ABSTRACT
Introduction: Our study aimed to evaluate the role of endovascular intervention in salvaging hemodialysis access in patients of end-stage renal disease with specific attention to features that may predict a poor outcome. We also evaluated the role of ultrasonography (USG) in the management of these patients. Methods: Forty-two patients with dysfunctional hemodialysis arteriovenous fistulas (AVF) were taken up for percutaneous transluminal angioplasty (PTA) with or without stent placement. All patients underwent a pre- and postprocedural USG Doppler to assess parameters such as mean flow, mean peak systolic velocity, and vessel diameter. Technical and clinical success rates were calculated, and characteristics causing increased failure rates (long-segment and multisite stenosis and diabetes) were noted. Results: The most common sites of stenosis were the anastomotic and perianastomotic sites (n = 27, 63%) on the venous side followed by distal venous drainage site (23%) and central venous stenosis (14%). The technical and clinical success rates were 98% and 92%, respectively. Three- and 6-month patency rates were 83% and 71%, respectively. Common characteristics in patients with failure (primary or secondary) were diabetes, increased age, increased length of stenosis (>2cm) and multisite stenosis. USG Doppler parameters showed a significant improvement post-PTA (P < 0.001) indicating clinical success. No major complication was noted in our study. Conclusion: PTA is successful for dysfunctional hemodialysis access. Careful selection of patients can improve the success rates and decrease economic burden in a resource-constrained country like ours. USG Doppler is essential in the assessment of iatrogenic hemodialysis AVFs.
ABSTRACT
OBJECTIVE: To compare the results and complications of treatment by double percutaneous aspiration injection (DPAI) in cystic echinococcosis (CE) of the liver with those of surgery. To the best of our knowledge, such a study has not been carried out till date. METHODS: From November 2012 to November 2015, 43 patients were randomly allocated to DPAI group (n = 22) and surgery group (n = 21). After the intervention, patients were evaluated monthly for 3 months, then at the sixth month and 6 monthly thereafter. RESULTS: Average hospital stay was 2.38 days in DPAI group and 8.23 days in the surgery group. Response to DPAI was categorized as successful in 95.3% (n = 20) patients and incomplete in 4.7% (n = 1) patients. Response to surgery was characterized as successful in 85.7% (n = 18) patients and incomplete in 4.7% (n = 1) patients, and recurrence was seen in 9.5% (n = 2) patients. Using a 10% margin for non-inferiority, treatment response in the DPAI group was non-inferior to that of the surgery group. In the DPAI group, 19 patients had no complications, minor complications were seen in 4.7% (n = 1) patients and a major complication was seen in 4.7% (n = 1) patients. In the surgery group, no complications were seen in 13 patients, major complications were seen in 28.57% (n = 6) patients and minor complications were seen in 9.5% (n = 2) patients. CONCLUSION: Over a follow-up period of 3 years, DPAI is non-inferior to surgery in the treatment of CE of the liver, while there is a statistically significant difference in the hospital stay and occurrence of complications. Advances in knowledge: DPAI offers advantages such as a short hospital stay, minimal invasiveness and morbidity, while being non-inferior to surgery. Total Immunoglobulin G antibody titres have limited utility in follow-up of patients treated.