Hybrid procedures in the dialysis fistula aneurysm treatment

Vascular ◽  
2020 ◽  
Vol 28 (6) ◽  
pp. 775-783
Author(s):  
Rafał Góra ◽  
Krzysztof Bojakowski ◽  
Bartosz Foroncewicz ◽  
Stanisław Kaźmierczak ◽  
Piotr Andziak
Keyword(s):  
Term Treatment ◽  
Late Complications ◽  
Primary Patency ◽  
Dialysis Access ◽  
Hybrid Procedures ◽  
Aneurysm Treatment ◽  
Long Term Treatment ◽  
Significant Difference ◽  
Dialysis Fistula ◽  
Vein Stenosis

Objectives Dialysis fistula aneurysms are common complications which in selective cases require surgical revision. It is recommended to detect and treat outflow stenosis concurrent with a dialysis fistula aneurysm, but usually, the treatment is divided into two stages – the open and endovascular stages are performed separately. We describe the results of hybrid procedures composed of aneurysm resection and endovascular correction for outflow veins performed for a dialysis fistula aneurysm treatment. Methods From March 2012, we performed hybrid procedures in 28 patients to correct dialysis fistula aneurysms. Patients, dialysis access, operative data, and the results obtained during a median follow-up of 28.5 months were analyzed. Results For dialysis fistula aneurysm correction, we performed 27 bypasses and 1 aneurysmorraphy. For outflow vein stenosis correction, we performed standard balloon angioplasty, no stents or stentgraft were used. The average increase in minimal diameter after angioplasty was 135.5% (range 57–275%). The 12- and 24-month primary patency rates of corrected fistulas in the observed group were 92.3% and 80%, respectively. A significant difference in the one-year patency rates between the urgent and planned procedures was observed (81.2% vs. 100%, respectively). No early complications related to endovascular or open procedures were observed. Late complications were observed in seven patients (25%) – mainly thrombosis caused by the recurrence of outflow vein stenosis (six patients, 21.5%), infection, lymphocele, and hematoma (one case of each complication). Conclusions A hybrid procedure for the surgical correction of dialysis fistula aneurysms with the simultaneous correction of outflow pathologies enables effective long-term treatment. The obtained data showed the efficiency and good results of this procedure. Procedures performed for urgent indications significantly increase the risk for later complications, especially fistula thrombosis and loss of dialysis access.

Aneurysm Excision With Arteriovenous Anastomosis Proximalization for Dialysis Fistula Aneurysm Treatment

2020 ◽  
pp. 153857442097672
Author(s):  
Rafał Góra ◽  
Krzysztof Bojakowski ◽  
Antoni Piasecki ◽  
Dominika Kasprzak ◽  
Stanisław Kaźmierczak ◽  
...  
Keyword(s):  
Primary Anastomosis ◽  
Significant Risk ◽  
Duplex Ultrasound ◽  
Primary Patency ◽  
Long Term Results ◽  
Dialysis Access ◽  
Arteriovenous Anastomosis ◽  
Aneurysm Treatment ◽  
Dialysis Fistula ◽  
End To End

Introduction: Dialysis fistula aneurysms are common complications, which require surgical revision in selective cases. The results of aneurysm excision with arteriovenous anastomosis proximalization for the treatment of dialysis fistula aneurysms have been described below. Methods: Patients qualified for the reconstruction of a dialysis fistula aneurysm underwent a duplex ultrasound examination. The diameter, length of the aneurysm, relations with the artery, thrombus presence and blood flow were determined. In the case of favorable anatomical conditions, we performed aneurysm excision with arteriovenous anastomosis proximalization as the procedure of choice. Patients, dialysis access, operative data and the results obtained during a median follow-up of 41 months were then analyzed. Findings: Since 2012, we have performed 20 aneurysm excision combined with primary anastomosis as dialysis fistula aneurysm treatment. In 18 patients, aneurysm excision was combined with simple re-anastomosis in the more proximal arterial segment. In 2 autogenous radio-cephalic forearm direct fistulas the aneurysm excision was combined with switching anastomosis type from side-to-end to end-to-end. The 12- and 24-month primary patency rates of corrected fistulas in the observed group were 94.7% and 82.4%, respectively. No early complications were noted. In 7 patients (35%) we observed late complications, which required reintervention or led to access failure. Dialysis fistula thrombosis as an indication for treatment was a significant risk factor for late re-occlusion. Discussion: A simple primary reconstruction by arteriovenous anastomosis proximalization and aneurysm excision for the surgical correction of dialysis fistula aneurysms has potential benefits compared to established methods—aneurysmorraphy and aneurysm excision with a vascular prosthesis bypass. The obtained data showed the efficiency, safety and excellent long-term results of this procedure.

scholarly journals Rivaroxaban for the treatment of cerebral venous thrombosis

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sara Esmaeili ◽  
Meysam Abolmaali ◽  
Sobhan Aarabi ◽  
Mohammad Reza Motamed ◽  
Samira Chaibakhsh ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Bleeding Risk ◽  
Term Treatment ◽  
Background Information ◽  
Minor Bleeding ◽  
Long Term Treatment ◽  
Significant Difference

Abstract Background New Oral Anticoagulants (NOACs) such as Rivaroxaban are introduced as alternatives to conventional vitamin-K antagonists in the long-term treatment of thrombotic events due to their lower bleeding risk. There is a lack of evidence on the effectiveness and safety of Rivaroxaban in Cerebral venous thrombosis (CVT). This study aims to assess the effectiveness and bleeding risk of Rivaroxaban in comparison with Warfarin for the treatment of CVT. Materials and methods 36 patients with diagnosis of CVT were included. Clinical and background information was assessed on admission and patients were followed for at least 12 months. Measured outcomes were modified Rankin Scale (mRS), evidence of recanalization on contrast-enhanced Brain MR venography (MRV) and major or minor bleeding. Patients were divided into two groups according to the type of oral anticoagulant (Rivaroxaban vs Warfarin). Groups were compared in terms of final outcomes and side effects. Result Overall, 13 (36.11%) patients received Warfarin and 23 (63.89%) received Rivaroxaban. Optimal mRS score (0–1) was attained in 9 of 10 (90%) of patients treated with Rivaroxaban and 19 of 22 (86.36%) of patients received Warfarin. MRV showed complete or partial recanalization in 12 of 14 (85.71%) patients treated with Rivaroxaban and all patients in the Warfarin group. There was no significant difference between the two groups in terms of major and minor hemorrhage. Conclusion Rivaroxaban holds promise for the treatment of CVT.

scholarly journals The plant secondary compound swainsonine reshapes gut microbiota in plateau pikas (Ochotona curzoniae)

2021 ◽  
Author(s):  
Shien Ren ◽  
Chao Fan ◽  
Liangzhi Zhang ◽  
Xianjiang Tang ◽  
Haibo Fu ◽  
...  
Keyword(s):  
Gut Microbiota ◽  
Artificial Diet ◽  
Alpha Diversity ◽  
Term Treatment ◽  
Short Term Treatment ◽  
Ochotona Curzoniae ◽  
Rdna Sequencing ◽  
Long Term Treatment ◽  
Significant Difference ◽  
Herbivorous Mammals

Abstract Plants produce various plant secondary compounds (PSCs) to deter the foraging of herbivorous mammals. However, little is known about whether PSCs can reshape gut microbiota and promote gut homeostasis of hosts. Using 16S rDNA sequencing to investigate the effects of PSCs on the gut microbiota of small herbivorous mammals, we studied plateau pikas (Ochotona curzoniae) fed diets containing swainsonine (SW) extracted from Oxytropis ochrocephala. Our results showed that both long- and short-term treatment of a single artificial diet in the laboratory significantly reduced alpha diversity and significantly affected beta diversity, core bacteria abundance, and bacterial functions in pikas. After SW was added to the artificial diet, the alpha diversity significantly increased in the long-term treatment, and core bacteria (e.g., Akkermansiaceae) with altered relative abundances in the two treatments showed no significant difference compared with pikas in the wild. The complexity of the co-occurrence network structure was reduced in the artificial diet, but it increased after SW was added in both treatments. Further, the abundances of bacteria related to altered alanine, aspartate, and glutamate metabolism in the artificial diet were restored in response to SW. SW further decreased the concentration of short-chain fatty acids (SCFAs) in both treatments. Our results suggest that PSCs play a key role in regulating gut microbiota community and intestinal homeostasis, thereby maintaining host health. Key points • Swainsonine improves the intestinal bacterial diversity of plateau pikas. • Swainsonine promotes the recovery of core bacterial abundances in the gut of plateau pikas. • Swainsonine promotes the restoration of intestinal bacterial functions of plateau pikas.

Tapered and non-tapered prosthetic grafts in upper extremity dialysis access: A systematic review and meta-analysis

2020 ◽  
pp. 112972982097417
Author(s):  
Venkata Sai Jasty ◽  
David Haddad ◽  
Babu Mohan ◽  
Wei Zhou ◽  
Jeffrey J Siracuse ◽  
...  
Keyword(s):  
Systematic Review ◽  
Upper Extremity ◽  
Meta Analysis ◽  
Primary Patency ◽  
Secondary Patency ◽  
Dialysis Access ◽  
Significant Difference ◽  
Arteriovenous Grafts ◽  
Meta Analyses ◽  
Steal Syndrome

Objective: It is unclear whether tapered arteriovenous grafts (AVGs) are superior to non-tapered AVGs when it comes to preventing upper extremity ischemic steal syndrome. We aimed to evaluate the outcomes of tapered and non-tapered AVGs using systematic review and meta-analysis. Methods: A literature search was systemically performed to identify all English publications from 1999 to 2019 that directly compared the outcomes of upper extremity tapered and non-tapered AVGs. Outcomes evaluated were the primary patency at 1-year (number of studies ( n) = 4), secondary patency at 1-year ( n = 3), and risk of ischemic steal ( n = 5) and infection ( n = 4). Effect sizes of individual studies were pooled using random-effects model, and between-study variability was assessed using the I2 statistic. Results: Of 5808 studies screened, five studies involving 4397 patients have met the inclusion criteria and included in the analysis. Meta-analyses revealed no significant difference for the risk of ischemic steal syndrome (pooled odds ratio (OR) 0.92, 95% Confidence Incidence (CI) 0.29–2.91, p = 0.89, I2 = 48%) between the tapered and non-tapered upper extremity AVG. The primary patency (OR 1.33, 95% CI 0.93–1.90, p = 0.12, I2 = 10%) and secondary patency at 1-year (OR 1.49, 95% CI 0.84–2.63, p = 0.17, I2 = 13%), and rate of infection (OR 0.62, 95% CI 0.30–1.27, p = 0.19, I2 = 29%) were also similar between the tapered and non-tapered AVG. Conclusions: The risk of ischemic steal syndrome and patency rate are comparable for upper extremity tapered and non-tapered AVGs. This meta-analysis does not support the routine use of tapered graft over non-tapered graft to prevent ischemic steal syndrome in upper extremity dialysis access. However, due to small number of studies and sample sizes as well as limited stratification of outcomes based on risk factors, future studies should take such limitations into account while designing more robust protocols to elucidate this issue.

scholarly journals Administration of ziprasidone for 10 days increases cocaine toxicity in mice

2008 ◽  
Vol 27 (6) ◽  
pp. 499-503 ◽  
Author(s):  
K Heard ◽  
S Krier ◽  
NR Zahniser
Keyword(s):  
Atypical Antipsychotic ◽  
Term Treatment ◽  
Toxic Effects ◽  
Neurotransmitter Receptors ◽  
Control Group ◽  
Long Term Treatment ◽  
Significant Difference ◽  
Group Survival ◽  
Cocaine Toxicity

Long-term treatment with antipsychotic medications alters the regional density of several of the neurotransmitter receptors that mediate cocaine toxicity. However, the effect of either up- or down-regulation of the neurotransmitter receptors on cocaine toxicity is unknown. In this study, we determined if subacute administration of the atypical antipsychotic ziprasidone altered the toxic effects of cocaine in mice. Ziprasidone (4 mg/kg) or placebo was administered to the first two groups of CF-1 mice for 10 days and, then on day 10, an estimated LD50 dose of cocaine (102 mg/kg) was given to these mice. In a third group, in order to produce a ziprasidone withdrawal state, we administered ziprasidone for 10 days, followed by no treatment for 2 days before cocaine administration. There was no significant difference among the three groups in overall survival: 63% in the treatment group, 60% in the withdrawal group, and 80% in the placebo group. Survival time was significantly shorter for the withdrawal group than for the control group. Our study may have been limited by lower than expected serum ziprasidone concentrations and lower than expected lethality from cocaine. However, our findings suggest that administration of an atypical antipsychotic for 10 days may increase the toxic effects of cocaine.

scholarly journals Quantitative determination of EPA and DHA in fish oil capsules for cardiovascular disease therapy in Indonesia by GC-MS

2021 ◽  
Vol 10 (2) ◽  
Author(s):  
Amelia Lorensia ◽  
Ryanto Budiono ◽  
Rivan Virlando Suryadinata ◽  
Navy Tiarasari
Keyword(s):  
Fish Oil ◽  
Positive Impact ◽  
Term Treatment ◽  
Epa And Dha ◽  
Long Run ◽  
Disease Therapy ◽  
Physical Form ◽  
Long Term Treatment ◽  
Significant Difference ◽  
The Cost

Background: The consumption of EPA (Eicosapentaenoic acid), and DHA (docosahexaenoic acid), from fish oil, in the long run, has been observed to have a positive impact on patients with coronary heart disease. Fish oil products, with so much EPA and DHA content are available, and have very variable prices. Therefore, as a therapy to be used for long-term treatment, the cost factor is to be considered.Design and methods: This study analyzed the content of EPA and DHA, using GC-MS. The sample to be analyzed was the fish oil that has the lowest price (Product A1), and that of the highest (Product A2). Furthermore, the macroscopic analysis was performed, by observing the physical form including organoleptic and qualitative tests, by reading the fragments identified by EPA and DHA.Results: Clinical trials were conducted on patients (about 46 people), with risk factors and dyslipidemia. Product A1 showed EPA at tR= 15.574 min (relative%= 88.49%, similarity= 95%), and DHA at tR= 21.714 min (relative%= 88.92%, similarity= 93%). Product A2 showed EPA at tR= 28.719 min (relative%= 22.58%, similarity= 89%), and DHA at tR= 32.327 min (relative%= 22.87%, similarity= 90%), which meant that both had EPA and DHA contents, in accordance with their labels. Both products were confirmed to reduce total cholesterol in 4weeks (p=0.000, p= 0.000), with no significant difference in their effectiveness (p=0.652).Conclusion: The results showed that both the A1 and A2 products, had the EPA and DHA contents in accordance with their respective labels. However, with the A2 product having a percentage relatively higher than that of the A1 brand, both are equally very effective.

scholarly journals Mid-term Outcomes of Patients with Central Venous Occlusive Disease Undergoing Surveillance Venography and Intervention

2020 ◽  
Vol 49 (6) ◽  
pp. 360-366
Author(s):  
Hui Lin Wong ◽  
Shaun Xavier JM Chan ◽  
Satheesh Ramamuthy ◽  
Kiang Hong Tay ◽  
Tze Tec Chong ◽  
...  
Keyword(s):  
Transluminal Angioplasty ◽  
Primary Patency ◽  
Occlusive Disease ◽  
Central Vein ◽  
Dialysis Access ◽  
Technical Success ◽  
Central Venous ◽  
Presenting Symptoms ◽  
Luminal Narrowing ◽  
Significant Difference

Introduction: To evaluate the mid-term outcomes of regular surveillance venography with or without percutaneous transluminal angioplasty in haemodialysis patients presenting with central venous occlusive disease. Materials and Methods: A single-centre retrospective analysis of haemodialysis patients who presented with central vein occlusion (CVO) and central vein stenosis (CVS) between January 2008 and December 2011 was performed. CVO and significant CVS were defined as 100% and >50% luminal narrowing respectively. Upon successful angioplasty on first presentation, patients were followed up with regular surveillance venography within 3–6 months of the intervention and were re-treated when a significant stenosis or occlusion was demonstrated. Data on patient’s demographics, comorbidities, presenting symptoms, type of upper limb dialysis access, lesion characteristics and complications were collected. Technical success, primary patency and primary assisted patency were analysed. Results: Thirty-five patients with CVO and 77 patients with CVS were enrolled. The technical success of initial PTA was 77% and 73% for the CVO and CVS groups, respectively. The primary patency at 3 months was 65% and 55% for the CVO group and CVS group, respectively (P = 0.32). The primary assisted patency at 1 year was 88% and 99% for the CVO group and CVS group, respectively (P = 0.009). At 2 years, the primary assisted patency were 77% and 90%, respectively (P = 0.07). There was significant difference in the overall primary assisted patency (P = 0.048) between the CVO and CVS groups. Conclusion: CVOs are more difficult to treat than CVS. High primary assisted patency rates can be achieved with surveillance venography, albeit at the expense of increased number of interventions. Further cost effectiveness studies need to be performed to study the true benefit of our surveillance programme. Ann Acad Med Singapore 2020;49:360–66 Key words: Dialysis circuit, End stage renal failure, Renal replacement therapy

scholarly journals The voiding dysfunctions in patients with non-Hunner-type interstitial cystitis/bladder pain syndrome do not affect long-term treatment outcome

2021 ◽  
Author(s):  
Wan-Ru Yu ◽  
Wei-Chuan Chang ◽  
Hann-Chorng Kuo
Keyword(s):  
Treatment Outcome ◽  
Interstitial Cystitis ◽  
Pain Syndrome ◽  
Bladder Pain Syndrome ◽  
Term Treatment ◽  
Bladder Pain ◽  
Long Term Treatment ◽  
Significant Difference ◽  
Voiding Dysfunctions

Aims: The role of urodynamic studies in the diagnosis and prognosis of interstitial cystitis/bladder pain syndrome (IC/BPS) remains controversial. We evaluated the correlation of baseline voiding dysfunctions with long-term treatment outcome in a large cohort of patients with IC/BPS. Methods: We studied 211 patients with nonulcerative IC/BPS. All patients underwent video urodynamic examination at baseline to identify their voiding conditions and they received subsequent treatments. The primary endpoint was the global response assessment (GRA) at the current interview. Secondary endpoints included O’Leary-Sant score (OSS), Visual Analog Scale (VAS) for pain, and the rate of IC symptom flare-up. Results: Mean patient age was 56.8 ± 12.8 years and mean IC symptom duration was 16.0 ± 9.9 years. At baseline, 83 (39.3%) patients had a voiding problem and 62.7% had one to three comorbidities. The duration, comorbidity, treatments, changes in OSS and VAS, maximum bladder capacity (MBC), glomerulations, GRA, and flare-up rate were not significantly different among the different voiding subtypes. When we divided the patients by their voiding conditions of normal (n = 32) and hypersensitive bladder with (n = 76) and without (n = 103) voiding dysfunctions, only MBC (P = 0.002) and glomerulation (P = 0.021) demonstrated a significant difference. When we analyzed subgroups by GRA, patients with a GRA ≥ 2 had a significantly shorter disease duration. There also were significant associations between GRA and the changes in OSS and VAS (P < 0.001). Conclusions: Voiding dysfunctions in patients with non-Hunner IC/BPS do not affect long-term treatment outcome.

Compared Incidence of First Myocardial Infarction in Hypertensive Patients under Treatment Containing Propranolol or excluding β-Receptor Blockade

1976 ◽  
Vol 51 (s3) ◽  
pp. 509s-511s ◽  
Author(s):  
I. McD. G. Stewart
Keyword(s):  
Myocardial Infarction ◽  
Term Treatment ◽  
Receptor Blocker ◽  
Receptor Blockade ◽  
Hypertensive Patients ◽  
Long Term Treatment ◽  
Significant Difference ◽  
Group A ◽  
Β Receptor

1. After some exclusions, 169 severe uncomplicated essential hypertensive patients presenting consecutively were divided into two groups according to their treatment. Of these, 121 had been given long-term treatment containing propranolol (PC group) and forty-eight had been treated with hypotensive agents excluding any β-receptor-blocker group, the non-β-receptor-blocker (NBB) group. 2. There were no significant differences in myocardial infarction risk factors between the two groups. 3. After a mean follow-up of 5·25 years, nine of the 121 subjects (7·5%) in the PC group had suffered first infarctions and fifteen of the forty-eight subjects (31%) in the NBB group, a significant difference (P < 0·01). 4. It was concluded that the presence of propranolol had prevented more or caused fewer infarctions, perhaps a combination of both, than had the older hypotensive agents unsupported by β-receptor blockade.

Long-term treatment for hyperphenylalaninemia and phenylketonuria: a risk for nutritional vitamin B12 deficiency?

2015 ◽  
Vol 28 (11-12) ◽  
Author(s):  
Dagmar Procházková ◽  
Jiří Jarkovský ◽  
Zdena Haňková ◽  
Petra Konečná ◽  
Hana Benáková ◽  
...  
Keyword(s):  
Vitamin B12 Deficiency ◽  
Term Treatment ◽  
Plasma Homocysteine ◽  
Serum Folate ◽  
Vitamin B ◽  
Long Term Treatment ◽  
Significant Difference ◽  
B12 Deficiency ◽  
Nutritional Vitamin

AbstractThe objective of the study was to determine the incidence of vitamin BThe group consisted of 51 PKU (n=29) and HPA (n=22) patients aged 3–48 years (28 children, 23 adults).A significant difference in serum folate levels was discovered between adult HPA patients and PKU patients (p=0.004, Mann-Whitney U-test). A significant difference in plasma homocysteine concentrations within the normal levels (p=0.032, χWe have proven that adult patients with PKU and HPA are at risk of vitamin B

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