RESUMO
Aim The objective of this study is to evaluate the feasibility of using iliac branch endoprosthesis (IBE) devices and to examine their short-term outcomes. Materials and methods This was a descriptive, retrospective observational study involving 15 patients diagnosed with either aortoiliac or isolated iliac artery aneurysms and treated with an IBE device. Data were collected for patients who received IBE devices at Glan Clwyd Hospital in Rhyl, United Kingdom, from February 2020 to May 2023. Results Most patients presented with asymptomatic aneurysms; 86.7% (n = 13) had bilateral common iliac artery (CIA) aneurysms. The mean diameter of the CIA was 38.7 ± 8.8 mm, and the mean diameter of the abdominal aortic aneurysm (AAA) was 39.8 ± 23 mm. For the indications of IBE use, 60% (n = 9) of the patients had iliac aneurysms reaching the intervention threshold, 20% (n = 3) had AAA reaching the threshold, and 20% (n = 3) had aortoiliac aneurysms reaching the threshold. The majority of patients underwent bilateral femoral access (86.7%; n = 13), while 13.3% (n = 2) required both femoral and brachial access. Technical success was achieved in all cases. Aside from 20% (n = 3) of cases where the sac size remained static, the majority of patients (80%; n = 12) experienced sac regression. All patients were free from buttock claudication. A type II endoleak was observed in 33.3% (n = 5) of patients. No reinterventions were reported. The mean primary patency was 30.9 ± 0.7 months, and the follow-up period ranged from 12 to 36 months. Conclusions IBEs are an effective medical device, demonstrating a high rate of technical success, minimal need for additional procedures, and a low incidence of complications while maintaining a satisfactory rate of primary patency.
RESUMO
Background Ultrasound (US) monitoring of arteriovenous fistulas (AVFs) presents contradictory findings. These differences may be attributed to variances in the chosen surveillance strategy, the specific type of fistula being monitored, and the precise technique used for ultrasound scanning. In this study, we are trying to assess the benefits and cost-effectiveness of US scanning of AVF. Patients and methods This was a descriptive, retrospective, and observational study. The study sample consisted of patients diagnosed with end-stage renal disease (ESRD) on hemodialysis who had AVF for dialysis either by native vein or using prosthetic grafts. We excluded all the patients whose fistula failed to mature, failed to attend the surveillance scan at six weeks, or had absent records or incomplete data. We retrieved the data of the patients who underwent AVF creation at Glan Clwyd Hospital between April 2020 and April 2023. The data was analysed using statistical software (SPSS) version 21 (IBM Corp., Armonk, NY, USA). Results Ninety-eight patients were studied. Stenosis 43.9% (n = 43) was the predominant complication, followed by thrombosis (15.3%; n = 15) while the remaining complications (bleeding, pseudoaneurysm) were less prominent. On the other hand, a total of 37.8% (n = 37) did not experience any complications. Primary patency ranged from 2 to 87 months with a mean of 9 ± 13.2 months SD, and secondary patency ranged from 1 to 24 months with a mean of 1.3 ± 3.9 months SD. The mean cost of a surveillance scan for AVF is 2520 USD, and the mean cost of intervention is 1332 + 1258 USD SD. Out of all the patients, 52 (53%) underwent intervention to salvage the AVF, 2 (2%) received open surgical intervention, and 50 (51%) underwent endovascular intervention. Considering the AVF failure to work, 29.6% (n = 29) had fistulas that failed to work, and 70.4% (n = 69) were still working. Conclusion Routine duplex scanning in six-month periods to diagnose failing AV fistulas is not cost-effective when compared to diagnosing failing or failed AV fistulas based on clinical symptoms.