Severe Cholestasis and Portal Hypertension with AV Fistula Formation Secondary to Amyloidosis

2012 ◽  
Vol 107 ◽  
pp. S422
Author(s):  
Benjamin Rodriguez ◽  
Dawn Torres ◽  
John Bassett
Keyword(s):  
Portal Hypertension ◽  
Fistula Formation ◽  
Av Fistula

A Rare Case of an Aneurysm of the External Iliac and the Common Femoral Vein

1996 ◽  
Vol 11 (1) ◽  
pp. 34-38 ◽  
Author(s):  
N. Labropoulos ◽  
S. K. Volteas ◽  
A. Al Kutoubi ◽  
A. N. Nicolaides ◽  
A. O. Mansfield
Keyword(s):  
Iliac Fossa ◽  
Femoral Vein ◽  
Oral Anticoagulants ◽  
Fistula Formation ◽  
Compression Stockings ◽  
Vein Wall ◽  
Av Fistula ◽  
Common Femoral Vein ◽  
Acute Thrombosis ◽  
The Right

Objective: To report a case of an external iliac – common femoral vein aneurysm and review the literature on the subject. Design: Case report. Setting: Academic Vascular Surgery and Radiology Units, St Mary's Hospital, London, UK. Patients, Interventions and Results: The aneurysm occurred in a 34-year-old woman and was diagnosed with venography, duplex scanning and magnetic resonance venography. It underwent acute thrombosis and, as the thrombus was well organized and extensive, thrombectomy was not possible. The patient was treated with standard heparin followed by oral anticoagulants for 5 months. Thirty months after the operation the right calf remains swollen but soft and non-tender and the patient is currently treated with grade II full-length compression stockings. Since there were no findings of vein compression or malignancy it seems that the formation of the aneurysm resulted from a congenital weakness of the venous wall. Conclusions: The most common presentation of these aneurysms is of a mass of the abdomen or the iliac fossa, while thromboembolism is not uncommon. The main causes are arteriovenous (AV) fistula formation and congenital weakness of the vein wall. For the first the preferred treatment is AV fistula ligation while for the rest ligation with or without vein reconstruction has been successfully used.

scholarly journals Brachio- Axillary Translocation Fistula with Reverse Saphenous Venous Graft: a New Hope for the Patients of End stage Renal Disease

2018 ◽  
Vol 33 (2) ◽  
pp. 134-137
Author(s):  
SMG Saklayen Russel ◽  
Jubayer Ahmad ◽  
Raju Ahmed ◽  
Jashim Uddin ◽  
Suman Nazmul Hosain
Keyword(s):  
Upper Limb ◽  
Brachial Artery ◽  
Proximal Part ◽  
Fistula Formation ◽  
Axillary Vein ◽  
Av Fistula ◽  
Venous Fistula ◽  
The Right ◽  
Stage Renal Disease ◽  
End Stage

Native arterio-venous fistula (AVF) are the preferred mode of repeated vascular access for the chronic renal failure patients surviving on hemodialysis because of their easy accessibility, good long term patency, low complication rate and cost-effectiveness. Creation of a fistula between the radial or brachial artery and a suitable adjacent vein is the most commonly practiced option. However the major upper arm veins of the CKD patients are often found thrombosed, cord like and not suitable for AV anastomosis. A 48 years old male patient of chronic kidney disease with a permanent catheter placed in the right subclavian vein was referred to create an AV fistula. On exploration none of the upper limb veins was found suitable for fistula formation. The proximal part of the left GSV was harvested from patient’s left upper thigh and was used to make a connection between left brachial artery at cubital fossa and the left axillary vein. To avoid over flooding of the limb vasculature, partial banding of the left axillary vein was done distal to this anastomosis. When all options in both upper limbs are exhausted, autologous great saphenous grafts may be a very useful tool for the surgeons in creating upper limb AV fistulas in difficult situations Bangladesh Heart Journal 2018; 33(2) : 134-137

scholarly journals Delayed Arteriovenous Fistula after Reverse Flow Sural Island Flap in Lower Leg: A Case Report

2020 ◽  
Vol 25 (4) ◽  
pp. 309-313
Author(s):  
Seung Jae Byun ◽  
Hong Je Kang ◽  
Min Su Joo ◽  
Keon Rok Kim
Keyword(s):  
Color Change ◽  
Reverse Flow ◽  
Rare Complication ◽  
Lower Leg ◽  
Posterior Tibial Artery ◽  
Island Flap ◽  
Fistula Formation ◽  
Soft Tissue Reconstruction ◽  
Flap Surgery ◽  
Av Fistula

Delayed arteriovenous (AV) fistula after soft tissue reconstruction with flap surgery is a rare complication. Here, we describe a case of delayed AV fistula formation after 4 years of reverse flow sural island flap surgery in the lower leg. The patient had swelling, tenderness, and color change to dark purple on previous flap area and foot, similar to cellulitis. Thrill and murmur were observed. AV fistula was formed around the previous vascular pedicle area, as revealed in angiography. We excised the right posterior tibial artery-saphenous vein fistula. The patient is having satisfactory progress since the surgery. We suggest that AV fistula was caused by enhanced angiogenesis and vascular damage.

scholarly journals Arterio-Venous (AV) Fistula: Surgical outcome in College of Medical Sciences Teaching Hospital, Bharatpur, Chitwan

2013 ◽  
Vol 8 (4) ◽  
pp. 1-6
Author(s):  
S Shah ◽  
N Maharjan ◽  
D Chapagain ◽  
KG Shrestha ◽  
DJ Reddy
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Fistula Formation ◽  
Limiting Factor ◽  
Safe Procedure ◽  
Medical Sciences ◽  
Av Fistula ◽  
Made In

Aims Arteriovenous fistula is considered as reliable form of vascular access for hemodialysis in Chronic Kidney Disease (CKD) patients. We aim to evaluate prospectively, the outcome and primary failure rate of Arteriovenous fistula in 30 Chronic kidney Disease patients with Glomerular Filtration Rate (GFR) <30ml/min. Materials and methods This prospective study was conducted at the department of cardiothoracic and vascular surgery (CTVS), College of Medical Sciences, Bharatpur from May 2011 to May 2012. Thirty patients ranging from age 25 to 76 years with stage IV and V CKD, i.e. GFR below 30ml/min, were included in this study. Detailed physical examination including arterial pulses i.e. axillary, brachial, radial and ulnar and blood pressure in both upper limbs was recorded. Allens test was performed on every patient and left upper limb was used for AV fistula formation. Brachiocephalic fistula was made in 19 (63.33%), while radiocephalic fistula was made in 11 (36.67%) patients. Patients were evaluated post operatively, on outdoor basis, weekly for 6weeks. All patients were evaluated for the presence or absence of complications i.e. infection, hematoma, thrombosis, aneurysms and steal syndrome. Results The complication was primary failure in two patients. One male patient got secondary infection and one female patient got post operative hematoma leading to 6.66% primary failure of fistula. No other complications were noted. Conclusion Arteriovenous fistula is the gold standard for vascular access for hemodialysis in patients with deteriorating renal function and end-stage renal disease. It is designed to improve the effectiveness of dialysis with fewer risks and complications than other vascular accesses. This study gives the higher success rate of 93.33% and concludes that age should not be a limiting factor when determining candidacy for arteriovenous fistula creation and is the safe procedure. Journal of College of Medical Sciences-Nepal, 2012, Vol-8, No-4, 1-6 DOI: http://dx.doi.org/10.3126/jcmsn.v8i4.8693

Dialysis Access, Infections, and Hospitalisations in Unplanned Dialysis Start Patients: Results from the Options Study

2017 ◽  
Vol 40 (2) ◽  
pp. 48-59 ◽  
Author(s):  
Anna Machowska ◽  
Mark D. Alscher ◽  
Satyanarayana Reddy Vanga ◽  
Michael Koch ◽  
Michael Aarup ◽  
...  
Keyword(s):  
Healthcare Utilisation ◽  
Venous Catheter ◽  
Infectious Complications ◽  
Fistula Formation ◽  
Study Patient ◽  
Dialysis Access ◽  
Av Fistula ◽  
Technique Survival ◽  
Start Ups ◽  
Unplanned Dialysis

Introduction Unplanned dialysis start (UPS) associates with worse clinical outcomes, higher utilisation of healthcare resources, lower chances to select dialysis modality and UPS patients typically commenced in-centre haemodialysis (HD) with central venous catheter (CVC). We evaluated patient outcomes and healthcare utilisation depending on initial dialysis access (CVC or PD catheter) and subsequent pathway of UPS patients. Methods In this study patient demographics, access procedures, hospitalisations, and major infectious complications were analysed over 12 months in 270 UPS patients. PD technique survival and impact of switching from HD to PD was examined along with logistic regression to investigate factors predicting AV fistula formation. Results 72 UPS patients started with PD catheter and 198 with CVC. PD patients were older and more comorbid but had a significantly lower number of access procedures while there was no difference in hospitalisation or major infections. 13/72 initial PD patients switched to HD and 1-year technique survival was 79%. 158/198 patients remained on HD and 73/158 reported permanent access formation. Older age, OR = 0.34 (CI, 0.17-0.68) and cardiac failure, OR = 0.31(CI, 0.13–0.78), were significant negative predictors of receiving fistula. Younger patients, OR = 0.29 (CI, 0.11–0.79) and those who received AVF, OR = 0.11 (CI, 0.03–0.38), had significantly lower odds of death. Discussion UPS with initial PD was possible in many patients and was associated with lower requirement for access procedures. AVF formation in UPS patients starting on HD was associated with better 1-year survival. Modality switching in UPS patients requires careful clinical management, including clinical practice patterns promoting permanent HD access formation.

EP.FRI.42 REBOA associated iatrogenic AV fistula

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Raghvinder Gambhir ◽  
Charlotte Grainger ◽  
Monica Davies ◽  
Matthew Harris ◽  
Abhilash Sudarsam
Keyword(s):  
Femoral Vein ◽  
Expectant Management ◽  
Paediatric Population ◽  
Balloon Occlusion ◽  
Fistula Formation ◽  
Av Fistula ◽  
Ct Angiogram ◽  
Post Traumatic ◽  
The Right ◽  
Stab Injuries

Abstract Aim To discuss a rarely reported complication of Resuscitative endovascular balloon occlusion of the aorta (REBOA) in a trauma patient with exsanguating haemorrhage. Case description A 15 year old male sustained was brought in as a cod Red, following multiple stab injuries to his Rt thigh. A REBOA was inserted via the contralateral Femoral artery on the scene to control the bleeding. Once proximal and distal control was obtained on the Right leg, the REBOA was deflated and removed. The right leg needed an interposition vein graft and ligation of femoral vein. The patient had received 12 units of transfusion. Post-operative CT-angiogram demonstrated an AV fistula between the Left Profunda femoris artery and Common femoral vein on the side of REBOA insertion. A Duplex scan showed flows of 2600ml/min on duplex and AVF diameter of 2.6mm. It was decided to wait for spontaneously closure as patient underwent rehab. At 6 weeks the AVF flow had reduced to 460ml/min however further expectant management did not lead to spontaneous closure of the AVF and he underwent surgical tie off during his next school holidays 6 months later. Conclusion AV fistula formation as a complication of REBOA insertion has not been reported in paediatric population. It highlights the need for a CT angio after surgical stabilisation. These post traumatic AVFs may need surgical repair if it does not spontaneously close in 3-6 month time.

scholarly journals TP10.2.8Adaptation in providing renal access surgery service in response to covid-19 pandemic- a single centre experience

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
S A Mir ◽  
Avneesh Kumar ◽  
Nathan Chidambaram ◽  
Ravi Pararajasingham
Keyword(s):  
Discharge Rate ◽  
Postoperative Outcome ◽  
Day Surgery ◽  
Outcome Data ◽  
Fistula Formation ◽  
Single Centre ◽  
Av Fistula ◽  
Same Day Discharge ◽  
Complex Fistula ◽  
Access Surgery

Abstract Aim Evaluate impact of Covid-19 pandemic on renal access surgery and changes in practice towards counteracting limitations to provide safe and effective peritoneal and haemodialysis. Methods Retrospective review of procedures for dialysis in ESRD patients from institutional databases in a single centre was carried out. Patients undergoing peritoneal catheter insertions (PD) or AV fistula formation (HD) between March 2020 and October 2020 were compared with similar period in 2019. Demographic, procedure and postoperative outcome data was collected. Results Between March and October 2019, 143 combined PD and HD procedures were performed compared to 98 in the same time period in 2020. The mean age of patients was 65 ± 15 years and 62 ± 12 years, respectively. In 2020, 26 patients had PD catheter insertion and 22 patients in 2019. 18% of these were performed laparoscopically in 2019 compared to 33% in 2020. The same day discharge rate increased to 34% from 22%. Patients having complex fistula procedures including basilic vein transpositions and grafts requiring overnight stay dropped from 83% patients (n = 23) to 71% (n = 7) in 2020. In 2019, 80% (n = 49) patients had radio-cephalic fistula performed as same day procedure increasing to 98% (n = 22) in 2020. Day-surgery unit utilisation increased from 55% to 71%. Same day discharge rate increased from 53% to 66%. There were no readmissions. Conclusions Adaptations in terms of increased support for same day surgery even for complex renal access procedures has improved service. A greater proportion of renal access service can be same day procedures avoiding inpatient stay.

Use of a VBX balloon expandable stent-graft for management of right brachiocephalic vein stenosis

2021 ◽  
pp. 112972982199883
Author(s):  
Robert G Jones ◽  
Andrew P Willis
Keyword(s):  
Stent Graft ◽  
Haemodialysis Patient ◽  
Fistula Formation ◽  
Brachiocephalic Vein ◽  
Luminal Diameter ◽  
Av Fistula ◽  
Advantages And Disadvantages ◽  
Extrinsic Compression ◽  
The Right ◽  
Vein Stenosis

Here we describe the use of a VBX balloon expandable stent-graft (WL Gore, Flagstaff, AZ, USA) to treat a right brachiocephalic vein stenosis in a haemodialysis patient prior to ipsilateral upper limb arterio-venous (AV) fistula formation. Balloon expandable stent-grafts are unsuitable for treating peripheral fistula stenoses due to their susceptibility of being crushed. The right brachiocephalic vein is both relatively short in comparison to the left and is less susceptible to extrinsic compression and the use of such a device to treat stenosis here allows for very accurate placement and restoration of luminal diameter. The advantages and disadvantages of using these devices in haemodialysis access circuits are also discussed herein, in what we believe to be the first report of the application of a dedicated commercially available balloon expandable stent graft in a haemodialysis patient.

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