, were included in this study. In all patients with a significantly decreased blood flow (flow <400 mL/min and/or ⩾20% decrease) measured by Transonic flowmeter before December 2016, duplex ultrasound was performed. Concordance between duplex ultrasound and angiography was analysed in all patients with a haemodynamically significant stenosis detected by duplex ultrasound. RESULTS: In all, 63 patients had a significant decrease in blood flow leading to duplex ultrasound. In 51 (80.9%) of the 63 duplex ultrasound, a haemodynamically significant stenosis was detected. In 45 (88.2%) of these, angiography was performed, all confirming the presence of significant stenosis. In eight patients, no angiography was performed (sufficient residual blood flow (n = 7), death (n = 1)). Most stenoses were located in the venous outflow tract (75.6%). In 95.6%, a venous approach was possible during angiography. After intervention, a significant increase in blood flow was observed (from 530 mL/min to 910 mL/min (p < 0.001)). CONCLUSION: We show that duplex ultrasound is likely reliable to ascertain the presence of arteriovenous fistula stenosis in addition to flow criteria. Also, it provides important information to select the most effective and safe approach for cannulation. Duplex ultrasound may reduce costs and burden of diagnosing stenoses.

Randomized multicenter trial on percutaneous versus open access in endovascular aneurysm repair (PiERO).

BACKGROUND: In endovascular valve and aortic repair, vascular access through a percutaneous approach has become the competing technique to an open surgical approach. The effect on postoperative complications and surgical site infections (SSIs) has been investigated, but randomized evidence is lacking. The objective was to investigate whether percutaneous access of the common femoral artery (CFA) with a percutaneous closure device would decrease the number of SSIs compared with open surgical access of the CFA in endovascular aneurysm repair (EVAR). METHODS: Patients with an abdominal aortic aneurysm suitable for EVAR were randomized to open or percutaneous access of the main device (MD) through the CFA. Through the contralateral side, access was obtained with the other technique than the one for which the MD was randomized. The primary outcome was number of SSIs. Secondary outcomes were wound complications, visual analog scale for pain scores, and standardized wound assessment scores during follow-up. Preoperative screening culture and groin biopsy specimens were obtained from all patients. RESULTS: Both groups contained 137 groins. SSI rate was 1.5% in the open group vs 0% in the percutaneous group. For MDs only, SSI rate was 3.1% (odds ratio, 3.3; 95% confidence interval, 0.31-347; P = .34). Wound complications were comparable in both groups. Neither nasal nor groin Staphylococcus aureus carriage had a significant effect on SSIs, Southampton Wound Assessment score, or visual analog scale score. Adjusted pain score was 0.69 lower, in favor of percutaneous access. Wound assessment was better after 2 weeks (odds ratio, 3.57; 95% confidence interval, 1.02-12.44; P = .046), also in favor of percutaneous access. CONCLUSIONS: Percutaneous access of the CFA does not reduce the number of SSIs. It does, however, reduce pain and improve wound healing with less inflammation 1 day and 2 weeks after EVAR, respectively.

Short-term Results of the RAPID Randomized Trial of the Legflow Paclitaxel-Eluting Balloon With Supera Stenting vs Supera Stenting Alone for the Treatment of Intermediate and Long Superficial Femoral Artery Lesions.

PURPOSE: To report a randomized trial comparing the Legflow paclitaxel-eluting balloon (PEB) + Supera stenting to Supera stenting alone in patients with intermediate to long superficial femoral artery (SFA) lesions. METHODS: The multicenter RAPID trial ( controlled-trials.com ; identifier ISRCTN47846578) randomized (1:1) 160 patients (mean age 67 years; 102 men) with Rutherford category 2-6 ischemia to treatment with Legflow PEB + Supera stent or Supera stent alone in intermediate to long SFA lesions (mean lesion length 15.8±7.4 vs 15.8±7.6 cm, respectively). The efficacy outcome was primary patency, defined as freedom from restenosis on duplex ultrasound or angiography. RESULTS: Baseline characteristics including the percentage of occlusions were similar between groups. In the intention-to-treat analysis, the estimated primary patency at 1 year was 68.3% (95% CI 56.7% to 79.9%) in the PEB + Supera group vs 62.0% (95% CI 49.1% to 74.9%) in the Supera group (p=0.900). Per-protocol analysis showed a 12-month primary patency estimate of 74.7% (95% CI 63.1% to 86.3%) in the PEB + Supera group vs 62.0% (95% CI 49.1% to 74.9%) in the control group (p=0.273). Secondary patency estimates at 12 months (per-protocol analysis) were 89.0% (95% CI 80.6% to 97.4%) vs 98.0% (95% CI 94.1% to 100%; p=0.484); the estimates for freedom from clinically driven target lesion revascularization (CD-TLR) were 83.0% (95% CI 72.8% to 93.2%) and 77.8% (95% CI 66.6% to 89.0%; p=0.277), respectively. CONCLUSION: The short-term results from the multicenter RAPID randomized controlled trial indicate that the Legflow PEB is safe and feasible for the treatment of intermediate to long SFA lesions. In this trial, at least 70% of the patients suffered an occlusion. The PEB group had higher rates of primary patency and freedom from CD-TLR, although there were no statistically significant differences vs controls.

Familial spontaneous splenic rupture in a patient with idiopathic splenomegaly-report of a case.

Spontaneous splenic rupture in a healthy individual is a rare phenomenon. This article reports on a patient with an uneventful medical history, presenting with atraumatic splenic rupture. Three family members of the patients experienced the same in the past.