Central venous lesion is a difficult problem in the vascular access complications of hemodialysis, which can cause serious clinical symptoms and affect the quality of hemodialysis and life of patients. We established arteriovenous fistula of the contralateral graft blood vessel with the used vein on the diseased side of the central vein of the patient. The arteriovenous fistula of the graft blood vessel was successfully punctured and hemodialysis was performed 2 weeks later. In this way, we not only solved the problem of venous hypertension and subsequent vascular access in the patient, but also reserved more vascular resources.
Humans ; Arteriovenous Shunt, Surgical/adverse effects* ; Blood Vessel Prosthesis Implantation ; Treatment Outcome ; Renal Dialysis ; Arteriovenous Fistula

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

INTRODUCTIONAn arteriovenous fistula (AVF) is the preferred method for haemodialysis in patients with end-stage renal failure. Previous studies have shown value in attempting percutaneous transluminal angioplasty (PTA) to salvage AVFs that fail to mature, but they are relatively small in size and mainly reported in Western populations. We reviewed our data of PTA in non-maturing AVFs to establish whether this technique is translatable to our local multiethnic population.

MATERIALS AND METHODSWe retrospectively reviewed the medical records and procedural images of 105 patients who had PTA for non-maturing AVFs performed at our department from January 2008 to January 2011. Technical success was defined as ≤30% residual stenosis after angioplasty. Clinical success was defined as at least 1 successful haemodialysis session within 4 weeks after PTA.

RESULTSAll 105 patients underwent angioplasty for at least 1 haemodynamically significant stenosis. Six (5.7%) had additional embolisation of accessory veins. Technical success was achieved in 95.2% of cases. The clinical success rate was 76.2%. Primary patency rates at 3, 6 and 12 months were 83%, 45% and 28%, respectively. Secondary patency rates at 3, 6 and 12 months were 90%, 79% and 70%, respectively. The minor complication rate was 18.1%. No major complications were encountered. An average of 1.7 interventions per access-year was required to maintain AVF patency. Patients with a preoperative vein size >2.0 mm and age <55 years were more likely to achieve clinical success, although not statistically significant.

CONCLUSIONPTA is a viable option to help salvage non-maturing AVFs in a multiethnic Asian population.

Angioplasty ; methods ; Arteriovenous Shunt, Surgical ; Constriction, Pathologic ; therapy ; Embolization, Therapeutic ; Female ; Humans ; Kidney Failure, Chronic ; therapy ; Male ; Middle Aged ; Renal Dialysis ; Reoperation ; Retrospective Studies ; Singapore ; Veins

Angiography ; Arteriovenous Shunt, Surgical ; Brachiocephalic Veins ; diagnostic imaging ; Collateral Circulation ; Constriction, Pathologic ; diagnostic imaging ; Female ; Humans ; Jugular Veins ; diagnostic imaging ; Kidney Failure, Chronic ; therapy ; Male ; Middle Aged ; Phlebography ; Renal Dialysis ; methods ; Subclavian Vein ; diagnostic imaging ; Vascular Access Devices

Arteriovenous Shunt, Surgical ; adverse effects ; Brachial Artery ; diagnostic imaging ; Diabetic Nephropathies ; complications ; therapy ; Hematoma ; complications ; diagnostic imaging ; Humans ; Magnetic Resonance Imaging ; Male ; Median Neuropathy ; diagnostic imaging ; etiology ; physiopathology ; Middle Aged ; Neural Conduction ; Renal Dialysis ; Ultrasonography

INTRODUCTIONThe key to treatment of a thrombosed dialysis graft is restoration and maintenance of function as long as possible. The objective of this study was to compare the outcomes of pharmacomechanical thrombolysis and surgical thrombectomy in the treatment of thrombosed haemodialysis grafts.

MATERIALS AND METHODSDuring a 3-year period, 108 patients with 114 thrombosed dialysis grafts were referred to our institute for treatment. Fifty thrombosed dialysis grafts underwent pulse-spray catheter thrombolysis using recombinant tissue plasminogen activator (rt-PA) with angioplasty, and 64 thrombosed dialysis grafts underwent surgical thrombectomy. The procedural success rates, complications and average patency times and patency rates were compared between the 2 procedures. P values less than 0.05 were considered to be statistically significant.

RESULTSThere were no statistically significant differences between the pharmacomechanical thrombolysis group and the thrombectomy group in the procedural success rates (94% and 93.8%, P = 0.15) or average patency times (6.24 months and 6.30 months, P = 0.17). The primary and secondary patency rates at 12 months were 28.0% ± 8.4% and 54.3% ± 7.8% for the thrombolysis with angioplasty group, and 30.0% ± 6.3% and 57.0% ± 4.8% for the thrombectomy group, respectively (P = 0.65 and P = 0.49, respectively). There were no procedural-related major complications.

CONCLUSIONOur study found no differences in outcomes between patients treated with pharmacomechanical thrombolysis and surgical thrombectomy for thrombosed haemodialysis grafts. Pharmacomechanical thrombolysis can be considered as an alternative treatment for dialysis graft thrombosis.

Aged ; Arteriovenous Shunt, Surgical ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Thrombectomy ; methods ; Thrombosis ; drug therapy

OBJECTIVE: To evaluate the technical aspects and outcomes of endovascular recanalization of a thrombosed native arteriovenous fistula (AVF) complicated with an aneurysm. MATERIALS AND METHODS: Sixteen patients who had a thrombosed AVF complicated with an aneurysm (two radiocephalic and 14 brachiocephalic) were included in this study. Recanalization procedures were performed by mechanical thrombectomy using the Arrow-Trerotola percutaneous thrombectomy device and adjunctive treatments. We evaluated dose of thrombolytic agent, underlying stenosis, procedure time, technical and clinical success, and complications. The primary and secondary patency rates were calculated using the Kaplan-Meier analysis. RESULTS: The thrombolytic agents used were 100000 U urokinase mixed with 500 IU heparin (n = 10) or a double dose of the mixture (n = 6). The thrombi in aneurysms were removed in all but two patients with non-flow limiting residual thrombi. One recanalization failure occurred due to a device failure. Aspiration thrombectomy was performed in 87.5% of cases (n = 14). Underlying stenoses were found in the outflow draining vein (n = 16), arteriovenous anastomosis or juxtaanastomosis area (n = 5), and the central vein (n = 3). Balloon angioplasty was performed for all stenoses in 15 patients. Two patients with a symptomatic central vein stenosis underwent insertion of a stent after balloon angioplasty. Mean procedure time was 116.3 minutes. Minor extravasation (n = 1) was resolved by manual compression. Both technical and clinical success rates were 93.8% (n = 15). The primary patency rates at 3, 6, and 12 months were 70.5%, 54.8%, and 31.3%, respectively. The secondary patency rates at 3, 6, and 12 months were 70.5%, 70.5%, and 47.0%, respectively. CONCLUSION: Thrombosed AVF complicated with an aneurysm can be successfully recanalized, and secondary patency can be prolonged with endovascular treatment.
Aged ; Aged, 80 and over ; Aneurysm/complications/*surgery ; Angioplasty, Balloon ; Arteriovenous Fistula/*surgery ; Arteriovenous Shunt, Surgical/adverse effects ; Constriction, Pathologic/complications ; Endovascular Procedures ; Equipment Failure ; Female ; Fibrinolytic Agents/therapeutic use ; Heparin/therapeutic use ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Retrospective Studies ; Stents/adverse effects ; Thrombectomy/instrumentation/*methods ; Thrombosis/etiology/*surgery ; Urokinase-Type Plasminogen Activator/therapeutic use ; Vascular Patency ; Veins

OBJECTIVE: To evaluate the service life of the arteriovenous fistula (AVF) in patients with dialysis and to explore the associated factors for AVF service life.
 METHODS: A cohort study regarding 472 cases with AVFs at the Second Xiangya Hospital from January 2009 to December 2009 was retrospectively analyzed. The AVF placement-associated primary and secondary failure rates, complications and various risk factors were examined. Kaplan-Meier survival curves and Cox proportional hazard models were used to determine the service life and associated factors.
 RESULTS: By the end of January 1st, 2014, after excluding the patients with indeterminate outcome (72 lost to follow-up; 101 died; 44 transplanted), the primary failure rate was 10.9%, the survival rate for 1, 3 or 5 years was 80.5%, 65.1% or 50.5%. The complication rate and hospitalization rate for AVF were 39.8% and 9.8%, respectively. The influential factors for AVF were diastolic hypotension (HR: 0.86; 95% CI: 0.82 to 0.89), diabetes (HR: 1.87; 95% CI: 1.32 to 3.31) and serum albumin (HR: 0.83; 95% CI: 0.74 to 0.94).
 CONCLUSION The complications after AVF placement must be considered before the surgery schedule. Hypotension, diabetes and serum albumin are the main risk factors for AVF service life.
Arteriovenous Fistula ; pathology ; Arteriovenous Shunt, Surgical ; Hospitalization ; statistics & numerical data ; Humans ; Kaplan-Meier Estimate ; Proportional Hazards Models ; Renal Dialysis ; Retrospective Studies ; Risk Factors ; Survival Analysis

OBJECTIVETo investigate risk factors for the occurrence of shunt-dependent hydrocephalus in patients with aneurysmal subarachnoid hemorrhage (aSAH).

METHODSA cohort of 136 consecutive patients who were treated for ruptured aneurysms within 72 h after onset of aSAH from January 2011 to January 2013 were retrospectively analyzed. Lumbar drainage was performed during the surgery in all patients. The risk factors of shunt-dependent hydrocephalus were analyzed.

RESULTSOf 136 patients, 23 (16.91%) underwent shunt operation to treat shunt-dependent hydrocephalus. Univariate analysis showed that Hunt-Hess grade at admission (P<0.01), Fisher grade (P<0.01), the presence of intraventricular hemorrhage (P<0.01), location of ruptured aneurysm (P=0.001), and the average daily volume of cerebrospinal fluid drainage (CSF) (P=0.047) were associated with shunt-dependent hydrocephalus.

CONCLUSIONThe aSAH patients with poor Hunt-Hess grade at admission, high Fisher grade, the presence of intraventricular hemorrhage, ruptured aneurysm in posterior circulation, and abnormal average daily volume of CSF are more likely to develop shunt-depended hydrocephalus.

Adult ; Aged ; Aneurysm, Ruptured ; complications ; Arteriovenous Shunt, Surgical ; adverse effects ; Female ; Humans ; Hydrocephalus ; etiology ; prevention & control ; Intracranial Aneurysm ; complications ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Subarachnoid Hemorrhage ; etiology ; surgery

OBJECTIVE: The current study retrospectively evaluated whether the percutaneous N-butyl cyanoacrylate (NBCA) seal-off technique is an effective treatment for controlling the angioplasty-related ruptures, which are irresponsive to prolonged balloon tamponade, during interventions for failed or failing hemodialysis vascular accesses. MATERIALS AND METHODS: We reviewed 1588 interventions performed during a 2-year period for dysfunction and/or failed hemodialysis vascular access sites in 1569 patients. For the angioplasty-related ruptures, which could not be controlled with repeated prolonged balloon tamponade, the rupture sites were sealed off with an injection of a glue mixture (NBCA and lipiodol), via a needle/needle sheath to the rupture site, under a sonographic guidance. Technical success rate, complications and clinical success rate were reported. The post-seal-off primary and secondary functional patency rates were calculated by a survival analysis with the Kaplan-Meier method. RESULTS: Twenty ruptures irresponsive to prolonged balloon tamponade occurred in 1588 interventions (1.3%). Two technical failures were noted; one was salvaged with a bailout stent-graft insertion and the other was lost after access embolization. Eighteen accesses (90.0%) were salvaged with the seal-off technique; of them, 16 ruptures were completely sealed off, and two lesions were controlled as acute pseudoaneurysms. Acute pseudoaneurysms were corrected with stentgraft insertion in one patient, and access ligation in the other. The most significant complication during the follow-up was delayed pseudoaneurysm, which occurred in 43.8% (7 of 16) of the completely sealed off accesses. Delayed pseudoaneurysms were treated with surgical revision (n = 2), access ligation (n = 2) and observation (n = 3). During the follow-up, despite the presence of pseudoaneurysms (acute = 1, delayed = 7), a high clinical success rate of 94.4% (17 of 18) was achieved, and they were utilized for hemodialysis at the mean of 411.0 days. The post-seal-off primary patency vs. secondary patency at 90, 180 and 360 days were 66.7 +/- 11.1% vs. 94.4 +/- 5.4%; 33.3 +/- 11.1% vs. 83.3 +/- 8.8%; and 13.3 +/- 8.5% vs. 63.3 +/- 12.1%, respectively. CONCLUSION: Our results suggest that the NBCA seal-off technique is effective for immediate control of a venous rupture irresponsive to prolonged balloon tamponade, during interventions for hemodialysis accesses. Both high technical and clinical success rates can be achieved. However, the treatment is not durable, and about 40% of the completely sealed off accesses are associated with developed delayed pseudoaneurysms in a 2-month of follow-up. Further repair of the vascular tear site, with surgery or stent-graft insertion, is often necessary.
Aged ; Aneurysm, False/etiology/therapy ; Angioplasty, Balloon/*adverse effects ; Arteriovenous Shunt, Surgical/*adverse effects ; Enbucrilate/*administration & dosage ; Ethiodized Oil/administration & dosage ; Female ; Graft Occlusion, Vascular/etiology/*therapy ; Humans ; Male ; *Renal Dialysis ; Retrospective Studies ; Rupture ; Survival Analysis ; Treatment Outcome ; Ultrasonography, Interventional ; Vascular Patency