Drug-eluting balloon for the treatment of failing hemodialytic radiocephalic arteriovenous fistulas: our experience in the treatment of juxta-anastomotic stenoses.

Purpose: The purpose of this article is to report our experience with drug-eluting balloons for the treatment of juxta-anastomotic stenoses of failing radiocephalic hemodialytic arteriovenous shunt and to evaluate the primary and secondary patency (PP and SP).

Methods: After approval by the local hospital's Ethical and Scientific Review Board, 26 consecutive patients with juxta-anastomotic stenosis of radiocephalic hemodialytic shunt were treated with angioplasty with drug-eluting balloon. The main objective was to evaluate PP defined, in accordance with the Kidney Disease Outcomes Quality Initiative recommendation, as the absence of dysfunction of the vascular access, patent lesion or residual stenosis <30% and no need for further reintervention of the target lesion (TL).

[Project work: formation of health-care personnel for self-care of tunnelled central venous catheters in hemodialysis patients of the territory].

Background: Scientific data from current literature demonstrate an incidence of bacteraemia due to tunnelled central venous catheter (tCVC) use accounting for 1.6 / 1000 days per tCVC, with a range of 1.5 to 1.

Atypical placement of hemodialysis catheters in patients with complete and irreversible obstruction of central venous vessels.

Purpose: This article describes the approach to atypical placement of central venous catheters (CVC) in dialysis patients with complete untreatable obstruction of central venous vessels.

Methods: Five patients with complete obstruction of central venous vessels underwent CT venography and digital venous angiography. After ultrasound-guided and radioscopic-assisted cannulation of the internal jugular vein, permanent CVCs were placed in atypical locations: in two patients a preliminary venous angioplasty was performed to facilitate the catheter positioning in a mediastinal enlarged collateral vein and in a persistent left superior vena cava; in three patients the CVC was placed in the azygos vein, enlarged because of the obstruction of the superior vena cava.

Venae comitantes as a potential vascular resource to create native arteriovenous fistulae.

Purpose: The arteriovenous fistula (AVF) represents the gold standard for hemodialysis (HD) vascular access. In some critical cases, use of the deep venous circle may represent an alternative approach and venae comitantes could be employed for this purpose.

Methods: Sixty patients with chronic renal failure in which the deep venous circle was used to create an AVF were identified; of the 48 who had a direct anastomosis between the brachial artery and vena comitans, 42 had a long-term follow-up (mean follow-up 59 weeks), while six were lost to follow-up.