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1.
Vasc Endovascular Surg ; 54(1): 80-84, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31533547

RESUMO

Brachial artery pseudoaneurysms (BAPs) are rare but could lead to complications of high morbidity. We report a case of a BAP presenting with hand ischemia and median nerve neuropathy nearly a decade after the inciting iatrogenic trauma, successfully treated with excision and direct repair. This report highlights that untreated pseudoaneurysms can be indolent and present late with both symptoms of embolization and local compression.


Assuntos
Falso Aneurisma/etiologia , Artéria Braquial/lesões , Doença Iatrogênica , Isquemia/etiologia , Flebotomia/efeitos adversos , Extremidade Superior/irrigação sanguínea , Lesões do Sistema Vascular/etiologia , Idoso de 80 Anos ou mais , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/fisiopatologia , Falso Aneurisma/cirurgia , Artéria Braquial/diagnóstico por imagem , Artéria Braquial/fisiopatologia , Artéria Braquial/cirurgia , Humanos , Isquemia/diagnóstico por imagem , Isquemia/fisiopatologia , Isquemia/cirurgia , Masculino , Neuropatia Mediana/etiologia , Fluxo Sanguíneo Regional , Fatores de Tempo , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/fisiopatologia , Lesões do Sistema Vascular/cirurgia
3.
Rev Port Cir Cardiotorac Vasc ; 26(3): 209-212, 2019.
Artigo em Português | MEDLINE | ID: mdl-31734973

RESUMO

INTRODUCTION: True arterial aneurysms of the upper limb are rare and their treatment is intended to avoid complications as distal embolization, compression of surrounding neurovascular structures or rupture. OBJECTIVE: The purpose of this study is to review the experience of a department in the surgical treatment of true arterial aneurysms of the upper limb. METHODS: A retrospective study was performed between January 2007 and August 2017. RESULTS: From a total of eleven patients, nine were male and two were female. One of the patients had surgery twice because of two consecutive aneurysms of the upper limb. From a total of twelve cases, two were subclavian, one was axillary and nine were brachial aneurysms. Three of them had degenerative/idiopathic aetiology, one was associated to a cervical rib and seven occurred in the setting of arteriovenous fistula or kidney graft. Five patients had emergent surgery and the others had elective surgery. All of the patients were submitted to aneurysmectomy. As 30-day complications, there were two haematomas, one compartment syndrome and two early graft occlusions. Four patients needed re-intervention. During the follow-up period, all the grafts initially preserved were patent. There were no further known complications or amputation procedures. CONCLUSION: In this review most of the aneurysms were found in patients with haemodialysis vascular access or kidney grafts. Despite the need for early re-intervention in some cases, the surgical treatment of true arterial aneurysms of the upper limb is a low morbidity procedure.


Assuntos
Aneurisma/cirurgia , Falência Renal Crônica/terapia , Doença Arterial Periférica/cirurgia , Extremidade Superior/irrigação sanguínea , Aneurisma/complicações , Feminino , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/cirurgia , Transplante de Rim , Masculino , Doença Arterial Periférica/complicações , Diálise Renal , Estudos Retrospectivos , Resultado do Tratamento , Extremidade Superior/cirurgia
4.
J Vasc Access ; 20(5): 457-460, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31416409

RESUMO

Long peripheral catheters are 6-15 cm peripheral dwelling catheters that are inserted via a catheter-over-needle or direct Seldinger (catheter-over-guidewire) technique. When inserted in the upper extremity, the distal tip terminates before reaching the axilla, typically no further than the mid-upper arm. This is distinct from a midline catheter, which is inserted via a modified Seldinger technique and terminates at the axilla. The nomenclature of this catheter is confusing and inconsistent. We have identified over a dozen labels in the literature, all describing the same device. These include '15 cm catheter', 'catheter inserted with a Seldinger method', 'extended dwell/midline peripheral catheter', 'Leaderflex line', 'long catheter', 'long IV catheter', 'long peripheral cannula', 'long peripheral catheter', 'long peripheral venous catheter', 'long polyurethane catheter', 'midline cannula', 'mini-midline', 'peripheral intravenous catheter', 'Seldinger catheter', 'short midline catheter', 'short long line' and 'ultrasound-guided peripheral intravenous catheter'. The purpose of this editorial is to achieve some level of standardisation in the nomenclature of this device. Is it time to address the confusion? We suggest adopting 'long peripheral catheter'. However, we encourage discussion and debate in reaching a consensus.


Assuntos
Cateterismo Periférico/instrumentação , Cateteres de Demora/classificação , Terminologia como Assunto , Extremidade Superior/irrigação sanguínea , Dispositivos de Acesso Vascular/classificação , Consenso , Desenho de Equipamento , Humanos
6.
Vasc Endovascular Surg ; 53(7): 529-535, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31230589

RESUMO

OBJECTIVE: We developed a duplex ultrasound simulator and used it to assess accuracy of volume flow measurements in dialysis access fistula (DAF) models. METHODS: The simulator consists of a mannequin, computer, and mock transducer. Each case is built from a patient's B-mode images that are used to create a 3-dimensional surface model of the DAF. Computational fluid dynamics is used to determine blood flow velocities based on model vessel geometry. The simulator displays real-time B-mode and color-flow images, and Doppler spectral waveforms are generated according to user-defined settings. Accuracy was assessed by scanning each case and measuring volume flow in the inflow artery and outflow vein for comparison with true volume flow values. RESULTS: Four examiners made 96 volume flow measurements on four DAF models. Measured volume flow deviated from the true value by 35 ± 36%. Mean absolute deviation from true volume flow was lower for arteries than veins (22 ± 19%, N = 48 vs. 58 ± 33%, N = 48, p < 0.0001). This finding is attributed to eccentricity of outflow veins which resulted in underestimating true cross-sectional area. Regression analysis indicated that error in measuring cross-sectional area was a predictor of error in volume flow measurement (ß = 0.948, p < 0.001). Volume flow error was reduced from 35 ± 36% to 9 ± 8% (p < 0.000001) by calculating vessel area as an ellipse. CONCLUSIONS: Duplex volume flow measurements are based on a circular vessel shape. DAF inflow arteries are circular, but outflow veins can be elliptical. Simulation-based analysis showed that error in measuring volume flow is mainly due to assumption of a circular vessel.


Assuntos
Derivação Arteriovenosa Cirúrgica , Simulação por Computador , Manequins , Modelos Cardiovasculares , Diálise Renal , Extremidade Superior/irrigação sanguínea , Velocidade do Fluxo Sanguíneo , Humanos , Hidrodinâmica , Variações Dependentes do Observador , Valor Preditivo dos Testes , Fluxo Sanguíneo Regional , Reprodutibilidade dos Testes , Transdutores , Ultrassonografia Doppler em Cores/instrumentação
7.
Ann Vasc Surg ; 60: 182-192, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31075457

RESUMO

BACKGROUND: The use of arteriovenous fistula (AVF) is hampered by long surgical wait times, slow maturation, and upwards of 60% that do not mature. We describe our clinical experience in using a system with a 4F catheter profile for endovascular AVF creation in patients on hemodialysis. METHODS: This was a multioperator, single-center, single-arm, prospective study intended to evaluate safety and efficacy of a 4 Fr endovascular AVF (endoAVF) system for the creation of vascular access in hemodialysis patients. The study was performed after institutional review board approval at Italian Hospital (Asuncion, Paraguay). Patients were followed up at regular intervals through 6 months to determine procedural, maturation, and cannulation success as well as intervention rate and patency. RESULTS: From May to November 2016, 32 patients underwent the endoAVF procedure with no device-related adverse events. An endoAVF was successfully created in the proximal forearm for all 32 patients (20 between the radial artery and radial vein; 12 between the ulnar artery and ulnar vein). Wrist access was used for 72% (23/32) of the procedures for the arterial catheter and 59% (19/32) of the procedures for the venous catheter. The device successfully created an endoAVF in every patient for a technical success rate of 100% (32/32). The device- or procedure-related serious adverse event rate was 3% (1/32); one patient experienced a venous guidewire perforation successfully managed with a stent graft. Primary and cumulative patency rates through 6 months were 83% and 87%, respectively, with an intervention rate of 0.21 per patient-year. Physiological suitability, as defined by target flow rates ≥500 ml/min and cannulation vessel diameters ≥4 mm, was achieved in 91% (29/32) of patients by 90 days. Successful 2-needle cannulation was achieved in 78% (21/27) by 90 days, with mean time to cannulation of 43 ± 14 days. Functional cannulation, as defined by successful 2-needle cannulation for two-thirds of the dialysis sessions within 1 month, was achieved in 95% (20/21) of the patients who were successfully cannulated for an overall rate of 74% (20/27). All patients who achieved functional cannulation had their central venous catheters (CVCs) removed before the 90-day follow-up for a CVC removal rate of 74% (20/27). CONCLUSIONS: The 4 Fr endoAVF system allowed for multiple access and fistula creation site options to tailor the procedure to individual patient anatomy. Furthermore, the outcomes are comparable to previous generation endoAVF technology, with a potentially improved safety profile because of the use of arteries at the wrist for access.


Assuntos
Derivação Arteriovenosa Cirúrgica/instrumentação , Procedimentos Endovasculares/instrumentação , Diálise Renal , Extremidade Superior/irrigação sanguínea , Dispositivos de Acesso Vascular , Adulto , Idoso , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paraguai , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
8.
Ann Vasc Surg ; 60: 264-269, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31075469

RESUMO

BACKGROUND: Bypass in the upper extremity is a rare procedure mainly performed for chronic ischemia, trauma, or hemodialysis access complications. Feasibility and success of use of the arm vein and small saphenous vein (SSV) for autologous vein bypass have been reported in peripheral artery bypass procedures. There are very few reports on the use of alternative veins in upper extremity bypass. We report our experience with arm vein and SSV as a graft source in upper extremity arterial disease. METHODS: Retrospective analysis of a consecutively collected case series in an academic tertiary referral center from January 2010 to February 2018. Study end points were primary patency, secondary patency, limb salvage, and survival. RESULTS: In total, 47 patients were treated with upper extremity bypass either using the SSV (n = 17) or arm veins (n = 30). Indications were either acute (n = 12) or chronic ischemia (n = 35) caused by acute (n = 8) and chronic (n = 9) trauma, sequela of iatrogenic interventions (n = 4), peripheral artery disease (n = 14), thrombangiitis obliterans (n = 3), and dialysis-access-related complications (n = 9). An arm vein was used in 30 and the SSV in 17 patients. Primary patency after 12 months was 87% with the SSV and 75% with an arm vein (P = 0.8) and 63% and 75% after 36 months (P = 0.9). Secondary patency were 100% with an arm vein and 100% with the SSV after 36 months (P = 0.4). One patient had to undergo major amputation and 2 minor amputations. CONCLUSIONS: Arm vein revascularization using the primarily arm vein or SSV as a bypass conduit can be performed with reasonable mortality and morbidity rates and provide good results comparable with the greater saphenous vein.


Assuntos
Isquemia/cirurgia , Veia Safena/transplante , Extremidade Superior/irrigação sanguínea , Enxerto Vascular/métodos , Adulto , Idoso , Feminino , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Oclusão de Enxerto Vascular/terapia , Humanos , Isquemia/diagnóstico por imagem , Isquemia/mortalidade , Isquemia/fisiopatologia , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Retratamento , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Enxerto Vascular/efeitos adversos , Enxerto Vascular/mortalidade , Grau de Desobstrução Vascular
9.
Ann Vasc Surg ; 60: 178-181, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31075479

RESUMO

BACKGROUND: Although arteriovenous fistulae (AVFs) are the preferred mode of hemodialysis access because of their high patency rates, they are associated with an appreciable rate of nonmaturation. Balloon-assisted maturation (BAM) has been described to treat this issue. BAM is defined as repeated sequential graduated dilatation of the outflow vein. This study aims to evaluate the short-term complications of using the radial artery as an access for BAM procedures and fisutloplasties. Transradial access was used preferentially with multiple lesions in the AVF that were difficult to access with a single venous puncture. METHODS: Data were collected over 3 years on 44 office-based duplex-guided transradial access BAM procedures in 27 patients of whom 19 were men. BAM with ultrasound guidance was performed in 324 cases using a venous puncture during this period. The indication for the procedures was a failure of AVF maturation, and 5 cases were with short segment thrombectomy. All procedures were performed with local anesthesia only. Access site puncture, vessel cannulation, wire placement, and balloon advancement and insufflation were duplex-guided. The radial artery was punctured with ultrasound guidance and a 4-5 French low-profile sheath was placed. After crossing the lesion(s), 5,000 units of heparin was given. The radial artery was used as the access vessel for all procedures except one, in which the brachial artery was used in addition. Vascular injuries were classified based on the postprocedural duplex assessment. All patients had follow-up duplex scans within a week. RESULTS: The average age was 79 years (±14 SD, range 39-99 years). The types of AVF were 35 radio-cephalic, 1 radio-basilic, 2 brachio-brachial, 2 brachio-cephalic, and 4 brachio-basilic. The number of sites of lesions was 17 on the venous outflow, 7 perianastomotic, and 6 in the radial artery. In the remaining 14 failing AVFs, we were not able to identify any lesion. The balloon size ranged from 3-6 mm (28 patients) and 7-12 mm (16 patients). The most common injury was outflow vein wall injury (25), the formation of wall hematoma of the outflow vein (11), localized extravasation or rupture at the balloon site (4), spasm of the AVF (3), the formation of a puncture-site hematoma (2), and intimal flap (3). Extravasation was controlled with duplex-guided compression. There were no radial artery thromboses, and all the AVFs were patent on completion duplex and follow-up duplex. CONCLUSIONS: These data suggest that the radial artery could be used as a safe access route for BAM procedures with relatively low rates of complication. This approach can be considered as an adjunct in the armamentarium for angioplasty of AVF.


Assuntos
Angioplastia com Balão , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Complicações Pós-Operatórias/terapia , Artéria Radial/cirurgia , Trombectomia , Ultrassonografia Doppler Dupla , Ultrassonografia de Intervenção/métodos , Extremidade Superior/irrigação sanguínea , Adulto , Idoso , Idoso de 80 Anos ou mais , Angioplastia com Balão/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/fisiopatologia , Valor Preditivo dos Testes , Artéria Radial/diagnóstico por imagem , Artéria Radial/fisiopatologia , Fluxo Sanguíneo Regional , Diálise Renal , Estudos Retrospectivos , Fatores de Risco , Trombectomia/efeitos adversos , Resultado do Tratamento , Ultrassonografia Doppler Dupla/efeitos adversos , Ultrassonografia de Intervenção/efeitos adversos , Grau de Desobstrução Vascular
10.
Int Angiol ; 38(3): 239-249, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31112027

RESUMO

BACKGROUND: We prospectively analyzed the effect of preexisting structural changes of the radial artery (RA) wall by histological examination on the wrist radiocephalic fistula (RCF) outcomes. METHODS: During RCF creation, one segment of the RA wall was collected and its histomorphometric analysis was performed. The RCF function was evaluated by measuring blood flow rate. RESULTS: At the end of follow-up, 75.7% of the thirty-seven patients enrolled were performing hemodialysis by using their successful RCF and 24.3% of them showed early RCF failure. Compared to patients with a healthy RA, the RCF of those with medial RA microcalcification reached up a lower flow and a shorter primary patency (P=0.005 and P=0.040, respectively). The RA microcalcification was predictive of the RCF function (coefficient -614.9, 95% CI: -994.7 to -235.1, P=0.003). Compared to patients with successful RCF, those with failed RCF had a greater frequency of weak RCF thrill after releasing the clamps (P=0.045). Dependence on hemodialysis during RCF placement was predictive of its early failure (OR: 23.2, 95% CI: 1.76 to 306.9, P=0.017). Both having at least one cardiovascular comorbidity (HR 4.30, 95% CI: 1.29 to 14.39, P=0.018) and a thicker media layer of the RA (HR 1.60, 95% CI: 1.87 to 2.15, P=0.002) were predictive of primary RCF patency. CONCLUSIONS: The function and survival of the successful RCF were related to preoperative RA abnormalities such as microcalcification and media layer thickness. Both dependence on hemodialysis during RCF placement and an attenuated RCF thrill were associated with early RCF failure.


Assuntos
Derivação Arteriovenosa Cirúrgica/efeitos adversos , Oclusão de Enxerto Vascular/etiologia , Esclerose Calcificante da Média de Monckeberg/complicações , Artéria Radial/patologia , Extremidade Superior/irrigação sanguínea , Grau de Desobstrução Vascular , Idoso , Idoso de 80 Anos ou mais , Feminino , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Calcificante da Média de Monckeberg/fisiopatologia , Análise Multivariada , Estudos Prospectivos , Artéria Radial/cirurgia , Radiografia , Análise de Regressão , Diálise Renal , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia
11.
Scand Cardiovasc J ; 53(4): 183-191, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31117835

RESUMO

Background. Remote ischemic conditioning (RIC) protects against acute ischemia-reperfusion injury and may have beneficial effects in patients with stable cardiovascular disease. We investigated the effect of long-term RIC treatment in patients with chronic ischemic heart failure (CIHF). Methods. Prespecified post-hoc analysis of a prospective, exploratory and outcome-assessor blinded study. Twenty-one patients with compensated CIHF and 21 matched controls without heart failure or ischemic heart disease were treated with RIC once daily for 28 ± 4 days. RIC was conducted as 4 cycles of 5 minutes upper arm ischemia followed by 5 minutes of reperfusion. We evaluated circulating markers of inflammation and cardiac remodeling at baseline and following long-term RIC. Results. RIC reduced C-reactive protein from 1.5 (0.6-2.5) to 1.3 (0.6-2.1) mg/l following long-term RIC treatment (p = .02) and calprotectin from 477 (95% CI 380 to 600) to 434 (95% CI 354 to 533) ng/ml (p = .03) in patients with CIHF, but not in matched controls. Overall, RIC did not affect circulating markers related to adaptive or innate immunology or cardiac remodeling in patients with CIHF. Among patients with CIHF and N-terminal pro-brain natriuretic peptide (NT-proBNP) plasma levels above the geometric mean of 372 ng/l, long-term RIC treatment reduced soluble ST2 (n = 9) from 22.0 ± 3.7 to 20.3 ± 3.9 ng/ml following long-term RIC treatment (p = .01). Conclusion. Our findings suggest that long-term RIC treatment has mild anti-inflammatory effects in patients with compensated CIHF and anti-remodeling effects in those with increased NT-proBNP levels. This should be further investigated in a randomized sham-controlled trial.


Assuntos
Insuficiência Cardíaca/terapia , Mediadores da Inflamação/sangue , Precondicionamento Isquêmico/métodos , Isquemia Miocárdica/complicações , Extremidade Superior/irrigação sanguínea , Remodelação Ventricular , Idoso , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Doença Crônica , Citocinas/sangue , Feminino , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Precondicionamento Isquêmico/efeitos adversos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/sangue , Isquemia Miocárdica/fisiopatologia , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Estudos Prospectivos , Fluxo Sanguíneo Regional , Fatores de Tempo , Resultado do Tratamento
12.
Eur J Vasc Endovasc Surg ; 57(6): 868-875, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31126835

RESUMO

OBJECTIVES: The main aim of this study was to evaluate the effect of remote ischaemic preconditioning (RIPC) on arterial stiffness in patients undergoing vascular surgery. METHODS: This was a randomised, sham controlled, double blind, single centre study. Patients undergoing open abdominal aortic aneurysm repair, surgical lower limb revascularisation surgery or carotid endarterectomy were recruited. A RIPC or a sham procedure was performed, using a blood pressure cuff, along with preparation for anaesthesia. The RIPC protocol consisting of four cycles of 5 min of ischaemia, followed by 5 min of reperfusion was applied. Arterial stiffness and haemodynamic parameters were measured pre-operatively and 20-28 h after surgery. Two primary outcomes were selected: augmentation index and pulse wave velocity. RESULTS: Ninety-eight patients were randomised. After dropouts 44 and 46 patients were included in the RIPC and sham groups, respectively. Both groups were comparable. There were no statistically significant differences in augmentation index (p = .8), augmentation index corrected for heart rate of 75 beats per minute (p = .8), pulse wave velocity (p = .7), large artery elasticity indices (p = .8), small artery elasticity indices (p = .6), or mean arterial pressure (p = .7) changes between the RIPC and sham groups. There occurred statistically significant (p ≤ .01) improvement in augmentation index (-5.8% vs. -5.5%), augmentation index corrected for a heart rate of 75 beats per minute (-2.5% vs. -2%), small artery elasticity indices (0.7 mL/mmHg × 100 vs. 0.9 mL/mmHg × 100), and mean arterial pressure post-operatively in both the RIPC and the sham groups (change median values in RIPC and sham groups, respectively). CONCLUSIONS: RIPC had no significant effect on arterial stiffness, but there was significant improvement in arterial stiffness after surgery in both groups. Arterial stiffness and haemodynamics may be influenced by surgery or anaesthesia or oxidative stress or all factors combined. Further studies are needed to clarify these findings. CLINICALTRIALS.GOV: NCT02689414.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Doenças das Artérias Carótidas/cirurgia , Precondicionamento Isquêmico/métodos , Extremidade Inferior/irrigação sanguínea , Doença Arterial Periférica/cirurgia , Oclusão Terapêutica/métodos , Extremidade Superior/irrigação sanguínea , Rigidez Vascular , Procedimentos Cirúrgicos Vasculares/métodos , Idoso , Aneurisma da Aorta Abdominal/diagnóstico , Aneurisma da Aorta Abdominal/fisiopatologia , Pressão Arterial , Doenças das Artérias Carótidas/diagnóstico , Doenças das Artérias Carótidas/fisiopatologia , Método Duplo-Cego , Estônia , Feminino , Humanos , Precondicionamento Isquêmico/efeitos adversos , Precondicionamento Isquêmico/instrumentação , Masculino , Manometria , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/fisiopatologia , Análise de Onda de Pulso , Oclusão Terapêutica/efeitos adversos , Oclusão Terapêutica/instrumentação , Fatores de Tempo , Torniquetes , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos
13.
J Vasc Access ; 20(1_suppl): 65-70, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31032726

RESUMO

Obtaining adequate and precise anatomical information is mandatory to prevent vascular access-related complications in dialysis patients. For this purpose, we underwent Doppler ultrasound, vascular access angiogram, and plain computer-assisted tomography scan of the arm with vascular access. With the use of computer graphics software, the anatomical structure of the vascular access can be visualized three dimensionally which is shared among the staffs for precise and better recognition. Furthermore, created object is applicable for virtual reality and/or augmented reality presentation that provides useful means for education and practical procedures in the management of vascular access.


Assuntos
Artérias/diagnóstico por imagem , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Angiografia por Tomografia Computadorizada , Imagem Tridimensional , Modelagem Computacional Específica para o Paciente , Ultrassonografia Doppler , Ultrassonografia de Intervenção/métodos , Extremidade Superior/irrigação sanguínea , Veias/diagnóstico por imagem , Realidade Virtual , Artérias/fisiopatologia , Artérias/cirurgia , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/fisiopatologia , Oclusão de Enxerto Vascular/cirurgia , Humanos , Valor Preditivo dos Testes , Interpretação de Imagem Radiográfica Assistida por Computador , Diálise Renal , Software , Cirurgia Assistida por Computador , Grau de Desobstrução Vascular , Veias/fisiopatologia , Veias/cirurgia
14.
J Vasc Access ; 20(1_suppl): 71-75, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31032728

RESUMO

INTRODUCTION: The number of elderly hemodialysis patients continues to grow. The aim of this study was to investigate differences in elderly high flow access patients compared with middle-aged and young patients. METHODS: We performed a retrospective study to determine the characteristics of elderly patients (aged >60 years) following blood flow suppression procedures. Preoperative and postoperative data from 177 patients who underwent blood flow suppression procedures and 73 patients who underwent procedures for run-off vein ligation and subcutaneous fixation of the superficial artery were compared. RESULTS: A high proportion of young (aged 20-40 years) and middle-aged (aged 41-60 years) patients met the criteria for blood flow suppression procedures (flow volume 1500 mL/min, flow volume/cardiac output 35%), whereas a high proportion of elderly patients did not. Moreover, heart strain could evidently be caused even with low flow volume. In elderly patients, a tricuspid regurgitation pressure gradient and right heart strain were observed more frequently. CONCLUSION: Elderly patients who underwent blood flow suppression procedures or subcutaneous fixation of the superficial artery exhibited lower flow volume, and the effects of high flow access in elderly patients depend on the nature of vascular changes. Ultimately, the underlying conditions and hemodynamics of each patient must be determined on an individual basis.


Assuntos
Artérias/cirurgia , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Débito Cardíaco Elevado/etiologia , Hemodinâmica , Diálise Renal , Extremidade Superior/irrigação sanguínea , Veias/cirurgia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Artérias/diagnóstico por imagem , Artérias/fisiopatologia , Velocidade do Fluxo Sanguíneo , Débito Cardíaco Elevado/diagnóstico , Débito Cardíaco Elevado/fisiopatologia , Débito Cardíaco Elevado/cirurgia , Feminino , Humanos , Ligadura , Masculino , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Ultrassonografia Doppler , Veias/diagnóstico por imagem , Veias/fisiopatologia , Adulto Jovem
15.
J Med Vasc ; 44(3): 194-198, 2019 May.
Artigo em Francês | MEDLINE | ID: mdl-31029273

RESUMO

INTRODUCTION: Acute upper limb ischemia is a medical and surgical emergency. Studies that have reported revascularization results in acute upper limb ischemia are rare. For this reason, the revascularization delay has remained poorly defined. The purpose of this study was to evaluate surgery results of acute upper limb ischemia related to revascularization delay. METHODS: We report a retrospective study of patients operated for acute upper limb ischemia between 2008 and 2016. Patients with thrombotic, traumatic or iatrogenic ischemia were excluded from this study. Patients were divided into two groups (those operated before 12hours and those operated after 12hours). A statistical analysis was performed to compare surgery results between the two groups in terms of limb salvage rate and neurological sequelae rate. RESULTS: Our population consisted of 138 patients. The average age was 69 [31,92]. There were 90 women and 48 men. The mean revascularization delay was 20hours [2,240]. Seventy-six patients were operated on before 12hours and 62 patients after 12hours. At one month, the mortality was 1.4% and the morbidity was 5.7%. The overall limb salvage rate was 86.9% and the overall neurologic sequelae rate was 31.8%. Statistical analysis showed that there was no significant difference between patients operated before or after 12hours in terms of limb salvage (86.8% versus 87%, P=0.258). However, there was a statistically significant difference in terms of neurological sequelae in favor of patients operated after 12hours (15.7% versus 51.6%, P=0.012). CONCLUSION: Revascularization of acute embolic upper limb ischemia is often associated with good results even if performed late. Beyond 12hours of ischemia, amputation rate is not significantly higher, however, the rate of neurological sequelae can be high.


Assuntos
Isquemia/cirurgia , Complicações Pós-Operatórias/etiologia , Tempo para o Tratamento , Extremidade Superior/irrigação sanguínea , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Amputação , Feminino , Humanos , Isquemia/diagnóstico por imagem , Isquemia/fisiopatologia , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
17.
Hand Clin ; 35(2): 155-178, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30928048

RESUMO

Replantation and revascularization in the pediatric extremity has unique challenges that provide a fertile field of research and clinical experience. Children regenerate peripheral nerves rapidly, resulting in good sensory and motor function. They adapt well to functional deficits and mismatch errors of reinnervation. The technical aspects of microsurgical care in children can be challenging because the structures are small. Additional technical challenges include preservation of growth centers, prevention of vasospasm, protection of the reconstruction, and psychosocial care. Despite these challenges, children show excellent functional outcomes with minimal complications.


Assuntos
Amputação Traumática/cirurgia , Reimplante/métodos , Extremidade Superior/lesões , Extremidade Superior/cirurgia , Amputação , Amputação Traumática/psicologia , Aneurisma/cirurgia , Anticoagulantes/uso terapêutico , Vasos Sanguíneos/transplante , Criança , Acesso aos Serviços de Saúde , Disparidades nos Níveis de Saúde , Humanos , Hiperemia/terapia , Microcirurgia , Regeneração Nervosa , Pediatria , Nervos Periféricos/transplante , Cuidados Pós-Operatórios , Extremidade Superior/irrigação sanguínea , Extremidade Superior/inervação
18.
J Vasc Surg ; 70(3): 853-857, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30837176

RESUMO

BACKGROUND: In 2002, Oakes et al described a novel procedure designed to salvage the distal cephalic venous outflow of a Brescia-Cimino fistula by placing a prosthetic graft between the brachial artery in the antecubital space and the cephalic vein at the wrist. In this fashion, the more proximal veins were saved for future procedures. Their approach was reported and found to be successful in the short term, but the long-term durability of the Oakes procedure has not been described. This study aimed to determine the long-term primary, primary-assisted, and secondary patency rates of the brachial to distal cephalic vein Oakes procedure. METHODS: This is a retrospective review of a prospective database in a large, single institution. All patients who underwent the Oakes procedure from 1998 to 2012 were followed up to 2018. We reviewed the time to intervention, type of intervention, patency rates, and mortality of this patient population. RESULTS: Over the 5-year study period, 14 patients were identified who underwent the Oakes procedure, of whom seven (50%) were female. The average age was 55.7 years (range, 38-73 years). All patients had a previously placed Brescia-Cimino that was not suitable for dialysis but was patent. The average number of days to placement of an Oakes brachial to distal cephalic graft was 396 (range, 119-1167) days. A total of 71% (10) of patients underwent an intervention to maintain the graft, of whom 50% (5) underwent an angioplasty and 50% (5) had a thrombectomy/revision procedure. The average number of days to first intervention was 367.3 (range, 21-1048) days from Oakes placement. Of this cohort, 30% (3) of patients had a second intervention, of whom one (33%) underwent an angioplasty and two (66%) had revisions. One patient had a third and a fourth intervention at 39 days and 74 days, respectively, that were both angioplasties. The overall number of days the Oakes procedure remained usable from placement was 843.6 (range, 21-3790) days or 2.3 years. CONCLUSIONS: This study concluded that the Oakes procedure may extend the use of the distal dialysis access site by 2.3 years without increasing infection and is hence a durable solution that should be considered in patients requiring dialysis access.


Assuntos
Derivação Arteriovenosa Cirúrgica/efeitos adversos , Implante de Prótese Vascular , Artéria Braquial/cirurgia , Oclusão de Enxerto Vascular/cirurgia , Artéria Radial/cirurgia , Terapia de Salvação/métodos , Extremidade Superior/irrigação sanguínea , Veias/cirurgia , Adulto , Idoso , Implante de Prótese Vascular/efeitos adversos , Artéria Braquial/diagnóstico por imagem , Artéria Braquial/fisiopatologia , Bases de Dados Factuais , Feminino , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Radial/diagnóstico por imagem , Artéria Radial/fisiopatologia , Diálise Renal , Reoperação , Estudos Retrospectivos , Fatores de Risco , Terapia de Salvação/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular , Veias/diagnóstico por imagem , Veias/fisiopatologia
19.
Anesth Analg ; 129(1): 287-293, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30896603

RESUMO

BACKGROUND: Acute kidney injury is a common complication after open total aortic arch replacement but lacks effective preventive strategies. Remote ischemic preconditioning has controversial results of its benefit to the kidney and may perform better in high-risk patients of acute kidney injury. We investigated whether remote ischemic preconditioning would prevent postoperative acute kidney injury after open total aortic arch replacement. METHODS: We enrolled 130 patients scheduled for open total aortic arch replacement and randomized them to receive either remote ischemic preconditioning (4 cycles of 5-minute right upper limb ischemia and 5-minute reperfusion) or sham preconditioning (4 cycles of 5-minute right upper limb pseudo ischemia and 5-minute reperfusion), both via blood pressure cuff inflation and deflation. The primary end point was the incidence of acute kidney injury within 7 days after the surgery defined by the Kidney Disease: Improving Global Outcomes criteria. Secondary end point included short-term clinical outcomes. RESULTS: Significantly fewer patients developed postoperative acute kidney injury with remote ischemic preconditioning compared with sham (55.4% vs 73.8%; absolute risk reduction, 18.5%; 95% CI, 2.3%-34.6%; P = .028). Remote ischemic preconditioning significantly reduced acute kidney injury stage II-III (10.8% vs 35.4%; P = .001). Remote ischemic preconditioning shortened the mechanical ventilation duration (18 hours [interquartile range, 14-33] versus 25 hours [interquartile range, 17-48]; P = .01), whereas no significant differences were observed between groups in other secondary outcomes. CONCLUSIONS: Remote ischemic preconditioning prevented acute kidney injury after open total aortic arch replacement, especially severe acute kidney injury and shortened mechanical ventilation duration. The observed renoprotective effects of remote ischemic preconditioning require further investigation in both clinical research and the underlying mechanism.


Assuntos
Lesão Renal Aguda/prevenção & controle , Aorta Torácica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Precondicionamento Isquêmico/métodos , Extremidade Superior/irrigação sanguínea , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/etiologia , Adulto , Pequim , Método Duplo-Cego , Feminino , Humanos , Precondicionamento Isquêmico/efeitos adversos , Masculino , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional , Respiração Artificial , Fatores de Tempo , Resultado do Tratamento
20.
J Vasc Interv Radiol ; 30(4): 572-577, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30910179

RESUMO

PURPOSE: To characterize the degree of venous collateralization before and after endovascular therapy and determine the effect of collateralization on success of thrombolysis and rate of repeat intervention in patients with Paget-Schroetter syndrome. MATERIALS AND METHODS: A single-center retrospective study of 37 extremities in 36 patients (mean age, 32.64 y; range, 15-72 y; 24 men) with PSS treated with endovascular therapy from 2007 through 2017 was conducted. Venograms at presentation, after lysis, postoperatively, and at each repeat intervention were graded for venous stenosis, thrombus burden, and collateralization on a 5-point scale. Collateralization was classified as high-grade (9 extremities) or low-grade (28 extremities) based on grading of the venograms at presentation. RESULTS: Primary technical success rate for endovascular treatment was 100%. Eighty-six percent of patients (32 of 37) underwent thrombolysis, 91% (34 of 37) underwent mechanical thrombectomy, and 83% (30 of 37) underwent balloon angioplasty. Overall primary patency rate was 50% at 12 months. The repeat intervention rate within 12 months was significantly higher for extremities with high- vs low-grade collateralization (89% vs 43%; P = .016). There was a significant decrease in the median grade of collateral severity after initial intervention (2 vs 1; P = .044) and 1 day postoperatively (2 vs 1; P = .040) vs the venogram at presentation. CONCLUSIONS: Severity of venous collateralization on the venogram at presentation of patients with PSS does not appear to affect success of endovascular therapy but may predict long-term patency of affected extremities. Patients in this cohort with severe collateralization on presentation were more likely to need repeat intervention.


Assuntos
Angioplastia com Balão , Circulação Colateral , Trombectomia , Terapia Trombolítica , Trombose Venosa Profunda de Membros Superiores/terapia , Extremidade Superior/irrigação sanguínea , Veias/fisiopatologia , Adolescente , Adulto , Idoso , Angioplastia com Balão/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional , Retratamento , Fatores de Risco , Trombectomia/efeitos adversos , Terapia Trombolítica/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Trombose Venosa Profunda de Membros Superiores/diagnóstico por imagem , Trombose Venosa Profunda de Membros Superiores/fisiopatologia , Grau de Desobstrução Vascular , Veias/diagnóstico por imagem , Adulto Jovem
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