scholarly journals Delayed cephalic arch rupture following balloon angioplasty

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Abdulaziz Algharras
Keyword(s):  
Balloon Angioplasty ◽  
Stent Placement ◽  
Treatment Strategies ◽  
Covered Stent ◽  
Rare Presentation ◽  
Diseased Segment ◽  
Complete Thrombosis ◽  
Stage Renal Disease ◽  
End Stage ◽  
Primary Management

Abstract Background Vascular access care comes with its substantial cost that include but not limited to poor blood flow during dialysis, stenosis throughout the dialysis circuits, aneurysmal dilatation, clots formation and complete thrombosis. Acute cephalic arch rupture is not that uncommon but delayed rupture is rare presentation that was not discussed previously. Case presentation We describe a case of a 70-year-old female with end-stage renal disease (ESRD) undergoing a fistulogram and angioplasty of cephalic arch stenosis that resulted in a small vessel rupture that was successfully treated with prolonged balloon inflation initially. Unfortunately, this was complicated with massive venous rupture after initiating hemodialysis. The diseased segment was successfully treated with covered stent placement. This paper review and discuss cephalic arch stenosis, clinical presentation, and available initial and bailout treatment strategies. Conclusions Primary management of cephalic arch rupture is a prolong-low pressure balloon angioplasty, with covered stent across the site of extravasation if persisted. This case depicted a delayed vascular rupture following hemodialysis in patient with previously controlled extravasation that necessities covered stent placement. No data in the literature suggested the time that is required to avoid dialysis and improve healing.

Circumferential stent fracture repaired using a covered stent in a 42-year-old man with coarctation of the aorta

2015 ◽  
Vol 26 (2) ◽  
pp. 375-377
Author(s):  
Fares Ayoub ◽  
Sameeha AlShelleh ◽  
Iyad AL-Ammouri
Keyword(s):  
High Pressure ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Aortic Coarctation ◽  
Coarctation Of The Aorta ◽  
Covered Stent ◽  
Stent Fracture ◽  
Ultra High Pressure ◽  
Stage Renal Disease ◽  
End Stage

AbstractWe present a case of circumferential fracture of aortic coarctation stent with severe re-stentosis presenting 16 years after initial stent implantation with end-stage renal disease. The patient was treated with a covered stent using the stent-in-stent technique. The use of an ultra-high-pressure balloon was proved necessary to overcome the tight, non-compliant stenosis.

scholarly journals Immunological Characteristics and Management of Kidney Transplantation

2020 ◽  
Vol 95 (1) ◽  
pp. 18-26
Author(s):  
Myung-Gyu Kim
Keyword(s):  
Kidney Transplantation ◽  
De Novo ◽  
Treatment Strategies ◽  
Adaptive Immune System ◽  
Diagnostic Tools ◽  
Term Survival ◽  
Stage Renal Disease ◽  
End Stage ◽  
Transplant Immunology

Kidney transplantation (KT) is the best way to improve the quality of life and survival of patients with end-stage renal disease. However, after KT the adaptive immune system plays important roles in the development of rejection via multiple pathways. Accordingly, the suppression or modulation of these pathways is key to allograft survival. Advances in our understanding of the immunology related to KT with the development of immunosuppressants have reduced the rate of acute rejection and improved short-term transplant outcomes. Nonetheless, <i>de novo</i> donor-specific antibodies and subsequent chronic rejection continue to be responsible for the poor long-term survival of transplanted patients. In addition, the morbidity and mortality rates in patients returning to dialysis after graft failure are high. Better long-term outcomes following KT require innovative treatment strategies that include a focus on de novo antibodies. Here, we review basic transplant immunology as well as the diagnostic tools and medications that contribute to successful KT. We also provide an update on newly developed immunosuppressants.

scholarly journals Comparison of the efficacy of using paclitaxel-eluting balloon and plain balloon angioplasty for arteriovenous fistula in hemodialysis patients

2019 ◽  
Vol 6 (5) ◽  
pp. 3151-3155
Author(s):  
Alireza Rai ◽  
Mohammadreza Sobhiyeh
Keyword(s):  
Success Rate ◽  
Balloon Angioplasty ◽  
Doppler Ultrasonography ◽  
Color Doppler ◽  
Hemodialysis Patients ◽  
Group 13 ◽  
Quasi Experimental ◽  
Stage Renal Disease ◽  
End Stage ◽  
To Receive

Introduction: Arteriovanous (AV) access failure is one of the main problems in patients with end stage renal disease (ESRD), who receive hemodialysis. Balloon angioplasty is a favorable method for managing vascular access failure. The purpose of this study was to compare the six-month efficacy of paclitaxel-eluting balloon and plain balloon angioplasty in failed AV access cases among hemodialysis patients. Methods: In this quasi-experimental study (http://en.irct.ir/trial/35333), 50 hemodialysis patients with failure of AV access (stenosis > 50%), who were candidates for angioplasty, were included. They were divided to receive either paclitaxel-eluting balloon (25 patients) or plain balloon (25 patients) angioplasty. Patients were followed up for six months with color Doppler ultrasonography and clinical examination for the hemodynamic success rate of angioplasty. Results: After six months, 19 patients (76%) in paclitaxel-eluting balloon angioplasty group achieved hemodynamic success, which was significantly higher than plain balloon angioplasty group (13 patients, 52%) (P = 0.012). Age, gender, diabetes mellitus, hypertension, and location of AVF (snuff box, forearm, and antecubital fossa) did not associate with hemodynamic success rate in any group. Conclusion: The use of angioplasty with paclitaxel-eluting balloon was superior to plain balloon angioplasty for failed AV access cases in hemodialysis patients. It is recommended to use paclitaxeleluting balloon angioplasty in patients with failure of AV access and requirement for balloon angioplasty.  

Identification and Treatment of Protein-energy Malnutrition in Renal Disease

2010 ◽  
Vol 71 (1) ◽  
pp. 27-32 ◽  
Author(s):  
Kari Mcknight ◽  
Anna Farmer ◽  
Lyn Zuberbuhler ◽  
Diana Mager
Keyword(s):  
Clinical Practice ◽  
Renal Disease ◽  
Practice Guidelines ◽  
Protein Energy Malnutrition ◽  
Treatment Strategies ◽  
Web Based ◽  
Medication Therapy ◽  
Protein Energy ◽  
Stage Renal Disease ◽  
End Stage

A web-based cross-country survey of renal registered dietitians (RRDs) was launched. It was used to assess whether or not their clinical practice in identifying and treating proteinenergy malnutrition (PEM) in adults with end-stage renal disease (ESRD) and dialysis was based on current nutrition practice guidelines (NPGs). The survey included questions on strategies, timelines, and markers used for the identification and treatment of PEM. Fifty-nine RRDs responded (21%). Sixty-seven percent did not base clinical practice on NPGs, while 33% indicated they followed the guidelines. Of those who followed guidelines, 76% use the National Kidney Foundation— Kidney Disease Outcomes Quality Initiative nutrition guidelines. Strategies used to identify and treat PEM were not related to duration of RRD experience in nephrology, but were significantly different between guidelines users and non-users. Guideline users commonly used key nutrition treatment strategies that included enteral/parenteral nutrition and medication therapy. The clinical practice of RRD is typically based on expert opinion/consensus, rather than on evidence-based practice guidelines (EBPG). It remains unclear if differences in RRDs’ adoption of clinical guidelines influences patient outcomes, particularly in the treatment of PEM. Up-to-date EBPG need to be developed for the identification and treatment of PEM in patients with ESRD.

scholarly journals An Intact Dopamine Sensitivity in the Brain: A Necessity to Recover Hyperprolactinemia and Galactorrhea in a Female Hemodialysis Patient?

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
Eva Philipse ◽  
Ester Philipse ◽  
Theodorus Twickler ◽  
Amaryllis Van Craenenbroeck ◽  
Marie Madeleine Couttenye ◽  
...  
Keyword(s):  
Hemodialysis Patient ◽  
Treatment Strategies ◽  
Hemodialysis Patients ◽  
Prolactin Secretion ◽  
Subsequent Treatment ◽  
Dialysis Session ◽  
Single Session ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Brain

A female hemodialysis patient with galactorrhea due to hyperprolactinemia was treated with different dialysis modalities to assess the effect on prolactin levels. A single session of both high-flux hemodialysis and hemodiafiltration resulted in decreased prolactin levels (16,6% and 77,2%, resp.). However, baseline prolactin levels measured immediately before the next dialysis session did not change markedly. After cabergoline treatment was started, prolactin levels normalized and galactorrhea disappeared. Thus, dopaminergic inhibition of prolactin secretion might be reduced in patients with end-stage renal disease. This dopaminergic resistance could be an important mechanism of hyperprolactinemia in hemodialysis patients and its subsequent treatment strategies.

Balloon angioplasty: A promising adjunct to arteriovenous fistula creation compared with hydrostatic dilatation in small-caliber cephalic veins

2021 ◽  
pp. 021849232110415
Author(s):  
Santosh K Tiwari ◽  
Rajendra P Basavanthappa ◽  
Ranjith K Anandasu ◽  
Sanjay C Desai ◽  
Chandrasekhar A Ramswamy ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Balloon Angioplasty ◽  
Duplex Ultrasound ◽  
Primary Patency ◽  
Maturation Time ◽  
Arteriovenous Access ◽  
Dilatation Group ◽  
Stage Renal Disease ◽  
End Stage ◽  
Venous Segment

Background To maintain the patency and longevity of arteriovenous fistula, the availability of a venous segment with adequate diameter is important. In Indian population, many chronic kidney disease patients have poor caliber veins. The study aimed to evaluate the efficacy of hydrostatic dilatation versus Primary balloon angioplasty of small caliber cephalic veins of (≤2.5 mm) preoperatively in terms of patency rate and maturation time of arteriovenous fistula. Methods Patients ( n = 80) with an end-stage renal disease requiring arteriovenous access surgery for hemodialysis with small caliber cephalic veins were randomized into two groups, i.e., hydrostatic dilatation and primary balloon angioplasty, each with 40 patients. All patients underwent a thorough clinical examination as well as duplex ultrasound vein mapping of both upper extremities. Patients were followed up for six months and primary patency, maturation time, and complications were noted. Results Immediate technical success with good palpable thrill was achieved in 97.5% of patients in the primary balloon angioplasty group and 87.5% in the hydrostatic dilatation group. The fistula maturation time in the primary balloon angioplasty group was 34.41 days and 46.18 days in the hydrostatic dilatation group. In the primary balloon angioplasty group, the primary patency of the fistula was 97.5% and 87.5% in the hydrostatic dilatation group, at six months. The arteriovenous fistula functioning rate was 77.5% in the hydrostatic dilatation group as compared to 92.5% in the primary balloon angioplasty group at six months. The incidence of surgical site infection was 5% in the primary balloon angioplasty group as compared to 10% in the hydrostatic dilatation group. Conclusion Primary balloon angioplasty of small caliber cephalic veins (≤2.5 mm) performed prior to arteriovenous fistula creation for hemodialysis is a beneficial procedure.

Disaster management of chronic dialysis patients

2007 ◽  
Vol 2 (2) ◽  
pp. 96-106 ◽  
Author(s):  
Richard Zoraster, MD ◽  
Raymond Vanholder, MD, PhD ◽  
Mehmet S. Sever, MD
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Management Strategies ◽  
Treatment Strategies ◽  
Chronically Ill ◽  
Dialysis Patients ◽  
Dietary Restrictions ◽  
Stage Renal Disease ◽  
End Stage ◽  
Do So

The chronically ill are often the hardest hit by dis-ruptions in the healthcare system—they may be highly dependent on medications or treatments that suddenly become unavailable, they are more physically fragile than the rest of the population, and for socioeconomic reasons they may be more limited in their ability to prepare or react. Medical professionals involved in dis-aster response should be prepared to care for individu-als suffering from the complications of chronic illness, and they must have some idea of how to do so with lim-ited resources. Dialysis-dependent, end-stage renal disease patients are at especially high risk following disasters. Infrastructure damage may make dialysis impossible for days, and few physicians have experience or train-ing in the nondialytic management of end-stage renal disease. Nondialytic management strategies include dietary restrictions, aggressive attempts at potassium removal via resins and cathartics, and adaptations of acute treatment strategies. Appropriate planning and stockpiling of medications such as Kayexalate are crit-ical to minimizing morbidity and mortality

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