1
|
Hogan D, Otoya D, Lavingia K, Amendola M. What is the MAUDE Database Telling us about 510(k) Authorization? Evaluation of Two Generations of Endovascular Arteriovenous Fistula Devices. Ann Vasc Surg 2024; 106:394-399. [PMID: 38815918 DOI: 10.1016/j.avsg.2024.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/19/2024] [Accepted: 03/19/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND In 2019, Bard Peripheral Vascular Inc (BV; now Becton, Dickinson and Company; Sparks, Maryland) received Food and Drug Administration (FDA) approval to begin marketing the WavelinQ EndoAVF System through a process known as 510(k) authorization. Such authorization relies on BV proving that the new WavelinQ EndoAVF System was of "substantial equivalence" to the WavelinQ 4F EndoAVF System. We set forth to analyze patient problems and device issues reported for the new device and determine if they were significantly different from the predicate device its 510(k) approval was based on. METHODS FDA database Manufacturer and User Facility Device Experience was queried for all adverse report events for the WavelinQ EndoAVF System and WavelinQ 4F EndoAVF System. Data were collected on patient issues and device issues. Fisher's exact test was used. RESULTS There were a total of 125 reports for the WavelinQ 4F EndoAVF System and 78 for the WavelinQ EndoAVF System. There was a significant increase in patient problem "hypertension" (0% vs. 5.1%; P = 0.02) for the WavelinQ EndoAVF System but a statistically significant decrease in device issue "failure to align" for the WavelinQ EndoAVF System (24.8% vs. 10.3%; P ≤ 0.01). CONCLUSIONS There were changes in device and patient outcomes between the WavelinQ EndoAVF System and WavelinQ 4F EndoAVF System. While we noted a decrease in device problem "failure to align", there was an overall increase in patients' "hypertension" rates. This highlights the importance of the FDA Manufacturer and User Facility Device Experience reporting in ensuring that device safety is maintained when devices are approved for marketing through the 510(k) process.
Collapse
Affiliation(s)
- Douglas Hogan
- Division of Vascular and Endovascular Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - Diana Otoya
- Division of Vascular and Endovascular Surgery, Virginia Commonwealth University Health System, Richmond, VA; Division of Vascular and Endovascular Surgery, Central Virginia VA Healthcare System, Richmond, VA
| | - Kedar Lavingia
- Division of Vascular and Endovascular Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA; Division of Vascular and Endovascular Surgery, Central Virginia VA Healthcare System, Richmond, VA.
| | - Michael Amendola
- Division of Vascular and Endovascular Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA; Division of Vascular and Endovascular Surgery, Central Virginia VA Healthcare System, Richmond, VA
| |
Collapse
|
2
|
Rajan DK, Kitrou PM. Prospective, Multicenter, Observational Study to Evaluate a Cell-Impermeable Endoprosthesis for Treatment of Stenosis or Occlusion within the Dialysis Outflow Circuit of an Arteriovenous (AV) Fistula or AV Graft (The WRAP Registry). Cardiovasc Intervent Radiol 2023; 46:1285-1291. [PMID: 37592020 PMCID: PMC10533592 DOI: 10.1007/s00270-023-03531-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/29/2023] [Indexed: 08/19/2023]
Abstract
PURPOSE Dysfunctional vascular access due to stenosis/occlusion within the arteriovenous fistula or graft (AVF/AVG) negatively affects the clinical management of patients undergoing hemodialysis. Results from the feasibility study of the WRAPSODY™ Cell-Impermeable Endoprosthesis demonstrated that the device can achieve high patency rates and maintain integrity of the dialysis outflow circuit. This study was designed to assess real-world evidence of safety and efficacy outcomes following device placement. MATERIALS AND METHODS This is a prospective, multicenter, non-investigational, post-market observational study of 500 patients at up to 50 centers worldwide with a mature AVF/AVG dialysis access (≥ 1 hemodialysis session) who experience stenosis/occlusion of the outflow circuit prior to placement of WRAPSODY. Patients will be divided into the following two cohorts: peripheral or central thoracic. Primary outcome measures include target lesion primary patency (TLPP) at 6 months and procedure and/or device-related events through 30 days post-procedure. Secondary outcome measures include TLPP, safety events, and the number of interventions needed to maintain patency through the 24 month study period. Exploratory endpoints include time to access abandonment, resumption of successful dialysis, functional patency, and pending available imaging data, any incidence of stent fractures, migration, or edge stenosis. Study enrollment began in June 2022, the last patient visit is expected in 2026. DISCUSSION It is expected that this study will provide real-world evidence regarding the performance of the WRAPSODY device in a diverse population of patients, which may encourage its use in the continuum of hemodialysis access management. TRIAL REGISTRATION NCT05062291.
Collapse
Affiliation(s)
- Dheeraj K Rajan
- Department of Medical Imaging, University Medical Imaging Toronto/University of Toronto, University Health Network, 585 University Avenue, 1-PMB-287, Toronto, ON, M5G 2N2, Canada.
| | | |
Collapse
|
3
|
Diego P, Fabián M, Constanza M, Mirna L, Martin P. Dialysis access graft occlusion with contrast and ultrasound guided thrombin injection for intractable arm edema and pseudoaneurysm. J Vasc Access 2023; 24:798-801. [PMID: 34590510 DOI: 10.1177/11297298211047330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We present the case of a patient with a brachio-basilic graft forearm loop with intractable edema and thrombosed central veins. She showed up with an important edema after some effort and a previously thrombosed pseudoaneurysm with significant growth. She refused angioplasty treatment for central veins, the graft had not been used for dialysis during the last year, so that arteriovenous graft (AVG) ligation was considered. Due to local conditions thrombin percutaneous embolization was performed to avoid possible complications of a conventional surgery approach. AVG occlusion was done in 10 min by fluoroscopy and ultrasound guidance. In 24 h the patient was significantly better and after 1 week she had no edema at all. There were no complications and no recanalization was observed after 3 months. Percutaneous thrombin embolization is a safe and effective technique for AVG occlusion in case of intractable arm edema with central vein thrombosis, and most likely to be considered in other situations where arteriovenous graft or fistula ligature is needed.
Collapse
Affiliation(s)
- Pinto Diego
- Department of Vascular Surgery, Hospital Privado de Comunidad, Mar del Plata, Argentina
| | - Montalvo Fabián
- Department of Vascular Surgery, Hospital Privado de Comunidad, Mar del Plata, Argentina
| | - Melendez Constanza
- Department of Nephrology, Hospital Privado de Comunidad, Mar del Plata, Argentina
| | - Lapadula Mirna
- Department of Nephrology, Hospital Privado de Comunidad, Mar del Plata, Argentina
| | - Perez Martin
- Department of Nephrology, Hospital Privado de Comunidad, Mar del Plata, Argentina
| |
Collapse
|
4
|
Nguyen B, Duong MC, Diem Tran HN, Do KQ, Nguyen KTT. Arteriovenous fistula creation by nephrologist and its outcomes: a prospective cohort study from Vietnam. BMC Nephrol 2023; 24:88. [PMID: 37016300 PMCID: PMC10074789 DOI: 10.1186/s12882-023-03123-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/20/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Arteriovenous fistula (AVF) is the gold standard vascular access for effective hemodialysis. There is a growing interest in AVF creations performed by nephrologists to help reduce vascular surgeons' workload and enhance the timely treatment of patients with end-stage renal disease (ESRD). However, little is known about the feasibility and effectiveness of this approach in the low-resource settings. We examined the AVF surgical success and failure rates and associated predictors as well as early complications of AVF creations by a trained nephrologist with supports from vascular surgeons in Vietnam. METHODS A prospective cohort study was conducted on all adult ESRD patients at the Hemodialysis Department of Thong Nhat Hospital between April 2018 and October 2020. Information on demographic characteristics, comorbidities, and AVF creations was collected using a standardized questionnaire. All patients were followed up until 18 weeks post-surgery. RESULTS Among 100 patients with a mean age of 61.22 ± 17.11 years old, male accounted for 54%. Common causes of ESRD included hypertension (57%) and diabetes (32%). Just more than half (52%) of them reported having an AVF creation prior to ESRD. The successful first-time AVF creation rate was 98% (13/99, 95%CI: 8.74-21.18%). The primary and secondary AVF failure rates were 13.13% (13/99, 95%CI: 8.74-21.18%) and 16.87% (14/83, 95%CI: 10.32-26.25%), respectively. Early complications included bleeding (1%) and early thrombosis of the anastomosis (2%). There was a statistically significant association between age and primary AVF failure (P = 0.005) and between operation time and secondary AVF failure (P = 0.038). CONCLUSIONS AVF creations performed by well-trained and skilled interventional nephrologists with supports from vascular surgeons can result in favorable short- and long-term outcomes. It is important to follow up older patients and those with a long operation time to detect AVF failures. A standardized AVF creation training program and practice for nephrologists is needed to increase successful rates.
Collapse
Affiliation(s)
- Bach Nguyen
- Department of Nephrology and Dialysis, Thong Nhat Hospital, 1 Ly Thuong Kiet Street, Ward 7, Tân Binh District, Ho Chi Minh City, Vietnam.
| | - Minh Cuong Duong
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Huynh Ngoc Diem Tran
- Department of Nephrology and Dialysis, Thong Nhat Hospital, 1 Ly Thuong Kiet Street, Ward 7, Tân Binh District, Ho Chi Minh City, Vietnam
| | - Kim Que Do
- Department of Cardiovascular Surgery, Thong Nhat Hospital, 1 Ly Thuong Kiet Street, Ward 7, Tân Binh District, Ho Chi Minh City, Vietnam
| | - Kim Thai Thien Nguyen
- Faculty of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City, 43 Dinh Tien Hoang Street, Ben Nghe Ward, District 1, Ho Chi Minh City, Vietnam
| |
Collapse
|
5
|
Satchithanantham V, Rajahram D. An unusual cause of venous hypertension. VEINS AND LYMPHATICS 2022. [DOI: 10.4081/vl.2022.10753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The gold standard vascular access for hemodialysis is the arteriovenous fistula (AVF). Venous hypertension (VH) is an unusual complication of AVF, which can be misdiagnosed as cellulitis due to the similarities in clinical presentation. Here we present a case of venous hypertension in a 40-years-old gentleman, who presented with progressive pain and swelling of three lateral fingers of his left hand without other inflammatory signs after a year of AVF creation. Further evaluation with a duplex scan supported the clinical diagnosis of VH. He had undergone a surgical ligation of AVF and completely recovered from the symptoms.
Collapse
|
6
|
Prasad R, Israrahmed A, Yadav RR, Singh S, Behra MR, Khuswaha RS, Prasad N, Lal H. Endovascular Embolization in Problematic Hemodialysis Arteriovenous Fistulas: A Nonsurgical Technique. Indian J Nephrol 2021; 31:516-523. [PMID: 35068757 PMCID: PMC8722546 DOI: 10.4103/ijn.ijn_84_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/01/2020] [Accepted: 05/23/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction: In the past, surgical techniques were considered gold standard practice for obliterating the accessory veins, reducing the flow across the high flowing arteriovenous fistulas (AVFs), or for closing the problematic hemodialysis AVFs. However, recently endovascular embolization has emerged as a safe and cost-effective alternative to these surgical techniques. In this study, technical and clinical success, and safety of endovascular embolization have been evaluated for accessory vein obliteration, flow reduction, and fistula closure in problematic AVFs using various embolizing agents. Methods: This is a retrospective study of patients with problematic hemodialysis AVFs, who underwent endovascular embolization for accessory vein obliteration, flow reduction, and AVF closure at our center from February 2017 to January 2019 with various embolic agents like vascular plugs (VP), thrombin, coils, and glue. Follow-up was done at 1 week, 3 months, 6 months, and annually thereafter. Results: In this study 30 patients with problematic hemodialysis AVFs [Left brachiocephalic fistula (BCF) (n = 22), right BCF (n = 4), and left radiocephalic fistula (RCF) (n = 4)], underwent endovascular embolization for accessory vein obliteration (n = 6), flow reduction (n = 3), and AVF closure (n = 21). Of the 6 patients undergoing embolization for obliteration of accessory collateral, 4 patients had nonmaturing AVFs and 2 patients had symptoms of venous hypertension (VH). Post embolization, all 4 AVFs matured over a month and symptoms of VH completely resolved within a week. Three patients who underwent embolization for flow reduction had patent AVF (on doppler) post procedure and they achieved adequate flow during dialysis with complete resolution of symptoms of VH. Out of 21 patients, who underwent endovascular closure, complete AVF thrombosis was seen in 18 patients only with the use of VP, while 4 patients required additional procedure to achieve complete thrombosis of AVF. Conclusion: Endovascular embolization in problematic hemodialysis AVF is a safe and cost-effective alternative to open surgical methods and vascular plug could be embolic agent of choice for AVF closure.
Collapse
Affiliation(s)
- Raghunandan Prasad
- Department of Radio Diagnosis, Sanjay Gandhi Post graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Amrin Israrahmed
- Department of Radio Diagnosis, Sanjay Gandhi Post graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rajanikant R Yadav
- Department of Radio Diagnosis, Sanjay Gandhi Post graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Somesh Singh
- Department of Radio Diagnosis, Sanjay Gandhi Post graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Manas Ranjan Behra
- Department of Nephrology, Sanjay Gandhi Post graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ravi Shankar Khuswaha
- Department of Nephrology, Sanjay Gandhi Post graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Post graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Hira Lal
- Department of Radio Diagnosis, Sanjay Gandhi Post graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| |
Collapse
|
7
|
Sore Hand Syndrome. Am J Med 2021; 134:e433-e434. [PMID: 33621532 DOI: 10.1016/j.amjmed.2021.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 01/11/2021] [Indexed: 11/24/2022]
|
8
|
Banasik M, Dawiskiba T, Letachowicz K, Zmonarski S, Mazanowska O, Lipiak E, Miś M, Janczak D, Krajewska M. Pleural effusion with arm, breast, and face edema as a complication of subclavian vein catheterization and arteriovenous fistula in a patient after renal transplantation: A therapeutic approach. J Vasc Access 2020; 22:1017-1020. [PMID: 32985359 DOI: 10.1177/1129729820961959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 52-year-old woman after renal transplantation developed unilateral pleural effusion as well as a massive edema of the upper limb, breast, and face as a complication of the subclavian vein catheterization and arteriovenous fistula for hemodialysis. We revealed that impaired venous drainage due to extensive vein occlusion after temporary catheter insertion, together with high venous flow from the arteriovenous fistula, were the explanation. Because of moderately impaired renal graft function and limited availability of vascular access in the patient, fistula ligation as a therapeutic method described in literature, was not an option in our case. The patient underwent an unsuccessful attempt of venous angioplasty, and eventually banding of the fistula and blood flow reduction resolved pleural effusions and edema. This is a reasonable approach to the problem of massive upper torso edema due to central vein occlusion with ipsilateral arteriovenous fistula.
Collapse
Affiliation(s)
- Mirosław Banasik
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław, Poland
| | - Tomasz Dawiskiba
- Department of Vascular, General and Transplantation Surgery, Wroclaw Medical University, Wrocław, Poland
| | - Krzysztof Letachowicz
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław, Poland
| | - Sławomir Zmonarski
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław, Poland
| | - Oktawia Mazanowska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław, Poland
| | - Edyta Lipiak
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław, Poland
| | - Marcin Miś
- Department of General Radiology, Interventional Radiology and Neuroradiology, Wroclaw Medical University, Wrocław, Poland
| | - Dariusz Janczak
- Department of Vascular, General and Transplantation Surgery, Wroclaw Medical University, Wrocław, Poland
| | - Magdalena Krajewska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław, Poland
| |
Collapse
|
9
|
Chen YY, Wu CK, Lin CH. Outcomes of the Gore Excluder abdominal aortic aneurysm leg endoprosthesis for treatment of central vein stenosis or occlusion in patients with chronic hemodialysis. J Vasc Surg Venous Lymphat Disord 2020; 8:195-204. [PMID: 32067725 DOI: 10.1016/j.jvsv.2019.08.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 08/24/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Central venous occlusive disease is a critical complication in long-term hemodialysis patients with arteriovenous (AV) dialysis circuits. The purpose of this retrospective, single-arm cohort study was to evaluate the effectiveness of an abdominal aortic aneurysm (AAA) contralateral leg endoprosthesis to treat symptomatic central venous occlusive diseases in patients with chronic hemodialysis. METHODS A prospective cohort study included 60 patients on hemodialysis presenting with central venous stenosis or occlusion, who were treated with a Gore Excluder AAA contralateral leg stent graft between December 2013 and July 2018. Follow-up angiography was obtained at 3, 6, and 12 months. The outcomes and duration of primary circuit and target site patency were measured from the time of the stent graft implantation to the first reintervention for AV circuit dysfunction and target site restenosis. Secondary patency was calculated from stent graft implantation to the point when AV access was no longer attainable. RESULTS Circuit primary patency rate was 54.9% at 1 year of Gore Excluder AAA contralateral leg or iliac extender stent grafts, implanted in 60 hemodialysis patients with central vein occlusive disease. Cumulative target site primary patency rate was 88.3% at 1 year. Secondary patency rate was 95% during follow-up. Patients with concomitant lesions had a significantly higher risk of circuit primary patency dysfunction. CONCLUSIONS Treatment of central vein obstructions in hemodialysis patients with stent grafts has been appealing owing to the tapered shape with a larger diameter and the availability of various lengths.
Collapse
Affiliation(s)
- Yen-Yang Chen
- Division of Cardiovascular Surgery, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Chung-Kuan Wu
- Division of Nephrology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Chia-Hsun Lin
- Division of Cardiovascular Surgery, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
| |
Collapse
|
10
|
Comparison of Percutaneous Transluminal Angioplasty with Stenting for Treatment of Central Venous Stenosis or Occlusion in Hemodialysis Patients: A Systematic Review and Meta-analysis. Cardiovasc Intervent Radiol 2020; 43:525-540. [PMID: 31900506 DOI: 10.1007/s00270-019-02383-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 11/19/2019] [Indexed: 01/11/2023]
Abstract
OBJECTIVES A common cause of hemodialysis vascular access dysfunction, a primary cause of morbidity and mortality in patients undergoing hemodialysis, is central venous stenosis or occlusion. The present study compared percutaneous transluminal angioplasty (PTA) with percutaneous transluminal angioplasty and stent placement (PTS) for treatment of central venous stenosis or central vein occlusion in hemodialysis patients. METHODS A systematic literature review was conducted using database searches of PubMed, Cochrane, and Embase. Articles were selected using the Population/Intervention/Comparator/Outcomes (PICO) process. Outcomes included the rate of procedural success, primary patency, assisted primary patency, re-intervention subjects, re-intervention rate, and adverse events. RESULTS A total of eight studies were included in the meta-analysis with subjects in the PTA group (n = 281) or PTS group (n = 192). Primary patency rate between PTA and PTS groups at 3-, 6-, 12-, or 24-month follow-up was not different (all p > 0.05). Patients treated with PTA had greater assisted primary patency rates than the PTS group (OR = 1.03, 1.73, 1.03, and 2.00 at 3, 6, 12, and 24 months, respectively). However, the statistical assessment only showed significantly at 24-month follow-up (p = 0.01). CONCLUSIONS The present meta-analysis revealed that, compared to PTS, PTA may provide increased assisted primary patency for endovascular treatment of central vein stenosis or occlusion in patients undergoing hemodialysis. LEVEL OF EVIDENCE Level 3a.
Collapse
|
11
|
Joshi V, Sheehan F, Chapman A. A rare case of arteriovenous fistula formation in a patient with inferior vena cava thrombosis, successfully managed with endovascular recanalisation. BJR Case Rep 2019; 5:20190007. [PMID: 31938558 PMCID: PMC6945264 DOI: 10.1259/bjrcr.20190007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/23/2019] [Accepted: 05/02/2019] [Indexed: 11/08/2022] Open
Abstract
Inferior vena cava (IVC) filters are recommended for patients with proximal deep vein thrombosis (DVT) who are not eligible for anticoagulation. Long-dwelling filters are well-known to be associated with the development of IVC thrombosis. Chronic caval occlusion can lead to a severe post-thrombotic syndrome (PTS), with manifestations of chronic venous insufficiency in the lower extremities. Animal studies have shown that post-thrombotic inflammation can trigger the development of an arteriovenous fistula (AVF), however, there is limited evidence for this phenomenon in patients with PTS. We describe the case of a spontaneous AVF in a patient with long-standing IVC thrombosis. It was postulated that the AVF could be compounding the venous hypertension and severe swelling of his lower extremities. The case additionally demonstrates the successful results of endovascular recanalisation for an occluded filter in the presence of an AVF.
Collapse
Affiliation(s)
- Vanya Joshi
- St Peter’s Hospital, Chertsey, United Kingdom
| | | | | |
Collapse
|
12
|
Yan LJ, Zhang FR, Ma CS, Zheng Y, Chen JT, Li W. Arteriovenous Graft for Hemodialysis: Effect of Cryotherapy on Postoperative Pain and Edema. Pain Manag Nurs 2019; 20:170-173. [PMID: 30425011 DOI: 10.1016/j.pmn.2018.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 02/14/2018] [Accepted: 07/13/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Arteriovenous grafting offers an alternative for patients whose vessels are unsuitable for arteriovenous fistula. However, as a result of subcutaneous tunnel dissection, postoperative pain and edema of the operated limb present early after surgery. As a traditional therapeutic approach, cryotherapy has the ability to suppress postoperative pain and edema. AIMS The purpose of the study was to investigate the feasibility of cryotherapy after arteriovenous graft surgery to decrease perioperative medication usage. DESIGN This study was a randomized controlled trial. SETTING A large integrated health care facility in South China. PARTICIPANTS/SUBJECTS A total of 85 hemodialysis patients who received arteriovenous graft surgery from March 2011 to February 2017 were enrolled. METHODS The participants were divided into an intervention group and a control group according to the postoperative management. Ice packs were applied covering the operative forearm for 120 minutes after wound closure in the intervention group. General information, pain score, analgesic consumption, wound inflammation, forearm edema, and participant satisfaction were compared between the two groups. RESULTS Cryotherapy-treated patients required less analgesia (26.19% vs. 48.84%, p < .05), reported lower pain score from 30 minutes to 48 hours postoperative (p < .05), less wound inflammation (11.90% vs. 25.58%, p < .05), and higher participant satisfaction (8.92 ± 0.57 vs. 6.52 ± 0.63, p < .05), whereas the incidence of forearm edema was equivalent (p > .05). No adverse events were reported in either group. CONCLUSIONS Cryotherapy is a preferable intervention for patients after arteriovenous graft implantation as a result of its favorable cost, convenience, and fewer side effects.
Collapse
Affiliation(s)
- Li-Jun Yan
- Department of Hemodialysis, The First Affiliated Hospital of Shantou University Medical College, Shantou City, Guangdong Province, China
| | - Fei-Ran Zhang
- Department of General Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou City, Guangdong Province, China
| | - Chan-Shan Ma
- Department of General Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou City, Guangdong Province, China
| | - Yang Zheng
- Department of General Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou City, Guangdong Province, China.
| | - Jun-Tian Chen
- Department of General Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou City, Guangdong Province, China
| | - Wei Li
- Department of General Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou City, Guangdong Province, China
| |
Collapse
|
13
|
Asari AIA, Damasceno DCF, Almeida NAD, Moreira HDC, Barros RAV, Ximenes Filho FAB. Úlceras de quirodáctilos e dorso de mão esquerda ocasionadas por hipertensão venosa após confecção de fístula arteriovenosa braquiocefálica: relato de caso. J Vasc Bras 2019; 18:e20190008. [PMID: 31692943 PMCID: PMC6822961 DOI: 10.1590/1677-5449.190008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Venous ulcers caused by venous hypertension secondary to arteriovenous fistulae are rare. Their etiology can be confirmed by vascular Doppler ultrasonography, which can differentiate between stenosis of central vessels and hemodynamic overload caused by development of tributaries from the vein responsible for the arteriovenous fistula. We present a case caused by hemodynamic overload of a tributary, which diverted the primary flow from the fistula to the distal limb. We chose to ligate the fistula to treat the ulcers and create another arteriovenous fistula in the contralateral limb.
Collapse
|
14
|
Abstract
This review examines four imaging modalities; ultrasound (US), digital subtraction angiography (DSA), magnetic resonance imaging (MRI) and computed tomography (CT), that have common or potential applications in vascular access (VA). The four modalities are reviewed under their primary uses, techniques, advantages and disadvantages, and future directions that are specific to VA. Currently, US is the most commonly used modality in VA because it is cheaper (relative to other modalities), accessible, non-ionising, and does not require the use of contrast agents. DSA is predominantly only performed when an intervention is indicated. MRI is limited by its cost and the time required for image acquisition that mainly confines it to the realm of research where high resolution is required. CT’s short acquisition times and high resolution make it useful as a problem-solving tool in complex cases, although accessibility can be an issue. All four imaging modalities have advantages and disadvantages that limit their use in this particular patient cohort. Current imaging in VA comprises an integrated approach with each modality providing particular uses dependent on their capabilities. MRI and CT, which currently have limited use, may have increasingly important future roles in complex cases where detailed analysis is required.
Collapse
|