TP5.2.1 Duplex ultrasound should be interpreted with caution in vascular access

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Andrew Wicks ◽  
Jonathan De Siqueira ◽  
Marc Bailey ◽  
Max Troxler ◽  
Julian Scott
Keyword(s):  
Median Time ◽  
Teaching Hospital ◽  
Vascular Access ◽  
Surgical Intervention ◽  
Venous Pressure ◽  
Duplex Ultrasound ◽  
Endovascular Intervention ◽  
Substantial Proportion ◽  
Imaging Findings ◽  
Clinical Presentations

Abstract Aims Dysfunctional vascular access in haemodialysis has varied clinical presentations, including prolonged bleeding, pain, loss of thrill, difficulties needling and ineffective dialysis. We aimed to establish whether specific presentations correlate with a higher frequency of adverse imaging findings and intervention. Methods Duplex ultrasound scans (DUS) of surgical AV fistulae and grafts performed in a teaching hospital trust between 01/07/2019 and 31/01/2020 were analysed. Referral reasons, diagnostic findings, onward imaging and interventions to salvage fistulae and grafts were cross-referenced from electronic patient databases. Results 359 scans of AV fistulae were performed in the period studied, of which, 220 were performed on men. Median age was 63 years (IQR 49-72). The most common referral reasons were loss of thrill and difficulty needling (n = 46, both). 185/359 (52%) scans lead to subtraction angiography and 46/359 (13%) to open surgical intervention. Median time from DUS to angiography was 21 days and 21% (39/185) of DUS did not match with angiographic results. When assessing outcomes based on presentation, 16/19 (85%, p < 0.01) patients who had high venous pressures on dialysis and 23/31 (74%, p < 0.01) of those with dialysis recirculation required endovascular intervention. Pain on dialysis correlated poorly with future intervention (6/30). Conclusions A substantial proportion of DUS of dysfunctional vascular access do not correlate with subtraction angiography. Referral for DUS prior to angiography may delay intervention. Patients with objective signs of dialysis dysfunction (recirculation and high venous pressure) are highly likely to need intervention. Such cases may benefit from proceeding directly to angiography and on-table intervention.

P1358THE MONITORING OF FIRST LEVEL IN DIAGNOSIS OF COMPLICATION OF VASCULAR ACCESS: MULTICENTRIC STUDY ON 900 HEMODIALIZED PATIENTS WITH FOLLOW UP TO 5 YEARS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Ersilia Satta ◽  
Carmine Romano ◽  
Carmelo Alfarone ◽  
Sandro Gentile ◽  
Domenico Russo
Keyword(s):  
Vascular Access ◽  
Health Care Professionals ◽  
Venous Pressure ◽  
Duplex Ultrasound ◽  
Patient Characteristics ◽  
Multicentric Study ◽  
Flow Monitoring ◽  
The Status

Abstract Background and Aims Vascular Access (VA) is the lifeline of hemodialysis patient. The universal goal of access monitoring is to identify access stenosis and enable intervention prior to thrombosis; thereby, maximizing access longevity and minimizing morbidity. The advent and use of techniques including dynamic and static venous pressure monitoring, physical examination, access flow measurement, imagining and combined imaging and flow monitoring by duplex ultrasound demonstrate that it is possible to predict which accesses are at high risk for future thrombosis. Currently arteriovenous fistula (AVF) and arteriovenous graft (AVF) have been recognized as the permanent access. This study takes advantage of the opportunity to utilize data from 19 associated Dialysis Clinics to examine trends in VA use, trends in patient characteristics and practice associated with VA. Determine the status quo of the overall information related to the VA to start a five years follow up study with the aims to reduce VA complications 8stenosis and thrombosis) and related hospitalization days to improve patient’s quality of life. Method VA data were collected for each patient at study entry. Practice pattern data from the facility medical director, nurse manager and VA surgeon were also analyzed. We have developed a mask on the management database to implement the first level monitoring of access and collected data at each treatment (Fig.1) Results Average age of 801 patients enrolled was 73,5 years. Native AVF was used by 79%, AVG by 2% and CVC by 19%. As the age increase as well as he use of CVC move from 6% (15-39(years) to 50,5% in patients with more than 85 years. Most frequent complications were: Thrombosis 16,5 %, Infectios 5,5%. Related VA hospitalization days are 28,7 % of total days. Average dialysis goals achieved were: QB 290 ml/Min; blood processed 69,7 L; KT/V:1,35. Conclusion By interpreting collecting data for specific performance measures using accurate reports allow health care professionals to highlight the VA performance/inefficiences and provide correct information to the clinical staff to support them in their daily clinical practice and decision making.

scholarly journals Prevalence and Clinical Presentations of Dilated Cardiomyopathy in Sudanese patients with Heart Failure.

2017 ◽  
Vol 2 (4) ◽  
Author(s):  
Mounkaila Noma ◽  
Siddig Ibrahim Khali ◽  
Suha Mahir Atabani ◽  
Mamoun Homeida
Keyword(s):  
Heart Failure ◽  
Dilated Cardiomyopathy ◽  
Teaching Hospital ◽  
Heart Muscle ◽  
Clinical Laboratory ◽  
Venous Pressure ◽  
Muscle Disease ◽  
Common Belief ◽  
Clinical Presentations ◽  
Significant Difference

BackgroundIdiopathic dilated cardiomyopathy (DCM) is a heart muscle disease of undefined cause that commonly presents as congestive cardiac failure. The etiology of weakness of the heart muscle is often unknown, but many causal factors had been identified. The aim of this study was to determine the prevalence and clinical presentations of dilated cardiomyopathy in Sudanese patients with heart failure.MethodA prospective hospital-based observational study was undertaken during the period of January to April 2007 in two teaching hospitals namely Academy Charity Teaching Hospital and Shaab Teaching Hospital. All patients diagnosed by the physician to have heart failure were included in the study after their well informed consent and the consent of their treating physician. A standardized questionnaire developed by the researcher was used to collect data on patients socio-demographic characteristics, results of clinical, laboratory and radiography exams. All data were analyzed through the Statistical package for Social Sciences. Significance testing of difference between proportions was conducted using the Chi-square test were applicable, adjusted by Pearson's or Fisher's exact test, depending on the number of observations, with a value corresponding to p <0.05 for significance unless otherwise.ResultsOf the 72 patients in the study, 53.0% were males and 47.0% were females. The prevalence of DCM was found to be 43.1% (31 out of 72 heart failure patients). The prevalence was higher in males than females with a prevalence of respectively 47.4% and 38.2%. There was no significant difference in gender distribution of DCM (p=0.4). DCM affected older age with a mean age of 55.4 years (SEM=2.5). Palpitations, severe grade of dyspnea (grade 3 and 4), raised jugular venous pressure and cardiomegaly were the most frequent clinical presentations. The mean ejection fraction in DCM was found to be 36.7 (SEM=1.4).ConclusionContrary to common belief among clinicians in Sudan DCM is one of the commonest causes of heart failure. Its prevalence called up a best practice among clinicians, in particular those practicing in emergency units.

1001 Intra-Articular Distal Radius Fracture Surgical Intervention Threshold Origins and Development

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
G Esworthy ◽  
N Johnson ◽  
J Dias ◽  
P Divall
Keyword(s):  
Distal Radius ◽  
Clinical Presentation ◽  
Surgical Intervention ◽  
Threshold Value ◽  
British Society ◽  
Relevant Today ◽  
Clinical Presentations ◽  
Post Traumatic ◽  
Current Guidance ◽  
Traumatic Arthritis

Abstract Background Treatment of intra-articular distal radius fractures is guided by the displacement of the articular fragments. Symptomatic post-traumatic arthritis is expected to occur if step displacement is &gt; 2mm; this value is often used as an indication for surgery if closed reduction is not possible. Method A systematic review was performed to establish the origin and adaptations of the threshold, with papers screened and relevant citations reviewed. Orthopaedic textbooks were reviewed to ensure no earlier mention of the threshold was present. Results Knirk and Jupiter, 1986, are the first to quantify a threshold, with all their patients developing arthritis with &gt;2mm displacement. Some papers have discussed using 1mm, although 2mm is most widely reported. Current guidance from the British Society for Surgery of the Hand supports 2mm. Although this paper is still widely cited, the authors published a re-examination of the data showing methodological flaws which is not as widely reported. They claim their conclusions are still relevant today; however, the radiological arthritis does not correlate with the clinical presentation. Conclusions Knirk and Jupiter originated the threshold value of 2mm. The lack of correlation between the radiological and clinical presentations warrants further investigation. The principle of treatment remains restoration of normal anatomical position.

The value of ultrasound in the multivariate assessment complications of permanent vascular access for hemodialysis

2021 ◽  
Vol 8 (1) ◽  
pp. 60-67
Author(s):  
T. V. Zakhmatova ◽  
V. S. Koen ◽  
R. E. Shtentsel
Keyword(s):  
Vascular Access ◽  
Ultrasound Examination ◽  
Main Tool ◽  
Duplex Ultrasound ◽  
Maximum Duration ◽  
Significant Difference ◽  
Dynamic Ultrasound ◽  
Access Complications ◽  
Design And Methods ◽  
Steal Syndrome

Background. The maximum duration of vascular access for hemodialysis functioning rarely exceeds 4 years. The main tool for diagnosing access dysfunction is duplex ultrasound. Dynamic ultrasound examination of vascular access is not included in the standard examination of patient undergoing hemodialysis in Russia.Objective. To study the structure of complications and changes in hemodynamics in the vascular access for hemodialysis and to determine the risk factors contributing to its development.Design and methods. Ultrasound, clinical and laboratory examination was performed in 550 patients undergoing program hemodialysis, 517 (94.0 %) of them had arteriovenous fistula, 33 (6.0 %) patients had arteriovenous graft.Results. Vascular access complications occurred in 26.7 % (147 patients), there was no significant difference in the detection rate of thrombosis (26.5 %), stenosis (23.8 %), and aneurysm (21.1 %). A combination of two complications was observed in 20.4 %, the steal syndrome — in 8.2 %. A correlation was established between the presence of significant stenosis, aneurysm of the outflow vein and the development of thrombosis, between the presence of concomitant diseases of the peripheral arteries and the development of steal syndrome and stenosis of the inflow artery and the anastomosis zone.Conclusion. Duplex ultrasound allows to diagnose complications of vascular access for hemodialysis and determine its causes.

scholarly journals Ruptured Petrous Carotid Pseudoaneurysm Due to Tuberculous Otitis: Endovascular Treatment

2006 ◽  
Vol 12 (1) ◽  
pp. 53-56 ◽  
Author(s):  
A.B. Yagci ◽  
F.N. Ardiç ◽  
I. Oran ◽  
F. Bir ◽  
N. Karabulut
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Endovascular Treatment ◽  
Unusual Case ◽  
Internal Carotid ◽  
Surgical Intervention ◽  
Imaging Findings ◽  
Parent Vessel ◽  
Detachable Balloon ◽  
Artery Pseudoaneurysm

We report the imaging findings and endovascular treatment in an unusual case of petrous internal carotid artery pseudoaneurysm due to primary tuberculous otitis. The aneurysm was recognized and ruptured during a surgical intervention for otitis. Successful endovascular treatment of the aneurysm was performed by occlusion of the parent vessel using detachable balloon and coils.

scholarly journals Preservation of vascular access.

1993 ◽  
Vol 4 (4) ◽  
pp. 997-1003
Author(s):  
J L Porile ◽  
M Richter
Keyword(s):  
Vascular Access ◽  
Venous Pressure ◽  
Graft Loss ◽  
Laboratory Evaluation ◽  
Dialysis Access ◽  
New Techniques ◽  
Lower Complication ◽  
Lower Complication Rate ◽  
Access Problems

Preservation of vascular access is critical in the long-term successful management of hemodialysis patients. Dialysis access abnormalities are the most common cause of hospitalization in this patient group, and access problems can increase the morbidity and cost involved in the care of these patients. Native fistulas are preferable to synthetic grafts because of longer survival and a lower complication rate. Venous outflow stenosis is the most common site of obstruction in a failing graft. The pathophysiology of access failure is poorly understood, but it seems to be related to intimal hyperplasia in the native vessel downstream from the anastomosis. The stimulation of local growth factors by needle puncture may also play a role. An assessment of access adequacy includes careful physical examination, laboratory evaluation, and ultimately, angiography. Measurements of recirculation and venous pressure are commonly used to screen for access dysfunction, and their appropriate use will lower the incidence of graft loss in dialysis units. Treatment is usually either angioplasty or surgery, with some centers having success with thrombolytic therapy. New techniques such as atherectomy and stent placement may prove to be beneficial, but this requires further study.

scholarly journals A Prospective study on Gastrointestinal Perforation Peritonitis in Andhra Pradesh, India

2020 ◽  
Vol 6 (5) ◽  
pp. 333-337
Author(s):  
Dr. G. Someswara Rao ◽  
◽  
Dr. B. Visweswara Rao ◽  
Keyword(s):  
Andhra Pradesh ◽  
Surgical Intervention ◽  
Common Type ◽  
Western World ◽  
Common Complication ◽  
Clinical Presentations ◽  
Perforation Peritonitis ◽  
Hollow Organ ◽  
A Prospective Study ◽  
Complications And Mortality

Introduction: Perforation is defined as an abnormal opening in a hollow organ or viscus. All overthe world, perforation peritonitis is the most prevalent surgical emergency tackled and treated by asurgical team. The etiology leading to peritonitis in tropical countries shows a different spectrumfrom its western world. The present study was conducted to highlight the spectrum of hollow viscusperforation peritonitis in terms of etiology, clinical presentations, site of perforation, surgicaltreatment, postoperative complications, and mortality encountered. Methods: The study was aprospective observational study conducted from March 2016 to March 2019 in the Department ofGeneral Surgery, Great Eastern Medical School and Hospital, Andhra Pradesh. A total of 320 patientswith perforation peritonitis were included in the study and underwent exploratory laparotomy.Results: Out of 320 patients, there were 276 males (86.25%) and 44 females (13.75%). Duodenalperforation was the most common type (34.38%), which was mainly due to Acid peptic diseasefollowed by Jejunal and Ileal perforations. Wound infection was the most common complication. Themortality rate was 8.44% (27 patients). Conclusion: Early diagnosis, resuscitation with fluids, andtimely surgical intervention are the most important factors deciding the fate of the patient withperforation peritonitis.

scholarly journals Lower Genital Tract Trauma in a Tertiary Care Centre in Mid-Western Nepal

2017 ◽  
Vol 56 (205) ◽  
pp. 137-140
Author(s):  
Anil Kumar Adhikari ◽  
Mahuya Dutta ◽  
Chittra Ranjan Das
Keyword(s):  
Genital Tract ◽  
Surgical Intervention ◽  
Tertiary Care ◽  
Morbidity And Mortality ◽  
Age Group ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Lower Genital Tract ◽  
Clinical Presentations ◽  
Fall From Height

Introduction: The study of lower genital tract trauma has become important in gynaecological practice. There is paucity of reports on this clinical entity from our settings. The main aim of this study is to document injuries in female lower genital tract in Mid-Western Nepal. Methods: Sixty female patients admitted to the hospital with genital tract injuries caused by coitus or accidents were included in the study. Details of the causes of trauma clinical presentations and management were recorded. Results: These injuries were grouped according to etiological factors. This study included 33 (55%) coital injuries and 27 (45%) non- coital injuries. Out of coital injury, 12 cases were criminal assault (rape) in age group of 4 to 18 years. Four unmarried girls had consensual sex. Non-coital injuries were due to fall from height, cattle horn injuries, straddle type of trauma, vulvar haematoma and anorectal injuries. Conclusions: Appropriate surgical intervention can avert morbidity and mortality. Keywords: accident; lower genital tract; Nepal; trauma.

scholarly journals Meconium peritonitis in a preterm infant: a surgical emergency

2021 ◽  
Vol 8 (4) ◽  
pp. 753
Author(s):  
Priyanka Yadav ◽  
Ankit Agarwal
Keyword(s):  
Intestinal Perforation ◽  
Surgical Intervention ◽  
Bowel Resection ◽  
Postnatal Period ◽  
Meconium Peritonitis ◽  
Clinical Presentations ◽  
Good Clinical Condition ◽  
Severe Peritonitis ◽  
Emergency Surgical Intervention ◽  
Chemical Peritonitis

Meconium peritonitis is sterile chemical peritonitis that occurs after intestinal perforation resulting in meconium leakage and subsequent inflammatory cascade within the peritoneal cavity. The clinical presentations after birth can range from completely sealed-off peritonitis without any symptoms, to severe peritonitis requiring emergency surgical intervention. We describe a case of meconium peritonitis in a premature infant following intestinal perforation. In the immediate postnatal period, the patient was intubated and a peritoneal drain was placed. Laparotomy with bowel resection was performed the following day. The postoperative course was uneventful and the patient was discharged home in good clinical condition.

Origins of the threshold for surgical intervention in intra-articular distal radius fractures

2021 ◽  
Vol 103-B (9) ◽  
pp. 1457-1461
Author(s):  
George Philip Esworthy ◽  
Nick A. Johnson ◽  
Pip Divall ◽  
Joseph J. Dias
Keyword(s):  
Joint Space Narrowing ◽  
Surgical Intervention ◽  
Threshold Value ◽  
Joint Space ◽  
British Society ◽  
Delphi Panel ◽  
Relevant Today ◽  
Clinical Presentations ◽  
Current Guidance ◽  
Further Development

Aims The aim of this study was to identify the origin and development of the threshold for surgical intervention, highlight the consequences of residual displacement, and justify the importance of accurate measurement. Methods A systematic review of three databases was performed to establish the origin and adaptations of the threshold, with papers screened and relevant citations reviewed. This search identified papers investigating functional outcome, including presence of arthritis, following injury. Orthopaedic textbooks were reviewed to ensure no earlier mention of the threshold was present. Results Knirk and Jupiter (1986) were the first to quantify a threshold, with all their patients developing arthritis with > 2 mm displacement. Some papers have discussed using 1 mm, although 2 mm is most widely reported. Current guidance from the British Society for Surgery of the Hand and a Delphi panel support 2 mm as an appropriate value. Although this paper is still widely cited, the authors published a re-examination of the data showing methodological flaws which is not as widely reported. They claim their conclusions are still relevant today; however, radiological arthritis does not correlate with the clinical presentation. Function following injury has been shown to be equivalent to an uninjured population, with arthritis progressing slowly or not at all. Joint space narrowing has also been shown to often be benign. Conclusion Knirk and Jupiter originated the threshold value of 2 mm. The lack of correlation between the radiological and clinical presentations warrants further modern investigation. Measurement often varies between observers, calling a threshold concept into question and showing the need for further development in this area. The principle of treatment remains restoration of normal anatomical position. Cite this article: Bone Joint J 2021;103-B(9):1457–1461.

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