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Medicina (Kaunas, Lithuania) Mar 2021Interventional radiology of the male urogenital system includes percutaneous and endovascular procedures, and these last consist mostly of transcatheter arterial... (Review)
Review
Interventional radiology of the male urogenital system includes percutaneous and endovascular procedures, and these last consist mostly of transcatheter arterial embolizations. At the kidney level, arterial embolizations are performed mainly for palliative treatment of parenchymal tumors, for renal traumas and, less frequently, for arteriovenous fistulas and renal aneurysms and pseudoaneurysms. These latter may often require emergency intervention as they can cause renal or peri-renal hematomas or significant hematuria. Transcatheter arterial embolization is also an effective therapy for intractable severe bladder hematuria secondary to a number of neoplastic and inflammatory conditions in the pelvis, including unresectable bladder cancer and radiation-induced or cyclophosphamide-induced hemorrhagic cystitis. Endovascular interventional procedures for the penis are indicated for the treatment of post-traumatic priapism. In this article, we review the main endovascular radiological interventions of the male urogenital system, describing the technical aspects, results, and complications of each procedure at the various anatomical districts.
Topics: Aneurysm, False; Arteriovenous Fistula; Embolization, Therapeutic; Endovascular Procedures; Humans; Male; Radiology, Interventional; Treatment Outcome
PubMed: 33802895
DOI: 10.3390/medicina57030278 -
Neurology India 2023
Topics: Humans; Arteriovenous Fistula; Embolization, Therapeutic
PubMed: 37929418
DOI: 10.4103/0028-3886.388121 -
Journal of Vascular Surgery Feb 2022The clinical utility of the native arteriovenous fistula (AVF) has been limited by the prolonged time required for maturation, the low overall maturation rate, and...
BACKGROUND
The clinical utility of the native arteriovenous fistula (AVF) has been limited by the prolonged time required for maturation, the low overall maturation rate, and subsequent abandonment. Endovascular intervention has been increasingly accepted as the first-line therapy for AVF stenosis. The objective of the present study was to evaluate the AVF formation outcomes when early endovascular intervention was selectively performed to bring about timely AVF maturation.
METHODS
We performed a retrospective study (February 2014 to February 2020) of 82 AVF consecutive patients (mean age, 62.5 ± 13.5 years; range, 17-83; 58 men [70.7%]) with end-stage renal failure who had undergone vascular access construction at a single institution. The 4-year AVF patency, vascular diameters, hemodialysis parameters, reintervention rate, and mortality were analyzed.
RESULTS
Radiocephalic AVF was the most common fistula constructed (71 patients; 88.6%). The evaluation at a mean of 46.2 ± 56.0 days (range, 5-343 days) after AVF formation revealed 33 immature AVFs (40.2%). Subsequently, 19 patients had undergone endovascular procedures, including angioplasty and/or stenting of the juxta-anastomosis, cannulation zones, and/or outflow segments to bring about timely maturation of the AVF. Hence, 93.9% of the AVFs had reached functional patency (maturation) by 6 months after formation, with a mean time to maturation of 67.8 ± 65.9 days (range, 5-320 days). After reaching maturation, the primary access functional patency was 82% ± 4.3% at 6 months, 58% ± 5.5% at 12 months, and 34% ± 6.8% at 48 months. The primary assisted access functional patency was 95% ± 2.4% at 6 months, 90% ± 3.3% at 12 months, and 83% ± 4.7% at 48 months. A total of 121 endovascular interventions were performed to maintain patency, equating to an endovascular reintervention rate of 0.37 procedure/patient year. The mean arterial, venous, and brachial flow rates did not change significantly after maturation with a mean AVF (primary assisted functional patency) survival time of 5.9 ± 0.26 years (range, 5.33-6.36 years) from maturation. Only 12 thromboses had occurred after the first follow-up review after AVF formation. These were all salvaged using endovascular techniques, leading to 100% total secondary functional patency at 4 years. The 5-year estimated all-cause mortality was 45.6% ± 12.7%.
CONCLUSIONS
The AVF maturation rate and interval to maturation were improved when early endovascular intervention was selectively performed after AVF formation. This allowed for near universal maturation. In addition, once matured, the use of ongoing endovascular reinterventions allowed for a low reintervention rate and long-term patency, providing reliable long-term renal vascular access.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Arteriovenous Fistula; Arteriovenous Shunt, Surgical; Brachial Artery; Endovascular Procedures; Female; Follow-Up Studies; Humans; Kidney Failure, Chronic; Male; Middle Aged; Renal Dialysis; Retrospective Studies; Risk Factors; Stents; Time Factors; Young Adult
PubMed: 34506894
DOI: 10.1016/j.jvs.2021.08.072 -
Transplantation Reviews (Orlando, Fla.) Dec 2023Aneurysms remain the most common complication of an arteriovenous fistula created for dialysis access. The management of an aneurysmal arteriovenous fistula (AAVF) in... (Review)
Review
Aneurysms remain the most common complication of an arteriovenous fistula created for dialysis access. The management of an aneurysmal arteriovenous fistula (AAVF) in kidney transplant recipients remains contentious with a lack of clear clinical guidelines. Recipients of a functioning graft do not require the fistula for dialysis access, however risk of graft failure and needing the access at a future date must be considered. In this review we outline the current evidence in the assessment and management of a transplant recipient with an AAVF. We will describe our recommended five-step approach to assessing an AAVF in transplant patients; 1.) Define AAVF 2.) Risk assess AAVF 3.) Assess transplant graft function and future graft failure risk 4.) Consider future renal replacement therapy options 5.) Vascular mapping to assess future vascular access options. Then we will describe the current therapeutic options and when they would most appropriately be employed.
Topics: Humans; Arteriovenous Shunt, Surgical; Kidney Transplantation; Renal Dialysis; Transplant Recipients; Treatment Outcome; Arteriovenous Fistula; Kidney Failure, Chronic
PubMed: 37804690
DOI: 10.1016/j.trre.2023.100799 -
Japanese Journal of Radiology Mar 2023Pelvic fractures are common in cases of blunt trauma, which is strongly associated with mortality. Transcatheter arterial embolization is a fundamental treatment... (Review)
Review
Pelvic fractures are common in cases of blunt trauma, which is strongly associated with mortality. Transcatheter arterial embolization is a fundamental treatment strategy for fatal arterial injuries caused by blunt pelvic trauma. However, vascular injuries due to blunt pelvic trauma can show various imaging findings other than arterial hemorrhage. We present a pictorial review of common and uncommon vascular injuries, including active arterial bleeding, pseudoaneurysm, arteriovenous fistula, arterial occlusion, vasospasm, and active venous bleeding. Knowledge of these vascular injuries can help clinicians select the appropriate therapeutic strategy and thus save lives.
Topics: Humans; Vascular System Injuries; Pelvis; Hemorrhage; Embolization, Therapeutic; Arteriovenous Fistula; Wounds, Nonpenetrating
PubMed: 36350523
DOI: 10.1007/s11604-022-01355-1 -
The Indian Journal of Medical Research Nov 2020
Topics: Arteriovenous Fistula; Arteriovenous Malformations; Humans
PubMed: 35345203
DOI: 10.4103/ijmr.IJMR_2310_19 -
Kidney360 Feb 2022
Topics: Arteriovenous Fistula; Arteriovenous Shunt, Surgical; Humans; Renal Dialysis
PubMed: 35373129
DOI: 10.34067/KID.0008012021 -
Nefrologia 2021The maturation and patency of permanent vascular access are critical in patients requiring hemodialysis. Although numerus trials have been attempted to achieve... (Review)
Review
BACKGROUND
The maturation and patency of permanent vascular access are critical in patients requiring hemodialysis. Although numerus trials have been attempted to achieve permanently patent vascular access, little have been noticeable. Cilostazol, a phosphodiesterase-3 inhibitor, has been shown to be effective in peripheral arterial disease including vascular injury-induced intimal hyperplasia. We therefore aimed to determine the effect of cilostazol on the patency and maturation of permanent vascular access.
METHODS
This single-center, retrospective study included 194 patients who underwent arteriovenous fistula surgery to compare vascular complications between the cilostazol (n=107) and control (n=87) groups.
RESULTS
The rate of vascular complications was lower in the cilostazol group than in the control group (36.4% vs. 51.7%; p=0.033), including maturation failure (2.8% vs. 11.5%; p=0.016). The rate of reoperation due to vascular injury after hemodialysis initiation following fistula maturation was also significantly lower in the cilostazol group than in the control group (7.5% vs. 28.7%; p<0.001). However, there were no significant differences in the requirement for percutaneous transluminal angioplasty (PTA), rate of PTA, and the interval from arteriovenous fistula surgery to PTA between the cilostazol and control groups.
CONCLUSION
Cilostazol might be beneficial for the maturation of permanent vascular access in patients requiring hemodialysis.
Topics: Arteriovenous Fistula; Cilostazol; Humans; Phosphoric Diester Hydrolases; Renal Dialysis; Retrospective Studies; Treatment Outcome; Vascular Patency; Vascular System Injuries
PubMed: 36165152
DOI: 10.1016/j.nefroe.2022.01.006 -
Texas Heart Institute Journal Mar 2023
Topics: Humans; Veins; Radial Artery; Arteriovenous Fistula; Catheterization; Arteriovenous Shunt, Surgical
PubMed: 36972538
DOI: 10.14503/THIJ-22-7995 -
European Journal of Vascular and... Mar 2021
Topics: Arteriovenous Fistula; Computed Tomography Angiography; Female; Humans; Mesenteric Artery, Superior; Mesenteric Veins; Middle Aged; Phlebography
PubMed: 33262092
DOI: 10.1016/j.ejvs.2020.10.034