The case of a cyanotic infant with a rare combination of atypical pulmonary artery sling, imperforate anus, absence of the left kidney, interruption of the inferior vena cava, left side hemihypertrophy and diffuse-type pulmonary arteriovenous fistula is described. The clinical features were confusing, because of compounding abnormalities involving the respiratory tract and pulmonary circulation. The diagnostic approach to the etiology of cyanosis is discussed and the embryonic origin of pulmonary artery sling is reviewed.
Arteriovenous Fistula/ultrasonography ; Arteriovenous Fistula/pathology* ; Case Report ; Human ; Infant ; Male ; Pulmonary Artery/pathology*

No abstract available.
Arteriovenous Fistula* ; Cerebral Infarction ; Intracranial Embolism* ; Ultrasonography, Doppler, Transcranial

The authors report a patient with a small traumatic cirsoid aneurysm of the scalp, diagnosed by duplex doppler ultrasonography. This 15-year-old boy was diagnosed as a cirsoid aneurysm by duplex doppler ultrasonogram which revealed an ovoid cystic lesion at left temporal area of scalp containing vascular flow mapping. The gross appearance showed an aneurysm with arteriovenous fistula, consisting of two feeding arteries and two draining veins. Total removal of mass was made and the histological examination revealed an aneurysm which showing irregular contour of inner surface and thickened fibrotic vascular wall without normal arterial layers. Noninvasive duplex doppler ultrasonography before surgical excision or direct puncture embolization of cirsoid aneurysms of the scalp could be recommended as an alternative management option.
Adolescent ; Aneurysm* ; Arteries ; Arteriovenous Fistula ; Humans ; Male ; Punctures ; Scalp* ; Ultrasonography ; Ultrasonography, Doppler* ; Ultrasonography, Doppler, Duplex ; Veins

Arteriovenous graft for hemodialysis vascular access is a widely used technique with many advantages. However, it has crucial complications with graft thrombosis and infection. We recently experienced an unusual case of arteriovenous graft complication involving graft thrombosis related to fistula formation between the graft and the natural vein with infection. We diagnosed this condition using Doppler ultrasound and computed tomography angiography. Successful surgical treatment including partial graft excision and creation of a secondary arteriovenous fistula using an inadvertently dilated cephalic vein was performed. The dialysis unit staff should keep this condition in mind and try to prevent this complication.
Angiography ; Arteriovenous Fistula ; Dialysis ; Fistula* ; Renal Dialysis ; Thrombosis* ; Transplants* ; Ultrasonography ; Veins*

BACKGROUND: For hemodialysis patients with end-stage renal disease (ESRD), it is important to construct an efficient vascular access with a superior patency rate. This study investigated the factors influencing the efficiency of arteriovenous fistulas (AVFs) constructed using an autologous vessel and evaluated the necessity of ultrasonography as a preoperative tool for AVF construction. METHODS: A retrospective analysis was performed of 250 patients in whom an AVF was constructed using an autologous vessel due to ESRD at our institution from January 2009 to April 2016. RESULTS: The 1-, 3-, and 5-year patency rates for all subjects were 87.6%, 85.6%, and 84.4%, respectively. The patients who underwent a preoperative evaluation of their vessels via ultrasonography had better patency rates than those who did not. Superior patency rates were found in patients under 65 years of age or with an anastomotic vein diameter of 3 mm or more. The 1-year patency rate and the diameter of the anastomotic vein showed a positive relationship. CONCLUSION: Ultrasonography is strongly recommended for AVF construction, and efforts should be made to increase the patency rate in patients over 65. Superior clinical results can be expected when an AVF is made using an autologous vessel with an anastomotic vein diameter of at least 3 mm.
Arteriovenous Fistula* ; Fistula ; Humans ; Kidney Failure, Chronic* ; Renal Dialysis* ; Retrospective Studies ; Ultrasonography ; Veins

OBJECTIVE: To evaluate the efficacy of ultrasound or fluoroscopic-guided percutaneous transluminal angioplasty (PTA) combined with thrombolysis for the treatment of acutely thrombosed arteriovenous fistula (AVF) or grafts (AVG). METHODS: One hundred and ninety-two hemodialysed patients, in whom the thrombosed arterio-venous AVF or AVG developed less than 72 h and there were no contraindications for thrombolysis and PTA, underwent PTA combined with thrombolysis therapy in Sir Run Run Shaw Hospital of Zhejiang University from October 2014 to October 2017. Under ultrasound and/or fluoroscopic guidance, balloon catheter was introduced to thrombosis sites along a guide wire. Then the balloon was inflated and normal saline mixed with urokinase and heparin was injected for thrombolysis. After blood flow was restored, angioplasty was performed on vascular stenosed sites. RESULTS: A total of 274 endovascular interventional operations were performed for 192 patients. The procedure success rate was 98.2%, clinical success rate was 93.8%and complication rate was 1.46%. The post-intervention primary patency rates for AVF group were 87.4%, 76.7%and 63.9%at 3, 6 and 12 months, respectively; while the post-intervention secondary patency rates were 93.7%, 91.6%and 83.0%, respectively. The post-intervention primary patency rates for AVG group were 60.7%, 51.5%and 43.1%at 3, 6 and 12 months, while the post-intervention secondary patency rates were 82.7%, 77.1%and 70.8%, respectively. CONCLUSIONS PTA combined with thrombolysis is an effective and safe therapeutic option for AVF and AVG thrombosis, which would prolong hemodialysis access and save vascular resources for hemodialyzed patients.
Angioplasty ; Arteriovenous Fistula ; Arteriovenous Shunt, Surgical ; Humans ; Renal Dialysis ; Retrospective Studies ; Thrombolytic Therapy ; Thrombosis ; surgery ; Treatment Outcome ; Ultrasonography

PURPOSE: We have already reported on a new method to calculate the intra-vascular conduit flow rate based on Bernoulli's theory for maintaining surveillance of the arteriovenous fistula (AVF) function. To assess the clinical validity of our methods, we examined a trend analysis on the calculated flow rate in hemodialysis vascular conduits. METHODS: From a total of 27 cases of native AVFs that were at least 3 months after construction, we measured the AVF flow rate (Q(D)) with Doppler ultrasonography first. When Q(D) was below 600 ml/min, a fistulogram was taken. The intra-vascular conduit static pressure (ps) was measured, and the flow rate (Q(a)) was calculated every month with using the mean arterial pressure. The patients with a decreased Q(a) of more than 10% over 3 months were referred for a diagnostic fistulogram. RESULTS: Twenty-seven AVFs were studied after 29.5+/-28.5 (4~120) months of operation. The mean Q(D) was 980.6+/-501.6 (144~2,230) ml/min. In 6 patients who showed a Q(D) less than 600 ml/min, 4 pathologic lesions were found on the diagnostic fistulogram: juxta-anastomosis stenosis (n=3) and a draining venous stenosis (n=1). Three patients who showed a Q(a) decrement were confirmed as having a draining venous stenosis. However, any unpredictable thrombosis with proximal stenosis (n=2) couldn't be detected. CONCLUSION: Q(a) represents the narrowing of the draining vein of an internal AVF. However, arterial or venous narrowing that is proximal to the arterial puncture site couldn't be detected with the calculated intra-conduit flow rate. The development of new methods that can detect proximal vascular stenosis and that can be used in combination with our method is anticipated in the near future.
Arterial Pressure ; Arteriovenous Fistula* ; Constriction, Pathologic ; Humans ; Punctures ; Renal Dialysis* ; Thrombosis ; Ultrasonography, Doppler ; Veins

BACKGROUND: Prophylactic stenosis correction is important in the durability of the vascular access, and routine surveillance for the detection of stenosis has been widely recommended to allow preemptive intervention before thrombotic occlusion. The ultrasound dilution technique has been considering not only a popular and validated in vascular access surveillance, but also useful in the measurement of access recirculation and cardiac output. METHODS: Access flow, recirculation, and cardiac output of seventy-six hemodialysis patients with arteriovenous fistulae were measured by ultrasound dilution technique, followed by access flow measurement by color doppler ultrasound in sixty-four patients. Access stenosis was defined as 50% and more reduction in the diameter of vessels by color doppler ultrasound. Cardiac output of thirty-seven patients by echocardiography within a year was also analyzed. RESULTS: Access stenosis was diagnosed in six of sixty-four patients by color doppler ultrasound (9.4%). Access flow in the group with stenosis (621+/-322 mL/min) was lower than the group without stenosis (1, 005+/-633 mL/min), but no statistical significance was found. The access flow measured by ultrasound dilution technique was significantly correlated with color doppler ultrasound (r=0.436, p= 0.01). The cardiac output measured by ultrasound dilution technique was also significantly correlated with echocardiography (r=0.660, p=0.01). CONCLUSION: The data did not provide statistical significances for the detection of stenosis by ultrasound dilution technique. But this study suggests that ultrasound dilution technique is a useful method in the measurement of access flow, cardiac output and recirculation. We hope further prospective studies based on our data will be performed.
Arteriovenous Fistula ; Cardiac Output ; Constriction, Pathologic ; Echocardiography ; Hope ; Humans ; Indicator Dilution Techniques ; Renal Dialysis* ; Ultrasonography*

BACKGROUND: Maintenance of a well-functioning vascular access and minimal needling pain are important goals for achieving adequate dialysis and improving the quality of life in hemodialysis (HD) patients. Far-infrared (FIR) therapy may improve endothelial function and increase access blood flow (Qa) and patency in HD patients. The aim of this study was to evaluate effects of FIR therapy on Qa and patency, and needling pain in HD patients. METHODS: This prospective clinical trial enrolled 25 outpatients who maintained HD with arteriovenous fistula. The other 25 patients were matched as control with age, sex, and diabetes. FIR therapy was administered for 40 minutes during HD 3 times/wk and continued for 12 months. The Qa was measured by the ultrasound dilution method, whereas pain was measured by a numeric rating scale at baseline, then once per month. RESULTS: One patient was transferred to another facility, and 7 patients stopped FIR therapy because of an increased body temperature and discomfort. FIR therapy improved the needling pain score from 4 to 2 after 1 year. FIR therapy increased the Qa by 3 months and maintained this change until 1 year, whereas control patients showed the decrease in Qa. The 1-year unassisted patency with FIR therapy was not significantly different from control. CONCLUSION: FIR therapy improved needling pain. Although FIR therapy improved Qa, the unassisted patency was not different compared with the control. A larger and multicenter study is needed to evaluate the effect of FIR therapy.
Arteriovenous Fistula ; Body Temperature ; Dialysis ; Humans ; Outpatients ; Prospective Studies ; Quality of Life ; Renal Dialysis* ; Ultrasonography

PURPOSE: A native vessel is preferable to an artificial graft for dialysis access. Duplex ultrasound (DUS) is noninvasive, cost-effective modality to evaluate the vessels for dialysis. The purpose of this study was to compare the rates of utilization of native vessels after preoperative imaging with DUS and contrast venography (CV). MATERIALS AND METHODS: A retrospective review was performed on patients who received an arteriovenous fistula (AVF) or arteriovenous graft (AVG) between June 2006 and July 2010. Patients were classified into 3 groups. In group 1, CV was used to evaluate the vessel. Both DUS and CV were used in group 2. In group 3, only DUS was used. The frequency of utilization of a native vessel was analyzed in each group. The chi-square test was used for statistical analysis. RESULTS: During the study period, 173 patients received an AVF or AVG. Eighty-nine patients were male. The mean age was 60.6±14.6 years. A native vessel was used in 56/81 patients (69.1%) and 74/81 patients (91.4%) in groups 1 and 3, respectively (P<0.001). In group 2, all patients underwent access procedures using native vessels. AVG was initially planned for 2 patients in group 2 after vessel evaluation using CV, but a native vessel was successfully used because DUS identified optimal vessels for AVF. The 1-year primary patency rate was similar in 3 groups. CONCLUSION: Preoperative DUS is safe and easy to use for vessel evaluation, and can be used as a primary imaging modality for creation of access.
Arteriovenous Fistula ; Dialysis ; Humans ; Male ; Phlebography ; Renal Dialysis* ; Retrospective Studies ; Transplants ; Ultrasonography*