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1.
Nephrol Nurs J ; 48(2): 169-176, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33886247

RESUMO

Although buttonhole cannulation has some benefits compared to rope-ladder cannulation, the increase of infection rates represents a major obstacle to patient safety, and its use is questionable in routine clinic practice. On the other hand, rope-ladder cannulation is difficult to implement even with a prescribed protocol, leading the cannulator in daily practice to a possible use of the area technique. This article provides a reflection on the impact of cannulation technique on the safety of patients on regular hemodialysis treatment and describes a new approach for arteriovenous fistula cannulation, the Multiple Single Cannulation Technique (MuST). The MuST has not been described before, but it has been used with promising results. Further studies are needed to confirm the benefits of this cannulation technique.


Assuntos
Fístula Arteriovenosa , Derivação Arteriovenosa Cirúrgica , Instituições de Assistência Ambulatorial , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Cateterismo/efeitos adversos , Humanos , Diálise Renal/efeitos adversos
2.
BMC Surg ; 21(1): 169, 2021 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-33781241

RESUMO

BACKGROUND: With the continuous improvement of surgical instruments in vitrectomy, the use of a trocar and cannula not only optimizes the incision process but also facilitates insertion and withdrawal of instruments during the procedure. Nevertheless, incision-related complications have also been reported in the literature. However, cannula fractures during 25G+ minimally invasive vitrectomy have rarely been reported. CASE PRESENTATION: A 62-year-old man underwent 25G+ pars plana vitrectomy for proliferative diabetic retinopathy. At the beginning of the operation, we used a trocar with a cannula to perform the sclerotomy. After the trocar was pulled out, the cannula was not seen on the surface of the sclera. Thus the inside and outside of the eye were carefully searched. The broken cannula tip was found in the ciliary body corresponding to the superonasal sclerotomy site and was subsequently removed. CONCLUSIONS: Awareness regarding the risk of intraoperative fractures of 25G+ minimally invasive ocular surgical instruments is imperative. Whenever a broken or missing cannula is encountered, the residual part should be immediately extracted to avoid revision surgeries and postoperative complications.


Assuntos
Cânula/efeitos adversos , Cateterismo/instrumentação , Falha de Equipamento , Complicações Intraoperatórias/etiologia , Esclerostomia , Vitrectomia , Cateterismo/efeitos adversos , Corpos Estranhos , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Esclera
3.
Br J Radiol ; 94(1120): 20200879, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33529044

RESUMO

Hemorrhagic complications are uncommon after percutaneous transhepatic biliary drainage. The presenting features include bleeding through or around the drainage catheter, hematemesis or melena. Diagnosis requires cholangiography, CT angiography or conventional angiography. Minor venous hemorrhage is managed by catheter repositioning, clamping or upgrading to a larger bore catheter. Major vascular injuries require percutaneous or endovascular procedures like embolization or stenting. A complete knowledge of these complications will direct the interventional radiologist to take adequate precautions to reduce their incidence and necessary steps in their management. This review presents and discusses various hemorrhagic complications occurring after percutaneous transhepatic biliary drainage along with their treatment options and suggests a detailed algorithm.


Assuntos
Cateterismo/efeitos adversos , Colestase/terapia , Drenagem/efeitos adversos , Hemorragia/diagnóstico por imagem , Hemorragia/terapia , Radiologia Intervencionista/educação , Angiografia , Ductos Biliares/diagnóstico por imagem , Cateterismo/métodos , Colangiografia , Angiografia por Tomografia Computadorizada , Drenagem/instrumentação , Drenagem/métodos , Fluoroscopia , Hemorragia/etiologia , Humanos , Internato e Residência , Punções , Radiologia Intervencionista/métodos , Ultrassonografia
5.
J Surg Res ; 257: 260-266, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32862054

RESUMO

BACKGROUND: Indications for extracorporeal life support (ECLS) have evolved and expanded, yet its use in trisomy 13 (T13) and trisomy 18 (T18) patients remains controversial. We reviewed the experience of the Extracorporeal Life Support Organization with ECLS in these patients to inform practice at our institution. METHODS: The Extracorporeal Life Support Organization registry was queried for all patients younger than 18 y with an International Classification of Diseases, Ninth Edition/Tenth Edition code for T13 or T18 from 2000 to 2018. Basic demographics, ECLS details, and clinical outcomes were recorded. Descriptive statistics were performed. RESULTS: Twenty-eight patients were identified (15 with T13; 13 with T18), representing 0.06% (28 of 46,901) of pediatric ECLS cannulations. The median weight was 3.5 kg (range, 1.4-13), and age at cannulation was 52 d (range, 0 d-6.8 y). Time on ECLS ranged from 13 to 478 h (median, 114). Cardiac defects were diagnosed in 19 (68%) patients, of which 13 (46%) underwent surgical repair. Median oxygenation index pre-ECLS was 45. Venoarterial cannulations accounted for 82% of patients, whereas 14% underwent venovenous cannulation. Overall survival to hospital discharge was 46% with 86% of patients experiencing one or more complications. There were no survivors when cannulation continued past 12 d. CONCLUSIONS: Although complications are frequent, the mortality rate in patients with T13 and T18 remains within the reported range for the general pediatric population. T13 and T18 alone should not be viewed as absolute contraindications to ECLS within the pediatric population but rather considered during the evaluation of a patient's potential candidacy.


Assuntos
Oxigenação por Membrana Extracorpórea/efeitos adversos , Cuidados para Prolongar a Vida/estatística & dados numéricos , Síndrome da Trissomia do Cromossomo 13/terapia , Síndrome da Trissomía do Cromossomo 18/terapia , Gasometria/estatística & dados numéricos , Cateterismo/efeitos adversos , Cateterismo/estatística & dados numéricos , Criança , Pré-Escolar , Oxigenação por Membrana Extracorpórea/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Cuidados para Prolongar a Vida/métodos , Masculino , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento , Síndrome da Trissomia do Cromossomo 13/sangue , Síndrome da Trissomia do Cromossomo 13/mortalidade , Síndrome da Trissomía do Cromossomo 18/sangue , Síndrome da Trissomía do Cromossomo 18/mortalidade
6.
J Vasc Interv Radiol ; 31(11): 1795-1800, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32962854

RESUMO

This brief report presents 8 patients with silicone-covered metallic stent placement for ureteral strictures refractory to double-J stent placement, following kidney transplantation. Stent removal was successfully performed in 7 patients via antegrade (n = 4) or retrograde (n = 3) access 6 weeks to 6 months after stenting for elective removal (6-month interval, n = 3), urothelial hyperplasia (n = 2), or stent migration (n = 2), and their mean primary ureteral patency after stent removal was 15.4 months (range, 2-27 months). Hematuria (n = 2) and pain (n = 3) occurred, but resolved within 1 week. One stent was removed during reconstructive surgery. During follow-up of mean 22.6 months after stent removal, ureteral strictures recurred in 2 patients.


Assuntos
Cateterismo/instrumentação , Remoção de Dispositivo , Transplante de Rim/efeitos adversos , Stents Metálicos Autoexpansíveis , Silicones , Obstrução Ureteral/terapia , Adulto , Idoso , Cateterismo/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nefrostomia Percutânea , Desenho de Prótese , Recidiva , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Obstrução Ureteral/diagnóstico por imagem , Obstrução Ureteral/etiologia
7.
Nephrol Nurs J ; 47(4): 343-346, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32830940

RESUMO

Peritoneal dialysis transfer sets (extension lines) are replaced every six to nine months to minimize peritoneal dialysis catheter complications. The aim of this study was to compare a revised non-bag transfer set exchange procedure with the standard bag exchange procedure on nursing time, costs, and safety. Thirty-three people were randomized to two groups - a standard bag exchange procedure group (n = 16) and a non-bag transfer set exchange procedure group (n = 17). The standard bag exchange procedure took a median of 32 minutes (interquartile range [IQR] 25 to 38 minutes) compared to the non-bag transfer set exchange procedure of 6 minutes (IQR 4 to 8 minutes) (p Ò 0.0001). There was one episode of peritonitis in each group within the 72-hour follow-up period. The average cost of the non-bag transfer set exchange procedure was $24.54 lower, a 37% cost reduction. This study has shown the revised non-bag transfer set replacement procedure appears to be safe, consume less participant and staff time, and decreases costs.


Assuntos
Diálise Peritoneal/métodos , Diálise Peritoneal/enfermagem , Cateterismo/efeitos adversos , Custos e Análise de Custo , Humanos , Pesquisa em Avaliação de Enfermagem , Diálise Peritoneal/efeitos adversos , Diálise Peritoneal/economia , Peritonite/etiologia , Peritonite/prevenção & controle , Resultado do Tratamento , Carga de Trabalho/estatística & dados numéricos
9.
Ulus Travma Acil Cerrahi Derg ; 26(4): 635-638, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32589238

RESUMO

In this study, we report a case of failed angioembolization of a ruptured liver hemangioma complicated by iatrogenic injury of the subclavian vein during catheter insertion. A 30-year-old woman experienced blunt trauma upon falling from her bed. Laceration of a seemingly preexisting hepatic hemangioma was diagnosed. No other injury was detected during a preoperative diagnostic workup. Subclavian vein catheterization was performed, followed by angioembolization to control bleeding due to the ruptured hemangioma. After angioembolization, the patient's systolic blood pressure and hemoglobin levels were 70 mmHg and 5.3 g/dL, respectively. She underwent emergency laparotomy. During the surgery, a large volume of blood in the abdominal cavity due to profuse bleeding from the ruptured hemangioma was observed. Because of a hemothorax found on chest radiography, we performed thoracoscopy, which revealed a large volume of blood in the right thoracic cavity and perforation of the subclavian vein by the catheter. After the damage-control surgery, the patient recovered safely. In this case, ruptured liver hemangioma complicated by subclavian vein catheter-related injury was treated safely using damage-control surgery. The catheter-related injury could be identified and treated using thoracoscopy.


Assuntos
Cateterismo/efeitos adversos , Embolização Terapêutica/efeitos adversos , Hemangioma , Neoplasias Hepáticas , Veia Subclávia/lesões , Adulto , Cateterismo/instrumentação , Cateteres/efeitos adversos , Embolização Terapêutica/instrumentação , Feminino , Hemangioma/fisiopatologia , Hemangioma/terapia , Humanos , Doença Iatrogênica , Neoplasias Hepáticas/fisiopatologia , Neoplasias Hepáticas/terapia , Ruptura Espontânea/fisiopatologia , Ruptura Espontânea/terapia , Falha de Tratamento
10.
Vasc Endovascular Surg ; 54(6): 477-481, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32419653

RESUMO

PURPOSE: The antegrade recanalization of an occlusion or high-grade stenosis of the celiac artery via the aorta often represents a technical challenge. A retrograde approach via the superior mesenteric artery and the pancreaticoduodenal arcade may be an alternative approach. Based on our experience, we assess the technical success and the short- and mid-term outcomes of this bailout procedure. METHODS: We performed a retrospective analysis of all consecutive patients who underwent recanalization and stent implantation in the celiac artery between January 2010 and December 2018. Data on vascular access, the materials used including stents, as well as the length of the intervention, radiation exposure, and follow-up were assessed. RESULTS: Recanalization in combination with stent implantation into the celiac artery was performed in 43 patients. In 39 (91%) of 43 patients, the recanalization was successful with an antegrade approach via the aorta, whereas in 4 (9%) of 43 patients the passage of the stenosis was possible only through a retrograde approach through the superior mesenteric artery and the pancreaticoduodenal arcade followed be advancement of the microwire through the celiac artery into the aorta. The tip of the microwire was captured in the aorta with a snare and pulled out in the femoral introducer sheath and used as a guide for the antegrade implantation of a balloon-expandable stent. CONCLUSIONS: The retrograde recanalization of the celiac artery via the pancreaticoduodenal arcade may be technically challenging yet represents a feasible alternative in case of a failed antegrade approach.


Assuntos
Cateterismo , Artéria Celíaca , Duodeno/irrigação sanguínea , Procedimentos Endovasculares , Isquemia Mesentérica/terapia , Oclusão Vascular Mesentérica/terapia , Pâncreas/irrigação sanguínea , Idoso , Idoso de 80 Anos ou mais , Cateterismo/efeitos adversos , Artéria Celíaca/diagnóstico por imagem , Artéria Celíaca/fisiopatologia , Circulação Colateral , Constrição Patológica , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Estudos de Viabilidade , Feminino , Humanos , Masculino , Isquemia Mesentérica/diagnóstico por imagem , Isquemia Mesentérica/fisiopatologia , Oclusão Vascular Mesentérica/diagnóstico por imagem , Oclusão Vascular Mesentérica/fisiopatologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Circulação Esplâncnica , Stents , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
11.
J Cardiothorac Surg ; 15(1): 101, 2020 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-32423421

RESUMO

BACKGROUND: Fractured catheter as a foreign body in situ is a rare complication after port catheter placement. We report a single center's experience on percutaneous transvenous retrieval of intravascular fractured port catheter and treatment techniques. METHODS: Patients undergoing percutaneous transvenous retrieval of intravascular fractured port catheter from Jan 2010 to Dec 2018 were retrospectively collected. A total of 10 patients (8 females and 2 males) were enrolled in this study. Procedures were performed within 1 day after diagnosis. Two methods of retrieval were considered, direct retrieval by gooseneck snare and guide wire as media to retrieve were used in the procedure. RESULTS: All the fractured catheters in 10 patients were successfully retrieval by 2 methods, direct retrieval by gooseneck snare(n = 6) and guide wire as media of retrieval(n = 4). The time interval between port catheter implantation and discovery of catheter fracture was 36.50 ± 42.99(ranged 1 to 146) days. The operation time was 24.10 ± 8.32(ranged 10 to 36) minutes. No immediate procedure related or 1 month follow-up complications occurred in all the 10 patients. CONCLUSION: Percutaneous transvenous retrieval of intravascular fractured port catheter is a simple and safe procedure, which maybe recommended as the first choice for patients with fractured port catheter in situ.


Assuntos
Cateteres de Demora/efeitos adversos , Remoção de Dispositivo/métodos , Corpos Estranhos/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateterismo/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Falha de Prótese , Estudos Retrospectivos , Resultado do Tratamento
12.
Vascular ; 28(5): 583-590, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32390559

RESUMO

OBJECTIVE: Varicocele is a common disease in young and middle-aged men. This study aims to compare the efficacy of internal spermatic vein embolization of left varicocele versus laparoscopic high ligation. METHODS: From January 2017 to September 2018, a total of 69 varicocele patients were admitted and given the opportunity to choose the treatment option. Among these, 26 patients were treated with sclerosing agent injection, while 43 patients underwent laparoscopic surgery. They were followed up for 12 months after surgery, and the technical success rate, recurrence rate, complication rate, cost, operative time, and hospitalization time with regard to these two methods were analyzed. RESULTS: All patients completed the medical procedures. There was no recurrence in patients in the sclerotherapy group during the follow-up period; however, the complication rate was 19.2%. Furthermore, the operative time, hospitalization time, and cost of treatment were 31.1 ± 11.1 min, 1.2 ± 0.49 days, and 9613.11 ± 895.97 Yuan, respectively. In the laparoscopic group, 9 patients underwent laparoscopic bilateral high ligation, while 34 patients received treatment on the left side alone. The recurrence rate of left varicocele was 4.7% and the complication rate was 44.2%. Furthermore, the operative time, hospitalization time, and treatment cost were 50.4 ± 14.48 min, 4.0 ± 2.02 days, and 10,948.29 ± 2547.00 Yuan, respectively. Moreover, there were statistically significant differences (P < 0.05) in operative time, hospitalization time, and treatment cost. Patients in the sclerotherapy group had an advantage with respect to the overall complication rate when compared with patients from the laparoscopic group (X2 = 4.448, P < 0.05), and there was a statistically significant difference in hydrocele (X2 = 4.555, P < 0.05). However, there was no significant difference in the recurrence rate between these two groups (X2 = 1.245, P > 0.05). CONCLUSION: Patients who underwent sclerotherapy showed a higher technical success rate, a lower recurrence rate, fewer complications, and shorter hospitalization time compared to those treated with laparoscopic ligation. Transcatheter sclerosing agent injection may be a preferable treatment option for patients with unilateral varicocele.


Assuntos
Cateterismo , Embolização Terapêutica , Laparoscopia , Soluções Esclerosantes/administração & dosagem , Escleroterapia , Testículo/irrigação sanguínea , Varicocele/terapia , Veias/cirurgia , Adolescente , Adulto , Cateterismo/efeitos adversos , Embolização Terapêutica/efeitos adversos , Humanos , Laparoscopia/efeitos adversos , Tempo de Internação , Ligadura , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Recidiva , Estudos Retrospectivos , Fatores de Risco , Soluções Esclerosantes/efeitos adversos , Escleroterapia/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Varicocele/diagnóstico por imagem , Veias/diagnóstico por imagem , Adulto Jovem
13.
Circ Heart Fail ; 13(4): e006731, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32295407

RESUMO

Acute decompensated heart failure remains the most common cause of hospitalization in older adults, and studies of pharmacological therapies have yielded limited progress in improving outcomes for these patients. This has prompted the development of novel device-based interventions, classified mechanistically based on the way in which they intend to improve central hemodynamics, increase renal perfusion, remove salt and water from the body, and result in clinically meaningful degrees of decongestion. In this review, we provide an overview of the pathophysiology of acute decompensated heart failure, current management strategies, and failed pharmacological therapies. We provide an in depth description of seven investigational device classes designed to target one or more of the pathophysiologic derangements in acute decompensated heart failure, denoted by the acronym DRI2P2S. Dilators decrease central pressures by increasing venous capacitance through splanchnic nerve modulation. Removers remove excess fluid through peritoneal dialysis, aquaphoresis, or hemodialysis. Inotropes directly modulate the cardiac nerve plexus to enhance ventricular contractility. Interstitial devices enhance volume removal through lymphatic duct decompression. Pushers are novel descending aorta rotary pumps that directly increase renal artery pressure. Pullers reduce central venous pressures or renal venous pressures to increase renal perfusion. Selective intrarenal artery catheters facilitate direct delivery of short acting vasodilator therapy. We also discuss challenges posed in clinical trial design for these novel device-based strategies including optimal patient selection and appropriate end points to establish efficacy.


Assuntos
Denervação Autônoma/instrumentação , Cateterismo/instrumentação , Terapia por Estimulação Elétrica/instrumentação , Insuficiência Cardíaca/terapia , Hemodinâmica , Rim/fisiopatologia , Diálise Renal/instrumentação , Animais , Denervação Autônoma/efeitos adversos , Cateterismo/efeitos adversos , Tomada de Decisão Clínica , Terapia por Estimulação Elétrica/efeitos adversos , Desenho de Equipamento , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Seleção de Pacientes , Recuperação de Função Fisiológica , Diálise Renal/efeitos adversos , Fatores de Risco , Resultado do Tratamento
14.
Obstet Gynecol ; 135(5): 1153-1160, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32282603

RESUMO

OBJECTIVE: To evaluate whether removal of a double-balloon device for cervical ripening for 6 compared with 12 hours in women with an unfavorable cervix will result in a shorter time to delivery, similar cervical ripening, and without affecting cesarean delivery rate. METHODS: In a prospective randomized trial, cervical ripening was performed using a double-balloon device. Women were randomized to removal of the device after 6 compared with 12 hours. Primary outcome was time to delivery. Secondary outcomes included mode of delivery, Bishop score, and maternal and neonatal adverse outcomes. A sample size of 100 nulliparous and 100 parous women was required assuming a 95% CI, power of 80%, and mean decrease of 6 hours to delivery between the groups. RESULTS: From March 2017 through February 2019, 688 women were screened, 243 were found eligible, and 197 were randomized as follows: nulliparous cohort (n=101): removal after 6 hours (n=48) compared with removal after 12 hours (n=53); parous cohort (n=96): removal after 6 hours (n=49) compared with removal after 12 hours (n=47). Insertion-to-delivery interval was significantly shorter in the 6-hour group for both nulliparous (25.6±12.8 hours vs 31.4±15.2 hours, P<.04; mean difference 5.8, 95% CI 0.2-11.3), and parous cohorts (18.0±6.8 hours vs 22.6±8.2 hours, P=.003; mean difference 4.7, 95% CI 1.6-7.7). Bishop score change and cesarean delivery rate were similar between groups regardless of parity. The 12-hour group in the combined cohort was associated with higher rates of maternal intrapartum fever (2% vs 10%, P=.02; odds ratio 5.3, 95% CI 1.1-24.8). CONCLUSION: Insertion-to-delivery interval is shorter after 6 compared with 12 hours for both nulliparous and parous women. Cervical ripening with a double-balloon device may be achieved in 6 hours. The longer time was associated with a higher rate of intrapartum fever. Six hours should be considered as standard placement time for double-balloon catheters. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT03045939.


Assuntos
Cateterismo/métodos , Maturidade Cervical , Trabalho de Parto Induzido/métodos , Ocitócicos/administração & dosagem , Fatores de Tempo , Adulto , Cateterismo/efeitos adversos , Colo do Útero , Cesárea/estatística & dados numéricos , Parto Obstétrico/métodos , Parto Obstétrico/estatística & dados numéricos , Feminino , Febre/induzido quimicamente , Febre/epidemiologia , Humanos , Trabalho de Parto Induzido/efeitos adversos , Paridade , Gravidez , Complicações na Gravidez/induzido quimicamente , Complicações na Gravidez/epidemiologia , Estudos Prospectivos
15.
Ann Vasc Surg ; 68: 568.e11-568.e15, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32283301

RESUMO

BACKGROUND: We report the percutaneous endovascular management of an iatrogenic perforation of the left common carotid artery (LCCA) during an attempted trans-subclavian pacemaker (PM) placement. METHODS: An 87-year-old woman was urgently transferred after an attempted left subclavian vein PM implantation. Computed tomography angiography scan showed the accidental cannulation of LCCA in its most proximal segment. Owing to the significant surgical risks, the mortality rate, and the distal position of the vessel from the skin, we opted for an endovascular strategy with a balloon-expandable stent graft. The Advanta 8 × 38 mm V12 was inserted via a 7 French Flexor Introducer sheath through the right common femoral artery. RESULTS: The patient was discharged on postoperative day 2 without complications. A 6-month follow-up computed tomography angiography demonstrated stent graft and LCCA patency and the patient was in a good stable condition. CONCLUSIONS: This case highlights the effectiveness of a minimal invasive endovascular approach to treat this uncommon but potentially lethal injury.


Assuntos
Angioplastia com Balão , Implante de Prótese Vascular , Estimulação Cardíaca Artificial , Lesões das Artérias Carótidas/cirurgia , Artéria Carótida Primitiva/cirurgia , Cateterismo/efeitos adversos , Doença Iatrogênica , Marca-Passo Artificial , Idoso de 80 Anos ou mais , Angioplastia com Balão/efeitos adversos , Angioplastia com Balão/instrumentação , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Lesões das Artérias Carótidas/diagnóstico por imagem , Lesões das Artérias Carótidas/etiologia , Artéria Carótida Primitiva/diagnóstico por imagem , Feminino , Humanos , Stents
16.
J Vasc Access ; 21(6): 883-891, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32141378

RESUMO

INTRODUCTION: As the demographics of the population changes, increasing challenges are being faced in providing reliable access for dialysis. This article reports on the outcomes from the largest series to date using the early cannulation graft Flixene in a single centre. METHODS: Between May 2012 and March 2018, 141 Flixene grafts were placed for dialysis access. The outcomes of the arteriovenous grafts were reviewed retrospectively from electronically held records and imaging. RESULTS: In 75 patients, placement of Flixene graft was performed on an emergency basis and in 66 patients on a planned elective list. The 12-month primary, assisted primary and secondary patency rates were 48.7%, 56.6% and 83.6%, respectively. Eight (5.7%) patients developed infections of the graft during the follow-up period. CONCLUSION: In our experience, we have found the use of the early cannulation graft Flixene to be safe with a low complication rate and favourable patency rates. We believe these early cannulation grafts provide a useful addition for vascular access surgeons preventing the use of tunnelled lines and providing more flexibility in the timing of placing a graft for dialysis.


Assuntos
Derivação Arteriovenosa Cirúrgica/instrumentação , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Cateterismo , Diálise Renal , Tempo para o Tratamento , Adulto , Idoso , Idoso de 80 Anos ou mais , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/efeitos adversos , Cateterismo/efeitos adversos , Feminino , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Infecções Relacionadas à Prótese/microbiologia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
17.
Dig Dis ; 38(6): 534-541, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32187605

RESUMO

BACKGROUND: Risk factors for post-endoscopic retrograde cholangiopancreatography (ERCP) complications are well-studied. However, risk factors for complications and success after endoscopic sphincterotomy (EST) for duct stones are poorly determined. This study aimed to verify risk factors for mortality, complications, and success after EST. METHODS: A multivariate analysis was carried out in a dataset of ERCPs performed during 17 years. RESULTS: A total of5,226 ERCPs were performed, of which 2,137 were in patients with bile duct stones (1,458 women and 679 men; mean age = 57 years) who underwent EST with attempted stone removal. There were 171 (8%) complications, with pancreatitis in 87 (4.1%), bleeding in 48 (2.2%), other complications in 36 (1.8%), and mortality of 0.6%. Successful stone(s) removal was obtained in 2,028 cases (94.9%). On multivariate analysis, mortality was associated with age >60 years (1 vs. 0.2%), cholangitis (4.3 vs. 0.3%), and EST-related complications (5.8 vs. 0.2%). Complications were associated with unsuccessful stone removal (13.4 vs. 7.5%) and difficult cannulation (13.9 vs. 5.4%). An unsuccessful EST was independently related to difficult cannulation (86.2 vs. 98.7%), precutting (79.4 vs. 96.4%), and complications (86.5 vs. 95.6%). CONCLUSIONS: Risk factors for complications after EST for stones are delayed bile duct cannulation and failed stone retrieval. Mortality is higher in older patients, those who presented with an EST-related complication, or those who presented initially with cholangitis. Difficult cannulation, EST-related complications, and precutting were associated with an unsuccessful procedure. In this series, outpatient EST with attempted stone retrieval was found to be as safe as performing the procedure in hospitalized patients.


Assuntos
Cálculos Biliares/epidemiologia , Cálculos Biliares/cirurgia , Complicações Pós-Operatórias/etiologia , Esfinterotomia Endoscópica/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateterismo/efeitos adversos , Criança , Pré-Escolar , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Feminino , Cálculos Biliares/mortalidade , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
18.
Niger J Clin Pract ; 23(3): 429-433, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32134046

RESUMO

Bleeding oesophageal varices is a rare condition in children and most of them are usually of extrahepatic causes. Neonatal umbilical catheterization even though safe has been identified as a cause of portal vein thrombosis and oesophaeal varices. We report a 9-year old Nigerian girl who had massive upper gastrointestinal bleeding from oesophageal varices secondary to pulmonary vein stenosis. She had umbilical catheterization for exchange blood transfusion as a neonate. She was sequentially managed with endoscopic sclerotherapy and band ligation We seek to highlight the need for a high index of suspicion of oesophageal varices in children with upper gastrointestinal bleeding who had neonatal umbilical catheterization.">.


Assuntos
Cateterismo/efeitos adversos , Varizes Esofágicas e Gástricas , Hemorragia Gastrointestinal , Veias Umbilicais/cirurgia , Transfusão de Sangue , Criança , Varizes Esofágicas e Gástricas/etiologia , Varizes Esofágicas e Gástricas/cirurgia , Feminino , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/cirurgia , Humanos , Recém-Nascido , Nigéria
19.
J Vasc Access ; 21(6): 908-916, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32207367

RESUMO

INTRODUCTION: The native arteriovenous fistula may remain immature despite adequate arterial inflow after formation. This may occur when the puncturable vein segment (cannulation zone) is too small to be reliably punctured, occluded or too deep under the skin for needle access. We performed stenting (stent-assisted maturation) of arteriovenous fistulas with an immature cannulation zone, allowing for a large subcutaneous channel which could then be immediately punctured for dialysis. METHODS: We performed a retrospective review of 49 patients (mean age was 58.7 ± 16.09 (12-83) years, mean arteriovenous fistula age of 162.6 ± 27.28 days) with end-stage renal failure who underwent balloon dilatation and bare-metal stent implantation (1.6 ± 0.67 (1-3) stents, median diameter and length of 8 (5-14) mm and 80 (40-150) mm, respectively) through their cannulation zone (forced maturation). Radiocephalic (35 arteriovenous fistulas), brachiocephalic (10 arteriovenous fistulas) and autogenous loop arteriovenous fistulas (4 arteriovenous fistulas) were included with 30 patients (61.2%) having an inadequate cannulation zone venous diameter, 9 patients (18.4%) having an absent cannulation zone and 10 patients (20.4%) having a patent cannulation zone deeper than 1 cm which was not reliably puncturable. The study was conducted over 9 years (January 2008-December 2016) with implantation of the SMART® stent and Absolute Pro® stent in 61.2% and 38.8%, respectively. Long-term outcomes including primary useable segmental and access circuit patency as well as assisted primary access circuit patency, rate of re-intervention, technical success and complications were analysed. RESULTS: At 6 months, 12 months and 4 years, respectively, cannulation zone primary patency was 84.4%, 74.4% and 56.1% and access circuit primary patency was 62.2%, 45.3% and 23.2%; however, assisted primary access circuit patency was 95.6%, 91.1% and 83.8%, achieved with an endovascular re-intervention rate of 0.53 procedures/year with only four thrombosed circuits occurring. DISCUSSION: Forced maturation using nitinol stents allows for long-term haemodialysis access with a low rate of re-intervention.


Assuntos
Ligas , Angioplastia com Balão/instrumentação , Derivação Arteriovenosa Cirúrgica , Cateterismo , Falência Renal Crônica/terapia , Diálise Renal , Stents , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Angioplastia com Balão/efeitos adversos , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Cateterismo/efeitos adversos , Criança , Feminino , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Oclusão de Enxerto Vascular/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular , Adulto Jovem
20.
Am J Kidney Dis ; 76(1): 82-89, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32151430

RESUMO

RATIONALE & OBJECTIVE: Compared with conventional (rope-ladder cannulation [RLC]) methods, use of buttonhole cannulation (BHC) to access arteriovenous fistulas (AVFs) may be associated with increased risk for bloodstream infection and other vascular access-related infection. We used national surveillance data to evaluate the infection burden and risk among in-center hemodialysis patients with AVFs using BHC. STUDY DESIGN: Descriptive analysis of infections and related events and retrospective observational cohort study using National Healthcare Safety Network (NHSN) surveillance data. SETTING & PARTICIPANTS: US patients receiving hemodialysis treated in outpatient dialysis centers. PREDICTORS: AVF cannulation methods, dialysis facility characteristics, and infection control practices. OUTCOMES: Access-related bloodstream infection; local access-site infection; intravenous (IV) antimicrobial start. ANALYTIC APPROACH: Description of frequency and rate of infections; adjusted relative risk (aRR) for infection with BHC versus RLC estimated using Poisson regression. RESULTS: During 2013 to 2014, there were 2,466 access-related bloodstream infections, 3,169 local access-site infections, and 13,726 IV antimicrobial starts among patients accessed using BHC. Staphylococcus aureus was the most common pathogen, present in half (52%) of the BHC access-related bloodstream infections. Hospitalization was frequent among BHC access-related bloodstream infections (37%). In 2014, 9% (n=271,980) of all AVF patient-months reported to NHSN were associated with BHC. After adjusting for facility characteristics and practices, BHC was associated with significantly higher risk for access-related bloodstream infection (aRR, 2.6; 95% CI, 2.4-2.8) and local access-site infection (aRR, 1.5; 95% CI, 1.4-1.6) than RLC, but was not associated with increased risk for IV antimicrobial start. LIMITATIONS: Data for facility practices were self-reported and not patient specific. CONCLUSIONS: BHC was associated with higher risk for vascular access-related infection than RLC among in-center hemodialysis patients. Decisions regarding the use of BHC in dialysis centers should take into account the higher risk for infection. Studies are needed to evaluate infection control measures that may reduce infections related to BHC.


Assuntos
Infecções Relacionadas a Cateter/epidemiologia , Cateterismo/efeitos adversos , Centers for Disease Control and Prevention, U.S. , Diálise Renal/efeitos adversos , Dispositivos de Acesso Vascular/efeitos adversos , Dispositivos de Acesso Vascular/microbiologia , Idoso , Infecções Relacionadas a Cateter/diagnóstico , Centers for Disease Control and Prevention, U.S./estatística & dados numéricos , Estudos de Coortes , Análise de Dados , Feminino , Humanos , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Diálise Renal/instrumentação , Estudos Retrospectivos , Fatores de Risco , Estados Unidos/epidemiologia
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