Dialysis access graft occlusion with contrast and ultrasound guided thrombin injection for intractable arm edema and pseudoaneurysm

2021 ◽  
pp. 112972982110473
Author(s):  
Pinto Diego ◽  
Montalvo Fabián ◽  
Melendez Constanza ◽  
Lapadula Mirna ◽  
Perez Martin
Keyword(s):  
Ultrasound Guidance ◽  
Central Vein ◽  
Dialysis Access ◽  
Graft Occlusion ◽  
Arteriovenous Graft ◽  
Effective Technique ◽  
Local Conditions ◽  
Percutaneous Embolization ◽  
Vein Thrombosis ◽  
Access Graft

We present the case of a patient with a brachio-basilic graft forearm loop with intractable edema and thrombosed central veins. She showed up with an important edema after some effort and a previously thrombosed pseudoaneurysm with significant growth. She refused angioplasty treatment for central veins, the graft had not been used for dialysis during the last year, so that arteriovenous graft (AVG) ligation was considered. Due to local conditions thrombin percutaneous embolization was performed to avoid possible complications of a conventional surgery approach. AVG occlusion was done in 10 min by fluoroscopy and ultrasound guidance. In 24 h the patient was significantly better and after 1 week she had no edema at all. There were no complications and no recanalization was observed after 3 months. Percutaneous thrombin embolization is a safe and effective technique for AVG occlusion in case of intractable arm edema with central vein thrombosis, and most likely to be considered in other situations where arteriovenous graft or fistula ligature is needed.

Midterm Results Following Percutaneous Rotational Thrombectomy for Acute Thrombotic Occlusions of Prosthetic Arteriovenous Access Grafts

2015 ◽  
Vol 100 (7-8) ◽  
pp. 1249-1254 ◽  
Author(s):  
Celalettin Karatepe ◽  
Mustafa Aldemir ◽  
Bayer Çınar ◽  
Akif Önalan ◽  
Halim Işsever ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
De Novo ◽  
Female Gender ◽  
Graft Patency ◽  
Prosthetic Graft ◽  
Dialysis Access ◽  
Graft Occlusion ◽  
Arteriovenous Graft ◽  
Percutaneous Mechanical Thrombectomy ◽  
The Mean

Patent vascular access is critical for patients on regular hemodialysis. Prosthetic grafts are good alternatives when the superficial venous system is of poor quality. However, thrombosis is one of the main drawbacks of synthetic grafts, with reports of 59% to 90% patency rates for 1 year. In cases of thrombotic occlusion of prosthetic arteriovenous fistula grafts, percutaneous mechanical thrombectomy has recently gained clinical popularity as a potential alternative to surgical thrombectomy or pharmacologic thrombolysis. We reviewed our preliminary results from 30 percutaneous rotational thrombectomies performed in a total of 22 patients in the setting of acute dialysis–access prosthetic graft occlusion of the upper extremity. Among the 30 cases of acute occlusion of the arteriovenous graft, immediate success with angiographic flow restoration was observed in all patients except for 2 patients (both females; 6%), with de novo occlusion where reocclusion occurred within 12 hours despite apparent immediate angiographic patency. The mean duration between the initial presentation with acute arteriovenous graft occlusion and the thrombectomy procedure was 27.4 ± 12.4 hours. The mean duration of graft patency was 10.45 ± 0.6 months. A total of 75% of the arteriovenous grafts were patent at the end of 12 months of follow-up. Female gender, diabetes mellitus, and diagnosis to intervention interval were reviewed for midterm graft failure, and the presence of diabetes mellitus yielded significance (P < 0.05). Percutaneous techniques play important roles in the treatment of failed or failing arteriovenous fistulae and grafts. Ongoing analysis of outcomes of both percutaneous and surgical intervention is necessary to continue to identify optimum treatment algorithms.

Platelet Coagulant Activities and Retinal Vein Thrombosis

1977 ◽  
Vol 38 (02) ◽  
pp. 0399-0406 ◽  
Author(s):  
Peter N. Walsh ◽  
Richard E. Goldberg ◽  
Richard L. Tax ◽  
Larry E. Magargal
Keyword(s):  
Platelet Aggregation ◽  
Venous Thrombosis ◽  
Retinal Vein Occlusion ◽  
Serotonin Release ◽  
Platelet Factor ◽  
Trigger Mechanism ◽  
Local Conditions ◽  
Plasma Coagulation ◽  
Vein Thrombosis ◽  
Vein Occlusion

SummaryTo determine whether platelets play a role in the pathogenesis of retinal vein occlusion (RVO), platelets and coagulation were evaluated in 28 patients with RVO. Platelet coagulant activities concerned with the initiation and early stages of intrinsic coagulation were 2–4 fold increased in 9 patients with acute primary RVO but not in patients with acute secondary (10 patients) or chronic (9 patients) RVO. Platelet factor 3 activity, platelet aggregation, serotonin release by platelets and plasma coagulation were normal in all patients. Platelets may provide a trigger mechanism for venous thrombosis in the eye when local conditions permit.

scholarly journals Endovascular mechanical thrombectomy and stenting in a case of central vein thrombosis

2021 ◽  
Vol 14 (2) ◽  
pp. e236508
Author(s):  
Rajesh Vijayvergiya ◽  
Navjyot Kaur ◽  
Saroj K Sahoo ◽  
Ashish Sharma
Keyword(s):  
Mechanical Thrombectomy ◽  
Transluminal Angioplasty ◽  
Brachiocephalic Vein ◽  
Central Vein ◽  
Vein Thrombosis ◽  
Catheter Directed Thrombolysis ◽  
Stage Renal Disease ◽  
End Stage ◽  
Vein Stenosis

Central vein stenosis and thrombosis are frequent in patients on haemodialysis for end-stage renal disease. Its management includes anticoagulation, systemic or catheter-directed thrombolysis, mechanical thrombectomy and percutaneous transluminal angioplasty (PTA). Use of mechanical thrombectomy in central vein thrombosis has been scarcely reported. We hereby report a case of right brachiocephalic vein thrombosis with underlying stenosis, which was successfully treated by mechanical thrombectomy followed by PTA and stenting. The patient had a favourable 10 months of follow-up.

Effectiveness and safety of repeated percutaneous intervention in an office-based endovascular center in maintaining hemodialysis access

Vascular ◽  
2021 ◽  
pp. 170853812110043
Author(s):  
Jay Patel ◽  
Stephanie Chang ◽  
Shaan Manawar ◽  
John Munn ◽  
Mark C Rummel ◽  
...  
Keyword(s):  
Percutaneous Intervention ◽  
Dialysis Access ◽  
Arteriovenous Graft ◽  
Hemodialysis Access ◽  
Upper Arm ◽  
Access Site ◽  
Arteriovenous Fistulas ◽  
Arteriovenous Grafts ◽  
The Mean

Objectives Percutaneous dialysis access interventions are routinely used to maintain the patency of dialysis access despite the lack of data regarding their long-term effectiveness. This retrospective study was undertaken to study the effectiveness and safety of percutaneous dialysis access interventions in arm fistulas and bridge grafts in an office-based endovascular center. Methods Patients who had a percutaneous dialysis access intervention in their upper extremity access site, performed at a single office-based endovascular center over a nine-year period (2007–2016) were included in this study. The patients’ demographic factors, patency, and complications were analyzed. Patients were entered in the study after first percutaneous dialysis access intervention. Results A total of 298 limbs in 259 patients had 913 procedures carried out over a nine-year period. There were 190 access arteriovenous fistulas and 108 arteriovenous grafts. The two most common arteriovenous fistulas were the brachiocephalic fistula ( n = 74, 39%) and radio cephalic fistula ( n = 69, 36%). Arteriovenous grafts were most commonly placed in the upper arm ( n = 66, 61%) followed by the forearm ( n = 42, 39%). The mean overall patency for all limbs was 50.86 months. Arteriovenous fistulas had a significantly longer patency than arteriovenous grafts (51.65 vs. 42.09 months; P = 0.01). In addition, patients with two or more percutaneous dialysis access intervention in their arteriovenous fistula had significantly greater patency than those with only one percutaneous dialysis access intervention (58.5 vs. 7.6 months; hazard ratio 0.41; P = 0.0008). This was not true for the arteriovenous graft group. Women represented 49% of the patient group. Their accesses had shorter patency than men (39.8 vs. 60 months; P = 0.0007). Conclusions This data support the use of repeated percutaneous dialysis access intervention to maintain long-term patency of dialysis access sites in an office-based endovascular center. Overall, fistulas have longer patency than grafts and women have poorer outcomes as compared to men

scholarly journals Ultrasound evaluation of dialysis access-related distal ischaemia

2021 ◽  
pp. 112972982093242
Author(s):  
N Pirozzi ◽  
L De Alexandris ◽  
J Scrivano ◽  
L Fazzari ◽  
J Malik
Keyword(s):  
Differential Diagnosis ◽  
Ultrasound Examination ◽  
Preoperative Evaluation ◽  
Signs And Symptoms ◽  
Central Vein ◽  
Dialysis Access ◽  
Needed Information ◽  
Vein Catheter ◽  
Ultrasound Evaluation ◽  
Central Vein Catheter

Dialysis access-related distal ischaemia is a rare yet potentially rather risky complication of haemodialysis angioaccess. Timely diagnosis is crucial to target both the goals of the access team: first of all to preserve the function of the hand ideally along with angioaccess patency. Unfortunately for some patients, urgent access ligation and central vein catheter insertion would be needed to save the hand. After a first clinical examination to determine the diagnostic suspicion, the ultrasound evaluation would provide nearly all the needed information to confirm the diagnosis and to determine the most appropriate procedure to rescue the patient from distal ischaemia. In some cases, photoplethysmography would help in the differential diagnosis of other non-ischaemic causes of similar signs and symptoms. Angiography would complete the preoperative evaluation for some. Dialysis access-related distal ischaemia would be briefly reviewed, and a deep description of the ultrasound examination tools and findings would be provided for a tailored therapeutic approach.

Catheter tip position in central vein thrombosis

1988 ◽  
Vol 12 (6) ◽  
pp. 613-614 ◽  
Author(s):  
A Pithie ◽  
JS Soutar ◽  
CR Pennington
Keyword(s):  
Central Vein ◽  
Vein Thrombosis ◽  
Catheter Tip ◽  
Tip Position

The role of venous pressure variability during hemodialysis in the prediction of impending arteriovenous graft occlusion

2021 ◽  
pp. 112972982110573
Author(s):  
Yuan-Hsi Tseng ◽  
Min Yi Wong ◽  
Chih-Chen Kao ◽  
Chien-Chao Lin ◽  
Ming-Shian Lu ◽  
...  
Keyword(s):  
Operating Characteristic ◽  
Characteristic Curve ◽  
Venous Pressure ◽  
Blood Flow Rate ◽  
Curve Analysis ◽  
Graft Occlusion ◽  
Arteriovenous Graft ◽  
Significant Elevation ◽  
Operating Characteristic Curve

Background: Elevated venous pressure during hemodialysis (VPHD) is associated with arteriovenous graft (AVG) stenosis. This study investigated the role of VPHD variations in the prediction of impending AVG occlusion. Methods: Data were retrieved from 118 operations to treat AVG occlusion (occlusion group) and 149 operations to treat significant AVG stenosis (stenosis group). In addition to analyzing the VPHD values for the three hemodialysis (HD) sessions prior to the intervention, VPHD values were normalized to mean blood pressure (MBP), blood flow rate (BFR), BFR × MBP, and BFR2 × MBP to yield ratios for analysis. The coefficient of variation (CV) was used to measure relative variations. Results: The within-group comparisons for both groups revealed no significant differences in the VPHD mean and CV values among the three HD sessions prior to intervention. However, the CVs for VPHD/MBP, VPHD/(BFR × MBP), and VPHD/(BFR2 × MBP) exhibited significant elevation in the occlusion group during the last HD session prior to intervention compared with both the penultimate and antepenultimate within-group HD data ( p < 0.05). In the receiver operating characteristic curve analysis, the CV for VPHD/(BFR2 × MBP) was the only parameter able to discriminate between the last and the penultimate HD outcomes ( p < 0.001). According to a multivariate analysis, after controlling for covariates, CV for VPHD/(BFR2 × MBP) >8.76% was associated with a higher risk of AVG thrombosis (odds ratio: 3.17, p < 0.001). Conclusions: Increasing the variation in VPHD/(BFR2 × MBP) may increase the probability of AVG occlusion.

scholarly journals What Does Early Mean? Remarks on Immediate Prosthetic Vascular Access Cannulation for Urgent Hemodialysis

2016 ◽  
Vol 2 (1) ◽  
pp. pocj.5000198
Author(s):  
Marco Franchin ◽  
Gabriele Piffaretti ◽  
Barbara Pasqualetti ◽  
Michele Cavo Dragone ◽  
Francesca Fortin ◽  
...  
Keyword(s):  
Vascular Access ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Maintenance Hemodialysis ◽  
Central Vein ◽  
Real Problem ◽  
Arterial Blood Gas ◽  
Vein Thrombosis ◽  
Arterial Blood ◽  
Vascular Catheters

Management of complicated vascular access. A step-by-step description of a case of hyperkalemia and vascular access failure in a patient receiving maintenance hemodialysis treated for numerous previous stenosis and thrombosis of the native vascular access. The discussion revolves around the following key questions: 1. Basilic vein thrombosis and re-stenosis, what do you think it should be done after this complication? 2. Venous back bleeding was satisfactory; do you think thrombectomy was effective? 3. We thought that central vein stenosis stenting was needed, wasn't it? 4. What do you think about basilic stenosis? The patient had undergone multiple recent basilic angioplasties. Consequently, a surgical intervention could have been definitive. Various surgical options were possible. But first of all, we had to solve a dilemma: The patient had received multiple previous central vascular catheters; our aim was to avoid a new central vascular access placement. At the same time, we required a vascular access for prompt cannulation. Do you think that was a real problem? Do you agree with us, or in the present circumstance, would you have preferred a central venous device? 5. Finally, we decided in favor of creation of a prosthetic vascular access. We chose a graftspecifically designed for early cannulation. Do you agree with us? Do you think early cannulation could cause a worse vascular access outcome? 6. Patient underwent last hemodialysis (HD) 24 hours before surgery. Consequently we trusted that the next HD could be delayed for at least 24 hours. Unfortunately, intraoperative arterial blood gas analysis documented hyperkalemia and acidosis. Our nephrologist suggested HD. In your opinion what does “early” mean?.

scholarly journals What Can Breast and Plastic Surgeons Do to Help Fight the Opioid Crisis: The Interpectoral Block for Pain Control Following Aesthetic and Reconstructive Breast Surgery

2020 ◽  
Vol 2 (1) ◽  
Author(s):  
Michael Scheflan ◽  
Tanir M Allweis
Keyword(s):  
Postoperative Pain ◽  
Pain Control ◽  
Ultrasound Guidance ◽  
Breast Surgery ◽  
Standard Of Care ◽  
Postoperative Pain Management ◽  
Effective Technique ◽  
Regional Analgesia ◽  
Pain Medications ◽  
Opioid Administration

Abstract With the heightened awareness of the dangers of opioid administration, the importance of providing effective non-opioid postoperative pain management is evident. Regional analgesia for breast surgery has been described, but it is unclear how widely it is utilized. The authors describe a simple block performed during ablative, aesthetic, and reconstructive breast surgery to improve postoperative pain control and significantly decrease the need for postoperative pain medications. The interpectoral (PECS I) block covers the lateral and medial pectoral nerves and can be administered by the anesthesiologist under ultrasound guidance after induction of general anesthesia, or by the surgeon under direct vision, using a blunt cannula, at the time of surgery. The authors have been practicing this technique in every patient undergoing aesthetic, ablative, and reconstructive breast surgery in the last 4 years. In approximately 350 patients, none received opioids after discharge, which was either same day or the following day. The authors provide a brief review of the literature and a detailed description of the technique along with a video demonstrating the procedures. Intraoperative pectoral block is a simple and effective technique for decreasing postoperative pain and analgesic requirements and could be widely adopted as a standard of care in breast surgery.

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