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Rahman NA, Wang A, Chihade DB, Feghali A. Giant 20 × 35 cm brachial artery pseudoaneurysm after fistulogram treated with surgical resection of pseudoaneurysm and patch angioplasty of brachial artery. J Surg Case Rep 2024; 2024:rjae213. [PMID: 38572280 PMCID: PMC10989281 DOI: 10.1093/jscr/rjae213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 03/16/2024] [Indexed: 04/05/2024] Open
Abstract
Brachial artery pseudoaneurysms are a rare entity, which can occur secondary to infectious, traumatic, or iatrogenic causes. We present a 78-year-old female with end-stage renal disease on hemodialysis via a right brachio-basilic arteriovenous fistula. She had previously undergone numerous fistulograms and endovascular interventions for right upper extremity swelling due to prolonged bleeding following dialysis. After a recent fistulogram she developed recurrent arm swelling. Duplex showed a large hematoma without any evidence of vascular flow. However, intraoperatively, she was noted to have a giant 20 × 35 cm pseudoaneurysm of the brachial artery. Therapeutic options include endovascular stenting, embolization, thrombin injection, ultrasound-guided compression, and surgery. We elected to perform resection of the large pseudoaneurysm and arteriovenous fistula ligation due to the large size. Given her end-stage renal disease status and lacking quality autogenous vein, we were able to perform a patch angioplasty repair of her brachial artery without requiring a bypass.
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Affiliation(s)
- Naveed A Rahman
- Department of Surgery, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, United States
| | - Alice Wang
- Department of Surgery, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, United States
| | - Deena B Chihade
- Department of Surgery, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, United States
| | - Anthony Feghali
- Department of Surgery, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, United States
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Bergmann M, Fakhoury B, Barroso T, Prushik SG, Jaber BL, Balakrishnan VS. Early access flow rate predicts vascular access patency-related intervention in the first year: A retrospective cohort study. Hemodial Int 2024. [PMID: 38533534 DOI: 10.1111/hdi.13148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 03/09/2024] [Accepted: 03/11/2024] [Indexed: 03/28/2024]
Abstract
INTRODUCTION Arteriovenous fistulas and grafts are lifelines for most hemodialysis patients, and a low access flow rate often requires patency-related intervention, such as angioplasty or thrombectomy, to prevent access failure. We examined whether early access flow rate, measured after initial fistula/graft cannulation, predicts vascular access patency-related intervention within 1 year. METHODS This was a single-center retrospective cohort study. Among 172 patients undergoing surgical creation of a fistula/graft, 52 (30.2%) had documented access flow rates measurement by the Transonic™ ultrasound dilution technique, performed within an average of 48 days from initial access cannulation. The need for a patency-related intervention, defined as undergoing a fistulogram, angioplasty, thrombectomy, or surgical revision, was ascertained within 1 year. A receiver-operating characteristic curve (ROC) was generated to evaluate the diagnostic performance of first and average access flow rates for predicting patency-related intervention within 1 year. FINDINGS Twenty-eight (53.8%) of the 52 study subjects required a patency-related intervention within 1 year. Their characteristics were not significantly different from those who did not require patency-related interventions. However, first access flow rates were significantly lower in patients requiring patency-related intervention compared to those who did not (898 vs. 1471 mL/min; p = 0.003), as were average access flow rates (841 vs. 1506 mL/min; p < 0.001). The ROC analyses revealed that first access flow rates and average access flow rates predicted the need for patency-related intervention within 1 year, with an area under-the-ROC curve of 0.743 (95% confidence interval [CI] 0.608, 0.877) and 0.775 (95% CI 0.648, 0.903), respectively, demonstrating acceptable discrimination. DISCUSSION In adults undergoing hemodialysis, early access flow rate measurement can predict patency-related intervention within 1 year after initial vascular access cannulation. Additional studies are required to confirm these findings and identify optimal access flow rate cut-off values to predict vascular accesses at higher risk of stenosis.
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Affiliation(s)
- Matthias Bergmann
- Division of Nephrology, Department of Medicine, St. Elizabeth's Medical Center, Boston, Massachusetts, USA
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Butros Fakhoury
- Division of Nephrology, Department of Medicine, St. Elizabeth's Medical Center, Boston, Massachusetts, USA
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Tiago Barroso
- Division of Nephrology, Department of Medicine, St. Elizabeth's Medical Center, Boston, Massachusetts, USA
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Scott G Prushik
- Division of Vascular and Endovascular Surgery, Department of Surgery, St. Elizabeth's Medical Center, Boston, Massachusetts, USA
- Department of Surgery, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Bertrand L Jaber
- Division of Nephrology, Department of Medicine, St. Elizabeth's Medical Center, Boston, Massachusetts, USA
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Vaidyanathapuram S Balakrishnan
- Division of Nephrology, Department of Medicine, St. Elizabeth's Medical Center, Boston, Massachusetts, USA
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
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Cacioppa LM, De Cinque A, Cocozza MA, Galaverni MC, Scrivo A, La Manna G, Ierardi AM, Renzulli M, Golfieri R. An unusual spontaneous recanalization by multiple palmar arteriovenous connections of a chronically occluded radiocephalic hemodialysis fistula. J Vasc Access 2024; 25:344-347. [PMID: 35996311 PMCID: PMC10845811 DOI: 10.1177/11297298221119590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 07/25/2022] [Indexed: 11/15/2022] Open
Abstract
Preservation of a vascular access is crucial in the management of hemodialysis patients. In this regard, percutaneous transluminal angioplasty (PTA) is an effective tool if performed after an adequate understanding of preliminary fistulograms. The present case showed a chronic dysfunction of a radial-cephalic arteriovenous fistula (AVF) due to arterial occlusion and partially relieved by the spontaneous development of multiple small arteriovenous connections in the palmar region of the hand. This dense network had been so far able to ensure a sufficient retrograde blood flow for an effective hemodialytic performance. The angioplasty of the post-anastomotic stenotic segment of the radial artery was effective in restoring this neoformed AVF patency.
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Affiliation(s)
- Laura Maria Cacioppa
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Antonio De Cinque
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Maria Adriana Cocozza
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Maria Cristina Galaverni
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Anna Scrivo
- Department of Nephrology, Dialysis and Renal Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Gaetano La Manna
- Department of Nephrology, Dialysis and Renal Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Anna Maria Ierardi
- Radiology Department, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Matteo Renzulli
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Rita Golfieri
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Idrees N, Haroon S, Zhang Y, Mangio JC, Siracuse JJ, Francis JM, Ganguli S, Daly K, Diamond M, Vilvendhan R, Cabral H, Dember LM, Farber A, Kolachalama VB, Chitalia VC. Contrast Venography Versus Intravenous Ultrasound in Hemodialysis Arteriovenous Access Dysfunction. Kidney Int Rep 2023; 8:1887-1891. [PMID: 37705907 PMCID: PMC10496077 DOI: 10.1016/j.ekir.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/16/2023] [Accepted: 06/12/2023] [Indexed: 09/15/2023] Open
Affiliation(s)
- Najia Idrees
- Renal Section, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- Veterans Affairs Boston Healthcare System, Boston MA 02118, USA
| | - Samir Haroon
- Section of Interventional Radiology, Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Yichi Zhang
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA
| | - Joanna Crisa Mangio
- Renal Section, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jeffrey J. Siracuse
- Division of Vascular and Endovascular Surgery, Department of Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jean M. Francis
- Renal Section, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Suvranu Ganguli
- Section of Interventional Radiology, Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Kevin Daly
- Section of Interventional Radiology, Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Matthew Diamond
- Section of Interventional Radiology, Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Rajendran Vilvendhan
- Department of Radiology, Interventional Radiology, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Harvard Medical School, Boston, Massachusetts, USA
| | - Howard Cabral
- Department of Biostatistics, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Laura M. Dember
- Renal-Electrolyte and Hypertension Division, Department of Medicine; Center for Clinical Epidemiology and Biostatistics; and Department of Biostatistics, Epidemiology and Informatics; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alik Farber
- Division of Vascular and Endovascular Surgery, Department of Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Vijaya B. Kolachalama
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA
- Department of Computer Science and Faculty of Computing & Data Sciences, Boston University, Boston, Massachusetts, USA
| | - Vipul C. Chitalia
- Renal Section, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- Veterans Affairs Boston Healthcare System, Boston MA 02118, USA
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA
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Weitzel WF, Rajaram N, Zheng Y, Funes-Lora MA, Hamilton J, Yessayan L, Krishnamurthy VN, Henke P, Osborne N, Bishop B, Shih AJ, Thelen BJ. Development of open-source software for free-hand 3D vascular ultrasound: Dialysis fistula application. J Vasc Access 2023; 24:722-728. [PMID: 34711097 DOI: 10.1177/11297298211055348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The arteriovenous fistula (AVF) is the preferred vascular access for End Stage Renal Disease, having superior patency and lower infection risks than prosthetic graft and catheter access. When AVF dysfunction or delayed maturation does occur, the gold standard for diagnosis is the fistula angiogram (a.k.a. fistulogram). 3D ultrasound is available for obstetrical and other specialized uses, but it is cost prohibitive and has a field of view that is too small to cover the region of interest for the dialysis fistula application. We sought to develop a point of care 3D solution using freehand 2D ultrasound data acquisition. METHODS We developed open-source software for 3D image reconstruction and projection of an angiogram-like image of the vascular access using a 2D freehand ultrasound scanner. We evaluated this software by comparing the ultrasound "sono-angiogram" images to fistulogram images in five subjects, using visual inspection and by applying the Percent of Exact Match (PEM) as a statistic test. RESULTS The sono-angiograms showed identifiable characteristics that matched the fistulogram results in all five subjects. The PEM ranged between 42.8% and 77.0%, with Doppler and grayscale ultrasound data, showing complementary advantages and disadvantages when used for sono-angiogram image construction. Motion from freehand ultrasound acquisition was a significant source of mismatch. 3D image generation is a potential advantage with ultrasound data. CONCLUSIONS While further work is needed to improve the accuracy with free hand scanning, fistulogram-like "sono-angiograms" can be generated using point of care 2D ultrasound. Methods such as these may be able to assist in point-of-care diagnosis in the future. The software is open-source, and importantly, the ultrasound data used are non-proprietary and available from any standard ultrasound machine. The simplicity and accessibility of this approach warrant further study.
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Affiliation(s)
- William F Weitzel
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Nirmala Rajaram
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Yihao Zheng
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Mechanical Engineering, Worcester Polytechnic Institute, Worcester, Massachusetts, USA
| | | | | | - Lenar Yessayan
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Venkataramu N Krishnamurthy
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Departments of Radiology and Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Peter Henke
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Departments of Radiology and Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Nicholas Osborne
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Departments of Radiology and Surgery, University of Michigan, Ann Arbor, MI, USA
| | | | - Albert J Shih
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Brian J Thelen
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Statistics, University of Michigan, Ann Arbor, MI, USA
- Michigan Tech Research Institute, Michigan Technological University, Ann Arbor, MI, USA
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6
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Malik MJ, Nabi RJ. Assessing the Inflow Segment of a Hemodialysis Access: The Fogarty Balloon Occlusion Technique. Cureus 2023; 15:e41534. [PMID: 37551204 PMCID: PMC10404460 DOI: 10.7759/cureus.41534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2023] [Indexed: 08/09/2023] Open
Abstract
Dialysis access maintenance often requires a fistulogram or shuntogram of arteriovenous access. Assessment of the arterial inflow segment and arterial anastomosis is often a critical portion of the procedure. Retrograde occlusive angiography (ROA) is often used to properly assess the inflow. Manual compression using finger compression or a hemostat is often described in the literature. The Fogarty balloon occlusion technique using a 4-Fr Fogarty catheter balloon (Henry Shein) is a simple and cost-effective method that preserves image quality and decreases radiation exposure in retrograde occlusive angiography.
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Affiliation(s)
- Mona J Malik
- Internal Medicine, University of California, Riverside, Riverside, USA
| | - Rema J Nabi
- Vascular Surgery, University of Houston, Houston, USA
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Prabhakaran M, Mahapatra HS, Nath RK, Pursnani L, Balakrishnan M, Singh A, Singh A, Patil S, Gautam A. Comparison of clinical examination, doppler and fistulogram for arterio-venous fistula surveillance in detecting secondary failure. J Vasc Access 2023:11297298231161461. [PMID: 37318136 DOI: 10.1177/11297298231161461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Arteriovenous Fistula (AVF) surveillance is required to detect early dysfunction (thrombosis, stenosis) and its timely correction prolongs access-patency. Clinical examination (CE) and doppler have been used as screening/surveillance of AVF, for early detection of AVF dysfunction. Since there was inadequate evidence for KDOQI to make recommendations on AVF surveillance and on secondary failure rate. We compared CE, doppler and fistulogram as surveillance modalities in detecting a secondary failure in matured AVF. METHODOLOGY This prospective-observational, single-center study, was done between December 2019-April 2021. CKD stage 5 patients on dialysis/Not-on-dialysis with matured AVF were included at third month. CE, doppler (blood flow, vein diameter, depth), and fistulogram were done at third and sixth month. Secondary failure was assessed at sixth month classifying AVF to patent/functional and failed group. Diagnostic tests were performed by comparing three methods considering fistulogram as gold-standard. Residual urine output is also monitored to look for any contrast induced residual renal function loss. RESULTS Of total 407 created AVF, 98 (24%) had primary failure. Twenty-five (6%) had surgical complications including unsuccessful AVF and aneurysm/rupture, 156 lost follow-up at third month, 104 consented patients were enrolled, 16 lost to follow-up subsequently, and 88 patients' data were analyzed at the end. At the sixth month, 76(86.4%) had patent AVF, 8 (9.1%) had secondary failure (Thrombosis-4, Central Venous Stenosis-4), and 4 (4.1%) patients expired. Considering fistulogram as a diagnostic standard, CE showed 87.5% sensitivity, and 93.4% specificity (cohen's kappa value of 0.66). Doppler had sensitivity and specificity of 87% and 96% respectively (cohen's kappa value of 0.75), Combination of clinical examination with doppler showed sensitivity and specificity of 100% and 89% respectively. CONCLUSION Although the secondary AVF failure rate is less than the primary, CE is an important and valuable tool in the diagnosis and surveillance of AVF in detecting its dysfunction. Moreover, CE with doppler can be used as a surveillance protocol that can detect early AVF dysfunction at par with Fistulogram.
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Affiliation(s)
- Manoj Prabhakaran
- Department of Nephrology, ABVIMS, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | | | - Ranjith Kumar Nath
- Department of Cardiology, ABVIMS, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Lalit Pursnani
- Department of Nephrology, ABVIMS, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | | | - Anamika Singh
- Department of Nephrology, ABVIMS, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Amandeep Singh
- Department of Nephrology, ABVIMS, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Sanket Patil
- Department of Nephrology, ABVIMS, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Abhisek Gautam
- Department of Nephrology, ABVIMS, Dr. Ram Manohar Lohia Hospital, New Delhi, India
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Wilson E, Sacknovitz Y, Dalmia V, Sanon O, Hatch A, Dauer M, Scher L, Lipsitz E, Koleilat I. Initiation of hemodialysis at one month following fistulogram in patients with advanced kidney disease. Vascular 2023; 31:387-391. [PMID: 34994670 DOI: 10.1177/17085381211068231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Previous studies have demonstrated that low contrast volume used in access-related interventions had limited effects on the progression of chronic kidney disease (CKD) after fistulography, but studies are limited and heterogeneous. We sought to evaluate the rate of and factors associated with progression to dialysis (HD) within 1 month after fistulography for patients with advanced CKD. METHODS A single-institution retrospective cohort analysis of patients with CKD stage IV and V, not yet on HD, undergoing fistulography from 1 January 2014 to 31 December 2018 was performed. The primary outcome was progression to HD within 1 month. Additional variables and the association with the primary outcome such as medical comorbidities, contrast type or volume were assessed. RESULTS A total of 34 patients underwent 41 fistulograms prior to HD initiation. Progression to HD within 1 month of fistulogram occurred in seven patients (all CKD V). The mean time between fistulogram and HD was 271 days for 31 of 34 patients who ultimately progressed to HD. Those with CKD IV began HD in 549 days on average, while those with CKD V began HD in 190 days on average. Three patients had not initiated HD at a mean of 539 days of follow-up. The only factors associated with progression to HD within 1 month included use of isovue (p = .005) and elevated contrast volume, with a mean of 40 mL (p = .027). CONCLUSION Although none of the patients with CKD IV required HD within 1 month after fistulogram, the use of larger iodinated contrast volume was associated with progression to HD within 1 month of fistulography for patients with CKD V. Further studies should investigate the safety of iodinated and alternative (e.g., carbon dioxide) contrast media in fistulography or duplex-based HD access procedures for CKD patients, especially CKD V, not yet on HD.
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Affiliation(s)
- Eelin Wilson
- Department of Cardiothoracic and Vascular Surgery, Department of Surgery, 2013Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Yoni Sacknovitz
- Department of Biology, 2007Yeshiva University, New York, NY, USA
| | - Varun Dalmia
- Department of Cardiothoracic and Vascular Surgery, 2006Albert Einstein College of Medicine, Bronx, NY, USA
| | - Omar Sanon
- Division of Vascular Surgery2613, Northwell Health - Lenox Hill Hospital, New York, NY, USA
| | - Ayesha Hatch
- Department of Vascular Surgery, 2613Medstar Washington Hospital Center, Washington, DC, USA
| | - Marc Dauer
- Department of Cardiothoracic and Vascular Surgery, Department of Surgery, 2013Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Larry Scher
- Department of Cardiothoracic and Vascular Surgery, Department of Surgery, 2013Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Evan Lipsitz
- Department of Cardiothoracic and Vascular Surgery, Department of Surgery, 2013Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Issam Koleilat
- Department of Surgery, Community Medical Center, 4598RWJ/Barnabas Health, Tom's River, NJ, USA
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9
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Walsh JP, Hentschel DM, Sharma G, Lotto CE, Ozaki CK. Contemporary Strategies to Promote Dialysis Access Fistula Maturation. Vasc Endovascular Surg 2022; 56:590-594. [PMID: 35574704 DOI: 10.1177/15385744211037834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: The inability of a newly created arteriovenous fistula to support hemodialysis due to non-maturation results in increased complications secondary to catheter dependence. Methods: In view of the highly variable approaches by providers with heterogenous backgrounds (general surgery, vascular surgery, interventional radiology and interventional nephrology, urology, transplant surgery, etc.) we sought to describe a collection of algorithms that have functioned well in our hands to manage this challenging clinical problem and guide trainees and practicing clinicians alike.Results: Physical examination along with selective duplex ultrasound and fistulogram can identify most pathologies underlying non-maturation.Conclusion: Both endovascular and open techniques can be employed to optimize maturation rates in this complex population.
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Affiliation(s)
- Jillian P Walsh
- 1861Division of Vascular and Endovascular Surgery, Brigham & Women's Hospital, Boston, MA, USA
| | - Dirk M Hentschel
- Brigham Health, Renal Division, 1861Brigham & Women's Faulkner Hospital, Boston, MA, USA
| | - Gaurav Sharma
- 1861Division of Vascular and Endovascular Surgery, Brigham & Women's Hospital, Boston, MA, USA
| | - Christine E Lotto
- Division of Vascular and Endovascular Surgery, Capital Health Medical Center, Pennington, NJ, USA
| | - Charles Keith Ozaki
- 1861Division of Vascular and Endovascular Surgery, Brigham & Women's Hospital, Boston, MA, USA
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Landy S, Peralta S, Fiani N. An Atypical Presentation of a Zygomatic Sialocele in a dog. J Vet Dent 2022; 38:223-230. [PMID: 35037496 DOI: 10.1177/08987564211072675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A sialocele is an accumulation of salivary fluid due to leakage into the interstitial space surrounding the affected salivary gland and/or its corresponding duct. Reported causes of salivary leakage include trauma, foreign bodies, sialoliths, and neoplasia, but in many cases the etiology is not identified. Clinical signs of sialoceles associated with the zygomatic salivary gland or corresponding duct usually include exophthalmos due to periorbital salivary accumulation, whereas sialoceles associated with the mandibular or sublingual glands or ducts usually manifest as cervical, pharyngeal and/or sublingual salivary accumulation. This case report describes an atypical cervical presentation of a zygomatic sialocele in a dog that resolved after zygomatic sialoadenectomy.
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Affiliation(s)
- Shanna Landy
- University College of Veterinary Medicine, 930 Campus Road, C2-513, Ithaca, NY 14853-6401
| | - Santiago Peralta
- 43317Cornell University College of Veterinary Medicine, C3-510 CPC, Box 31, College of Veterinary Medicine, Ithaca, NY 14853
| | - Nadine Fiani
- 43317Cornell University College of Veterinary Medicine, 930 Campus rd., Ithaca, NY 14853-0001
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11
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Weitzel WF, Rajaram N, Krishnamurthy VN, Hamilton J, Thelen BJ, Zheng Y, Morgan T, Funes-Lora MA, Yessayan L, Bishop B, Shih AJ. Sono-angiography for dialysis vascular access based on the freehand 2D ultrasound scanning. J Vasc Access 2021; 23:871-876. [PMID: 33971754 DOI: 10.1177/11297298211015066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Dialysis vascular access, preferably an autogenous arteriovenous fistula, remains an end stage renal disease (ESRD) patient's lifeline providing a means of connecting the patient to the dialysis machine. Once an access is created, the current gold standard of care for maintenance of vascular access is angiography and angioplasty to treat stenosis. While point of care 2D ultrasound has been used to detect access problems, we sought to reproduce angiographic results comparable to the gold standard angiogram (fistulogram) using ultrasound data acquired from a conventional 2D ultrasound scanner. METHODS A 2D ultrasound probe was used to acquire a series of cross sectional images of the vascular access including arteriovenous anastomosis of a subject with a radio-cephalic fistula. These 2D B-mode images were used for 3D vessel reconstruction by binary thresholding to categorize vascular versus non-vascular structures followed by standard image segmentation to select the structure representative of dialysis vascular access and morphologic filtering. Image processing was done using open source Python Software. RESULTS The open source software was able to: (1) view the gold standard fistulogram images, (2) reconstruct 2D planar images of the fistula from ultrasound data as viewed from the top, analogous to computerized tomography images, and (3) construct a 2D representation of vascular access similar to the angiogram. CONCLUSION We present a simple approach to obtain an angiogram-like representation of the vascular access from readily available, non-proprietary 2D ultrasound data in the point of care setting. While the sono-angiogram is not intended to replace angiography, it may be useful in providing 3D imaging at the point of care in the dialysis unit, outpatient clinic, or for pre-operative planning for interventional procedures. Future work will focus on improving the robustness and quality of the imaging data while preserving the straightforward freehand approach used for ultrasound data acquisition.
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Affiliation(s)
- William F Weitzel
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Nirmala Rajaram
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Venkataramu N Krishnamurthy
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Departments of Radiology and Surgery, University of Michigan, Ann Arbor, MI, USA
| | - James Hamilton
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Emerge Now Inc., Los Angeles, CA, USA
| | - Brian J Thelen
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Statistics, University of Michigan, Ann Arbor, MI, USA.,Michigan Tech Research Institute, Michigan Technological University, Ann Arbor, MI, USA
| | - Yihao Zheng
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Mechanical Engineering, Worcester Polytechnic Institute, Worcester, MA, USA
| | | | | | - Lenar Yessayan
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Albert J Shih
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA
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12
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Abstract
Bronchobiliary fistula (BBF) is a rare condition that results from the communication between the bile ducts and the bronchial tree. It is characterized by the presence of bile in the sputum as pathognomonic symptom, and it is often associated with suspicious pneumonia. The most common causes include infections (e.g. echinococcosis), hepatobiliary surgery, blunt torso traumas, tumors and percutaneous transhepatic procedures. Opinions about BBF treatment are still controversial as it can be treated by both conservative and surgical procedures, while pharmacological treatments are only rarely used. This case report presents a patient who had been diagnosed with chronic BBF of unknown cause, underwent several ineffective conservative procedures and was at last surgically treated.
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Affiliation(s)
- Marzia Acquasanta
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Gaia Spadarella
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
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13
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Elkins JM, Kates S, Lange J, Lange J, Lichstein P, Otero J, Soriano A, Wagner C, Wouthuyzen-Bakker M. General Assembly, Diagnosis, Definitions: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S181-S185. [PMID: 30348558 DOI: 10.1016/j.arth.2018.09.069] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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14
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Cooper CJ, Gerges AS, Anekwe E, Hernandez GT. Double superior vena cava on fistulogram: A case report and discussion. Am J Case Rep 2013; 14:395-7. [PMID: 24130918 PMCID: PMC3795019 DOI: 10.12659/ajcr.889589] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Revised: 10/02/2013] [Accepted: 07/24/2013] [Indexed: 11/16/2022]
Abstract
Patient: Female, 50 Final Diagnosis: Double superior vena cava Symptoms: — Medication: — Clinical Procedure: — Specialty: Nephrology
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Affiliation(s)
- Chad J Cooper
- Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A
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15
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Abstract
The management of enterocutaneous fistulas continues to be a challenging postoperative complication. Understanding the anatomy of the fistula optimizes its evaluation and management. Diagnostic radiology has always played an important role in this task. The use of plain radiography with contrasted studies and fistulograms is well documented in the earliest investigations of fistulas and they continue to be helpful techniques. The imaging techniques have evolved rapidly over the past 15 years with the introduction of cross-sectional imaging, ultrasound and endoscopy. The purpose of this chapter is to review both the diagnostic and therapeutic roles of fistulograms, small bowel follow-through, computed tomography, magnetic resonance imaging, ultrasound, and endoscopy in the setting of acquired enterocutaneous fistulas.
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Affiliation(s)
- Jennifer K Lee
- Department of Surgery, University Hospitals, Case Medical Center, Cleveland, Ohio
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16
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Yanofsky G, Bonneau NH, Breton L. Fistulography as an aid in the diagnosis of a nonradiopaque foreign body in a dog. Can Vet J 1986; 27:291-2. [PMID: 17422681 PMCID: PMC1680287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
A case of chronic fistula associated with foreign body penetration of the soft tissues was diagnosed in the skull of a dog by fistulography. Radiographic technique and diagnostic features are described and illustrated.
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