Arteriovenous Fistula Aneurysm Research Articles

Salvage of brachiocephalic aneurysmatic fistulas, using ePTFE graft with a minimally invasive approach.

In this study, we evaluated our surgical approach in requiring surgical treatment of brachiocephalic arteriovenous fistula (AVF) aneurysms for salvage of AVF. Between 2012 and 2022, 20 patients (16 men, 4 women; mean age 54.5 years) who were surgically treated for a brachiocephalic AVF aneurysm in our Cardiovascular Surgery Clinic were evaluated retrospectively. These 20 patients were operated on for aneurysm thrombosis and fistula failure in 16 patients, sudden rupture and severe bleeding in 3 patients, cosmetic reasons, and anxiety in 1 patient. These aneurysms were ligated and divided from distal and proximal cephalic veins. Then, a 6 mm dialysis graft was interposed between the well-developed cephalic vein distal and proximal to the aneurysm with small skin incisions. All patients were taken to dialysis via this dialysis graft 24 h after the procedure without any problem. All patients were discharged after dialysis. After surgery, no catheterization or any other additional procedure was required for hemodialysis. No complications, such as infection, hematoma, neurological damage, or ischemia, were observed after the surgical procedure. The mean postoperative follow-up was 12 months. In brachiocephalic AVF aneurysms requiring surgical treatment, hemodialysis can be continued with a graft placed in the same arm in this technique.

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.

Salvage Aneurysmorrhaphy as an Adaptable and Still Pertinent Technique in the Management of Challenging True Aneurysms of Arteriovenous Fistulas: A Case Series of Different Variations, With Illustrative Surgical Pictures

Salvage Aneurysmorrhaphy as an Adaptable and Still Pertinent Technique in the Management of Challenging True Aneurysms of Arteriovenous Fistulas: A Case Series of Different Variations, With Illustrative Surgical Pictures

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.

Ex-vivo Mechanical Augmentation of Human Saphenous Vein Graft By UV-A Irradiation in Emergency Vascular Reconstruction – Preliminary Results

Abstract Introduction In vascular reconstruction in arterial trauma, ruptured abdominal aortic aneurysm or ruptured aneurysmal arteriovenous fistula, the challenge no longer lies in the surgical procedure itself, but rather the prevention of intimal hyperplasia, thrombosis and aneurysm formation, in parallel with extending as long as possible the patency of the grafts. The aim of this study is to present the preliminary findings of a novel non-ionizing radiation-based therapeutic method for stabilizing and strengthening the extracellular matrix of the venous wall, improving the biomechanical profile of the autologous graft used in myocardial and lower limb revascularization. Material and methods We developed the protocol and method for UV-A irradiation as a new method of mechanical augmentation of the resistance structure of the venous graft. Samples of the superficial femoral artery, superficial femoral vein, and great saphenous vein (GSV) were extracted from a 58-year-old patient who underwent above-the-knee amputation, and were prepared in 5 × 5 cm2 patches. Additionally, we analyzed the samples biomechanically biaxially with the BioTester® 5000, in which we established a 25% equibiaxial stretch. The GSV sample was also treated by UV-A irradiation after being kept in riboflavin 5′-phosphate monosodium salt for 30 min. Results After UV-A treatment of the GSV wall, we observed an important increase of Cauchy stress from 82 kPa to 131 kPa in the longitudinal axis and from 66 kPa to 115 kPa in the circumferential axis. Young’s modulus also changed after treating the GSV wall from 0.564 MPa to 1.218 MPa (longitudinal) and from 0.397 MPa to 0.709 MPa (circumferential). As a result of the therapy, we observed a considerable similarity of the mechanical behavior of the GSV wall to that of the artery wall. Conclusion The photocrosslinking of collagen fibbers at the vein graft adventitia hardens and stiffens the venous wall, making it behave like the arterial wall after treatment. These preliminary ex vivo results on human vascular tissue may serve as the foundation for the development of new treatment approaches utilizing mechanical augmentation of the vein grafts.

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.

Retrospective Study of The Outcome of Primary Repair of Arteriovenous Fistula (AVF) Aneurysm and Pseudoaneurysm in Secondary Hospital Setting

Aneurysms and pseudoaneurysm are commonly encountered with arteriovenous vascular access for haemodialysis. They are difficult complications to manage. Due to the limited number of vascular centers available, patients were unable to seek treatment until further complications arise. The technique of partial aneurysmectomy and primary repair was adopted as the method of repair in this study. A total of 20 cases underwent the surgery from 2019 to 2020. Among the 20 cases, one patient had two pseudoaneurysms at different location which requires her to undergo the procedure twice. The successful cannulation rate post repair was 70% whereas the overall complication rate was 35% which might be attributed to the small sample size. Overall, this study demonstrated that AVF aneurysm and pseudoaneurysm can be safely treated with this approach and can be done effectively in non-vascular centers by general surgeons. Keywords: pseudoaneurysm, aneurysm repair, arteriovenous fistula

Arteriovenous fistula aneurysmorrhaphy is associated with improved patency and decreased vascular access abandonment

BackgroundUpper extremity hemodialysis arteriovenous fistulas (AVFs) can become aneurysmal over time due to repeated cannulation and/or outflow steno-occlusive disease. The optimal surgical management of aneurysmal AVFs (aneurysmorrhaphy vs interposition graft) has remained unclear. MethodsWe performed a retrospective review in which current procedural terminology codes were used to screen for patients who had undergone surgical treatment of aneurysmal AVFs between 2016 and 2021 at a single hospital system. The patients were included after a review of the operative reports. The cases were divided by surgical procedure (aneurysmorrhaphy vs interposition graft placement). The patients who had undergone primary AVF ligation or other types of repair were excluded. The primary outcomes were primary assisted and secondary patency, and the secondary outcome was dialysis access abandonment. Multivariable Cox proportional hazards regression was used to test the association between the type of AVF aneurysm repair and the primary and secondary outcomes. ResultsFrom 2016 to 2021, 6951 patients had undergone 16,190 dialysis access procedures. Of these procedures, 381 (2.4%) were related to surgical treatment of an aneurysmal AVF. We excluded 58 primary AVF ligation cases and 20 cases involving other types of repair, leaving 303 cases for analysis. These were divided into two groups: aneurysmorrhaphy (n = 123; 41%) and interposition graft (n = 180; 59%). No differences were found between the groups in male gender (68% vs 63%), hypertension (98% vs 98%), or central stenosis (14% vs 22%). The patients who had undergone aneurysmorrhaphy were younger (median age, 54 years vs 59 years); had had a lower rate of diabetes (41% vs 59%), coronary artery disease (41% vs 58%), and congestive heart failure (41% vs 55%); and were less likely to have undergone upper arm access (72% vs 92%). The median follow-up was 11.1 months (interquartile range, 3.6-25.2 months). No differences were found in the incidence of 30-day wound complications (1% vs 3%) or surgical site infections (4% vs 6%). On multivariable Cox regression, interposition graft placement was associated with the loss of primary assisted patency (adjusted hazard ratio [aHR], 2.42; 95% confidence interval [CI], 1.18-4.95), loss of secondary patency (aHR, 3.10; 95% CI, 1.21-7.94), and abandonment of dialysis access (aHR, 3.07; 95% CI, 1.61-5.87; P < .05 for all) at 2 years. ConclusionsAVF aneurysmorrhaphy was associated with improved primary assisted and secondary patency and decreased abandonment of dialysis access. We suggest using aneurysmorrhaphy when AVF aneurysms are indicated for repair. However, individual factors such as patient comorbidities, AVF anatomy, remaining dialysis access options, and patient preference should be considered when planning the surgical approach.

Manual compression technique improves the success rate in the treatment of thrombosed aneurysmal arteriovenous fistula: A single-center experience.

Endovascular intervention for thrombosed aneurysmal arteriovenous fistula (AVF) is still a challenge. Manual compression technique (MCT)-assisted angioplasty may be helpful, but there is no evidence or data to support it. From January 2018 to May 2021, patients with thrombosed aneurysmal AVFs were retrospectively enrolled. The patients were separated into the MCT group or the traditional group according to the procedure received. Technical failure, clinical failure, 90-day patency, and safety were analyzed. A total of 159 cases (64 ± 12 years old, 60% male) were enrolled, of which 87 cases received MCT and 72 underwent traditional angioplasty. No technical failure was observed in the MCT group, while five technical failures were observed in the traditional group (0% vs. 7%, p = 0.02). There were no differences in the clinical failure rate (3% vs. 7%, p = 0.30), 90-day patency rate, or procedure time between the MCT group and the traditional group. There was no symptomatic pulmonary embolism or other complication in the two groups. MCT is a low-cost, less invasive, and safe procedure for thrombosed aneurysmal AVF, and it achieves a higher technical success rate than traditional angioplasty.

A Hyperdynamic Arteriovenous Fistula Aneurysm After Long Time Renal Transplantation.

Closure of arteriovenous fistula should be considered in patients who underwent successful renal transplantation to avoid potential complications that may result from the presence of unused fistula especially, in patients who are predisposed to aneurysm formation in the future.

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.

Revision of Aneurysmal Arteriovenous Access with Immediate Use Graft Is Safe and Avoids Prolonged Use of Tunneled Hemodialysis Catheters

Aneurysmal arteriovenous fistulas (AVF) can pose a difficult treatment dilemma for the vascular surgeons. Prolonged tunneled dialysis catheters (TDCs) in patients requiring long-term dialysis are associated with significantly increased mortality compared to AVF. We aimed to elucidate the outcomes of aneurysmal arteriovenous (AV) access revision with aneurysm resection and Artegraft® (LeMaitre, New Brunswick, NJ) Collage Vascular Graft placement to avoid prolonged use of TDCs. We reviewed all patients with aneurysmal AV access in whom the access was revised with aneurysm resection and jump graft placement at a single institution from 2018 to 2021. Outcomes were time to cannulation, reintervention rates, time to reintervention, and patency (primary, primary assisted, and secondary). Patency rates were estimated with Kaplan-Meier Survival analysis. A total of 51 revised aneurysmal AV accesses in 51 patients were studied, of which 23.5% (n=12) had perioperative TDC placement. Three patients were done for emergent bleeding. The cohort was 62.8% male (n=32) with a median age of 58years (interquartile range: 49-67). Most patients had brachiocephalic AVF (n=37 [72.6%]). The median follow-up time was 280days. The median time to cannulation was 2days. Time to cannulation was significantly longer in patients with perioperative TDC as compared with those without TDC (24days vs. 2days, P<0.001). Reintervention was required in 41.2% of patients (n=21), at median time of 47days. At 30, 90, 180, and 365days, primary patency rates were 84.3%, 78.3%, 66.6%, and 54.9%; primary assisted patency rates were 94.1%, 88.1%, 79.4%, and 79.4%; and secondary patency rates were 100%, 97.8%, 91.6%, and 91.6%, respectively. The revision of aneurysmal AV access (urgent or elective) with Artegraft as jump graft is safe, with acceptable short- and mid-term patency results. This allows dialysis patients to continue to have a functional access, decreasing the need for a tunneled catheter and reducing the associated risk of sepsis and increased mortality. This should be considered for all patients with aneurysmal, dysfunctional fistulas to maintain AV access and avoid TDC placement.

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.

Recanalization of thrombosed aneurysmal hemodialysis arterovenous fistulas using a hybrid technique based on data from a single center

ObjectiveTo explore the technical specifications and clinical outcomes of thrombosed aneurysmal haemodialysis arteriovenous fistula (AVF) treated with ultrasound-guided percutaneous transluminal angioplasty combined with minimal aneurysmotomy.MethodsThis case series study included 11 patients who had thrombosed aneurysmal AVF and underwent salvage procedures over a 13-month period. All procedures were performed under duplex guidance. Minimal aneurysmotomy was performed, along with manual thrombectomy and thrombolytic agent infusion, followed by angioplasty to macerate the thrombus and sufficiently dilate potential stenoses. A successful procedure was defined as immediate restoration of flow through the AVF.ResultsThe 11 patients (four males and seven females) had a mean age of 49.6 years ± 11.9 years. Six patients (54.5%) had two or more aneurysms. The mean aneurysm maximal diameter was 21.5 mm (standard deviation: ± 5.0 mm), and the mean thrombus length was 12.9 cm (8–22 cm). Ten (83.3%) of the 12 procedures were technically successful. The mean duration of operation was 150.9 minutes (standard deviation: ± 34.2 minutes), and mean postoperative AVF blood flow was 728.6 ml/min (standard deviation: ± 53.7 mi/min). The resumption of hemodialysis was successful in all 11 cases, with a clinical success rate of 100%. The primary patency rates were 90.0% and 75.0% at three and four months over a mean follow-up time of 6.3 months (3–12 months). The secondary patency rates were 90.4% at three and four months.ConclusionA hybrid approach combining ultrasound-guided percutaneous transluminal angioplasty and minimal aneurysmotomy might be a safe and effective method for thrombosed aneurysmal AVF salvage.

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.

Revision Of Aneurysmal Arteriovenous Access With Immediate Use Graft Is Safe And Avoids Prolonged Use Of Tunneled Hemodialysis Catheters

<h3>INTRODUCTION AND OBJECTIVES</h3> Tunneled dialysis catheters (TDC) in patients requiring long-term dialysis are associated with significantly increased mortality compared to arteriovenous fistulas (AVF). Aneurysmal AVF pose a difficult treatment dilemma for vascular surgeons. We aimed to elucidate the outcomes of aneurysmal AV access revision with aneurysm resection and Artegraft Collage Vascular Graft placement to avoid prolonged TDC use. <h3>METHODS</h3> We reviewed patients with aneurysmal AV access in which the access was revised with aneurysm resection and jump graft placement at a single institution from 2018 to 2021. Outcomes were time to cannulation, reintervention rates, time to reintervention and patency. <h3>RESULTS</h3> A total of 41 patients with revised aneurysmal AV access were studied, of which 26.8% (n=11) had perioperative TDC placement. Three patients were done for emergent bleeding. The cohort was 58.5% male (n=24) with a median age of 58 years (IQR: 49-65). Most patients had brachiocephalic AVF (n=31 [75.6%]). Median follow up time was 315 days. Median time to cannulation was 3 days. Time to cannulation was significantly longer in patients with perioperative TDC as compared with those without TDC (24 days vs 1 day, P<0.001). Reintervention was required in 39.0% of patients (n=16), at median time of 30 days. At 30, 90, and 180 days, primary patency rates were 82.9%, 75.5% and 66.6%, primary assisted patency rates were 92.7%, 85.2% and 76.1%, and secondary patency rates were 100%, 97.4% and 90.9% respectively. <h3>CONCLUSIONS</h3> Revision of aneurysmal AV access with Artegraft as jump graft is safe, with acceptable short and mid-term patency results. This allows dialysis patients to continue to have a functional access, decreasing the need for tunneled catheter and reducing the associated risk of sepsis and increased mortality. This should be considered for all patients with aneurysmal, dysfunctional fistulas to maintain AV access and avoid TDC placement

Rozycki-Feliciano Lecture Rudolph Matas, the Father of Vascular Surgery.

Rudolph Matas (1860-1957) was one of the foremost figures in the history of vascular surgery. He is considered the father of vascular surgery for his operations for arteriovenous fistula and peripheral artery aneurysm, all devised before the isolation of heparin and the wide adoption of techniques for vascular anastomosis. A medical and surgical prodigy, Matas received his medical degree from Tulane University at age 19 (1880) and was named its chair of surgery at 35 (1895), a position he would hold until 1927. A contemporary and friend of Halsted, Matas throughout his career was known as a leader in the field, holding the presidencies of the American College of Surgeons (1925-1926) and the American Surgical Association (1909). He maintained loyal relationships to those who trained in surgery with him at Touro Hospital in New Orleans, including the author's grandfather, the first Richard J. Field. Matas was an honored guest at the dedication of the Centreville Clinic in 1928, the facility where three generations of Field surgeons have provided continuous service to its rural Mississippi community for nearly a century.

A Staged Approach for Repair of Multiple Arteriovenous Fistula Aneurysms Reduces the Need for Temporary Central Venous Catheter for Hemodialysis

A Staged Approach for Repair of Multiple Arteriovenous Fistula Aneurysms Reduces the Need for Temporary Central Venous Catheter for Hemodialysis