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Neurosurgery Clinics of North America Jul 2024Carotid cavernous fistulae (CCFs) are arteriovenous shunts involving the cavernous sinus. CCFs are defined as direct or indirect. Direct CCFs are treated by... (Review)
Review
Carotid cavernous fistulae (CCFs) are arteriovenous shunts involving the cavernous sinus. CCFs are defined as direct or indirect. Direct CCFs are treated by deconstructive or reconstructive techniques depending on whether the affected internal carotid artery is required to perfuse the ipsilateral cerebral hemisphere, as determined by a balloon test occlusion. Indirect CCFs, or dural fistulae of the cavernous sinus wall, are most often treated with transvenous embolization. Stereotactic radiosurgery is reserved for cases of indirect CCFs that are not completely obliterated by embolization. Overall, cure rates are high with relatively low complication rates.
Topics: Humans; Carotid-Cavernous Sinus Fistula; Embolization, Therapeutic; Cavernous Sinus; Radiosurgery
PubMed: 38782525
DOI: 10.1016/j.nec.2024.02.004 -
Cardiovascular and Interventional... Sep 2023In patients requiring long-term hemodialysis for chronic kidney disease, an arteriovenous fistula is the preferred mode of hemodialysis access over synthetic... (Review)
Review
In patients requiring long-term hemodialysis for chronic kidney disease, an arteriovenous fistula is the preferred mode of hemodialysis access over synthetic arteriovenous graft or hemodialysis catheters. The National Kidney Foundation recommended in their Kidney Dialysis Outcomes Quality Initiative (KDOQI) Clinical Practice Guidelines that the creation of an autogenous arteriovenous fistula should initially be sought whenever possible. In 2003, a program named the Fistula First Breakthrough Initiative was initiated in the U.S. to increase the use of arteriovenous fistula for hemodialysis and to ultimately surpass the goal of 50% fistula use in incident and 40% fistula use in prevalent hemodialysis patients per recommendation by KDOQI Guidelines. While this goal was achieved, the encouraged creation of arteriovenous fistulas saw a rise in fistulas that failed to mature. Researchers have focused on developing strategies to optimize fistula maturation. Studies have revealed that the presence of stenoses and accessory draining veins may contribute to unsuccessful fistula maturation. Endovascular treatment, including balloon angioplasty and accessory vein embolization, aim to correct anatomical factors that negatively affect the maturation process. This article reviews the techniques and outcomes of endovascular treatment in the management of immature fistulas.
Topics: Humans; Arteriovenous Shunt, Surgical; Vascular Patency; Treatment Outcome; Angioplasty, Balloon; Arteriovenous Fistula
PubMed: 37142801
DOI: 10.1007/s00270-023-03440-y -
Journal of Vascular Surgery. Venous and... Mar 2024
Topics: Humans; Arteriovenous Fistula; Pulmonary Veins; Pulmonary Artery
PubMed: 37972756
DOI: 10.1016/j.jvsv.2023.101717 -
Cardiovascular and Interventional... Sep 2023Plain balloon angioplasty remains the first-line treatment for dialysis access stenosis. This chapter reviews the outcomes of plain balloon angioplasty from cohort... (Review)
Review
Plain balloon angioplasty remains the first-line treatment for dialysis access stenosis. This chapter reviews the outcomes of plain balloon angioplasty from cohort studies and comparative studies. Angioplasty outcomes are more favourable in arteriovenous fistulae (AVF) compared to arteriovenous grafts (AVG) with primary patency at 6 months ranging from 42-63% compared to 27-61%, respectively, and improved for forearm fistulae compared with upper arm fistulae. Higher pressures are required to treat stenoses in AVFs compared to AVGs. Outcomes are worse in more severe stenoses, increased patient age, previous interventions and fistulae that develop early stenoses. Major complication rates following angioplasty in dialysis access are between 3 and 5%. Repeat treatments and the use of adjuncts such as drug-coated balloons and stents can prolong the patency of dialysis access. Level of Evidence No level of evidence (Review paper).
Topics: Humans; Graft Occlusion, Vascular; Vascular Patency; Constriction, Pathologic; Renal Dialysis; Arteriovenous Shunt, Surgical; Treatment Outcome; Angioplasty, Balloon; Arteriovenous Fistula
PubMed: 37156943
DOI: 10.1007/s00270-023-03441-x -
Radiologie (Heidelberg, Germany) Mar 2024Carotid cavernous fistulas (CCFs) are rare but clinically significant vascular anomalies characterized by abnormal connections between the cavernous sinus and arteries.... (Review)
Review
BACKGROUND
Carotid cavernous fistulas (CCFs) are rare but clinically significant vascular anomalies characterized by abnormal connections between the cavernous sinus and arteries. This overview presents a comprehensive analysis of anatomy, classification, clinical presentation, diagnosis, imaging, and therapy of CCFs. The cavernous sinus, a central venous structure in the brain, is of critical importance for understanding CCFs due to its proximity to key structures such as the internal carotid artery and cranial nerves.
CLASSIFICATION
CCFs are classified into direct and dural types, with direct fistulas typically being high-flow and dural fistulas being low-flow. The symptomatology varies greatly and can range from noises in the head, diplopia, red eye, tearing, to blurred vision and headaches. The diagnostic assessment requires a combination of detailed medical history, neurological and ophthalmological examination, and the use of imaging techniques.
METHODS
In imaging, computed tomography (CT) and magnetic resonance imaging (MRI) are crucial for depicting the anatomical structures and blood vessels, while digital subtraction angiography (DSA) is considered the gold standard for accurate representation of the fistula. The treatment of CCFs is complex and depends on the type of fistula, location, and clinical condition of the patient.
CONCLUSION
This overview emphasizes the importance of precise diagnosis and individualized therapy to achieve optimal results and avoid complications. Ongoing developments in medical imaging and treatment techniques will continuously improve the treatment outcomes of patients with CCFs.
Topics: Humans; Carotid-Cavernous Sinus Fistula; Cavernous Sinus; Magnetic Resonance Imaging; Vision Disorders; Diplopia
PubMed: 38351202
DOI: 10.1007/s00117-024-01269-1 -
Cardiovascular and Interventional... Sep 2023Thrombotic occlusion of autologous arteriovenous fistulas or synthetic arteriovenous grafts is a serious adverse event in hemodialysis patients and declotting should be... (Review)
Review
Thrombotic occlusion of autologous arteriovenous fistulas or synthetic arteriovenous grafts is a serious adverse event in hemodialysis patients and declotting should be performed before next hemodialysis session, in order to avoid a central venous catheter. Various techniques exist to declot a thrombosed vascular access, including open surgical thrombectomy, catheter-directed thrombolysis and use of different types of percutaneous thrombo-aspiration catheters and mechanical thrombectomy devices. These devices can be categorized as devices with direct wall contact and hydrodynamic devices without direct wall contact. Technical and early clinical outcome results of percutaneous hemodialysis declotting are high and ranging between 70 and 100%; late clinical patency results are much lower related to restenosis or re-thrombosis; these patency results are higher for autologous arteriovenous fistulas compared to synthetic arteriovenous grafts and mainly depend on the combined efficacy of successful thrombectomy and durable treatment of the underlying stenoses, associated with the acute thrombosis.
Topics: Humans; Vascular Patency; Renal Dialysis; Treatment Outcome; Thrombosis; Arteriovenous Fistula
PubMed: 37055545
DOI: 10.1007/s00270-023-03434-w -
Journal of the American College of... Jun 2023The Fontan operation has resulted in significant improvement in survival of patients with single ventricle physiology. As a result, there is a growing population of... (Review)
Review
The Fontan operation has resulted in significant improvement in survival of patients with single ventricle physiology. As a result, there is a growing population of individuals with Fontan physiology reaching adolescence and adulthood. Despite the improved survival, there are long-term morbidities associated with the Fontan operation. Pulmonary complications are common and may contribute to both circulatory and pulmonary insufficiency, leading ultimately to Fontan failure. These complications include restrictive lung disease, sleep abnormalities, plastic bronchitis, and cyanosis. Cyanosis post-Fontan procedure can be attributed to multiple causes including systemic to pulmonary venous collateral channels and pulmonary arteriovenous malformations. This review presents the unique cardiopulmonary interactions in the Fontan circulation. Understanding the cardiopulmonary interactions along with improved recognition and treatment of pulmonary abnormalities may improve the long-term outcomes in this growing patient population. Interventions focused on improving pulmonary function including inspiratory muscle training and endurance training have shown a promising effect post-Fontan procedure.
Topics: Adolescent; Humans; Fontan Procedure; Heart Defects, Congenital; Pulmonary Artery; Arteriovenous Fistula; Cyanosis; Pulmonary Circulation
PubMed: 37344046
DOI: 10.1016/j.jacc.2023.04.036 -
American Journal of Physiology. Heart... Jul 2023Arteriovenous fistulae (AVF) fail to mature more frequently in female patients compared with male patients, leading to inferior outcomes and decreased utilization. Since...
Arteriovenous fistulae (AVF) fail to mature more frequently in female patients compared with male patients, leading to inferior outcomes and decreased utilization. Since our mouse AVF model recapitulates sex differences in human AVF maturation, we hypothesized that sex hormones mediate these differences during AVF maturation. C57BL/6 mice (9-11 wk) were treated with aortocaval AVF surgery and/or gonadectomy. AVF hemodynamics were measured via ultrasound (). Blood was collected for FACS and tissue for immunofluorescence and ELISA ( and ); wall thickness was assessed by histology (). Inferior vena cava shear stress was higher in male mice ( = 0.0028) after gonadectomy, and they had increased wall thickness (22.0 ± 1.8 vs. 12.7 ± 1.2 µm; < 0.0001). Conversely, female mice had decreased wall thickness (6.8 ± 0.6 vs. 15.3 ± 0.9 µm; = 0.0002). Intact female mice had higher proportions of circulating CD3 T cells on ( = 0.0043), CD4 ( = 0.0003) and CD8 T cells ( = 0.005) on , and CD11b monocytes on ( = 0.0046). After gonadectomy, these differences disappeared. In intact female mice, CD3 T cells ( = 0.025), CD4 T cells ( = 0.0178), CD8 T cells ( = 0.0571), and CD68 macrophages ( = 0.0078) increased in the fistula wall on and 7. This disappeared after gonadectomy. Furthermore, female mice had higher IL-10 ( = 0.0217) and TNF-α ( = 0.0417) levels in their AVF walls than male mice. Sex hormones mediate AVF maturation, suggesting that hormone receptor signaling may be a target to improve AVF maturation. After arteriovenous fistula creation, females have lower rates of maturation and higher rates of failure than males. In a mouse model of venous adaptation that recapitulates human fistula maturation, sex hormones may be mechanisms of the sexual dimorphism: testosterone is associated with reduced shear stress, whereas estrogen is associated with increased immune cell recruitment. Modulating sex hormones or downstream effectors suggests sex-specific therapies and could address disparities in sex differences in clinical outcomes.
Topics: Humans; Male; Female; Mice; Animals; CD8-Positive T-Lymphocytes; Sexual Maturation; Mice, Inbred C57BL; Arteriovenous Shunt, Surgical; Disease Models, Animal; Testosterone; Arteriovenous Fistula; Immunity; Renal Dialysis
PubMed: 37145957
DOI: 10.1152/ajpheart.00049.2023 -
Neurological Sciences : Official... Mar 2024A 28-year-old woman who suffered a head injury 2 months before presented with a history of progressive right eye proptosis, ophthalmoplegia, and conjunctival injection....
A 28-year-old woman who suffered a head injury 2 months before presented with a history of progressive right eye proptosis, ophthalmoplegia, and conjunctival injection. The radiological workup with a magnetic resonance imaging of the brain and cerebral angiography revealed a direct, high-flow, right post-traumatic carotid-cavernous fistula. An endovascular procedure was performed, and the carotid-cavernous fistula was successfully occluded with a progressive resolution of the complained symptoms.
Topics: Female; Humans; Adult; Magnetic Resonance Imaging; Carotid-Cavernous Sinus Fistula; Endovascular Procedures; Cerebral Angiography; Embolization, Therapeutic
PubMed: 37996776
DOI: 10.1007/s10072-023-07183-z -
The American Journal of Cardiology Jan 2024Radial artery occlusion (RAO) has been the most common postprocedural complication of transradial artery access. The optimal method of prevention of RAO is still...
Radial artery occlusion (RAO) has been the most common postprocedural complication of transradial artery access. The optimal method of prevention of RAO is still lacking. In our study, we aimed to evaluate the effect of patent hemostasis on early (24 hours) and late (2 weeks) RAO prevention. The Open Radial Artery Study was a single-arm, prospective, and multicenter study. The primary end points were early and late RAO at the vascular access site after transradial coronary procedures. Secondary end points were access site hematoma, pseudoaneurysm formation, arteriovenous fistula, and nerve injury. A total of 2,181 patients were analyzed (67% male, mean age 68 years). The mean interventional duration and hemostatic times were 75.6 ± 55.6 and 60 ± 5.6 minutes, respectively. Radial artery spasm occurred in 10% of patients (n = 218). Catheter kinking, radial artery rupture, or dissection were not observed during the procedure. RAO, hematoma, pseudoaneurysm, arteriovenous fistula, or nerve damage was not observed in any of the patients in the early or late period. In patients who undergo coronary diagnostic or interventional procedures through transradial artery access, the patent hemostasis method seems a critical step in the prevention of early and late RAO.
Topics: Humans; Male; Aged; Female; Radial Artery; Prospective Studies; Aneurysm, False; Arterial Occlusive Diseases; Hematoma; Arteriovenous Fistula; Cardiac Catheterization; Coronary Angiography
PubMed: 38035500
DOI: 10.1016/j.amjcard.2023.09.041