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Arteriovenous Fistula Aneurysm: Bench to Bedside. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03412-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Georgakarakos E, Anastasiadou E, Papoutsi M, Koufopoulos G, Georgiadis GS. Tips and tricks for facilitating teaching of Doppler waveforms and ankle-brachial index in undergraduate level: A practical guide. JOURNAL OF VASCULAR NURSING 2018; 37:64-68. [PMID: 30954201 DOI: 10.1016/j.jvn.2018.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 10/07/2018] [Accepted: 10/12/2018] [Indexed: 11/16/2022]
Abstract
Although the measurement of ankle-brachial index (ABI) is considered a fundamental skill in assessment and diagnosis of peripheral arterial disease and a predictive tool for cardiovascular events, real-world practice shows that the experience of many health professionals is far from ideal. Not only teaching and practice of ABI measurement in undergraduate medical curricula are limited but various mistakes in the process of calculation, estimation, and interpretation of ABI results in the postgraduate practice have also been documented. Because vascular surgery is a core subject in our medical school, we deal with the difficulties and challenges that undergraduate medical students and nurses face to measure and comprehend ABI. We came up with useful tips and maneuvers to overcome these difficulties. Accordingly, this article provides twelve easy-to-follow useful tips to enhance and facilitate the teaching and comprehension of ABI. Moreover, it favors the simultaneous teaching of Doppler arterial waveform examination as a means to facilitate accurate interpretation and validation of ABI results.
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Affiliation(s)
- Efstratios Georgakarakos
- Department of Vascular Surgery, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, Alexandroupolis, Greece.
| | - Evgenia Anastasiadou
- Department of Vascular Surgery, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Marilena Papoutsi
- Department of Vascular Surgery, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Georgios Koufopoulos
- Department of Vascular Surgery, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - George S Georgiadis
- Department of Vascular Surgery, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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Georgiadis GS, Argyriou C, Kantartzi K, Georgakarakos EI. Which is the most powerful adverse factor for autogenous access patency between diabetes and high arterial calcification burden? Ren Fail 2018; 40:455-457. [PMID: 30278807 PMCID: PMC6171449 DOI: 10.1080/0886022x.2018.1497518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- George S Georgiadis
- a Department of Vascular Surgery , "Democritus" University of Thrace, University General Hospital of Alexandroupolis , Alexandroupolis , Greece
| | - Christos Argyriou
- a Department of Vascular Surgery , "Democritus" University of Thrace, University General Hospital of Alexandroupolis , Alexandroupolis , Greece
| | - Konstantia Kantartzi
- b Department of Nephrology , "Democritus" University of Thrace, University General Hospital of Alexandroupolis , Alexandroupolis , Greece
| | - Efstratios I Georgakarakos
- a Department of Vascular Surgery , "Democritus" University of Thrace, University General Hospital of Alexandroupolis , Alexandroupolis , Greece
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Nojima T, Motomiya Y. Graft Inclusion Technique: A New Flow Reduction Procedure for High Flow Arteriovenous Fistulae. Ann Vasc Dis 2018; 11:202-209. [PMID: 30116412 PMCID: PMC6094033 DOI: 10.3400/avd.oa.17-00132] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objective: Flow reduction is required to preserve vascular access in cases with high flow access (HFA). We report a new flow reduction procedure, the graft inclusion technique (GIT). Methods: The GIT procedure developed by us involves the intraluminal placement and suturing of a 4-mm polytetrafluoroethylene graft to the anastomosis and outflow tract to plicate the enlarged anastomosis and maintain lower flow volumes. Flow reduction for HFA was retrospectively assessed in a series of 25 patients (age 65±12 years; 17 males and 8 females) to evaluate flow volume and patency rate, wherein 10 patients underwent conventional methods of flow reduction and 15 underwent GIT. Results: Compared with preprocedure values, mean flow volume (MFV) was significantly lower after the procedure with both the conventional methods (1,817 vs. 586 ml/min; P<0.05) and the GIT (2,262 vs. 890 ml/min; P<0.05). An increase in MFV occurred during follow-up after conventional flow reduction (586 vs. 1,036 ml/min), while GIT could maintain lower MFV (890 vs. 791 ml/min), suggesting that GIT can significantly lower MFV levels (2,262 vs. 791 ml/min; P<0.05) and maintain these lower MFV levels during follow-up. Secondary patency rate for the GIT was 100% at 1 year and 83% at 3 years. Conclusion: The GIT may be used as an access-preserving, reliable, long-term, and stable flow-reducing procedure that does not require flow adjustment during surgery.
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Kordzadeh A, Askari A, Panayiotopoulos Y. Independent association of arteriovenous ratio index on the primary functional maturation of autologous radiocephalic arteriovenous fistula. J Vasc Surg 2018. [PMID: 29526374 DOI: 10.1016/j.jvs.2017.10.082] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE It has been hypothesized that a novel measurement technique of arteriovenous ratio (AVR) index obtained from inflow (radial artery diameter) to that of outflow (cephalic vein diameter) and its application through the Bernoulli effect has no impact on the primary functional maturation (FM) of autogenous radiocephalic arteriovenous fistula (RCAVF). METHODS A prospective consecutive single-center cohort study with intention to treat of 324 patients undergoing RCAVF during a period of 4 years was conducted. Variables of demographics, anatomic factors, laterality, comorbidities, anesthesia type, presence of intraoperative thrill, angle of anastomosis, and AVR index were assessed through univariate and multivariate logistic regression analysis on the end point of FM. The AVR was subjected to three decimal points to ensure maximal accuracy for best sensitivity and 1 - specificity by receiver operating characteristic curve. The χ2 (subgroup) analyses were undertaken to investigate the differences in FM incidence within different ranges of AVR. Test of probability (P value) was considered to be significant with P < .05. Effect sizes were reported as odds ratio with their measure of uncertainty at 95% confidence intervals. RESULTS Among all variables, the AVR index remained the only independent factor associated with FM (66%; n = 214/324) of RCAVFs (P = .001; 95% confidence interval, 0.08-0.26). AVR of 1 to 1.06 was associated with 100% FM in RCAVFs. Decrease or increase of this index was associated with stepwise reduction in FM of RCAVFs (P < .05). CONCLUSIONS The suggested novel measurement technique (AVR index) is an independent predictor of FM in RCAVFs. This study implies that minimal diameter (ie, inflow artery dimeter to outflow cephalic vein diameter) mismatch (AVR, 1-1.06) irrespective of other variables remains crucial for optimal hemodynamics (pressure and velocity) of RACVFs and their primary FM.
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Affiliation(s)
- Ali Kordzadeh
- Faculty of Medical Sciences, Anglia Ruskin University, Cambridge, United Kingdom; Department of Vascular, Endovascular and Renal Access Surgery, Broomfield Hospital, Mid Essex Hospitals Services NHS Trust, Chelmsford, United Kingdom.
| | - Alan Askari
- Department of Surgery, Ipswich Hospital, Ipswich, United Kingdom
| | - Yiannis Panayiotopoulos
- Department of Vascular, Endovascular and Renal Access Surgery, Broomfield Hospital, Mid Essex Hospitals Services NHS Trust, Chelmsford, United Kingdom
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Rokošný S, O'Neill S, Baláž P. Contemporary management of arteriovenous hemodialysis fistula aneurysms. COR ET VASA 2018. [DOI: 10.1016/j.crvasa.2017.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Duque JC, Tabbara M, Martinez L, Cardona J, Vazquez-Padron RI, Salman LH. Dialysis Arteriovenous Fistula Failure and Angioplasty: Intimal Hyperplasia and Other Causes of Access Failure. Am J Kidney Dis 2016; 69:147-151. [PMID: 28084215 DOI: 10.1053/j.ajkd.2016.08.025] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 08/02/2016] [Indexed: 12/27/2022]
Abstract
The arteriovenous fistula (AVF) is the preferred hemodialysis access type because it has better patency rates and fewer complications than other access types. However, primary failure remains a common problem impeding AVF maturation and adding to patients' morbidity and mortality. Juxta-anastomotic (or inflow) stenosis is the most common reason leading to primary failure, and percutaneous transluminal angioplasty continues to be the gold-standard treatment with excellent success rates. Intimal hyperplasia (IH) has been traditionally blamed as the main pathophysiologic culprit, but new evidence raises doubts regarding the contribution of IH alone to primary failure. We report a 64-year-old man with a 2-stage brachiobasilic AVF that was complicated by failure 4 months after creation. An angiogram showed multiple juxta-anastomotic and midfistula stenotic lesions. Percutaneous transluminal angioplasty was successful in assisting maturation and subsequently cannulating the AVF for hemodialysis treatment. We failed to identify the underlying cause of stenosis because biopsy specimens from fistula tissue obtained at the time of transposition revealed no occlusive IH. This case emphasizes the need for additional research on factors contributing to AVF failure besides IH and highlights the need for more therapeutic options to reduce AVF failure rate.
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Affiliation(s)
- Juan C Duque
- Department of Medicine, Leonard M. Miller School of Medicine, University of Miami, Miami, FL
| | - Marwan Tabbara
- DeWitt Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL
| | - Laisel Martinez
- DeWitt Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL
| | - Jose Cardona
- Division of Nephrology, Leonard M. Miller School of Medicine, University of Miami, Miami, FL
| | - Roberto I Vazquez-Padron
- DeWitt Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL
| | - Loay H Salman
- Section of Interventional Nephrology, Leonard M. Miller School of Medicine, University of Miami, Miami, FL.
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Zheng C, Zhou Y, Huang C, Zhang Z, Liu YI, Xu Y. Establishment of a rat autogenous arteriovenous fistula model following 5/6 nephrectomy. Exp Ther Med 2015; 10:219-224. [PMID: 26170938 DOI: 10.3892/etm.2015.2451] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Accepted: 03/05/2015] [Indexed: 12/30/2022] Open
Abstract
The aim of this study was to establish a stable rat model of autogenous arteriovenous fistula (AVF) with chronic renal function insufficiency. Forty Sprague-Dawley rats were randomly divided into an experimental group (n=20) and sham surgery group (n=20) and a 5/6 nephrectomy model was established in the rats. One week later, in the experimental group, the ipsilateral caroid artery was inserted into the external jugular vein by a cuff technique to establish a carotid arteriovenous fistula; in the sham group, the external jugular vein and carotid artery were dissociated. At 7 and 28 days following the establishment of the AVF, the renal functions of the two groups were measured. Hematoxylin and eosin staining and double collagen and elastin staining were conducted to evaluate the area of intimal hyperplasia in the external jugular vein, and the expression of α-smooth muscle actin in the vein was investigated by immunohistochemistry. The creatinine and urea nitrogen levels in the experimental group at each time-point were significantly higher than those in the sham surgery group (P<0.05). The intimal hyperplasia of the external jugular vein of the experimental group was increased significantly compared with that in the sham group at each time-point (P<0.05). The model, which is easy to establish and simple to master, provides a new and feasible experimental method for the study of intimal hyperplasia associated with autogenous AVF in chronic renal insufficiency, and is worthy of wider use.
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Affiliation(s)
- Chenfei Zheng
- Department of Nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Ying Zhou
- Department of Nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Chaoxing Huang
- Department of Nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Zhouchang Zhang
- Department of Nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Y I Liu
- Department of Nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Yulan Xu
- Department of Nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
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Salamon T, Safadi W, Izakson A. Acute haemorrhage secondary to arteriovenous haemodialysis fistula pseudoaneurysm--the challenge of restoring a deformed upper limb. BMJ Case Rep 2015; 2015:bcr-2015-210243. [PMID: 26153288 DOI: 10.1136/bcr-2015-210243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Tal Salamon
- Department of Vascular Surgery, Ziv Hospital, Affiliated to the Faculty of Medicine in the Galilee Bar Ilan University, Safed, Israel
| | - Wajdi Safadi
- Department of Surgery, Ziv Hospital, Galilee, Israel Golan Polyclinic, Golan Heights, Israel
| | - Alexander Izakson
- Department of Anesthesiology, Ziv Hospital, Affiliated to the Faculty of Medicine in the Galilee Bar Ilan University, Safed, Israel
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True aneurysm in autologous hemodialysis fistulae: definitions, classification and indications for treatment. J Vasc Access 2015; 16:446-53. [DOI: 10.5301/jva.5000391] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2015] [Indexed: 11/20/2022] Open
Abstract
Introduction Definition, etiology, classification and indication for treatment of the arteriovenous access (AVA) aneurysm are poorly described in medical literature. The objectives of the paper are to complete this information gap according to the extensive review of the literature. Methods A literature search was performed of the articles published between April 1, 1967, and March 1, 2014. The databases searched included Medline and the Cochrane Database of Systematic Reviews. The eligibility criteria in this review studies the need to assess the association of aneurysms and pseudoaneurysms with autologous AVA. Aneurysms and pseudoaneurysms involving prosthetic AVA were not included in this literature review. From a total of 327 papers, 54 non-English papers, 40 case reports and 167 papers which did not meet the eligibility criteria were removed. The remaining 66 papers were reviewed. Results Based on the literature the indication for the treatment of an AVA aneurysm is its clinical presentation related to the patient's discomfort, bleeding prevention and inadequate access flow. A new classification system of AVA aneurysm, which divides it into the four types, was also suggested. Conclusions AVA aneurysm is characterized by an enlargement of all three vessel layers with a diameter of more than 18 mm and can be presented in four types according to the presence of stenosis and/or thrombosis. The management of an AVA aneurysm depends on several factors including skin condition, clinical symptoms, ease of cannulation and access flow. The diameter of the AVA aneurysm as a solo parameter is not an indication for the treatment.
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The Eternal Tale of Dialysis Access Vessels and Restenosis: Are Drug-Eluting Balloons the Solution? J Vasc Access 2014; 15:439-47. [DOI: 10.5301/jva.5000271] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2014] [Indexed: 11/20/2022] Open
Abstract
In dialysis access fistulas and grafts, percutaneous transluminal angioplasty (PTA) is frequently followed by restenosis development, which results in repeated periodical re-interventions. The technique of drug-eluting balloon (DEB) angioplasty has shown promising results in the treatment of femoropopliteal arteriosclerotic lesions. In contrast to arteriosclerotic arteries, dialysis access vessels host unfavorable hemodynamics due to the direct conduction of high-pressure fluid into a low-pressure system. Hence, the beneficial effect of DEB angioplasty may be limited in this system. However, a first prospective randomized trial on 40 patients with arteriovenous fistula or graft stenoses exhibited a significantly higher 6-month primary patency of the treated lesions after DEB angioplasty than after uncoated balloon angioplasty. Despite such a positive reference, general recommendations regarding the value of DEBs in dialysis access vessels cannot be considered as serious unless large randomized controlled trials have been performed.
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Correlation of pre-existing radial artery macrocalcifications with late patency of primary radiocephalic fistulas in diabetic hemodialysis patients. J Vasc Surg 2014; 60:462-70. [DOI: 10.1016/j.jvs.2014.02.042] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 02/17/2014] [Indexed: 11/18/2022]
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A Computational Study of the Factors Influencing Pressure in Arteriovenous Fistulae Venous Aneurysms. J Vasc Access 2013; 14:325-9. [DOI: 10.5301/jva.5000144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2013] [Indexed: 11/20/2022] Open
Abstract
Purpose To investigate the factors influencing the hydrostatic pressure exerted within the venous aneurysms (VA) of an arteriovenous fistula (AVF). Methods Ideal models of a side-to-end brachial-cephalic AVF were computationally constructed and typical values for the length and the local diameters were considered for both the artery and vein sections of the models. Three VA configurations were reconstructed (spherical, fusiform and curved) and hydrostatic pressure was assessed with respect to different degrees of the outflow vein stenosis, ranging from 25% to 95%, and VA maximum diameters, using validated, commercially available software. Results The pressure in the VA was steady (1200 Pa) for venous outflow stenoses up to 75%. For stenoses greater than 75% a exponential pressure rise was observed, reaching 1500 Pa for stenoses of 95%. Neither the VA configuration nor its maximum diameter affected the pressure values exerted within the VA or the point of the pressure upstroke. Conclusions our study supports the presence of a critical stenotic outflow vein diameter beyond which there is an exponential VA pressure increase, influenced neither by the shape nor the size of the VA. Whether the prompt, non-invasive detection of this finding can contribute or lead to the determination of a criterion for early intervention in VAs before clinical complications are developed, should be investigated by future studies.
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Overcoming the venous outflow obstruction in true venous aneurysms of arteriovenous fistulae can lead to aneurysms' remodeling and shrinking. J Vasc Access 2012; 13:538-9. [PMID: 22729526 DOI: 10.5301/jva.5000083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2012] [Indexed: 11/20/2022] Open
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