Drug Combinations ; Fibrinogen ; therapeutic use ; Fistula ; etiology ; therapy ; Groin ; Humans ; Lymphatic Diseases ; etiology ; therapy ; Postoperative Complications ; therapy ; Thrombin ; therapeutic use ; Treatment Outcome

INTRODUCTIONOne complication of autogenous arteriovenous fistula (AVF) for haemodialysis is the formation of a venous aneurysm.

CLINICAL PICTUREThe clinical picture is typically an expanding aneurysm leading to skin atrophy and ulceration with the risk of rupture and infection. Aneurysm also reduces the potential cannulation area.

TREATMENTThe cases described here used a surgical 'remodelling' technique involving complete skeletonisation of the venous aneurysm, reduction of lumen diameter and retention of vein wall using a Hegar dilatator to remodel a new fistula.

OUTCOMESix patients were treated using this method and the arterior venous shunt (AVS) was used for haemodialysis the following day. No recurrent aneurysm developed.

CONCLUSIONRemodelling of aneurysmal AVF is an effective and low-risk option for managing this kind of complication, allowing direct access for haemodialysis.

Aneurysm ; etiology ; surgery ; Arteriovenous Shunt, Surgical ; adverse effects ; Catheters, Indwelling ; Humans ; Postoperative Complications ; Renal Dialysis ; adverse effects ; methods ; Vascular Surgical Procedures

INTRODUCTIONClotted arteriovenous grafts (AVG) for haemodialysis which are not used (silent grafts) can serve as a potential source of chronic bacterial infection in patients on dialysis programs. In some cases, the local finding is unclear. The patient only suffers from repeated metastatic infection and the detection of AVG infection is difficult. Nuclear medicine methods have the potential to uncover AVG infection. In this study, we correlated the positron emission tomography (PET)/ computed tomography (CT) findings of the AVG examination with the microbiological findings from removed grafts. The aim was to evaluate the relevance of the Fluorodeoxyglucose (FDG) PET/CT method in detecting clotted graft infection.

MATERIAL AND METHODSA cohort of 13 patients with clotted grafts were followed-up. Four patients had overall symptoms of infection and 9 patients were asymptomatic. In all cases, the PET CT examination and microbiological examination of the removed graft were provided.

RESULTSOnly one mismatch-negative PET CT finding and positive microbiological culture was recorded in the 13 followed-up patients.

CONCLUSIONIn patients with silent grafts and recurrent infection of equivocal aetiology, PET CT examination can contribute to the diagnosis of AVG infection and, subsequently, to prevent further infectious complications, if the AVG infection is treated appropriately and the graft is removed.

Bacterial Infections ; epidemiology ; etiology ; Chronic Disease ; Cohort Studies ; Fluorodeoxyglucose F18 ; Humans ; Magnetic Resonance Imaging ; methods ; Microbial Sensitivity Tests ; Positron-Emission Tomography ; Radiopharmaceuticals ; Renal Dialysis ; adverse effects ; Staphylococcal Infections ; epidemiology ; etiology ; Staphylococcus aureus ; Tomography, X-Ray Computed ; methods