Case Of Arteriovenous Fistula Research Articles

Quadruple coaxial catheter system on transvenous embolization for dural arteriovenous fistula

Background:Although transvenous embolization (TVE) is an effective method for treating dural arteriovenous fistula (AVF), directing the catheter to the lesion site is difficult.Objective:We report on the utility of a quadruple coaxial catheter system for TVE.Materials and methods:The quadruple catheter system comprised a 6 Fr guiding sheath, 6 Fr guiding catheter, 4 Fr intermediate catheter, and a regular microcatheter. The system was utilized in 27 consecutive dural AVF cases treated with TVE. In this study, we reviewed our experience with this system, including the theory, method of use, and complications.Results:Stenosis or obstruction of the vascular access was identified in 12 cases. The catheter could not reach to the lesion in three cases of cavernous sinus (7·4%); therefore, transarterial embolization was employed. Angiographic results revealed that the cases consist of total occlusion (n = 16, 59·5%), subtotal (n = 10, 37·0%), and partial occlusion (n = 1, 3·7%). Complete resolution or improvement of symptoms was observed in 23 patients (85·2%), no improvement of symptoms was observed in three patients (7·4%), and deterioration of symptoms was observed in one patient (3·7%). Venous perforation occurred in one patient without any neurological deficit. The catheter system provided access to the lesion and provided stability during the mechanically demanding process navigating the catheter and placing the coils.Conclusion:We determined that the quadruple coaxial system was safe and efficient for TVE for dural AVF.

Prospective long-term study of patency and outcomes of 505 arteriovenous fistulas in patients with chronic renal failure: Authors experience and review of literature.

Background:This study describes our experience of arteriovenous fistula (AVF) creation as vascular access for haemodialysis.Materials and Methods:This study has been carried out in our hospital from January 2004 to December 2012. A total of 505 AVFs were created in 443 patients. Maximum follow-up was 8 years, and minimum was 6 months.Observations and Results:In this study of 505 cases of AVFs, primary patency rates by Kaplan — Meier analysis showed 78.81% patency of fistulas at the end of 1 year and patency dropped to 14.81% at the end of 5 years. Our primary failure rate was 21.2%. Basilic vein was used in 26.35% cases, cephalic vein in 63.5%, and antecubital vein in 9.75% cases. On table, bruit was present in 459 (90.9%) and thrill in 451 (89.3%) cases. During dialysis, flow rate >250 ml/min was obtained in 150 (29.9%) cases. In complications, 2 (0.4%) patients developed distal oedema, 33 (6.5%) developed steal phenomenon.Conclusions:Presence of on table thrill and bruit are indicators of successful AVF. If vein diameter is <2 mm, chances of AVF failure are high. Flow rates in patients with vein diam. >2 mm were significantly higher as compared with patients with vein diam. <2 mm (P < 0.001). Flow rates are higher in non-diabetic patients as compared to diabetic patients (P < 0.001). Average blood urea and serum creatinine values are significantly lesser in patients undergoing dialysis through successful fistulas as compared to patients with failed fistulas. Correspondingly, incidence of deaths is significantly lesser in patients with successful fistulas. During proximal side-to-side fistula between antecubital/basilic vein and brachial artery, dilating of the first valve toward wrist helps to develop distal veins in the forearm by retrograde flow. This technique avoids requirement of superficialization of basilic vein in the arm.

Management of Postbiopsy Arteriovenous Fistulas in Transplanted Kidneys and Effectiveness of Endovascular Treatment: A Single-center Experience

We sought to evaluate the best therapeutic management of postbiopsy arteriovenous fistulas (AVFs) in transplanted kidneys. Between January 2005 and December 2011, we observed 17 cases of postbiopsy AVF in transplanted kidneys (9 asymptomatic; 8 symptomatic). Asymptomatic cases were managed conservatively, while patients with symptomatic AVF underwent endovascular treatment. We used a technique that consisted in a superselective transcatheter embolization of the afferent branch. We evaluated the technical success (postoperative closure of AVF), the immediate clinical efficacy (cessation of symptoms), and clinical efficacy at follow-up (measurement of serum creatinine at 7 days and 6 and 12 months compared with preoperative levels using t-tests). Asymptomatic AVFs resolved spontaneously, while the endovascular treatment in symptomatic AVFs showed a complete technical and clinical success with prompt remission of the presented symptoms. We observed a statistically significant reduction in serum creatinine at 7 days and 6 and 12 months postoperatively (mean creatinine--preoperative: 3.23 ± 1.4 mg/dL; 7 days: 2.25 ± 0.8 mg/dL; 6 months: 1.65 ± 0.28 mg/dL; 12 months: 1.4 ± 0.26 mg/dL; in all cases P < 0.05). In our experience, asymptomatic AVFs could be managed conservatively with close follow-up while the endovascular treatment for symptomatic AVFs is both safe and effective in the short- and long-term.

Four‐dimensional computed tomographic angiography of an arteriovenous fistula in the neck

Arteriovenous fistula (AVF), a type of vascular anomaly, is a relatively uncommon disease characterized by abnormal connections between the arterial and venous systems. Recently, remarkable advances in four-dimensional computed tomographic angiography (4D-CTA) have enabled detailed analysis of the hemodynamic features of vascular anomalies, which cannot be achieved by conventional imaging modalities. We report a case of AVF in a 59-year-old female presenting as a right neck mass. Using reconstructed animations from various viewing angles, 4D-CTA could clearly visualize not only a mass but the feeding artery and draining vein from the mass. 4D-CTA was useful for the diagnosis of AVF and to determine the surgical strategy preoperatively.

Balloon-Assisted N-Butyl-2-Cyanoacrylate Closure of an Iatrogenic Femoral Arteriovenous Fistula

Femoral arteriovenous fistula (AVF) is an abnormal communication between femoral artery and vein, which is frequently caused by an iatrogenic or traumatic event. Surgery and endovascular approach with coil and stent graft placement are the most frequent choices of treatment. Herein, we present 2 cases of iatrogenic superficial femoral AVF, which were treated with percutaneous balloon-assisted N-butyl-2-cyanoacrylate glue (N-BCA). Both fistulae had a short tract, and 1 of the patients had previously undergone a failed coil embolization. The occlusions with N-BCA were achieved immediately, and both fistulae remained obliterated at 1 and 12 months of follow-up.

Complications Related to Radial Artery Cannulation from 2004 to 2013

Complications Related to Radial Artery Cannulation from 2004 to 2013 Radial artery cannulation facilitates the monitoring of arterial pressure, enables the introduction of gas-sampling lines, and provides routes for cardiac diagnostic and interventional catheterization. However, detailed information is needed to prevent complications associated with radial arterial cannulations.Through an extensive literature search for case reports in PubMed and other databases from 2004 to 2013, 27 cases (from 24 articles) of complications related to radial artery cannulation for pressure monitoring and cardiac catheterization were identified. These cases included 7 cases of pseudoaneurysms, 6 cases of hand or finger ischemia, 5 cases of foreign bodies, 1 case of spasm, 2 cases of arteriovenous fistula, and 6 cases of perforation. In 13 cases, surgical intervention was required and completed successfully. Most cases of pseudoaneurysms and ischemia were associated with co-existing diseases, such as ischemic heart disease with an assumption of atherosclerosis. Radial artery perforations were successfully treated with catheter interventions.

Iatrogenic Femoral Arteriovenous Fistula with Double Connection between Femoral Artery and Vein Leading to High-Output Heart Failure Years after Mitral and Tricuspid Valve Replacement

Arteriovenous fistulas (AVFs) are potentially harmful but curable complications of diagnostic and interventional cardiac catheterizations. In this report, we present a case of iatrogenic AVF both from superficial and deep femoral arteries to common femoral vein leading to progressively developing severe right-sided heart failure in a patient who had two normally functioning mechanical valves at mitral and tricuspid positions. A 58-year-old woman who had a history of mitral and tricuspid valve replacement operations was admitted to our clinic with exertional dyspnea, palpitation, abdominal tenderness, and right-sided inguinal pain. Coronary angiography was performed via right femoral arterial access ten months ago. Doppler ultrasonography and computerized tomography revealed right superficial femoral artery to common femoral vein fistulisation. The patient was operated, and a double connection between the femoral artery and vein was encountered and treated successfully. Soon after the surgical procedure, clinical signs of right-sided heart failure ceased dramatically. The postoperative course was uneventful. Access site complications following interventional procedures represent significant problems. Sudden and progressive clinical deterioration in a patient especially with a history of diagnostic or therapeutic cardiovascular intervention may evocate the possibility of peripheral access site AVF formation.

Retrospective analysis of 271 arteriovenous fistulas as vascular access for hemodialysis.

This report describes our experience of arteriovenous fistula (AVF) creation as vascular access for hemodialysis (HD). Study has been carried out in Deenanath Mangeshkar Hospital, Pune from January 2004 to December 2009. A total of 271 AVFs were created in 249 patients. Maximum follow up was 7 years and minimum was 1 year. In this study of 271 cases of AVFs, there were 196 (72.3%) successful cases and 75 (27.7%) failures. Basilic vein was used in 77 (28.4%) cases, cephalic vein in 186 (68.6%), and antecubital vein in 8 (3%) cases. End (vein) to side (artery) anastomosis was done in 170 (63%) cases. Side to side anastomosis was done in 100 (37%) cases. On table bruit was present in 244 (90%) and thrill in 232 (85.6%) cases. During dialysis, flow rate >250 ml/min was obtained in 136 (50.4%) cases. In complications, 16 (5.9%) patients developed distal edema, 32 (11.8%) developed steal phenomenon. Presence of on table thrill and bruit are indicators of successful AVF. If vein diameter is <2 mm, chances of AVF failure are high. During proximal side to side fistula between antecubital/basilic vein and brachial artery, breaking of first valve toward wrist helps to develop distal veins in forearm by retrograde flow. This technique avoids requirement of superficialization of basilic vein in arm.

A retrospective study on endovascular management of iatrogenic vascular injuries

The purpose of this study was to evaluate the outcome of endovascular management of iatrogenic vascular injuries (IVIs). We retrospectively reviewed the clinical records of 19 consecutive patients who underwent endovascular therapy of IVIs. Endograft implantation was conducted in 13 patients, intravascular embolization using coil was performed in four patients, combined treatment involving endovascular balloon intervention and percutaneous thrombin injection was done in one patient and the remaining one patient received balloon compression for hemostasis. There were no deaths after the operation. In the patients with vessel rupture (n = 9) or perforation (n = 4), cessation of bleeding and restoration of blood flow were achieved following the endovascular treatments. Four cases of pseudoaneurysm and one case of arteriovenous fistula were successfully eliminated. At a median follow-up of 23.8 months (range 4-84), one patient suffered a mild cerebral infarction secondary to covered stent placement and one patient developed a partial renal infarction secondary to coil embolization. Additionally, stent collapse was found in one patient with stenosis of the iliofemoral vein, accounting for the failure to resolve the lower limb edema. In conclusion, endovascular therapy is an effective technique in the management of different types of IVIs, but is associated with minor ischemic complications.

Arteriovenous Fistula after Femoral Artery Puncture Leading to Pulmonary Edema: The Role of Ultrasonography

Local complications of arterial puncture include hematoma, pseudoaneurysm and formation of arteriovenous fistula (AVF). The latter could cause ischemia of the particular extremity or can be hemodynamically significant especially in patients suffering from congestive heart failure. We report a case of femoro-femoral AVF after thin needle arterial puncture for blood drawing. The development of this iatrogenic AVF led to pulmonary edema. The patient stabilized completely after surgical closure of the AVF. The AVF was diagnosed by duplex Doppler ultrasonography and this method was also used for estimation of blood flow through the AVF. We discuss the role of ultrasound AVF diagnostics and the method of flow calculation.

Arteriovenous Fistulae and Steal Syndrome Complicating Renal Allograft Biopsies. A Report of Two Cases

Background: Biopsy-related kidney transplants Arteriovenous Fistulae (AVF) are common. Most resolve spontaneously but rarely are they complicated by graft dysfunction. We describe 2 such cases of AVF occurring post renal allograft biopsy. Case reports: A 33 year old lady had multiple biopsies of her renal allograft due to ongoing rejection. Her renal function worsened and a 1.3 cm AVF was diagnosed on Doppler Ultrasound. The AVF closed spontaneously during angiogram and the patient’s renal function improved. The second case was a 25 year old man who had a biopsy due to acute rise in creatinine 14 weeks post transplantation. The biopsy was complicated by haematuria and an AVF was diagnosed on doppler ultrasound. The AVF enlarged over 3 months. An angiogram and endovascular coiling was performed with good resolution of the AVF. The patient’s renal function normalised. Conclusion: Endovascular coiling can ensure good resolution of renal AVF and is generally well tolerated.

Perimedullary Arteriovenous Fistula at the Craniocervical Junction -Case Report-

Perimedullary arteriovenous fistulas (AVFs) at the craniocervical junction are uncommon, and are often fed by the anterior spinal artery, with only a few cases fed by the intradural vertebral artery (VA). A 55-year-old man presented with a case of perimedullary AVF fed by the VA at the craniocervical junction manifesting as subarachnoid hemorrhage. Left vertebral angiography demonstrated an AVF supplied by branches from the VA. Three-dimensional computed tomography angiography (3D-CTA) revealed that the feeding arteries originated from the VA at the intradural position. Two feeding arteries were coagulated and dissected, followed by coagulation of a small feeder. The draining veins became discolored and shrank. 3D-CTA performed 2 months after the operation revealed disappearance of the AVF. Open surgery was successfully performed for the almost perimedullary AVF at the craniocervical junction, and is considered to be preferable for the treatment of this disease.

Clinical Analysis of Arteriovenous Fistula Using Perforating Vein on Antecubital Fossa

Background: It is very important to obtain vascular access that resists repeated punctures and maintains an adequate blood flow for performing hemodialysis in patients with ESRD. This study was designed to identify the risk factors that may influence the patency rate of arteriovenous fistula (AVF) using perforating vein on antecubital fossa. Material and Method: We analyzed 205 cases of AVF in 195 patients who underwent hemodialysis access surgery on antecubital fossa in our hospital from May 2006 to December 2009. Result: The patency rate of AVF from 6 months after surgery using perforating vein was 75.91%. The risk factors that influence the patency rate was age. There was no statistic difference between used vessels. Conclusion: The patency of the AVF using perforating vein on antecubital fossa was comparable. The condition of sex and location and presence or absence of diabetes and hypertension and other cardio-neurovascular disease did not make statistically significant effect on the AVF patency rate. The age was an independent risk factor for patency rate.

Imaging for Hepatic Vascular Injury from Blunt Trauma in Children—Nine Cases Report

Introduction Hepatic vascular injury (HVI) is an uncommon complication of blunt abdominal trauma (BAT) in children. Diagnosis and management must be done by imaging. Methods A retrospective review of pediatric patients over a seven-year period (2000–2007). Of 25 files of liver injuries (LI), 9 cases of HVI were diagnosed. All of our cases were explored by sonographic, duplex sonography and computed tomography. Results Of twenty-five cases of LI, nine cases of HVI were recorded. Sex ratio male/female = 1.25 with mean age = 7.88, five cases of vein injuries, two cases of traumatic hepatic artery pseudoaneurysm, and two cases of arteriovenous fistula. Conclusion HVI affects 36% of liver injuries. Those injuries are often lethal, so systematic detection and treatment in emergency is essential. The role of imaging is both diagnosis and therapeutic.

Acquired Arteriovenous Fistula of the Temporal Artery and Vein: A Rare Finding

An arteriovenous fistula is an abnormal communication that exists between an artery and a vein. There have been few cases of arteriovenous fistulae involving the superficial temporal artery reported and even fewer deemed to be nontraumatic in origin. This report describes a case of arteriovenous fistula of the superficial temporal artery that was diagnosed by duplex ultrasound complemented with color Doppler and confirmed by pathology. In addition to relating the details of the sonographic examination, the case study will examine the etiology, clinical manifestations, and treatment options for arteriovenous fistulae of the superficial temporal artery.

Spinal Epidural Arteriovenous Fistula: A Unique Pathway into the Perimedullary Vein

Spinal dural arteriovenous fistulas (AVFs) are rare vascular malformations in the spinal dura, fed by dural branches of the radicular arteries, and drain primarily into intradural venous plexuses. They may cause elevated medullary venous pressure and produce a progressive myelopathy. We describe a case of AVF in the epidural space of the previous surgery site of L3 and it showed a unique complex venous pathway into the perimedullary vein, leading to classic clinical symptoms of venous congestion in the spinal cord. The shunt was draining into bilateral epidural venous plexus and then to the paravertebral veins at the level of L2. The venous outflow entered to the epidural space again and finally refluxed into the intradural perimedullary vein.

CT Angiography of Renal Arteriovenous Fistulae: A Report of Two Cases

Renal arteriovenous fistulas (AVFs) are rare abnormal communications between the arterial and venous circulations that can be congenital or acquired. We describe the multidetector computed tomography angiography (MDCTA) appearance of 2 cases of renal AVF, one with the cirsoid and one with the aneurysmal subtype, and the impact of these findings on therapeutic decision making and treatment follow-up.

Is Postoperative Arteriovenous Fistula Still a Concern After En Bloc Stapling of the Renal Hilum During Laparoscopic Nephrectomy?

To report our experience with en bloc stapling of the renal hilum during laparoscopic nephrectomy (LN) and nephroureterectomy and to compare it with separate stapling performed during the same period at the same institution. We conducted a retrospective review of 125 laparoscopic nephrectomies and nephroureterectomies performed between November 2003 and September 2006 for benign and malignant conditions. The main outcome was assessment of complications, with special emphasis on postoperative arteriovenous fistula. Secondary outcomes included operative blood loss and operative time. Statistical analysis was performed using two-sided parametric, nonparametric, or categorical tests as appropriate. Statistical significance was set at P < or = 0.05. The transperitoneal approach and 2.5 mM vascular titanium clips were used in all cases. En bloc stapling (group 1) was performed in 65 patients and individual stapling (group 2) in 60. There was a significantly higher proportion of right-side surgeries in group 1 than in group 2 (51 vs 25%, P = 0.05). Overall complications were 31% vs 32%, P = 0.91; mean operative time (confidence interval [CI]) 130 (95% 119, 141) vs 125 min (95% 115, 136), P = 0.3; and mean operative blood loss (CI) 100 (95% 39, 160) vs 135 mL (95% 76, 193), P = 0.33 did not differ for groups 1 and 2, respectively. After a median follow-up (interquartile range) of 25 (24.7) vs 30 (30.0) months, P = 0.14, no cases of arteriovenous fistula were detected. En bloc stapling of the renal hilum is as safe and effective as individual stapling. Arteriovenous fistula after LN does not seem to be a concern with the use of modern inorganic titanium staplers.

Serial Angiography of Dynamic Changes of Traumatic Middle Meningeal Arteriovenous Fistula -Case Report-

A 48-year-old woman suffered head trauma and presented with an acute epidural hematoma with a linear fracture of the right temporal bone across the middle meningeal groove. Initial angiography demonstrated no vascular abnormalities. Eight months later, she again suffered head trauma and computed tomography demonstrated traumatic subarachnoid hemorrhage. Right external carotid angiography revealed a middle meningeal arteriovenous fistula (AVF) which drained into the superficial sylvian veins via the sphenoparietal sinus. Serial angiography showed progressive dilation of the draining veins, but she refused surgical intervention and dropped out of our outpatient clinic. Fifteen years after the first head trauma, she presented with subarachnoid hemorrhage. Angiography demonstrated formation of venous aneurysms on the drainer of the AVF. The dilated superficial sylvian vein was removed together with the ruptured venous aneurysm. Histological examination of the drainer revealed an arterialized vein. The serial angiographic evaluations revealed dynamic changes of the traumatic middle meningeal AVF, including progressive dilation of the drainers, simplification of the drainage routes, and the formation of venous aneurysms, which presumably represents the entire natural course of traumatic middle meningeal AVF manifesting as hemorrhage. The present case of traumatic middle meningeal AVF with a deteriorating course suggests that surgical removal or embolization of the AVF is strongly indicated if follow-up angiography shows dilation of the drainers, which implies increased shunt flow.

Congenital Arteriovenous Fistula with Aneurysm Formation of Ulnar Artery Origin

Naturally formed arteriovenous fistula (AVF) causing local vascular aneurysm dilatation in the forearm ulnar artery region is rare and is exceedingly uncommon in any age group. Presented is a case of AVF in the left ulnar artery of a 39-year-old man in whom there was no history of trauma; the deformity had been noted since childhood. The AVF had become tortuous and enlarged in size as the patient aged. As a result, aneurysm dilatation formed on the base of the AVF and that of the ulnar artery origin. Despite normal preoperative Allen test result and normal preoperative finger pressure measurement with ulnar artery occlusion, arterial duplex imaging showed that the radial artery was the dominant artery of the left arm; the AVF was resected and the base of the aneurismal dilatation, which was directly related to the ulnar artery, was repaired for the sake of the natural continuity of ulnar blood flow.