scholarly journals The role of Doppler ultrasonography in vascular access surveillance—controversies continue

2021 ◽  
pp. 112972982092817
Author(s):  
Jan Malik ◽  
Carlo Lomonte ◽  
Mario Meola ◽  
Cora de Bont ◽  
Robert Shahverdyan ◽  
...  
Keyword(s):  
Doppler Ultrasonography ◽  
Blood Stream ◽  
Chronic Hemodialysis ◽  
Arteriovenous Fistulas ◽  
Duplex Doppler ◽  
Current Guidelines ◽  
Time Diagnosis ◽  
Lower Morbidity ◽  
Ultrasound Surveillance

Chronic hemodialysis therapy required regular entry into the patient’s blood stream with adequate flow. The use of arteriovenous fistulas and grafts is linked with lower morbidity and mortality than the use of catheters. However, these types of accesses are frequently affected by stenoses, which decrease the flow and lead to both inadequate dialysis and access thrombosis. The idea of duplex Doppler ultrasound surveillance is based on the presumption that in-time diagnosis of an asymptomatic significant stenosis and its treatment prolongs access patency. Details of performed trials are conflicting, and current guidelines do not support ultrasound surveillance. This review article summarizes the trials performed and focuses on the reasons of conflicting results. We stress the need of precise standardized criteria of significant access stenosis and the weakness of the metaanalyses performed.

Analysis of 855 Upper Extremity Fistulas Created Using a Standard Protocol: The Role of Graft Extension to Achieve Functional Status

2013 ◽  
Vol 79 (6) ◽  
pp. 625-629
Author(s):  
Bassan J. Allan ◽  
Enrique R. Perez ◽  
Marwan Tabbara
Keyword(s):  
Upper Extremity ◽  
Chronic Hemodialysis ◽  
Standard Protocol ◽  
Hemodialysis Access ◽  
Arteriovenous Fistulas ◽  
Excellent Method ◽  
The Creation ◽  
National Programs ◽  
Current Guidelines

The Fistula First Breakthrough Initiative (FFBI) has been one of the most important national programs to help achieve considerable improvements in the care of patients on chronic hemodialysis. FFBI has helped place guidelines to push practitioners to reduce the use of tunneled central venous catheters and to increase the rate of arteriovenous fistula use in patients requiring chronic hemodialysis access. However, despite current guidelines, no specific protocols exist for the creation and management of autogenous arteriovenous fistulas and outcomes at most centers are below national benchmarks. In this study, we examine the effectiveness of a standard protocol used at our institution for the creation of autogenous upper extremity fistulas for hemodialysis access in achieving early cannulation and early removal of tunneled dialysis catheters. Our review encompasses 855 consecutive autogenous fistulas created over a 10-year period. Our findings suggest that the use of a standard protocol for creation and management of autogenous fistulas can help increase the rate of functional accesses over national benchmarks. Additionally, extension/conversion of malfunctioning fistulas to grafts appears to be an excellent method to expedite removal of a tunneled dialysis catheter with concomitant preservation of a fistula.

scholarly journals Duplex doppler ultrasonography in the diagnosis of deep venous thrombosis of the lower extremities

2006 ◽  
Vol 59 (1-2) ◽  
pp. 11-14 ◽  
Author(s):  
Viktorija Vucaj-Cirilovic ◽  
Kosta Petrovic ◽  
Olivera Nikolic ◽  
Viktor Till ◽  
Dijana Niciforovic ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Doppler Ultrasonography ◽  
Varicose Veins ◽  
Color Doppler ◽  
Lower Extremities ◽  
Postthrombotic Syndrome ◽  
Duplex Doppler ◽  
Age Range

Introduction. The aim of this study was to investigate the role of duplex Doppler ultrasonography in diagnosis of deep venous thrombosis (DVT) of the lower extremities. Material and methods. During a 2-year period, 860 patients were examined by duplex Doppler sonography. Among these, 619(72%) were women and 241 (28%) men, with the age-range of 16-91; (mean 56,2) years. Siemens Versa Pro color doppler was used, with 7MHz transducers. Findings were categorized into four categories: 1. deep venous thrombosis (DVT); 2. pathology predominantly related to superficial veins without DVT; 3. pathology of superficial and deep veins; 4. normal findings. Results. 185 (21%) patients had DVT, 366 (42.5%) patients had pre?dominant pathology of superficial veins: postthrombotic syndrome, superficial thrombophlebitis and varicose veins. 128 (14.9%) patients had pathology of superficial and deep veins. Normal findings were found in 181 (21.1%) patients. Conclusions. Various vascular and nonvascular diseases may mimic deep venous thrombosis, and that is why US should be used whenever possible to avoid unnecessary anticoagulant therapy. .

scholarly journals Arteriovenous Fistula after Femoral Artery Puncture Leading to Pulmonary Edema: The Role of Ultrasonography

2012 ◽  
Vol 113 (1) ◽  
pp. 49-52 ◽  
Author(s):  
Jan Malík ◽  
R. Holaj ◽  
Z. Krupičková ◽  
T. Janota
Keyword(s):  
Heart Failure ◽  
Pulmonary Edema ◽  
Arteriovenous Fistula ◽  
Doppler Ultrasonography ◽  
Arterial Puncture ◽  
Surgical Closure ◽  
Blood Drawing ◽  
Flow Through ◽  
Duplex Doppler

Local complications of arterial puncture include hematoma, pseudoaneurysm and formation of arteriovenous fistula (AVF). The latter could cause ischemia of the particular extremity or can be hemodynamically significant especially in patients suffering from congestive heart failure. We report a case of femoro-femoral AVF after thin needle arterial puncture for blood drawing. The development of this iatrogenic AVF led to pulmonary edema. The patient stabilized completely after surgical closure of the AVF. The AVF was diagnosed by duplex Doppler ultrasonography and this method was also used for estimation of blood flow through the AVF. We discuss the role of ultrasound AVF diagnostics and the method of flow calculation.

Predictive role of duplex Doppler ultrasonography in the diagnosis of acute renal obstruction in patients with unilateral renal colic

2009 ◽  
Vol 71 (06) ◽  
pp. 680-686 ◽  
Author(s):  
A. Granata ◽  
S. Andrulli ◽  
M.Q. Bigi ◽  
P. Pozzoni ◽  
F. Fiorini ◽  
...  
Keyword(s):  
Doppler Ultrasonography ◽  
Renal Colic ◽  
Renal Obstruction ◽  
Predictive Role ◽  
Duplex Doppler

scholarly journals Shunt flow of arteriovenous fistulas from plantar artery

2010 ◽  
Vol 26 (1) ◽  
pp. 32-34 ◽  
Author(s):  
Y Yoshida ◽  
M Fujita
Keyword(s):  
Healthy Subjects ◽  
Doppler Ultrasonography ◽  
Varicose Veins ◽  
Shunt Flow ◽  
Arteriovenous Fistulas ◽  
Non Invasive ◽  
Colour Flow ◽  
Plantar Artery ◽  
Duplex Doppler ◽  
Two Phases

Objective The purpose of this study was to visualize the shunt flow of arteriovenous fistulas (AVFs) passing towards the top side of the foot from the plantar artery. Methods Colour-flow duplex Doppler ultrasonography was performed in 112 patients who consulted an outpatient clinic with varicose veins and/or symptoms such as foot oedema, dullness, cramp and coldness. Thirteen age-and sex-matched healthy subjects served as controls. Results AVFs were detected in 86 of 112 patients (77%). They were also detected in 10 (77%) of 13 healthy subjects. The shunt flow pattern consisted of two phases of flow corresponding to systole and diastole, and the diastolic fraction of time–velocity integral was larger, although the peak flow velocity in systole was higher than that in diastole. Conclusion Colour-flow duplex Doppler ultrasonography is useful for non-invasive visualization of the shunt flow of AVFs connecting the plantar artery with the venous arch of the top side of the foot.

Telmisartan in High Cardiovascular Risk Patients

2012 ◽  
Vol 8 (1) ◽  
pp. 10 ◽  
Author(s):  
Roland Asmar ◽  
Keyword(s):  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Ace Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
High Cardiovascular Risk ◽  
Raas Blockade ◽  
Risk Patients ◽  
Receptor Blockers ◽  
Current Guidelines

The worldwide morbidity and mortality burden of cardiovascular disease (CVD) is overwhelming and caused by increasing life expectancy and an epidemic of risk factors, including hypertension. Therapeutic options targeting different areas of the renin–angiotensin–aldosterone system (RAAS) to disrupt pathophysiological processes along the cardiovascular continuum are available. Angiotensin-converting enzyme (ACE) inhibitors are first-line treatments for CVD and angiotensin receptor blockers (ARBs) are suitable alternatives. Both ACE inhibitors and ARBs prevent CVD by lowering blood pressure (BP). Additionally, several studies have demonstrated that RAAS blockade can reduce cardiovascular risk beyond what might be expected from BP lowering alone. However, the ARBs are not all equally effective. Telmisartan is a long-lasting ARB that effectively controls BP over the full 24-hour period. Recently, the Ongoing telmisartan alone and in combination with ramipril global endpoint trial (ONTARGET) study showed that telmisartan reduces cardiovascular events in high cardiovascular risk patients similarly to the gold standard ACE inhibitor ramipril beyond BP lowering alone, but with a better tolerability. Based on the results of the ONTARGET and Telmisartan randomized assessment study in ACE intolerant subjects with cardiovascular disease (TRANSCEND) studies, telmisartan is indicated for the reduction of cardiovascular morbidity. This article aims to review current guidelines for the management of CVD and consider key data from clinical trials and clinical practice evaluating the role of telmisartan in CVD.

Patent Foramen Ovale, the Role of Antiplatelet Therapy Alone or Anticoagulant Therapy Alone Versus Device Closure for Cryptogenic Stroke: A Review of the Literature and Current Recommendations

2020 ◽  
Vol 18 (2) ◽  
pp. 135-150
Author(s):  
Harsha S. Nagarajarao ◽  
Chandra P. Ojha ◽  
Archana Kedar ◽  
Debabrata Mukherjee
Keyword(s):  
Patent Foramen Ovale ◽  
Cryptogenic Stroke ◽  
Narrow Channel ◽  
Paradoxical Embolism ◽  
Current Evidence ◽  
Foramen Ovale ◽  
The Right ◽  
The Relationship ◽  
Current Guidelines

: Cryptogenic stroke and its relation to the Patent Foramen Ovale (PFO) is a long-debated topic. Recent clinical trials have unequivocally established the relationship between cryptogenic strokes and paradoxical embolism across the PFO. This slit-like communication exists in everyone before birth, but most often closes shortly after birth. PFO may persist as a narrow channel of communication between the right and left atria in approximately 25-27% of adults. : In this review, we examine the clinical relevance of the PFO with analysis of the latest trials evaluating catheter-based closure of PFO’s for cryptogenic stroke. We also review the current evidence examining the use of antiplatelet medications versus anticoagulants for stroke prevention in those patients with PFO who do not qualify for closure per current guidelines.

The role of microRNA-33 as a key regulator in hepatic lipogenesis signaling and a potential serological biomarker for NAFLD with excessive dietary fructose consumption in C57BL/6N mice

2021 ◽  
Author(s):  
Jeong Hoon Pan ◽  
Hanvit Cha ◽  
Jingsi Tang ◽  
Seoyoon Lee ◽  
Suk Hee Lee ◽  
...  
Keyword(s):  
Fatty Liver ◽  
Blood Stream ◽  
Hepatic Lipogenesis ◽  
Dietary Fructose

Fructose-induced hepatic miR-33 suppression lead to fatty liver via upregulation of SREBP1. Additionally, fructose-induced hepatic ferroptosis may cause a spill-over of miR-33 into blood stream, which could be a potential serological biomarker for fructose-induced NAFLD.

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