Case Of Arteriovenous Fistula Research Articles

Efficacy of drug-coated balloon catheters for patients with short-term recurrent dysfunction of arteriovenous fistula.

In this study, we aimed at clarifying the usefulness of drug-coated balloon catheters (DCBs) for arteriovenous fistulas (AVFs) that repeatedly undergo restenosis over a short period and to examine the factors that influence the patency period after DCB use. This retrospective observational study was conducted using IN.PACT AV in 29 cases of AVFs with repeated restenosis within approximately 3 months, and temporary patency before and after DCB use in the same patients was compared. For target participants, the flow volume, resistive index (RI), and vascular diameter of the brachial artery were measured using an ultrasound diagnostic device. Stenosis diameter, reference vessel diameter, and stenosis length of the lesion were measured before and after DCB dilatation using digital subtraction angiography. Before DCB angioplasty, the postintervention primary patency at 3 months was 66%, and the average interval was 92 ± 21 days (mean ± standard deviation). After DCB angioplasty, the postintervention primary patency rates at 3 and 6 months were 92% and 36%, respectively. The postintervention primary patency was significantly higher after than before DCB angioplasty (p < 0.0001). A sub-analysis was performed on 25 patients who were followed up for 4 months or more after DCB. The RI values before and after dilatation with DCB significantly differed between the patency group 4 or more months after DCB and the patency group less than 4 months after DCB. For AVFs that require frequent PTA over a short period of time, DCB improved the patency rate 3 months after PTA, but the improvement effect at 6 months was limited. The effect of DCB on prolonging the patency rate of AVFs that require frequent PTA over a short period of time may be correlated with the RI value before and after PTA.

Intraorbital Arteriovenous Fistulas: Case Series and Systematic Review.

Intraorbital arteriovenous fistulas (AVFs) are an extremely rare subtype of intracranial fistula with ophthalmic symptoms similar to cavernous sinus dural AVFs or carotid cavernous fistulas but worse visual outcomes. Here, we present a case series and thorough systematic review on intraorbital AVFs to demonstrate treatment modalities and address this rare type of AVF. We conducted a retrospective study at a single center, in which we identified all cases of intraorbital AVFs that occurred between 2002 and 2022. We collected and analyzed data on demographics, fistula characteristics, treatment methods, clinical outcomes, and fistula closure. In addition, we conducted a systematic review of intraorbital AVFs. Seven cases in our center and 41 cases of intraorbital AVFs reported in the 35 articles were identified. At our center, transarterial embolization (TAE) (42.9%) alone resulted in immediate complete occlusion in 3 cases. Transvenous embolization (14.3%) resulted in one case of immediate complete occlusion. In 2 cases, surgery (28.6%) resulted in immediate complete occlusion. In one case, conservative treatment (14.3%) was used, and the fistula was eventually spontaneously occluded. Immediate complete occlusion rate was 85.7%. One blindness occurred (14.3%). In the literature reported, 3 cases (60%) of retinal artery occlusion were reported when performing TAE via the ophthalmic artery. Two fistulas recurred as reported. In 33 (80.5%) patients, the fistula was finally completely occluded. TAE via the ophthalmic artery carries a high risk of blindness and a low cure rate. Transvenous techniques such as conventional transvenous routes, surgical exposure, or direct puncture of the drainage vein have been used as the first line of treatment for intraorbital AVFs.

Salvage treatment of forearm arteriovenous fistula with small caliber inflow distal artery by percutaneous transluminal angioplasty

Background: Dysfunctional distal arteriovenous fistulas (AVFs) with small caliber distal inflow arteries theoretically require percutaneous transluminal angioplasty (PTA) throughout the entire arterial length. However, in clinical practice, whole distal inflow arterial PTA is not frequently performed due to concerns about possible arterial rupture. Therefore, we investigated the safety and efficacy of this procedure at our center, comparing it with the standard venous PTA. Methods: From March 2017 to December 2022, 48 cases of distal AVF salvaged by whole distal inflow arterial PTA were assigned into a treatment group and 121 cases of distal AVF salvaged by venous standard PTA not involving the whole inflow artery were assigned into a control group. These two groups were then compared. Results: Those in the treatment group (who received whole distal inflow arterial PTA) were older than those in the control group (mean age, 69 vs 59 years, p &lt; 0.001). Otherwise, differences between the two groups were unremarkable. After the salvage treatment, primary patency seemed to decrease in the treatment group with whole distal inflow arterial PTA compared to the control group with conventional PTA, although such decrease was not significant ( p = 0.072). However, primary assisted patency and secondary patency were comparable between the two groups ( p = 0.350 and p = 0.590, respectively). And in the treatment group, only one arterial dissection occurred, which was successfully managed with balloon tamponade so that no distal AVF was abandoned due to complications following whole distal inflow arterial PTA. Conclusion: Whole distal inflow arterial PTA is an effective and safe option for distal AVF salvage with a narrowed inflow artery, frequently refractory to conventional venous PTA.

Surgically treated intracranial arteriovenous fistulas with hemorrhage, resulting in complete obliteration: illustrative cases.

Intracranial arteriovenous fistula (AVF) is a rare disease, defined as anastomoses between cerebral or meningeal arteries and dural venous sinuses or cortical veins. With the development of new agents and devices, endovascular embolization has been considered safe and effective in a majority of cases. However, cases that require direct surgery do exist. Herein, the authors present 3 cases of intracranial AVFs that presented with hemorrhage and were treated with direct surgery, achieving complete obliteration and favorable outcomes. Intracranial AVFs that present with hemorrhage require immediate and complete obliteration. When AVFs involve the dural sinus, transvenous embolization is usually the first choice of treatment. AVFs with single cortical venous drainage are best treated with interruption of the draining vein close to the fistula. Transarterial embolization can be a curative treatment if there are no branches supplying cranial nerves or an association with pial feeders. In cases in which endovascular treatment is technically challenging or has resulted in incomplete occlusion, surgical treatment is indicated. Despite the recent rise in endovascular treatment, it is important to recognize situations in which such treatment is not suitable for intracranial AVFs. Direct surgery is effective in such cases to offer the best possible outcome.

Extracorporeal membrane oxygenation in critical airway interventional therapy: A review.

Extracorporeal membrane oxygenation (ECMO) is widely used during refractory cardiac or respiratory failure, and some case reports described ECMO utilization in critical airway interventional therapy. Eligible reports about patients receiving airway interventional therapy under ECMO were retrieved from Web of Science, Embase, Medline, and Cochrane databases up to 1 August 2022. Forty-eight publications including 107 patients who underwent ECMO for critical airway problems met the inclusion criteria. The critical airway problem that was reported the most was tumor-associated airway obstruction (n = 66, 61.7%). The second most reported etiology was postoperative airway collapse or stenosis (n = 19, 17.8%). The main interventional therapies applied were airway stent placement or removal (n = 61, 57.0%), mass removal (n = 22, 20.6%), and endotracheal intubation (n = 12, 11.2%) by bronchoscopy. The median ECMO duration was 39.5 hours. Eleven patients had ECMO-associated complications, including seven cases of airway hemorrhage, one case of arteriovenous fistula, one case of vein rupture and hematoma, one case of foot ischemia, and one case of neuropraxia of the cannulation site. In total, 91.6% of the patients survived and were discharged from the hospital. ECMO appears to be a viable form of life support for patients undergoing interventional therapy for critical airway problems.

Radial Arteriovenous Fistula After Coronary Catheterizations

A 57-year-old man with a history of 2 percutaneous coronary interventions through the right radial artery (6 months and 5 months prior) reported a right radial bruit with a palpable thrill. Doppler ultrasound imaging revealed a radial arteriovenous fistula (AVF). Transbrachial angiogram showed blood flow between the radial artery and venous system (Fig. 1). The patient's condition was managed conservatively because it was a case of AVF without pain or heart failure symptoms. Two years later, the patient presented with progressive development of the bruit and new wrist pain. Physical examination revealed local swelling of the right distal forearm (Fig. 2). A worsened AVF with dilated superficial veins was confirmed on Doppler ultrasound imaging (Fig. 3). Consequently, the patient underwent surgical ligation under local anesthesia (Fig. 4). The swelling, thrill, and pain resolved. The patient underwent follow-ups every 3 months for 2 years, and no vascular events occurred during that time.Arteriovenous fistula as a complication of catheterization generally occurs at brachial and femoral arteries/veins. Radial AVF is extremely rare, with an incidence of approximately 0.05% in the transradial approach, according to the SPIRIT of ARTEMIS study.1 Other complications of the transradial approach include radial artery occlusion, perforation, and pseudoaneurysm.1 Radial AVF, which can be generally described as a delayed-onset vascular complication, can cause wrist pain and heart failure symptoms because of left-to-right shunt. The management of radial AVF, which can include surgery, percutaneous intervention, or conservative management, varies according to individual cases, as reported previously.2–4 Conservative management occasionally fails, as noted in this case. Percutaneous intervention is less invasive, but there is a possibility of stent restenosis and stent fracture resulting from excessive wrist and forearm movement. Surgical ligation would enable a repeat transradial approach in coronary reinterventions. In this era of radial access catheterizations, cardiac interventionists should be knowledgeable about appropriate evaluation and management of radial AVF.The authors thank Dr Kazuhiro Yoneda and Dr Masako Okada for helping with the patient's treatment.

Comparison of the safety and efficiency of temporary cardiac pacing methods during left bundle branch pacemaker implantation: Femoral vein pacing versus atrial spiral pacing with electrodes placed at the ventricle.

Left bundle branch pacemakers (LBBPs) can better maintain ventricular electrical synchronization than traditional right ventricular pacing (RVP). Temporary cardiac pacing (TCP) is needed to ensure the safety of the operation in patients undergoing LBBP. Currently, there are two methods of installing TCP in conventional permanent pacemaker implantation. To evaluate the safety and efficiency of replacing femoral vein pacing with atrial spiral pacing in the right ventricle for temporary cardiac pacing (TCP) during left bundle branch pacemaker (LBBP) implantation. A total of 179 patients who underwent TCP during LBBP were selected for retrospective analysis from April 2019 to 2021 and divided into two groups: the atrial spiral electrode group (n = 76) and the femoral vein electrode group (n = 103). The following were observed: operation time; radiation dose; radiation time; operation expenses; hospitalization time; pacemaker parameters immediately after the operation and at 1 week, 1 month, 3 months, and 6 months after the operation; operation complications and femoral vein puncture point complications were observed in the two groups. Compared to the femoral vein electrode group, the atrial electrode group had significantly lower operation times ([116.86 ± 24.63] versus [128.94 ± 25.27] min, p < 0.05), radiation doses ([805.07 ± 132.94] versus [846.42 ± 87.37] mgy, p < 0.05), and decreased risk of a displaced or dislodged temporary pacing electrode during the operation ([0.00%] versus [4.85%], p < 0.05). The atrial electrode group did not have significant operation costs or material costs associated with femoral vein temporary pacing electrode implantation. In addition, the atrial electrode group did not have an increased risk of pacemaker-related infections, and the parameters of the pacemaker were unaffected. However, some puncture point complications appeared in the femoral vein electrode group (8 cases of local subcutaneous hematoma, 3 cases of pseudoaneurysms, 3 cases of arteriovenous fistula). The replacement of the femoral vein pacing electrode with an atrial spiral pacing electrode in the right ventricle for TCP during LBBP implantation was safe and effective.

Nursing Assessment of Vascular Complications after Cardiac Catheterization through the Distal Radial Artery.

Distal Radial Artery (DRA) is a new arterial access for coronary catheterization. Assessment of the vascular complications of this new procedure is important in the provision of nursing care to cardiac patients. The aim of this study was the nursing assessment of vascular complications of DRA in angiography and angioplasty. This qualitative longitudinal study was conducted on 315 consecutive patients who were candidates for coronary catheterization via DRA from 2017 to 2020 in three hospitals in Tehran, Iran. Patients who had palpable DRA and were capable and willing to consent to inclusion in the study were evaluated. Moreover, patients whose DRA access failed, and those who had previously undergone coronary artery bypass graft were excluded from the study. Vascular complications were assessed on the day of the procedure and about 1 month later. After the procedure, 29 cases of ecchymosis, 8 cases of hematoma, and 1 case of arteriovenous fistula in the DRA were observed. We did not observe any major vascular complications. Nursing assessment of the snuffbox area indicated that this approach is a safe and convenient technique for cardiac catheterization with few minor complications.

MO792: Validation and Applicability of an Innovative Monitoring System for Vascular Access in Haemodialysis—A Multicentre Study

Abstract BACKGROUND AND AIMS Routine systems for monitoring vascular access (VA) performance are lacking. We recently showed that with a VA triage system it is possible to improve the average value of a number of HD efficiency parameters and that the triage score was associated with clinical outcomes [1]. The triage categorization is generated monthly by a scoring system which is based on a number of parameters (blood flows, VA pressure values, end HD circuit clots and a dedicated score of the external VA examination) recorded at each session by the staff and by the KT/V value recorded once every month. According to threshold values, each VA is classified as Green (G), Yellow (Y) or Red (R), thus attracting the attention of the staff. In our open-label single centre study, with 3 years of follow-up, the average VA scores improved significantly and G VA associated with lower mortality, compared to the Y and R VA. To validate our triage system with a multicentre, blinded approach in a large number of patients. The primary outcome was to evaluate if the triage identifies VA with an increased rate of complications; the secondary outcome was to verify the association of G VA score with better clinical outcomes. METHOD In this interventional prospective multicentre study, each centre used the electronic spreadsheet without knowledge of the generated score and triage. After 6 months of system implementation, 2 years of follow-up (1 January 2020–1 December 2021) were planned to record VA-related events. Two external reviewers evaluated the records. A minimum of 3 months VA follow-up was necessary for patients’ enrolment. RESULTS From 18 HD centres we enrolled 757 patients, aged 64.5 ± 15.5 years; x/y M/F; 27% diabetics; HD since 24.4 ± 32.4 months; 369 (48.7%) with arteriovenous fistula (AVF) and 388 (51.3%) with permanent central venous catheter (CVC). During 11.4 ± 5.6 months of follow-up (range 3–23), 108 537 HD sessions were recorded on the triage electronic spreadsheet, with 214 total clinical events and an event-free time of 224.5 ± 172 days (range 4–713). The VA-related events were 150 (70.1%) with an event-free time of 230 ± 160 days (range 11–713). As of today, we have the association of VA triage with VA events in a subgroup of 300 patients (66.1 ± 11.7 years; HD vintage 28 ± 18; diabetes 27.6%; 180 with AVF and 120 had CVC) who are not different from the remaining 457. In this subgroup, 54% had G VA triage, 39% Y and 7% R. In the subgroups distinguished by VA type, AVF cases (64.5 ± 12.1 years; HD since 30.3 ± 27.2; 24.4% diabetics) were triaged as G in 54%, Y in 41% and R in 5%, while CVC cases (66.5 ± 11.7 years; HD since 28.8 ± 36.5 months; 34.3% diabetics) were G in 54%, Y in 34% and R in 11%. 83 patients had VA-related events VA during 16.3 ± 2.2 months of follow-up (range 3–23), with an event-free time of 237.8 ± 195.9 days. Figure 1 shows how both AVF and CVC patients, stratified into only two triage groups (G versus Y and R together) according to their average triage, had significantly different time-free from events, which was higher in both populations (AVF P = 0.04; CVC P = 0.001) in the green triage groups. CONCLUSION Our VA triage system identifies 40% of vascular accesses as yellow-red triage, thus deserving clinical surveillance. This score has increased the rate of clinical complications which, according to the time survival curve could be detectable roughly 237.8 days before the event developed.

Postero-lateral arterio-venous fistula with particular histological aspects as the main cause of severe spinal thoracal stenosis

Spinal dural arteriovenous fistulas (AVFs) are rare spine vascular malformations. We report a case of AVF in the epidural space of T10 and degenerative medial osteophytes leading to clinical symptoms of severe spinal stenosis operated with good evolution.

An in vitro evaluation of the efficacy of Agomelatine in combination with Thapsigargin and 2-Aminoethoxydiphenyl borate for the treatment of type 2 diabetes

Traumatic lumbar artery injuries are quite uncommon, and arteriovenous fistula (AVF) lesions are also rare. The clinical symptoms associated with AVF of the lumbar artery are often vague and non-specific and can be masked by symptoms due to the spinal cord injury. Therefore, AVF of the lumbar artery can often be missed if the performance of a contrast-enhanced computed tomography (CECT) scan is absent. In this article, we portrait a case of post-traumatic lumbar artery AVF along with pseudoaneurysm in a 40-year-old who suffered from pain in the right lumbar region. After endovascular intervention therapy for one month, the Visual Analogue Scale (VAS) was 1 in comparison with 8 prior to treatment. Thus, an endovascular intervention should be considered an effective treatment option for AVF and pseudoaneurysm of the LA.

A Rare Case of Pseudoaneurysm and an Arteriovenous Fistula of the Lumbar Artery Treated by Endovascular Intervention

Traumatic lumbar artery injuries are quite uncommon, and arteriovenous fistula (AVF) lesions are also rare. The clinical symptoms associated with AVF of the lumbar artery are often vague and non-specific and can be masked by symptoms due to the spinal cord injury. Therefore, AVF of the lumbar artery can often be missed if the performance of a contrast-enhanced computed tomography (CECT) scan is absent. In this article, we portrait a case of post-traumatic lumbar artery AVF along with pseudoaneurysm in a 40-year-old who suffered from pain in the right lumbar region. After endovascular intervention therapy for one month, the Visual Analogue Scale (VAS) was 1 in comparison with 8 prior to treatment. Thus, an endovascular intervention should be considered an effective treatment option for AVF and pseudoaneurysm of the LA.

A three years’ experience of Arteriovenous Fistula (AVF) cases in a tertiary care hospital of East Java, Indonesia: a descriptive observational study

Introduction: The incidence of end-stage renal disease (ESRD) globally is 700 million people approximately. Patients with ESRD need vascular access for hemodialysis as renal replacement therapy (RRT). Among hemodialysis access, arteriovenous fistula is considered as the most preferred form of vascular access due to its characteristics. This study aimed to to present a descriptive characteristic of arteriovenous fistula creation cases in a tertiary care hospital with a specific view of demographic parameters, fistulas' sites, type of fistulas. Methods: We conducted a descriptive study of single-center in the Department of Thoracic, Cardiac and Vascular Surgery of Dr. Soetomo Academic General Hospital Surabaya, collected data from January 1st, 2017 to December 31st, 2020. All patients who undergo arteriovenous fistula creation considered as a subject in this study. We retrieved the characteristics of the patients, the type of fistula, the site, surgical technique, and underlying disease from patients’ electronic medical data records. Results: A total of 167 patients requiring long-term hemodialysis in our center. Females were dominantly in our study with 56.9% (95). Most of AVFs were created on the left arm. Radiocephalic type of AVF was the most common arteriovenous fistula type found in 111 subjects (66.5%). The highest postoperative successful rate was found in brachiocephalic type in 78.8%, followed by radiocephalic AVF type with 66.7%. The wrist region was favorable in subjects (43.1%). Conclusions: Arteriovenous fistulas for hemodialysis are needed and in our center. Radiocephalic AVFs are the most common type. Further study to learn the different aspects of arteriovenous fistula cases is needed to fulfill queries in the local population.

Early Experience with Sine Wave Technique for Superficialization of a difficult to cannulate Arterio Venous Fistula

To highlight safety and efficacy of sine wave technique (SWT) in superficializing deep arterio venous fistula (AVF) and managing infiltrations and other complications. It is a single center observational study done from Jul 2017 to July 2020. All successive cases of deep AVFs, aneurysm / pseudoaneurysms of AVFs, and AVFs requiring open venoplasty were managed with SWT. Data was collected prospectively and analyzed. SWT is based on random pattern skin flaps. Using ultrasound, a line is marked on either side of centre line (AVF) at a distance of approximately 1.5-2 cm. A sine wave is drawn starting from either of the lines to the other with multiple crests and troughs. The base of flap should be double the height of the flap, that is, about 3-4 cm. Skin is incised and flaps are raised at level of AVF. Excess fat is removed. A sliver of unhealthy skin can be sacrificed if required. Flaps are sutured back to restore sine wave continuity. SWT was used in a total of eleven patients. Median age was 58 years (range 10-67 years). Eight were females and three males. One was radio-cephalic and rest were brachio-cephalic AVFs. Eight AVFs were deep with median depth of 10.25mm (range 8-13mm), median body mass index of 25.5 kg/m2 (range 23.9-26.5kg/m2), median vein diameter of 7 mm (range 6-8 mm), and median flow rate of 1137.5ml/min (range 650- 1380 ml/min). Out of eight, four AVFs presented with infiltration. In other three, SWT was used for exposing AVF to treat underlying pathology (one case each of aneurysm, pseudoaneurysm & stenosis). Ten cases were done under local or regional anesthesia and one under general anesthesia. There was no peri-operative mortality or loss of AVF. Transient limb oedema developed in one case. Median time to cannulate was 20 days (range 13-28 days). Median follow up was 13 months (range 6 - 31months). Cumulative patency at 18 months was 90% (95% CI 47.3%-98.53%) and 45 % (95% CI 9.9%-87.1%) at 24months and at the end of the study. SWT is safe and effective in superficialization of deep / difficult to cannulate AVF as well a good approach to treat complications like infiltration. Post procedure cannulation time is reasonably short.

Bone-destructive osseous arteriovenous fistula at the jugular bulb mimicking a glomus jugular tumor

BackgroundSome reports have described intraosseous arteriovenous fistulas showing osteolytic changes, but an osseous arteriovenous fistula (AVF) at the jugular bulb showing extensive bone destruction is a very rare disease. Case descriptionA 60-year-old man presented with pulsatile tinnitus and right facial nerve palsy. Radiological imaging showed a large homogenously enhanced osteolytic lesion at the right jugular foramen. A cerebral angiogram showed a high-flow vascular lesion of the jugular bulb associated with retrograde sinus reflux, resulting in venous congestion of the deep venous system. These findings led us to misdiagnose this lesion as a glomus jugular tumor. However, combined arterial and venous angiography after transarterial embolization revealed the precise angioarchitecture, and we finally diagnosed this lesion as a high-flow osseous AVF at the jugular bulb. We performed transvenous embolization using a triple catheter technique. The lesion was successfully obliterated, and the 6-months angiogram showed no recurrence. ConclusionA rare case of high flow osseous AVF at the jugular bulb associated with osteolytic changes in the surrounding bony structure is reported. Although many hypervascular lesions at the jugular bulb are glomus tumors, bone destructive osseous AVF at the jugular bulb should be considered.

A Case of Arteriovenous Fistula with a Shunt Point Including the Cauda Equina

A Case of Arteriovenous Fistula with a Shunt Point Including the Cauda Equina

Occlusion de l’aorte abdominale chez les patients infectés par le virus de l’immunodéficience humaine : cas clinique et revue de littérature

HIV infection has now become a chronic disease with a good life expectancy thanks to antiretrovirals. The mortality currently is attributed to other pathologies in particular cardiovascular because of the inflammation and the side effects of the drugs. All arteries can be damaged in HIV, especially the aorta, with several types of lesions which can be occlusive, aneurysmal, dissecting, even with the cases of arteriovenous fistula which have been described. HIV occlusive arterial disease is different from atheromatous disease in HIV-free patients and this is confirmed by pathology and ultrasound studies, which makes it more difficult to manage HIV-related occlusions. The open surgical treatment especially in the acute forms is disappointing with complications of rethrombosis and infectious and of sepsis of prosthesis considering the immunosuppression, the endovascular treatment begins to become the treatment of choice in the aneurysmal pathology and probably it would be in the future for occlusive disease.

The attitude of kidney transplant recipients towards elective arteriovenous fistula ligation.

Arteriovenous fistulas (AVF) are a source of various complications. Among previously hemodialyzed kidney transplant recipients (KTxR), the AVF may persist over time. The patients' decisions whether to ligate the functioning AVF may be prompted by many factors. Our knowledge of benefits concerning the procedure as well as patients' attitude towards it is scarce. Evaluation of the patients' opinion on the persistent AVF ligation after a successful kidney transplantation. An anonymous survey was carried out among 301 previously hemodialyzed KTxR. The patients were recruited during scheduled visits in the Transplantation Outpatient Unit. All subjects completed an anonymous questionnaire including questions about their attitude towards the matter in question. 69 patients (22.9%) have considered AVF closure. The most common causes for such attitude were esthetic reasons (n = 29) and concerns about heart health (n = 13). Among those 69 subjects, 18 have presented with symptomatic AVF due to multiple symptoms. Symptomatic AVFs were localized on the forearm in 14 out of 18 cases. As many as 116 (38.5%) cases have never wanted to ligate the AVF and 116 (38.5%) subjects did not have a clear opinion. In our study we report 158 (52.5%) cases of non-functioning AVFs. The main reason for the above was spontaneous AVF thrombosis (121 cases). Only 24 subjects reported to rely on the physician-provided information about the AVF management. One fourth of KTRs have ever considered AVF ligation. There is a distinct need for educating patients on the possibilities of post-transplantation AVF management.

Our experience of arteriovenous fistula creation as vascular access for hemodialysis

Background: End stage renal disease (ESRD) patients depend on lifelong renal replacement therapy. The arteriovenous fistula (AVF) is the preferred hemodialysis access. Cimino fistulas are currently accepted as the best mode of vascular access for hemodialysis (HD). The present study was planned to study for presence of on table bruit and thrill and to know postoperative outcome and patency.Methods: This single center, prospective study was carried out in department of Urology at SNMC, Jodhpur from November 2018 to May 2019. Dominance of hand was examined, and preference was given to non-dominant hand. Physical examination of the arterial system along with physical examination of the venous system was done. Preoperative color Doppler of upper limb veins and arteries was done in selected patients. End to side anastomosis was done between cephalic vein and radial artery.Results: In this study of 70 cases of AVFs, there were 53 (75.71%) successful cases and 17 (24.2%) were failures. End (vein) to side (artery) anastomosis was done in 70 (100%) cases. On table bruit was present in 63 (90%) and thrill in 58 (82.8%) cases. All patients with failed post-operative fistula were not doing ball exercise.Conclusions: Presence of on table thrill and bruit are indicators of successful AVF. Post-operative ball exercise should be done for better results.

P1354POSTOPERATIVE MATURATION AND CHANGES IN CARDIAC FUNCTION DIFFER BETWEEN TYPES OF VASCULAR ACCESS

Abstract Background and Aims The blood flow of vascular access can be increased about tens of times after access creation. If the flow of vascular access is too low, vascular access does not provide sufficient circulation for hemodialysis and sometimes gets thrombosed. However, if the flow of vascular access is too high, it can result in high cardiac output and trigger heart failure. Although patients receiving hemodialysis require vascular access with necessary and sufficient flow, the actual change in flow after access creation is not well known. We investigated the relationships among preoperative factors, types of vascular access, clinical courses of access maturation, and changes in cardiac function. Method This single-center retrospective observational study included patients who underwent vascular access-related surgery, except thrombectomy, in 2016. Diameters and flow volumes of the brachial artery were examined using Doppler ultrasound before surgery and 1 week, 12 months, and 24 months after surgery. Cardiac functions were assessed using sonography at the same timepoints. Patients’ background information and data related to surgery, such as anastomosis size, were extracted from medical records. The obtained data were statistically analyzed. Results Fifty-eight patients [37 arteriovenous fistula (AVF), 10 arteriovenous graft (AVG), and 11 partial replacement using grafts (PR)] participated in this study. Diameters of the brachial artery increased from 4.7 mm to 5.4 mm at 1 week after access surgery. Blood flows of the brachial artery also increased from 106 mL/min to 699 mL/min. Blood flow through AVG at 1week was significantly higher than that through AVF (940 ml/min vs. 589 ml/min). Although blood flow through AVF at 12 and 24 months after access creation was significantly increased than that at 1 week after access creation, blood flow through AVG at 12 and 24 months after access creation did not show significant changes, and blood flow through PR at 12 and 24 months after access creation was significantly decreased. AVG and PR required more catheter intervention for vascular access than AVF during this observational period. Preoperative blood flow of the brachial artery and cardiac outputs were positively correlated to postoperative blood flow through AVF. However, this relationship was not observed in AVG and PR cases. The amount of cardiac output increased from 4.2 L/min before surgery to 4.4 L/min and 4.6 L/min at 12 and 24 months, respectively, although not significantly. Cardiac output at 24 months after surgery significantly increased only in AVF cases. Conclusion The clinical maturation course after vascular access creation surgery differs between AVF and AVG cases. Because blood flow through AVF is likely to increase gradually after access creation, surgeons should consider cardiac stresses related to vascular access, especially in cases with high-flow brachial artery or high cardiac output before surgery. Blood flow through AVG is not likely to increase in the long course. However, because blood flow through AVG just after access creation is high, regardless of the brachial artery size, surgeons should consider the risk of arteriovenous access-related ischemic steal syndrome after surgery especially in cases with severe arteriosclerosis. PR is not likely to affect blood flow volume of accesses and cardiac function.