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Diagnostics (Basel, Switzerland) May 2024Percutaneous renal surgery, although much less invasive than other procedures, is subject to several complications, which can occur at any time during the course of...
Percutaneous renal surgery, although much less invasive than other procedures, is subject to several complications, which can occur at any time during the course of treatment, starting from the performance of the minimal nephrostomy procedure. We present an extremely rare vascular complication of percutaneous nephrostomy represented by arteriovenous fistula that occurred in a 24-year-old patient known to have right ureteropelvic junction obstruction operated with the absence of double-J catheter permeability and grade II-III hydronephrosis for which minimal percutaneous nephrostomy was urgently fitted. The arteriovenous fistula was resolved by supraselective artery embolization.
PubMed: 38893647
DOI: 10.3390/diagnostics14111121 -
International Journal of Molecular... Jun 2024Pulmonary arteriovenous malformations (PAVMs) are vascular anomalies resulting in abnormal connections between pulmonary arteries and veins. In 80% of cases, PAVMs are...
Pulmonary arteriovenous malformations (PAVMs) are vascular anomalies resulting in abnormal connections between pulmonary arteries and veins. In 80% of cases, PAVMs are present from birth, but clinical manifestations are rarely seen in childhood. These congenital malformations are typically associated with Hereditary Hemorrhagic Telangiectasia (HHT), a rare disease that affects 1 in 5000/8000 individuals. HHT disease is frequently caused by mutations in genes involved in the TGF-β pathway. However, approximately 15% of patients do not have a genetic diagnosis and, among the genetically diagnosed, more than 33% do not meet the Curaçao criteria. This makes clinical diagnosis even more challenging in the pediatric age group. Here, we introduce an 8-year-old patient bearing a severe phenotype of multiple diffuse PAVMs caused by an unknown mutation which ended in lung transplantation. Phenotypically, the case under study follows a molecular pattern which is HHT-like. Therefore, molecular- biological and cellular-functional analyses have been performed in primary endothelial cells (ECs) isolated from the explanted lung. The findings revealed a loss of functionality in lung endothelial tissue and a stimulation of endothelial-to-mesenchymal transition. Understanding the molecular basis of this transition could potentially offer new therapeutic strategies to delay lung transplantation in severe cases.
Topics: Humans; Telangiectasia, Hereditary Hemorrhagic; Child; Pulmonary Artery; Pulmonary Veins; Endothelial Cells; Male; Mutation; Arteriovenous Malformations; Epithelial-Mesenchymal Transition; Lung Transplantation; Arteriovenous Fistula; Lung; Female
PubMed: 38892351
DOI: 10.3390/ijms25116163 -
Healthcare (Basel, Switzerland) May 2024(1) Background: The surgical procedure to create an arteriovenous fistula (AVF) can be performed in either an ambulatory or in-patient hospital setting, depending on the...
(1) Background: The surgical procedure to create an arteriovenous fistula (AVF) can be performed in either an ambulatory or in-patient hospital setting, depending on the case's complexity, the anesthesia type used, and the patient's comorbidities. The main scope of this study is to assess the cost-effectiveness and clinical implications of surgically creating an AVF in both ambulatory and in-hospital settings. (2) Methods: We conducted a retrospective observational study, in which we initially enrolled all patients with end-stage kidney disease (ESKD) admitted to the Vascular Surgery Department, Emergency County Hospital of Targu Mures, Romania, to surgically create an AVF for dialysis, between January 2020 and December 2022. The primary endpoint of this study is to assess the cost-effectiveness of surgically creating an AVF in an ambulatory vs. in-hospital setting by comparing the costs required for the two types of admissions. Further, the 116 patients enrolled in this study were divided into two groups based on their preference for hospitalization: and . (3) Results: Regarding in-patient comorbidities, there was a higher prevalence of peripheral artery disease (PAD) ( = 0.006), malignancy ( = 0.020), and previous myocardial infarction ( = 0.012). In addition, active smoking ( = 0.006) and obesity ( = 0.018) were more frequent among these patients. Regarding the laboratory data, the in-patients had lower levels of white blood cells (WBC) ( = 0.004), neutrophils count ( = 0.025), lymphocytes ( = 0.034), and monocytes ( = 0.032), but there were no differences between the two groups regarding the systemic inflammatory biomarkers or the AVF type. Additionally, we did not register any difference regarding the outcomes: local complications ( = 0.588), maturation failure ( = 0.267), and primary patency ( = 0.834). In our subsequent analysis, we discovered no significant difference between the hospitalization type chosen by patients regarding AVF primary patency failure ( = 0.195). We found no significant association between the hospitalization type and the recorded outcomes (all > 0.05) in both multivariate linear regression and Cox proportional hazard analysis. (4) Conclusions: In conclusion, there are no significant differences in the clinical implications, short-term and long-term complications of AVF for out-patient and in-patient admissions. Additionally, we found no variation in the costs associated with laboratory tests and surgical supplies for an AVF creation. Therefore, it is safe to perform ambulatory AVFs, which can reduce the risk of hospital-acquired infections and provide greater comfort to the patient.
PubMed: 38891176
DOI: 10.3390/healthcare12111102 -
Clinical Journal of the American... Jun 2024Outpatient hemodialysis facilities report BSI events to NHSN. Pooled mean rates with 95% CI were calculated overall and for each type of vascular access (arteriovenous...
METHODS
Outpatient hemodialysis facilities report BSI events to NHSN. Pooled mean rates with 95% CI were calculated overall and for each type of vascular access (arteriovenous (AV) fistula, AV graft, or a central venous catheter (CVC)). Standardized infection ratios were calculated as observed BSI events divided by the predicted number of events based on national aggregate data. Median facility-level standardized infection ratios and 95% confidence intervals (CIs) were stratified by state and US territory.
RESULTS
During 2020, 7,183 outpatient hemodialysis facilities reported data for 5,235,234 patient months with 15,181 BSI events. Pooled mean rates per 100 person-months were 0.29 (95% CI, 0.29-0.30) overall, 0.80 (95% CI, 0.78-0.82) for CVC, 0.12 (95% CI, 0.12-0.12) for AV fistula, 0.21 (95% CI, 0.20-0.22) for AV graft, and 0.28 (95% CI, 0.19-0.40) for other access types. The national standardized infection ratio was 0.40 (95% CI, 0.39-0.41). South Dakota had a standardized infection ratio significantly higher than one (1.34; 95% CI, 1.11 - 1.62). Fifty-one of 54 states and territories had BSI standardized infection ratio significantly lower than one.
CONCLUSIONS
In 2020, the median standardized infection ratio for BSI in US outpatient hemodialysis facilities was lower than predicted overall and in almost all states and territories. An elevated standardized infection ratio was identified in South Dakota.
PubMed: 38888965
DOI: 10.2215/CJN.0000000000000476 -
EJVES Vascular Forum 2024Aneurysmorrhaphy, described as reduction aneurysmoplasty, partial aneurysmectomy, or vessel wall recalibration, can be considered a suitable surgical plan for true...
Salvage Aneurysmorrhaphy as an Adaptable and Still Pertinent Technique in the Management of Challenging True Aneurysms of Arteriovenous Fistulas: A Case Series of Different Variations, With Illustrative Surgical Pictures.
INTRODUCTION
Aneurysmorrhaphy, described as reduction aneurysmoplasty, partial aneurysmectomy, or vessel wall recalibration, can be considered a suitable surgical plan for true aneurysms of arteriovenous fistulas (AVFs), allowing for a dynamic approach to reconstruction of aneurysmal AVFs of different severities, ensuring salvage of the native access.
REPORT
Six challenging cases of AVF aneurysms are presented, some with extremely dilated and tortuous megafistulas, for which three surgical technique variations were performed. The patients had a mean age of 59.2 years, 50% were female, with brachiocephalic ( = 5, 83.3%) or brachiobasilic ( = 1, 16.7%) AVFs. The fistulas were created an average of 4.67 years previously, and the aneurysms had an average maximum diameter of 37.5 mm (range 25-60 mm). Surgical indications were rupture risk, thrombosis, or outflow stenosis compromising haemodialysis, infections, and concerns for quality of life (affected by post-puncture bleedings, disfiguring aesthetics, pain, and discomfort). The surgical techniques were simple aneurysmorrhaphy ( = 3, 50%), aneurysmorrhaphy with partial excision of aneurysmal segment with end to end anastomosis of venous ends ( = 2, 33.3%), and aneurysmorrhaphy with establishment of new venous outflow ( = 1, 16.7%). All AVFs were patent post-operatively and at follow up (mean 5.6 months, median one month). Haemodialysis was resumed through the AVFs at a mean of 2.17 weeks post-operatively, with placement of an alternative route for haemodialysis in the meantime. No patients experienced post-operative complications.
DISCUSSION
Experience with the more challenging cases shows that aneurysmorrhaphy can still be considered an acceptable, flexible, and pertinent method for salvage of megafistulas, giving the surgeon the much needed versatility to adapt to anatomical and pathological variations, with high patency rates and minimal complications, especially when other treatment options are not possible in complicated cases. AVF salvage through aneurysmorrhaphy allows for a dynamic approach to the reconstruction of severely tortuous, dilated veins, ensuring patency of the native AVF.
PubMed: 38884071
DOI: 10.1016/j.ejvsvf.2024.05.002 -
IScience Jun 2024Endothelial cell (EC) damage or dysfunction serves as the initial event in the pathogenesis of various cardiovascular diseases. Progenitor cells have been postulated to...
Endothelial cell (EC) damage or dysfunction serves as the initial event in the pathogenesis of various cardiovascular diseases. Progenitor cells have been postulated to be able to differentiate into ECs, facilitate endothelial regeneration, and alleviate vascular pathological remodeling. However, the precise cellular origins and underlying mechanisms remain elusive. Through single-cell RNA sequencing (scRNA-seq), we identified an increasing population of progenitors expressing stem cell antigen 1 (Sca1) during vascular remodeling in mice. Using both mouse femoral artery injury and vein graft models, we determined that Sca1 cells differentiate into ECs, restored endothelium in arterial and venous remodeling processes. Notably, we have observed that the differentiation of Sca1 cells into ECs is negatively regulated by the microRNA-145-5p (miR-145-5p)-Erythroblast transformation-specific-related gene (ERG) pathway. Inhibiting miR-145-5p promoted Sca1 cell differentiation and reduced neointimal formation after vascular injury. Finally, a similar downregulation of miR-145-5p in human arteriovenous fistula was observed comparing to healthy veins.
PubMed: 38883819
DOI: 10.1016/j.isci.2024.110080 -
Cureus May 2024More than one million cardiac catheterization procedures are performed each year in the United States for both diagnostic and therapeutic purposes. Obtaining access...
More than one million cardiac catheterization procedures are performed each year in the United States for both diagnostic and therapeutic purposes. Obtaining access through the radial artery has gained popularity in recent years due to its economic as well as its morbidity and mortality benefits over femoral artery access. However, with any invasive procedure there are associated risks, including arteriovenous fistula formation. This case illustrates the formation of an iatrogenic arteriovenous fistula as a complication of transradial coronary catheterization. Albeit rare, this case will discuss the presentation and clinical course of a patient who was diagnosed with a radial arteriovenous fistula seven weeks post-cardiac catheterization. Ultimately, she underwent direct surgical repair with ligation of the venous branches of the arteriovenous circulation.
PubMed: 38883000
DOI: 10.7759/cureus.60370 -
Interventional Neuroradiology : Journal... Jun 2024Carotid-cavernous fistulas (CCFs) are complex arteriovenous shunting lesions of the cavernous sinus with diverse clinical presentations. This study aimed to analyze...
BACKGROUND
Carotid-cavernous fistulas (CCFs) are complex arteriovenous shunting lesions of the cavernous sinus with diverse clinical presentations. This study aimed to analyze clinical outcomes and differentiate patients treated with conservative observation versus those needing endovascular intervention.
METHODS
A retrospective analysis of 84 patients with angiographically confirmed CCF was conducted from 2000 to 2022. Endovascular treatment decisions were made at the discretion of neurointerventionalists. Clinical and angiographic data were collected, including Barrow CCF classification and treatment outcomes.
RESULTS
Patients managed conservatively ( = 17) had longer symptom duration (165 vs 42 days) and more indirect CCF (100% vs 68%) compared to those treated with endovascular embolization ( = 67). High-risk clinical symptoms, including proptosis, diplopia, decreased visual acuity, and chemosis, were more common in the embolization group. Cortical venous reflux and ophthalmic venous reflux were more prevalent in the embolization group (39% and 91%, respectively). Overall, 31% of embolized CCFs required retreatment, mainly Barrow type D lesions (65%). Transvenous coil embolization was the primary technique used (78%), followed by feeder artery embolization (16%), and internal carotid artery flow diversion (8%).
CONCLUSION
In selected CCF patients without high-risk symptoms or angiographic features, conservative observation is a safe and effective alternative to endovascular embolization. High-risk symptoms and angiographic features favor endovascular intervention. Complications were rare, and most were transient, emphasizing the safety of endovascular management. Longitudinal angiographic and ophthalmologic surveillance is essential for monitoring fistula persistence or recurrence.
PubMed: 38881351
DOI: 10.1177/15910199241261761 -
Nefrologia Jun 2024Patient activation is a concept that refers to the willingness to manage one's health and medical care. To assess it, a patient activation measure (PAM) has been...
BACKGROUND AND OBJECTIVE
Patient activation is a concept that refers to the willingness to manage one's health and medical care. To assess it, a patient activation measure (PAM) has been developed and validated. Several studies report low activation in patients with chronic diseases. However, information on activation in hemodialysis patients is scarce. The aim of the present study is to describe the activation level of patients on chronic treatment in an HD unit and its relationship with disease control parameters.
MATERIALS AND METHODS
Cross-sectional observational study in patients with advanced chronic kidney disease on chronic HD treatment. Ninety-six patients were included. Activation was measured with the PAM-13 questionnaire. Its relationship with descriptive variables (age, sex, comorbidity, studies, habitat) and disease control variables (vascular access, blood flow, potassaemia, phosphataemia, interdialytic gain) was studied. For this purpose, Spearman's correlation test, multiple linear regression model and logistic model were used as statistical methods.
RESULTS
The mean (SD) PAM-13 score was 63.19 (15.21). Activation was significantly associated with vascular access (P = 0.003), blood flow (P = 0.024), and interdialytic gain of patients (P = 0.008).
CONCLUSIONS
Activation in patients on chronic hemodialysis treatment is low. Higher activation is related having an arteriovenous fistula, higher blood flow and lower interdialytic gain. Future studies are needed to confirm and apply our results.
PubMed: 38879439
DOI: 10.1016/j.nefroe.2023.05.019 -
World Neurosurgery Jun 2024Cavernous sinus(CS) dural arteriovenous fistulas(DAVFs) are commonly treated by transvenous embolization, but the details of treatment need to be more clearly defined....
BACKGROUND
Cavernous sinus(CS) dural arteriovenous fistulas(DAVFs) are commonly treated by transvenous embolization, but the details of treatment need to be more clearly defined. We propose a classification of CS-DAVF that can contribute to formulating endovascular treatment process.
METHODS
CS-DAVF was classified into seven categories based on the cumulative CS range and drainage patterns. CS-DAVF angioarchitecture, clinical characteristics, treatment strategies, and outcomes of CS-DAVF patients treated in our hospital from 2012 to 2021 were summarized and analyzed.
RESULTS
Among the 116 patients with CS-DAVF: Type 1, 71(61.2%); Type 2, 9(7.8%); Type 3, 18(15.5%); Type 4, 2(1.7%); Type 5, 8(6.9%); Type 6, 3(2.6%); and Type 7, 5(4.3%). Intercavernous sinus or inferior petrosal sinus drainage was relatively rare in Types 1 and 6(p<0.001 and p<0.001); basilar venous plexus drainage was more prevalent in Types 2, 5, and 7(p=0.019). Inferior petrosal sinus occlusion was more commonly seen in Types 2, 3, and 5(p=0.005). The most frequent first symptoms and symptoms at admission in patients with CS-DAVF is ocular/orbital symptoms, occurring in 64 cases (55.2%) and 104 cases (89.7%), respectively. In this study, 108 patients (93.1%) underwent endovascular embolization. Among those who received endovascular embolization, 96(88.9%) CS-DAVFs were treated via transvenous embolization. In long-term follow-up, 98 cases (84.5%) achieved cure, and 17 cases (14.7%) showed symptomatic improvement.
CONCLUSION
Our proposed classification system based on cumulative CS range and drainage patterns can assist in formulating treatment strategies for transvenous embolization.
PubMed: 38878890
DOI: 10.1016/j.wneu.2024.06.042