Arteriovenous Aneurysm Research Articles

Dual-energy CT angiography in detecting underlying causes of intracerebral hemorrhage: an observational cohort study.

CT angiography (CTA) is often used to detect underlying causes of acute intracerebral hemorrhage (ICH). Dual-energy CT (DECT) is able to distinguish materials with similar attenuation but different compositions, such as hemorrhage and contrast. We aimed to evaluate the diagnostic yield of DECT angiography (DECTA), compared to conventional CTA in detecting underlying ICH causes. All non-traumatic ICH patients who underwent DECTA (both arterial as well as delayed venous phase) at our center between January 2014 and February 2020 were analyzed. Conventional CTA acquisitions were reconstructed ('merged') from DECTA data. Structural ICH causes were assessed on both reconstructed conventional CTA and DECTA. The final diagnosis was based on all available diagnostic and clinical findings during one-year follow up. Of 206 included ICH patients, 30 (14.6%) had an underlying cause as final diagnosis. Conventional CTA showed a cause in 24 patients (11.7%), DECTA in 32 (15.5%). Both false positive and false negative findings occurred more frequently on conventional CTA. DECTA detected neoplastic ICH in all seven patients with a definite neoplastic ICH diagnosis, whereas conventional CTA only detected four of these cases. Both developmental venous anomalies (DVA) and cerebral venous sinus thrombosis (CVST) were more frequently seen on DECTA. Arteriovenous malformations and aneurysms were detected equally on both imaging modalities. Performing DECTA at clinical presentation of ICH may be of additional diagnostic value in the early detection of underlying causes, especially neoplasms, CVST and DVAs.

Arteriovenous malformation-associated aneurysms in the pediatric population: the University of Pittsburgh Medical Center experience.

Arteriovenous malformations (AVMs) are the most common cause of spontaneous intracranial hemorrhage (ICH) in children, often leading to devastating complications. The current literature from the adult AVM population suggests that both younger age and associated aneurysms carry an increased risk of hemorrhagic presentation. However, detailed analysis of pediatric AVM-associated aneurysms and their link to ICH is relatively unknown, with the literature largely consisting of case reports. This study aimed to determine whether AVM-associated aneurysms predispose pediatric patients to ICH. A retrospective cohort study of 238 pediatric patients with AVMs who presented to the Children's Hospital of Pittsburgh from 1988 to 2023 was performed. Hospital records, patient charts, and radiographic imaging studies were reviewed for patient demographic characteristics, presentation status, and AVM architecture. Of the 238 total patients, 44 (18.5%) children with AVM had associated aneurysms. There were 19 (38.8%) feeding artery aneurysms, 8 (16.3%) intranidal aneurysms, 21 (42.9%) postnidal aneurysms, and 1 (2.0%) unrelated aneurysm of 49 aneurysms. Five patients had venous varices. One hundred forty (58.8%) children presented with hemorrhage. Twenty-one of 44 (47.7%) patients with an AVM-associated aneurysm presented with hemorrhage, whereas 119 of 194 (61.3%) with a solitary AVM presented with hemorrhage (p = 0.10). On multivariate analysis, postnidal aneurysm (OR 0.36, p = 0.037) and an increased number of draining veins (OR 0.66, p = 0.049) were significantly associated with a decreased likelihood of hemorrhagic presentation. Deep venous drainage was associated with an increase in hemorrhagic presentation (OR 2.25, p = 0.0045) on multivariate analysis. Approximately one-fifth of children with AVMs in this study had accompanying aneurysms, and in this patient population, those with postnidal aneurysms and increased number of draining veins had a decreased incidence of hemorrhage on presentation. Feeding artery and intranidal aneurysms were not associated with an elevated risk of hemorrhagic presentation.

Application of prophylactic flow restriction in brachiocephalic arteriovenous fistulas

To investigate the effects of prophylactic flow restriction for brachiocephalic arteriovenous fistula on postoperative high-flow-related complications and patency rate in patients undergoing hemodialysis. Clinical data of patients with end-stage renal disease who underwent brachiocephalic arteriovenous fistula surgery for hemodialysis from February 2017 to May 2022 in Department of Nephrology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine were retrospectively analyzed. During surgery, a 4-5 mm vascular suture loop was placed around the vein near the anastomosis as a flow restriction device in 43 patients (flow restriction group), while 42 patients did not receive the prophylactic flow restriction ring (control group). All patients were followed up for 1 to 5 years. The incidence rates of complications related to the hemodialysis access pathway, including distal ischemia syndrome, the formation of arteriovenous fistula aneurysms, thrombus, high-flow congestive heart failure, anastomosis of the vein within 1 cm of the anastomosis and cephalic arch stenosis, were compared between the two groups. The natural blood flow rate of the arteriovenous fistula, anastomosis size, the internal diameter of the vein near the anastomosis, primary patency rate, assisted primary patency rate, and secondary patency rate of the arteriovenous fistula, were also evaluated and compared between the two groups. Logistic regression analysis was used to investigate the factors affecting arteriovenous fistula patency rates, as well as the impact of the flow-restricting ring on postoperative factors. Ultrasound measurements showed that the internal diameter of the vein at the site of the flow restriction ring in the flow restriction group was (3.7±0.6) mm at three months postoperatively, which was significantly smaller than the internal diameter of the narrowest part of the vein near the anastomosis in the control group [(4.1±1.0) mm, t=－2.416, P<0.01]. The postoperative anastomotic diameter and natural blood flow rate of the arteriovenous fistula in the flow restriction group were both significantly lower than those in the control group (both P<0.05). Furthermore, the incidence rates of various complications in the flow restriction group were significantly lower than those in the control group (all P<0.05). At 6, 12, and 24 months postoperatively, the primary patency rate and assisted primary patency rate in the flow restriction group were significantly higher than those in the control group (both P<0.05), while there was no significant difference in secondary patency rates between the two groups (P>0.05). Binary logistic regression analysis indicated that age, diabetes, and natural blood flow rate of the arteriovenous fistula at 3 months postoperatively were independent risk factors for primary patency rate, while the flow restriction for brachiocephalic arteriovenous fistula was an independent protective factor for primary patency rate (P<0.01 or P<0.05). The application of flow restriction was negatively correlated with anastomotic diameter at 6 and 12 months, natural arteriovenous fistula blood flow, and the incidence rates of cephalic arch stenosis and aneurysm formation (all P<0.05). The prophylactic constriction during brachiocephalic arteriovenous fistula surgery in patients undergoing hemodialysis can limit the size of the anastomosis and postoperative arteriovenous fistula blood flow, reducing complications such as cephalic arch stenosis and high-flow heart failure, and increasing primary patency rates of arteriovenous fistula and delay the reintervention of the fistula.

Impact of arteriovenous fistula aneurysms on a UK dialysis populations’ perception of vascular access

BackgroundClinically-oriented outcome measures are increasingly being recognized as lacking in consideration of factors important to patients. There is an emerging move of guideline bodies advocating a more patient-centred approach. Aneurysms in autogenous arteriovenous fistula (AVF) can be considered unsightly and a constant reminder for patients of their dependence on dialysis. However, their impact on patient’s perception has not previously been reported.MethodsBetween April 2017–18, the Vascular Access Questionnaire (VAQ) was administered to prevalent haemodialysis patients across ten dialysis units via structured interviews, as part of a quality improvement project. Data for the subgroup of patients with aneurysmal AVF (categorised as per classification by Valenti et al.), were retrospectively evaluated and compared to the wider cohort.ResultsData were collected for 539 patients (median age: 66 years; 59% male), of whom 195 (36%) had aneurysmal AVF, with Type 2 morphology (cannulation site) being the most common (75%). Duration of AVF was found to be significantly associated with aneurysmal development, with estimated likelihoods of 11%, 43% and 61% after one, five and ten years, respectively. Interestingly, patients with diabetes had a significantly lower prevalence of aneurysmal development than those that were non-diabetic (25% vs. 43%, p < 0.001). Overall VAQ scores were not found to differ significantly by aneurysm status (p = 0.816) or across morphology types (p = 0.277). However, patients with aneurysmal AVF were significantly more concerned with the appearance of their AVF (p < 0.001) than the wider cohort. Despite this, patients with aneurysmal AVF gave significantly higher scores for satisfaction and ease of use and lower scores for bruising and clotting (p < 0.05).ConclusionsAneurysmal AVF are often cited as an important factor by patients for not proceeding with fistula formation. In this evaluation of patient reported experiences, those with aneurysmal AVF reported high satisfaction levels. This may help clinicians highlight positive patient reported outcomes of aneurysmal AVF during preprocedural consent processes.

The Effectiveness of Electronic Cannulation Atlas in Patients with Arteriovenous Fistula.

This study aimed to assess the effectiveness of an electronic cannulation atlas in preventing and treating complications of arteriovenous fistula. The observation group, consisting of 92 dialysis patients from July to December 2021, was managed with an electronic cannulation atlas. After 6 months, the incidence of complications such as stenosis, hematoma, thrombus, aneurysm, and cannulation failure was compared between the groups. Nurse satisfaction with the electronic cannulation atlas system was also assessed through a questionnaire. The observation group had lower incidence rates of arteriovenous fistula stenosis, thrombus, aneurysm, and failure rate of cannulation compared to the control group, with statistically significant differences (p<0.05). The incidence rates of hematoa were similar in both groups, showing no significant difference (p>0.05). After 3 months of management, the incidence of arteriovenous fistula complications in the observation group was significantly lower than in the control group (p<0.05). Additionally, utilizing the electronic cannulation atlas system was found to increase nurses' job satisfaction. The use of electronic cannulation atlas for the treatment of patients' arteriovenous fistula could effectively reduce the incidence of complications of patients' arteriovenous fistula, reduce the failure rate of cannulation, reduce the workload of nurses, and improve the job satisfaction of nurses.

#1340 Validation of artificial intelligence algorithm classifying arteriovenous access aneurysms in hemodialysis: a blinded multicenter prospective study

Abstract Background and Aims In hemodialysis (HD) patients, arteriovenous (AV) access aneurysms may lead to severe and potentially life-threatening consequences, such as rupture. To address this issue, we developed an artificial intelligence-based application that utilizes images of the AV access to classify AV aneurysms [1]. We conducted a blinded, multicenter, prospective pilot study to assess the correlation between the classification results generated by the aneurysm classification application and the independent clinical examination conducted by physicians specializing in vascular access care. Method AV accesses were photographed using tablets. These images were then uploaded to the cloud, where they were classified as either "Advanced" or "Not Advanced" by a convolutional neural network algorithm [1] (Fig. 1A). The study compared AV aneurysm classifications generated by our application to those made by vascular access physicians blinded to the app results. The physicians’ classifications served as the ground truth for our analysis. Results The study was conducted at two vascular access care centers in New York, NY, USA. A total of 121 patients were included in the analysis (Table 1). The physicians’ assessment identified a 21% prevalence of advanced aneurysms. The application accurately classified 84 out of 95 aneurysm images as “Not Advanced” and 20 out of 26 as “Advanced,” resulting in an accuracy of 86.0% (95% CI: 78.5% to 91.6%), a sensitivity of 76.9% (95% CI: 56.4% to 91.0%), a specificity of 88.4% (95% CI: 80.2% to 94.1%), and an area under the receiver operating characteristics curve (AUROC) of 0.87 (95% CI: 0.78 to 0.94) (Fig. 1B). Conclusion Our results demonstrate that an AI-powered application exhibits actionable accuracy in classifying AV aneurysms within a demographically diverse HD population. These findings align with Zhang et al., where a team of vascular access experts classified 1,093 out of 1,341 (81.5%) images as “Not Advanced” aneurysms and 248 (18.5%) as “Advanced,” resulting in an AUROC of 0.96 in the validation set (n = 402) [1]. The difference in AUROCs can be attributed to the fact that, in Zhang et al., vascular access experts evaluated only AV access images, whereas in the present study, they performed a physical examination of the patient. Our tool may have the potential to support aneurysm monitoring processes, enabling timely detection, decision-making, and interventions.

A Case of Large Arteriovenous Fistula Aneurysm at Elbow

Abstract Arteriovenous (AV) fistula aneurysms are a late-onset complication of surgically created dialysis access sites. They can be of two types: true or false aneurysms (pseudoaneurysms). They can be managed either by endovascular or surgical techniques. We report a patient who presented with an expanding, painful AV fistula aneurysm at the left elbow along with features of left arm and forearm cellulitis. The fistula was ligated and the aneurysm was excised. Postsurgery, the left radial pulse was palpable. Follow-up postsurgery showed a healthy surgical scar with complete resolution of the left upper limb swelling.

Midterm outcomes of arteriovenous fistula aneurysm repair with simultaneous inflow revision or outflow tract revascularization

ObjectiveThe aim of this study was to investigate the 2-year outcomes of extensive revisions aimed at simultaneously addressing arteriovenous fistula (AVF) aneurysms, outflow stenosis, and/or high flow volumes. MethodsThis was a retrospective cohort study in a tertiary referral center. The study population comprised hemodialysis patients with aneurysmal AVFs requiring revision. Subjects were eligible if they were ≥18 years of age and had aneurysm repair associated with inflow revision or treatment of outflow lesions. Patients were followed-up for a minimum of 2 years, and the primary outcome measure was cumulative patency. ResultsOur cohort comprised 93 patients with a mean age of 56 ± 12 years. The most frequent access type was brachiocephalic fistula (61%), and the median access age at the time of revision was 66 months (interquartile range, 46-93 months). The median access flow volume was 2300 ml/min (interquartile range, 1281-2900), and 31 subjects (33%) presented aneurysms associated with both high flow and venous obstruction. Aneurysm repair consisted of aneurysmorraphy in the overwhelming majority (95%). Inflow revision was performed in a total of 49 cases (53%), and outflow tract obstruction was treated in 71 patients (72%), with 27 patients (29%) receiving a simultaneous 3-component revision. At 2 years, the primary, primary assisted, and cumulative patencies were 60% ± 1%, 91% ± 3%, and 94% ± 3%, respectively. The most frequent indication for first-time reinterventions was outflow tract stenosis (24%). Aneurysm recurrence was observed in 13 subjects (14%) during the entire follow-up and was responsible for reinterventions in seven of them (8%), with a 2-year freedom from aneurysm-related reintervention rate of 95% ± 3%. ConclusionsExtensive AVF revision with simultaneous aneurysm repair, inflow revision, and outflow tract revascularization is feasible, safe, and associated with favorable 2-year patency rates.

Endovascular Treatment and Peri-interventional Management of Ruptured Cerebrovascular Lesions During Pregnancy

PurposeHemorrhagic stroke, particularly occurring from ruptured cerebrovascular malformations, is responsible for 5–12% of all maternal deaths during pregnancy and the puerperium. Whether endovascular treatment is feasible and safe for both the mother and the fetus, is still a matter of debate. The main objective of this case series and systematic review was to share our multi-institutional experience and to assess the feasibility and safety of endovascular treatment during pregnancy, as well as the corresponding maternal and fetal outcomes based on currently available evidence.MethodsWe report a case series of 12 pregnant women presenting with hemorrhagic stroke from ruptured cerebrovascular arteriovenous malformations or aneurysms who underwent endovascular treatment prior to delivery. A systematic literature review of pregnant patients with endovascular treated cerebrovascular malformations, published between 1995 and 2022, was performed. Clinical patient information, detailed treatment strategies, maternal and fetal outcomes as well as information on the delivery were collected and assessed.ResultsIn most patients the course was uneventful and an excellent outcome without significant neurological deficits (mRS ≤ 1) was achieved. Furthermore, the maternal outcome was not worse compared to the general population who underwent endovascular treatment of ruptured vascular brain lesions. Also, in most cases a healthy fetus was born.ConclusionEndovascular treatment of ruptured cerebrovascular malformations during pregnancy is safe and feasible regarding both aspects, the maternal and fetal outcomes. Still, a stronger knowledge base is needed to correctly approach future cases of intracranial hemorrhage in the pregnant population.

Durability of Bovine Carotid Artery Graft for Revisions of Arteriovenous Fistula Aneurysms and Associated Complications

Durability of Bovine Carotid Artery Graft for Revisions of Arteriovenous Fistula Aneurysms and Associated Complications

Six different surgical method options according to etiology in repair of arteriovenous fistula aneurysms

Aim: This study aims to evaluate the considerations that should be taken into account when choosing a surgical method and the early results of six methods used for repair in patients who underwent surgical repair due to arteriovenous fistula (AVF) aneurysms. Material and Methods: One hundred and five patients who underwent AVF aneurysm repair between 2012 and 2020 were reviewed retrospectively. Methods for surgical repair were used according to the etiology: Plication, Arteriotomy constrictions and plication, Aneurysm excision and creation of a new fistula, Saphenous vein or synthetic graft interposition, End-to-end anastomosis and plication after aneurysm excision, Banding method. Results: Sixty-one of the cases were male and 44 were female. The mean age was 56.6 (27-75) years. The total number of surgeries was 119, including the surgeries and reoperations performed in 2 planned sessions. As surgical method, 44 Plication, 13 Arteriotomy constrictions and plication, 10 Aneurysm excision and creation of a new fistula, 25 Saphenous vein or synthetic graft interposition, 13 End-to-end anastomosis and plication after aneurysm excision and 14 Banding methods were used. AVF flow of 38 patients was measured to be over 1700 ml/min, and 34 of these patients had an arteriotomy length of more than 7 mm. In patients who underwent repair due to high flow rate, an average of 30-65% flow reduction was achieved compared to the preoperative period. In the first postoperative 3 months, 7 (6%) patients required reoperation. Fistula loss did not occur in any of the patients who underwent repair. Conclusion: The etiology of aneurysm, flow rate, aneurysm localization, and the presence of intimal hyperplasia or chronic thrombus are important in choosing an aneurysm repair method. We think that the results will be positively affected if the surgical method is determined according to the association of one or few of these factors.

Abstract Number ‐ 254: Yield of CTA in Patients over 50 with Brain Hemorrhages at Sites Typical for Hypertension

Introduction Approximately 10%–15% of acute strokes are spontaneous, nontraumatic intraparenchymal cerebral hemorrhage (IPH). Hypertension (HTN), amyloid angiopathy, or impaired coagulation cause most spontaneous IPHs, in which case the CTA is unlikely to identify an underlying vascular lesion. Prior investigators have identified clinical and non‐contrast CT (NCCT) features that increase the likelihood of identifying a vascular etiology for an IPH, including younger age (&lt; 40–50), absence of hypertension, and presence of subarachnoid (SAH) or intraventricular hemorrhage (IVH). Findings from earlier studies of patients with IPH suggested that older age, HTN, together with certain locations (basal ganglia, thalamus, cerebellum, and pons) could reliably exclude IPH patients with underlying lesions. We aimed to assess the yield of CTA, a costly study with risks of radiation, contrast induced renal injury and death, in identifying vascular lesions in this group. Methods This retrospective study involved reviewing medical records of all patients admitted to Carilion RMH hospital for brain hemorrhage during the period 2008–2020, inclusive. Patients were considered if they were over 50 year of age, had HTN (and/or left ventricular hypertrophy on electrocardiograms or echocardiograpy) and IPH in the thalamus, basal ganglia, cerebellum or pons. Patients with SAH, lobar IPH, traumatic IPH, pure IVH, and patients with known vascular lesions were excluded. Imaging of all patients was reviewed with attention to finding CTAs showing vascular lesions that might have caused of the recent symptomatic IPH (arteriovenous malformations, aneurysms, venous anomalies and dural venous sinus thrombosis). Small saccular aneurysms at remote sites were not considered relevant, nor were intra‐ or extracranial stenoses. Results A total of (446) charts were reviewed, of which 143 met the inclusion criteria (94 males and 49 females). Family history was positive for cerebral aneurysm in one patient and Alzheimer’s with brain hemorrhage in another. Twenty‐six patients were on anticoagulation: 10 on NOAC, 14 on Warfarin (INR was &lt; 2 in 8, 2–3 in 5, and &gt;3 in only one patient). One was on subcutaneous heparin (PTT was 53). No other patient had major coagulation abnormalities; only 5 patients had platelets count &lt; 100K, the lowest was 62K. CTA was negative for underlying vascular lesion at the site of bleeding in all 143 patients, confidence interval 2.6% using Confidence intervals for proportions, using Wilson’s method for proportions. Conclusions In patients over 50 year of age with evidence of hypertension, and ICH in the basal ganglia, thalamus, brain stem and cerebellum; the diagnostic yield of CTA is negligible. Performing this study routinely in the evaluation of these patient increases health care costs, and exposes patients to the risks of unnecessary radiation, contrast induced kidney injury and death. We recommend against the routine use of CTA in patients meeting the above criteria.

Surgeon eye lens dose monitoring in interventional neuroradiology, cardiovascular and radiology procedures

PurposeThis study investigated the radiation dose to surgeon eye lens for single procedure and normalised to exposure parameters for eight selected neuroradiology, cardiovascular and radiology interventional procedures. MethodsThe procedures investigated were diagnostic study, Arteriovenous Malformations treatment (AVM) and aneurysm embolization for neuroradiology procedures, Coronary Angiography and Percutaneous Transluminal Coronary Angioplasty (CA-PTCA), Pacemaker and Implantable Cardioverter-Defibrillator implantation (PM-ICD), Endovascular Aortic Repair (EVAR) and Fenestrated Endovascular Aortic Repair (FEVAR) for cardiovascular and electrophysiology procedures. CT-guided lung biopsy was also monitored.All procedures were performed with table-mounted and ceiling-suspended shields (0.5 mm lead equivalent thickness), except for FEVAR and PM-ICD where only a table mounted shield was present, and CT-guided lung biopsy where no shield was used. Dose assessment was performed using a dosemeter positioned close to the most exposed eye of the surgeon, outside the protective eyewear. ResultsThe surgeon most exposed eye lens median Hp(3) equivalent dose for a single procedure, without protective eyewear contribution, was 18 μSv for neuroradiology diagnostic study, 62 μSv for AVM, 38 μSv for aneurysm embolization, 33 μSv for CA-PTCA, 39 μSv for PM-ICD, 49 μSv for EVAR, 2500 μSv for FEVAR, 153 μSv for CT-guided lung biopsy. ConclusionsIn interventional procedures, the 20 mSv/year dose limit for surgeon eye lens exposure might be exceeded if shields or protective eyewear are not used.Surgeon eye lens doses, normalised to single procedures and to exposure parameters, are a valuable tool for determining appropriate radiation protection measures and dedicated eye lens dosemeter assignment.

Hemifacial Spasm Caused by Cerebellar Arteriovenous Malformation and Spasm-Relief after Nidus Removal

Secondary hemifacial spasm (HFS) occurs by a conflict between the facial nerve and intracranial pathology, such as cerebellopontine angle tumor or vascular abnormality like arteriovenous malformation (AVM) or aneurysm. HFS caused by AVM is rare, and optimal combination of treatment options has not been established. AVM treatment with or without microvascular decompression (MVD) of the facial nerve was provided in the previous studies, and the outcomes in terms of spasm relief have been successful. Here, we report a case of HFS caused by cerebellar AVM. HFS symptom disappeared after AVM nidus removal without MVD of the facial nerve.

A pediatric case of spontaneous intracerebral hemorrhage of unknown etiology

Pediatric ICH peaks in the first year of life especially in neonatal period with hematological abnormalities or structural vascular disorders such as arteriovenous malformations (AVM) or aneurysms. Imaging modality of choice is NCCT head. Urgent surgery when indicated should be performed early. To evaluate the causes of spontaneous ICH in paediatric patients and reviewing the literature. We have discussed the causes of spontaneous ICH in our paediatric patient and we have discussed the management provided to this patient. Taking a detailed history from the parents and the child is important for determining any history of head injury and bleeding episodes. Despite comprehensive evaluation, it may not be possible to determine the cause of ICH in some pediatric cases.

End-to-end anastomosis as a superior repair type to prevent recurrence of arteriovenous fistula aneurysms and improve patency outcomes.

Arteriovenous fistulae (AVF) complicated by aneurysms are repaired through several mechanisms. Little is known about risk factors for aneurysm recurrence or the efficacy of subsequent repair of recurring aneurysms. About 291 patients underwent AVF aneurysm repair between 2009 and 2019 at a large urban medical center. Patients who underwent staged repair, had a primary graft with pseudoaneurysm, were status-post kidney transplant, or using other dialysis access at the time of repair were excluded. One hundred sixty-two patients were included in the study, of which 52 developed a secondary aneurysm. Chi-square and t-test analyses were used to compare demographics. Multivariate logistic regression was used to examine independent risk factors for aneurysm recurrence. Of the 52 patients with recurrent aneurysms, 41 were repaired again. Patency was examined for each group 1 year postoperatively. Patients without secondary aneurysms were more likely to have a Charlson Comorbidity Index score ⩾5 (p = 0.045). Males were 2.8 times more likely to develop a secondary aneurysm compared to females (p = 0.023). Patients who underwent elective compared to emergent or urgent surgery for primary aneurysms were significantly less likely to recur (OR = 0.222; p = 0.016). Primary aneurysms repaired by end-to-end anastomosis, compared to aneurysmorrhaphy or graft, were significantly less likely to recur (OR = 0.239; p = 0.041). Among patients with secondary aneurysms, those repaired via end-to-end anastomosis had a significantly higher primary patency rate 1 year postoperatively (p = 0.024). Secondary aneurysm repairs exhibited 1-year primary and secondary patency rates of 51.2% and 82.9%, respectively. End-to-end anastomosis reduces risk of recurrence and demonstrates superior patency rates when repairing recurrent aneurysms. It remains unclear why some patients are prone to aneurysm recurrence, however continued attempts to repair existing vascular access are proven to be successful.

Closing the Gap in Pediatric Hemorrhagic Stroke: A Systematic Review

Pediatric hemorrhagic stroke (HS) accounts for a large proportion of childhood strokes, 1 of the top 10 causes of pediatric deaths. Morbidity and mortality lead to significant socio-economic and psychosocial burdens. To understand published data on recognizing and managing children with HS, we conducted a systematic review of the literature presented here. We searched PubMed, Embase, CINAHL and the Cochrane Library databases limited to English language and included 174 studies, most conducted in the USA (52%). Terminology used interchangeably for HS included intraparenchymal/intracranial hemorrhage, spontaneous ICH, and cerebrovascular accident (CVA). Key assessments informing prognosis and management included clinical scoring (Glasgow coma scale), and neuroimaging. HS etiologies reported were systemic coagulopathy (genetic, acquired pathologic, or iatrogenic), or focal cerebrovascular lesions (brain arteriovenous malformations, cavernous malformations, aneurysms, or tumor vascularity). Several scales were used to measure outcome: Glasgow outcome score (GOS), Kings outcome score for head injury (KOSCHI), modified Rankin scale (mRS) and pediatric stroke outcome measure (PSOM). Most studies described treatments of at-risk lesions. Few studies described neurocritical care management including raised ICP, seizures, vasospasm, or blood pressure. Predictors of poor outcome included ethnicity, comorbidity, location of bleed, and hematoma &gt;2% of total brain volume. Motor and cognitive outcomes followed independent patterns. Few studies reported on cognitive outcomes, rehabilitation, and transition of care models. Interdisciplinary approach to managing HS is urgently needed, informed by larger cohort studies targeting key clinical question (eg development of a field-guide for the clinician managing patients with HS that is reproducible internationally).

Overview of hemodialysis access and assessment.

To provide family physicians with an evidence-based overview on the various methods of vascular access for hemodialysis (HD) and to provide a framework for the clinical assessment of HD access. A MEDLINE literature search was conducted using the MeSH terms arteriovenous fistula, arteriovenous graft, central venous catheter, and hemodialysis (or haemodialysis), including all relevant English-language articles published between January 1995 and September 2021. The main types of permanent vascular access for HD are arteriovenous fistulas, arteriovenous grafts, and central venous catheters. A pragmatic, patient-centred approach is required when choosing the type of access for an individual. Common complications of vascular access creation include thrombosis, central venous stenosis, dialysis access steal syndrome, and arteriovenous fistula aneurysms. Family physicians play an important role in the clinical assessment and monitoring of HD vascular access. A thorough clinical assessment can detect a failing arteriovenous fistula and any associated complications, which can allow for prompt investigation and intervention to restore functionality, maintain access longevity, and improve patient quality of life.

Risk factors and prevalence of arteriovenous fistula aneurysm in hemodialysis patients: systematic review

The term arteriovenous fistula aneurysm is used in medicine to define that it is a localized vascular dilatation, where the entire vessel wall participates increasing the vascular diameter by 50% or more. General objective: To review the scientific evidence on determining the risk factors and prevalence of arteriovenous fistula aneurysm in hemodialysis patients. Methodology: We worked with a descriptive approach method regarding the search strategies, we used scientific databases such as PubMed, Scopus, Web of Science, by combining keywords which allowed us to select articles in Spanish and English between the years of publication 2015 to 2021, we chose those that had some relation with the topic to be addressed. Main results: The method used in the research will be hypothetical deductive, it will use a non-experimental design of descriptive level, which will collect the information in a period of the last 5 years, whose results will be visualized graphically and textually. Conclusion: Significant evidence to affirm the observed factors if they are significantly associated with the formation of aneurysms in arteriovenous fistula, with a p-value &lt; 0.05, affirming or nullifying the hypothesis posed for these factors.

Graft repair of arteriovenous fistula aneurysms is associated with decreased long-term patency

IntroductionArteriovenous fistula (AVF) aneurysms are a chronic complication which can be disfiguring, painful, and can rupture. Here, we compare the outcomes between three different methods of AVF aneurysm repair. MethodsOne-way ANOVA, Chi-square, and Fisher Exact analyses were used to compare demographics. Multivariate logistic regression compared outcomes. Kaplan-Meier estimate illustrated long-term fistula patency. ResultsThere were no differences between demographics in the aneurysmorrhaphy, end-to-end anastomosis, and synthetic graft groups. The odds of patients who received graft repair losing primary patency within one year compared to the aneurysmorrhaphy group was 3.5 (p = 0.025). Graft repair patients were 6.7 times more likely to develop an infection compared to aneurysmorrhaphy (p = 0.014). Synthetic grafts also exhibited accelerated rates of complete access loss compared to autogenous methods (p = 0.034). ConclusionsGraft repair of AVF aneurysms results in higher rates of infection and decreased primary and ultimate patency compared to autogenous repair techniques. Therefore, synthetic grafts should be avoided whenever possible.