Hemodialysis Patients with High-Flow Arteriovenous Fistulas: An Evaluation of the Impact on Cardiac Function.

Purpose: : Patients undergoing hemodialysis often experience changes in cardiac function when they have a high-flow arteriovenous fistula (AVF). This study aimed to assess the effect of high-flow AVFs on cardiac function in patients undergoing hemodialysis. Materials and Methods: : A longitudinal study was conducted on hemodialysis patients with high-flow AVFs. Echocardiographic parameters, such as left ventricular ejection fraction (LVEF), left atrial diameter (LAD), left ventricular end-diastolic dimension (LVEDD), right ventricular end-diastolic dimension (RVEDD), inferior vena cava diameter (IVCD), systolic blood pressure, and diastolic blood pressure, were measured and compared before and after AVF creation. Results: : One hundred hemodialysis patients with high-flow AVFs (mean age: 55.95±13.39 years, mean body mass index: 24.71±3.43 kg/m²) were studied. LVEF significantly decreased (51.10%±5.39% to 47.50%±5.79%), while LAD, LVEDD, and IVCD significantly increased after AVF creation (P<0.05). Systolic (132.49±16.42 mmHg to 146.60±17.43 mmHg) and diastolic (79.98±8.40 mmHg to 83.33±9.68 mmHg) blood pressure substantially rose post-fistularization (P<0.001). Notably, LVEF reduction was more significant in brachio-cephalic AVFs (46.29%±4.24%) compared to distal radio-cephalic or snuffbox AVFs (49.17%±7.15%) (P=0.014). Conclusion: : High-flow AVFs can significantly affect echocardiographic parameters in hemodialysis patients, thereby increasing the risk of cardiac failure. Close cardiac monitoring may be necessary for early intervention. Distal AVFs may be preferable in patients with decreased cardiac function.

Autologous Blood-Clot Embolisation of Iatrogenic Femoral Artery Pseudoaneurysm Caused by Arterial Sheath Placement; A Case Report.

Iatrogenic Femoral Artery Pseudoaneurysm (FAP) is a common complication that occurs in diagnostic and therapeutic catheterization procedures and can cause morbidity and even mortality in patients. Aneurysm larger than 2 cm, symptomatic or complicated should be treated. Here we report a 59-year-old man with post-catheterization FAP following femoral artery angiography, treated successfully by direct transcatheter autologous blood clot embolisation. To the best of our knowledge, our case report is the first to demonstrate that FAP can be successfully treated endovascularly by autologous blood clot embolisation.

A rare case of papillary cystadenoma of epididymis presented with painless scrotal mass.

BACKGROUND: It is a rare cardiac malignant primary tumor that seems to derive from the same cellular line as myxomas, but the prognosis is very different. It is a rare cardiac malignant primary tumor that seems to derive from the same cellular line as myxomas, but the prognosis is very different. It is a rare cardiac malignant primary tumor that seems to derive from the same cellular line as myxomas, but the prognosis is very different. Cardiac myxosarcoma is a rare neoplasm that appears to rise from the same cellular source like myxoma. It is difficult to differentiate a myxoma tumor from a myxosarcoma tumor because of its appearance and pathology examination. Myxosercoma tumor requires surgery and chemoradiotherapy, but myxoma is treated only by surgery. CASE PRESENTATION: We describe a case of a 58-year-old patient with a left atrium myxosarcoma, presenting with congestive heart failure. Transthoracic echocardiogram (TTE) showed a large polypoid and mobile mass in the left atrium, the patient underwent cardiac surgery and the tumor was successfully extracted, and histopathological result revealed typical features of myxoma. 15 days after surgery, he underwent explorative laparatomy because of progressive GI bleeding. Laparatomy revealed extensive metastatic masses in abdomen and the pathology diagnoses was myxosaroma. Unfortunately, in spite of supportive care, the patient expired on postoperative day one. CONCLUSION: It is difficult to differentiate a myxoma tumor from a myxosarcoma tumor because of its appearance and pathology examination. Maybe magnetic resonance imaging can help us to achieve more data suggesting malignancy.

Extensive Acute Lower Extremity Arterial Thrombosis: A Major Thrombus Formation Caused by COVID-19.

Acute thromboembolic events have been frequently reported in patients with coronavirus disease 2019 (COVID-19) due to an increase in the coagulation system activity and endothelial dysfunction. This report describes a patient with COVID-19 who initially reported respiratory symptoms and developed acute lower limb ischemia secondary to extensive macrovascular arterial thrombosis, which was treated with thrombectomy. The development of such extensive arterial thrombosis with anticoagulants at therapeutic doses is a new sign of increased viral pathogenicity, and it is necessary to develop and apply updated prophylaxis protocols for thrombosis in these patients.

Intermittent right upper extremity ischemia in a patient with simultaneous aberrant right subclavian artery and patent foramen ovale: A case report.

BACKGROUND: Upper extremity intermittent ischemia due to non-aneurysmal, not occluded aberrant right subclavian artery (ARSA) is rare. CASE PRESENTATION: We describe a 30-year-old male who suffered from PFO and non-aneurysmal, not occluded ARSA, and presented by intermittent right upper extremity ischemia. He was treated by right carotid subclavian transposition for ARSA and antiplatelet medication for PFO. CONCLUSION: Authors assume that intermittent limb ischemia can occur secondary to anatomical changes in a patient without aneurysmal degeneration or occluded ARSA and the existence of pure PFO without any evidence of venous thrombosis is not enough to prove the paradoxical emboli scenario.

Brachial Vein Transposition with Consecutive Skin Incisions in a Hemodialysis Patient with Absence of Adequate Superficial Veins: A Case Report.

The creation of an arteriovenous fistula instead of a synthetic vascular graft is a smart decision in hemodialysis patients who do not have a suitable superficial vein. Basilic vein transposition (BVT) is a viable option in most cases, except in patients who do not have a proper basilic vein. In patients with inadequate superficial veins, another source of the autogenous vein is the brachial vein, a deep vein of the upper arm. Most surgeons choose a full medial arm incision to perform brachial vein exploration. We describe a patient in whom BVT was not possible and so brachial vein transposition using skip incisions was performed, with good results.

Concurrent bilateral testicular tumors with different histopathology: A case report.

BACKGROUND: Bilateral synchronous testis germ cell tumors with different histopathology are not common. CASE PRESENTATION: Here, a case of 27-year-old male who is reported presented with bilateral testicular swellings. There was a high α-fetoprotein level with bilateral lesions on scrotal Ultrasonography. Bilateral orchiectomy was performed. According to pathology report, there was a right testicular seminoma and left testicular mixed germ cell tumor composed of seminoma, yolk sac tumor and embryonal carcinoma. CONCLUSION: He received one cycle of chemotherapy with BEP regimens.