FACTORS PREDICTING OUTCOMES OF UPPER LIMB RADIO-CEPHALIC ARTERIO-VENOUS FISTULA- A PROSPECTIVE OBSERVATIONAL STUDY

2021 ◽  
pp. 74-76
Author(s):  
Ershad Hussain Galeti ◽  
Ifrah Ahmad ◽  
Veda Murthy Reddy Pogula
Keyword(s):  
Upper Limb ◽  
Vascular Anatomy ◽  
Cephalic Vein ◽  
Successful Outcome ◽  
Av Fistula ◽  
Doppler Study ◽  
Study Results ◽  
Vein Diameter ◽  
Venous Fistula ◽  
Minimum Criteria

AIMS AND OBJECTIVES: To study the factors predicting outcomes of upper limb radio-cephalic arterio-venous stula. MATERIALAND METHODS: This was an observational prospective study that included all chronic renal failure patients requiring AV Fistula surgery between June 2018 to December 2019. All patients whose vascular anatomy does not permit the construction of a native AV stula, as detected on preoperative doppler study, were excluded from the study. RESULTS: Out of 120 cases studied, 88 were male, and 32 were females. In males out of 88 cases, 61 cases had successful outcome (69%) and in 27 cases, stula failed (31%). No signicance on the outcome of the AV stula noted related to comorbidities. Mean preoperative radial artery diameter of 2.8 and 1.9 mm was associated with successful and failed stula, respectively. Mean preoperative cephalic vein diameter of 2.2 and 1.9 mm were associated with successful and failed stulae, respectively. Results suggested a threshold PSV of at least 50cm/sec for stula success. A stula diameter of > 0.4 cm and a minimum ow rate of > 58mL/min resulted in a 93% chance that the stula would be adequate versus 28 % if neither of the minimum criteria were met. Mean post-operative cephalic vein diameter 4.24 and 3.28 mm were associated with successful and failed stula, respectively. CONCLUSION: In our study the cephalic vein size, arterial size and ow rate is the predominant factor determining the success of the radio cephalic stula. There is increasing evidence that routine preoperative duplex USG reduces the rate of primary stula failure and unnecessary surgical exploration. Aminimum arterial diameter of 2mm is associated with successful stula formation. Below this diameter, the success of the stula depends on the ability of the artery to dilate. Athreshold for the minimal venous diameter is difcult to establish. But most clinical studies use a value of 2.5mm for AFV.

scholarly journals Brachio- Axillary Translocation Fistula with Reverse Saphenous Venous Graft: a New Hope for the Patients of End stage Renal Disease

2018 ◽  
Vol 33 (2) ◽  
pp. 134-137
Author(s):  
SMG Saklayen Russel ◽  
Jubayer Ahmad ◽  
Raju Ahmed ◽  
Jashim Uddin ◽  
Suman Nazmul Hosain
Keyword(s):  
Upper Limb ◽  
Brachial Artery ◽  
Proximal Part ◽  
Fistula Formation ◽  
Axillary Vein ◽  
Av Fistula ◽  
Venous Fistula ◽  
The Right ◽  
Stage Renal Disease ◽  
End Stage

Native arterio-venous fistula (AVF) are the preferred mode of repeated vascular access for the chronic renal failure patients surviving on hemodialysis because of their easy accessibility, good long term patency, low complication rate and cost-effectiveness. Creation of a fistula between the radial or brachial artery and a suitable adjacent vein is the most commonly practiced option. However the major upper arm veins of the CKD patients are often found thrombosed, cord like and not suitable for AV anastomosis. A 48 years old male patient of chronic kidney disease with a permanent catheter placed in the right subclavian vein was referred to create an AV fistula. On exploration none of the upper limb veins was found suitable for fistula formation. The proximal part of the left GSV was harvested from patient’s left upper thigh and was used to make a connection between left brachial artery at cubital fossa and the left axillary vein. To avoid over flooding of the limb vasculature, partial banding of the left axillary vein was done distal to this anastomosis. When all options in both upper limbs are exhausted, autologous great saphenous grafts may be a very useful tool for the surgeons in creating upper limb AV fistulas in difficult situations Bangladesh Heart Journal 2018; 33(2) : 134-137

scholarly journals Successful Salvage of the Upper Limb After Crush Injury Requiring Nine Operations: A Case Report

2015 ◽  
Vol 100 (3) ◽  
pp. 540-546
Author(s):  
Qingmin Zeng ◽  
Guoping Cai ◽  
Dechang Liu ◽  
Kun Wang ◽  
Xinchao Zhang
Keyword(s):  
Upper Limb ◽  
Surgical Repair ◽  
Crush Injury ◽  
Successful Outcome ◽  
Post Injury ◽  
Level Of Evidence ◽  
Life Threatening ◽  
Management Choice ◽  
Repair Techniques

Emergency treatment of amputation is one of the most frequently used therapeutic methods for patients with severe upper limb crush injury with a mangled extremity severity score (MESS) of more than 7. With the development of advanced surgical repair techniques and reconstructive technology, cases that once required amputation can now be salvaged with appropriate management, and some limb functions may also be reserved. A patient with a severe upper limb crush injury with a MESS score of 10 was treated in our hospital. The limb was salvaged after 9 surgeries over 10 months. The follow-up visits over the next 18 months post-injury showed that the shoulder joint functions were rated as “excellent” (90) according to the Neer score, the Harris hip evaluation (HHS) for elbow joint functions was “good” (80), and the patient was very satisfied with the overall therapeutic outcome. We conclude from the successful outcome of this extreme injury that salvage attempts should be the first management choice for upper limbs with complex injuries to save as much function as possible. Amputation should only be adopted when the injury is life-threatening or no more function can be saved. The level of evidence was V.

The relation between tourniquet pressure and cephalic vein diameter and pressure

2000 ◽  
Vol 17 (Supplement 19) ◽  
pp. 24
Author(s):  
Y. Risin ◽  
A. Breitgand ◽  
A. Ben-Or ◽  
N. Leiberman
Keyword(s):  
Cephalic Vein ◽  
Vein Diameter

scholarly journals Prevalence and Risk Factors of Arterio-Venous Fistula Obstruction on Patient with Chronic Kidney Disease

2021 ◽  
Vol 7 (2) ◽  
pp. 5
Author(s):  
Muhamad Taufik Ismail ◽  
Hariadi Hariawan ◽  
Yulia Wardhani ◽  
Metalia Puspitasari ◽  
I Putu Aditio Artayasa ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Risk Factor ◽  
Kidney Disease ◽  
Doppler Ultrasound ◽  
Duplex Ultrasound ◽  
Smoking Habits ◽  
Av Fistula ◽  
Venous Fistula

Prevalence and Risk Factors of Arterio-Venous Fistula Obstruction on Patient with Chronic Kidney Disease Ismail MT1, Hariawan H1, Wardhani Y2, Puspitasari M2, Artayasa IPA1, Ramadhan G1, Tarigan T1, Triatmaja R1   1Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, 55284, Indonesia 2Department of Internal Medicine Faculty of Medicine Universitas Gadjah Mada-RSUP Dr. Sardjito Yogyakarta Indonesia   ABSTRACT Aim: AV fistula obstruction has become one of the main vascular access complications in patients undergoing haemodialysis. This complications have significant impacts on the morbidity and mortality of dialysis patients while also leading to higher medical costs. Clinical monitoring has been routinely used for early detection of AV fistula stenosis and obstruction, however screening with Doppler ultrasound is still not a routine recommendation. This study aims to know prevalence and risk factors of AV Fistula obstruction detected by Duplex ultrasound examination.   Methods: This study was a hospital-based descriptive analytic study with cross sectional design conducted at the haemodialysis center of National General Hospital Dr. Sardjito, Yogyakarta, Indonesia. Patient demographic and clinical risk factor were recorded using direct interview. AV fistula obstruction were assessed using Duplex ultrasound by professional sonographer.   Results: Seventy four (74) patients are using AV fistula as entry access for hemodialysis in RSUP dr. Sardjito. It is consist of 39 male (53%) and 35 Female (47%). The mean age of patients is 50 years old. Surveillance using Doppler ultrasound found 20 patients (27%) have stenotic AV Fistula. Smoking habits (OR 5.37, 95% CI, 1.760 - 16.431, p=0.002) and diabetes mellitus (OR 5.00, 95% CI, 1.631 – 15.503, p=0.004) increase risk for having stenotic AV fistula. Only 4 patient (20 %) of all 20 patient with stenotic AV fistula were symptomatic, and needed for further vascular intervention   Conclusion: Prevalence of AV fistula obstruction detected by Doppler ultrasound was 27% of all AV fistula patient with only 5% had symptomatic AV fistula failure. Smoking habits and diabetes mellitus are important risk factor for AV fistula obstruction. Asymptomatic AV fistula obstruction often goes undetected by clinical monitoring that can increase of risk of symptomatic AV fistula obstruction in the future. The further study is needed to determine level recommendation of routine AV fistula surveillance with Doppler Ultrasound.   Key words: AV Fistula obstruction, CKD, Doppler ultrasound surveillance, Risk factors, Prevalence

scholarly journals Acute pulmonary embolism complicating deep vein thrombosis in a young patient with stroke

2021 ◽  
Vol 11 (2) ◽  
pp. 142-144
Author(s):  
Mohammed Mirazur Rahman ◽  
Farjana Binte Habib ◽  
Ahmed Imran Kabir ◽  
Samprity Islam ◽  
Rajashish Chakrabortty ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Lower Limb ◽  
Acute Pulmonary Embolism ◽  
Successful Outcome ◽  
Shortness Of Breath ◽  
Vein Thrombosis ◽  
Doppler Study ◽  
Left Lower Limb ◽  
Deep Vein

Acute pulmonary embolism is one of the most common causes of vascular death after myocardial infarction and cerebrovascular accidents. It usually presents with severe chest pain and shortness of breath and occasionally occurs in the background of deep vein thrombosis. A 32-year-old male presented with swelling of left lower limb and shortness of breath. Subsequent investigations revealed that he developed DVT of left lower limb and pulmonary embolism. However, in general, if left untreated, pulmonary embolism is associated with an overall mortality of up to 30 percent compared with 2 to 11 percent in those treated with anticoagulation. Early diagnosis by D-dimer, computed tomograpgy pulmonary angiogram and doppler study of the left lower limb and prompt intervention through low molecular weight heparin and rivaroxaban led to a successful outcome in our case. Birdem Med J 2021; 11(2): 142-144

scholarly journals Diagnostic accuracy of CT angiography in evaluation of vascular anatomy in comparison with intraoperative findings an assessment of  392 patients

F1000Research ◽  
2015 ◽  
Vol 4 ◽  
pp. 998
Author(s):  
Mohankumar Vijayakumar ◽  
Sanika Ganpule ◽  
Arvind P. Ganpule ◽  
Vinodh Murali ◽  
Shashikant Mishra ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Ct Scan ◽  
Ct Angiography ◽  
Renal Vein ◽  
Vascular Anatomy ◽  
Donor Nephrectomy ◽  
Successful Outcome ◽  
Laparoscopic Donor Nephrectomy ◽  
Early Recovery ◽  
Operative Findings

Introduction: Transplantation of kidneys from living related donors is the treatment of choice for patients with end stage renal disease. With lessmorbidity and early recovery,  laparoscopy has become the standard of care for donor nephrectomies. The precise knowledge of vascular anatomy is crucial to a successful outcome. Computed tomography (CT) findings are misleading and less informative in a small number of cases. The reported accuracy of CT angiography in assessing the vascular anatomy is around 85 to 100 %. We did a prospective study to assess the diagnostic accuracy of CT angiography in the evaluation of vascular anatomy in comparison with intra operative findings.Aim:  To assess the accuracy of CT in predicting the anatomy in patients who underwent laparoscopic donor nephrectomy.Materials and methods: 392 patients who underwent laparoscopic donor nephrectomy in our institute between January 2010 and December 2012 were included in our study.Results: CT scan correlated well with the intra operative findings in most of our patients with good sensitivity and specificity. CT interpreted a case of double renal vein as single and a case of circumaortic vein reported on CT was not detected intra operatively. A case of right side early branching was not detected on CT. A case of a retroaortic branch of renal vein was missed on CT scan. The incidental findings detected on CT scan such as calculi, mass and hemangioma or fibroid can be of help in managing the patient after surgery.

The Effect Of Hand Exercise On Grip Strength, Forearm Circumference, Diameter Of Vein, Blood Flow Volume And Velocity In Patient Who Underwent Arteriovenous Fistula Surgery And On Routine Haemodialysis

2019 ◽  
Vol 1 (1) ◽  
pp. 14
Author(s):  
Jufri Febriyanto Poetra ◽  
Andriati Andriati ◽  
Dewi Poerwandari
Keyword(s):  
Blood Flow ◽  
Flow Velocity ◽  
Grip Strength ◽  
Blood Flow Velocity ◽  
Intervention Group ◽  
Cephalic Vein ◽  
Flow Volume ◽  
Blood Flow Volume ◽  
Before And After ◽  
Vein Diameter

Background: The arteriovenous fistula (AVF) is considered the gold standard for haemodialysis access. The fistula needs time to be mature and functional. Maturation process respond to increases in blood flow. Exercise stimulates vascular response as such an increase of blood flow. Aims: The purpose of this study is to determine the effectiveness of hand exercise in increasing grip muscle performance, and its effectiveness in supporting maturation process of fistula.Methods: This experimental study done on 14 patients underwent AVF procedure and on routine haemodialysis. Randomly, 7 subjects allocated on intervention group by doing hand exercise using hand gripper (HG) for 5 weeks, and 7 subjects allocated as control group without introduction to hand gripper. Grip strength and forearm circumference were measured before and after 5 weeks of intervention. Cephalic vein diameter, blood flow volume and velocity were measured using Doppler USG on AVF arm. The comparison of intervention effects between groups treatment were analyzed based on effect size (ES).Results: Grip strength and forearm circumference increased significantly on intervention group before and after exercise intervention (p<.001, p=.001). Cephalic vein diameter and blood flow were increased significantly in this group (p=.027, p=.033). Blood flow velocity showed no difference before and after exercise intervention. Significant results were found on increased grip strength, forearm circumference, cephalic vein diameter and blood flow volume in comparison between treated group (p<.001; ES=.94, p<.001; ES=.4, p=.046; ES=.84, p=.035; ES=.53). There were no differences on cephalic vein blood flow velocity between these two groups.Conclusion: Five weeks hand exercise were effective to increase grip strength, forearm circumference, cephalic vein diameter and blood flow volume, nonetheless ineffective to increase cephalic vein blood flow velocity in post AVF procedure patients with routine haemodialysis.

Accessory Veins and Radial-Cephalic Arteriovenous Fistula Non-Maturation: A Prospective Analysis Using Contrast-Enhanced Magnetic Resonance Angiography

2007 ◽  
Vol 8 (4) ◽  
pp. 281-286 ◽  
Author(s):  
R.N. Planken ◽  
L.E. Duijm ◽  
A.G. Kessels ◽  
T. Leiner ◽  
J.P. Kooman ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Arteriovenous Fistula ◽  
Predictive Value ◽  
Preoperative Assessment ◽  
Cephalic Vein ◽  
Salvage Procedure ◽  
Venous Stenosis ◽  
Contrast Enhanced ◽  
Vein Diameter

Purpose To determine if large caliber accessory veins are associated with radial-cephalic arteriovenous fistula (RC-AVF) non-maturation. Methods RC-AVFs were created in 15 consecutive patients (radial artery and cephalic vein diameter >2 mm, in the absence of arterial inflow or venous outflow stenoses or occlusions). Contrast-enhanced magnetic resonance angiography (CE-MRA) was performed preoperatively for the determination of vessel diameters, stenoses and occlusions. The location and caliber of accessory veins was determined. Vascular access (VA) function was monitored and all interventions required to obtain a functioning VA were recorded. Non-maturation was defined as a nonfunctional VA at 2 months after creation. The predictive value of accessory vein caliber for prediction of RC-AVF non-maturation was evaluated using receiver operating characteristic (ROC) analysis. Results Non-maturation occurred in 10 (67%) out of 15 RC-AVFs. Large caliber accessory veins (n=4), venous stenosis (n=3) or both (n=2) were associated with RC-AVF non-maturation. The presence of large caliber accessory veins was the only significant predictor for RC-AVF non-maturation (p=0.01). Preoperatively detected accessory veins with a diameter >70% of the cephalic vein diameter, had a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 80, 100, 100 and 91% for prediction of RC-AVF non-maturation on patient level. Accessory vein ligation and dilatation of venous stenosis resulted in an overall salvage success rate of 89% (8/9). Conclusion Large caliber accessory veins are associated with RC-AVF non-maturation. Ligation of large caliber accessory veins is a successful salvage procedure in a substantial group of patients. Furthermore, ligation of these accessory veins during initial RC-AVF creation can potentially reduce non-maturation rates; and therefore, preoperative assessment of accessory veins is recommended.

scholarly journals Development of a core outcome set for studies on prevention and management of pregnancy-associated venous thromboembolism (COSPVenTE): a study protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e034017 ◽  
Author(s):  
Alexandria King ◽  
Rohan D’Souza ◽  
Lizabeth Teshler ◽  
Nadine Shehata ◽  
Ann K Malinowski
Keyword(s):  
Venous Thromboembolism ◽  
Post Partum ◽  
Core Outcome Set ◽  
Mount Sinai Hospital ◽  
Core Outcome ◽  
Outcome Reporting ◽  
Open Access Journals ◽  
Outcome Set ◽  
Study Results ◽  
Minimum Criteria

IntroductionPregnancy and post partum are times of heightened risk for the development of venous thromboembolism (VTE), which in turn is one of the leading causes of maternal mortality and long-term morbidity. The current research aimed at improving health guidelines for women with pregnancy-associated VTE is limited by inconsistency in outcome reporting preventing comparison across studies, and lack of input from patients with respect to outcomes they propose are most important to measure. A suggested solution is the development of a core outcome set (COS) that defines the minimum criteria for outcome reporting in clinical trials and prospective studies. COSs function to facilitate data harmonisation and increase homogeneity in outcome reporting while incorporating the voice of women in this population in the planning of research to inform their ongoing care.Methods and analysisThe development of a COS for studies on pregnancy-associated VTE will comprise five steps. First, a systematic review of the published literature will identify currently reported outcomes, their definitions and measurements if applicable. This will be followed by in-person interviews with patients, clinicians, researchers, hospital administrators and policy-makers to identify outcomes they consider important. Third, the long list of outcomes obtained from steps I and II will be condensed through online Delphi surveys involving an international group of relevant stakeholders including patients. This will be followed by a face-to-face consensus meeting with representatives of all stakeholder groups to arrive at a consensus on the final COS. Lastly, to determine how the identified core outcomes should be measured, another literature review and Delphi process will be carried out as necessary.Ethics and disseminationThis study has been approved by the Mount Sinai Hospital Research Ethics Board (REB 18-0314-E). Study results will be published in open-access journals and presented at obstetrics, maternal–fetal medicine and haematology conferences. All progress will be documented on the international prospective register of systematic reviews (PROSPERO) and Core Outcome Measures in Effectiveness Trials databases.PROSPERO registration numberCRD42019111479.

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