Trans-radial percutaneous intervention for thrombosed hemodialysis access: A single-center experience.

BACKGROUND: Traditionally, percutaneous transluminal angioplasty (PTA) is a first-line approach for stenosed dialysis accesses and has been performed through the non-thrombosed vein segment. For thrombosed accesses, thrombectomy (whether open or percutaneous) is a standard approach. The primary objective of our study is to determine the clinical and technical outcomes of the trans-radial approach of PTA among thrombosed dialysis accesses, in terms of safety and feasibility, technical and clinical aspects and factors influencing them, as well as assisted primary patency, secondary patency at 6 and 12 months. METHODS: This is a single-center retrospective study that included 150 patients over 3 years. About 123 patients underwent successful percutaneous balloon angioplasty through the radial access. RESULTS: We report an overall technical and clinical success rate of 82%, assisted primary patency rate of about 90.25% at 3 months, 82.93% at 6 months, 73.18% at 1 year, and secondary patency rate of 94% at 1 year. Twenty-seven patients were referred for surgical revisions/creation of a new fistula for reasons like inability to pass wire (6 patients), unfavorable anatomical variations like aneurysms at the proximal segments (5 patients), inability to cross the fistula (5 patients), and persistent fistula dysfunction with no flow after initial balloon dilatation (11 patients). Three patients had hematoma at the radial access site (2.5%) while two patients had the AV fistula segment rupture and were successfully treated conservatively. CONCLUSION: We conclude that PTA through the trans-radial approach to completely thrombosed hemodialysis accesses is a good alternative to transvenous access and has a very good assisted primary patency and secondary patency at 1 year without major complications.

A study of narrow QRS tachycardia with emphasis on the clinical features, ECG, electrophysiology/radiofrequency ablation.

Aim: Atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reentrant tachycardia (AVRT) are the most common forms of paroxysmal regular supraventricular tachycardias. Materials & methods: The clinical, ECG and electrophysiological findings of 121 patients with narrow QRS tachycardia were evaluated prospectively. Results: A total of 75 (62%) of the patients had AVNRT while 46 (38%) had AVRT. Pounding sensation in the neck (40 vs 15.2%; p = 0.004), presynope (26.7 vs 56.5%; p = 0.001) identifiable P wave after QRS complex (25.3 vs 73.9%; p = 0.001), pseudo r'/s waves (45.3 vs 4.3%; p = 0.001), limb leads ST-T changes (34.7 vs 60.9%; p = 0.004) were the significant changes observed. A total of 94.7% of AVNRT and 87% of AVRT could be diagnosed correctly considering both clinical and ECG criteria. Conclusion: Pounding sensation in the neck and presyncope along with ECG features like identifiable P wave after QRS complex, pseudo r'/s waves and limb lead ST-T changes very accurately differentiate AVNRT and AVRT.

Prinzmetals Angina Masquerading as Acute Pericarditis.

Coronary artery spasm is an intense vasoconstriction of the coronary arteries and may be responsible for the myocardial ischemia, myocardial infarction as well as sudden deaths. Coronary angiography is generally needed to identify the cause. Coronary artery spasm is a multifactorial disease with underlying mechanism still poorly understood. Here, we present case of a 48-year-old male with no significant past history who presented with acute episodic onset chest pain. Clinical, Electrocardiography (ECG) and echocardiographic findings suggested pericarditis but a diagnostic coronary angiography revealed significant coronary vasospasm. Patient's symptoms significantly improved with calcium channel blockers and Nitroglycerine (NTG).

All That Glitters is Not Gold: All Unilateral Oedema is Not DVT.

Innominate vein stenosis or thrombotic occlusion can occur in dialysis patients. Central vein stenosis is a common problem in patients on dialysis. Placement of a central vein catheter for dialysis access increases the risk of central vein stenosis. Central vein stenosis sometimes can jeopardize the arteriovenous fistula and arteriovenous graft in the ipsilateral extremity unless recognized early and treated. We describe three patients with left innominate vein stenosis who were known case of chronic kidney disease on haemodialysis and had a left brachio-cephalic fistula and presented with unilateral facial and upper limb oedema.

A Novel Approach for the Retrieval of Broken Catheter Fragment - Using Balloon Dilatation Technique.

In this era of an ever increasing number of interventions in cardiology, there is a parallel increase in the number of complications associated with these interventions, such as broken catheter tip and guide wire embolisation. The most commonly used and effective method for the percutaneous retrieval of such broken fragments is a goose neck snare. However in cases where this technique has been a failure, newer and novel innovations have been implemented for the retrieval of such broken fragments. We present a case of seven-year-old female child with a 3mm peri-membranous ventricular septal defect who was taken up for device closure. During the procedure the internal mammary catheter was broken in the left ventricle and subsequently the broken fragment was embolised to the left common carotid artery. The broken fragment was snared down upto the common iliac but could not be retrieved out of the sheath. A novel approach was used, consisting of negotiating a coronary guide wire across the broken catheter and inflating a balloon in the catheter fragment which helped to achieve a co-axial alignment with the arterial sheath and hence by which it was possible to retrieve the broken catheter fragment out of the circulatory system.