A prospective randomized study of heparin-bonded graft (Propaten) versus standard graft in prosthetic arteriovenous access.

Objective: Prosthetic grafts continue to be required for hemodialysis access when the options for native fistulas have been exhausted. The inferior long-term patency of grafts makes the possibility of preventing occlusion with heparin-bonded grafts an attractive alternative. We carried out a prospective randomized study to compare the patency of standard grafts with heparin-bonded grafts.

Upper limb grafts for hemodialysis access.

Arteriovenous (AV) grafts are required for hemodialysis access when options for native fistulas have been fully exhausted, where they continue to play an important role in hemodialysis patients, offering a better alternative to central vein catheters. When planning autogenous accesses using Doppler ultrasound, adequate arterial inflow and venous outflow must be consciously preserved for future access creation with grafts. Efforts to improve graft patency include changing graft configuration, graft biology and hemodynamics.

Stent grafts for central venous occlusive disease in patients with ipsilateral hemodialysis access.

Purpose: To assess long-term outcomes of stent grafts in patients with symptomatic central venous stenoses and occlusions ipsilateral to hemodialysis grafts or fistulas.

Materials And Methods: The study included 52 of 55 consecutive patients with symptomatic stenoses of the central veins draining upper limb dialysis access grafts or fistulas treated with stent grafts. Indications for stent grafts were poor angioplasty results, rapid recurrence, or total occlusion.

Stent graft treatment for hemodialysis access aneurysms.

Background: Aneurysms that develop in arteriovenous accesses as a result of repeated punctures are sometimes complicated by infection or ischemia causing sloughing of the overlying skin, which may endanger the access and risk major bleeding and other complications. Surgical revision may necessitate the temporary use of a central venous catheter until dialysis can be resumed via the access. We used stent grafts in selected patients for the exclusion of access aneurysms.

Ultrasound-guided direct basilic-axillary approach in preoperative venography for hemodialysis access.

Purpose: Hemodialysis patients with suspected central vein stenosis or occlusion require venographic assessment before access surgery. Conventional venography may be unsatisfactory because of the limited ability to image central veins via peripheral arm veins that are inadequate or that have been damaged by multiple cannulations. Imaging of the central veins requires high flow contrast injection, which may be unattainable through small peripheral veins.

Thrombolysis for early failure of prosthetic arteriovenous access.

Background: Early failure (within 6 weeks of construction) of prosthetic arteriovenous access (AVA) is traditionally treated by surgical revision rather than endovascular intervention because it is assumed to be related to technical factors related to the surgery. This premise is not evidence based and our results for surgical thrombectomy have been poor. Based on our previous experience with angiography and thrombolysis in newly constructed autogenous AVAs, we changed our approach to perform endovascular thrombolysis initially, instead of proceeding directly to surgical revision.

Stratification for malignant external otitis.

Objective: To propose a CT-based method for early identification of severe cases of malignant external otitis (MEO) by correlating between initial CT findings and clinical course.

Study Design And Setting: Eighteen MEO patients who underwent CT on admission were included in this retrospective study conducted at a tertiary center. The number and extent of anatomical areas involved according to CT were compared to clinical course severity.

Blood flow volume changes in the maturing arteriovenous access for hemodialysis.

In our center, we start hemodialysis using arteriovenous accesses empirically 1 mo after surgery in nearly all patients, when the vein diameter reaches 5 mm and blood flow is assumed to be adequate. We measured blood flow and vessel diameter in the maturing autogenous and prosthetic access to determine if this approach can be justified by quantitative physiological parameters. Of 66 consecutive autogenous and prosthetic arteriovenous accesses created over 3 mo in 2004, 62 were prospectively examined by duplex ultrasonography preoperatively, immediately after surgery in the recovery room, at 10 d postoperatively and 1 mo after surgery before first cannulation.

Intra-operative central vein angioplasty during arteriovenous access creation.

Central vein stenosis or occlusion due to prior use of central vein hemodialysis catheters may lead to disabling extremity edema or cause early failure after arteriovenous access construction. Our integrated program for arteriovenous access management enables us to identify these stenoses pre-operatively. We carried out intra-operative angiography and angioplasty during arteriovenous access creation in 3 patients with good immediate and long-term results.

An integrated vascular management programme.

This paper discusses the development of an integrated approach for the creation and maintenance of arteriovenous access (AVA), under the direction of a dedicated vascular access surgeon in close cooperation with the haemodialysis staff, involving pre-operative imaging, anaesthetic and surgical techniques together with a post-operative graft surveillance programme, in order to maximize autogenous arteriovenous access (AAVA) construction (the preferred access for haemodialysis patients with end-stage renal disease), and to improve patency rates for AAVA and prosthetic arteriovenous access (PAVA).

Integrated approach to construction and maintenance of prosthetic arteriovenous access for hemodialysis.

Autogenous arteriovenous access is the preferred access for hemodialysis patients with end-stage renal disease but is not feasible in a significant number of patients. The creation of a prosthetic arteriovenous access (PAVA) for hemodialysis using expanded polytetrafluoroethylene is technically simple and the short-term results are usually good, but the PAVA's 1-year patency rate is low (less than 60% in many centers). We have developed an integrated approach for the creation and maintenance of PAVAs, under the direction of a dedicated vascular access surgeon, involving preoperative imaging, anesthetic and surgical techniques, and a postoperative graft surveillance program, to improve patency rates.

Primary epiploic appendagitis: clinical and radiological manifestations.

Background: Primary epiploic appendagitis is a relatively rare condition in which torsion and inflammation of an epiploic appendix result in localized abdominal pain. This is a non-surgical situation that clinically mimics other conditions requiring surgery such as acute diverticulitis or appendicitis.

Objective: To investigate the clinical, laboratory and radiological findings of the disease.