Percutaneous Superselective Coil-Embolization of Intrarenal Arteriovenous Fistulas

1996 ◽  
Vol 37 (3P2) ◽  
pp. 539-541 ◽  
Author(s):  
H. Husstedt ◽  
A. Chavan ◽  
F. Ghadban ◽  
A. Leppert ◽  
M. Galanski

Purpose: To evaluate the role of percutaneous transcatheter coil-occlusion in the management of uncontrollable postoperative hematuria due to iatrogenic arteriovenous (AV) fistula. Material and Methods: In 2 patients, AV fistulas were occluded with percutaneous catheter-guided superselective coil embolization. Results: In both cases, occlusion of the AV fistulas was successful. Only small parts (less than 10%) of the parenchyma had to be sacrificed. No hypertension occurred. Conclusion: Percutaneous coil embolization is a useful alternative to surgery in cases of postoperative AV fistulas. Hematuria can be effectively controlled without resulting hypertension.

1991 ◽  
Vol 74 (2) ◽  
pp. 199-204 ◽  
Author(s):  
Stanley L. Barnwell ◽  
Van V. Halbach ◽  
Christopher F. Dowd ◽  
Randall T. Higashida ◽  
Grant B. Hieshima ◽  
...  

✓ Dural arteriovenous (AV) fistulas are thought to be acquired lesions that form in an area of thrombosis within a sinus. If the sinus remains completely thrombosed, venous drainage from these lesions occurs through cortical veins, or, if the sinus is open, venous drainage is usually into the involved sinus. Among 105 patients with dural A V fistulas evaluated over the the past 5 years, seven had a unique type of dural AV fistula in the superior sagittal, transverse, or straight sinus in which only cortical venous drainage occurred despite a patent involved sinus; the fistula was located within the wall of a patent dural sinus, but outflow was not into the involved sinus. This variant of dural AV fistulas puts the patient at serious risk for hemorrhage or neurological dysfunction caused by venous hypertension. Three patients presented with hemorrhage, one with progressive neurological dysfunction, one with seizures, and two with bruit and headaches. A combination of surgical and endovascular techniques was used to close the fistula while preserving flow through the sinus.


1989 ◽  
Vol 70 (3) ◽  
pp. 354-359 ◽  
Author(s):  
Gregory R. Criscuolo ◽  
Edward H. Oldfield ◽  
John L. Doppman

✓ Acute or subacute neurological deterioration without evidence of hemorrhage in a patient with a spinal arteriovenous (AV) malformation has been referred to as “Foix-Alajouanine syndrome.” This clinical entity has been considered to be the result of progressive vascular thrombosis resulting in a necrotic myelopathy; it has therefore been thought to be largely irreversible and hence untreatable. The authors report five patients with dural AV fistulas who presented in this manner, and who improved substantially after embolic and surgical therapy. The outcome of these patients indicates that acute and subacute progression of myelopathy in cases of spinal dural AV fistulas may be caused by venous congestion and not necessarily by thrombosis. Therefore, a clinical diagnosis of Foix-Alajouanine syndrome is of little practical use, as spinal cord dysfunction from venous congestion is a potentially reversible process whereas thrombotic infarction is not. This diagnosis may result in suboptimal management. The recognition of nonhemorrhagic acute or subacute myelopathy as a complication of a spinal dural AV fistula is important since what appears to be irreversible cord injury is often treatable by standard surgical techniques.


1986 ◽  
Vol 64 (6) ◽  
pp. 962-967 ◽  
Author(s):  
Douglas A. Graeb ◽  
Clarisse L. Dolman

✓ A case of dural arteriovenous (AV) fistula is presented with detailed radiological and pathological findings. The complex hemodynamic alterations that may result from dural AV fistulas are described. Pathological examination in this case demonstrated widespread occlusion of the superior sagittal sinus with multiple abnormal fistulous communications between abnormal arteries and arterialized veins. A portion of the lesion resembled a recanalized blood clot, in support of the theory proposed by others that dural AV fistulas are acquired lesions.


Toxins ◽  
2020 ◽  
Vol 12 (4) ◽  
pp. 237 ◽  
Author(s):  
Yu-Chung Shih ◽  
Chih-Cheng Wu ◽  
Shen-Chih Wang ◽  
Jun-Yang Liou ◽  
Po-Hsun Huang ◽  
...  

Chronic kidney disease (CKD) accelerates the development of neointima formation at the anastomosis site of arteriovenous (AV) fistulas. Accumulation of certain uremic toxins has a deleterious effect on the cardiovascular system. The oral charcoal adsorbent, AST-120, reduces circulating and tissue uremic toxins, but its effect on neointima formation at an AV fistula is unknown. To understand the effect of CKD and AST-120 on neointima formation, we created AV fistulas (common carotid artery to the external jugular vein in an end-to-side anastomosis) in mice with and without CKD. AST-120 was administered in chow before and after AV fistula creation. Administration of AST-120 significantly decreased serum indoxyl sulfate levels in CKD mice. CKD mice had a larger neointima area than non-CKD mice, and administration of AST-120 in CKD mice attenuated neointima formation. Both smooth muscle cell and fibrin components were increased in CKD mice, and AST-120 decreased both. RNA expression of MMP-2, MMP-9, TNFα, and TGFβ was increased in neointima tissue of CKD mice, and AST-120 administration neutralized the expression. Our results provided in vivo evidence to support the role of uremic toxin-binding therapy on the prevention of neointima formation. Peri-operative AST-120 administration deserves further investigation as a potential therapy to improve AV fistula patency.


2017 ◽  
Vol 01 (01) ◽  
pp. 020-022
Author(s):  
Praveen Vasanthraj ◽  
Varun Bandi ◽  
Venkata Sai ◽  
Manikanthan Shekar

AbstractChronic renal diseases have been on rise with most patients requiring renal transplantation. With advances in treatment, patients undergo hemodialysis through arteriovenous (AV) fistulas and grafts. Thrombosis in these fistulas and grafts are more common and may result in failure. Interventional radiology plays an important role in managing these thromboses through catheter-directed thrombolysis. With success rate of more than 80%, catheter-directed thrombolysis has become the treatment of choice. However, the need of trained personnel, well-equipped catheter laboratories, and expensiveness are its disadvantages. We share our initial experience in two patients in whom we have performed ultrasound-guided percutaneous pulse-spray pharmacomechanical thrombolysis as a day-care procedure. This technique is less expensive, can have a wider outreach, and patients can be benefitted early to avoid new access.


Author(s):  
Ned Block

Mental (or semantic) holism is the doctrine that the identity of a belief content (or the meaning of a sentence that expresses it) is determined by its place in the web of beliefs or sentences comprising a whole theory or group of theories. It can be contrasted with two other views: atomism and molecularism. Molecularism characterizes meaning and content in terms of relatively small parts of the web in a way that allows many different theories to share those parts. For example, the meaning of ‘chase’ might be said by a molecularist to be ‘try to catch’. Atomism characterizes meaning and content in terms of none of the web; it says that sentences and beliefs have meaning or content independently of their relations to other sentences or beliefs. One major motivation for holism has come from reflections on the natures of confirmation and learning. As Quine observed, claims about the world are confirmed not individually but only in conjunction with theories of which they are a part. And, typically, one cannot come to understand scientific claims without understanding a significant chunk of the theory of which they are a part. For example, in learning the Newtonian concepts of ‘force’, ‘mass’, ‘kinetic energy’ and ‘momentum’, one does not learn any definitions of these terms in terms that are understood beforehand, for there are no such definitions. Rather, these theoretical terms are all learned together in conjunction with procedures for solving problems. The major problem with holism is that it threatens to make generalization in psychology virtually impossible. If the content of any state depends on all others, it would be extremely unlikely that any two believers would ever share a state with the same content. Moreover, holism would appear to conflict with our ordinary conception of reasoning. What sentences one accepts influences what one infers. If I accept a sentence and then later reject it, I thereby change the inferential role of that sentence, so the meaning of what I accept would not be the same as the meaning of what I later reject. But then it would be difficult to understand on this view how one could rationally – or even irrationally! – change one’s mind. And agreement and translation are also problematic for much the same reason. Holists have responded (1) by proposing that we should think not in terms of ‘same/different’ meaning but in terms of a gradient of similarity of meaning, (2) by proposing ‘two-factor’ theories, or (3) by simply accepting the consequence that there is no real difference between changing meanings and changing beliefs.


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