Arteriovenous fistulas (AVF) are the preferred vascular access for hemodialysis, however patency rates remain low. Animal AVF models are essential for uncovering mechanisms of AVF remodeling. Yet most lack coexisting chronic kidney disease (CKD), critical to AVF failure. Existing CKD-AVF models are often acute surgical models and cause substantial discomfort and high mortality, limiting their translational value. This study assessed high-oxalate diet-induced kidney injury in a mouse AVF model and its effect on AVF remodeling. Male and female C57BL/6J mice were fed either a high-oxalate or control diet for six weeks. AVF surgery was performed at week three. Kidney function (glomerular filtration rate [GFR], plasma urea), blood pressure, and ultrasound-assessed AVF volume were monitored. Three weeks post-surgery, AVFs, blood, and kidneys were analyzed by immunohistochemistry and flow-cytometry to assess morphometry, endothelial damage, inflammation, and immune activation. High-oxalate diet reduced GFR by 49% (P<0.001) and increased plasma urea, confirming kidney injury. AVF volume did not differ between groups, whereas mean arterial pressure was 23% higher in the high-oxalate group (P=0.024). AVFs from these mice showed 13% less outward remodeling (P=0.026), increased endothelial damage, immune cell infiltration and vascular calcification. Flow-cytometry demonstrated increased systemic immune activation in the high-oxalate group. The high-oxalate-induced chronic kidney injury-AVF model express key similarities to human impaired AVF remodeling, including long-term kidney failure, hypertension, endothelial damage and immune activation. By reducing animal burden and improving disease representation, this model advances preclinical AVF research towards greater translational applicability.

Hemodialysis access (HA) may induce distal ischemia and impair peripheral nerve function in the ipsilateral limb. Peripheral neuropathy is common in end-stage renal disease (ESRD) and may remain subclinical without electrophysiological testing. This study evaluated the effect of arteriovenous fistula (AVF) on electrophysiological parameters of the median (MN) and ulnar (UN) nerves and examined the impact of HA localization and flow. Ninety ESRD patients with functioning AVF underwent bilateral nerve conduction studies (DML, CMAP, CSAP, MCV, SCV) one hour before dialysis. HA flow was measured by Doppler sonography. Sensory symptoms and clinical tests (Phalen, Tinel) were recorded. Compared to the contralateral arm, the HA arm showed longer DML and reduced CMAP, CSAP, MCV, and SCV in both MN and UN. CSAP and MCV reductions were significant in both nerves, CMAP in UN. Electrophysiological impairment was greater with forearm HA and high flow (>979ml/min). Patients with sensory complaints exhibited significantly worse parameters than asymptomatic patients. AVF is associated with mixed axonal sensory-motor neuropathy, likely due to chronic distal ischemia. Sensory fibers are particularly vulnerable. Forearm location and high flow exacerbate deficits. Early electrophysiological screening may enable timely detection and intervention.

Clinical utility of imaging for pulsatile tinnitus.

To summarize 12-month results from the randomized controlled arm of the Wrapsody Arteriovenous Access Efficacy (WAVE) trial. The WAVE trial was a prospective, multicenter study conducted across 43 international centers. In the randomized arm of the trial, patients with an arteriovenous fistula on hemodialysis with evidence of stenosis within the peripheral venous outflow circuit were randomized 1:1 to treatment with the Wrapsody Cell-Impermeable Endoprosthesis (CIE) or percutaneous transluminal angioplasty (PTA). Safety outcomes of interest at 12 months included device-related events and serious adverse events. Effectiveness outcomes of interest at 12 months included target lesion primary patency (TLPP), access circuit primary patency (ACPP), and the number of reinterventions. Two hundred forty-five patients were analyzed (CIE, n = 122; PTA, n = 123). At 12 months, TLPP and ACPP were significantly higher for patients treated with the CIE than for those treated with PTA (TLPP: 70.4% vs 38.5%, P < .0001; ACPP: 56.4% vs 31.1%, P = .0002). The mean number of reinterventions to maintain target lesion patency was significantly lower for patients treated with the CIE than for those treated with PTA at 12 months (0.49 [SD ± 0.92] vs 1.08 [SD ± 1.16], P < .0001), as was the mean number of reinterventions required to maintain access circuit patency (1.08 [SD ± 1.63] vs 1.70 [SD ± 1.93], P = .001). Device-related events were lower for the CIE versus PTA (2.9% vs 9.5%, P = .049). No significant differences were observed for the proportion of patients experiencing serious adverse events. The superior performance of the CIE versus PTA provides useful information to help physicians prolong vascular access patency for hemodialysis patients who experience stenosis in their venous outflow circuit.

Spontaneous closure of an atraumatic cervical spinal arteriovenous fistula in a pediatric patient.

Globally, quantitative information on healthcare coverage for chronic kidney disease (CKD) is scarce. Our objective was to estimate the supply/demand ratio for CKD-related procedures in the Brazilian Unified Health System (SUS) between 2015 and 2024. The volume of tests, consultations and treatments related to CKD was retrieved from the website of the SUS Information Technology Department. The requirement parameters of these procedures were obtained from the Ministry of Health ordinances as well as from literature review. The percentage coverage of each procedure was defined by the ratio between the volume performed and the estimated need. Coverage of the following procedures increased between 2015 and 2024: serum creatinine dosage (70% to 122%), proteinuria testing (4% to 12%), kidney ultrasonography (76% to 107%), outpatient consultation with a nephrologist (48% to 164%), multidisciplinary care of pre-dialysis CKD (0% to 3%), and chronic dialysis (69% to 81%). Coverage of kidney biopsy remained nearly stable (19% to 21%). There was a reduction in coverage of arteriovenous fistula for hemodialysis (HD) (66% to 59%) and of kidney transplantation (46% to 37%). The use of peritoneal dialysis (PD) among chronic dialysis methods (PD and HD) declined from 7% to 4%. Possible explanations for these results include excessive creatinine testing and nephrology consultations, neglect of CKD screening for proteinuria, lack of adherence to multidisciplinary pre-dialysis follow-up, underutilization of PD, and insufficient availability of kidney biopsy and kidney replacement therapy (lower coverage of kidney transplantation compared to chronic dialysis).

Prevalence and spectrum of coronary artery anomalies detected on coronary CT angiography.

Longitudinal three-dimensional photoacoustic imaging reveals hyperoxic perilesional microvasculature associated with keloid recurrence.

A novel technique for preventing distal embolism during endovascular therapy for femoropopliteal lesions: The flow-controlled anti-embolic technique.

Endovascular therapy is the preferred option for arteriovenous fistula dysfunction. The aim of this trial is to compare the 12-month efficacy and safety outcomes of cutting balloon with the drug-coated balloon. The DRAGON study is a multicenter, prospective, observational cohort study. One hundred and eighty patients with stenosis of the venous segment of arteriovenous fistula will be recruited for treatment with the cutting balloon or the drug-coated balloon. The primary efficacy endpoint is the 12-month target-lesion primary patency rate. The secondary efficacy endpoints are the 3- and 6-month target-lesion primary patency rate, the 6- and 12-month access-circuit primary patency rate, the total number of target-lesion reintervention, the 12-month target-lesion reintervention rate, and the 12-month access-circuit thrombosis rate. The safety endpoints included complications and death. The Dragon study has been registered at www. gov (registration number: NCT06527963). The study protocol has been approved by the Institutional review board and Human Research Ethics Committee of Renji Hospital, School of Medicine, Shanghai Jiao Tong University (Approved number: LY2024-102-B). The results will be disseminated by publication in a peer-reviewed journal.

The aim of this study is to systematically retrieve, appraise, and synthesize high-level evidence related to ultrasound-guided Autologous Arteriovenous Fistula (AVF) cannulation and to develop evidence-based recommendations to support standardized and safe clinical practice in vascular access management. All evidence on ultrasound-guided autologous AVF cannulation were searched from January 1, 2015, to December 30, 2024, including UpToDate, DynaMed, Guidelines International Network, National Institute for Health and Care Excellence, Scottish Intercollegiate Guidelines Network, Registered Nurses' Association of Ontario, National Kidney Foundation, European Society for Vascular Surgery, American Institute of Ultrasound in Medicine, Infusion Nurses Society, Joanna Briggs Institute (JBI), Medlive, PubMed, Embase, the Cochrane Library, CNKI, WanFang Data, and VIP Database. Eligible literature included clinical decision-making tools, practice guidelines, practice recommendations, evidence summaries, systematic reviews, and expert consensus statements. The quality of all included studies was assessed using appropriately critical appraisal tools. A total of 20 articles were included, comprising 2 clinical decision-making documents, 9 guidelines, 4 expert consensus statements, 2 systematic reviews, 1 practice recommendations, 2 evidence summaries. Ultimately, 17 items of best evidence were synthesized, covering five major domains: Indications, vascular assessment, equipment preparation, cannulation implementation, and education and training. This study summarized the best available evidence on ultrasound-guided autologous AVF cannulation, thereby providing scientific evidence to support clinical practice in vascular access management for hemodialysis. However, as the included studies originated from different countries, the applicability of the evidence should be carefully considered within the context of specific clinical settings to ensure standardization and safety.Reporting method:This study reported in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The protocol was prospectively registered with the Fudan University Center for Evidence-Based Nursing (Registration No. ES20257908).Patient or public contribution:No Patient or Public Contribution. This study is a systematic evidence summary based on published literature and did not involve the collection of primary data from patients or the public.

The arteriovenous fistula (AVF) is required for hemodialysis in end-stage kidney disease (ESKD). AVF creation results in compensatory cardiovascular hemodynamics, which are subsequently associated with cardiac remodeling. Relatedly, cardiovascular mortality and morbidity are elevated in ESKD patients, which worsens in dialysis patients. Currently, no suitable uremic large animal models exist to investigate the mechanisms of AVF-induced cardiac remodeling. This study aims to characterize cardiovascular changes secondary to AVF creation, supported by percutaneous transluminal angioplasty (PTA), in a uremic pig model. Chronic kidney disease (CKD) was induced via renal embolization, followed by AVF creation 28 days later. AVF stenosis was alleviated 28 days thereafter via PTA, and cardiac MRI was performed at 14-, 28-, and 42-days post-PTA. Increased end-diastolic volumes were observed in both ventricles, while systolic function was preserved. LV stroke volume and blood flow through the aorta, pulmonary artery, and vena cava were also increased. In perivascular areas of the LV, senescence markers showed increased p16 expression and decreased p21 expression. The LV showed perivascular fibrosis, with increased cardiomyocyte cross-sectional area, reduced collagen-type IV expression, and MMP2 activity, possibly not driven by TGF-β/CTGF/pSMAD signaling. However, CD4+ or CD68+ cell LV infiltration or inflammatory polarization of resident macrophages were unchanged. In conclusion, AVF creation modified left and right ventricular function and increased peripheral flow, potentially mediated by cellular senescence and fibrosis, resulting in progressive cardiac remodeling. This model may be used to evaluate mechanisms of AVF induced cardiac disease and potentially investigate the efficacy of senolytics and anti-fibrotic agents.

This study aimed to examine the knowledge, attitude, and practice toward arteriovenous fistula (AVF) self-care among diabetic kidney disease (DKD) patients who received maintenance hemodialysis. This cross-sectional study was carried out from 1st January to 31st March, 2024 among patients with DKD who received maintenance hemodialysis. A self-administered questionnaire was utilized to collect demographic information and evaluate knowledge, attitude, and practice related to AVF self-care. A total of 757 valid surveys were collected for this study; average age of participants was 59.70 ± 10.7 years. The scores for knowledge, attitude, and practice were 29.59 ± 7.96 (ranging from 0 to 38), 41.89 ± 4.02 (ranging from 9 to 45), and 67.57 ± 7.44 (ranging from 15 to 75), respectively. Multivariate logistic regression revealed that knowledge (odds ratio [OR] = 5.044, 95% confidence interval [CI]: [3.052-8.335], P < .001) and attitude (OR = 14.17, 95% CI: [8.328-24.12], P < .001) were independently associated with proactive practice. The Structural Equation Model showed that knowledge had a direct and positive impact on attitude (β = 0.527, P < .001) and practice (β = 0.243, P < .001). Attitude also had a direct and positive influence on practice (β = 0.692, P < .001). Patients with DKD who received maintenance hemodialysis showed positive attitude and proactive practice towards AVF self-care, even if their level of knowledge was inadequate. Targeted education was recommended to improve patients' knowledge.

Background: Anterior cranial fossa dural arteriovenous fistulas (ACF DAVFs) usually receive ethmoidal dural supply. Pial arterial supply has been described in intracranial DAVFs, including ACF DAVFs, but a dominant orbitofrontal pial feeder can create diagnostic overlap with mixed pial-dural arteriovenous malformation and make endovascular treatment hazardous. Case Presentation: A 75-year-old man with atrial fibrillation presented with right middle cerebral artery occlusion and underwent intravenous thrombolysis followed by mechanical thrombectomy. During right internal carotid angiography, transient arterial-phase opacification of a contralateral frontal draining vein through the anterior communicating artery prompted post-recanalization angiography. A high-grade left ACF DAVF was diagnosed, with dominant supply from the left orbitofrontal artery, minor anterior ethmoidal supply, two venous drainage routes, cortical venous reflux, and a varix. Although the DAVF was incidental to the ischemic presentation, it was considered to require treatment because of high-risk angioarchitecture, including Borden type III/Cognard type IV drainage, cortical venous reflux, and venous ectasia. No intraparenchymal nidus or normal venous-phase use of the refluxing veins was identified. Because pial transarterial access and complete transvenous closure were considered unsafe or uncertain, microsurgical draining-vein disconnection was performed. Postoperative angiography confirmed complete obliteration. Conclusions: In this case, microsurgical disconnection achieved angiographic cure, and the patient was transferred for rehabilitation with a modified Rankin Scale score of 1. The central diagnostic and therapeutic issue in pial-feeder-dominant ACF DAVF is not rarity alone, but angiographic differentiation from mixed pial-dural arteriovenous malformation and assessment of whether the shunt can be closed without compromising normal pial arteries or venous outflow. The thrombectomy angiogram provided the route to diagnosis, whereas pial arterial dominance and divided venous drainage determined the curative strategy.

Gyral hypointensity (GH) on susceptibility-weighted imaging (SWI) has occasionally been observed in intracranial dural arteriovenous fistulas (dAVFs), but its pathophysiology and clinical relevance remain unclear. This study aimed to characterize GH as an indicator of venous congestion and to evaluate its reversibility and clinical implications after treatment. We retrospectively reviewed 48 patients with intracranial dAVFs who underwent successful endovascular treatment and had both pre- and post-treatment SWI available. GH was classified as band-like, brush-like, or mixed based on morphology. Imaging findings, angiographic characteristics, and clinical data were compared between patients with and without GH. Subgroup analyses were performed in retrograde leptomeningeal venous drainage (RLVD) positive cases to assess venous collateral capacity using angiographic contrast stagnation and DSA perfusion delay. GH was identified in 16 of 48 patients (33.3%), predominantly in those with high-grade shunts and RLVD (100%, p < 0.001). GH correlated with higher pseudophlebitic pattern (PPP) grades (p < 0.001), FLAIR positivity (p < 0.001), DWI restriction (p = 0.012), and focal neurologic deficits (p < 0.001). Among 14 evaluable lesions, 12 (85.7%) showed interval improvement on follow-up SWI. Brush-like GH frequently resolved completely, whereas band-like GH demonstrated limited reversibility. In RLVD-positive cases, coexistence of contrast stagnation on feeder-territory injection and DSA perfusion delay on normal territory injection was significantly associated with GH (r = 0.40, 95% CI [0.05-0.67], p = 0.028). GH on SWI reflects severe cortical venous congestion and demonstrates varying reversibility after treatment. Its appearance likely results from the combined effects of deoxyhemoglobin accumulation, microcirculatory delay, and flow-related phase changes. Recognition of brush-like GH-especially when accompanied by FLAIR or DWI abnormalities-may facilitate early identification of reversible venous pathology and guide timely management in patients with aggressive intracranial dAVF.

Physical Therapy for Arteriovenous Fistula Pain: A Systematic Review and Network Meta-Analysis.

Scalp arteriovenous fistulas (sAVFs) are rare vascular lesions that may cause cosmetic deformity, bruit, headache, and recurrence after incomplete treatment. We report a patient in their 30s with a recurrent left frontotemporal sAVF previously embolized with PHIL 25, who presented with progressive enlargement, audible bruit, and headache. Digital subtraction angiography demonstrated a high-flow fistula supplied by bilateral superficial temporal and ophthalmic artery branches. Direct-puncture embolization with 12 mL of ihtObtura 20 achieved complete angiographic occlusion without complications. Clinical and imaging follow-up at 3, 6, and 12 months showed durable symptom resolution, no recurrence, progressive loss of radiopacity, reduced imaging artifacts, absence of skin tattooing, and volume reduction of the treated mass. This case suggests that ihtObtura may be useful for selected superficial recurrent vascular lesions in which cosmesis, durable occlusion, and artifact-free follow-up imaging are clinically relevant.

Decoding the DKK1/CKAP4 signaling Axis: A novel mechanism driving Neointimal hyperplasia in arteriovenous fistulas.

Tick-derived protein Qinghaienin-based anticoagulant coating inhibits activation of the zymogen FXII.

Transradial versus transfemoral access for diagnostic cerebral angiography: Lesion-specific radiation metrics and outcomes.