scholarly journals An Unusual Case of an Epidermoid Cyst Eroding into an Arteriovenous Graft Resulting in Graft Loss

2019 ◽  
pp. 1-2
Author(s):  
Anthony Feghali ◽  
Anthony Feghali ◽  
Kailyn Wilcox ◽  
You Wang
Keyword(s):  
Foreign Body ◽  
Epidermoid Cyst ◽  
Patient Population ◽  
Unusual Case ◽  
Chronic Wound ◽  
Graft Loss ◽  
Arteriovenous Graft ◽  
Hemodialysis Access ◽  
Dialysis Graft ◽  
Arteriovenous Grafts

Arteriovenous grafts (AVG) are unfortunately vulnerable to infection given their nature of being a foreign body that is routinely accessed in a patient population that typically has multiple comorbidities. Management of AVG infections can become more complex when a patient has exhausted all options of hemodialysis access and gets an infection involving the AVG or a chronic wound in closed proximity. Herein, we present a case of an epidermoid cyst that caused breakdown of a thigh PTFE dialysis graft, which became infected and encapsulated the femoral anastomosis.

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

Comparison of axillary-atrial and axillary-iliac arteriovenous grafts for hemodialysis access creation

2019 ◽  
Vol 21 (1) ◽  
pp. 55-59
Author(s):  
Gabriel Lopez-Pena ◽  
Javier E Anaya-Ayala ◽  
Ramon Garcia-Alva ◽  
Lizeth Luna ◽  
Rene Lizola ◽  
...  
Keyword(s):  
Axillary Artery ◽  
Infectious Complications ◽  
Primary Patency ◽  
Secondary Patency ◽  
Arteriovenous Graft ◽  
Hemodialysis Access ◽  
Endovascular Recanalization ◽  
Arteriovenous Grafts ◽  
The Right ◽  
Stage Renal Disease

Objective: The aim of this study was to compare two complex vascular access techniques that utilize the axillary artery as inflow and accesses were created with early cannulation grafts: the axillary-atrial arteriovenous graft versus axillary-iliac arteriovenous graft. Methods: This is a retrospective study of end-stage renal disease patients with occluded intrathoracic central veins that underwent complex hemodialysis access creation in our institution after failed endovascular recanalization attempts. Patients’ demographics, comorbidities, number and types of previous accesses, intraoperative variables, and clinical outcomes were collected and compared. Results: Four patients underwent axillary-atrial arteriovenous graft creation with Flixene™ (Atrium™, Hudson, NH, USA) grafts, through a midline sternotomy to expose the right atrium; all were successfully implanted and used for hemodialysis within the first 72 h; one patient developed a pseudoaneurysm in the mid-graft portion, requiring surgical repair, and it is currently functional. Eight axillary-iliac arteriovenous grafts were created; all grafts were patent and were utilized within 96 h after placement. At 6 months of follow-up period, five (62 %) of our patients underwent graft thrombectomy, one (12 %) balloon angioplasty at the vein anastomosis secondary to stenosis, and two (25 %) grafts were removed due to infectious complications. Axillary-atrial arteriovenous graft and axillary-iliac arteriovenous graft primary patency rates at 6 months were 75% and 48%, respectively; 6-month secondary patency of the axillary-atrial arteriovenous graft compares favorably against that of axillary-iliac arteriovenous graft (100% vs 75%, respectively). Conclusion: Despite the invasiveness, direct atrial outflow procedures remain a valid alternative in carefully selected patients with adequate cardiopulmonary reserve.

Forearm brachial artery to brachial vein looped arteriovenous grafts: A single center, single surgeon observational study

2021 ◽  
pp. 112972982110150
Author(s):  
Jeremy Liu ◽  
Josiah Situmeang ◽  
Devin Takahashi ◽  
Russell Harada
Keyword(s):  
Primary Patency ◽  
The Body ◽  
Secondary Patency ◽  
Close Monitoring ◽  
Arteriovenous Graft ◽  
Inclusion Criteria ◽  
Kaplan Meier ◽  
Brachial Vein ◽  
Arteriovenous Grafts

Background: Long-term hemodialysis (HD) treatment requires the establishment of a cannulatable vascular access (VA) point. While the arteriovenous fistula (AVF) is considered the gold standard, the arteriovenous graft (AVG) is a viable alternative especially in patients with poor superficial venous anatomy. Few studies have assessed the efficacy of the brachial-brachial arteriovenous graft (BB-AVG) for long-term HD access. By analyzing one surgeon’s experience in creating, surveilling and maintaining BB-AVGs, this retrospective study aims to add to the body of literature in assessing patency outcomes of BB-AVGs. Methods: We identified 57 BB-AVGs that met inclusion criteria and were created between October 6, 2005 and May 1, 2019 by a single surgeon in 54 patients. We analyzed primary failures, patency, complications and interventions. Patency rates were calculated by the Kaplan–Meier method. The incidence of complications and interventions were expressed as number of events per person-year. Results: A total of 54 patients (median age of 65 years) were analyzed. Primary patency rates at 12, 24, and 36 months were 20.4% 7.4%, and 5.0%. Primary assisted patency rates at 12, 24, and 36 months were 46.7%, 33.5%, and 15.1%. The secondary patency rates at 12, 24, and 36 months were 81.8%, 63.8%, and 60.1%, respectively. The incidence of complications and interventions was 2.164 per person-year. Most complications and interventions were due to stenosis (1.202 per person-year) or thrombosis (0.802 per person-year). Conclusion: In patients with poor superficial veins, the brachial vein is a reasonable alternative to use as the venous outflow. However, in order to achieve acceptable patency rates, close monitoring of the VA, as well as aggressive treatment of complications within the brachial vein is necessary. Overall, the BB-AVG should be considered in patients who lack adequate superficial veins and require preservation of the more proximal veins.

The usefulness and feasibility of placing a clinch knot with a guidewire to achieve temporary hemostasis in arteriovenous dialysis access interventions

2020 ◽  
pp. 112972982095474
Author(s):  
Sung-Joon Park ◽  
Hwan Hoon Chung ◽  
Seung Hwa Lee ◽  
Sung Beom Cho ◽  
Tae-Seok Seo ◽  
...  
Keyword(s):  
Clinical Success ◽  
Primary Patency ◽  
Interventional Treatment ◽  
Secondary Patency ◽  
Dialysis Access ◽  
Hemodialysis Access ◽  
Purse String Suture ◽  
Purse String ◽  
Arteriovenous Fistulas ◽  
Arteriovenous Grafts

Purpose: To evaluate the usefulness and feasibility of using a reversible clinch knot with a guidewire in place rather than eliminating the access route during an arteriovenous hemodialysis access (AV access) intervention using the facing sheath technique. Material and methods: From July 2016 to June 2019, we retrospectively studied 78 sessions performed as interventional treatment for arteriovenous (AV) hemodialysis (HD) access using the “facing-sheath technique.” In all sessions, all antegrade sheaths were removed while a 0.035-inch guidewire remained in place with purse-string suture and the clinch knot. Seventy-two sessions were performed in patients with thrombosed AV accesses (69 arteriovenous grafts [AVGs] and three arteriovenous fistulas [AVFs]), and six sessions were carried out to treat non-thrombosed AV accesses (four AVGs and two AVFs). We evaluated whether proper hemostasis and successful reinsertion of the sheath over the wire into the clinch knot was achieved. Clinical success was defined as achieving prompt restoration of blood flow for AV access, and the postintervention primary and secondary patency were also evaluated. Result: In all 87 clinch knots created in 78 total sessions, proper hemostasis was achieved. All clinch knots that required reversal for additional procedures were successfully reopened (55 clinch knots in 50 sessions). The postintervention primary patency rates at 1, 3, and 6 months, and at 1 year were 77.8%, 68.9%, 55.6%, and 33.3%, respectively. The postintervention secondary patency rates at 1, 3, and 6 months, and also at 1 year were 93.3%, 91.1%, 86.7%, and 86.7%, respectively. Conclusion: Our AV access intervention which used a clinch knot with purse-string suture while the guidewire remained in place was both useful and feasible for maintaining temporary hemostasis.

scholarly journals The Effect of Race on Arteriovenous Graft Outcomes in a Veteran Dialysis Patient Population

2021 ◽  
Vol 74 (3) ◽  
pp. e214
Author(s):  
Diana Otoya ◽  
Kedar S. Lavingia ◽  
Marc Posner ◽  
Michael Amendola
Keyword(s):  
Patient Population ◽  
Dialysis Patient ◽  
Arteriovenous Graft

Good long-term patency: 10-year follow-up using the mid-thigh adductor loop arteriovenous graft

2018 ◽  
Vol 20 (3) ◽  
pp. 313-320 ◽  
Author(s):  
Samantha J McEwan ◽  
Hannah Maple ◽  
Paul J Gibbs
Keyword(s):  
Venous Access ◽  
Fistula Formation ◽  
Published Data ◽  
Arteriovenous Graft ◽  
Patient Journey ◽  
Graft Thrombosis ◽  
Arteriovenous Grafts ◽  
Good Patency

Introduction: Definitive access in patients requiring renal replacement therapy is an ever-increasing challenge. For those where autogenous venous access is no longer a viable option, arteriovenous grafts can be considered. This article describes long-term follow-up, complications and patency rates of the mid-thigh ‘adductor loop’ arteriovenous graft. Methods: 50 mid-thigh loop arteriovenous grafts have been inserted into 48 patients in our unit over the past 11 years. A prospective database was collected on patients receiving an arteriovenous graft at our unit by the senior author. All remained under the care of our unit ensuring accurate follow-up data collection and database was updated at regular intervals. Results: Death-only censored primary patency at 1, 3 and 5 years was 76%, 44% and 23%, respectively. Patients receiving transplants were not censored as follow-up of the arteriovenous grafts was possible. Secondary patency at 1, 3 and 5 years was 95%, 63% and 45%. These rates are higher than previous studies looking at lower limb arteriovenous grafts. Graft thrombosis occurred in 14 patients (28%). Six patients were treated for an infection (12%) but only four grafts were excised; much lower than documented in previous studies. Conclusion: Autogenous venous access remains the perceived gold standard for patients requiring dialysis for end stage renal failure, despite some published data reporting poor outcomes. We have shown that adductor loop arteriovenous grafts can be a reliable, safe and long-term alternative in those whom fistula formation is not possible and may have a role earlier in the patient journey than previously thought, as a result of good patency and lower complications.

scholarly journals Unusual case of a graphite foreign body in the anterior chamber

2011 ◽  
Vol 1 (3) ◽  
pp. 73 ◽  
Author(s):  
Anika Amritanand ◽  
Sheeja S. John ◽  
Swetha S. Philip ◽  
Deepa John ◽  
Sarada David
Keyword(s):  
Foreign Body ◽  
Anterior Chamber ◽  
Inflammatory Reaction ◽  
Unusual Case ◽  
Foreign Bodies ◽  
Progressive Damage ◽  
Severe Inflammatory Reaction ◽  
Pencil Lead

Retained intraocular graphite foreign bodies are uncommon. Although they are generally inert, they have been reported to cause severe inflammatory reaction and progressive damage to intraocular structures. We report a case of a six-year-old girl with a retained intraocular graphite pencil lead foreign body in the anterior chamber of the eye and discuss the various considerations in the management of such cases.

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