WorldWideScience

Sample records for intracranial arteriovenous fistula

  1. Progressive versus Nonprogressive Intracranial Dural Arteriovenous Fistulas: Characteristics and Outcomes.

    Science.gov (United States)

    Hetts, S W; Tsai, T; Cooke, D L; Amans, M R; Settecase, F; Moftakhar, P; Dowd, C F; Higashida, R T; Lawton, M T; Halbach, V V

    2015-10-01

    A minority of intracranial dural arteriovenous fistulas progress with time. We sought to determine features that predict progression and define outcomes of patients with progressive dural arteriovenous fistulas. We performed a retrospective imaging and clinical record review of patients with intracranial dural arteriovenous fistula evaluated at our hospital. Of 579 patients with intracranial dural arteriovenous fistulas, 545 had 1 fistula (mean age, 45 ± 23 years) and 34 (5.9%) had enlarging, de novo, multiple, or recurrent fistulas (mean age, 53 ± 20 years; P = .11). Among these 34 patients, 19 had progressive dural arteriovenous fistulas with de novo fistulas or fistula enlargement with time (mean age, 36 ± 25 years; progressive group) and 15 had multiple or recurrent but nonprogressive fistulas (mean age, 57 ± 13 years; P = .0059, nonprogressive group). Whereas all 6 children had fistula progression, only 13/28 adults (P = .020) progressed. Angioarchitectural correlates to chronically elevated intracranial venous pressures, including venous sinus dilation (41% versus 7%, P = .045) and pseudophlebitic cortical venous pattern (P = .048), were more common in patients with progressive disease than in those without progression. Patients with progressive disease received more treatments than those without progression (median, 5 versus 3; P = .0068), but as a group, they did not demonstrate worse clinical outcomes (median mRS, 1 and 1; P = .39). However, 3 young patients died from intracranial venous hypertension and intracranial hemorrhage related to progression of their fistulas despite extensive endovascular, surgical, and radiosurgical treatments. Few patients with dural arteriovenous fistulas follow an aggressive, progressive clinical course despite treatment. Younger age at initial presentation and angioarchitectural correlates to venous hypertension may help identify these patients prospectively. © 2015 by American Journal of Neuroradiology.

  2. Intracranial dural arteriovenous fistula with spinal medullary venous drainage

    Energy Technology Data Exchange (ETDEWEB)

    Wiesmann, M.; Padovan, C.S.; Pfister, H.W.; Yousry, T.A. [Muenchen Univ. (Germany). Abt. fuer Neuroradiologie

    2000-10-01

    We report on a 46-year-old patient in whom an intracranial dural arteriovenous (AV) fistula, supplied by a branch of the ascending pharyngeal artery, drained into spinal veins and produced rapidly progressive symptoms of myelopathy and brainstem dysfunction including respiratory insufficiency. Magnetic resonance imaging studies demonstrated brainstem oedema and dilated veins of the brainstem and spinal cord. Endovascular embolization of the fistula led to good neurological recovery, although the patient had been paraplegic for 24 h prior to embolization. This case demonstrates the MRI characteristics of an intracranial dural AV fistula with spinal drainage and illustrates the importance of early diagnosis and treatment. Even paraplegia may be reversible, if angiography is performed and the fistula treated before ischaemic and gliotic changes become irreversible. (orig.)

  3. Intracranial dural arterio-venous fistula presenting with progressive myelopathy.

    LENUS (Irish Health Repository)

    Ogbonnaya, Ebere Sunny

    2011-01-01

    Spinal dural arterio-venous fistula (DAVF) is rare and usually involves the thoracic segments. The classical presentation is a slowly progressive ataxia. Clinical presentation of intracranial DAVF depends on the site of the DAVF, as well as the vessels involved. Patients may present with pulsatile tinnitus, occipital bruit, headache, dementia, visual impairment as well as neurological deterioration distant from the DAVF as a result of venous hypertension and cortical haemorrhage. The authors present a rare case of progressive myelopathy secondary to an intracranial DAVF.

  4. Cervical Myelopathy Caused by Intracranial Dural Arteriovenous Fistula

    Science.gov (United States)

    Kim, Won Young; Kim, Jin Bum; Nam, Taek Kyun; Kim, Young Baeg

    2016-01-01

    Intracranial dural arteriovenous fistula (dAVF) usually results in various problems in the brain. But it can be presented as a myelopathy, which may make early diagnosis and management to be difficult. We recently experienced a case of cervical myelopathy caused by intracranial dAVF. A 60-year-old man presented with a 3-year history of gait disturbance due to a progressive weakness of both legs. Neurological examination revealed spastic paraparesis (grade IV) and Babinski sign on both sides. Magnetic resonance imaging showed serpentine vascular signal voids at C2-T1 on T2-weighted image with increased signal intensity and swelling of spinal cord at C1-C4. We performed a brain computed tomography angiography and found intracranial dAVF with multiple arteriovenous shunts. Venous drainages were noted at tentorial veins and cervical perimedullary veins. After Onyx embolization, the patient showed gradual improvement in motor power and gait disturbance. The venous drainage pattern is a well-known prognostic factor of dAVF. In our case, the intracranial dAVF drained to spinal perimedullary vein, which seemed to result in the ischemic myelopathy. Although it is rare condition, it sometimes can cause serious complications. Therefore, we should keep in mind the possibility of intracranial dAVF when a patient presents myelopathy. PMID:27437016

  5. Arteriovenous Fistula

    Science.gov (United States)

    ... home. Accessed Feb. 23, 2015. Vascular access for hemodialysis. National Kidney and Urologic Diseases Information Clearinghouse. http:// ... www.mayoclinic.org/diseases-conditions/arteriovenous-fistula/basics/definition/CON-20034876 . Mayo Clinic Footer Legal Conditions and ...

  6. Endovascular management of intracranial pial arterio-venous fistulas.

    Science.gov (United States)

    Limaye, U S; Siddhartha, W; Shrivastav, M; Anand, S; Ghatge, S

    2004-03-01

    From 1996-2002 we treated 5 consecutive cases of pial fistula. There were 3 patients with a single hole-single channel pial fistula and two patients had a complex pial fistula. Three patients presented with intracerebral hematoma and had a focal neurological deficit. One patient presented with history of seizures and 1 patient had headache. The results of the treatment were analyzed both clinically and angiographically. The follow-up period ranged from 6 months to 6 years. All fistulas were treated with concentrated glue. The glue cast included the distal part of the feeding artery, A-V connection and the proximal part of the vein. Post-embolisation angiography showed complete occlusion of two single-hole fistulas and one complex pial A-V fistula and near total occlusion of one single-hole and one complex pial A-V fistula. Four patients had excellent clinical outcome. One patient with single-hole fistula had a hemorrhagic venous infarct resulting in transient hemiparesis.

  7. [Intraoperative fluid therapy in infants with congestive heart failure due to intracranial pial arteriovenous fistula].

    Science.gov (United States)

    Arroyo-Fernández, F J; Calderón-Seoane, E; Rodríguez-Peña, F; Torres-Morera, L M

    2016-05-01

    Pial arteriovenous fistula is a rare intracranial congenital malformation (0.1-1: 100,000). It has a high blood flow between one or more pial arteries and drains into the venous circulation. It is usually diagnosed during the childhood by triggering an intracranial hypertension and/or congestive heart failure due to left-right systemic shunt. It is a rare malformation with a complex pathophysiology. The perioperative anaesthetic management is not well established. We present a 6-month-old infant diagnosed with pial arteriovenous fistula with hypertension and congestive heart failure due to left-right shunt. He required a craniotomy and clipping of vascular malformation. Anaesthetic considerations in patients with this condition are a great challenge. It must be performed by multidisciplinary teams with experience in paediatrics. The maintenance of blood volume during the intraoperative course is very important. Excessive fluid therapy can precipitate a congestive heart failure or intracranial hypertension, and a lower fluid therapy may cause a tissue hypoxia due to the bleeding. Copyright © 2015 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  8. Intracranial pial arteriovenous fistula in infancy: a case report and literature review.

    Science.gov (United States)

    Kraneburg, U M; Nga, V D W; Ting, E Y S; Hui, F K H; Lwin, S; Teo, C; Chou, N; Yeo, T T

    2014-02-01

    Intracranial pial arteriovenous fistulas (AVF) are rare vascular malformation especially in the first 2 years of life. The pathology in this age group is associated with greater morbidity and mortality. We report a rare case of 36-day-old male infant with a pial AVF associated with an arterial aneurysm, who presented with intraventricular hemorrhage and hydrocephalus. In addition, an online review of the literatures on pediatric pial AVF was performed using PubMed on published case reports and articles from 1980 to April 2013.

  9. Optimizing Arteriovenous Fistula Maturation

    OpenAIRE

    2009-01-01

    Autogenous arteriovenous fistulas are the preferred vascular access in patients undergoing hemodialysis. Increasing fistula prevalence depends on increasing fistula placement, improving the maturation of fistula that fail to mature and enhancing the long-term patency of mature fistula. Percutaneous methods for optimizing arteriovenous fistula maturation will be reviewed.

  10. Paroxysmal supraventricular tachycardia as first manifestation of right atrial hemangioma during endovascular treatment of intracranial arteriovenous fistulas.

    Science.gov (United States)

    Spanò, Francesca; Cereda, Alberto; Moreo, Antonella; Bonacina, Edgardo; Peritore, Angelica; Roghi, Alberto; Giannattasio, Cristina; Pedrotti, Patrizia

    2015-06-10

    We report the description of a cardiac mass occupying almost the entire right atrium in a young man who developed paroxysmal supraventricular tachycardia during endovascular treatment of intracranial arteriovenous fistulas. The mass was detected at echocardiographic examination, its tissue characteristics were defined with cardiac magnetic resonance and it was successfully surgically removed. The histopathological findings were consistent with a mixed type cavernous-capillary hemangioma of the heart. The intriguing co-existence of cardiac hemangioma and cerebral arteriovenous fistulas, to the best of our knowledge, has not been previously reported in English Literature.

  11. Pulmonary arteriovenous fistula

    Science.gov (United States)

    ... medlineplus.gov/ency/article/001090.htm Pulmonary arteriovenous fistula To use the sharing features on this page, please enable JavaScript. Pulmonary arteriovenous fistula is an abnormal connection between an artery and ...

  12. Pediatric intracranial dural arteriovenous fistulas: age-related differences in clinical features, angioarchitecture, and treatment outcomes.

    Science.gov (United States)

    Hetts, Steven W; Moftakhar, Parham; Maluste, Neil; Fullerton, Heather J; Cooke, Daniel L; Amans, Matthew R; Dowd, Christopher F; Higashida, Randall T; Halbach, Van V

    2016-11-01

    OBJECTIVE Intracranial dural arteriovenous fistulas (DAVFs) are rare in children. This study sought to better characterize DAVF presentation, angioarchitecture, and treatment outcomes. METHODS Children with intracranial DAVFs between 1986 and 2013 were retrospectively identified from the neurointerventional database at the authors' institution. Demographics, clinical presentation, lesion angioarchitecture, treatment approaches, angiographic outcomes, and clinical outcomes were assessed. RESULTS DAVFs constituted 5.7% (22/423) of pediatric intracranial arteriovenous shunting lesions. Twelve boys and 10 girls presented between 1 day and 18 years of age; boys presented at a median of 1.3 years and girls presented at a median of 4.9 years. Four of 8 patients ≤ 1 year of age presented with congestive heart failure compared with 0/14 patients > 1 year of age (p = 0.01). Five of 8 patients ≤ 1 year old presented with respiratory distress compared with 0/14 patients > 1 year old (p = 0.0021). Ten of 14 patients > 1 year old presented with focal neurological deficits compared with 0/8 patients ≤ 1 year old (p = 0.0017). At initial angiography, 16 patients harbored a single intracranial DAVF and 6 patients had 2-6 DAVFs. Eight patients (38%) experienced DAVF obliteration by the end of treatment. Good clinical outcome (modified Rankin Scale score 0-2) was documented in 77% of patients > 1 year old at presentation compared with 57% of patients ≤ 1 year old at presentation. Six patients (27%) died. CONCLUSIONS Young children with DAVFs presented predominantly with cardiopulmonary symptoms, while older children presented with focal neurological deficits. Compared with other pediatric vascular shunts, DAVFs had lower rates of angiographic obliteration and poorer clinical outcomes.

  13. Intracranial arteriovenous malformation and dural arteriovenous fistula embedded in a meningioma—case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Moujahed Labidi

    2015-12-01

    Full Text Available The association between a vascular malformation and a meningioma is a rare occurrence intracranially. We document the case of a 59-year-old man who presented with a right parietal extra-axial mass with headaches and seizures. Hemangiopericytoma was initially suspected on the basis of an unusual vascular pattern and rapid lesion progression. Angiography revealed abnormal vessels and an early draining vein associated with the mass. Arterial feeders were primarily from the middle cerebral artery with discrete contribution from both middle meningeal arteries. Craniotomy and Simpson 0 resection of the lesion were undertaken and revealed the coexistence of a dural based tumor with an AVM and a dural arteriovenous fistula (dAVF. Histology and immunohistochemistry were consistent with the diagnosis of meningioma and associated AVM. This case represents the eleventh report of an AVM associated with a meningioma, among which only 6 were contiguous. Such cases illustrate the pathogenic roles of angiogenesis and inflammation that is common to AVMs, dAVF and meningiomas.

  14. [Intracranial dural arteriovenous fistulae. Experience after 81 cases and literature review].

    Science.gov (United States)

    Paredes, Igor; Martinez-Perez, Rafael; Munarriz, Pablo M; Castaño-Leon, Ana María; Campollo, Jorge; Alén, Jose F; Lobato, Ramiro D; Lagares, Alfonso

    2013-01-01

    To analyse the clinical, radiological and therapeutic variables of intracranial dural arteriovenous fistulae (DAVF) treated at our institution, and to assess the validity of the Borden and Cognard classifications and their correlation with the presenting symptoms. The DAVF identified were retrospectively analysed. They were classified according to their location, drainage pattern and the Borden and Cognard classifications. We recorded the different treatments, their complications and efficacy. There were 81DAVF identified between 1975 and 2012. The cavernous sinus (CS) location was the most frequent one. The Borden and Cognard classifications showed an interobserver Kappa index of 0.72 and 0.76 respectively. The odds ratio of aggressive presentation in the presence of cortical venous drainage (CVD) was 19.3 (2.8-132.4). No location, once adjusted by venous drainage pattern, showed significant association with an aggressive presentation. Endovascular transarterial treatment of cavernous sinus DAVF achieved symptomatic improvement of 78%, with a complication rate of 5%. The DAVF of non-CS locations, with CVD, treated surgically were angiographically shown cured in 100% of the cases, with no treatment-related complications. The presence of CVD was significantly associated with aggressive presentations. The Borden and Cognard classifications showed little interobserver variability. Endovascular treatment for CS DAVF is safe and relatively effective. Surgical treatment of non-CS DAVF with CVD is safe, effective and the first choice treatment in our environment. Copyright © 2012 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  15. A tiny dural arteriovenous fistula

    Institute of Scientific and Technical Information of China (English)

    ZHANG Peng 张 鹏; ZHU Fengshui 朱风水; LING Feng 凌 锋; Christophe COGNARD

    2003-01-01

    @@ Pulsatile tinnitus is commonly encountered in approximately 10% of a given population.1 Since causes of the disease vary, selecting appropriate protocols of imaging strategies is quite challenging.2 Vascular anormalies or diseases including anormalies of the carotid arteries and jugular veins, intracranial arteriovenous malformation and dural arteriovenous fistula (DAVF) are major causative factors of the disease. Before imaging studies, history inquiry and physical examination are important for detect the possible causes of pulsatile tinnitus. Different imaging examinations are depended on histories and clinical signs of different patients.

  16. Cognard Type V intracranial dural arteriovenous fistula presenting in a pediatric patient with rapid, progressive myelopathy.

    Science.gov (United States)

    Jermakowicz, Walter J; Weil, Alexander G; Vlasenko, Artyom; Bhatia, Sanjiv; Niazi, Toba N

    2017-08-01

    Cognard Type V dural arteriovenous fistulas (dAVFs) are a unique type of cranial vascular malformation characterized by congestion of the perimedullary venous system that may lead to devastating spinal cord pathology if left untreated. The authors present the first known case of a pediatric patient diagnosed with a Type V dAVF. A 14-year-old girl presented with a 3-week history of slowly progressive unilateral leg weakness that quickly progressed to bilateral leg paralysis, sphincter dysfunction, and complete sensory loss the day of her presentation. MRI revealed an extensive T2 signal change in the cervical spine and tortuous perimedullary veins along the entire length of the cord. An emergency cranial angiogram showed a Type V dAVF fed by the posterior meningeal artery with drainage into the perimedullary veins of the cervical spine. The fistula was not amenable to embolization because vascular access was difficult; therefore, the patient underwent urgent suboccipital craniotomy and ligation of the arterialized venous drainage from the fistula. The patient's clinical course immediately reversed; she had a complete recovery over the course of a year, and she remains asymptomatic at the 2-year follow-up. This report adds to a growing body of evidence that describes the diverse and unpredictable nature of Type V dAVFs and highlights the need to obtain a cranial angiogram in pediatric patients with unexplained myelopathy and cervical cord T2 signal change on MRI.

  17. Clinical and angiographic characteristics of cavernous sinus dural arteriovenous fistulas manifesting as venous infarction and/or intracranial hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Miyamoto, Naoko; Naito, Isao; Takatama, Shin; Shimizu, Tatsuya; Iwai, Tomoyuki [Geriatrics Research Institute and Hospital, Department of Neurosurgery, Maebashi (Japan); Shimaguchi, Hidetoshi [Gunma University Graduate School of Medicine, Department of Neurosurgery, Maebashi (Japan)

    2009-01-15

    Cavernous sinus (CS) dural arteriovenous fistulas (DAVFs) rarely cause venous infarction (VI) and/or intracranial hemorrhage (ICH) despite the presence of cortical venous drainage (CVD). The present study investigated the characteristics of CS DAVFs manifesting as VI/ICH. Fifty-four patients treated for CS DAVFs were retrospectively studied. Six patients presented with VI/ICH. Two of the three patients presenting with ICH had CVD only to the superficial sylvian vein (SSV) or the deep sylvian vein (DSV). Three patients presenting with VI had multiple drainages, and angiography of these patients showed a varix on the SSV, drainage into the DSV with agenesis of the second and third segment of basal vein of Rosenthal, and thrombosis of the distal petrosal vein. CS DAVF with CVD only carries higher risk of VI/ICH than multiple drainages. Many CS DAVFs presenting with VI, especially those with drainage into the petrosal vein, have multiple drainages in the early stage. Thrombosis of the inferior and superior petrosal sinuses and superior orbital vein gradually increases pressure of the CVD, and then, VI may occur. In contrast, CS DAVFs with CVD only from the beginning, common in the patients with drainage into the SSVs and DSVs, are likely to cause ICH. Angiographic risk factors causing VI/ICH are CVD only, varix formation, agenesis of the second and third segment of basal vein of Rosenthal, and thrombosis of the superior orbital vein, lateral half of the superior petrosal sinus, and distal CVD. (orig.)

  18. Diagnostic performance of CT and MRI on the detection of symptomatic intracranial dural arteriovenous fistula: a meta-analysis with indirect comparison

    Energy Technology Data Exchange (ETDEWEB)

    Lin, Yen-Heng [National Taiwan University, Institute of Epidemiology and Preventive Medicine, Taipei (China); National Taiwan University Hospital in Taipei and Yuan-Lin Branch, Department of Medical Imaging and Radiology, Hospital and Medical College, Taipei (China); Lin, Hsien-Ho [National Taiwan University, Institute of Epidemiology and Preventive Medicine, Taipei (China); Liu, Hon-Man; Lee, Chung-Wei; Chen, Ya-Fang [National Taiwan University Hospital in Taipei and Yuan-Lin Branch, Department of Medical Imaging and Radiology, Hospital and Medical College, Taipei (China)

    2016-08-15

    This study aims to review the diagnostic performance of computed tomography (CT) and magnetic resonance imaging (MRI) in symptomatic dural arteriovenous fistula (DAVF). EMBASE, PubMed, and Cochrane Library were searched until April 2015 for studies which compared CT, MRI, or both with angiography for the detection of DAVF. The diagnostic performances of MRI and CT were indirectly compared using modality as a covariate in the analysis. Thirteen studies met our inclusion criteria. MRI had a sensitivity of 0.90 (95 % confidence interval (CI) = 0.83-0.94) and specificity of 0.94 (95 % CI = 0.90-0.96). CT had a sensitivity of 0.80 (95 % CI = 0.62-0.90) and specificity of 0.87 (95 % CI = 0.74-0.94). MRI showed better diagnostic performance than CT (p = 0.02). Contrast medium use and time-resolved MR angiography did not improve MRI diagnostic performance (p = 0.31 and 0.44, respectively). Both CT and MRI had good diagnostic performance. MRI was better than CT on the detection of symptomatic intracranial dural arteriovenous fistula in the indirect comparison. (orig.)

  19. [Traumatic arteriovenous pial fistula masquerading as a carotid-cavernous fistula: an uncommon disorder with an unusual presentation].

    Science.gov (United States)

    Santos-Franco, Jorge Arturo; Lee, Angel; Nava-Salgado, Giovanna; Zenteno, Marco; Gómez-Villegas, Thamar; Dávila-Romero, Julio César

    2012-01-01

    Traumatic intracranial pial arteriovenous fistulae are infrequent lesions. Their cardinal signs have been related to mass effect and hemorrhage, but their clinical manifestations due to venous retrograde flow into ophthalmic veins has never been described. This phenomenon is usually seen in dural arteriovenous fistula draining to the cavernous sinus or carotid-cavernous sinus fistula.A traumatic intracranial pial arteriovenous fistula arising from the supraclinoid internal carotid artery in a young patient was revealed by aggressive behavior and ophthalmologic manifestations. The endovascular management included the use of coils, stent, and ethylene-vinyl alcohol with transient balloon occlusion of the parent vessel.

  20. Venous manifestations of spinal arteriovenous fistulas

    NARCIS (Netherlands)

    Andersson, T; van Dijk, JMC; Willinsky, RA

    2003-01-01

    Impairment of the spinal cord venous outflow may create symptoms caused by venous hypertension and congestion. This has been referred to as venous congestive myelopathy. Spinal dural arteriovenous fistulas, as well as some of the epidural arteriovenous fistulas and perimedullary spinal cord arteriov

  1. Vector Volume Flow in Arteriovenous Fistulas

    DEFF Research Database (Denmark)

    Hansen, Peter Møller; Heerwagen, Søren; Pedersen, Mads Møller;

    2013-01-01

    , but is very challenging due to the angle dependency of the Doppler technique and the anatomy of the fistula. The angle independent vector ultrasound technique Transverse Oscillation provides a new and more intuitive way to measure volume flow in an arteriovenous fistula. In this paper the Transverse...

  2. Endovascular therapy of arteriovenous fistulae with electrolytically detachable coils

    Energy Technology Data Exchange (ETDEWEB)

    Jansen, O.; Doerfler, A.; Forsting, M.; Hartmann, M.; Kummer, R. von; Tronnier, V.; Sartor, K. [Dept. of Neuroradiology, University of Heidelberg Medical School (Germany)

    1999-12-01

    We report our experience in using Guglielmi electrolytically detachable coils (GDC) alone or in combination with other materials in the treatment of intracranial or cervical high-flow fistulae. We treated 14 patients with arteriovenous fistulae on brain-supplying vessels - three involving the external carotid or the vertebral artery, five the cavernous sinus and six the dural sinuses - by endovascular occlusion using electrolytically detachable platinum coils. The fistula was caused by trauma in six cases. In one case Ehlers-Danlos syndrome was the underlying disease, and in the remaining seven cases no aetiology could be found. Fistulae of the external carotid and vertebral arteries and caroticocavernous fistulae were reached via the transarterial route, while in all dural fistulae a combined transarterial-transvenous approach was chosen. All fistulae were treated using electrolytically detachable coils. While small fistulae could be occluded with electrolytically detachable coils alone, large fistulae were treated by using coils to build a stable basket for other types of coil or balloons. In 11 of the 14 patients, endovascular treatment resulted in complete occlusion of the fistula; in the remaining three occlusion was subtotal. Symptoms and signs were completely abolished by this treatment in 12 patients and reduced in 2. On clinical and neuroradiological follow-up (mean 16 months) no reappearance of symptoms was recorded. (orig.)

  3. Foramen magnum dural arteriovenous fistula presenting with epilepsy

    Science.gov (United States)

    Manisor, Monica; Aloraini, Ziad; Chibarro, Salvatore; Proust, Francois; Quenardelle, Véronique; Wolff, Valérie; Beaujeux, Rémy

    2015-01-01

    Intracranial dural arteriovenous fistulas (dAVFs) with perimedullary drainage represent a rare subtype of intracranial dAVF. Patients usually experience slowly progressive ascending myelopathy and/or lower brainstem signs. We present a case of foramen magnum dural arteriovenous fistula with an atypical clinical presentation. The patient initially presented with a generalised tonic-clonic seizure and no signs of myelopathy, followed one month later by rapidly progressive tetraplegia and respiratory insufficiency. The venous drainage of the fistula was directed both to the left temporal lobe and to the perimedullary veins (type III + V), causing venous congestion and oedema in these areas and explaining this unusual combination of symptoms. Rotational angiography and overlays with magnetic resonance imaging volumes were helpful in delineating the complex anatomy of the fistula. After endovascular embolisation, there was complete remission of venous congestion on imaging and significant clinical improvement. To our knowledge, this is the first report of a craniocervical junction fistula presenting with epilepsy. PMID:26472637

  4. Dural arteriovenous fistulae after forehead knife-cut injury

    Institute of Scientific and Technical Information of China (English)

    朱刚; 陈志; 冯华

    2004-01-01

    @@ Dural arteriovenous fistulae (DAVF) is a rare intracranial vascular disease. It is pathologically characterized by direct shunting of the intracranial artery and vein, which results in cerebral ischemia, intracranial hemorrhage, neural deficit and intracranial murmur. The etiological mechanism of DAVF is not well known, but most researchers think it is associated with congenital abnormal development, especially abnormal development of dural blood vessels at the stage of embryogenesis. Recently, some researchers have found that DAVF is also associated with some acquired factors. This article reports a case who developed DAVF within 2 years after debridement of frontal bone fragmentation, depressed fracture, left frontal lobe contusion and superior sagittal sinus injury due to forehead knife-cut injury. The pathogenic mechanism was explored through a review of the related literatures.

  5. Embryological Consideration of Dural Arteriovenous Fistulas

    Science.gov (United States)

    TANAKA, Michihiro

    2016-01-01

    The topographical distribution of dural arteriovenous fistulas (DAVFs) was analyzed based on the embryological anatomy of the dural membrane. Sixty-six consecutive cases of intracranial and spinal DAVFs were analyzed based on the angiography, and each shunt point was identified according to the embryological bony structures. The area of dural membranes was categorized into three different groups: a ventral group located on the endochondral bone (VE group), a dorsal group located on the membranous bone (DM group) and a falcotentorial group (FT group) located in the falx cerebri, tentorium cerebelli, falx cerebelli, and diaphragm sellae. The FT group was designated when the dural membrane was formed only with the dura propria (meningeal layer of the dura mater) and not from the endosteal dura. Cavernous sinus, sigmoid sinus, and anterior condylar confluence was categorized to VE group, which had a female predominance, more benign clinical presentations, and a lower rate of cortical and spinal venous reflux. Transverse sinus, confluence, and superior sagittal sinus belonged to the DM group. Olfactory groove, falx, tent of the cerebellum, and nerve sleeve of spinal cord were categorized to the FT group, which presented later in life and which had a male predominance, more aggressive clinical presentations, and significant cortical and spinal venous reflux. The DAVFs was associated with the layers of the dural membrane characterized by the two different embryological bony structures. The FT group was formed only with the dura propria as an independent risk factor for aggressive clinical course and hemorrhage of DAVFs. PMID:27250699

  6. Noncavernous arteriovenous shunts mimicking carotid cavernous fistulae

    Science.gov (United States)

    Kobkitsuksakul, Chai; Jiarakongmun, Pakorn; Chanthanaphak, Ekachat; Singhara Na Ayudya, Sirintara (Pongpech)

    2016-01-01

    PURPOSE The classic symptoms and signs of carotid cavernous sinus fistula or cavernous sinus dural arteriovenous fistula (AVF) consist of eye redness, exophthalmos, and gaze abnormality. The angiography findings typically consist of arteriovenous shunt at cavernous sinus with ophthalmic venous drainage with or without cortical venous reflux. In rare circumstances, the shunts are localized outside the cavernous sinus, but mimic symptoms and radiography of the cavernous shunt. We would like to present the other locations of the arteriovenous shunt, which mimic the clinical presentation of carotid cavernous fistulae, and analyze venous drainages. METHODS We retrospectively examined the records of 350 patients who were given provisional diagnoses of carotid cavernous sinus fistulae or cavernous sinus dural AVF in the division of Interventional Neuroradiology, Ramathibodi Hospital, Bangkok between 2008 and 2014. Any patient with cavernous arteriovenous shunt was excluded. RESULTS Of those 350 patients, 10 patients (2.85%) were identified as having noncavernous sinus AVF. The angiographic diagnoses consisted of three anterior condylar (hypoglossal) dural AVF, two traumatic middle meningeal AVF, one lesser sphenoid wing dural AVF, one vertebro-vertebral fistula (VVF), one intraorbital AVF, one direct dural artery to cortical vein dural AVF, and one transverse-sigmoid dural AVF. Six cases (60%) were found to have venous efferent obstruction. CONCLUSION Arteriovenous shunts mimicking the cavernous AVF are rare, with a prevalence of only 2.85% in this series. The clinical presentation mainly depends on venous outflow. The venous outlet of the arteriovenous shunts is influenced by venous afferent-efferent patterns according to the venous anatomy of the central nervous system and the skull base, as well as by architectural disturbance, specifically, obstruction of the venous outflow. PMID:27767958

  7. Scimitar syndrome with pulmonary arteriovenous fistulas.

    Science.gov (United States)

    Le Rochais, J P; Icard, P; Davani, S; Abouz, D; Evrard, C

    1999-10-01

    Right abnormal pulmonary venous return into the inferior vena cava associated with abnormal fissure, dextrocardia, and systemic arterial supply of a variable degree, are the characteristics of the scimitar syndrome. We report on a patient in whom this rare syndrome was associated with pulmonary arteriovenous fistulas within the involved lung.

  8. Endovascular treatment of hemodialysis arteriovenous fistulas

    DEFF Research Database (Denmark)

    Heerwagen, Søren T; Hansen, Marc A; Schroeder, Torben V;

    2012-01-01

    Purpose: The purpose of this study was to investigate if the immediate hemodynamic outcome of an endovascular intervention on a dysfunctional hemodialysis arteriovenous fistula is a prognostic factor for primary patency. Methods: This was a prospective observational study including 61 consecutive...

  9. Coronary Arteriovenous Fistula Causing Hydrops Fetalis

    Directory of Open Access Journals (Sweden)

    Nilüfer Çetiner

    2014-01-01

    Full Text Available Fetal heart failure and hydrops fetalis may occur due to systemic arteriovenous fistula because of increased cardiac output. Arteriovenous fistula of the central nervous system, liver, bone or vascular tumors such as sacrococcygeal teratoma were previously reported to be causes of intrauterine heart failure. However, coronary arteriovenous fistula was not reported as a cause of fetal heart failure previously. It is a rare pathology comprising 0.2–0.4% of all congenital heart diseases even during postnatal life. Some may remain asymptomatic for many years and diagnosed by auscultation of a continuous murmur during a routine examination, while a larger fistulous coronary artery opening to a low pressure cardiac chamber may cause ischemia of the affected myocardial region due to steal phenomenon and may present with cardiomyopathy or congestive heart failure during childhood. We herein report a neonate with coronary arteriovenous fistula between the left main coronary artery and the right ventricular apex, who presented with hydrops fetalis during the third trimester of pregnancy.

  10. Dural arteriovenous fistula at the foramen magnum: Report of a case and clinical-anatomical review.

    Science.gov (United States)

    Llácer, José L; Suay, Guillermo; Piquer, José; Vazquez, Victor

    2016-01-01

    Arterial supply and venous drainage at the foramen magnum is variable. Two main forms of clinical presentation, intracranial and spinal, can be differentiated when a dural arteriovenous fistula (DAVF) is found at this level. We describe a case of a 68-year-old patient with a progressive paraparesis, diagnosed of dural arteriovenous fistula located at the posterior lip of foramen magnum. We review, in this setting, the vascular radiological anatomy of those fistulas and its important correlation with neurologic clinical symptoms. Copyright © 2016 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  11. Endovascular treatment of hemodialysis arteriovenous fistulas

    DEFF Research Database (Denmark)

    Heerwagen, Søren T; Hansen, Marc A; Schroeder, Torben V

    2012-01-01

    Purpose: The purpose of this study was to investigate if the immediate hemodynamic outcome of an endovascular intervention on a dysfunctional hemodialysis arteriovenous fistula is a prognostic factor for primary patency. Methods: This was a prospective observational study including 61 consecutive...... patients with dysfunctional arteriovenous fistulas referred to our endovascular unit. Patients were treated in accordance with institutional standard protocol including immediate pre- and post-interventional blood flow measurements using an intravascular catheter system. The primary endpoint was primary...... potential predictor variables. Results: Post interventional flow did not significantly influence primary patency (p = 0.76). Primary patency was found to be affected by having a history of previous intervention(s) (p = 0.008, hazard ratio 2.9) or low fistula age (P=.038, hazard ratio 0.97 [one...

  12. Delayed postoperative dural arteriovenous fistula presenting with progressive dementia.

    Science.gov (United States)

    Higashida, Tetsuhiro

    2015-12-09

    A 64-year-old woman underwent right suboccipital craniotomy to treat spontaneous cerebrospinal fluid (CSF) otorrhoea. Although the CSF leak was cured, the patient developed pulsatile tinnitus, ambulatory disturbance and progressive dementia. Four years after the surgery, she presented with generalised seizure. Cerebral angiography showed a dural arteriovenous fistula at the right transverse-sigmoid sinus, which was associated with sinus occlusion, retrograde blood flow in the sinus and diffuse intracranial cortical venous reflux. A combination of endovascular transarterial embolisation and transvenous embolisation with direct sinus puncture was performed. After the procedure, the patient's mental status and cognitive function improved significantly.

  13. Hydrocephalus in a patient with an unruptured pial arteriovenous fistula: hydrodynamic considerations, endovascular treatment, and clinical course.

    Science.gov (United States)

    Morales-Gómez, Jesús A; Garza-Oyervides, Vicente V; Arenas-Ruiz, José A; Mercado-Flores, Mariana; Elizondo-Riojas, C Guillermo; Boop, Frederick A; de León, Ángel Martínez-Ponce

    2017-03-01

    Intracranial pial arteriovenous fistulas, also known as nongalenic fistulas, are rare vascular malformations affecting predominantly the pediatric population. Hydrocephalus is an unusual presentation in which the exact pathophysiology is not fully understood. The aim of treatment in these cases is occlusion of the fistula prior to considering ventricular shunting. Here, the authors describe the hydrodynamic considerations of the paravascular pathway and the resolution of hydrocephalus with endovascular treatment of the fistula.

  14. Posterior cranial fossa arteriovenous fistula with presenting as caroticocavernous fistula

    Energy Technology Data Exchange (ETDEWEB)

    Liu, H.M.; Shih, H.C.; Huang, Y.C.; Wang, Y.H. [Dept. of Medical Imaging, National Taiwan University Hospital, Taipei (Taiwan)

    2001-05-01

    We report cases of posterior cranial fossa arteriovenous fistula (AVF) with presenting with exophthalmos, chemosis and tinnitus in 26- and 66-year-old men. The final diagnoses was vertebral artery AVF and AVF of the marginal sinus, respectively. The dominant venous drainage was the cause of the unusual presentation: both drained from the jugular bulb or marginal sinus, via the inferior petrosal and cavernous sinuses and superior ophthalmic vein. We used endovascular techniques, with coils and liquid adhesives to occlude the fistulae, with resolution of the symptoms and signs. (orig.)

  15. Vascular access for hemodialysis: arteriovenous fistula.

    Science.gov (United States)

    Malovrh, Marko

    2005-06-01

    The long-term survival and quality of life of patients on hemodialysis (HD) is dependant on the adequacy of dialysis via an appropriately placed vascular access. The optimal vascular access is unquestionably the autologous arteriovenous fistula (AVF), with the most common method being the conventional radio-cephalic fistula at the wrist. Recent clinical practice guidelines recommend the creation of native fistula or synthetic graft before the start of chronic HD therapy to prevent the need for complication-prone dialysis catheters. This could also have a beneficial effect on the rapidity of worsening kidney failure. A multidisciplinary approach (nephrologists, surgeons, radiologists and nurses) should improve the HD outcome by promoting the use of AVF. An important additional component of this program is the Doppler ultrasound for preoperative vascular mapping. Such an approach may be realized without unsuccessful surgical explorations, with a minimal early failure rate and a high maturation, even in patients with diabetes mellitus.

  16. Initial etiological research of intracranial dural arteriovenous fistulas%硬脑膜动静脉瘘形成机制的初步探讨

    Institute of Scientific and Technical Information of China (English)

    陈亮; 赵曜; 毛颖; 周良辅

    2009-01-01

    Objective To investigate the pathogenesis of intracranial dural arteriovenous fistula, with a focus on the role of angiogenic factors and chronic brain hypoperfusion in it. Methods 120 Sprague-Dawley rats were randomly divided into 4 groups: 1) Group A (n=25) , sham operation; 2) Group B (n = 25), thrombosis of the sagittal sinus; 3) Group C (n = 35), anastomosis of the right common carotid artery(CCA) to the external jugular vein(EJV) and occlusion of the proximate-cardiac end of the transverse sinus on the left; 4) Group D(n =35) , procedures done as Group C and thrombosis of the sagittal sinus was added. Mean arterial pressure, sinus pressure, blood flow of the brain were monitored during the operation and again tested 1, 2, 4, 12 weeks after operation in subgroups of animals, respectively. Histological examination was used to test the distribution and concentration of VEGF and MMP-9 in dura mater, arachnoid membrane, cortex and basal ganglia. Perfusion MRI of the brain was done to compare blood flow in different site of the brain. Results In group C and D, the mean blood pressure decreased soon after operation, and the sinus pressure elevated to (28.55±4. 92) mm Hg and kept stable at (22. 34 ±3.24) mm Hg 4 weeks later. The blood flow of the brain went down significantly after operation in group C and D, with markedly reduction in the right occipital lobe versus any of the other sites. Two weeks later the blood flow had returned to the normal level in the left side but remained abnormal in the right occipital lobe. Perfusion MRI found higher blood volume and longer mean time to enhance in the right occipital lobe, than in its contralateral side. Immunohistological stain of VEGF was positive in basal ganglia, right occipital lobe and arachnoid membrane one week after operation, but weakened in basal ganglia two weeks later. VEGF expression was weak in dura mater one week after operation, but became strongly positive from the 4th to 12th week after operation

  17. Splenic arteriovenous fistula treated with percutaneous transarterial embolization

    DEFF Research Database (Denmark)

    Madsen, M.A.; Frevert, S.; Madsen, P.L.

    2008-01-01

    Splenic arteriovenous fistula is a rare complication following splenectomy. We report a case of a large splenic arteriovenous fistula 23 years after splenectomy in a 50-year old male with abdominal pain, gastro-intestinal bleeding, ascites, diarrhoea, dyspnoea, portal hypertension and heart failure...

  18. Stent-graft repair of a recurrent popliteal arteriovenous fistula

    NARCIS (Netherlands)

    Tielliu, IFJ; Verhoeven, ELG; Prins, TR; van Det, M; van den Dungen, JJAM

    2002-01-01

    Purpose: To describe the successful endovascular treatment of a popliteal arteriovenous fistula with a stent-graft. Case Report: A 54-year-old man was referred to our hospital with a distal popliteal arteriovenous fistula following an arthroscopic meniscectomy 6 years earlier. Three surgical attempt

  19. Diagnosis and evaluation of intracranial arteriovenous malformations

    OpenAIRE

    Andrew Conger; Charles Kulwin; Lawton, Michael T; Cohen-Gadol, Aaron A.

    2015-01-01

    Background: Ideal management of intracranial arteriovenous malformations (AVMs) remains poorly defined. Decisions regarding management of AVMs are based on the expected natural history of the lesion and risk prediction for peritreatment morbidity. Microsurgical resection, stereotactic radiosurgery, and endovascular embolization alone or in combination are all viable treatment options, each with different risks. The authors attempt to clarify the existing literature′s understanding of the natu...

  20. Endovascular treatment for bilateral vertebral arteriovenous fistulas in neurofibromatosis 1.

    Science.gov (United States)

    Siddhartha, W; Chavhan, Govind B; Shrivastava, Manish; Limaye, Uday S

    2003-12-01

    We report a rare case of a 36-year-old woman with neurofibromatosis 1 (NF1) with bilateral vertebro-vertebral arteriovenous fistulas. The patient presented with quadriparesis and had neck pain. Angiography revealed vertebral arteriovenous fistulas bilaterally with dilated epidural venous plexuses compressing the cervical cord resulting in quadriparesis. Endovascular treatment using coils and balloons resulted in successful occlusion of both fistulas. At 6-months postembolization, the patient had improved significantly and is now able to walk with support.

  1. Surgical management of a pial arteriovenous fistula with giant varix in an infant

    Directory of Open Access Journals (Sweden)

    Pillai Ashok

    2006-01-01

    Full Text Available A seven-month-old infant presented with a generalized seizure. The radiological evaluation revealed a large arteriovenous fistula in the left sylvian region. The fistula connected the left middle cerebral artery and the vein of Trolard. A giant varix was present at the venous end. The child underwent craniotomy, complete disconnection of the fistula and excision of the varix. Except for recurrent seizures, which were eventually controlled on anticonvulsants, the child′s neurological development has been good on long-term follow-up of three years. Pial arteriovenous fistulae are rare intracranial vascular malformations. Though significant operative risks exist, they can be successfully managed surgically with good long-term prognosis.

  2. Effects of arteriovenous fistulas on cardiac oxygen supply and demand

    NARCIS (Netherlands)

    Bos, W.J.W.; Zietse, R.; Wesseling, K.H.; Westerhof, N.

    1999-01-01

    Background. Arteriovenous (AV) fistulas used for hemodialysis access may affect cardiac load by increasing the preload while decreasing the afterload. In dogs, AV fistulas have also been shown to affect coronary perfusion negatively. We investigated the net effect of AV fistulas on cardiac oxygen su

  3. EFFECT OF HEPARIN ON THE PATENCY OF ARTERIOVENOUS FISTULA

    Directory of Open Access Journals (Sweden)

    H Ravari

    2008-11-01

    Full Text Available "nPatients with end stage renal disease need a good vascular access for hemodialysis. Arteriovenous fistula is the method of choice for vascular access in these patients. However, failure of arteriovenous fistula due to thrombosis is a major problem. The aim of this study was to evaluate the effect of the heparin on the patency of the arteriovenous fistula. This prospective interventional case control study was performed from November 2003 through May 2005 in vascular surgery ward in Imam Reza Hospital. All the patients who underwent a surgery in order to perform an arteriovenous fistula in cubital or snuff box areas for the dialysis means were enrolled. They were randomly divided into two groups. The case group (n = 96 received intraoperative heparin whereas the controls (n = 102 did not. Early observation of arteriovenous fistula (immediately after surgery showed patency in 89% of heparin group and in 87% of the control group. The patency rate 2 weeks after the surgery was 85% in heparin group versus 74% in the control group, resulting in a statistically significant difference (P value = 0.046. According to higher patency rate of arteriovenous fistula in 2 weeks following surgery in case group, we recommend intraoperative use of heparin in arteriovenous fistula operations.

  4. Assessment and treatment planning of lateral intracranial dural arteriovenous fistulas in 3 T MRI and DSA: A detailed analysis under consideration of time-resolved imaging of contrast kinetics (TRICKS) and ce-MRA sequences

    Energy Technology Data Exchange (ETDEWEB)

    Ertl, L.; Brueckmann, H.; Patzig, M.; Brem, C.; Forbrig, R.; Fesl, G. [Ludwig-Maximilians-University, Grosshadern Campus, Department of Neuroradiology, Institute of Clinical Radiology, Munich (Germany); Kunz, M. [Ludwig-Maximilians-University, Grosshadern Campus, Department of Neurosurgery, Munich (Germany)

    2016-12-15

    The current gold standard in the assessment of lateral intracranial dural arteriovenous fistulas (LDAVF) is digital subtraction angiography (DSA). However, magnetic resonance imaging (MRI) is a non-invasive emerging tool for the evaluation of such lesions. The aim of our study was to compare the DSA to our 3 T MR-imaging protocol including a highly spatial resolved (ce-MRA) and a temporal resolved (''time-resolved imaging of contrast kinetics'', TRICKS) contrast-enhanced MR angiography to evaluate if solely DSA can remain the gold-standard imaging modality for the treatment planning of LDAVF. We retrospectively reviewed matched pairs of DSA and 3 T MRI examinations of 24 patients with LDAVF (03/2008-04/2014) by the same list of relevant criteria for an endovascular LDAVF treatment planning. In particular, we determined intermodality agreement for the Cognard classification, the identifeication of arterial feeders, and the detailed assessment of each venous drainage pattern. Intermodality agreement for the Cognard classification was excellent (k = 1.0). Whereas MRI failed in identifying small arterial feeders, it was superior to the DSA in the assessment of the sinus and the venous drainage pattern. The combination of MRI and DSA is the new gold standard in LDAVF treatment planning. (orig.)

  5. Volume Flow in Arteriovenous Fistulas Using Vector Velocity Ultrasound

    DEFF Research Database (Denmark)

    Hansen, Peter Møller; Olesen, Jacob Bjerring; Pihl, Michael Johannes

    2014-01-01

    Volume flow in arteriovenous fistulas for hemodialysis was measured using the angle-independent ultrasound technique Vector Flow Imaging and compared with flow measurements using the ultrasound dilution technique during dialysis. Using an UltraView 800 ultrasound scanner (BK Medical, Herlev......, Denmark) with a linear transducer, 20 arteriovenous fistulas were scanned directly on the most superficial part of the fistula just before dialysis. Vector Flow Imaging volume flow was estimated with two different approaches, using the maximum and the average flow velocities detected in the fistula. Flow...

  6. Volume Flow in Arteriovenous Fistulas Using Vector Velocity Ultrasound

    DEFF Research Database (Denmark)

    Hansen, Peter Møller; Olesen, Jacob Bjerring; Pihl, Michael Johannes;

    2014-01-01

    Volume flow in arteriovenous fistulas for hemodialysis was measured using the angle-independent ultrasound technique Vector Flow Imaging and compared with flow measurements using the ultrasound dilution technique during dialysis. Using an UltraView 800 ultrasound scanner (BK Medical, Herlev......, Denmark) with a linear transducer, 20 arteriovenous fistulas were scanned directly on the most superficial part of the fistula just before dialysis. Vector Flow Imaging volume flow was estimated with two different approaches, using the maximum and the average flow velocities detected in the fistula. Flow...

  7. Diagnosis and evaluation of intracranial arteriovenous malformations

    Science.gov (United States)

    Conger, Andrew; Kulwin, Charles; Lawton, Michael T.; Cohen-Gadol, Aaron A.

    2015-01-01

    Background: Ideal management of intracranial arteriovenous malformations (AVMs) remains poorly defined. Decisions regarding management of AVMs are based on the expected natural history of the lesion and risk prediction for peritreatment morbidity. Microsurgical resection, stereotactic radiosurgery, and endovascular embolization alone or in combination are all viable treatment options, each with different risks. The authors attempt to clarify the existing literature's understanding of the natural history of intracranial AVMs, and risk-assessment grading scales for each of the three treatment modalities. Methods: The authors conducted a literature review of the existing AVM natural history studies and studies that clarify the utility of existing grading scales available for the assessment of peritreatment risk for all three treatment modalities. Results: The authors systematically outline the diagnosis and evaluation of patients with intracranial AVMs and clarify estimation of the expected natural history and predicted risk of treatment for intracranial AVMs. Conclusion: AVMs are a heterogenous pathology with three different options for treatment. Accurate assessment of risk of observation and risk of treatment is essential for achieving the best outcome for each patient. PMID:25984390

  8. Arteriovenous Malformation in Temporal Lobe Presenting as Contralateral Ocular Symptoms Mimicking Carotid-Cavernous Fistula

    Directory of Open Access Journals (Sweden)

    Fadzillah Mohd-Tahir

    2013-01-01

    Full Text Available Aim. To report a rare case of arteriovenous malformation in temporal lobe presenting as contralateral orbital symptoms mimicking carotid-cavernous fistula. Method. Interventional case report. Results. A 31-year-old Malay gentleman presented with 2-month history of painful progressive exophthalmos of his left eye associated with recurrent headache, diplopia, and reduced vision. Ocular examination revealed congestive nonpulsating 7 mm exophthalmos of the left eye with no restriction of movements in all direction. There was diplopia in left lateral gaze. Left IOP was elevated at 29 mmHg. Left eye retinal vessels were slightly dilated and tortuous. CT scan was performed and showed right temporal arteriovenous malformation with a nidus of 3.8 cm × 2.5 cm with right middle cerebral artery as feeding artery. There was dilated left superior ophthalmic vein of 0.9 mm in diameter with enlarged left cavernous sinus. MRA and carotid angiogram confirmed right temporal arteriovenous malformation with no carotid-cavernous fistula. Most of the intracranial drainage was via left cavernous sinus. His signs and symptoms dramatically improved following successful embolisation, completely resolved after one year. Conclusion. Intracranial arteriovenous malformation is rarely presented with primary ocular presentation. Early intervention would salvage the eyes and prevent patients from more disaster morbidity or fatality commonly due to intracranial haemorrhage.

  9. Paraplegia in a chiropractic patient secondary to atraumatic dural arteriovenous fistula with perimedullary hypertension: case report.

    Science.gov (United States)

    Foreman, Stephen M; Stahl, Michael J; Schultz, Gary D

    2013-07-08

    Intracranial dural arteriovenous fistulas are abnormal communications between higher-pressure arterial circulation and lower-pressure venous circulation. This abnormal communication can result in important and frequently misdiagnosed neurological abnormalities.A case of rapid onset paraplegia following cervical chiropractic manipulation is reviewed. The patient's generalized spinal cord edema, lower extremity paraplegia and upper extremity weakness, were initially believed to be a complication of the cervical spinal manipulation that had occurred earlier on the day of admission. Subsequent diagnostic testing determined the patient suffered from impaired circulation of the cervical spinal cord produced by a Type V intracranial arteriovenous fistula and resultant venous hypertension in the pontomesencephalic and anterior spinal veins.The clinical and imaging findings of an intracranial dural arteriovenous fistula with pontomesencephalic venous congestion and paraplegia are reviewed.This case report emphasizes the importance of thorough and serial diagnostic imaging in the presence of sudden onset paraplegia and the potential for error when concluding atypical neurological presentations are the result of therapeutic misadventure.

  10. [Right renal arteriovenous fistula after nephrectomy with streptococcal endarteritis].

    Science.gov (United States)

    Natali, J; Emerit, J; Reynier, P; Maraval, M

    1975-01-18

    The authors add a new case, to the 41 already published, of arterio-venous fistula of the renal pedicle after nephrectomy, with the peculiarity of its presentation as a prolonged fever resulting from streptococcal bacterial endarteritis at the site of the fistula (3rd case in the literature). Surgical treatment in association with massive and prolonged antibiotic therapy resulted in recovery.

  11. [Spondylodiscitis after embolization of an extramedullary intraspinal arteriovenous fistula].

    Science.gov (United States)

    Baudrillard, J C; Toubas, O; Lerais, J M; Auquier, F; Gatfosse, M; Bernard, M H

    1985-04-01

    The authors report a case of spondylitis Th11-Th12 occurred 1 month after embolization of an intraspinal extramedullary arteriovenous fistulae; this fistulae was fed by 11th left intercostal artery. The infecting organism isolated from the affected intervertebral disc was streptococcus sanguis a common agent of dental abscess.

  12. Arteriovenous fistula: An evidence based practice in nursing care

    OpenAIRE

    2013-01-01

    The arteriovenous fistula (AVF) is the most frequent form of vascular access for patients undergoing haemodialysis because it ensures good quality of dialysis and reduce haemodialysis mortality. For this reason, the nephrology nurse plays an important role in the appropriate care of fistula with a view to promoting the longevity and prevention of complications. Purpose: The purpose of this review was to investigate the role of Nephrology nurse in the appropriate care of fistula, promoting lon...

  13. Tentorial dural arteriovenous fistula successfully treated with surgical interruption of leptomeningeal venous drainage:a case report

    Institute of Scientific and Technical Information of China (English)

    LI Mei-hua; XU Geng-sheng; LI Yi-yun

    2005-01-01

    @@ Tentorial dural arteriovenous fistula (DAVF) is a rare disease, accounting for some 4% of all cases of intracranial DAVF.1 Because of a high risk of intracranial hemorrhage, patients with DAVF need aggressive treatment. Despite recent advances in endovascular technology, many researchers2-4 advocate open surgery for the treatment of tentorial DAVF. In this report, we present a case of tentorial DAVF with pure leptomeningeal venous drainage successfully treated by interruption of the draining vein.

  14. Large spinal intraosseous arteriovenous fistula: case report.

    Science.gov (United States)

    Imajo, Yasuaki; Kanchiku, Tsukasa; Yoshida, Yuichiro; Nishida, Norihiro; Taguchi, Toshihiko

    2015-04-01

    Here the authors report the case of a fresh vertebral body fracture with a large spinal intraosseous arteriovenous fistula (AVF). A 74-year-old woman started to experience low-back pain following a rear-end car collision. Plain radiography showed diffuse idiopathic skeletal hyperostosis (DISH). Sagittal CT sections revealed a transverse fracture of the L-4 vertebral body with a bone defect. Sagittal fat-suppressed T2-weighted MRI revealed a flow void in the fractured vertebra. Spinal angiography revealed an intraosseous AVF with a feeder from the right L-4 segmental artery. A fresh fracture of the L-4 vertebral body with a spinal intraosseous AVF was diagnosed. Observation of a flow void in the vertebral body on fat-suppressed T2-weighted MRI was important for the diagnosis of the spinal intraosseous AVF. Because conservative treatment was ineffective, surgery was undertaken. The day before surgery, embolization through the right L-4 segmental artery was performed using 2 coils to achieve AVF closure. Posterolateral fusion with instrumentation at the T12-S2 vertebral levels was performed without L-4 vertebroplasty. The spinal intraosseous AVF had disappeared after 4 months. At 24 months after surgery, the bone defect was completely replaced by bone and the patient experienced no limitations in daily activities. Given their experience with the present case, the authors believe that performing vertebroplasty or anterior reconstruction may not be necessary in treating spinal intraosseous AVF.

  15. Intracranial dural arteriovenous fistula as a cause for symptomatic superficial siderosis: A report of two cases and review of the literature

    Directory of Open Access Journals (Sweden)

    Griffin R Baum

    2016-01-01

    Conclusions: We describe the second and third cases of a dAVF as the cause of SS, and the first cases of successful treatment of SS-associated dAVF with endovascular embolization. As noninvasive imaging techniques become more sensitive and easily obtained, one must consider their limitations in detecting occult intracranial vascular malformations such as dAVF as a possible etiology for SS.

  16. Middle Meningeal Arteriovenous Fistula and Its Spontaneous Closure: A Case Report and Review of the Literature

    OpenAIRE

    2007-01-01

    Middle meningeal artery pseudo-aneurysms and arteriovenous fistulas are usually post-traumatic, although occasional iatrogenic cases have been reported. The treatment has been obliteration of the fistula by surgical or endovascular means. Spontaneous closure of fistula is uncommon. We report a case of non-traumatic middle meningeal arteriovenous fistula in a patient with alcoholism, which resolved spontaneously without treatment.

  17. Radial Artery Approach to Salvage Nonmaturing Radiocephalic Arteriovenous Fistulas

    Energy Technology Data Exchange (ETDEWEB)

    Hsieh, Mu-Yang; Lin, Lin; Tsai, Kuei-Chin; Wu, Chih-Cheng, E-mail: chihchengwumd@gmail.com [National Taiwan University Hospital, Department of Cardiology (China)

    2013-08-01

    PurposeTo evaluate the usefulness of an approach through the radial artery distal to the arteriovenous anastomosis for salvaging nonmaturing radiocephalic arteriovenous fistulas.MethodsProcedures that fulfilled the following criteria were retrospectively reviewed: (1) autogenous radiocephalic fistulas, (2) fistulas less than 3 months old, (3) distal radial artery approach for salvage. From 2005 to 2011, a total of 51 patients fulfilling the above criteria were enrolled. Outcome variables were obtained from angiographic, clinical and hemodialysis records, including the success, complication, and primary and secondary patency rates.ResultsThe overall anatomical and clinical success rates for the distal radial artery approach were 96 and 94 %, respectively. The average procedure time was 36 {+-} 19 min. Six patients (12 %) experienced minor complications as a result of extravasations. No arterial complication or puncture site complication was noted. The postinterventional 6-month primary patency rate was 51 %, and the 6-month secondary patency rate was 90 %. When the patients were divided into a stenosed group (20 patients) and an occluded group (31 patients), there were no differences in the success rate, complication rate, or primary and secondary patency rates.ConclusionAn approach through the radial artery distal to the arteriovenous anastomosis is an effective and safe alternative for the salvage of nonmaturing radiocephalic arteriovenous fistulas, even for occluded fistulas.

  18. Care of arteriovenous fistula by patients with chronic renal failure.

    OpenAIRE

    Monteiro Furtado, Angelina; Elisângela Teixeira Lima, Francisca

    2008-01-01

    This descriptive study aimed at identifying care of arteriovenous fistula (AVF) performed patients under hemodialysis. Twenty one hemodialysis patients were randomly selected in a clinic in Fortaleza, Ceara, Brazil:11 female and 11 male patients, age between 30 and 50 yearold, and most were single, retired, and had low education level. Semi-structured interview was applied. The following procedures were mentioned: cleaning the fistula arm, thrill palpation, avoiding lifting weight with AVF...

  19. Arteriovenous fistulas aggravate the hemodynamic effect of vein bypass stenoses

    DEFF Research Database (Denmark)

    Nielsen, T G; Djurhuus, C; Pedersen, Erik Morre;

    1996-01-01

    PURPOSE: The purpose of this study was to assess the impact of arteriovenous fistulas combined with varying degrees of stenosis on distal bypass hemodynamics and Doppler spectral parameters. METHODS: In an in vitro flow model bypass stenoses causing 30%, 55%, and 70% diameter reduction were induced...... 10 cm upstream of a fistula with low outflow resistance. Flow and intraluminal pressure were measured proximal to the stenosis and downstream of the fistula. The waveform parameters peak systolic velocity, end-diastolic velocity, pulsatility index, and pulse rise time were determined from midstream...... Doppler spectra obtained 10 cm downstream of the fistula. All measurements were carried out with open and clamped fistula. RESULTS: At 30% diameter reducing stenosis opening of the fistula induced a 12% systolic pressure drop across the stenosis but had no adverse effect on the Doppler waveform parameters...

  20. Immunohistochemical study in dural arteriovenous fistula and possible role of ephrin-B2 for development of dural arteriovenous fistula

    Institute of Scientific and Technical Information of China (English)

    Wuttipong Tirakotai 王宝隆; BIAN Liu-guan 卞留贯; Helmut Bertalanffy; Siegfried Bien; Ulrich Sure

    2004-01-01

    Background Although there were several clinical and experimental studies discussing the pathogenesis of dural arteriovenous fistula (DAVF), the pathological process leading to intracranial DAVF so far remains unknown. In this study, we investigated the expression of vascular growth factors in order to elucidate the possible role of these factors for the development of DAVF and to study the biological activity of this uncommon lesion.Methods We examined the histological features, proliferative and angiogenic capacities of the tissue specimens obtained from 6 patients who underwent surgery at our institution. Immunohistochemical staining for vascular endothelial growth factor (VEGF), its receptors Flk-1 and Flt-1, ephrin-B2, MIB-1 and proliferating cell nuclear antigen (PCNA) was performed using standard immunohistochemical techniques. Results A positive immunostaining was found for all antibodies studied except MIB-1, whereas nuclear endothelial expression of PCNA was observed in only 3/6 cases. VEGF stained positive in all of the available specimens (6/6). Flk-1 showed a positive immunoreaction in only 2/6 cases and Flt-1 in 4/6 cases. Ephrin-B2 was expressed in the majority (5/6) of the cases.Conclusions These results support the hypothesis that DAVFs might be acquired dynamic vascular malformations with low biological activity. Vascular growth factors like VEGF and ephrin-B2 might play a pivotal role in the formation of DAVF.

  1. Venous aneurysm complicating arteriovenous fistula access and matrix metalloproteinases

    Directory of Open Access Journals (Sweden)

    Serra Raffaele

    2015-01-01

    Full Text Available Introduction: An arteriovenous fistula (AVF for placed for hemodialysis may be burdened by one particular complication-the formation of a venous aneurysm. It has been shown that matrix metalloproteinases (MMPs and neutrophil gelatinase-associated lipocalin (NGAL could represent markers of disease in both venous and arterial vessels.

  2. Traumatic basilar pseudoaneurysm with a basilar-cavernous arteriovenous fistula

    Energy Technology Data Exchange (ETDEWEB)

    Connor, S.E.J.; Deasy, N.P.; Jeffree, M.A. [Dept. of Neuroradiology, King' s Coll. Hospital, London (United Kingdom); Martin, A.J.; Strong, A.J. [Dept. of Neurosurgery, King' s Coll. Hospital, London (United Kingdom)

    2001-03-01

    A traumatic pseudoaneurysm of the basilar artery with a basilar-cavernous sinus arteriovenous fistula was diagnosed in a 12-year-old girl using CT, MRI and angiography. It was successfully treated by coil embolisation. We speculate on the mode of formation of this rare traumatic lesion. (orig.)

  3. [Arteriovenous fistula in patients with a complicated postphlebitic syndrome].

    Science.gov (United States)

    Quiñones Castro, M; Fernández de la Vara Sánchez, L; Perera González, F; Alvarez Sánchez, J A

    1991-01-01

    An investigation, which goal is to evidencing AV fistulas in patients with a complicated postthrombotic syndrome, as well as to determinate the efficacy of noninvasive methods used for the study of AV fistulas in such patients, is presented. So, patients with a complicated postphlebitic syndrome interned into the Instituto de Angiología were studied. Twenty-five patients were included in the study, 9 of these patients (36%) had arteriovenous fistulas, arteriographically evidenced. Haemodynamic study do not support the evidence of such communications.

  4. Dural Arteriovenous Fistula Following Translabyrinthine Resection of Cerebellopontine Angle Tumors: Report of Two Cases

    Science.gov (United States)

    Li, Peter M.M.C.; Fischbein, Nancy J.; Do, Huy M.; Blevins, Nikolas H.

    2011-01-01

    We describe two cases of dural arteriovenous fistula (DAVF) developing in a delayed fashion after translabyrinthine resection of cerebellopontine angle tumors. Two patients in an academic tertiary referral center, a 46-year-old woman and a 67-year-old man, underwent translabyrinthine resection of a 2-cm left vestibular schwannoma and a 4-cm left petrous meningioma, respectively. Both patients subsequently developed DAVF, and in each case the diagnosis was delayed despite serial imaging follow-up. In one patient, cerebrospinal fluid diversion before DAVF was identified as the cause of her intracranial hypertension; the other patient was essentially asymptomatic but with a high risk of hemorrhage due to progression of cortical venous drainage. Endovascular treatment was effective but required multiple sessions due to residual or recurrent fistulas. Dural arteriovenous fistula is a rare complication of translabyrinthine skull base surgery. Diagnosis requires a high index of clinical suspicion and an understanding of subtle imaging findings that may be present on follow-up studies performed for tumor surveillance. Failure to recognize this complication may lead to misguided interventions for treatment of hydrocephalus and other complications, as well as ongoing risks related to venous hypertension and intracranial hemorrhage. As this condition is generally curable with neurointerventional and/or surgical methods, timely diagnosis and treatment are essential. PMID:23984203

  5. Tentorial artery embolization in tentorial dural arteriovenous fistulas

    Energy Technology Data Exchange (ETDEWEB)

    Rooij, Willem Jan van; Sluzewski, Menno [St. Elisabeth Ziekenhuis, Department of Radiology, Tilburg (Netherlands); Beute, Guus N. [St. Elisabeth Ziekenhuis, Department of Neurosurgery, Tilburg (Netherlands)

    2006-10-15

    The tentorial artery is often involved in arterial supply to tentorial dural fistulas. The hypertrophied tentorial artery is accessible to embolization, either with glue or with particles. Six patients are presented with tentorial dural fistulas, mainly supplied by the tentorial artery. Two patients presented with intracranial hemorrhage, two with pulsatile tinnitus and one with progressive tetraparesis, and in one patient the tentorial dural fistula was an incidental finding. Different endovascular techniques were used to embolize the tentorial artery in the process of endovascular occlusion of the fistulas. All six tentorial dural fistulas were completely occluded by endovascular techniques, confirmed at follow-up angiography. There were no complications. When direct catheterization of the tentorial artery was possible, glue injection with temporary balloon occlusion of the internal carotid artery at the level of the tentorial artery origin was effective and safe. Different endovascular techniques may be successfully applied to embolize the tentorial artery in the treatment of tentorial dural fistulas. (orig.)

  6. The Patency Rate of Arteriovenous Fistulas

    Directory of Open Access Journals (Sweden)

    Aşkın Ender Topal

    2004-01-01

    Full Text Available The purpose of this investigation is to determine the patency of thearteriovenous (A-V fistulas, created in patients with chronic renal failure, inthe early and late periods according to sex.The A-V fistulas created for hemodialisis were investigated retrospectively.Of 238 patients, there were 130 male.269 operations were made to 238 patients. Of these, 198 (73.6 % wereradiochephalic, 56 (20.8 % were brachiochephalic, 8 (3 % were brachiobasilicA-V fistulas. In 3 (1.1 % patients loop graft between brachial artery and vein,in 1 (0.37 % patient graft between radial artery and brachial vein, in 1 patientgraft between brachial artery and basilic vein, in 1 patient graft betweensuperficial femoral artery and saphenous vein were placed. Of 198radiochephalic A-V fistulas 24 (12.1 % in early period and 3 (1.5 % in lateperiod became inactive. Of 56 brachiochephalic A-V fistulas 4 (7.1 % and of 8brachiobasilic A-V fistulas 2 (25 % became unsuccessful in early period. 1 of 6A-V fistulas with prosthetic graft failed in late period because of thrombosis. Inradial level patency rate of A-V fistulas in females were lower than in males(82.3 %-89.8 %.The patency rate of A-V fistulas in radial and brachial levels were similar,but in radial level rate of successful of A-V fistulas decreased in femalesaccording to males. Use of graft in A-V fistula didn’t give superiority to A-Vfistulas without graft.

  7. Surgical management of multiple posttraumatic arteriovenous fistulas of femoral vessels.

    Science.gov (United States)

    Pokrovsky, A V; Shubin, A A; Kuntsevich, G I; Subbotin, V V; Suntsov, D S

    2008-01-01

    Presented herein are two case reports concerning surgical management of posttraumatic arteriovenous fistulas of femoral vessels. Case 1. A 45-year-old female patient attended with a history of a shotgun injury wound of her left femur and crus sustained when a girl of eight. She sought medical attention for a progressively deteriorating condition, accompanied by pain, and breathlessness dyspnea at rest. Detected were multiple fistulas between the deep femoral artery and superficial femoral artery and femoral vein. Management consisted in separation of the arteriovenous fistulas, followed by prosthetic repair of the deep femoral artery. Case 2. A 32-year-old male patient after an accidentally inflicted shotgun injury of the his left femur underwent within a time period of 3 year three vascular operations including ligation of the deep femoral artery and femoral vein followed by having later on developed secondary lymphedema of his left lower limb and pronounced manifested chronic venous insufficiency. Management included dissociation of the numerous arteriovenous fistulas between the branches of the deep femoral artery and the common femoral artery, as well as between the superficial femoral artery and femoral vein.

  8. Urokinase treatment for arteriovenous fistulae declotting in dialyzed patients.

    Science.gov (United States)

    Mangiarotti, G; Canavese, C; Thea, A; Segoloni, G P; Stratta, P; Salomone, M; Vercellone, A

    1984-01-01

    Urokinase treatment, previously employed with success in the declotting of deep venous thrombosis and arteriovenous shunts in patients undergoing regular dialytic treatment (RDT), was used in 23 cases of arteriovenous fistula thrombotic occlusion in 18 RDT patients. The treatment was successful in 65.2% of the cases without any negative side effects, except 1 case which may have developed a pulmonary embolism. Patients with severe hypofibrinolysis may need larger doses or may have a recurrence of the thrombotic episode. All therapeutic failures correlated with the presence of fibrosis or sclerosis.

  9. Arteriovenous Fistula Complicated by Popliteal Venous Access for Endovascular Thrombolytic Therapy of Deep Vein Thrombosis

    Energy Technology Data Exchange (ETDEWEB)

    Byun, Sung Su; Kim, Jeong Ho; Park, Chul Hi; Hwang, Hee Young; Kim, Hyung SiK [Gacheon University Gil Medical Center, Gacheon (Korea, Republic of); Jeon, Young Sun; Kim, Won Hong [Inha University College of Medicine, Incheon (Korea, Republic of)

    2008-10-15

    We report a case of an iatrogenic arteriovenous fistula complicated by catheter- directed thrombolytic therapy in a patient with acute deep vein thrombosis of a lower extremity. To the best of our knowledge, this is the first report of an arteriovenous fistula between the sural artery and popliteal vein in that situation. As the vessels have a close anatomical relationship, the arteriovenous fistula seems to be a potential complication after endovascular thrombolytic therapy of acute deep vein thrombosis.

  10. Outcome of Kidney Allografts in Recipients With a Femoral Arteriovenous Fistula: Report of Two Cases

    Directory of Open Access Journals (Sweden)

    Denise M.D. Özdemir-van Brunschot

    2016-09-01

    Full Text Available Two patients, who were on hemodialysis over a femoral arteriovenous fistula, were transplanted in our center. Despite adequate blood pressure, perfusion of the renal allograft remained poor after completion of the vascular anastomoses. Ligation of the femoral arteriovenous fistula (1.6 L/min led to adequate perfusion. Initial graft function was good. Although it remains unclear whether ischemia of a renal allograft is caused by venous hypertension or vascular steal due to a femoral arteriovenous fistula, it might be necessary to ligate a femoral arteriovenous fistula to obtain adequate graft perfusion.

  11. Congenital arteriovenous fistula of the horseshoe kidney with multiple hemangiomas

    Directory of Open Access Journals (Sweden)

    Lazić Miodrag

    2012-01-01

    Full Text Available Introduction. Congenital renal arteriovenous fistulas (AVF are rare, especially if they are associated with other developmental renal anomalies. Case Outline. A 34-year-old female was hospitalized due to total painless hematuria and bladder tamponade. Excretory urography revealed a horseshoe kidney with normal morphology of pyelocaliceal system and ureters. Aortography and selective renovasography detected a cluster-like vascular formation with multiple arteriovenous fistulas (AVF. Due to a large AVF gauge and poor flow of the efferent vein to the inferior vena cava, a surgical procedure of two renal artery segmentary branches ligation and division was performed. During the operative procedure, the presence of multiple superficial renal hemangiomas was detected. Conclusion. Although selective arterial embolization represents the preferable treatment option, conventional surgery remains favorable alternative in selected cases with large and complex AVF.

  12. Pulmonary Arteriovenous Fistula: Clinical and Histologic Spectrum of Four Cases

    Directory of Open Access Journals (Sweden)

    Soomin Ahn

    2016-09-01

    Full Text Available Pulmonary arteriovenous fistula (PAVF is abnormally dilated vessels that provide a right-to-left shunt between pulmonary artery and pulmonary vein and is clinically divided into simple and complex type. Here, we report four cases of surgically resected sporadic PAVFs presenting various clinical and histologic spectrums. Cases 1 (a 57-old-female and 2 (a 54-old-female presented as incidentally identified single aneurysmal fistulas and the lesions were surgically removed without complication. On the other hand, case 3 (an 11-old-male showed diffuse dilated vascular sacs involving both lungs and caused severe hemodynamic and pulmonary dysfunction. Embolization and surgical resection of the main lesion failed to relieve the symptoms. Case 4 (a 36-old-male had a localized multiloculated cyst clinically mimicking congenital cystic adenomatoid malformation. Microscopically, the lesion consisted of dilated thick vessels, consistent with the diagnosis of fistulous arteriovenous malformation/hemangioma.

  13. Peroneal Arteriovenous Fistula and Pseudoaneurysm: An Unusual Presentation

    Directory of Open Access Journals (Sweden)

    Kevin C. Ching

    2014-01-01

    Full Text Available Peroneal artery arteriovenous fistulas and pseudoaneurysms are extremely rare with the majority of reported cases due to penetrating, orthopedic, or iatrogenic trauma. Failure to diagnose this unusual vascular pathology may lead to massive hemorrhage or limb threatening ischemia. We report an interesting case of a 14-year-old male who presented with acute musculoskeletal pain of his lower extremity. Initial radiographs were negative. Further imaging workup revealed a peroneal arteriovenous fistula with a large pseudoaneurysm. After initial endovascular intervention was unsuccessful, the vessels were surgically ligated in the operating room. Pathology revealed papillary endothelial hyperplasia consistent with an aneurysm and later genetic testing was consistent with Ehlers-Danlos syndrome Type IV. This case illustrates an unusual cause of acute atraumatic musculoskeletal pain and uncommon presentation of Ehlers-Danlos syndrome.

  14. Acquired arteriovenous fistula in a grizzly bear (Ursus arctos horribilis).

    Science.gov (United States)

    Tuttle, Allison D; MacLean, Robert A; Linder, Keith; Cullen, John M; Wolfe, Barbara A; Loomis, Michael

    2009-03-01

    A captive adult male grizzly bear (Ursus arctos horribilis) was evaluated due to multifocal wounds of the skin and subcutaneous tissues sustained as a result of trauma from another grizzly bear. On presentation, one lesion that was located in the perineal region seemed to be a deep puncture with purple tissue protruding from it. This perineal wound did not heal in the same manner or rate as did the other wounds. Twenty-five days after initial detection, substantial active hemorrhage from the lesion occurred and necessitated anesthesia for examination of the bear. The entire lesion was surgically excised, which later proved curative. An acquired arteriovenous fistula was diagnosed via histopathology. Arteriovenous fistulas can develop after traumatic injury and should be considered as a potential complication in bears with nonhealing wounds.

  15. Accessory veins in nonmaturing autogenous arteriovenous fistulae: analysis of anatomic features and impact on fistula maturation.

    Science.gov (United States)

    Engstrom, Bjorn I; Grimm, Lars J; Ronald, James; Smith, Tony P; Kim, Charles Y

    2015-01-01

    The appropriate management of nonmaturing arteriovenous (AV) fistulae continues to be a controversial issue. While coil embolization of accessory side-branch veins can be performed to encourage maturation of nonmaturing AV fistulae, the true efficacy and optimal patient population are not well understood. Fistulagrams performed on nonmaturing AV fistulae were retrospectively reviewed in 145 patients (86 males, median age 63 years) for the presence of accessory veins. Fistula and accessory vein measurements were obtained, as were rates of eventual fistula maturation after accessory vein coil embolization. Of 145 nonmaturing fistulae, 49 (34%) had a stenosis without any accessory veins, 76 (52%) had a stenosis and one or more accessory veins, and 20 (14%) had an accessory vein without concurrent stenosis. Eighteen AV fistulae had one or more accessory veins without coexisting stenosis. Nine fistulae had a caliber decrease immediately downstream from the accessory vein. Coil embolization of dominant accessory veins with a caliber decrease immediately downstream (n = 6) resulted in a 100% eventual fistula maturation rate versus 67% for fistulae without this configuration (n = 6, p = 0.15). Accessory vein size was not correlated with maturation rates (p = 0.51). The majority of nonmaturing fistulae with accessory veins had a coexisting stenosis. Higher maturation rates may result with selected anatomic parameters, although additional studies with more robust sample sizes are needed prior to definitive conclusions. © 2014 Wiley Periodicals, Inc.

  16. Stent explantation from an arteriovenous fistula for hemodialysis: a case report.

    Science.gov (United States)

    Nano, Giovanni; Dalainas, Ilias; Casana, Renato; Bianchi, Paolo; Lupattelli, Tommaso; Malacrida, Giovanni; Tealdi, Domenico G

    2006-01-01

    Percutaneous transluminal angioplasty is the first treatment of a dysfunctional vascular access for hemodialysis. A case of stenting of a native arteriovenous hemodialysis fistula is reported that was treated with a stent placement at the anastomosis level, with explantation of the stent after complete thrombosis of the fistula 48 hours after the procedure. It is preferable to treat arteriovenous fistulas with simple balloon dilatation, avoiding stenting of the fistula, especially in the anastomosis site.

  17. Anesthesia considerations and intraoperative monitoring during surgery for arteriovenous malformations and dural arteriovenous fistulas.

    Science.gov (United States)

    Miller, Christina; Mirski, Marek

    2012-01-01

    The anesthetic considerations for surgical resection of arteriovenous malformations (AVMs) and dural arteriovenous fistulas (DAVFs) incorporate many principles that are common to craniotomies for other indications. However, a high-flow, low-resistance shunt results in chronic hypoperfusion of adjacent brain tissue that is vulnerable to ischemia and at high risk for hyperemia and hemorrhage as resection of the lesion redirects blood flow. A comprehensive understanding of AVM pathophysiology and rapidly titratable anesthetic and vasoactive agents allow the anesthesiologist to alter blood pressure targets as resection evolves for optimal patient outcome. Intensive management is continued post-operatively as the brain acclimatizes to new parameters.

  18. Surgical correction of an arteriovenous fistula in a ring-tailed lemur (Lemur catta).

    Science.gov (United States)

    Boedeker, Nancy C; Guzzetta, Philip; Rosenthal, Steven L; Padilla, Luis R; Murray, Suzan; Newman, Kurt

    2014-02-01

    A 10-y-old ovariohysterectomized ring-tailed lemur (Lemur catta) was presented for exacerbation of respiratory signs. The lemur had a history of multiple examinations for various problems, including traumatic lacerations and recurrent perivulvar dermatitis. Examination revealed abnormal lung sounds and a femoral arteriovenous fistula with a palpable thrill and auscultable bruit in the right inguinal area. A diagnosis of congestive heart failure was made on the basis of exam findings, radiography, abdominal ultrasonography, and echocardiography. The lemur was maintained on furosemide until surgical ligation of the fistula was performed. Postoperative examination confirmed successful closure of the fistula and resolution of the signs of heart failure. Arteriovenous fistulas are abnormal connections between an artery and a vein that bypass the capillary bed. Large arteriovenous fistulas may result in decreased peripheral resistance and an increase in cardiac output with consequent cardiomegaly and high output heart failure. This lemur's high-flow arteriovenous fistula with secondary heart failure may have been iatrogenically induced during blood collection by prior femoral venipuncture. To our knowledge, this report is the first description of an arteriovenous fistula in a prosimian. Successful surgical correction of suspected iatrogenic femoral arteriovenous fistulas in a cynomolgus monkey (Macaca fascicularis) and a rhesus macaque (Macaca mulatta) have been reported previously. Arteriovenous fistula formation should be considered as a rare potential complication of venipuncture and as a treatable cause of congestive heart failure in lemurs.

  19. Chronic kidney disease aggravates arteriovenous fistula damage in rats.

    Science.gov (United States)

    Langer, Stephan; Kokozidou, Maria; Heiss, Christian; Kranz, Jennifer; Kessler, Tina; Paulus, Niklas; Krüger, Thilo; Jacobs, Michael J; Lente, Christina; Koeppel, Thomas A

    2010-12-01

    Neointimal hyperplasia (NIH) and impaired dilatation are important contributors to arteriovenous fistula (AVF) failure. It is unclear whether chronic kidney disease (CKD) itself causes adverse remodeling in arterialized veins. Here we determined if CKD specifically triggers adverse effects on vascular remodeling and assessed whether these changes affect the function of AVFs. For this purpose, we used rats on a normal diet or on an adenine-rich diet to induce CKD and created a fistula between the right femoral artery and vein. Fistula maturation was followed noninvasively by high-resolution ultrasound (US), and groups of rats were killed on 42 and 84 days after surgery for histological and immunohistochemical analyses of the AVFs and contralateral femoral vessels. In vivo US and ex vivo morphometric analyses confirmed a significant increase in NIH in the AVFs of both groups with CKD compared to those receiving a normal diet. Furthermore, we found using histological evaluation of the fistula veins in the rats with CKD that the media shrank and their calcification increased significantly. Afferent artery dilatation was significantly impaired in CKD and the downstream fistula vein had delayed dilation after surgery. These changes were accompanied by significantly increased peak systolic velocity at the site of the anastomosis, implying stenosis. Thus, CKD triggers adverse effects on vascular remodeling in AVFs, all of which contribute to anatomical and/or functional stenosis.

  20. Transitional Flow in an Arteriovenous Fistula: Effect of Wall Distensibility

    Science.gov (United States)

    McGah, Patrick; Leotta, Daniel; Beach, Kirk; Aliseda, Alberto

    2012-11-01

    Arteriovenous fistulae are created surgically to provide adequate access for dialysis in patients with end-stage renal disease. Transitional flow and the subsequent pressure and shear stress fluctuations are thought to be causative in the fistula failure. Since 50% of fistulae require surgical intervention before year one, understanding the altered hemodynamic stresses is an important step toward improving clinical outcomes. We perform numerical simulations of a patient-specific model of a functioning fistula reconstructed from 3D ultrasound scans. Rigid wall simulations and fluid-structure interaction simulations using an in-house finite element solver for the wall deformations were performed and compared. In both the rigid and distensible wall cases, transitional flow is computed in fistula as evidenced by aperiodic high frequency velocity and pressure fluctuations. The spectrum of the fluctuations is much more narrow-banded in the distensible case, however, suggesting a partial stabilizing effect by the vessel elasticity. As a result, the distensible wall simulations predict shear stresses that are systematically 10-30% lower than the rigid cases. We propose a possible mechanism for stabilization involving the phase lag in the fluid work needed to deform the vessel wall. Support from an NIDDK R21 - DK08-1823.

  1. Perfusion-weighted MRI of spinal dural arteriovenous fistula

    Energy Technology Data Exchange (ETDEWEB)

    Yanaka, K.; Matsumaru, Y.; Uemura, K.; Matsumura, A.; Nose, T. [Department of Neurosurgery, Institute of Clinical Medicine, University of Tsukuba, Ibaraki (Japan); Anno, I. [Department of Radiology, Institute of Clinical Medicine, University of Tsukuba, Ibaraki (Japan)

    2003-10-01

    A 72-year-old woman was admitted with rapidly progressive paraplegia and sphincter disturbance. T2-weighted images of the thoracic spine showed intramedullary high signal with flow voids suggesting dilated medullary veins. Conventional spinal angiography demonstrated a dural arteriovenous fistula draining into perimedullary veins. Perfusion-weighted MRI demonstrated a prolonged mean transit time and increased blood volume in the high-signal area. The loss of normal perfusion gradient and venous hypertension and were thought to produce these differences. The time-to-peak was almost identical in the high-signal and isointense areas, although the bolus of contrast medium arrived earlier in the former. Arteriovenous shunting was thought to cause faster inflow. These changes may have resulted in increased blood volume in the spinal cord. The high signal has been attributed to oedema due to venous congestion, but there has been no histological confirmation. Perfusion MRI in this case supports this hypothesis. (orig.)

  2. [Arteriovenous fistulae of posttraumatic origin: apropos 7 cases].

    Science.gov (United States)

    Lerma, R; Galego, G; Lisbona, C; Martorell, A; Silveira, P; Callejas, J M

    1992-01-01

    We present our experience with arterio-venous traumatic fistulas. Seven cases, between 6 patients are reviewed. Respective etiologies were: 4 cases after an accidental traumatism, 2 cases produced by iatrogenicity and 1 case of idiopathic etiology. Respective localizations were: 6 cases at lower limbs (85.7%) and one case at cervical column (14.2%). All patients underwent surgical treatment. There was any case of mortality and treatment results were satisfactory in all cases. Patients were followed and, up to now, no recidives have been registered. follow-time ranged from 1.5 to more than 6 years.

  3. Novalis Stereotactic Radiosurgery for Spinal Dural Arteriovenous Fistula.

    Science.gov (United States)

    Sung, Kyoung-Su; Song, Young-Jin; Kim, Ki-Uk

    2016-07-01

    The spinal dural arteriovenous fistula (SDAVF) is rare, presenting with progressive, insidious symptoms, and inducing spinal cord ischemia and myelopathy, resulting in severe neurological deficits. If physicians have accurate and enough information about vascular anatomy and hemodynamics, they achieve the good results though the surgery or endovascular embolization. However, when selective spinal angiography is unsuccessful due to neurological deficits, surgery and endovascular embolization might be failed because of inadequate information. We describe a patient with a history of vasospasm during spinal angiography, who was successfully treated by spinal stereotactic radiosurgery using Novalis system.

  4. Surgical treatment of complicated traumatic aneurysm and arteriovenous fistula

    Institute of Scientific and Technical Information of China (English)

    乔正荣; 时德

    2003-01-01

    Objective: To evaluate the surgical methods and the outcome of management for traumatic arterial aneurysm (TAA) and traumatic arteriovenous fistula (TAVF). Methods: A total of 121 patients with TAA or TAVF were treated by surgery. Clinical, operative and postoperative data were collected and analyzed retrospectively. Results: The surgical techniques included aneurysmectomy and arterial end-to-end anastomosis or vascular grafting or artery ligation, aneurysm ligation and bypass, vascular repair, fistula excision and vascular ligation or vascular grafting or repair and so on. One patient died (0.83%). The follow-up rates of TAA and TAVF were 65.7% and 60% respectively. Conclusions: Complicated TAA and TAVF in different sites should be treated with different methods.

  5. Acute paraplegia following embolization of spinal dural arteriovenous fistula

    Institute of Scientific and Technical Information of China (English)

    HUANG Cheng-guang; QI Xiang-qian; CHEN Huai-rui; L(U) Li-quan; WU Xiao-jun; BAI Ru-lin; LU Yi-cheng

    2011-01-01

    Embolization therapy has been used as the initial treatment for spinal dural arteriovenous fistula (SDAVF) only for certain patients or in certain medical institutions due to its minimal invasiveness, but the recurrence of embolization remains a clinical challenge. The recurrent patient usually exhibits a gradual onset of symptoms and progressive deterioration of neurological function. Developing paraplegia several hours after embolization is commonly seen in patients with venous thrombosis-related complications, for which anticoagulation therapy is often administered. This article reports on a SDAVF patient who had weakness of both lower extremities before embolization and developed complete paraplegia several hours after embolization therapy, later confirmed by angiography as fistula recurrence. The symptoms were relieved gradually after second embolization. The pathophysiology of this patient is also discussed.

  6. Does regional compared to local anaesthesia influence outcome after arteriovenous fistula creation?

    OpenAIRE

    Macfarlane, Alan James Robert; Kearns, Rachel; Aitken, Emma; Kinsella, John; Clancy, Marc

    2013-01-01

    Background An arteriovenous fistula is the optimal form of vascular access in patients with end-stage renal failure requiring haemodialysis. Unfortunately, approximately one-third of fistulae fail at an early stage. Different anaesthetic techniques can influence factors associated with fistula success, such as intraoperative blood flow and venous diameter. A regional anaesthetic brachial plexus block results in vasodilatation and improved short- and long-term fistula flow compared to the infi...

  7. Gene Expression Changes in Venous Segment of Overflow Arteriovenous Fistula

    Directory of Open Access Journals (Sweden)

    Yasuhiro Hashimoto

    2013-01-01

    Full Text Available Aim. The objective of this study was to characterize coordinated molecular changes in the structure and composition of the walls of venous segments of arteriovenous (AV fistulas evoked by overflow. Methods. Venous tissue samples were collected from 6 hemodialysis patients with AV fistulas exposed to overflow and from the normal cephalic veins of 4 other hemodialysis patients. Total RNA was extracted from the venous tissue samples, and gene expression between the 2 groups was compared using Whole Human Genome DNA microarray 44 K. Microarray data were analyzed by GeneSpring GX software and Ingenuity Pathway Analysis. Results. The cDNA microarray analysis identified 397 upregulated genes and 456 downregulated genes. Gene ontology analysis with GeneSpring GX software revealed that biological developmental processes and glycosaminoglycan binding were the most upregulated. In addition, most upregulation occurred extracellularly. In the pathway analysis, the TGF beta signaling pathway, cytokines and inflammatory response pathway, hypertrophy model, and the myometrial relaxation and contraction pathway were significantly upregulated compared with the control cephalic vein. Conclusion. Combining microarray results and pathway information available via the Internet provided biological insight into the structure and composition of the venous wall of overflow AV fistulas.

  8. Endovascular management of spontaneous vertebrovertebral arteriovenous fistula associated with neurofibromatosis 1

    Directory of Open Access Journals (Sweden)

    Randhi Venkata Narayana

    2015-01-01

    Full Text Available Extra cranial vertebrovertebral arteriovenous fistulas (VV AVF are commonly associated with trauma. Their presentation may vary from palpable thrill and myelopathy or myeloradiculopathy. Sudden onset paraparesis is rare.

  9. The effect of arteriovenous fistulas on in situ saphenous vein bypasses

    DEFF Research Database (Denmark)

    Rørdam, Peter; Jensen, Leif Panduro; Schroeder, T;

    1991-01-01

    Intraoperative identification and later development of arteriovenous fistulas were investigated prospectively in 70 in situ saphenous vein bypass procedures. Surveillance was performed by completion arteriography and intra- and postoperative continuous wave Doppler examination. The intraoperative...

  10. Renal aneurysm and arteriovenous fistula; Management with transcatheter embolization

    Energy Technology Data Exchange (ETDEWEB)

    Savastano, S.; Feltrin, G.P.; Miotto, D.; Chiesura-Corona, M. (Padua Univ. (Italy). Ist. di Radiologia Padua Univ. (Italy). Ist. di Fisioterapia)

    1990-01-01

    Embolization was performed in six patients with renal artery aneurysms (n=2) and arteriovenous fistulas (AVF) (n=5). The aneurysms were observed in one patient with fibromuscular dysplasia and in another with Ehlers-Danlos syndrome. All the AVFs were intraparenchymal and secondary to iatrogenic trauma. Elective embolization was performed in five patients with good clinical results at follow-up between 1 and 9 years. Because of rupture of the aneurysm emergency embolization was attempted without success in the patient with Ehlers-Danlos syndrome, and nephrectomy was carried out. A postembolization syndrome complicated three procedures in which Gelfoam and polyvinyl alcohol were used; in two of these cases unexpected reflux of the particulate material occurred, resulting in limited undesired ablation of the ipsilateral renal parenchyma. Embolization is the most reliable and effective treatment for intrarenal vascular abnormalities since it minimizes the parenchymal damage. (orig.).

  11. Spinal dural arteriovenous fistula: Imaging features and its mimics

    Energy Technology Data Exchange (ETDEWEB)

    Jeog, Ying; Ting, David Yen; Hsu, Hui Ling; Huang, Yen Lin; Chen, Chi Jen; Tseng, Ting Chi [Dept. of Radiology, aipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan (China)

    2015-10-15

    Spinal dural arteriovenous fistula (SDAVF) is the most common spinal vascular malformation, however it is still rare and underdiagnosed. Magnetic resonance imaging findings such as spinal cord edema and dilated and tortuous perimedullary veins play a pivotal role in the confirmation of the diagnosis. However, spinal angiography remains the gold standard in the diagnosis of SDAVF. Classic angiographic findings of SDAVF are early filling of radicular veins, delayed venous return, and an extensive network of dilated perimedullary venous plexus. A series of angiograms of SDAVF at different locations along the spinal column, and mimics of serpentine perimedullary venous plexus on MR images, are demonstrated. Thorough knowledge of SDAVF aids correct diagnosis and prevents irreversible complications.

  12. Spontaneous scalp arteriovenous fistula in a child with hartnup disease.

    Science.gov (United States)

    Kim, Doris Maria; Benndorf, Goetz; Von Moers, Arpad; Campi, Adriana; Lehmann, Thomas-Nicolas

    2004-06-01

    To report the endovascular treatment of a spontaneous scalp arteriovenous fistula (AVF) in a child with Hartnup disease. A 6-year-old girl with Hartnup disease presented with recurrent attacks of intense, migraine-like, right-sided headache; a tender, pulsatile small mass was observed in the scalp. Selective digital subtraction angiography revealed a high-flow scalp AVF fed by the frontal branch of the right superficial temporal artery draining via the scalp veins. Endovascular treatment was performed by direct puncture of the distal feeding artery and injection of 2 mL of a 50% mixture of N-butyl-cyanoacrylate and Lipiodol. Serial arteriograms performed 6 months and 2 years later documented complete resolution of the lesion. The patient has had no recurrence of clinical symptoms or local signs for recanalization. Scalp AVFs may progress in size, causing significantly disabling symptoms, particularly in children. We recommend endovascular treatment at the earliest possible stage.

  13. Hybrid management of a spontaneous ilio-iliac arteriovenous fistula: a case report

    LENUS (Irish Health Repository)

    O'Brien, Gavin C

    2011-08-22

    Abstract Introduction Spontaneous iliac arteriovenous fistulae are a rare clinical entity. Such localized fistulation is usually a result of penetrating traumatic or iatrogenic injury. Clinical presentation can vary greatly but commonly includes back pain, high-output congestive cardiac failure and the presence of an abdominal bruit. Diagnosis, therefore, is often incidental or delayed. Case presentation We report a case of a spontaneous ilio-iliac arteriovenous fistula in a 68-year-old Caucasian man detected following presentation with unilateral claudication and congestive cardiac failure. Following computed tomography evaluation, the fistula was successfully treated with a combined endovascular (aorto-uni-iliac device) and open (femoro-femoral crossover) approach. Conclusion Endovascular surgery has revolutionized the management of such fistulae and we report an interesting case of a high-output iliac arteriovenous fistulae successfully treated with a hybrid vascular approach.

  14. Endophthalmitis: a rare complication of arteriovenous fistula infection.

    Science.gov (United States)

    Desai, Madhav; Rapoor, Ram; Gudithi, Swarna Latha; Kumar, Ravi; Prasad, Neela; Dakshinamurty, Kaligotla Venkata

    2008-04-01

    Vascular access infection is a frequent problem in patients undergoing maintenance hemodialysis. Infection of arteriovenous fistula (AVF) is less common than dialysis catheter-associated infection. Previous case reports described endophthalmitis secondary to hemodialysis catheter-related infection, but not secondary to native AVF infection. We report a rare patient of endophthalmitis as a metastatic infection of AVF cannulation site abscess. A 19-year-old girl on maintenance hemodialysis for the past 2 years has presented with a history of fever, chills, and rigor of 3-days duration and painful dimness of vision in the left eye of 1-night duration. It was followed by redness of the eye, photophobia, and ocular discharge. On examination, the patient was febrile with an abscess near cannulation site of AVF. There was no perception of light in the left eye, conjunctiva was congested, cornea was clear, hypopyon present, and pupil was mid-dilated, not reacting to light. Lens was clear. Vitreitis and exudative retinal detachment was present. Methicillin sensitive Staphylococcus aureus was isolated from blood, pus from AVF abscess and vitreous fluid. Diagnosis of endophthalmitis was confirmed by B-scan ultrasound. She was treated with both intravenous and intraocular antibiotics and drainage of pus from AVF abscess and therapeutic vitrectomy. Though arteriovenous abscess responded to sensitive antibiotics and drainage, vision has not improved much. Strict aseptic precautions during regular AVF cannulation are required. Lapses may lead to loss of vision apart from described complications like access closure, endocarditis, and osteomyelitis.

  15. Treatment of postcatheterization femoral arteriovenous fistulas with simple prolonged bandaging

    Institute of Scientific and Technical Information of China (English)

    ZHOU Tao; LIU Zhen-jiang; ZHOU Sheng-hua; SHEN Xiang-qian; LIU Qi-ming; FANG Zhen-fei; HU Xin-qun; LI Jiang; L(U) Xiao-lin

    2007-01-01

    Background The methods for the treatment of postcatheterization femoral arteriovenous fistulas (AVF-s) - simple observation, ultrasound guided compression, covered stents implantation and coil embolization have poor outcome.Surgery is the standard method for treatment of femoral AVFs, but it is a traumatic operation. In this study, we report the results of the treatment of postcatheterization femoral AVFs by simple prolonged compressing bandage.Methods To treat iatrogenic femoral AVFs caused by transfemoral catheterization, prolonged binding with elastic or common bandage was applied in 16 cases. Catheterization was performed in 7 cases for radiofrequency current catheter ablation, in 4 for occlusion of congenital heart disease, in 3 for percutaneous coronary intervention, in 1 for coronary angiography and in 1 for right heart catheterization.Results All iatrogenic femoral AVFs were healed after simple binding with elastic or common bandage for 4-46 days (mean (15±10) days). During the period of binding, local skins ulceration occurred at puncture site in two cases and femoral vein thrombus was found in one patient. During 6-24 months (mean (11.8±3.6) months) followup with colour Doppler ultrasonography, no recurrent arteriovenous shunting or other complications were observed.Conclusion The results suggest that simple prolonged bandaging for postcatheterization femoral AVFs is an effective and economical procedure.

  16. Three cases of hypertension and renal arteriovenous fistula with a de novo fistula.

    Science.gov (United States)

    Melo, Natalia Correa Vieira; Mundim, Juliano Sacramento; Costalonga, Elerson Carlos; Lucon, Antonio Marmo; Santello, Jose Luiz; Praxedes, Jose Nery

    2009-05-01

    The Renal Arteriovenous Fistula (RAVF) is a rare and potentially reversible cause of hypertension and kidney and/or heart failure. The treatment of RAVF aims at preserving the most of the renal parenchyma and, concomitantly, eradicating the symptoms and hemodynamic effects caused by the RAVF. The present study reports three cases of RAVF, including one case of a de novo idiopathic RAVF, which presented with hypertension and kidney and/or heart failure and describes the therapeutic measures used to treat these patients as well as the outcomes.

  17. An unusual case of fistula formation and thrombosis between arteriovenous graft and a native vein

    Directory of Open Access Journals (Sweden)

    Young Sub Kim

    2016-03-01

    Full Text Available Arteriovenous graft for hemodialysis vascular access is a widely used technique with many advantages. However, it has crucial complications with graft thrombosis and infection. We recently experienced an unusual case of arteriovenous graft complication involving graft thrombosis related to fistula formation between the graft and the natural vein with infection. We diagnosed this condition using Doppler ultrasound and computed tomography angiography. Successful surgical treatment including partial graft excision and creation of a secondary arteriovenous fistula using an inadvertently dilated cephalic vein was performed. The dialysis unit staff should keep this condition in mind and try to prevent this complication.

  18. ARTERIO-VENOUS FISTULA IN THE TEMPORAL REGIONS – A CLINICAL CASE

    Directory of Open Access Journals (Sweden)

    Irina Dobrin

    2011-12-01

    Full Text Available The arterio-venous fistulae in the temporal regions, to be first described by Bartholin around 1730, were considered as tardy post-traumatic lesions correlated with the impact of tough objects in the above-mentioned area. The superficial temporal arterio-venous axis is usually interested at the level of the pterional region, while establishment of some communication between the artery and the vein generates an arterio-venous fistula with a systolodiastolic murmur and the tendency for progressive growth. The study discusses a clinical case and its surgical solution.

  19. Endovascular management of dural arteriovenous fistulas of the transverse and sigmoid sinus in 150 patients

    Energy Technology Data Exchange (ETDEWEB)

    Kirsch, M. [Ernst-Moritz-Arndt-Universitaet Greifswald, Institut fuer Diagnostische Radiologie und Neuroradiologie, Greifswald (Germany); Liebig, T. [TU Muenchen, Institut fuer Neuroradiologie, Klinikum Rechts der Isar, Munich (Germany); Kuehne, D. [Klinik fuer Radiologie und Neuroradiologie, Alfried-Krupp-Krankenhaus, Essen (Germany); Henkes, H. [Katharinenhospital-Klinikum Stuttgart, Klinik fuer Neuroradiologie, Stuttgart (Germany)

    2009-07-15

    This study aimed to evaluate the safety and efficiency of the endovascular treatment of transverse-sigmoid sinus dural arteriovenous fistulas (TS{sub d}AVF). A total of 150 consecutive patients and 348 procedures were evaluated. Pulsatile tinnitus (81%), headache (15%), and intracranial hemorrhage (10%) were the most frequent manifestations of the TS{sub d}AVFs. More than half of the affected sinuses were partially or completely thrombosed. Access-wise treatment was performed transarterial (n = 33), transvenous (n = 21), or a combination thereof (n = 96). A mean of 2.4 procedures per patient was required. Immediate postprocedural occlusion rate after transarterial embolization was 30% only. Transvenous treatment alone resulted in an early occlusion rate of 81%, with delayed complete obliteration of half of the remaining fistulas. After combined transarterial/transvenous treatment, the angiographic cure rate was 54%. At follow-up, 88% of patients with residual shunt after the treatment showed complete occlusion. The cumulative complication rate was 9% (n = 13), with minor adverse events in ten patients (7%) and major complications in three patients (2%). Transvenous coil occlusion of the sinus segment with the adjacent dAVF site, eventually combined with transarterial occlusion of supplying arteries, is a very effective and well-tolerated treatment method. In selected patients, variations of these methods (e.g., sinus stenting, compartmental sinus occlusion) can be useful. (orig.)

  20. Neuro-endovascular Embolic Agent for Treatment of a Renal Arteriovenous Fistula

    Directory of Open Access Journals (Sweden)

    Gurpreet Singh

    2016-01-01

    Full Text Available Renal arteriovenous fistula is a known complication following a renal biopsy, and may require catheter based embolization. Distal location of these fistulas in the renal parenchyma in many a case may necessitate non-traditional embolic materials. Liquid embolic agents that allow a controlled delivery may be suitable in this situation, as demonstrated in this case report.

  1. Endovascular and surgical treatment of spinal dural arteriovenous fistulas

    Energy Technology Data Exchange (ETDEWEB)

    Andres, Robert H. [University of Berne (Switzerland). Department of Neurosurgery; University of Berne (Switzerland). Department of Diagnostic and Interventional Neuroradiology; Stanford University Medical Center, Department of Neurosurgery, Stanford, CA (United States); University of Berne (Switzerland). Inselspital; Barth, Alain [University of Berne (Switzerland). Department of Neurosurgery; Medical University of Graz, Department of Neurosurgery, Graz (Austria); University of Berne (Switzerland). Inselspital; Guzman, Raphael [University of Berne (Switzerland). Department of Neurosurgery; Stanford University Medical Center, Department of Neurosurgery, Stanford, CA (United States); University of Berne (Switzerland). Inselspital; Remonda, Luca; El-Koussy, Marwan; Schroth, Gerhard [University of Berne (Switzerland). Department of Diagnostic and Interventional Neuroradiology; University of Berne (Switzerland). Inselspital; Seiler, Rolf W.; Widmer, Hans R. [University of Berne (Switzerland). Department of Neurosurgery; University of Berne (Switzerland). Inselspital

    2008-10-15

    The aim of this retrospective study was to evaluate the clinical outcome of patients with spinal dural arteriovenous fistulas (SDAVFs) that were treated with surgery, catheter embolization, or surgery after incomplete embolization. The study included 21 consecutive patients with SDAVFs of the thoracic, lumbar, or sacral spine who were treated in our institution from 1994 to 2007. Thirteen patients were treated with catheter embolization alone. Four patients underwent hemilaminectomy and intradural interruption of the fistula. Four patients were treated by endovascular techniques followed by surgery. The clinical outcome was assessed using the modified Aminoff-Logue scale (ALS) for myelopathy and the modified Rankin scale (MRS) for general quality of life. Patient age ranged from 44 to 77 years (mean 64.7 years). Surgical as well as endovascular treatment resulted in a significant improvement in ALS (-62.5% and -31.4%, respectively, p<0.05) and a tendency toward improved MRS (-50% and -32%, respectively) scores. Patients that underwent surgery after endovascular treatment due to incomplete occlusion of the fistula showed only a tendency for improvement in the ALS score (-16.7%), whereas the MRS score was not affected. We conclude that both endovascular and surgical treatment of SDAVFs resulted in a good and lasting clinical outcome in the majority of cases. In specific situations, when a secondary neurosurgical approach was required after endovascular treatment to achieve complete occlusion of the SDAVF, the clinical outcome was rather poor. The best first line treatment modality for each individual patient should be determined by an interdisciplinary team. (orig.)

  2. Hemodynamic effects of closure of residual arteriovenous fistulae during in situ graft procedures

    DEFF Research Database (Denmark)

    Laustsen, Jesper; Nielsen, Henriette Svarre; Pedersen, Erik Morre

    2011-01-01

    The objective was to study the intraoperative hemodynamic effects of closure of residual arteriovenous fistulae during in situ saphenous vein graft procedures. Data on 60 residual arteriovenous fistulae in nine patients (five men) with a median age of 74 years (range 64-83 years) with critical...... lower limb ischemia were obtained. Direct measurements of proximal and distal blood pressures in the graft were taken and simultaneous determinations of volume blood flow proximally and distally in the graft with ultrasound transit time technique before and after closure of residual fistulae were made....... Closure of a fistula with blood flow around or below 100 mL/min did not increase distal outflow, whereas closure of fistulae with higher blood flow resulted in unpredictable changes in distal outflow. Only fistulae with a blood flow above approximately 100 mL/min may be of hemodynamic significance....

  3. The upper arm arterio-venous fistula--an alternative for vascular access in haemodialysis

    DEFF Research Database (Denmark)

    Gade, J; Aabech, J; Hansen, R I

    1995-01-01

    Forty-eight consecutive arteriovenous fistulae of the upper arm constructed in 44 patients between 1983 and 1987 were reviewed. The median observation time was 8.5 months (range 1 day-65 months). The overall patency rate for fistulae used for haemodialysis (early failures excluded) was 50% after...... one year and 38% after two years. However, only six (18.7%) of the used fistulae stopped because of thrombosis. The total number of thromboses was nine (19.6%). The main cause of discontinuance of fistulae was a high number of deaths (n = 22), presumably a result of a high median age of 62 years....... Early failure rate was seven of 46 (15.2%); in three cases (6.5%) this was caused by thrombosis. The results are compared to other alternatives for radiocephalic fistulae and the difficulties of comparisons are discussed. It is concluded that the upper arm arteriovenous fistula can serve as a second...

  4. Treatment of an Immature Autogenous Arteriovenous Fistula with Percutaneous Transluminal Angioplasty

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hyoung Rae [Kangwon National University, Chuncheon (Korea, Republic of)

    2008-11-15

    The purpose of this study was to evaluate the efficacy of percutaneous transluminal angioplasty (PTA) in facilitating maturation of autogenous arteriovenous fistulae. There were 12 immature autogenous arteriovenous fistulae. We performed 15 PTAs transvenously. Post-intervention anatomic and clinical successes were estimated, and the 6-month and 1-year primary and secondary patency rates were calculated using Kaplan-Meier analysis. All immature fistulae had underlying stenosis (n=20): arteriovenous anastomosis (n=1) and venous outflow (n=19): 1) within 5 cm from the anastomosis (n=10); 2) more than 5 cm but less than 10 cm from the anastomosis (n=5); 3) more than 10 cm from the anastomosis, including central veins (n=4). Six fistulae had two or more stenoses. Repeat intervention was necessary in two patients. The anatomical success rate was 94.3%, and the clinical success rate was 86.7%. The 6-month and 1-year primary patency rates were 72.7% and 54.5%, and the secondary patency rates were 100% and 81.8%, respectively. All immature hemodialysis fistulae have underlying stenosis, most of which are located near the arteriovenous anastomosis. Early interventional procedures are helpful in the salvage and maintenance of immature arteriovenous fistulae, with a high degree of success

  5. High cervical spinal subdural hemorrhage as a harbinger of craniocervical arteriovenous fistula: an unusual clinical presentation.

    Science.gov (United States)

    Kasliwal, Manish K; Moftakhar, Roham; O'Toole, John E; Lopes, Demetrius K

    2015-05-01

    Craniocervical dural arteriovenous fistula (dAVF) is rare as compared with the typical thoracolumbar dAVFs of the spine and usually presents with hemorrhagic manifestation, predominantly intracranial subarachnoid hemorrhage. We describe the first case of craniocervical dAVF with initial presentation as neck pain and spinal subdural hemorrhage. Case report. We present the case of a 59-year-old woman who presented with sudden onset of neck pain at an outside institution emergency department (ED) and was discharged after negative cervical spine radiographs. Magnetic resonance imaging of the cervical spine performed because of persistent pain demonstrated presence of high cervical spinal subdural hematoma and she was managed conservatively. She subsequently presented to our ED a week later with headache and was found to have an intraventricular hemorrhage on computed tomography scan of the head, which on subsequent workup with an angiography revealed the presence of a craniocervical dAVF. Surgical obliteration of the fistula was performed with use of intraoperative angiography as an adjunct to confirm complete fistula obliteration. She had an excellent clinical outcome with no deficits at her last follow-up at 9 months. Even though hemorrhagic presentation is fairly common in craniocervical dAVFs, there is no report of a craniocervical dAVF presenting with spinal subdural hemorrhage. The present case further highlights the propensity of these vascular lesions to bleed and emphasizes the clinical importance of including these lesions in the differential diagnosis of hemorrhage in the vicinity of foramen magnum region, whether subarachnoid or subdural in location. Physicians treating spinal pathologies should be aware of this entity and clinical presentation, as an angiography needs to be considered in these cases to direct appropriate referral and treatment. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Medical image of the week: pulmonary arteriovenous fistula

    Directory of Open Access Journals (Sweden)

    Bajracharya M

    2014-04-01

    Full Text Available No abstract available. Article truncated after 150 words. A 60 year-old man with hepatic cirrhosis, was referred for chest pain, shortness of breath, and progressive cyanosis and an echocardiographic evaluation. PaO2 was 64 mm Hg on room air, but only 74 mm Hg on 100% oxygen. Chest X-ray and pulmonary function testing were normal. A contrast echocardiography using agitated saline (bubble study was performed. A delayed appearance of a substantial amount of micro-bubbles in the left atrium greater than three cardiac cycles after appearance in the right atrium and ventricle was suggestive of pulmonary arteriovenous fistula (Figure 1A. The delayed appearance and a large amount of micro-bubbles in the left atrium preclude the intracardiac shunting result of a patent foramen ovale (PFO or atrial septal defect (ASD. Interestingly, the density of micro-bubbles were same in the left and the right cardiac chambers even after 10 cardiac cycles (Figure 1B and 1C. When the injection was stopped, there were ...

  7. Clinical evaluation of an expert system for arteriovenous fistula assessment.

    Science.gov (United States)

    Chanliau, Jacques; Charasse, Christophe; Rose, Cédric; Béné, Bernard

    2014-11-01

    The monitoring of ionic dialysance in hemodialysis allows early detection of arterio-venous fistula stenosis. One limitation to the practical use of ionic dialysance is that the analysis is very time consuming on a majority of normal cases.The purpose of the study is to evaluate the utility of an expert system reproducing a human analysis and allowing continuous monitoring of the ionic dialysance by helping the physician to focus his or her expertise on the abnormal cases.The method is based on a Bayesian model that analyzes the blood flow rate, the ionic dialysance, and the venous and arterial pressures measured on the extra corporeal circuit.The clinical evaluation was performed on 90 dialysis patients at the hospital dialysis center of Saint Brieux in France with a history of at least four consecutive months of validated recording. The retrospective automated analysis was evaluated in comparison to vascular access problems identified from invasive investigation or treatment. The sensitivity of the automated analysis is 92% with a specificity of 75%.As a conclusion we suggest that this expert system could be used in a continuous vascular access monitoring procedure consisting in a weekly review of the patient population at the dialysis center. The patients with the highest risk score need a further investigation of their historical data and their medical history in order to decide whether or not to perform an invasive intervention.

  8. Brain Abscesses Associated with Asymptomatic Pulmonary Arteriovenous Fistulas

    Science.gov (United States)

    Nam, Taek-Kyun; Park, Yong-sook; Kwon, Jeong-taik

    2017-01-01

    Brain abscess commonly occurs secondary to an adjacent infection (mostly in the middle ear or paranasal sinuses) or due to hematogenous spread from a distant infection or trauma. Pulmonary arteriovenous fistulas (AVFs) are abnormal direct communications between the pulmonary artery and vein. We present two cases of brain abscess associated with asymptomatic pulmonary AVF. A 65-year-old woman was admitted with a headache and cognitive impairment that aggravated 10 days prior. An magnetic resonance (MR) imaging revealed a brain abscess with severe edema in the right frontal lobe. We performed a craniotomy and abscess removal. Bacteriological culture proved negative. Her chest computed tomography (CT) showed multiple AVFs. Therapeutic embolization of multiple pulmonary AVFs was performed and antibiotics were administered for 8 weeks. A 45-year-old woman presented with a 7-day history of progressive left hemiparesis. She had no remarkable past medical history or family history. On admission, blood examination showed a white blood cell count of 6290 cells/uL and a high sensitive C-reactive protein of 2.62 mg/L. CT and MR imaging with MR spectroscopy revealed an enhancing lesion involving the right motor and sensory cortex with marked perilesional edema that suggested a brain abscess. A chest CT revealed a pulmonary AVF in the right upper lung. The pulmonary AVF was obliterated with embolization. There needs to consider pulmonary AVF as an etiology of cerebral abscess when routine investigations fail to detect a source. PMID:28061502

  9. A new computerized program for surveillance of prosthetic arteriovenous fistulas

    Directory of Open Access Journals (Sweden)

    Matteo Tozzi

    2015-05-01

    Full Text Available Stenosis and thrombosis are common causes of prosthetic vascular access (pVA failure. The role of arteriovenous fistula (AVF surveillance is widely debated. The aim of this paper is to present a new real-time application designed for AVF surveillance called SPIDER. Surgical staff and hemodialysis nurses are responsible for data entry. SPIDER automatically analyses data and generates alerts in case of abnormal trends. Surgical evaluation and duplex Doppler ultrasonography are then immediately performed to confirm presence of stenosis or other possible pVA defects. Surgery can be performed if required. A preliminary analysis of results will be completed at 12 months after the program begins and subsequently after 24 months. Primary assisted patency will be compared with historical using multivariate analysis. Expected results are an improvement in primary assisted pVA patency and reduction of hospitalizations. Simultaneous management of a high number of patients can become difficult due to the large amount of data required for surveillance. We want to demonstrate whether a real-time automated system could help to prevent thrombosis and graft loss.

  10. Arterio-venous fistula following a lumbar disc surgery

    Directory of Open Access Journals (Sweden)

    Thanyani V Mulaudzi

    2011-01-01

    Full Text Available Vascular complications during posterior lumbar disc surgery are rare and its presentation with varicose veins is even rarer. A 23 year-old male patient presented with large varicose veins in right lower limb. He underwent a posterior lumbar spine discectomy surgery. He noticed mild swelling of the distal third right lower limb 3 months after index surgery and reported 6 months later when he developed varicose veins. Duplex Doppler confirmed varicose veins of the long saphenous vein and its tributaries with a patent deep venous system. A digital subtraction angiogram demonstrated a large right common iliac artery (CIA false aneurysm with an arteriovenous fistula between right common iliac vessels. He had a right CIA covered stent insertion with good results. Varicose veins were later managed with sapheno-femoral junction ligation and a below knee long saphenous vein stripping. At six month follow-up the lower limb swelling had completely recovered and duplex ultrasound did not show any recurrence of varicose veins.

  11. Arteriovenous fistula and pseudoaneurysm as complications of renal biopsy treated with percutaneous intervention

    Institute of Scientific and Technical Information of China (English)

    JIANG Wen-xia; WANG Hui-fang; MA Jun; HAN Hong-jie

    2010-01-01

    @@ Symptomatic arteriovenous fistula (AVF) with pseudoaneurysm after percutaneous renal biopsy is an uncommon anomaly, occurring from 0.34% to 6.3%.1Most of these vascular lesions are of little clinical importance. However, severe bleeding,2 persistent hematuria, or acute urinary retention may occur, requiring treatment. Here we report a case of gross hematuria and acute urinary retention after renal biopsy in a male patient.An arteriovenous fistula with pseudoaneurysm was detected by renal ultrasound, confirmed by angiography and then successfully treated by transcatheter arterial embolization3 without damage to renal parenchyma.

  12. Endovascular repair of traumatic arteriovenous fistula between axillary artery and vein

    Institute of Scientific and Technical Information of China (English)

    Mo Ansheng

    2014-01-01

    Traumatic arteriovenous fistula between the axillary artery and vein may present a difficult problem in treatment.There are few reports demonstrating the endovascular repair of this challenge.Herein,we present such a case of endovascular repair of traumatic arteriovenous fistula between the axillary artery and vein with false aneurysm formation.The patient was discharged 1 1 days after successful operation.Oral clopidogrel and aspirin were administerted for 18 months.At one year follow-up,the patient was in good condition and showed no evidence of neurological deficit in the left upper limb.

  13. Experimental and Numerical Analysis of the Bulk Flow Parameters Within an Arteriovenous Fistula.

    Science.gov (United States)

    Browne, Leonard D; Walsh, Michael T; Griffin, Philip

    2015-12-01

    The creation of an arteriovenous fistula for hemodialysis has been reported to generate unstable to turbulent flow behaviour. On the other hand, the vast majority of computational fluid dynamic studies of an arteriovenous fistula use low spatial and temporal resolutions resolution in conjunction with laminar assumptions to investigate bulk flow and near wall parameters. The objective of the present study is to investigate if adequately resolved CFD can capture instabilities within an arteriovenous fistula. An experimental model of a representative fistula was created and the pressure distribution within the model was analysed for steady inlet conditions. Temporal CFD simulations with steady inflow conditions were computed for comparison. Following this verification a pulsatile simulation was employed to assess the role of pulsatility on bulk flow parameters. High frequency fluctuations beyond 100 Hz were found to occupy the venous segment of the arteriovenous fistula under pulsatile conditions and the flow within the venous segment exhibited unstable behaviour under both steady and pulsatile inlet conditions. The presence of high frequency fluctuations may be overlooked unless adequate spatial and temporal resolutions are employed. These fluctuations may impact endothelial cell function and contribute to the cascade of events leading to aggressive intimal hyperplasia and the loss of functionality of the vascular access.

  14. Medullary Venous Hypertension Secondary to a Petrous Apex Dural Arteriovenous Fistula: A Case Report

    Directory of Open Access Journals (Sweden)

    Meghan Murphy

    2012-11-01

    Full Text Available Background: Dural arteriovenous fistulae (dAVF are common intracranial vascular lesions typically becoming symptomatic with cortical venous hypertension and possible hemorrhage. Here, we present a case illustration of a petrous apex dAVF with marked medullary venous hypertension and a unique clinical presentation. Methods: Case report. Results: A 72-year-old female, whose clinical progression was significant for altered mental status and progressive weakness, presented with diplopia, right leg paresis, and ataxia. Magnetic resonance imaging revealed edema involving the medulla. On digital subtraction cerebral angiogram, the patient was found to have a petrous apex dAVF, Cognard type IV. Following treatment with Onyx embolization, her symptoms rapidly improved, with complete resolution of diplopia and drastic improvement of her ataxia. Conclusion: The importance of this case is in the presentation and deterioration of the clinical exam, resembling an acute ischemic event. Further, this case illustrates that dAVF may cause venous hypertension with rapid onset of focal neurologic symptoms not exclusive to cortical locations.

  15. Dural arteriovenous fistula-induced thalamic dementia: report of 4 cases.

    Science.gov (United States)

    Holekamp, Terrence F; Mollman, Matthew E; Murphy, Rory K J; Kolar, Grant R; Kramer, Neha M; Derdeyn, Colin P; Moran, Christopher J; Perrin, Richard J; Rich, Keith M; Lanzino, Giuseppe; Zipfel, Gregory J

    2016-06-01

    Nonhemorrhagic neurological deficits are underrecognized symptoms of intracranial dural arteriovenous fistulas (dAVFs) having cortical venous drainage. These symptoms are the consequence of cortical venous hypertension and portend a clinical course with increased risk of neurological morbidity and mortality. One rarely documented and easily misinterpreted type of nonhemorrhagic neurological deficit is progressive dementia, which can result from venous hypertension in the cortex or in bilateral thalami. The latter, which is due to dAVF drainage into the deep venous system, is the less common of these 2 dementia syndromes. Herein, the authors report 4 cases of dAVF with venous drainage into the vein of Galen causing bithalamic edema and rapidly progressive dementia. Two patients were treated successfully with endovascular embolization, and the other 2 patients were treated successfully with endovascular embolization followed by surgery. The radiographic abnormalities and presenting symptoms rapidly resolved after dAVF obliteration in all 4 cases. Detailed descriptions of these 4 cases are presented along with a critical review of 15 previously reported cases. In our analysis of these 19 published cases, the following were emphasized: 1) the clinical and radiographic differences between dAVF-induced thalamic versus cortical dementia syndromes; 2) the differential diagnosis and necessary radiographic workup for patients presenting with a rapidly progressive thalamic dementia syndrome; 3) the frequency at which delays in diagnosis occurred and potentially dangerous and avoidable diagnostic procedures were used; and 4) the rapidity and completeness of symptom resolution following dAVF treatment.

  16. Stereotactic radiosurgery for intracranial arteriovenous malformations: A review

    Directory of Open Access Journals (Sweden)

    Ranjith K Moorthy

    2015-01-01

    Full Text Available Stereotactic radiosurgery (SRS has proven to be an effective strategy in the management of intracranial arteriovenous malformations (AVMs in children and adults over the past three decades. Its application has resulted in lowering the morbidity and mortality associated with treatment of deep-seated AVMs. SRS has been used as a primary modality of therapy as well as in conjunction with embolization and microsurgery in the management of AVMs. The obliteration rate after SRS has been reported to range from 35% to 92%. Smaller AVMs receiving higher marginal doses have obliteration rates of 70% and more. The median follow-up reported in most series is approximately 36–40 months. The median time to obliteration has been reported to be approximately 24–36 months in most series. Radiation-induced neurological complications have been reported in less than 10% of patients, with a 1.5%–6% risk of developing a new permanent neurological deficit. The bleeding rate during the latency to obliteration has been reported to be approximately 5%. This review describes the experience reported in literature with respect to the indications, dosage, factors affecting obliteration rate of AVMs, and complications after SRS.

  17. Systemic-pulmonary arteriovenous fistula of traumatic origin: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Hirsch, M.; Maroko, I.; Gueron, M.; Goleman, L.

    1983-08-01

    Arteriovenous fistulas between the systemic circulation and the pulmonary artery are extremely rare. Continuous precordial murmur is the usual clinical sign while unilateral rib notching may be the only radiologic manifestation of this condition. Selective angiographic investigation is necessary to localize the site of such an arteriovenous (AV) fistula before surgery is performed. In a review of the literature of 15 published cases, the majority were of congenital origin, with four of these systemic-pulmonary AV fistulas of traumatic origin, of which one occurred after insertion of an intercostal catheter. We describe one case of traumatic origin 9 years after percutaneous thoracic drainage for spontaneous pneumothorax, in which transcatheter embolic occlusion of the feeding arteries of an AV fistula was attempted. The advantages and the disadvantages of the non-surgical and surgical therapeutic approaches are discussed.

  18. Characteristics, diagnosis and treatment of hypoglossal canal dural arteriovenous fistula: report of nine cases

    Energy Technology Data Exchange (ETDEWEB)

    Manabe, Shinji; Satoh, Koichi; Matsubara, Shunji; Satomi, Junichiro; Hanaoka, Mami; Nagahiro, Shinji [University of Tokushima, Department of Neurosurgery, Tokushima (Japan)

    2008-08-15

    We report the characteristics, diagnosis and treatment of dural arteriovenous fistula (DAVF) of the hypoglossal canal in nine patients with this relatively rare vascular disorder. Of 248 patients with intracranial DAVFs managed at our institution, nine patients (3.6%; four men, five women; mean age 62 years) were diagnosed with hypoglossal canal DAVF. We investigated patient characteristics with respect to clinical symptoms, neuroradiological findings, efficacy and complications related to endovascular treatment. Seven patients had experienced head injury. All patients presented with pulsatile tinnitus. One patient displayed ipsilateral hypoglossal nerve palsy before treatment. MR angiography showed a 'magic wand' appearance between the affected hypoglossal canal and the internal jugular vein in four patients. Angiography demonstrated an AV fistula on the medial aspect of the superior jugular bulb, mostly arising from the bilateral occipital, ascending pharyngeal and vertebral arteries with drainage to the internal jugular vein via the anterior condylar vein. Contralateral carotid injection accurately clarified the shunting point. Five patients underwent endovascular treatment: transarterial embolization (TAE; n=2), transvenous embolization (TVE; n=2), and TAE/TVE (n=1). Complete shunt obliteration was achieved in four patients and shunt reduction in one. The remaining four patients were treated conservatively and the shunt had disappeared at follow-up. Postoperative hypoglossal nerve palsy occurred in one patient after TVE, possibly due to coil overpacking. The incidence of hypoglossal canal DAVF was not very low in our series. Contralateral carotid injection is an essential examination to provide an accurate diagnosis. TVE should be considered when access is available, although TAE is also appropriate for shunt reduction. (orig.)

  19. Autogenous Sapheonus Vein Graft Interposition in Arteriovenous Fistula Formation

    Directory of Open Access Journals (Sweden)

    Alper Uzun

    2013-10-01

    Full Text Available Aim: Other techniques are required due to the negative influence of poor superficial venous system calibration (<1.5-2 mm to the long term patency of the arteriovenous fistula which is documented via preoperative Doppler ultrasound examination. The postoperative outcome of 32 patients were compared prospectively whom autologous saphenous vein bridge graft was interposed between brachial artery/high brachial vein and radial artery/basilic vein. Material and Method: Patients were divided into two groups; patients whom radial artery/basilic vein autologous saphenous vein graft interposition was performed were labelled as Group 1 (17 patients while patients whom brachial artery/high brachial vein autologous saphenous vein graft was interpositioned were labelled as Group 2 (15 patients. Patients were followed up for 12 months. Graft related complications were recorded. Primary and secondary patency rate were calculated. Results: Graft infection, edema or ischemia of the hand or arm, congestive heart failure and mortality was not observed. There was not a significant difference in puncture site complications between two groups. Primary patency rate was 76.5% (13 of 17 in Group 1 while it was 93.3% (14 of 15 for Group 2 (p=0,185. Secondary patency rate was 82.4% (14 of 17 in Group1 and 100% (15 of 15 for Group 2 (p=0.093. Primary and secondary patency rate were similar between two groups. Discussion: We sought to compare the complication and patency rate of the proximal (brachial artery/high brachial vein and distal (radial artery/basilic vein located bridge graft interpositions and could not found statistical difference between two groups. It is reasonable to keep proximal regions for further interventions, so radial artery/basilic vein bridge graft interposition can be recommended as the initial option according to our findings.

  20. Selective Transvenous Coil Embolization of Dural Arteriovenous Fistula: A Report of Three Cases

    OpenAIRE

    2007-01-01

    We herein report three cases of dural arteriovenous fistula (DAVF) in which the venous outlet immediately adjacent to the fistula was selectively embolized. Case 1: A 69-year-old man presented with a subarachnoid hemorrhage (SAH). Angiography demonstrated a DAVF in the left superior petrous sinus. Case 2: A 59-year-old woman presented with dizziness. Angiography demonstrated a DAVF adjacent to great vein of Galen. The DAVF drained through the great vein of Galen with retrograde leptomeningeal...

  1. Dural arteriovenous fistulas of the cavernous sinus - clinical case and treatment

    Directory of Open Access Journals (Sweden)

    Chiriac A.

    2014-06-01

    Full Text Available The purpose of our article is to present the results of our treatment of dural arteriovenous fistula of the cavernous sinus by glue embolization of the external carotid artery feeders. By this case presentation we try to clarify the clinical course, with the dural carotid cavernous fistula (CCF, characterizing a pallet of symptoms, paying special attention to radiological finding and endovascular treatment.

  2. Effect of cryotherapy on arteriovenous fistula puncture-related pain in hemodialysis patients

    OpenAIRE

    P. B., Sabitha; Khakha, D. C.; Mahajan, S.; Gupta, S; M. Agarwal; Yadav, S. L.

    2008-01-01

    Pain during areteriovenous fistula (AVF) cannulation remains a common problem in hemodialysis (HD) patients. This study was undertaken to assess the effect of cryotherapy on pain due to arteriovenous fistula puncture in hemodialysis patients. A convenience sample of 60 patients (30 each in experimental and control groups) who were undergoing hemodialysis by using AVF, was assessed in a randomized control trial. Hemodialysis patients who met the inclusion criteria, were randomly assigned to ex...

  3. Efficacy of preoperative US vascular mapping for arteriovenous fistula in patients with hemodialysis

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Min Sun; Hwang, Ji Young; Kang, Byung Chul; Baek, Seung Yon [College of Medicine, Ewha Womans University, Seoul (Korea, Republic of)

    2007-07-15

    The purpose of this study is to assess the efficacy of preoperative US vascular mapping to predict postoperative patency of the arteriovenous fistula for hemodialysis. Sixty-six patients who underwent hemodialysis for end-stage renal failure (M:F = 34:32, mean age, 58.8 years) were observed prospectively from January 2001 to April 2003. The patients were divided into two groups: the vascular mapping group and the control group. A comparative analysis of the re-operation rate between the two groups was determined by use of the chi-square rest, efficacy of preoperative US vascular mapping according to the type of surgery. A comparative analysis of the secondary patency after percutaneous transluminal angioplasty was determined by the use of Fischer exact test, and a comparative analysis of the diminution of patency during the follow-up periods was determined by the use of the Logrank test. In the mapping group, the diameters of intraoperatively selected vessels were investigated and compared with the recommended diameter on preoperative US vascular mapping determined statistically by the use of Fisher's exact test. The preoperative US vascular mapping group had relatively lower re-operation rates (11.8%) than the control group (28.1%) ({rho} = 0.09). The preventive role of US vascular mapping in more effective in decreasing the re-operation rate for a native arteriovenous fistula (7.4%) than for a synthetic arteriovenous graft (25.9%) ({rho} = 0.06). For patients than had an interventional procedure, the failure rate to obtain a secondary patency was smaller than in the mapping group (33.3%), compared with the control group (46.3%) ({rho} = 0.37). Patients in the mapping group had a higher patency than the control group patients for a native arteriovenous fistula (92.0%) and a synthetic arteriovenous graft (71.4%) at one year following surgery ({rho} = 0.10, {rho} = 0.79). The arteriovenous fistulas in the mapping group had a higher patency for both a native

  4. Paradoxical embolism following thromboaspiration of an arteriovenous fistula thrombosis: a case report

    Directory of Open Access Journals (Sweden)

    Amara Brahim

    2010-10-01

    Full Text Available Abstract Introduction Paradoxical embolism is an increasingly reported cause of arterial embolism. Several embolic sources have been described, but thrombosis of an arteriovenous fistula as a paradoxical emboligenic source has not, to the best of our knowledge, been reported. Case presentation A 50-year-old Caucasian woman received a renal graft for primary hyperoxaluria. After transplantation, she was maintained on daily hemodialysis. Thrombosis of her arteriovenous fistula occurred two weeks post-transplantation and was treated by thromboaspiration, which was partially successful. During a hemodialysis session immediately following thromboaspiration, she developed a coma with tetraplegia requiring intensive cardiorespiratory resuscitation. Brain magnetic resonance imaging revealed various hyperdense areas in the vertebrobasilar territory resulting from bilateral occlusion of posterior cerebral arteries. Transesophageal echocardiographic examination showed a patent foramen ovale, while pulse echography of the arteriovenous fistula revealed the persistence of extensive clots that were probably the embolic source. A paradoxical embolus through a patent foramen ovale was suggested because of the proximity of the neurological event to the thrombectomy procedure. Conclusions The risk of paradoxical embolism in a hemodialyzed patient with a patent foramen ovale deserves consideration and requires careful evaluation in situations of arteriovenous fistula thrombosis.

  5. [Childhood transverse sinus dural arteriovenous fistula treated with endovascular and direct surgery: a case report].

    Science.gov (United States)

    Niizuma, Kuniyasu; Sakata, Hiroyuki; Koyama, Shinya; Kon, Hiroyuki; Chonan, Masashi; Sasaki, Tatsuya; Nishijima, Michiharu; Ezura, Masayuki; Tominaga, Teiji

    2012-11-01

    Infantile dural arteriovenous fistula is a rare cerebrovascular malformation carrying a poor prognosis with an anatomic cure of only 9%. Endovascular embolization is mainly selected to treat this entity, aiming to obtain normal development of the patients. We present a case of a 20-month-old girl with epilepsy. Digital subtraction angiography revealed a dural arteriovenous fistula involving the right transverse sinus. The arteriovenous fistula was fed by multiple dural branches from the middle meningeal, occipital, meningohypophyseal, and anteroinferior cerebellar arteries. The right transverse sinus was transvenously embolized with platinum coils. Although the shunt flow remained, the patient was liberated from epilepsy. Nine months later, the patient suffered from a recurrence of epilepsy. Digital subtraction angiography demonstrated some increase in shunt flow. Right middle meningeal, occipital, posterior deep temporal, and tentorial arteries were transarterially embolized using N-butyl cyanoacrylate, followed by complete surgical resection of the right transverse sinus. The shunt flow disappeared after surgery, and her epilepsy improved significantly. Our experience suggests that the combination of endovascular and surgical treatment is effective for recurrent infantile dural arteriovenous fistula.

  6. Accelerated increase of arteriovenous fistula use in haemodialysis centres : results of the multicentre CIMINO initiative

    NARCIS (Netherlands)

    Huijbregts, Henricus J. T. A. M.; Bots, Michiel L.; Moll, Frans L.; Blankestijn, Peter J.

    2007-01-01

    Background. In the Netherlands, arteriovenous fistulas (AVFs) are used in 60-65% of the haemodialysis patients and this compares poorly with the European average. A multicentre guidelines implementation programme, CIMINO, was initiated aiming at increasing the use of AVFs. Methods. Physicians and di

  7. [Arterial steal via an arteriovenous fistula for hemodialysis. A clinical case and review of the literature].

    Science.gov (United States)

    Juliá Montoya, J; Lozano Vilardell, P; Corominas Roura, C; Blanes Mompó, I; Flores López, D; Manuel-Rimbau Muñoz, E; García de la Torre, A

    1993-01-01

    We related a case of arterial atrappment in the left upper limb by an arteriovenous humerus-cephalic hyperfunctioning fistula. Surgical procedure consisted on the insertion of a PTFE's banding around the arterialized vein obtaining satisfactory clinic and functional results. We review in the literature, the frequency the pathogeny and the therapeutics possibilities.

  8. Recurrence Rates After Surgical or Endovascular Treatment of Spinal Dural Arteriovenous Fistulas : A Meta-analysis

    NARCIS (Netherlands)

    Bakker, Nicolaas A.; Uyttenboogaart, Maarten; Luijckx, G. J.; Eshghi, Omid S.; Mazuri, Aryan; Metzemaekers, Jan D. M.; Groen, Rob J. M.; Van Dijk, J. Marc C.

    2015-01-01

    BACKGROUND:There is an increasing tendency to treat spinal dural arteriovenous fistulas (SDAVFs) endovascularly despite the lack of clear evidence favoring embolization over surgery.OBJECTIVE:To compare the initial failure and recurrence rates of primary treatment of SDAVFs by surgery and endovascul

  9. Arteriovenous fistulas aggravate the hemodynamic effect of vein bypass stenoses

    DEFF Research Database (Denmark)

    Nielsen, Tina G; Djurhuus, Christian Born; Morre-Pedersen, Erik

    1996-01-01

    Doppler spectra obtained 10 cm downstream of the fistula. All measurements were carried out with open and clamped fistula. RESULTS: At 30% diameter reducing stenosis opening of the fistula induced a 12% systolic pressure drop across the stenosis but had no adverse effect on the Doppler waveform parameters...

  10. [Blood flow measurement in arteriovenous fistula. Comparison of 2 ultrasonic methods, direct and indirect by compression of the fistula].

    Science.gov (United States)

    Deklunder, G; Goullard, L; Lecroart, J L; Foulard, M; Houdas, Y

    1990-05-19

    Measuring blood flow in arteriovenous fistulae in patients under chronic dialysis is of interest to evaluate the repercussions of the fistula on the heart. The apparently simplest method is direct measurement of the mean blood flow velocity by the pulsed doppler technique and ot the cross-section area by ultrasonography, the product of these two values being the blood flow rate. Another method has been proposed, which consists of measuring the cardiac output before and after compression of the fistula, the difference between the two values being supposed to represent the blood flow rate in the fistula. A comparative study of these two methods was conducted in 17 patients aged from 2 to 21 years (mean: 14 years). The direct method gave a figure of 475 ml.min-1.m-2 (SD = 240), while the figure obtained with the indirect method was 471 ml.min-1.m-2 (SD = 227); the difference was statistically not significant. In terms of concept, however, the indirect method is open to much more severe criticism than the direct method, and whenever possible the latter should be preferred when measuring blood flow in arteriovenous fistulae.

  11. Microvascular anatomy of spinal dural arteriovenous fistulas: arteriovenous connections and their relationships with the dura mater.

    Science.gov (United States)

    Takai, Keisuke; Komori, Takashi; Taniguchi, Makoto

    2015-10-01

    OBJECT The microvascular anatomy of spinal dural arteriovenous fistulas (AVFs), especially the relationships of the vessels with the dura mater, has yet to be angiographically demonstrated in detail and proven histologically. METHODS From January 2012 through April 2014, a total of 7 patients with spinal dural AVFs in the thoracic region underwent open microsurgical obliteration at Tokyo Metropolitan Neurological Hospital. The microvascular anatomy of spinal dural AVFs was comprehensively assessed by using advanced microangiography, including 3D computer graphics and intraoperative indocyanine green video angiography, and by histological findings. RESULTS The 2 microangiography techniques revealed the spatial course and in vivo blood flow of the meningeal vessels and their relationships with the dura mater in sufficient detail. The meningeal branch of the intercostal artery split into multiple meningeal vessels on the outer dural surface adjacent to the root sleeve. After crossing the dura mater to the inner dural surface, these vessels gathered and joined a single intradural draining vessel. On the inner dural surface, the single draining vessel was fed by the surrounding multiple meningeal vessels, which appeared to be caput medusae. Histological findings revealed that the structure of the meningeal branch of the intercostal artery corresponded to that of a normal artery. The structure of intradural draining vessels corresponded to that of a vein modified by retrograde arterial inflow. On the inner dural surface, more than 1 meningeal artery gathered and joined with the proximal radiculomedullary vein. CONCLUSIONS Spinal dural AVFs are located on the inner dural surface, where multiple direct AV connections between more than 1 meningeal feeding artery and a single proximal radiculomedullary vein occur at the site where the vein connects to the dura mater.

  12. GIA-Aneurysmorrhaphy and Dermal Detachment: A Novel Technique to Repair Arteriovenous Fistula Aneurysms.

    Science.gov (United States)

    Chang, Jason; Prema, Jateen; Pedersen, Rose; Li, Yiping; Liebl, Max; Patel, Kaushal; Mueller, Mark

    2016-05-01

    This report describes a simplified technique for management of aneurysmal arteriovenous fistulas along with results of initial clinical experience in 12 patients. Various techniques have been described which seek to repair the arteriovenous fistula and lengthen its duration of use. Here, we introduce the GIA-aneurysmorrhaphy and dermal detachment (GADD) procedure, a novel technique which requires minimal dissection to decompress tension on the overlying skin. Transverse incisions were made proximally and distally to the aneurysmal segment, which was then bluntly dissected along its length on either side. A GIA stapler is then fired along the longitudinal axis, narrowing the lumen of the fistula and separating the aneurysm from the skin. After the operation, the arteriovenous fistulae were used continuously until death (1 patient for 12 months), until thrombosis (1 patient for 13 months), or continue to be in use (9 patients, mean patency 18 months). One patient underwent conversion to open aneurysmorrhaphy due to intraoperative fistula occlusion. Five patients resumed hemodialysis immediately, while the remaining resumed hemodialysis within 3 months. The most common complication was cellulitis (3 patients). The GADD procedure as described in this report offers an effective and low-risk option for the management of venous aneurysms with threatened skin in hemodialysis patients.

  13. Clinical usefulness of doppler ultrasonography before percutaneous transluminal angioplasty immature native arteriovenous fistula

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jeong Eun [Dept. of Radiology, Inje University Seoul Paik Hospital, College of Medicine, Inje University, Seoul (Korea, Republic of); Cho, Young Kwon; Sim, Jae Chan; Lee, So Young; Sung, Su Ah; Hwang, Young Hwan [Eulji General Hospital, College of Medicine, Eulji University, Seoul (Korea, Republic of)

    2013-11-15

    To report the clinical efficacy of preprocedural doppler ultrasound examination for the treatment of immature arteriovenous fistula by means of percutaneous transluminal angioplasty (PTA) and the efficacy of PTA about its treatment. From November 2008 to May 2013, 28 patients who were diagnosed with immature arteriovenous fistula using doppler ultrasound examination and obtained successful maturation of it after PTA were included in this study. A retrospective comparative analysis was performed according to the findings between doppler ultrasound examination and fistulography during the procedure. The success rate of PTA and patency of fistula were evaluated in each patient Doppler ultrasound examination revealed stenosis in twenty three patients and thrombotic total occlusion in five patients. Stenosis was located in the proximal cephalic vein 2 cm from the anastomosis in 67.8% (19/28). In the five cases of thrombotic total occlusion, the lesions were long lesions from the anastomosis to the entire proximal cephalic vein at the elbow joint level. Fistulography revealed 5 patients with thrombotic total occlusion and 24 stenosis sites in 23 patients, respectively. The location and characteristics of all lesions were consistent on doppler ultrasound examination. Only four cases were observed as non-thrombotic total occlusion on fistulography, which had more than 90% stenosis on doppler ultrasound examination. The initial success rate of PTA for immature arteriovenous fistula was 96.4% (27/28). In three patients, clinical success was obtained after four times of additional PTA. Six additional PTAs were performed during follow-up, no complications related to the procedures were found. The primary patency rate was 92.9% at 3 months, 60.7% at 6 months and 39.3% at 12 months. The estimated mean survival of arteriovenous fistula was 347.9 days and the estimated median survival was 232 days. Also, the 12 months primary patency rates between the stenosis group and occlusion

  14. A Case of Femoral Arteriovenous Fistula Causing High-Output Cardiac Failure, Originally Misdiagnosed as Chronic Fatigue Syndrome

    Directory of Open Access Journals (Sweden)

    J. Porter

    2014-01-01

    Full Text Available Percutaneous arterial catheterisation is commonly undertaken for a range of diagnostic and interventional procedures. Iatrogenic femoral arteriovenous fistulas are an uncommon complication of these procedures. Most are asymptomatic and close spontaneously, but can rarely increase in size leading to the development of symptoms. We report a case of an iatrogenic femoral arteriovenous fistula, causing worsening congestive cardiac failure, in a 34-year-old marathon runner. This was originally diagnosed as chronic fatigue syndrome. Following clinical examination, duplex ultrasound, and CT angiography a significant arteriovenous fistula was confirmed. Elective open surgery was performed, leading to a dramatic and rapid improvement in symptoms. Femoral arteriovenous fistulas have the potential to cause significant haemodynamic effects and can present many years after the initial procedure. Conservative, endovascular, and open surgical management strategies are available.

  15. Does regional compared to local anaesthesia influence outcome after arteriovenous fistula creation?

    Science.gov (United States)

    Macfarlane, Alan James Robert; Kearns, Rachel Joyce; Aitken, Emma; Kinsella, John; Clancy, Marc James

    2013-08-19

    An arteriovenous fistula is the optimal form of vascular access in patients with end-stage renal failure requiring haemodialysis. Unfortunately, approximately one-third of fistulae fail at an early stage. Different anaesthetic techniques can influence factors associated with fistula success, such as intraoperative blood flow and venous diameter. A regional anaesthetic brachial plexus block results in vasodilatation and improved short- and long-term fistula flow compared to the infiltration of local anaesthetic alone. This, however, has not yet been shown in a large trial to influence long-term fistula patency, the ultimate clinical measure of success.The aim of this study is to compare whether a regional anaesthetic block, compared to local anaesthetic infiltration, can improve long-term fistula patency. This study is an observer-blinded, randomised controlled trial. Patients scheduled to undergo creation of either brachial or radial arteriovenous fistulae will receive a study information sheet, and consent will be obtained in keeping with the Declaration of Helsinki. Patients will be randomised to receive either: (i) an ultrasound guided brachial plexus block using lignocaine with adrenaline and levobupivicaine, or (ii) local anaesthetic infiltration with lignocaine and levobupivicaine.A total of 126 patients will be recruited. The primary outcome is fistula primary patency at three months. Secondary outcomes include primary patency at 1 and 12 months, secondary patency and fistula flow at 1, 3 and 12 months, flow on first haemodialysis, procedural pain, patient satisfaction, change in cephalic vein diameter pre- and post-anaesthetic, change in radial or brachial artery flow pre- and post-anaesthetic, alteration of the surgical plan after anaesthesia as guided by vascular mapping with ultrasound, and fistula infection requiring antibiotics. No large randomised controlled trial has examined the influence of brachial plexus block compared with local anaesthetic

  16. [Giant cervical angioma caused by "malignant" arteriovenous fistulae].

    Science.gov (United States)

    Palou, J; Mir y Mir, L

    1992-01-01

    A case of angioma by malignant AV fistula (described by F. Martorell in 1970) is reported. Such kind of fistulas have usually a lethal course. The case reported underwent a surgical correction, and after a following of 10 years, no major complications have been reported.

  17. Gamma Knife surgery for clival epidural-osseous dural arteriovenous fistulas.

    Science.gov (United States)

    Lee, Cheng-Chia; Chen, Ching-Jen; Chen, Shao-Ching; Yang, Huai-Che; Lin, Chung Jung; Wu, Chih-Chun; Chung, Wen-Yuh; Guo, Wan-Yuo; Hung-Chi Pan, David; Shiau, Cheng-Ying; Wu, Hsiu-Mei

    2017-06-16

    OBJECTIVE Clival epidural-osseous dural arteriovenous fistula (DAVF) is often associated with a large nidus, multiple arterial feeders, and complex venous drainage. In this study the authors report the outcomes of clival epidural-osseous DAVFs treated using Gamma Knife surgery (GKS). METHODS Thirteen patients with 13 clival epidural-osseous DAVFs were treated with GKS at the authors' institution between 1993 and 2015. Patient age at the time of GKS ranged from 38 to 76 years (median 55 years). Eight DAVFs were classified as Cognard Type I, 4 as Type IIa, and 1 as Type IIa+b. The median treatment volume was 17.6 cm(3) (range 6.2-40.3 cm(3)). The median prescribed margin dose was 16.5 Gy (range 15-18 Gy). Clinical and radiological follow-ups were performed at 6-month intervals. Patient outcomes after GKS were categorized as 1) complete improvement, 2) partial improvement, 3) stationary, and 4) progression. RESULTS All 13 patients demonstrated symptomatic improvement, and on catheter angiography 12 of the 13 patients had complete obliteration and 1 patient had partial obliteration. The median follow-up period was 26 months (range 14-186 months). The median latency period from GKS to obliteration was 21 months (range 8-186 months). There was no intracranial hemorrhage during the follow-up period, and no deaths occurred. Two adverse events were observed following treatment, and 2 patients required repeat GKS treatment with eventual complete obliteration. CONCLUSIONS Gamma Knife surgery offers a safe and effective primary or adjuvant treatment modality for complex clival epidural-osseous DAVFs. All patients in this case series demonstrated symptomatic improvement, and almost all patients attained complete obliteration.

  18. Four-dimensional computed tomography angiographic evaluation of cranial dural arteriovenous fistula before and after embolization

    Energy Technology Data Exchange (ETDEWEB)

    Tian, Bing, E-mail: bing.tian@hotmail.com; Xu, Bing, E-mail: aishanli0102@126.com; Lu, Jianping, E-mail: tianbing2003@163.com; Liu, Qi, E-mail: liuqimd@126.com; Wang, Li, E-mail: wangli_changhai@163.com; Wang, Minjie, E-mail: cjr.wangminjie@vip.163.com

    2015-06-15

    Highlights: • 4D CTA showed excellent agreement with DSA with regard to identification of feeding arteries and drainage veins. • The most important finding was 4D CTA in determining the impact of DAVF treatment with transarterial embolization. • 4D CTA provides images similar to those obtained with DSA both before and after treatment. - Abstract: Purpose: This study aimed to evaluate the usefulness of four-dimensional CTA before and after embolization treatment with ONYX-18 in eleven patients with cranial dural arteriovenous fistulas, and to compare the results with those of the reference standard DSA. Patients and Methods: Eleven patients with cranial dural arteriovenous fistulas detected on DSA underwent transarterial embolization with ONYX-18. Four-dimensional CTA was performed an average of 2 days before and 4 days after DSA. Four-dimensional CTA and DSA images were reviewed by two neuroradiologists for identification of feeding arteries and drainage veins and for determining treatment effects. Interobserver and intermodality agreement between four-dimensional CTA and DSA were assessed. Results: Forty-two feeding arteries were identified for 14 fistulas in the 11 patients. Of these, 36 (85.71%) were detected on four-dimensional CTA. After transarterial embolization, one patient got partly embolized, and the fistulas in the remaining 10 patients were completely occluded. The interobserver agreement for four-dimensional CTA and intermodality agreement between four-dimensional CTA and DSA were excellent (κ = 1) for shunt location, identification of drainage veins, and fistula occlusion after treatment. Conclusion: Four-dimensional CTA images are highly accurate when compared with DSA images both before and after transarterial embolization treatment. Four-dimensional CTA can be used for diagnosis as well as follow-up of cranial dural arteriovenous fistulas in clinical settings.

  19. Treatment of acquired arteriovenous fistula with severe hemodynamic effects: therapeutic challenge

    Directory of Open Access Journals (Sweden)

    Bruna Ferreira Pilan

    2014-03-01

    Full Text Available A 34-year-old female patient with severe heart failure and pulmonary hypertension was diagnosed late with a high-output acquired arteriovenous fistula between the right common iliac vein and artery. The most probable cause was an iatrogenic vascular injury inflicted during a prior laparoscopic cholecystectomy. Treatment was conducted by placement of an endoprosthesis in the common iliac artery, achieving total exclusion of the fistula and complete remission of symptoms. Considering the options available for treating this type of lesion, endovascular techniques are becoming ever more effective and are now the option of first-choice for management of this pathology.

  20. Congenital pial arteriovenous fistula in the temporal region draining into cavernous sinus: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Ziyin; Wang, Chaohua; Zhang, Changwei; Xie, Xiaodong [Dept. of Neurosurgery, West China Hospital of Sichuan University, Chengdu (China); Wang, Kun; Tang, Jianjian [Dept. of Neurosurgery, Affiliated Hospital of Hainan Medical College, Haikou (China)

    2013-06-15

    This report concerns a 4-month-old infant with progressive prominent and redness of his left eye since birth. This report concerns a 4-month-old infant with progressive prominent redness of his left eye since birth. Angiography revealed a congenital pial arteriovenous fistula between the temporal branch of the left posterior cerebral artery and left cavernous sinus through the sphenoparietal sinus, a condition not reported in the literature. The fistula was successfully occluded with two micro-coils by vertebrobasilar approach.

  1. Superior mesenteric arteriovenous fistula presenting as gastrointestinal bleeding: case report and literature review

    Directory of Open Access Journals (Sweden)

    Chong Wang

    Full Text Available Superior mesenteric arteriovenous fistula (SMAVF is a rare vascular disorder usually following penetrating abdominal trauma or gastrointestinal surgery. Percutaneous endovascular treatment such as embolization, has been widely used to treat this disease. We report a patient, who was presented with melena at the onset of his symptoms, then an acute hematemesis in shock. A SMAVF was diagnosed on an angiogram after a large mesenteric vein was seen on CT. The patient had a successful emergency endoscopic variceal ligation (EVL to stop bleeding. Then the patient received fistula embolization with covered stent.

  2. Myocardial abscess as a complication of an infected arteriovenous fistula: autopsy report

    Directory of Open Access Journals (Sweden)

    Cristiane Rúbia Ferreira

    2011-09-01

    Full Text Available Myocardial abscess is a severe and life-threatening infectious complication thatis commonly but not exclusively associated with infective endocarditis. It mayalso be developed in necrotic myocardial tissue, post trauma, in septic burnpatients, in transplanted heart, in ventricular aneurysm and post angioplasty.Patients on hemodialysis are prone to bacteremia, and infectious complicationsoccur in 48-73% of cases. Myocardial abscess is a rare complication of aninfected arteriovenous fistula. We present an autopsy report of a hemodialysispatient who had an arteriovenous fistula with a polytetrafluoroethylene graftwhere a local infection developed. The patient presented with fever and toxemia.On post-admission day 2, he unexpectedly suffered sudden cardiopulmonaryarrest and died. The autopsy revealed a myocardial abscess, near a branch ofthe left coronary artery, with septic embolism.

  3. Traumatic arteriovenous fistula after kickboxing injury: a case report and review of the literature.

    Science.gov (United States)

    Rezvani, Masoud

    2014-03-01

    A traumatic arteriovenous fistula (AVF) after repetitive blunt trauma has not been described previously. In a 34-year-old male, the first reported case of such an injury after repetitive blunt trauma is described. A 34-year-old gentleman presented with a non-healing ulcer near his medial malleolus. A bone scan was performed and then treated for presumed osteomyelitis. An arteriogram confirmed an AVF, and coil embolization was performed with complete occlusion of the AVF. Subsequently, the ulcer healed rapidly with no complication. Along with the cause of AVF, this case is notable for symptom presentation. Arteriovenous fistula after blunt trauma can present as a non-healing venous stasis ulcer, which could be treated non-invasively.

  4. Long term follow-up of 43 pure dural arteriovenous fistulae (AVF) of the lateral sinus

    Energy Technology Data Exchange (ETDEWEB)

    Fermand, M.; Reizine, D.; Melki, J.P.; Riche, M.C.; Merland, J.J.

    1987-07-01

    Fourty-three patients with arterio-venous fistulae of the dura of the transverse sinus with a complaint of tinnitus are reviewed, with a follow-up of 12 months to 11 years. 34 patients were embolized, 2 treated surgically, and 7 were untreated. Embolization appears to have been beneficial. The benign nature of this abnormality must be emphasized, and serious psychological study of the patient must be made before deciding on therapy.

  5. Dural arteriovenous fistula of the lesser sphenoid wing region treated with Onyx: technical note

    Energy Technology Data Exchange (ETDEWEB)

    Rezende, Marco Tulio Salles; Piotin, Michel; Mounayer, Charbel; Spelle, Laurent; Abud, Daniel Giansante [Fondation Rothschild, Department of Interventional Neuroradiology, Paris (France); Moret, Jacques [Fondation Rothschild, Department of Interventional Neuroradiology, Paris (France); Hopital de la Fondation Rothschild, Service de Neuroradiologie Interventionnelle, Paris, CEDEX 19 (France)

    2006-02-15

    A 45-year-old man presented with acute right orbital pain and right-sided headache. Magnetic resonance imaging (MRI) and cerebral angiography revealed a dural arteriovenous fistula (DAVF) of the lesser sphenoid wing region. The lesion was endovascularly treated by transarterial embolization with Onyx (ethyl vinyl alcohol; Micro Therapeutics, Irvine, Calif.). We review some anatomical and therapeutic features involving DAVFs of this region and describe the feasibility of the use of Onyx in the treatment of these lesions. (orig.)

  6. A case report of a pediatric traumatic aneurysm with arteriovenous (A-V) fistula CASE-BASED UPDATE.

    Science.gov (United States)

    Anami, Hidenori; Aihara, Yasuo; Kawashima, Akitsugu; Yamaguchi, Koji; Nagahara, Ayumi; Okada, Yoshikazu

    2014-12-01

    Traumatic intracranial aneurysms (TICAs) are rare, representing less than 5 % of all intracranial aneurysms. Most TICAs are located within the anterior circulation, and less than 10 % of TICAs occur in the posterior circulation. Histopathologically, most TICAs are false aneurysms and have a high risk of rupture or re-bleeding. When they are discovered, careful observation or treatment may be required. Once they are enlarged, they have a high risk of rupture, and immediate treatment is essential. For the first time in the literature, we report a rare case of an 8-year-old boy with a TICA in anterior inferior cerebellar artery (AICA) and arteriovenous (A-V) fistula after severe head trauma. Trapping of AICA and resection of the aneurysm was performed. Postoperatively, he has peripheral facial palsy but is otherwise neurologically normal. Surgical treatment for traumatic aneurysms is challenging because most of TICAs are histopathologically pseudoaneurysms. It may be technically difficult to perform direct surgery of aneurysms especially located in the posterior circulation, but when the treatment is successful, the outcome was favorable.

  7. Transvenous embolization of dural arteriovenous fistula of cavernous region by multiple venous routes

    Institute of Scientific and Technical Information of China (English)

    CHEN Huai-rui; BAI Ru-lin; HUANG Cheng-guang; LI Bin; LU Yi-cheng

    2007-01-01

    Objective: To evaluate the safety and efficiency of transvenous embolization of dural arteriovenous fistula of cavernous region by multiple venous routes. Methods: Twenty seven patients with dural arteriovenous fistula uf cavernous region were treated by transvenous embolization with micro-coils. The transvenous routes included inferior petrosal sinus, superior ophthalmic vein and facial vein. Results: Clinical cure was achieved in 23 cases and significant improvement of symptoms in 4 cases. Complete angiographic obliteration was documented in 22 patients (82%). Residual shunting were left in 2 patients via pterygoid drainage and 1 case via inter-cavernous sinus, 2 cases via inferior petrosal sinus, disappeared one month later by manual compression carotid artery. Headache and vomiting were the most common symptoms after embolization. Three patients had diplopia and relieved within two months after embolization.There was no permanent procedure-related morbidity. The clinic follow up ranged from 5 months to 6 years, and there was not recurrence case. Conclusion: Transvenous embolization via different venous routes is a safe and efficient method for dural arteriovenous fistula of cavernous region treatment.

  8. Spinal dural arteriovenous fistulas. Diagnostics and therapy; Spinale durale arteriovenoese Fisteln. Diagnostik und Therapie

    Energy Technology Data Exchange (ETDEWEB)

    Reith, W.; Kettner, M.; Simgen, A.; Yilmaz, U. [Universitaetsklinikum des Saarlandes, Klinik fuer Diagnostische und Interventionelle Neuroradiologie, Homburg/Saar (Germany)

    2012-05-15

    Spinal dural arteriovenous fistulas are rare spinal vascular malformations which can cause progressive paraparesis and paraplegia if not treated. As symptoms are unspecific diagnosis is often delayed and clinical outcome is dependent on early therapy. While magnetic resonance imaging (MRI) is the first choice imaging procedure, selective spinal digital subtraction angiography is necessary to analyze the angioarchitecture and to plan the treatment. This article provides an overview on the epidemiology, etiology, clinical aspects and imaging features as well as therapeutic aspects of spinal dural arteriovenous fistulas. Knowledge of spinal vascular anatomy is the basis for understanding spinal dural arteriovenous fistulas. (orig.) [German] Spinale durale arteriovenoese Fisteln (dAVF) sind seltene spinale vaskulaere Malformationen, die unbehandelt zu einer progredienten Paraparese und Paraplegie fuehren koennen. Da die klinischen Symptome oft unspezifisch sind, werden sie haeufig erst in einem spaeteren Stadium diagnostiziert. Die Erkrankungshaeufigkeit ist mit 5-10 Neuerkrankungen/1 Mio. Einwohner/Jahr relativ selten, ueber 80% der Betroffenen sind Maenner. Der unbehandelt schlechte klinische Verlauf der dAVF sowie die Moeglichkeit der Therapie, deren Erfolg von einer fruehzeitigen Behandlung abhaengt, macht sie jedoch zu einer wichtigen Erkrankung. Die Diagnose ist haeufig im MRT zu stellen, zur genauen Darstellung der Fistel ist eine selektive spinale Subtraktionsangiographie jedoch notwendig. Ziel dieses Artikels ist, einen Ueberblick ueber die Epidemiologie, Aetiologie, Klinik und bildgebende Verfahren sowie therapeutischen Moeglichkeiten dieser spinalen vaskulaeren Malformation zu geben. Voraussetzung zum grundlegenden Verstaendnis der duralen AVF sind genaue Kenntnisse der vaskulaeren spinalen Gefaessversorgung. (orig.)

  9. Posttraumatic nonunion of the clavicle in a 13-year-old boy causing an arteriovenous fistula

    Directory of Open Access Journals (Sweden)

    Feiran Wu

    2013-01-01

    Full Text Available Context: Fractures of the clavicle are one of the most common injuries to the bone in childhood, but posttraumatic nonunion of pediatric clavicle fractures are extremely rare, with only isolated reports in literature. Case Report: We report a case of a posttraumatic painful nonunion of a clavicle fracture in a 13-year-old boy that caused symptomatic compression of the external jugular vein (EJV and the formation of an arteriovenous fistula. The fracture was treated successfully with open reduction and internal fixation with a contoured recon plate 6 months following the injury. The fistula was treated by ligation and closure. Conclusion: The patient made a full recovery 6 months following surgery and was asymptomatic with full range of shoulder movement. Fracture union was confirmed by computed tomography (CT scanning and no residual fistula was found.

  10. Therapeutic embolization of cavernous sinus dural arteriovenous fistulas via transvenous approach

    Institute of Scientific and Technical Information of China (English)

    侯凯; 罗祺; 陈强; 王宏磊; 罗毅男; 王长坤

    2003-01-01

    Objective To describe the transvenous catheterization technique for the treatment of cavernous sinus dural arteriovenous fistulas (CSdAVFs), including its indications, complications and efficacy.Methods Eight patients with symptomatic CSdAVFs were treated by endovascular embolization with platinum coils, via the inferior petrosal sinus (IPS) in 6 patients, and via the Sylvian vein after surgical exposure in other 2 patients.Results Complete angiographic resolution of the fistula was obtained in six patients immediately after the procedures, and a complete resolution of symptoms and signs was achieved in all patients. The residual fistulas in two patients disappeared completely in the follow-up angiography.Conclusion Transvenous embolization is a useful and safe approach in the management of CSdAVFs.

  11. Factors predictive of failure of Brescia-Cimino arteriovenous fistulas

    NARCIS (Netherlands)

    Zeebregts, C; van den Dungen, J; Franssen, C; Verhoeven, E; van Schilfgaarde, R

    2002-01-01

    Objective: To evaluate patency rates of Brescia-Cimino fistulas and to find out which independent factors were predictors of failure. Design: Retrospective clinical study. Setting: University hospital, The Netherlands. Subjects: 150 consecutive patients (mean age 56 years. range 17-80) who had 153 p

  12. Embolization with Gamma Knife Radiosurgery of Giant Intracranial Arteriovenous Malformations.

    Science.gov (United States)

    Chun, Dong Hyun; Kim, Moo Seong; Kim, Sung Tae; Paeng, Sung Hwa; Jeong, Hae Woong; Lee, Won Hee

    2016-01-01

    Giant arteriovenous malformations (i.e., those greater than 6 cm maximum diameter or volume > 33 cc) are difficult to treat and often carry higher treatment morbidity and mortality rates. In our study, we reviewed the angiographic results and clinical outcomes for 11 patients with giant arteriovenous malformations who were treated between 1994 and 2012. The patients selected included 9 males (82%) and 2 females (18%). Their presenting symptoms were hemorrhage (n=2; 18%), seizure (n=7; 64%), and headache (n=2; 12%). Nine patients were Spetzler-Martin Grade III, 2 were Spetzler-Martin Grade IV. The mean arteriovenous malformation volume was 41 cc (33-52 cc). The mean age of the patients was 45.1 years (24-57 years) and the mean radiation dose delivered to the margin of the nidus was 14.2 Gy. Ten patients received pre-Gamma Knife radiosurgery embolization and Gamma Knife radiosurgery, 1 patient received pre-Gamma Knife radiosurgery embolization and Gamma Knife radiosurgery twice and the interval between Gamma Knife radiosurgeries was 3 months. The complete obliteration rate following Gamma Knife radiosurgery was 36%, subtotal obliteration ( > 70% decreased size of nidus) was 36%, and partial obliteration was 28%. One patient experienced a small hemorrhage after embolization. Combined embolization and Gamma Knife radiosurgery showed successful obliteration of the arteriovenous malformation nidus. The use of embolization to initially reduce nidus size followed by Gamma Knife radiosurgery improves the treatment results. Repeated Gamma Knife radiosurgery should be a treatment option when there is a small nidus remnant.

  13. Non-contrast-enhanced MR angiography for detecting arteriovenous fistula dysfunction in haemodialysis patients.

    Science.gov (United States)

    Jin, W T; Zhang, G F; Liu, H C; Zhang, H; Li, B; Zhu, X Q

    2015-08-01

    To assess the diagnostic value of non-contrast-enhanced magnetic resonance angiography (NCE-MRA), using time-of-flight and black-blood MRA, in the evaluation of arteriovenous fistulas in haemodialysis patients in comparison to multidetector computed tomography angiography (MDCTA). NCE-MRA and MDCTA were performed on the same day in 21 patients on maintenance haemodialysis with dysfunctional arteriovenous fistulas. The fistulas included three segments: arterial inflow, anastomosis, and venous outflow. Two experienced observers, who were blinded to the results of the NCE-MRA, recorded in consensus the significant stenoses (≥50%) seen on CTA. Two other experienced observers, unaware of the results of CTA, independently recorded significant stenoses (≥50%) in the NCE-MRA. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of NCE-MRA were calculated, with MDCTA as the standard reference. Sixty-three vascular segments in the 21 patients were clearly displayed. For the two observers of NCE-MRA, the accuracy was 98% and 95.4%; sensitivity 96.4% and 96.4%; specificity 97.1% and 94.3%; positive predictive value 96.4% and 93.1%; and, negative predictive value 97.1% and 97.1%. Inter-/intra-observer agreement for detecting stenosis was excellent for NCE-MRA, with a weighted kappa of 0.968 (95% confidence interval [CI], 0.874-1) and 0.936 (95% CI, 0.848-1). Non-contrast-enhanced MRA, using time-of-flight and black-blood MRA, is a reproducible and reliable imaging technique for detecting ≥50% stenosis in dysfunctional haemodialysis arteriovenous fistulas. Copyright © 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  14. The radiological management of the thrombosed arteriovenous dialysis fistula

    Energy Technology Data Exchange (ETDEWEB)

    Bent, C.L., E-mail: clare_bent@yahoo.co.u [Royal Bournemouth and Christchurch Hospitals, Bournemouth (United Kingdom); Sahni, V.A. [Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women' s Hospital, Harvard Medical School, Boston (United States); Matson, M.B. [Barts and The London NHS Trust, London (United Kingdom)

    2011-01-15

    Patent vascular access is a prerequisite for adequate haemodialysis, and is a major determinant of quality of life and long-term survival of patients with end-stage renal disease. Autogenous haemodialysis fistulas (AVFs) have demonstrated superior clinical outcome when compared to synthetic grafts, but both types of access remain susceptible to venous stenoses, and consequent thrombotic occlusion. Recent publications have reported primary patency rates of up to 100% following percutaneous de-clotting of AVFs incorporating techniques such as pharmacological thrombolysis, mechanical thrombectomy, and thrombo-aspiration. Endovascular management also provides information regarding the underlying cause of access thrombosis, with option to treat. Consequently, there has been a paradigm shift in the management of fistula thrombosis, with interventional radiology assuming a lead role in initial salvage procedures. This article will attempt to provide the reader with an insight into the multiple radiological techniques that can be employed to salvage a thrombosed AVF based on current published literature.

  15. Improvement of depression after treatment of dural arteriovenous fistula: a case report and a review.

    Science.gov (United States)

    Nakagawa, Minoru; Sugiu, Kenji; Tokunaga, Koji; Sakamoto, Chihoko; Fujiwara, Kenjiro

    2012-01-01

    Patients with dural arteriovenous fistulas (DAVFs) in the transverse-sigmoid sinus suffer from several symptoms: bruit, headache, visual impairment, and so on. But depression is rare in patients with DAVF. The authors reported a rare case presenting the improvement of depression after the treatment of a dural arteriovenous fistula in the left transverse-sigmoid sinus. A 46-year-old male had suffered from depression and was treated with antidepressants at a local hospital for four years. The patient was temporarily laid off due to his depression. Afterwards, he had Gerstmann's syndrome and came to our hospital. A DAVF in the left transverse-sigmoid sinus was demonstrated on the angiogram. The DAVF was successfully treated with endovascular surgery, coil embolization of the isolated diseased sinus through the mastoid emissary vein which was a draining vein from the fistula. After this treatment, his depression as well as Gerstmann's syndrome was improved and the quantity of the antidepressants decreased. The patient returned to work without any antidepressant two years after the treatment. DAVFs might be one of the causes of depression. It may be necessary to evaluate cerebral vessels in patients suffering from depression by using MRA or 3D-CTA even if there are not any abnormal findings on plain CT scans.

  16. Value of Duplex Ultrasound Assistance for Thromboaspiration and Dilation of Thrombosed Native Arterio-Venous Fistulae

    Energy Technology Data Exchange (ETDEWEB)

    Garcia-Medina, J., E-mail: josegmedina57@gmail.com [Reina Sophia University Hospital, Vascular and Interventional Radiology Unit, Department of Radiology (Spain)

    2013-12-15

    Purpose: To evaluate the value of duplex ultrasound assistance during thromboaspiration of thrombosed arteriovenous fistulae for haemodialysis. Materials and Methods: We prospectively studied 54 thrombosed native fistulae (23 with total thrombosis and 31 with partial thrombosis), in which we performed manual thromboaspiration guided by ultrasonography associated with fluoroscopy. Results: The fistulae were located in the forearm (n = 39) or in the upper arm (n = 15) of 46 patients. Mean patient age was 65 years, and hypertension was the most common risk factor (74 %). Mean access age was 928 days (range 69-2,290), and most fistulae were on the left side (41 cases, 75.92 %). The success rate was 83 % in the total thrombosis group and 100 % in the partial thrombosis group. Including initial failures, the respective primary patency rates in the total thrombosis group and the partial thrombosis group were, respectively, 83 {+-} 8 % (n = 20) and 87 {+-} 6 % (n = 28) at 1 month, 39 {+-} 10 % (n = 10) and 61 {+-} 8 % (n = 20) at 6 months, and 17 {+-} 8 % (n = 5) and 26 {+-} 8 % (n = 9) at 1 year. The mean decrease of fluoroscopy time with ultrasound was 3 min (range 1-5). The mean decrease of radiation dose was 2.6 Gy cm Superscript-Two (range 0.9-4.3]. Conclusion: Ultrasound is a feasible and useful tool in the management of thrombosed native fistulae, thus decreasing radiation exposure, and has no detrimental effect on success rates.

  17. Transvenous treatment of a complex cavernous sinus dural arteriovenous fistula secondary to balloon embolization of a traumatic carotid-cavernous fistula

    Institute of Scientific and Technical Information of China (English)

    HAI Jian; CHEN Zuo-quan; DENG Dong-feng; PAN Qing-gang; LING Feng

    2006-01-01

    @@ AIthough recurrent traumatic carotid-cavernous fistula (CCF) and its treatment have been reported sporadically,1 a complex cavernous sinus dural arteriovenous fistula (DAVF) secondary to balloon embolization of a direct traumatic CCF is rare. In 2005, we treated such a case via transvenous approach using coils and N-buty-2-cyanoacrylate (NBCA). The causes of recurrent cavernous sinus DAVF and its endovascular approach are discussed.

  18. Impact of arteriosclerosis on the functioning of arteriovenous fistula for hemodialysis

    Directory of Open Access Journals (Sweden)

    Stolić Radojica

    2007-01-01

    Full Text Available Background/Aim. Numerous clinical studies have shown that the incidence of artheriosclerosis is higher in patients with progressive renal insufficiency. The aim of this study was to examine the incidence of artheriosclerosis in patients on chronic hemodialysis and its influence on survival and functioning of vascular access. Methods. The study was organized as one-year prospective study. All the patients had arteriovenous fistulas native as a vascular access. The study analyzed demographic, biochemical, clinical and Doppler echomorphological characteristics of the patients in order to make an evidence of artheriosclerotic incidences as compared to functioning arteriovenous fistulas for hemodialysis. Results. The examined patients were of the mean age 55.7±12.68 years. Of them, 53.8% were males and 46.2% females. Functioning arteriovenous fistulas for haemodialysis were found in 56.8% of the examined patients. Concentration of hemoglobin was a significant parameter of functioning fistula (group with complications - 89±14.034 vs. group with no complications - 96.6±17.71; p = 0.0489. An amount of urea removed (URR was a statistically more significant parameter among the patients without fistula complications: (group with complications - 58.67±7.92% vs. group with no complications - 62.80±7.53%; p = 0.037. A Cox regressive analysis of an index of Doppler parameters of the carotid arteries found no statistical significance between the examined groups. There was a positive correlation between artheriosclerosis and the age, as well as the time on dialysis. In multiple regression, where intima media is a dependent and the age and time on dialysis independent variables, the regressive model was statistically significant (F = 8.22, p = 0.001. Both independent variables had statistically significant inclinations, p < 0.01. Conclusion. Anemia and the level of urea elimination, as a statistically significant indicator of hemodialysis adequacy, were in

  19. Microscope-assisted endoscopic interlaminar ligation of spinal arteriovenous fistulas: technical note.

    Science.gov (United States)

    Wang, Chen; Chen, Chien-Min; Shen, Fang; Fang, Xiao-Dong; Ying, Guang-Yu; Ren, Yu-Cheng; Yu, Dan-Feng; Zhu, Liang-Liang; Zhu, Yong-Jian; Zhang, Jian-Min

    2016-09-01

    Spinal dural arteriovenous fistulas (SDAVFs) are the most common type of spinal arteriovenous malformations, and microsurgical ligation is the treatment modality most frequently used for these lesions. Developments in endoscopic techniques have made endoscopy an even less invasive alternative to routine microsurgical approaches in spine surgery, but endoscopic management of SDAVF or other intradural spinal lesions has not been reported to date. The authors describe the use of a microscope-assisted endoscopic interlaminar approach for the ligation of the proximal draining vein of an L-1 SDAVF in a 58-year-old man. A complete cure was confirmed by postoperative angiography. The postoperative course was uneventful, and short-term follow-up showed improvements in the patient's neurological function. The authors conclude that the endoscopic interlaminar approach with microscope assistance is a safe, minimally invasive, innovative technique for the surgical management of SDAVFs in selected patients.

  20. A rare cause of progressive paraparesis and urinary retention: Spinal dural arteriovenous fistula- Case report

    Directory of Open Access Journals (Sweden)

    Sırma Geyik

    2016-12-01

    Full Text Available Spinal arteriovenous fistulas (AVF, are rarely seen clinical pathology, have serious morbidity in cases without treatment although spinal AVF are the most common types of spinal arteriovenous malformation. Fifty years old male patient suffered from urine retention and paraparesis after lifted a heavy object. Spinal magnetic resonance images (MRI showed diffuse hyper intense lesion from midthoracic spinal cord segment to conus medullaris in T2A sequance. Spinal angiography revealed a long segmental dorsal AVF on the right side of T 7-8 level in spinal cord. Because of the low flow and a small AVF neurosurgical Department decided to perform an operation for spinal AVF. We should keep in mind spinal AVF, in which prognosis is well after prompt and appropriate theraphy, as a differential diagnosis in patients presented with progressive spinal symptoms.

  1. Double spinal dural arteriovenous fistulas: case report and review of the literature

    Energy Technology Data Exchange (ETDEWEB)

    Krings, T. [Department of Neuroradiology, University Hospital of the University of Technology, Aachen, Pauwelsstrasse 30, 52057, Aachen (Germany); Department of Neurosurgery, University Hospital of the University of Technology, Aachen, Pauwelsstrasse 30, 52057, Aachen (Germany); Mull, M.; Thron, A. [Department of Neuroradiology, University Hospital of the University of Technology, Aachen, Pauwelsstrasse 30, 52057, Aachen (Germany); Reinges, M.H.T. [Department of Neurosurgery, University Hospital of the University of Technology, Aachen, Pauwelsstrasse 30, 52057, Aachen (Germany)

    2004-03-01

    Spinal dural arteriovenous fistula (SDAVF) is the most common spinal vascular malformation. It mainly affects men after the fifth decade and is usually an acquired lesion with an unknown etiology. We report on a patient with the unusual finding of two separate SDAVFs at the level of L1 on the right and L2 on the left side. Initial selective spinal digital subtraction angiography (DSA) was terminated with demonstration of a SDAVF at the level of L1 but incomplete demonstration of all segmental arteries. Due to a recurrent deterioration of the patient's neurological status, and persistent pathological vessels seen on MRI, a second spinal DSA was performed 6 years later, demonstrating the second fistula at the level of L2 on the left side with a separate venous drainage pattern. A retrospective analysis of the angiographic films suggested that both fistulas had already been present 6 years previously. This conclusion is justified because of a transient and faint opacification of the left L2 fistula demonstrated on the films after injection of the right L2 segmental artery. We conclude that in the case of incomplete angiography and persistent clinical and MR findings not only reopening of the treated SDAVF has to be taken into account but also the existence of a second fistula. Since this is the first case of a double fistula in our series of 129 SDAVFs, and given the few reported cases of double SDAVFs, we do not think that completion of selective spinal DSA has to be postulated routinely after a fistula has been found. However, repeat angiography should be performed in patients who continue to deteriorate, fail to improve with persisting MRI pathologies, or demonstrate delayed deterioration after a period of improvement. (orig.)

  2. Endovascular treatment of cranial dural arteriovenous fistulae: a single-centre, 14-year experience and the impact of Onyx on local practise

    Energy Technology Data Exchange (ETDEWEB)

    Macdonald, Jason Hector Michael; Millar, John S.; Barker, C.S. [Southampton General Hospital, Wessex Neurological Centre, Southampton (United Kingdom)

    2010-05-15

    Dural arteriovenous fistulae (DAVFs) are a potentially dangerous group of intracranial arteriovenous shunts with significant morbidity and mortality. Treatment has traditionally included transvenous and/or transarterial embolisation, which may be followed by surgical ligation. This study assesses the impact of Onyx on treatment. Forty-nine consecutive patients referred for endovascular management of DAVFs between 1994 and 2008 were included in a retrospective, intention-to-treat analysis. DAVFs managed conservatively or purely surgically were excluded. Success rates and complications were compared between patients treated by transvenous, transarterial Onyx and transarterial non-Onyx material embolisation. Fifty-six separate DAVFs were detected in 49 patients. Embolisation of 52 DAVFs was performed or attempted. Transvenous sinus occlusion of ten type I or II DAVFs resulted in cure but was unsuccessful in a single type IV fistula and three of the four indirect carotico-cavernous fistulae treated in this way. Two type I and nine type III/IV were identified in the transarterial, non-Onyx group and three of 11 (27.3%) were cured. Amongst the six type II and 20 type III/IV DAVFs belonging to the transarterial Onyx group, cure was achieved in 17 of 26 (65.4%) rising to 72.7%, considering only those cases where the fistula could be accessed and Onyx was injected. The introduction of Onyx has improved the endovascular cure rate of DAVFs, particularly types III and IV. Advances in technology have made an endovascular approach the management of choice for the majority of DAVFs requiring treatment. Low complication rates are achievable. (orig.)

  3. Treatment of a cavernous sinus dural arteriovenous fistula by deep orbital puncture of the superior ophthalmic vein

    Energy Technology Data Exchange (ETDEWEB)

    Benndorf, G. [Neuroangiography, Department of Radiology, Charite, Humboldt University Berlin (Germany); Bender, A. [Neuroradiology, Department of Radiology, Charite, Humboldt University Berlin (Germany); Campi, A. [Dept. of Neuroradiology, Hospital San Raffaele, Milan (Italy); Menneking, H. [Dept. of Maxillofacial Surgery, Charite, Humboldt University Berlin (Germany); Lanksch, W.R. [Department of Neurosurgery, Charite, Humboldt University Berlin, Augustenburger Platz 1, 13 353 Berlin (Germany)

    2001-06-01

    In a patient with progressive ophthalmological problems, including uncontrolled intraocular pressure related to a cavernous sinus dural arteriovenous fistula, urgent intervention may be necessary to prevent permanent visual loss. We report a case in which inadequate transarterial embolisation and lack of access for transvenous catheterisation, including a direct approach through the superior ophthalmic vein, preceded percutaneous puncture of the superior ophthalmic vein deep within the orbit, permitting venous occlusion without complications. This case demonstrates that deep orbital puncture of the vein is feasible for occlusion of a cavernous sinus dural arteriovenous fistula. (orig.)

  4. Refashioning of an aneurysmatic arterio-venous fistula by using the multifire GIA 60 surgical stapler.

    Science.gov (United States)

    Hakim, N S; Romagnoli, J; Contis, J C; Akoh, J; Papalois, V E

    1997-01-01

    We describe a technique for refashioning an aneurysmatic arterio-venous fistula by using the multifire GIA 60 surgical stapler. After obtaining proximal and distal control of the aneurysmatic vein each aneurysmal segment of the anterior wall of the vein is excised by applying the GIA 60 stapler. The layer of the staple-line is re-enforced with one layer of 6/0 prolene continuous suture. After completion of the procedure, the size of the vein is reduced by approximately 50%. The AVFs were successfully re-used for dialysis within four weeks postoperatively.

  5. Cardiac complications of arteriovenous fistulas in patients with end-stage renal disease.

    Science.gov (United States)

    Alkhouli, Mohamad; Sandhu, Paul; Boobes, Khlaed; Hatahet, Kamel; Raza, Farhan; Boobes, Yousef

    2015-01-01

    Cardiovascular disease is the leading cause of the death in dialysis patients. Arteriovenous fistulas (AVFs) are associated with lower mortality and are viewed as the desired access option in most patients with advanced kidney disease needing dialysis. However, AVFs have significant and potentially deleterious effects on cardiac functions particularly in the setting of preexisting heart disease. This article provides a comprehensive and contemporary review to what is known about the impact of AVFs on: congestive heart failure, left ventricular hypertrophy, pulmonary hypertension, right ventricular dysfunction, coronary artery disease and valvular heart disease. Copyright © 2015 The Authors. Published by Elsevier España, S.L.U. All rights reserved.

  6. Endovascular occlusion of primary major pelvic arteriovenous fistula using patent ductus arteriosus occluder.

    Science.gov (United States)

    Xu, L; Wu, Z; Qu, L; Burchell, S

    2016-03-01

    The aim of the present study was to investigate the effects and safety of a patent ductus arteriosus occluder (PDAO) in the management of major abdominal arteriovenous fistula. A 56-year-old man was admitted into our hospital, presenting with impeded defecation and claudication. Computed tomographic angiography (CTA) was conducted upon admission, which revealed an aneurysm-like lesion, with the left internal iliac artery as its feeding artery. Super-selective embolization treatment was accomplished using a single PDAO. The results of the CTA at follow-up showed no recanalization of the lesion and that a PDAO was at the site. The patient had no pelvic ischemia complications.

  7. Stent graft repair of iatrogenic femoral arteriovenous fistula: a useful therapeutic approach in a hostile groin.

    Science.gov (United States)

    De Martino, Randall R; Nolan, Brian W; Powell, Richard J; Walsh, Daniel B; Stone, David H

    2010-01-01

    The incidence of iatrogenic femoral arteriovenous fistulas (IFAVF) has increased in contemporary practice. We herein report the case of a 55-year-old obese woman with significant surgical comorbidities who sustained an IFAVF between the superficial femoral artery (SFA) and the femoral vein. Given her substantial risk factors, she was treated with a SFA stent-graft (iCast 6 x 22 mm) using a contralateral endovascular approach. She remains asymptomatic at 15 months with ongoing resolution of the AVF. This report highlights the utility of stent-graft repair of an IFAVF in high surgical risk patients or in those with ''hostile'' anatomy.

  8. Isolated oculomotor nerve palsy caused by cavernous sinus dural arteriovenous fistula: Case report

    Energy Technology Data Exchange (ETDEWEB)

    Ihn, Yon Kwon; Jung, Won Sang [The Catholic Univ. of Korea, Suwon (Korea, Republic of); Kim, Bum Soo [The Catholic Univ. of Korea, Seoul (Korea, Republic of)

    2012-10-15

    Cavernous dural arteriovenous fistula (DAVF), which usually presents with conjunctival injection, proptosis, loss of visual acuity, and ophthalmoplegia, is a rare cause of ophthalmoplegia. Thus, it may be overlooked when the typical symptoms are lacking. There have been some cavernous DAVF case reports presenting with isolated oculomotor, abducens and trochlear nerve palsy. We report a patient presenting with isolated oculomotor palsy, caused by cavernous DAVF, which was treated by transvenous coil embolization. This case suggests that cavernous DAVF should be considered in the differential diagnosis of isolated oculomotor nerve palsy and for which case - selective angiography and embolization may be helpful in reaching a diagnosis and providing a guide for optimal treatment.

  9. Evaluation of the degree of arteriovenous shunting in intracranial arteriovenous malformations using pseudo-continuous arterial spin labeling magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Sunwoo, Leonard; Park, Sun-Won [Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Department of Radiology, Seoul (Korea, Republic of); Seoul National University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Sohn, Chul-Ho; Yun, Tae Jin; Choi, Seung Hong; Cho, Young Dae; Kim, Ji-hoon; Han, Moon Hee [Seoul National University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Seoul National University Hospital, Department of Radiology, Seoul (Korea, Republic of); Lee, Jong Young [Kangdong Sacred Heart Hospital, Department of Neurosurgery, Seoul (Korea, Republic of); Yi, Kyung Sik [Chungbuk National University Hospital, Department of Radiology, Cheongju (Korea, Republic of); Paek, Sun Ha; Kim, Yong Hwy; Kim, Jin Wook; Chung, Hyun-Tai; Kim, Dong Gyu [Seoul National University Hospital, Department of Neurosurgery, Seoul (Korea, Republic of)

    2015-08-15

    Intracranial arteriovenous malformations (AVMs) display venous signals on arterial spin labeling (ASL) magnetic resonance (MR) imaging due to the presence of arteriovenous shunting. Our aim was to quantitatively correlate AVM signal intensity on ASL with the degree of arteriovenous shunting estimated on digital subtraction angiography (DSA) in AVMs. MR imaging including pseudo-continuous ASL at 3 T and DSA were obtained on the same day in 40 patients with intracranial AVMs. Two reviewers assessed the nidus and venous signal intensities on ASL images to determine the presence of arteriovenous shunting. Interobserver agreement on ASL between the reviewers was determined. ASL signal intensity of the AVM lesion was correlated with AVM size and the time difference between normal and AVM venous transit times measured from the DSA images. Interobserver agreement between two reviewers for nidus and venous signal intensities was excellent (κ = 0.80 and 1.0, respectively). Interobserver agreement regarding the presence of arteriovenous shunting was perfect (κ = 1.0). AVM signal intensity showed a positive relationship with the time difference between normal and AVM venous transit times (r = 0.638, P < 0.001). AVM signal intensity also demonstrated a positive relationship with AVM size (r = 0.561, P < 0.001). AVM signal intensity on ASL in patients with AVM correlates well with the degree of early vein opacification on DSA, which corresponds to the degree of arteriovenous shunting. (orig.)

  10. Endovascular treatment of congenital arteriovenous fistulae of the internal maxillary artery

    Energy Technology Data Exchange (ETDEWEB)

    Kim, B.S. [Department of Radiology, Catholic University of Korea, Seoul (Korea); Lee, S.K.; terBrugge, K.G. [Department of Medical Imaging, Toronto Western Hospital, Fell Pavilion 3-210, 399 Bathurst St, Toronto, Ontario M5T2S8 (Canada)

    2003-07-01

    Congenital arteriovenous fistulae (AVF) of the internal maxillary artery (IMA) are rare. We present the angiographic findings and management of six AVF of the IMA, selected from 147 patients with facial vascular malformations. The fistula was thought to be congenital in all six in view of a life-long history, with no recorded trauma. Our analysis included angioarchitecture, treatment modality, embolic material, treatment results and follow-up. All patients had angiography showing an AVF originating from the IMA and draining to the jugular vein. Five patients underwent endovascular treatment with detachable balloons; a combination of Guglielmi detachable coils and N-acetyl-2-cyanoacrylate (NBCA) was used in one child. We successfully closed the AVF in all cases, without procedure-related complications, except for delayed transient facial numbness in one patient. No recurrence was observed on follow-up of 5 months to 7 years (mean 44 months). (orig.)

  11. Endovascular repair of traumatic external iliac vessel pseudoaneurysm and arteriovenous fistulae

    Directory of Open Access Journals (Sweden)

    Juan Marin

    2013-09-01

    Full Text Available A 17-year-old male patient presenting with an abdominal gunshot wound and severe hypovolemic shock was initially operated and presented several injuries to the small bowel and cecum associated with severe hemorrhage. The patient had to be operated twice due to hypothermia, acidosis, and coagulopathy. In the late postoperative period, murmur and fremitus were observed. Angiography revealed a pseudoaneurysm associated with arteriovenous fistulae at the left external iliac vessels. Lesions were repaired with a stent graft placed in the external iliac artery, with a satisfactory outcome. Control computed tomography performed 6 months later evidenced artery integrity with closure of the fistulae. Endovascular therapy should be the preferred method in this type of vascular trauma complications.

  12. The feasibility of surgical salvage of thrombosed arteriovenous fistula by an interventional nephrologist

    Directory of Open Access Journals (Sweden)

    Seong Cho

    2017-06-01

    Full Text Available Background: Salvage of a thrombosed arteriovenous fistula (AVF by secondary fistula conversion may be more effective than a conventional endovascular procedure for forearm fistula thrombosis. Surgical access procedures are an undeveloped area in interventional nephrology compared to endovascular procedures. Herein, the author report the results of surgical salvage of thrombosed AVFs by interventional nephrologists. Methods: The author retrospectively analyzed 52 surgical salvage procedures for AVF thrombosis (radiocephalic fistula = 44 cases, brachiocephalic fistula = 8 cases that were performed by interventional nephrologist between March 2007 and January 2016. Results: Secondary fistula formation using the proximal vein was performed for 46 cases (88.5%; outflow rerouting was performed for two cephalic-arch stenosis cases (3.9%, simple thrombectomy was performed for two cases (3.9%, and a graft interposition was performed for two cases (3.9%. Technical success after the surgical procedures was achieved in 51 cases (98.1%, and 39 AVFs (75.0% were prepared for immediate puncturing without catheter insertion. The primary and secondary patency rates for AVF at 6, 12, 18, and 24 months were 88.5%, 83.2%, 83.2%, and 83.2% and 96.0%, 96.0%, 93.2%, and 93.2%, respectively. The re-intervention rate was 0.27 ± 0.92/patient/ year. Conclusion: Based on these results, the author conclude that surgical salvage of a thrombosed AVF, when performed under local anesthesia by a skilled interventional nephrologist, offers favorable short- and long-term success and should be the preferred treatment.

  13. Dural arteriovenous fistula at the foramen magnum presenting with subarachnoid hemorrhage: case reports and literature review.

    Science.gov (United States)

    Guo, L-M; Zhou, H-Y; Xu, J-W; Wang, G-S; Tian, X; Wang, Y; Qiu, Y-M; Jiang, J-Y

    2010-05-01

    Spinal dural arteriovenous fistulas (DAVFs) may arise at any level from the foramen magnum to the sacrum. Only a few case series of DAVFs at the foramen magnum have been reported, especially with patients presenting with subarachnoid hemorrhage (SAH). We performed a retrospective study of four such cases and summarize experiences in the diagnosis and surgical treatment of a DAVF at the foramen magnum. Four male patients, aged from 35 to 51 years, were admitted with severe headache. The cranial computerized tomography scans of all four patients showed SAH, with hemorrhage in the fourth ventricle with or without hemorrhage in the occipital horns of the lateral ventricles. Pre-operative digital subtraction cerebral angiography showed a DAVF at the foramen magnum draining to medullary veins and/or the straight sinus and the confluence of sinuses. Two DAVFs were fed by the vertebral artery, whilst the others were fed by dural branches of the occipital artery and/or the ascending pharyngeal artery. Three patients underwent direct microsurgical electrocoagulation and disconnection of the arteriovenous shunt via an enlargement of the foramen magnum and a hemilaminectomy at C1 by the far lateral suboccipital approach. Post-operative angiography confirmed complete obliteration of the fistula. Cerebral digital subtraction angiography is an effective and accurate method for examination of a DAVF at the foramen magnum. It can be treated effectively and with minimal surgical trauma by microsurgical electrocoagulation and disconnection of the shunt.

  14. Accuracy of doppler ultrasonography in the evaluation of hemodialysis arteriovenous fistula maturity

    Directory of Open Access Journals (Sweden)

    João Humberto da Fonseca Junior

    Full Text Available OBJECTIVE: to determine the accuracy of Doppler ultrasonography (USD for hemodialysis arteriovenous fistula (AVF maturity.METHODS: we included patients with no prior AVF. Each patient underwent two USD examinations. After initiation of hemodialysis, we followed the patients during the first month of the access use and verified its adequacy to hemodialysis sessions. At statistical analysis we measured specificity, sensitivity, accuracy, ROC curve (Receiver operator characteristic curve, TG-ROC (Two graph - receiver operator characteristic and logistic regression.RESULTS: we included 76 patients, of which 51 completed the study. They formed two groups, those who have had good adequacy for hemodialysis (45 and those who had not (6. The average flow volume (FV and the average draining vein diameter (DVD of each group were, respectively: 940mL/min (95% CI: 829-1052 and 325mL/min (95% CI: 140-510; and 0.48cm (95% CI: 0.45-0.52 and 0.33cm (95% CI: 0.27-0.40. The area under the ROC curve of FV and DVD were 0.926 and 0.766, respectively.CONCLUSION: the accuracy of the measured volume flow measured at the draining vein to evaluate maturation of hemodialysis arteriovenous fistula was 85%.

  15. The accuracy and utility of contrast-enhanced MR angiography for localization of spinal dural arteriovenous fistulas : the Toronto experience

    NARCIS (Netherlands)

    Lindenholz, Arjen; TerBrugge, Karel G.; van Dijk, J. Marc C.; Farb, Richard I.

    2014-01-01

    The purpose of this study was to determine the accuracy and utility of contrast-enhanced MR angiography (CE-MRA) in spinal dural arteriovenous fistulas (SDAVF). A retrospective analysis from 1999-2012 identified 70 patients clinically suspected of harboring a SDAVF. Each patient underwent consecutiv

  16. Serum sclerostin levels, arteriovenous fistula calcification and 2-years all-cause mortality in prevalent hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Alper Kirkpantur

    2016-01-01

    Clinical trial registration number: The study was performed as a post hoc survival analysis of the patients involved in a single-center prospective trial investigating the association between serum sclerostin levels and arteriovenous fistula calcification and patency [Balcı M, et al. Herz 2015;40:289–97] with a Clinicaltrials.gov number: NCT01382966.

  17. Early follow-up results of arteriovenous fistulae created for hemodialysis

    Directory of Open Access Journals (Sweden)

    Iyem H

    2011-05-01

    Full Text Available Hikmet IyemÇanakkale 18 Mart, Üniversitesi Tip Fakültesi, TurkeyBackground: The aim of this study was to evaluate the site, early results, and postoperative complications of arteriovenous fistula (AVF creation procedures for hemodialysis in our clinic.Methods: The hospital records of 384 patients who underwent 411 AVF creation procedures for hemodialysis by the same team at our clinic between February 2008 and January 2010 were included for retrospective analysis. All procedures were performed under local anesthesia with lidocaine. Vasospasm was treated by mechanical dilatation with a probe and topical papaverine.Results: Of our 384 patients, 58.5% were male and 41.5% were female. Mean age was 46 (range 12–72 years. Of the 411 AVF procedures performed, 106 (25.8% were created at the anatomical snuffbox, 264 (64.3% were Brescia–Cimino procedures, and 41 (9.9% were antecubital, brachiocephalic, or brachiobasilic procedures. Twenty-three patients (5.98% were subjected to more than one surgical intervention due to early thrombosis or failure of AVF. Early patency was found in 94.0% of the AVF created. Twenty-three patients underwent more than one surgical intervention due to early AVF thrombosis or failure. Early AVF failure occurred more often in females (60.8% than in males (39.2%. Complications were observed in a total of 11.4% patients.Conclusion: Mechanical dilatation of the artery and vein, before starting the anastomosis, as well as the use of vasodilatory agents, could decrease early thrombosis of the fistula, and this method has very high early patency.Keywords: end-stage renal failure, arteriovenous fistula, early patency, complications

  18. Giant Pseudoaneurysm Associated with Arteriovenous Fistula of the Brachial and Femoral Arteries following Gunshot Wounds: Report of Two Cases

    Science.gov (United States)

    Daniel, Handy Eone; Firmin, Ankouane; Angele, Pondy O.; Esthelle, Minka Ngom; Freddy, Bombah; Bernadette, Ngo Nonga

    2015-01-01

    Posttraumatic pseudoaneurysm associated with arteriovenous fistula of the upper or lower limb is exceptional. We are reporting herein the history of two cases in civil life that have been followed and repaired in our service. Both patients were shot more than a year before being referred to our tertiary hospital for an enlarging mass which was a pseudoaneurysm associated with an arteriovenous fistula. The aneurysm was repaired and the fistula closed. Due to the absence of well-trained professionals, vascular injuries and their complications are usually discovered late in Cameroon while these pseudoaneurysms can reach very dramatic sizes. This presentation intends to raise the attention on a careful clinical exam and search of vascular lesion in the case of penetrating wound of the limb associated with profuse bleeding. PMID:25705543

  19. Giant Pseudoaneurysm Associated with Arteriovenous Fistula of the Brachial and Femoral Arteries following Gunshot Wounds: Report of Two Cases

    Directory of Open Access Journals (Sweden)

    Handy Eone Daniel

    2015-01-01

    Full Text Available Posttraumatic pseudoaneurysm associated with arteriovenous fistula of the upper or lower limb is exceptional. We are reporting herein the history of two cases in civil life that have been followed and repaired in our service. Both patients were shot more than a year before being referred to our tertiary hospital for an enlarging mass which was a pseudoaneurysm associated with an arteriovenous fistula. The aneurysm was repaired and the fistula closed. Due to the absence of well-trained professionals, vascular injuries and their complications are usually discovered late in Cameroon while these pseudoaneurysms can reach very dramatic sizes. This presentation intends to raise the attention on a careful clinical exam and search of vascular lesion in the case of penetrating wound of the limb associated with profuse bleeding.

  20. MRI evidence for preserved regulation of intracranial pressure in patients with cerebral arteriovenous malformations

    Energy Technology Data Exchange (ETDEWEB)

    Meinel, Felix G.; Fischer, Judith; Pomschar, Andreas; Wöhrle, Natalie; Koerte, Inga K.; Steffinger, Denise [Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Marchioninistr. 15, 81377 Munich (Germany); Laubender, Rüdiger P. [Institute of Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University, Marchioninistr. 15, 81377 Munich (Germany); Muacevic, Alexander [European Cyberknife Center Munich, 81377 Munich (Germany); Reiser, Maximilian F. [Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Marchioninistr. 15, 81377 Munich (Germany); Alperin, Noam [Department of Radiology, Miller School of Medicine, University of Miami, Miami, FL 33136 (United States); Ertl-Wagner, Birgit, E-mail: birgit.ertl-wagner@med.uni-muenchen.de [Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Marchioninistr. 15, 81377 Munich (Germany)

    2014-08-15

    Purpose: The purpose of this study was to investigate intracranial pressure and associated hemo- and hydrodynamic parameters in patients with cerebral arteriovenous malformations AVMs. Methods: Thirty consecutive patients with arteriovenous malformations (median age 38.7 years, 27/30 previously treated with radiosurgery) and 30 age- and gender-matched healthy controls were investigated on a 3.0 T MR scanner. Nidus volume was quantified on dynamic MR angiography. Total arterial cerebral blood flow (tCBF), venous outflow as well as aqueductal and craniospinal stroke volumes were obtained using velocity-encoded cine-phase contrast MRI. Intracranial volume change during the cardiac cycle was calculated and intracranial pressure (ICP) was derived from systolic intracranial volume change (ICVC) and pulse pressure gradient. Results: TCBF was significantly higher in AVM patients as compared to healthy controls (median 799 vs. 692 mL/min, p = 0.007). There was a trend for venous flow to be increased in both the ipsilateral internal jugular vein (IJV, 282 vs. 225 mL/min, p = 0.16), and in the contralateral IJV (322 vs. 285 mL/min, p = 0.09), but not in secondary veins. There was no significant difference in median ICP between AVM patients and control subjects (6.9 vs. 8.6 mmHg, p = 0.30) and ICP did not correlate with nidus volume in AVM patients (ρ = −0.06, p = 0.74). There was a significant positive correlation between tCBF and craniospinal CSF stroke volume (ρ = 0.69, p = 0.02). Conclusions: The elevated cerebral blood flow in patients with AVMs is drained through an increased flow in IJVs but not secondary veins. ICP is maintained within ranges of normal and does not correlate with nidus volume.

  1. Coil embolization of cavernous sinus in patients with direct and dural arteriovenous fistula

    Energy Technology Data Exchange (ETDEWEB)

    Bink, Andrea; Berkefeld, Joachim; Zanella, Friedhelm; Mesnil de Rochemont, Richard du [Goethe University, Department of Neuroradiology, Frankfurt am Main (Germany); Luechtenberg, Marc [Goethe University, Department of Ophthalmology, Frankfurt/Main (Germany); Gerlach, Ruediger [Goethe University, Department of Neurosurgery, Frankfurt/Main (Germany); Neumann-Haefelin, Tobias [Goethe University, Department of Neurology, Frankfurt/Main (Germany)

    2009-06-15

    To determine technical success and acute complication rates after endovascular coil packing of the cavernous sinus. Nineteen patients presented with either direct (13) or dural (6) arteriovenous fistula (AVF) and were treated by means of coil embolization of the cavernous sinus. The aim of treatment was complete obliteration of the fistula. In a retrospective study, the degree of obliteration, regression of symptoms as well as complication rates were evaluated. Initial complete obliteration was achieved in 12 patients, subtotal occlusion of the sinus in 6 and incomplete packing with major residual fistula in 1 of the patients. Retreatment was successfully performed in two patients with early recurrence of AVF. Follow-up showed complete occlusion rates in 16 and subtotal obliteration in 3 patients. Chemosis and exophthalmus regressed rapidly in all affected patients. Persistence of cranial nerve deficits was observed in 11 cases. Postinterventional thrombosis of the ophthalmic vein was the only major acute complication (n = 2). Coil embolization of the cavernous sinus in cases with AVF is a complex procedure that is technically feasible and safe in the majority of cases. Adequate anticoagulation is recommended to avoid thrombembolic complications. Long-term outcome has to be determined by further studies. (orig.)

  2. Endovascular treatment of sphenoid wing dural arteriovenous fistula with pure cortical venous drainage.

    Science.gov (United States)

    Fukuda, Hitoshi; Miyake, Kosuke; Kunieda, Takenobu; Murao, Kenichi

    2014-07-01

    Curative endovascular treatment of sphenoid wing dural arteriovenous fistula (dAVF) with pure cortical venous drainage is challenging because of its rarity, lack of accessible dural sinus for transvenous embolization (TVE), and proximity of skull base vital regions. Direct surgery to disconnect venous reflux has been favored. We report the curative endovascular treatment of two sphenoid wing dAVFs with pure cortical venous drainage. One patient revealed complete obliteration of dAVF by a single session of transarterial embolization (TAE). As part of strategic TAE for this complex dAVF, we used a novel approach to create a complete flow-arrest condition in which coils and an occlusion balloon were combined. A liquid agent was then injected across the pathological fistula and into the parent venous apparatus, thereby occluding the lesion. The other patient was treated with percutaneous TVE after TAE was unsuccessful. With a specific strategy and appropriate devices, the microcatheter was successfully introduced through sigmoid sinus, transverse sinus, superior sagittal sinus, and refluxing cortical vein by puncture of the jugular vein. Coils were deployed at the venous side of the fistula, resulting in successful obliteration of the dAVF. Sphenoid wing dAVF with pure cortical venous drainage could be curable by endovascular treatment with proper strategy and instruments when anatomical condition permits.

  3. Predictive value of serum myeloperoxidase activity for thrombosis of arteriovenous fistulas.

    Science.gov (United States)

    Stolic, Radojica V; Trajkovic, Goran Z; Kostic, Mirjana; Stolic, Dragica Z; Miric, Dijana J; Kisic, Bojana M; Pajovic, Slavica D; Peric, Vladan M

    2014-07-01

    Myeloperoxidase is a proinflammatory protein that appears as a result of increased oxidative stress. It plays an important role in the promotion and progression of atherosclerosis. The aim of this study was to determine the importance of MPO as a predictive parameter for thrombosis of arteriovenous fistula (AVF). The study involved monitoring patients with AVFs for hemodialysis over a period of 2 years. There were 41 patients, 19 (46%) men and 22 (54%) women, with mean age of 65 ± 12.7 years. Routine laboratory analyses were carried out in all respondents, including determination of MPO concentration. Gender, demographic and anthropometrical characteristics, smoking, alcohol consumption, as well as the presence of diabetic nephropathy, as an etiological factor of kidney disease, were recorded. The group of patients who developed initial thrombosis of the AVFs had significantly different values for leukocytes (8.5 ± 3.8 vs. 7.3 ± 2.1, P = 0.024), erythrocytes (2.8 ± 0.27 vs. 3.2 ± 0.65; P = 0.019), hemoglobin (88.5 ± 81 vs. 99.1 ± 6.02; P = 0.041), and myeloperoxidase (19.3 ± 4.67 vs. 11.1 ± 4.43; P = 0.007) when compared with the group without fistula thrombosis. Diabetic nephropathy (P = 0.02) characterized the group of patients with thrombosis of the fistula. Diabetic nephropathy (B = 2.53, P = 0.049) and MPO (B = 0.03, P = 0.029) were statistically significant predictors of fistula thrombosis. In our study, MPO and diabetic nephropathy were predictors of thrombosis of the AVF.

  4. Vector velocity volume flow estimation: Sources of error and corrections applied for arteriovenous fistulas.

    Science.gov (United States)

    Jensen, Jonas; Olesen, Jacob Bjerring; Stuart, Matthias Bo; Hansen, Peter Møller; Nielsen, Michael Bachmann; Jensen, Jørgen Arendt

    2016-08-01

    A method for vector velocity volume flow estimation is presented, along with an investigation of its sources of error and correction of actual volume flow measurements. Volume flow errors are quantified theoretically by numerical modeling, through flow phantom measurements, and studied in vivo. This paper investigates errors from estimating volumetric flow using a commercial ultrasound scanner and the common assumptions made in the literature. The theoretical model shows, e.g. that volume flow is underestimated by 15%, when the scan plane is off-axis with the vessel center by 28% of the vessel radius. The error sources were also studied in vivo under realistic clinical conditions, and the theoretical results were applied for correcting the volume flow errors. Twenty dialysis patients with arteriovenous fistulas were scanned to obtain vector flow maps of fistulas. When fitting an ellipsis to cross-sectional scans of the fistulas, the major axis was on average 10.2mm, which is 8.6% larger than the minor axis. The ultrasound beam was on average 1.5mm from the vessel center, corresponding to 28% of the semi-major axis in an average fistula. Estimating volume flow with an elliptical, rather than circular, vessel area and correcting the ultrasound beam for being off-axis, gave a significant (p=0.008) reduction in error from 31.2% to 24.3%. The error is relative to the Ultrasound Dilution Technique, which is considered the gold standard for volume flow estimation for dialysis patients. The study shows the importance of correcting for volume flow errors, which are often made in clinical practice.

  5. Posterior cranial fossa single-hole arteriovenous fistulae in children: 14 consecutive cases

    Energy Technology Data Exchange (ETDEWEB)

    Yoshida, Y.; Weon, Y.C.; Sachet, M.; Mahadevan, J.; Alvarez, H.; Rodesch, G.; Lasjaunias, P. [Service de Neuroradiologie Diagnostique et Therapeutique, CHU de Bicetre, 78 rue du General Leclerc, 94275, Le Kremlin Bicetre (France)

    2004-06-01

    We report 14 consecutive children with 23 posterior cranial fossa arteriovenous fistula (AVF); six had multifocal lesions, involving the supratentorial brain in three and the spinal cord in one. There were two boys and four girls with a family history compatible with hereditary haemorrhagic telangiectasia. The diagnosis was made in infancy in eight cases and in a further six before the age of 12 years; mean age at diagnosis was 3.5 years. The male-to-female ratio was 1.8:1. Presenting features were macrocrania in four cases, haemorrhage or headache in three and nonhaemorrhagic neurological deficits or and cardiac overload in two. Dominant supply to the symptomatic fistula arose from the posterior inferior cerebellar artery in five cases, anterior inferior cerebellar artery in two and the upper basilar artery system in seven. All children were primarily treated by transarterial embolisation. We treated thirteen children (93%) by transarterial embolisation alone; one older child with a history of haemorrhage also underwent radiosurgery. We obtained 100% exclusion of the fistula(e) in six children, 95-80% in five, 80-50% in one and <50% in one. Of the incompletely treated cases, three had conservative management, and two with 80% and one with 60% reduction of their lesion are scheduled for elective treatment; two partially treated case died. There was no morbidity due to the endovascular procedures. Follow-up since referral is 6 months-10 years (mean 4.5 years). Ten children are neurologically normal, two have persistent (pre-existing) neurological deficits and two are dead. (orig.)

  6. The effect of ligation of the distal vein in snuff-box arteriovenous fistula

    Directory of Open Access Journals (Sweden)

    Beigi Ali

    2009-01-01

    Full Text Available Arterio-venous fistula (AVF in the snuff-box region is one of the current techniques used for creating a vascular access in patients undergoing dialysis. The aim of this study is to find out whether ligating the distal vein in AVF in the snuff-box will bring about any change in the efficiency and complications of the fistula. Sixty patients (30 males, 30 females suffering from chronic renal failure, who had been admitted for creating an AVF, were randomly divided into two groups after having filled out consent forms. After the AVF was made, the distal vein was ligated in the first group, but not in the second group. The patients were discharged after being given the necessary advice on how to take care of their fistula. They were examined on post-surgical days 1, 30 and 90. Early efficiency in the ligated and non-ligated groups was 100% and 96.7% respectively while late efficiency in the two groups was 90% and 83.4%, respectively (P > 0.05. The most common complication in both groups was thrombosis (11.7%. Venous hypertension and edema were observed in two patients (both from the non-ligated group and infection of the surgical site was observed in only one patient. Our study suggests that, considering the high efficiency level and low complication rate, AVF at the snuff-box region constitutes one of the best possible vascular accesses for patients undergoing hemodialysis. Ligation of the distal vein prevents the development of venous hypertension in the fistula.

  7. Ultrasonography-guided Balloon Angioplasty in an Autogenous Arteriovenous Fistula: Preliminary Results

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ji Chang [Daejeon St Mary' s Hospital, Daejeon (Korea, Republic of); Cho, June Sik [Chungnam National University College of Medicine, Daejeon (Korea, Republic of)

    2007-09-15

    Percutaneous trasnluminal angioplasty (PTA) of a malfunctioning arteriovenous fistula (AVF) in hemodialysis patients requires the use of contrast angiography and fluoroscopy guidance. We attempted to perform this procedure under duplex ultrasound guidance to reduce the amount of contrast agent administered and to reduce the radiation dose during the interventional procedures. From September 2006 to February 2007, 45 patients received interventional treatment due to malfunctioning hemodialysis access in our hospital. Among the patients, we selected 10 patients diagnosed with stenosis of an autogenous arteriovenous fistula based on a physical examination. There were six males and four females aged 51-78 years (mean age, 59 years). Seven of these patients had a Brescia-Cinimo type fistula and three patients had a basilic vein transposition. All procedures were performed in the angiography suite. All procedures that required angioplasty were performed under duplex ultrasound guidance and then contrast angiography was performed to confirm the final patency of the vessels. Conventional angioplasty was also performed under fluoroscopy guidance for any lesions that required an additional angioplasty. The volume flow before and after the PTA and procedure time were recorded. Clinical success was defined as the performance of one or more successful hemodialysis sessions after treatment. Eight of ten patients did not require an additional angioplasty by conventional angiography after the duplex- guided angioplasty. One case showed recoiling of stenosis after the duplex-guided PTA and another case was missed at duplex scanning due to the extremely short nature of the recoiling of stenosis. The mean volume flow before and after PTA was 167 ml/min (range, 80-259 ml/min) and 394.2 ml/min (range, 120-586 ml/min), respectively. No complications associated with the duplex-guide procedure occurred. In nine cases, PTA enabled hemodialysis to be conducted more than one time. In one

  8. Left pulmonary artery banding to repair ipsilateral diffuse pulmonary arteriovenous fistula

    Directory of Open Access Journals (Sweden)

    Hirata Takuya

    2012-08-01

    Full Text Available Abstract Congenital pulmonary arteriovenous fistula (PAVF is a rare disease which causes hypoxemia by shunting deoxygenated blood from the pulmonary artery into pulmonary venous return. Lung transplantation is the most effective therapy to treat severe, diffuse PAVF. However, the availability of lungs for transplantation is limited in most parts in the world. For patients with diffuse PAVF affecting only one side of the lungs, ipsilateral pulmonary artery banding (PAB is an effective treatment, but not yet standard of care. We report successful treatment of a patient with diffuse left-sided PAVF with PAB. We believe that PAB is an effective therapy for severe unilateral PAVF and may serve as a bridge to lung transplantation.

  9. A dural arteriovenous fistula in cavernous sinus developed from viral meningitis.

    Science.gov (United States)

    Hai, Jian; Zhang, Lin; Wan, Jue-Feng; Su, Shao-Hua; Wang, Fei; Zhang, Gui-Yun

    2011-06-01

    Although hormonal influences, inflammation, trauma, sinus thrombosis, venous hypertension, and congenital origin have been proposed as sources of dural arteriovenous fistulas (DAVFs) in cavernous and sigmoid sinuses, the etiology of these lesions remains controversial. We present a case with a cavernous sinus DAVF developed from viral meningitis which has not been previously described. A 24-year-old male was admitted to our institute because of periorbital pain, decreased vision, pulsatile tinnitus, chemosis, and exophthalmos on the right side after he had suffered viral meningitis four months before. Cerebral angiography demonstrated a cavernous sinus DAVF, which was successfully obliterated with several platinum coils using a transvenous approach. The viral meningitis most likely caused the inflammation, that may be responsible for the occurrence of the cavernous sinus DAVF. Prompt treatment for inflammation may help to prevent the development of DAVFs.

  10. [A case of multiple arteriovenous fistulae in a postphlebitic syndrome of longterm evolution].

    Science.gov (United States)

    Delgado Daza, R; Moga Donadeu, L; Mañosa Bonamich, J; Muncunill Gil, J; Vidal Conde, V

    1992-01-01

    Authors report a case of a 77-years-old man who, after an accident of traffic on 1968, presented a left ileo-femoral deep venous thrombosis. Consequently, the patient suffered and important postphlebitic syndrome, with several varicose packs which were treated by surgical procedure in other centre. During several years, patient presented severe trophic diseases. Seventeen years after the beginning of his pathology, and during an angiologic examination, multiple arteriovenous fistulas at the left ileofemoral area have been shown. An skeletalization was impossible because of the severe ulcerations of the leg; so a left iliac arterial ligature and a Dacron Banding in primitive iliac artery, reducing a 50% the diameter, were made. The postoperative result was excellent, with an spectacular reduction of the fistulous communications and a complete remission of the cutaneous ulcerations.

  11. Endovascular management of sigmoid sinus dural arteriovenous fistula associated with sinus stenosis in an infant.

    Science.gov (United States)

    Cohen, José E; Gomori, John M; Benifla, Moni; Itshayek, Eyal; Moscovici, Samuel

    2013-01-01

    A 4-month-old female presented with a dural arteriovenous fistula (DAVF), which was successfully managed using endovascular techniques. There are very few case series reporting DAVF in infants younger than 12 months and, to our knowledge, only 60 pediatric patients with DAVF have been reported to date. Although most DAVF have a benign course, they can result in life-threatening hemorrhage. Endovascular therapies are usually indicated in the management of these neurosurgical vascular malformations. Endovascular therapy of DAVF in neonatal patients presents some major issues. Gaining arterial access may be problematic in femoral arteries too small for the introduction of a sizeable guiding catheter. The volumes of contrast and infused fluids must be carefully monitored to prevent fluid overload. Radiation exposure should be restricted as far as possible. This report contributes to the limited body of evidence on neonatal DAVF and its endovascular management. Copyright © 2012 Elsevier Ltd. All rights reserved.

  12. Endovascular management of early-onset post-nephrectomy renal arteriovenous fistula: A report of two cases

    Directory of Open Access Journals (Sweden)

    Henghui Yin

    2015-12-01

    Full Text Available Purpose: Here, we report two cases of early-onset post-nephrectomy renal arteriovenous fistula who were successfully managed by implantation of patent ductus arteriosus occluders. Case report: Both patients were female, aged 38 and 36 years. They received left renal nephrectomy 9 and 6 months, respectively, with a complaint of chest congestion and dyspnea before admitting to our center. Computed tomographic angiography revealed a huge arteriovenous fistula of the left renal pedicle with a renal venous aneurysm in both patients. The fistulas were isolated by implanting patent ductus arteriosus occluders in the renal artery stumps. Clinical symptoms disappeared after intervention. Computed tomographic angiography confirmed the effectiveness of the occluders during follow-up time. The venous aneurysms shrank to normal size. Conclusion: Our experience indicates that post-nephrectomy renal arteriovenous fistula can present as an early complication which can be efficiently managed by endovascular occlusion of the arterial stump by patent ductus arteriosus occluder.

  13. Effect of Fish Oil Supplementation and Aspirin Use on Arteriovenous Fistula Failure in Patients Requiring Hemodialysis: A Randomized Clinical Trial.

    Science.gov (United States)

    Irish, Ashley B; Viecelli, Andrea K; Hawley, Carmel M; Hooi, Lai-Seong; Pascoe, Elaine M; Paul-Brent, Peta-Anne; Badve, Sunil V; Mori, Trevor A; Cass, Alan; Kerr, Peter G; Voss, David; Ong, Loke-Meng; Polkinghorne, Kevan R

    2017-02-01

    Vascular access dysfunction is a leading cause of morbidity and mortality in patients requiring hemodialysis. Arteriovenous fistulae are preferred over synthetic grafts and central venous catheters due to superior long-term outcomes and lower health care costs, but increasing their use is limited by early thrombosis and maturation failure. ω-3 Polyunsaturated fatty acids (fish oils) have pleiotropic effects on vascular biology and inflammation and aspirin impairs platelet aggregation, which may reduce access failure. To determine whether fish oil supplementation (primary objective) or aspirin use (secondary objective) is effective in reducing arteriovenous fistula failure. The Omega-3 Fatty Acids (Fish Oils) and Aspirin in Vascular Access Outcomes in Renal Disease (FAVOURED) study was a randomized, double-blind, controlled clinical trial that recruited participants with stage 4 or 5 chronic kidney disease from 2008 to 2014 at 35 dialysis centers in Australia, Malaysia, New Zealand, and the United Kingdom. Participants were observed for 12 months after arteriovenous fistula creation. Participants were randomly allocated to receive fish oil (4 g/d) or matching placebo. A subset (n = 406) was also randomized to receive aspirin (100 mg/d) or matching placebo. Treatment started 1 day prior to surgery and continued for 12 weeks. The primary outcome was fistula failure, a composite of fistula thrombosis and/or abandonment and/or cannulation failure, at 12 months. Secondary outcomes included the individual components of the primary outcome. Of 1415 eligible participants, 567 were randomized (359 [63%] male, 298 [53%] white, 264 [47%] with diabetes; mean [SD] age, 54.8 [14.3] y). The same proportion of fistula failures occurred in the fish oil and placebo arms (128 of 270 [47%] vs 125 of 266 [47%]; relative risk [RR] adjusted for aspirin use, 1.03; 95% CI, 0.86-1.23; P = .78). Fish oil did not reduce fistula thrombosis (60 [22%] vs 61 [23%]; RR, 0.98; 95% CI, 0

  14. Three-dimensional Computational Simulation and In-vitro Experiments for Assessing Radiocephalic Wrist Arteriovenous Fistulas

    Science.gov (United States)

    Song, Ryungeun; Park, Sun Cheol; Kim, Hyun Kyu; Lee, Jinkee

    2016-11-01

    A radio-cephalic arteriovenous fistula (RC-AVF) is the best choice for achieving vascular access (VA) for hemodialysis, but this AVF has high rates of early failure depending on the vessel condition. The high wall shear stress (WSS) contributes to VA failures due to plaque rupture, thrombosis, etc. Thus, we have used a low-Re k- ɛ turbulence based CFD model combined with an in-vitro experimental approach to evaluate the WSS distribution and to minimize its effects under several conditions. The properties considered in this study were non-Newtonian flow characteristics, complete cardiac pulse cycle, and distention of blood vessels. The computational domain was designed for arteriovenous end-to-side anastomosis based on anastomosis angles of 45°, 90°, and 135°. For experiment the digital domains were converted into 3D artificial RC-AVF via poly(dimethylsiloxame) (PDMS) and 3D printing technology. The micro-particle image velocimetry (μ-PIV) was used to measure the velocity field within the artificial blood vessel. The results showed that the largest anastomosis angle (135°) resulted in lower WSS, which would help reduce AVF failures. This research would provide the future possibility of using the proposed method to reduce in-vivo AVF failure for various conditions in each patient.

  15. Preliminary arteriovenous fistula for free-flap reconstruction in the diabetic foot.

    Science.gov (United States)

    Atiyeh, B S; Sfeir, R E; Hussein, M M; Husami, T

    1995-05-01

    We present our experience at the American University of Beirut Medical Center with two diabetic patients suffering from large necrotic and infected foot ulcers. Both patients were ambulatory at the time of presentation despite their extensive wounds and were believed to have a useful limb with adequate protective sensation worth saving. Below-knee amputation was prevented in both cases by successful soft-tissue coverage of the ulcers using microvascular composite-tissue transfer a few days after performing a preliminary arteriovenous fistula with a long vein graft loop. The flap vessels were anastomosed end-to-end to the arterial and venous limbs of the divided arteriovenous loop. This reconstructive technique of difficult diabetic wounds of the lower extremity, though in two stages, may be safer than one long procedure in a high-risk patient. It is technically easier than long interpositional vein grafts at the same time as free-flap transfer or microvascular anastomoses with small and diseased vessels. It definitely provides more chance of success as larger vessels are used to supply the flap. It permits distension of the vein graft at normotensive physiologic pressures and allows testing the arterial anastomosis as well as the venous flow before final flap transfer. Above all, it allows extreme freedom in performing tension-free anastomoses away from the infected wound.

  16. EVALUATION OF THE DIAGNOSTIC CRITERIA FOR THE LOCALIZATION OF ACQUIRED ARTERIOVENOUS FISTULAS BY COLOR DOPPLER FLOW IMAGING

    Institute of Scientific and Technical Information of China (English)

    李建初; 蔡胜; 姜玉新; 张缙熙; 王岩青

    2001-01-01

    Objective. To evaluate the diagnostic criteria for the localization of acquired arteriovenous fistulas (AVFs)by color Doppler flow imaging (CDFI) based on the features of their hemodynamic changes.Methods. The shape and hemodynamic changes of involved vessels which could be helpful to localize thesites of fistulas were studied according to the observation of 10 cases of acquired AVFs.Results. The s tes of the fistulas could be shown by two-dimensional ultrasonography and color flow imagingin 40% and 80% tases, respectively. In all cases, turbulent high-velocity flow was present at the sites of thefistulas, low resistant flow was present in the arteries proximal to the fistulas, and artery-like flow was detected inthe veins.Conclusion. C OFt was accurate for the localization of acquired AVFs, which were mainly localized by theirhemodynamic changes shown by pulse Doppler ultrasound.``

  17. Association between Venous Angioarchitectural Features of Sporadic Brain Arteriovenous Malformations and Intracranial Hemorrhage.

    Science.gov (United States)

    Alexander, M D; Cooke, D L; Nelson, J; Guo, D E; Dowd, C F; Higashida, R T; Halbach, V V; Lawton, M T; Kim, H; Hetts, S W

    2015-05-01

    Intracranial hemorrhage is the most serious outcome for brain arteriovenous malformations. This study examines associations between venous characteristics of these lesions and intracranial hemorrhage. Statistical analysis was performed on a prospectively maintained data base of brain AVMs evaluated at an academic medical center. DSA, CT, and MR imaging studies were evaluated to classify lesion side, drainage pattern, venous stenosis, number of draining veins, venous ectasia, and venous reflux. Logistic regression analyses were performed to identify the association of these angiographic features with intracranial hemorrhage of any age at initial presentation. Exclusively deep drainage (OR, 3.42; 95% CI, 1.87-6.26; P < .001) and a single draining vein (OR, 1.98; 95% CI, 1.26-3.08; P = .002) were associated with hemorrhage, whereas venous ectasia (OR, 0.52; 95% CI, 0.34-0.78; P = .002) was inversely associated with hemorrhage. Analysis of venous characteristics of brain AVMs may help determine their prognosis and thereby identify lesions most appropriate for treatment. © 2015 by American Journal of Neuroradiology.

  18. Association Between Venous Angioarchitectural Features of Sporadic Brain Arteriovenous Malformations and Intracranial Hemorrhage

    Science.gov (United States)

    Alexander, Matthew D.; Cooke, Daniel L.; Nelson, Jeffrey; Guo, Diana E.; Dowd, Christopher F.; Higashida, Randall T.; Halbach, Van V.; Lawton, Michael T.; Kim, Helen; Hetts, Steven W.

    2015-01-01

    Background and Purpose Intracranial hemorrhage is the most serious outcome for brain arteriovenous malformations (AVM). This study examines associations between venous characteristics of these lesions and intracranial hemorrhage. Materials and Methods Statistical analysis was performed on a prospectively maintained database of brain AVMs evaluated at an academic medical center. DSA, CT, and MRI studies were evaluated to classify lesion side, drainage pattern, venous stenosis, number of draining veins, venous ectasia, and venous reflux. Logistic regression analyses were performed to identify association of these angiographic features with intracranial hemorrhage of any age at initial presentation. Results Exclusively deep drainage (OR 3.42, 95% CI 1.87–6.26, p<0.001) and a single draining vein (OR 1.98, 95% CI 1.26–3.08, p=0.002) were associated with hemorrhage, whereas venous ectasia (OR 0.52, 95% CI 0.34–0.78, p=0.002) was inversely associated with hemorrhage. Conclusion Analysis of venous characteristics of brain AVMs may help determine their prognosis and thereby identify lesions most appropriate for treatment. PMID:25634722

  19. Percutaneous treatment of thrombosed native arteriovenous dialysis fistula insufficiency: efficacy of mechanical thrombectomy with using the stone basket

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Young Hwan; Ko, Sung Min; Kim, Mi Jung; Kwon, Jung Hyeok; Sohn, Cheol Ho; Choi, Jin Soo; Park, Kyung Sik [Dongsan Medical Center, Keimyung University College of Medicine, Daegu (Korea, Republic of); Kim, Yong Joo [Andong General Hospital, Andon (Korea, Republic of)

    2006-06-15

    We wanted to evaluate the procedural success after percutaneous treatment of thrombosed native arteriovenous dialysis fistula insufficiency and the efficacy of performing mechanical thrombectomy with using the stone basket. From March 2004 to June 2005, 36 thrombosed native hemodialysis access shunts in the upper limbs (brachiocephalic fistulas: 16 and radiocephalic fistulas: 20) were percutaneously treated in 30 patients. Declotting procedures were performed with using urokinase (100,00-200,000 unit) and manual catheter-directed thrombo-aspiration in all the patients. Angioplasty (6 mm in diameter and 4 cm in length) was performed at the identified area of the stenosis and /or with maceration of the thrombus. In 14 cases with massive thrombosis that was refractory to the above mentioned declotting procedures, mechanical thrombectomy with using a Wittich nitinol stone basket (Cook, Bloomington, IN) was performed. Data regarding the procedural success rate and the patency rate were analyzed by means of Fischer's exact test, and the Kaplan-Meier method with the Log-rank test was used for statistical inter-group comparisons between the brachiocephalic and radiocephalic fistulas. Successful declotting and restoration of thrill were achieved in 30 of 36 procedures (83%). Reestablishment of normal dialysis for at least one session was achieved in 29 of 36 procedures (81%). The procedural success rate for the brachiocephalic fistulas was 94% compared with 70% for the radiocephalic fistulas, but the difference was not statistically significant ({rho} = 0.104). In the cases with performing mechanical thrombectomy and using the stone basket, procedural success was achieved in 93% (13/14). The expected patency rates at 3, 6 and 12 months were 78%, 61% and 51%, respectively. The patency rates after declotting procedures were not significantly different between the brachiocephalic and radiocephlaic fistulas ({rho} = 0.871). Percutaneous treatment of thrombosed native

  20. Surgical treatment of tentorial dural arteriovenous fistulae located around the tentorial incisura.

    Science.gov (United States)

    Hatano, Taketo; Bozinov, Oliver; Burkhardt, Jan-Karl; Bertalanffy, Helmut

    2013-07-01

    Tentorial dural arteriovenous fistulae (DAVF) are relatively uncommon and are the most dangerous type of DAVF. Because of a high incidence of hemorrhage and subsequent neurological deficits, treatment is mandatory. A consecutive series of nine surgically treated patients with symptomatic tentorial DAVF were analyzed in this study. All lesions were located around the tentorial incisura and were treated microsurgically using a subtemporal approach in eight cases and a supracerebellar approach in one case. The dural bases of the lesions were located adjacent to the tentorial edge in six patients and the tentorial apex in three patients. Complete obliteration was achieved in all treated tentorial DAVF. In one patient, the torcular fistula remained untreated without cortical venous reflux. Postoperative asymptomatic temporal lobe hemorrhage was diagnosed in one patient with a tentorial apex DAVF; however, no new neurological symptoms were present after surgical treatment. The subtemporal approach for unilateral tentorial DAVF is a favorable and direct approach for the highly skilled surgeon. Perimesencephalic venous dilatation or varix is an important finding on MRI to help localize tentorial DAVF in the tentorial edge or apex.

  1. Biopsy Induced Arteriovenous Fistula and Venous Stenosis in a Renal Transplant

    Directory of Open Access Journals (Sweden)

    Sridhar R. Allam

    2015-01-01

    Full Text Available Renal transplant vein stenosis is a rare cause of allograft dysfunction. Percutaneous stenting appears to be safe and effective treatment for this condition. A 56-year-old Caucasian female with end stage renal disease received a deceased donor renal transplant. After transplant, her serum creatinine improved to a nadir of 1.2 mg/dL. During the third posttransplant month, her serum creatinine increased to 2.2 mg/dL. Renal transplant biopsy showed BK nephropathy. Mycophenolate was discontinued. Over the next 2 months, her serum creatinine crept up to 6.2 mg/dL. BK viremia improved from 36464 copies/mL to 15398 copies/mL. A renal transplant ultrasound showed lower pole arteriovenous fistula and abnormal waveforms in the renal vein. Carbon dioxide (CO2 angiography demonstrated severe stenosis of the transplant renal vein. Successful coil occlusion of fistula was performed along with angioplasty and deployment of stent in the renal transplant vein. Serum creatinine improved to 1.5 mg/dL after.

  2. Endosurgical repair of an iatrogenic facial arteriovenous fistula due to percutaneous trigeminal balloon rhizotomy.

    Science.gov (United States)

    Lesley, W S

    2007-12-01

    A 56-year-old woman with right-sided trigeminal neuralgia (TN), who underwent technically uneventful percutaneous balloon rhizotomy, developed significant bilateral pulsatile tinnitus on the first post-operative day. Although the patient reported significantly improved neuralgia, auscultation revealed a right facial bruit. Magnetic resonance angiography (MRA) of the face and brain demonstrated prominent right facial and jugular venous vascularity. Catheter angiography confirmed the suspected facial arteriovenous fistula (AVF). A transarterial approach was used to explore the AVF which arose from a laceration of the right internal maxillary artery and which fistulized directly with the pterygoid venous plexus. Endosurgical repair utilizing three non-fibered platinum coils was done under conscious sedation at the same setting as the diagnostic angiogram. Angiographically, the fistula was obliterated, and the patient's bruit and tinnitus immediately resolved. Follow-up MRA at 3.5 months was normal, and, the patient had no clinical symptoms of recurrent AVF. In conclusion facial AVF can complicate percutaneous trigeminal rhizotomy. Iatrogenic facial AVF can be repaired via an endovascular approach.

  3. Retrospective analysis of 271 arteriovenous fistulas as vascular access for hemodialysis

    Directory of Open Access Journals (Sweden)

    P Sahasrabudhe

    2013-01-01

    Full Text Available This report describes our experience of arteriovenous fistula (AVF creation as vascular access for hemodialysis (HD. Study has been carried out in Deenanath Mangeshkar Hospital, Pune from January 2004 to December 2009. A total of 271 AVFs were created in 249 patients. Maximum follow up was 7 years and minimum was 1 year. In this study of 271 cases of AVFs, there were 196 (72.3% successful cases and 75 (27.7% failures. Basilic vein was used in 77 (28.4% cases, cephalic vein in 186 (68.6%, and antecubital vein in 8 (3% cases. End (vein to side (artery anastomosis was done in 170 (63% cases. Side to side anastomosis was done in 100 (37% cases. On table bruit was present in 244 (90% and thrill in 232 (85.6% cases. During dialysis, flow rate >250 ml/min was obtained in 136 (50.4% cases. In complications, 16 (5.9% patients developed distal edema, 32 (11.8% developed steal phenomenon. Presence of on table thrill and bruit are indicators of successful AVF. If vein diameter is <2 mm, chances of AVF failure are high. During proximal side to side fistula between antecubital/basilic vein and brachial artery, breaking of first valve toward wrist helps to develop distal veins in forearm by retrograde flow. This technique avoids requirement of superficialization of basilic vein in arm.

  4. Effect of cryotherapy on arteriovenous fistula puncture-related pain in hemodialysis patients.

    Science.gov (United States)

    P B, Sabitha; Khakha, D C; Mahajan, S; Gupta, S; Agarwal, M; Yadav, S L

    2008-10-01

    Pain during areteriovenous fistula (AVF) cannulation remains a common problem in hemodialysis (HD) patients. This study was undertaken to assess the effect of cryotherapy on pain due to arteriovenous fistula puncture in hemodialysis patients. A convenience sample of 60 patients (30 each in experimental and control groups) who were undergoing hemodialysis by using AVF, was assessed in a randomized control trial. Hemodialysis patients who met the inclusion criteria, were randomly assigned to experimental and control groups using a randomization table. Objective and subjective pain scoring was done on two consecutive days of HD treatment (with cryotherapy for the experimental and without cryotherapy for the control group). The tools used were a questionnaire examining demographic and clinical characteristics, an observation checklist for assessing objective pain behavior, and a numerical rating scale for subjective pain assessment. Descriptive statistics were used as deemed appropriate. Chi square, two-sample and paired t-tests, the Mann Whitney test, Wilcoxon's signed rank test, the Kruskal Wallis test, and Spearman's and Pearson's correlations were used for inferential statistics. We found that the objective and subjective pain scores were found to be significantly (P = 0.001) reduced within the experimental group with the application of cryotherapy. This study highlights the need for adopting alternative therapies such as cryotherapy for effective pain management in hospital settings.

  5. Improvement of Depression after Treatment of Dural Arteriovenous Fistula: A Case Report and a Review

    Directory of Open Access Journals (Sweden)

    Minoru Nakagawa

    2012-01-01

    the treatment of a dural arteriovenous fistula in the left transverse-sigmoid sinus. A 46-year-old male had suffered from depression and was treated with antidepressants at a local hospital for four years. The patient was temporarily laid off due to his depression. Afterwards, he had Gerstmann's syndrome and came to our hospital. A DAVF in the left transverse-sigmoid sinus was demonstrated on the angiogram. The DAVF was successfully treated with endovascular surgery, coil embolization of the isolated diseased sinus through the mastoid emissary vein which was a draining vein from the fistula. After this treatment, his depression as well as Gerstmann's syndrome was improved and the quantity of the antidepressants decreased. The patient returned to work without any antidepressant two years after the treatment. DAVFs might be one of the causes of depression. It may be necessary to evaluate cerebral vessels in patients suffering from depression by using MRA or 3D-CTA even if there are not any abnormal findings on plain CT scans.

  6. Fístula arteriovenosa pós-nefrolitotripsia percutânea Arteriovenous fistula after percutaneous nephrolithotomy

    Directory of Open Access Journals (Sweden)

    Luis Alberto Batista Peres

    2009-09-01

    Full Text Available Fístula arteriovenosa (FAV é uma rara complicação pós-nefrolitotripsia percutânea (NLP. Apresentamos o caso de um paciente de 70 anos, sexo masculino, que apresentou sangramento maciço após NLP, tratado por angioembolização renal superseletiva com implante de stent. Após a embolização, houve resolução do sangramento. FAV é uma complicação incomum da NLP, que pode ser tratada com sucesso com angioembolização.Arteriovenous fistula (AVF is a rare complication of percutaneous nephrolithotomy (PNL. We report the case of a 70-year-old man, who had massive bleeding after PNL and underwent treatment with superselective renal angiographic embolization and stent implantation. Bleeding resolved after embolization. Arteriovenous fistula is an uncommon complication of PNL, which may be successfully treated with angiographic embolization.

  7. Therapeutic clues in spinal dural arteriovenous fistulas - a 30 year experience of 156 cases.

    Science.gov (United States)

    Hessler, C; Regelsberger, J; Grzyska, U; Illies, T; Zeumer, H; Westphal, M

    2010-02-01

    Spinal dural arteriovenous fistulae (SDAVF) are rare but remain the most common type of spinal vascular malformations. Treatment options for SDAVF include endovascular embolization, microsurgical dissection or a combination of both. But the optimal treatment paradigm has yet to be defined and may well be an individualized interdisciplinary combinatorial approach. From 1980 to 2008, 156 patients with the diagnosis of SDAVF were treated by neuroradiological and neurosurgical means. Based on the procedure-related complications we retrospectively analyzed our data to elucidate the reasons for endovascular failure and the evolution of the surgical technique. 156 patients were included in this study. There were 31 (19.9%) female and 125 (80.1%) male patients. Average age at the time of diagnosis was 60.8 years. 102 out of 156 (65.4%) underwent endovascular obliteration, 54 (34.6%) patients were treated primarily by surgery. 134 (85.9%) underwent follow-up examination. A total of 29 (18.6%) out of 156 patients could not be treated successfully by endovascular (9.4%) or surgical (4.1%) means. Microsurgery can be recommended as the first choice treatment when the fistula's point is unmistakably identified intradurally. Endovascular obliteration may be justifiable in cases with an easy access to a monoradicular feeding artery during diagnostic angiography. Surgery is a definitive treatment with stable long-term results in which procedure-related morbidity is low. During evolution of the combined approach, endovascular coil placement for correct localization of the fistula and the use of intraoperative micro-Doppler was found to be very helpful in increasing the safety of the surgical procedure and minimizing surgical exposure. Georg Thieme Verlag KG Stuttgart * New York.

  8. Embolization of Brain Aneurysms and Fistulas

    Science.gov (United States)

    ... Z Embolization of Brain Aneurysms and Arteriovenous Malformations/Fistulas Embolization of brain aneurysms and arteriovenous malformations (AVM) ... Fistulas? What is Embolization of Brain Aneurysms and Fistulas? Embolization of brain aneurysms and arteriovenous malformations (AVM)/ ...

  9. ASSESSMENT OF FACTORS INFLUENCING ADEQUACY OF NATIV E ARTERIOVENOUS FISTULA FOR LONG TERM VENOUS ACCESS I N HEMODIALYSIS PATIENTS

    OpenAIRE

    Shahid; Sharad; Riaz

    2013-01-01

    ABSTRACT: OBJECTIVE :-The aim of our study was to assess the factors af fecting adequacy of arteriovenous fistula (AVF) and to correlate it wit h clinical and demographic factors. MATERIAL AND METHODS: The prospectively designed study was conducted to det ermine adequacy of AVF in 130 patients over a period of tw o years. Adequacy of AVF was graded if the blood flow rate was higher or equal to 300 ml/ min on at least fifty percent of dialysis sessions in on...

  10. Atypical inguinal malignant peripheral nerve sheath tumour with arteriovenous fistula of the left femoral nerve in a child

    Energy Technology Data Exchange (ETDEWEB)

    Melloni, Pietro; Veintemillas, Maite [Corporacio Sanitaria Parc Tauli, Unitat de Diagnostic per Imatge d' Alta Tecnologia, Barcelona (Spain); Olsina, Gustavo; Oliva, Eulalia; Garcia-Continente, Gemma [Capio Hospital General de Catalunya, Servei de Diagnostic per la Imatge, Barcelona (Spain); Garcia-Hernandez, Felip [Capio Hospital General de Catalunya, Servei de Anatomia Patalogica, Barcelona (Spain)

    2008-07-15

    We report a 9-year-old girl who developed a malignant peripheral nerve sheath tumour (MPNST) with an arteriovenous fistula arising from the left femoral nerve and adjacent to the iliofemoral vessels in the ipsilateral groin, but without infiltrating them. We describe the MRI and MRA findings. Although MPNST is relatively well known and widely studied, the location of this mass is unique in a child. The mass was surgically removed. (orig.)

  11. Transvenous Coil Embolization for Dural Arteriovenous Fistulas of the Ophthalmic Sheath: Report of Two Cases and Review of the Literature

    Science.gov (United States)

    Hwang, Juyoung; Jo, Kyung-Il; Yeon, Je Young; Hong, Seung-Chyul

    2016-01-01

    We present two patients with a dural arteriovenous fistula (dAVF) of the ophthalmic sheath who developed progressive exophthalmos, conjunctival chemosis, and visual loss. These symptoms mimic those of cavernous sinus dAVFs. Dural AVFs of the ophthalmic sheath are extremely rare and their clinical management is controversial. We successfully treated these two patients by transvenous coil embolization. Transvenous embolization appears to be a safe and effective method to treat dAVFs of the ophthalmic sheath.

  12. Spontaneous intracranial hemorrhage in children – ruptured lobar arteriovenous malformations: report of two cases

    Directory of Open Access Journals (Sweden)

    Tascu A.

    2015-03-01

    Full Text Available Brain arteriovenous malformations (AVMs are lesions thought to be primarily congenital in origin, consisting of fistulous connections of abnormal arteries and veins, without normal intervening capillary beds and no cerebral parenchyma between vessels. In the pediatric population, AVMs represent the most common cause of spontaneous intracranial hemorrhage (ICH, with a high recurrent bleeding risk. The aim of this paper is to report 2 cases of ruptured lobar AVMs in children, presenting with spontaneous ICH. Due to the patients’ neurological status, the only imaging examination performed preoperatively was a CT scan, showing intraparenchymal hemorrhage. Thus, there was no MRI/angiographic examination to prove the existence of a brain AVM prior to the surgical interventions. Also, the cerebral angiography performed after the surgery showed, in both patients, no signs of residual vascular malformations. Therefore, the diagnosis of AVM was certified by macroscopic and microscopic pathological findings, with no brain imaging suggestive of a vascular malformation.

  13. Clinical-radiological evaluation of sequelae of stereotactic radiosurgery for intracranial arteriovenous malformations

    Energy Technology Data Exchange (ETDEWEB)

    Levy, R.P.; Fabrikant, J.I.; Frankel, K.A.; Phillips, M.H.; Steinberg, G.K.; Marks, M.P.; DeLaPaz, R.L.; Chuang, F.Y.S.

    1989-12-01

    Stereotactic heavy-charged-particle Bragg peak radiosurgery has been used to treat 322 patients with surgically-inaccessible intracranial vascular malformations. (The clinical results of this method for the treatment of angiographically demonstrable arteriovenous malformations (AVMs) and angiographically occult vascular malformations (AOVMs) of the brain are described in separate reports of this symposium). The great majority of patients have had an uneventful post-treatment course with satisfactory health outcomes. However, several categories of delayed sequelae of stereotactic radiosurgery have been identified, involving the vascular structures essential for the integrity of the brain tissue and the brain parenchyma directly. These categories reflect both reaction to injury and to alterations in regional hemodynamic status, and include vasogenic edema, occlusion of functional vasculature, radiation necrosis, and local or remote effects on cerebral arterial aneurysms. 10 refs., 7 figs., 1 tab.

  14. Intraparenchymal Renal Artery Pseudoaneurysm and Arteriovenous Fistula on a Solitary Kidney Occurring 38 Years after Blunt Trauma

    Science.gov (United States)

    Hammer, Frank; Tombal, Bertrand

    2017-01-01

    Pseudoaneurysm and arteriovenous fistulae of the renal artery are rare complications of kidney trauma. They commonly result from open traumas and occur within days after the injury. Common symptoms include acute haematuria, pain, or hypertension. We report the case of a fifty-three-year-old man presenting with symptomatic complex chronic high flow kidney arteriovenous fistula with interposition of a pseudoaneurysmal pouch and arterial aneurysmal dilatation in a solitary left kidney 38 years after a blunt trauma. Those conditions were successfully treated by endovascular embolization followed by regular radiologic, biological, and clinical follow-up. To the best of our knowledge, few similar cases were reported more than 20 years after trauma. However, no case combining an arteriovenous fistula and a pseudoaneurysm revealing as late as 38 years after trauma was found. In addition, management of those conditions on a solitary kidney and outcomes has not been described. We believe that our case depicts the clinical presentation and management of this rare entity that should not be unrecognized due to its potential lethal implications.

  15. Patients started on hemodialysis with tunneled dialysis catheter have similar survival after arteriovenous fistula and arteriovenous graft creation.

    Science.gov (United States)

    Yuo, Theodore H; Chaer, Rabih A; Dillavou, Ellen D; Leers, Steven A; Makaroun, Michel S

    2015-12-01

    Current guidelines suggest that arteriovenous fistula (AVF) is associated with survival advantage over arteriovenous graft (AVG). However, AVFs often require months to become functional, increasing tunneled dialysis catheter (TDC) use, which can erode the benefit of an AVF. We sought to compare survival in patients with end-stage renal disease after creation of an AVF or AVG in patients starting hemodialysis (HD) with a TDC and to identify patient populations that may benefit from preferential use of AVG over AVF. Using U.S. Renal Data System databases, we identified incident HD patients in 2005 through 2008 and observed them through 2008. Initial access type and clinical variables including albumin levels were assessed using U.S. Renal Data System data collection forms. Attempts at AVF and AVG creation in patients who started HD through a TDC were identified by Current Procedural Terminology codes. We accounted for the effect of changes in access type by truncating follow-up when an additional AVF or AVG was performed. Survival curves were then constructed, and log-rank tests were used for pairwise survival comparisons, stratified by age. Multivariate analysis was performed with Cox proportional hazards regressions; variables were chosen using stepwise elimination. An interaction of access type and albumin level was detected, and Cox models using differing thresholds for albumin level were constructed. The primary outcome was survival. Among the 138,245 patients who started with a TDC and had complete records amenable for analysis, 22.8% underwent AVF creation (mean age ± standard deviation, 68.9 ± 12.5 years; 27.8% mortality at 1 year) and 7.6% underwent AVG placement (70.2 ± 12.0 years; 28.2% mortality) within 3 months of HD initiation; 69.6% remained with a TDC (63.2 ± 15.4 years; 33.8% mortality). In adjusted Cox proportional hazards regression, AVF creation is equivalent to AVG placement in terms of survival (hazard ratio [HR], 0.98; 95% confidence

  16. Effects of wall shear stress in venous neointimal hyperplasia of arteriovenous fistulae.

    Science.gov (United States)

    Jia, Lan; Wang, Lihua; Wei, Fang; Yu, Haibo; Dong, Hongye; Wang, Bo; Lu, Zhi; Sun, Guijiang; Chen, Haiyan; Meng, Jia; Li, Bo; Zhang, Ruining; Bi, Xueqing; Wang, Zhe; Pang, Haiyan; Jiang, Aili

    2015-05-01

    An arteriovenous fistulae (AVF) is the preferred vascular access for maintenance haemodialysis patients. Its dysfunction is often due to venous stenosis, which is mainly caused by neointimal hyperplasia. Additionally, haemodynamic forces, especially wall shear stress (WSS), as a mechanical stimuli to venous wall have a significant role in neointimal hyperplasia. The purpose of this study was to evaluate the association between WSS and neointimal hyperplasia. An 'end-to-side' AVF was created between the right femoral artery and vein of canines. Canines were killed at 7 and 28 days post-surgery. The velocity and WSS in the three-dimensional computational model of AVF were simulated using computational fluid dynamics (CFDs). The four typical sites of the vein evaluated in this study, chosen according to the haemodynamic analysis, included the arteriovenous anastomosis (A-V), the juxta-anastomotic segment (J-V), the juxta-ligation segment (L-V) and the proximal vein (P-V). The specimens were haematoxylin-eosin stained and the intima-media thickening was then measured. Neointimal hyperplasia was more obvious in the inner wall of the J-V and L-V (low-and-disturbed WSS) sites compared with the P-V and A-V sites, and the outer wall of the L-V and J-V segments (high or laminar WSS) (P hyperplasia predisposed to occur in the inner wall of venous segment near the anastomosis. We also found that not only the neointimal hyperplasia has a strong inverse correlation with WSS levels, but also is related to flow patterns. © 2015 Asian Pacific Society of Nephrology.

  17. Endovascular recanalization of a thrombosed native arteriovenous fistula complicated with an aneurysm: Technical aspects and outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Ahn, Su Yeon [Dept. of Radiology, Seoul National University Hospital, College of Medicine, Seoul National University, Seoul (Korea, Republic of); So, Young Ho; Choi, Young Ho; Jung, In Mok; Chung, Jung Kee [Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul (Korea, Republic of)

    2015-04-15

    To evaluate the technical aspects and outcomes of endovascular recanalization of a thrombosed native arteriovenous fistula (AVF) complicated with an aneurysm. Sixteen patients who had a thrombosed AVF complicated with an aneurysm (two radiocephalic and 14 brachiocephalic) were included in this study. Recanalization procedures were performed by mechanical thrombectomy using the Arrow-Trerotola percutaneous thrombectomy device and adjunctive treatments. We evaluated dose of thrombolytic agent, underlying stenosis, procedure time, technical and clinical success, and complications. The primary and secondary patency rates were calculated using the Kaplan-Meier analysis. The thrombolytic agents used were 100000 U urokinase mixed with 500 IU heparin (n = 10) or a double dose of the mixture (n = 6). The thrombi in aneurysms were removed in all but two patients with non-flow limiting residual thrombi. One recanalization failure occurred due to a device failure. Aspiration thrombectomy was performed in 87.5% of cases (n = 14). Underlying stenoses were found in the outflow draining vein (n = 16), arteriovenous anastomosis or juxtaanastomosis area (n = 5), and the central vein (n = 3). Balloon angioplasty was performed for all stenoses in 15 patients. Two patients with a symptomatic central vein stenosis underwent insertion of a stent after balloon angioplasty. Mean procedure time was 116.3 minutes. Minor extravasation (n = 1) was resolved by manual compression. Both technical and clinical success rates were 93.8% (n = 15). The primary patency rates at 3, 6, and 12 months were 70.5%, 54.8%, and 31.3%, respectively. The secondary patency rates at 3, 6, and 12 months were 70.5%, 70.5%, and 47.0%, respectively. Thrombosed AVF complicated with an aneurysm can be successfully recanalized, and secondary patency can be prolonged with endovascular treatment.

  18. Clinical and angioarchitectural factors influencing the endovascular approach to galenic dural arteriovenous fistulas in adults: case series and review of the literature.

    Science.gov (United States)

    Cohen, José E; Gomori, John Moshe; Rajz, Gustavo; Paldor, Iddo; Moscovici, Samuel; Itshayek, Eyal

    2017-05-01

    Galenic dural arteriovenous fistulas (DAVF) are rare; however, they are the most frequent type of DAVF to manifest aggressive clinical behavior and usually represent a diagnostic and therapeutic challenge for clinicians. We retrospectively reviewed clinical and imaging data of patients managed with neuroendovascular techniques for the treatment of galenic DAVFs from 2000 to 2016. We searched the 2000-2016 English-language literature for papers discussing neuroendovascular management of galenic DAVFs, with or without companion surgical procedures. Five patients were treated for galenic DAVFs during the study period (four males; mean age, 61 years). Three presented with progressive neurological deterioration due to venous congestion, two with acute intracranial hemorrhage. Three were treated by staged transarterial embolization procedures (three procedures in two, four procedures in one); two underwent a single transvenous embolization procedure. Four out of five fistulas were completely occluded. All patients improved clinically; the patient whose fistula was partially occluded remains angiographically stable at 2-year follow-up. Six reports describing 17 patients are reviewed. Embolization was performed via transvenous approach in 1/17 and transarterial approach in 16/17 with additional open surgery in 9/16. The trend toward the use of transarterial approaches is based primarily on advances on embolization techniques that allow better and more controllable penetration of the embolizing agents with improved clinical and angiographic results, as well as the technical complexity of the transvenous approach. Although transarterial embolization is the preferred endovascular route for the management of most galenic DAVFs, selected cases can be successfully treated by transvenous approach.

  19. Percutaneous transluminal angioplasty of malfunctioning Brescia-Cimino arteriovenous fistula: analysis of factors adversely affecting long-term patency.

    Science.gov (United States)

    Sugimoto, Koji; Higashino, Takanori; Kuwata, Yoichiro; Imanaka, Kazufumi; Hirota, Shozo; Sugimura, Kazuro

    2003-07-01

    Our objective was to identify the factors adversely affecting long-term patency after percutaneous transluminal angioplasty (PTA) for hemodialysis Brescia-Cimino arteriovenous fistulas. Between November 1995 and March 2000, 91 PTA procedures were performed on 50 patients with 57 Brescia-Cimino fistulas. A retrospective study based on the chart review was performed. The initial technical success rate for all procedures and the primary and secondary patency rates for all fistulas were calculated. Regarding fistulas successfully maintained by the primary PTA, the primary and secondary patency rates were compared using the Kaplan-Meier method between two patient groups. They were classified on the basis of several factors, including age (older, over 70 years, and younger group), age of the fistulas (older, over 6 months, and younger group), with or without diabetes mellitus (DM), solitary or multiple lesions, long or short segment lesion, stenosis or occlusion, and with or without arterial and/or anastomotic lesions. Initial technical success rates for all procedures and fistulas were 91.2 and 89.5%, respectively. Cumulative primary and secondary patency rates at 1 year were 47.3 and 67.3%, respectively. In the comparative study, the secondary patency rate for the older group was lower than that of the younger group with statistical significance ( p=0.029). The higher age is the only factor that reduces the long-term patency rate after PTA.

  20. Percutaneous transluminal angioplasty of malfunctioning Brescia-Cimino arteriovenous fistula: analysis of factors adversely affecting long-term patency

    Energy Technology Data Exchange (ETDEWEB)

    Sugimoto, Koji; Hirota, Shozo; Sugimura, Kazuro [Department of Radiology, Kobe University School of Medicine, 7-5-2 Kusunoki-cho, Chuo-Ku, 650-0017, Kobe (Japan); Higashino, Takanori; Kuwata, Yoichiro; Imanaka, Kazufumi [Department of Radiology, Nishi-Kobe Medical Center, 5-7-1 Koji-dai, Nishi-ku, 651-2273, Kobe (Japan)

    2003-07-01

    Our objective was to identify the factors adversely affecting long-term patency after percutaneous transluminal angioplasty (PTA) for hemodialysis Brescia-Cimino arteriovenous fistulas. Between November 1995 and March 2000, 91 PTA procedures were performed on 50 patients with 57 Brescia-Cimino fistulas. A retrospective study based on the chart review was performed. The initial technical success rate for all procedures and the primary and secondary patency rates for all fistulas were calculated. Regarding fistulas successfully maintained by the primary PTA, the primary and secondary patency rates were compared using the Kaplan-Meier method between two patient groups. They were classified on the basis of several factors, including age (older, over 70 years, and younger group), age of the fistulas (older, over 6 months, and younger group), with or without diabetes mellitus (DM), solitary or multiple lesions, long or short segment lesion, stenosis or occlusion, and with or without arterial and/or anastomotic lesions. Initial technical success rates for all procedures and fistulas were 91.2 and 89.5%, respectively. Cumulative primary and secondary patency rates at 1 year were 47.3 and 67.3%, respectively. In the comparative study, the secondary patency rate for the older group was lower than that of the younger group with statistical significance (p =0.029). The higher age is the only factor that reduces the long-term patency rate after PTA. (orig.)

  1. Traumatic arteriovenous fistula due to an old gunshot injury: a victim from the Afghanistan War.

    Science.gov (United States)

    Dabbagh, Ali; Mar'ashi, Ali S; Malek, Bahman

    2007-10-01

    A 75-year-old man referred to the outpatient vascular surgery clinic of Taleghani Hospital (Shaheed Beheshti University of Medicine, Tehran, Iran) due to a local nontender mass in his groin. In his history, it was discovered that the mass had appeared a few months after a gunshot injury. He had a history of shortness of breath with a New York Heart Association functional class fluctuating between II and III, but no history of smoking or addiction. In the physical examination, a 5-cm by 5-cm nonpulsatile mass with engorged vessels was found in the anterior portion of the left groin, which was not tender. An elective arterial angiography revealed an arteriovenous fistula joining the femoral artery to the femoral vein at the left groin. The cardiac assessments revealed cor pulmonale (with a restrictive pattern and diastolic dysfunction) and pulmonary hypertension due to primary pulmonary dysfunction. The patient was anesthetized with a balanced general anesthesia method, considering all relevant cardiac and respiratory monitoring methods and specially withholding drugs increasing pulmonary vascular bed pressure, suppressing the myocardium, or increasing the regurgitant flow across the mitral and, especially, the tricuspid valve. The moment the fistula was closed, a rapid fall in the patient's heart rate was noted, from approximately 60 beats per minute to above 40 beats per minute; this decreased heart rate continued up to a few hours after the surgery and did not accompany any significant hemodynamic derangement including the patient's blood pressure. The patient received his postoperative care in the ordinary surgical ward and was discharged a few days later.

  2. Management of post-biopsy renal allograft arteriovenous fistulas with selective arterial embolization: immediate and long-term outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Loffroy, R. [Department of Diagnostic and Interventional Radiology, University of Dijon School of Medicine, Bocage Teaching Hospital, Dijon (France)], E-mail: loffroy.romaric@neuf.fr; Guiu, B.; Lambert, A. [Department of Diagnostic and Interventional Radiology, University of Dijon School of Medicine, Bocage Teaching Hospital, Dijon (France); Mousson, C.; Tanter, Y. [Department of Nephrology and Renal Transplantation (France); Martin, L. [Department of Pathology, University of Dijon School of Medicine, Bocage Teaching Hospital, Dijon (France); Cercueil, J.-P.; Krause, D. [Department of Diagnostic and Interventional Radiology, University of Dijon School of Medicine, Bocage Teaching Hospital, Dijon (France)

    2008-06-15

    Aim: To evaluate the outcomes after transcatheter embolization of percutaneous biopsy-related arteriovenous fistulas in renal allografts. Materials and methods: All post-biopsy renal-transplant vascular injuries referred for embolization between June 1999 and October 2006 were reviewed retrospectively. There were six male and six female patients with a mean age of 49.8 years (range 25-67 years); nine patients were symptomatic, three asymptomatic. Colour Doppler ultrasound (CDUS) and angiography showed one intra-renal arteriovenous fistula in 10 patients and two in two patients, combined with a pseudoaneurysm in six patients. Superselective embolization using a single catheter or coaxial microcatheter was performed with 0.035'' coils or 0.018''microcoils, respectively, in all 12 cases. 24-h creatinine clearance values before (the day of biopsy) and after (7-14 days; 3 months) the procedure were compared using the Wilcoxon signed-rank test. Physical examination and CDUS were performed after 1, 6, and 12 months, and yearly thereafter. Mean follow-up was 33.6 months. Results: Complete definitive occlusion of the fistula was achieved consistently with a single procedure. No procedure-related complications occurred. Renal infarction was minor in all patients (0-10% in nine and 10-20% in three). Symptoms resolved completely. Creatinine clearance values obtained before and after embolization were not statistically different (p = 0.168;.889 respectively). No late recurrences were reported. Conclusion: Transcatheter embolization with coaxial or single-catheter techniques was effective and safe for treating post-biopsy arteriovenous fistulas in renal transplants. The loss of renal parenchyma was minimal and no mid-term deterioration of allograft function was noted. The long-term survival of the renal allograft seemed to be not affected by embolization.

  3. Comparison of dynamic contrast-enhanced 3T MR and 64-row multidetector CT angiography for the localization of spinal dural arteriovenous fistulas.

    Science.gov (United States)

    Oda, S; Utsunomiya, D; Hirai, T; Kai, Y; Ohmori, Y; Shigematsu, Y; Iryo, Y; Uetani, H; Azuma, M; Yamashita, Y

    2014-02-01

    For the localization of spinal dural arteriovenous fistulas, it is not determined whether dynamic contrast-enhanced MRA is more reliable than multidetector CTA. The aim of this study was to compare the agreement between intra-arterial DSA, dynamic contrast-enhanced MRA at 3T, and 64-row multidetector CTA for the localization of spinal dural arteriovenous fistulas. We enrolled 12 consecutive patients (11 men, 1 woman; age range, 46-83 years; mean, 65 years) who underwent preoperative dynamic contrast-enhanced MRA at 3T and 64-row multidetector CTA. The spinal dural arteriovenous fistula location was confirmed by intra-arterial DSA as the reference standard. Two reviewers independently evaluated the level of the artery feeding the spinal dural arteriovenous fistula on the basis of continuity between the feeder and abnormal spinal vessels on 3T dynamic contrast-enhanced MRA and 64-row multidetector CTA images. Interobserver and intermodality agreement was determined by calculation of the κ coefficient. On DSA, the vessel feeding the spinal dural arteriovenous fistula was the intercostal artery (7 cases), the lumbar artery (3 cases), and the internal iliac artery or the ascending pharyngeal artery (1 case each). For the fistula level, interobserver agreement was excellent for 3T dynamic contrast-enhanced MRA (κ = 0.97; 95% CI, 0.92-1.00) and very good for 64-row multidetector CTA (κ = 0.84; 95% CI, 0.72-0.96). Intermodality agreement with DSA was good for 3T dynamic contrast-enhanced MRA (κ = 0.78; 95% CI, 0.49-1.00) and moderate for 64-row multidetector CTA (κ = 0.41; 95% CI, 0.020-0.84). For the localization of spinal dural arteriovenous fistulas, 3T dynamic contrast-enhanced MRA may be more reliable than 64-row multidetector CTA.

  4. Recovery of opthalmoplegia associated with cavernous sinus dural arteriovenous fistulas after transvenous cavernous sinus packing

    Energy Technology Data Exchange (ETDEWEB)

    Lv Xianli; Jiang Chuhan; Li Youxiang; Yang Xinjian [Beijing Neurosurgical institute, Beijing Tiantan Hospital, Capital Medical University, 6, Tiantan Xili, Chongwen, Beijing (China); Wu Zhongxue, E-mail: ttyyzjb@sina.co [Beijing Neurosurgical institute, Beijing Tiantan Hospital, Capital Medical University, 6, Tiantan Xili, Chongwen, Beijing (China)

    2010-08-15

    Background: We report the recovery of ophthalmoplegia in 11 patients with cavernous sinus dural arteriovenous fistula (CSDAVF) after sinus packing at follow-up. Methods: Of 18 patients with CSDAVF treated with transvenous cavernous sinus packing between August 2002 and December 2007 at Beijing Tiantan Hospital, there were 9 patients with initial CNIII or CNVI dysfunction and 2 patients with CNVI dysfunction immediately after cavernous sinus packing selected and reevaluated. Results: Of 11 patients with CNIII or CNVI palsy, recovery was complete in 10. In 1 patient, complete CNVI palsy was unchanged because the CSDAVF was not cured. There were 6 men and 5 women with a mean age of 52.9 years. In 5 patients, CNVI palsy was associated with chemosis, proptosis and pulsatile tinnitus. Timing of treatment after onset of symptoms was from 4 to 35 days in 9 patients. All CSDAVFs were Barrow type D. Mean follow-up after treatment was 17.7 months (range, 2-54 months). Conclusion: CSDAVF-induced CNIII or CNVI palsies can be cured after cavernous sinus packing transvenously in most patients.

  5. Unusual MRI findings of dural arteriovenous fistula: Isolated perfusion lesions mimicking TIA

    Directory of Open Access Journals (Sweden)

    Kim Yong-Won

    2012-08-01

    Full Text Available Abstract Background The diagnosis of transient ischemic attack (TIA based on clinical history and objective findings, even including multiparametric MRI, can be misleading. We report two patients who presented with TIA-like deficits with isolated perfusion lesions in corresponding areas but were finally diagnosed as transient neurological symptoms associated with dural arteriovenous fistula (dAVF. Case presentation Two patients presented with transient focal neurological symptoms lasting less than one hour. An isolated perfusion deficit with no diffusion change in the clinically relevant area was shown on brain MRI, indicating transient ischemia as the most plausible cause of neurological symptoms. However, cerebral angiography let to diagnosis of dAVF in both cases. Intracerebral hemorrhage occurred after the initial diagnosis of TIA in one patient, and the small area of perfusion abnormality accompanied by the enlarged cortical vein in the other case helped to identify the dAVF through the further investigation. The pattern of perfusion-weighted imaging in both cases revealed increase of mean transit time and relative cerebral blood volume denoting the venous congestion in a clinically corresponding area. Conclusion Reported cases are uncommon clinical presentation of a dAVF, which can be misdiagnosed as TIA on clinical grounds. In rare cases, the isolated perfusion deficits could be attributable to venous congestion, despite the similar pattern of clinical presentation, such as with TIA.

  6. Superior cerebellar artery infarction in endovascular treatment for tentorial dural arteriovenous fistulas

    Energy Technology Data Exchange (ETDEWEB)

    Zhang Jingbo; Lv Xianli; Jiang Chuhan; Li Youxiang [Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, 6, Tiantan, Xili, Chongwen, 100050, Beijing (China); Wu Zhongxue, E-mail: ttyyzjb@sina.co [Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, 6, Tiantan, Xili, Chongwen, 100050, Beijing (China)

    2010-06-15

    Background: Superior cerebellar artery (SCA) syndrome shows ipsilateral cerebellar ataxia and Horner's syndrome, contralateral superficial sensory disturbance, as well as nystagmus toward the impaired side, vertigo, and nausea. Occasionally, unilateral lesions may produce bilateral hypogeusia and contralateral hypoacusia. Objective: To report 2 patients with unilateral lower midbrain ischemic lesions of the inferior colliculus level caused by transarterial embolization for tentorial dural arteriovenous fistulas (TDAVFs). Methods: Hospital records for 21 patients with TDAVFs mainly treated by endovascular techniques between 2005 and 2008 were reviewed. Two patients with MRI evidence of unilateral SCA territory infarction were investigated. Results: Of 21 patients, 2 treated transarterially with Onyx-18 (a nonahesive liquid embolic agent) developed infarctions in the territory of SCA. One patient had lateral SCA infarction characterized by ipsilateral gait ataxia, contralateral hemihypoesthesia, with additional ipsilateral ocular motor palsy and bilateral gustatory loss. And the other patient had medial SCA infarction characterized by ipsilateral ataxia contralateral hemihypoesthesia with additional contralateral hypoacusia. Conclusion: SCA infarction can be caused by transarterial injection of Onyx-18 via SCA or the posterior cerebral artery (PCA) for TDAVFs and additionally presented with gustatory loss and deafness, which is generally not a feature of the SCA syndrome.

  7. Right Ventricular Enlargement within Months of Arteriovenous Fistula Creation in 2 Hemodialysis Patients.

    Science.gov (United States)

    Ragupathi, Loheetha; Johnson, Drew; Marhefka, Gregary D

    2016-08-01

    Surgically created arteriovenous fistulae (AVF) for hemodialysis can contribute to hemodynamic changes. We describe the cases of 2 male patients in whom new right ventricular enlargement developed after an AVF was created for hemodialysis. Patient 1 sustained high-output heart failure solely attributable to the AVF. After AVF banding and subsequent ligation, his heart failure and right ventricular enlargement resolved. In Patient 2, the AVF contributed to new-onset right ventricular enlargement, heart failure, and ascites. His severe pulmonary hypertension was caused by diastolic heart failure, diabetes mellitus, and obstructive sleep apnea. His right ventricular enlargement and heart failure symptoms did not improve after AVF ligation. We think that our report is the first to specifically correlate the echocardiographic finding of right ventricular enlargement with AVF sequelae. Clinicians who treat end-stage renal disease patients should be aware of this potential sequela of AVF creation, particularly in the upper arm. We recommend obtaining preoperative echocardiograms in all patients who will undergo upper-arm AVF creation, so that comparisons can be made postoperatively. Alternative consideration should be given to creating the AVF in the radial artery, because of less shunting and therefore less potential for right-sided heart failure and pulmonary hypertension. A multidisciplinary approach is optimal when selecting patients for AVF banding or ligation.

  8. Collaborative Approach to the Creation of an Arteriovenous Fistula on a US Navy Hospital Ship.

    Science.gov (United States)

    Thompson, Kimberly A; Krishnan, Amrish; Stehman, Charles; Hanling, Steven; Casey, Kevin

    2017-04-01

    Early creation of arteriovenous fistulas (AVFs) decreases morbidity and mortality in patients with end-stage renal disease and is the standard of care in the United States. However, this procedure is frequently not accessible in low- and middle-income countries (LMICs). We present the first reported case of successful AVF creation as part of a humanitarian assistance mission. The patient was a 51-year-old male with diabetes, hypertension, and end-stage renal disease on hemodialysis via a temporary dialysis catheter. Preoperative assessment and patient selection were coordinated with the host nation (HN) nephrologist and dialysis team. The visiting surgical team provided education on AVF anatomy, complications, and cannulation techniques to the HN dialysis team. A left brachiocephalic AVF was created under regional anesthesia performed by the visiting surgeon and anesthesiologists. There were no postoperative complications, and the AVF was matured and accessed successfully by the HN dialysis team 7 weeks after creation. Performing AVFs as part of humanitarian assistance missions has the potential to significantly reduce morbidity and mortality in LMICs.

  9. Endovascular treatment of post-laparoscopic pancreatectomy splenic arteriovenous fistula with splenic vein aneurysm.

    Science.gov (United States)

    Ueda, Tatsuo; Murata, Satoru; Yamamoto, Akira; Tamai, Jin; Kobayashi, Yuko; Hiranuma, Chiaki; Yoshida, Hiroshi; Kumita, Shin-Ichiro

    2015-07-01

    Splenic arteriovenous fistulas (SAVFs) with splenic vein aneurysms are extremely rare entities. There have been no prior reports of SAVFs developing after laparoscopic pancreatectomy. Here, we report the first case. A 40-year-old man underwent a laparoscopic, spleen-preserving, distal pancreatectomy for an endocrine neoplasm of the pancreatic tail. Three months after surgery, a computed tomography (CT) scan demonstrated an SAVF with a dilated splenic vein. The SAVF, together with the splenic vein aneurysm, was successfully treated using percutaneous transarterial coil embolization of the splenic artery, including the SAVF and drainage vein. After the endovascular treatment, the patient's recovery was uneventful. He was discharged on postoperative day 6 and continues to be well 3 mo after discharge. An abdominal CT scan performed at his 3-mo follow-up demonstrated complete thrombosis of the splenic vein aneurysm, which had decreased to a 40 mm diameter. This is the first reported case of SAVF following a laparoscopic pancreatectomy and demonstrates the usefulness of endovascular treatment for this type of complication.

  10. Physical examination of arteriovenous fistula: The influence of professional experience in the detection of complications.

    Science.gov (United States)

    Sousa, Clemente Neves; Teles, Paulo; Dias, Vanessa Filipa Ferreira; Apóstolo, João Luís Alves; Figueiredo, Maria Henriqueta Jesus Silva; Martins, Maria Manuela

    2014-07-01

    Vascular access is one of the leading causes of mobilization of financial resources in health systems for people with chronic kidney disease on hemodialysis. Physical examination of the arteriovenous fistula (AVF) has demonstrated its effectiveness in identifying complications. We decided to evaluate the influence of nurses' professional experience in the detection of complications of the AVF (venous stenosis and steal syndrome). The study took place in eight hemodialysis centers between May and September of 2011 in the north of Portugal. Sample was constituted by registered nurses. The nurses involved in the experiment were divided in two groups: those who had more than 5 years of experience and those who had less than 5 years of experience. Ninety-two nurses participated in the study: 34 nurses had less than 5 years of professional experience and 58 had more than 5 years of professional experience. In the practices considered by nurses in the detection of venous stenosis, there were no differences observed between the groups (P > 0.05). In steal syndrome, there were no differences observed between the groups in the practices of the nurses in the detection of this complication of the AVF (P > 0.05). We concluded that professional experience does not influence the detection of venous stenosis and steal syndrome. © 2014 International Society for Hemodialysis.

  11. Outcomes of arteriovenous fistula for hemodialysis in Sudanese patients: Single-center experience

    Directory of Open Access Journals (Sweden)

    Gamal Mustafa Ahmed

    2012-01-01

    Full Text Available A well-functioning arteriovenous fistula (AVF is essential for the maintenance of hemodialysis (HD in patients with chronic renal failure. Our aim is to review our experience of creating AVF and to asses its success rate and common complication. A prospective, hospital-based study was conducted on 73 patients (48 males and 25 females on chronic HD in Gezira Hospital for Renal Diseases and Surgery, from January to July 2007. Their mean age was 43.9 years (range from 18 to 72 years. Seventy-one (97.3% of the study subjects had been dialyzed before creation of the AVF, 67 (91.8% of them having undergone HD with temporary access. All patients (n=73 had a native AVF as the permanent vascular access (VA. A primary radiocephalic AVF was created in 78.1% of the patients, cubital fossa in 20.5% and one case had left snuff box AVF (1.4%. Percentage of AVF maturation was reported in 67.1% of the cases within the first six weeks and in 9.6% of the cases AVF never matured. Failure of AVF function occurred in 26% of the cases, due to thrombosis in 20.5% (n=15 and aneurysm in 5.5% of the cases. We conclude that an optimum outcome is likely when there is a multidisciplinary team approach, and early referral to vascular surgery is paramount.

  12. Does regional anesthesia influence early outcome of upper arm arteriovenous fistula?

    Directory of Open Access Journals (Sweden)

    Elsharawy Mohamed

    2010-01-01

    Full Text Available To assess the effect of regional anesthesia on the outcome of elbow arteriovenous fistula (AVF, prospectively studied consecutive patients with end-stage renal disease referred for permanent vascular access to the Vascular Unit of King Fahd University Hospital between September 2004 and September 2007. The patients were divided into 2 groups: Group 1: patients who underwent the construction of the AVF under regional anesthesia and Group 2: patients who were operated under general anesthesia, indicated by their preferences or failure of regional anesthesia. Data including patient characteristics and type of AVF were recorded. The internal diameter of the vein and the artery and intra-operative blood flow were measured. The complications of both types of anesthesia were recorded. The patients were followed up for three months. Eighty four cases were recruited in this study. Complete brachial plexus block was achieved in 57 (68% patients. Seven patients were converted to general anesthesia and 20 patients had AVF under general anesthesia from the start. There were no significant differences between the 2 groups with regard to basic characteristics or operative data. There were no instances of systemic toxicity, hematomas, or nerve injury from the regional block. No major complications were reported from the general anesthesia. There was no significant difference between both groups regarding early failure of AVF (Group 1, 14% vs. Group2; 11%. P= 0.80. No significant advantage of regional over general anesthesia in terms of early outcome of AVF was seen in this study.

  13. A Novel Classification Technique of Arteriovenous Fistula Stenosis Evaluation Using Bilateral PPG Analysis

    Directory of Open Access Journals (Sweden)

    Yi-Chun Du

    2016-08-01

    Full Text Available The most common treatment for end-stage renal disease (ESRD patients is the hemodialysis (HD. For this kind of treatment, the functional vascular access that called arteriovenous fistula (AVF is done by surgery to connect the vein and artery. Stenosis is considered the major cause of dysfunction of AVF. In this study, a noninvasive approach based on asynchronous analysis of bilateral photoplethysmography (PPG with error correcting output coding support vector machine one versus rest (ESVM-OVR for the degree of stenosis (DOS evaluation is proposed. An artificial neural network (ANN classifier is also applied to compare the performance with the proposed system. The testing data has been collected from 22 patients at the right and left thumb of the hand. The experimental results indicated that the proposed system could provide positive predictive value (PPV reaching 91.67% and had higher noise tolerance. The system has the potential for providing diagnostic assistance in a wearable device for evaluation of AVF stenosis.

  14. The advantages of balloon assistance in endovascular embolization of spinal dural arteriovenous fistulas.

    Science.gov (United States)

    Cohen, José E; Moscovici, Samuel; Itshayek, Eyal

    2013-01-01

    Endovascular embolization is accepted as an alternative to surgical management of spinal dural arteriovenous fistulas (DAVF) in most patients; however, when the feeder vessel arises from the trunk vessel with an acutely angled origin, microcatheter navigation may be difficult, hazardous, and sometimes impossible. We propose a technique that eases microguidewire engagement and microcatheterization of arteries that arise at very acute angles with the assistance of a parallel compliant balloon that acts as supporter, guider, and protector. This technique was successfully applied in three consecutive patients with spinal DAVF with unfavorable vascular anatomy that limited selective microcatheterization. The balloon supports and guides the microguidewire along the feeder (supportive role). The balloon can then be placed at the origin of the feeder vessel and inflated during embolization to prevent liquid agent reflux (protective role). Use of this technique as a first option reduces procedure time and radiation exposure. A limiting factor is the need for a relatively large working channel to allow the combined use of a balloon and a microcatheter. Copyright © 2012 Elsevier Ltd. All rights reserved.

  15. Effect of anastomosis angle on hemodynamic of side-to-end radiocephalic arteriovenous fistula (RCAVF)

    Science.gov (United States)

    Hassan, Wan Anuar Wan; Osman, Kahar; Kadir, Mohammed Rafiq Abdul; Abdullah, Wan Ahmad Kamil Wan; Haron, Juhara; Ngali, Mohd Zamani

    2012-06-01

    Radiocephalic arteriovenous fistula (RCAVF) at wrist is the chosen access for hemodialysis. Most studies describe access complications without considering the effect of the anastomosis angle. In the present investigation, eighteen three-dimensional, simplified models of RCAVF were used to analyze the hemodynamic effect of anastomosis angle under fixed flow rate of 900 ml/min, corresponding to Reynolds number 950. EFD. Lab software was used in the flow simulation with steady flow conditions. The results show that high pressure drop was observed for RCAVF with smaller anastomosis angle. However, for cases with anastomosis angle larger than 45°, pressure drop became relatively constant. The results also show that large vortices appeared in cases with angle smaller than 30°. For cases with angle larger than 60°, low flow zone appeared at the inner wall that may lead to promotion of intimal thickening and formation of stenosis. Overall, for average flowrate, it is recommended that anastomosis angle should be maintained between 45° and 60° to minimize adverse effects.

  16. Portal, mesenteric, and splenic vein thromboses after endovascular embolization for gastrointestinal bleeding caused by a splenic arteriovenous fistula.

    Science.gov (United States)

    Ding, Pengxu; Li, Zhen; Han, Xin-Wei; Wang, Zhong-Gao; Zhang, Wen-Guang; Fu, Ming-Ti

    2014-07-01

    We present an unusual case of portal, mesenteric, and splenic vein thromboses after endovascular embolization for gastrointestinal bleeding caused by a splenic arteriovenous fistula. The thromboses were successfully treated with anticoagulation therapy. The patient was a 37-year-old woman who presented with portal hypertension manifested by gastrointestinal bleeding with no evidence of liver disease. Splenic arteriography confirmed the presence of a high-flow arteriovenous fistulous communication from the splenic artery directly into the splenic vein. The arteriovenous fistula was successfully treated with percutaneous transarterial embolization by embolization coils and the patient achieved effective hemostasis. Low-molecular-weight heparin and warfarin were administrated to prevent thrombosis in the portal venous system after the procedure. Although anticoagulants were immediately administered, thromboses of the portal, mesenteric, and splenic veins were diagnosed by contrast-enhanced computed tomography after 10 days. Complete recanalization of the portal venous system confirmed by contrast-enhanced computed tomography was achieved by administering warfarin orally for 3 months.

  17. Low-density lipoprotein apheresis by membrane differential filtration (cascade filtration) via arteriovenous fistula performed in children with familial hypercholesterolemia.

    Science.gov (United States)

    Gülle, Saniye; Bak, Mustafa; Serdaroglu, Erkin; Can, Demet; Karabay, Ozalp

    2010-02-01

    Membrane differential filtration (cascade filtration) is an apheresis technique by which atherogenic lipoproteins can be eliminated from plasma on the basis of particle size. In this study, we aim to discuss the efficacy of low-density lipoprotein (LDL) apheresis performed by providing alternative vascular routes in two siblings with familial hypercholesterolemia who did not respond to medical treatment and diet. Of the two siblings, one was nine years old and the other one was three-and-a-half years old. Of the total of 78 apheresis processes performed, 24 were done via a permanent subclavian catheter, 36 were done via a subsequently provided arteriovenous fistula, and 18 were done via an arteriovenous graft. We observed a mean reduction in the plasma levels of total cholesterol (61.6%), LDL cholesterol (65.5%), and high-density lipoprotein cholesterol (38.6%). We noted that cascade filtration apheresis was effective in decreasing the LDL cholesterol in plasma, and no serious complications were noted. The success of the apheresis program depends on well-functioning blood access. An arteriovenous fistula may be the best route for the long-term treatment of familial hypercholesterolemia, which requires complication-free apheresis treatments.

  18. Cardiac Arrest Secondary to Bilateral Pulmonary Emboli following Arteriovenous Fistula Thrombectomy: A Case Report with Review of the Literature

    Directory of Open Access Journals (Sweden)

    Avni Shah

    2012-01-01

    Full Text Available Number of patients with End Stage Renal Disease (ESRD is growing worldwide. Hemodialysis remains the main modality of renal replacement therapy for ESRD patients. A patent hemodialysis access (arteriovenous fistula or arteriovenous graft plays a key role in successful delivery of hemodialysis. Common vascular access issues encountered by patients and nephrologists are thrombosis and infection. The thrombosed access is declotted by various percutaneous techniques these days by multiple outpatient access centers in a timely fashion. Thrombolysis can give rise to various complications, a few of which can be life threatening. A young hemodialysis patient underwent percutaneous thrombolysis of his clotted arteriovenous fistula. Outpatient access thrombectomy was complicated immediately afterwards with cardiac arrest requiring cardiac resuscitation in the recovery room. The patient was admitted to intensive care unit after life sustaining care. Work up revealed multiple pulmonary emboli to both lung fields on CT scan of the chest. Patient was anticoagulated and discharged from the hospital. Thrombolysis of clotted hemodialysis access is associated commonly with occurrences of pulmonary embolic which are usually asymptomatic. Massive pulmonary embolization due to access thrombolysis is rare. Nephrologists and radiologists should be aware of this dangerous complication particularly in patients with preexisting cardiopulmonary disease.

  19. Therapeutic management of pregnant women with intracranial haemorrhage related to most commonly occurring arteriovenous malformations

    Directory of Open Access Journals (Sweden)

    Adrianna Jarych

    2016-03-01

    Full Text Available Intracranial haemorrhage in pregnancy poses a serious threat to both the mother and the foetus. It is associated with a high mortality and it is the third among non-obstetric causes of death in this group of patients, accounting for 5–12% of all deaths of the pregnant. Vascular malformations, mainly intracranial aneurysms and arteriovenous malformations observed also in the general population, are the most common cause of bleeding in pregnant women. So far, there have been no clear guidelines for the treatment of pregnant women with intracranial haemorrhage in the course of the above mentioned malformations, therefore the objective of this study is to summarize the knowledge about the specificity of therapeutic management in those cases. The study discusses the location of vascular lesions, physiological processes in a pregnant woman that must be taken into consideration during a therapeutic intervention, the problem of selecting the treatment (surgical treatment, endovascular therapy, radiosurgery, method and time of delivery, the use of ionizing radiation and drugs during endovascular procedures. In the available literature a special attention is paid to the mother’s welfare during the undertaken treatment, including the maintenance of normal uteroplacental perfusion, which has an effect on the general condition of the foetus. Therefore, it is essential to know the discussed physiological changes in a pregnant women as they condition specific therapeutic management. The safety of applied endovascular procedures in pregnant women is equally important due to the use of both ionizing radiation and certain medications. It is believed that these procedures are acceptable in pregnant women when appropriate radiological protection is used, radiation doses are reduced and medications are selected properly. However, surgical intervention is still considered to be the main method of treatment in this group of patients. The decision about the

  20. A Meta-analysis of Randomized Trials Comparing Surgery versus Endovascular Therapy for Thrombosed Arteriovenous Fistulas and Grafts in Hemodialysis

    Energy Technology Data Exchange (ETDEWEB)

    Kuhan, G., E-mail: gkuhan@nhs.net; Antoniou, G. A. [Central Manchester University Hospital Foundation Trust, Regional Vascular and Endovascular Unit (United Kingdom); Nikam, M.; Mitra, S. [Central Manchester University Hospital Foundation Trust, Department of Renal Medicine (United Kingdom); Farquharson, F. [Central Manchester University Hospital Foundation Trust, Department of Radiology (United Kingdom); Brittenden, J. [University of Aberdeen (United Kingdom); Chalmers, N. [Central Manchester University Hospital Foundation Trust, Department of Radiology (United Kingdom)

    2013-06-15

    Purpose. To carry out a systematic review of randomized trials comparing surgery vs. endovascular therapy for occluded fistulas and grafts. Methods. All randomized trials which compared surgery and endovascular therapy for occluded fistulas and grafts were retrieved from 1990 onwards. The following search terms were used: 'haemodialysis,' 'thrombosis,' 'arteriovenous fistula,' 'arteriovenous shunt,' 'end stage renal failure' on Medline and PubMed. The results of the pooled data were analysed by a fixed-effect model. Results. There were no randomized trials comparing surgery vs. endovascular therapy for native fistulas and vein grafts. Six randomized studies reporting on 573 occluded grafts were identified. Technical success, need for access line and primary patency at 30 days were similar between the two groups (odds ratio [OR] 1.40, 95 % confidence interval [CI] 0.91-2.14; OR 0.77, 95 % CI 0.44-1.34; and OR 1.15, 95 % CI 0.79-1.68, respectively). There was no significant difference in morbidity at 30 days between groups (OR 1.12, 95 % CI 0.67-1.86). There were no statistical difference between the two groups for 1 year primary patency (OR 2.08, 95 % CI 0.97-4.45). Primary assisted patency at 1 year was better with surgery (OR 3.03, 95 % CI 1.12-8.18) in a single study. Conclusion. Comparable results to surgery have been achieved with endovascular techniques for occluded prosthetic grafts for dialysis access. Long-term data comparing the two groups were lacking. Further trials designed to encompass variation in methods are warranted in order to obtain the best available evidence particularly for native fistulas.

  1. Adrift in the world of therapeutic apheresis: One center's experience in using arterio-venous fistulas during apheresis procedures.

    Science.gov (United States)

    Larson, Jennifer

    2016-10-01

    Therapeutic plasma exchange (TPE) is often an isolated specialty with very little research, especially in regard to the mode of access. This lack of information drove this attempt at reviewing the use of arterio-venous fistulas (AVF) in TPE, and specifically the issue of monitoring the accesses patency. Using a Transonic®, we attempted to obtain a reading, using the Spectra Optia™ on a patient's access. Unfortunately, due to the limitations of the equipment, we were unable to get a reading. Our conclusion is that we will have to monitor using other approaches, such as physical assessment and ultrasound.

  2. Multimodality evaluation of dural arteriovenous fistula with CT angiography, MR with arterial spin labeling, and digital subtraction angiography: case report.

    Science.gov (United States)

    Alexander, Matthew; McTaggart, Ryan; Santarelli, Justin; Fischbein, Nancy; Marks, Michael; Zaharchuk, Greg; Do, Huy

    2014-01-01

    Dural arteriovenous fistulae (DAVF) are cerebrovascular lesions with pathologic shunting into the venous system from arterial feeders. Digital subtraction angiography (DSA) has long been considered the gold standard for diagnosis, but advances in noninvasive imaging techniques now play a role in the diagnosis of these complex lesions. Herein, we describe the case of a patient with right-side pulsatile tinnitus and DAVF diagnosed using computed tomography angiography, magnetic resonance with arterial spin labeling, and DSA. Implications for imaging analysis of DAVFs and further research are discussed.

  3. Patency rates of the arteriovenous fistula for hemodialysis: a systematic review and meta-analysis.

    Science.gov (United States)

    Al-Jaishi, Ahmed A; Oliver, Matthew J; Thomas, Sonia M; Lok, Charmaine E; Zhang, Joyce C; Garg, Amit X; Kosa, Sarah D; Quinn, Robert R; Moist, Louise M

    2014-03-01

    Advantages of the arteriovenous fistula (AVF), including long patency and few complications, were ascertained more than 2 decades ago and may not apply to the contemporary dialysis population. Systematic review and meta-analysis. Estimates were pooled using a random-effects model and sources of heterogeneity were explored using metaregression. Patients treated with long-term hemodialysis using an AVF. English-language studies indexed in MEDLINE between 2000 and 2012 using prospectively collected data on 100 or more AVFs. Age, AVF location, and study location. Outcomes of interest were primary AVF failure and primary and secondary patency at 1 and 2 years. 7,011 citations were screened and 46 articles met eligibility criteria (62 unique cohorts; n = 12,383). The rate of primary failure was 23% (95% CI, 18%-28%; 37 cohorts; 7,393 AVFs). When primary failures were included, the primary patency rate was 60% (95% CI, 56%-64%; 13 studies; 21 cohorts; 4,111 AVFs) at 1 year and 51% (95% CI, 44%-58%; 7 studies; 12 cohorts; 2,694 AVFs) at 2 years. The secondary patency rate was 71% (95% CI, 64%-78%; 10 studies; 11 cohorts; 3,558 AVFs) at 1 year and 64% (95% CI, 56%-73%; 6 studies; 11 cohorts; 1,939 AVFs) at 2 years. In metaregression, there was a significant decrease in primary patency rate in studies that started recruitment in more recent years. Low quality of studies, variable clinical settings, and variable definitions of primary AVF failure. In recent years, AVFs had a high rate of primary failure and low to moderate primary and secondary patency rates. Consideration of these outcomes is required when choosing a patient's preferred access type. Copyright © 2014 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  4. The relationship between the flow of arteriovenous fistula and cardiac output in haemodialysis patients.

    Science.gov (United States)

    Basile, Carlo; Lomonte, Carlo; Vernaglione, Luigi; Casucci, Francesco; Antonelli, Maurizio; Losurdo, Nicola

    2008-01-01

    Satisfactory haemodialysis (HD) vascular access flow (Qa) is necessary for dialysis adequacy. High Qa is postulated to increase cardiac output (CO) and cause high-output cardiac failure. Aim of the present prospective study was to evaluate the relationship between Qa of arteriovenous fistulas (AVFs) and CO in order to have a closer insight into this scarcely explored aspect of HD pathophysiology. Ninety-six patients bearing an AVF entered the study. All were evaluated a priori for the existence of cardiac failure according to the functional classification of the American College of Cardiology/American Heart Association task force. Qa and CO were measured by means of the ultrasound dilution Transonic Hemodialysis Monitor HD02. The mean Qa of the 65 lower arm AVFs was 0.948+/-0.428 SD l/min, whereas that of the 31 upper arm AVFs was 1.58+/-0.553 l/min. The difference was statistically significant (Ppolynomial regression model best fitted the relationship between Qa and CO. The analysis of the regression equation identified 0.95 and 2.2 l/min as Qa cut-off points. The receiver operating characteristic curve analysis showed that Qa values >or= 2.0 l/min predicted the occurrence of high-output cardiac failure more accurately than two other Qa values (sensitivity 89%, specificity 100%, curve area 0.99) and three Qa/CO ratio values (cardio-pulmonary recirculation-CPR). The better performance among the latter was that of CPR values >or= 20% (sensitivity 100%, specificity 74.7%, curve area 0.92). Our prospective study shows that the relationship between Qa of AVFs and CO is complex and a third-order polynomial regression model best fits this relationship. Furthermore, it is the first study to clearly show the high predictive power for high-output cardiac failure occurrence of Qa cut-off values >or= 2.0 l/min.

  5. Cranial Nerve Dysfunction Associated with Cavernous Dural Arteriovenous Fistulas After Transvenous Embolization with Onyx

    Energy Technology Data Exchange (ETDEWEB)

    Li, Chuanhui; Wang, Yang; Li, Youxiang; Jiang, Chuhan; Wu, Zhongxue; Yang, Xinjian, E-mail: yang-xj@163.net [Capital Medical University, Beijing Neurosurgical Institute and Beijing Tiantan Hospital (China)

    2015-10-15

    PurposeCranial nerve dysfunction (CND) is not uncommon in patients with cavernous dural arteriovenous fistulas (cDAVFs), and may represent an initial manifestation or a complication after endovascular treatment. This study evaluated the outcome of CND associated with cDAVFs after transvenous embolization (TVE) using Onyx.Materials and MethodsForty-one patients with cDAVFs were treated with TVE in our department between April 2009 and October 2013. For each patient, clinical and radiologic records were retrospectively reviewed and evaluated, with an emphasis placed on evaluating the outcomes of the pre-existing cDAVF-induced CND and the TVE-induced CND.ResultsOf the 41 cases, 25 had a history of preoperative CND. Postoperatively, gradual remission to complete recovery (CR) within 8 months was observed in 17 of these cases, transient aggravation in 7, and significant improvement to be better than preoperative function but no CR in 1. All aggravation of CND occurred immediately or within 1 day after TVE and resolved completely within 5 months. Nine patients developed new CND after TVE. New CND occurred during the perioperative period in 8 cases, but all cases resolved completely within 15 days–6 months. Delayed CND was observed in 3 cases with a time lag of 3–25 months after TVE. Two of these completely resolved within 20 days–1 month and the remaining case significantly improved.ConclusionBoth the pre-existing cDAVF-induced CND and the TVE-induced new or aggravated CND completely resolved in almost all cases after embolization with Onyx.

  6. Health-related quality of life in patients with spinal dural arteriovenous fistulae.

    Science.gov (United States)

    Sasamori, Toru; Hida, Kazutoshi; Osanai, Toshiya; Yano, Shunsuke; Seki, Toshitaka; Houkin, Kiyohiro

    2017-01-01

    Neurological improvement in patients with spinal dural arteriovenous fistulae (SDAVF) is often partial even after adequate treatment. While treatment outcomes have been evaluated primarily on the basis of the postoperative changes in neurological deficits, outcome measures should also reflect the patient-reported outcome (PRO). We conducted a health-related quality of life (HRQOL) survey in 52 SDAVF patients; 33 (63.5%) completed the short-form 36 Health Survey (SF-36) questionnaire. They were 25 males and 8 females ranging in age from 47 to 85 years (mean age 70.0 years). The mean follow-up period was 95.6 months. We analyzed the completed questionnaires and examined the clinical factors associated with their HRQOL. After treatment, gait- and micturition disturbances persisted in 31 (93.9%) and 31 (93.9%) of our patients; 26 (78.8%) reported chronic leg pain. The SF-36 scores of treated SDAVF patients were significantly lower than the national average of 50 for all 8 sub-items in the questionnaire. The scores for physical functioning (PF) and role-physical (RP) were particularly low. With the exception of bodily pain (BP), there was a significant negative correlation between the Aminoff-Logue scale (ALS) scores for gait- and micturition and the sub-item scores. The score for BP showed a significant positive correlation with the scores for the 7 other SF-36 sub-items. The HRQOL of treated SDAVF patients was lower than the national average with respect to both physical and mental aspects. Persistent post-treatment pain and gait- and micturition disturbances were responsible for their lower HRQOL.

  7. Congestive myelopathy (Foix-Alajouanine Syndrome) due to intradural arteriovenous fistula of the filum terminale fed by anterior spinal artery: Case report and review of literature.

    Science.gov (United States)

    Krishnan, Prasad; Banerjee, Tapas Kumar; Saha, Manash

    2013-07-01

    Spinal arteriovenous fistulas are rare entities. They often present with congestive myelopathy but are infrequently diagnosed as the cause of the patients' symptoms. Only one such case has been described previously in Indian literature. We describe one such case who presented to us after a gap of 3 years since symptom onset and following a failed laminectomy where the cause was later diagnosed to be an intradural fistula in the filum terminale fed by the anterior spinal artery and review the available literature.

  8. Direct percutaneous transorbital puncture under fluoroscopic guidance with a 3D skull reconstruction overlay for embolisation of intraorbital and cavernous sinus dural arteriovenous fistulas.

    Science.gov (United States)

    Lv, Ming; Jiang, Chuhan; Liu, Dong; Ning, Zhiguang; Yang, Jun; Wu, Zhongxue

    2015-06-01

    To describe the direct percutaneous transorbital puncture technique for embolisation of the selected intraorbital and cavernous sinus dural arteriovenous fistula, which failed to be treated by conventional endovascular techniques. One case of intraorbital and five cases of cavernous sinus dural arteriovenous fistula were embolised through direct percutaneous transorbital puncture in 2012, and the clinical data were reviewed. Under fluoroscopic guidance with a three-dimensional (3D) skull reconstruction overlay, the cavernous sinus or ophthalmic vein was punctured via the superior orbital fissure. Then a microcatheter was inserted via the needle, and Onyx was injected to embolise the fistula with or without a combination of coils. Complete obliteration of the fistula was achieved in all six patients. After operation all the patients experienced transient swelling of the punctured orbit persisting for three to five days. No other complications occurred. Follow-up of six patients at three to six months showed resolution of their initial neuro-ophthalmological symptoms in five and left visual loss in one did not recover. Six months follow-up angiogram showed no recurrence of these fistulas. Direct percutaneous transorbital puncture provides an option for the intraorbital and cavernous sinus dural arteriovenous fistulas, particularly when the conventional transvenous routes are inaccessible. Overlay of the 3D skull reconstruction can facilitate the precise puncture of the superior orbital fissure. © The Author(s) 2015.

  9. Comprehensive Comparison of the Performance of Autogenous Brachial-Basilic Transposition Arteriovenous Fistula and Prosthetic Forearm Loop Arteriovenous Graft in a Multiethnic Asian Hemodialysis Population

    Directory of Open Access Journals (Sweden)

    Koy Min Chue

    2016-01-01

    Full Text Available Aim. For patients who have exhausted cephalic vein arteriovenous fistula (AVF options, controversy exists on whether brachial-basilic AVF with transposition (BBTAVF or a forearm arteriovenous graft (AVG should be the next vascular access of choice. This study compared the outcomes of these two modalities. Methods. A retrospective study of 122 Asian multiethnic patients who underwent either a BBTAVF (81 or an AVG (41. Maturation time and intervention rates were analyzed. Functional primary, secondary, and overall patency rates were evaluated. Results. The maturation time for BBTAVFs was significantly longer than AVGs. There was also a longer deliberation time before surgeons abandon a failing BBTAVF compared to an AVG. Both functional primary and secondary patency rates were significantly higher in the BBTAVF group at 1-year follow-up: 73.2% versus 34.1% (p<0.001 and 71.8% versus 54.3% (p=0.022, respectively. AVGs also required more interventions to maintain patency. When maturation rates were considered, the overall patency of AVGs was initially superior in the first 25 weeks after creation and then became inferior afterwards. Conclusion. BBTAVFs had superior primary and functional patency and required less salvage interventions. The forearm AVG might have a role in patients who require early vascular access due to complications from central venous catheters or with limited life expectancy.

  10. Surgical Management of Combined Intramedullary Arteriovenous Malformation and Perimedullary Arteriovenous Fistula within the Hybrid Operating Room after Five Years of Performing Focus Fractionated Radiotherapy: Case Report

    Science.gov (United States)

    GEKKA, Masayuki; SEKI, Toshitaka; HIDA, Kazutoshi; OSANAI, Toshiya; HOUKIN, Kiyohiro

    2014-01-01

    Perimedullary arteriovenous fistula (AVF) shunts occur on the spinal cord surface and can be treated surgically or by endovascular embolization. In contrast, the nidus of an intramedullary arteriovenous malformation (AVM) is located in the spinal cord and is difficult to treat surgically or by endovascular techniques. The benefits of radiotherapy for treating intramedullary AVM have been published, but are anecdotal and consist largely of case reports. We present a case of combined cervical intramedullary AVM and perimedullary AVF which received surgical treatment within a hybrid operating room (OR) after 5 years of focus fractionated radiotherapy. A 37-year-old male presented with stepwise worsening myelopathy. Magnetic resonance imaging and spinal angiography revealed intramedullary AVM and perimedullary AVF at the C3 to C5 levels. In order to reduce nidus size and blood flow, we first performed focal fractionated radiotherapy. Five years later, the lesion volume was reduced. Following this, direct surgery was performed by an anterior approach using corpectomy in the hybrid OR. The spinal cord was monitored by motor-evoked potential throughout the surgery. Complete obliteration of the fistulous connection was confirmed by intraoperative indocyanine green video-angiography and intraoperative angiography, preserving the anterior spinal artery. We conclude that surgical treatment following focal fractionated radiotherapy may become one strategy for patients who are initially deemed ineligible for endovascular embolization and surgical treatment. Furthermore, the hybrid OR enables safe and precise treatment for spinal vascular disorders in the fields of endovascular treatment and neurosurgery. PMID:25367581

  11. Surgical management of combined intramedullary arteriovenous malformation and perimedullary arteriovenous fistula within the hybrid operating room after five years of performing focus fractionated radiotherapy: case report.

    Science.gov (United States)

    Gekka, Masayuki; Seki, Toshitaka; Hida, Kazutoshi; Osanai, Toshiya; Houkin, Kiyohiro

    2014-01-01

    Perimedullary arteriovenous fistula (AVF) shunts occur on the spinal cord surface and can be treated surgically or by endovascular embolization. In contrast, the nidus of an intramedullary arteriovenous malformation (AVM) is located in the spinal cord and is difficult to treat surgically or by endovascular techniques. The benefits of radiotherapy for treating intramedullary AVM have been published, but are anecdotal and consist largely of case reports. We present a case of combined cervical intramedullary AVM and perimedullary AVF which received surgical treatment within a hybrid operating room (OR) after 5 years of focus fractionated radiotherapy. A 37-year-old male presented with stepwise worsening myelopathy. Magnetic resonance imaging and spinal angiography revealed intramedullary AVM and perimedullary AVF at the C3 to C5 levels. In order to reduce nidus size and blood flow, we first performed focal fractionated radiotherapy. Five years later, the lesion volume was reduced. Following this, direct surgery was performed by an anterior approach using corpectomy in the hybrid OR. The spinal cord was monitored by motor-evoked potential throughout the surgery. Complete obliteration of the fistulous connection was confirmed by intraoperative indocyanine green video-angiography and intraoperative angiography, preserving the anterior spinal artery. We conclude that surgical treatment following focal fractionated radiotherapy may become one strategy for patients who are initially deemed ineligible for endovascular embolization and surgical treatment. Furthermore, the hybrid OR enables safe and precise treatment for spinal vascular disorders in the fields of endovascular treatment and neurosurgery.

  12. Microinflammation is involved in the dysfunction of arteriovenous fistula in patients with maintenance hemodialysis

    Institute of Scientific and Technical Information of China (English)

    LIU Bi-cheng; LI Li; GAO Min; WANG Yan-li; YU Ji-rong

    2008-01-01

    Background Vascular access (VA) dysfunction is a major clinical complication in the hemodialysis population and has a direct effect on dialysis outcome.This study was conducted to explore the role of microinflammation in the VA dysfunction in maintenance hemodialysis patients.Methods Forty-seven patients (male 35 and female 12) receiving maintenance hemodialysis were included for this study.They were divided into three groups:group 1 (n=15),patients with initial hemodialysis and new arteriovenous fistula (AVF);group 2 (n=18),patients treated with hemodialysis for long term with well-functional VA;group 3 (n=14),maintenance hemodialysis patients with VA dysfunction.Biochemical parameters and serum tumor necrosis factor-a (TNF-a),interleukin 6 (IL-6) and monocyte chemoattractant protein-1 (MCP-1) were determined.High-sensitivity C-reactive protein (hs-CRP) was determined by latex-enhanced immuno-nephelometric method.Tissues of radial artery were taken from group 1 and group 3 for the histological study.Expression of CD68 and MCP-1 in the radial artery was determined by immunohistochemistry.Results Serum hs-CRP in group 3 was significantly higher than those in group 1 and group 2 ((7.40±2.42) mg/L vs (4.21±1.62) mg/L and (5.04±3.65) mg/L,P<0.01 and P<0.05,respectively).Serum TNF-a in group 3 was significantly higher than those in group 1 and group 2 ((64.03±9.29) pg/ml vs (54.69±12.39) pg/ml and (54.05±7.68) pg/ml,P<0.05 and P<0.01,respectively).Serum IL-6 in group 3 was also significantly higher than those in group 1 and group 2 ((70.09±14.53) pg/ml vs (56.43±10.11) pg/ml and (60.77±9.70) pg/ml,P<0.01 and P<0.05,respectively).Patients in group 3 had a thicker internal layer of vessels than in group 1 ((0.356±0.056) mm vs (0.111±0.021) mm,P<0.01).Expression of CD68 and MCP-1 in the fistula vessel walls in group 3 were much higher than those in group 1 (P<0.01).Moreover,serum hs-CRP level was positively correlated with the neointimal hyperplasia

  13. Transvenous embolization with a combination of detachable coils and Onyx for a complicated cavernous dural arteriovenous fistula

    Institute of Scientific and Technical Information of China (English)

    HE Hong-wei; JIANG Chu-han; WU Zhong-xue; LI You-xiang; LU Xian-li; WANG Zhong-cheng

    2008-01-01

    Background Treatment of cavemous dural arteriovenous fistulas (DAVF) is usually made by a transartedal approach.However,in many complicated patients,treatments via transarterial approaches can not be achieved,and only an operation via a transvenous approach is feasible.We aimed to study the feasibility of transarterial embolJzation of cavernous dural arteriovenous fistulas with a combination detachable coils and Onyx to embolize a complicated cavemous DAVF via a transvenous approach.Methods From August 2006 to August 2007,six cases of complicated cavernous DAVF were embolized with a combination of detachable coils and Onyx via a transvenous approach.Three cases were male and the other three were female.Their ages ranged from 36 to 69 years old.The fistula was in the right lateral cavernous sinus in one case,in the left lateral cavernous sinus in another,and in the bilateral cavernous sinus in 4 cases.One fistula was fed by the right internal carotid artery and its meningohypophyseal trunk;one was fed by the branches of the left internal carotid artery and left extemal carotid artery;four were fed by the branches of the bilateral internal carotid artery and/or the bilateral external carotid artery.One case was drained via one lateral inferior petrosal sinus;three were drained via bilateral inferior petrosal sinuses;one was drained via one lateral ophthalmic and facial veins;one was drained via the infedor petrosal sinus and the ophthalmic and facial veins.Four were embolized via the inferior petrosal sinus,and two were embolized via the ophthalmic and facial veins.Results Among six cases of complicated cavernous DAVF,four were fully embolized with Onyx by a single operation,and two cases were fully embolized with Onyx following two operations.Transient headache was found after operation in all patients,but was cured after several days by the symptomatic treatments.In one case,the first operation via the inferior petrosal sinus was a failure;the feeding branches of

  14. Giant intracranial aneurysm with fistula to the paranasal sinuses - a case report; Aneurisma gigante intracraniano com fistula para os seios paranasais - relato de um caso

    Energy Technology Data Exchange (ETDEWEB)

    Cabral, Luciano Gusmao; Monteiro, Soraya Silveira; Rossi, Luiz Antonio; Araujo, Marcelo Antonio Nobrega; Iagarachi, Celso Kendy; Oliveira, Luiz Antonio Nunes de [Hospital do Servidor Publico Estadual de Sao Paulo, SP (Brazil). Serv. de Radiologia

    1998-09-01

    The authors present a case of giant aneurysm of internal carotid artery with extensive bone erosion, which led to a fistula to the paranasal sinuses. The clinical aspects, radiological findings and differential diagnosis of giant intracranial aneurysms are discussed. (author) 9 refs., 5 figs.

  15. The Impact of Anastomotic Angle for Re-Occlusion of Brachioaxillary Graft Arteriovenous Fistula after Percutaneous Thromboaspiration

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Keon Young; Jin, Gong Yong; Hwang, Seung Bae; Choi, Eun Jung; Song, Ji Soo; Han, Young Min; Kwon, Keun Sang [Chonbuk National University Hospital and Medical School, Jeonju (Korea, Republic of)

    2013-03-15

    The purpose of this study is to evaluate the factors that affect graft patency in brachioaxillary graft arteriovenous fistula patients. A retrospective study was conducted on 33 patients (20 men, 13 women; mean age, 67.5 years; mean interval to first stenosis, 17 months), who had performed percutaneous angioplasty for first episode of stenosis after brachioaxillary graft surgery. We evaluated the relevant factors affecting the graft patency after first episode of stenosis, such as age, sex, underlying disease (hypertension, diabetes mellitus, hyperlipidemia, cardiovascular disease, cerebrovascular attack), anastomotic angle between graft and axillary vein, and anastomotic angle between the graft and brachial artery. Kaplan-Meier method and log rank test and receiver operating characteristics curve analysis were used in statistical analysis. Graft patency rates after 1 month, 6 months, and 12 months were 75.8%, 39.4%, and 9.1%. There was a correlation between graft-axillary vein anastomotic angle and patency rates (r = 0.372, p = 0.033); larger the venous anastomotic angle, the longer patency rate. However, it does not come up with significant results in patency rates on age, sex, underlying disease, and graft-brachial artery angle. In patients with brachioaxillary graft arteriovenous fistula, as venous anastomotic angle more obtuse, the graft patency may be longer.

  16. Construction and validation of a scale of assessment of self-care behaviors with arteriovenous fistula in hemodialysis.

    Science.gov (United States)

    Sousa, Clemente Neves; Apóstolo, João Luís Alves; Figueiredo, Maria Henriqueta Jesus Silva; Dias, Vanessa Filipa Ferreira; Teles, Paulo; Martins, Maria Manuela

    2015-04-01

    Several guidelines recommend the importance of educating the patient about the care of vascular access. Nurses have a key role in promoting the development of self-care behaviors by providing the necessary knowledge to patients, so that they develop the necessary skills to take care of the arteriovenous fistula (AVF). This article describes the process of building a scale of assessment of self-care behaviors with arteriovenous fistula in hemodialysis (ASBHD-AVF). This is a cross-sectional study in which the development, construction, and validation process followed the directions of the authors Streiner and Norman. This is a convenience sample, sequential, and nonprobabilistic constituted by 218 patients. The study was conducted in two stages during 2012-2014. The first phase corresponds to the scale construction process, 64 patients participated, while the second corresponds to the evaluation of metric properties and 154 patients participated. The principal component analysis revealed a two-factor structure, with factorial weights between 0.805 and 0.511 and between 0.700 and 0.369, respectively, explaining 39.12% of the total variance of the responses. The Cronbach's alpha of the subscale management of signs and symptoms is 0.797 and from the subscale prevention of complications is 0.722. The ASBHD-AVF revealed properties that allow its use to assess the self-care behaviors in the maintenance and conservation of the AVF.

  17. MDCT angiography with 3D image reconstructions in the evaluation of failing arteriovenous fistulas and grafts in hemodialysis patients

    Energy Technology Data Exchange (ETDEWEB)

    Dimopoulou, Angeliki; Raland, Hans; Magnusson, Anders (Dept. of Radiology, Univ. Hospital, Uppsala (Sweden)), email: angeliki.dimopoulou@akademiska.se; Wikstroem, Bjoern (Dept. of Medical Sciences, Renal Section, Univ. Hospital, Uppsala (Sweden))

    2011-11-15

    Background. Arteriovenous fistulas and grafts are the methods of choice for vascular access in renal failure patients in need of hemodialysis. Their major complication, however, is stenosis, which might lead to thrombosis. Purpose. To demonstrate the usefulness of 16-MDCTA with 3D image reconstructions, in long-term hemodialysis patients with dysfunctional arteriovenous fistulas and grafts (AVF and AVG). Material and Methods. During a 17-month period, 31 patients with dysfunctional AVF and AVG (24 AVF and seven AVG) were examined with MDCTA with 3D image postprocessing. Parameters such as comprehension of the anatomy, quality of contrast enhancement, and pathological vascular changes were measured. DSA was then performed in 24 patients. Results. MDCTA illustrated the anatomy of the AVF/AVG and the entire vascular tree to the heart, in a detailed and comprehensive manner in 93.5% of the evaluated segments, and depicted pathology of AVF/AVG or pathology of the associated vasculature. MDCTA demonstrated a total of 38 significant stenoses in 25 patients. DSA verified 37 stenoses in 24 patients and demonstrated two additional stenoses. MDCTA had thus a sensitivity of 95%. All 24 patients were treated with percutaneous transluminal angioplasty (PTA) with good technical results. Conclusion. MDCTA with 3D reconstructions of dysfunctioning AVFs and AVGs in hemodialysis patients is an accurate and reliable diagnostic method helping customize future intervention

  18. Traumatic coronary arteriovenous fistula communicating the left main coronary artery to pulmonary artery, associated with pulmonary valvular insufficiency and endocarditis: case report.

    Science.gov (United States)

    Rangel, A; Badui, E; Verduzco, C; Valdespino, A; Enciso, R

    1990-02-01

    The authors present a case of a seventeen-year-old white male who suffered from a knife chest wound and secondarily developed a traumatic coronary arteriovenous fistula communicating the left main coronary artery to the pulmonary artery, associated with pulmonary valvular insufficiency and endocarditis.

  19. Arteriovenous fistula complicating iliac artery pseudo aneurysm: diagnosis by CT angiography.

    Science.gov (United States)

    Huawei, L; Bei, D; Huan, Z; Zilai, P; Aorong, T; Kemin, C

    2002-01-01

    Fistula formation to the inferior vena cava is a rare complication of aortic aneurysm which is often misdiagnosed clinically. In one hundred of reported arteriocaval fistulae, none was originating from the right common iliac artery. We report a case of ileo-caval fistula due to a iatrogenic pseudoaneurysm. High resolution 3D imaging using breath-hold CT angiography is highly specific in identifying the location, extent of the aortocaval fistula as well as the neighbouring anatomic structures.

  20. New predictive model for microsurgical outcome of intracranial arteriovenous malformations: study protocol

    Science.gov (United States)

    Tong, Xianzeng; Wu, Jun; Cao, Yong; Zhao, Yuanli; Wang, Shuo

    2017-01-01

    Introduction Although microsurgical resection is currently the first-line treatment modality for arteriovenous malformations (AVMs), microsurgery of these lesions is complicated due to the fact that they are very heterogeneous vascular anomalies. The Spetzler-Martin grading system and the supplementary grading system have demonstrated excellent performances in predicting the risk of AVM surgery. However, there are currently no predictive models based on multimodal MRI techniques. The purpose of this study is to propose a predictive model based on multimodal MRI techniques to assess the microsurgical risk of intracranial AVMs. Methods and analysis The study consists of 2 parts: the first part is to conduct a single-centre retrospective analysis of 201 eligible patients to create a predictive model of AVM surgery based on multimodal functional MRIs (fMRIs); the second part is to validate the efficacy of the predictive model in a prospective multicentre cohort study of 400 eligible patients. Patient characteristics, AVM features and multimodal fMRI data will be collected. The functional status at pretreatment and 6 months after surgery will be analysed using the modified Rankin Scale (mRS) score. The patients in each part of this study will be dichotomised into 2 groups: those with improved or unchanged functional status (a decreased or unchanged mRS 6 months after surgery) and those with worsened functional status (an increased mRS). The first part will determine the risk factors of worsened functional status after surgery and create a predictive model. The second part will validate the predictive model and then a new AVM grading system will be proposed. Ethics and dissemination The study protocol and informed consent form have been reviewed and approved by the Institutional Review Board of Beijing Tiantan Hospital Affiliated to Capital Medical University (KY2016-031-01). The results of this study will be disseminated through printed media. Trial registration

  1. The “focus on aneurysm” principle: Classification and surgical principles of management of concurrent arterial aneurysm with arteriovenous malformation causing intracranial hemorrhage

    Science.gov (United States)

    Jha, Vikas; Behari, Sanjay; Jaiswal, Awadhesh K.; Bhaisora, Kamlesh Singh; Shende, Yogesh P.; Phadke, Rajendra V.

    2016-01-01

    across arteriovenous fistula and eloquence of cortex. Follow up (F/U) (23.29 months; range: 1.5-69 months) mRS scores were 0 in 12, 2 in 2, 3 in 1 and 6 in 1 patients, respectively. Conclusions: Patients with intracranial AVMs should be screened for concurrent AAs. Further grading, management protocols and prognostication should particularly “focus on the aneurysm.” PMID:27366251

  2. Spinal dural arterio-venous fistula: Clinico-radiological profile and outcome following surgical occlusion in an Indian neurosurgical center

    Directory of Open Access Journals (Sweden)

    Sivashanmugam Dhandapani

    2013-01-01

    Full Text Available Background: Spinal dural arteriovenous fistula (SDAVF is a common type of spinal vascular lesion. However, there has not been any published study on its clinico-radiological characteristics or surgical outcome from India. Aim: The aim of this study was to determine the clinico-radiological features of patients with SDAVF, outcomes following surgical ligation of the fistula and the various factors involved. Materials and Methods: Patients who were operated for SDAVF were studied for demographic details, symptoms, clinical severity, radiological features and neurological outcome in the form of improvement in gait disability grades. Appropriate statistical tests were performed. Results: There were 22 (19 males, 3 females patients of SDAVF who underwent surgical ligation with a mean age of 55 years. The mean duration of symptoms at presentation was 15 months. Three patients had acute onset while the rest had insidious onset of symptoms. Out of the 22 patients, 11 (50% had motor weakness as the first symptom, 13 (59% were bedridden and 19 (86.4% had bladder involvement at presentation. Thirteen patients had fistulae in thoracic spine, whereas eight had fistulae in the lumbar spine. All had a favorable outcome in the form of at least non-progression of gait disability (14 had improvement while 8 had stabilized. The improvement was non-significantly associated with younger age, acute onset, ambulant status and fistula below T9. It was inversely associated with pain as the first symptom and fluctuant clinical course. Conclusion: Surgical occlusion of SDAVF is usually associated with either improvement or stabilization of motor weakness.

  3. The impact of haemodialysis arteriovenous fistula on haemodynamic parameters of the cardiovascular system.

    Science.gov (United States)

    Basile, Carlo; Vernaglione, Luigi; Casucci, Francesco; Libutti, Pasquale; Lisi, Piero; Rossi, Luigi; Vigo, Valentina; Lomonte, Carlo

    2016-10-01

    Satisfactory vascular access flow (Qa) of an arteriovenous fistula (AVF) is necessary for haemodialysis (HD) adequacy. The aim of the present study was to further our understanding of haemodynamic modifications of the cardiovascular system of HD patients associated with an AVF. The main objective was to calculate using real data in what way an AVF influences the load of the left ventricle (LLV). All HD patients treated in our dialysis unit and bearing an AVF were enrolled into the present observational cross-sectional study. Fifty-six patients bore a lower arm AVF and 30 an upper arm AVF. Qa and cardiac output (CO) were measured by means of the ultrasound dilution Transonic Hemodialysis Monitor HD02. Mean arterial pressure (MAP) was calculated; total peripheral vascular resistance (TPVR) was calculated as MAP/CO; resistance of AVF (AR) and systemic vascular resistance (SVR) are connected in parallel and were respectively calculated as AR = MAP/Qa and SVR = MAP/(CO - Qa). LLV was calculated on the principle of a simple physical model: LLV (watt) = TPVR·CO(2). The latter was computationally divided into the part spent to run Qa through the AVF (LLVAVF) and that part ensuring the flow (CO - Qa) through the vascular system. The data from the 86 AVFs were analysed by categorizing them into lower and upper arm AVFs. Mean Qa, CO, MAP, TPVR, LLV and LLVAVF of the 86 AVFs were, respectively, 1.3 (0.6 SD) L/min, 6.3 (1.3) L/min, 92.7 (13.9) mmHg, 14.9 (3.9) mmHg·min/L, 1.3 (0.6) watt and 19.7 (3.1)% of LLV. A statistically significant increase of Qa, CO, LLV and LLVAVF and a statistically significant decrease of TPVR, AR and SVR of upper arm AVFs compared with lower arm AVFs was shown. A third-order polynomial regression model best fitted the relationship between Qa and LLV for the entire cohort (R (2) = 0.546; P polynomial regression model, but only in lower arm AVFs. On the contrary, no statistically significant relationship was found between the two parameters in upper

  4. A Case Report of Coronary Arteriovenous Fistulas with an Unruptured Coronary Artery Aneurysm Successfully Treated by Surgery

    Directory of Open Access Journals (Sweden)

    Nobuhiro Takeuchi

    2012-01-01

    Full Text Available A 58-year-old female with a history of Wolff-Parkinson-White syndrome presented at our institution with palpitations and chest pain. Electrocardiography revealed paroxysmal supraventricular tachycardia with a heart rate of 188 beats/min. Antiarrhythmic drugs were ineffective, and tachycardia was resolved by electrical cardioversion. Transthoracic echocardiography revealed abnormal vessels around the right coronary artery (RCA and pulmonary artery (PA; in addition, we suspected coronary arteriovenous fistula (CAVF. Coronary angiography and coronary computed tomography revealed dilated fistula vessels, with a 1 cm saccular aneurysm around the RCA, originating from the proximal RCA and left anterior descending artery into the main trunk of PA. Therefore, we confirmed the diagnosis of CAVF with an unruptured aneurysm. We surgically ligated and clipped the fistula vessels and resected the aneurysm. The resected aneurysm measured  cm in size. Pathological examination of the resected aneurysm revealed hypertrophic walls comprising proliferating fibroblasts cells thin elastic fibers. Very few atherosclerotic changes manifested in the aneurysm walls. We report the case of a patient with CAVF and an unruptured coronary artery aneurysm who was successfully treated by surgery.

  5. The accuracy and utility of contrast-enhanced MR angiography for localization of spinal dural arteriovenous fistulas: the Toronto experience

    Energy Technology Data Exchange (ETDEWEB)

    Lindenholz, Arjen [University Medical Center Groningen, Department of Neurosurgery AB71, PO Box 30001, Groningen (Netherlands); Toronto Western Hospital, Department of Medical Imaging, Division of Neuroradiology, Toronto, ON (Canada); TerBrugge, Karel G.; Farb, Richard I. [Toronto Western Hospital, Department of Medical Imaging, Division of Neuroradiology, Toronto, ON (Canada); Dijk, J.M.C. van [University Medical Center Groningen, Department of Neurosurgery AB71, PO Box 30001, Groningen (Netherlands)

    2014-11-15

    The purpose of this study was to determine the accuracy and utility of contrast-enhanced MR angiography (CE-MRA) in spinal dural arteriovenous fistulas (SDAVF). A retrospective analysis from 1999-2012 identified 70 patients clinically suspected of harboring a SDAVF. Each patient underwent consecutive conventional MR-imaging, CE-MRA, and digital subtraction angiography (DSA). The presence or absence of serpentine flow voids, T2-weighted hyperintensity, and cord enhancement were evaluated, as well as location of the fistula as predicted by CE-MRA. DSA was used as the reference standard. Of the 70 cases, 53 were determined to be a SDAVF, 10 cases were shown to be other forms of vascular malformation, and 7 were DSA-negative. On MRI, all reported cases of SDAVF showed serpentine flow voids (100 %). T2-weighted hyperintensity was seen in 48 of 50 cases (96 %), extending to the conus in 41 of 48 cases (85 %). Cord enhancement was seen in 38 of 41 cases (93 %). CE-MRA correctly localized the SDAVF in 43 of the 53 cases (81 %). CE-MRA is a useful non-invasive examination for the detection and localization of SDAVF. CE-MRA facilitates but does not replace DSA as confirmation of location, fistula type, and arterial detail, which are required before treatment. (orig.)

  6. ASSESSMENT OF FACTORS INFLUENCING ADEQUACY OF NATIV E ARTERIOVENOUS FISTULA FOR LONG TERM VENOUS ACCESS I N HEMODIALYSIS PATIENTS

    Directory of Open Access Journals (Sweden)

    Shahid

    2013-04-01

    Full Text Available ABSTRACT: OBJECTIVE :-The aim of our study was to assess the factors af fecting adequacy of arteriovenous fistula (AVF and to correlate it wit h clinical and demographic factors. MATERIAL AND METHODS: The prospectively designed study was conducted to det ermine adequacy of AVF in 130 patients over a period of tw o years. Adequacy of AVF was graded if the blood flow rate was higher or equal to 300 ml/ min on at least fifty percent of dialysis sessions in one month. AV-fistula adequacy was correlated wi th clinical and demographic factors like age, gender, diabetic status, smoking status, body mass index (BMI, serum calcium, serum phosphorus and Ca×P product, serum albumin and an eval uation for peripheral vascular disease (PVD. RESULTS: The study included 130 patients (68 males and 42 fem ales. Early adequacy rate of 110 fistulas was 66% and 51% at end of 3 rd and 6 th months respectively. Diabetes was present in 41%, 32% were hypertensive and 27% of the patients were overweight (BMI ≥27 kg/m 2 . The adequacy rate was lower in older (age ≥ 65 patients (34.0 vs. 57.6%, P = 0.028, in overweight (BMI ≥ 27 kg/m 2 patients (33.3 vs. 57.5%, P = 0.026. It was also marginally lower in diabetics versus nondiabetics (40.0 vs. 58%, P = 0.058 and the presence of peripheral vascular disease and increase calcium phosphorus produ ct adversely affected AVF adequacy. The adequacy rate was not affected by patient smokin g status and serum albumin. The adequacy rate was substantially lower for forearm v ersus upper arm fistulas (40.0 vs. 64%, P = 0.0131. The adequacy of forearm fistulas was partic ularly poor in women (13%, patients age 65 or older (12.5%, and diabetics (24%. In contra st, upper arm fistulas were adequate in ORIGINAL ARTICLE Journal of Evolution of Medical and Dental Sciences/ Volume 2/ Issue 13/ April 1, 2013 Page- 2033 59.2% of women, 56.3% of older patients, 54% of diab etics, and 30% of those having moderate to severe PVD. CONCLUSIONS

  7. Fistulas

    Science.gov (United States)

    A fistula is an abnormal connection between two parts inside of the body. Fistulas may develop between different organs, such as between ... two arteries. Some people are born with a fistula. Other common causes of fistulas include Complications from ...

  8. Disturbed flow in a patient-specific arteriovenous fistula for hemodialysis: Multidirectional and reciprocating near-wall flow patterns.

    Science.gov (United States)

    Ene-Iordache, Bogdan; Semperboni, Cristina; Dubini, Gabriele; Remuzzi, Andrea

    2015-07-16

    Actual surgical creation of vascular access has unacceptable failure rates of which stenosis formation is a major cause. We have shown previously in idealized models of side-to-end arteriovenous fistula that disturbed flow, a near-wall hemodynamic condition characterized by low and oscillating fluid shear stress, develops in focal points that corresponds closely to the sites of future stenosis. Our present study was aimed at investigating whether disturbed flow occurs in patient-specific fistulae, too. We performed an image-based computational fluid dynamics study within a realistic model of wrist side-to-end anastomosis fistula at six weeks post-surgery, with subject-specific blood rheology and boundary conditions. We then categorized disturbed flow by means of established hemodynamic wall parameters. The numerical analysis revealed laminar flow within the arterial limbs and a complex flow field in the swing segment, featuring turbulent eddies leading to high frequency oscillation of the wall shear stress vectors. Multidirectional disturbed flow developed on the anastomosis floor and on the whole swing segment. Reciprocating disturbed flow zones were found on the distal artery near the floor and on the inner wall of the swing segment. We have found that both multidirectional and reciprocating disturbed flow develop on the inner side of the swing segment in a patient-specific side-to-end fistula used for vascular access after six weeks post-operatively. This has obvious implications for elucidating the hemodynamic forces involved in the initiation of venous wall thickening in vascular access. Copyright © 2015 Elsevier Ltd. All rights reserved.

  9. Dynamic contrast-enhanced magnetic resonance angiography for the localization of spinal dural arteriovenous fistulas at 3T.

    Science.gov (United States)

    Zhou, G; Li, M H; Lu, C; Yin, Y L; Zhu, Y Q; Wei, X E; Lu, H T; Zheng, Q Q; Gao, W W

    2017-02-01

    This study was undertaken to evaluate the accuracy of dynamic contrast-enhanced magnetic resonance angiography (DCE-MRA) in the precise location and demonstration of fistulous points in spinal dural arteriovenous fistulas (SDAVFs). Fifteen patients (14 men, 1 woman; age range: 40-78 years; mean: 55.5 years) harboring SDAVF who underwent preoperative DCE-MRA and spinal digital subtraction angiography (DSA) between January 2012 and January 2015 were evaluated retrospectively. Two reviewers independently evaluated the level and side of the arteriovenous fistula and feeding artery on 3T DCE-MRA and DSA images. The accuracy of DCE-MRA was assessed by comparing its findings with those from DSA and surgery in each case. All 15 patients underwent DCE-MRA and DSA. DSA was unsuccessful in two patients due to technical difficulties. All cases were explored surgically, guided by the DCE-MRA. Surgery confirmed that 14 AVF sites were located in the thoracic spine, 5 in the lumbar spine, and 1 in the cervical spine. The origin of the fistulas and feeding arteries was accurately shown by DCE-MRA in 11 of the 15 patients. DCE-MRA also detected dilated perimedullary veins in all 15 patients. Overall, DCE-MRA facilitated DSA catheterization in 10 cases. In six patients, the artery of Adamkiewicz could be observed. In 15 out of 20 fistulas (75%), both readers agreed on the location on DCE-MRA images, and the κ coefficient of the interobserver agreement was 0.67 (95% confidence interval [CI], 0.16-0.87). In 13 of 16 shunts (75%), the DCE-MRA consensus findings and DSA findings coincided. The intermodality agreement was 0.77 (95% CI: 0.35-0.92). Our DCE-MRA studies benefited from the use of a high-field 3T MR imaging unit and reliably detected and localized the SDAVF and feeding arteries. As experience with this technique grows, it may be possible to replace DSA with DCE-MRA if surgery is the planned treatment. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  10. Absence of abnormal vessels in the subarachnoid space on conventional magnetic resonance imaging in patients with spinal dural arteriovenous fistulas.

    Science.gov (United States)

    Miller, Timothy R; Eskey, Clifford J; Mamourian, Alexander C

    2012-05-01

    Spinal dural arteriovenous fistula (DAVF) is an uncommon condition that can be difficult to diagnose. This often results in misdiagnosis and treatment delay. Although conventional MRI plays an important role in the initial screening for the disease, the typical MRI findings may be absent. In this article, the authors present a series of 4 cases involving patients with angiographically proven spinal DAVFs who demonstrated cord T2 prolongation on conventional MRI but without abnormal subarachnoid flow voids or enhancement. These cases suggest that spinal DAVF cannot be excluded in symptomatic patients with cord edema based on conventional MRI findings alone. Dynamic Gd-enhanced MR angiography (MRA) was successful in demonstrating abnormal spinal vasculature in all 4 cases. This limited experience provides support for the role of spinal MRA in patients with abnormal cord signal and symptoms suggestive of DAVF even when typical MRI findings of a DAVF are absent.

  11. Moving beyond the "perpetual novice": understanding the experiences of novice hemodialysis nurses and cannulation of the arteriovenous fistula.

    Science.gov (United States)

    Wilson, Barbara; Harwood, Lori; Oudshoorn, Abe

    2013-01-01

    Cannulation of the arteriovenous fistula (AVF) is an essential skill for hemodialysis (HD) nurses. With declining rates of AVFs, opportunities to develop expert cannulation skills have become limited. This study explored the concept of perpetual novice and AVF cannulation from the perspective of the novice cannulator. Nine hemodialysis nurses were interviewed using ethnographic methodology. The study identified the interplay between personal and environmental/contextual factors that hindered skill acquisition. Personal attributes identified by participants included HD nurses' approach to learning and previous experience, emotional reaction to stress, and interpersonal relationships with colleagues. Environmental/contextual factors identified as impediments to cannulation skill development included limited learning opportunities, attitudes and demands from patients, unit flow and time pressures, and limitations imposed by the current model of nursing care. This study will be helpful in directing future educational, operational, and supportive interventions for novice HD nurses around cannulation skill development.

  12. A rare association of cerebral dural arteriovenous fistula with venous aneurysm and contralateral flow-related middle cerebral artery aneurysm.

    Science.gov (United States)

    Onu, David O; Hunn, Andrew W; Harle, Robin A

    2013-09-19

    The association of cerebral dural arteriovenous fistula (DAVF) and ipsilateral flow related aneurysm has infrequently been reported. We describe a male patient who presented with an acute haemorrhagic stroke and was found to have a large right fronto-parietal intra-parenchymal haemorrhage from the ruptured Borden type II DAVF in addition to a large venous aneurysm and a flow related intraosseous aneurysm of the contralateral middle meningeal artery (MMA) all clearly delineated by CT and DSA. He underwent emergency stereotactic evacuation of the intraparenchymal haemorrhage and successful surgical treatment of all the vascular lesions at the same time with residual neurological deficit. To our knowledge, this is the first such reported case. We discuss the challenging surgical treatment, emphasising the role of CT/DSA in management, and provide a literature review.

  13. Primary balloon angioplasty plus balloon angioplasty maturation to upgrade small-caliber veins (<3 mm) for arteriovenous fistulas.

    Science.gov (United States)

    De Marco Garcia, Lorena P; Davila-Santini, Luis R; Feng, Qin; Calderin, Julio; Krishnasastry, Kambhampaty V; Panetta, Thomas F

    2010-07-01

    Small-diameter veins are often a limiting factor for the successful creation of arteriovenous fistulas (AVFs). This study evaluated the use of intraoperative primary balloon angioplasty (PBA) as a technique to upgrade small-diameter veins during AVF creation. Sequential balloon angioplasty maturation (BAM) was evaluated as a technique to salvage failed fistulas, expedite maturation, and improve the patency of AVFs after PBA. Sixty-two PBAs were performed in 55 patients with an intent-to-treat using an all-autologous policy. PBAs of veins were performed just before AVF creation using 2.5- to 4-mm angioplasty balloons (1- to 1.5-mm larger than the nominal vein diameter). PBAs were performed through the spatulated end of the vein for a length of up to 8 cm using hydrophilic guidewires and hand inflations without fluoroscopy. BAM was performed in 53 of the 62 PBAs at 2, 4, and 6 weeks after the PBA. Successful outcome was determined as the functional ability to use the fistula for hemodialysis without surgical revision. Of the 62 PBAs, 53 (85.4%), comprising 47 of the original AVFs and 6 new site AVFs created at other sites, remained patent and subsequently underwent BAM with a resulting functional AVF. Fifteen of the 47 original AVFs: 14 due to occlusion; one AVF with a steal was ligated. Seven of the 14 fistulas that occluded were salvaged using recanalization techniques during sequential BAMs. Two of the seven fistulas that were not salvaged required AVGs (3%), and five patients underwent redo AVFs using alternative veins. These five cases were also performed using PBAs and BAMs technique. One patient with a functioning fistula underwent intentional ligation for steal syndrome and also underwent an alternative site AVF, PBA, and BAM. At 3 months, 53 AVFs were functional and successfully used for dialysis. Overall, a working AVF was obtained at the initial site in 47 of 55 patients (85.4%), and 53 (96.3%) received working AVFs that were functioning for dialysis

  14. Predictive parameters of arteriovenous fistula functional maturation in a population of patients with end-stage renal disease.

    Directory of Open Access Journals (Sweden)

    Khalid Bashar

    Full Text Available With increasing numbers of patients diagnosed with ESRD, arteriovenous fistula (AVF maturation has become a major factor in improving both dialysis related outcomes and quality of life of those patients. Compared to other types of access it has been established that a functional AVF access is the least likely to be associated with thrombosis, infection, hospital admissions, secondary interventions to maintain patency and death.Study of demographic factors implicated in the functional maturation of arteriovenous fistulas. Also, to explore any possible association between preoperative haematological investigations and functional maturation.We performed a retrospective chart review of all patients with ESRD who were referred to the vascular service in the University Hospital of Limerick for creation of vascular access for HD. We included patients with primary AVFs; and excluded those who underwent secondary procedures.Overall AVF functional maturation rate in our study was 53.7% (52/97. Female gender showed significant association with nonmaturation (P = 0.004 and was the only predictor for non-maturation in a logistic regression model (P = 0.011. Patients who had history of renal transplant (P = 0.036, had relatively lower haemoglobin levels (P = 0.01 and were on calcium channel blockers (P = 0.001 showed better functional maturation rates.Female gender was found to be associated with functional non-maturation, while a history kidney transplant, calcium channel-blocker agents and low haemoglobin levels were all associated with successful functional maturation. In view of the conflicting evidence in the literature, large prospective multi-centre registry-based studies with well-defined outcomes are needed.

  15. The learning curve effect on embolization of cerebral dural arteriovenous fistula single-center experience in 48 consecutive patients.

    Science.gov (United States)

    Le Foll, D; Raoult, H; Ferré, J C; Naudet, F; Trystram, D; Gauvrit, J Y

    2017-02-01

    Cerebral dural arteriovenous fistulas (DAVFs) are rare intracranial vascular lesions but can cause significant morbidity and mortality. To analyze the effect of the center's experience on DAVF embolization efficacy and safety. From May 2008 to October 2014, 57 embolization procedures were attempted on 48 patients (37 men and 11 women; median age: 63.9 years) for DAVF in a single center. DAVF presented with cortical venous reflux in 44/48 cases (91.7%) and hemorrhagic manifestation in 21/48 cases (43.75%). Angiographic occlusion quality, whether complete or incomplete (efficacy), and neurological complications (safety) were recorded. The patient population was divided into four consecutive quartiles during the inclusion period to assess the progress profile. Efficacy and safety outcomes were compared with Fisher's test. A logistic regression was performed to explore a learning curve phenomenon, showing a significant association between the chronological rank in the cohort and embolization efficacy (P=0.007). Significant differences were found between first and last quarter (P=0.036). The endovascular technique involved an arterial injection of Onyx(®) in 36/48 cases (75%), administered via the middle meningeal artery in 25/36 cases (69.5%). The complete occlusion rate improved significantly from 33.3% for the first quartile of the population, to 75.0% for the 2nd and 3rd quartiles and 83.3% for the last quartile. Neurological complications were found in 7/48 patients (14.6%), the rate decreased by 41.7% to 16.7%, without statistically difference. The efficacy and safety of DAVF embolization improved with the experience gained at the center, suggesting the existence of a learning curve. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  16. Endovascular treatment for dural arteriovenous fistula at the foramen magnum: report of five consecutive patients and experience with balloon-augmented transarterial Onyx injection.

    Science.gov (United States)

    Liang, Guobiao; Gao, Xu; Li, Zhiqing; Wang, Xiaogang; Zhang, Haifeng; Wu, Zhongxue

    2013-05-01

    Foramen magnum dural arteriovenous fistulas (DAVF) with perimedullary venous drainage represent a small minority of intracranial DAVF, and only a number of small series with limited cases have been reported. The purpose of this retrospective study is to summarize experience of transarterial Onyx embolisation in the treatment of these lesions, with emphasis on the balloon-augmented technique. Five consecutive patients with DAVF at the foramen magnum were treated by transarterial embolisation using the Onyx system. Their symptoms included myelopathy (n=4) and SAH (n=1). Suppliers were from the vertebral artery (VA) (n=4), occipital artery (OA) (n=4), and ascending pharyngeal artery (APA) (n=2), with drainage to the perimedullary veins. After catheterization of the dilated supplier, the fistulous connections, proximal draining veins and appropriate distal segment of the feeders of these DAVF were transarterial embolized using Onyx-18. In three patients, balloon-augmented technique was used to assist embolisation. The technical feasibility of the procedure, angiographic results, and clinical outcome were evaluated. In every case, complete obliteration was achieved. Neither intraprocedural vessel rupture nor other procedure-related complications occurred. The results remained stable in all patients on follow-up angiograms (mean, 7.2 months). At the last clinical follow-up (mean, 17.6 months), two patients showed complete resolution of the initial symptoms, and three patients showed significant improvement. We found that Onyx embolisation is a feasible and safe alternative to open surgery in the treatment of selective DAVF at the foramen magnum. The balloon-augmented technique widens indications for transarterial Onyx packing of these lesions, and improved safety of the procedure. Copyright © 2013. Published by Elsevier Masson SAS.

  17. 人工动静脉内瘘成型术的护理与体会%Artificial arteriovenous internal fistula plasty nursing and experience

    Institute of Scientific and Technical Information of China (English)

    姬萍; 贾钰

    2012-01-01

    Objective: To investigate the artificial arteriovenous fistula nursing measures and matters needing attention. Method: 80 cases of fistula of anastomosis in a patient with strengthening the preoperative and postoperative care, nursing measures included preoperative evaluation to select the ideal vessel, postoperative brake and raising the affected limb, avoid fistula compression, to strengthen health education. Results: 80 patients in this group, formation of arteriovenous fistula thrombosis in 12 cases, good after thrombolytic therapy. Occlusion in 18 cases, successful thrombolysis in 6 cases, 10 cases with operation again, semi permanent deep venous channel 2An example. Conclusion: careful and effective health care, can reduce the internal arteriovenous fistula complications, prolonged service life of internal fistula, alleviate the suffering and economic burden of patients.%目的:探讨人工动静脉内瘘术的护理措施及注意事项.方法:通过对80例内瘘吻合术患者加强术前及术后护理,护理措施包括术前评估选择理想的血管、术后制动并抬高患肢、避免内瘘受压、加强健康教育等.结果:本组80例患者,形成动静脉内瘘血栓12例,溶栓后应用良好.闭塞者18例,溶栓成功6例,重新手术10例,改用半永久深静脉通路2例.结论:精心有效健康的护理,能够减少动静脉内瘘并发症的发生,延长内瘘使用寿命,减轻患者的痛苦和经济负担.

  18. Fístula arteriovenosa em crianças e adultos jovens Arteriovenous fistula in children and young adults

    Directory of Open Access Journals (Sweden)

    Marcio Lopes Miranda

    2000-12-01

    Full Text Available OBJETIVO: Com a introdução e o aprimoramento de técnicas para a realização de fístulas arteriovenosas (FAV em crianças, pacientes renais crônicos puderam iniciar tratamento com hemodiálise sem a necessidade de uso de shunts externos. MÉTODOS: Com o objetivo avaliar os resultados da confecção de fístulas arteriovenosas em crianças e adultos jovens de baixo peso e os fatores de risco relacionados. Foram levantados retrospectivamente os prontuários de 31 pacientes submetidos a 35 FAV, com idade variando de cinco a 24 anos, com peso entre 16 e 50kg. Os fatores de risco estudados foram hipertensão arterial, antecedentes de trombose, tendência à hipovolemia e presença de hipercolesterolemia. RESULTADOS: O índice de perda observado foi de 25% em pacientes com menos de 20kg e de 22,2% naqueles com mais de 20kg, resultados comparáveis aos da literatura. CONCLUSÕES: Observou-se que fístulas proximais não sofreram trombose; não houve relação entre a perda da FAV e os fatores de risco estudados e observou-se um índice de perda tardia de 23,5% nos pacientes que não estavam sendo submetidos à hemodiálise. Nos pacientes que utilizavam a FAV não se observou perda da mesma.BACKGROUND: Since the development of operative techniques for arteriovenous fistula (AVF creation, chronic hemodialysis for treatment of end-stage renal disease in children and young adults became an actual therapeutic option, obviating the need for external shunts. PURPOSE: To report our experience with surgically created AVF in 31 patients, aged 5 to 24 years old, relating long-term fistula patency with risk factors such as arterial hypertension, previous thrombosis events, tendency to hypovolemy, hypercholesterolemy, vein caliber and routine use of the fistula. RESULTS: Overall rate of fistula thrombosis was 22,8%, being 25% in patients weighing less than 20kg and 22,2% in those over 20kg. All fistulas performed on proximal arm veins were patent after 5 to 32

  19. The role of CT in evaluation of the effectiveness of embolisation of spinal dural arteriovenous fistulae with N -butyl cyanoacrylate

    Energy Technology Data Exchange (ETDEWEB)

    Cognard, C. [Service de Neuroradiologie Charcot, Hopital de la Salpetriere, Paris (France); Miaux, Y. [Service de Neuroradiologie Charcot, Hopital de la Salpetriere, Paris (France); Pierot, L. [Service de Neuroradiologie Charcot, Hopital de la Salpetriere, Paris (France); Weill, A. [Service de Neuroradiologie Charcot, Hopital de la Salpetriere, Paris (France); Martin, N. [Service de Neuroradiologie Charcot, Hopital de la Salpetriere, Paris (France); Chiras, J. [Service de Neuroradiologie Charcot, Hopital de la Salpetriere, Paris (France)

    1996-10-01

    A failed embolisation of a spinal dural arteriovenous fistula (AVF), because a pedicular injection has not reached the initial venous compartment, must be identified immediately, to allow prompt surgery and thus avoid clinical deterioration. The purpose of our study was to determine the role of CT in confirming a complete cure just after embolisation with N -butyl cyanoacrylate (NBCA). Seven patients embolised for spinal dural AVFs with perimedullary venous drainage had an immediate postembolisation CT scan. In six patients a complete cure was achieved, with a normal postembolisation angiogram in five cases. Just after injection of NBCA, we were unable to determine on plain films whether or not the glue had reached the draining vein in six of seven cases. The postembolisation CT showed various patterns: in two cured patients, the glue was visible in the inner surface of the dura mater and therefore on the venous side. In five cases, the glue was approaching the dura mater around the cord or seemed to reach its surface: in the four patients cured, the glue column was 7-18 mm high, whereas it was less than 2 mm high in the patient with angiographic proof of recurrent fistula. The follow-up angiogram remains the only way to confirm a durable cure. We suggest that immediate postembolisation CT may help in assessing endovascular treatment of spinal dural AVFs. (orig.). With 4 figs., 2 tabs.

  20. Foramen Magnum Dural Arteriovenous Fistula Treated by a Microsurgical Technique Combined with a Feeder Occlusion Using Transarterial Coil Embolization.

    Science.gov (United States)

    Hiramatsu, Ryo; Kuroiwa, Terumasa; Nozaki, Kazuhiko; Kuroiwa, Toshihiko

    2015-01-01

    The treatment of dural arteriovenous fistulas (DAVFs) at the foramen magnum remains controversial by reason that DAVFs appearing from the foramen magnum represent only a minority of spinal DAVFs. We present our treatment for an asymptomatic patient suffering from a foramen magnum DAVF. A 53-year-old man presented to our hospital with the complaint of a floating sensation. Although there was no subarachnoid hemorrhage or cerebral infarction on magnetic resonance imaging, a magnetic resonance angiography revealed a number of dilated veins and a large varix surrounding the medulla oblongata. Cerebral digital subtraction angiography (DSA) showed a foramen magnum DAVF fed by the neuromeningeal branch of the left ascending pharyngeal artery and occipital artery, draining into the posterior spinal vein. Occlusion of the fistula was achieved by a microsurgical technique combined with a feeder occlusion using transarterial coil embolization, without complications. We verified the complete occlusion on post-operative cerebral DSA. While this combined therapy was already established for the treatment of DAVFs, there were no reports of the combined therapy for foramen magnum DAVFs. This treatment was considered to be useful for foramen magnum DAVFs, especially those DAVFs at the foramen magnum with a number of dilated veins and a large varix.

  1. Patients on hemodialysis are better served by a proximal arteriovenous fistula for long-term venous access.

    LENUS (Irish Health Repository)

    Sultan, Sherif

    2012-11-01

    Patients with end-stage renal disease should have arteriovenous fistula (AVF) formation 3 to 6 months prior to commencing hemodialysis (HD). However, this is not always possible with strained health care resources. We aim to compare autologous proximal AVF (PAVF) with distal AVF (DAVF) in patients already on HD. Primary end point is 4-year functional primary. Secondary end point is freedom from major adverse clinical events (MACEs). From January 2003 to June 2009, out of 495 AVF formations, 179 (36%) patients were already on HD. These patients had 200 AVF formations (49 DAVF vs 151 PAVF) in arms in which no previous fistula had been formed. No synthetic graft was used. Four-year primary functional patency significantly improved with PAVF (68.9% ± SD 8.8%) compared to DAVF (7.3% ± SD 4.9%; P < .0001). Five-year freedom from MACE was 85% with PAVF compared to 40% with DAVF (P < .005). Proximal AVF bestows long-term functional access with fewer complications compared to DAVF for patients already on HD.

  2. Congestive myelopathy (Foix-Alajouanine Syndrome due to intradural arteriovenous fistula of the filum terminale fed by anterior spinal artery: Case report and review of literature

    Directory of Open Access Journals (Sweden)

    Prasad Krishnan

    2013-01-01

    Full Text Available Spinal arteriovenous fistulas are rare entities. They often present with congestive myelopathy but are infrequently diagnosed as the cause of the patients′ symptoms. Only one such case has been described previously in Indian literature. We describe one such case who presented to us after a gap of 3 years since symptom onset and following a failed laminectomy where the cause was later diagnosed to be an intradural fistula in the filum terminale fed by the anterior spinal artery and review the available literature.

  3. The deleterious effects of arteriovenous fistula-creation on the cardiovascular system: a longitudinal magnetic resonance imaging study

    Directory of Open Access Journals (Sweden)

    Dundon BK

    2014-09-01

    Full Text Available Benjamin K Dundon,1–3 Kim Torpey,3 Adam J Nelson,1 Dennis TL Wong,1,2 Rae F Duncan,1 Ian T Meredith,2 Randall J Faull,1,3 Stephen G Worthley,1,4 Matthew I Worthley1,4 1Cardiology Department, Royal Adelaide Hospital, Central Adelaide Local Health Network, Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia; 2Monash Cardiovascular Research Centre, MonashHEART, Monash Health, Melbourne, Vic, Australia; 3Central Northern Renal and Transplantation Service, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia; 4South Australian Health and Medical Research Institute, Adelaide, SA, Australia Aim: Arteriovenous fistula-formation remains critical for the provision of hemodialysis in end-stage renal failure patients. Its creation results in a significant increase in cardiac output, with resultant alterations in cardiac stroke volume, systemic blood flow, and vascular resistance. The impact of fistula-formation on cardiac and vascular structure and function has not yet been evaluated via "gold standard" imaging techniques in the modern era of end-stage renal failure care. Methods: A total of 24 patients with stage 5 chronic kidney disease undergoing fistula-creation were studied in a single-arm pilot study. Cardiovascular magnetic resonance imaging was undertaken at baseline, and prior to and 6 months following fistula-creation. This gold standard imaging modality was used to evaluate, via standard brachial flow-mediated techniques, cardiac structure and function, aortic distensibility, and endothelial function. Results: At follow up, left ventricular ejection fraction remained unchanged, while mean cardiac output increased by 25.0% (P<0.0001. Significant increases in left and right ventricular end-systolic volumes (21% [P=0.014] and 18% [P<0.01], left and right atrial area (11% [P<0.01] and 9% [P<0.01], and left ventricular mass were observed (12.7% increase (P<0.01. Endothelial

  4. The accuracy and utility of contrast-enhanced MR angiography for localization of spinal dural arteriovenous fistulas: the Toronto experience.

    Science.gov (United States)

    Lindenholz, Arjen; TerBrugge, Karel G; van Dijk, J Marc C; Farb, Richard I

    2014-11-01

    The purpose of this study was to determine the accuracy and utility of contrast-enhanced MR angiography (CE-MRA) in spinal dural arteriovenous fistulas (SDAVF). A retrospective analysis from 1999-2012 identified 70 patients clinically suspected of harboring a SDAVF. Each patient underwent consecutive conventional MR-imaging, CE-MRA, and digital subtraction angiography (DSA). The presence or absence of serpentine flow voids, T2-weighted hyperintensity, and cord enhancement were evaluated, as well as location of the fistula as predicted by CE-MRA. DSA was used as the reference standard. Of the 70 cases, 53 were determined to be a SDAVF, 10 cases were shown to be other forms of vascular malformation, and 7 were DSA-negative. On MRI, all reported cases of SDAVF showed serpentine flow voids (100 %). T2-weighted hyperintensity was seen in 48 of 50 cases (96 %), extending to the conus in 41 of 48 cases (85 %). Cord enhancement was seen in 38 of 41 cases (93 %). CE-MRA correctly localized the SDAVF in 43 of the 53 cases (81 %). CE-MRA is a useful non-invasive examination for the detection and localization of SDAVF. CE-MRA facilitates but does not replace DSA as confirmation of location, fistula type, and arterial detail, which are required before treatment. • CE-MRA correctly localized the site of the SDAVF in over 80 % of cases. • CE-MRA facilitates diagnostic DSA and expedites the diagnostic process. • CE-MRA does not replace diagnostic DSA in SDAVF cases as confirmative test. • CE-MRA provides better understanding of missed or mislocalized SDAVF cases.

  5. A traumatic dural arteriovenous fistula between the inferolateral trunk of the internal carotid artery and the ophthalmic vein: A case of transvenous coil embolization via the facial vein

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jun Young; Hong, Chang Ki; Suh, Sang Hyun [Dept. of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Kim, Dong Ik [Dept. of of Radiology, CHA Bundang Medical Center, CHA University, Seongnam (Korea, Republic of)

    2017-05-15

    A 31-year-old man was admitted with exophthalmos. He suffered from progressive exophthalmos, bruit and conjunctival chemosis 7 days after head trauma caused by falling down. Cerebral angiography showed a dural arteriovenous fistula (DAVF) draining into the ophthalmic vein caused by tear in the inferolateral trunk, which is a rare presentation of traumatic DAVF. Selective transvenous coil embolization was performed via the facial vein without neurologic complications.

  6. A case of a spontaneous intraorbital arteriovenous fistula: clinico-radiological findings and treatment by transvenous embolisation via the superior ophthalmic vein.

    Science.gov (United States)

    Naqvi, Jawad; Laitt, Roger; Leatherbarrow, Brian; Herwadkar, Amit

    2013-04-01

    A 72-year-old male presented with progressive right axial proptosis and red eye. Catheter angiography demonstrated an intraorbital arteriovenous fistula (IAVF) distal to the central retinal artery (CRA). Transvenous embolisation following direct surgical exposure of the superior ophthalmic vein (SOV) resulted in rapid resolution of his symptoms and signs. Transvenous embolisation via the SOV is a safe, effective alternative to transarterial embolisation for treating spontaneous IAVF where transarterial embolisation poses a risk of CRA occlusion.

  7. Paclitaxel-coated balloon fistuloplasty versus plain balloon fistuloplasty only to preserve the patency of arteriovenous fistulae used for haemodialysis (PAVE): study protocol for a randomised controlled trial.

    Science.gov (United States)

    Karunanithy, Narayan; Mesa, Irene Rebollo; Dorling, Anthony; Calder, Francis; Katsanos, Konstantinos; Semik, Vikki; Robinson, Emily; Peacock, Janet; Das, Neelanjan; Forman, Colin; Lawman, Sarah; Steiner, Kate; Wilkins, C Jason; Robson, Michael G

    2016-05-12

    The initial therapy for a stenosis in an arteriovenous fistula used for haemodialysis is radiological balloon dilatation or angioplasty. The benefit of angioplasty is often short-lived, intervention-free survival is reported to be 40-50 % at 1 year. Previous small studies and observational data suggest that paclitaxel-coated balloons may be of benefit in improving outcomes after fistuloplasty of stenotic arteriovenous fistulae. We have designed a multicentre, double-blind randomised controlled trial to test the superiority of paclitaxel-coated balloons for preventing restenosis after fistuloplasty in patients with a native arteriovenous fistula. Two hundred and eleven patients will be followed up for a minimum of 1 year. Inclusion criteria include a clinical indication for a fistuloplasty, an access circuit that is free of synthetic graft material or stents, and a residual stenosis of 30 % or less after plain balloon fistuloplasty. Exclusion criteria include a synchronous venous lesion in the same access circuit, location of the stenosis central to the thoracic inlet or a thrombosed access circuit at the time of treatment. The primary endpoint is time to end of target lesion primary patency. This is defined as a clinically-driven radiological or surgical re-intervention at the treatment segment, thrombosis that includes the treatment segment, or abandonment of the access circuit due to an inability to re-treat the treatment segment. Secondary endpoints include angiographic late lumen loss, time to end of access circuit cumulative patency, the total number of interventions, and quality of life. The trial is funded by the National Institute for Health Research. We anticipate that this trial will provide rigorous data that will determine the efficacy of additional paclitaxel-coated balloon fistuloplasty versus plain balloon fistuloplasty only to preserve the patency of arteriovenous fistulae used for haemodialysis. ISRCTN14284759 . Registered on 28 October 2015.

  8. 容易误诊漏诊的硬脑膜动静脉瘘9例分析%Dural arteriovenous fistula with easily inaccurate or missed diagnosis: analysis of 9 cases

    Institute of Scientific and Technical Information of China (English)

    廖焕权; 王鸿轩; 陈红兵; 杨智云; 王莹; 贺涓涓; 尚文锦; 洪华

    2011-01-01

    目的 提高对容易误诊漏诊的硬脑膜动静脉瘘(dural arteriovenous fistula,DAVF)的诊断水平.方法 回顾性总结9例DAVF的临床资料,结合文献进行分析.结果 9例主要临床表现及误诊情况分别为:视朦或视力下降4例,无颅内高压症状,误诊为视神经炎、颅内结核感染或特发性颅内压增高;记忆力下降1例,误诊为病毒性脑炎;双下肢无力1例,误诊为急性脊髓炎、神经鞘瘤;反复头痛1例,误诊为偏头痛、特发性颅内压增高;反复抽搐1例,误诊为正常颅内压脑积水;饮水呛咳、吞咽困难1例,误诊为脑梗死.3例满足于静脉窦血栓的诊断而忽略了DAVF.所有病例影像学均漏诊,但如仔细观察仍可发现细微的血管形态改变,提示动静脉畸形.结论 DAVF临床表现缺乏特异性,加上临床及放射科医师对本病认识不足,诊断思路狭窄,造成本病误诊、漏诊率高.%Objective To improve the diagnostic capability of dural arteriovenous fistula(DAVF) which easily leads to inaccurate or missed diagnosis.Methods The clinical information of 9 cases of DAVF was summarized retrospectively, and analyzed with a literature review.Results The main clinical manifestations and misdiagnosis of 9 cases were: 4 cases presenting with only amaurosis fugax or vision loss without symptoms of increased intracranial pressure were misdiagnosed as optic neuritis,intracranial tuberculosis infection and idiopathic intracranial hypertension;1 case presenting with memory decline was misdiagnosed as viral encephalitis;1 case presenting with bilateral lower limbs weakness was misdiagnosed as acute myelitis and neurilemmoma; 1 case presenting with recurrent headache was misdiagnosed as migraine and idiopathic intracranial hypertension;1 case presenting with repeating seizures was misdiagnosed as normal intracranial pressure hydrocephalus;1 case presenting with choking water and swallowing difficulty was misdiagnosed as cerebral infarction.3

  9. Quality of life, anxiety, and depression in patients with an untreated intracranial aneurysm or arteriovenous malformation

    NARCIS (Netherlands)

    van der Schaaf, IC; Brilstra, EH; Rinkel, GJE; Bossuyt, PM; van Gijn, J

    2002-01-01

    Background and Purpose-The objective of this study was to assess the health-related quality of life and symptoms of anxiety and depression in patients who are aware of the presence of a patent aneurysm or arteriovenous malformation. Methods-Participants were retrospectively identified and invited to

  10. Direct percutaneous venous puncture and embolization of giant perimedullary arteriovenous fistulas.

    Science.gov (United States)

    Casasco, A; Guimaraens, L; Cuellar, H; Theron, J; Heredero, J

    2011-01-01

    PMAVFs are rare entities that are formed by a direct communication between an artery that feeds the spinal cord and a vein. The goal of treatment is to occlude the shunt; this is done endovascularly either from an arterial or a venous approach. When these approaches are not possible, direct percutaneous puncture of the draining veins may be attempted to embolize the arteriovenous shunt directly.

  11. Lateral sacral artery supply to an intramedullary arteriovenous fistula at the conus medullaris

    Energy Technology Data Exchange (ETDEWEB)

    Mochizuki, T.; Nemoto, Y.; Inoue, Y.; Tashiro, T. (Osaka City Univ. Medical School (Japan). Dept. of Radiology); Sakanaka, H. (Osaka City Univ. Medical School (Japan). Dept. of Orthopedics)

    1991-10-01

    In this 25-year-old woman, severe low back pain, flaccid paraparesis, sensory disturbance of both legs and sphincter dysfunction resulted from an intramedullary conal arteriovenous malformation fed by an anterior spinal artery arising from the left sixth intercostal artery and by the left lateral sacral artery, a branch of the left internal iliac artery. Magnetic resonance (MR) images showed low signal (flow void) within an intramedullary mass that expanded the conus from T12 to L1. (orig./GDG).

  12. Posterior fossa dural arteriovenous fistulas: diagnosis and follow-up with time-resolved imaging of contrast kinetics (TRICKS) at 1.5T

    Energy Technology Data Exchange (ETDEWEB)

    Pekkola, Johanna; Kangasniemi, Marko (Helsinki Medical Imaging Center, Helsinki Univ. Central Hospital, Helsinki (Finland)), email: johanna.pekkola@hus.fi

    2011-05-15

    Background Time-of-flight MR angiography (TOF MRA) is currently the most widely used non-invasive imaging tool to diagnose dural arteriovenous fistula (DAVF). It is, however, not as sensitive as invasive digital subtraction angiography (DSA) for detecting the arteriovenous shunting inherent in DAVF. Dynamic contrast-enhanced MR angiography allows separation of arterial and venous phases of contrast passage though the brain and can thus demonstrate early venous filling through the arteriovenous shunt. Purpose To compare the diagnostic value of TOF MRA and a commercially available dynamic contrast-enhanced MR angiography sequence (TRICKS) at 1.5T in detecting posterior fossa DAVF. Material and Methods We retrospectively collected image data for 19 patients who underwent TOF MRA, TRICKS, and DSA either for primary diagnosis or for follow-up of posterior fossa DAVF and assessed the performance of TOF MRA and TRICKS in demonstrating the arteriovenous shunt, with DSA as the reference standard. Results TRICKS detected early arterial filling at 94.4% sensitivity and 83.3% specificity. TOF MRA detected high flow-related signal within venous structures at 64.7% sensitivity and 80% specificity. Conclusion The commercially available dynamic MR angiography sequence TRICKS with fully automatic vendor postprocessing at 1.5T is more sensitive than TOF MRA in detecting the arteriovenous shunt in posterior fossa DAVF

  13. Automated double-cone-beam CT fusion technique. Enhanced evaluation of glue distribution in cases of spinal dural arteriovenous fistula (SDAVF) embolisation

    Energy Technology Data Exchange (ETDEWEB)

    Farago, Giuseppe [Foundation Neurological Institute ' ' C. Besta' ' , Department of Interventional Neuroradiology, Milan (Italy); Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Interventional Neuroradiology, Milan (Italy); Caldiera, V. [Foundation Neurological Institute ' ' C. Besta' ' , Department of Interventional Neuroradiology, Milan (Italy); Antozzi, C.; Bellino, A. [Foundation Neurological Institute ' ' C. Besta' ' , Department of Neuroimmunology and Neuromuscular Diseases, Milan (Italy); Innocenti, A. [Foundation Neurological Institute ' ' C. Besta' ' , Department of Neuro-Oncology, Milan (Italy); Ciceri, E. [Foundation Neurological Institute ' ' C. Besta' ' , Department of Interventional Neuroradiology, Milan (Italy); Azienda Ospedaliera Universitaria Integrata Borgo Trento, Department of Neuroradiology, Verona (Italy)

    2017-05-15

    Spinal dural arteriovenous fistulas (SDAVFs) are acquired diseases that represent the majority of all arteriovenous spinal shunts, leading to progressive and disabling myelopathy. Treatment is focused on accurately disconnecting the fistula point. We present our experience with the double-cone-beam CT fusion technique successfully applied to evaluate treatment results in a series of SDAVFs. Between November 2011 and December 2015 we performed double-DynaCT acquisition (pre- and post-embolisation) in 12 cases of SDAVF. A successful DynaCT fusion technique was only achieved in the group of patients with pre- and post-treatment images acquired at the same time as the treatment session, under general anaesthesia (4/12). DynaCT performed on different days proved to be inadequate for the automated fusion technique because of changes in the body position (8/12). A pre-treatment flat-panel cone-beam CT with contrast, at the time of diagnostic angiography, can be very helpful to detect the correct level of the fistula and the relationship between the fistula and the surrounding structures. In case of the endovascular approach, additional post-treatment native acquisition merged with the pre-treatment acquisition (double-cone-beam CT fusion technique) permits to immediately evaluate the distribution of the glue cast and to confirm the success of the procedure. (orig.)

  14. Complications corner: Anterior thoracic disc surgery with dural tear/CSF fistula and low-pressure pleural drain led to severe intracranial hypotension

    Directory of Open Access Journals (Sweden)

    Eline A Oudeman

    2015-01-01

    Conclusion: Severe neurological deterioration occurring after thoracic decompressive surgery may rarely be attributed to intracranial hypotension due to a subarachnoid-pleural fistula. Patients should be treated with external lumbar drainage of cerebrospinal fluid for 3-5 days rather than a low-pressure pleural drain to avoid the onset of intracranial hypotension leading to symptomatic subdural hematomas.

  15. Transvenous embolization of cavernous sinus dural arteriovenous fistula via angiographic occlusive inferior petrous sinus

    Directory of Open Access Journals (Sweden)

    Chao-Bao Luo

    2015-09-01

    Conclusion: Angiographic occlusive IPS of CSDAVF may be related to true occlusion of IPS or patent IPS with compartment of the IPS-CS. There is no statistically significant difference in procedural times for these two different fistula anatomies. Transvenous embolization via angiographic occlusive IPS is a safe and effective method to manage CSDAVFs.

  16. Aneurisma ilíaco associado a fístula arteriovenosa Iliac aneurysm associated with arteriovenous fistula

    Directory of Open Access Journals (Sweden)

    Daniel Mendes Pinto

    2007-09-01

    Full Text Available A ruptura dos aneurismas aorto-ilíacos para a veia ilíaca ou veia cava é uma complicação pouco comum. A hipertensão venosa leva a vários sinais e sintomas, o que dificulta o diagnóstico pré-operatório, tais como edema do membro inferior, dispnéia, hematúria, sinais de insuficiência renal ou cardíaca. Sopro abdominal é a chave do diagnóstico clínico, associado à massa pulsátil e dor abdominal. O reconhecimento da fístula arteriovenosa no pré-operatório é importante para o planejamento cirúrgico. Relatamos um caso de aneurisma da artéria ilíaca comum e interna direita associado a fístula para veia ilíaca comum, cursando, inicialmente, com edema do membro inferior direito e dispnéia, o que levou ao diagnóstico incorreto de trombose venosa profunda.Rupture of aortoiliac aneurysms into the iliac vein or vena cava is an uncommon complication. Many signs and symptoms develop as a result of venous hypertension, which makes preoperative diagnosis difficult, such as leg edema, dyspnea, hematuria, signs of renal or cardiac insufficiency. Abdominal bruit, associated with pulsatile mass and abdominal pain, is the key for clinical diagnosis. Preoperative recognition of arteriovenous fistula is important for surgical planning. We report a case of right internal and common iliac artery aneurysm associated with fistula into the common iliac vein. Initial symptoms were right leg edema and dyspnea, which induced to the incorrect diagnosis of deep vein thrombosis.

  17. First-Pass Contrast-Enhanced MR Angiography in Evaluation of Treated Spinal Arteriovenous Fistulas: Is Catheter Angiography Necessary?

    Science.gov (United States)

    Mathur, S; Symons, S P; Huynh, T J; Marotta, T R; Aviv, R I; Bharatha, A

    2017-01-01

    Catheter angiography is typically used for follow-up of treated spinal AVFs. The purpose of this study was to determine the diagnostic performance and utility of first-pass contrast-enhanced MRA in the posttreatment evaluation of spinal AVFs compared with DSA. A retrospective review was performed of all patients at our tertiary referral hospital (from January 2000 to April 2015) who underwent spine MR imaging, first-pass contrast-enhanced MRA, and DSA after surgical and/or endovascular treatment of a spinal AVF. Presence of recurrent or residual fistula on MRA, including vertebral level of the recurrent/residual fistula, was evaluated by 2 experienced neuroradiologists blinded to DSA findings. Posttreatment conventional MR imaging findings were also evaluated, including presence of intramedullary T2 hyperintensity, perimedullary serpentine flow voids, and cord enhancement. The performance of MRA and MR imaging findings for diagnosis of recurrent/residual fistula was determined by using DSA as the criterion standard. In total, 28 posttreatment paired MR imaging/MRA and DSA studies were evaluated in 22 patients with prior spinal AVF and 1 patient with intracranial AVF with prior cervical perimedullary venous drainage. Six image sets of 5 patients demonstrated recurrent/residual disease at DSA. MRA correctly identified all cases with recurrent/residual disease with 1 false-positive (sensitivity, 100%; specificity 95%; P MR imaging parameters were not significantly associated with recurrent/residual spinal AVF. First-pass MRA demonstrates high sensitivity and specificity for identifying recurrent/residual spinal AVFs and may potentially substitute for DSA in the posttreatment follow-up of patients with spinal AVFs. © 2017 by American Journal of Neuroradiology.

  18. Embolization of Intracranial Dural Arteriovenous Fistulas Using PHIL Liquid Embolic Agent in 26 Patients

    DEFF Research Database (Denmark)

    Lamin, S; Chew, H S; Chavda, S

    2017-01-01

    BACKGROUND AND PURPOSE: The introduction of liquid embolic agents has revolutionized endovascular approach to cranial vascular malformations. The aim of the study was to retrospectively assess the efficacy and safety of Precipitating Hydrophobic Injectable Liquid (PHIL), a new nonadhesive liquid ...

  19. [Rapidly progressive dementia and parkinsonism associated to multiple dural arteriovenous fistulas].

    Science.gov (United States)

    Mejia, P; Piedra, L M; Merchan-Del Hierro, X

    2017-03-01

    Introduccion. Las demencias rapidamente progresivas son un grupo poco frecuente de enfermedades caracterizadas por un deterioro cognitivo y otras alteraciones neurologicas que evolucionan en el transcurso de semanas a meses. Su etiologia es diversa e incluye un gran numero de condiciones neurodegenerativas, toxicas, metabolicas, autoinmunes, infecciosas y vasculares. Caso clinico. Varon de 69 años, que ingreso por demencia rapidamente progresiva y parkinsonismo causado por multiples fistulas arteriovenosas durales tratadas exitosamente mediante terapia endovascular. Conclusion. Las fistulas arteriovenosas durales son conexiones anomalas entre las arterias durales y los senos venosos o venas corticales que constituyen una causa inusual de demencia rapidamente progresiva, pero que debe considerarse, dada la disponibilidad de un tratamiento especifico con reversion de los sintomas.

  20. Percutaneous transvenous embolisation through the occluded sinus for transverse-sigmoid dural arteriovenous fistulas with sinus occlusion

    Energy Technology Data Exchange (ETDEWEB)

    Naito, I.; Iwai, T.; Shimaguchi, H.; Suzuki, T.; Tomizawa, S. [Dept. of Neurosurgery, Geriatrics Research Inst. and Hospital, Maebashi (Japan); Negishi, M.; Sasaki, T. [Dept. of Neurosurgery, Gunma Univ. School of Medicine (Japan)

    2001-08-01

    We report six cases of transverse-sigmoid dural arteriovenous fistulae (TS DAVF) treated with percutaneous transvenous embolisation through the occluded sinus. All patients had sinus occlusive lesions: an isolated sinus in five cases and a distal occlusion of the affected sinus in one. Leptomeningeal retrograde venous drainage via the vein of Labbe or the sylvian vein was observed in all patients with an isolated sinus. In five patients a microcatheter was easily passed through the occluded sinus. In four of them, a complete angiographic cure was achieved by packing the sinus with coils. However, in one, sinus packing was ineffective and surgical excision of the affected sinus was necessary. The microcatheter could not be passed through the occluded sinus in one case, and direct packing of the isolated sinus was later required. In all cases, complete cure was achieved without complications. This safe, not very invasive and highly effective treatment for TS DAVF with sinus occlusion is thus worth trying when the occluded segment is relatively short. (orig.)

  1. Pre-existing Arterial Micro-Calcification Predicts Primary Unassisted Arteriovenous Fistula Failure in Incident Hemodialysis Patients.

    Science.gov (United States)

    Choi, Su Jin; Yoon, Hye Eun; Kim, Young Soo; Yoon, Sun Ae; Yang, Chul Woo; Kim, Yong-Soo; Park, Sun Cheol; Kim, Young Ok

    2015-01-01

    Vascular access micro-calcification is a risk factor for cardiovascular morbidity and mortality in hemodialysis (HD) patients but its influence on vascular access patency is still undetermined. Our study aimed to determine the impact of arterial micro-calcification (AMiC) on the patency of vascular access in HD patients. One-hundred fourteen HD patients receiving arteriovenous fistula (AVF) operation were included in this study. During the operation, we obtained partial arterial specimen and performed pathological examination by von Kossa stain to identify AMiC. We compared primary unassisted AVF failure within 1 year between positive and negative AMiC groups, and performed Cox regression analysis for evaluating risk factor of AVF failure. The incidence of AMiC was 37.7% and AVF failure occurred in 45 patients (39.5%). The AVF failure rate within 1 year was greater in the positive AMiC group than those in the negative AMiC group (53.5% vs. 31.0%, p = 0.02). Kaplan-Meier analysis showed that the positive AMiC group had a lower AVF patency rate than the negative AMiC group (p = 0.02). The presence of AMiC was an independent risk factor for AVF failure. In conclusion, preexisting AMiC of the vascular access is associated with primary unassisted AVF failure in incident HD patients.

  2. The effect of in-plane arterial curvature on blood flow and oxygen transport in arterio-venous fistulae

    Science.gov (United States)

    Iori, F.; Grechy, L.; Corbett, R. W.; Gedroyc, W.; Duncan, N.; Caro, C. G.; Vincent, P. E.

    2015-03-01

    Arterio-Venous Fistulae (AVF) are the preferred method of vascular access for patients with end stage renal disease who need hemodialysis. In this study, simulations of blood flow and oxygen transport were undertaken in various idealized AVF configurations. The objective of the study was to understand how arterial curvature affects blood flow and oxygen transport patterns within AVF, with a focus on how curvature alters metrics known to correlate with vascular pathology such as Intimal Hyperplasia (IH). If one subscribes to the hypothesis that unsteady flow causes IH within AVF, then the results suggest that in order to avoid IH, AVF should be formed via a vein graft onto the outer-curvature of a curved artery. However, if one subscribes to the hypothesis that low wall shear stress and/or low lumen-to-wall oxygen flux (leading to wall hypoxia) cause IH within AVF, then the results suggest that in order to avoid IH, AVF should be formed via a vein graft onto a straight artery, or the inner-curvature of a curved artery. We note that the recommendations are incompatible—highlighting the importance of ascertaining the exact mechanisms underlying development of IH in AVF. Nonetheless, the results clearly illustrate the important role played by arterial curvature in determining AVF hemodynamics, which to our knowledge has been overlooked in all previous studies.

  3. Fabrication of artificial arteriovenous fistula and analysis of flow field and shear stress by using μ-PIV technology

    Energy Technology Data Exchange (ETDEWEB)

    Park, Sun Cheol; Kim, Hyun Kyu [Div. of Vascular Surgery, Dept. of Surgery, College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of); Song, Ryun Geun; Kim, Sun Ho; Lee, Jin Kee [School of Mechanical Engineering, Sungkyunkwan University, Suwon (Korea, Republic of); Kim, Seung Hyun [School of Engineering, Brown University, Providence (United States)

    2016-12-15

    Radio-cephalic arteriovenous fistula (RC-AVF) is an operation performed to achieve vascular access for hemodialysis. Although RC-AVF is a reliable and well-known method, this technique presents high rates of early failure depending on the vessel condition. These failures are due to blood shear stress around the anastomosis site and the vascular access failure caused by thrombosis secondary to stenosis formation, as well as vascular access reocclusion after percutaneous interventions. In this work, we fabricate in vitro 3D RC-AVF by using polydimethylsiloxane and 3D printing technology to understand the underlying mechanism and predict AVF failure. Micro- Particle image velocimetry (μ-PIV) focusing on the cardiac pulse cycle is used to measure the velocity field within the artificial blood vessel. Results are confirmed by numerical simulation. Accordingly, the in vitro AVF model agrees well with the simulations. Overall, this research would provide the future possibility of using the proposed method to reduce in vivo AVF failure for various conditions.

  4. Whole-brain CT digital subtraction angiography of cerebral dural arteriovenous fistula using 320-detector row CT

    Energy Technology Data Exchange (ETDEWEB)

    Fujiwara, Hirokazu; Momoshima, Suketaka; Kuribayashi, Sachio [Keio University, Department of Diagnostic Radiology, School of Medicine, Tokyo (Japan); Akiyama, Takenori [Keio University, Department of Neurosurgery, School of Medicine, Tokyo (Japan)

    2013-07-15

    The purpose of this study was to evaluate the usefulness of CT digital subtraction angiography (CTDSA) by using 320-detector row CT in the diagnosis and classification of cerebral dural arteriovenous fistula (dAVF) and comparing it with DSA as the standard reference. A total of 29 CTDSA/DSA from 25 patients with dAVF were retrospectively evaluated by two neuroradiologists. The presence, Cognard classification, and feeding arteries of dAVFs on CTDSA were assessed according to DSA. DSA depicted 33 dAVFs in 28 cases. By consensus reading, CTDSA correctly detected 32 dAVFs in 27 cases and properly graded 31 lesions. The intermodality agreement for the presence and classification of dAVFs was excellent (kappa = 0.955 and 0.921, respectively). CTDSA detected 77 of 109 feeding arteries (70.6 %) in 25 cases. The intermodality agreement for the feeding arteries was good (kappa = 0.713). Although CTDSA is limited in temporal and spatial resolution in comparison with DSA, it is an effective non-invasive tool for the detection and classification of dAVF. (orig.)

  5. Factors influencing technical success and outcome of percutaneous balloon angioplasty in de novo native hemodialysis arteriovenous fistulas

    Energy Technology Data Exchange (ETDEWEB)

    Heye, Sam, E-mail: sam.heye@uzleuven.be [University Hospitals Leuven, Department of Radiology, Herestraat 49, 3000 Leuven (Belgium); Maleux, Geert, E-mail: geert.maleux@uzleuven.be [University Hospitals Leuven, Department of Radiology, Herestraat 49, 3000 Leuven (Belgium); Vaninbroukx, Johan, E-mail: johan.vaninbroukx@uzleuven.be [University Hospitals Leuven, Department of Radiology, Herestraat 49, 3000 Leuven (Belgium); Claes, Kathleen, E-mail: Kathleen.claes@uzleuven.be [University Hospitals Leuven, Department of Nephrology, Herestraat 49, 3000 Leuven (Belgium); Kuypers, Dirk, E-mail: dirk.kuypers@uzleuven.be [University Hospitals Leuven, Department of Nephrology, Herestraat 49, 3000 Leuven (Belgium); Oyen, Raymond, E-mail: raymond.oyen@uzleuven.be [University Hospitals Leuven, Department of Radiology, Herestraat 49, 3000 Leuven (Belgium)

    2012-09-15

    Objective: To determine predictors of technical success, dysfunction recurrence and patency after percutaneous transluminal angioplasty (PTA) of de novo dysfunctional hemodialysis arteriovenous fistulas (AVFs). Methods: Retrospective analysis of first time PTA of 167 AVF in 162 patients (100 men, 66 ± 13 years). Anatomical (location, length, grade and number of stenoses) and clinical variables (sex, age, prior AVF, diabetes mellitus and AVF age, side and location) were reviewed. Results: 217 stenoses or segmental occlusions were treated. Technical success rate (84.4%) was higher in radiocephalic AVF compared to brachial artery–median vein AVF (p = 0.030) and was negatively correlated with initial stenosis (p = 0.049). Dysfunction recurrence was seen in 52.7% and correlated negatively with technical success (p = 0.013) and AVF age (p = 0.008). Early dysfunction (within 6 months) was negatively correlated with AVF age (p = 0.016) and positively with diabetes (p = 0.003). Higher AVF age resulted in higher primary (p = 0.005) and secondary patency rates (p = 0.037–0.005). Conclusions: Technical success of PTA in hemodialysis AVF is affected by AVF type and initial stenosis and has significant effect on dysfunction recurrence, but not on AVF longevity. Younger AVF has increased risk for (early) recurrent dysfunction and lower patency rates. Patients with diabetes mellitus have higher risk for early dysfunction.

  6. Improving arteriovenous fistula patency: Transdermal delivery of diclofenac reduces cannulation-dependent neointimal hyperplasia via AMPK activation.

    Science.gov (United States)

    MacAskill, Mark G; Watson, David G; Ewart, Marie-Ann; Wadsworth, Roger; Jackson, Andrew; Aitken, Emma; MacKenzie, Graeme; Kingsmore, David; Currie, Susan; Coats, Paul

    2015-08-01

    Creation of an autologous arteriovenous fistula (AVF) for vascular access in haemodialysis is the modality of choice. However neointimal hyperplasia and loss of the luminal compartment result in AVF patency rates of ~60% at 12months. The exact cause of neointimal hyperplasia in the AVF is poorly understood. Vascular trauma has long been associated with hyperplasia. With this in mind in our rabbit model of AVF we simulated cannulation autologous to that undertaken in vascular access procedures and observed significant neointimal hyperplasia as a direct consequence of cannulation. The neointimal hyperplasia was completely inhibited by topical transdermal delivery of the non-steroidal anti-inflammatory (NSAID) diclofenac. In addition to the well documented anti-inflammatory properties we have identified novel anti-proliferative mechanisms demonstrating diclofenac increases AMPK-dependent signalling and reduced expression of the cell cycle protein cyclin D1. In summary prophylactic transdermal delivery of diclofenac to the sight of AVF cannulation prevents adverse neointimal hyperplasic remodelling and potentially offers a novel treatment option that may help prolong AVF patency and flow rates.

  7. Aortic Arch Calcification as a Predictor of Repeated Arteriovenous Fistula Failure within 1-Year in Hemodialysis Patients

    Directory of Open Access Journals (Sweden)

    Yit-Sheung Yap

    2017-01-01

    Full Text Available Objectives. The aim of the study was to identify the factors associated with repeated arteriovenous fistula (AVF failure within 1-year, especially the impact of aortic arch calcification (AAC on patency of AVF. Materials and Methods. We retrospectively assessed chest radiography in hemodialysis patients who had undergone initial AVF. The extent of AAC was categorized into four grades (0–3. The association between AAC grade, other clinical variables, and repeated failure of AVF was then analyzed by binary logistic regression analysis. Results. This study included 284 patients (158 males, mean age 61.7±13.1 years. Patients with higher AAC grade were older, had more frequently diabetes mellitus and cardiovascular disease, had lower diastolic blood pressure, and had higher corrected calcium and lower intact parathyroid hormone levels. In multivariate analysis, the presence of higher AAC grade (odds ratio (95% confidence interval: 2.98 (1.43–6.23; p=0.004, lower mean corrected calcium (p=0.017, and mean serum albumin level (p=0.008 were associated with repeated failure of AVF. Conclusions. The presence of higher AAC grade, lower mean corrected calcium and mean serum albumin level were independently associated with repeated AVF failure within 1 year in hemodialysis patients.

  8. CT and MR imaging of non-cavernous cranial dural arteriovenous fistulas: Findings associated with cortical venous reflux

    Energy Technology Data Exchange (ETDEWEB)

    Letourneau-Guillon, Laurent; Cruz, Juan Pablo; Krings, Timo, E-mail: Timo.Krings@uhn.ca

    2015-08-15

    Highlights: • The conventional neuroimaging manifestations of dural arteriovenous fistulas are highly variable. • Identification of cortical venous reflux is important to prevent complications. • Tortuous and dilated vessels without a nidus are associated with cortical venous reflux. • Digital subtraction angiography remains the gold standard for DAVF diagnosis. - Abstract: Purpose: To compare the conventional CT and MR findings of DAVFs in relation to the venous drainage pattern on digital subtraction angiography (DSA). Materials and Methods: Cross-sectional imaging findings (CT and/or MR) in 92 patients were compared to the presence of cortical venous reflux (CVR) on DSA. Results: Imaging features significantly more prevalent in patients with CVR included: abnormally dilated and tortuous leptomeningeal vessels (92% vs. 4%, p < 0.001) or medullary vessels (69% vs. 0%, p < 0.001), venous ectasias (45% vs. 0%, p < 0.001) and focal vasogenic edema (38% vs. 0%, p < 0.001). The following findings trended towards association but did not reach the p value established following Bonferroni correction: dilated external carotid artery branches (71% vs. 38%, p = 0.005), cluster of vessels surrounding dural venous sinus (50% vs. 19%, p = 0.009), presence of hemorrhage (33 vs. 12%, p = 0.040), and parenchymal enhancement (21% vs. 0%, p = 0.030). Conclusion: In the appropriate clinical setting, recognition of ancillary signs presumably related to venous arterialization and congestion as well as arterial feeder hypertrophy should prompt DSA confirmation to identify DAVFs associated with CVR.

  9. Fistula

    Science.gov (United States)

    ... oxygen in the lungs) The navel and gut Inflammatory bowel disease, such as ulcerative colitis or Crohn disease, can lead to fistulas between one loop of intestine and another. Injury can cause fistulas to form ...

  10. Transposition of cephalic vein to rescue hemodialysis access arteriovenous fistula and treat symptomatic central venous obstruction

    Directory of Open Access Journals (Sweden)

    Felipe Jose Skupien

    2014-03-01

    Full Text Available It is known that stenosis or central venous obstruction affects 20 to 50% of patients who undergo placement of catheters in central veins. For patients who are given hemodialysis via upper limbs, this problem causes debilitating symptoms and increases the risk of loss of hemodialysis access. We report an atypical case of treatment of a dialysis patient with multiple comorbidities, severe swelling and pain in the right upper limb (RUL, few alternative sites for hemodialysis vascular access, a functioning brachiobasilic fistula in the RUL and severe venous hypertension in the same limb, secondary to central vein occlusion of the internal jugular vein and right brachiocephalic trunk. The alternative surgical treatment chosen was to transpose the RUL cephalic vein, forming a venous necklace at the anterior cervical region, bypassing the site of venous occlusion. In order to achieve this, we dissected the cephalic vein in the right arm to its junction with the axillary vein, devalved the cephalic vein and anastomosed it to the contralateral external jugular vein, providing venous drainage to the RUL, alleviating symptoms of venous hypertension and preserving function of the brachiobasilic fistula.

  11. Lymphatic fistula in a uremia patient after arteriovenous fistula operation in the upper arm:a case re-port%尿毒症上臂动静脉内瘘术后淋巴瘘一例

    Institute of Scientific and Technical Information of China (English)

    张熙熙

    2013-01-01

    Arteriovenous fistula is a long-term vascular access for treatment of uremia patients in maintenance hemodialysis.The complication of lymphatic fistula after arteriovenous fistula operation is rare.Lymphatic fistula is lymphatic outflow caused by lymph-vessel impairment.The clinical manifestation is the mass or discharge of unknown cause appeared in early postoperative wound.Treatment commonly used for lym-phatic fistula is filling and compression , then it could use lymphatic ligation for those patients who had large volume of lymphatic fistula output and invalid compression therapy.Here we reported a case of treatment of lymphatic fistula in the upper arm of a uremia patient after arteriovenous fistula operation.The diagnosis of lym-phatic fistula was made according to the clinical manifestation , physical sign and leakage chyle test.The pa-tient started with drainage of the lymphatic fistula debridement surgery and local compression therapy which had poor effect, finally the incision healed by use of immersion with 50%glucose, compression bandage by com-pression air sac after local lymphatic fistula cavity exploration drainage surgery and combined with atropine in -jection treatment , follow-up evaluation was good.%动静脉内瘘是尿毒症患者长期维持血液透析治疗的血管通路,术后并发淋巴瘘少见。淋巴瘘是淋巴管受损引起的淋巴液外流,临床表现为术后早期伤口出现不能解释的包块或溢液。淋巴瘘常用的治疗方法为局部填塞、加压包扎,对于渗液量较大、压迫治疗无效的患者,可行手术治疗。该文报道了1例上臂动静脉内瘘术后并发淋巴瘘的尿毒症患者的诊治经过,该例经临床表现、体征结合漏液乳糜试验诊断为淋巴瘘。开始行淋巴瘘清创引流术,用局部加压包扎,效果欠佳,遂再行局部淋巴瘘腔探查引流术并局部使用50%葡萄糖液浸泡冲洗,术后予加压气囊加压包扎,同时联合

  12. Biosynthetic bacterial cellulose graft as arteriovenous fistula and ndash; a complement to existing synthetic grafts?

    Directory of Open Access Journals (Sweden)

    Johan Magnusson

    2016-06-01

    Materials and Methods: As graftmaterial bacterial cellulose was used, produced around a preformed scaffold. Bacterial cellulose (BC is a material produced by the bacteria acetobacter xylinum. A pilotstudy was conducted on 6 pigs to validate the animalmodel and the new graftmaterial. In the following survival study a BC-graft AV-fistula was constructed in 15 pigs. Results: In the pilot study, 5 out of 6 animals had a patent AV-fistula 4 hours after implantation. In the survival study, after 4 (n3 and 8 (n10 weeks an angiography was performed prior to explantation of the BC-graft. All grafts were occluded with a presumed platelet plug. We conducted an additional acute patch-test comparing the BC and expanded PolyTetraFluoro- Ethylene. A patch of BC and ePTFE was applied to the right and left common femoral artery respectively. At explantation three hours later, all BC-patches showed a thin gel like layer, most likely consisting of platelets, throughout the whole sur- face while the ePTFE-patch showed no, or minimal, signs of platelet adhesions. Conclusion: Theoretically the cellulose might be similar to autologous veins considering risk of infections and thrombo- genicity. The animal model and the graft material showed good potential in the pilot study. The survival study was discour- aging with the reason for occlusion still to be explained. Bacterial cellulose has a good potential but further development and studies need to be performed. [Arch Clin Exp Surg 2016; 5(2.000: 70-77

  13. Case report: Manual lymphatic drainage and kinesio taping in the secondary malignant breast cancer-related lymphedema in an arm with arteriovenous (A-V) fistula for hemodialysis.

    Science.gov (United States)

    Chou, Ya-Hui; Li, Shu-Hua; Liao, Su-Fen; Tang, Hao-Wei

    2013-08-01

    Lymphedema is a dreaded complication of breast cancer treatment. The standard care for lymphedema is complex decongestive physiotherapy, which includes manual lymphatic drainage (MLD), short stretch bandaging, exercise, and skin care. The Kinesio Taping could help to improve lymphatic uptake. We reported a patient with unilateral secondary malignant breast cancer-related lymphedema and arteriovenous (A-V) fistula for hemodialysis happened in the same arm, and used kinesio taping, MLD, and exercise to treat this patient because no pressure could be applied to the A-V fistula. The 12-session therapy created an excellent effect. We do not think the kinesio taping could replace short stretch bandaging, but it could be another choice for contraindicating pressure therapy patients, and we should pay attention to wounds induced by kinesio tape.

  14. First Clinical Investigations of New Ultrasound Techniques in Three Patient Groups: Patients with Liver Tumors, Arteriovenous Fistulas, and Arteriosclerotic Femoral Arteries

    DEFF Research Database (Denmark)

    Hansen, Peter Møller

    ultrasound images of very high quality with high frame rate. Synthetic aperture is unfortunately very demanding computationally, and is therefore used only in experimental scanners. SASB reduces the data volume by a factor of 64, thereby making it possible to implement the technology on a commercial...... ultrasound scanner, to perform wireless data transfer and in the future to develop e.g. a wireless ultrasonic transducer. Nineteen patients with either primary liver cancer or liver metastases from colon cancer were ultrasound scanned the day before planned liver resection. Patients were scanned...... of the significant data reduction, is suitable for clinical use. In Study II, 20 patients with arteriovenous fistulas for hemodialysis were ultrasound scanned directly on the most superficial and accessible part of the fistula. The vector ultrasound technique Vector Flow Imaging (VFI) was used. VFI can...

  15. Effects of starting hemodialysis with an arteriovenous fistula or central venous catheter compared with peritoneal dialysis: a retrospective cohort study.

    Science.gov (United States)

    Coentrão, Luis; Santos-Araújo, Carla; Dias, Claudia; Neto, Ricardo; Pestana, Manuel

    2012-08-23

    Although several studies have demonstrated early survival advantages with peritoneal dialysis (PD) over hemodialysis (HD), the reason for the excess mortality observed among incident HD patients remains to be established, to our knowledge. This study explores the relationship between mortality and dialysis modality, focusing on the role of HD vascular access type at the time of dialysis initiation. A retrospective cohort study was performed among local adult chronic kidney disease patients who consecutively initiated PD and HD with a tunneled cuffed venous catheter (HD-TCC) or a functional arteriovenous fistula (HD-AVF) in our institution in the year 2008. A total of 152 patients were included in the final analysis (HD-AVF, n = 59; HD-TCC, n = 51; PD, n = 42). All cause and dialysis access-related morbidity/mortality were evaluated at one year. Univariate and multivariate analysis were used to compare the survival of PD patients with those who initiated HD with an AVF or with a TCC. Compared with PD patients, both HD-AVF and HD-TCC patients were more likely to be older (pdialysis access-related complications (1.53 vs. 0.93 vs. 0.64, per patient-year; pdialysis initiation was the important factor associated with death (HR 16.128, 95%CI [1.431-181.778], p = 0.024). Our results suggest that HD vascular access type at the time of renal replacement therapy initiation is an important modifier of the relationship between dialysis modality and survival among incident dialysis patients.

  16. Intraoperative balloon angioplasty using fogarty artertial embolectomy balloon catheter for creation of arteriovenous fistula for hemodialysis: single center experience.

    Science.gov (United States)

    Jin, Moran; Yoon, Young Chul; Wi, Jin Hong; Lee, Yang-Haeng; Han, Il-Yong; Park, Kyung-Taek

    2015-04-01

    The purpose of this study was to evaluate the use of a Fogarty arterial embolectomy catheter (Fogarty catheter) in intraoperative balloon angioplasty of the cephalic vein, in order to determine its effect on the patency of arteriovenous fistulas (AVFs) created for hemodialysis access. A total of 156 patients who underwent creation of an AVF were divided into two groups, based whether a Fogarty catheter was used during AVF creation. Group A (89 patients) comprised the patients who underwent balloon angioplasty with a Fogarty catheter during the operation. Group B (67 patients) included the patients in whom a Fogarty catheter was not used during the operation. Patient records were reviewed retrospectively and documented. The patency rate was determined by the Kaplan-Meier method. The records of 156 patients who underwent the creation of an AVF from January 2007 to October 2011 were included. The mean follow-up duration was 40.2±19.4 months (range, 1 to 97 months). The patency rates in group A at 12, 36, and 72 months were 83.9%±3.9%, 78.3%±4.6%, and 76.3%±4.9%, respectively, while the corresponding patency rates in group B were 92.5%±3.2%, 82.8%±0.5%, and 79.9%±5.7%, respectively. The patency rates in group B were found to be slightly higher than those in group A, but the difference was not statistically significant (p=0.356). Intraoperative balloon angioplasty of the cephalic vein using the Fogarty catheter is a simple and easily reproducible procedure, and it can be helpful in increasing AVF patency in cases of insufficient runoff or a suboptimal cephalic vein.

  17. The Effect of Arterial Curvature on Blood Flow in Arterio-Venous Fistulae: Realistic Geometries and Pulsatile Flow.

    Science.gov (United States)

    Grechy, L; Iori, F; Corbett, R W; Gedroyc, W; Duncan, N; Caro, C G; Vincent, P E

    2017-07-26

    Arterio-Venous Fistulae (AVF) are regarded as the "gold standard" method of vascular access for patients with End-Stage Renal Disease (ESRD) who require haemodialysis. However, up to 60% of AVF do not mature, and hence fail, as a result of Intimal Hyperplasia (IH). Unphysiological flow and oxygen transport patterns, associated with the unnatural and often complex geometries of AVF, are believed to be implicated in the development of IH. Previous studies have investigated the effect of arterial curvature on blood flow in AVF using idealized planar AVF configurations and non-pulsatile inflow conditions. The present study takes an important step forwards by extending this work to more realistic non-planar brachiocephalic AVF configurations with pulsatile inflow conditions. Results show that forming an AVF by connecting a vein onto the outer curvature of an arterial bend does not, necessarily, suppress unsteady flow in the artery. This finding is converse to results from a previous more idealized study. However, results also show that forming an AVF by connecting a vein onto the inner curvature of an arterial bend can suppress exposure to regions of low wall shear stress and hypoxia in the artery. This finding is in agreement with results from a previous more idealized study. Finally, results show that forming an AVF by connecting a vein onto the inner curvature of an arterial bend can significantly reduce exposure to high WSS in the vein. The results are important, as they demonstrate that in realistic scenarios arterial curvature can be leveraged to reduce exposure to excessively low/high levels of WSS and regions of hypoxia in AVF. This may in turn reduce rates of IH and hence AVF failure.

  18. A Systematic Review and Meta-Analysis of Circulating Biomarkers Associated with Failure of Arteriovenous Fistulae for Haemodialysis

    Science.gov (United States)

    Morris, Dylan R.; Bhandari, Abhishta P.; Moxon, Joseph V.

    2016-01-01

    Background Arteriovenous fistula (AVF) failure is a significant cause of morbidity and expense in patients on maintenance haemodialysis (HD). Circulating biomarkers could be valuable in detecting patients at risk of AVF failure and may identify targets to improve AVF outcome. Currently there is little consensus on the relationship between circulating biomarkers and AVF failure. The aim of this systematic review was to identify circulating biomarkers associated with AVF failure. Methods Studies evaluating the association between circulating biomarkers and the presence or risk of AVF failure were systematically identified from the MEDLINE, EMBASE and Cochrane Library databases. No restrictions on the type of study were imposed. Concentrations of circulating biomarkers of routine HD patients with and without AVF failure were recorded and meta-analyses were performed on biomarkers that were assessed in three or more studies with a composite population of at least 100 participants. Biomarker concentrations were synthesized into inverse-variance random-effects models to calculate standardized mean differences (SMD) and 95% confidence intervals (CI). Results Thirteen studies comprising a combined population of 1512 participants were included after screening 2835 unique abstracts. These studies collectively investigated 48 biomarkers, predominantly circulating molecules which were assessed as part of routine clinical care. Meta-analysis was performed on twelve eligible biomarkers. No significant association between any of the assessed biomarkers and AVF failure was observed. Conclusion This paper is the first systematic review of biomarkers associated with AVF failure. Our results suggest that blood markers currently assessed do not identify an at-risk AVF. Further, rigorously designed studies assessing biological plausible biomarkers are needed to clarify whether assessment of circulating markers can be of any clinical value. PROSPERO registration number CRD42016033845

  19. Arterio-venous fistula for automated red blood cells exchange in patients with sickle cell disease: Complications and outcomes.

    Science.gov (United States)

    Delville, Marianne; Manceau, Sandra; Ait Abdallah, Nassim; Stolba, Jan; Awad, Sameh; Damy, Thibaud; Gellen, Barnabas; Sabbah, Laurent; Debbache, Karima; Audard, Vincent; Beaumont, Jean-Louis; Arnaud, Cécile; Chantalat-Auger, Christelle; Driss, Françoise; Lefrère, François; Cavazzana, Marina; Franco, Gilbert; Galacteros, Frederic; Ribeil, Jean-Antoine; Gellen-Dautremer, Justine

    2017-02-01

    Erythrocytapheresis (ER) can improve outcome in patients with sickle cell disease (SCD). A good vascular access is required but frequently it can be difficult to obtain for sickle cell patients. Arterio-venous fistulas (AVFs) have been suggested for ER in SCD supported by limited evidence. We report the largest cohort of ER performed with AVFs from three French SCD reference centers. Data of SCD patients undergoing ER with AVFs in the French SCD reference center were retrospectively collected. The inclusion criteria were: SS or Sβ-Thalassemia and AVF surgery for ER. SCD-related complications, transfusion history, details about AVF surgical procedure, echocardiographic data before and after AVF, AVF-related surgical and hemodynamical complications were collected. Twenty-six patients (mean age 20.5 years, mean follow-up 68 months [11-279]) were included. Twenty-three patients (88.5%) required central vascular access before AVF. Fifteen AVFs (58%) were created on the forearm and 11 (42%) on the arm. Nineteen patients (73%) had stenotic, thrombotic or infectious AVF complications. A total of 0.36 stenosis per 1,000 AVF days, 0.37 thrombosis per 1,000 AVF days and 0.078 infections per 1.000 AVF days were observed. The mean AVF lifespan was 51 months [13-218]. One patient with severe pulmonary hypertension worsened after AVF creation and died. We report the first series of SCD patients with AVF for ER, demonstrating that AVFs could be considered as a potential vascular access for ER. Patients with increased risk for hemodynamic intolerance of AVFs must be carefully identified, so that alternative vascular accesses can be considered. Am. J. Hematol. 92:136-140, 2017. © 2016 Wiley Periodicals, Inc.

  20. A Systematic Review and Meta-Analysis of Circulating Biomarkers Associated with Failure of Arteriovenous Fistulae for Haemodialysis.

    Directory of Open Access Journals (Sweden)

    Susan K Morton

    Full Text Available Arteriovenous fistula (AVF failure is a significant cause of morbidity and expense in patients on maintenance haemodialysis (HD. Circulating biomarkers could be valuable in detecting patients at risk of AVF failure and may identify targets to improve AVF outcome. Currently there is little consensus on the relationship between circulating biomarkers and AVF failure. The aim of this systematic review was to identify circulating biomarkers associated with AVF failure.Studies evaluating the association between circulating biomarkers and the presence or risk of AVF failure were systematically identified from the MEDLINE, EMBASE and Cochrane Library databases. No restrictions on the type of study were imposed. Concentrations of circulating biomarkers of routine HD patients with and without AVF failure were recorded and meta-analyses were performed on biomarkers that were assessed in three or more studies with a composite population of at least 100 participants. Biomarker concentrations were synthesized into inverse-variance random-effects models to calculate standardized mean differences (SMD and 95% confidence intervals (CI.Thirteen studies comprising a combined population of 1512 participants were included after screening 2835 unique abstracts. These studies collectively investigated 48 biomarkers, predominantly circulating molecules which were assessed as part of routine clinical care. Meta-analysis was performed on twelve eligible biomarkers. No significant association between any of the assessed biomarkers and AVF failure was observed.This paper is the first systematic review of biomarkers associated with AVF failure. Our results suggest that blood markers currently assessed do not identify an at-risk AVF. Further, rigorously designed studies assessing biological plausible biomarkers are needed to clarify whether assessment of circulating markers can be of any clinical value. PROSPERO registration number CRD42016033845.

  1. Coagulation, thrombophilia and patency of arteriovenous fistula in children undergoing haemodialysis compared with healthy volunteers: a prospective analysis.

    Science.gov (United States)

    Fadel, Fatina I; Elshamaa, Manal F; Abdel-Rahman, Safaa M; Thabet, Eman H; Kamel, Solaf; Kandil, Dina; Ibrahim, Mona H; El-Ahmady, Mostafa

    2016-03-01

    This study aimed to assess whether markers of coagulation, fibrinolysis or thrombophilia are increased in children on haemodialysis compared with controls and whether measurement of any of these factors could help to identify patients at an increased risk of arteriovenous fistula (AVF) occlusion. Blood samples were taken from 55 children immediately before a session of haemodialysis and from 20 healthy volunteers. Thrombin-antithrombin (TAT), D-dimer, plasmin-antiplasmin (PAP) and anticardiolipin immunoglobulin G (ACA-Ig G) were measured by ELISA. Factor V Leiden mutation (G1691A) was determined by gene polymorphism [restriction fragment length polymorphism (RFLP)]. Determination of the patency of the AVF was prospectively followed up for a minimum of 4 years or until the AVF was nonfunctioning. Fifty-five patients were studied with a median follow-up of 659 days (range 30-1670 days). A significant increase was found in the levels of D-dimer, PAP and ACA-Ig G in haemodialysis patients with thrombosed and nonthrombosed native AVFs vs. There was a significant difference between both chronic haemodialysis patients with thrombosed and nonthrombosed native AVF with regard to ACA-IgG levels. At 1 year follow-up, primary patency was 61.4% (27 patients). In multivariate analysis, D-dimer was inversely associated with secondary patency.Thrombophilia may predispose children with end stage renal disease to access failure. The promising finding is that in children on haemodialysis, D-dimer levels were increased and inversely correlated with secondary patency. Further evaluation is required into the possible role of D-dimer as a biomarker of AVF occlusion.

  2. Use of intracranial and ocular thermography before and after arteriovenous malformation excision

    Science.gov (United States)

    Hwang, Peter Y. K.; Lewis, Philip M.; Maller, Jerome J.

    2014-11-01

    Excision of arteriovenous malformations (AVMs) is known to carry a risk of postoperative hemorrhage, postulated to be the result of normal perfusion pressure breakthrough. It is also possible that AVMs may cause a steal effect, reducing perfusion in nearby vessels. There is currently no simple method of visualizing the presence or absence of steal effect intraoperatively. We hypothesized that the infrared thermographic (heat sensitive) imaging of perilesional brain may be useful for detecting reduced perfusion due to steal. Moreover, we hypothesized that if steal effect was present, it could impact on ocular perfusion and thereby temperature. Our objective was, therefore, to investigate whether perilesional cortical and ocular temperature (OT) may be a marker of steal effect. We intraoperatively acquired conventional and thermal images of the surgical field and eyes bilaterally, pre- and post-excisions of a large left hemisphere AVM. We found OT asymmetry preoperatively, which was absent after the AVM was excised. Intraoperative thermal images showed an increase of perilesional temperature, although this could be confounded by generalized changes in cortical perfusion due to anesthetics or surgery.

  3. Monitoring of ultrasonography in artificial vascular graft for arteriovenous fistula%人工血管移植动静脉瘘术后超声检测价值

    Institute of Scientific and Technical Information of China (English)

    韩秀婕; 陈秀华; 任俊红

    2008-01-01

    Objective To evaluate the monitoring of ultrasonography in artificial vascular graft for arteriovenous fistula and its complications in patients with chronic renal failure. Methods Eighteen cases of artificial vascular graft arteriovenous fistula after four to six weeks were enrolled. The diameter, the peak velocity and blood flow were examined in arterial fistula. And the artificial vascular diameter, the peak velocity and blood flow of artificial vessels next to artery were all examined and analyzed. And the patients with symptoms in the upper extremity were tested by ultrasound. Results Intravascular blood showed good filling in fistula and artificial blood vessels in four to six weeks after artificial vascular graft for arteriovenous fistula by color doppler ultrasonography. The arterial fistula diameter, the peak velocity and blood flow were(3.61±0.68)mm and(298.56±93.42)cm/s and (583.62±216.77)ml/min. Artificial vascular diameter in (4.47±0.61)mm, the peak velocity and blood flow were (219.37±68.42)cm/s and (325.23±117.12) ml/min in the artificial blood vessels next to artery. Seven patients with upper extremity discomfort were examined by ultrasonography. One case was serum swollen. Three cases were thrombosis in artificial vessels. One case was pseudoaneurysm. Two cases were edema. Conclusions Ultrasonography plays a significant clinic role in testing artificial vascular graft for arteriovenous fistula and its complications.%目的 探讨彩色多普勒超声对人工血管移植动静脉瘘及其并发症的检测价值.方法 对18例人工血管移植动静脉瘘术后4~6周的患者,应用彩色多普勒超声测量动脉侧吻合口和移植人工血管动脉端内径、峰值流速和血流量,同时对上肢出现不适症状患者进行超声检测.结果 术后4~6周彩色多普勒超声显示吻合口和移植人工血管血流充盈良好,动脉侧吻合口内径、峰值流速和血流量分别为(3.61±0.68)mm、(298

  4. Fístula arterio-venosa secundaria a picadura de raya de río Arteriovenous fistula secondary to stingray puncture

    Directory of Open Access Journals (Sweden)

    Rodrigo Girón

    1993-03-01

    Full Text Available

    Se presenta el caso de un paciente de sexo masculino, pescador, lesionado en la región fe. moral por una raya de río (Potamotrygon magdalenne lo que le produjo una fístula arterio-venosa de los vasos femorales. Fue tratado exitosamente mediante rafia de la vena y resección y anastomosis término-terminal de la arteria. En una revisión del tema no se encontraron informes previos de fístulas A-V de esta etiología.

    We report on the case of a fisherman who was wounded by a stingray (Potamotrygon magdalenne. As a consequence he developed a femoral arterio-venous fistula that was surgical treated with success. Suture of the vein and end to end anastomosis of the artery were performed. A review of the literature yielded no cases of arteriovenous fistula of this etiology.

  5. Concurrent cervical dural and multiple perimedullary arteriovenous fistulas presenting with subarachnoid hemorrhage: The source of bleeding was invisible at initial angiography

    Science.gov (United States)

    Nambu, Iku; Uchiyama, Naoyuki; Misaki, Kouichi; Mohri, Masanao; Nakada, Mitsutoshi

    2017-01-01

    Background: We report the concurrence of a spinal dural arteriovenous fistula (DAVF) and multiple perimedullary arteriovenous fistulas (PAVFs) presenting with subarachnoid hemorrhage (SAH). Moreover, the bleeding site was detected 1 month after onset. Case Description: A 56-year-old man was admitted to our hospital with an SAH. A DAVF and two PAVFs were detected at the C2 level by two rounds of digital subtraction angiography. The source of bleeding, an aneurysm on the feeding artery of PAVF, was detected at the second angiogram, which was performed 1 month after the onset of SAH. The aneurysm was not demonstrated at initial angiogram because of thrombosis in the aneurysm. The DAVF was interrupted by transarterial embolization, and the two PAVFs were subsequently treated with surgery. Conclusion: A part of the whole AVFs or the source of bleeding may be invisible in the acute stage just after hemorrhage. Repeated angiography is necessary to diagnose such complex AVFs especially in case of an SAH and treatment should be performed during the subacute stage. PMID:28217381

  6. 透析用上肢自体动静脉内瘘的临床研究%Clinical observation on upper extremity autogenous arteriovenous fistulas for hemodialysis

    Institute of Scientific and Technical Information of China (English)

    郝清斌; 刘丽红; 刘建元; 张海河; 魏玉峰

    2012-01-01

    Objective: To investigate the advantages and disadvantages of three types of autogenous arteriovenous (AV) fistulas for hemodialysis, so as to provide guidance for their clinical application and maintenance. Methods: Sixty-three patients undergoing autogenous AV fistula procedures were divided into snuff-box AV fistula group (20 cases), wrist AV fistula group (25 cases) and elbow AV fistula group (18 cases) according to the type of AV fistula. The incidences of postoperative thrombosis, pseudoaneurysm formation and high-output heart failure, and the average anastomosis diameter and blood flow volume through AV fistula of the three groups were analyzed and compared. Results: In the entire group, postoperative thrombosis developed in 7 patients and their dialysis treatments were continued after removal of the embolus. Of these patients, 5 cases in wrist AV fistula group progressed to fistula failure within one year after operation, and then were switched to perform a contralateral forearm AV or elbow AV. One case each in wrist AV fistula group and elbow AV fistula group developed high-output heart failure which was alleviated by narrowing the anastomotic diameter. Color ultrasound examination one year after operation showed that the AV fistula blood flow of each group was more than 300 mL/min. Comparison among the three groups showed that the incidence of postoperative thrombosis in wrist AV fistula group (5/25) was higher than that in snuff-box AV fistula group (1/20) and elbow AV fistula group (1/18), and the incidence of pseudoaneurysm formation in elbow AV fistula group (7/18) was higher than that in snuff-box AV fistula group (2/20) and wrist AV fistula group (3/25) (all P0.05); the anastomosis diameter and AV blood flow volume in elbow AV fistula group were both higher than those in snuff-box AV fistula group and wrist AV fistula group (all P<0.05).Conclusion: Snuff-box AV fistula should be the first choice for patients with satisfactory vascular access, while

  7. Effects of starting hemodialysis with an arteriovenous fistula or central venous catheter compared with peritoneal dialysis: a retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Coentrão Luis

    2012-08-01

    Full Text Available Abstract Background Although several studies have demonstrated early survival advantages with peritoneal dialysis (PD over hemodialysis (HD, the reason for the excess mortality observed among incident HD patients remains to be established, to our knowledge. This study explores the relationship between mortality and dialysis modality, focusing on the role of HD vascular access type at the time of dialysis initiation. Methods A retrospective cohort study was performed among local adult chronic kidney disease patients who consecutively initiated PD and HD with a tunneled cuffed venous catheter (HD-TCC or a functional arteriovenous fistula (HD-AVF in our institution in the year 2008. A total of 152 patients were included in the final analysis (HD-AVF, n = 59; HD-TCC, n = 51; PD, n = 42. All cause and dialysis access-related morbidity/mortality were evaluated at one year. Univariate and multivariate analysis were used to compare the survival of PD patients with those who initiated HD with an AVF or with a TCC. Results Compared with PD patients, both HD-AVF and HD-TCC patients were more likely to be older (pp = 0.017 and cardiovascular disease (p = 0.020. Overall, HD-TCC patients were more likely to have clinical visits (p = 0.069, emergency room visits (ppvs. 0.93 vs. 0.64, per patient-year; pvs. 0.07 vs. 0.14, per patient-year; p = 0.034 than HD-AVF and PD patients, respectively. The survival rates at one year were 96.6%, 74.5% and 97.6% for HD-AVF, HD-TCC and PD groups, respectively (pp = 0.024. Conclusion Our results suggest that HD vascular access type at the time of renal replacement therapy initiation is an important modifier of the relationship between dialysis modality and survival among incident dialysis patients.

  8. Evolutionary History of Multiple Dural Fistula

    Directory of Open Access Journals (Sweden)

    Braulio Martinez-Burbano MD

    2016-12-01

    Full Text Available Intracranial dural arteriovenous fistulas (DAVFs are abnormal communications between arteries and veins or dural venous sinuses, which sit between the sheets of the dura. They represent 10% to 15% of intracranial vascular malformations. Clinical manifestations and prognosis depend on the pattern of venous drainage and location. The clinical presentation of DAVF may be mistaken for vascular or nonvascular brain pathologies. For that reason, within the differential diagnosis come a wide range of conditions, such as secondary headaches, encephalopathies, dementias including those with rapid progression, neurodegenerative diseases, inflammatory processes, or tumors typically at the orbital level or in the cavernous sinus. Diagnosis requires a high degree of suspicion because of the multiplicity of symptoms and presentations, making this pathology an entity that provides a major challenge for clinicians, yet early and multidisciplinary treatment of high-grade fistulas improve the possibility of avoiding poor or unfavorable outcomes for the patient.

  9. Evolutionary History of Multiple Dural Fistula

    Science.gov (United States)

    Martinez-Burbano, Braulio; Correa Diaz, Edgar Patricio; Jácome Sánchez, Carolina

    2016-01-01

    Intracranial dural arteriovenous fistulas (DAVFs) are abnormal communications between arteries and veins or dural venous sinuses, which sit between the sheets of the dura. They represent 10% to 15% of intracranial vascular malformations. Clinical manifestations and prognosis depend on the pattern of venous drainage and location. The clinical presentation of DAVF may be mistaken for vascular or nonvascular brain pathologies. For that reason, within the differential diagnosis come a wide range of conditions, such as secondary headaches, encephalopathies, dementias including those with rapid progression, neurodegenerative diseases, inflammatory processes, or tumors typically at the orbital level or in the cavernous sinus. Diagnosis requires a high degree of suspicion because of the multiplicity of symptoms and presentations, making this pathology an entity that provides a major challenge for clinicians, yet early and multidisciplinary treatment of high-grade fistulas improve the possibility of avoiding poor or unfavorable outcomes for the patient. PMID:28203571

  10. Fístula axilo-cava para hemodiálise: relato de caso Axillary arteriovenous fistula for hemodialysis: case report

    Directory of Open Access Journals (Sweden)

    Yosio Nagato

    2009-12-01

    Full Text Available Na confecção de fístula arteriovenosa (FAV para hemodiálise, condutos venosos autógenos demonstram performance superior quando comparados com material protético em relação à perviedade primária ou secundária. A prótese de politetrafluoroetileno (PTFE é reservada para casos de falência de material autógeno e é geralmente utilizada em fístulas em membros superiores. Descrevemos o caso de uma paciente de 52 anos que, após falência de acessos para hemodiálise e impossibilidade de realização de diálise peritoneal em razão de peritonite bacteriana, foi submetida à confecção de FAV entre a artéria axilar direita e a veia cava inferior com prótese de PTFE de 6 mm. O acesso foi utilizado para hemodiálise 1 mês após sua criação e permanece pérvio após 24 meses. Até o momento, não houve complicações infecciosas, sinais de insuficiência cardíaca ou síndrome de roubo em membro superior direito.With regards to the creation of an arteriovenous fistula (AV fistula for hemodialysis, autogenous venous grafts clearly show high performance when compared with prosthetic material in terms of primary or secondary patency. Polytetrafluoroethylene (PTFE grafts for the reconstruction of AV fistulae must be restricted to cases of failure of the autogenous material, which is generally used in upper limb fistulae. We describe a case of a 52-year-old patient, who, after access failure for hemodialysis and the impossibility of performing peritoneal dialysis due to bacterial peritonitis, underwent the reconstruction of an AV fistula between the right axillary artery and the cava vein using a 6-mm PTFE prosthesis. One month after surgery, this AV fistula started to be used for hemodialysis. The AV fistula remains patent 24 months after its creation. No infectious complications, cardiac insufficiency symptoms, or steal syndromes of right upper limb were detected.

  11. Prevention of self arteriovenous fistula dysfunction in patients with hemodialysis%血透患者自体动静脉内瘘失功防护

    Institute of Scientific and Technical Information of China (English)

    王红翠

    2016-01-01

    目的:探讨血液透析患者自体动静脉内瘘失功的防护。方法:回顾性分析内瘘栓塞及狭窄患者24例的临床资料。结果:试验组内瘘失功比例高于对照组,患者舒适度、知识了解优于对照组,差异具有统计学意义(P<0.05)。结论:血管吻合手术前后预防各种危险因素,加强健康教育,提高患者自我护理能力,可延长尿毒症患者内瘘使用时间。%Objective:To investigate the prevention of self arteriovenous fistula dysfunction in patients with hemodialysis.Methods:The clinical data of 24 cases of patients with internal fistula thrombosis and stenosis were analyzed retrospectively.Results:The proportion of fistula dysfunction in the experiment group was higher than that of the control group,the patients' comfort and knowledge were better than those in the control group,and the differences were statistically significant(P<0.05).Conclusion:Preventing all kinds of risk factors before and after vascular anastomosis surgery,strengthening health education and improving the self-care ability of patients could prolong the application time of the fistula in patients with uremia.

  12. 透析患者动静脉内瘘的护理指导%Nursing Guidance for Patients with Arteriovenous Fistula in Hemodialysis

    Institute of Scientific and Technical Information of China (English)

    张静; 孔林英

    2015-01-01

    血液透析是慢性肾功能衰竭患者延长生命,而血管通路的建立又是进行血透的必需条件。动静脉内瘘是一种安全且能为血液透析患者提供长期使用的永久性血管通路,被95%的血液透析患者视为自己的“生命线”[1]。能否保护好动静脉内瘘直接关系到患者生命的延续。我院对维持性血液透析患者的内瘘穿刺和护理给予足够的重视,采取多方面的护理措施,有效减少了内瘘的并发症及穿刺所带来的疼痛感,确保透析的正常进行,现将护理体会介绍如下。%Hemodialysis is an extension of life in patients with chronic renal failure, and the establishment of vascular access is essential for hemodialysis. Arteriovenous fistula is a safe, and can provide long-term use of permanent vascular access for hemodialysis patients, 95% hemodialysis patients as their own "lifeline"[1]. Whether the protection of active venous fistula is directly related to the continuation of the patient's life. Our hospital on maintenance hemodialysis patients with internal fistula puncture and nursing care given enough at ention, to take many aspects of nursing measures, reduce the complications of internal fistula and the pain caused by puncture, to ensure the normal dialysis, the nursing experience is described as fol ows.

  13. The snuffbox arteriovenous fistula for vascular access :28 cases report.%血液透析用鼻烟窝动静脉内瘘28例

    Institute of Scientific and Technical Information of China (English)

    朱仁明; 陈学明; 李晨宇; 冯海; 于宏志; 张喆; 房杰; 刘彬; 高翔

    2011-01-01

    Objective To determine the establishment,patency rate ,complication and applicability of internal arteriovenous fistula at anatonmical snuff- box. Methods Twenty - eight chronic renalfailure patients have been established internal arteriovenous fistula at anatomical snuff - box below the carpal joint since July, 2007, end - to - side anastomosis between cephalic vein and the dorsal branch of arteria radialis, for clinical hemodialysis 6 weeks later. Results Twenty - eight patients were all operated for first time, the instant pantency rate during the operation was 100%. 3 patients were operated again on standard side for vascular occlusion, and 2 patients for insufficient blood flow during hemodialysis 6 weeks later. 28 patients had the follow - up after operation from 2 months to 4 years. The fistula worked well with less complications, 1 year pantency is 75%. Conclusion The snuffbox AV fistula enlarges the puncture range,and preserves the proximal vessels. It can be the first choice of blood access for chronic hemodialysis patients who have good vessel condition.%目的 探讨血液透析鼻烟窝动静脉内瘘的制作方法、通畅率、并发症及临床应用效果.方法 2007年7月以来,对28例慢性肾功能衰竭者在腕关节以远的解剖"鼻烟窝"部建立动静脉内瘘,采用头静脉与桡动脉的背侧支端侧吻合,6周后用于临床血液透析.结果 28例均为首次行内瘘术,术中即刻通畅率100%.3例术后近期内因血管闭塞,2例因流量不足在腕部行标准动静脉内瘘术.28例患者得到术后随访,随访时间2月至4年.透析后1年通畅率为75%,使用良好,并发症少.结论 鼻烟窝动静脉内瘘扩大了可穿刺范围,保护了近端血管,可成为血管条件良好的长期血透患者的首选血液透析通路.

  14. An innovative technique for detecting the caudal end of occluded inferior petrosal sinus in cavernous arteriovenous fistula using intravascular ultrasonography--technical note.

    Science.gov (United States)

    Yamauchi, Shigeru; Nishio, Akimasa; Takahashi, Yoshinobu; Kondo, Kimito; Kawakami, Taichiro; Terakawa, Yuzo; Mitsuhashi, Yutaka; Ohata, Kenji

    2015-08-01

    Although cavernous sinus (CS) dural arteriovenous fistulas (d-AVFs) are usually treated with transvenous embolization (TVE) via the inferior petrosal sinus (IPS), IPSs are sometimes thrombosed and angiographically invisible. In such cases, the first obstacle to TVE is detecting the entry to the IPS. We report a new technique for TVE via IPS using intravascular ultrasonography (IVUS). Three consecutive cases of CS d-AVF with ipsilateral or bilateral IPS occlusion were involved in this study. On TVE, the orifice of the IPS was investigated with IVUS placed in the jugular vein or jugular bulb. This technique has been successfully adapted in all three cases. In two of these cases, IPS was well visualized with the help of IVUS, and TVE was successfully performed. To our knowledge, this is the first report to mention the usefulness of IVUS for detecting angiographically occult IPS.

  15. [Tunnelled internal jugular vein catheters with taurolidine lock: an acceptable challenge to arterio-venous fistula in 70 years old haemodialyzed patients: a prospective pilot study].

    Science.gov (United States)

    Branger, Bernard; Reboul, Pascal; Prelipcean, Camélia; Noguera, Maria Eugenia; Cariou, Sylvain; Granolleras, Céline; Vecina, Frédérique; Zabadani, Bachir; Boubenider, Samir; Rousseau, Philippe; Deshodt, Gérard; Ramperez, Pierre; Hory, Bernard; Picard, Eric; Branchereau, Pascal; Fabbro-Peray, Pascale; Fourcade, Jacques

    2011-07-01

    Arteriovenous fistula (AVF) is still in 2010 the gold standard of vascular(2) access in haemodialysis (HD) patients. Nevertheless it may be difficult to obtain and/or to use AVF in elderly. With this prospective randomised pilot study, we compare two strategies of vascular access in 70 years old or more new HD patients. AVF were compared to tunnelled jugular vein catheters (TIJC) with taurolidine as bacterial lock solution. Results were as follow: [table: see text] The responses with the visual analogic scale of comfort was 8/10 for TIJC and 5/10 with AVF * Ptaurolidine because of partial clotting of catheters. Albuminemia was significantly lower in AVF failure patients compared to AVF success patients (24.8g/L vs 31.1g/L). This pilot study allows to conclude that TIJC is an acceptable challenge to AVF in haemodialysed patients of 70 years or more in a two years long use.

  16. Comparison of Two Kinds of Protective Nursing Care for Arteriovenous Fistula%两种保护动静脉内瘘血管的护理体会

    Institute of Scientific and Technical Information of China (English)

    刘慧; 李文秀

    2015-01-01

    目的:比较三七叶泥+多磺酸粘多糖联合应用与单纯使用多磺酸粘多糖湿敷内瘘血管,观察两种方法对患者内瘘血管弹性的保护与血肿吸收效果的比较。方法:总结本院2011年1月-2013年1月72例使用动-静脉内瘘行血液透析的患者,按照随机数字表法分成观察组36例与对照组36例,观察组产生内瘘血肿27例次,对照组产生血肿33例次,观察组采用三七叶泥联合多磺酸粘多糖交替对动-静脉内瘘血管和血肿进行湿敷,对照组使用多磺酸粘多糖湿敷动静脉内瘘血管和血肿。结果:观察组较对照组内瘘血管弹性好,血肿吸收快。结论:采用三七叶泥+多磺酸粘多糖联合应用在血透患者动静脉内瘘中的应用,能延缓内瘘血管的硬化,促进血肿的吸收,有效保护内瘘血管。%Objective:To observe the protective effects on arteriovenous fistula(AV)vascular elasticity and comparison of hematoma absorption benefits of two wet dressing methods for patients with AV fistula hematoma,using Panax Notoginseng Leaves Mud and Mucopolysaccharide Polysulfate vs. only Mucopolysaccharide Polysulfate Cream. Method:Seventy-two patients on maintenance hemodialysis through AV fistula in our hospital from January 2011 to January 2013 were selected and randomly assigned 36 cases to experimental group and 36 cases to control group. There were 27 episodes of AV fistula hematoma developed in the experimental group,and 33 episodes of AV fistula hematoma developed in the control group. The patients in the experimental group received wet dressing care over the AV fistula and hematoma with Panax Notoginseng Leaves Mud alternatively with Mucopolysaccharide Polysulfate Cream. The patients in the control group received wet dressing care over the AV fistula and hematoma with only Mucopolysaccharide Polysulfate Cream. Result:The AV fistula vascular elasticity was better preserved in the experimental group than

  17. Three-dimensional dynamic time-resolved contrast-enhanced MRA using parallel imaging and a variable rate k-space sampling strategy in intracranial arteriovenous malformations.

    Science.gov (United States)

    Petkova, Mina; Gauvrit, Jean-Yves; Trystram, Denis; Nataf, François; Godon-Hardy, Sylvie; Munier, Thierry; Oppenheim, Catherine; Meder, Jean-François

    2009-01-01

    To evaluate the effectiveness of three-dimensional (3D) dynamic time-resolved contrast-enhanced MRA (TR-CE-MRA) using a combination of a parallel imaging technique (ASSET: array spatial sensitivity encoding technique) and a time-resolved method (TRICKS: time-resolved imaging of contrast kinetics) and to compare it with 3D dynamic TR-CE-MRA using ASSET alone in the assessment of intracranial arteriovenous malformations (AVMs). Twenty consecutive patients with angiographically confirmed AVMs were investigated using both 3D dynamic TR-CE-MRA techniques. Examinations were compared with respect to image quality, spatial resolution, number and type of feeders and drainers, nidus size, presence of early venous filling and temporal resolution. Digital subtraction angiography was used as standard of reference. The higher temporal and spatial resolution of 3D dynamic TR-CE-MRA TRICKS ASSET allowed a better assessment of intracranial vascular malformations, namely better depiction of feeders, drainers and better detection of early venous drainage. There was no significant difference between them in terms of nidus size. 3D dynamic TR-CE-MRA combining parallel imaging and a time-resolved method with subsecond and submillimeter resolution could become the first-line investigation technique in both diagnosis and follow-up of intracranial AVMs.

  18. Nursing care of hemodialysis patients receiving thrombolytic therapy for occlusion of arteriovenous graft fistula%血液透析患者人造血管内瘘闭塞后溶栓治疗的护理

    Institute of Scientific and Technical Information of China (English)

    吴春燕; 王文娟; 应迎娟; 蒋欣欣; 叶有新

    2012-01-01

    目的 探讨血液透析患者人造血管内瘘闭塞后溶栓治疗的护理方法.方法 采用尿激酶溶栓和肝素钠抗凝治疗,同时在治疗前后采取针对性护理措施.结果 98例人造血管内瘘患者中,对11例18例次出现人造血管内瘘闭塞的患者采用尿激酶溶栓治疗,14例次溶栓成功、内瘘恢复血流,4例次溶栓无效后经Fogarty导管取栓治疗恢复内瘘功能,其中除2例次出现穿刺点出血外,其他未见并发症.结论 人造血管内瘘闭塞后采取针对性的治疗及护理措施,是提高人造血管内瘘溶栓成功率的关键.%Objective To explore the nursing care of hemodialysis patients receiving thrombolytic therapy for the treatment of occlusion of arteriovenous graft fistula. Method The patients with occlusion of arteriovenous graft fistula received thrombolytic therapy with urokinase and anticoagulant therapy with heparin sodium as well as proper nursing care during the treatment. Results Among the 98 patients with arteriovenous graft fistula, occlusion happened 18 times in 11 patients. After thrombolytic therapy with urokinase,blood flow of fistula restored 14 times,and the others were treated by Fogarty catheter thrombectomy, but two cases suffered from bleeding on the puncture site. Conclusion Proper and timely treatment and nursing care for graft fistula occlusion are key points to improve the success rate of fistula thrombolysis.

  19. 糖尿病肾病血液净化患者动静脉内瘘护理研究%Study on the nursing of arteriovenous fistula in patients with diabetic nephropathy

    Institute of Scientific and Technical Information of China (English)

    杨光

    2015-01-01

    目的:研究探讨对糖尿病肾病血液透析患者动静脉内瘘护理的有效方式。方法选取自2012年1月—2014年6月期间收治的78例糖尿病肾病透析患者,对其动静脉内瘘情况进行有针对性护理,然后观察。结果经过科学的系统化护理,动静脉内瘘使用良好的有75例(96.15%);使用3年后闭塞的2例(2.6%);由脑出血导致死亡的1例(1.3%);均未发生内瘘感染。结论对糖尿病肾病血液透析患者,准确和熟练掌握动静脉内瘘的穿刺方法,并认真观察透析过程,正确把握好动静脉内瘘的启用时机,同时注意结束时,正确按压血管以及严格无菌操作等,都是保护动静脉内瘘的关键所在。%Objective To study the effective method of nursing of arteriovenous fistula in hemodialysis patients with diabetic nephropathy. Methods From January 2012 to June 2014, 78 patients with diabetic nephropathy were treated with dialysis patients, and the arteriovenous fistula in the case of targeted nursing, and then observe. Results After scientific systematic nursing, 75 cases (96.15%) were used in the arteriovenous fistula (3), 2 cases (2.6%) were occluded after years, 1 cases (1.3%) died of cerebral hemorrhage. Conclusion On diabetic nephropathy in hemodialysis patients, accurate and skilled master dynamic internal arteriovenous fistula puncture method, and careful observation of the dialysis process, correctly grasp the opportunity for the active vein fistula opening, also pay attention to the end, the correct pressing blood vessel and strict aseptic operation, is to protect animals, arteriovenous fistula is the key.

  20. “Spontaneous” CSF Fistula due to Transtegmental Brain Herniation in Combination with Signs of Increased Intracranial Pressure and Petrous Bone Hyperpneumatization: An Illustrative Case Report

    Science.gov (United States)

    Rivera, Diones; Fermin-Delgado, Rafael; Stoeter, Peter

    2014-01-01

    Background and Importance Transtegmental brain herniation into the petrous bone is a rare cause of rhinoliquorrhea. Our case presents a combination of several typical clinical and imaging findings illustrating the ongoing etiologic discussion of such cerebrospinal fluid (CSF) fistulas. Clinical Presentation A 53-year-old man presented with nasal discharge after a strong effort to suppress coughing. Imaging revealed a transtegmental herniation of parts of the inferior temporal gyrus into the petrous bone and in addition a combination of signs of chronically increased intracranial pressure and a hyperpneumatization of the petrous bone. The fistula was closed by a middle cranial fossa approach. Conclusion The case illustrates the two main predisposing factors for development of petrous bone CSF fistulas: increased intracranial pressure and thinning of the tegmental roof due to extensive development of air cells. Because the CSF leakage repair does not change the underlying cause, patients have to be informed about the possibility of developing increased intracranial pressure and recurrences of brain herniations at other sites. PMID:25485224

  1. Papilledema due to a permanent catheter for renal dialysis and an arteriovenous fistula: a "two hit" hypothesis.

    Science.gov (United States)

    Simon, Melissa A; Duffis, Ennis J; Curi, Michael A; Turbin, Roger E; Prestigiacomo, Charles J; Frohman, Larry P

    2014-03-01

    Elevated intracranial pressure in patients with chronic renal failure has several potential causes. Its rare occurrence secondary to the hemodynamic effects of hemodialysis is described and the findings support a multifactorial etiology ("two hits").

  2. Hemodialysis patients with arteriovenous fistula occlusion causes and nursing intervention%血液透析患者动静脉内瘘闭塞原因分析及护理干预

    Institute of Scientific and Technical Information of China (English)

    张晓莉; 谢萍; 李蕾; 张慧

    2014-01-01

    Objective:To analyze the causes of occlusion of the fistula and nursing of vein in patients with main-tenance hemodialysis.Methods:To establish a permanent internal arteriovenous fistula parallel maintenance hemodialysis nursing observation was performed in 107 patients,analysis of internal fistula occlusion of the cause and take corresponding nursing intervention.Results:15 cases occurred fistula occlusion,which resulted in 7 cases of hy-potension during dialysis fistula occlusion,2 cases of internal fistula puncture caused vascular damage,fistula care improper maintenance in 2 cases, the blood viscosity was increased in 2 cases,1 cases of fistula infection, fistula in 1 cases with early.Conclusion:Rational use of arteriovenous fistula occlusion and hypotension in the hemodialysis,arte-riovenous fistula and the general condition of the patients have a close relationship.%目的:分析维持性血液透析患者动静脉内瘘闭塞的原因及护理。方法:回顾性分析107例患者建立永久性动静脉内瘘,在透析过程中进行护理观察,分析内瘘发生闭塞的原因并采取护理干预。结果:15例发生内瘘闭塞,其中透析中低血压导致内瘘闭塞者7例,穿刺不当造成内瘘血管损伤2例,内瘘护理维护不当2例,血液黏稠度增加2例,内瘘感染1例,内瘘使用过早1例。结论:动静脉内瘘闭塞与透析中低血压、内瘘的合理使用以及患者全身情况有密切关系。

  3. Evaluation of Diagnostic Values of Clinical Assessment in Determining the Maturation of Arteriovenous Fistulas for Satisfactory Hemodialysis.

    Science.gov (United States)

    Salimi, Fereshteh; Shahabi, Shahab; Talebzadeh, Hamid; Keshavarzian, Amir; Pourfakharan, Mohammad; Safaei, Mansour

    2017-01-01

    Fistulas are the preferred permanent hemodialysis vascular access, but a significant obstacle to increasing their prevalence is the fistula's high "failure to mature" (FTM) rate. This study aimed to identify postoperative clinical characteristics that are predictive of fistula FTM. This descriptive cross-sectional study was performed on 80 end-stage renal disease patients who referred to Al Zahra Hospital, Isfahan, for brachiocephalic fistula placement. After 4 weeks, the clinical criteria (trill, firmness, vein length, and venous engorgement) examined and the fistulas situation divided to favorable or unfavorable by each criterion, and the results comprised with dialysis possibility. Data were analyzed with SPSS version 21. Diagnostic index for CLINICAL examination was calculated. Among the 80 cases, 25 (31.2%) female and 55 (68.8%) male were studied with the mean age of 51.9 (standard deviation = 17) year ranged between 18 and 86 years old. Sixty-two (77.5%) cases had successful hemodialysis. All four clinical assessments were significantly more acceptable in patients with successful dialysis (P < 0.001). According to the results of our study, the accuracy of all physical assessments was above 70% and except vein length other criteria had a sensitivity and negative predictive value of 100%. In this study, firmness of vein has highest specificity and positive predictive value (83.9% and 64.3%, respectively). Results of our study showed that high sensitivity and relatively low specificity of the clinical criterion. It means that unfavorable results of each clinical criterion predict unfavorable dialysis. Clinical evaluation of a newly created fistula 4-6 weeks after surgery should be considered mandatory.

  4. Two Stage Complex Embolization of an Arteriovenous Fistula between the Right Common Iliac Artery and the Inferior Vena Cava

    Directory of Open Access Journals (Sweden)

    Marc Gingell Littlejohn

    2009-01-01

    Full Text Available

    We  present an interesting case of a symptomatic high flow AV fistula between the right common iliac artery (CIA and the inferior vena cava (IVC, successfully treated by endovascular coil embolization. The patient was found to have a right lower polar renal artery crossing the ipsilateral ureter arising from the CIA, causing pelvi-ureteric junction (PUJ obstruction and recurrent pyelonephritis.  It is hypothesized that this fistula arising from the lower polar renal artery and entering the IVC, may have occurred as a result of trauma during a previous pyeloplasty, or a pathologically induced process of angiogenesis stemming from recurrent pyelonephritis.

  5. Fístula arteriovenosa del labio inferior: Presentación de un caso Arteriovenous fistula of the lower lip: Case report

    Directory of Open Access Journals (Sweden)

    M. Estrada Sarmiento

    2007-10-01

    Full Text Available El objetivo del trabajo es exponer nuestra experiencia en el tratamiento quirúrgico de una fístula arteriovenosa del labio inferior de una paciente de 15 años de edad, producida por un mordisco. La paciente fue diagnosticada en su inicio como un hemangioma traumático, el cual fue tratado con esteroides y exéresis quirúrgica. A los 4 años apareció con una tumoración más voluminosa, se realizó disección de la carótida externa y arteriografía carotídea la cual diagnóstico fístula arteriovenosa, se realizó ligadura de la facial y de los vasos venosos, para aislarla de la circulación. Se inyectaron 4 cc de betametazona en la tumoración, posteriormente se inyectaron 4 inyecciones adicionales con intervalos e 3 semanas, a los tres meses de la ligadura de los vasos sé realizo la exéresis de la fibrosis de la tumoración. En estos momentos la paciente tiene 5 años desde la última intervención, no presentando recidiva. Se destaca la importancia del estudio angiográfico para el diagnóstico y tratamiento de esta entidad patológica, que es poco frecuente.The object of this work is to present our experience in the surgical management of an arteriovenous fistula in the lower lip of a fifteen year-old patient as a result of a bite. The patient was diagnosed initially as having a trauma-induced hemangioma, which was treated with steroid and surgical exeresis. Four years later, a larger tumor appeared. The external carotid artery was dissected and an arteriography of the carotid was carried out that gave the diagnosis of arteriovenous fistula. Ligation was carried out of the facial artery and of the venous vessels for isolation from the circulation. Four injections were given with 4cc of betamethasone into the mass. Later 4 additional injections were given with intervals of 3 weeks. Four months after the ligation of the vessels, the fibrous mass was excised. Five years have now passed since the last intervention and there has been no

  6. Oral prostacycline analog and clopidogrel combination provides early maturation and long-term survival after arteriovenous fistula creation: A randomized controlled study

    Directory of Open Access Journals (Sweden)

    A F Abacilar

    2015-01-01

    Full Text Available Vascular access is used as a lifeline for hemodialysis in patients with end stage renal disease failure (ESRD. Failure of arteriovenous fistula (AVF maturation is still high. The purpose of this study was to research the effects of clopidogrel in combination with oral iloprost, a synthetic analog of prostacyclin PGI 2. Ninety-six diabetic ESRD patients were divided into two groups. In the first group (Group 1, N = 50, clopidogrel (75 mg daily dose and an oral prostacycline analog (200 mg daily dose were administered. In the second group (Group 2, N = 46, placebo was given. All patients took study medication 7-10 days prior to surgery. A Doppler ultrasound (USG was performed for measurement of arterial and venous diameters, and peak systolic velocity of arterial flow based on subsequent fistula adequacy. Autogenous AVFs were constructed in forearm as distally as possible in all patients. Both groups were followed-up for a year. In the placebo group, early AVF thrombosis was detected in two patients (4.3%. AVF maturation failure was noted in 14 patients (30.4% in placebo group and in four patients (8% in clopidogrel plus oral prostacycline analog group in the early postoperative period (P = 0.001. The mean maturation time was 38 ± 6.5 and 53 ± 12.8 days in study and placebo groups, respectively (P = 0.023. The mean blood flow was 352 ± 94 mL/min in placebo group and 604 ± 125 mL/min in study group (P = 0.001. The arterial end diastolic velocity was 116 ± 14 cm/s in study group and 72 ± 21 cm/s in placebo group (P = 0.036 1 year after the surgery. Our data indicated that clopidogrel and oral prostacycline analog combination is effective and safe for the prevention of primary AVF failure in hemodialysis patients and decreased acute and chronic thrombotic events.

  7. Oral prostacycline analog and clopidogrel combination provides early maturation and long-term survival after arteriovenous fistula creation: A randomized controlled study.

    Science.gov (United States)

    Abacilar, A F; Atalay, H; Dogan, O F

    2015-01-01

    Vascular access is used as a lifeline for hemodialysis in patients with end stage renal disease failure (ESRD). Failure of arteriovenous fistula (AVF) maturation is still high. The purpose of this study was to research the effects of clopidogrel in combination with oral iloprost, a synthetic analog of prostacyclin PGI2. Ninety-six diabetic ESRD patients were divided into two groups. In the first group (Group 1, N = 50), clopidogrel (75 mg daily dose) and an oral prostacycline analog (200 mg daily dose) were administered. In the second group (Group 2, N = 46), placebo was given. All patients took study medication 7-10 days prior to surgery. A Doppler ultrasound (USG) was performed for measurement of arterial and venous diameters, and peak systolic velocity of arterial flow based on subsequent fistula adequacy. Autogenous AVFs were constructed in forearm as distally as possible in all patients. Both groups were followed-up for a year. In the placebo group, early AVF thrombosis was detected in two patients (4.3%). AVF maturation failure was noted in 14 patients (30.4%) in placebo group and in four patients (8%) in clopidogrel plus oral prostacycline analog group in the early postoperative period (P = 0.001). The mean maturation time was 38 ± 6.5 and 53 ± 12.8 days in study and placebo groups, respectively (P = 0.023). The mean blood flow was 352 ± 94 mL/min in placebo group and 604 ± 125 mL/min in study group (P = 0.001). The arterial end diastolic velocity was 116 ± 14 cm/s in study group and 72 ± 21 cm/s in placebo group (P = 0.036) 1 year after the surgery. Our data indicated that clopidogrel and oral prostacycline analog combination is effective and safe for the prevention of primary AVF failure in hemodialysis patients and decreased acute and chronic thrombotic events.

  8. Evaluating the Need for and Effect of Percutaneous Transluminal Angioplasty on Arteriovenous Fistulas by Using Total Recirculation Rate per Dialysis Session (“Clearance Gap”

    Directory of Open Access Journals (Sweden)

    Ugawa,Toyomu

    2012-12-01

    Full Text Available The functioning of an arteriovenous fistula (AVF used for vascular access during hemodialysis has been assessed mainly by dilution methods. Although these techniques indicate the immediate recirculation rate, the results obtained may not correlate with Kt/V. In contrast, the clearance gap (CL-Gap method provides the total recirculation rate per dialysis session and correlates well with Kt/V. We assessed the correlation between Kt/V and CL-Gap as well as the change in radial artery (RA blood flow speed in the fistula before percutaneous transluminal angioplasty (PTA in 45 patients undergoing continuous hemodialysis. The dialysis dose during the determination of CL-Gap was 1.2 to 1.4 Kt/V. Patients with a 10% elevation or more than a 10% relative increase in CL-Gap underwent PTA (n=45, and the values obtained for Kt/V and CL-Gap before PTA were compared with those obtained immediately afterward. The mean RA blood flow speed improved significantly (from 52.9 to 97.5cm/sec after PTA, as did Kt/V (1.07 to 1.30 and CL-Gap (14.1% to -0.2%. A significant correlation between these differences was apparent (r=-0.436 and p=0.003. These findings suggest that calculating CL-Gap may be useful for determining when PTA is required and for assessing the effectiveness of PTA, toward obtaining better dialysis.

  9. Impact of arteriovenous fistula blood flow on serum il-6, cardiovascular events and death: An ambispective cohort analysis of 64 Chinese hemodialysis patients

    Science.gov (United States)

    Zhang, Nan; Zhang, Chunxiu; Pei, Guangchang; Wang, Pengge; Yang, Juan; Guo, Yujiao; Wang, Meng; Wang, Yuxi; Yang, Qian; Zhu, Han; Liao, Wenhui; Zhang, Zhiguo; Yao, Ying; Zeng, Rui; Xu, Gang

    2017-01-01

    Flows (Qa) of arteriovenous fistula (AVF) impact the dialysis adequacy in hemodialysis (HD) patients. However, data for different access flow levels on outcomes related to long-term dialysis patients, especially in Chinese patients, are limited. Herein, we performed an ambispective, mono-centric cohort study investigating the association between the AVF flows and inflammation, cardiovascular events and deaths in Chinese hemodialysis patients bearing a radio-cephalic fistula (AVF) from 2009 to 2015. Twenty-three patients (35.9%) developed at least one episode of cardiovascular disease (CVD) in two years after AVF creation. AVF Qa, IL-6 and hsCRP were significantly higher in patients with CVD than in patients without CVD. Multi-factorial binary logistic regression analysis found that the independent and strongest risk factor for CVD in HD patients was serum IL-6, which showed a positive association with AVF Qa levels in patients. Therefore, the linkage between AVF Qa tertiles and adverse clinical outcomes (cardiovascular events and mortality) was examined over a median follow-up of five years. IL-6 was significantly increased in the high AVF Qa (>1027.13 ml/min) group. Patients with median AVF Qa showed the lowest morbidity and mortality of CVD according to the AVF Qa tertiles, whereas higher Qa was associated with a higher risk of CVD, and lower AVF Qa (600 ml/min ≤AVF Qa <821.12 ml/min) had a higher risk of non-CVD death. Therefore, keeping the AVF Qa at an optimal level (821.12 to 1027.13 ml/min) would benefit HD patients, improve long-term clinical outcomes and lower AVF-induced inflammation. PMID:28267753

  10. The Impact of Transient Hepatic Attenuation Differences in the Diagnosis of Pseudoaneurysm and Arteriovenous Fistula on Follow-Up CT Scans after Blunt Liver Trauma

    Directory of Open Access Journals (Sweden)

    Andreas Hjelm Brandt

    2014-09-01

    Full Text Available A feared complication to liver trauma is delayed vascular complication, such as pseudoaneurysm and arteriovenous fistula (PS/AF seen as focal enhancement on contrast-enhanced computed tomography (CT in the arterial phase. A hyperdense area termed transient hepatic attenuation difference (THAD representing altered hepatic blood flow can be seen in the arterial phase near the liver lesion. The objective of this study was to describe THAD and PS/AF on follow-up CT after blunt liver trauma, and to evaluate if THAD influenced the evaluation of PS/AF. Three radiology residents retrospectively evaluated scans of 78 patients. The gold standard for PS/AF was an evaluation by an experienced senior radiologist, while THAD was a consensus between the residents. PS/AF was present in 14% and THAD in 54%. THAD was located in the periphery of the lesion with hazy borders and mean HU levels of 100, while PS/AF was located within the lesion with focal enhancement and mean HU levels of 170 (p < 0.05. In evaluation of PS/AF, the likelihood of agreement between the observers and the gold standard was 89% when THAD was present, and 98% when THAD was absent (p = 0.04. THAD is common and can hamper the evaluation of PS/AF.

  11. [Using Interdisciplinary Cooperation to Improve the Rate of Proper Performance of a Hand Exercise Among Hemodialysis Patients With Arteriovenous Fistula Construction].

    Science.gov (United States)

    Hsiao, Ya-Hsin; Shin, Miao-Ling; Huang, Cyong-Pei; Chen, Siang-Jyun; Huang, Tsuey-Yuan

    2017-06-01

    Patients who undergo new arteriovenous fistula (AVF) construction as part of their hemodialysis treatment program are required to perform hand exercises properly in order to maintain AVF function. However, poor performance of these hand exercises currently results in the failure of many patients to preserve AVF function. To increase the rate of performing this hand exercise properly from 55% to 80%. A comprehensive investigation identified the following five main problems: (a) Insufficient muscular endurance; (b) Resistance was not labeled on the ball; (c) Difficulties with maintaining a grip on the ball during the exercise; (d) Lack of standardized education procedures; and (e) Nurses lack latest knowledge on the hand exercise. The strategies used to improve the situation included: (a) Interdisciplinary team cooperation with physiotherapists to design individualized resistance training regimens; (b) Exercise tool improvement; (c) Standardized AVF care; (d) Continuous education for nursing staffs; and (e) Seed teacher program for hand exercise. The rate of proper hand exercise performance increased from 55% to 93%. This nursing project involved an interdisciplinary team that included physiotherapists in order to successfully improve the rate at which the hand exercise was performed properly. This positive experience may be applied to other hemodialysis departments in the treatment of patients with AVF.

  12. A treatment-refractory spinal dural arteriovenous fistula sharing arterial origin with the Artery of Adamkiewicz: Repeated endovascular treatment after failed microsurgery

    Directory of Open Access Journals (Sweden)

    Johanna Eneling

    2014-01-01

    Full Text Available Background: Effective management of a spinal dural arteriovenous fistula (SDAVF can be accomplished with either microsurgery or endovascular embolization, but there is a consensus that in patients in whom a radiculomedullary artery supplying the anterior spinal artery (ASA originates from the same feeding artery as the SDAVF, the endovascular approach is to be avoided. Case Description: The patient was a 46-year-old woman with progressive lower limb paraparesis, sensory deficit, and sphincter dysfunction. Magnetic resonance imaging (MRI and spinal angiography showed an SDAVF fed by a branch from the left second lumbar segmental artery, and the artery of Adamkiewicz (AA, a major ASA supplier, originating from the same segmental artery just proximal to the SDAVF. Microsurgical disconnection of the SDAVF was attempted, but failed. Embolization with cyanoacrylates was done in two occasions, the first time through a microcatheter placed just distal to the origin of the AA and the second time through another feeder coming from the same segmental artery that could not be visualized in the previous angiographies. All procedures were neurologically uncomplicated. Magnetic resonance imaging (MRI 1 month after the last embolization showed resolution of the spinal cord edema. MRI scan taken 68 months after embolization revealed a slightly atrophic spinal cord with visible central canal and no recurrence of medullary edema. The patient presented good, but incomplete neurological improvement. Conclusion: Microsurgery is the first choice for an SDAVF branching off the same radiculomedullary artery supplying the ASA, but uncomplicated embolization can be feasible after failed surgery.

  13. Coil embolization of arteriovenous fistulae on in situ saphenous vein bypasses: success rate and complications; Erfolgs- und Komplikationsrate der Coil-Embolisation arteriovenoeser Fisteln nach Vena-saphena-magna-in-situ-Bypassanlage

    Energy Technology Data Exchange (ETDEWEB)

    Krueger, K. [Koeln Univ. (Germany). Inst. und Poliklinik fuer Radiologische Diagnostik; Vivantes Humboldt-Klinikum, Berlin (Germany). Inst. fuer Radiologie und Interventionelle Therapie; Wagner, D.; Strohe, D.; Uedelhoven, J.; Lackner, K. [Koeln Univ. (Germany). Inst. und Poliklinik fuer Radiologische Diagnostik; Gawenda, M.; Brunkwall, J. [Vivantes Humboldt-Klinikum, Berlin (Germany). Inst. fuer Radiologie und Interventionelle Therapie

    2007-06-15

    Purpose: To determine the success and complication rate of coil embolization of arteriovenous fistulae on in situ saphenous vein bypasses. Materials and Method: 82 AV-fistulae on 30 bypasses (28 patients, 20 men, age 62.5 {+-} 8.3 years) were treated using coils. The success rate, complications, duration, amount of contrast material and radiation exposure were measured. Color-coded duplex sonography was performed 1 - 2 days and up to 6 - 18 months after embolization. Results: The success rate was 68.3 %. The reasons for persistent fistula perfusion were: 96 % fistula not accessible, 4 % reperfusion during thrombolysis. 7 complications were observed in 6 bypasses: failure of placement and retrieving of coil (n = 4), thrombembolic complications with thrombolysis (n = 3). The duration of intervention was 118.3 {+-} 46.6 min, the contrast material need was 277.03 {+-} 94.0 ml, and the radiation exposure was 10 966 {+-} 11 295 cGy/cm{sup 2}. Additional balloon dilatation was performed in 30 % of the bypasses. All bypasses were open 1 - 2 days after intervention. During follow-up, 11 persistent fistulae were detected. (orig.)

  14. 自体动静脉内瘘在血液透析中的应用与护理%Application and Nursing of Autologous Arteriovenous Fistula in Hemodialysis

    Institute of Scientific and Technical Information of China (English)

    刘倩雯

    2013-01-01

    Objective:To study the application and nursing of autologous arteriovenous fistula in hemodialysis. Method:Thirty cases of hemodialysis in the hospital from August 2008 to August 2010 were taken the forearm radial artery and cephalic vein internal fistula,to establish a vascular access for hemodialysis,then to observe the application. Result:The service life of 30 patients with autologous arteriovenous fistula were 1-5 years,and the average were(3.4 ±0.4)years. There were 5 cases with infection,3 cases with fistula thrombosis,2 cases with aneurysm and 1 cases with insufficient blood supply. Conclusion:It is an important method to improve the quality of patients hemodialysis and life by strengthen the nursing of arteriovenous fistula,and prolong the service life of internal fistula.%目的:探讨研究自体动静脉内瘘在血液透析中的应用与护理。方法:选取2008年8月-2010年8月本院30例血液透析患者,采用前臂桡动脉和头静脉制作内瘘,以建立用于血液透析的血管通道,观察其应用情况。结果:30例患者自体动静脉内瘘的使用寿命为1~5年,平均使用寿命为(3.4±0.4)年;患者中有5例发生感染,3例并发内瘘血栓,2例形成动脉瘤,1例血量供应不足。结论:加强自体动静脉内瘘的护理,延长内瘘的使用寿命,这对提高患者的血液透析质量和生活质量具有重要的意义。

  15. 前臂自体动静脉内瘘建立血液透析通路的临床分析%A clinical analysis of dynamic forearm autogenous hemodialysis pathway of arteriovenous fistula

    Institute of Scientific and Technical Information of China (English)

    王伟; 秦东强

    2014-01-01

    Objective To investigate the end-stage renal failure patients with forearm operation mode, establish the fistula intravenous operation experience and application value. Methods in our department from 2007 to 2013 implementation of internal arteriovenous fistula in 106 cases of clinical data, wherein thesnuffbox arteriovenous fistula group (82 cases), wrist fistula group (24 cases), postoperative anastomotic acute occlusion detection Forgarty thrombectomy in5cases,anastomotic stenosis and thrombosis embolectomy operation again balloon dilatation of recanalization in 4 cases. Reasons for success rate and complications of operation mode, operation points. Results 106 patients with autologous arteriovenous fistula, 98(92.5%) cases were successful, failed in 8(7.5%) cases, 1 cases of re occlusion thrombectomy, 42 cases of limb edema patients. No high output heart failure and stealsyndrome. Color Doppler ultrasound examination of fistula blood flow more than 300ml/min after March. Conclusion snuffbox arteriovenous fistula is the preferred way to access for hemodialysis, the same wrist fistula can successfully recommended hemodialysis access, to treat the postoperative complication, can avoid the fistulae.%目的:探讨终末期肾功能衰竭患者前臂自体动静脉内瘘建立的手术方式、手术经验及应用价值。方法总结我科2007年1月-2013年3月施行自体动静脉内瘘术106例患者的临床资料,其中鼻咽窝内瘘组(82例),腕部内瘘组(24例);术后吻合口急性闭塞探查Fogarty取栓5例,吻合口狭窄并血栓形成再次手术取栓加球囊扩张再通4例。分析手术方式的选择、操作要点、成功率及并发症原因。结果106例自体动静脉内瘘术,成功98例(92.5%),失败8例(7.5%),取栓后再次闭塞1例,患肢不同程度水肿42例。无高输出量心力衰竭及窃血综合征发生。3个月后彩色多普勒超声检查内瘘血流量大于300 mL/min。结论鼻

  16. 自体动静脉内瘘并发医源性动脉瘤的原因分析与护理对策%Causes of autologous arteriovenous fistula complicated with iatrogenic aneurysm and nursing countermeasures

    Institute of Scientific and Technical Information of China (English)

    张力

    2012-01-01

    目的 探讨自体动静脉内瘘穿刺后并发医源性动脉瘤的原因和护理措施.方法 对13例自体动静脉内瘘穿刺后合并动脉瘤的原因进行分析,并根据病情给予相应护理.结果 13例中5例给予手术切除,其余8例采取保守治疗,均获得满意效果.结论 医源性动脉瘤是因手术方式及长期反复穿刺自体动静脉内瘘造成的严重并发症,关键在于预防,应根据患者内瘘具体情况选择合理的操作方式,加强护理,预防早期动脉瘤,减少并发症发生.%Objective To explore causes of iatrogenic aneurysm complicating autogenous arteriovenous fistula and countermeasures. Methods Thirteen patients suffered iatrogenic aneurysm after formation of autologous arteriovenous fistula, causes of iatrogenic aneurysm were analyzed and corresponding nursing care was provided according to patients' conditions. Results Five of them received operations! And the rest were given conservative treatment. All patients obtained satisfactory results. Conclusion Iatrogenic aneurysm is a severe complication resulting from surgery types and repeated punctures of the autologotrs arteriovenous fistula, and the key point is prevention. We should choose an appropriate operation mode and strengthen nursing care to prevent iatrogenic aneurysm and to reduce complications.

  17. Arteriovenous fistula angiography using carbon dioxide as contrast medium; Estudo angiografico de fistula arteriovenosa utilizando gas carbonico como meio de contraste

    Energy Technology Data Exchange (ETDEWEB)

    Simao, Jose Reginaldo [Pontificia Universidade Catolica de Campinas, SP (Brazil). Hospital e Maternidade Celso Pierro. Servico de Diagnostico por Imagem]. E-mail: regisimao@uol.com.br; Guillaumon, Ana Terezinha [Universidade Estadual de Campinas, SP (Brazil). Faculdade de Ciencias Medicas. Disciplina de Angiologia e Cirurgia Vascular

    2004-12-01

    The aim of this study is to obtain an alternative angiographic diagnostic method which can be used in patients at a high risk for the use of iodine contrast medium. Twenty-six patients with chronic renal failure whose fistulas were assessed by digital angiography were first evaluated using iodine contrast medium. Subsequently, carbon dioxide was used as contrast medium, and the images were printed in angiographic film. The angiographic studies were evaluated by opacification, radiological diagnosis and vessel diameter by two independent vascular surgeons; the author performed a comparative analysis of the measurement of the artery and the vein, and respiratory frequency before and after contrast injection. The results obtained with the statistical analysis using kappa coefficient showed agreement between the two doctors and were 0.3217 for opacification, 0.5583 for radiological diagnosis and of 0.4298 for the analysis of vessel diameter. For the carbon dioxide technique, no significant difference was seen in the comparative analysis of the measures of the artery (p=0.3657) and vein (p=0.2041), in the position measurements and dispersion; the analysis of the position measurements and dispersion for respiratory frequency showed no significant difference. We concluded that this method can be used as an alternative for angiographic study in patients with history of allergy or risk of nephrotoxicity. (author)

  18. 血液透析动静脉造瘘术前与术后的超声应用价值%Value of applying ultrasonography to patients with hemodialysis before and after artificial arteriovenous fistula

    Institute of Scientific and Technical Information of China (English)

    陈子元; 尹凤英

    2014-01-01

    目的:观察并分析采用超声技术对血液透析患者动静脉造瘘手术前后临床治疗和诊断的应用情况。方法对我院收治的72例尿毒症血液透析患者动静脉造瘘手术前和手术后进行超声检测,选择合适的血管并对人工动静脉瘘的功能进行评价分析。结果超声显示血流量低的造瘘成功率为25.00%;正常血流量造瘘成功率55.56%;血流量高造瘘成功率19.44%。正常组成功率明显高于高、低血流量组。手术后1、2、4周内患者的血流量和血流速度在稳定增长。结论采用超声技术对患者血液透析动静脉造瘘进行诊断和监测,有利于提高该疾病的临床诊断和治疗水平,对临床进一步推广应用有一定作用。%Objective To observe and analyze the application of ultrasonography to clinical treatment and diagnosis of patients with hemodialysis before and after artificial arteriovenous fistula. Methods A total of 72 cases with uremia hemodialysis treated in our hospital received ultrasonography before and after artificial arteriovenous fistula. The suit-able blood vessels were selected, and the functions of artificial arteriovenous fistula were evaluated and analyzed. Re-sults The ultrasound indicated that the success rate of fistulization with low blood flow was 25.00%, and that with nor-mal blood flow was 55.56%, and that with high blood flow was 19.44%. The success rate of the normal group was evi-dently higher than that of the high or low blood-flow group. The blood flow and blood velocity of patients 1 week, 2 weeks and 4 weeks after operation increased steadily. Conclusion Applying ultrasonography to diagnose and monitor the patients with hemodialysis of artificial arteriovenous fistula can improve the diagnostic level and treatment level for the disease, which can be promoted and applied in clinical practice.

  19. Acute Renal Failure and Volume Overload Syndrome Secondary to a Femorofemoral Arteriovenous Fistula Angioplasty in a Kidney Transplant Recipient

    Directory of Open Access Journals (Sweden)

    Dominique Bertrand

    2013-01-01

    Full Text Available Experimental and clinical studies analyzing the impact of AVF on cardiovascular and renal parameters, as well as outcomes, in kidney transplant recipients are lacking. On the other hand, it is not known whether AVF ligation after transplantation modifies hemodynamic parameters and kidney function. We report a case of a renal transplant recipient who developed an acute congestive heart failure accompanied by renal failure, which were triggered by femorofemoral AVF angioplasty. Prompt AVF ligation rapidly reversed clinical symptoms and normalized cardiac and renal functions. This paper illustrates the potential deleterious consequences of high-output AVF after kidney transplantation and raises considerations regarding the impact of the fistula on cardiac status and kidney function after kidney transplantation and, consequently, the management AVF after transplantation.

  20. 自体动静脉内瘘使用早期的护理干预及观察%Autogenous arteriovenous fistula in the early nursing intervention and observation

    Institute of Scientific and Technical Information of China (English)

    吴红梅; 梅咏华

    2014-01-01

    Objective to consolidate hemodialysis patients with autogenous arteriovenous internal fistula surgical curative effect, ensure the safety of long-term use, discusses the nursing intervention measures of early use of scientific and reasonable.Methods With the nursing intervention to 83 cases of early autogenous arteriovenous fistula in use:①estimate the fistula blood vessels before the assessment; ② Began to use by an experienced nurse with 17 g needle puncture, choose the internal fistula elbow cephalic vein or expensive to venous blood as a guide path; ③ improve Nursing skil s, develop good working habits; ④ give patients health guidance, avoid and reduce the complications occurred in fistula. Results In our center, 83 AVF patients without infection, 1 case of diabetic nephropathy patients with refractory hypotension , hemal stricture and occlusion after 25 months regular dialysis, 10 cases of internal fistula is used currently has 36 months, 24 to 36 months 24 cases, 12 to 24 months December 16 cases, 32 cases, inadequate dialysis, blood flow are for 210 to 300 ml/min, function is good. Conclusions early nursing intervention to autogenous arteriovenous fistula in hemodialysis patients can promote internal fistula maturity, improve the success rate of fistula, and play an important role in the prevention and treatment of complications, prolonging the service life of internal fistula.%目的:为巩固血液透析患者自体动静脉内瘘手术疗效、保证长期安全使用,探讨使用早期科学合理的护理干预措施。方法对83例自体动静脉内瘘使用早期,实施护理干预:①穿刺前进行内瘘血管评估;②开始使用时由有经验的护士选择内瘘肘部头静脉或贵要静脉作为引血通路进行穿刺;③提高护士技能,养成良好工作习惯,预防并发症及早期处置④给予患者健康指导,提高自我护理技能。结果本中心83例AVF患者无感染发生,1例糖尿病肾病

  1. Progress in prevention and treatment of hemangioma complications of autogenous arteriovenous fistulas%自体动静脉内瘘血管瘤并发症的防治

    Institute of Scientific and Technical Information of China (English)

    陈新河; 王娜娜; 肖厚勤

    2014-01-01

    Hemangioma complications of autogenous arteriovenous fistulas are common in dialysis patients, involving almost all the maintenance dialysis patients, it often occurs after a few months or a few years after a fistula used, increases year by year. Its occurrence is due to hemodynamic changes, fistula surgical techniques, puncture skills and basic condition of the patients. Hemangioma complications are related to fistula stenosis and thrombosis, significantly shorten the life of the fistulas, reduce quality of life of dialysis patients. Physicians and nurses of dialysis centers and dialysis patients affected hemangioma complications, their careful maintenance, early treatment of such complications will prolong the life of fistula. To effectively control hemodynamic effects of the fistula, improve surgical techniques, improve puncture skills and puncture needle to reduce puncture injury, delay arteriosclerosis, strengthen fistula maintenance, timely surgical or endovascular treatment of hemangioma of the fistula, extension of fistula life and improve the quality of life of dialysis patients has extremely important significance.%自体动静脉内瘘血管瘤并发症几乎涉及所有维持性透析患者,常在内瘘穿刺后数月或数年出现,逐年增加,其发生与血流动力学改变、手术技巧、内瘘穿刺使用、患者基础状况均有关,与内瘘狭窄、血栓互为因果,显著缩短内瘘寿命,降低透析患者生存质量。受到透析中心医师、护士及患者三方面的影响,内瘘全程维护、积极处理血管瘤并发症有助于延长内瘘寿命。合理控制内瘘的血流动力学效应,提高手术技巧,改善穿刺技术,改良穿刺针,减少穿刺损伤,延缓动脉硬化,加强内瘘维护,及时手术或血管内介入处理血管瘤,对延长内瘘使用寿命、提高透析患者生存质量具有极为重要的意义。

  2. Non-contrast-enhanced 4D MR angiography with STAR spin labeling and variable flip angle sampling: a feasibility study for the assessment of Dural Arteriovenous Fistula.

    Science.gov (United States)

    Jang, Jinhee; Schmitt, Peter; Kim, Bom-yi; Choi, Hyun Seok; Jung, So-Lyung; Ahn, Kook-Jin; Kim, Inseong; Paek, Munyoung; Kim, Bum-soo

    2014-04-01

    This study aimed to evaluate the feasibility of non-contrast-enhanced 4D magnetic resonance angiography (NCE 4D MRA) with signal targeting with alternative radiofrequency (STAR) spin labeling and variable flip angle (VFA) sampling in the assessment of dural arteriovenous fistula (DAVF) in the transverse sinus. Nine patients underwent NCE 4D MRA for the evaluation of DAVF in the transverse sinus at 3 T. One patient was examined twice, once before and once after the interventional treatment. All patients also underwent digital subtraction angiography (DSA) and/or contrast-enhanced magnetic resonance angiography (CEMRA). For the acquisition of NCE 4D MRA, a STAR spin tagging method was used, and a VFA sampling was applied in the data readout module instead of a constant flip angle. Two readers evaluated the NCE 4D MRA data for the diagnosis of DAVF and its type with consensus. The results were compared with those from DSA and/or CEMRA. All patients underwent NCE 4D MRA without any difficulty. Among seven patients with patent DAVFs, all cases showed an early visualization of the transverse sinus on NCE 4D MRA. Except for one case, the type of DAVF of NCE 4D MRA was agreed with that of reference standard study. Cortical venous reflux (CVR) was demonstrated in two cases out of three patients with CVR. NCE 4D MRA with STAR tagging and VFA sampling is technically and clinically feasible and represents a promising technique for assessment of DAVF in the transverse sinus. Further technical developments should aim at improvements of spatial and temporal coverage.

  3. Non-contrast-enhanced 4D MR angiography with STAR spin labeling and variable flip angle sampling: a feasibility study for the assessment of Dural Arteriovenous Fistula

    Energy Technology Data Exchange (ETDEWEB)

    Jang, Jinhee; Kim, Bom-yi; Choi, Hyun Seok; Jung, So-Lyung; Ahn, Kook-Jin; Kim, Bum-soo [The Catholic University of Korea, Department of Radiology, Seoul St. Mary' s Hospital, College of Medicine, Seoul (Korea, Republic of); Schmitt, Peter [Siemens AG, Healthcare Sector, Erlangen (Germany); Kim, Inseong; Paek, Munyoung [Siemens AG, Healthcare, Seoul (Korea, Republic of)

    2014-04-15

    This study aimed to evaluate the feasibility of non-contrast-enhanced 4D magnetic resonance angiography (NCE 4D MRA) with signal targeting with alternative radiofrequency (STAR) spin labeling and variable flip angle (VFA) sampling in the assessment of dural arteriovenous fistula (DAVF) in the transverse sinus. Nine patients underwent NCE 4D MRA for the evaluation of DAVF in the transverse sinus at 3 T. One patient was examined twice, once before and once after the interventional treatment. All patients also underwent digital subtraction angiography (DSA) and/or contrast-enhanced magnetic resonance angiography (CEMRA). For the acquisition of NCE 4D MRA, a STAR spin tagging method was used, and a VFA sampling was applied in the data readout module instead of a constant flip angle. Two readers evaluated the NCE 4D MRA data for the diagnosis of DAVF and its type with consensus. The results were compared with those from DSA and/or CEMRA. All patients underwent NCE 4D MRA without any difficulty. Among seven patients with patent DAVFs, all cases showed an early visualization of the transverse sinus on NCE 4D MRA. Except for one case, the type of DAVF of NCE 4D MRA was agreed with that of reference standard study. Cortical venous reflux (CVR) was demonstrated in two cases out of three patients with CVR. NCE 4D MRA with STAR tagging and VFA sampling is technically and clinically feasible and represents a promising technique for assessment of DAVF in the transverse sinus. Further technical developments should aim at improvements of spatial and temporal coverage. (orig.)

  4. Far-infrared therapy: a novel treatment to improve access blood flow and unassisted patency of arteriovenous fistula in hemodialysis patients.

    Science.gov (United States)

    Lin, Chih-Ching; Chang, Chao-Fu; Lai, Ming-Yu; Chen, Tzen-Wen; Lee, Pui-Ching; Yang, Wu-Chang

    2007-03-01

    Vascular access malfunction, usually presenting with an inadequate access flow (Qa), is the leading cause of morbidity and hospitalization in hemodialysis (HD) patients. Many methods of thermal therapy have been tried for improving Qa but with limited effects. This randomized trial was designed to evaluate the effect of far-infrared (FIR) therapy on access flow and patency of the native arteriovenous fistula (AVF). A total of 145 HD patients were enrolled with 73 in the control group and 72 in the FIR group. A WS TY101 FIR emitter was used for 40 min, and hemodynamic parameters were measured by the Transonic HD(02) monitor during HD. The Qa(1)/Qa(2) and Qa(3)/Qa(4) were defined as the Qa measured at the beginning/at 40 min later in the HD session before the initiation and at the end of the study, respectively. The incremental change of Qa in the single HD session with FIR therapy was significantly higher than that without FIR therapy (13.2 +/- 114.7 versus -33.4 +/- 132.3 ml/min; P = 0.021). In comparison with control subjects, patients who received FIR therapy for 1 yr had (1) a lower incidence (12.5 versus 30.1%; P unassisted patency of AVF (85.9 versus 67.6%; P < 0.01). In conclusion, FIR therapy, a noninvasive and convenient therapeutic modality, can improve Qa and survival of the AVF in HD patients through both its thermal and its nonthermal effects.

  5. Role of far infra-red therapy in dialysis arterio-venous fistula maturation and survival: systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    Khalid Bashar

    Full Text Available A well-functioning arteriovenous fistula (AVF is the best modality for vascular access in patients with end-stage renal disease (ESRD requiring haemodialysis (HD. However, AVFs' main disadvantage is the high rate of maturation failure, with approximately one third (20%-50% not maturing into useful access. This review examine the use of Far-Infra Red therapy in an attempt to enhance both primary (unassisted and secondary (assisted patency rates for AVF in dialysis and pre-dialysis patients.We performed an online search for observational studies and randomised controlled trials (RCTs that evaluated FIR in patients with AVF. Eligible studies compared FIR with control treatment and reported at least one outcome measure relating to access survival. Primary patency and secondary patency rates were the main outcomes of interest.Four RCTs (666 patients were included. Unassisted patency assessed in 610 patients, and was significantly better among those who received FIR (228/311 compared to (185/299 controls (pooled risk ratio of 1.23 [1.12-1.35], p = 0.00001. In addition, the two studies which reported secondary patency rates showed significant difference in favour of FIR therapy--160/168 patients--compared to 140/163 controls (pooled risk ratio of 1.11 [1.04-1.19], p = 0.003.FIR therapy may positively influence the complex process of AVF maturation improving both primary and secondary patency rates. However blinded RCTs performed by investigators with no commercial ties to FIR therapy technologies are needed.

  6. MR selective flow-tracking cartography: a postprocessing procedure applied to four-dimensional flow MR imaging for complete characterization of cranial dural arteriovenous fistulas.

    Science.gov (United States)

    Edjlali, Myriam; Roca, Pauline; Rabrait, Cécile; Trystram, Denis; Rodriguez-Régent, Christine; Johnson, Kevin M; Wieben, Oliver; Turski, Patrick; Meder, Jean-François; Naggara, Olivier; Oppenheim, Catherine

    2014-01-01

    To assess the feasibility of a selective flow-tracking cartographic procedure applied to four-dimensional (4D) flow imaging and to demonstrate its usefulness in the characterization of dural arteriovenous fistulas (DAVFs). Institutional review board approval was obtained, and all patients provided written informed consent. Eight patients (nine DAVFs) underwent 3.0-T magnetic resonance (MR) imaging and digital subtraction angiography (DSA). Imaging examinations were performed within 24 hours of each other. 4D flow MR imaging was performed by using a 4D radial phase-contrast vastly undersampled isotropic projection reconstruction pulse sequence with an isotropic spatial resolution of 0.86 mm (5 minutes 35 seconds). Two radiologists independently reviewed images from MR flow-tracking cartography and reported the location of arterial feeder vessels and the venous drainage type and classified DAVFs according to the risk of rupture (Cognard classification). These results were compared with those at DSA. Quadratic weighted κ statistics with their 95% confidence intervals (CIs) were used to test intermodality agreement in the identification of arterial feeder vessels, draining veins, and Cognard classification. Interreader agreement for shunt location on MR images was perfect (κ = 1), with good-to-excellent interreader agreement for arterial feeder vessel identification (κ = 0.97; 95% CI = 0.92, 1.0), and matched in all cases with shunt location defined at DSA. There was good-to-excellent agreement between MR cartography and DSA in the definition of the main feeding arteries (κ = 0.92; 95% CI = 0.83, 1.0), presence of retrograde flow in dural sinuses (κ = 1), presence of retrograde cortical venous drainage (κ = 1), presence of venous ectasia (κ = 1), and final Cognard classification of DAVFs (κ = 1, standard error = 0.35). MR selective flow-tracking cartography enabled the noninvasive characterization of cranial DAVFs. © RSNA, 2013.

  7. Perilymph Fistula

    Science.gov (United States)

    ... to the head or in some cases a "whiplash" injury. Other common causes include ear trauma, objects perforating the eardrum, or “ear block” on descent of an airplane or SCUBA diving. Fistulas may also develop after rapid increases in intracranial pressure, such as may ...

  8. Volumetric Modulated Arc-Based Hypofractionated Stereotactic Radiotherapy for the Treatment of Selected Intracranial Arteriovenous Malformations: Dosimetric Report and Early Clinical Experience

    Energy Technology Data Exchange (ETDEWEB)

    Subramanian, Sai; Srinivas, Chilukuri; Ramalingam, K.; Babaiah, M.; Swamy, S. Thirumalai; Arun, G.; Kathirvel, M.; Ashok, S. [Yashoda Super Specialty Hospital, Hyderabad (India); Clivio, Alessandro [Oncology Institute of Southern Switzerland, Bellinzona (Switzerland); Fogliata, Antonella, E-mail: antonella.fogliata-cozzi@eoc.ch [Oncology Institute of Southern Switzerland, Bellinzona (Switzerland); Nicolini, Giorgia [Oncology Institute of Southern Switzerland, Bellinzona (Switzerland); Rao, K. Srinivasa; Reddy, T. Pratap; Amit, Jotwani [Yashoda Super Specialty Hospital, Hyderabad (India); Vanetti, Eugenio; Cozzi, Luca [Oncology Institute of Southern Switzerland, Bellinzona (Switzerland)

    2012-03-01

    Purpose: To evaluate, with a dosimetric and clinical feasibility study, RapidArc (a volumetric modulated arc technique) for hypofractionated stereotactic radiotherapy treatment of large arteriovenous malformations (AVMs). Methods and Materials: Nine patients were subject to multimodality imaging (magnetic resonance, computed tomography, and digital subtraction angiography) to determine nidus and target volumes, as well as involved organs at risk (optical structures, inner ear, brain stem). Plans for multiple intensity-modulated arcs with a single isocenter were optimized for a fractionation of 25 Gy in 5 fractions. All plans were optimized for 6-MV photon beams. Dose-volume histograms were analyzed to assess plan quality. Delivery parameters were reported to appraise technical features of RapidArc, and pretreatment quality assurance measurements were carried out to report on quality of delivery. Results: Average size of AVM nidus was 26.2 cm{sup 3}, and RapidArc plans provided complete target coverage with minimal overdosage (V{sub 100%} = 100% and V{sub 110%} < 1%) and excellent homogeneity (<6%). Organs at risk were highly spared. The D{sub 1%} to chiasm, eyes, lenses, optic nerves, and brainstem (mean {+-} SD) was 6.4 {+-} 8.3, 1.9 {+-} 3.8, 2.3 {+-} 2.2, 0.7 {+-} 0.9, 4.4 {+-} 7.2, 12.2 {+-} 9.6 Gy, respectively. Conformity index (CI{sub 95%}) was 2.2 {+-} 0.1. The number of monitor units per gray was 277 {+-} 45, total beam-on time was 2.5 {+-} 0.3 min. Planning vs. delivery {gamma} pass rate was 98.3% {+-} 0.9%. None of the patients developed acute toxicity. With a median follow-up of 9 months, 3 patients presented with deterioration of symptoms and were found to have postradiation changes but responded symptomatically to steroids. These patients continue to do well on follow-up. One patient developed headache and seizures, which was attributed to intracranial bleed, confirmed on imaging. Conclusion: Hypofractionated stereotactic radiotherapy can be

  9. Association of Genetic Polymorphisms of Renin–Angiotensin–Aldosterone System-Related Genes with Arterio-Venous Fistula Malfunction in Hemodialysis Patients

    Directory of Open Access Journals (Sweden)

    Yu-Wei Chen

    2016-05-01

    Full Text Available Hemodialysis (HD is the most commonly-used renal replacement therapy for patients with end-stage renal disease worldwide. Arterio-venous fistula (AVF is the vascular access of choice for HD patients with lowest risk of infection and thrombosis. In addition to environmental factors, genetic factors may also contribute to malfunction of AVF. Previous studies have demonstrated the effect of genotype polymorphisms of angiotensin converting enzyme on vascular access malfunction. We conducted a multicenter, cross-sectional study to evaluate the association between genetic polymorphisms of renin-angiotensin-aldosterone system and AVF malfunction. Totally, 577 patients were enrolled. Their mean age was 60 years old and 53% were male. HD patients with AVF malfunction had longer duration of HD (92.5 ± 68.1 vs. 61.2 ± 51.9 months, p < 0.001, lower prevalence of hypertension (44.8% vs. 55.3%, p = 0.025, right-sided (31.8% vs. 18.4%, p = 0.002 and upper arm AVF (26.6% vs. 9.7%, p < 0.001, and higher mean dynamic venous pressure (DVP (147.8 ± 28.3 vs. 139.8 ± 30.0, p = 0.021. In subgroup analysis of different genders, location of AVF and DVP remained significant clinical risk factors of AVF malfunction in univariate and multivariate binary logistic regression in female HD patients. Among male HD patients, univariate binary logistic regression analysis revealed that right-side AVF and upper arm location are two important clinical risk factors. In addition, two single nucleotide polymorphisms (SNPs, rs275653 (Odds ratio 1.90, p = 0.038 and rs1492099 (Odds ratio 2.29, p = 0.017 of angiotensin II receptor 1 (AGTR1, were associated with increased risk of AVF malfunction. After adjustment for age and other clinical factors, minor allele-containing genotype polymorphisms (AA and CA of rs1492099 still remained to be a significant risk factor of AVF malfunction (Odds ratio 3.63, p = 0.005. In conclusion, we demonstrated that rs1492099, a SNP of AGTR1 gene, could

  10. 动静脉内瘘血管穿透伤并发皮下血肿的防护%Protection research of arteriovenous fistula blood vessels penetrating trauma complicated with subcutaneous hematoma

    Institute of Scientific and Technical Information of China (English)

    刘小平

    2016-01-01

    Objective To investigate the prevention and care of vascular penetrating trauma com‐plicated by hematoma in arteriovenous fistula puncture of hemodialysis patients .Methods T he care in‐formations of 705 hemodialysis patients treated by arteriovenous fistula puncture from February 2009 to January 2014 were retrospectively analyzed .Patients were denoted into observation group ,the methods of prevention(appropriate duration of dialysis selecting ,fistula maturationp Promoting ,right timing and vascular puncture puncture selecting ,puncture technique strengthening ,and properly fixed)and compli‐cations care(ice compresses ,magnesium sulfate heat compresses combined aloe vera topicalcompresses) were summarized .And 1830 hemodialysis patients with routine care from January 2005 to January 2009 were denoted as control group .Arteriovenous fistula vessels penetrating trauma complicated with subcu‐taneous hematoma rate of two groups were compared .Results In control group of 1830 cases ,arteriove‐nous fistula vessels penetrating trauma complicated with subcutaneous hematoma rate was 1 3.7% (25/1830) ,of which three cases was venous thrombosis ,1 case was arterial end penetrating wounds ,all were improved after treatment 7.05 cases in observation group arteriovenous fistula vessels penetrating trau‐ma complicated with subcutaneous hematoma rate was 0 2.8% (2/705) .Arteriovenous fistula blood ves‐sels penetrating trauma complicated with subcutaneous hematoma rate of observation group was signifi‐cantly lower than control group ,the difference was statistically significant( P <0 0.5) .Conclusion Ef‐fective prevention and intensive care can reduce arteriovenous fistula vessels penetrating trauma compli‐cated with subcutaneous hematoma rate ,alleviate the suffering of patients ,extend the life of fistula ,nd improve the life quality of hemodialysis patients .%①目的探讨维持性血液透析患者动静脉内瘘穿刺中血管穿透伤并发皮下血

  11. Effect of Wet Dressing Therapy with Papaw Wine to Prevent Complications of Arteriovenous Fistula in Patients with Maintenance Hemodialysis%木瓜酒湿敷预防动静脉内瘘并发症的效果观察

    Institute of Scientific and Technical Information of China (English)

    卓少贤; 吴凤金; 李妹; 罗丹; 黄海燕

    2012-01-01

    Objective To discuss the effect of wet dressing therapy with papaw wine to prevent the complications of arteriovenous fistula in patients with maintenance hemodialysis. Methods The 86 maintenance hemodialysis patients who used arteriovenous fistula firstly were randomly divided into observation group(43 cases) and control group(43 cases).24 h after the dialysis, the arteriovenous fistulas were treated with the conventional methods in the control group and with wet dressing therapy using papaw wine in the observation group. The follow up was 19 months. The incidence rate of arterial insufficiency,stenosis or complete closure of the fistula,vascular sclerosis and aneurysm were recorded and compared in both groups. Results The incidence rate of arterial insufficiency,stenosis or complete closure of the fistula and vascular sclerosis in the observation group was significantly lower than that in the control group,and the differences was statistically significant P <0.01). The incidence of aneurysm in the observation group was also significantly lower than that in the control group (P < 0. 05). Conclusion The wet dressing therapy with papaw wine can effectively prevent the complications of arterriovenous fistula and may extend the service life of arterrio-venous fistula.%目的 探讨木瓜酒湿敷对预防维持性血液透析患者动静脉内瘘并发症的效果.方法 将86例首次使用动静脉内瘘的维持性血透患者随机分为对照组和观察组各43例,透析结束24h后,对照组采用内瘘穿刺后常规处理,观察组使用木瓜酒湿敷动静脉内瘘,观察并比较两组患者动静脉内瘘在19个月内血流量不足及内瘘狭窄、内瘘闭塞、血管硬化及动脉瘤的发生情况.结果 观察组患者血流量不足、内瘘狭窄、内瘘堵塞及血管硬化的发生率显著低于对照组,两组比较差异均有统计学意义(P<0.01).观察组患者动脉瘤的发生率也明显低于对照组,两组

  12. [Neuro-ophthalmology and interventional neuro-radiology--co-treatment for carotid cavernous sinus fistula].

    Science.gov (United States)

    Platner, Eva; Bakon, Mati; Huna-Baron, Ruth

    2013-02-01

    Carotid-cavernous fistulas (CCFs) are abnormal arteriovenous communications in the cavernous sinus. In many cases of CCF's the primary signs are ocular manifestations, which include: pulsatile proptosis, orbital bruit, chemosis and conjunctival injection, elevated intraocular pressure, venous stasis retinopathy, and cranial nerve pareses. Patients in whom the fistula causes arterial drainage into the cerebral veins and sinuses are at risk for intracranial hemorrhage. The most common treatment for CCF's is endovascular occlusion of the lesion. The goal of this procedure is to occlude the fistula but preserve the patency of the internal carotid artery. The CCF itself, as well as its treatment, can be sight- and even life-threatening. We describe 3 case reports of patients with CCF, in order to demonstrate the cooperation between the neuro-opthalmologist and the invasive neuro-radiologist, in the follow-up of the patient and in the treatment timing decision.

  13. 损伤灵与喜疗妥软膏治疗动静脉内瘘皮下血肿对照研究%INJURY SPIRIT AND HIRUDOID OINTMENT FOR THE TREATMENT OF ARTERIOVENOUS FISTULA HEMATOMA CONTROL STUDY

    Institute of Scientific and Technical Information of China (English)

    李丽

    2015-01-01

    Objective To investigate the damage ointment topical treatment of arteriovenous fistula sub‐cutaneous hematoma with Hirudoid cream ‐control study clinical efficacy .Methods Our hospital dialysis centers the arteriovenous fistula subcutaneous hematoma 64 patients were randomly divided into observa‐tion group and control group ,the control group ,according to conventional observation group damage oint‐ment topical ointment to smear Hirudoid observe and record two groups of patients with hematoma subsi‐ded ,duration of pain ,whether the formation of subcutaneous induration and dialysis blood flow were compared therapeutic effect .Results The two groups of patients in the subcutaneous hematoma subsided time , duration of pain ,the formation of subcutaneous indu‐ration , dialysis blood flow statistically significant difference ( P < 0 .05 ) .Conclusion The injury ointment topical treatment of arteriovenous fistula the sub‐cutaneous hematoma efficacy ,should be widely applied .%目的:通过与喜疗妥软膏对照研究探讨损伤灵软膏外敷治疗动静脉内瘘皮下血肿临床疗效。方法选择我院透析中心出现动静脉内瘘皮下血肿的64例患者,随机分成观察组和对照组,观察组使用损伤灵软膏外敷,对照组按常规使用喜辽妥软膏涂沫,观察并记录两组患者皮下血肿消退时间、疼痛持续时间、是否形成皮下硬结及透析血流量情况,比较两组治疗效果。结果两组患者在皮下血肿消退时间、疼痛持续时间、皮下硬结形成,透析血流量情况在统计学上有显著性差异(P<0.05)。结论损伤灵软膏外敷治疗动静脉内瘘皮下血肿疗效确切,值得推广应用。

  14. 维持性血液透析患者动静脉内瘘阻塞的原因分析及预防对策%Cause analysis and preventive measures for arteriovenous fistula obstruction in patients with maintenance hemodialysis

    Institute of Scientific and Technical Information of China (English)

    严艳; 黄芝

    2013-01-01

    Objective To analyze the causes of arteriovenous fistula obstruction in patients with maintenance hemodialysis and develop corresponding preventive measures. Methods The study monitored the use of arteriovenous fistula and recorded the start time of hemodialysis, and the start time and dysfunction time of arteriovenous fistula. Results 12 cases (10.3%) of fistula obstruction were observed in 117 patients using arteriovenous fistula. Among the 12 cases of fistula obstruction, 10 cases of hypertension, 7 cases of diabetic nephropathy, 5 cases of lupus nephritis and 2 cases of polycystic kidney disease were observed. Among the 12 cases of fistula obstruction, 5 cases were caused by hypercoagulable state, 4 cases caused by ultrafiltration, 2 cases caused by long-time oppression, and 1 case caused by premature fistula. Conclusion Aggressive treatment of primary diseases, proper selection of blood vessels, effective postoperative care, avoiding premature fistula, and health education can actively prevent occurrence of fistula occlusion.%目的:分析维持性血液透析患者动静脉内瘘阻塞的原因,制定相关的预防对策。方法记录动静脉内瘘的使用情况,统计患者开始透析时间,动静脉内瘘开始使用时间和失功时间。结果117例使用动静脉内瘘患者中,发生内瘘阻塞12例,占10.3%。12例发生内瘘阻塞者中高血压10例、糖尿病肾病7例、红斑狼疮肾炎5例、多囊肾2例;高凝状态所致5例,超滤量过多4例,压迫时间过长2例,内瘘使用过早1例。结论对原发病进行积极治疗,正确选择血管,进行有效的术后护理,避免过早使用内瘘并对患者进行健康教育,积极预防内瘘阻塞的发生。

  15. The clinical effect of maintence of arteriovenous fistula by Songling Xuemaikang%松龄血脉康对动静脉内瘘功能保持的价值

    Institute of Scientific and Technical Information of China (English)

    师丙帅; 刘建林; 王晓磊

    2011-01-01

    Objective To valuate the clinical effect of maintence of arteriovenous fistula by Songling Xuemaikang capsule.Methods 40 cases were obtained from patients with chronic renal failure had received arterio-venous fistula operation,24 cases were observed with the combination treatment and 16 cases were served as control group,Hemorheology and difference value of vein diameter before and after treatment,blood flow of native arteivenous fistula and primary using time were observed.Results The improvement degree of high shear rate and low shear rate were significantly as compared with that in the control group (P =0.000,P =0.001 ),while the blood flow after fistula maturation and ifference value of vein diameter were better than that in the control group( P =0.0356),primary using time between two groups were no significant differences ( P =0.056).Conclusion Songlinxuemaikang capsule was an effective drug for prevention high blood caogulation state,increasing blood flow of native arteivenous fistula,and enlargment vein diameter after arterio-venous fistula operation,which had certain value in clinical application.%目的 探讨松龄血脉康胶囊对动静脉内瘘功能保持的价值.方法 选择肾功能不全行动静脉内瘘手术患者40例予分组观察:联合治疗组24例和对照组16例在治疗前后血液流变学,内瘘成熟后的血流量,静脉内径差值及初次使用时间的变化.结果 联合治疗组治疗前后全血黏度下的高切变率改善程度比较(P=0.000)和低切变率改善程度比较(P=0.001),均差异有统计学意义;两组内瘘血流量比较(P=0.0356)以及两组治疗前后静脉内径差值比较(P<0.05),均差异有统计学意义;初次使用时间的变化比较,差异无统计学意义(P=0.056).结论 松龄血脉康胶囊是改变动静脉内瘘术后血液高凝状态;增加内瘘的血流量;有效扩大静脉内径的有效药物.具有一定的临床应用价值.

  16. Splenic arteriovenous fistula and sudden onset of portal hypertension as complications of a ruptured splenic artery aneurysm: Successful treatment with transcatheter arterial embolization. A case study and review of the literature

    Institute of Scientific and Technical Information of China (English)

    Dimitrios Siablis; Zafiria G Papathanassiou; Dimitrios Karnabatidis; Nikolaos Christeas; Konstantinos Katsanos; Constantine Vagianos

    2006-01-01

    Splenic arteriovenous fistula (SAVF) accounts for an unusual but well-documented treatable cause of portal hypertension[1-4]. A case of a 50-year-old multiparous female who developed suddenly portal hypertension due to SAVF formation is presented. The patient suffered from repeated episodes of haematemesis and melaena during the past twelve days and thus was emergently admitted to hospital for management. Clinical and laboratory investigations established the diagnosis of portal hypertension in the absence of liver parenchymal disease. Endoscopy revealed multiple esophageal bleeding varices. Abdominal computed tomography (CT)and transfemoral celiac arteriography documented the presence of a tortuous and aneurysmatic splenic artery and premature filling of an enlarged splenic vein, findings highly suggestive of an SAVF. The aforementioned vascular abnormality was successfully treated with percutaneous transcatheter embolization. Neither recurrence nor other complications were observed.

  17. 利用彩色多普勒超声对终末期肾病患者人工动静脉内瘘血管的监测%Using Color Doppler sonography in end-stage renal disease surveillance of artificial blood vessel arteriovenous internal fistula

    Institute of Scientific and Technical Information of China (English)

    顾星; 茅红卫; 季平; 张新源

    2013-01-01

    Objective: The use of Color Doppler sonography monitoring end-stage renal disease artificial vascular arteriove-nous fistula. Methods: 34 cases of Color Doppler sonography in patients with end-stage renal disease artificial arteriovenous fistula vessel diameter, flow velocity, resistance index(RI), blood flow. Results:34 cases of patients with end-stage renal dis-ease in 25 cases of fistula patency good, there are different situations complications in nine cases. Conclusion: Color Doppler sonography in end-stage renal disease artificial arteriovenous fistula of the indicators play an important role in monitoring , artificial arteriovenous fistula inside diameter 3-7 mm, flow rate at 350-800 mL/min can meet the normal amount of hemodialysis.%目的:利用彩色多普勒超声监测终末期肾病患者人工动静脉内瘘的血管。方法:应用彩色多普勒超声测定34例终末期肾病患者人工动静脉内瘘血管内径、血流速度、阻力指数(resistent index,RI)、血流量。结果:34例终末期肾病患者中25例内瘘通畅良好,9例出现不同情况的并发症。结论:彩色多普勒超声在终末期肾病患者人工动静脉内瘘的各项指标监测中起重要作用,人工动静脉内瘘口内径在3~7 mm,血流量在350~800 mL/min时,可满足正常血透量。

  18. 动静脉内瘘吻合术式的临床观察%Clinical Observation on Anastomosis of Arteriovenous Fistula

    Institute of Scientific and Technical Information of China (English)

    吴云; 叶中景; 魏伟强; 曾纳新

    2011-01-01

    [Objective] To compare the different methods of arteriovenous fistula(AVF) surgery and concerned operative skills, and to evaluate the postoperative patency rate of AVF. [Methods] The clinical data of 296 cases undergoing forearm AVF surgery were analyzed retrospectively. Among them, 279 cases underwent autogenous AVF surgery, and 11 cases underwent autogenous vein graft, and 6 cases underwent vascular prosthesis implantation. End-to-side (ETS) or side-to-side (STS) anastomosis was performed for 216 cases,while end-to-end(ETE) anastomosis was performed for 74 cases. [Results] The postoperative patency rate of ETS or STS and ETE anastomosis was 97.6% and 97.2%, respectively, and there was no significant difference( P >0.05). The patency rate of ETS or STS anastomosis 3 months after operation was 94.4% which was obviously higher than that of ETE anastomosis(87.8 %), and there was significant difference(p<0. 05).The patency rate of AVF with vascular prosthesis implantation after operation and 3 months after operation was 100%. [Conclusion] ETS or STS anastomosis is the preferred method for forearm AVF operation. AVF with autogenous vein graft or vascular prosthesis implantation can be as the preferred operative methods for patients without appropriate autogenous vessel for anastomosis.%[目的]比较不同动静脉内瘘成形手术(AVF术)方法及手术相关技巧,评估术后瘘管通畅率.[方法]回顾性分析290例前臂AVF术患者的临床资料,其中自体AVF术279例,自体静脉移植AVF术及人工血管植入AVF术11例.采取端-侧或侧-侧吻合术216例;端-端吻合术74例.[结果]采取端-侧或侧-侧吻合术术后通畅率(97.6%)与端-端吻合术术后通畅率(97.2%),相比差异无显著性(P>0.05),术后3个月通畅率(94.4%)明显高于端-端吻合术(87.8%),且差异有显著性(P<0.05);人工血管植入AVF术后及术后3月通畅率达100%.[结论]前臂AVF术采取端-侧或侧-侧吻合术是首选方法,对无

  19. The efficacy of dipyridamole combined with narceine in the protection of internal arteriovenous fistula%潘生丁联用罂粟碱保护动静脉内瘘效果观察

    Institute of Scientific and Technical Information of China (English)

    彭卫平; 钟观宝; 叶晓莲; 张青; 黄登鹏

    2012-01-01

    Objective To investigate an effective method for protection of arteriovenous fistula ( AVF ) in patients on maintenance hemodialysis.Methods 85 patients on maintenance hemodialysis who required surgery for arteriovenous fistula were randomly divided into dipyridamole and narceine group ( n =43 ) and aspirin group ( n =42 ).The incidence rates of vascular stenosis, occlusion of blood vessels, vascular ectasia, and vascular sclerosis were observed.Volume of blood flow to fistula,bleeding time after needle removal,dynamic venous pressure,and KT/V values?? were compared.Results In dipyridamole and narceine group,occlusion of blood vessels occurred in one patient ( 2.33% ) and vascular stenosis developed in 6 ( 13.95% ); whereas in the control group,occlusion of blood vessels occurred in 8 patients ( 19.05% ) and vascular stenosis developed in 15 ( 35.71% ),with a significant statistical difference ( P< 0.05 ).There were significant differences in volume of blood flow to fistula,bleeding time after needle removal,dynamic venous pressure,and KT/V ( P< 0.05 ).Conclusions Dipyridamole combined with narceine can effectively protect internal arteriovenous fistula and prolong its lifespan.%目的 探讨维持性血液透析患者动静脉内瘘(AVF)有效的保护方法.方法 85例维持性血液透析需行动静脉内瘘手术的患者随机分为2组,即潘生丁与罂粟碱联合治疗组(n=43),阿司匹林对照组(n=42),观察两组患者血管狭窄、血管闭塞、血管瘤样扩张、血管硬结的发生率及内瘘血流量、拔针后出血时间、动态静脉压、KT/V数值比较.结果 治疗组43例中出现闭塞1例,占2.33%,血管狭窄6例,占13.95%,对照组42例中出现闭塞8例,占19.05%,血管狭窄15例,占35.71%,两组比较有统计学意义(P<0.05);治疗组与对照组内瘘血流量、拔针后出血时间、动态静脉压、KT/V比较均有统计学意义(P< 0.05).结论 潘生丁联用罂粟碱可有效保护动

  20. Left Anterior Descending Artery-Pulmonary Artery Fistula

    Directory of Open Access Journals (Sweden)

    Turan Ege

    2011-12-01

    Full Text Available Despite the fact that coronary arteriovenous fistulas constitute approximately half (48% of coronary artery anomalies, they are rarely seen anomalies. In this report,we aim to present a coronary arteriovenous fistula case detected during a coronary angiography between left anterior descending artery and pulmonary artery.

  1. Clinical and radiobiological advantages of single-dose stereotactic light-ion radiation therapy for large intracranial arteriovenous malformations. Technical note.

    Science.gov (United States)

    Andisheh, Bahram; Brahme, Anders; Bitaraf, Mohammad A; Mavroidis, Panayiotis; Lind, Bengt K

    2009-11-01

    Radiation treatment of large arteriovenous malformations (AVMs) remains difficult and not very effective, even though seemingly promising methods such as staged volume treatments have been proposed by some radiation treatment centers. In symptomatic patients harboring large intracranial AVMs not amenable to embolization or resection, single-session high-dose stereotactic radiation therapy is a viable option, and the special characteristics of high-ionization-density light-ion beams offer several treatment advantages over photon and proton beams. These advantages include a more favorable depth-dose distribution in tissue, an almost negligible lateral scatter of the beam, a sharper penumbra, a steep dose falloff beyond the Bragg peak, and a higher probability of vascular response due to high ionization density and associated induction of endothelial cell proliferation and/or apoptosis. Carbon ions were recently shown to be an effective treatment for skull-base tumors. Bearing that in mind, the authors postulate that the unique physical and biological characteristics of light-ion beams should convey considerable clinical advantages in the treatment of large AVMs. In the present meta-analysis the authors present a comparison between light-ion beam therapy and more conventional modalities of radiation treatment with respect to these lesions. Dose-volume histograms and data on peripheral radiation doses for treatment of large AVMs were collected from various radiation treatment centers. Dose-response parameters were then derived by applying a maximum likelihood fitting of a binomial model to these data. The present binomial model was needed because the effective number of crucial blood vessels in AVMs (the number of vessels that must be obliterated to effect a cure, such as large fistulous nidus vessels) is low, making the Poisson model less suitable. In this study the authors also focused on radiobiological differences between various radiation treatments. Light

  2. Imaging diagnosis of dural and direct cavernous carotid fistulae

    Energy Technology Data Exchange (ETDEWEB)

    Santos, Daniela dos; Monsignore, Lucas Moretti; Nakiri, Guilherme Seizem; Cruz, Antonio Augusto Velasco e; Colli, Benedicto Oscar; Abud, Daniel Giansante, E-mail: danisantos2404@gmail.com [Universidade de Sao Paulo (HCFMRP/USP), Ribeirao Preto, SP (Brazil). Faculdade de Medicina. Hospital das Clinicas

    2014-07-15

    Arteriovenous fistulae of the cavernous sinus are rare and difficult to diagnose. They are classified into dural cavernous sinus fistulae or direct carotid-cavernous fistulae. Despite the similarity of symptoms between both types, a precise diagnosis is essential since the treatment is specific for each type of fistula. Imaging findings are remarkably similar in both dural cavernous sinus fistulae and carotid-cavernous fistulae, but it is possible to differentiate one type from the other. Amongst the available imaging methods (Doppler ultrasonography, computed tomography, magnetic resonance imaging and digital subtraction angiography), angiography is considered the gold standard for the diagnosis and classification of cavernous sinus arteriovenous fistulae. The present essay is aimed at didactically presenting the classification and imaging findings of cavernous sinus arteriovenous fistulae. (author)

  3. Percutaneous transluminal angioplasty for arteriovenous fistula stenosis or occlusion in hemodialysis patients%经皮血管成形术治疗血液透析动静脉内瘘狭窄或闭塞

    Institute of Scientific and Technical Information of China (English)

    谭隆旺; 和卫梅; 孟熙; 张勇; 贺斌; 成友华; 孙寒; 俞赶年; 郑霞; 刘力; 曹礼应; 余月明

    2012-01-01

    Objective:To observe the clinical effect of percutaneous transluminal angioplasty (PTA) for the treatment of arteriovenous fistula stenosis or occlusion in hemodialysis patients. MethodS:PTA was performed in 16 hemodialysis patients with arteriovenous fistula stenosis or occlusion. The pre- and post- operative angiographic findings, the volume of blood flow,and the level of venous pressure during hemodialysis were compared. Results:The stenotic segment was dilated, the occluded site was re-canalized and the palpation feeling of thrill became stronger immediately after PTA. During the second day of hemodialysis treatment,as the volume of blood flow increased to more than 200ml/min,the procedure of hemodialysis could be finished. As the volume of blood flow reached 250ml/min,the venous pressure could decrease to 110. 62± 15. 71mmHg. Recurrent stenosis was found in 2 cases at 3 and 6 months after treatment, the volume of blood flow returned to normal after the second PTA was performed. No complications such as vascular perforation,hemorrhage and thrombosis were observed. Conclnsions:PTA is an effective, safe and micro-invasive treatment for arteriovenous fistula stenosis or occlusion and could be chosen as the treatment for certain patients with indication.%目的:探讨经皮血管成形术(PTA)治疗血液透析患者动静脉内瘘狭窄和闭塞的临床效果.方法:对16例动静脉内瘘狭窄和闭塞的血液透析患者行PTA治疗,比较PTA治疗前后的血管造影表现、透析时血流量及静脉压的变化情况.结果:术后血管造影显示狭窄和闭塞的血管扩张、再通,触诊感血管震颤增强.术后第2天透析时血流量升高至200ml/min以上,可完成透析,在血流量为250ml/min时静脉压下降为(110.62±15.71)mmHg;其中2例分别在术后3个月和6个月发生再狭窄,再次行PTA后血流量恢复.所有患者均未出现血管破裂、出血、血栓形成等并发症.结论:PTA是治疗动静脉内瘘狭窄和

  4. 健康教育对血液净化患者自体动静脉内瘘自我维护的影响%Health education of self care on arteriovenous fistula for patients with autologous blood purification with

    Institute of Scientific and Technical Information of China (English)

    黄云辉; 曾洁; 李味美; 马晓华; 伍丽珍; 黄旋珠

    2010-01-01

    目的 探讨健康教育对维持性血液净化患者自体动静脉内瘘延长其使用寿命的重要性.方法 选择血液净化室160例采用自体动静脉内瘘作为血管通路的血液净化患者,随机分为对照组和实验组各80例,对照组进行常规护理,实验组实施针对性健康教育.比较健康教育实施前后自体动静脉内瘘自我维护知识的知晓率及健康行为执行率.结果 健康教育实施前后实验组在自体动静脉内瘘自我维护知识知晓率及健康行为执行率均高于对照组,差异有统计学意义.结论 科学的健康教育,可减少自体动静脉内瘘并发症发生,延长自体动静脉内瘘的使用寿命.%Objective To investigate the importance of health education on extending use of arteriovenous fistula in hemodialysis. Methods A total of 160 cases of hemodialysis with arteriovenous fistula as vascular access in hemodialysis room were selected and randomly divided into two groups: experimental group and control group. The control group performed routine nursing while the experimental group conducted individualized health education on the basis of usual nursing. The knowledge and behavior in self care of arteriovenous fistula were compared between two groups. Results The knowledge and behavior in self care of arteriovenous fistula in the experimental group were better than that in the control group. Conclusions Individualized health education on hemodialysis patients can reduce the complications of arteriovenous fistula and extend the use life of it.

  5. Hemiparesis in carotid cavernous fistulas (CCFs):a case report and review of the literature

    Institute of Scientific and Technical Information of China (English)

    王慧晓; 白如林; 黄承光; 卢亦成; 张光霁

    2004-01-01

    @@ Carotid-cavernous fistulas (CCFs) are abnormal arteriovenous anastamoses between the carotid artery and the cavernous sinus. These fistulas may be classified by cause (spontaneous or traumatic), flow velocity (high or low ), or pathogenesis (direct or indirect).

  6. Preservação da fístula arteriovenosa: ações conjuntas entre enfermagem e cliente Preservación de la fistula arteriovenosa: acciones conjuntas de la enfermería y cliente Preservation of arteriovenous fistula: conjunct actions from nursing and client

    Directory of Open Access Journals (Sweden)

    Alessandra Guimarães Monteiro Moreira

    2013-06-01

    preservación del acceso necesita enterarse de indicios no verbales que indiquen fragilidades en el desempeño de los papeles para el autocuidado.Identify the customer care on haemodialysis treatment with the puncture site for the preservation of arteriovenous fistula. Method: A qualitative study, descriptive-exploratory which included 17 clients of the University Hospital (RJ with chronic kidney disease of any etiology, greater than 18 years old, both sexes, having as access an arteriovenous fistula for at least six months. Results: 100% of the interviewees know the necessity of caring and maintain the via puncture pervious, 42% had some type of intercadent in the fistula, stand out the pain in the limb and loss in the thrill, 29% carry ice pack at home after haemodialysis. And 17% assert that any different or abnormal event they talk to the medical staff and nursing. Conclusion: A nurse who directs the client to the preservation of access needs to realize nonverbal clues that point to weaknesses in the performance roles for self-care.

  7. Onset Time of 2% Lidocaine and 0.5% Bupivacaine Mixture versus 0.5% Bupivacaine Alone using Ultrasound and Double Nerve Stimulation for Infraclavicular Brachial Plexus Anesthesia in ESRD Patients Undergoing Arteriovenous Fistula Creation.

    Science.gov (United States)

    Pongraweewan, Orawan; Inchua, Nipa; Kitsiripant, Chanatthee; Kongmuang, Benchawan; Tiwirach, Wannapa

    2016-05-01

    To reduce the onset of 0.5% bupivacaine by adding 2% lidocaine with 0.5% bupivacaine for ultrasound-guided and double stimulation technique at musculocutaneous and radial nerve for infraclavicular brachial plexus block. Prospective randomized double-blinded, controlled trial study. 90 patients undergoing creation of arteriovenous fistula under ultrasound-guided infraclavicular brachial plexus block were randomized into 2 groups. Gr B (46 patients) received 0.5% bupivacaine 30 mL and Gr BL (44 patients) received mixture of 0.5% bupivacaine 20 mL and 2% lidocaine 10 mL. The onset of sensory block were assessed by response to pinprick (grading: 0 = no sensation, 1 = hypoesthesia, and 2 = normal sensation). Rescue analgesia during the operation, duration of sensory and motor blockade were recorded. Surgeon and patient satisfactions are also evaluated using 6-point scale (0 = dissatisfied to 5 = very satisfied). There were no significant difference in the onset time of either group. Duration of sensory and motor block was not different. Surgeons' and patients' satisfaction were also not significantly different between the groups. Mixing 2% lidocaine with 0.5% bupivacaine to the final concentration of 0.67%for lidocaine and 0.33% for bupivacaine does not reduce the onset of ultrasound-guided infraclavicular brachial plexus block.

  8. Selection of the methods used in MR angiography with arteriovenous malformation, carotid cavernous fistula, moyamoya disease, and cerebral aneurysms; A comparison of 3-D phase-contrast MRA with 3-D time-of-flight MRA

    Energy Technology Data Exchange (ETDEWEB)

    Ikawa, Fusao; Uozumi, Tohru; Kuwabara, Satoshi (Hiroshima Univ. (Japan). School of Medicine) (and others)

    1993-02-01

    The methods used in MR angiography (MRA) can be roughly divided into two groups: time-of-flight methods (TOF methods) which make use of the influx effect of the flow, and the phase-contrast method of Dumoulin, Souza, and their collaborators (PC method), which utilizes phase differences induced by the flow. In this study, the selection of the MRA method was determined by a comparison of the three-dimensional (3-D) PC and the 3-D TOF method in normal and clinical cases. The tool used was SIGNA Advantage (1.5T) made by GE. The 3-D PC method was applied under a pulse sequence generated by gradient-recalled acquisition in the steady state (GRASS); the pulse sequence used for the 3-D TOF method was spoiled GRASS (SPGR) in a total of 28 cases. The following conclusions were reached: the TOF method should be used when aneurysms, arteriovenous malformations (AVM), and moyamoya disease have been diagnosed, and the PC method should be used when AVM and carotid cavernous fistulae (CCF) are to be evaluated in the flow and when CCFs have been diagnosed. (author).

  9. 安全标识在动静脉内瘘护理中的应用效果评价%Security Tags in Arteriovenous Fistula Nursing Application Effect Evaluation

    Institute of Scientific and Technical Information of China (English)

    刘宪丽

    2015-01-01

    目的评价安全标识在动静脉内瘘患者手术前后护理中的使用效果。方法采用回顾性研究,将2013年1~12月肾内科收治的200例尿毒症患者行动静脉内瘘手术患者纳入对照组,2014年1月~12月收治的200例患者纳入试验组。试验组在行动静脉内瘘手术前后,予术侧肢体贴鲜明警示性安全标识(纹身贴),对照组采用常规护理。评价两组护理差错发生率、瘘管使用良好率、内瘘保护方法知晓率、患者满意率的差异。结果实施安全标识后,护理差错发生率为0.5%、患者瘘管成熟良好率为93%、内瘘保护方法知晓率95%、患者满意率为98%;2013年同期对照组200例护理差错发生率为4%、患者瘘管成熟良好率为84%、内瘘保护方法知晓率86%、患者满意率为91%。护理差错发生率大为降低,其他三方面分别提高了9%、9%、7%。两组护理差错发生率、瘘管使用良好率、内瘘保护方法知晓率、患者满意率均有显著性差异(<0.05)。结论在动静脉内瘘患者手术前后的护理中使用警示性安全标识,有利于加强患者对内瘘的自我保护意识,增强了护士安全防范意识,减少了护理差错的发生,提高了护理工作的满意度。%Objective To evaluate the ef ect of safety tags on patients before and after artificial arteriovenous fistula surgery.Methods 200 uremia patients that were admit ed into the nephrology department in 2013, al of whom underwent artificial arteriovenous fistula surgery, were selected for the control group while 200 uremia patients that were admit ed in 2014 were selected for the experiment group. The patients in the experiment group were given distinctive safety tags to put on the arm of surgery, both before and after the surgery procedure. The control group employed standard nursing procedures. Comparison was made between the two groups in the fol owing aspects:ef ect of safety tags on fistula usage

  10. Fístula Arteriovenosa após Nefrectomia Radical: A Propósito de um Caso Clínico Arteriovenous fistula after Radical Nephrectomy:: a case report

    Directory of Open Access Journals (Sweden)

    Nádia Duarte

    2011-09-01

    Full Text Available Existem três tipos diferentes de fístulas arteriovenosas (FAV renais, as congénitas, as idiopáticas e as adquiridas, sendo as últimas as mais frequentes. Dentro destas, as resultantes da nefrectomia são uma raridade. A FAV entre a artéria renal e a veia cava inferior (VCI é uma complicação rara após nefrectomia, estando descritos cerca de 10 casos na literatura. Os autores descrevem um caso de um homem de 51 anos, insuficiente renal crónico (IRC em hemodiálise, enviado à consulta de Urologia por nódulo sólido do rim direito sugestivo de neoplasia, detectado em ressonância magnética (RMN. Foi submetido a nefrectomia radical direita, tendo sido efectuada laqueação conjunta do pedículo renal, sem intercorrências cirúrgicas. Quatro meses depois, inicia clínica de sobrecarga hídrica, de difícil controlo com a hemodiálise e surge um sopro abdominal localizado no flanco direito, contínuo. O estudo por eco-doppler abdominal e angiografia demonstrou a presença de fístula entre a artéria renal e a veia cava inferior. Foi submetido a embolização da FAV com coils, tendo-se registado migração dos mesmos para a artéria pulmonar. A sua recolha foi efectuada imediatamente com basket, sem outras intercorrências. Posteriormente, foi submetido a laparotomia com laqueação simples da artéria renal justa-aórtica, com resolução e estabilização do quadro clínico. A propósito deste caso clínico os autores discutem a abordagem diagnóstica e a hierarquia terapêutica da FAV reno-VCI nomeadamente na cirurgia directa e endovascular.There are three different types of renal arteriovenous fistula (AVF, congenital, idiopathic and acquired, being the latter the most frequent. Within these, those resulting from nephrectomy are rare. The AVF between the renal artery and the inferior vena cava (IVC is a rare complication, with about 10 cases described in literature. The authors describe the case of a 51 year old man, with chronic

  11. Analysis on influencing factors of different placements of arteriovenous fistula%不同部位行动静脉内瘘手术的影响因素分析

    Institute of Scientific and Technical Information of China (English)

    张莹; 古英明; 李强; 黄莹; 肖龙; 蔡杨

    2014-01-01

    Objective To analyze the different placement of arteriovenous fistula (AVF) in hemodialysis patients and to explore the related influencing factors.Methods Eighty-nine patients underwent AVF operation from January 2012 to December 2013.Gender,age,diabetes,hypertension,BMI ≥ 25,smoke,hemoglobin,platelet,serum creatinine,blood urea nitrogen,uric acid,calcium,phosphorus,intact parathyroid hormone,albumin,cholesterol,high density lipoprotein,low density lipoprotein,triglyceride,fibrinogen,INR were collected.According to the placement of AVF,the patients were divided into wrist fistula group (n=68) and elbow fistula group (n=21).Statistical analysis was made and compared between the two groups.Results The number of female,with diabetes,age,fibrinogen in elbow fistula group were higher than those in wrist fistula group (P < 0.05).Binary Logistic Regression analysis showed that diabetes could significantly influence the placement of AVF (OR=6.034,P=0.032).Conclusion Selecting the placements of AVF should consider the following conditions of patients,such as diabetes,whether they were menopausal women or not,their ages and higher blood fibrinogen,in order to improve the success rate of operation.%目的 通过对在我院行动静脉内瘘(AVF)手术并长期进行维持性血液透析患者的手术部位及相关因素进行分析,以探讨影响AVF手术部位的主要原因.方法 2012年1月至2013年12月在我院行AVF手术患者89例,记录患者的一般情况(性别、年龄、糖尿病、高血压、BMI≥25、吸烟)及临床资料(血红蛋白、血小板、血肌酐、尿素氮、尿酸、钙、磷、全段甲状旁腺激素、白蛋白、总胆固醇、高密度脂蛋白、低密度脂蛋白、甘油三酯、纤维蛋白原、INR).依手术部位分为腕部AVF组68例和肘部AVF组21例,并对两组的影响因素进行比较.结果 肘部AVF组的女性比例、合并糖尿病的人数、年龄、纤维蛋白原均高于腕部AVF组(P<0.05).二分

  12. 自我护理指导在糖尿病肾病患者动静脉内瘘成熟中的应用效果%The application effect of self-care instruction in patients with diabetic nephropathy arteriovenous fistula maturation

    Institute of Scientific and Technical Information of China (English)

    刘丽; 汪吉平; 李虹; 单新莉

    2011-01-01

    目的 探讨自我护理指导在糖尿病肾病患者动静脉内瘘成熟中的应用效果.方法 将45例行动静脉内瘘的糖尿病肾病患者随机分为观察组25例和对照组20例,观察组在常规护理指导的基础上进行个体化的全程自我护理指导,强化自我护理的重要性,并随时监督检查,对照组进行常规的护理指导.观察两组护理指导依从性、护理知识知晓率、内瘘成熟情况,首次穿刺成功率的变化.结果 8周后护理指导依从性、护理知识知晓率、内瘘成熟情况,首次穿刺成功率比较有显著性差异(P<0.05).结论 自我护理指导在糖尿病肾病患者动静脉内瘘成熟中有积极的作用,可以促进动静脉内瘘尽早成熟.%Objective To explore the application effect of the self-care instruction in patients with diabetic nephropathy arteriove nous fistula maturation. Methods Forty five patients with diabetic nephropathy arteriovenous fistula were randomly divided into observation group and control group. 20 cases in the control group were treated with normal nursing instruction while the other 25 ones in the observation group , with the whole individual self-care instruction on the basis of nursing instruction and strengthened the importance of self-care instruction and supervised, inspected at any time. Then compared the patients'nursing guide compliance, nursing knowledge awareness, fistula maturation and the first time success rate. Results After eight weeks , the nursing guide compliance, nursing knowledge awareness, fistula maturation and the first time success rate in the observation group were higher than those in the control group (P <0. 05) . Conclusions Self-care instruction in patients with diabetic nephropathy arteriovenous fistula maturation has a positive effect, can promote early maturation of arteriovenous fistula.

  13. 如意金黄散外敷与喜疗妥治疗动静脉内瘘血肿的疗效比较%Clinical efficacy of Ruyi golden powder external application and hirudoid for arteriovenous fistula hematoma

    Institute of Scientific and Technical Information of China (English)

    刘丽红; 刘玉红; 刘慧军

    2015-01-01

    目的:探讨如意金黄散外敷及喜疗妥涂抹治疗动静脉内瘘血肿的效果。方法将132例动静脉内瘘使用过程中发生皮下血肿的患者随机分为两组,其中对照组66例,发生血肿后常规按压,止血后冰袋冷敷血肿处,24 h后使用毛巾进行局部湿热敷,于热敷后在血肿局部涂抹喜疗妥软膏并轻轻按摩5~10 min,直至药膏全部经皮肤吸收,每日进行3~4次。研究组66例,血肿发生24 h后将如意金黄散用蜂蜜或清茶调匀成稀泥状外敷,每天更换2~3次。观察两组临床疗效。结果对血肿范围5~10 cm及>10 cm,研究组在血肿面积缩小等方面的疗效明显优于对照组,差异有统计学意义(P10 cm的皮下血肿消散、吸收的疗效显著,操作简便,值得推广。%Objective To compare the clinical efficacy between Ruyi golden powder with hiru doid for arteriovenous fis-tula hematoman. Methods A total of 132 cases with subcutaneous hematoma in arteriovenous fistula were divided into two groups randomly. 66 cases of control group was treated with conventional pressure, icepack being applied after hemostasis, local wet towels fomentation after 24 hours, then hirudoid cream topical smearing with massage for 5-10 minutes until creams being absorbed through the skin, with 3-4 times per day. 66 cases of study group were treated with Ruyi golden powder with tea or honey to mix thoroughly into the mud like for local application in 24h of hematoma formation, with 2-3 times per day. Clinical efficacy of two groups was compared. Results In range of 5-10 cm and range of >10 cm, hmatoma size reduction of study group was better than that in the control group (P10 cm subcutaneous hematoma dissipated,absorption is signifi-cant,and easy to operate,worthy of clinical promotion.

  14. Increased expression of HIF-1α, VEGF-A and its receptors, MMP-2, TIMP-1, and ADAMTS-1 at the venous stenosis of arteriovenous fistula in a mouse model with renal insufficiency

    Science.gov (United States)

    Misra, Sanjay; Shergill, Uday; Yang, Binxia; Janardhanan, Rajiv; Misra, Khamal D.

    2010-01-01

    Purpose A mouse model of renal insufficiency with arteriovenous fistula (AVF) and venous stenosis was created. We tested the hypothesis that there is increased gene expression of hypoxia inducible factor-1 alpha (HIF-1α), vascular endothelial growth factor- A (VEGF-A) and its receptors (VEGFR-1, -2), matrix metalloproteinase-2 (MMP-2), -9 (MMP-9), tissue inhibitor of metalloproteinase-1, -2 (TIMP-1, -2), and a disintegrin and metalloproteinase thrombospondin-1 (ADAMTS-1) at the venous stenosis. Materials and methods Nineteen male C57BL/6 mice underwent a left nephrectomy and a surgical occlusion of the right upper pole to induce renal insufficiency and characterized in eight mice. Twenty eight days later, an AVF (n=11) was created from the right carotid artery to ipsilateral jugular vein and the mice were sacrificed at day 7 (n=4) and day 14 (n=4). The outflow and control veins were removed for gene expression. Three mice were sacrificed at day 28 for histologic analysis. Results The mean serum blood urea nitrogen remained significantly elevated for 8 weeks when compared to baseline (P<0.05). By day 7, there was a significant increase in the expression of HIF-1α, VEGF-A, VEGFR-1, VEGFR-2, MMP-2, TIMP-1, and ADAMTS-1 at the outflow vein with HIF-1α and TIMP-1 being significantly elevated at day 14 (P<0.05). By day 28, the venous stenosis was characterized by a thickened vein wall and neointima. Conclusions A mouse model of renal insufficiency with AVF was developed which had increased expression of HIF-1α, VEGF-A, VEGFR-1, VEGFR-2, MMP-2, TIMP-1, and ADAMTS-1 at the outflow vein with venous stenosis by day 28. PMID:20598569

  15. The Application Research of Kangfuxin Liquid Combined Hirudoid in Arteriovenous Fistula%康复新联合喜疗妥在动静脉内瘘中的应用研究

    Institute of Scientific and Technical Information of China (English)

    杨晗; 邓丽蓉; 王琴; 肖妍琴

    2014-01-01

    Objective To observe the efficacy of Kangfuxin Liquid combinedhirudoid in the treatment of puncture point bleeding and subcutaneoushematoma related to arteriovenous fistula after paracentesis. Methods 90 patients with puncture point bleeding patients and 90 patients with subcutaneoushematoma were randomly divided into treatment group(Kangfuxin Liquid com-binedhirudoid) and control group (hirudoid),which were in ourhospital long-term maintenance hemodialysis in October 2012 to May 2014. The puncture point of bleeding and the pain relief and the situation of ecchymosis and hematoma were observed at 24, 48,72h after this treatment. Results The treatment group of the puncture point bleeding time is less than the control group obvi-ously(P 2cm 2的皮下血肿90例次,按就诊顺序随机分为治疗组(喜疗妥加康复新组)和对照组(洗疗妥组),观察治疗24、48、72h 后患者疼痛缓解、瘀斑及血肿消失情况,并进行统计学分析。结果治疗后48h 内两组血肿消退差异无统计学意义(P >0.05);治疗后72h 治疗组皮下血肿消退明显优于对照组,差异有统计学意义(P <0.05)。结论康复新联合喜疗妥能有效促进皮下血肿吸收,减轻患者症状。

  16. 品管圈活动在降低血液透析患者动静脉内瘘皮下血肿发生率中的应用价值%Application value on quality control circle activity in hemodialysis pa-tients with arteriovenous internal fistula in the incidence of subcutaneous hematoma

    Institute of Scientific and Technical Information of China (English)

    王晓玲; 丁学梅; 刘丽秀; 朱红; 施丹明

    2014-01-01

    Objective To explore the application effect on quality control circle activity in hemodialysis patients with arteriovenous internal fistula in the incidence of subcutaneous hematoma. Methods Hemodialysis interior ministry 10 nurses voluntarily to form a "circle",establish "reduce static artery fistula in hemodialysis patients the incidence of subcutaneous haematomas" as the theme,the patients with arteriovenous fistula in subcutaneous hematoma incidence dialysis of activities before and after hemodialysis were counted,analyzed,and to formulate and implement corrective actions. Results The arteriovenous fistula in subcutaneous hematoma incidence after the implementation of quality con-trol circle activity was significantly lower than before (P<0.05).Members of the team spirit,professional knowledge,inter-personal relationship,the nursing quality consciousness and mental development and so on various scores were signifi-cantly higher than that of before the implementation of quality control circle activity, he difference was statistically sig-nificant (P<0.05). Conclusion To carry out quality control circle activities can reduce hemodialysis patients with arteri-ovenous fistula in subcutaneous blood kind of incidence,prolong the service life of arteriovenous internal fistula,thus prolonging the survival time,improve the quality of life of patients.%目的:探讨品管圈活动在降低血液透析患者动静脉内瘘皮下血肿发生率中的应用效果。方法血透室内部10名护士自愿组成一个“圈”,确立“降低血液透析患者静动脉内瘘皮下血肿发生率”为活动主题,对活动前后血透透析患者动静脉内瘘皮下血肿发生率进行统计、分析,并制订和落实整改措施。结果实施品管圈活动后动静脉内瘘皮下血肿发生率显著低于活动前(P<0.05);各位成员的团队精神、专业知识、人际关系、护理品质意识与脑力开发等各项评分均显著高于实施品管圈

  17. Gastrointestinal fistula

    Science.gov (United States)

    Entero-enteral fistula; Enterocutaneous fistula; Fistula - gastrointestinal ... Most gastrointestinal fistulas occur after surgery. Other causes include: Blockage in the intestine Infection Crohn disease Radiation to the abdomen (most ...

  18. Endovascular revascularization of chronically thrombosed arteriovenous fistulas and grafts for hemodialysis: a retrospective study in 15 patients with 18 access sites.

    Science.gov (United States)

    Weng, Mei-Jui; Chen, Matt Chiung-Yu; Chi, Wen-Che; Liu, Yi-Chun; Liang, Huei-Lung; Pan, Huay-Ben

    2011-04-01

    The current study retrospectively evaluated whether endovascular revascularization of chronically thrombosed and long-discarded vascular access sites for hemodialysis was feasible. Technical and clinical success rates, postintervention primary and secondary patency rates, and complications were reported. During a 1-year period, we reviewed a total of 924 interventions performed for dysfunction and/or failed hemodialysis vascular access sites and permanent catheters in 881 patients. In patients whose vascular access-site problems were considered untreatable or were considered treatable with a high risk of failure and access-site abandonment, we attempted to revascularize (resurrect) the chronically occluded and long-discarded (mummy) vascular access sites. We attempted to resurrect a total of 18 mummy access sites (mean age 46.6 ± 38.7 months; range 5-144) in 15 patients (8 women and 7 men; mean age 66.2 ± 11.5 years; age range 50-85) and had an overall technical success rate of 77.8%. Resurrection failure occurred in 3 fistulas and in 1 straight graft. The clinical success rate was 100% at 2 months after resurrection. In the 14 resurrected vascular access sites, 6 balloon-assisted maturation procedures were required in 5 fistulas; after access-site maturation, a total of 22 interventions were performed to maintain access-site patency. The mean go-through time for successful resurrection procedures was 146.6 ± 34.3 min (range 74-193). Postmaturation primary patency rates were 71.4 ± 12.1% at 30 days, 57.1 ± 13.2% at 60 days, 28.6 ± 13.4% at 90 days, and 19 ± 11.8% at 180 days. Postmaturation secondary patency rates were 100% at 30, 60, and 90 days and 81.8 ± 11.6% at 180 days. There were 2 major complications consisting of massive venous ruptures in 2 mummy access sites during balloon dilation; in both cases, prolonged balloon inflation failed to achieve hemostasis, but percutaneous N-butyl cyanoacrylate glue seal-off was performed successfully. Percutaneous

  19. Fístula arteriovenosa safeno-femoral superficial como acesso à hemodiálise: descrição de técnica operatória e experiência clínica inicial Superficial saphenofemoral arteriovenous fistula as access to hemodialysis: description of operative technique and initial clinical experience

    Directory of Open Access Journals (Sweden)

    João Antônio Corrêa

    2005-01-01

    Full Text Available OBJETIVO: Descrever uma técnica de confecção de fístula arteriovenosa para acesso à hemodiálise, avaliando os aspectos técnicos de sua confecção, eficácia e complicações. MÉTODO: Foram realizadas 16 fístulas arteriovenosas safeno-femoral superficial em 15 pacientes, no período de agosto de 1998 a outubro de 2000. Esses procedimentos foram efetuados em pacientes sem opções de acesso em membros superiores. A técnica utilizada foi a anteriorização e superficialização da veia safena magna, anastomosando-a na artéria femoral superficial distal. As fístulas arteriovenosas safeno-femoral superficial foram avaliadas quanto à facilidade de punção, fluxo adequado, pressão venosa espontânea, adequação de diálise e complicações no intra-operatório. RESULTADOS: Todas as fístulas puderam ser concluídas com sucesso, sem complicações no intra-operatório. Houve um óbito precoce, porém as demais estavam aptas às punções no 30º dia pós-operatório. Quatorze fístulas foram utilizadas e, na evolução, três pacientes foram submetidos a transplante renal, quatro apresentaram trombose, dois apresentaram pseudoaneurisma de punção. CONCLUSÃO: As fístulas arteriovenosas safeno-femoral superficial mostram-se como boa alternativa para pacientes que não possuem outras possibilidades de acesso em membros superiores, permitindo tratamento hemodialítico eficaz, com boa taxa de perviedade em médio prazo.OBJECTIVE: To describe a technique for creating an arteriovenous fistula as an access to hemodialysis, evaluating its technical aspects, efficacy and complications. METHOD: From August 1998 to October 2000, 16 superficial saphenofemoral arteriovenous fistulas were performed in 15 patients. These procedures were used in patients without access options in upper limbs. The surgical technique consisted of an anteriorization and a superficialization of the saphenous vein anastomosed to the superficial femoral artery in the

  20. Evaluation of Clinical Decision-making in Artificial Arteriovenous Fistula Complications Applied with Color Doppler Ultrasound%彩色多普勒超声在人工动静脉内瘘并发症中的临床决策评价

    Institute of Scientific and Technical Information of China (English)

    薄华颖

    2012-01-01

    As a result of wide range application of hemodialysis,the survival time in patients with uremia was significantly longer. Establish and maintain good and long - term vascular access for chronic hemodialysis is prerequisite. Color Doppler ultrasound as a non-invasive checking method has important clinical value in mcnitoring the vascular access of artificial arteriovenous fistula. This text has evaluated the importance of clinical decision - making in artificial arteriovenous fistula complications applied with color Doppler ultrasound.%由于血液透析的广泛应用,尿毒症患者的生存时间显著延长. 建立并保持良好的血管通路是长期慢性血液透析的前提条件.彩色多普勒超声作为一种无创性检查方法,在人工动静脉内瘘血管通路的监测中发挥着重要的临床价值.本文评估彩色多普勒超声在人工动静脉内瘘并发症临床决策中的重要作用.

  1. 维持性血液透析患者动静脉内瘘穿刺疼痛的相关因素分析%Analysis of the correlated factors of puncture-related pain in patients with the arteriovenous fistula undergoing maintenance hemodialysis

    Institute of Scientific and Technical Information of China (English)

    刘佳; Shan Liu; 严谨; 王露芳

    2015-01-01

    Objective To investigate the current situation of puncture-related pain in patients with the arteriovenous fistula undergoing maintenance hemodialysis and its correlated factors. Methods A total of 180 hemodialysis patients with the arteriovenous fistula undergoing maintenance hemodialysis were investigated with demographic data questionnaire, visual analogue scale and pain self-efficacy questionnaire. Results The effective questionnaires rate was 93.89%(169/180). The median score of puncture-related pain was 5 scores, the score of pain self-efficacy was (31.42±14.59) scores;multivariate analysis demonstrated that the puncture-related pain was positively correlated with the patient gender, using time of arteriovenous fistula and pain self-efficacy ( β=0.152,-0.017,-0.409, P<0.05), OR (95%CI)were 2.069 (1.206-3.148), 0.803(0.710-0.984), 1.004(0.886-1.431). There was negative correlation between the puncture-related pain score and pain self-efficacy in these patients, r=-0.647, P<0.01. Conclusions Puncture-related pain is common sense in patients with the arteriovenous fistula undergoing maintenance hemodialysis, some factors including the patient gender, using time of arteriovenous fistula and pain self-efficacy influence this feeling.%目的:调查分析维持性血液透析患者动静脉内瘘穿刺疼痛的现状及相关影响因素。方法使用疼痛视觉模拟法评分、疼痛自我效能量表及患者一般情况调查表对180例使用动静脉内瘘进行维持性血液透析治疗的患者进行调查。结果回收有效问卷169份,有效回收率93.89%(169/180)。动静脉内瘘穿刺患者穿刺疼痛强度中位数评分为5分,疼痛自我效能得分为(31.42±14.59)分;逐步多元回归分析显示,穿刺疼痛主要与患者性别、内瘘使用时间及疼痛自我效能有关(β=0.152、-0.017、-0.409,P<0.05),OR值(95%CI)分别为2.069(1.206~3.148)、0.803(0.710~0.984)、1.004(0.886~1.431

  2. Avaliação da maturação das fístulas arteriovenosas para hemodiálise pelo eco-Doppler colorido Evaluation of hemodialysis arteriovenous fistula maturation by color-flow Doppler ultrasound

    Directory of Open Access Journals (Sweden)

    Jeferson Freitas Toregeani

    2008-09-01

    Full Text Available CONTEXTO: Quando se confecciona uma fístula arteriovenosa para hemodiálise (FAVH autógena, é necessário que se aguarde a dilatação da veia em questão e o desenvolvimento de volume de fluxo mínimo, fenômeno chamado de maturação. Ainda hoje se discute qual o tempo necessário para ocorrer essa maturação. OBJETIVO: Avaliar a maturação de FAVH utilizando-se critérios ecográficos. MÉTODO: Entre maio de 2004 e 2005, 40 pacientes foram selecionados prospectivamente, sendo 23 homens (57,5%, com média de idade de 17,5±51,3 anos, com indicação de confecção de uma FAVH. Utilizou-se o aparelho Logic III® com transdutor de 10 MHz para a avaliação no pré-operatório e nos 7º, 14º, 21º e 28º dias de pós-operatório. Os critérios para a maturação após a cirurgia foram: veia com diâmetro médio maior que 4 mm e volume de fluxo maior que 400 mL/min. RESULTADOS: O diâmetro médio pré-operatório foi de 3,24±1,43 e 3,71±1,37 mm para fístulas de punho e de cotovelo, respectivamente. O diâmetro final foi de 5,01±0,87 mm para as FAVH de punho (p = 0,006 e de 6,15±1,16 mm para as FAVH de cotovelo (p = 0,95. O volume de fluxo no 7º dia pós-operatório foi de 493,63±257,49 mL/min e 976,33±332,90 mL/min para as FAVH de punho e cotovelo, respectivamente. Ao final do estudo, foi calculado o valor de 556,81±288,42 mL/min nas FAVH de punho (p BACKGROUND: When a hemodialysis arteriovenous fistula (HAVF is created, it is important to wait for venous dilatation and volume flow increase through the HAVF, a phenomenon called maturation. There is still some controversy as to the exact time required for this maturation to occur. OBJECTIVE: To evaluate the time required for HAVF maturation using ultrasound criteria. METHOD: From May 2004 through May 2005, 40 patients were prospectively selected. The sample was comprised of 23 men (57.5 %, mean age of 51.3±17.5 years, with indication of HAVF creation. Logic III® ultrasound with 10

  3. 单中心动静脉内瘘手术临床分析%A clinical analysis of arteriovenous fistula operations in a hemodialysis center

    Institute of Scientific and Technical Information of China (English)

    何达; 苏姗娜; 万胜; 潘建华; 熊飞

    2014-01-01

    Objective Toanalyzetheclinicaldatafromhemodialysispatientssubjecttoarterio-venous fistulas (AVF)operations in a single center,to retrospectively define the establishment and protectionofarteriovenousfistulas.Methods Thestudyenrolled490hemodialysispatientsafterfistu-laoperationsbetweenJanuary2012andMarch2014intheFirstHospitalofWuhan.Results Thepri-mary diseases of the 490 patients screened were mainly chronic nephritis (49.6%), diabetes (17.6%),hypertension (12.9%).37.4% of the patients completed the operation before the first di-alysis,and the vast majority of the patients had reached CKD 5 level.Seventy-seven (15.7%)patients had successful AVF construction with the conventional side,without affecting their daily life during the follow-up.The diameters of the artery and vein of patients in the first AVF were (2.25 ±0.47) mm and 2.08±0.49 mm respectively,significantly smaller than those of the patients undergoing re-peated AVF surgery [(3.10±0.92)mm and (3.65±1.58)mm respectively,P<0.05].The success rate of AVF initial construction or reconstruction was 98.5% (447/454).Furthermore,there was no significant difference in patency rate between diabetic and non-diabetic group.Elderly patients had de-creasedone-yearpatencyrateascomparedwiththeyoungpatients.Conclusions (1)Thestarttiming of fistula operation for uremic patients is usually late;(2)Conventional side operation has no signifi-cant influence on patient's daily lives;(3)No remarkable difference in operation success rate and pa-tency rate exists between diabetic and non-diabetic groups;(4)Long-term patency rate for elderly pa-tients? is usually on the lower side.%目的分析行动静脉内瘘手术的血液透析患者的临床资料,以期对动静脉内瘘的建立及保护提供理论依据。方法收集2012年1月1日至2014年3月31日在武汉市第一医院行动静脉内瘘手术的490例患者病例资料进行回顾性统计分析。结果手术患者原发病以慢性肾球肾炎243例(占49.6%)

  4. 喜疗妥联合电磁疗治疗动静脉内瘘炎症的疗效观察%Evaluation on curative effect of hirudoid in combined to electromagnetic therapy to treat Inflammation of arteriovenous fistula

    Institute of Scientific and Technical Information of China (English)

    陈燕; 李桃梅; 范星

    2011-01-01

    Objective: To probe into the effect of hirudoid cream in combined to electromagnetic therapy to treat autogenous arteriovenous fistula (AVF) inflammation. Methods: A total of 42 AVF local inflammation patients randomly were divided into experimental group (22 cases) and control group (20 cases) , hirudoid in combined to electromagnetic therapy for experimental group cases and hirudoid therapy for control group cases. The therapeutic effect,the average time of curing,the condition of antibiotics use,the time of first use of AVF for hematodialysis after treatment and incidence of related complications were recorded. Results: Compared with control group,the cure rate was higher (P<0. 01) ,the average time of curing was shorter (P<0. 01) , and the combined rate of antibiotic was less (P<0. 01), and incidence of subsequent dialysis complications of experimental group was less (P<0. 05). Conclusion: The hirudoid in combined to electromagnetic therapy has the benefits of rapid onset, short duration and low cost and is effective for AVF inflammation in chronic renal failure patients undergoing maintenance hemodialysis%[目的]探讨喜疗妥联合电磁疗治疗自体动静脉内瘘(AVF)炎症的效果.[方法] AVF局部炎症病人42例,随机分喜疗妥联合电磁疗组22例和喜疗妥组20例,分别采用喜疗妥联合电磁疗治疗和喜疗妥治疗.记录两组病人疗效、治愈时间、合并使用抗生素情况,治疗后首次使用AVF行血液透析时间以及相关并发症发生情况等.[结果]喜疗妥联合电磁疗组病人治愈率明显高于喜疗妥组(P<0.01),治愈时间短于喜疗妥组(P<0.01),抗生素合用率明显少于喜疗妥组(P<0.01),后续透析并发症发生率明显低于喜疗妥组(P<0.05).[结论]喜疗妥联合电磁疗治疗起效快、疗程短、费用低,能有效用于慢性肾衰维持性血液透析病人AVF炎症的治疗.

  5. Vascular structure and binomial statistics for response modeling in radiosurgery of cerebral arteriovenous malformations

    Energy Technology Data Exchange (ETDEWEB)

    Andisheh, Bahram; Mavroidis, Panayiotis; Brahme, Anders; Lind, Bengt K [Department of Medical Radiation Physics, Karolinska Institutet and Stockholm University, Stockholm (Sweden); Bitaraf, Mohammad A [Department of Neurosurgery, Tehran University of Medical Sciences and Iran Gamma Knife Center, Tehran (Iran, Islamic Republic of)

    2010-04-07

    Radiation treatment of arteriovenous malformations (AVMs) has a slow and progressive vaso-occlusive effect. Some studies suggested the possible role of vascular structure in this process. A detailed biomathematical model has been used, where the morphological, biophysical and hemodynamic characteristics of intracranial AVM vessels are faithfully reproduced. The effect of radiation on plexiform and fistulous AVM nidus vessels was simulated using this theoretical model. The similarities between vascular and electrical networks were used to construct this biomathematical AVM model and provide an accurate rendering of transnidal and intranidal hemodynamics. The response of different vessels to radiation and their obliteration probability as a function of different angiostructures were simulated and total obliteration was defined as the probability of obliteration of all possible vascular pathways. The dose response of the whole AVM is observed to depend on the vascular structure of the intra-nidus AVM. Furthermore, a plexiform AVM appears to be more prone to obliteration compared with an AVM of the same size but having more arteriovenous fistulas. Finally, a binomial model was introduced, which considers the number of crucial vessels and is able to predict the dose response behavior of AVMs with a complex vascular structure.

  6. Três casos de hipertensão e Fístula Arteriovenosa Renal: com uma fístula de novo Tres casos de hipertención y Fístula Arteriovenosa Renal: con una fístula de novo Three cases of hypertension and Renal Arteriovenous fistula with a de novo fistula

    Directory of Open Access Journals (Sweden)

    Natalia Correa Vieira Melo

    2009-05-01

    Full Text Available Fístula Arteriovenosa Renal (FAVR é uma causa rara e potencialmente reversível de hipertensão e insuficiência renal e/ou cardíaca. O tratamento da FAVR visa preservar o máximo de parênquima renal e, concomitantemente, erradicar os sintomas e efeitos hemodinâmicos decorrentes da FAVR. No presente estudo, serão relatados três casos de FAVR, incluindo um caso de FAVR idiopática de novo, que se apresentaram com hipertensão e insuficiência renal e/ou cardíaca, e descrever a terapêutica adotada e os resultados obtidos.La Fístula Arteriovenosa Renal (FAVR es una causa rara y potencialmente reversible de hipertensión e insuficiencia renal y/o cardíaca. El tratamiento de la FAVR busca preservar el máximo de parénquima renal y, concomitantemente, erradicar los síntomas y efectos hemodinámicos resultantes de la FAVR. En el presente estudio, se relatarán tres casos de FAVR, incluyendo un caso de FAVR idiopática de novo, que se presentaron con hipertensión e insuficiencia renal y/o cardíaca, y describir la terapéutica adoptada y los resultados obtenidos.The Renal Arteriovenous Fistula (RAVF is a rare and potentially reversible cause of hypertension and kidney and/or heart failure. The treatment of RAVF aims at preserving the most of the renal parenchyma and, concomitantly, eradicating the symptoms and hemodynamic effects caused by the RAVF. The present study reports three cases of RAVF, including one case of a de novo idiopathic RAVF, which presented with hypertension and kidney and/or heart failure and describes the therapeutic measures used to treat these patients as well as the outcomes.

  7. Fístula arteriovenosa postraumática: tratamiento endovascular. Revisión de la literatura y presentación de un caso clínico Endovascular treatment of a post-traumatic arterio-venous fistula: Presentation of a clinical case and literature review

    Directory of Open Access Journals (Sweden)

    R. Sánchez

    2010-06-01

    Full Text Available Las fístulas arteriovenosas en la cabeza y el cuello son entidades poco frecuentes. La mayoría es secundaria a heridas penetrantes por arma blanca. Se describe el tratamiento exitoso mediante cirugía endovascular de una fístula postraumática tras una herida penetrante entre la arteria maxilar interna izquierda y la vena yugular externa. A través de este caso clínico y la revisión de la literatura se ilustran las causas, manifestaciones, estudio radiológico y tratamiento de una fístula postraumática entre la arteria maxilar interna y la vena yugular externa. A través de este caso clínico se demuestra la utilidad de los procedimientos endovasculares en el tratamiento de estas complicaciones.Traumatic arteriovenous fistulas of the head and neck region are uncommon. The majority are due to penetration of blunt injury. We describe a successful endovascular treatment of a posttraumatic fistula between the left maxillary artery and the external jugular vein due to a penetration injury. This case and a review of the literature illustrate the causes, manifestations, image studies and treatment for a posttraumatic fistula between the maxillary artery and the external jugular vein. This case demonstrate the utility of endovascular treatment of head and neck injuries complications.

  8. Vesicovaginal Fistula

    African Journals Online (AJOL)

    user1

    labour is consistently the most common cause (65.9%–96.5%) in all the series. .... causes; vesicovaginal fistula prevention; and vesicovaginal fistula ..... promotion of institutional deliveries. .... Risk factors for obstetric fistula in north-eastern ...

  9. Vaginal Fistula

    Science.gov (United States)

    Vaginal fistula Overview By Mayo Clinic Staff A vaginal fistula is an abnormal opening that connects your vagina to ... or urine to pass through your vagina. Vaginal fistulas can develop as a result of an injury, ...

  10. Effect and nursing experience of hirudoid ointment treatment for the internal arteriovenous fistula in patients with hemodialysis%多磺酸粘多糖乳膏治疗血液透析患者动静脉内瘘的疗效及护理

    Institute of Scientific and Technical Information of China (English)

    凌扣荣

    2013-01-01

    目的 探讨多磺酸粘多糖乳膏治疗血液透析患者动静脉内瘘的疗效及护理体会.方法 将60例血液透析动静脉内瘘患者按照随机数字法随机分为对照组和观察组各30例,对照组给予常规治疗及护理,观察组在常规治疗基础上,给予多磺酸粘多糖乳膏及相应护理干预.观察和比较两组患者临床疗效.结果 对照组治疗的总有效率为43.3%,观察组为93.3%,两组比较,差异有统计学意义(x2=17.33,P<0.05).结论 对于血液透析动静脉内瘘患者,多磺酸粘多糖乳膏及相应护理干预能显著提高临床疗效,改善患者的预后,值得临床推广.%Objective To discuss the effect and nursing experience of hirudoid ointment treatment for the internal arteriovenous fistula in patients with hemodialysis.Methods Totals of 60 hemodialysis patients with internal arteriovenous fistula were randomly divided into the control group and the observation group,each with 30 cases.The control group received conventional treatment and nursing while the observation group received hirudoid ointment treatment and related nursing intervention in addition.Two groups' clinical effect was observed and compared.Results Effective rate was 43.3% in the control group and 93.3% in the observation group,and the difference was statistically significant (x2 =17.33,P < 0.05).Conclusions Hirudoid ointment treatment and related nursing intervention for hemodialysis patients with internal arteriovenous fistula can significantly improve clinical effect and patients' prognosis quality,thus is worthy of clinical promotion.

  11. 脑动静脉畸形破裂出血并脑疝的急诊手术治疗%Emergent Surgical Treatment of Acute Hemorrhagic Intracranial Arteriovenous Malformation with Intracerebral Herniation

    Institute of Scientific and Technical Information of China (English)

    魏健; 刘维生; 王永和; 曹培成; 卜振富

    2013-01-01

      目的探讨脑动静脉畸形(AVMs)破裂出血并脑疝的急诊手术问题。方法回顾性分析我院17例AVMs急性破裂出血合并脑疝并行急诊手术治疗的病例资料。结果患者术后半年GOS评定疗效,良好4例,中残6例,重残2例,植物生存2例,死亡3例。术后并发肺部感染4例,皮瓣下积液2例,颅内感染并脑积水1例,迟发血肿1例。结论急诊手术治疗是AVMs破裂出血并脑疝首选治疗方法,能够提高病人生存率,降低致残率。%Objective To study the emergent operative treatment of acute hemorrhagic cerebral arteriove-nous malformations(AVMs) with cerebral herniation.Methods A retrospective analysis of 17 patients with acute hemor-rhagic cerebral AVMs with cerebral herniation was carried out ,who were treated with emergent operative treatment .Re-sults According to GOS scale six month after operation ,4 patients recovered well,moderately disabled in 6 cases,se-verely disabled in 2 cases,vegetably survived in 2 cases,3 patients died after operation,4 cases with pneumonia after op-eration,2 cases with subdural hydroma ,1 case with intracranial infection and hydrocephalus ,1 case with recurrent hema-toma.Conclusion The emergent hematoma debridement and AVMs excision by microneurosurgery is the optimal effec-tive method to treat AVMs with cerebral herniation because it can heighten survival rate and decrease disability rate .

  12. [Arteriovenous malformation-glioma association: study of four cases].

    Science.gov (United States)

    Borges, Lia Raquel R; Malheiros, Suzana M F; Pelaez, Maria Paula; Stávale, João Norberto; Santos, Adrialdo J; Carrete, Henrique; Nogueira, Roberto Gomes; Ferraz, Fernando A P; Gabbai, Alberto A

    2003-06-01

    We reviewed the clinical presentation, imaging and histopathologic findings in 4 patients with the diagnosis of arteriovenous malformation associated with glioma that were operated on from 1991 to 2000 in our institution. Four patients (2 males; age between 15 and 52 years) presented with progressive headache with clinical evidence of intracranial hypertension (in 3) and partial seizures (in 1). CT scan showed a brain tumor without any detectable pathologic vessels. Histologic examination revealed astrocytic tumors associated with arteriovenous malformation. No patient presented the vascular component intermixed with the tumor. The arteriovenous-glioma association is rare and must be identified by a clear demarcation between the malformation and the tumor.

  13. Post procedure headache in patients treated for neurovascular arteriovenous malformations and aneurysms using endovascular therapy

    DEFF Research Database (Denmark)

    Khan, Sabrina; Amin, Faisal Mohammad; Hauerberg, John

    2016-01-01

    BACKGROUND: Though endovascular therapy (EVT) is increasingly applied in the treatment of intracranial vascular lesions, little is known about the effect of EVT on post-procedure headache. We aimed to investigate the prevalence of headache in patients who have undergone EVT for cerebral arteriove......BACKGROUND: Though endovascular therapy (EVT) is increasingly applied in the treatment of intracranial vascular lesions, little is known about the effect of EVT on post-procedure headache. We aimed to investigate the prevalence of headache in patients who have undergone EVT for cerebral...... arteriovenous malformations (AVMs) and aneurysms. METHODS: A total of 324 patients underwent EVT treatment for aneurysms and AVMs at the Danish National Hospital from January 2012 to December 2014. We applied strict exclusion criteria in order to minimize the effect of other factors on headache occurrence, e.......g., craniotomy. Eligible subjects were phone-interviewed using a purpose-developed semi-structured questionnaire. Headaches were classified according to ICHD-III beta criteria. RESULTS: The 59 patients underwent treatment of aneurysms (n = 43), cranial dural fistulas (n = 11), and AVMs (n = 5...

  14. Hemodynamic wall shear stress profiles influence the magnitude and pattern of stenosis in a pig AV fistula.

    Science.gov (United States)

    Krishnamoorthy, Mahesh K; Banerjee, Rupak K; Wang, Yang; Zhang, Jianhua; Roy, Abhijit Sinha; Khoury, Saeb F; Arend, Lois J; Rudich, Steve; Roy-Chaudhury, Prabir

    2008-12-01

    Venous stenosis is a significant problem in arteriovenous fistulae, likely due to anatomical configuration and wall shear stress profiles. To identify linkages between wall shear stress and the magnitude and pattern of vascular stenosis, we produced curved and straight fistulae in a pig model. A complete wall stress profile was calculated for the curved configuration and correlated with luminal stenosis. Computer modeling techniques were then used to derive a wall shear stress profile for the straight arteriovenous fistula. Differences in the wall shear stress profile of the curved and straight fistula were then related to histological findings. There was a marked inverse correlation between the magnitude of wall shear stress within different regions of the curved arteriovenous fistula and luminal stenosis in these same regions. There were also significantly greater differences in wall shear stress between the outer and inner walls of the straight as compared to curved arteriovenous fistula, which translated into a more eccentric histological pattern of intima-media thickening. Our results suggest a clear linkage between anatomical configuration, wall shear stress profiles, and the pattern of luminal stenosis and intima-media thickening in a pig model of arteriovenous fistula stenosis. These results suggest that fistula failure could be reduced by using computer modeling prior to surgical placement to alter the anatomical and, consequently, the wall shear stress profiles in an arteriovenous fistula.

  15. Arteriovenous shunt graft ulceration with sinus and graft epithelialization

    Directory of Open Access Journals (Sweden)

    Pooja Singhal

    2015-03-01

    Full Text Available Arteriovenous fistula and grafts are used as access sites for patients with chronic kidney disease and are prone for complications. Stent grafts are used to treat access site complications. We report a rare and unusual finding of epithelialization of the sinus tract and the lumen of a polytetrafluoroethylene graft, following ulceration of the overlying skin.

  16. 分阶段护理干预在血液透析患者动静脉内瘘成形术中的应用%Application of nursing intervention by stages to the arteriovenous fistula angioplasty in the patients with hemodialysis

    Institute of Scientific and Technical Information of China (English)

    王熙宁; 张静

    2011-01-01

    Objective: To investigate the application effect of nursing intervention by stages to the arteriovenous fistula angioplasty in the patients with hemodialysis. Methods: 106 hemodialysis patients who underwent arteriovenous fistula angioplasty were randomly divided into an intervention group ( n = 52 ) and a control group ( n = 54 ). The nursing intervention by stages was implemented in the intervention group and routine nursing care was taken in the control group. The patients were followed up for 3 months and then the patient's satisfaction, the effect of health education, fistula maturation rate and time, self- care ability and the incidence of complications were compared between the two groups. The patient's satisfaction, the effect of health education,fistula maturation rate and self - care ability were better and higher in the intervention group than those in the control group ( P <0.05 ); the fistula maturation time and the incidence of complications were shorter and lower in the intervention group than those in the control group ( P < 0.05 ). Conclusion: The nursing intervention by stages can improve the patient's satisfaction, the effect of health education, fistula maturation rate and self - care ability and effectively shorten and reduce the fistula maturation time and the incidence of complications as well.%目的:探讨分阶段护理干预在血液透析患者动静脉内瘘成形术中的应用效果.方法:将106例血液透析动静脉内瘘成形术患者随机分为干预组52例和对照组54例,干预组实施分阶段护理干预,对照组进行常规护理.均随访3个月,比较两组患者满意度、健康教育效果、内瘘成熟率及时间、自护行为能力及术后并发症的发生情况.结果:干预组患者满意度、健康教育效果、内瘘成熟率及自护行为能力均高于对照组(P<0.05),内瘘成熟时间、并发症发生率低于对照组(P<0.05).结论:分阶段护理干预可提高血液透析动静脉内

  17. Avaliação da perviedade precoce das fístulas arteriovenosas para hemodiálise Evaluation of early patency of the arteriovenous fistulas for hemodialysis

    Directory of Open Access Journals (Sweden)

    Milton Alves das Neves Junior

    2011-06-01

    Full Text Available CONTEXTO: A insuficiência renal crônica é uma doença de alta prevalência e morbidade, o que determina queda da qualidade de vida. Pacientes em hemodiálise necessitam de um acesso vascular que permita a conexão da circulação do paciente ao circuito externo de hemodiálise. Dentre os acessos disponíveis, as fístulas arteriovenosas (FAV são as que mais se aproximam do acesso ideal. OBJETIVO: Avaliar a perviedade precoce das FAV, identificando os fatores relacionados ao insucesso destas. MÉTODOS: Foram acompanhados todos os pacientes submetidos à confecção das FAV no Hospital do Servidor Público Municipal de São Paulo, no período de agosto de 2008 a janeiro de 2009, avaliando-se a perviedade destas no 1º, 10º e 30º pós-operatório. Foram realizadas 31 FAV no período, apresentando-se média de idade de 63,06 anos, sendo 18 pacientes do sexo masculino e 13 do feminino. RESULTADOS: Vinte e seis FAV foram distais, todas radiocefálicas; quatro foram proximais, das quais duas braquiocefálicas e duas braquiobasílicas superficializadas; uma FAV confeccionada com alça de politetrafluoretileno (PTFE fêmoro-femoral esquerda. A taxa de perviedade no primeiro mês foi de 71% dos casos. O uso de cateteres venosos centrais apresentou-se como fator de risco para oclusão da FAV (p=0,01. As FAV continuam sendo o acesso vascular para hemodiálise mais aceito e mais seguro. A indicação precoce para confecção das FAV é de fundamental importância, evitando-se, assim, o uso de cateteres e suas complicações. CONCLUSÕES: A perviedade precoce encontrada neste estudo é semelhante à da literatura, e o uso prévio de cateteres é o fator de risco mais significativo para oclusão precoce desta.BACKGROUND: Chronic renal failure is a disease of high prevalence and high morbidity, which impairs the patients' quality of life. Patients on hemodialysis need a vascular access for connection with the hemodialysis equipment. Arteriovenous fistulas

  18. Arteriovenøs fistel efter skudlaesion. Kvalitativ og kvantitativ diagnosticering

    DEFF Research Database (Denmark)

    Beck, A M; Bülow, J B; Mortensen, D P

    1989-01-01

    A man aged 33 years developed an arterio-venous fistula following a gunshot wound from behind in the right calf. The quality of the fistula could be demonstrated employing digital subtraction angiographic technique while the quantity was demonstrated employing 99Tc macroaggregated albumin....... The localization of the fistula is important in view of the surgical procedure and the haemodynamic amount is important to determine cardiac involvement....

  19. Complications of arteriovenous fistula with polytetraflouroethylen ...

    African Journals Online (AJOL)

    2014-07-20

    Jul 20, 2014 ... Purpose: Vessels with high venous flow rate are needed for the ... The increase in the number of chronic hemodialysis patients has led to an increase ... infection risk. .... late complication was graft thrombosis, which was seen.

  20. Diagnosis and evaluation of intracranial arteriovenous malformations

    Directory of Open Access Journals (Sweden)

    Andrew Conger

    2015-01-01

    Conclusion: AVMs are a heterogenous pathology with three different options for treatment. Accurate assessment of risk of observation and risk of treatment is essential for achieving the best outcome for each patient.

  1. Aortoenteric Fistula

    Directory of Open Access Journals (Sweden)

    Shou-Jiang Tang

    2014-04-01

    Conclusions: Diagnosis of aortoenteric fistula requires a high index of suspicion and careful history-taking. Endoscopic findings include adherent clots or bleeding at the fistula opening and/or eroded vascular graft or stent into the bowel.

  2. Colovesicular Fistula

    OpenAIRE

    2012-01-01

    A fistula is an atypical connection between two epithelial surfaces, in the case of an enterovesical fistula between the urinary and gastrointestinal systems. These may be the result of a number of causes including: 1. Congenital abnormalities 2. Inflammatory diseases of the bowel (such as diverticulitis and Crohn’s Disease) 3. Cancer 4. Infection 5. Trauma 6. Iatrogenic (such as a post-operative complication) [3] A colovesical fistula (colovesicular fistula), an abnor...

  3. Necessidades de aprendizagem de profissionais de enfermagem na assistência aos pacientes com fístula arteriovenosa Necesidades de aprendizaje de profesionales de enfermería en la asistencia a pacientes con fístula arteriovenosa Learning needs of professional nurses to care for patients with arteriovenous fistula

    Directory of Open Access Journals (Sweden)

    Rita de Cássia Helú Mendonça Ribeiro

    2009-01-01

    de las agujas; el 19,4% informaron tener dudas en la orientación de los pacientes y el 13,9% relataron falta de habilidad cuando la FAV presenta hematoma. CONCLUSIÓN: Fue posible conocer las necesidades de aprendizaje en la asistencia de enfermería al paciente portador de FAV y elaborar un protocolo para la asistencia de enfermería, a fin de mejorar los cuidados prestados a estos pacientes.OBJECTIVES: To identify the learning needs of professional nurses to provide quality care for patients with arteriovenous fistula (AV Fistula for hemodialysis. METHODS: This cross-sectional descriptive study was conducted with 36 professional nurses from the hemodialysis unit of a hospital in the State of São Paulo. A semi-structured questionnaire was used to collect the data. Initially, questionnaires were distributed to 43 nurses, but only 36 (83.7% responded and returned the questionnaires. RESULTS: A great number of nurses (44.9 % reported to have difficulties in providing quality care for patients with AV Fistula. Difficulties were related to the access of AV Fistula for hemodialysis (47.2%, hemostasis of the site when withdrawing the needle after hemodialysis (19.4% and lack of competency for the management of hematoma (13.9%, and patient's instructions and education (19.4%. CONCLUSIONS: Nurses had many learning needs to prepare them to care for patients with arteriovenous AV Fistula. This finding led to the development of a protocol to facilitated quality care nursing care.

  4. 双血管融合技术在硬脑膜动静瘘诊断和手术计划中的应用%Application of dual vessel fusion technique in the diagnosis of dural arteriovenous fistula and surgical planning

    Institute of Scientific and Technical Information of China (English)

    盛柳青; 李俊; 李国栋; 李欢欢; 陈刚; 向伟楚; 王强; 甘志强; 马廉亭

    2015-01-01

    Objective To investigate the application values of dual vessel fusion technique in the diagnosis of dural arteriovenous fistula (DAVF) and surgical planning.Methods Ten patients with DAVF underwent selective cerebral angiography using plate digital subtraction angiography (DSA).The lesion vessels performed three-dimensional angiography.The "double volume reconstruction" technique was used to perform two-vessel three-dimensional image fusion at the three-dimensional workstation.The angioarchitecture of DAVF was investigated.Results Ten patients obtained satisfactory "dual vessel fusion" with a good spatial coherence.On the dual vessel fusion images,the blood flow from different feeding arteries flowed together into the same fistula and draining vein (presented as a fusion of red and white blood flow) and the location and shape of the fistula cold be identified clearly.It could be used to guide the choice of treatment strategy,design surgery and surgical intervention plan.Conclusions Based on the "dual vessel fusion" of fiat panel DSA three-dimensional vascular data,it can obtain accurate vascular fusion,more clearly reveal fistulas,feeding arteries,draining veins and other angioarchitecture information of DAVF,and ultimately be beneficial to the development of surgical planning.%目的 探讨双血管融合技术在硬脑膜动静瘘(dural arteriovenous fistula,DAVF)诊断和手术计划中的应用价值,指导术中准确找到瘘口.方法 在10例DAVF病例采用平板DSA行选择性全脑血管造影,病变血管行三维血管成像.在三维工作站采用“双容积重建”技术进行两支血管三维像的融合,研究DAVF的血管构筑.结果 在10例均获得满意的“双血管融合”,具有很好的空间一致性.在双血管融合图像上可以清晰看到来自不同供血动脉的血流汇流到同一瘘口和引流静脉(表现为红白相间的血流融合),可以清晰判断瘘口的部位和形态,指导选择治疗策略、设计外

  5. Assessment of Arteriovenous Shunt Pathway Function and Hypervolemia for Hemodialysis Patients by Using Integrated Rapid Screening System

    Directory of Open Access Journals (Sweden)

    Wei-Ling Chen

    2017-06-01

    Full Text Available Currently, the hemodialysis patients received body weight measurement by themselves, vital sign checking by nursing staffs before dialysis. Whenever, the arteriovenous routes with problems doubted, the patients needed to be referred to surgeon for vascular echography checking and then to be corrected. How to integrate these three tasks in one time is a very important issue. The project proposes to combine our previous study of audio-phono angiographic technology in detecting vascular stenosis with rapid screening system to evaluate dialysis patients’ arteriovenous routes function and their status of excess body fluids: inspecting and integrating the blood pressure, body weight, and fistula function work into a rapid screening system, and using the quantization of fistula phono angiography pitch to achieve assessing arteriovenous routes. Future hoping is developed a complete integrated intelligence system by combining the arteriovenous fistula signal processing with feature extraction with wireless sensor network technology.

  6. Application of portable moxibustion combined with hirudoid in autogenous internal arteriovenous fistula in hemodialysis patients%随身灸联合喜疗妥在血液透析患者自体动静脉内瘘血管中的应用

    Institute of Scientific and Technical Information of China (English)

    梁桂兰; 戈海; 殷贵兰

    2016-01-01

    Objective To observe the effect of portable moxibustion combined with hiru doid in autogenous in-ternal arteriovenous fistula in hemodialysis patients. Methods A total of 80 patients undergoing hemodialysis internal arteriovenous fistual puncture from March 2013 to November 2014 were randomly divided into the experimental group and the control group. The patients in the control group received fomentation combined with hirudoid ointment, while the patients in the experimental group received portable moxibustion combined with hirudoid ointment. The blood vessels conditions were compared between the two groups after intervention for 3 months. Results There were no significant differences in the patients' age, gender, internal fistual time or laboratory examinations. The effective rate of internal fistual conditions in the wild, moderate and severe groups were significantly higher than those of the control group after intervention for 3 months, and the difference was statistically significant (P<0. 05) . Conclusions Portable moxibus-tion combined with hirudoid could promote the repair of internal arteriovenous fistual injured vessel wall, reduce indura-tion and other complications, prolong the life of internal arteriovenous fistula, obtain enough blood flow, ensure effec-tive dialysis, alleviate the pain of patients and improve the life quality of hemodialysis patients.%目的:观察随身灸联合喜疗妥对血液透析患者自体动静脉内瘘血管的影响。方法将在本院2013年3月至2014年11月行血液透析动静脉内瘘穿刺的患者80例随机分为实验组和对照组,对照组采用热敷联合喜疗妥软膏的方法,实验组采用随身灸联合喜疗妥软膏的方法,比较两组干预3个月后的血管情况。结果两组患者在年龄、性别、内瘘使用时间及实验室检查方面均无统计学差异,干预3个月后治疗组患者内瘘血管情况在轻型、中型、重型组的有效率均高于对照组

  7. 经皮腔内血管成形术在糖尿病肾病血液透析患者动静脉内瘘狭窄中的应用%Application of percutaneous transluminal angioplasty in the treatment of arteriovenous fistula stenosis or occlusion in diabetic nephropathy patients with hemodialysis

    Institute of Scientific and Technical Information of China (English)

    解德琼; 朱军; 唐前容; 朱磊; 李程; 赵平

    2015-01-01

    目的:观察经皮腔内血管成形术(percutaneous transluminal angioplasty ,PTA)在糖尿病肾病血液透析患者动静脉内瘘狭窄中的应用效果。方法选择20例基础疾病为糖尿病肾病的血液透析动静脉内瘘狭窄患者进行 PTA 治疗,比较 PTA治疗前后的血管造影表现、透析血流量及静脉压变化。结果19例患者经球囊扩张后,狭窄段明显扩张,触诊感血管震颤增强,经造影证实狭窄小于30%。术后首次血液透析血流量由扩张前(124.32±18.43)ml/min 增至(242.12±16.35)ml/min;在血流量为250 ml/min 时,静脉压由扩张前的(178.46±13.4)mmHg 降至(98.62±14.36)mmHg;kt/V 较前明显提高,差异有统计学意义(P <0.05)。术中未出现血管破裂、出血及血栓形成等并发症。结论 PTA 是治疗糖尿病肾病血液透析患者动静脉内瘘狭窄的有效方法,其操作简便、创伤小、近期效果明显,对血液透析动静脉内瘘的维护有重要价值.%Objective To observe the clinical effect of percutaneous transluminal angioplasty (PTA) in the treatment of arte-riovenous fistula stenosis in diabetic nephropathy (DN) patients with hemodialysis.Methods Twenty hemodialytic DN patients with arteriovenous fistula stenosis were selected to have PTA .The angiographic findings,changes in blood flow volume and venous pressure level during hemodialysis between pre -and post-operation were compared.Results In 19 patients,the stenotic segment was dilated,the occluded site was re-canalized and the palpation feeling of thrill became stronger immediately after PTA .The stenosis was less than 30% confirmed by angiography.The hemodialysis blood flow was increased from (124.32 ±18.43)ml/min of pre-operation to(242.12 ±16.35)ml/min of post-operation.The venous pressure was decreased from (178.46 ±13.4 ) mmHg of pre-operation to (98.62 ± 14.36)mmHg of post-operation when blood flow

  8. Impact of staged education of self management on the self-care ability of patients undergoing internal arteriovenous fistula operation%阶段式自我管理教育对动静脉内瘘成形术患者自我护理能力的影响

    Institute of Scientific and Technical Information of China (English)

    张娅; 蒋依果; 王荣

    2012-01-01

    目的:探讨阶段式自我管理教育对动静脉内瘘成形术患者自我护理能力的影响.方法:对48例动静脉内瘘成形术患者进行阶段式自我管理教育,于出院时、出院后1个月和3个月采用自行设计内瘘自我护理知识掌握情况调查表和自我护理能力实施量表(ESCA)评估患者的自我护理能力.结果:本组患者自我护理知识掌握情况:出院当天掌握13例(27.08%),基本掌握19例(39.58%),未掌握16例(33.33%);出院后1个月掌握31例(64.58%),基本掌握17例(35.42%);出院后3个月掌握46例(95.83%),基本掌握2例(4.17%).患者出院时、出院后1个月和3个月内瘘自我护理知识掌握情况调查表评分及ESCA评分比较差异有统计学意义(P<0.01).结论:阶段式自我管理教育能有效提高动静脉内瘘成形术患者的自我护理能力,值得临床推广应用.%To explore the impact of staged education of self management on the self - care ability of patients undergoing internal arteriovenous fistula operation. Methods: The staged education of self management was given to 48 patients with internal arteriovenous fistula operation. The self - designed questionnaire on grasp of self - care knowledge and ESCA were used to assess patient self - care ability respectively at discharge, one and three months after discharge. Results: On the right day at discharge, 13 patients grasped the knowledge ( 27.08% }, 19 patients grasped some knowledge ( 39. 58% ), 16 patients did not grasp any knowledge ( 33. 33%); one month after discharge, 31 patients grasped the knowledge( 64.58%),17 patients grasped some knowledge( 35.42% ); 3 months after discharge, 46 patients grasped the knowledge( 95.83% ), 2 patients grasped some knowledge ( 4.17% ). The differences in the comparison of the scores of grasp of self - care knowledge and ESCA were statistically significant at the different time ( P <0. 01 ). Conclusion:The staged education of self management can effectively

  9. A noisy zygoma fracture--complication of carotid-cavernous sinus fistula: total recovery of monocular blindness and frozen-eye after endoarterial coil embolization.

    NARCIS (Netherlands)

    Bierenbroodspot, F.; Damme, P.A. van; Cruysberg, J.R.M.

    2005-01-01

    A case of a patient with a zygoma fracture in combination with a carotid-cavernous sinus fistula--an arterio-venous fistula between the internal carotid artery and the cavernous sinus--is presented. The most frequent cause is trauma, but the carotid-cavernous sinus fistula itself may have been the c

  10. 血红蛋白及红细胞分布宽度预测动静脉内瘘晚期血栓形成的研究%Hemoglobin and red cell distribution width for the prediction of late thrombosis of arteriovenous fistula

    Institute of Scientific and Technical Information of China (English)

    段书众; 董巧荣; 王景福; 张宝红

    2015-01-01

    Objective To probe relatively cheap and generally available laboratory test for predicting late thrombosis of arteriovenous fistu-la( AVF). Methods Retrospective analysis of laboratory data of hemoglobin( HGB),red cell distribution width-standard deviation( RDW-SD),red cell distribution width-coefficient of variation( RDW-CV),platelet,triglyceride and cholesterol was undertaken in 30 patients with late thrombosis of arteriovenous fistula. Thirty patients with AVF for maintenance hemodialysis but without thrombosis in the same hemodialysis center were as control. The above parameters were compared between two groups. Results The values of HGB and RDW in patients with throm-bosis were higher than those in control group,and the differences were statistically significant(all P 0. 05). Conclusion HGB and RDW may be used as the indicator for the prediction of late thrombosis of AVF.%目的:寻找廉价的、易于获得的能预测透析用动静脉内瘘晚期血栓形成的化验指标。方法回顾性研究30例动静脉内瘘晚期血栓形成患者的血红蛋白、红细胞分布宽度、血小板计数、甘油三酯、胆固醇;选择同一透析中心内瘘流量良好患者30例作为对照组,收集上述数据。比较两组间指标差异。结果晚期血栓形成者血红蛋白、红细胞分布宽度均明显高于对照组( P 0.05)。结论血红蛋白、红细胞分布宽度可作为预测动静脉内瘘晚期血栓形成的实验室指标。

  11. Subclavian artery to internal jugular vein fistula following percutaneous internal jugular vein catheterization.

    Science.gov (United States)

    Merino-Angulo, J; Cortazar, J L; Saez-Garmendia, F; Montejo, M

    1984-01-01

    The percutaneous internal jugular vein approach is now a commonly performed procedure for central venous catheterization. Iatrogenic arteriovenous fistulae are a very infrequent complication. We report an asymptomatic subclavian artery to internal jugular vein fistula following two percutaneous internal jugular vein catheterization attempts.

  12. 256层CT上肢血管成像对血液透析患者自体动静脉内瘘功能不全的评价%Multi-slice CT angiography evaluation of autogenous arteriovenous fistula dysfunction in hemodialysis patients

    Institute of Scientific and Technical Information of China (English)

    金文韬; 李斌; 刘洪超; 刘士远; 郝楠馨; 于红

    2013-01-01

    Objective To evaluate the clinical value of CT angiography (CTA) using 256-slicc CT scanner for autogenous arteriovenous fistula dysfunction in hemodialysis patients. Methods A total of 20 hemodialysis patients with autogenous arteriovenous fistula dysfunction underwent CTA of the affected upper limbs. A total of 80-100 ml- of noniodinatcd contrast agent (iopamidol) was injected at a rate of 3-1. 5 mL/s into the antccubital vein of contralatcral limb. A contrast agent concentration tracking technology was utilized. Aortic arch was regarded as the region of interest (ROI) and the threshold was set at 150 HU. Imaging commenced after a delay of 18 s when ROI arrived at the threshold. In two patients, the delay phase scanning was started at 30 s after the first scanning . The images were reconstructed with standard algorithm, with 0. 625 mm slice thickness and 0. 625 mm slice gap, using different postprocessing techniques such as surface reconstruction, multiple planar reconstruction, maximum intensity projection and volume rendering on the EBW workstation. The cross sectional area of the fistula anastomotic stoma was measured using the vessel analysis and measurement function of the EBW workstation, and compared with the supplying artery. Results The blood vessels in affected limb were clearly displayed on CTA. Of 94 vascular segments in 20 hemodialysis patients, 29 were of stenosis, including 15 at arteriovenous anastomotic stoma (51.7%), 8 at venous outflow in forearm (27.5%), 3 at venous outflow in upper arm ( 10. 3 % ) and 3 at subclavian vein ( 10. 3%). Five cases exhibited collateral circulation formation; 10 had draining vein dilatation; 9 had supplying artery variation and 1 had hematoma in the elbow. Conclusion Autogenous arteriovenous fistula can be accurately evaluated by using CT angiography, which is helpful for guiding management clinically of the patients with chronic renal failure fistula dysfunction.%目的 研究256层CT血管成像对于血液透

  13. 儿童期颅内动静脉畸形临床及形态学分析%Clinical and morphological analysis of intracranial arteriovenous malformation in childhood

    Institute of Scientific and Technical Information of China (English)

    沈文俊; 李秋平; 李昊

    2014-01-01

    Objective To discuss the clinical manifestations and the morphological features of intracranial arteriovenous malformation (AVM) in childhood. Methods During the period from Jan. 2012 to June 2013, a total of 14 AVM patients under the age of 14 years were admitted to authors’ hospital. Of the 14 patients, 11 had a history of spontaneous intracerebral hemorrhage (78.6%), 7 complained of headache (50.5% ), 5 showed signs of unilateral limb weakness (35.7% ), and 2 was accompanied with epileptic attacks (14.3% ). The clinical characteristics, the preoperative imaging features and DSA findings were retrospectively analyzed. Results DSA showed that terminal feeding branches were visualized in 9 cases and blood supply from perforating branches was seen in the remaining 5 cases. In seven cases the feeding artery was single, while in the remaining 7 cases the feeding artery was multiple, and in four of them combination blood supply from both anterior and posterior circulation was found. The lesions were situated at the lateral or convex surface of cerebral hemisphere (n = 5), lateral ventricle (n = 4), cerebral bottom (n = 3) or medial surface of cerebral hemisphere (n = 2). The lesion’s diameter was < 30 mm in 10 cases and (30 -60) mm in 4 cases. According to Spetzler- Martin grading, grade Ⅰ was seen in 4 cases, grade Ⅱ in 2 cases, grade Ⅲ in 5 cases and grade Ⅳ in 3 cases. Conclusion Although in childhood AVM lesion is small in size and lower in grading, its onset is early and the lesion is prone to bleeding. DSA findings indicate that most AVMs in childhood take the form of immature type. Nevertheless, its natural course needs to be further studied.%目的:探讨儿童期颅内动静脉畸形(AVM)的临床特点及形态学表现。方法2012年1月-2013年6月收治14岁以下颅内 AVM 患儿14例,其中11例(78.6%)曾有自发性脑出血病史,头痛7例(50.0%),单侧肢体乏力5例(35.7%),2例(14.3%)伴有癫痫

  14. 肱动脉-贵要静脉内瘘与动静脉移植物内瘘在长期血液透析患者中的应用%Brachial-basilic arteriovenous fistula versus arteriovenous graft in vascular access for mainteinance hemodialysis patients

    Institute of Scientific and Technical Information of China (English)

    高民; 汤日宁; 杨金芳; 张留平; 王越; 刘宏; 涂岩; 刘必成

    2013-01-01

    Objective To compared the outcomes of autogenous brachial-basilic arteriovenous fistula (BBAVF) and AV graft (AVG) in patients undergoing long-term hemodialysis.Methods Approved by Zhong Da hospital ethics committiee,we analyzed 61 complex patients,30 randomized to receive AVG and 31 received BBAVF.We compared patency rates of BBAVF and AVG in 3 months,1 year,2 years,3 years,and complication rates.Results Patency rates of BBAVF in 3 months,1 year,2 years,3 years were 100%,96.8%,90.3%,87.1%,3 years accumulative total infection rate was 3.2%,thrombosis rate was 3.2%.Patency rates of AVG in 3 months,1 year,2 years,3 years were 96.7%,50.0%,36.7%,33.3%,3 years accumulative total infection rate was 26.7%,thrombosis rate was 33.3%.Patency rates of BBAVF in 1 year,2 years,3 years were higher than patency rates of AVG.The complication rates of infection and thrombosis were significantly lower for BBAVF than for AVG (P <0.05,respectively).Conclusions BBAVF has the advantage of a higher patency rate,a lower complicantion rates of infection and thrombosis,should be served as a favourable choice in building the vascular access in maintenance hemodialysis patients.%目的 比较肱动脉-贵要静脉动静脉内瘘和动静脉移植物内瘘在长期血液透析(血透)患者中的临床应用效果.方法 选择东南大学附属中大医院肾内科2008年1月1日至12月31日期间的复杂血管通路患者61例,经医院伦理委员会审核,数字表法随机分为2组:肱动脉-贵要静脉动静脉内瘘(31例),人工血管建立动静脉移植物内瘘(30例),比较两组内瘘的3个月、1、2、3年的通畅率及并发症发生率.结果 肱动脉-贵要静脉动静脉内瘘组3个月、1、2、3年的通畅率为100%、96.8%、90.3%、87.1%,3年累计感染率3.2%,栓塞率3.2%;动静脉移植物内瘘组3个月、1、2、3年的初级通畅率为96.7%、50.0%、36.7%、33.3%,3年累计感染率26.7%,栓塞率33.3

  15. A successful treatment of an intrarenal arteriovenous fistual by percutaneous embolization

    Energy Technology Data Exchange (ETDEWEB)

    Winkler, J.; Neuman-Levin, M.; Boner, G. (Beilinson Medical Center, Petah Tiqua (Israel) Univ. of Tel-Aviv (Israel))

    1991-02-06

    A 37-year-old woman patient, known to have poorly controlled arterial hypertension that was diagnosed following a cerebrovascular accident at the age of 15 years, was referred to the authors' outpatient clinic for investigation in 1987. An intrarenal arteriovenous fistula was diagnosed by selective renal angiography. Embolization of the fistula was performed using four 15-mm/5-cm coils, which induced thrombosis and obstructed the fistula. The vascularization of the affected kidney improved immediately. During the following 4 months, the antihypertensive treatment was stopped gradually, and the patient remained normotensive. This is an unusual case of a large intrarenal arteriovenous fistula, whose etiology was not clear, that was successfully treated by percutaneous embolization.

  16. 两种不同吻合方法在前臂动静脉内瘘手术中的随机对照研究%Two different anastomosis methods for arteriovenous fistula plasty of forearm in hemodialysis patients:a randomized controlled study

    Institute of Scientific and Technical Information of China (English)

    李明; 宋永胜; 卜仁戈; 吴斌; 李德天; 苏雪松; 边晓慧; 杜丰; 费翔

    2013-01-01

    目的 比较间断结节吻合与连续吻合两种不同方法在前臂动静脉内瘘手术中的临床效果,结合文献总结治疗经验,以期进一步提高手术效果.方法 76例施行前臂动静脉内瘘术的患者被随机分为两组:其中间断结节吻合38例,连续吻合38例,两组均采用端-侧吻合.比较两种吻合方法在血管吻合时间、总体手术时间、术后血管通畅度及血管并发症的差异并作统计学分析.结果 血管吻合时间间断结节吻合组平均为(27.4±5.2)min、连续缝合组为(18.4±4.6) min,差异具有统计学意义(P<0.05);总体手术时间间断结节吻合组平均为(68.6±18.4) min、连续缝合组为(54.8±12.2)min;差异具有统计学意义(P<0.05).内瘘成熟后血流量间断结节吻合组平均为(647.6±102.8) ml/min、连续吻合组为(604.8±82.5)ml/min,差异具有统计学意义(P<0.05).术后1个月、6个月和1年通畅率分别为间断结节吻合组100%(38/38)、97.4%(37/38)、97.4%(37/38),连续缝合组97.4%(37/38)、94.7%(36/38)、94.7% (36/38);两组间均无统计学差异(P>0.05).结论 连续吻合建立动静脉内瘘血管吻合时间及总体手术时间比间断结节吻合更短,而近远期通畅率与间断吻合无明显差异,但内瘘成熟后血流量较间断结节吻合小.因此,采用个体化方案决定吻合方式可能对患者更有利.%Objectives To compare the efficacy of discontinuous anastomosis and continuous anastomosis for arteriovenous fistula plasty of forearm in hemodialysis patients,referring to the literature and summarize our experience to improve the operation outcome.Methods Totally 76 patients operating for arteriovenous fistula plasty of forearm were randomized divided into 2 groups:38 patients received discontinuous anastomosis and 38 patients received continuous anastomosis.The two groups were all used for end-to-side anastomosis.Comparing the time of vascular anastomosis、total operation

  17. Pulmonary Arteriovenous Malformations

    DEFF Research Database (Denmark)

    Kjeldsen, A D; Oxhøj, H; Andersen, P E

    1999-01-01

    Hereditary hemorrhagic telangiectasia (HHT) is a dominantly inherited disease with a high prevalence of pulmonary arteriovenous malformations (PAVMs). The first symptom of HHT may be stroke or fatal hemoptysis associated with the presence of PAVM....

  18. 彩色多普勒超声检查人工动静脉内瘘的临床应用%The Clinical Application of Color Doppler Ultrasound in Monitoring Artificial Arteriovenous Fistula

    Institute of Scientific and Technical Information of China (English)

    潘梅芳

    2014-01-01

    目的:探讨彩色多普勒超声在监测人工动静脉内瘘中的临床应用价值。方法用彩色多普勒超声检查人工动静脉内瘘共111例,观察内瘘形态,检查有无并发症,判断内瘘功能。结果内瘘通畅33例,并发症78例,多种并发症可同时发生。其中狭窄22例,血栓形成38例,静脉瘤样扩张32例,盗血综合征1例,桡动脉及吻合口瘤样扩张1例,头静脉分支血管9例。结论彩色多普勒超声可以及时发现各种内瘘并发症,有利于临床及时处理,在延长内瘘使用寿命中有重要的作用。%Objective To discuss the clinical application value of color Doppler ultrasound in monitoring artificial arteriovenous fistula. Method Monitor 111 cases of artificial arteriovenous fistula by color Doppler ultrasound. Observe the morphology of internal fistula. Monitor the possibility of syndrome and judge the function of internal fistula. Results 33 cases of internal fistula patency, 78 cases of syndrome, 22 cases of stenosis, 38 cases of thrombosis, 32 cases of phlebangioma ectasia, a case of steal syndrome, a case of radial artery and anastomotic stoma ectasia, 9 cases of cephalic vein vascular branches. Conclusion Various internal fistula syndrome can be detected in time. It benefits clinical treatment in a timely manner and makes great contributions to prolonging the service life of the internal fistula.

  19. Tracheoesophageal fistula.

    Science.gov (United States)

    Slater, Bethany J; Rothenberg, Steven S

    2016-06-01

    Tracheoesophageal fistula (TEF) is a relatively rare congenital anomaly. Surgical intervention is required to establish esophageal continuity and prevent aspiration and overdistension of the stomach. Since the first successful report of thoracoscopic TEF repair in 2000, the minimally invasive approach has become increasingly utilized. The main advantages of the thoracoscopic technique include avoidance of a thoracotomy, improved cosmesis, and superior visualization of the anatomy and fistula afforded by the laparoscope׳s magnification. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Simvastatin Therapy is not Associated with Improved Autogenous Internal Arteriovenous Fistula in Neointimal Hyperplasis on 5/6 Nephrectomy Rats Outcomes%辛伐他汀未能改善5/6肾切除大鼠自体动静脉内瘘血管内膜增生

    Institute of Scientific and Technical Information of China (English)

    郑尘非; 张周沧; 徐利鸳; 刘毅; 郑景晨

    2013-01-01

    Objective: To investigate the effectness of simvastatin on neointimal hyperplasis of autogenous internal arteriove-nous fistula in rats model with chronic renal failure by 5/6 nephrectomy. Methods: 36 rats were randomly divided into three groups: sham group, CRF control group and CRF statin group of 12 each . CRF models were made by 5/6 nephrectomy and then followed by end - to - end anastomosis of the right carotid artery and internal jugular vein. After the operation for 7 and 28 days, rats were sacrificed , and the blood sample was taken for renal funtion and lipids, also the vein near the anastomosis site were examined for histologi-cal changes after staining with HE, combined staining for elastic and collagen fibers, and immunohistochemical staining for alpha SMA and PCNA. Results:( 1 )Renal function and lipids: Blood creatinine and BUN levels were significantly increased in the CRF control group and CRF statin group than sham group( P 0. 05 ). (3 )Immunohistochemisty results showed that alpha SMA, PCNA were significantly increased in CRF control and CRF statin groups compared to sham group( P 0. 05 ). Conclusion: Simvastatin therapy is not associated with improved autogenous internal arteriovenous fistula in neointimal hyperplasis on 5/6 Nephrectomy rats outcomes.%目的:观察辛伐他汀对5/6肾切除大鼠自体移植静脉内膜增生的影响,探讨其防治透析内瘘内膜增生是否有潜在的价值.方法:36只大鼠随机分为3组:假手术组、CRF对照组和CRF他汀组各12只.各组在成模后分别于第7天、28天各处死6只,抽血行肾功能、血脂检测,并取其内瘘内膜组织行组织病理学检查.比较相同时间点各组肾功能,血脂及内膜增生程度.结果:(1)肾功能和血脂:与同一时点假手术组相比,CRF对照组、CRF他汀组造模后第7、28天后的肌酐和尿素氮均显著增高(P<0.05),各组血脂无显著差异.(2)新生内膜面积、厚度测定:术后第7天,已见各组内瘘血管

  1. Cerebellar arteriovenous malformations in children

    Energy Technology Data Exchange (ETDEWEB)

    Griffiths, P.D. [Sheffield Univ. (United Kingdom). Acad. Dept. of Radiol.; Blaser, S.; Armstrong, D.; Chuang, S.; Harwood-Nash, D. [Division of Neuroradiology, The Hospital for Sick Children and University of Toronto, Toronto (Canada); Humphreys, R.P. [Division of Neurosurgery, The Hospital for Sick Children and University of Toronto, Toronto (Canada)

    1998-05-01

    We review the presentation, imaging findings and outcome in 18 children with cerebellar arteriovenous malformations (AVM). This group is of particular interest because of the reported poor outcome despite modern imaging and neurosurgical techniques. All children had CT and 15 underwent catheter angiography at presentation. Several of the children in the latter part of the study had MRI. Of the 18 children, 17 presented with a ruptured AVM producing intracranial haemorrhage. The remaining child presented with temporal lobe epilepsy and was shown to have temporal, vermian and cerebellar hemisphere AVM. This child had other stigmata of Osler-Weber-Rendu syndrome. Three other children had pre-existing abnormalities of possible relevance. One had a vascular malformation of the cheek and mandible, one a documented chromosomal abnormality and another a midline cleft upper lip and palate. Six of the 17 children with a ruptured cerebellar AVM died within 7 days of the ictus. Vascular pathology other than an AVM was found in 10 of the 14 children with a ruptured cerebellar AVM who had angiography: 4 intranidal aneurysms, 5 venous aneurysms and 2 cases of venous outflow obstruction (one child having both an aneurysm and obstruction). The severity of clinical presentation was directly related to the size of the acute haematoma, which was a reasonable predictor of outcome. (orig.) With 4 figs., 4 tabs., 23 refs.

  2. Observation of the effect of urokinase thrombolysis combined the guide wire fragmentation and low molecular heparin anticoagulation for the treatment of arteriovenous fistula embolization%尿激酶溶栓联合导丝碎栓及低分子肝素抗凝治疗血液透析患者动静脉内瘘栓塞的疗效观察

    Institute of Scientific and Technical Information of China (English)

    张雷; 柯斯奇

    2015-01-01

    Objective To analyze the curative effect used the common urokinase thrombolysis combined with topo-guide-wire fragmentation and low molecular heparin in the treatment of hemodialysis patients with arteriove-nous fistula embolization and explore the prospects of its application.Methods 30 hemodialysis patients with arterio-venous fistula embolization were divided into 15 cases of thrombolysis group and 15 cases of thrombectomy group ac-cording to the voluntary.The thrombolysis group was given simple urokinase thrombolysis,and the thrombectomy group was given thrombectomy combined with anticoagulant therapy.The curative effect and the difference in complication were compared.Results In curative effect,the recanalization rate,using time after recanalization,and dosage of uro-kinase of the thrombectomy group were better than those of the thrombolysis group[13cases vs.7cases,(22.13 ± 17.51)months vs.(11.05 ±10.55)months,(40.48 ±22.26)ten thousands IU vs.(60.29 ±15.81)ten thousands IU,χ2 =5.40,t=2.10,all P0.05).For the thrombectomy group,there were fewer cases of re -embolization after recanalization (2 cases/13 cases vs.4 cases/7 cases,χ2 =3.85,P <0.05),but more cases of organ embolism(4 cases vs.0 cases,χ2 =4.62,P<0.05).Conclusion Compared with the traditional urokinase thrombolytic therapy,the guide wire fragmentation combined with low molecular weight hepa-rin anticoagulant therapy has a higher fistula recanalization rate and a lower re-embolization rate.It does not increase the incidence of bleeding complications.Besides,it can extend the use of internal fistula.However,it may cause the serious organ embolism,so it is necessary to strictly grasp the indications,applying only to the patients who are in the poor efficiency of thrombolytic and unable to have another operation.%目的:分析常规尿激酶溶栓联合局部导丝碎栓和低分子肝素抗凝治疗血液透析患者动静脉内瘘栓塞的疗效,探讨其应用前景。方法30例血液透

  3. 维持性血液透析患者动静脉内瘘狭窄、闭塞的手术和介入治疗%Clinical Observation of Surgery and Intervention Treatment in Maintenance Hemodialysis Patients with Arteriovenous Fistula Stenosis and Occlusion

    Institute of Scientific and Technical Information of China (English)

    李龙凯; 王可平; 赵光本; 杨宁

    2011-01-01

    目的 探讨维持性血液透析(maintenance hemodialysis,MHD)患者动静脉内瘘(autogenous arterio-venous fistulas,AVF)狭窄、闭塞手术和介入治疗的效果及可行性.方法 对自体AVF狭窄、闭塞的38例MHD患者行手术和介入治疗,多处狭窄者行端端、端侧吻合AVF重建再造术,一处狭窄者采用经皮穿刺腔内血管成形术(PTA),血管条件差、已多次手术者行人造血管移植.结果 本组32例行内瘘再造手术,成功率为100%,对患者心功能无影响;2例行PTA治疗,术后即出现明显的血管震颤,可闻及清晰的血管杂音,血流量明显增加,无血管破裂、肺栓塞等并发症;4例行人造血管移植,术后4周开始血液透析,血流量达到300 ml/min以上.结论 AVF重建再造术、PTA、人造血管移植均可有效改善MHD患者AVF狭窄、闭塞后血管通路问题,其中AVF重建再造术最为常用.%Objective To investigate the effect and feasibility of surgery and intervention treatment of arterivenous fistula (AVF) stenosis and occlusion in maintenance hemodialysis(MHD) patients.Methods 38 MHD patients with AVF stenosis and occlusion underwent surgery and intervention treatment.Patients with several stenosis underwent surgery of end to end or end to side anastomosis.Percutaneous transluminal angioplasty (PTA) was performed in patients with only one vessel stenosis.Artificial vessels transplantation were performed in patients with poor vessel condition after multiple AVF surgeries.Results 32 patients underwent AVF reconstruction surgery without effect on cardiac function after treatment,and the successful rate was 100%; 2 patients received PTA treatment, with obvious vascular tremor and murmur occurring after treatment, their blood flow improved significantly without complications of vessels rupture and pulmonary embolism.4 patients received artificial vessel transplantation, which provided enough blood flow of more than 300 mL/min in the 4th week after treatment

  4. Treatment of post-bioptic intrahepatic arteriovenous fistulas. Results in 5 HCC patients treated with intraarterial chemo embolization and percutaneous ethanol injection; Trattamento delle fistole artero venose intraepatiche post bioptiche. Risultati in 5 pazienti con epatocarcinoma candidati a chemioembolizzazione

    Energy Technology Data Exchange (ETDEWEB)

    Maspes, Federico; Gandini, Roberto; Pocek, Marco; Montanaro, Martina; Guazzaroni, Manlio; Simonetti, Giovanni [Rome, Univ. ``Tor Vergata`` (Italy). Istituto di Radiologia

    1997-04-01

    They report their experience in the treatment of post-bioptic intrahepatic arterioportal fistulas (HAPF) in 5 patients with hepatocellular carcinoma (HCC) treated February, 1993, to May, 1995. In this retrospective study, they reviewed the imaging findings and clinical records of 3 men and 2 women (age range: 49-71 years) with HCC previously diagnosed with US, CT and biopsy. HAPF was detected by angiography (DSA) performed before chemo embolization (TACE). All HAPFs were referrable to biopsy and were treated with platinum coils positioned through coaxial catheters. TACE was performed immediately after or within a week of HAPF embolization. Therapeutic response after TACE was assessed on the basis of clinical and CT findings, while HAPF embolization success was assessed on the basis of DSA and color Doppler US findings. Complete HAPF occlusion was demonstrated in 4 patients during color Doppler follow-up and immediately after and at 13 and 24 months (in 2 patients) at DSA. Two of 5 patients died, one because of liver failure after 15 months` follow-up and the other because of complications related to liver transplantation at 11 months` follow-up. Of the extant 3 patients, one underwent liver transplantation and was followed-up for 25 months, while the other two are alive after 24 and 13 months. Their experience demonstrates that HAPF embolization HCC patients is really useful for hemodynamic redistribution before TACE and to avoid further HAPF progression.

  5. New hybrid procedures in treating occluded arteriovenous hemodialysis grafts.

    Science.gov (United States)

    Bachleda, Petr; Janeckova, Jana; Xinopulos, Pavel; Smakal, Oldrich

    2016-03-01

    The use of arteriovenous graft is indicated in patients if the subcutaneous venous bed is exhausted or unsuitable for arteriovenous fistula creation. The leading cause of failure of a prosthetic arteriovenous hemodialysis-access graft is venous anastomotic stenosis causing thrombosis of the graft. A number of surgical techniques and endovascular tools have been used to treat this stenosis and thrombosis. None have yet proven to be ideal. This study was designed to evaluate the results of hybrid treatment of arteriovenous graft thrombosis associated with venous anastomotic stenosis. Over the period 2013-2014, we treated 16 AVG occlusions. Immediately after the diagnosis of occlusion was made, the patients underwent thrombectomy using a Fogarty catheter. After thrombectomy, a diagnostic fistulogram was performed and if VAG stenosis was confirmed, it was treated with balloon angioplasty and stent graft introduction. Lesions were dilated to reduce the stenosis in the treated area to less than 25%. Primary patency after 12 months was 32.8%. Primary assisted patency was 44.7%, secondary patency was 47.6%. Restenosis of the stent graft was seen in two patients. Recurring AVG occlusion was observed in four patients. The average number of interventions to maintain AVG patency was 1.18 per patient/1 year of dialysis. Treatment of AVG thrombosis due to VAG stenosis by hybrid procedure proved to be effective and improved secondary patency.

  6. [Coronary artery fistulas, a current problem: Clinical and therapeutic considerations].

    Science.gov (United States)

    Tiritilli, A; Iaria, P; Viard, P; Sayah, S; Benali, T; Detienne, J-P; Martis, S; Tchatchum, F; Aouate, P

    2016-02-01

    The coronary fistula is a link between one or more of the coronary arteries and cardiac cavity or great vessel. The exact occurrence is unknown. The majority of these fistulas are congenital in origin. However, they may occasionally be detected after cardiac surgery. For a long time, fistulas are asymptomatic, especially if they are small; the frequency of the symptoms and especially the complications rise with age. The potential complications are: cardiac failure, endocarditis, endarteritis, atrial fibrillation, ventricular arrhythmias, rupture, and thrombosis. The main differential diagnosis is patent arterial duct, while other congenital arteriovenous shunts need to be excluded. Even though echocardiography Doppler can help to differentiate shunts, the coronary angiography remains the main diagnostic tool for the description of the anatomy. For a long time, the surgery was the only therapeutic means, up till now, percutaneous occlusion is the first line therapy of coronary fistulas and that the different devices can be tailored to meet different anatomic and functional characteristics.

  7. Familial Brain Arteriovenous Malformations

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2007-11-01

    Full Text Available Researchers at University Medical Centre Utrecht, the Netherlands, reviewed the literature on patients with familial brain arteriovenous malformations (BAVMs, and their age, sex, and clinical presentation were compared with those in population-based patients with sporadic BAVMs.

  8. High Output Cardiac Failure Resolving after Repair of AV Fistula in a Six-Month-Old

    OpenAIRE

    Uygar Teomete; Rubee Anne Gugol; Holly Neville; Ozgur Dandin; Ming-Lon Young

    2016-01-01

    Background. Acquired AVF in pediatrics are commonly caused by iatrogenic means, including arterial or venous punctures. These fistulae can cause great hemodynamic stress on the heart as soon as they are created. Case. A six-month-old 25-week gestation infant was referred for respiratory distress. Initial exam revealed tachypnea, tachycardia, and hypertension. There was a bruit noted on her left arm. An ultrasound showed an arteriovenous fistula. Its location, however, precluded intervention b...

  9. Transcatheter occlusion of a large coronary artery fistula using a patent ductus arteriosus occluder.

    Science.gov (United States)

    Białkowski, Jacek; Szkutnik, Małgorzata; Fiszer, Roland; Zembala, Marian

    2011-01-01

    A large fistula from the left coronary artery to the right ventricle was successfully closed percutaneously in a 40 year-old patient using a patent ductus arteriosus occluder. The device was positioned and deployed via the venous system using a guidewire that had been advanced via the aorta, coronary artery and fistula to the venous circulation (arterio-venous loop creation). No complications were reported at follow-up.

  10. Anal Abscess/Fistula

    Science.gov (United States)

    ... to determine if antibiotics are indicated. TREATMENT OF ANAL FISTULA Currently, there is no medical treatment available for ... surgery is almost always necessary to cure an anal fistula. If the fistula is straightforward (involving minimal sphincter ...

  11. Coronary artery fistula

    Science.gov (United States)

    Congenital heart defect - coronary artery fistula; Birth defect heart - coronary artery fistula ... A coronary artery fistula is often congenital, meaning that it is present at birth. It generally occurs when one of the coronary arteries ...

  12. Efficacy of External Application of Hirudoid and Yunnanbaiyao on Controlling Arteriovenous Fistula in Hemodialysis Patients%喜疗妥加云南白药外敷防治血透患者内瘘并发症的疗效观察

    Institute of Scientific and Technical Information of China (English)

    丁英; 叶君; 韦珍妮; 邹子兴; 曾维富; 陈晖; 张宁; 陈再荣

    2014-01-01

    目的:观察喜疗妥联合云南白药外敷在血液透析患者内瘘并发症中的疗效。方法:将60例在笔者所在医院行血液透析患者按照随机数字表法分为观察组和对照组,每组30例。观察组应用喜疗妥加云南白药外敷,对照组则单纯使用热敷。结果:治疗4周后,观察组总有效率为97.67%,明显高于对照组的60.00%,两组比较差异有统计学意义(P<0.01)。观察组患者血管并发症的发生率为10.0%,明显低于对照组的33.3%,两组比较差异有统计学意义(P<0.01)。结论:喜疗妥软膏联合云南白药外敷对防治血透患者动静脉内瘘并发症具有明显的效果,可延长动静脉内瘘的使用寿命,值得临床推广应用。%Objective:To observe the effect of external application of Hiru patients.Method:Sixty hemodialysis patients were randomly assigned to the treatment group and the control group respectively,each group of 30 cases. Patients in the treatment group were treated with external application of Hirudoid and Yunnanbaiyao. Hot compress was utilized in the control group.Result:The total effective rate in the treatment group was 96.67%,which was statistically higher than that of 60.00%in the control group(P<0.01). The incidence of complications of vascular with patients of the treatment group with 10.0%were significantly lower than the control group with 33.3%(P<0.05).Conclusion:External application of Hirudoid and Yunnanbaiyao can extends the utility time of arteriovenous fistula,which is worthy of extensive application.

  13. Vesicocervical fistula following vesicovaginal fistula repair report

    Directory of Open Access Journals (Sweden)

    Hamudur Rahman

    2016-07-01

    Full Text Available Vesicocervical fistula following vesicovaginal fistula repair is a very rare condition. It is a complication following repeated lower uterine cesarean section. We report a case of an young married woman who was admitted in the depart­ment of urology, Banghabandhu Sheikh Mujib Medical University Hospital with vesico-cervical fistula following vesico­vaginal fistula repair. Reposition of cervix into vaginal vault and repair of urinary bladder was done. There was no such report of vesicocervical fistula following vesicovaginal fistula repair from Bangladesh.

  14. Outcomes and Complications After Endovascular Treatment of Brain Arteriovenous Malformations: A Prognostication Attempt Using Artificial Intelligence.

    Science.gov (United States)

    Asadi, Hamed; Kok, Hong Kuan; Looby, Seamus; Brennan, Paul; O'Hare, Alan; Thornton, John

    2016-12-01

    To identify factors influencing outcome in brain arteriovenous malformations (BAVM) treated with endovascular embolization. We also assessed the feasibility of using machine learning techniques to prognosticate and predict outcome and compared this to conventional statistical analyses. A retrospective study of patients undergoing endovascular treatment of BAVM during a 22-year period in a national neuroscience center was performed. Clinical presentation, imaging, procedural details, complications, and outcome were recorded. The data was analyzed with artificial intelligence techniques to identify predictors of outcome and assess accuracy in predicting clinical outcome at final follow-up. One-hundred ninety-nine patients underwent treatment for BAVM with a mean follow-up duration of 63 months. The commonest clinical presentation was intracranial hemorrhage (56%). During the follow-up period, there were 51 further hemorrhagic events, comprising spontaneous hemorrhage (n = 27) and procedural related hemorrhage (n = 24). All spontaneous events occurred in previously embolized BAVMs remote from the procedure. Complications included ischemic stroke in 10%, symptomatic hemorrhage in 9.8%, and mortality rate of 4.7%. Standard regression analysis model had an accuracy of 43% in predicting final outcome (mortality), with the type of treatment complication identified as the most important predictor. The machine learning model showed superior accuracy of 97.5% in predicting outcome and identified the presence or absence of nidal fistulae as the most important factor. BAVMs can be treated successfully by endovascular techniques or combined with surgery and radiosurgery with an acceptable risk profile. Machine learning techniques can predict final outcome with greater accuracy and may help individualize treatment based on key predicting factors. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. The Intervention Effect of Pain Education Combined with Progressive Relaxation Training on Puncture Ache of Arteriovenous Fistula in Hemodialysis Patients%疼痛教育联合渐进性放松训练对血透患者动静脉内瘘穿刺疼痛的干预效果

    Institute of Scientific and Technical Information of China (English)

    卓少贤; 谢芳; 汤小玲; 曾蕾; 吴凤金

    2016-01-01

    目的:探讨疼痛教育联合渐进性放松训练对维持性血液透析患者动静脉内瘘穿刺疼痛的干预效果,为实施疼痛管理提供帮助。方法将86例维持性血液透析患者随机分为观察组和对照组,每组43例。对照组患者在干预期间接受常规动静脉内瘘穿刺护理,观察组患者在穿刺常规护理的基础上进行疼痛教育及渐进性肌肉放松训练为主的护理干预,共干预8w。比较两组患者干预前后状态焦虑、特质焦虑、自我效能感、舒适度及内瘘穿刺疼痛评分,分析此干预方法对缓解动静脉内瘘穿刺疼痛的影响。结果观察组患者干预2、4及8w后的内瘘穿刺疼痛评分比对照组患者同时间点的疼痛评分明显降低( P﹤0.05, P﹤0.01);随着干预时间的延长,观察组患者的疼痛强度逐渐下降,以干预8 w后的疼痛程度下降最显著( P﹤0.001);干预8 w后,观察组患者的状态焦虑评分和特质焦虑评分比干预前及对照组干预后均显著降低(均P﹤0.01),观察组患者的自我效能感评分、心理舒适度、生理舒适度、环境舒适度及整体舒适度水平均比干预前及对照组干预后明显提高( P﹤0.01, P﹤0.05);社会舒适度未见明显改善( P﹥0.05)。结论疼痛教育联合渐进性放松训练有助于减轻动静脉内瘘患者穿刺疼痛引起的焦虑负性情绪、增强其自我效能感、提高舒适度,有效缓解动静脉内瘘穿刺疼痛。%Objective To observe the intervention effect of pain education and progressive relaxation training in hemodialysis pa-tients undergoing puncturing on arteriovenous fistula.Methods 86 hemodialysis patients were randomly divided into the experimental group and the control group, with 43 patients in each group.The control group received routine care, while those in the experimental group accepted pain education and progressive relaxation training intervention

  16. [Retrospective analysis of the treatment of recurrent congenital fistula or cyst in lateral cervical part].

    Science.gov (United States)

    Yuan, Yongyi; Zhang, Guozheng; Wang, Guojian; Huang, Deliang; Liu, Liangfa; Wu, Wenming; Wang, Jialing

    2011-12-01

    To analysis the therapeutic procedure on the recurrent congenital fistula or cyst in lateral cervical part. Thirty-nine cases with recurrent congenital fistula or cyst in lateral cervical part were enrolled in this study including 12 cases from the first branchial cleft, 6 from the second branchial cleft and 21 from the third branchial cleft. All the cases underwent fistula or cyst excision for 2 to 5 times in their whole therapeutic process, not counting the incision and drainage. During 9 months to 17 years follow-up, fistula or cyst in 6 cases relapsed,including 1 fistula from the first branchial cleft,3 fistulae from the second branchial cleft, 1 fistula and 1 cyst from the third branchial cleft, respectively. One case with recurrent fistula from the first branchial cleft was diagnosed temporal verrucous carcinoma six months after the third fistula excision operation and died one year after the forth operation probably due to the intracranial metastasis of temporal bone verrucous carcinoma. In two cases, the fistulae went through the thyroid gland to the piriform fossa and both the fistulae and part of the thyroid glands were resected. In the patients whose inner orificium fistulae were found and ligated effectively,no recurrence occurred during the followed-up period. The key point to cure the recurrent congenital fistula or cyst in lateral cervical part lies in proper occasion of operation, stain tracing in operation and reasonable program of operation.

  17. Catheter-based flow measurements in hemodialysis fistulas - Bench testing and clinical performance

    DEFF Research Database (Denmark)

    Heerwagen, Søren T; Lönn, Lars; Schroeder, Torben V

    2012-01-01

    for systematic bias. In the clinical study, two interventional radiologists conducted a total of 250 measurements in 14 patients with arteriovenous fistulas to determine clinical precision and enable testing for bias between measurers.Results: Accuracy was excellent for both catheters with a high level...

  18. Retarded hand growth due to a hemodialysis fistula in a young girl.

    NARCIS (Netherlands)

    Hoek, F. van; Scheltinga, M.R.M.; Krasznai, A.G.; Cornelissen, E.A.M.

    2009-01-01

    Long-term presence of an arteriovenous hemodialysis fistula (AVF) may lead to alterations in hand perfusion. In the case reported here, a 14-year-old girl developed pain associated with hand ischemia 5 years after a successful kidney transplantation. At age 8 years, she required a period of hemodial

  19. Pediatric intracranial aneurysms: new and enlarging aneurysms after index aneurysm treatment or observation.

    Science.gov (United States)

    Hetts, S W; English, J D; Dowd, C F; Higashida, R T; Scanlon, J T; Halbach, V V

    2011-12-01

    Children with brain aneurysms may be at higher risk than adults to develop new or enlarging aneurysms in a relatively short time. We sought to identify comorbidities and angiographic features in children that predict new aneurysm formation or enlargement of untreated aneurysms. Retrospective analysis of the University of California-San Francisco Pediatric Aneurysm Cohort data base including medical records and imaging studies was performed. Of 83 patients harboring 114 intracranial aneurysms not associated with brain arteriovenous malformations or intracranial arteriovenous fistulas, 9 (8.4%) developed new or enlarging brain aneurysms an average of 4.2 years after initial presentation. Comorbidities that may be related to aneurysm formation were significantly higher in patients who developed new aneurysms (89%) as opposed to patients who did not develop new or enlarging aneurysms (41%; RR, 9.5; 95% CI, 1.9%-48%; P = .0099). Patients with multiple aneurysms at initial presentation were more likely than patients with a single aneurysm at presentation to develop a new or enlarging aneurysm (RR, 6.2; 95% CI, 2.1%-185; P = .0058). Patients who initially presented with at least 1 fusiform aneurysm were more likely to develop a new or enlarging aneurysm than patients who did not present with a fusiform aneurysm (RR, 22; 95% CI, 3.6%-68%; P = .00050). Index aneurysm treatment with parent artery occlusion also was associated with higher risk of new aneurysm formation (RR, 4.2; 95% CI, 1.3%-13%; P = .024). New aneurysms did not necessarily arise near index aneurysms. The only fatality in the series was due to subarachnoid hemorrhage from a new posterior circulation aneurysm arising 20 months after index anterior circulation aneurysm treatment in an immunosuppressed patient. Patients who presented with a fusiform aneurysm had a significantly greater incidence of developing a new aneurysm or enlargement of an index aneurysm than did those who presented with a saccular aneurysm

  20. Is a Swine Model of Arteriovenous Malformation Suitable for Human Extracranial Arteriovenous Malformation? A Preliminary Study

    Energy Technology Data Exchange (ETDEWEB)

    Lv, Ming-ming, E-mail: lvmingming001@163.com [Ninth People' s Hospital, Shanghai Jiao Tong University School of Medicine, Department of Oral and Maxillofacial Surgery, Shanghai Key Laboratory of Stomatology (China); Fan, Xin-dong, E-mail: fanxindong@yahoo.com.cn [Ninth People' s Hospital, Shanghai Jiao Tong University School of Medicine, Department of Radiology (China); Su, Li-xin, E-mail: sulixin1975@126.com [Ninth People' s Hospital, Shanghai Jiao Tong University School of Medicine, Department of Oral and Maxillofacial Surgery, Shanghai Key Laboratory of Stomatology (China)

    2013-10-15

    Objective: A chronic arteriovenous malformation (AVM) model using the swine retia mirabilia (RMB) was developed and compared with the human extracranial AVM (EAVM) both in hemodynamics and pathology, to see if this brain AVM model can be used as an EAVM model. Methods: We created an arteriovenous fistula between the common carotid artery and the external jugular vein in eight animals by using end-to-end anastomosis. All animals were sacrificed 1 month after surgery, and the bilateral retia were obtained at autopsy and performed hematoxylin and eosin staining and immunohistochemistry. Pre- and postsurgical hemodynamic evaluations also were conducted. Then, the blood flow and histological changes of the animal model were compared with human EAVM. Results: The angiography after operation showed that the blood flow, like human EAVM, flowed from the feeding artery, via the nidus, drained to the draining vein. Microscopic examination showed dilated lumina and disrupted internal elastic lamina in both RMB of model and nidus of human EAVM, but the thickness of vessel wall had significant difference. Immunohistochemical reactivity for smooth muscle actin, angiopoietin 1, and angiopoietin 2 were similar in chronic model nidus microvessels and human EAVM, whereas vascular endothelial growth factor was significant difference between human EAVM and RMB of model. Conclusions: The AVM model described here is similar to human EAVM in hemodynamics and immunohistochemical features, but there are still some differences in anatomy and pathogenetic mechanism. Further study is needed to evaluate the applicability and efficacy of this model.

  1. MRI与DSA影像融合联合电生理监测对脑动静脉畸形伴癫痫手术的价值%Value of MRI and 3D-DSA images fusion combined with intraoperative neuro-electrophysiological technique to surgery for intracranial arteriovenous malformation associated with epilepsy

    Institute of Scientific and Technical Information of China (English)

    孙荣辉; 徐国政; 杜浩; 宋健; 黄河; 赵曰圆; 马廉亭

    2015-01-01

    目的:探讨MRI与3D-DSA三维影像融合联合电生理监测在脑动静脉畸形伴癫痫显微手术中的应用价值。方法将1例脑动静脉畸形合并癫痫患者的MRI与3D-DSA影像数据输入神经导航进行影像融合,对病灶进行精准定位,联合术中电生理监测,完成脑动静脉畸形及致痫灶显微切除术。结果本例通过MRI与3D-DSA影像融合,精确定位显示病灶范围,术中实时导航找到主要供血动脉及引流静脉,成功切断主要供血动脉,完整切除畸形血管团,同时结合术中神经电生理技术定位脑功能区及致痫灶,术后患者无神经功能缺损,复查DSA示畸形无残留,脑电监测颅内未见异常放电。结论MRI与3D-DSA影像融合结合术中电生理监测联合应用,可以既能完全切除脑动静脉畸形病灶,又能同时清除致痫灶,保护脑重要功能区,为重要功能区脑动静脉畸形继发癫痫的治疗提供了一种安全有效的新方法。%Objective To investigate the value of MRI and 3D-DSA images fusion combined with intraoperative neuro-electrophysiological technique to the surgery for intracranial arteriovenous malformation (AVM) associated with epilepsy. Methods MRI and 3D-DSA images fusion was performed in 1 patient with epilepsy induced by AVM, in whom, AVM and epileptogenic zone were resected by neuronavigator-assisted surgery under eletroophysiological monitoring. Results The lesion was exactly located by MRI and 3D-DSA images fusion. The main arteries supplying blood to AVM and veins dainaging from AVM were found by the real-time navigation and then were ligated and cut off. AVM was totally resected. The epileptogenic zone and the functional cortex were accurately located by intraoperative eletrophysiological technique. The epileptogenic zone were successfully resected without neurological functional deficits. Conclusions MRI and 3D- DSA images fusion technology, which can clearly show

  2. Intracranial haemorrhage

    African Journals Online (AJOL)

    His interests include vascular neurosurgery and spinal deformities. ... he returned to specialise in neurosurgery after time spent working abroad. ... at Groote Schuur Hospital, where his major interests are skull base surgery and ... intracranial bleed is hypertension – this is an ... cerebellar signs and symptoms or with raised.

  3. Hipoxemia por fístulas artério-venosas pulmonares em criança: relato de caso Hipoxemia por fístulas artério-venosas pulmonares en niño: relato de caso Hypoxemia by pulmonary arteriovenous fistulae in childhood: case report

    Directory of Open Access Journals (Sweden)

    Aleksandra Paula Lima

    2004-08-01

    ístulas pulmonares o en otros órganos podrán surgir, caracterizando la síndrome de Rendu-Osler-Weber.BACKGROUND AND OBJECTIVES: Pulmonary arteriovenous fistulae (PAVF should be investigated in patients with cyanosis of unknown cause. This is a case of cyanosis in a child submitted to pulmonary lobectomy with PAVF. CASE REPORT: Male patient, 3 years old, with history of cyanosis without dyspnea since 8 months of age. He presented significant cyanosis, finger clubbing and normal heart auscultation. Chest X-ray showed condensation in the upper half of the left lung. Normal echocardiography and ECG. PaO2 = 28 mmHg in room air and PaO2 = 31.5 mmHg with nasal O2 catheter. Pulmonary arteriovenous fistula was diagnosed through magnetic resonance imaging, with no possibility of embolization. Patient was submitted to upper left lobectomy under general anesthesia associated to spinal anesthesia with morphine and bupivacaine. Selective tracheal tube for the right lung was inserted for monopulmonary ventilation. SaO2 was 59% in room air; at operating room admission 69% (FiO2 = 1.0; after general anesthesia induction 65% (FiO2 = 1.0; during monopulmonary ventilation 58% (FiO2 = 1.0, after lobectomy 98% (FiO2 = 1.0 and 98% at the end of the surgery (FiO2 = 0.6. Extubation was performed one hour after surgery completion. As from the fifth postoperative day patient started presenting progressive SpO2 decrease down to 83% due to increase of another PAVF, which was embolized under general anesthesia. Patient was discharged on the 15th PO day. CONCLUSIONS: In this case, there was poor preoperative response to oxygen therapy, and patient has immediately improved after surgical treatment. However, after surgical resection of the largest PAVF, another fistula increased, thus leading to decrease in postoperative SpO2, reverted by embolization. As the child grows, other pulmonary fistula or fistulae in other organs may be diagnosed, indicating Rendu-Osler-Weber Syndrome.

  4. Arteriovenous malformation within an isocitrate dehydrogenase 1 mutated anaplastic oligodendroglioma

    Directory of Open Access Journals (Sweden)

    Grace Lai

    2015-01-01

    Full Text Available Background: The co-occurrence of intracranial arteriovenous malformations (AVMs and cerebral neoplasms is exceedingly rare but may harbor implications pertaining to the molecular medicine of brain cancer pathogenesis. Case Description: Here, we present a case of de novo AVM within an isocitrate dehydrogenase 1 mutated anaplastic oligodendroglioma (WHO Grade III and review the potential contribution of this mutation to aberrant angiogenesis as an interesting case study in molecular medicine. Conclusion: The co-occurrence of an IDH1 mutated neoplasm and AVM supports the hypothesis that IDH1 mutations may contribute to aberrant angiogenesis and vascular malformation.

  5. Successful Coil Embolization of Pediatric Carotid Cavernous Fistula Due to Ruptured Posttraumatic Giant Internal Carotid Artery Aneurysm.

    Science.gov (United States)

    Wajima, Daisuke; Nakagawa, Ichiro; Park, Hun Soo; Yokoyama, Shohei; Wada, Takeshi; Kichikawa, Kimihiko; Nakase, Hiroyuki

    2017-02-01

    The goal of the treatment of direct carotid cavernous fistula (CCF) is to occlude the arteriovenous shunt and to preserve the patency of the concerned internal carotid artery. However, for the ipsilateral posttraumatic fragile cerebrum, coil embolization plus parent artery occlusion for the high-flow direct CCF is better for the prevention of hyperperfusion syndrome and intracranial hemorrhage. We experienced such a case and managed it successfully. A 6-year-old boy had severe head trauma caused by being hit by a car. He was transferred to our department and diagnosed as having left acute subdural hematoma and acute brain swelling. Emergent evacuation of hematoma and external decompression were performed. He was treated for severe brain swelling in the intensive care unit for 2 months. Cranioplasty was performed 3 months after the injury. His right hemiparesis and aphasia persisted, so he was transferred to a rehabilitation hospital. However, 2 years after the head injury, he was referred to our department because of abducens nerve palsy. He was diagnosed as having a symptomatic posttraumatic direct CCF, which was caused by a ruptured left cavernous giant internal carotid artery aneurysm. The direct CCF was treated with coil embolization of the giant aneurysm and parent artery occlusion. Coil embolization of the aneurysm and parent artery occlusion for the posttraumatic direct CCF was a good option to manage the abducens nerve palsy and to prevent postoperative hyperperfusion. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Local Model of Arteriovenous Malformation of the Human Brain

    Science.gov (United States)

    Nadezhda Telegina, Ms; Aleksandr Chupakhin, Mr; Aleksandr Cherevko, Mr

    2013-02-01

    Vascular diseases of the human brain are one of the reasons of deaths and people's incapacitation not only in Russia, but also in the world. The danger of an arteriovenous malformation (AVM) is in premature rupture of pathological vessels of an AVM which may cause haemorrhage. Long-term prognosis without surgical treatment is unfavorable. The reduced impact method of AVM treatment is embolization of a malformation which often results in complete obliteration of an AVM. Pre-surgical mathematical modeling of an arteriovenous malformation can help surgeons with an optimal sequence of the operation. During investigations, the simple mathematical model of arteriovenous malformation is developed and calculated, and stationary and non-stationary processes of its embolization are considered. Various sequences of embolization of a malformation are also considered. Calculations were done with approximate steady flow on the basis of balanced equations derived from conservation laws. Depending on pressure difference, a fistula-type AVM should be embolized at first, and then small racemose AVMs are embolized. Obtained results are in good correspondence with neurosurgical AVM practice.

  7. Analysis of the influential factors related to dysfunction in arteriovenous fistula on main-tenance hemodialysis patients%维持性血液透析患者自体动静脉内瘘失功的影响因素

    Institute of Scientific and Technical Information of China (English)

    童昌军; 谈雅吟; 高峰; 张卫东

    2013-01-01

    Objective:To identify the potential influencing factors associ-ated with arteriovenous fistula ( AVF ) dysfunction in patients undergoing maintenance hemodialysis for early intervention of the failure .Methods:Included were 153 patients undergone maintenance hemodialysis ( MHD) by use of vascular access via initial creation of native upper arm AVF in our hospital between Jan.2005 and Jun.2012.Of the total subjects,76 were males and 77 females with an average age of 54 ±18 years.The baselines were measured and assessed with multivariate logistic regression analysis regarding the primary diseases, serum lipid levels, hemoglobin levels,blood platelet count,calcium-phosphorus product and weight gains at regular hemodialysis intervals.Results:Dysfunctional AVFs occurred in 37 patients,and the major influencing factors were associated with exces-sive weight gain between dialysis .Conclusion:The findings suggest that the risk factors for vascular access failure in dialysis are involved in exces-sive weight gain between dialysis,diabetes as primary condition,higher LDL level, abnormally elevated hemoglobin content and increased calci-um-phosphorus products,which indicates that attention should be paid to the occurrence of risk factors that require early intervention to prevent the dysfunction of AVF for patients in maintenance haemodialysis .%目的:旨在研究自体动静脉内瘘失功的影响因素,并进一步分析找出导致内瘘失功的主要影响因素,为临床医师早期有效的预防内瘘失功提供参考依据。方法:选择2005年1月~2012年6月在我院首次行自体动静脉内瘘术并长期在我院行维持性血液透析的153例次内瘘手术患者,男76例次,女77例次;患者平均年龄(54±18)岁。我们对患者原发病、血脂水平、血红蛋白水平、血小板计数、钙磷乘积以及间期体质量增长等六项指标进行量化后使用Logistic回归分析。结果:共37例次发生内瘘失功

  8. THE CARE OF NURSES IN MAINTENANCE OF ARTERIOVENOUS FISTULA (FAV

    Directory of Open Access Journals (Sweden)

    Noêmia Teixeira Rodrigues Aguiar

    2011-10-01

    Full Text Available Objetivo: Discutir a importância da atuação do enfermeiro na orientação aos cuidados com esta fístula. Métodos: foi realizada uma pesquisa bibliográfica, exploratória, descritiva e qualitativa realizada na Biblioteca Virtual de Saúde (LILACS e BDENF. Após a coleta de dados foi realizada uma leitura exploratória, seletiva, crítica e análise temática. Resultados: a seguinte categoria emergiu: A importância do enfermeiro nos cuidados com a fístula arteriovenosa. Conclusão: concluímos que se faz necessário o acompanhamento do enfermeiro que atua na área de terapia renal ao paciente renal crônico que faz uso da fístula arteriovenosa, visando propiciar a redução do sofrimento do paciente durante as sessões de hemodiálise e reduzir as taxas de abandono do tratamento por complicações ou perda da FAV, pois a fístula arteriovenosa é a linha de vida do renal crônico, logo se ela funciona bem tudo fluirá de acordo.

  9. Renal arteriovenous fistula simulating hydronephrosis: A case report.

    Science.gov (United States)

    Lusenti, T; Fiorini, F; Barozzi, L

    2011-12-01

    Sommario INTRODUZIONE: Tra le fistole arterovenose (FAV) acquisite vi sono quelle che si formano quale complicanza dell’esecuzione di una biopsia renale. CASO CLINICO: Gli autori riportano il caso di una paziente giunta in ambulatorio di ecografia nefrologica per l’esecuzione di un’ecografia dei reni e delle vie urinarie per un’ipertensione sistolica di I grado di recente insorgenza. Negli esami di laboratorio era presente microematuria con proteinuria clinico-ecografico. DISCUSSIONE: Tra le malformazioni vascolari renali di non rara osservazione sono le FAV. Il caso descritto ribadisce l’importanza dell’impiego dell’eco color Doppler (ECD) nel sospetto di uropatia ostruttiva, per diagnosticare una FAV, specialmente nei pazienti già sottoposti a biopsia renale.

  10. [Endovascular treatment of spinal dorsal intradural arteriovenous fistulas].

    Science.gov (United States)

    Santos-Franco, Jorge Arturo; Collado-Arce, María Griselda Lizbeth; Dávila-Romero, Julio César; Saavedra-Andrade, Rafael; Sandoval-Balanzario, Miguel Antonio

    2015-01-01

    Introducción: las fístulas arteriovenosas intradurales dorsales espinales (FAVIDE) son lesiones poco frecuentes y complejas que son subdiagnósticadas y condicionan discapacidad. El objetivo es presentar nuestra experiencia en el manejo endovascular. Métodos: estudio ambispectivo de pacientes con FAVIDE, tratados mediante terapia endovascular (TEV) con n-butil-cianoacrilato en el periodo de 2007 a 2013. Resultados: se incluyeron 15 pacientes con edad media de 37 años. En 12 casos la presentación fue progresiva e insidiosa en un lapso de entre 6 meses y un año, mientras que 3 presentaron hemorragia. La lesión tuvo localización torácica en 73 % de los casos, lumbar en 20 % y cervical en 7 %. Previo al tratamiento observamos discapacidad de grados 5 y 4 en 73 %, y 67 % tenían alteraciones de la micción de grado 3. Como complicaciones, solo una paciente tuvo deterioro del estado de alerta transitorio 6 horas después del procedimiento. Se encontró una mejoría hacia los grados 1 y 2 de discapacidad, a las 48 horas, 3 y 6 meses, de 53 %, 73 % y 87 %, respectivamente. Conclusiones: con la TEV se tiene un tiempo quirúrgico corto, el volumen de hemorragia es bajo y la estancia hospitalaria es corta, respecto de otras técnicas quirúrgicas. La TEV es un procedimiento seguro y con efectividad significativa en el tratamiento de FAVIDE. Esta es la primera serie de casos tratados con TEV en México.

  11. Contribuição para o diagnóstico e o tratamento das fístulas arteriovenosas pulmonares após a operação de Glenn bidirecional Contribution to the diagnosis and treatment of pulmonary arteriovenous fistulae after a bidirectional Glenn operation

    Directory of Open Access Journals (Sweden)

    Maria Virgínia Tavares Santana

    2004-12-01

    Full Text Available OBJETIVO: Determinar a incidência de fístulas arteriovenosas pulmonares (FAVPs pós-operação de Glenn bidirecional; as possíveis variáveis independentes que poderiam influenciar no seu aparecimento; comprovar o uso do ecocardiograma contrastado com microbolhas na sua detecção; e testar a sensibilidade e especificidade da angiografia pulmonar. MÉTODOS: Operados 59 pacientes, entre março 1990 e dezembro 1995, com idades entre 2 e 132 meses (média 32,7±33,6. Todos submetidos a exames clínico, laboratorial, ecocardiograma contrastado com microbolhas e cateterismo cardíaco. RESULTADOS: Nos 54 pacientes sobreviventes as FAVPs ocorreram em 20 (37,0%. A idade desses pacientes variou de 2 a 132 meses (média 29,6± 29,7. A atresia tricúspide em 10 (50,0% e o coração univentricular em 8 (40,0%, foram as cardiopatias prevalentes. Em 13 (65% a operação de Glenn bidirecional foi realizada à direita, em 2 (10,%, à esquerda e em 5 (25% foi bicaval. O tempo de seguimento dos pacientes FAVPs, variou de 4 a 84 meses (média 32,4±21,65, e nos sem fístulas de 1 a 77 meses (média de 23,4±18,8, com valor de p=0,04, com significância estatística. O diagnóstico de FAVPs foi feito pelo ecocardiograma contrastado com microbolhas nos 20 casos, sendo considerado positivo, ao se detectar retorno de microbolhas pelas veias pulmonares. A angiografia pulmonar mostrou alterações compatíveis com FAVPs em 16, demonstrando sensibilidade de 80%. CONCLUSÃO: A incidência de FAVPs pós-operação de Glenn bidirecional foi alta (37%, e o intervalo de tempo decorrido após a operação de Glenn bidirecional, foi a única variável independente que se correlacionou de forma significativa com o aparecimento das FAVPs (p=0,04; o ecocardiograma com microbolhas foi o método padrão de diagnóstico; a angiografia pulmonar se revelou um método com sensibilidade de 80,0%.OBJECTIVE: To determine the incide