Twin anemia-polycythemia sequence (TAPS) is characterized by a wide discrepancy of hemoglobin between two monochorionic fetuses without sign of twin oligo-polyhydramnios sequence. A primiparous woman with monochorionic diamniotic twin transferred for preterm labor. Ultrasonographic evaluation at 32+3 weeks of gestation revealed increased middle cerebral artery-peak systolic velocity (77.4 cm/sec, 1.69 multiples of median) in donor and decreased in recipient twin (36.4 cm/sec, 0.79 multiples of median), the twin was diagnosed with TAPS. Repeated cesarean section was performed at 32+5 weeks of gestation following preeclampsia and preterm labor. After delivery, TAPS was confirmed through neonatal hematologic examination. There were no signs of acute hemorrhagic shock or brain injury. Placental evaluation via dye infusion and barium angiogram revealed one arterioarterial anastomoses with six arteriovenous anastomoses of placenta. We report a prenatally diagnosed case of spontaneous TAPS with arterioarterial and arteriovenous anastomoses and suggest careful monitoring of monochorionic twin and opinion on placenta vascular architecture.
Arteriovenous Anastomosis ; Barium ; Brain Injuries ; Cesarean Section ; Female ; Fetus ; Humans ; Obstetric Labor, Premature ; Placenta ; Pre-Eclampsia ; Pregnancy ; Prenatal Diagnosis* ; Shock, Hemorrhagic ; Tissue Donors ; Twins*

OBJECTIVETo explore the surgical approaches for management of postoperative stenosis of ateriovenous fistula (AVF) in patients with end-stage renal disease (ESRD).

METHODSOf the 415 patients with ESRD receiving radial-cephalic end-to-side anastomosis during the last 3 years, 29 developed postoperative AVF stenosis (of type Ia in 5 cases, type Ib in 17 cases, type II in 3 cases, and type II in 2 cases). A proximal anastomosis was created between the radical artery and cephalic vein for type Ia stenosis. In the 17 cases with type I b stenosis, 5 were managed by interception of suitable segments from the accessory cephalic veins for cephalic vein reconstructions, and 12 by transposition of the accessory cephalic veins. Of 3 cases with type II stenosis, 1 was managed by interception of the accessory cephalic vein for interposing into the cephalic vein, 1 by interception of the distal great saphenous vein for interposing into the cephalic vein, and 1 by transposition of the forearm basilic vein for end-to-side anastomosis with the radial artery. The 2 cases with type III were managed by end-to-side anastomosis between the forearm basilic vein and the radial artery or by conversion to AVF repair on the contralateral forearm.

RESULTSTwenty-eight of the 28 patients finally received surgical repair of AVF stenosis and the surgeries were completed successfully. Thrombosis of the outflow vein occurred 12 h after the repair in 1 case to require emergency embolectomy and anastomosis; restenosis occurred in 2 cases at 9 months postoperatively, for which progressive percutaneous transluminal angioplasty (PTA) was performed. The rate of restenosis was 7.1% (2/28). All the 28 patients undergoing AVF stenosis repair had successful HD for 12 months after the operation.

CONCLUSIONReconstructing the arteriovenous anastomosis, replacing the stenosis segment with an accessory cephalic vein or great saphenous vein graft, or altering the outflow with the forearm basilic vein can be surgical options for repairing postoperative AVF stenosis.

Aged ; Anastomosis, Surgical ; Arteriovenous Fistula ; surgery ; Arteriovenous Shunt, Surgical ; Brachiocephalic Veins ; surgery ; Constriction, Pathologic ; surgery ; Diabetic Nephropathies ; surgery ; Female ; Humans ; Male ; Middle Aged ; Radial Artery ; surgery

Inadvertent left internal mammary artery (LIMA)-great cardiac vein (GCV) anastomosis is a rare complication of coronary artery bypass graft surgery. Patients with iatrogenic aortocoronary fistula (ACF) were usually treated surgical repair, percutaneous embolic occlusion with coil or balloon. We report a case of iatrogenic LIMA to GCV anastomosis successfully treated with coil embolization and protected left main coronary intervention through the percutaneous transfemoral approach.
Arteriovenous Fistula ; Coronary Artery Bypass ; Embolization, Therapeutic ; Fistula ; Humans ; Internal Mammary-Coronary Artery Anastomosis ; Mammary Arteries ; Transplants ; Veins

Inadvertent left internal mammary artery (LIMA)-great cardiac vein (GCV) anastomosis is a rare complication of coronary artery bypass graft surgery. Patients with iatrogenic aortocoronary fistula (ACF) were usually treated surgical repair, percutaneous embolic occlusion with coil or balloon. We report a case of iatrogenic LIMA to GCV anastomosis successfully treated with coil embolization and protected left main coronary intervention through the percutaneous transfemoral approach.
Arteriovenous Fistula ; Coronary Artery Bypass ; Embolization, Therapeutic ; Fistula ; Humans ; Internal Mammary-Coronary Artery Anastomosis ; Mammary Arteries ; Transplants ; Veins

PURPOSE: The authors of the present case report observed a bilateral retinal racemose hemangioma which was located within the peripapillary area. CASE SUMMARY: A 17-year-old man presented with floaters in both eyes. Fundus revealed tortuous and anastomosed retinal vasculature around the optic disc. In addition, fluorescein angiography showed a non-leaking retinal arteriovenous anastomosis. Seven years after the initial visit, vitreous hemorrhage occurred in the patient's left eye, and then 1 year later, subretinal hemorrhage was found in his left eye. CONCLUSIONS: Because retinal racemose hemangioma can accompany vitreous hemorrhage and subretinal hemorrhage regardless of size, a routine periodic ophthalmic examination is recommended.
Adolescent ; Arteriovenous Anastomosis ; Eye ; Fluorescein Angiography ; Hemangioma ; Hemorrhage ; Humans ; Retinaldehyde ; Vitreous Hemorrhage

Glomus tumors are rare neoplasms that originate from the glomus bodies, an arteriovenous anastomosis with a specialized vascular structure. The most common site for these tumors is the subungal region of the fingers. Occasionally, glomus tumors are found in the middle ear, trachea, nasal cavities, stomach, and lungs. The occurrence in the parotid regions is very rare. While multiple glomus tumors in the whole body are thought to represent only 10% of all cases, instances of multiple tumors in the neck have not yet been reported in the literature. We report a case of double glomus tumors in the submandibular and parotid regions.
Arteriovenous Anastomosis ; Ear, Middle ; Fingers ; Glomus Tumor ; Lung ; Nasal Cavity ; Neck ; Parotid Region ; Stomach ; Trachea

Glomus tumors are rare neoplasms that originate from the glomus bodies, an arteriovenous anastomosis with a specialized vascular structure. The most common site for these tumors is the subungal region of the fingers. Occasionally, glomus tumors are found in the middle ear, trachea, nasal cavities, stomach, and lungs. The occurrence in the parotid regions is very rare. While multiple glomus tumors in the whole body are thought to represent only 10% of all cases, instances of multiple tumors in the neck have not yet been reported in the literature. We report a case of double glomus tumors in the submandibular and parotid regions.
Arteriovenous Anastomosis ; Ear, Middle ; Fingers ; Glomus Tumor ; Lung ; Nasal Cavity ; Neck ; Parotid Region ; Stomach ; Trachea

PURPOSE: The vessels of the finger tip are very small and fragile, have many branches, so the anastomosis of this vessel is very difficult. Guillotine type amputation of digits are rare, on the other hand, crush/avulsion injuries which require complex surgical solutions are more frequent. We often found that the arteries of distal amputee on crush/avulsion injuries are lost. In these cases, replantation is much more difficult even impossible. But when replantation is successes, the replantated finger tip provides adequate soft tissue, restoration of length, sensory and nail. MATERIALS AND METHODS: We report here our experience of finger tip replantation using afferent a-v anastomosis technique accumulated from March 2006 to March 2009. RESULT: The success rate was 96.4%. Complications occurred in eight patients. (5 digit atrophy, 1 osteomyelitis, 1 severe digit pain and 1 cold intolerance) CONCLUSIONS: We believe that the afferent a-v anastomosis replantation provides us wider range of indication of finger tip replantation on crush/avulsion injuries.
Amputation ; Amputees ; Arteries ; Arteriovenous Anastomosis ; Atrophy ; Cold Temperature ; Fingers ; Glycosaminoglycans ; Hand ; Humans ; Osteomyelitis ; Replantation

PURPOSE: The purpose of this study was to evaluate the efficacy of percutaneous transluminal angioplasty (PTA) in facilitating maturation of autogenous arteriovenous fistulae. MATERIALS AND METHODS: There were 12 immature autogenous arteriovenous fistulae. We performed 15 PTAs transvenously. Post-intervention anatomic and clinical successes were estimated, and the 6-month and 1-year primary and secondary patency rates were calculated using Kaplan-Meier analysis. RESULTS: All immature fistulae had underlying stenosis (n=20): arteriovenous anastomosis (n=1) and venous outflow (n=19): 1) within 5 cm from the anastomosis (n=10); 2) more than 5 cm but less than 10 cm from the anastomosis (n=5); 3) more than 10 cm from the anastomosis, including central veins (n=4). Six fistulae had two or more stenoses. Repeat intervention was necessary in two patients. The anatomical success rate was 94.3%, and the clinical success rate was 86.7%. The 6-month and 1-year primary patency rates were 72.7% and 54.5%, and the secondary patency rates were 100% and 81.8%, respectively. CONCLUSION: All immature hemodialysis fistulae have underlying stenosis, most of which are located near the arteriovenous anastomosis. Early interventional procedures are helpful in the salvage and maintenance of immature arteriovenous fistulae, with a high degree of success.
Angioplasty ; Angioplasty, Balloon ; Arteriovenous Anastomosis ; Arteriovenous Fistula ; Constriction, Pathologic ; Fistula ; Humans ; Renal Dialysis ; Veins

Twin-twin transfusion syndrome (TTTS) is a complex cardiovascular disease affecting monochorionic (MC) twin pregnancies, and has a high perinatal mortality rate. Its pathogenesis remains poorly understood, but TTTS involves unbalanced transfusion of blood from a donor to a recipient along one or more placental arteriovenous anastomosis in absence of adequate compensatory superficial counter-transfusion. Recent data demonstrated laser ablation to be better than amnioreduction, especially when the condition develops before 26 weeks of gestation.
Arteriovenous Anastomosis ; Cardiovascular Diseases ; Humans ; Laser Therapy ; Perinatal Mortality ; Pregnancy ; Pregnancy, Twin ; Tissue Donors