Upper Arm Basilic Vein Transposition for Hemodialysis: A Single Center Study for 300 Cases

PURPOSE: The population of end-stage renal failure patients dependent on hemodialysis continues to expand with an increasing number of patients having an unsuitable cephalic vein or failed radio- and brachio-cephalic fistula. In these patients, the transposed basilic vein to brachial artery arteriovenous fistula (BaVT) provides autologous choice for hemodialysis. The results of basilic vein transposition arteriovenous fistula were assessed. MATERIALS AND METHODS: Three hundred cases of BaVT performed at a single center during the period of January 2005 to December 2011 were reviewed retrospectively. Data including demographics and postoperative complications were collected. Primary and secondary patency rates were determined by using Kaplan-Meier methods. RESULTS: The median age of patients was 57.4±13.1 years, and 154 patients were male. Renal failure was associated with hypertension in 88.7%, and with diabetes in 34.0%. The mean follow-up was 27.4±20.0 (12 to 72) months. There was no operation-related death. Eighteen patients required prosthetic graft interposition because of short vein. Thirty-five postoperative complications developed in 41 patients (148 cases), including thrombosis, stenosis, hematoma, seroma, arm swelling, steal syndrome, infection and aneurysm formation. Primary patency of BaVT was 69%, 60%, 53%, 52%, 44%, and 22% at 1, 2, 3, 4, 5, and 6 years, respectively. Secondary patency was 99%, 97%, 97%, 97%, 95%, and 95%, respectively. CONCLUSION: Chronic renal failure patients with hemodialysis may benefit from BaVT, because of high patency, less radiologic procedure, and less infection rate. The BaVT fistula should be used in preference to polytetrafluoroethylene grafts for secondary access.

Comparison of Post-surgical Patency Rates between Failing and Failed Arterio-venous Graft for Hemodialysis with Venous Anastomosis Stenosis

PURPOSE: The most frequent complication in vascular access for hemodialysis is the stenosis of venous anastomosis site and resultant thrombosis. And it has been suggested that the correction of stenosis before thrombosis can prolong graft survival. We compared the outcomes of surgical repair between stenosed group and thrombosed group. METHODS: From March 2003 to July 2007, 155 cases of stenosed graft-venous anastomosis (GVA) of arteriovenous graft (AVG) underwent salvage operation; 53 elective revisions for stenosis (group A), and 102 emergency open thrombectomies with jump grafts (group B). Outcomes were compared by post-intervention primary patency (PIPP) and post-intervention secondary patency (PISP). RESULTS: The mean follow-up duration was 24.8+/-15.2 months. Surgical success rate was 100% for elective revision group and 98% for emergency operation group. Elective revision of symptomatic GVA stenosis improved PIPP compared to emergency operation of thrombosed graft (mean 13.0 vs. 8.6 months, P=0.018). But PISP was not extended (mean 24.2 vs. 23.2 months, P=0.359). The electively revised GVA stenosed graft had fewer subsequent thrombotic events (0.3 vs 0.7 thrombosis/patient year, P=0.027) and fewer interventions (0.6 vs. 1.2 interventions/patient year, P=0.06). The proportion of other stenoses for group A and group B was 35.8% and 38.2%, respectively. CONCLUSION: The frequency of subsequent thrombotic events and total number of postoperative interventions decreased significantly after elective revision. Elective revision of GVA stenosis in PTFE graft prolongs PIPP, and should be considered before the occurrence of thrombosis.

A Case of Colon Cancer Associated with Colonic Tuberculosis

Inflammatory bowel disease, such as ulcerative colitis and Crohn's disease, has a potential risk of developing into colorectal cancer. However, there is little relationship between intestinal tuberculosis and colon cancer because intestinal tuberculosis is a curable disease and has a relatively short disease course. Nevertheless, there have been a few case reports of intestinal tuberculosis associated with colon cancer. There was a case report in which the carcinoma facilitated entry of tubercle bacilli with development of a secondary infection, and ulcerative lesions of tuberculosis may be precursors of carcinomas. We experienced a 77-year-old woman who had intestinal tuberculosis combined with ascending colon cancer. She visited our hospital because of abdominal pain and constipation. Colonoscopy showed a luminal obstruction mass in the ascending colon. Histologic examination revealed an adenocarcinoma. After surgery, the surgical specimen disclosed an adenocarcinoma in the cecum and ascending colon and intestinal tuberculosis around the cancer site of the cecum. Herein, we report a rare case of colon cancer co-existing with colonic tuberculosis with a review of the literature.

A Comparative Study of Operated and Non-operated Groups in Patients with Hepatic Metastasis from Colorectal Cancer

PURPOSE: The prognosis for patients with liver metastases (LM) from colorectal cancer is significantly influenced by the clinician's decision. Recently, there have been remarkable advances in treatment of LM, so there can be some changes in therapeutic modalities. We performed a comparative study between operated and non-operated groups of patients with LM to analyze the clinical outcome. METHODS: From Feb. 2001 to Feb. 2006, 27 patients with LM underwent a hepatectomy, and 113 patients received non-surgical therapy. thirteen hepatectomized cases among the 27 patients had multiple LM. The outcomes of those 13 patients (Group A) were retrospectively compared to those of the non-operated group (Group B, n=21), which had had potentially resectable LM at the initial diagnosis or after chemotherapy, but didn't undergo hepatic resection. RESULTS: After a median follow-up duration of 31.3 months, the estimated 3-years overall survival (OS) rates were 76.9% and 14.3% in group A and B, respectively (P=0.0001). In the stepwise Cox multivariate regression analysis, factors such as the absence of hepatic resection and a greater diameter of the liver mass independently influenced the poor survival (P=0.005 and P=0.012 respectively). Additionally, two radiologists evaluated the intraoperative ultrasonographic (IOUS) results. IOUS detected new metastatic lesions in 4/13 (30%) patients. There were sub-centimeter metastatic lesions (5~7 mm) and had not been detected in SPIO-enhanced MRI. CONCLUSIONS: Our results compared to palliative chemotherapy suggest that aggressive surgical resection should be performed to increase the survival rate in patients with LM. Additionally, the treatment plan for LM patients should be discussed with the gastroenterololgist, the radiologist, the oncologist, and the surgeon.