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 Assessment of Proximal Radio-median Cubital/Radio-Cephalic Arterio-venous Fistula

2021 ◽  
pp. 612-619
Author(s):  
Jawed Akther ◽  
Y. R. Lamture ◽  
Varsha P. Gajbhiye ◽  
Ranjit Ambad ◽  
Aditya V. Ghunage
Keyword(s):  
Postoperative Complications ◽  
Chronic Glomerulonephritis ◽  
Mean Flow ◽  
Cross Sectional ◽  
Av Fistula ◽  
Proximal Forearm ◽  
Venous Fistula ◽  
Stage Renal Disease ◽  
End Stage

The present study aims to conducted the Assessment of Proximal radio-median cubital/radio-cephalic Arterio-venous Fistula. Arterio-venous Fistula is life line for long-term hemodialysis for end stage renal disease patients. The order of preference as per National Kidney Foundation/ Kidney Disease Out Come Quality Initiative (KDOQI) is distal Radio Cephalic fistula is considered as gold standard followed by elbow Brachio Cephalic Fistula, transposed Brachio-Basilic Fistula, forearm arterio-venous graft. This is a cross sectional-prospective interventional study, 05/2017 to 04/2019, JNMC, Wardha, MH, with sample size of 66 cases. Out of 66 cases 25 % patients had diabetes mellitus, 48% cases were suffering from chronic glomerulonephritis, 15 % cases were suffering hypertension, 6 % cases had COPD and another 6 % cases had some cardiovascular disease. About 54 % cases had previous access failure. In our study the mean flow volume for AV fistula in proximal forearm was 485± 291 ml/minon postoperative day1, 695 ± 298 on postoperative day 7 and 755± 347 ml/min. Overall postoperative complications in 12% cases was reported in our case study though Yilmiz et al reported postoperative complications in 15% cases.

scholarly journals Morphological feature of brachial artery and its clinical significance

2015 ◽  
Vol 32 (03) ◽  
pp. 129-134
Author(s):  
W. Al Talalwah ◽  
D. Getachew ◽  
R. Soames
Keyword(s):  
Clinical Significance ◽  
Upper Limb ◽  
Brachial Artery ◽  
Surgical Complication ◽  
Ulnar Artery ◽  
Internal Diameter ◽  
Terminal Branch ◽  
External Diameter ◽  
Venous Fistula ◽  
The Right

Abstract Introduction: The present study is to provide comprehensive data concerning the morphology of brachial artery which has a clinical significance for clinicians, orthopedics, vascular surgeons and anatomists. Materials and Methods: Routine dissections of the right and left upper limb of 34 adult cadavers (20 male and 14 female: mean age 78.9 year) were undertaken. It investigates the characteristics of the brachial artery such as the internal diameter, external diameter, wall thickness and distance of bifurcation of brachial artery. Results: The mean of the external and internal diameters of the brachial artery from proximal to distal ranged from 6.87-5.35 mm respectively. The bifurcation of the brachial artery from the head of radius into its terminal branch radial and ulnar artery ranged from 13.49-13.79 mm, while the distance of bifurcation of common interosseous from origin of the ulnar artery ranged from 33.11-33.45 mm. The angle of bifurcation ofthe radial and ulnar arteries from the brachial artery ranged from 5.79-7.33° and 18.640-19.36° respectively. Due to variability of the brachial artery in the upper limb, the surgical and invasive procedures are performed in the region such as artiicial arterial-venous fistula become more difficult and may result in iatrogenic injury. Conclusion: Therefore, it is a clinical significant for surgeons to known the variable morphology and course of brachial artery to minimize surgical complication prior to operation.

scholarly journals Medical Adjuvant Therapy in Reducing Thrombosis With Arteriovenous Grafts and Fistulae Use: A Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Vol 27 ◽  
pp. 107602962110638
Author(s):  
Kaleem Ullah ◽  
Maham Bashir ◽  
Noor Ul Ain ◽  
Azza Sarfraz ◽  
Zouina Sarfraz ◽  
...  
Keyword(s):  
Adjuvant Therapy ◽  
Adjuvant Treatment ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Graft Thrombosis ◽  
Av Fistula ◽  
Number Of Patients ◽  
Long Term Follow Up ◽  
Stage Renal Disease ◽  
End Stage

Hemodialysis is required for patients with end-stage renal disease (ESRD) that require arteriovenous (AV) grafts or fistulas for vascular access. These access points are prone to thrombosis. To determine the effect of medical adjuvant therapy on AV graft/fistula patency among patients with ESRD on hemodialysis. Adhering to the PRISMA 2020 statement, a systematic search was conducted until August 20, 2021, with keywords including arteriovenous graft, fistula, patency, thrombosis, hemodialysis, adjuvant treatment. The following databases were searched: PubMed, Scopus, Web of Science, CINAHL Plus, and Cochrane. A random-effects model was employed using Review Manager 5.4 for data analysis. The meta-analysis pooled in 1985 participants with 1000 (50.4%) in the medical adjuvant treatment group. At a snapshot, medical adjuvant therapy reduced the risk for graft thrombosis (RR = 0.64, P = .02). Notable medications included aspirin for graft thrombosis (RR = 0.36, P = .006) and ticlopidine for fistula thrombosis (RR = 0.53, P = .01). Certain antiplatelet therapies (aspirin and ticlopidine) reduced the number of patients with AV fistula/graft thrombosis among patients with high heterogeneity among the trials. Other therapies (fish oil, sulfinpyrazone, clopidogrel, and aspirin/dipyridamole) did not demonstrate significant improvement but may be promising once concrete evidence is available. Potential benefits of anti-platelet therapies may be explored to maintain the potency of AV grafts/fistulas through well-designed placebo-controlled trials and long-term follow-up.

scholarly journals Intracardiac fistula: an unusual complication of catheter-related blood stream infection

JRSM Open ◽  
2017 ◽  
Vol 8 (9) ◽  
pp. 205427041772823 ◽  
Author(s):  
Abhilash Koratala ◽  
Hussain Aboud ◽  
Robert Gibson ◽  
Karen K Hamilton
Keyword(s):  
End Stage Renal Disease ◽  
Blood Stream Infection ◽  
Significant Risk ◽  
Blood Stream ◽  
Unusual Complication ◽  
Early Use ◽  
Venous Fistula ◽  
Stage Renal Disease ◽  
End Stage ◽  
High Index Of Suspicion

Lesson In end stage renal disease patients on dialysis, the use of catheter as a vascular access is associated with a significant risk of sepsis compared to an arterio-venous fistula. Our case emphasizes the importance of having high index of suspicion for unusual complications in patients presenting with possible catheter-related blood stream infection and early use of complementary tools such as trans-oesophageal echocardiography whenever applicable.

MO960RENAL TRANSPLANTATION FROM A LIVING DONOR WITH RENAL ARTERY FIBROMUSCULAR DYSPLASIA

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Eva Paraskevi Andronikidi ◽  
Glykeria Tsouka ◽  
Myrto Giannopoulou ◽  
Konstantinos Botsakis ◽  
Xanthi Benia ◽  
...  
Keyword(s):  
Renal Disease ◽  
Serum Creatinine ◽  
Renal Artery ◽  
Left Renal Artery ◽  
Close Monitoring ◽  
History Of ◽  
The Right ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background and Aims Renal transplantation is considered the most effective and less costly modality of renal replacement therapy in patients with end stage renal disease. The disparity between kidney allografts and recipients has led to a global effort to increase the pool of kidney donors. Accordingly, fibromuscular dysplasia (FMD) is no longer considered an absolute contraindication for kidney donation. The incidence of FMD is about 2.3%-5.8% in potential kidney donors. There are few cases in the literature where renal artery stenosis in allografts with known pre-transplantation FMD became worse after transplantation, indicating the importance of a proper follow up in the recipients. This is a case of a living kidney donor with no history of hypertension, proteinuria or elevated serum creatinine, whose intra-arterial digital subtraction angiography revealed FMD lesions in the left renal artery. Method Case report Results A 54-year-old Caucasian female with medical history of hypothyroidism took the decision to offer her kidney to her 37-year-old son who was diagnosed with end-stage renal disease five years ago secondary to diabetes mellitus type I. She had no history for diabetes, hypertension and renal disease. Her vital signs on admission were heart rate of 78 beats/min and blood pressure of 130/70 mmHg. Urinalysis, biochemical profile and serological evaluations were all within normal ranges. Blood urea was 36 mg/dL and serum creatinine was 0.6 mg/dL (eGFR 97ml/min/1.73m2). The abdominal ultrasound and renogram with Tc-99m DTPA showed no remarkable findings. On intra-arterial digital subtraction angiography an abnormal succession of dilatations and multifocal stenoses of the left renal artery, characteristic of medial FMD, was found. The right renal artery was normal. Apart from a dysfunctional permanent left femoral catheter, the patient had no other vascular access for hemodialysis because of Superior Vena Cava syndrome, so he needed urgent transplantation. Taking all of these into consideration, the patient was offered renal transplantation as the best option. A left open donor nephrectomy was performed; the renal artery was divided distal to the stenotic dysplastic area. The allograft was placed at the right iliac fossa of the recipient with arterial and venous anastomosis to the extrarenal iliac vessels. Post-operatively, the recipient had a delayed graft function lasted 13 days. On renal artery Doppler in the allograft we found increased resistance index (RI) that gradually normalized without any intervention. An immunosuppressive regiment of tacrolimus, mycophenolate and prednisone was administered according to our center protocol. At discharge serum creatinine was 1.7 mg/dL (eGFR: 50ml/min/1.73m2). At the year follow-up, the donor was normotensive and had near normal renal function (Cr:1.3mg/dL, eGFR: 70ml/min/1.73m2). The recipient has a well-controlled blood pressure receiving two antihypertensive drugs and maintains a satisfactory renal function. Conclusion Few cases with FMD in renal allografts from living and deceased donors have been described. In a review of 4 studies the authors concluded that the outcome of transplantation with allografts from living donors with medial FMD was satisfactory and these allografts could be used to increase the donor pool. Furthermore, it is strongly recommended to have a thorough pre-transplantation check of the donor as well as a close monitoring of both the donor and recipient after transplantation. This case shows that allografts harvested from carefully selected donors with renal arterial FMD can be successfully used, particularly in urgent conditions. Detailed pre-tranplantation imaging of donor’s renal arteries, selection of the appropriate screening method, as well as close monitoring of both donor and recipient for early interventions after transplantation is of paramount importance.

Management of acute kidney injury and chronic kidney disease

2017 ◽  
pp. 1087-1096
Author(s):  
Natalie Ebert ◽  
Elke Schaeffner
Keyword(s):  
Older Adults ◽  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Staging System ◽  
Kidney Damage ◽  
The Right ◽  
Stage Renal Disease ◽  
End Stage

Both acute and chronic states of kidney disease have considerable healthcare impact as they can produce enormous disease burden and costs. To classify chronic kidney disease into the CKD staging system, glomerular filtration rate as an index of kidney function, as well as albuminuria as a marker of kidney damage have to be assessed as correctly as possible. Misclassification is a serious concern due to the difficulties in precise GFR assessment and correct interpretation of results. Differentiating between pure senescence and true disease among older adults can be a delicate issue. To find the right renal replacement option for individuals that progress to end-stage renal disease can be challenging, and some older patients may even benefit from conservative care without dialysis. To prevent acute kidney injury as a frequent and potentially life-threatening complication, clinicians need to develop an understanding of the common vulnerability to kidney damage among older adults.

scholarly journals Unilateral high division of brachial artery

2016 ◽  
Vol 05 (02) ◽  
pp. 266-272
Author(s):  
T. M. Sucharitha ◽  
L. Hema ◽  
S. V. Phanindra
Keyword(s):  
Upper Limb ◽  
Brachial Artery ◽  
Clinical Importance ◽  
Branching Pattern ◽  
Invasive Procedures ◽  
Arterial Variations ◽  
Female Cadaver ◽  
Variation Patterns ◽  
Cubital Fossa ◽  
The Right

AbstractArterial variations in the arm are of great clinical importance as this area is commonly involved in many surgical and invasive procedures. During dissection, we observed in the right upper limb a variation in the division and branching pattern of brachial artery in a female cadaver. The short segmented brachial artery divided about 6 cms. above the line joining the epicondyles of the humerus, but not in the cubital fossa. The course of the two divisions in the forearm is normal. Knowledge of these variation patterns is useful during surgeries.

Fatal external bleeding from self-severed arterial dialysis tube: An unusual method of suicide

2019 ◽  
Vol 59 (4) ◽  
pp. 210-213
Author(s):  
Supawon Srettabunjong
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Multidisciplinary Approach ◽  
Early Screening ◽  
Haemodialysis Catheter ◽  
Appropriate Treatment ◽  
Treatment Of Depression ◽  
The Right ◽  
Stage Renal Disease ◽  
End Stage

A high risk of suicide has been observed in adults with end-stage renal disease who are undergoing haemodialysis. Since suicide is preventable, early screening, a prompt multidisciplinary approach and appropriate treatment of depression are critical and are recommended to treating physicians. Recently, the case of a woman with end-stage renal disease who had been undergoing haemodialysis was encountered. She died by suicide after self-severing the temporary haemodialysis catheter secured to the right side of her neck. This method of suicide is unusual and rare. This case not only underscores the association between haemodialysis and suicide in patients with end-stage renal disease but also raises awareness of the possibility of such deaths.

scholarly journals Superficial radial artery - a rare variation and its clinical significance

2014 ◽  
Vol 03 (04) ◽  
pp. 225-228
Author(s):  
Sankaran PK ◽  
Gunapriya Raghunath ◽  
Sathyan R. ◽  
Keyword(s):  
Clinical Significance ◽  
Radial Artery ◽  
Upper Limb ◽  
Brachial Artery ◽  
Axillary Artery ◽  
Terminal Branch ◽  
Rare Variation ◽  
Female Cadaver ◽  
The Right

AbstractDuring routine dissection of upper limb, a variation in the origin of radial artery was observed in a female cadaver of about 60 years. The radial artery is usually a smaller terminal branch of the brachial artery in the forearm. On the right side of the cadaver the radial artery was found to originate from second part of the axillary artery, whereas on the left side the origin of radial artery was found to be normal. This variant of radial artery has been rarely documented in literature. Accurate anatomy of radial artery and its variations have definite diagnostic, interventional, and surgical significance.

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