RESUMO
BACKGROUND: Reliable vascular access is a fundamental tool for providing effective hemodialysis. Vascular access dysfunction is associated with increased morbidity and mortality among hemodialysis patients. Current vascular access guidelines strongly recommend creating an arteriovenous fistula (AVF) as the first option; however, a substantial proportion of new AVFs may not be usable. OBJECTIVES: To assess possible predictors of primary and secondary failure of vascular access. METHODS: This retrospective cohort study included all vascular access sites created at Meir Medical Center from 2006 through 2012. Vascular access site, primary and secondary failure rates, and relevant demographic and clinical data were recorded during 60 months of follow-up. RESULTS: A total of 612 vascular accesses were created and followed for a median of 32 ± 29.4 months. Of these, 490 (80%) were suitable for initiating hemodialysis. Vascular access site was the most important predictor of primary failure but did not predict secondary failure. Co-morbidities such as diabetes mellitus and congestive heart failure, as well as the use of antiplatelet agents did not predict primary or secondary failure. Preoperative vascular mapping using Doppler ultrasonography was performed in 36.4% of cases and was not associated with lower rates of primary or secondary failure. CONCLUSIONS: Vascular access site is an important predictor of primary failure. We did not find a benefit of pre-operative vessel mapping or chronic antiplatelet therapy in terms of decreasing primary and secondary failure rates. Physicians should carefully consider the characteristics of the patient and blood vessels before creating vascular access in patients requiring chronic hemodialysis.
Assuntos
Derivação Arteriovenosa Cirúrgica , Falência Renal Crônica , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Humanos , Falência Renal Crônica/etiologia , Falência Renal Crônica/terapia , Diálise Renal/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento , Grau de Desobstrução VascularRESUMO
A mobile thrombus of the thoracic aorta is a rare entity, which might have serious clinical manifestations, including arterial emboli. Due to its low incidence, there is no consensus regarding the most adequate management of mobile thoracic aorta thrombus. The current case describes a patient with Polycythemia Vera and myeloproliferative neoplasm, who presented with mobile thrombus of the thoracic aorta, manifested by blue toe syndrome and asymptomatic splenic infarct. She was treated conservatively with anti-coagulation and Iloprost alongside the patient's permanent treatment of Aspirin, Hydrea and Atorvastatin. Under this treatment, the thrombus resolved completely, and the blue toes improved, except for one.
Assuntos
Embolia , Trombose , Feminino , Humanos , Aorta Torácica/diagnóstico por imagem , Resultado do Tratamento , Trombose/diagnóstico por imagem , Trombose/tratamento farmacológico , Trombose/etiologia , Embolia/etiologia , AspirinaRESUMO
Mycotic aortic aneurysm is a rare vascular condition, with high-risk for fatal complications. In cases of bacterial infection, prolonged antibiotic therapy is administered. There is no consensus on duration of antibiotic therapy and close follow-up is recommended following surgical and endovascular interventions. We report a case of a patient, who was diagnosed with mycotic aneurysm and underwent successful endovascular repair. Extended postoperative antibiotic treatment was administered. The duration was determined by sequential Fluorine-18 fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) scans over a period of 6 months.
RESUMO
OBJECTIVE: Spontaneous multiple artery dissection is a relatively rare phenomenon. Early clinical signs are often nonspecific, making it difficult to diagnose. CASE REPORT: This is a case of a 51-year-old female who presented with spontaneous dissection of 4 visceral arteries, both iliac arteries, and of the right internal carotid artery. The patient underwent urgent successful endovascular repair. Later complications included acute respiratory distress syndrome and pneumonia after massive blood transfusion. She recovered gradually and was discharged after 21 days. Due to this rare presentation, genetic investigation was performed in search of a connective tissue disorder. Results revealed a new COL3A1 subtype mutation. The pathogenicity of this variant remains unclear. CONCLUSION: We recommend a high index of suspicion for visceral artery dissection in the differential diagnosis for abdominal pain with concurrent uncontrolled hypertension. Early diagnosis and intervention are crucial to reducing the mortality rate.
Assuntos
Dissecção Aórtica , Artéria Carótida Interna , Aneurisma Ilíaco , Vísceras/irrigação sanguínea , Dissecção Aórtica/diagnóstico por imagem , Dissecção Aórtica/genética , Dissecção Aórtica/cirurgia , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/cirurgia , Colágeno Tipo III/genética , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares , Feminino , Predisposição Genética para Doença , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Aneurisma Ilíaco/genética , Aneurisma Ilíaco/cirurgia , Pessoa de Meia-Idade , Mutação , Fenótipo , Fatores de Risco , Resultado do TratamentoRESUMO
The dilemma of how to treat penetrating wound injuries to the neck, which involve a combination of a common carotid artery rupture and a cervical spinal fracture, is presented in this case report.
Assuntos
Lesões das Artérias Carótidas/terapia , Artéria Carótida Primitiva , Vértebras Cervicais/lesões , Fraturas Expostas/etiologia , Stents , Ferimentos por Arma de Fogo/complicações , Adolescente , Angiografia , Lesões das Artérias Carótidas/diagnóstico por imagem , Lesões das Artérias Carótidas/etiologia , Artéria Carótida Primitiva/diagnóstico por imagem , Vértebras Cervicais/diagnóstico por imagem , Desenho de Equipamento , Fraturas Expostas/terapia , Humanos , Masculino , Dispositivos de Fixação Ortopédica , Tomografia Computadorizada por Raios XAssuntos
Aneurisma Infectado/diagnóstico , Aneurisma da Aorta Abdominal/diagnóstico , Duodenopatias/diagnóstico , Fístula Intestinal/diagnóstico , Infecções por Salmonella/diagnóstico , Fístula Vascular/diagnóstico , Aneurisma Infectado/tratamento farmacológico , Aneurisma Infectado/cirurgia , Antibacterianos/uso terapêutico , Aneurisma da Aorta Abdominal/cirurgia , Ruptura Aórtica/cirurgia , Diagnóstico Diferencial , Duodenopatias/cirurgia , Humanos , Fístula Intestinal/cirurgia , Masculino , Pessoa de Meia-Idade , Recidiva , Infecções por Salmonella/tratamento farmacológico , Infecções por Salmonella/cirurgia , Fatores de Tempo , Resultado do Tratamento , Fístula Vascular/cirurgiaAssuntos
Síndrome Nefrótica/etiologia , Trombose/etiologia , Adulto , Angiografia , Angioplastia com Balão/métodos , Artéria Braquial , Glomerulonefrite Membranosa/complicações , Humanos , Masculino , Ativadores de Plasminogênio/uso terapêutico , Stents , Artéria Subclávia , Trombectomia/métodos , Terapia Trombolítica/métodos , Trombofilia/etiologia , Trombose/diagnóstico por imagem , Trombose/tratamento farmacológico , Trombose/cirurgia , Resultado do Tratamento , Ativador de Plasminogênio Tipo Uroquinase/uso terapêuticoAssuntos
Doenças da Aorta/etiologia , Implante de Prótese Vascular/efeitos adversos , Duodenopatias/etiologia , Fístula Intestinal/etiologia , Fístula Vascular/etiologia , Adulto , Aorta Abdominal/cirurgia , Doenças da Aorta/diagnóstico , Doenças da Aorta/cirurgia , Arteriopatias Oclusivas/cirurgia , Candidíase/etiologia , Duodenopatias/diagnóstico , Duodenopatias/cirurgia , Endoscopia Gastrointestinal , Artéria Femoral/cirurgia , Seguimentos , Humanos , Artéria Ilíaca/cirurgia , Fístula Intestinal/diagnóstico , Fístula Intestinal/cirurgia , Masculino , Politetrafluoretileno , Infecções Relacionadas à Prótese/etiologia , Fatores de Tempo , Fístula Vascular/diagnóstico , Fístula Vascular/cirurgiaRESUMO
Complete dislocation of the knee is a rare injury, and is frequently associated with injuries to other structures in the popliteal fossa. Prompt recognition of associated popliteal artery disruption and early revascularization is paramount for successful and functional results. The necessity for emergency vascular reconstruction markedly complicates an already difficult orthopaedic problem. Arteriography is recommended in all cases of complete dislocation of the knee.
Assuntos
Luxação do Joelho/complicações , Perna (Membro)/irrigação sanguínea , Artéria Poplítea/lesões , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hematoma/etiologia , Hematoma/cirurgia , Humanos , Luxação do Joelho/diagnóstico , Masculino , Pessoa de Meia-Idade , Artéria Poplítea/diagnóstico por imagem , Pulso Arterial , Radiografia , Ruptura , Veia Safena/transplante , Trombose/etiologia , Trombose/cirurgiaRESUMO
Carotid artery rupture in the setting of advanced carcinoma of the head and neck constitutes a surgical emergency. This report details three such patients, two of whom presented with profuse bleeding, the other with imminent rupture. Notably, our first patient ruptured 27 years after having had radiotherapy for carcinoma of the larynx. This patient had had no previous surgery and at operation no recurrent tumor was evident. In the other two patients, previous surgery had demonstrated tumor invasion of the carotid artery. The choice of therapy in this calamitous condition is controversial, the question being whether to resect and reconstruct or ligate the ruptured artery. Our three patients underwent ligation with no recurrence of bleeding and no neurological sequelae for a follow-up period of 5-36 months. Of paramount importance is the hemodynamic stabilization of the patient prior to being submitted to surgery. Our results favor ligation rather than resection and reconstruction as the procedure of choice in this difficult predicament.