Treatment of Hand Ischemia Following Angioaccess Surgery Using the Distal Revascularization Interval-Ligation Technique with Preservation of Vascular Access: Description of an 18-Case Series

Background: Chronic hand ischemia refers to progressive, non-acute ischemic symptoms such as cold intolerance, rest pain, ulceration, tissue necrosis, and digit loss and poses a significant challenge in management. Conservative treatment begins with medical optimization and pharmacologic therapy, but when symptoms persist, surgical intervention may be required. Various operations exist to improve circulation including sympathectomy, arterial bypass, or venous arterialization. The purpose of this study is to systematically review published outcomes and present our experience with each surgical technique. Methods: A systematic review of literature regarding surgical treatment of chronic hand ischemia published between 1990 and 2016 was conducted using PRISMA guidelines. A retrospective-review of surgical interventions for chronic hand ischemia from 2010 to 2016 was then conducted. Primary outcomes included improvement in pain, wound-healing, and development of new ulcerations. Results: The review included 38 eight studies, showing all three techniques were effective in treating chronic hand ischemia. Sympathectomy had the lowest rate of new ulcerations (0.8%); bypass had the highest rate of healing existing ulcerations (89%). Arterialization was associated with consistent pain improvement pain (100%) but more complications (30.8%). Our series included 18 patients with 21 affected hands, 18 sympathectomies, 6 ulnar artery bypasses, and 1 arterialization. Most hands had improvement of wounds (89.5%) and pain (78.9%). No patients developed new ulcerations, but one required secondary amputation. Conclusions: When conservative measures fail to improve chronic hand ischemia, surgical intervention is an effective last line treatment. An algorithmic approach can determine the best operation for patients with chronic hand ischemia.

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Lower limb vascular access for maintenance hemodialysis patients – A case series

Journal of Dr NTR University of Health Sciences ◽

10.4103/jdrntruhs.jdrntruhs_47_19 ◽

2020 ◽

Vol 9 (1) ◽

pp. 60

Author(s):

KSiva Parvathi ◽

T Nagalakshmi ◽

C Mahesh ◽

R Nagaraj ◽

A Sunnesh ◽

...

Keyword(s):

Vascular Access ◽

Lower Limb ◽

Case Series ◽

Hemodialysis Patients ◽

Maintenance Hemodialysis ◽

Maintenance Hemodialysis Patients

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Brachio-azygos transthoracic arteriovenous grafts for hemodialysis patients with bilateral central venous obstruction: A small case series

The Journal of Vascular Access ◽

10.1177/11297298211058580 ◽

2021 ◽

pp. 112972982110585

Author(s):

Dan Song ◽

Young Woo Park

Keyword(s):

Lower Extremity ◽

Vascular Access ◽

Median Sternotomy ◽

Case Series ◽

Hemodialysis Patients ◽

Arteriovenous Graft ◽

Venous Obstruction ◽

Central Venous ◽

Arteriovenous Grafts ◽

Central Venous Obstruction

Background: It is difficult to find a reliable outflow vein for vascular access in hemodialysis patients with bilateral central venous obstruction. The lower extremity veins are currently used as the most common alternative veins to make a new vascular access. However, in patients not amenable to make lower extremity access, intrathoracic vein should be considered as an outflow vein, but there are limitations in its use due to postoperative complications. Methods: We introduce a series of cases that underwent arteriovenous graft operation using an intrathoracic vein, the azygos arch, as an outflow vein. Brachio-azygos transthoracic arteriovenous graft is a surgical procedure that anastomoses the azygos arch and the brachial artery with 7 mm ringed polytetrafluoroethylene graft via lateral thoracotomy without median sternotomy. Results: The chest tubes of the patients were removed on the third postoperative day and they discharged within a week. About 1 month later, hemodialysis was initiated through the BATAVG, and it has been used without access dysfunction. Conclusion: Brachio-azygos transthoracic arteriovenous grafts were performed using the azygos arches without major complications. The azygos arch can be a good alternative outflow vein to make a new vascular access for hemodialysis patients with bilateral central venous obstruction.

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The novel use of the Haemodialysis reliable outflow graft (HeRo®) in intestinal failure patients with end-stage vascular access

The Journal of Vascular Access ◽

10.1177/1129729820961972 ◽

2020 ◽

pp. 112972982096197

Author(s):

Fungai Dengu ◽

James Hunter ◽

Georgios Vrakas ◽

James Gilbert

Keyword(s):

Parenteral Nutrition ◽

Vascular Access ◽

Intestinal Failure ◽

Case Series ◽

Venous Access ◽

Central Venous ◽

Central Venous Stenosis ◽

Venous Stenosis ◽

Life Threatening ◽

End Stage

Intestinal failure (IF) patients are dependent on central venous access to receive parenteral nutrition. Longstanding central venous catheters are associated with life-threatening complications including infections and thromboses resulting in multiple line exchanges and the development ofprogressive central venous stenosis or occlusion. The Haemodialysis Reliable Outflow (HeRO) graft is an arterio-venous device that has been successfully used in haemodialysis patients with ‘end-stage vascular access’. We describe a case series of HeRO graft use in patients with IF and end-stage vascular access. Four HeRO grafts were inserted into IF patients with end-stage vascular access to facilitate or support intestinal transplantation. In all patients the HeRO facilitated immediate vascular access, supporting different combinations of parenteral nutrition, intravenous medications, fluids or renal replacement therapy with no bloodstream infections. In a highly complex group of IF patients with central venous stenosis/occlusion limiting conventional venous access or at risk of life-threatening catheter-related complications, a HeRO® graft can be a feasible alternative.

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Distal transradial artery access for vascular access intervention

The Journal of Vascular Access ◽

10.1177/1129729820974235 ◽

2020 ◽

pp. 112972982097423

Author(s):

Shingo Watanabe ◽

Michio Usui

Keyword(s):

Radial Artery ◽

Vascular Access ◽

Case Series ◽

Treatment Method ◽

Artery Occlusion ◽

Hemorrhagic Complication ◽

Dialysis Patients ◽

Access Site ◽

Contrast Volume ◽

Average Contrast

Background: Vascular access intervention is a useful treatment method for maintaining arteriovenous fistula (AVF) in dialysis patients. The outflow vein is commonly used as the access site for vascular access intervention. In cases where it is difficult to puncture veins due to multiple lesions or poor AVF development, vascular access intervention is performed using the radial artery. However, it is difficult to perform a vascular access intervention with radial artery access to the AVF in the distal forearm. We reported the efficacy and safety of vascular access intervention with distal transradial artery access (dTRA). Case series: We have been conducting vascular access intervention with dTRA access since January 2019. We evaluated complications and procedure time for 12 cases of vascular access intervention with dTRA access performed from January to December 2019. The success rate of the procedure was 100% and no puncture hemorrhagic complication was observed in 12 cases performed at our institution. No radial artery occlusion was observed in 12 cases. The average fluoroscopy time was 11.5 min and the average contrast volume was 41 ml. Conclusion: dTRA for vascular access intervention has advantages over conventional radial artery access in terms of safety of the procedure and ease of hemostasis.

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An alternative needling site for haemodialysis: Retrograde brachiocephalic AV fistulas: A case series

International Surgery ◽

10.9738/intsurg-d-15-00048.1 ◽

2016 ◽

Author(s):

Usman Khalid ◽

Szabolcs Horvath ◽

Elaine Saunders ◽

Lynn Davies ◽

Rhys Morris ◽

...

Keyword(s):

Vascular Access ◽

Case Series ◽

Cephalic Vein ◽

Health Board ◽

Av Fistula ◽

Distal Branch ◽

Median Cubital Vein ◽

Av Fistulas ◽

Male Patients ◽

Vein Stenosis

Abstract Introduction: Establishing a patient with a functioning AVF remains a challenge for vascular access surgeons. Presence of venous branches directing flow away from the main outflow vein in a brachiocephalic fistula may be one of the reasons for their failure to mature and often these are ligated. When not ligated 'retrograde flow' may occur and develop into an 'unorthodox' fistula. Case presentation: In Cardiff & Vale University Health Board, 331 brachiocephalic fistulas were created for haemodialysis access over a 3 year period. Five male patients were identified, with a median age of 69, who had, as a result of proximal cephalic vein stenosis/occlusion, developed a functioning mature fistula within a distal branch/forearm vein that eventually drains via the basilic vein. Moreover, the flow rates within these 'new' fistula outflow veins were comparable to functioning conventional brachiocephalic fistulas. Conclusion: These 'retrograde' brachiocephalic fistulas that have been inadvertently/accidentally created appear to be successful in providing stable vascular access for haemodialysis. These cases are an interesting find, as often such branches would have been ligated at time of fistula creation. When creating an AV fistula between the brachial artery and the median cubital vein consideration should be given to not ligating the below elbow cephalic vein.

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