access complications
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2022 ◽  
pp. 153857442110686
Author(s):  
Madeleine de Boer ◽  
Timothy Shiraev ◽  
Jacky Loa

Objectives Despite the increasing use of endovascular techniques in the management of peripheral vascular disease, there is little data on the safety of percutaneous closure devices in punctures of synthetic vascular material. Our paper sought to address this paucity in the literature by reviewing the incidence of complications occurring in patients in whom the ProGlide device was utilised to achieve haemostasis post-percutaneous puncture of vascular patches and graft materials. Methods A retrospective review of patient records was conducted at a tertiary referral centre. Patients who had undergone percutaneous punctures of prosthetic bypass grafts or patch angioplasties between January 2011 and December 2020 were identified from a prospectively collected database. Medical records and post-procedural imaging were reviewed to assess the occurrence of post-procedural complications such as pseudoaneurysms, puncture site stenosis and further interventions for access complications. Results A total of 73 punctures of prosthetic material were performed in 42 patients, of which 39 utilised ProGlides. Median age of included patients was 72 years. There was male predominance in the cohort (69.8%), and most punctures (87.3%) were through polyurethane patches. Device success rate was 95%, and no patients required open repair. There was a low incidence of complications, with no patients developing pseudoaneurysms, arteriovenous fistulas, ischaemic limbs or > 50% stenosis when either manual pressure or the ProGlide device was used to achieve haemostasis. Furthermore, there were no returns to theatre or further interventions performed for access site complications. Conclusion The use of the ProGlide closure device has a low incidence of complications and its safety appears to be equivalent to manual compression when used to achieve haemostasis in percutaneous punctures of synthetic vascular material in select patients. To our knowledge, this is the only article to date to assess the safety of the ProGlide in this setting.


Author(s):  
Michael Yacoub ◽  
Ali F. AbuRahma
Keyword(s):  

2021 ◽  
Vol 10 (2) ◽  
pp. 240-248
Author(s):  
Siti Nafisah ◽  
Meira Irawati ◽  
Wahyu Hidayati

Background: Cannulation is an intervention that inserts a needle through the skin into a blood vessel. Av-shunt is the most recommended access for use in the hemodialysis therapy process. Psychosocial problems, especially feelings of anxiety and fear can be felt by patients due to AV-shunt. Anxiety is a scientific attitude experienced by each individual as a form of response in dealing with problems or threats Vascular access complications may threaten lives and reduce treatment satisfaction and life quality.  Objectives: This study aimed to describe hemodialysis patient anxiety with arteriovenous fistula (AV-shunt) access. Methods: A descriptive qualitative study using the in-depth interview method with phenomenology approach. The study was carried out with four informants undergoing hemodialysis in RSUD dr. Haryoto Lumajang. Samples were taken using purposive sampling. Participant statements were recorded using a voice recorded, transcribed, coded, interpreted, and categorized to create a theme. Results: The study results produced three themes: (1) Emotional feeling perceived associated with AV-shunt experience: Anxiety, fear, and helplessness, (2) Physical and physical activity changes: Dark skin, dry skin, limp body, and fatigue, and (3) Patient knowledge regarding av-shunt, i.e., AV-shunt access and based on information sources. Conclusion: Patients with arteriovenous fistula (AV-shunt) access had anxieties caused by cannulation initial pain, fear, and sense of uselessness.


2021 ◽  
pp. 112972982110504
Author(s):  
Gianfranco Aprigliano ◽  
Luca Giupponi ◽  
Altin Palloshi ◽  
Fabio Glavina ◽  
Nuccia Morici

Antegrade femoral puncture (AFP) is the preferred strategy to treat lower limb obstructive disease. However, the presence of vascular calcification may be associated with procedure related adverse events, impairing endovascular device strategies. We describe a case series of superficial femoral and popliteal artery treatments by Supera stent implantation using a simple technique to significantly minimize the dimension of the antegrade femoral puncture from 6 to 4 French (Fr). All antegrade femoral punctures, crossing femoro-popliteal lesion and predilation were made with 4 Fr introducer. After preparation the Supera stent was navigated in sheathless fashion via 0.018-inch guidewire. Postdilation and final control were made replacing the 4 Fr introducer via the same guidewire. A good final result was achieved. Patients were discharged early without any complications. This minimally invasive technique in cases of infrainguinal peripheral artery disease could be feasible and effective for minimizing the risk of complications in patients with critical limb ischemia.


Author(s):  
Sumon Roy ◽  
Mohamad Kabach ◽  
Dhavalkumar B. Patel ◽  
Luis A. Guzman ◽  
Ion S. Jovin

2021 ◽  
pp. 37-49
Author(s):  
Naveen Galla ◽  
Rajesh I. Patel
Keyword(s):  

2021 ◽  
Vol 1 (2) ◽  
pp. 88-99
Author(s):  
Massimo Torreggiani ◽  
Lucia Bernasconi ◽  
Marco Colucci ◽  
Simone Accarino ◽  
Ettore Pasquinucci ◽  
...  

The arteriovenous fistula (AVF) has long been considered the optimal vascular access. However, the evolving characteristics of the ageing dialysis population limit the creation of an AVF in all patients. Thus, more patients start hemodialysis (HD) with a central venous catheter (CVC) rather than an AVF, and the supremacy of the AVF has recently been questioned. The aim of this study was to analyze the incidence and rate of access complications in 100 patients between 2010 and 2015. A total of 63 patients started HD with an AVF, while 37 began HD with a CVC. We found no differences in patient survival according to the vascular access in use at the beginning of dialysis, but patients were more likely to die while undergoing dialysis by means of a CVC than an AVF. Patients started on dialysis with a CVC had more cardiovascular disease, while patients who began dialysis with an AVF presented more hypertension. Fistulas presented a longer survival time despite more hospital admissions, but CVCs bore a higher risk of infections. Our results suggest that starting dialysis with a CVC does not confer a greater risk of death.


2021 ◽  
pp. 112972982110180
Author(s):  
Mario Meola ◽  
Antonio Marciello ◽  
Gianfranco Di Salle ◽  
Ilaria Petrucci

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.


Author(s):  
B. A. Veselov ◽  
E. P. Burleva

Introduction. Vascular access complications are associated with about 30% of patient hospitalizations, and annual costs of vascular access maintenance account for 14–20% of total healthcare costs for dialysis patients. At the same time, current international clinical guidelines emphasize the need to implement a patient-centered approach with planning of possible vascular access complications and selection of optimal surgical interventions (risk/benefit balance) for correction of compromised access.Aim. To present the first experience of endovasal laser obliteration of arteriovenous fistulas for correction of venous hypertension syndrome.Materials and methods. The first experience of complicated arteriovenous fistulas liquidation using endovasal laser obliteration in 6 patients receiving hemodialysis replacement therapy for stage 5 chronic kidney disease (National kidney Foundation (NkF) classification) is presented. In 5 patients due to the presence of venous hypertension of the upper extremity, where the arteriovenous fistula functioned, open intervention was unacceptable because of the high risk of bleeding. In one patient the arteriovenous fistula was closed due to its aneurysmatic transformation. we performed endovasal laser obliteration of four Cimino-type radial artery-cephalic arteriovenous fistulas, one brachial-basilar arteriovenous fistula, and one brachial-cubital arteriovenous fistula. Endovasal laser obliteration was performed with an endovascular light guide under ultrasound navigation using tumescent anesthesia. we used a laser device with a wavelength of 1.56 µm and power of 15 w, working in continuous mode (time 2–4 min, energy density 500 to 1,000 J/cm). The average diameter (Me) of the fistula vein was 8 mm.Results. The course of the early postoperative period in all patients was uncomplicated. The follow-up period was 30 days. Symptoms of venous hypertension were eliminated in all patients, the pain syndrome disappeared completely, there were slight feelings of heaviness and fullness of the limb.Discussion. Experience has shown that standard modes used for varicose vein obliteration for elimination of arteriovenous fistulas in chronic renal failure are ineffective: under conditions of blood flow in the area of arteriovenous anastomosis the energy density is almost 10 times higher. Therefore, other modes were used in our study: energy density from 500 to 1,000 J/cm. This was due to the lack of coagulation of the fistula vein when using standard parameters due to high blood flow rate, despite the use of proximal and distal vascular compression. In all cases we obtained positive results (obliteration of arteriovenous fistulas) without complications along with the correction of venous hypertension within 1 month after the intervention.Conclusion. The advantages of this method are technical simplicity and minimal blood loss, which is especially important for this cohort of patients with initial anemia against chronic renal failure.


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