Background: Best practice guidelines for dialysis access creation emphasize distal sites and autogenous tissue before more proximal sites and synthetic shunts. Pre-operative vein mapping is a useful modality to evaluate optimal access location; however, vein size is often underestimated secondary to patient hypovolemia, room temperature, and basal vascular tone. Supraclavicular brachial plexus blocks (BPB) are routinely performed to provide surgical anesthesia but also have known vasodilatory effects. Although many surgeons use both techniques, most do not repeat vein mapping after BPB to re-evaluate targets after block-mediated vasodilation. Therefore, we evaluated whether the role of physician-directed vein mapping after BPB resulted in more favorable access creations.
Methods: All patients who underwent primary ipsilateral access creation with physician-directed post-block duplex between 2017 and 2018 were evaluated. Vein mapping was reviewed for "theoretical access location" using the criterion of >2.5 mm vessels. Fistula preference was analogous to current indications with the following order of preference: wrist radiocephalic, forearm radiocephalic, brachiocephalic, brachiobasilic, and finally prosthetic graft.
Results: Forty-three patients met inclusion criteria. In total, physician-directed duplex after regional block resulted in the creation of higher preference accesses than predicted in 62.8% of patients. In 34.9% the access was at the predicted level and only 2.3% were at a lower preference. Furthermore, there were no differences in the maturation rates between accesses placed at higher preference locations than predicted compared to those at expected sites (74% vs. 79%, P = 0.38). The overall revision rate for higher preference access was 22.2% compared to 23.1% for equal/lower preference accesses. Of those accesses that failed, 83.3% of new accesses were created at the original theoretical location while 17.7% required placement of a lower preference access.
Conclusions: Physician-directed ultrasound after BPB allows for identification of more preferential targets for access creation compared to pre-operative vein mapping. For access created at more preferential locations than pre-operatively predicted prior to BPB, there was no difference in maturation rates compared to those created at the theoretical vein mapping location.
Download full-text PDF |
Source |
---|---|
http://dx.doi.org/10.1016/j.avsg.2022.09.032 | DOI Listing |
Pulmonary vein anatomical variations are frequently observed in atrial fibrillation patients undergoing catheter ablation. However, when it comes to patients with atrial fibrillation and bilateral common ostium in the inferior pulmonary veins, using a bilateral circumferential pulmonary vein isolation approach during catheter ablation heightens the risk of esophageal injury. At present, there is no established standard catheter ablation strategy for such cases.
View Article and Find Full Text PDFPacing Clin Electrophysiol
December 2024
Department of Cardiology, International University of Health and Welfare Hospital, Tochigi, Japan.
Background: Cryoballoon ablation has been widely performed in patients with paroxysmal atrial fibrillation (AF). In some challenging pulmonary veins (PVs), the procedure requires additional touch-up applications against the residual conduction gaps. It implies that there could exist difficult sites to cover with standard cryoballoon applications (CBAs), resulting in resistant conduction gaps (RCGs).
View Article and Find Full Text PDFAnn Surg Oncol
December 2024
Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Background: Techniques involving dye injection or regional ischemia are commonly used for the precise identification of liver regions during hepatectomy. The visualization of regions with indocyanine green (ICG) has been widely used for liver segmentation. ICG is typically administered only once during each hepatectomy.
View Article and Find Full Text PDFJAMA Cardiol
December 2024
Section for Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania, Philadelphia.
Importance: Infrequent intraprocedural premature ventricular complexes (PVCs) limit the efficacy of catheter ablation. Intravascular stimulation of sympathetic nerves via vertebral veins (VVs) has been used to activate cardiac sympathetic tone and may promote PVCs.
Objective: To characterize the ability of direct electrical sympathetic stimulation via VVs to induce PVCs at the time of catheter ablation.
JACC Clin Electrophysiol
November 2024
Department of Cardiology, Institute of Science Tokyo, Tokyo, Japan.
Background: Conventional endocardial mapping cannot fully elucidate Marshall bundle (MB)-related atrial tachycardia (AT).
Objectives: This study aimed to clarify the clinical and electrophysiological characteristics of MB-related AT definitively diagnosed using catheter insertion.
Methods: Forty-eight patients with AT who had previously undergone mitral isthmus ablation were enrolled in this study.
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!