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Franchin M, Goddi A, Muscato P, Cervarolo MC, Piffaretti G, Tozzi M. Implanted blood vessel external support device for the treatment of distal hypoperfusion ischemic syndrome in arteriovenous fistulas and high-frame-rate Vector Flow quality assessment. J Vasc Access 2024; 25:642-650. [PMID: 36708038 DOI: 10.1177/11297298231151715] [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: 01/29/2023] Open
Abstract
INTRODUCTION Distal hypoperfusion ischemic syndrome (DHIS) is a complication occurring after arteriovenous fistula (AVF) creation. Different surgical alternatives haves been proposed in case of severe DHIS. Aim of the present paper is to present a new technique for DHIS treatment. MATERIAL AND METHODS Between the 1st of January 2021 and the 31st December 2021 all the patients referred to our center for DHIS grade 2-4 were treated with a new surgical technique. It consists of AVF remodeling using an external nitinol support (VasQ®) to reduce the risk of outflow vein enlargement and DHIS recurrence. To better appreciate the hemodynamic effects of the surgery, a new ultrasound technique called high-frame-rate Vector Flow (HiFR-VF) was used. RESULTS Seven patients (M:F 1:3; mean age 43 ± 12 years, range 29-65) were included in this study. Central line was never necessary, and technical success was 100% at 12 months. The comparison with historical data demonstrated lower recurrence of symptoms in comparison to simple artery-to-vein redo (p 0.50). The HiFR-VF showed flow with limited turbulent characteristics at the anastomosis site. DISCUSSION AND CONCLUSION The new technique proposed demonstrated to be safe and effective for treatment of DHIS, preventing symptoms recurrence. Ultrasound examination and HiFR-VF can be considered a valuable method to evaluate complex flows at the levels of vascular anastomosis.
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Affiliation(s)
- Marco Franchin
- Vascular Surgery, Department of Surgery and Morphological Sciences, Circolo University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy
| | - Alfredo Goddi
- Centro Medico SME - Diagnostica per Immagini, Varese, Italy
| | - Paola Muscato
- Vascular Surgery, Department of Surgery and Morphological Sciences, Circolo University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy
| | - Maria Cristina Cervarolo
- Vascular Surgery, Department of Surgery and Morphological Sciences, Circolo University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy
| | - Gabriele Piffaretti
- Vascular Surgery, Department of Surgery and Morphological Sciences, Circolo University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy
| | - Matteo Tozzi
- Vascular Surgery, Department of Surgery and Morphological Sciences, Circolo University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy
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Alqahtani SS, Aljaber FK, Alsuwailem BY, AlMashouq YA, AlHarbi BG, Elawad AM. Dialysis Access-Associated Steal Syndrome in High-Risk Patients Undergoing Surgery for Hemodialysis Access: A Systematic Review and Meta-Analysis of Preventive Operative Techniques. Cureus 2023; 15:e49612. [PMID: 38161832 PMCID: PMC10755340 DOI: 10.7759/cureus.49612] [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: 11/28/2023] [Indexed: 01/03/2024] Open
Abstract
This systematic review and meta-analysis examine preventive operative techniques in high-risk patients undergoing surgery for hemodialysis access to mitigate the risk of Dialysis Access-Associated Steal Syndrome (DASS). Chronic kidney disease often leads to end-stage renal disease (ESRD), necessitating dialysis. Successful vascular access is crucial for efficient dialysis, but complications, such as DASS, pose significant challenges. DASS redirects arterial blood flow, affecting populations undergoing arteriovenous access surgery. This study aims to assess preventive strategies, including distal revascularization with interval ligation (DRIL) and extension techniques. A systematic search of PubMed, Cochrane Library, EMBASE, and Web of Science until 2022 identified 11 relevant studies. The inclusion criteria comprised non-pediatric hemodialysis patients reporting outcomes related to patency and complications. The data were analyzed using Review Manager 5.3.5 (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen). Meta-analysis indicated a significant association between DASS and arteriovenous fistula (AVF) or arteriovenous graft (AVG) procedures. Radiocephalic AVF (RC-AVF) and distal endovascular AVF procedures were favored. Various interventions addressed venous narrowing, including simple plication and loop interposition. The Modified by Inserted Latex Link for Endovascular Repair (MILLER) technique, DRIL, Extension Technique, and Proximalization of Arterial Inflow (PAI) were assessed for arterial bypass graft and blood supply preservation. This study underscores the importance of individualized strategies in preventing DASS during hemodialysis access surgery. Prophylactic measures, such as the extension technique, show promise, while DRIL remains effective in treatment. Ongoing research is imperative for optimizing outcomes in this complex patient population.
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Affiliation(s)
- Saeed S Alqahtani
- Vascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, DEU
- Vascular Surgery, Prince Sultan Military Medical City, Riyadh, SAU
| | - Fahad K Aljaber
- Vascular Surgery, Prince Sultan Military Medical City, Riyadh, SAU
| | - Bader Y Alsuwailem
- Vascular Surgery, Prince Sultan Military Medical City, Riyadh, SAU
- Vascular Surgery, King Fahad Medical City, Riyadh, SAU
| | | | - Bander G AlHarbi
- Vascular Surgery, Prince Sultan Military Medical City, Riyadh, SAU
- Vascular Surgery, Samsung Medical Center, Seoul, KOR
| | - AlSayed M Elawad
- Vascular Surgery, Prince Sultan Military Medical City, Riyadh, SAU
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Gusev MV, Mannoia KA, Patel ST. Rapid progression of finger gangrene in a hemodialysis patient: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231207710. [PMID: 37904785 PMCID: PMC10613399 DOI: 10.1177/2050313x231207710] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 09/28/2023] [Indexed: 11/01/2023] Open
Abstract
Severe hemodialysis access-induced distal ischemia is an uncommon complication after arteriovenous fistula creation. Finger amputation is rare and generally does not involve the entirety of the digit. The distal revascularization interval ligation procedure has become less commonly used for hemodialysis access-induced distal ischemia over the past decade. The procedure typically requires general anesthesia, greater saphenous vein harvest, and brachial artery ligation. We describe a 64-year-old female with hypertension, diabetes mellitus, and end-stage renal disease on hemodialysis via a well-functioning brachiocephalic arteriovenous fistula who developed rapid progression of finger gangrene. She underwent the distal revascularization interval ligation procedure, followed by finger amputations. The finger amputations healed within 6 months of the distal revascularization interval ligation procedure and the fistula was preserved at 2-year follow-up.
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Affiliation(s)
- Maksim V Gusev
- Division of Vascular Surgery, Loma Linda University Health, Loma Linda, CA, USA
| | - Kristyn A Mannoia
- Division of Vascular Surgery, Loma Linda University Health, Loma Linda, CA, USA
| | - Sheela T Patel
- Division of Vascular Surgery, Loma Linda University Health, Loma Linda, CA, USA
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4
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Zardi EM, Marra A, Pignatelli M, Melina G, Sada L, Zardi DM. Unstable angina as a result of coronary steal syndrome due to escape flow from a double large coronary-pulmonary artery fistula. Acta Cardiol 2023:1-2. [PMID: 37882648 DOI: 10.1080/00015385.2023.2272552] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/13/2023] [Indexed: 10/27/2023]
Affiliation(s)
- Enrico Maria Zardi
- Department of Medicine and Surgery, Internistic Ultrasound Service, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Andrea Marra
- Interventional Cardiology Unit, Castelli Hospital (NOC), Ariccia, RM, Italy
| | | | - Giovanni Melina
- Department of Clinical and Molecular Medicine, Cardiac Surgery Unit, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Lidia Sada
- Interventional Cardiology Unit, Castelli Hospital (NOC), Ariccia, RM, Italy
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Banana Y, Boukabous S, El malki H, Rezziki A, Belarbi A, Haddiya I, Bentata Y, Moutaouekkil EM, Benzirar A, El Mahi O. Long-term patency of bypass to the right atrium as a last resort in two hemodialysis patients: case report. Ann Med Surg (Lond) 2023; 85:5043-5046. [PMID: 37811058 PMCID: PMC10553076 DOI: 10.1097/ms9.0000000000001012] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/10/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Central venous occlusion (CVO), which is caused by central venous catheters in haemodialysis patients , remains a challenge in vascular surgery. Case presentation The authors report data evaluating bypass graft patency and complications of two patients with CVO who have benefited from a subclavian artery to right atrium bypass using polytetrafuloroetylene. The first patient , underwent three times an angioplasty of the atrio prothetic anastomosis , finally the graft failed at 12 month. The second one, presented a steal syndrome with ischaemia of the right upper limb immediately postoperatively. Three months after the procedure , she underwent an angiographic control that showed a stenosis of the protheto atrial junction. Clinical discussion Central venous occlusion in patients with end-stage kidney disease is most often due to central venous catheters. Although the endovascular therapy is the first-line approach to the treatment of CVO, the surgical bypass to the right atrium is often the last resort to preserve adequate vascular access in haemodialysis patients, with CVO. The autologous vein and bovine arterial bypass remains better than polytetrafuloroetylene grafts in terms of long-term patency. Only few cases have been reported un the literature , besides no long-term outcome data has been previously reported. Conclusion Long-term secondary patency of bypass to the right atrium can be achieved, but requires strict follow-up, and multiple endovascular procedures to maintain the bypass access.
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Affiliation(s)
| | | | - Hicham El malki
- Cardiovascular Surgery, Mohammed VI University Hospital of Oujda
- Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, Mohammed the First University of Oujda, Oujda, Morocco
| | - Abdellah Rezziki
- Departments of Vascular Surgery
- Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, Mohammed the First University of Oujda, Oujda, Morocco
| | - Adam Belarbi
- Cardiovascular Surgery, Mohammed VI University Hospital of Oujda
| | - Intissar Haddiya
- Nephrology—Dialysis and Kidney Transplantation
- Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, Mohammed the First University of Oujda, Oujda, Morocco
| | - Yassamine Bentata
- Nephrology—Dialysis and Kidney Transplantation
- Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, Mohammed the First University of Oujda, Oujda, Morocco
| | - El Mehdi Moutaouekkil
- Cardiovascular Surgery, Mohammed VI University Hospital of Oujda
- Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, Mohammed the First University of Oujda, Oujda, Morocco
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Usman R, Jamil M, Fatima R, Mazhar M, Majeed S, Shahab A. Efficacy of Revision Using Distal Inflow in Patients with Symptomatic Dialysis Access-Associated Steal Syndrome. Ann Vasc Dis 2023; 16:205-209. [PMID: 37779643 PMCID: PMC10539131 DOI: 10.3400/avd.oa.23-00043] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/21/2023] [Indexed: 10/03/2023] Open
Abstract
Objectives: In this study, we aim to assess the efficacy of revision using distal inflow (RUDI) in patients with symptomatic dialysis access-associated steal syndrome (DASS). Materials and Methods: All consecutive patients who were diagnosed with grade 3 or 4 DASS and have undergone RUDI in 4 years were included in this study. Results: In total, 35 patients were included in this study; participants had a mean age of 47.5±7.52 years and 54% (n=19) were males. As per our findings, significant improvement was noted in terms of paresthesia (81.2%, p-value: 0.012), coolness (79.4%, p-value: 0.006), pain (78.1%, p-value: 0.006), discoloration (76.4%, p-value: 0.044), paresis (71.4%, p-value: 0.016), and ulcer healing (50%, p-value: 0.044). Gangrene did not further progress in all patients (n=35). Reduction in fistula flow rate after RUDI was 57.5% (682±121 ml/min, p-value: 0.001). Digital systolic pressure was noted to improve by 71.4% (60±9.2 mmHg, p-value: 0.002) after RUDI. Peak systolic velocity increased in both ulnar (66.1±8.2 cm/s, p-value: 0.04) and radial (64.2±7.6 cm/s, p-value: 0.024) arteries of the wrist. Cumulative patency of RUDI graft was 100%, 91.4%, and 85.7% at 3, 6, and 12 months, respectively. Conclusion: RUDI has resulted in significant improvements in terms of DASS symptoms. Using a native vein as conduit, RUDI should be considered a procedure of choice for patients with high-flow DASS.
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Affiliation(s)
- Rashid Usman
- Department of Surgery, Combined Military Hospital, Lahore Cantt, Pakistan
| | - Muhammad Jamil
- Department of Surgery, Combined Military Hospital, Multan Cantt, Pakistan
| | - Rabail Fatima
- Department of Surgery, CMH Lahore Medical College, Lahore Cantt, Pakistan
| | - Minahil Mazhar
- Department of Surgery, CMH Lahore Medical College, Lahore Cantt, Pakistan
| | - Shahid Majeed
- Department of Surgery, Combined Military Hospital, Lahore Cantt, Pakistan
| | - Amna Shahab
- Department of Surgery, Combined Military Hospital, Lahore Cantt, Pakistan
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7
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Adly M, Ladha MA, Mydlarski R, Petrasek P, Parsons L. Painless ulceration due to digital hypoperfusion ischaemic syndrome: case report and literature review. J Wound Care 2023; 32:S26-S30. [PMID: 37405963 DOI: 10.12968/jowc.2023.32.sup7.s26] [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: 07/07/2023]
Abstract
Digital hypoperfusion ischaemic syndrome (DHIS), also known as steal syndrome, is a well recognised serious complication of haemodialysis (HD) access creation. The clinical presentation varies from cyanosis to tissue loss due to necrosis or gangrene. In this article, we present a case of painless digital ulceration due to DHIS and provide a review of the literature. A 40-year-old-female presented with multiple painless digital ulcerations of the left hand. Her medical profile included atherosclerotic disease, hypertension, hyperparathyroidism and type I diabetes causing retinopathy, peripheral neuropathy, gastroparesis and end-stage renal disease (ESRD). Her ESRD required HD with the construction of a left-arm basilic vein transposition arteriovenous fistula (AVF). A year later, she developed intermittent, painless ulcerations of the left hand. A Doppler ultrasound confirmed the diagnosis of DHIS. The patient was treated with AVF ligation surgery. At six months postoperatively, she had near complete re-epithelialisation of her ulcers. This case is unique in that the patient did not have preceding pain, likely due to her underlying diabetic neuropathy. While DHIS in haemodialysis patients with AVF is well documented in literature, digital ulceration in this context is an advanced form of this condition. Early recognition of digital ulceration as a complication of DHIS may enable early intervention and prevent permanent damage.
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Affiliation(s)
- Merna Adly
- University of Calgary, Cumming School of Medicine, University of Calgary, Canada
| | - Malika A Ladha
- Division of Dermatology, Department of Medicine, University of Calgary, Canada
| | - Régine Mydlarski
- Division of Vascular Surgery, Department of Surgery, University of Calgary, Canada
| | - Paul Petrasek
- Division of Vascular Surgery, Department of Surgery, University of Calgary, Canada
| | - Laurie Parsons
- Division of Dermatology, Department of Medicine, University of Calgary, Canada
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8
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Kamel NF, Bowers MT, Leonard C, Dillavou ED. Early Intervention for Steal Syndrome in Patients on Hemodialysis. Nephrol Nurs J 2023; 50:117-130. [PMID: 37074936] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
Dialysis access-associated steal syndrome (DASS) is a serious, challenging complication related to diminished arterial blood flow to the hand. Patients may not be routinely assessed for this diagnosis, resulting in a delayed presentation with severe hand pain, nerve damage, and tissue loss. This pilot project examined the feasibility of implementing an assessment tool to routinely screen patients for steal syndrome. The tool was used for all patients in three participating dialysis centers. Positive patients had a streamlined referral to vascular surgery for assessment and possible treatment. This pilot project demonstrates that education and subsequent routine screening for DASS within the dialysis facility is feasible, and can be incorporated into the workflow for both the dialysis facility and the servicing vascular surgery office. Early recognition of DASS will prevent severe injuries and tissue loss.
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Affiliation(s)
- Nada F Kamel
- Vascular Nurse Practitioner and Dialysis Access Coordinator, Duke Vascular Surgery, Duke Regional Hospital, Durham, NC
| | - Margaret T Bowers
- Clinical Professor and Nurse Practitioner, Duke University School of Nursing and Duke Health, Duke University Hospital, Durham, NC
| | - Christina Leonard
- Assistant Professor, Duke University School of Nursing, Durham, NC
- Nurse Practitioner, WakeMed Hospital, Raleigh, NC
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Kazantsev AN, Chernykh KP, Bagdavadze GS, Dzhanelidze MO, Lider RY, Korotkikh AV, Zharova AS, Kazantseva EG. [Subclavian-carotid transposition and subclavian artery stenting for steal-syndrome]. Khirurgiia (Mosk) 2022:77-84. [PMID: 36073587 DOI: 10.17116/hirurgia202209177] [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: 06/15/2023]
Abstract
OBJECTIVE To analyze in-hospital results of subclavian-carotid transposition and subclavian artery stenting in patients with steal-syndrome. MATERIAL AND METHODS A retrospective open study included 137 patients with occlusion or severe stenosis of the first segment of subclavian artery and steal-syndrome. The 1st group included 50 patients who underwent stenting or recanalization with stenting of the first segment of subclavian artery between January 2010 and March 2020. The 2nd group included 87 patients who underwent subclavian-carotid transposition between January 2010 and March 2020. RESULTS There were no in-hospital mortality, myocardial infarction, ischemic stroke or bleeding. In the second group, damage to recurrent laryngeal nerve with irreversible laryngeal paresis occurred in 6.9% of patients, and one patient had brachial plexus neuropathy. One patient developed lymphorrhea with chylothorax accompanied by shortness of breath on exertion. Conservative management with repeated pleural punctures was not accompanied by clinical compensation. The patient was discharged for outpatient treatment. Thromboembolism of the left branch of the aorto-femoral prosthesis and deep femoral artery on the left was diagnosed in the endovascular correction group after implantation of Protege GPS stent (10´60 mm) and post-dilation with a PowerFlex PRO balloon catheter (9´4 mm). Acute ischemia of the left lower limb required thrombectomy with patch repair of deep femoral artery. The patient was discharged after 5 days. In another case, vertebral artery dissection occurred after implantation of Protege GPS stent (10×40 mm) and post-dilatation with a PowerFlex PRO balloon catheter (8´20 mm). In this regard, the patient underwent stenting of the fourth segment of vertebral artery (Endeavor Resolute 4.0´24 mm stent) with post-dilation (Boston Scientific Samurai balloon catheter 0.014´190 cm). The patient was discharged after 3 days. CONCLUSION Subclavian-carotid transposition and subclavian artery stenting are safe methods of revascularization that are not accompanied by myocardial infarction, ischemic stroke or mortality. However, subclavian-carotid transposition is characterized by higher risk of neurological disorders (laryngeal paresis, phrenic nerve paresis, brachial plexus neuropathy) and wound complications (lymphorrhea, chylothorax). In turn, subclavian artery stenting is associated with the risk of dissection and embolism. Therefore, the choice of treatment strategy in patients with occlusive-stenotic lesions of the first segment of subclavian artery should be personalized and carried out by a multidisciplinary team.
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Affiliation(s)
- A N Kazantsev
- St. Petersburg City Alexandrovskaya Hospital, St. Petersburg, Russia
| | - K P Chernykh
- St. Petersburg City Alexandrovskaya Hospital, St. Petersburg, Russia
| | - G Sh Bagdavadze
- Mechnikov North-Western State Medical University, St. Petersburg, Russia
| | - M O Dzhanelidze
- Western Regional Center of Modern Medical Technologies, Kutaisi, Georgia
| | - R Yu Lider
- Kemerovo State Medical University, Kemerovo, Russia
| | | | - A S Zharova
- Mechnikov North-Western State Medical University, St. Petersburg, Russia
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10
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Vachev AN, Dmitriev OV, Golovin EA, Stepanov MI. [Optimal method of reconstruction in patients with pathology of the 1st segment of the subclavian artery]. Angiol Sosud Khir 2020; 26:133-139. [PMID: 32597894 DOI: 10.33529/angio2020218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The study enrolled a total of 318 patients presenting with lesions of the 1st segment of the subclavian artery and the clinical course of vertebrobasilar insufficiency. All patients prior to admission had been receiving the best course of medicamentous therapy under the supervision of a neurologist for more than 6 months but with no significant clinical improvement. According to the type of the reconstructive operation on the 1st segment of the subclavian artery, all patients were subdivided into three groups. Group I included 48 (15.1%) patients presenting with occlusion of the subclavian artery and undergoing carotid subclavian bypass grafting. Group II consisted of 224 (70.4%) patients who underwent endarterectomy from the subclavian artery and its transposition to the common carotid artery. Group III was composed of 46 (14.5%) patients presenting with local stenosis of the subclavian artery and subjected to stenting of the 1st segment of the subclavian artery. The main criteria for assessment of the results were patency of the zone of reconstruction and clinical improvement of the patient after surgery. RESULTS: Clinical improvement in the early postoperative period was observed in 301 (94%) patients. In Group I, in the early postoperative period, clinical improvement was achieved in 32 (66.7%) patients. Clinical improvement after 3 years persisted only in 16 (33.3%) patients. In Group II comprising patients with transposition of the subclavian artery to the common carotid artery, clinical improvement was observed in 223 (99.6%) patients. Within 3 years of follow-up, 13 (6.4%) patients were found to have a relapse of the clinical picture of vertebrobasilar insufficiency. Clinical improvement after transposition of the subclavian artery to the common carotid artery at 3 years persisted in 210 (93.6%) patients. In Group III patients after stenting of the 1st segment of the subclavian artery in the early postoperative period and during the follow-up period up to 1 year, the angiographic and clinical success amounted to 100%. After 3 years, 8 (17.3%) patients developed relapse of the clinical course because of restenosis, fracture, and thrombosis of the stent. Clinical improvement at 3 years persisted only in 38 (82.6%) patients after stenting. Comparing the remote results demonstrated that transposition of the subclavian artery to the common carotid artery turned out to be the most justified (p<0.05). CONCLUSION: For reconstruction of the 1st segment of the subclavian artery, an operation of choice is transposition of the subclavian artery to the common carotid artery.
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Affiliation(s)
- A N Vachev
- Clinic and Chair of Faculty Surgery, Samara State Medical University of the RF Ministry of Public Health, Samara, Russia
| | - O V Dmitriev
- Clinic and Chair of Faculty Surgery, Samara State Medical University of the RF Ministry of Public Health, Samara, Russia
| | - E A Golovin
- Clinic and Chair of Faculty Surgery, Samara State Medical University of the RF Ministry of Public Health, Samara, Russia
| | - M Iu Stepanov
- Clinic and Chair of Faculty Surgery, Samara State Medical University of the RF Ministry of Public Health, Samara, Russia
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11
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Abstract
Timely creation and maintenance of a safe and reliable vascular access is essential for hemodialysis patients with end-stage renal disease. Hemodialysis access-induced distal ischemia (HAIDI) is a recognized complication of arteriovenous fistulas and grafts that may result in serious or even devastating consequences. Avoiding such complications is clearly preferred over treatment of HAIDI once established. Proper recognition of patients at increased risk of HAIDI includes careful pre-operative evaluation of the patient's medical and surgical history along with physical examination and imaging to determine a plan for creating a functional permanent access while minimizing the risk of distal ischemia. Our aim is to review identifying characteristics of individuals at risk of HAIDI and provide recommendations regarding pre-operative assessment. Vascular access options and techniques are suggested for establishing a functional vascular access without distal ischemia for such patients.
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Affiliation(s)
- Vernon D Horst
- Division of Vascular Surgery, Department of Surgery, School of Community Medicine, The University of Oklahoma, Tulsa, OK, USA
| | - Peter R Nelson
- Division of Vascular Surgery, Department of Surgery, School of Community Medicine, The University of Oklahoma, Tulsa, OK, USA
| | | | - Kelly Kempe
- Division of Vascular Surgery, Department of Surgery, School of Community Medicine, The University of Oklahoma, Tulsa, OK, USA
| | - Viraj Pandit
- Division of Vascular Surgery, Department of Surgery, School of Community Medicine, The University of Oklahoma, Tulsa, OK, USA
| | - Hyein Kim
- Division of Vascular Surgery, Department of Surgery, School of Community Medicine, The University of Oklahoma, Tulsa, OK, USA
| | - William C Jennings
- Division of Vascular Surgery, Department of Surgery, School of Community Medicine, The University of Oklahoma, Tulsa, OK, USA
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12
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Dinoto E, Pecoraro F, Mirabella D, Ferlito F, Farina A, Lo Biundo N, Conti P, Bajardi G. Endovascular Treatment with Drug-Eluting Balloon for Severe Subclavian Artery Stenosis Involving the Origin of the Vertebral Artery. Transl Med UniSa 2020; 21:35-37. [PMID: 32123680 PMCID: PMC7039271] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
The first line approach for subclavian steal syndrome is PTA-stenting of subclavian artery. When the ipsilateral vertebral artery origin is involved or in closed proximity of the atherosclerotic lesion in the subclavian artery PTA-stenting is at risk of ipsilateral vertebral artery coverage. Herein we report our experience with DEB to address lesions involving the subclavian artery and the origin of the ipsilateral vertebral artery. From January 2017 to February 2019, patients presenting subclavian artery lesion involving the origin of the ipsilateral vertebral artery and treated using primary DEB, were included. Three patients, with left subclavian steal syndrome, were identified. The perioperative mortality and morbidity were outcomes evaluated. Freedom from occlusion, secondary patency, amputation rate was registered. A total of 3 (2 female) patients were included in the study. No complication, symptoms recurrence, restenosis or occlusion were reported at duplex scan during 12-month follow-up. Indication for stenting was arterial dissection. In our limited experience, the use of DEB in association to embolic protection device in the treatment of atherosclerotic subclavian lesion involving the origin of the vertebral artery was safe and technically feasible.
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Affiliation(s)
- E Dinoto
- Vascular Surgery Unit; Department of Surgical, Oncological and Oral Sciences, University of Palermo
| | - F Pecoraro
- Vascular Surgery Unit; Department of Surgical, Oncological and Oral Sciences, University of Palermo
| | - D Mirabella
- Vascular Surgery Unit; Department of Surgical, Oncological and Oral Sciences, University of Palermo
| | - F Ferlito
- Vascular Surgery Unit; Department of Surgical, Oncological and Oral Sciences, University of Palermo
| | - A Farina
- Vascular Surgery Unit; Department of Surgical, Oncological and Oral Sciences, University of Palermo
| | - N Lo Biundo
- Vascular Surgery Unit; Department of Surgical, Oncological and Oral Sciences, University of Palermo
| | - P Conti
- Vascular Surgery Unit; Department of Surgical, Oncological and Oral Sciences, University of Palermo
| | - G Bajardi
- Vascular Surgery Unit; Department of Surgical, Oncological and Oral Sciences, University of Palermo
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13
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Beathard GA, Jennings WC, Wasse H, Shenoy S, Hentschel DM, Abreo K, Urbanes A, Nassar G, Dolmatch B, Davidson I, Asif A. ASDIN white paper: Assessment and management of hemodialysis access-induced distal ischemia by interventional nephrologists. J Vasc Access 2019. [PMID: 31884872 DOI: 10.1177/1129729819894774.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Although not common, hemodialysis access-induced distal ischemia is a serious condition resulting in significant hemodialysis patient morbidity. Patients with signs and symptoms suggestive of hand ischemia frequently present to the general and interventional nephrologist for evaluation. In order to care for these cases, it is necessary to understand this syndrome and its management. Most cases can be managed conservatively without intervention. Some cases requiring intervention may be treated using techniques within the scope of practice of the interventional nephrologists while other cases require vascular surgery. In order for the interventional nephrologists to evaluate and manage these cases in a timely and appropriate manner, practice guidelines are presented.
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Affiliation(s)
| | - William C Jennings
- School of Community Medicine, The University of Oklahoma, Tulsa, OK, USA
| | | | - Surendra Shenoy
- Barnes-Jewish Hospital, Washington University, St. Louis, MO, USA
| | | | - Kenneth Abreo
- School of Medicine, LSU Health Shreveport, Shreveport, LA, USA
| | - Aris Urbanes
- Internal Medicine, Wayne State University, Detroit, MI, USA
| | - George Nassar
- Weill Cornell Medicine, New York, NY, USA.,Houston Methodist Hospital, Houston, TX, USA
| | | | - Ingemar Davidson
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Arif Asif
- Hackensack Meridian School of Medicine at Seton Hall University, Nutley, NJ, USA
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Fominykh NM, Zulkarnaev AB, Gegenava BB, Kardanakhishvili ZB. [Endovascular embolization of arteriovenous fistula in a patient with hand ischemia]. Khirurgiia (Mosk) 2019:111-116. [PMID: 31317950 DOI: 10.17116/hirurgia2019061111] [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
We present a case report of atypical hand ischemia probably caused by a combination of venous insufficiency and steal syndrome in patient with arteriovenous fistula for hemodialysis. Unclear clinical symptoms may be due to severe trophic disorders (delayed treatment) or combination of two complications (steal syndrome and venous insufficiency). At the same time, we did not get any diagnostic data confirming organic injury of the upper limb veins or central veins. AVF closure did not result positive changes. Angiography made it possible to assess veins patency, to detect additional patent AVF and to close it. It was previously assumed that this previously created AVF was completely occluded. Therefore, positive changes were observed: rapid healing of trophic ulcers, complete disappearance of pain and gradual restoration of function.
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Affiliation(s)
- N M Fominykh
- Department of transplantology, nephrology and artificial organs, Vladimirsky Moscow Regional Research and Clinical Institute, Moscow, Russia
| | - A B Zulkarnaev
- Department of transplantology, nephrology and artificial organs, Vladimirsky Moscow Regional Research and Clinical Institute, Moscow, Russia
| | - B B Gegenava
- Department of transplantology, nephrology and artificial organs, Vladimirsky Moscow Regional Research and Clinical Institute, Moscow, Russia
| | - Z B Kardanakhishvili
- Department of transplantology, nephrology and artificial organs, Vladimirsky Moscow Regional Research and Clinical Institute, Moscow, Russia
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15
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Chen JX, Levin LS, Mantell MP, Redmond JW, Clark TWI. Endovascular Therapy for Below-the-Elbow Arterial Disease: An Initial Single-Center Experience. J Endovasc Ther 2019; 26:505-511. [PMID: 31179815 DOI: 10.1177/1526602819854167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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
Purpose: To evaluate the technical success, clinical success, and complication rates of endovascular revascularization for below-the-elbow (BTE) peripheral artery disease. Materials and Methods: A retrospective review was performed of 19 patients (mean age 63 years; 12 men) with critical hand ischemia (CHI) who underwent 25 interventions in 19 arms between October 2010 and June 2017. Access was attained using 4-F or 5-F sheaths via antegrade brachial, retrograde radial, or fistula/graft access routes depending on the target vessel. A 0.018-inch hydrophilic microwire was used for intimal or subintimal recanalization. Angioplasty was performed over a 0.014-inch guidewire using low-profile balloons. The primary endpoint of the study was technical success, defined as successful lesion crossing/dilation, with residual stenosis <30%. Clinical success referred to improvement in pain and/or steal symptoms. Results: Technical success was achieved in 88% (22 of 25 procedures), with no significant difference in outcome associated with indications or baseline vessel disease. Complications occurred in 6 cases, of which 5 were minor and 1 was major. Clinical success was achieved in 12 of 14 patients with available follow-up; 5 of 7 patients with ulcers experienced wound healing. Conclusion: Endovascular revascularization for BTE occlusive disease is an effective and safe strategy for treating CHI.
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Affiliation(s)
- James X Chen
- 1 Division of Interventional Radiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,2 Vascular and Interventional Specialists, Charlotte Radiology, Charlotte, NC, USA
| | - L Scott Levin
- 3 Department of Orthopedic Surgery and Division of Plastic Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Mark P Mantell
- 4 Division of Vascular Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jonas W Redmond
- 1 Division of Interventional Radiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Timothy W I Clark
- 1 Division of Interventional Radiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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16
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Hansrani V, Muhammad K, Charlswood N, Al-Khaffaf H. The efficacy of the secondary Extension Technique in the management of arterio-venous fistula-associated steal syndrome. J Vasc Access 2019; 20:592-596. [PMID: 30712439 DOI: 10.1177/1129729819826046] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Dialysis-associated steal syndrome remains a difficult clinical scenario for vascular access surgeons. The ideal treatment would improve blood flow to the hand without compromising the fistula; however, most treatment options rarely allow for both. The study describes an innovative technique used in clinical practice over a 17-year period for the treatment of dialysis-associated steal syndrome. The procedure and long-term results are discussed. METHODS 27 patients with dialysis-associated steal syndrome were recruited over 17 years at two large UK University Teaching Hospitals and treated with the extension technique. All patients included were assessed for resolution of their symptoms, patency of the fistula and adequacy of needling. RESULTS 27 patients were admitted with dialysis-associated steal syndrome and underwent surgery using the extension technique. Complete symptom resolution was seen in 26 of the 27 patients (96%), with improvements in pain, sensori-motor disturbance and temperature. All 26 patients had a patent fistula at 6-months' follow-up. At 12 months, 3 of 27 (11.1%) developed fistula thrombosis which could not be salvaged and 2 of 27 (7.4%) developed thrombosis successfully salvaged by fistulaplasty. CONCLUSION Our study shows that the Extension Technique is an effective treatment method for dialysis-associated steal syndrome and results have demonstrated a high level of fistula patency and a low rate of complications. It has several advantages when compared with other established treatment methods and has the versatility to be used as a method for dialysis-associated steal syndrome prevention in high-risk groups as well as treatment.
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Affiliation(s)
- Vivak Hansrani
- Department of Vascular Surgery, Royal Blackburn Hospital, Blackburn, UK
| | - Kamel Muhammad
- Department of Vascular Surgery, Royal Blackburn Hospital, Blackburn, UK
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17
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Gupta R, Patadia D, Belligund P. An atypical presentation of pulmonary sequestration. J Res Med Sci 2017; 22:127. [PMID: 29259638 PMCID: PMC5721488 DOI: 10.4103/jrms.jrms_234_17] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 08/13/2017] [Accepted: 09/20/2017] [Indexed: 11/04/2022]
Abstract
Pulmonary sequestration (PS) is a rare congenital malformation of the lower respiratory tract and is commonly complicated by recurrent infections and presents with respiratory failure. We report an atypical clinical presentation of postprandial abdominal pain and cramps in a patient with intralobar PS.
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Affiliation(s)
- Raghav Gupta
- SUNY Downstate Medical Center, Brooklyn, New York, USA.,Department of Pulmonary and Critical Care Medicine, VA Hospital, Brooklyn, New York, USA
| | - Deep Patadia
- SUNY Downstate Medical Center, Brooklyn, New York, USA.,Department of Internal Medicine, VA Hospital, Brooklyn, New York, USA
| | - Pooja Belligund
- SUNY Downstate Medical Center, Brooklyn, New York, USA.,Department of Pulmonary and Critical Care Medicine, VA Hospital, Brooklyn, New York, USA
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Abstract
PURPOSE To report an investigation of a purely endovascular procedure to address access-induced hand ischemia in dialysis patients. CASE REPORT Two dialysis patients presented with stage III steal syndrome consisting of severe pain and numbness in their fingers. Preoperative fistulograms distal to the anastomosis showed alternating antegrade and retrograde flow. Under ultrasound guidance, the fistula was accessed and a 4-F micropuncture sheath placed. An angled guidewire was then advanced proximally into the brachial artery. A 6-F short sheath with marker was placed followed by a 4-F straight guide catheter inserted into the proximal brachial artery. A 9-F Flair endovascular stent-graft was advanced over a 0.035-inch stiff angled Glidewire into the fistula just distal to the arterial anastomosis and deployed. Postoperatively, pain and numbness resolved in both patients immediately. Postoperative fistulograms documented antegrade flow. Access flow velocity readings decreased significantly and pulse oximetry readings increased significantly in both patients, who were followed for >6 months with no reported complications. CONCLUSION These 2 cases suggest that this endovascular approach to access-induced hand ischemia may be a viable alternative to open/hybrid surgery.
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Affiliation(s)
- Chien Yi M Png
- 1 Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Peter L Faries
- 1 Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David J Finlay
- 1 Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Alamshah SM, Nazari I, Nahidi A, Sametzadeh M, Khodabakhshi S. Prosthetic Hemodialysis Access-induced Distal Hand Ischemia and its Contributors in Diabetics. Indian J Nephrol 2017; 27:199-204. [PMID: 28553040 PMCID: PMC5434686 DOI: 10.4103/0971-4065.202836] [Citation(s) in RCA: 3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Avoidance of hand ischemia in the construction of prosthetic access for hemodialysis in diabetics that have no suitable vein for arteriovenous fistula is appreciated. Taper type may be an appropriately matched conduit to prevent its occurrence. This is a prospective controlled trial of 38 selected diabetics requiring hemodialysis, who were referred to our clinic during a period of 6 months. The aim of the study was to evaluate the efficacy of tapered grafts in preventing distal hand hypoperfusion and determining its most likely contributors. In 18 intervening cases, taper 4 mm × 7 mm and in twenty cases (control group), standard 6 mm polytetrafluoroethylene as straight Brachial-Axillary access was used. Graft flow rates, artery and vein diameters, and mean arterial pressure were included for evaluation. Within the control group, 11 patients (55%) (7 cases Grade 1, 3 Grade 2, 1 Grade 3) and in intervening group, 2 cases (11%) (Grade 1, Grade 3) developed Steal syndrome. There was no significant difference in the mean flow rates (P = 0.82). Increased risk of distal hypoperfusion was observed in the control group when flow rates were more than 1000 ml/min. Arterial diameters (P = 0.011) and mean arterial pressure (P = 0.05) were found to be important contributing factors. Taper grafts causes reduced incidence of distal hand hypoperfusion. When artery diameter was <6 mm and mean arterial pressure lower than 100 mmHg and the index (brachial artery diameter × mean arterial pressure) was under 500, distal hand ischemia occurred in standard and tapper type. We therefore recommend selective usage of taper grafts in diabetics with diminished distal hand pulses, considering the contributing factors when fistula first is not feasible.
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Affiliation(s)
- S M Alamshah
- Department of Vascular Surgery and Trauma and Transplantation, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - I Nazari
- Department of Vascular Surgery and Trauma and Transplantation, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - A Nahidi
- Department of Surgery, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - M Sametzadeh
- Department of Radiology, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - S Khodabakhshi
- Department of Vascular Surgery and Trauma and Transplantation, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Abstract
Coronary-subclavian artery (SCA) steal syndrome is an uncommon phenomenon in which coronary flow is diverted into the SCA through the patent left internal mammary artery (LIMA) conduit due to critical subclavian stenosis. The prevalence of significant left SCA (LSCA) stenosis in patients, referred for coronary bypass surgery, has been reported to be 0.2 to 6.8%. Most patients usually present with angina pectoris, and secondary myocardial infarction is rarely reported. Herein, we present a case of coronary bypass graft in which a left anterior descending artery-LIMA graft was applied to supply the left arm due to complete LSCA occlusion. The patient was hospitalized with a diagnosis of non-ST elevation myocardial infarction.
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Affiliation(s)
- Bulent Uzunlar
- Department of Cardiology, Istanbul Medicine Hospital, Istanbul, Turkey
| | - Ahmet Karabulut
- Department of Cardiology, Acıbadem Atakent Hospital, Istanbul, Turkey
| | - Zeki Dogan
- Department of Cardiology, Istanbul Medicine Hospital, Istanbul, Turkey
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21
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Sueki S, Sakurada T, Miyamoto M, Tsuruoka K, Matsui K, Sato Y, Shibagaki Y, Kimura K. Change in skin perfusion pressure after the creation of upper limb arteriovenous fistula for maintenance hemodialysis access. Hemodial Int 2015; 18 Suppl 1:S19-22. [PMID: 25330827 DOI: 10.1111/hdi.12219] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Arteriovenous fistula (AVF) is the most important vascular access method for hemodialysis (HD). However, ischemic steal syndrome occasionally develops. This study evaluated the change in skin perfusion pressure (SPP) after the creation of upper limb AVF and analyzed the relationship between blood flow measurements and the change in SPP. The subjects included 21 patients who underwent radiocephalic AVF creation for the first time between November 2012 and September 2013. We measured SPP on the palm side of the third finger of both hands and assessed blood flow measurements using ultrasound examination before and after the creation of AVF. The subjects consisted of 15 men and 6 women (average age: 65.3 ± 12.7 years, including 12 diabetic patients). Observational period between before and after surgery was 4.9 ± 5.2 days. None of the patients had ischemic steal syndrome after the creation of AVF. Skin perfusion pressure tended to decrease after creation of AVF on the finger of AVF side (100.0 ± 20.9 vs. 87.9 ± 26.5 mmHg, P = 0.063). In contrast, SPP did not change in the limb without AVF (97.9 ± 20.7 vs. 101.0 ± 19.4 mmHg, P = 0.615). The rate of change in SPP was significantly decreased on the finger of AVF side compared with that of limb without AVF (0.055% vs. -0.112%, P = 0.014). There was no correlation between the change in SPP and blood flow measurements. Skin perfusion pressure is possible to detect ischemic steal syndrome after the creation of upper limb AVF.
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Affiliation(s)
- Shina Sueki
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
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22
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Sato M, Tahara S, Sugiyama D, Terashi H. Blood circulation in the fingers is aggravated after creating a vascular access for dialysis: assessment using skin perfusion pressure. J Plast Surg Hand Surg 2014; 48:327-9. [PMID: 24506447 DOI: 10.3109/2000656x.2014.886580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Internal vascular shunts for haemodialysis can cause different complications. One of the most serious complications is steal syndrome, which can result in disturbed peripheral circulation causing finger necrosis and lead to amputation. Thus, prevention of these complications is important. Measurement of skin perfusion pressure (SPP) has been used in various clinical settings, including wound-healing management, and its usefulness has been increasingly unveiled. The present study was undertaken to evaluate changes in haemodynamics after internal shunt creation by measuring SPP of the thumb and the little finger before and after surgery in five patients undergoing shunt surgery using the radial artery and the cephalic vein. The study revealed average changes of -22.8 mmHg in thumb SPP. The change in the thumb was statistically significant (p < 0.05). If the effect of surgery and the threshold for wound healing are taken into account, the present results indicate the necessity to pay extra attention to fingers with extremely low preoperative SPP values. For the prevention of serious disturbances of peripheral circulation (e.g. steal syndrome), routine preoperative SPP measurement seems effective for screening of high-risk patients.
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Affiliation(s)
- Makoto Sato
- Department of Plastic Surgery, Seirei Mikatahara General Hospital , Hamamatsu , Japan
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Stolic R, Mijailovic M, Cvetkovic A, Stanojevic M, Stolic D, Cvetkovic D. Distal ischemia induced by vascular access for hemodialysis - a case report. Hippokratia 2012; 16:375-377. [PMID: 23935322 PMCID: PMC3738617] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Arteriovenous fistulas for hemodialysis may cause significant local and general changes in the bloodstream. Vascular access-induced ischemia is a rare but very serious complication which, if not treated in time, can lead to tissue necrosis. We describe a 66 year-old man with symptoms of distal limb ischemia caused by an arteriovenous fistula for hemodialysis.
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Affiliation(s)
- Rv Stolic
- Medical faculty Pristina/K.Mitrovica, University of Pristina, Serbia
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Spacek M, Adla T, Veselka J. Long-term positive remodeling of the right coronary artery after reimplantation from the pulmonary artery to the ascending aorta. Int J Angiol 2012; 20:117-20. [PMID: 22654476 DOI: 10.1055/s-0031-1279684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
A 53-year-old woman, nonsmoking patient, with a history of surgically corrected anomalous origin of the right coronary artery from the pulmonary artery 17 years prior to admission, presented to our department complaining of mild, left-sided exertional chest pain for the past 3 months. She underwent a computed tomography examination of the heart and coronary angiography revealing postsurgical changes to the coronary vasculature and severe stenosis of the left circumflex artery, which was successfully treated by percutaneous stent implantation.
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Abstract
Neonatal stroke may occur silently. Identification of potential embolic pathways unique to the neonate is important when investigating the aetiology of infarction and arterial occlusion, and preventing further episodes. This is a case report of an infant with venous thrombus embolising across the foramen ovale causing cerebral infarction and subclavian artery steal syndrome, without neurological signs.
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Affiliation(s)
- L M Beattie
- Paediatric Department, Queen Mother's Hospital, Dalnair Street, Glasgow G3 8SJ, Scotland, UK. lynne_
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