Autogenous arteriovenous elbow fistula for haemodialysis and upper extremity ischemia.

BACKGROUND: The autogenous brachiocephalic or brachiobasilic arteriovenous elbow fistula is not considered to be only the secondary haemodialysis access. In patients with an unsuitable forearm vessel bundle, it is indicated as primary access and it is the method preferred to the fistula creation using a vascular prosthesis. Its rather rare complication is the development of upper extremity ischemia. AIM: To summarise current knowledge of this fistula type and its associated complications METHODS: Review of the literature. RESULTS: The creation and maturation of the fistula and occurrence of the steal syndrome is influenced by a number of factors. The analysis and awareness of such factors will provide for creation of a suitable fistula as well as for timely complication diagnostics and treatment. CONCLUSIONS: The autogenous elbow fistula utilising the brachial artery and the cephalic or basilic vein in the upper extremity represents a high-quality haemodialysis access. Its potential complication is the occurrence of the steal syndrome. Its occurrence and manifestations do not constitute indications for ligation of the access. The gathered information shows that a suitable surgical procedure can help meet the basic rule for haemodialysis access--resolving the ischemia and maintaining the access.

Peripheral venous hypertension after the creation of arteriovenous fistula for haemodialysis.

The function of an arteriovenous (av) fistula for haemodialysis may be complicated by manifestation of peripheral venous hypertension, which results from the arterial blood flow through the venous system into the periphery of the upper extremity. Its development is most typically caused by a proximal forearm av-fistula, as, in addition to the desirable arterialisation of the subcutaneous venous system of the arm, arterialisation of the venous system of the forearm and the hand may occur and possibly promote the development of venous hypertension, which may in the extreme result in gangrene of the fingers. Awareness of these problems as well as of the necessity of their surgical solution is essential for doctors dealing with haemodialysis.

Endovascular treatment of abdominal aortic aneurysms--6 years of experience with Ella stent-graft system.

PURPOSE: Evaluation of 6-year results of abdominal aortic aneurysm (AAA) treatment by Ella stent-grafts with regard to safety and effectivity in relation to morphology of the aneurysm. METHODS: From a group of 172 patients with AAA, in whom elective endovascular treatment was considered, 120 of them (69.8%) were found to be suitable for this type of therapy. The bifurcated type of stent-graft was implanted in 97 patients, uniiliacal type in 19 patients and only four patients were found to be suitable for tubular type of stent-graft. Additional necessary procedures (internal iliac artery occlusion or contralateral common iliac artery occlusion in a group of patients with uniiliacal type of stent-graft) were performed surgically during the stent-graft implantation. CT and US controls were performed at 3, 6 and 12 months after implantation, later every 12 months. RESULTS: Primary technical success was achieved in 109 of the 120 patients (91%). Primary endoleak was recorded in 11 patients (primary endoleak type Ia in seven patients, type Ib in three patients and type IIIa in one patient). Assisted technical success after reintervention or spontaneous seal was 98.3%. Surgical conversion was indicated in two patients (1.7%). Perioperative mortality rate was 3.3%. Total average follow-up period was 20.7 months (range from 2 to 60 months). In nine patients (7.5%) secondary endoleak type II was found at control CT or US, in three patients partial thrombosis of the stent-graft was found. There was no aneurysm rupture during follow-up. CONCLUSION: Treatment of AAA with Ella stent-graft system is effective and safe. Bifurcated stent-graft is the most frequently used type. Uniiliacal type of stent-graft is used by us only in cases of complicated morphology.

Endovascular treatment of central venous stenoses in patients with dialysis shunts.

OBJECTIVE: Evaluation of long-term results of percutaneous treatment of central vein stenoses or occlusions in patients with haemodialysis shunt. MATERIALS AND METHODS: In 26 patients with haemodialysis shunts and confirmed central vein stenosis or occlusion, 28 primary percutaneous transluminal angioplasties (PTA) and 5 repeated PTAs (re-PTA) were performed; in three patients a stent was implanted - primary in one patient and due to early restenosis after PTA in two patients. To maintain stent patency, 10 re-PTA were performed. RESULTS: The technical success rate of primary interventions was 96 % (100 % in stenoses and 50 % in occlusions). Primary post-PTA patency rate was 70 % at 3 months, 60 % at 6 months and 30 % at 12 months. CONCLUSION: PTA with possible stent implantation is a first-choice method in the treatment of stenoses and occlusions of the central venous system. Despite the relatively frequent re-interventions, endovascular treatment is capable to preserve long-term function of the dialysis shunt.

Effect of various protective solutions on function after kidney transplantation.

UNLABELLED: From 1995 to 2002 we monitored a group of 127 patients who had undergone kidney transplantations in the Olomouc transplantation centre. The aim of our study was to assess the function of the kidneys after the transplantation, which were rinsed during the removal from cadaverous donors and afterwards were treated by different preservative dilutions. We divided the patients into three groups of approximate similar size, according to the used dilution - EC (Eurocollins), HTK (Custodiol) and UW (Viaspan). In the first three weeks we assessed in each group, the immediate function of the kidneys as primary, belated and afunction. The EC group showed the primary function in 51.2 % of cases, belated in 46.8 % of cases and afunction in 2.1 % of cases. In the HTK group, primary function was found in 73.7 %, belated 23.6 % and afunction 2.7 %. The results of the UW group came to primary function 71.5 %, belated 26.2 % and afunction 2.3 %. The criteria of the immediate but also the long-term function (five year investigation) was a serum creatinine figure. The lowest decline of creatinine in three weeks after the transplantation was noticed in the EC group (the average figure = 429 micro mol/l). In contrast the HTK group (the average figure 279 micro mol/l) and the UW group (the average figure 288 micro mol/l) had comparable figures and there was no significant difference between them from the statistical point of view. It means later in the first, the third and the fifth year after the transplantation the figures levelled out: EC 154 micro m/l, HTK 182 micro m/l, and UW 133 micro m/l. There was statistically a minimum significant difference between the HTK group and the UW group. Another criteria was to determine the amount of functional grafts in alive donees. The Assessment was carried out always in each year after the transplantation, altogether five years. The amount of the functional renal grafts in EC and HTK group was 100 %, in the UW group 76.9 %. CONCLUSION: HTK and UW gave better immediate functionality results, but there were no differences found among EC, HTK and the UW group from the long-term point of view.

Venous hypertension following average arterious-venous fistula for haemodialysis.

The authors emphasize the need for the investigation of the central venous system prior to the insertion of an avfistula, this they consider to be of utmost importance in patients with anamnesis of central vessel access. After the av-fistula is inserted, an unrecognized obstacle (stenosis or thrombosis) may result in the occurrence of venous hypertension and hypofunction, this may lead to av-fistula malfunction.