Aperçu de l'accès pour l'hémodialyse et de son évaluation.

OBJECTIF: Présenter aux médecins de famille un aperçu fondé sur des données probantes des diverses méthodes d'accès vasculaire pour l'hémodialyse (HD), et fournir des paramètres pour l'évaluation clinique de l'accès vasculaire pour l'HD. SOURCES DE L'INFORMATION: Une recherche documentaire dans MEDLINE a été effectuée au moyen des termes MeSH en anglais arteriovenous fistula, arteriovenous graft, central venous catheter et hemodialysis (ou haemodialysis), et tous les articles pertinents publiés en anglais entre janvier 1995 et septembre 2021. MESSAGE PRINCIPAL: Les principaux types d'accès vasculaire permanent pour l'HD sont les fistules artérioveineuses, les greffes artérioveineuses et les cathéters veineux centraux. Il faut suivre une approche pratique et centrée sur le patient dans le choix du type d'accès pour chaque personne. Les complications courantes de la création d'un accès vasculaire comprennent la thrombose, la sténose veineuse centrale, le syndrome vasculaire de vol d'accès en dialyse et les anévrismes des fistules artérioveineuses. CONCLUSION: Les médecins de famille jouent un rôle important dans l'évaluation clinique et la surveillance de l'accès vasculaire pour l'HD. Une évaluation clinique rigoureuse peut détecter une fistule artérioveineuse déficiente et ses complications connexes, et peut permettre une investigation et une intervention rapides pour restaurer le fonctionnement, maintenir la longévité de l'accès et améliorer la qualité de vie du patient.

Overview of hemodialysis access and assessment.

OBJECTIVE: To provide family physicians with an evidence-based overview on the various methods of vascular access for hemodialysis (HD) and to provide a framework for the clinical assessment of HD access. SOURCES OF INFORMATION: A MEDLINE literature search was conducted using the MeSH terms arteriovenous fistula, arteriovenous graft, central venous catheter, and hemodialysis (or haemodialysis), including all relevant English-language articles published between January 1995 and September 2021. MAIN MESSAGE: The main types of permanent vascular access for HD are arteriovenous fistulas, arteriovenous grafts, and central venous catheters. A pragmatic, patient-centred approach is required when choosing the type of access for an individual. Common complications of vascular access creation include thrombosis, central venous stenosis, dialysis access steal syndrome, and arteriovenous fistula aneurysms. CONCLUSION: Family physicians play an important role in the clinical assessment and monitoring of HD vascular access. A thorough clinical assessment can detect a failing arteriovenous fistula and any associated complications, which can allow for prompt investigation and intervention to restore functionality, maintain access longevity, and improve patient quality of life.

Syphilitic Popliteal Pseudoaneurysm Complicated by Acute Lower-Limb Ischemia.

Case presentation: We present a case of a patient with a syphilitic popliteal pseudoaneurysm who developed acute lower-limb ischemia secondary to thromboembolism related to the pseudoaneurysm. The diagnosis of a syphilitic popliteal aneurysm was made due to positive syphilitic serological testing and with exclusion of all other potential causes. The pseudoaneurysm was surgically repaired using a great saphenous vein patch angioplasty, which was done without delay to prevent further thromboembolic complications. This was then followed by a course of intravenous benzyl penicillin. Discussion: Peripheral arterial involvement of tertiary syphilis remains exceedingly rare, with the vast majority of reported cases of vascular syphilis relating to aortic involvement. Given the paucity of literature on this condition, there is no good evidence to guide current management. Conclusion: With the globally increasing rates of syphilis, more cases of peripheral arterial involvement may become apparent, as was the case in the early 20th century.

Carotid artery stenosis: An approach to its diagnosis and management.

BACKGROUND: Carotid artery stenosis (CAS) is one of the major causes of acute ischaemic stroke, accounting for approximately 20% of cases. It is not always symptomatic; however, when it is, the neurological vascular territory it commonly affects is the anterior circulation of the brain, causing symptoms such as hemiplegia, dysphasia or vision loss. OBJECTIVE: The aim of this article is to review the current literature on CAS, summarise the main updates and evidence base for surgical management, and discuss when vascular surgical input may be beneficial. DISCUSSION: CAS can be classified as symptomatic or asymptomatic disease. Carotid endarterectomy remains important in the treatment of symptomatic disease because of a strong evidence base for its benefit in the overall reduction of recurrent stroke risk. The benefit of surgery is less clear for asymptomatic disease. Commencement of best medical therapy as well as cardiovascular risk factor modification is a mainstay of treatment for both groups of patients.

An approach to olfactory impairments in the general practice setting.

BACKGROUND: Olfactory impairment is a common condition, particularly in the geriatric population, which can be underrecognised as a result of clinician and patient unfamiliarity. OBJECTIVE: The aim of this article is to bring awareness to olfactory impairment, describe the common aetiologies and provide a framework for its diagnosis and management in the general practice setting, including advice about when to refer. DISCUSSION: A thorough history and examination can often elucidate the common causes, which include rhinosinusitis, upper respiratory tract viral illnesses and head trauma. Rhinosinusitis is the most readily managed aetiology in the general practice setting, with other causes often requiring multidisciplinary input. Chronic olfactory impairment is often irreversible and can be a debilitating condition, causing disability in day-to-day living and impairing quality of life.

Management of primary mycotic aneurysms and prosthetic graft infections: an 8-year experience with in-situ cryopreserved allograft reconstruction.

BACKGROUND: Primary mycotic aneurysms and prosthetic graft infections are traditionally managed by resection of infected vascular tissue and revascularisation with an extra-anatomical bypass. Long-term patency for this method has been reported to be poor with associated high reinfection and limb amputation rates. The aim of this study was to analyse the outcomes of those patients in our department between 2010 and 2018 whom had revascularisation with in-situ arterial reconstruction using cryopreserved allograft as a conduit. METHODS: The data were retrospectively reviewed and 13 patients were identified. There were five patients with primary mycotic aneurysms and eight patients with prosthetic graft infections, three of which were complicated by aortoenteric fistulae (AEF). RESULTS: There were three peri-operative mortalities (23%) with all three mortalities related to graft re-infection and post-implantation haemorrhage; two of these from uncontrolled bile leaks related to the original AEF with persistent graft contamination. The 10 surviving patients were followed up for a mean duration of 15.8 months with an overall primary graft patency of 89% and no incidence of graft re-infection or aneurysmal degeneration. CONCLUSION: Patients that survived the peri-operative period demonstrated acceptable medium-term allograft durability, with the most favourable outcomes observed in those patients who had arterial infections uncomplicated by AEF. The main barrier to more wide-spread use in our state remains inadequate supply of banked cryopreserved tissue.