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The Journal of Vascular Access May 2024An accessible tool is required to analyze volume flow trends in arteriovenous fistulas for hemodialysis. Earlybird, an easy-to-place ultrasound Doppler device, has shown...
Assessment of volume flow rate in arteriovenous fistulas with a novel ultrasound Doppler device (earlybird): Trend analysis, comparison of methods, and inter- and intra-rater reliability.
BACKGROUND
An accessible tool is required to analyze volume flow trends in arteriovenous fistulas for hemodialysis. Earlybird, an easy-to-place ultrasound Doppler device, has shown comparable accuracy to duplex ultrasound. In this study, we compared volume flow measurements obtained with duplex ultrasound and the dilution technique to an enhanced earlybird device, featuring a dual Doppler probe system, eliminating the requirement for a known insonation angle.
METHODS
Nine patients with a distal radiocephalic arteriovenous fistula were monitored for 12 months with regular volume flow measurements. Correlation and inter- and intra-class reliability analyses were conducted.
RESULTS
An overall moderate correlation was observed between earlybird and duplex ultrasound or dilution technique (intraclass correlation coefficient = 0.606 (95% confidence interval 0.064, 0.721) and 0.581 (0.039, 0.739), respectively). Duplex ultrasound compared to dilution measurements, demonstrated an overall moderate correlation (0.725 (0.219, 0.843)). Correlation between earlybird and duplex ultrasound was stronger for the arteriovenous fistula (0.778 (0.016, 0.901)) than the brachial artery (0.381 (-0.062, 0.461)). For earlybird, inter-rater reliability was excellent for the arteriovenous fistula (0.907 (0.423, 0.930)) and poor for the brachial artery (0.430 (0.241, 0.716)). Duplex ultrasound showed a good inter-rater reliability (arteriovenous fistula: 0.843 (0.610, 0.871), brachial artery: 0.819 (0.477, 0.864)). The overall intra-rater reliability was good for duplex ultrasound (rater A: 0.893 (0.727, 0.911); rater B: 0.853 (0.710, 0.891)), while excellent for earlybird (rater A: 0.905 (0.819, 0.928); rater B: 0.921 (0.632, 0.969)).
CONCLUSION
We observed a weaker correlation in the measurements of volume flow rates in arteriovenous fistulas when obtained using earlybird compared to dilution technique, unlike the comparison between duplex ultrasound and the dilution technique. However, inter-rater reliability for the arteriovenous fistula was excellent with earlybird and good with duplex ultrasound, indicating the potential of earlybird as a tool for frequent measurements, enabling trend surveillance and predicting adverse outcomes.
PubMed: 38708835
DOI: 10.1177/11297298241250379 -
Transplantation Proceedings May 2024The risk of morbidity and mortality in the group of people qualified for kidney transplantation is high. Although currently, the qualification for kidney transplantation...
BACKGROUND
The risk of morbidity and mortality in the group of people qualified for kidney transplantation is high. Although currently, the qualification for kidney transplantation is very extensive and detailed, the final examination and assessment at the transplant center is crucial for the success of the transplantation.
CASE REPORT
A 50-year-old woman with end-stage kidney disease was admitted to the Department of General, Vascular, and Transplant Surgery on July 21, 2023, for kidney transplantation. A month earlier, she had undergone surgery to create an arteriovenous fistula on the left forearm. The regional anesthesia was performed. Apart from temporary pain and cough, the postoperative course was uncomplicated. Upon admission to the Department, the patient was in good general condition, and only a dry cough was noted during the physical examination. Chest X-ray revealed pneumothorax on the left side with partial lung atelectasis. The patient was temporarily disqualified from kidney transplantation and the pneumothorax was cured. She is currently on the active list waiting for a kidney transplant.
CONCLUSIONS
The analysis of the above case emphasizes the importance of a physical examination and final qualification at the transplant center. Detailed examination and evaluation at the above center can improve patients' quality of life and survival.
Topics: Humans; Kidney Transplantation; Female; Middle Aged; Pneumothorax; Kidney Failure, Chronic
PubMed: 38705736
DOI: 10.1016/j.transproceed.2024.04.010 -
Nature Communications May 2024Arteriovenous fistulas (AVFs) are the most common vascular access points for hemodialysis (HD), but they have a high incidence of postoperative dysfunction, mainly due...
Arteriovenous fistulas (AVFs) are the most common vascular access points for hemodialysis (HD), but they have a high incidence of postoperative dysfunction, mainly due to excessive neointimal hyperplasia (NIH). Our previous studies have revealed a highly conserved LncRNA-LncDACH1 as an important regulator of cardiomyocyte and fibroblast proliferation. Herein, we find that LncDACH1 regulates NIH in AVF in male mice with conditional knockout of smooth muscle cell-specific LncDACH1 and in male mice model of AVF with LncDACH1 overexpression by adeno-associated virus. Mechanistically, silence of LncDACH1 activates p-AKT through promoting the expression of heat shock protein 90 (HSP90) and serine/arginine-rich splicing factor protein kinase 1 (SRPK1). Moreover, LncDACH1 is transcriptionally activated by transcription factor KLF9 that binds directly to the promoter region of the LncDACH1 gene. In this work, during AVF NIH, LncDACH1 is downregulated by KLF9 and promotes NIH through the HSP90/ SRPK1/ AKT signaling axis.
Topics: Animals; Humans; Male; Mice; Arteriovenous Fistula; Cell Proliferation; HSP90 Heat-Shock Proteins; Hyperplasia; Kruppel-Like Transcription Factors; Mice, Inbred C57BL; Mice, Knockout; Myocytes, Smooth Muscle; Neointima; Phenotype; Protein Serine-Threonine Kinases; Proto-Oncogene Proteins c-akt; RNA, Long Noncoding; Signal Transduction
PubMed: 38702316
DOI: 10.1038/s41467-024-48019-4 -
Surgical Case Reports May 2024Colonic varices are a rare gastrointestinal anomaly often associated with portal hypertension. Arteriovenous fistula (AVF) in the inferior mesenteric artery (IMA) region...
BACKGROUND
Colonic varices are a rare gastrointestinal anomaly often associated with portal hypertension. Arteriovenous fistula (AVF) in the inferior mesenteric artery (IMA) region is even rarer. Diagnosis and treatment of these entities present unique challenges, especially when the IMA is involved.
CASE PRESENTATION
A 48-year-old man with a history of cholecystectomy presented with after a positive fecal occult blood test. Investigations revealed varices from the splenic flexure to the transverse colon and suspected AVF in the IMA region. Given the high risk and low efficacy of endoscopic and radiological interventions, laparoscopic sigmoidectomy was performed. This surgical approach successfully addressed both the AVF and the associated varices.
CONCLUSION
This case underscores the importance of surgical intervention for AVF and colonic varices in the IMA region, particularly when other treatment options pose high risks and have limited efficacy. The favorable postoperative outcome in this case highlights the effectiveness of carefully chosen surgical methods when managing such complex and rare conditions.
PubMed: 38700649
DOI: 10.1186/s40792-024-01911-z -
Cureus Apr 2024Background The wrist radiocephalic arteriovenous fistula (RCAVF) is the initial suggested procedure for establishing hemodialysis vascular access (HVA) in the most...
Background The wrist radiocephalic arteriovenous fistula (RCAVF) is the initial suggested procedure for establishing hemodialysis vascular access (HVA) in the most distal site of the upper limb. The anatomical snuffbox arteriovenous fistula (SBAVF) is barely utilised, despite its remote location. In this study, we aimed to analyse and compare the results of SBAVF and RCAVF in terms of their maturity, patency, and failure rates. Methodology This descriptive, retrospective study compared outcomes between SBAVF and RCAVF in terms of maturation, patency, and failure. All patients with chronic kidney disease who attended and underwent either procedure at Betsi Cadwaladr University Health Board between 2013 and 2023 were studied. Results In a period of 10 years, 179 patients were included. Overall, 102 (57%) were male and 77 (43%) were female, with a male-to-female ratio of 1.3:1. Wrist radiocephalic fistula was the dominant type of surgery done in 76% (n = 136), while the snuffbox radiocephalic fistula was done in fewer than 24% (n = 43) of patients. Most patients underwent a successful arteriovenous (AV) fistula (n = 105, 58.7%), in contrast to 67 patients whose fistulas failed. There was a significant relationship between fistula failure and complications (p = 0.000). There was no significant effect of the fistula site, hypertension, diabetes, cardiac diseases, smoking, peripheral vascular disease, or central vein stenosis on the failure of the AV fistula (p = 0.127, 0.534, 0.510, 0.397, 0.017, 0.68, and 0.371, respectively). Conclusions The snuffbox AV fistula is a suitable and feasible first choice for patients on hemodynamic therapy.
PubMed: 38699137
DOI: 10.7759/cureus.57442 -
Annals of Medicine and Surgery (2012) May 2024This study aims to assess the effect of needle distance of arteriovenous fistula (AVF) cannulation on haemodialysis adequacy based on KT/V.
BACKGROUND
This study aims to assess the effect of needle distance of arteriovenous fistula (AVF) cannulation on haemodialysis adequacy based on KT/V.
MATERIALS AND METHODS
This study was a parallel-group, randomized controlled trial. Patients who met the inclusion criteria were divided into two groups with 3 and 6 cm needle distances using block randomization. Data acquisition transpired through a comprehensive checklist encompassing demographic variables such as age and sex, alongside clinical metrics comprising actual weight, dry weight, average dialysis duration, fistula longevity, and KT/V rate.
RESULTS
A total of 42 haemodialysis patients were enroled in this investigation, with 21 allocated to the 3 cm needle distance group and another 21 to the 6 cm needle distance group. The mean post-haemodialysis KT/V values for the 3 cm and 6 cm needle distance groups were 1.25 (SD=0.25) and 1.42 (SD=0.24), respectively, demonstrating a statistically significant difference (<0.001). While there was no significant difference in the average pre-haemodialysis and post-haemodialysis KT/V values within the 3 cm needle distance group (=1.93, =0.068), the corresponding values for the 6 cm needle distance group exhibited a notable discrepancy (=9.66, <0.001).
CONCLUSION
In general, a needle distance of 6 cm between arteriovenous points yielded superior enhancements in dialysis adequacy compared to a 3 cm needle distance following haemodialysis. Consequently, health administrators and policymakers may consider instituting efficacious interventions to scrutinize the care and therapeutic protocols for haemodialysis patients, involving the development of policies and applications.
PubMed: 38694348
DOI: 10.1097/MS9.0000000000001966 -
Heliyon May 2024Trigeminal neuralgia (TN) secondary to a dural arteriovenous fistula (DAVF) is quite rare, and the goal of treatment is to resolve both the fistula and the pain.
BACKGROUND
Trigeminal neuralgia (TN) secondary to a dural arteriovenous fistula (DAVF) is quite rare, and the goal of treatment is to resolve both the fistula and the pain.
CASE PRESENTATION
We herein report a case of TN secondary to a DAVF in a 64-year-old woman with a 1-year history of right-sided TN. Brain magnetic resonance imaging and digital subtraction angiography showed a right tentorial DAVF. Interventional embolization was performed, but the pain was not relieved after the operation. Six months later, we performed microvascular decompression of the trigeminal nerve. During the operation, we electrocoagulated the tortuous and dilated malformed vein, which was compressing the trigeminal nerve, to reduce its diameter and mitigate the compression on the cisternal segment of the trigeminal nerve. That patient's pain was relieved postoperatively. In addition, we reviewed the literature of TN caused by DAVF and found a total of 30 cases, 22 of which were treated by interventional embolization. Of these 22 cases, the interventional embolization healed the fistula with pain relief in 14 cases and healed the fistula without pain relief in 8 cases. We found that the venous drainage methods of the 8 cases were all classified into the posterior mesencephalic group.
CONCLUSIONS
We believe that this drainage pattern contributes to the more common occurrence of unrelieved pain. For such patients, microvascular decompression can be performed with intraoperative coagulation to narrow the dilated veins until the cisternal segment of the trigeminal nerve is no longer compressed. Satisfactory curative effects can be obtained using this technique.
PubMed: 38694083
DOI: 10.1016/j.heliyon.2024.e30000 -
Renal Failure Dec 2024The association between blood flow rate (BFR) and clinical outcomes in patients undergoing maintenance hemodialysis (MHD) is inconclusive. This retrospective study...
The association between blood flow rate (BFR) and clinical outcomes in patients undergoing maintenance hemodialysis (MHD) is inconclusive. This retrospective study included 175 patients undergoing MHD treatment between July 2015 and March 2022, divided into two groups based on time-averaged effective blood flow rate (eBFR) median value. We investigated arteriovenous fistula (AVF) outcomes and the association of eBFR with all-cause mortality and new major adverse cardiovascular events (MACE). Mean ± SD and median time-averaged eBFR values were 276 ± 24 and 275 mL/min, respectively. After adjusting for relevant factors including age, sex, vintage, diabetes, CVD, receiving hemodiafiltration (HDF) treatment and spKt/V, Cox models indicated a low time-averaged eBFR (≤ 275 ml/min) was associated with increased risks of all-cause mortality (hazard ratio [HR] 14.18; 95% confidence interval [CI], 3.14-64.1) and new MACE (HR 3.76; 95% CI, 1.91-7.40) in MHD patients. Continuous Cox models demonstrated each 20 ml/min increase in eBFR linked to a 63% decrease in the risk of all-cause mortality (HR: 0.37, 95% CI: 0.23-0.59) and a 38% decrease in the occurrence of new MACE (HR: 0.62, 95% CI: 0.46-0.84). There was no significant difference in AVF outcomes between the two groups. Our study noted higher eBFR (>275 mL/min) is associated with lower risks of both all-cause mortality and new MACE compared with low eBFR (≤275 mL/min). Increased eBFR is not associated with a higher risk of AVF failure.
Topics: Humans; Female; Male; Middle Aged; Retrospective Studies; Renal Dialysis; Aged; Kidney Failure, Chronic; Blood Flow Velocity; Arteriovenous Shunt, Surgical; Proportional Hazards Models; Cardiovascular Diseases; Treatment Outcome; Hemodiafiltration
PubMed: 38685582
DOI: 10.1080/0886022X.2024.2344655 -
Medicina 2024Paradoxical embolism due to an isolated pulmonary arteriovenous malformation (PAVM) is a rare cause of ischemic stroke. PAVMs are abnormal high-flow connections between...
Paradoxical embolism due to an isolated pulmonary arteriovenous malformation (PAVM) is a rare cause of ischemic stroke. PAVMs are abnormal high-flow connections between pulmonary arteries and veins, diverting deoxygenated blood into the systemic circulation and they represent a less common source of paradoxical embolisms, especially in young individuals. Endovascular embolization is the preferred treatment for clinically significant PAVMs. We present the case of a 34-year-old woman with a left thalamic ischemic stroke. Severe contrast passage was detected in cerebral arteries through transcranial Doppler. Intracardiac ultrasound did not reveal a patent foramen ovale, prompting further investigation with pulmonary CT angiography, confirming the presence of PAVM. The patient underwent successful endovascular treatment. It is essential to consider PAVM in the etiological diagnosis of ischemic stroke, especially in young patients with signs of abnormal right-to-left communication. Periodic follow-up imaging is recommended to assess potential recurrence or changes in PAVM, emphasizing the importance of appropriate management of these malformations.
Topics: Humans; Adult; Female; Embolism, Paradoxical; Ischemic Stroke; Pulmonary Artery; Pulmonary Veins; Arteriovenous Malformations; Computed Tomography Angiography; Arteriovenous Fistula; Embolization, Therapeutic
PubMed: 38683523
DOI: No ID Found -
Frontiers in Cardiovascular Medicine 2024End-stage renal disease (ESRD) patients have a high potential cardiovascular burden, and cardiovascular disease (CVD) is the leading cause of death in maintenance...
BACKGROUND
End-stage renal disease (ESRD) patients have a high potential cardiovascular burden, and cardiovascular disease (CVD) is the leading cause of death in maintenance haemodialysis (MHD) patients. Arteriovenous fistula (AVF) is the preferred vascular access for MHD patients, but AVF significantly affects the haemodynamics of the cardiovascular system, leading to or exacerbating CVD, including atrial fibrillation (AF). This study aimed to evaluate the impact of AVF on cardiac function, especially of the left atrium (LA), in patients with ESRD and to further explore the relationship between AVF establishment and the occurrence of AF.
METHODS
We selected 1,107 ESRD patients on haemodialysis using AVF and 550 patients with tunneled-cuffed catheters (TCC) admitted between January 2016 and December 2022 for follow-up to compare the rate of AF between the two groups. A total of 153 patients in the AVF group with complete information (clinical data, echocardiographic and biochemical indices, and other data) were enrolled and retrospectively analysed for risk factors for the development of AF and were followed up for adverse clinical outcomes (including all-cause death, cardiac death, readmission due to heart failure, and stroke).
RESULTS
The incidence of new-onset AF was higher in the AVF group than the TCC group after dialysis access was established (16.30% vs. 5.08%, < 0.001). Echocardiography showed that the LA anteroposterior diameter increased ( < 0.001) and the incidence of AF increased from 11.76% to 26.14% ( = 0.001) after AVF establishment. Multivariate logistic regression analysis showed that age and LA enlargement were independent risk factors for new-onset AF after AVF establishment ( < 0.05). Adverse clinical outcomes were more common in patients with AF than in patients without AF ( < 0.001). Multivariate Cox risk regression analysis suggested that new-onset AF (HR = 4.08, 95% CI: 2.00-8.34, < 0.001) and left ventricular systolic dysfunction (HR = 2.42, 95% CI: 1.20-4.88, = 0.01) after AVF establishment were independent risk factors for adverse clinical outcomes.
CONCLUSION
LA enlargement after AVF establishment is associated with a significant increase in the incidence of AF, in addition, AF which is as an important influential factor in patients with MHD combined other systemic diseases might increase adverse clinical events.
CLINICAL TRIAL REGISTRATION
(NCT06199609).
PubMed: 38682103
DOI: 10.3389/fcvm.2024.1386304