Osteocutaneous free flaps for reconstruction of composite hand defects: A systematic review of clinical and functional outcomes.

To describe the technical feasibility and early clinical outcomes of basilic vein to fistula outflow vein transposition as an autogenous salvage option for malfunctioning forearm arteriovenous fistulas (AVFs) with venous outflow obstruction at the elbow level and a patent basilic vein. This single-center retrospective technical note reviewed nine patients who underwent basilic vein to fistula outflow vein transposition between December 2023 and March 2026. Clinical indications, reasons for selecting surgical transposition over further endovascular treatment, operative details, time to postoperative dialysis use, complications, reinterventions, and individual access outcomes were summarized descriptively. The mean age was 67.8 ± 7.2years; seven patients were male. Hypertension was present in all patients and diabetes mellitus in two patients. The main clinical triggers for intervention were venous hypertension during hemodialysis, thrombotic occlusion of the cephalic outflow vein, and inadequate dialysis blood flow. The mean preoperative basilic vein diameter was 2.0 ± 0.28mm. After reconstruction, all patients had restoration of a normal access thrill and resolution of abnormal fistula pulsatility, while intradialytic venous hypertension improved compared with the preoperative status. All AVFs were successfully used for hemodialysis within 48h after surgery. Two patients had wound hemorrhage that resolved after bedside management. During follow-up, five patients required reintervention for restenosis, including PTA and open thrombectomy. No early thrombosis, hematoma, nerve injury, wound infection, clinically significant steal syndrome, or access abandonment occurred during the available follow-up. In patients with a functioning forearm AVF, preserved arterial inflow, elbow-level venous outflow obstruction, and a suitable basilic vein, basilic vein-to-fistula outflow vein transposition may represent a practical autogenous salvage option. These findings should be interpreted as preliminary technical experience.

Arteriovenous Grafts Demonstrate Comparable Patency and Faster Maturation Than Basilic Vein Transposition in Octogenarians.

Regional and specialty-specific Medicare reimbursement trends in open and endovascular dialysis access interventions.

Short-Term Results of an Algorithm for Brachial Artery Injury Repair Favoring a Reversed Ipsilateral Arm Vein Conduit.

To assess patency and characterize anatomical patterns of restenosis following percutaneous transluminal angioplasty (PTA) of cephalic arch stenosis (CAS) from patients with hemodialysis arteriovenous fistulas who were enrolled in the ArterioVeNous Stent Graft in the TreatmEnt of Venous OutfloW Stenosis in Arteriovenous Fistula Access Circuits (AVeNEW) trial. Among 280 patients enrolled in AVeNEW, patients with CAS randomized to PTA were identified. Clinical data and fistulograms were reviewed through 730 days. Kaplan-Meier curves were used to estimate target lesion primary patency (TLPP) and access circuit primary patency (ACPP). The cephalic vein arch was segmented into 3 regions: proximal, arch, and terminus. Recurrence patterns were characterized by comparing the site of index stenosis with the site of restenosis using Sankey diagrams. Seventy patients with CAS were treated with PTA. Two ruptures and 2 unsuccessful PTAs yielded a modified intention-to-treat group of 66 patients. TLPP and ACPP were equivalent at the 180-, 365-, and 730-day time points: 39.5%, 13.2%, and 5.6%, respectively. Regarding post-PTA restenosis, 15 patients were censored, leaving 51 patients for analysis. Terminus stenoses recurred at the terminus. Arch region stenoses often recurred in the arch region; however, 6 (20%) of 30 formed a new terminus stenosis. PTA has a high technical successful rate for treating CAS; however, TLPP and ACPP were poor; their equivalence indicates CAS drives circuit failure. Recurrence at the index site of stenosis was the most common, although PTA of stenosis in the arch region induced a new site of stenosis at the terminus region in some patients. Proximal stenoses exhibited variable recurrence patterns.

Late thrombosis of radiocephalic arteriovenous fistulas (RCAVFs) is most commonly associated with inadequate venous outflow, and when superficial veins are unavailable or unsuitable, surgical salvage options remain limited. We report a case of complete RCAVF thrombosis caused by perforating vein occlusion in the setting of absent effective central venous drainage due to a sclerotic, non-patent cephalic vein of the arm. Surgical salvage was achieved by thrombectomy of the efferent vein followed by creation of a latero-lateral anastomosis with a brachial comitant vein. The fistula was immediately functional and successfully cannulated for hemodialysis using the original distal puncture sites. Although brachial comitant veins are well described as primary autogenous access conduits, their use as a secondary venous outflow for salvage of a thrombosed RCAVF has not been previously reported. This technique may represent a feasible and effective salvage strategy in selected patients.

Owing to its superficial location and accessibility, the anatomical snuff box is increasingly used for minimally invasive and image-guided procedures. This study evaluated the morphology and variations of its key neurovascular structures. The study was conducted on 60 upper limbs (30 right and 30 left) from embalmed adult cadavers (15 males and 15 females; age range: 20-90years). After exposure of superficial structures, detailed dissection of the anatomical snuff box was performed. The tendons forming its boundaries, along with the cephalic vein, superficial branch of the radial nerve, and radial artery, were assessed for their course, depth, diameter, and related morphometric parameters. The cephalic vein diameter ranged from 1.22 to 3.98mm. The mean radial artery diameter was 2.65 ± 0.64mm. Both cephalic vein and radial artery diameters were significantly greater in males than females. A tortuous radial artery course was observed in 73.3% of cases, while the remainder showed a relatively straight course. Radial artery tortuosity was significantly more common on the right side. A cephalic vein diameter of at least 2mm, considered suitable for arteriovenous fistula creation, was observed in 88.8% of cases. The radial artery diameter exceeded 2.3mm in 80% of specimens, supporting the feasibility of distal radial catheterization. Overall, the anatomical snuff box demonstrates favorable vascular dimensions for arteriovenous fistula creation and distal radial access. However, frequent radial artery tortuosity, particularly on the right side, should be considered during clinical interventions to minimize complications.

Risk factors for difficult cannulation of the cephalic vein in children remain underexplored. This study aimed to perform an ultrasound-based morphometric assessment of the vein in pediatric patients. An ultrasound examination of the proximal third of the dominant forearm was conducted in the emergency department of a children's hospital using a Philips Lumify device with a linear transducer (4-12MHz). Measurements included internal vein diameter, depth from the skin surface, and calculated cannula insertion path length for inclinations of 20° and 30°. Demographic and morphometric data were recorded for each patient. The study protocol was approved by the institutional Bioethics Committee (decision number KB/169/2024). Cephalic vein diameter correlated positively with age (r = 0.52, p < 0.001), height (r = 0.55, p < 0.001), and weight (r = 0.64, p < 0.001). Larger forearm circumference was associated with greater vein diameter (r = 0.60, p < 0.001), increased depth from the skin (r = 0.28, p < 0.01), and longer cannula insertion path length (r = 0.28, p < 0.01). Vein diameter was best predicted by patient weight, whereas prediction of vein depth and cannula insertion path length based on forearm circumference was limited (8% explained variance). Prediction of vein depth and cannula insertion path length based on demographic and morphometric variables is limited. Ultrasound guidance should be considered to improve first-attempt success and reduce procedural time and trauma in pediatric patients.

Tunnel Transposition versus Lipectomy for Second-Stage Superficialization of Deep Brachiocephalic Arteriovenous Fistulas: A Multicenter Retrospective Study.

Introducing the Minimally Invasive Novel Open Revascularization - The "MINOR" Approach - To Improve Outcomes in Lower and Upper Limb Arterial Bypass Surgery.

Peripherally inserted central catheters (PICCs) are widely used in neonatal intensive care units (NICUs) but are associated with a broad spectrum of complications. Evidence regarding their incidence and risk factors in neonates remains limited. We conducted a retrospective cohort study including 1800 neonates who underwent PICC placement between 2018 and 2025, accounting for 24,660 catheter-days. Mechanical, infectious, thrombotic, and other PICC-related complications were systematically recorded. Incidence densities were calculated per 1000 catheter-days. Multivariable logistic regression was used to identify independent predictors of catheter-related bloodstream infection (CRBSI) and non-technical complications. At least one PICC-related complication occurred in 58.2% of neonates (41.8 per 1000 catheter-days). Catheter tip malposition was the most frequent event (47.8%), followed by occlusion or edema (18.3%) and migration or dislodgement (12.2%). CRBSI occurred in 6.2% of infants, with an incidence of 4.3 per 1000 catheter-days. Cephalic vein insertion was strongly associated with malposition (adjusted odds ratio [aOR] 7.30; 95% CI 5.90-9.02). Prolonged catheter dwell time independently increased the risk of CRBSI (aOR 1.10 per day; p < 0.001), while total parenteral nutrition and intravenous anticonvulsant therapy were additional independent predictors. Non-technical complications were independently associated with lower birth weight, catheter malposition, hyperosmolar medication exposure, and longer dwell time. PICC-related complications are common in neonates, with malposition representing the predominant event and associated with subsequent adverse outcomes. Optimizing insertion site selection, minimizing catheter dwell time, and cautious use of hyperosmolar infusions may reduce PICC-related morbidity in the NICU.

Do wound protectors reduce contamination in total shoulder arthroplasty? A randomized controlled trial.

Introduction: Thoracic outlet syndrome (TOS) encompasses a spectrum of neurovascular compression disorders involving the brachial plexus, subclavian artery, and subclavian vein. Diagnosis remains challenging due to variable clinical presentations and limited specificity of imaging findings, particularly in neurogenic TOS. This case series aims to demonstrate the multimodality imaging spectrum of TOS across arterial, venous, and neurogenic subtypes, compare imaging appearances among subtypes, and emphasise the importance of clinicoradiological correlation in diagnosis.Methods: This retrospective case series was conducted at Sri Ramachandra Medical Health Centre, Chennai, Tamil Nadu, India, from January 2020 to March 2026. Eight consecutive patients with clinical suspicion of TOS (upper limb pain, swelling, venous engorgement, neurological symptoms, or ischaemic changes) underwent imaging evaluation. Imaging included Doppler ultrasound with provocative manoeuvres, computed tomography angiography (CTA), CT venography (CTV), and magnetic resonance imaging (MRI), tailored to clinical presentation. Imaging was assessed for osseous anomalies, site of compression across thoracic outlet compartments, vascular stenosis or occlusion, thrombosis, aneurysmal change, collateralisation, and indirect signs of brachial plexus compression. Results: Imaging demonstrated a broad spectrum of pathology across all TOS subtypes. Arterial TOS cases showed dynamic or fixed subclavian artery compromise, ranging from focal costoclavicular stenosis detected on CTA to long-segment chronic occlusion associated with an anomalous first rib. Venous TOS cases demonstrated subclavian vein compression at the costoclavicular space, including McCleery syndrome without thrombosis, muscular compression from a hypertrophied subclavius muscle, and chronic obstruction with extensive collateral venous channels. One patient demonstrated multi-level venous obstruction involving the subclavian and cephalic veins with associated central venous thrombosis. Neurogenic TOS demonstrated thoracic outlet narrowing due to a cervical rib with displacement of adjacent neurovascular structures on MRI. Dynamic Doppler imaging was critical in demonstrating haemodynamically significant stenosis not evident at rest. Conclusion: This case series demonstrates the broad imaging spectrum of TOS, ranging from dynamic arterial stenosis and chronic arterial occlusion to venous compression with collateralisation and indirect signs of neurogenic involvement. The cases highlight that the imaging appearance varies significantly depending on the affected structure and the site of compression within the thoracic outlet. Recognition of characteristic vascular findings such as focal costoclavicular narrowing, thrombosis, chronic occlusion, and collateral venous pathways can facilitate subtype classification and guide further management. However, imaging findings must be interpreted in conjunction with clinical symptoms, particularly in neurogenic TOS, where radiologic abnormalities may be subtle or absent.

Anterior Interosseous Artery as a Recipient Vessel in Superficial Circumflex Iliac Artery Perforator Flap Transplantation to the Forearm.

Introduction Granulomatosis with polyangiitis (GPA) is an autoimmune vasculitis which predominantly affects the respiratory system and kidneys. Immunosuppressive therapy effectively induces remission, but also may cause life-threatening complications. Consequently, maintaining balance between disease control and the risk of treatment-related adverse events is crucial in the therapeutic process. Case description In January 2020, a 62-year-old woman was admitted to a local hospital with unintentional weight loss, malaise, ascites and oliguria ongoing for several weeks. Chest high-resolution computed tomography revealed lung infiltrates with cavitary lesions, suggestive of Staphylococcus aureus pneumonia (Fig. 1 ). Unsuccessful treatment with antibiotics, together with oral and labial ulcerations, raised the suspicion of GPA. The diagnosis was confirmed by the presence of elevated levels of proteinase 3 antineutrophil cytoplasmic autoantibody (PR3-ANCA). Progressive renal failure required hemodialysis (HD) via a tunneled catheter. Plasmapheresis, intravenous prednisolone, and cyclophosphamide were initiated. In June 2023, the patient was readmitted with suspected pneumonia and radiological progression of pulmonary lesions. Bronchioalveolar lavage cultures yielded Acinetobacter baumannii and Candida krusei, prompting initiation of targeted therapy with amikacin, colistin, and micafungin. Echocardiography revealed a thrombus in the right atrium and intravenous catheter distal tip thickening. Although positron emission tomography suggested fungal endocarditis, repeated blood and catheter cultures were negative. However, continuation of antifungal therapy resulted in clinical improvement. After creating an arteriovascular shunt on the right arm, HD was continued. Persistent pulmonary progression, elevated PR3-ANCA levels and hearing loss prompted qualification for rituximab. In September 2023, the patient developed right arm cellulitis due to the right subclavian vein thrombosis, which was treated with piperacillin-tazobactam. Endovascular embolisation of the lateral rami of the cephalic vein contributed to the reduction of cellulitis. After subsidence of inflammation, rituximab treatment was initiated in December 2023. Conclusions The underlying disease and its treatment can cause severe infections and thrombotic events, contributing to the complexity of GPA management. This case shows that systematic reassessment and individualised therapy are essential to maintaining the effectiveness of the treatment, along with minimising treatment-related morbidity.

Establishing a functional arteriovenous fistula (AVF) is crucial to ensure effective dialysis treatment. However, there are currently no definitive criteria for predicting AVF maturation using preoperative ultrasound. This study aims to assess the efficacy of AI-driven models in analyzing comprehensive ultrasonographic variables across multiple forearm locations to predict successful AVF maturation. A retrospective analysis was conducted on 492 cases within a cohort of 494 individuals who underwent radiocephalic arteriovenous fistula (AVF) creation across three centers over a span of four years. The analysis involved various variables such as demographic data, cephalic vein diameters at distal (vein 1), mid (vein 2), and proximal (vein 3) locations, vein wall thickness, competing tributaries, peak systolic velocity, and radial artery waveform. To assess the predictive value of these variables, XGBoost, a machine learning model, was utilized. Significant predictors of AVF maturation included cephalic vein diameters (distal, mid, and proximal) with p-values of 0.004, 0.003, and 0.009, respectively, and competing tributaries (p < 0.001). The optimal model performance was in Stage 4, excluding vein 1 data, achieving an F1 score of 0.883, a Matthews Correlation Coefficient of 0.741, and an AUC of 86.9%. A vein 2 diameter cut-off of 4.5 mm resulted in an 89.5% success rate in maturation. This study underscores the value of comprehensive ultrasonographic assessments in predicting AVF maturation, advocating for detailed preoperative ultrasound mapping of the entire forearm to enhance AVF outcomes.

Early post-operative nerve complications after primary open Latarjet: a single-surgeon series of 164 shoulders

ObjectivesThe aim of the present study was to identify patient, vein and operator factors associated with first-attempt success of peripheral intravenous catheter (PIVC) insertion in cats presenting to an emergency room.MethodsA prospective study was conducted in the emergency room of a university small animal hospital between February and April 2024. Cats requiring PIVC insertion were enrolled. Data collected included patient signalment, vein visibility and palpability, catheter size, indication for catheterization and operator characteristics (role, years of experience and estimated number of previous PIVC insertions). First-attempt success was defined as catheterization with visible blood flashback and successful flushing without extravasation or discomfort. Univariable and multivariable logistic regression analyses were performed to assess associations with first-attempt success.ResultsA total of 97 PIVC insertions in 95 cats were analyzed. Overall, first-attempt success was 85.6% (n = 83/97). Most insertions involved the cephalic vein (96.9%) and 22 G catheters (57.7%). Neither catheter size, target vein nor indication for insertion was significantly associated with success. Operators with 8–15 years of experience had significantly higher odds of success compared with those with 2 years or less (P = 0.03). Operators who had inserted more than 500 intravenous catheters had greater odds of success than those with fewer than 100 insertions (odds ratio [OR] 8.63, 95% confidence interval [CI] 1.48–50.12; P = 0.02). Vein visibility was strongly associated with first-attempt success (OR 7.78, 95% CI 2.29–26.42; P = 0.001), while palpability was not. In the final multivariable model, both vein visibility (OR 8.0, 95% CI 2.16–30) and more than 500 prior insertions (OR 13.24, 95% CI 1.54–144) remained independently associated with success.Conclusions and relevanceFirst-attempt intravenous catheter insertion success in cats was strongly influenced by operator experience and vein visibility. These findings highlight the clinical importance of operator training and vein assessment during catheter insertion in feline emergency patients.

Owing to insufficient understanding of the molecular basis of arteriovenous fistula (AVF) failure, strategies to facilitate maturation and prevent access loss remain limited. This study aimed to identify potential biomarkers for AVF nonmaturation. We enrolled 123 patients with end-stage renal disease who underwent AVF surgery. Finally, 86 were classified into AVF matured (AM; n = 52) and AVF nonmatured (ANM; n = 34) groups following exclusion. Four cephalic vein tissue samples from each group were used for data-independent acquisition-mass spectrometry (DIA-MS) proteomic analysis to identify differently expressed genes. All 86 vein tissue samples were used for histological analysis, and all serum samples were used for ELISA. DIA-MS proteomic analysis identified 17 upregulated and 363 downregulated proteins in the ANM group compared with the AM group. Fibrinogen α (FGA), fibrinogen β (FGB), and fibrinogen γ (FGG) were the most activated proteins. Univariate logistic regression analysis revealed collagen volume fraction (CVF) (odds ratio [OR] = 1.278, 95% confidence interval [CI] 1.133-1.440, P < 0.001), FGA (OR = 1.005, 95% CI 1.003-1.007, P < 0.001), FGB (OR = 1.269, 95% CI 1.147-1.403, P < 0.001), and FGG (OR = 1.010, 95% CI 1.007-1.014, P < 0.001) as potential independent predictors of AVF nonmaturation. Multivariable logistic regression models further confirmed that FGA, FGB, and FGG could predict AVF outcomes. This study suggested high FGA, FGB, and FGG levels are risk factors for AVF nonmaturation and could be potential biomarkers.