Resolution of high-output cardiac failure secondary to high flow radiocephalic fistula by precision banding under ultrasound guidance: A case report

2020 ◽  
pp. 112972982094785
Author(s):  
Ziming Wan ◽  
Vincent N Mboya ◽  
Qiquan Lai ◽  
Bo Tu ◽  
Yu Zhou ◽  
...  
Keyword(s):  
Cardiac Failure ◽  
Ultrasound Guidance ◽  
High Flow ◽  
Volume Flow ◽  
Dialysis Access ◽  
Flow Reduction ◽  
Successful Resolution ◽  
The Right ◽  
Flow Dialysis ◽  
High Output

Background: The creation of dialysis shunt affects hemodynamic and cardiac function. High-output cardiac failure may occur if dialysis access volume flow is greater than 1500 to 2000 mls/min. To resolve symptoms of cardiac failure due to high flow dialysis shunt requires flow reduction procedure. We describe successful resolution of symptoms of heart failure due to excessive flow dialysis access by adopting precision banding, totally under vascular ultrasound guidance without angiography. Case: Hemodialysis adult patient uses the right arm radiocephalic fistula for 4 years. Recently, the patient presented with symptoms of high-output cardiac failure, including dyspnea, palpitations, fatigue, and orthopnea. The cardiac unit excluded all other causes of cardiac failure and referred the patient to our center for further evaluation. Ultrasonography revealed high blood volume flow measuring 3100 mls/min at brachial artery, marking high flow fistula and the underlying cause of cardiac failure. Juxta-anastomotic segment of fistula vein was identified; 3 mm diameter balloon was advanced to the juxta-anastomotic segment and maximally inflated. Two precision bandings were made on this segment, 1 to 2 cm apart with flow reduction to 691 mls/min. All steps of the procedure were done under ultrasound guidance without angiography. All symptoms were significantly alleviated immediately following the procedure. The patient was discharged after 48 h of monitoring. At 6 months, the patient was stable, no recurrence of high flow access, no signs or symptoms of cardiac failure, and the flow was 1119 mls/min. Conclusion: This case demonstrates that the precision banding procedure is feasible under ultrasound guidance, and the procedure is safe and effective in resolution of cardiac failure due to high flow radiocephalic fistula.

Early echocardiographic modifications after flow reduction by proximal radial artery ligation in patients with high-output heart failure due to high-flow forearm arteriovenous fistula

2020 ◽  
Vol 21 (5) ◽  
pp. 753-759
Author(s):  
Barbara Maresca ◽  
Fausta Barbara Filice ◽  
Sara Orlando ◽  
Giuseppino Massimo Ciavarella ◽  
Jacopo Scrivano ◽  
...  
Keyword(s):  
Heart Failure ◽  
Arteriovenous Fistula ◽  
Radial Artery ◽  
Reduction Rate ◽  
Left Ventricular ◽  
High Flow ◽  
Evaluation Tool ◽  
Artery Ligation ◽  
Flow Reduction ◽  
High Output

Background: Arteriovenous fistula (AVF) for haemodialysis (HD) induces a volume/pressure overload which impairs bi-ventricular function and increases systolic pulmonary arterial pressure (PAPS) and left ventricular mass (LVM). In the presence of high blood flow (Qa) AVF (> 1.5 L/min/1.73 m2) and cardio-pulmonary recirculation (>20%), high-output congestive heart failure (CHF) may occur and AVF flow reduction is recommended. Proximal Radial Artery Ligation (PRAL) is an effective technique for distal radio-cephalic (RC) AVF flow reduction. Methods: we evaluated six HD and four transplant patients with high-flow RC AVF and symptoms of CHF who underwent PRAL. We compared echocardiographic (ECHO) findings before (T0) and 1 and 6 months (T1,T6) after PRAL. Preoperative ECHO was performed before (T0b) and after AVF anastomosis manual compression (T0c). Results: At T1 AVF flow reduction rate was 58.4% ± 13% and 80% of patients reported improved CHF symptoms. ECHO data showed an improvement of tricuspid annular plane systolic excursion (TAPSE) at T1 (p = 0.03) and a reduction of PAPS at T6 (p = 0.04). TAPSE improved after AVF anastomosis compression during preoperative ECHO (p = 0.03). Delta of TAPSE at the dynamic manoeuvre at T0 directly correlated with early (1 month after PRAL, p = 0.01) and late (6 months after PRAL, p = 0.04) deltas of TAPSE. Conclusions: AVF flow reduction after PRAL induces immediate regression of CHF symptoms, early improvement of TAPSE and late improvement of PAPS, suggesting a prevalent right sections involvement in CHF. Preoperative TAPSE modification after AVF anastomosis compression could represent a useful evaluation tool to determine which patients would benefit of PRAL.

scholarly journals Pathophysiology of High Flow Access and Surgical Flow Reduction Procedures

2021 ◽  
Vol 1 (1) ◽  
pp. 36-46
Author(s):  
Takehisa Nojima ◽  
Yasuki Motomiya
Keyword(s):  
Blood Flow ◽  
Vessel Diameter ◽  
Venous Hypertension ◽  
High Flow ◽  
Symptom Improvement ◽  
Dialysis Access ◽  
Flow Reduction ◽  
Blood Flow Reduction ◽  
High Output Heart Failure ◽  
Good Patency

High flow access (HFA) is a condition in which hemodynamics is affected by a flow rate that is larger than the blood flow required for hemodialysis. HFA sometimes causes high output heart failure, venous hypertension, and dialysis access steal syndrome. Flow reduction is effective for improving symptoms, and various surgical procedures have been reported. HFA is recognized as a well-developed type of access due to its good access sound, thrill, and vessel diameter; also, HFA probably has good patency if not intervened with by flow reduction. Therefore, the blood flow reduction procedures used to treat HFA need to minimize disadvantages such as access thrombosis, insufficient blood flow, aneurysm formation, and infection due to therapeutic intervention while, at the same time, achieving symptom improvement and long-term patency. The surgical procedure used to correct HFA must be highly reproducible and simple. This article reviews the pathophysiology and surgical flow reduction procedures for HFA.

Clinical Application and Results of the Assessment of Coronary Blood Flow by the Regional Precordial Xenon Residue Detection Technique

1978 ◽  
Vol 17 (04) ◽  
pp. 161-171
Author(s):  
H.-J. Engel ◽  
H. Hundeshagen ◽  
P. R. Lichtlen
Keyword(s):  
Wall Motion ◽  
High Flow ◽  
Detection Technique ◽  
Fatty Tissue ◽  
Technical Aspects ◽  
Residue Detection ◽  
High Affinity ◽  
Artery Disease ◽  
The Right ◽  
Drug Interventions

Methodological and technical aspects as well as application and results of the precordial Xenon-residue-detection technique are critically reviewed. The results concern mainly normal flow in various regions of the heart esp. in the free wall of the right and left ventricle, poststenotic flow in patients with coronary artery disease in relation to the degree of proximal nar-rowings as well as wall motion of the corresponding LV segment, bypassgraft flow and flow after drug interventions esp. nitrates, betablockers, the calcium-antagonist Nifedipine and the coronary dilator Dipyridamole. In spite of its serious limitations (high affinity of Xenon for fatty tissue, geometrical problems in the assessment of flow and its relation to anatomy, gas exchange in situations of high flow etc.), the technique is found to be a usefull investigatory tool. Due to its technical display and the related high costs routine application is, however, prohibitive.

Comparative Arterial Antithrombotic Activity of Clopidogrel and Acetyl Salicylic Acid in the Pig

1992 ◽  
Vol 68 (05) ◽  
pp. 500-505 ◽  
Author(s):  
Ch M Samama ◽  
Ph Bonnin ◽  
M Bonneau ◽  
G Pignaud ◽  
E Mazoyer ◽  
...  
Keyword(s):  
Platelet Aggregation ◽  
Femoral Artery ◽  
Bleeding Time ◽  
Ex Vivo ◽  
Flow Reduction ◽  
Cyclic Flow ◽  
Left Femoral Artery ◽  
Before And After ◽  
The Right ◽  
Induced Aggregation

SummaryWe investigated the comparative antithrombotic properties of clopidogrel, an analogue of ticlopidine, and aspirin, using the Folts' model on femoral arteries in 22 pigs. On each animal, clopidogrel or aspirin were used to treat the thrombotic process on the left femoral artery and to prevent this process on the right femoral artery. Sequentially: an injury and stenosis were carried out on the left femoral artery; the thrombotic process was monitored with a Doppler during a 30-min observation period for cyclic flow reductions or permanent cessation of flow; after the first cyclic flow reduction occurred, clopidogrel (5 mg kg-1) or aspirin (2.5, 5, 100 mg kg-1) were injected intravenously; if cyclic flow reductions were abolished, epinephrine (0.4 µg kg-1 min-1) was injected to try to restore cyclic flow reductions and/or permanent cessation of flow; then injury and stenosis were applied on the right femoral artery. Before and after injection of clopidogrel or aspirin, ear immersion bleeding times and ex-vivo platelet aggregation were performed. Clopidogrel (n = 7) abolished cyclic flow reductions in all animals and epinephrine did not restore any cyclic flow reduction. On the right femoral artery, cyclic flow reductions were efficiently prevented, even for two injuries. Basal bleeding time (5 min 28) was lengthened (>15 min, 30 min after clopidogrel and remained prolonged even after 24 h). ADP-induced platelet aggregation was inhibited (more than 78%). Comparatively, aspirin had a moderate and no dose-dependent effect. Aspirin 2.5 mg kg-1 (n = 6) abolished cyclic flow reductions in 2 animals, CFR reoccurred spontaneously in one animal and epinephrine restored it in a second animal. Aspirin 5 mg kg-1 (n = 6) abolished cyclic flow reductions in only 3 animals and epinephrine always restored it. Aspirin 100 mg kg-1 (n = 3) was unable to abolish cyclic flow reductions. On the right femoral artery, aspirin did not significantly prevent cyclic flow reductions which occurred in all animals after one (n = 14) or two injuries (n = 1), except for one animal. Basal bleeding time was lengthened but it shortened rapidly, reaching its basal value after 24 h. ADP-induced aggregation was not significantly inhibited, whereas arachidonic acid induced aggregation was always inhibited. Clopidogrel appears as a more potent antithrombotic drug than aspirin in this model, in treating and preventing spontaneous or epinephrine-induced cyclic flow reductions and lengthening bleeding time.

The value of real-time ultrasound-guidance for definite placement of a right supraclavicular subclavian central venous catheter

2021 ◽  
pp. 112972982199853
Author(s):  
Jens M Poth ◽  
Stefan F Ehrentraut ◽  
Se-Chan Kim
Keyword(s):  
Ultrasound Guidance ◽  
Venous Catheter ◽  
Needle Insertion ◽  
Major Surgery ◽  
Axillary Vein ◽  
Central Venous ◽  
Supraclavicular Fossa ◽  
The Right ◽  
High Index Of Suspicion ◽  
Insertion Process

Central venous catheters (CVC) are widely used in critically ill patients and in those undergoing major surgery. Significant adverse events, such as pneumothorax and hemothorax, can be caused by needle insertion during CVC insertion. CVC misplacement is less often described, yet equally important, as it can lead to deleterious complications. Here, we describe a case in which misplacement of a guidewire following infraclavicular puncture of the right axillary vein was detected by continuous ultrasound employing the right supraclavicular fossa view. Utilizing this ultrasound view, the insertion approach to the vessel was changed and correct CVC placement could be achieved. While ultrasound guidance is widely accepted for vessel puncture, this case demonstrates the value of continuous ultrasound guidance for the entire process of CVC insertion: vessel puncture, correct guidewire advancement, catheter placement, and exclusion of complications such as pneumothorax. It also shows that there should be a high index of suspicion for guidewire misplacement, even after successful venipuncture. In conclusion, ultrasound protocols covering the complete CVC insertion process should be implemented into current clinical practice.

An intrathoracic arteriovenous malformation discovered as an extremely uncommon reason of neonatal congestive cardiac failure

2009 ◽  
Vol 19 (5) ◽  
pp. 530-533 ◽  
Author(s):  
Sigrun R. Hofmann ◽  
Matthias Weise ◽  
Katharina I. Nitzsche
Keyword(s):  
Arteriovenous Malformation ◽  
Cardiac Failure ◽  
Arteriovenous Malformations ◽  
Neonatal Period ◽  
High Flow ◽  
Congestive Cardiac Failure ◽  
Vein Of Galen ◽  
Prenatal Detection ◽  
First Case

AbstractCongenital arteriovenous malformations are rare causes of congestive cardiac failure in neonates. The most common sites are in the head and liver, but other sites include the thorax, the abdomen and the limbs. The onset of failure is usually not in the immediate neonatal period, but later on in life, albeit that lesions such as the arteriovenous malformation of the vein of Galen, and other arteriovenous malformations in different locations which produce high flow can present early. We describe here the first case, to the best of our knowledge, of prenatal detection of an intrathoracic arteriovenous malformation producing neonatal cardiac failure, which was successfully treated by surgery postnatally.

High-Output Cardiac Failure and Coronary Steal With an Arteriovenous Fistula

2018 ◽  
Vol 71 (6) ◽  
pp. 896-903
Author(s):  
Amtul Aala ◽  
Sairah Sharif ◽  
Leslie Parikh ◽  
Paul C. Gordon ◽  
Susie L. Hu
Keyword(s):  
Arteriovenous Fistula ◽  
Cardiac Failure ◽  
Coronary Steal ◽  
High Output

MULTINODULAR HEMANGIOMATOSIS OF THE LIVER IN INFANCY

PEDIATRICS ◽  
1972 ◽  
Vol 49 (4) ◽  
pp. 563-573
Author(s):  
Robert H. McLean ◽  
James H. Moller ◽  
Warren J. Warwick ◽  
Leon Satran ◽  
Russell V. Lucas
Keyword(s):  
Cardiac Failure ◽  
Intensive Treatment ◽  
Combined Effect ◽  
Arteriovenous Shunt ◽  
Congestive Cardiac Failure ◽  
Treatment Modalities ◽  
Arteriovenous Fistulae ◽  
Classical Triad ◽  
Hepatic Hemangiomas ◽  
High Output

Multinodular hemangiomatosis of the liver (MHL) is characterized pathologically by multiple hemangiomas, primarily in the liver but also in other organs. The hepatic hemangiomas act as small arteriovenous fistulae and their combined effect may result in a massive peripheral arteriovenous shunt and high output congestive cardiac failure. Patients with MHL may be recognized clinically by the classical triad of congestive cardiac failure, hepatomegaly, and cutaneous hemangiomas. All but 2 of 31 cases of MHL herein reviewed had the onset of symptoms prior to 6 months of age. High output cardiac failure were severe and resulted in a 70% mortality. Hepatomegaly was massive and out of proportion to the degree of cardiac failure. Therapy includes intensive treatment of congestive cardiac failure and judicious transfusion in anemic patients. Irradiation of the liver and corticosteroids have been utilized in attempts to speed evolution of the hepatic arteriovenous fistulae. The data are not sufficient to establish the efficacy of either of these treatment modalities.

Pressure-flow and volume-flow relationships of the systemic circulation of the dog

1975 ◽  
Vol 229 (3) ◽  
pp. 761-769 ◽  
Author(s):  
JF Green
Keyword(s):  
Volume Flow ◽  
Back Pressure ◽  
Atrial Pressure ◽  
Right Atrial ◽  
Right Atrial Pressure ◽  
Sodium Pentobarbital ◽  
Pressure Flow ◽  
Group I ◽  
Group Ii ◽  
The Right

Mean systemic pressure-flow (Ps-Q) and volume-flow (V-Q) relationships of the systemic vascular bed were determined in two groups of dogs anesthetized with sodium pentobarbital (group I) and with methoxyflurane (group II). All blood returning to the heart (Q) was removed from the right atrial appendage and passed through a Starling resistor, a pump, a flowmeter , and then returned directly into the pulmonary artery. Ps was estimated from plateau values of right atrial pressure obtained during stop-flow procedures. Both the Ps-Q and V-Q relationships were nonlinear. This nonlinearity may be attributed to a redistribution of blood flow between systemic vascular compartments of unequal time constants. With group II, the Ps-Q and V-Q curves were shifted markedly to the right along the Ps and V axes, respectively. Evidence is presented which suggests that this shift was due to an effective back pressure other than right atrial pressure produced by a hepatic waterfall. The beta-adrenergic antagonist practolol increased the effective back pressure and augmented the shift in the Ps-Q and V-Q curves.

Sign in / Sign up

Export Citation Format

Share Document