ANXIETY OF HEMODIALYSIS PATIENT WITH ACCESS ARTERIOVENOUS FISTULA (AV-SHUNT): A QUALITATIVE STUDY

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.

Abelacimab Reduces Thrombus Propagation in a Baboon Model of Vascular Graft Thrombosis

Background: Factor XI (FXI) inhibition demonstrated strong efficacy in preventing thrombus formation in preclinical and clinical models of arterial and venous thrombosis. However, the effect of FXI inhibition in halting the progression of a formed clot remains largely unknown. Aims: This study aims to test whether abelacimab, a dual-acting FXI and activated FXI (FXIa) monoclonal antibody, is effective in halting clot formation and downstream growth when administered before or during active clot formation in an established baboon femoral arterio-venous (AV) shunt model. Methods: Three baboons had a chronic femoral AV shunt put in place; platelet and fibrin deposition inside and distal to collagen- or collagen + tissue factor (TF)-coated vascular grafts were measured at baseline (control), in a therapeutic setting, where abelacimab (1 mg/kg, intravenously) was administered 30 minutes after thrombus initiation, and in a preventative setting within the first 48 h and 1 week (144 - 216 h) post-administration. Pharmacodynamic effect was measured by activated partial thromboplastin time (aPTT). Results: Consistent with its half-life of 20 to 30 days, single iv administration of abelacimab at a dose of 1 mg/kg resulted in long-lasting (> 4-week) aPTT prolongation (> 2-fold). Administration of abelacimab 30 minutes after initiation of thrombosis using grafts coated either with collagen or with collagen + TF quickly halted downstream propagation of platelet and fibrin deposition compared to control. Further, downstream propagation of platelet and fibrin deposition was markedly reduced when clotting was induced by collagen, or collagen + tissue factor after abelacimab administration. Conclusions: These data suggest that abelacimab, a dual-acting anti-FXI/FXIa monoclonal antibody with a single long-lasting iv injection has the potential to slow down the growth and reduce the size of thrombi when admistered before or after clot induction. Data indicate a potential for therapeutic benefit of targeting FXI both in therapeutic and preventive settings. Sponsored by: Anthos Therapeutics Inc., 55 Cambridge Parkway, Suite 103, Cambridge, MA 02142 Figure 1 Figure 1. Disclosures Wallisch: Aronora Inc,: Current Employment. Khder: Anthos Therapeutics: Consultancy; Novartis: Current equity holder in publicly-traded company, Other: Retiree. Bloomfield: Anthos Therapeutics: Current Employment. Gruber: Aronora Inc.: Current Employment, Current equity holder in publicly-traded company; Oregon Health and Science University: Current Employment.

Undifferentiated embryonal sarcoma of liver with macroaneurysms and arteriovenous shunt

Undifferentiated embryonal sarcoma (UES) is an uncommon primary hepatic tumour of childhood. The mass usually shows paradoxical features of being cystic on CT and solid on ultrasound. These lesions are usually hypovascular. Very rarely they may present as hypervascular liver masses with macroaneurysms and arteriovenous (AV) shunt, with only less than six cases reported in literature. We report a case of an 11-year-old child who presented with progressive abdominal distention, and CT revealed a large exophytic hypervascular mass of liver with multiple macroaneurysms, pooling of contrast and a high-flow AV shunt. Histopathology, along with immunohistochemistry, revealed the mass to be UES. The child underwent neoadjuvant chemotherapy followed by successful surgery. The prognosis of this tumour depends on prompt diagnosis and early intervention. We present this case to highlight the atypical presentation of UES, which will encourage radiologists to keep this differential in relevant clinical settings.

Arteriovenous shunt as the best hemodialysis access in Chronic Kidney Disease (CKD) patients: a literature review

Arteriovenous Shunt (AV Shunt) is a minor surgical operation that connects (creating anastomoses) the arteries and veins in the arm or other body part for the purpose of making connection access for hemodialysis. AV shunt is the primary choice in establishing vascular access for hemodialysis in patients with Chronic Kidney Disease (CKD). Therefore, this study aims to review the arteriovenous shunt as a hemodialysis access option in CKD patients. The literature study was conducted by searching various written sources, whether in the form of books, archives, articles and journals, or documents relevant to the problem being studied. The mortality rate after AV shunt is 0%, even though it still has postoperative complications. Based on the location of the operation, making the AV shunt is prioritized on the distal part that is not dominant to minimize the damage to the AV shunt. The location of the wrist, namely the brachiocephalic, is a top priority in making an AV shunt because it has many advantages. AV shunt is the primary choice of vascular access for hemodialysis in patients with chronic kidney disease. It is hoped that through the AV shunt, the life expectancy of patients with CKD can be increased, and patients with CKD must receive support from other disciplines such as interns, psychologists, and the patient's family.

Screening in cryptogenic brain abscess: Do not forget pulmonary arteriovenous malformations

Background: Brain abscess usually occurs secondary to trauma, through contiguous spread (e.g.; dental infections, [paranasal] sinusitis, otitis, and mastoiditis), after intracranial neurosurgical procedures, or through hematogenous spread in case of an arteriovenous (AV) shunt, for example; atrial septum defect. Although uncommon, another possible cause of AV shunt which can facilitate brain abscess is a pulmonary arteriovenous malformation (PAVM). We report a case of brain abscess secondary to a solitary PAVM and review the literature. Case Description: A 74-year-old male patient presented with headaches, fatigue, low-grade fever, and homonymous hemianopsia. He was diagnosed with a brain abscess in the left occipital lobe. A chest computed tomography (CT) with intravenous (IV) contrast was performed because of fever and respiratory insufficiency in a period where screening for COVID-19 in suspected patients was important. A solitary PAVM of the left lung was diagnosed. Initial stereotactic burr hole drainage of the abscess was insufficient and resection of the abscess was deemed necessary. Routine workup did not reveal any additional pathology apart from the PAVM. After treatment of the cerebral abscess, the PAVM was treated with embolization using an endovascular plug. Conclusion: It is recommended to screen for PAVM by chest CT with IV contrast in patients with brain abscess when no obvious source of infection can be identified.

Strategies for embolization of direct arteriovenous shunts in brain arteriovenous malformations

Intranidal direct arteriovenous (AV) shunts are rarely observed in brain arteriovenous malformations (bAVMs).1 The endovascular treatment of such direct AV shunts may be challenging. Indeed, there is a significant risk of venous migration of the embolic agent used to occlude the AV shunt, leading to a subsequent risk of nidus bleeding due to impairment (slowdown or even occlusion) of the bAVM’s venous drainage.2Various endovascular techniques have been developed to avoid the risk of such inopportune impairment of the venous drainage during attempts to occlude a direct intranidal AV shunt.3–5 We present in this Technical Video (video 1) different endovascular strategies to occlude such direct AV shunts using dual-lumen balloons with various liquid embolic agents, or using occlusion plugs.Video 1

Outcomes of Patients Who Have Undergone AV Shunt Procedure at Dr. Zainoel Abidin General Hospital in Banda Aceh

In recent decades, kidney disease has been documented as a global public health problem. The current challenge is about improving the treatment of chronic kidney disease (CKD) patients in order to provide a longer life expectancy for them. In hemodialysis, there has been a considerable development in finding access to the vascular system, one of which developments was the creation of arteriovenous access by Cimino and Brescia (called an AV shunt). Research on the AV shunt is still limited, so the researchers are interested in conducting this descriptive epidemiological survey study on the profile of patients undergoing AV shunt procedures at Dr. Zainoel Abidin General Hospital in Banda Aceh in 2017. Data were obtained retrospectively from the medical records of the Central Surgery Installation Department of Dr.Zainoel Abidin General Hospital in Banda Aceh, and there were 105 patients have undergone AV shunt, 72 men (68.6%) and 33 women (31.4%). The frequency based on the age was the risking age about 45-54 years as many as 30 people (28.6%). Based on the outcomes obtained 95 people (90.48%) who have used the AV shunt for hemodialysis access, consisting of 66 men (62.86%) and 29 women (27.62). Based on the duration of use, AV Shunt is mostly used for 1 year with the number of 48 patients (50.52%) in the proportion of men and women were 38.95% and 11.57%. With an average duration of use of AV Shunt 2,6 years. From the results of this study, we conclude that the result was obtained that the highest cases in patients who have undergone AV Shunt is man as much as 68.6%. Furthermore, Pertaining to this study, it was obtained that the majority of age who undergo Av shunt is 45-54 years. In addition, the result of this study showed that the success rate of surgery AV shunt in Dr. Zainoel Abidin General Hospital in Banda Aceh was high. It is about 90, 48% with an average duration use of Av shunt is 2.6 years.

Accuracy Of Spiral Laminar Flow, Spectral Broadening And Murmur / Thrill As Av-Shunt Maturuty Predictors In Dr. Mohammad Hoesin Hospital Palembang

Background : Hemodialysis is a therapy for end-stage cornic kidney disease (ESRD) which is most often used as renal replacement therapy. Vascular access for hemodialysis is essential in the management of patients with chronic kidney disease. One type of vascular access is av fistula. A well-matured AVF is needed in order to function optimally during the hemodialysis process. The study of Srivastava et al. In India examined a predictor parameter of the maturation of AVF using Doppler ultrasound. The parameters studied were Spiral Laminar Flow (SLF), Spectral Broadening and Murmur / thrill. The results of this study state that SLF is the most important and early predictor of AVF maturation.5 Research on the accuracy of spiral laminar flow, spectral broadening and murmur / thrill as predictors of av-shunt maturity has never been carried out in Indonesia. This encourages this research to be carried out. Method : This type of research is the prognostic test. The study was conducted in the vascular and endovascular subdivisions from July - September 2020 or until the number of research samples is met. Result : There were 30 samples in this study, Murmur / thrill had high sensitivity and specificity values ​​on day 21 while SLF and spectral broadening had very high sensitivity and specificity values ​​in predicting AVF maturase from day 7th and 21th, also had a significant association with AVF maturase (p < 0.001). Conclusion : Murmur / thrill on 21th day can be a perdictor for maturity of AVF

Characteristics Of Chronic Kidney Failure Patients Using Vascular Access For Hemodialysis In Vascular Surgical Division Dr. Mohammad Hoesin General Hospital Period 1 Januari – 31 Desember 2018

Hemodialysis has been accepted as a method of treatment in patients with CKD in stage 5. A-V fistula is the closest ideal hemodialysis vascular access, so that it can reduce morbidity and mortality of CKD patients. This research is a retrospective descriptive study with data obtained from the A-V fistula surgery form archive in the Vascular and Endovascular Division of the Department of Surgery, FK UNSRI in January 2018-December 2018 and from the patient's medical record. Data processing was carried out with SPSS 16.0. The results of the study obtained 203 patient data with the use of AV Shunt that met the inclusion criteria. The mean age of patients was 50.53 years. There were 114 (56%) male patients and 89 (44%) female patients. Risk factors such as smoking were found in 9 (4%) patients. History of the disease prior to experiencing chronic renal failure was hypertension in 115 patients (56.6%) and diabetes in 81 (40%). There were 69 patient’s Hb data before AV shunt with Hb <7 (1%) in 2 people, 7-8.9 (33%) 67 people, 9-10.9 (53%) 108 people,> 11 (13%) 26 people. 128 (63%) patients had double lumen catheters installed in the right jugular, 5 (2%) patients were placed in the left jugular, and 70 (34%) patients did not have a double lumen catheter. A total of 169 (83%) patients had a history of using AV Shunt. There were 71 (35%) patients with the wrist region anastomosis, 132 (65%) patients with cubiti region anastomosis. Native AV shunt was the most commonly performed in 202 (99.5%) patients. There were no recorded complications after AV Shunt placement in 99 (48.8%) patients, 51 (25.2%) patients had AVF branches, 23 (11.3%) had AV Shunt rupture, 18 (8.8%) AVF stenosis, 1 (0.5%) central stenosis, 1 (0.5%) thrombus, and 11 (5.4%) infections. A total of 167 (82.2%) patients took AV Shunt after 3 months.

Abstract 14952: Hemodynamic Comparison of Left Ventricular Function in Pressure Overload- versus Volume Overload-Induced Heart Failure Models by Invasive Pressure-Volume Analysis

Introduction: Both sustained left ventricular (LV) pressure overload (PO) and volume overload (VO) induces LV remodeling and eventually development of heart failure (HF). Using rat models, the present study aimed to provide a detailed comparison of distinct aspects of LV function in PO- and VO-induced HF. Methods: PO and VO was induced by transverse aortic constriction (TAC, n=12) and aortocaval shunt (AV-shunt, n=12) creation respectively. Controls underwent corresponding sham operations (n=11). LV remodeling was characterized by echocardiography, histology, qRT PCR, and western blot. LV function was assessed by invasive pressure-volume (P-V) analysis. Results: Both sustained PO and VO resulted in the development of HF, as evidenced by increased LV BNP mRNA expression, pulmonary edema, and characteristic symptoms. While the extent of LV hypertrophy was comparable between the HF models, PO induced concentric while VO evoked eccentric LV remodeling. P-V analysis revealed impaired systolic function in both HF models. Accordingly, decreased ejection fraction and impaired ventriculo-arterial coupling (calculated as the ratio of arterial elastance/LV contractility [VAC]: 0.38±0.05 vs. 1.30±0.13, ShamTAC vs. TAC and 0.52±0.08 vs. 1.17±0.13, ShamAV-Shunt vs. AV-shunt; p<0.05) was detected in both HF models. However, in case of VO the severely reduced LV contractility (slope of end-systolic P-V relationship: 1.79±0.19 vs. 0.52±0.06, ShamAV-Shunt vs. AV-shunt, p<0.05 and 2.14±0.28 vs. 2.03±0.21, ShamTAC vs. TAC p>0.05) underpinned the contractility-afterload mismatch, while in case of PO the increased afterload (arterial elastance: 0.77±0.07 vs. 2.64±0.28, ShamTAC vs. TAC and 0.80±0.07 vs. 0.54±0.05, ShamAV-Shunt vs. AV-shunt; p<0.05) was the main determinant. Furthermore, prolongation of active relaxation occurred to a greater extent in case of PO. In addition, increased myocardial stiffness was only observed in PO-induced HF. Conclusion: Systolic function was reduced in both HF models. However, different factors underpinned the impaired VAC in case of VO (reduced LV contractility) and PO (increased arterial elastance). Furthermore, although diastolic function deteriorated in both models, it occurred to a greater extent in case of PO.