The importance of ultrasonography in surgical treatment of vascular access for hemodialysis complications

Background. Most complications of vascular access for hemodialysis require surgical treatment and if ineffective lead to fistula loss and depletion of the vascular resource for the new fistula creation.Objective. To identify complications of permanent vascular access for hemodialysis which require surgical treatment and evaluate its results using duplex scanning.Design and methods. Ultrasonography, clinical and laboratory examinations were performed in 550 patients undergoing hemodialysis.Results. Complications of vascular access for hemodialysis were detected in 154 (28.0 %) patients, surgical treatment was performed in 96 (62.3 %) patients. The main indications for surgical treatment were: significant stenosis, occlusive thrombosis, non-occlusive thrombosis in combination with significant vein stenosis, aneurysm with increased access flow, ischemic steal syndrome of the hand and pulsating hematoma. The analysis of surgical interventions showed that the creation of a new access was more often performed (41.7 %) compared to other types of fistula reconstructions which leads to a decrease in the number of vessels in the upper extremities that can be used to create access in the future.Conclusion. Duplex ultrasound allows diagnosing vascular access for hemodialysis complications and evaluating the results of their surgical treatment.

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The value of ultrasound in the multivariate assessment complications of permanent vascular access for hemodialysis

Translational Medicine ◽

10.18705/2311-4495-2021-8-1-60-67 ◽

2021 ◽

Vol 8 (1) ◽

pp. 60-67

Author(s):

T. V. Zakhmatova ◽

V. S. Koen ◽

R. E. Shtentsel

Keyword(s):

Vascular Access ◽

Ultrasound Examination ◽

Main Tool ◽

Duplex Ultrasound ◽

Maximum Duration ◽

Significant Difference ◽

Dynamic Ultrasound ◽

Access Complications ◽

Design And Methods ◽

Steal Syndrome

Background. The maximum duration of vascular access for hemodialysis functioning rarely exceeds 4 years. The main tool for diagnosing access dysfunction is duplex ultrasound. Dynamic ultrasound examination of vascular access is not included in the standard examination of patient undergoing hemodialysis in Russia.Objective. To study the structure of complications and changes in hemodynamics in the vascular access for hemodialysis and to determine the risk factors contributing to its development.Design and methods. Ultrasound, clinical and laboratory examination was performed in 550 patients undergoing program hemodialysis, 517 (94.0 %) of them had arteriovenous fistula, 33 (6.0 %) patients had arteriovenous graft.Results. Vascular access complications occurred in 26.7 % (147 patients), there was no significant difference in the detection rate of thrombosis (26.5 %), stenosis (23.8 %), and aneurysm (21.1 %). A combination of two complications was observed in 20.4 %, the steal syndrome — in 8.2 %. A correlation was established between the presence of significant stenosis, aneurysm of the outflow vein and the development of thrombosis, between the presence of concomitant diseases of the peripheral arteries and the development of steal syndrome and stenosis of the inflow artery and the anastomosis zone.Conclusion. Duplex ultrasound allows to diagnose complications of vascular access for hemodialysis and determine its causes.

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PARTICULARITY OF HEMODYNAMICS IN HEMODIALYSIS PATIENTS WITH HAND ISCHEMIA

Clinical Practice ◽

10.17816/clinpract34257 ◽

2020 ◽

Author(s):

Tatiana V. Zakhmatova ◽

Valeria S. Koen ◽

Alexander V. Holin

Keyword(s):

Blood Flow ◽

Vascular Access ◽

Ultrasound Examination ◽

Peripheral Resistance ◽

Duplex Ultrasound ◽

Hemodialysis Patients ◽

Fistula Formation ◽

Hand Ischemia ◽

Flow Through ◽

Steal Syndrome

Introduction. Successful hemodialysis is impossible without effective vascular access. However, the average duration of its normal functioning is 2.53.0 years that is associated with complications, one of them is steal syndrome of the hand. Objective. To examine hemodynamic parameters in vascular access and forearm arteries in hemodialysis patients with hand ischemia. Methods. Duplex ultrasound was performed in 550 patients, 517 of which (94.0%) had an arteriovenous fistula, 33 (6.0%) had an arteriovenous graft. The inflow artery, anastomotic zone, outflow vein and arteries distal to the anastomotic zone were assessed during ultrasound examination, linear and volumetric speed indicators, peripheral resistance indices were measured. Results. Steal syndrome was detected in 2.7% of cases. The main reasons are the inflow artery alterations due to diabetes and atherosclerosis that lead to insufficient growth of blood flow through the artery (20,0%); huge anastomosis diameter that causes a vein dilation and significant increase in access flow (13,3%); insufficient blood flow through the ulnar, anterior interosseous arteries and the absence of collateral branches that did not compensate for retrograde blood flow in the radial artery distal to anastomosis (40,0%); microcirculatory dysfunction of the hand and alterations of the regulation mechanisms of the resistive vessels tone (26,7%). Conclusion. Dynamic ultrasound examination of vascular access can detect adverse changes in hemodynamics and avoid severe ischemic complications. The main reason of steal syndrome is the condition of the forearm arteries not participating in the fistula formation and the hand microvasculature.

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THREAT ANALYSIS OF REASONS LEADING TO FAILURE OF PERMANENT HEAMODIALYSIS ACCESS

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v71i3.4797 ◽

2021 ◽

Vol 71 (3) ◽

pp. 861-65

Author(s):

Falak Siyar ◽

Muhammad Jamil ◽

Kishwar Ali ◽

Humera Latif ◽

Hafiz Khalid Pervaiz ◽

...

Keyword(s):

Vascular Access ◽

Venous Hypertension ◽

Military Hospital ◽

Central Vein ◽

True Aneurysm ◽

Threat Analysis ◽

Central Venous Stenosis ◽

Vein Stenosis ◽

Steal Syndrome ◽

Central Vein Stenosis

Objective: To analyze the commonest threats which lead to the failure of a permanent vascular haemodialysis access. Study Design: Prospective observational study. Place and Duration of Study: Department of Vascular Surgery, Combined Military Hospital Rawalpindi, from Nov 2018 to Nov 2019. Methodology: All patients who presented with arteriovenous fistula (AVF) or arteriovenous graft (AVG) related complications which can potentially fail an access were included. The frequency, with which these complications occurred, was noted. Results: A total of 158 patients were included, 73 (46.20%) were male and 85 (53.80%) were females. The complications observed in order of frequency were arteriovenous fistulathrombosis (anastomotic or draining vein) in 60 (38%), pseudo aneurysms in 39 (24.68%), stealing veins causing non-maturity of the access in 14 (8.86%), venous hypertension causing extremity edema in 14 (8.86%) (7 due to stealing veins and 7 due to central venous stenosis), AVF anastomotic or draining vein stenosis in 8 (5.06%), wound hematoma in 5 (3.16%), wound infection in 5 (3.16%), true aneurysm of the draining vein in 4 (2.56%), steal syndrome in 3 (1.9%), wound seroma in 3 (1.9%), post op arm edema(not related to central vein stenosis orstealing veins) in 2 (1.26%) and compression neuropathy in 1 (0.6%) of the patients. Conclusion: Complications of vascular access are the potential threats to the life of a permanent vascular access. Early diagnosis and timely intervention can help in fistula salvage.

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Ultrasound evaluation of access complications: Thrombosis, aneurysms, pseudoaneurysms and infections

The Journal of Vascular Access ◽

10.1177/11297298211018062 ◽

2021 ◽

pp. 112972982110180

Author(s):

Mario Meola ◽

Antonio Marciello ◽

Gianfranco Di Salle ◽

Ilaria Petrucci

Keyword(s):

Vascular Access ◽

Pulse Wave ◽

De Novo ◽

Late Complications ◽

Prosthesis Infection ◽

Ultrasound Evaluation ◽

Access Complications ◽

Vein Stenosis ◽

Post Implantation

Arteriovenous fistula (AVF) complications are classified based on fistula outcomes. This review aims to update colour Doppler (CD) and pulse wave Doppler (PWD) roles in managing early and late complications of the native and prosthetic AVF. Vascular access (VA) failure occurs because inflow or outflow stenosis activates Wirchow’s triad inducing thrombosis. Therefore, the diagnosis of the tributary artery and outgoing vein stenosis will be the first topic considered. Post-implantation complications occur from the inability to achieve AVF maturation and dialysis suitability due to inflow/outflow stenosis. Late stenosis is usually a sequence of early defects repaired to maintain patency. Less frequently, in the mature AVF or graft, complications are acquired ‘de novo’. They derive either from incorrect management of vascular access (haematoma, pseudoaneurysm, prosthesis infection) or wall pathologies (aneurysm, myxoid valve degeneration, kinking, coiling, abnormal dilation from defects of elastic structures). High-resolution transducers (10–20 MHz) allow the characterization of the wall damage, haemodynamic dysfunctions, early and late complications even if phlebography remains the gold standard for the diagnosis for its sensitivity and specificity.

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Surgical Treatment of Coronary Subclavian Steal Syndrome with Carotid Subclavian Bypass

Annals of Vascular Surgery ◽

10.1007/s10016-001-0342-y ◽

2003 ◽

Vol 17 (1) ◽

pp. 22-26 ◽

Cited By ~ 10

Author(s):

Philip S.K. Paty ◽

Manish Mehta ◽

R. Clement Darling ◽

Paul B. Kreienberg ◽

Benjamin B. Chang ◽

...

Keyword(s):

Surgical Treatment ◽

Subclavian Steal Syndrome ◽

Subclavian Steal ◽

Coronary Subclavian Steal Syndrome ◽

Steal Syndrome

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‘A transverse scar on the neck’ – psychosomatic approach in the differential diagnosis and surgical treatment of hyperthyroidism in post-war Finland

Medical History ◽

10.1017/mdh.2021.4 ◽

2021 ◽

Vol 65 (2) ◽

pp. 140-156

Author(s):

Eve-Riina Hyrkäs

Keyword(s):

Surgical Treatment ◽

Psychiatric Patients ◽

Differential Diagnostics ◽

Historical Study ◽

Complex Nature ◽

Surgical Interventions ◽

Somatic Illness ◽

Post War ◽

Definition Of ◽

The Mind

AbstractIn the Finnish medical discussion during the middle decades of the twentieth century, the challenging differential diagnostics between hyperthyroidism and various neuroses was perceived to yield a risk of unnecessary surgical interventions of psychiatric patients. In 1963, the Finnish surgeon Erkki Saarenmaa claimed that ‘the most significant mark of a neurotic was a transverse scar on the neck’, a result of an unnecessary thyroid surgery. The utterance was connected to the complex nature of thyroid diseases, which seemed to be to ‘a great extent psychosomatic’. Setting forth from this statement, the article aims to decipher the connection between hyperthyroidism, unnecessary surgical treatment and the psychosomatic approach in Finnish medicine. Utilising a wide variety of published medical research and discussion in specialist journals, the article examines the theoretical debate around troublesome diagnostics of functional complaints. It focuses on the introduction of new medical ideas, namely the concepts of ‘psychosomatics’ and ‘stress’. In the process, the article aims to unveil a definition of psychosomatic illness that places it on a continuum between psychological and somatic illness. That psychosomatic approach creates a space with interpretative potential can be applied to the historiography of psychosomatic phenomena more generally. Further inquiry into the intersections of surgery and psychosomatics would enrich both historiographies. It is also argued that the historical study of psychosomatic syndromes may become skewed, if the term ‘psychosomatic’ is from the outset taken to signify something that is all in the mind.

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Surgical treatment of acute abscesses and gangrene of the lungs

Kazan medical journal ◽

10.17816/kazmj59786 ◽

1982 ◽

Vol 63 (1) ◽

pp. 28-31

Author(s):

E. A. Wagner ◽

V. M. Subbotin ◽

V. D. Firsov ◽

V. A. Cherkasov ◽

V. I. Ilchishin ◽

...

Keyword(s):

Surgical Treatment ◽

Conservative Treatment ◽

Surgical Interventions

Abstract. The experience of treating 263 patients with acute abscesses and lung gangrene is generalized. Acute abscesses are mainly subject to conservative treatment; surgical interventions were performed in 13%. With gangrene of the lung, conservative treatment and palliative operations are futile. Preference is given to early radical operations performed before dangerous complications occur. Possible ways to reduce mortality in acute pulmonary suppuration are indicated.

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Problems of surgical treatment of the anterior pelvic ring chronic injuries

Practical medicine ◽

10.32000/2072-1757-2021-3-47-54 ◽

2021 ◽

Vol 19 (3) ◽

pp. 47-54

Author(s):

A. F. LAZAREV ◽

◽

E. I. SOLOD ◽

YA. G. GUDUSHAURI ◽

E. I. KALININ ◽

...

Keyword(s):

Surgical Treatment ◽

Pelvic Ring ◽

Metal Structure ◽

Complex Problem ◽

Long Term Results ◽

Fixation Method ◽

Surgical Interventions ◽

Anterior Section ◽

Pelvic Injuries ◽

Study Results

A surgical treatment of the joints of the pelvic ring, especially the pubic joint is a separate and complex problem. When using standard plates, which are applied in the treatment of patients with fresh injuries to stabilize old injuries of the pelvic ring, problems arise with fatigue fracture of plates, destabilization of the metal structure and the need for repeated surgical interventions. Therefore, in the case of old injuries, during surgical treatment, it is necessary to use other tactical approaches to fixing pelvic injuries and to search for adapted structures for such cases. The purpose — to study the features of fixation of old injuries of the pelvic ring and to determine the results of different methods of the anterior pelvis fixation in old cases. Materials and methods. A retrospective analysis of the performed surgical treatment was carried out. In 2000-2015, in the first department of National Medical Research Center of Traumatology and Orthopedics named after N.N. Priorov, 117 patients underwent surgical treatment of old injuries of the anterior pelvic ring under our supervision using standard reconstructive plates applied in the surgical treatment of new injuries of the pelvic ring. Results. Of the 65 patients who underwent fixation of an old injury of the anterior semiring with AO reconstructive plates and AO pelvic plates, installed in a standard manner as in new injuries, 12 patients (10,2%) experienced migration or fracture of structures within 2 to 6 months from the operation. In 52 patients, fixation of the anterior section with two AO plates was applied, one of which was located in a standard way along the upper edge of the pubic bones, the second was implanted additionally along the anterior surface of the pelvic ring perpendicular to the first one. In this group, migration and destabilization of the structures was observed in 7 patients (13,4%) within a period from 2 weeks to 2 months from the date of the operation. Conclusion. The analysis of the study results suggests that surgical treatment of old injuries of the anterior pelvic ring requires a special approach to the choice of the surgical fixation method, which differs from the treatment of new injuries. Over time, in the absence of treatment for injuries and ruptures of the pelvic ring, cicatricial-fibrous adhesions of the pelvic ring occur, which does not always ensure the stability of the pelvic ring, but leads to rigid post-traumatic deformity of the pelvis. Taking into account the cases of destabilization in groups 1 — 10,2% and 2 — 13,4%, as well as the assessment of the long-term results according to the Majeed scale, the use of standard methods for fixing the anterior pelvic semiring can be considered ineffective in old pelvic injuries.

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