AV Graft Thrombosis | ScienceGate

Endovascular treatment of arteriovenous graft dysfunction as a result of graft delamination and fracture

CVIR Endovascular ◽

10.1186/s42155-020-00181-8 ◽

2021 ◽

Vol 4 (1) ◽

Author(s):

Aditi Chaurasia ◽

Tushar Garg ◽

Rakesh Ahuja ◽

Michael Ferra

Keyword(s):

Quality Care ◽

Arteriovenous Graft ◽

Level Of Evidence ◽

Graft Thrombosis ◽

Provide Quality Care ◽

Arteriovenous Grafts ◽

Clot Material ◽

Stage Renal Disease ◽

End Stage ◽

Av Graft

Abstract Background Graft thrombosis due to fabric delamination is a rare cause of delayed failure of arteriovenous grafts. Graft delamination is primarily an imaging diagnosis and is confirmed with the help of ultrasound which shows the separation of graft fabric layers. Only two such cases have been described in the literature so far. Case presentation We present a case of upper extremity arteriovenous graft thrombosis in a 79 year old COVID-19 positive patient with end-stage renal disease. The diagnosis was established on ultrasonography which revealed separation of the graft fabric layers with thrombosis within the “false” and “true” lumen of the graft. The patient was managed with angioplasty and embolectomy of the clot material followed by stent-graft placement across the delaminated portion of the graft. Post-procedural angiography confirmed brisk flow across the graft and patient could successfully have subsequent hemodialysis sessions. Conclusions Identification of graft delamination as a cause of graft failure is important as its management differs from other conventional causes since it requires stent-grafts to cover the area of delamination to re-establish flow and salvage the AV graft. The recognition of this phenomenon is essential to provide quality care and successful reuse of the AV graft. Level of evidence Level 4, Case Report.

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Factor V Leiden (FV Leiden) and AV Graft thrombosis(AVG) in children with end stage renal disease(ESRD). 1685

Pediatric Research ◽

10.1203/00006450-199704001-01704 ◽

1997 ◽

Vol 41 ◽

pp. 283-283

Author(s):

Yatin Shah ◽

Ninad Desai ◽

Anup Singh ◽

Amir Tejani ◽

Marc S.C. Cheah

Keyword(s):

Renal Disease ◽

End Stage Renal Disease ◽

Factor V Leiden ◽

Factor V ◽

Graft Thrombosis ◽

Fv Leiden ◽

Stage Renal Disease ◽

End Stage ◽

Av Graft

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Abstract No. 94: Locally Applied Recombinant Plasmin Results in Effective Thrombolysis in a Porcine Model of AV Graft Thrombosis

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2007.12.105 ◽

2008 ◽

Vol 19 (2) ◽

pp. S37-S38

Author(s):

I.E. Hoefer ◽

E.S. Stroes ◽

G. Pasterkamp ◽

M. Levi ◽

J.A. Reekers ◽

...

Keyword(s):

Porcine Model ◽

Graft Thrombosis ◽

Av Graft

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Extended Venous Resections for Borderline Resectable Pancreatic Head Adenocarcinoma—A Retrospective Studies of Nine Cases

Healthcare ◽

10.3390/healthcare9080978 ◽

2021 ◽

Vol 9 (8) ◽

pp. 978

Author(s):

Nicolae Bacalbasa ◽

Irina Balescu ◽

Mihai Dimitriu ◽

Cristian Balalau ◽

Florentina Furtunescu ◽

...

Keyword(s):

Pancreatic Cancer ◽

Portal Vein ◽

Radical Surgery ◽

Portal Vein Resection ◽

Resectable Pancreatic Cancer ◽

Borderline Resectable ◽

Venous Resection ◽

Graft Thrombosis ◽

Borderline Resectable Pancreatic Cancer ◽

Vein Resection

Background: pancreatic cancer is one of the most lethal malignancies and a leading cause of cancer-related death worldwide. The only chance to improve the long-term outcomes of patients with pancreatic cancer is surgery with radical intent. Methods: in the present paper, we aim to describe a case series of 9 patients submitted to radical surgery for borderline resectable pancreatic cancer. Results: in all cases, negative resection margins were achieved. The types of venous resection consisted of tangential portal vein resection in four cases, circumferential portal vein resection with direct reanastomosis in one case and circumferential resection with graft placement in another four cases; postoperatively, one patient developed a vascular surgery-related complication consisting of graft thrombosis and thus necessitated prolonged anticoagulant therapy. Conclusions: extended venous resections can be a safe and efficient way to maximize the benefits of radical surgery in locally advanced, borderline resectable pancreatic cancer.

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Changes in duplex ultrasound parameters during maturation according to arteriovenous access types in incident hemodialysis patients

The Journal of Vascular Access ◽

10.1177/11297298211005248 ◽

2021 ◽

pp. 112972982110052

Author(s):

Jae Jin Lee ◽

Sun Ryoung Choi ◽

Eun Ju Lee ◽

Ha Youn Yang ◽

Seon Ha Baek ◽

...

Keyword(s):

Pulsatility Index ◽

Significant Positive Correlation ◽

Duplex Ultrasound ◽

Hemodialysis Patients ◽

Hemodynamic Parameters ◽

Positive Correlation ◽

Arteriovenous Access ◽

Artery Flow ◽

Ultrasound Parameters ◽

Av Graft

Background: Little is known about the changes in hemodynamic parameters during arteriovenous (AV) access maturation using duplex ultrasound according to radiocephalic fistula (RCF), brachiocephalic fistula (BCF), and AV graft (AVG) in incident hemodialysis (HD) patient. The objective of this study was to evaluate changes and differences in brachial artery flow rate (BAFR) and related parameters affecting maturation by duplex ultrasound in incident HD patients according to access type. Methods: This study was an observational study conducted from March 2019 to October 2020. During the study period, 109 incident patients underwent new AV access creation, of which 100 were included in the study. The duplex ultrasound was performed on the day prior to access creation, further, day 1, 2 weeks, and 4 weeks later after access creation in incident HD patients. Results: Among all the patients, 38 (38%) received BCF, while 26 (26%) underwent RCF. Of the patients with AVG, 18 (50%) had a forearm loop AVG. The overall mean age was 62.2 ± 13.8 years (range, 32–89). The BAFR increased about 6.9 times in the RCF, 17.4 times in the BCF, and 19.5 times in the AVG at day 1. The median BAFR measured on day 1 was 580.4 mL/min for RC, 1029.0 mL/min for BC, and 1133.0 mL/min for AVG. Relative to the values measured in week 4, the BAFR on day 1 was 69.5% in RCF, 90.6% in BCF, and 93.9% in AVG. The acceleration decreased most significantly on day 1( p < 0.05). The acceleration time increased significantly on day 1 ( p < 0.05) and beyond during maturation in the RCF and BCF. The BAFR of the RCF had a significantly negative correlation with the pulsatility index. The BAFR of the BCF showed a significantly positive correlation with the systolic and diastolic blood pressure but negatively correlated with pulse rate. The BAFR of the AVG showed a significant positive correlation with the diameter of the outflow vein. Conclusions: There were differences in the clinical and duplex parameters during maturation according to access type. The most dramatic changes of duplex parameters were on the day after AV access creation regardless of AV access types. Though RCF had a lower BAFR rate compared to BCF and AVG, it already had a sufficient BAFR required for adequate HD treatment the day after creation. The BAFR of BCF was not different from that of AVG.

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O59: USE OF DEXTRAN 40 FOLLOWING PANCREAS TRANSPLANT MAY REDUCE EARLY INFLAMMATION AND SIGNIFICANT BLEEDING COMPARED TO A HEPARIN-BASED PROTOCOL

British Journal of Surgery ◽

10.1093/bjs/znab117.059 ◽

2021 ◽

Vol 108 (Supplement_1) ◽

Author(s):

AH Innes ◽

SJ Tingle ◽

I Ibrahim ◽

E Thompson ◽

L Bates ◽

...

Keyword(s):

Pancreas Transplantation ◽

Pancreas Transplant ◽

Graft Thrombosis ◽

Dextran 40 ◽

Risk Of Bleeding ◽

Transplant Patients ◽

Synthetic Colloid ◽

Operative Complications ◽

Reduced Risk ◽

Post Operative Complications

Abstract Introduction Dextran 40 (D40) is a synthetic colloid with anticoagulant properties, which is commonly used instead of heparin following pancreas transplantation, however there is a lack of evidence over which is more effective. Graft thrombosis and pancreatitis, which may be mediated through micro or macrothrombosis within the graft, remain significant complications following pancreas transplantation. We hypothesised that D40 reduces inflammation through its antithrombotic pro-microcirculatory effects. We aimed to evaluate D40 compared to a heparin-based protocol by comparing post-operative complications and post-transplant levels of inflammation. Method Data were collected retrospectively for pancreas transplant patients between December 2009 and August 2018 – 26 patients had been treated with the pre-Dextran protocol and 37 had received D40. Post-operative complications and inflammatory markers (WCC, CRP and amylase) on post-operative days 1, 2, 3 and 7 were compared between the two groups. Potential confounders were also recorded. Result Patients in the D40 group had similar thrombosis rates but were less likely to have had substantial post-operative bleeding compared to the heparin-based protocol. The group who received D40 had significantly lower CRP and WCC on days 2, 3 and 7. The differences on days 3 and 7 remained when the results were adjusted for the significant confounders - cold ischaemic time and donor age. Conclusion D40 appears to be as effective as IV heparin at preventing graft thrombosis following pancreas transplant, and to confer a reduced risk of bleeding. It may also reduce post-operative inflammatory processes, leading to reduced graft pancreatitis. Take-home message Using Dextran 40 as an anticoagulant after pancreas transplantation is as effective as IV heparin at preventing graft thromboses and has a reduced risk of bleeding.

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