Occlusion Of Arteriovenous Fistula Research Articles

Efficacy of ultrasound-guided percutaneous transluminal angioplasty for arteriovenous fistula stenosis or occlusion at juxta-anastomosis: A 3-year follow-up cohort study

ObjectiveArteriovenous fistula (AVF) is the preferred access for hemodialysis. Percutaneous transluminal angioplasty (PTA) has become a choice for AVF stenosis, and ultrasound has been used in PTA more frequently. MethodsThis single-center retrospective cohort study analyzed 129 patients who underwent PTA in the First Affiliated Hospital of Chongqing Medical University from January 2016 to December 2016. Angioplasty was performed using a noncompliant high-pressure balloon. The process was visualized by duplex scan. Our inclusion criteria were as follows: (1) stenoses or occlusions were located at the juxta-anastomosis site: the first 5 cm of the vein distal to the anastomosis; (2) stenosis was confirmed with the following conditions: (a) flow rates are <500 mL/min in the brachial artery and <200 mL/min in the fistula during dialysis, and (b) the stenosis diameter is <1.7 mm. We used the Kaplan-Meier curve to show the postintervention primary and secondary patency rates of patients with stenosis and occlusion. ResultsAltogether, 129 patients with 76 males were analyzed. Moreover, 104 have AVFs on the left arm, and only one patient had an ulnar-basilic AVF, whereas others had a radial-cephalic AVF. The postintervention primary patency rates are better in occlusion cases (P < .05), whereas secondary patency rates have no difference. The postintervention primary patency rates are better in patients without diabetes mellitus (P < .05), whereas the secondary patency rates had no difference. ConclusionsFor juxta-anastomosis site stenosis or occlusion, PTA can be used to obtain satisfactory results.

P1499FGF21 CORRELATES POSITIVELY WITH ARTERIOVENOUS FISTULA OCCLUSION IN HEMODIALYSIS PATIENTS

Abstract Background and Aims Arteriovenous fistula occlusion lead to insufficient dialysis, increases the probability of hemodialysis complications, even life-threatening. Fibroblast growth factor 21 (FGF21) is increased progressively with a decline of renal function and higher plasma FGF-21 level can be used as a meaningful index to evaluate microinflammation, lipid metabolism and predict dialysis-related complications such as cardiovascular diseases in end stage renal disease patients. This study aimed to investigate the relationship and role of FGF21 in arteriovenous fistula occlusion in our hemodialysis patients cohort. Method We screened 802 HD patients in Nanjing Zhongda Hospital (n=450) and The First People’s Hospital of Changzhou (n=352) according to a strict inclusion criteria and exclusion criteria. We recorded demographic information, blood data before dialysis and serum FGF21 levels and counted the frequency of arteriovenous fistula occlusion in our hemodialysis cohort. We used bivariate correlation analyses to assess the correlation of the frequency of arteriovenous fistula occlusion with serum FGF21 and other clinical parameters. Stepwise multivariate linear regression analyses were employed to evaluate variables independently associated with the frequency of arteriovenous fistula occlusion. P &amp;lt; 0.05 was considered to be statistically significant. SPSS Software, version 22.0 was used for all statistical analyses. Results In this cross-sectional study, of 802 hemodialysis patients screened, 76 were eligible. The median dialysis vintage was 6.4 years (range 0.5 to 23). Serum FGF21 levels were significantly positive associated with the frequency of arteriovenous fistula occlusion (r = 0.321, P = 0.005). In addition, the frequency of arteriovenous fistula occlusion was correlated with the level of hemoglobin (r = -0.277, P = 0.015), the level of albumin (r = -0.269, P = 0.019) and left ventricular mass (r = 0.272, P = 0.018). The result showed that serum FGF21 (β = 0.259, P= 0.022) and left ventricular mass (β = 0.223, P =0.048) were factors independently associated with the frequency of arteriovenous fistula occlusion in hemodialysis patients. Conclusion We reported for the first time that serum FGF21 and Left ventricular mass were independently associated with arteriovenous fistula occlusion. These findings provide a novel insight about FGF21 on arteriovenous fistula occlusion in hemodialysis patients and may indicate a new therapeutic target for arteriovenous fistula occlusion. Figure 1. Correlation of serum FGF21 and LVMI with the frequency of arteriovenous fistula occlusion in HD patients.

The intracranial vasculature of canines represents a model for neurovascular ischemia and training residents and fellows in endovascular neurosurgery.

We describe use of a canine model to evaluate physiological effects and neuroprotective strategies in the setting of cerebral ischemia and endovascular neurosurgery training. We performed transfemoral digital subtraction cerebral and cervical angiography on eight anesthetized dogs. Angiographic images of cerebral arteries were obtained following cannulation of the femoral artery. Cerebral ischemia models were made after angiography. The canine cerebral vasculature exhibited extensive tortuosity of the carotid and vertebral arteries. Conversely, the bilateral anterior spinal arteries were easily catheterized using microcatheters and microguidewires. The basilar artery and its branches were facilely cannulable. Circle of Willis continuity sans hypoplasia or aplasia of its constitutive segments was appreciated in all animals. The middle cerebral arteries could be easily accessed via the posterior communicating arteries. We generated an empirically evaluable therapeutically interventional experimental animal model of cerebral ischemia by occluding the middle cerebral artery using small coils for a duration between 15 and 60 min. Unique amenability of the canine intracranial vasculature to selective and microcatheter cannulation renders experimentally induced cerebral, cerebellar, and brainstem via occlusion of the supratentorial and infratentorial arteries a simple matter. The neural vasculature irrigating the canine cerebrum, brainstem, and cerebellum may consequently prove useful in helping young and nascent endovascular neurosurgeons in developing and refining their skills of microcatheter navigation and manipulation and deployment of therapeutic devices to achieve effective occlusion of aneurysms, arteriovenous malformations, arteriovenous fistulas, and neoplasms of the intracranial cavity.

SUN-253 FGF21 correlates positively with arteriovenous fistula occlusion in hemodialysis patients

Good vascular pathway is the key to ensure the quality of life in hemodialysis patients. Arteriovenous fistula occlusion lead to insufficient dialysis, increases the probability of hemodialysis complications, even life-threatening. Fibroblast growth factor 21 (FGF21) is increased progressively with a decline of renal function and higher plasma FGF-21 level can be used as a meaningful index to evaluate microinflammation, lipid metabolism and predict dialysis-related complications such as cardiovascular diseases in end stage renal disease patients. This study aimed to investigate the relationship and role of FGF21 in arteriovenous fistula occlusion in our hemodialysis patients cohort. We screened 802 HD patients in Nanjing Zhongda Hospital (n=450) and The First People’s Hospital of Changzhou (n=352) according to a strict inclusion criteria and exclusion criteria. We recorded demographic information, blood data before dialysis and serum FGF21 levels and counted the frequency of arteriovenous fistula occlusion in our hemodialysis cohort. We used bivariate correlation analyses to assess the correlation of the frequency of arteriovenous fistula occlusion with serum FGF21 and other clinical parameters. Stepwise multivariate linear regression analyses were employed to evaluate variables independently associated with the frequency of arteriovenous fistula occlusion. P < 0.05 was considered to be statistically significant. SPSS Software, version 22.0 was used for all statistical analyses. In this cross-sectional study, of 802 hemodialysis patients screened, 76 were eligible. Age of hemodialysis patients was 55.46±15.18 years, and 48 of participants (63.7 %) were male. The median dialysis vintage was 6.4 years (range 0.5 to 23). Serum FGF21 levels were significantly positive associated with the frequency of arteriovenous fistula occlusion (r = 0.321, P = 0.005). In addition, the frequency of arteriovenous fistula occlusion was correlated with the level of hemoglobin(r = -0.277, P = 0.015), the level of albumin (r = -0.269, P = 0.019) and left ventricular mass (r = 0.272, P = 0.018). Variables including FGF 21, hemoglobin, albumin and left ventricular mass and others those well known as promoters of arteriovenous fistula occlusion such as PTH, calcium, phosphorus, glycerin trilaurate and total cholesterol were entered a multivariate linear regression analyses, the result showed that serum FGF21 (β = 0.259, P= 0.022) and left ventricular mass (β = 0.223, P =0.048) were factors independently associated with the frequency of arteriovenous fistula occlusion in hemodialysis patients. We reported for the first time that serum FGF21 and Left ventricular mass were independently associated with arteriovenous fistula occlusion. These findings provide a novel insight about FGF21 on arteriovenous fistula occlusion in hemodialysis patients and may indicate a new therapeutic target for arteriovenous fistula occlusion.

Assessing the Effect of Personalized Nursing on Thrombolytic Hemodialysis Patients After Arteriovenous Fistula Occlusion

Objective: To assess the effect of personalized nursing on thrombolytic hemodialysis patients after arteriovenous fistula occlusion. Methods: 92 patients who undergoing arteriovenous fistula in the hospital were invited to join our study. The time of they receive the treatment is from May 2015 to July 2020. In study beginning, the patients were randomly assigned to the control group (n = 46) and an intervention group (n = 46). The two groups receive different nursing intervention. The control group receive common nursing intervention. On the other hand, the intervention group patients receive personalized nursing intervention in treatment process. Result: In basic patient information, the patient basic status are similar [20 (47.6%) vs 23 (54.8%), 38.14±9.12 vs 37.88±10.07, 1.41±0.75 vs 1.37±0.69], that the gender, age and number of thrombolysis are not statistical significance (p > 0.05). In thrombolysis success rate research, the intervention group has higher thrombolysis success rate than that of control group [38 (90.5%) vs 32 (76.2%), p = 0.016]. In patient satisfaction research result, more intervention group patients make very well assessment than that of control group patients [19 (45.2%) vs 10 (23.8%), p < 0.005]. Conclusion: the personalized nursing intervention not only increase thrombolysis success rate but also improve the patient satisfaction in arteriovenous fistula occlusion.

Safety and Efficacy of the Percutaneous Manual Aspiration Thrombectomy Technique to Treat Thrombotic Occlusion of Native Arteriovenous Fistulas for Hemodialysis

목적혈액투석용 자가혈관 동정맥루의 혈전을 동반한 폐색에서 경피적 수동 흡인 혈전제거술의 안전성과 유용성에 대해 평가하고자 한다.대상과 방법2012년 3월부터 2017년 12월까지 자가혈관 동정맥루의 혈전을 동반한 폐색으로 내원하여 경피적 혈관 내 시술을 시행 받은 20명의 환자를 후향적으로 분석하였다. 기술적 및 임상적 시술 성공률, 1차 및 2차 개통률, 그리고 시술에 따른 합병증을 분석하였다.결과총 20명의 환자에서 20회의 경피적 혈관 내 시술을 시행하였다. 모든 환자에서 혈전을 제거하기 위해 경피적 수동 흡인 혈전제거술을 시행하였고, 협착이 동반된 경우 풍선카테터를 이용한 혈관성형술을 함께 시행하였다. 17명의 환자는 혈전이 제거되어 혈류가 정상적으로 회복되었고(기술적 성공률 85%), 17명 환자 모두 시술 직후 혈액투석이 정상적으로 시행되었다(임상적 성공률 85%). 동정맥루 위치는 좌측 요골두정맥루가 13명, 좌측 상완두정맥루가 4명, 우측 요골두정맥루가 3명이었다. 동반된 협착 부위는 문합부 주위 정맥이 16예, 원위부 배출정맥이 12예, 중심정맥이 4예였다. 1차 및 2차 개통률은 1, 3, 6, 12개월에서 각각 100%, 70.6%, 70.6%, 56.5% 및 100%, 94.1%, 94.1%, 86.9%였다. 시술과 관련된 합병증은 없었다.결론혈액투석용 자가혈관 동정맥루에서 혈전을 동반한 폐색의 치료로서 경피적 수동 흡인 혈전제거술은 안전하고 유용한 시술이다.

Percutaneous transluminal angioplasty for failing native hemodialysis arteriovenous fistulas

Background Stenosis and associated thrombosis is a continual complication of hemodialysis arteriovenous fistulas (AVFs). Early management of stenosis may avoid AVF occlusion and extend its use. Objective The objectives were to evaluate effectiveness, safeness, and durability of percutaneous transluminal angioplasty (PTA) in treatment of failing native hemodialysis AVFs. Patients and methods A total of 20 patients (12 females and eight males) with chronic renal failure dependent on hemodialysis underwent PTA for their failing native AVFs. The indications for these procedures were significant stenosis (>50% decrease of the vessel diameter). Results A total of 20 PTA procedures were performed in 20 fistulas of 20 patients with end-stage renal disease. These interventions were performed on 14 (70%) brachiocephalic and six (30%) radiocephalic fistulas. PTA succeeded technically in 18 (90%) procedures, and clinical success was accomplished after 17 (85%) procedures. The authors found the commonest site (65%) of AVF stenosis is in the juxtaanastomotic segment. Recurrent stenosis occurred in three (15%) patients; the three cases were subjected to a second successful PTA. The primary patency rates were 70% after 6 months and 50% after 12 months. The primary assisted patency rate was 100% after 12 months. A total of 12 (60%) patients required no further reintervention and continued hemodialysis from their fistulas till the end of the study. Conclusion PTA for treatment of failing native hemodialysis AVFs is a successful efficient technique to prolong the patency of the fistulas. By preserving the existing fistulas, venous segments can be saved for future AVF creation.

The Comparison of Medical Expenses and Patency Between Surgical Reconstruction and Percutaneous Transluminal Angioplasty to Treat Arteriovenous Fistula Stenosis or Occlusion – A Regional Teaching Hospital’s Experience in Taiwan

The Comparison of Medical Expenses and Patency Between Surgical Reconstruction and Percutaneous Transluminal Angioplasty to Treat Arteriovenous Fistula Stenosis or Occlusion – A Regional Teaching Hospital’s Experience in Taiwan

Factors associated with the patency loss of arteriovenous fistula for hemodialysis

&amp;lt;p&amp;gt;Introduction. The aim of the study is to examine the frequence of both early and later postoperative complications of arteriovenous fistula (AVF), as well as to determine the factors associated with the patency loss of AVF. Methods. The examination included 250 patients underwent native lower-arm AVF for hemodialysis createion, after which they had been monitored for at least six months. The patients were divided into two groups: group 1, consisting of 50 patients (30 males, aged 65.9 &amp;amp;plusmn; 11.9 years), in which there was the patency loss of AVF after 31.8 &amp;amp;plusmn; 38.8 months; group 2, consisted of 200 patients (106 males, aged 67.6 &amp;amp;plusmn; 9.5 years) with functional AVF that was followed for 57.5 &amp;amp;plusmn; 40.1 months. Apart from clinical state and AVF functionality, the biochemical parameters recommended for the hemodialysis patients were regularly checked. Results. There was significantly greater percentage of diabetes (42% vs. 12%), hypertension (42% vs. 2%) and anaemia (100% vs. 83.5%) found among the patients belonging to the first group, in comparison with the second one. On the other hand, there was no significant difference in the demographic, clinical and laboratory parameters. The patients from the first group had a significantly smaller diameter of the vein used for AVF (2.4 &amp;amp;plusmn; 0.25 mm vs. 2.7 &amp;amp;plusmn; 0.31 mm; p = 0.0001), frequently thickened venous walls (32% vs. 8%), as well as the lower quality of the artery used for AVF, in comparison with the second group. Time passed from the operation of AVF to its exploitation was significantly shorter in patients with than in those without occlusion of AVF (28.9 &amp;amp;plusmn; 6.6 days vs. 95.0 &amp;amp;plusmn;1 52.6 days; p=0.0025). The number of intraoperative, as well as early and later postoperative complications was significantly larger in the first group than in the second one. Hypotension, the use of AVF for hemodialysis less than 45 days after the creation, number of intraoperative complications, diabetes, anaemia, the previous cannnulation of the vein used for AVF, quality of artery and vein and the number of postoperative complications were selected by multivariate logistic regression analysis as independent factors associated with the patency loss of AVF. Conclusion. The patients with the patency loss of AVF had a significantly greater number of both intraoperative and postoperative complications. The patency loss of AVF is associated with the range of changeable risk factors the recognition and elimination of which can improve the AVF functionality status, as well as prolong the time of its exploitation.&amp;lt;/p&amp;gt;

Complications Post Inferior Vena Cava Filter Placement

Duplex and color Doppler imaging have proved to be an excellent noninvasive modality for evaluating complications of percutaneous interventional vascular procedures. Complications including hematoma, pseudoaneurysm, arteriovenous fistula (AVF), thrombosis, stenosis, and vessel occlusion are routinely diagnosed with duplex imaging. The most common complication of vena cava filter placement is bleeding and access site thrombosis. AVF is a rare complication of vena cava filters. Puncture-related AVFs are false vascular channels between an adjacent vein and artery that demonstrate low-resistance arterial signals, high velocity venous outflow, and variable flow patterns within themselves. Vena cava filter placement is a relatively low-risk alternative for prophylaxis against pulmonary embolism in patients with deep vein thrombosis who are not suitable for anticoagulation. There is an increasing trend in the number of vena cava filter implantation procedures performed each year. Vena cava filters are effective in preventing pulmonary embolism but have risks associated with implantation. Awareness of potential complications can lead to early detection as well as management of complications to improve clinical outcomes.

Impact of Lesion Morphology on Durability After Angioplasty of Failed Arteriovenous Fistulas in Hemodialysis Patients

Purpose: To investigate if morphological patterns of arteriovenous fistula (AVF) venous lesions affect primary patency after percutaneous transluminal angioplasty (PTA). Methods: From July 2014 to June 2015, 262 patients underwent PTA for failed AVFs. A total of 104 patients were excluded owing to (1) calcification or AVF occlusion precluding ultrasound examination, (2) central venous or arterial lesions, and (3) no follow-up, leaving 158 patients (mean age 71±12; 96 men) for analysis. More than half of the patients had one or more previous PTAs for the failed AVF. Prior to PTA the stenotic lesions were assessed using ultrasonography to determine stenotic patterns at the minimum lumen area site and to evaluate the flow volume in the brachial artery. Three stenotic patterns were identified: intimal hyperplasia (IH) stenosis (n=110), shrinking lumen stenosis (n=32), and venous valve–related stenosis (n=16). The main outcome measure was primary patency after PTA estimated using Kaplan-Meier analysis. Predictors for loss of primary patency were determined using a multivariate Cox proportional hazards model; the results are presented as the adjusted hazard ratio (HR) and 95% confidence interval (CI). Results: Median follow-up after PTA was 6.3 months (interquartile range 3.3, 10.5). The 6-month primary patency estimates were 56%±5% in the IH group, 40±9% in the shrinking lumen group, and 100% in the valve stenosis group (IH vs shrinking, p=0.013; IH vs valve, p=0.003). In multivariate analysis, shrinking lumen morphology had a negative impact on primary patency (HR 2.05, 95% CI 1.25 to 3.36, p=0.005), while venous valve–related stenosis had a positive impact (HR 0.19, 95% CI 0.04 to 0.79, p=0.023). Flow volume (10-mL/min increments; HR 0.97, 95% CI 0.96 to 0.99, p=0.004) and history of PTA (HR 1.66, 95% CI 1.06 to 2.60, p=0.029) were also independently associated with primary patency after PTA. Conclusion: The patterns of AVF stenosis as determined by ultrasound can affect the outcome of treatment with balloon dilation.

A novel technique for duplex-guided office-based interventions for patients with acute arteriovenous fistula occlusion

ObjectiveThe purpose of the study was to aggressively salvage acutely occluded arteriovenous fistulas (AVFs) using duplex imaging as the sole imaging modality for percutaneous transluminal angioplasty of acutely thrombosed AVF. MethodsOver a period of 12 months, 14 patients with acute thrombosis of their AVFs underwent 18 procedures in a single center for AVF salvage. All 14 patients presented with chronic renal failure, and six were diabetic. All patients were treated under duplex guidance alone. Treatment included simple balloon dilation and maceration (group A; n =10 procedures [56%]) for subacute thrombosis or pharmacomechanical thrombectomy (group B; n = 8 procedures [44%]) for more hypoechoic thrombus. A successful procedure was defined as immediate restoration of flow through the AVF. ResultsOf the 18 procedures, 13 (72%) were successful. Of the 14 patients, thrombus was located at the perianastomotic AVF in 6 (43%), proximal-mid AVF in 6 (43%), mid AVF in 1 (7%), and distal AVF in 1 (7%). From group A, six (60%) were successful. From group B, seven (88%) were successful. Among the unsuccessful procedures, one group B patient was hypercoagulable (polycythemia vera). Of the 18 procedures, 16 (89%) were treated within 2 weeks from when duplex revealed the presence of thrombus. Early rethrombosis (<1-month patency) occurred in three cases (17%), and these patients received new fistulas. Full restoration of the fistula flow was established in 14 cases (78%). Of these 14 patients, 8 (57%) are currently on hemodialysis via fistula, 3 patients (21%) had newly placed fistulas after failed interventions, 2 patients (14%) are not on dialysis yet, and 1 patient (7%) with polycythemia vera disorder is on dialysis via a Tesio catheter (MedComp, Harleysville, Pa). ConclusionsThe sole use of duplex ultrasound imaging to salvage acutely occluded AVFs using percutaneous transluminal angioplasty is a safe and effective alternative to traditional treatment of thrombosed failing/maturing AVF.

Endovascular Treatment of Dural Arteriovenous Fistulas of the Transverse and Sigmoid Sinuses Using Transarterial Balloon-Assisted Embolization Combined with Transvenous Balloon Protection of the Venous Sinus.

Combined transarterial balloon-assisted endovascular embolization with double-lumen balloon microcatheters and concomitant transvenous balloon protection was described as a promising treatment technique for dural arteriovenous fistulae of the transverse and sigmoid sinus. The purpose of this study was to evaluate the technical efficacy and safety of this combined treatment technique. Nine consecutive patients presenting with dural arteriovenous fistulas of the transverse and sigmoid sinuses underwent combined transarterial and transvenous balloon-assisted endovascular embolization. Prospectively collected data were reviewed to assess the technical success rate, complication rate, and clinical outcome. Six patients presented with clinically symptomatic Borden type I, and 3 patients, with Borden type II dural arteriovenous fistulas of the transverse and sigmoid sinuses (3 men, 6 women; mean age, 50.4 years). Transarterial embolization was performed with a double-lumen balloon with Onyx and concomitant transvenous sinus protection with a dedicated venous remodeling balloon. Complete angiographic occlusion at the latest follow-up (mean, 4.8 months) was achieved in 6 patients, and near-complete occlusion, in 2 patients. Clinical cure or remission of symptoms was obtained in 6 and 2 patients, respectively. One patient with a residual fistula underwent further treatment in which the dural arteriovenous fistula was cured by sinus occlusion. Complete occlusion of the dural arteriovenous fistula was visible on the follow-up angiography after final treatment in 8 patients. One patient refused follow-up angiography but was free of symptoms. There were no immediate or delayed postinterventional complications. Transarterial balloon-assisted embolization of dural arteriovenous fistulas of the transverse and sigmoid sinuses with combined transvenous balloon protection is safe and offers a high rate of complete dural arteriovenous fistula occlusion and remission of clinical symptoms.

Degree and Duration of Functional Improvement on Long-Term Follow-Up of Spinal Dural Arteriovenous Fistulae Occluded by Endovascular and Surgical Treatment.

Long-term outcomes following occlusion of spinal dural arteriovenous fistula (SDAVF) are poorly understood and are based on small series reporting predominantly short-term outcomes. The degree and duration of improvement remain unclear. In this study, we analyzed long-term outcomes following occlusion in a cohort of patients with SDAVF. This was a single-center cohort study of patients with SDAVF identified from a prospective database. Outcomes were assessed using a modified Aminoff and Logue Disability (ALD) Scale, the modified Rankin Scale (mRS), and patient-reported outcomes at presentation and long-term follow-up. Both angiographic recanalization and idiopathic functional recurrence rates were calculated. Of the total of 67 patients with SAVDF identified, 59 were eligible for inclusion in this study. Fifty-seven of these 59 (97%) underwent occlusion. Twenty-two patients underwent initial embolization; 12 were occluded. Two patients recanalized. Eleven patients underwent surgery after attempted embolization; 10 were occluded. Thirty-seven patients treated by surgery only were occluded. The median duration of follow-up was 63 months (range, 12-240 months). After occlusion, the ALD gait and urinary scores improved by a median of 1 point. Although the median mRS score was unchanged, 49% of the patients experienced improvement, most by 1 point. There was no difference between the patients occluded by embolization or surgery, but those requiring both approaches had worse gait and urinary scores (P= 0.005 and 0.03, respectively). The duration of symptoms by itself had no effect on outcomes (P= 0.61). Following occlusion, 5 patients experienced an idiopathic late functional deterioration. Of 16 patients presenting with paraplegia, 13 (81%) improved, with a median mRS improvement of 1 point. Following occlusion, patients with SDAVF experienced a modest improvement in symptoms, most commonly by 1 point on the ALD scale. Idiopathic late deterioration was seen in 9.1% of patients.

Distal Femoral Arteriovenous Fistula with Iliac Vein Thrombosis after Blunt Trauma

A 39-year-old woman arrived at our emergency department, complaining of severe pain and swelling of her left leg. She had slipped down stairs and injured on her left leg about 3 months ago. Computed tomography angiography showed left distal superficial femoral artery’s pseudoaneurysm with arteriovenous fistula and thrombotic occlusion of left common iliac vein. We decided to do endovascular intervention due to severe venous hypertension and chronic inflammation around the fistula. The femoral arteriovenous fistula was closed via stent-graft (7 mm×5, 9 mm×5 cm) deployment. The occluded left iliac vein was reopened by nitinol metal stenting (12 mm×4 cm, 14 mm×4 cm). The authors report a very rare case of femoral arteriovenous fistula combined with iliac vein thrombosis developed after a blunt trauma.

Effects of far infrared therapy on arteriovenous fistulas in hemodialysis patients: a meta-analysis

Background: Far infrared (FIR) therapy may have a beneficial effect on maturity and function of arteriovenous fistulas (AVFs) in hemodialysis (HD) patients. Therefore, we performed this pooled analysis to assess the protective effects of FIR therapy in HD patients.Methods: The randomized controlled trials (RCTs) and quasi-RCTs of FIR therapy for HD patients were searched from multiple databases. Relevant studies were screened according to the predefined inclusion criteria. The meta-analyses were performed using RevMan 5.2 software (The Cochrane Collaboration, Oxford, UK).Results: Meta-analysis showed that FIR therapy could significantly increase the vascular access blood flow level (MD, 81.69 ml/min; 95% CI, 46.17–117.21; p < .001), AVFs diameter level (MD, 0.36 mm; 95% CI, 0.22–0.51; p < .001), and the primary AVFs patency (pooled risk ratio = 1.24; 95% CI, 1.12–1.37, p < .001). In addition, therapy with FIR ray radiation could decrease AVFs occlusion rates (pooled risk ratio = 0.20; 95% CI, 0.08–0.46; p < .001) and the level of needling pain (pooled risk ratio = 0.08; 95% CI, 0.06–0.10, p < .001).Conclusions: FIR therapy can reduce AVFs occlusion rates and needling pain level, while significantly improve the level of vascular access blood flow, AVFs diameter and the primary AVFs patency.

Embolization of Intracranial Dural Arteriovenous Fistulas Using PHIL Liquid Embolic Agent in 26 Patients: A Multicenter Study.

The introduction of liquid embolic agents has revolutionized endovascular approach to cranial vascular malformations. The aim of the study was to retrospectively assess the efficacy and safety of Precipitating Hydrophobic Injectable Liquid (PHIL), a new nonadhesive liquid embolic agent, in the treatment of patients with cranial dural arteriovenous fistulas. The primary end point was the rate of complete occlusion of dural arteriovenous fistulas. Secondary end points included the incidence of adverse events and clinical status at 3-month follow-up. This was a retrospective multicenter study. Twenty-six consecutive patients with dural arteriovenous fistulas (de novo or previously treated) treated by injection of PHIL only or with PHIL in combination with other embolization products (such as Onyx or detachable coils) were included in the study. Recruitment started in August 2014 and ended in September 2015. Twenty-two (85%) patients were treated with PHIL only, with 3 patients treated with both PHIL and Onyx, and 1, with both PHIL and coils. Immediate complete angiographic occlusion was achieved in 20 (77%) patients. Of the 6 patients with residual fistulas, 3 were retreated with PHIL and 1 achieved angiographic cure. An adverse event was seen in 1 patient who developed worsening of preexisting ataxia due to acute thrombosis of the draining vein. PHIL appears to be safe and effective for endovascular treatment of cranial dural arteriovenous fistulas. Short-term angiographic and clinical results are comparable with those of Onyx, with the added advantage of easier preparation and improved homogeneous cast visualization. The use of iodine as a radio-opacifier also produces considerably less artifacts on CT compared with tantalum-based embolic materials.

TCTAP C-221 Successful Opening to Recent Thrombotic Occlusion of Arteriovenous Fistula Due to Central Venous Stenosis Using Hybrid Therapy

TCTAP C-221 Successful Opening to Recent Thrombotic Occlusion of Arteriovenous Fistula Due to Central Venous Stenosis Using Hybrid Therapy

Coagulation, thrombophilia and patency of arteriovenous fistula in children undergoing haemodialysis compared with healthy volunteers: a prospective analysis.

This study aimed to assess whether markers of coagulation, fibrinolysis or thrombophilia are increased in children on haemodialysis compared with controls and whether measurement of any of these factors could help to identify patients at an increased risk of arteriovenous fistula (AVF) occlusion. Blood samples were taken from 55 children immediately before a session of haemodialysis and from 20 healthy volunteers. Thrombin-antithrombin (TAT), D-dimer, plasmin-antiplasmin (PAP) and anticardiolipin immunoglobulin G (ACA-Ig G) were measured by ELISA. Factor V Leiden mutation (G1691A) was determined by gene polymorphism [restriction fragment length polymorphism (RFLP)]. Determination of the patency of the AVF was prospectively followed up for a minimum of 4 years or until the AVF was nonfunctioning. Fifty-five patients were studied with a median follow-up of 659 days (range 30-1670 days). A significant increase was found in the levels of D-dimer, PAP and ACA-Ig G in haemodialysis patients with thrombosed and nonthrombosed native AVFs vs. There was a significant difference between both chronic haemodialysis patients with thrombosed and nonthrombosed native AVF with regard to ACA-IgG levels. At 1 year follow-up, primary patency was 61.4% (27 patients). In multivariate analysis, D-dimer was inversely associated with secondary patency.Thrombophilia may predispose children with end stage renal disease to access failure. The promising finding is that in children on haemodialysis, D-dimer levels were increased and inversely correlated with secondary patency. Further evaluation is required into the possible role of D-dimer as a biomarker of AVF occlusion.

Treatment of High Flow Arteriovenous Fistulas after Successful Renal Transplant Using a Simple Precision Banding Technique

Observation versus ligation of a functional arteriovenous fistula (AVF) after successful renal transplantation (SRT) has been a controversial topic of debate. Congestive heart failure and pulmonary hypertension are common in dialysis patients, and more frequent when vascular access flow is excessive. Renal transplant failure may occur in up to 34% of patients after 5years, therefore maintaining a moderate flow AVF appears warranted. We review SRT patients with high flow-AVFs (HF-AVF) and clinical signs of heart failure where a modified precision banding procedure was used for access flow reduction. Patients referred for HF-AVF evaluation after SRT were identified and records reviewed retrospectively. In addition to recording clinical signs of heart failure, each patient had ultrasound AVF flow measurement before and after temporary AVF occlusion of the access by digital compression. Pulse rate and the presence or absence of a cardiac murmur was noted before and after AVF compression. Adequacy of access flow restriction was evaluated intraoperatively using ultrasound flow measurements, adjusting the banding diameter in 0.5mm increments to achieve the targeted AVF flow. Twelve patients were evaluated over a 19-month period. Eight (66%) were male and one (8%) obese. Ages were 15-73years (mean=42). The AVFs were established 24-86months previously. The mean pulse rate declined after AVF compression from 90/min to 72/min (range 110-78). Six patients had a precompression cardiac flow murmur that disappeared with temporary AVF compression. One patient with poor cardiac function underwent immediate AVF ligation with dramatic improvement in cardiac status. All other patients underwent a precision banding procedure with real-time flow monitoring. Mean access flow was 2,280mL/min (1,148-3,320mL/min) before access banding and was 598mL/min (481-876) after flow reduction. The clinical signs of heart failure disappeared in all patients. All AVFs remained patent although one individual later requested ligation for cosmesis. Two patients had renal transplant failure and later successfully used the AVF. Follow-up postbanding was 1-18months (mean=12). Patients with successful renal transplants and HF-AVFs had resolution of heart failure findings and maintenance of access patency using a modified precision banding procedure. Flow reduction in symptomatic renal transplant patients with elevated access flow is recommended. Further study is warranted to substantiate these recommendations and clarify the appropriate thresholds for such interventions.