BACKGROUND The exercise of limb function is the most economical and safe method to promote the maturation of arteriovenous fistula(AVF).However,due to the lack of a uni-fied exercise standard in China,many patients ha...BACKGROUND The exercise of limb function is the most economical and safe method to promote the maturation of arteriovenous fistula(AVF).However,due to the lack of a uni-fied exercise standard in China,many patients have insufficient awareness of the importance of AVF,leading to poor effectiveness of limb function exercise.The self-management education model can effectively promote patients to take pro-active health-related actions.This study focuses on the characteristics of patients during the peri-AVF period and conducts a phased limb function exercise under the guidance of the self-management education model to observe changes in fac-tors such as the maturity of AVF.AIM To assess the impact of stage-specific limb function exercises,directed by a self-management education model,on the maturation status of AVFs.METHODS This study is a randomized controlled trial involving 74 patients with forearm AVFs from the Nephrology Department of a tertiary hospital in Sichuan Province,China.Patients were randomly divided into an observation group and a control group using a random number table method.The observation group underwent tailored stage-specific limb func-tion exercises,informed by a self-management education model which took into account the unique features of AVF at various stages,in conjunction with routine care.Conversely,the control group was given standard limb function exercises along with routine care.The assessment involves the maturity of AVFs post-intervention,post-operative complications,and the self-management level of the fistula in both groups patients.Analyses were conducted using SPSS version 23.0.Count data were represented by frequency and percentage and subjected to chi-square test comparisons.Measurement data adhering to a normal distribution were presented as mean±SD.The independent samples t-test was utilized for inter-group comparisons,while the paired t-test was used for intra-group comparisons.For measurement data not fitting a normal distribution,the median and interquartile range were presented and analyzed using the Wilcoxon rank sum test.RESULTS At the 8-wk postoperative mark,the observation group demonstrated significantly higher scores in AVF symptom recognition,symptom prevention,and self-management compared to the control group(P<0.05).However,the variance in symptom management scores between the observation and control groups lacked statistical signi-ficance(P>0.05).At 4 wk after the operation,the observation group displayed a superior vessel diameter and depth from the skin of the drainage vessels in comparison to the control group(P<0.05).While the observation group did manifest elevated blood flow rates in the drainage vessels relative to the control group,this distinction was not statistically significant(P>0.05).By the 8-wk postoperative interval,the observation group outperformed the control group with notable enhancements in blood flow rates,vessel diameter,and depth from the skin of drainage vessels(P<0.01).Seven days following the procedure,the observation group manifested significantly diminished limb swelling and an overall reduced complication rate in contrast to the control group(P<0.05).The evaluation of infection,thrombosis,embolism,arterial aneurysm stenosis,and incision bleeding showed no notable differences between the two groups(P>0.05).By the 4-wk postoperative juncture,complications between the observation and control groups were statistically indistinguishable(P>0.05).CONCLUSION Stage-specific limb function exercises,under the guidance of a self-management education model,amplify the capacity of AVF patients to discern and prevent symptoms.Additionally,they expedite AVF maturation and miti-gate postoperative limb edema,underscoring their efficacy as a valuable method for the care and upkeep of AVF in hemodialysis patients.展开更多
Objective:To explore the preventive effect of comprehensive nursing intervention on arteriovenous fistula failure in patients in the hemodialysis room.Methods:82 patients with arteriovenous fistula in the hemodialysis...Objective:To explore the preventive effect of comprehensive nursing intervention on arteriovenous fistula failure in patients in the hemodialysis room.Methods:82 patients with arteriovenous fistula in the hemodialysis chamber treated in our hospital from July 2022 to October 2023 were selected as the research subjects.The random number table method divided them into a control group and an experimental group of 41 cases each.The control group received general nursing intervention measures,while the experimental group underwent comprehensive nursing intervention.The incidence of complications(internal fistula failure,bleeding,thrombosis,infection),psychological emotions(SAS scale,SDS scale),quality of life(physical pain,physiological function,emotional function,social function),and nursing satisfaction(very satisfied,basically satisfied,satisfied,dissatisfied)were compared between the two groups of patients.Results:The incidence of complications in the experimental group(4,9.76%)was significantly lower than that in the control group(29,70.73%);the SAS scores and SDS scores of the patients in the experimental group after intervention were both lower than those in the control group;the quality of life score(physical pain,physiological function,emotional function,and social function)was all higher than those of the control group;the post-intervention nursing satisfaction of the experimental group(40,97.57%)was also significantly higher than that of the control group(29,73.17%);and the listed differences were statistically significant(P<0.01).Conclusion:For patients with hemodialysis ventricular arteriovenous fistula failure,comprehensive nursing intervention can reduce the incidence of complications,relieve anxiety and stress,improve quality of life and nursing satisfaction,and achieve better preventive effects.展开更多
BACKGROUND Cerebral ischemic stroke is attributed to paradoxical cerebral embolism.Pulmonary arteriovenous fistula(PAVF)is a rare potential cause of cerebral ischemic stroke,and cerebral ischemic stroke induced by PAV...BACKGROUND Cerebral ischemic stroke is attributed to paradoxical cerebral embolism.Pulmonary arteriovenous fistula(PAVF)is a rare potential cause of cerebral ischemic stroke,and cerebral ischemic stroke induced by PAVF in children is rare.CASE SUMMARY We report a case of right PAVF that presented as a transient ischemic attack(TIA)in a 13-year-old boy.The patient underwent embolization therapy and remained clinically stable for 2 years after treatment.CONCLUSION TIA induced by PAVF in children is rare,lacks typical clinical manifestations,and should not be ignored.展开更多
A dural arteriovenous fistula(DAVF) is an abnormal linkage connecting the arterial and venous systems within the intracranial dura mater. A basicranial emissary vein DAVF drains into the cavernous sinus and the ophtha...A dural arteriovenous fistula(DAVF) is an abnormal linkage connecting the arterial and venous systems within the intracranial dura mater. A basicranial emissary vein DAVF drains into the cavernous sinus and the ophthalmic vein, similar to a cavernous sinus DAVF. Precise preoperative identification of the DAVF location is a prerequisite for appropriate treatment. Treatment options include microsurgical disconnection, endovascular transarterial embolization(TAE), transvenous embolization(TVE), or a combination thereof. TVE is an increasingly popular approach for the treatment of DAVFs and the preferred approach for skull base locations, due to the risk of cranial neuropathy caused by dangerous anastomosis from arterial approaches. Multimodal magnetic resonance imaging(MRI) can provide anatomical and hemodynamic information for TVE. The therapeutic target must be precisely embolized in the emissary vein, which requires guidance via multimodal MRI. Here, we report a rare case of successful TVE for a basicranial emissary vein DAVF, utilizing multimodal MRI assistance. The fistula had vanished, pterygoid plexus drainage had improved, and the inferior petrosal sinus had recanalized, as observed on 8-month follow-up angiography. Symptoms and signs of double vision, caused by abduction deficiency, disappeared. Detailed anatomic and hemodynamic assessment by multimodal MRI is the key to guiding successful diagnosis and treatment.展开更多
In dialysis treatment, the radio-cephalic arteriovenous fistula (RCAVF) is a commonly used fistula, yet its low maturation rate remains a challenge. To enhance surgical outcomes, the relationship between stenosis-pron...In dialysis treatment, the radio-cephalic arteriovenous fistula (RCAVF) is a commonly used fistula, yet its low maturation rate remains a challenge. To enhance surgical outcomes, the relationship between stenosis-prone locations and RCAVF anastomosis angle is studied during maturation by developing two sets of RCAVF models for early (non-mature) and mature RCAVFs at five anastomosis angles. The impact of hemodynamics and wall shear stress (WSS) is examined to determine optimal anastomotic angles. Results indicate that acute angles produce more physiological WSS distributions and fewer disturbed regions, with early stenosis-prone regions located near the anastomosis that shift to the bending venous segment during remodeling. A pilot study comparing clinical and numerical results is conducted for validation.展开更多
Arteriovenous fistulas have a substantial impact on systemic hemodynamics, however their effect on extracorporeal circulation is not well understood. We report our clinical observation on the management under extracor...Arteriovenous fistulas have a substantial impact on systemic hemodynamics, however their effect on extracorporeal circulation is not well understood. We report our clinical observation on the management under extracorporeal circulation of a patient with renal insufficiency with a high-flow arteriovenous fistula. This is a 59-year-old man who was referred to us for surgical treatment of ischemic coronary artery disease in a context of anuric chronic renal failure. Hypothermia at 32°C is started from the start in CEC due to hyperflow at the level of the arteriovenous fistula. We performed two coronary artery bypasses of the marginal and IVA via the two internal thoracic arteries. The patient is hemofiltered in order to avoid hyperkalaemia and possibly avoid fluid overload related to filling per CEC. The clamping time was 71 minutes and the SCC lasted 141 minutes. There was no homologous transfusion in the operating room. It turns out that the input/output balance is zero at the end of the CEC. The postoperative course was simple.展开更多
Objective: To evaluate the effectiveness of cryotherapy in managing the pain at the puncture site of Arterio-Venous Fistula (AVF) among children undergoing maintenance hemodialysis (HD).Methods: A one-group pre-post q...Objective: To evaluate the effectiveness of cryotherapy in managing the pain at the puncture site of Arterio-Venous Fistula (AVF) among children undergoing maintenance hemodialysis (HD).Methods: A one-group pre-post quasi-experiment was performed in two HD centers affiliated with Cairo University.The experiment involved 40 children with AVF undergoing HD.Before puncturing,cryotherapy was applied using 2 cm-3 cm pieces of frozen distilled water in a plastic bag.Pain was assessed subjectively and objectively in two dialysis sessions before and after cryotherapy.A part from a physiological assessment of vital signs,pain was assessed using the Wong-Baker Faces Pain and the Observed Pain Behavior rating scales.All research ethics were applied.Results: HD had a median duration of four years,while cryotherapy had a median application time of 8.8 min.The Wong-Baker Faces Pain score and almost all observed pain behaviors significantly decreased after cryotherapy.Significant improvements were observed in respiratory rate before and after needle puncture and in oxygen saturation after needle puncture.A lower skin dryness was observed after cryotherapy (12.5%) than before cryotherapy (52.5%;p < 0.001).Conclusions: Cryotherapy can effectively reduce the venipuncture pain among children with AVF undergoing maintenance HD.However,the confounding effects of distraction and the non-randomized design used must be both considered when interpreting the findings.This study recommends the use of cryotherapy in managing needle puncture pain.Further research must adopt a randomized trial design with a placebo to support further the benefits of this procedure.展开更多
<span style="font-family:Verdana;">The main reason for the early failure of radio-cephalic arteriovenous fistula (RCAVF) is non-maturity, which means that the blood flow rate in the fistula cannot incr...<span style="font-family:Verdana;">The main reason for the early failure of radio-cephalic arteriovenous fistula (RCAVF) is non-maturity, which means that the blood flow rate in the fistula cannot increase to the expected value for dialysis. From a mechanical perspective, the vascular resistance at the artificially designed anastomosis causes an energy loss that affects blood flow rate growth and leads to early failure. This research studied how to maximize the RCAVF maturity and primary patency by controlling the energy loss rate. We theoretically analyzed and derived a model that evaluates the energy loss rate <em>E</em><sub><em>avf</em></sub> in RCAVF as a function of its blood vessel geometric parameters (GPs) for given flow rates. There was an aggregate of five controllable GPs in RCAVF: radial artery diameter (<em>D</em><sub><em>ra</em></sub>), cephalic vein diameter (<em>D</em><sub><em>cv</em></sub>), blood vessel distance between artery and vein (<em>h</em>), anastomotic diameter (<em>D</em><sub><em>a</em></sub>), and anastomotic angle (<em>θ</em>). Through this analysis, it was found that <em>E</em><sub><em>avf</em></sub> was inversely proportional to <em>D</em><sub><em>ra</em></sub>, <em>D</em><sub><em>cv</em></sub>, <em>D</em><sub><em>a</em></sub>, and <em>θ</em>, whereas proportional to <em>h</em>. Therefore, we recommended surgeons choose the vessels with large diameters, close distance, and increase the diameter and angle of the anastomosis to decrease the early failure of RCAVF. Simultaneously, we could explain the results of many clinical empiricisms with our formula. We found that increasing <em>D</em><sub><em>cv</em></sub> and <em>θ</em> was more significant in reducing <em>E</em><sub><em>avf</em></sub> than increasing <em>D</em><sub><em>ra</em></sub> and <em>D</em><sub><em>a</em></sub>. Based on our model, we could define two critical energy loss rates (<em>CEL</em><sub><em>a</em></sub>, <em>CEL</em><sub><em>b</em></sub>) to help surgeons evaluate the blood vessels and choose the ideal range of <em>θ</em>, and help them design the preoperative RCAVF plan for each patient to increase the maturity and the primary patency of RCAVF.</span>展开更多
BACKGROUND Arteriovenous fistula of the sigmoid sinus is an abnormal connection of arteries with the sigmoid sinus.Endovascular treatments of such lesions are considered safe and with low rates of complications.CASE S...BACKGROUND Arteriovenous fistula of the sigmoid sinus is an abnormal connection of arteries with the sigmoid sinus.Endovascular treatments of such lesions are considered safe and with low rates of complications.CASE SUMMARY A 62-year-old female patient underwent endovascular treatment of an arteriovenous fistula of the right sigmoid sinus on February 7,2017,but her tinnitus was not cured.She was admitted to the Beijing Tiantan Hospital,Capital Medical University,on March 20,2017,and her pre-operative diagnosis,by digital subtraction cerebral angiography,was arteriovenous fistula of the sigmoid sinus.She underwent endovascular embolization of the distal occipital artery and posterior auricular artery using Onyx-18.The arteriovenous fistula of the sigmoid sinus was cured,and her tinnitus disappeared,but ischemia of the upper 2/3 of the right auricle occurred without hearing loss.The patient received treatment to improve microcirculation,in addition to fluid supplementation,analgesia,and hyperbaric oxygen,and the swelling due to ischemia in the right auricle did not progress further.The patient reported no tinnitus,and the right auricle had returned to normal 3 years later.CONCLUSION Ischemic complications of vital organs should be considered when performing embolization procedures for arteriovenous fistulas of cerebral sinuses.Compensation of the organs should be evaluated before the operation,and the related treatment regimens should be planned.展开更多
Dural arteriovenous fistulas(DAVFs)include a wide range of pathological conditions that are associated with intracranial vessel abnormalities.While some types of DAVFs present with typical neuroimaging characteristics...Dural arteriovenous fistulas(DAVFs)include a wide range of pathological conditions that are associated with intracranial vessel abnormalities.While some types of DAVFs present with typical neuroimaging characteristics,others share overlapping pathological and neuroimaging features that can hinder accurate differentiation.Hence,misclassification of the various types of DAVFs is common.Thorough knowledge of DAVF imaging findings is essential to avoid such misinterpretations.Traditional digital subtraction angiography(DSA)is considered the gold standard for diagnosing and evaluating DAVFs.However,angiography cannot detect changes in a patient’s brain structure.Conventional magnetic resonance imaging(MRI)sequences,including MR angiography(MRA),allow the evaluation of DAVFs without ionizing radiation or invasiveness.Advanced MRI techniques,such as susceptibility-weighted imaging(SWI)and dynamic contrast-enhanced MRA,provide added value to real-time physio-pathological data regarding the hemodynamics of DAVFs.Beyond these techniques,new insights using high-resolution vascular wall MRI are incorporated for the noninvasive evaluation of DAVFs.This article reviews the pathophysiology of DAVFs,focusing on the specifics of MRI findings that facilitate their classification.The role of conventional and advanced MRI sequences for DAVFs was assessed using insights derived from the data provided by structured reports of multimodal MRIs to evaluate DAVFs.展开更多
Chronic lower limb wounds are common. They can be of arterial or venous origin. In this article, we will present a clinical case of a 30-year-old patient with a chronic injury to the right medial malleolus. In his his...Chronic lower limb wounds are common. They can be of arterial or venous origin. In this article, we will present a clinical case of a 30-year-old patient with a chronic injury to the right medial malleolus. In his history, we can note a gunshot wound to the right leg. Ultrasonography and CT angiography helped in the diagnosis of traumatic arteriovenous fistula. The patient underwent a fistula embolization which allowed the wound to heal. The clinical presentation, additional examinations and the latest treatment recommendations will be discussed in this article.展开更多
Spinal epidural hemorrhages(SEDH)caused by spinal epidural arteriovenous fistulas(SEAVFs)are rare;thus,their specific pathogenesis has not been explained.Furthermore,the standard treatment for SEAVFs has not yet been ...Spinal epidural hemorrhages(SEDH)caused by spinal epidural arteriovenous fistulas(SEAVFs)are rare;thus,their specific pathogenesis has not been explained.Furthermore,the standard treatment for SEAVFs has not yet been defined.Here we report the case of a 36-year-old Chinese man who experienced acute onset chest pain and tightness.His symptoms rapidly aggravated until the lower limbs were unable to support him.Spinal magnetic resonance angiography(MRA)revealed a localized SEAVF and a secondary spinal cord lesion at the T4 level.Digital subtraction angiography(DSA)confirmed the presence of the SEDH/SEAVF at the T3–4 level with the left radicular artery feeding the fistula.Based on DSA and MRA findings,SEDH,local spinal cord infarction,and spinal venous reflux disorder were conditionally diagnosed.Using the arterial route,Onyx-34 was injected into the fistula to embolize the feeding arteries and the venous system.Angiography was performed after the microcatheter was withdrawn,and no residual fistula or anterior spinal artery was observed.The six-week follow-up MRI showed acceptable healing of the SEAVF,and the patient improved neurologically.This case suggests that endovascular treatment with Onyx-34 embolization should be considered a promising treatment strategy for this type of complicated SEAVF.展开更多
The arteriovenous fistula (AVF) has been considered for several decades as the preferred approach for hemodialysis because of its longevity and its lower morbidity and mortality rate. However, it can be the cause of s...The arteriovenous fistula (AVF) has been considered for several decades as the preferred approach for hemodialysis because of its longevity and its lower morbidity and mortality rate. However, it can be the cause of several infectious and especially cardiovascular complications. Stenosis is the most common complication of AVF. It is favored by several hemodynamic, cellular and mechanical factors. Reduced dialysis performance and thrombosis are the main risks associated with stenosis. Intervention for dilation is indicated in the presence of any pre-thrombotic stenosis or stenosis that alters the quality of dialysis. However, in patients with heart disease, an assessment of the risk of decompensation is mandatory before considering any gesture of dilation of a fistula. We report a case of acute cardiac decompensation in an 85-year-old patient with severe but stable dilated cardiomyopathy after dilatation of an AVF stenosis. This observation shows that particular attention should be given to elderly subjects with AVF stenosis, especially in the presence of underlying heart disease where closure of the AVF with placement of a tunneled catheter is an alternative that should always be discussed.展开更多
Introduction: Arteriovenous fistula (AVF) operation is recognized a gold standard of hemodialysis for end-stage renal disease. Because various complications may occur during perioperative period, medical care plays an...Introduction: Arteriovenous fistula (AVF) operation is recognized a gold standard of hemodialysis for end-stage renal disease. Because various complications may occur during perioperative period, medical care plays an important role in improving the possibility of AVF operation. The objective of the study was to explore the effect of the mode of multiple disciplinary team (MDT) medical care on the patients with end-stage renal disease treated by arteriovenous fistula (AVF) operation. Method: 98 patients with end-stage renal disease under the AVF operation were divided into observation group and control group. The control group was performed with regular medical care and for the observation group was treated under the mode of MDT medical care. Complications after operation, hospitalized time and medical satisfaction were comprehensively compared between the both groups. Results: The overall complications including swelling, bleeding, infection and thrombosis in observation group accounted for 5%, however, 19% of patients suffered different complications in the control group. The total complications significantly decreased in the observation group compared with control group (P < 0.001). The hospitalization time was shortened to 9.8 ± 5.6 days in the observation group, and the average hospitalization in control group was 17.8 ± 8.9 days. The medical satisfaction was increased by 20.83 percent in the observation group compared with the control group (P < 0.001). 75% patients in control group were satisfied with medical care, and 98.53% patients were satisfied for observation group. Conclusion: The mode of MDT medical care was beneficial for patients with end-stage renal disease after AVF operation, which could significantly reduce complications, hospitalized time and improve patients’ degree of satisfaction. Thus, it should be recommended in the clinical work.展开更多
<div style="text-align:justify;"> <span style="font-family:Verdana;">Posterior approach lumbar disc surgeries (LDS) can be associated with serious iatrogenic vascular complications whic...<div style="text-align:justify;"> <span style="font-family:Verdana;">Posterior approach lumbar disc surgeries (LDS) can be associated with serious iatrogenic vascular complications which could be a serious life threatening condition. We report a rare case of right sided acute iliac vessels iatrogenic arteriovenous fistula (IAVF) which was diagnosed and managed in 24 hours duration in a 45 years old healthy female who underwent surgical posterior approach L4-5 discectomy. Intraoperative, she developed sudden hypotension, tachycardia, wide pulse pressure and acute drop of hemoglobin level without obvious operative site bleeding which raise the index of suspicion of vascular injury and urge the team for doing emergency CT angiography (CTA), vascular and endovascular team consultation for digital subtraction angiography (DSA) and endovascular management. Endovascular stenting is nowadays the modality of choice of intervention. We provide case report with literature review.</span> </div>展开更多
Objective:to describe the clinical features of bilateral multiple pulmonary arteriovenous fistulas(PAF)with paroxysmal aphasia as the first symptom.Methods:we collected the clinical history and examination data of a p...Objective:to describe the clinical features of bilateral multiple pulmonary arteriovenous fistulas(PAF)with paroxysmal aphasia as the first symptom.Methods:we collected the clinical history and examination data of a patient with paroxysmal aphasia.In order to trace the etiology,we performed chest computed tomography(CT)and pulmonary CT angiography(CIA).Results:the patient had paroxysmal aphasia with dizziness,brain magnetic resonance imaging(MRI)showed cerebral infarction,the transcranial Doppler(TCD)foaming test was positive,transesophageal ultrasound showed no patent foramen ovale,and chest CT and CIA showed bilateral multiple PAF.Conclusion:bilateral multiple PAF are rare in clinic.When patients have paroxysmal neurological symptoms,the possibility of PAF leading to embolism should be considered.展开更多
This study aimed to evaluate pain intensity in chronic renal patients under hemodialysis during the arteriovenous fistula cannulation. It was a cross-sectional study conducted in a hemodialysis clinic in the second se...This study aimed to evaluate pain intensity in chronic renal patients under hemodialysis during the arteriovenous fistula cannulation. It was a cross-sectional study conducted in a hemodialysis clinic in the second semester of 2014. 70 individuals participated in the research and were assessed by the visual analogue scale. The project was approved with opinion number 453.508-2013. During cannulation, the pain reported was moderate in 58.5% of patients, intense in 30% and mild in 11.5%. There was no association between the occurrence of pain in relation to gender, shift and time of hemodialysis. The study points out to the need for pre-cannulation analgesia to improve comfort during the procedure.展开更多
Arthroscopically assisted reconstruction of the anterior cruciate ligament (LCA) is generally a safe and effective procedure with a low rate of vascular complications. We report on a case of a 33-year-old woman with a...Arthroscopically assisted reconstruction of the anterior cruciate ligament (LCA) is generally a safe and effective procedure with a low rate of vascular complications. We report on a case of a 33-year-old woman with a combined arteriovenous fistula (AVF) and venous popliteal aneurysm that developed 6 months after arthroscopic anterior cruciate ligament reconstruction. At clinical exam the patient presented with left popliteal and calf pain, a tender pulsatile mass posterior to her left knee, popliteal bruit and a thrill at the popliteal fossa. CT scan showed an AVF arising from the left popliteal artery. An aneurysm was seen to fill at the same time as the popliteal vein. Findings at open surgical revision included AVF between the tibioperoneal trunk and the popliteal vein and a venous popliteal aneurysm at the level of the arteriovenous communication. The aneurysm and fistula were repaired. The patient had an uneventful follow up with complete recovery. We also report an endovascular treatment of a iatrogenic arterio-venous fistula.展开更多
Objective To evaluate the clinical significance of intraoperative indocyanine green (ICG) videoangiography in surgical management of spinal dural ateriovenots fistulae (dAVFs) . Methods In this retrospective analysis ...Objective To evaluate the clinical significance of intraoperative indocyanine green (ICG) videoangiography in surgical management of spinal dural ateriovenots fistulae (dAVFs) . Methods In this retrospective analysis we examined nine cases of dAVFs,diagnosed by complete spinal angiography,in which laminoplasty were performed through posterior approach. An operating microscope-integrated light展开更多
Autogenous arteriovenous fistula(AVF)is a lifeline for maintenance hemodialysis patients.In 2006,the vascular access guidelines issued by the Kidney Disease Outcomes Quality Initiative(KDOQI)introduced the concept of...Autogenous arteriovenous fistula(AVF)is a lifeline for maintenance hemodialysis patients.In 2006,the vascular access guidelines issued by the Kidney Disease Outcomes Quality Initiative(KDOQI)introduced the concept of“Fistula first”.1 In 2019,the same organization updated these vascular access guidelines and proposed the concept of“Patient first”,2 sparking a wide range of controversy and discussion on whether to abandon the“Fistula first”principle.Given this context,experts from across China mainland conducted a comprehensive and systematic evaluation of the relevant literature,evidence-based medical guidelines,and international guidelines.展开更多
基金Supported by The Research Project 2022 of The People's Hospital of Jianyang City,No.JY202208.
文摘BACKGROUND The exercise of limb function is the most economical and safe method to promote the maturation of arteriovenous fistula(AVF).However,due to the lack of a uni-fied exercise standard in China,many patients have insufficient awareness of the importance of AVF,leading to poor effectiveness of limb function exercise.The self-management education model can effectively promote patients to take pro-active health-related actions.This study focuses on the characteristics of patients during the peri-AVF period and conducts a phased limb function exercise under the guidance of the self-management education model to observe changes in fac-tors such as the maturity of AVF.AIM To assess the impact of stage-specific limb function exercises,directed by a self-management education model,on the maturation status of AVFs.METHODS This study is a randomized controlled trial involving 74 patients with forearm AVFs from the Nephrology Department of a tertiary hospital in Sichuan Province,China.Patients were randomly divided into an observation group and a control group using a random number table method.The observation group underwent tailored stage-specific limb func-tion exercises,informed by a self-management education model which took into account the unique features of AVF at various stages,in conjunction with routine care.Conversely,the control group was given standard limb function exercises along with routine care.The assessment involves the maturity of AVFs post-intervention,post-operative complications,and the self-management level of the fistula in both groups patients.Analyses were conducted using SPSS version 23.0.Count data were represented by frequency and percentage and subjected to chi-square test comparisons.Measurement data adhering to a normal distribution were presented as mean±SD.The independent samples t-test was utilized for inter-group comparisons,while the paired t-test was used for intra-group comparisons.For measurement data not fitting a normal distribution,the median and interquartile range were presented and analyzed using the Wilcoxon rank sum test.RESULTS At the 8-wk postoperative mark,the observation group demonstrated significantly higher scores in AVF symptom recognition,symptom prevention,and self-management compared to the control group(P<0.05).However,the variance in symptom management scores between the observation and control groups lacked statistical signi-ficance(P>0.05).At 4 wk after the operation,the observation group displayed a superior vessel diameter and depth from the skin of the drainage vessels in comparison to the control group(P<0.05).While the observation group did manifest elevated blood flow rates in the drainage vessels relative to the control group,this distinction was not statistically significant(P>0.05).By the 8-wk postoperative interval,the observation group outperformed the control group with notable enhancements in blood flow rates,vessel diameter,and depth from the skin of drainage vessels(P<0.01).Seven days following the procedure,the observation group manifested significantly diminished limb swelling and an overall reduced complication rate in contrast to the control group(P<0.05).The evaluation of infection,thrombosis,embolism,arterial aneurysm stenosis,and incision bleeding showed no notable differences between the two groups(P>0.05).By the 4-wk postoperative juncture,complications between the observation and control groups were statistically indistinguishable(P>0.05).CONCLUSION Stage-specific limb function exercises,under the guidance of a self-management education model,amplify the capacity of AVF patients to discern and prevent symptoms.Additionally,they expedite AVF maturation and miti-gate postoperative limb edema,underscoring their efficacy as a valuable method for the care and upkeep of AVF in hemodialysis patients.
文摘Objective:To explore the preventive effect of comprehensive nursing intervention on arteriovenous fistula failure in patients in the hemodialysis room.Methods:82 patients with arteriovenous fistula in the hemodialysis chamber treated in our hospital from July 2022 to October 2023 were selected as the research subjects.The random number table method divided them into a control group and an experimental group of 41 cases each.The control group received general nursing intervention measures,while the experimental group underwent comprehensive nursing intervention.The incidence of complications(internal fistula failure,bleeding,thrombosis,infection),psychological emotions(SAS scale,SDS scale),quality of life(physical pain,physiological function,emotional function,social function),and nursing satisfaction(very satisfied,basically satisfied,satisfied,dissatisfied)were compared between the two groups of patients.Results:The incidence of complications in the experimental group(4,9.76%)was significantly lower than that in the control group(29,70.73%);the SAS scores and SDS scores of the patients in the experimental group after intervention were both lower than those in the control group;the quality of life score(physical pain,physiological function,emotional function,and social function)was all higher than those of the control group;the post-intervention nursing satisfaction of the experimental group(40,97.57%)was also significantly higher than that of the control group(29,73.17%);and the listed differences were statistically significant(P<0.01).Conclusion:For patients with hemodialysis ventricular arteriovenous fistula failure,comprehensive nursing intervention can reduce the incidence of complications,relieve anxiety and stress,improve quality of life and nursing satisfaction,and achieve better preventive effects.
基金Supported by Scientific Research Project of Hainan Provincial Health Industry,China,No.20A200081Clinical Medical Center Project of Hainan Province,China,No.QWYH202175.
文摘BACKGROUND Cerebral ischemic stroke is attributed to paradoxical cerebral embolism.Pulmonary arteriovenous fistula(PAVF)is a rare potential cause of cerebral ischemic stroke,and cerebral ischemic stroke induced by PAVF in children is rare.CASE SUMMARY We report a case of right PAVF that presented as a transient ischemic attack(TIA)in a 13-year-old boy.The patient underwent embolization therapy and remained clinically stable for 2 years after treatment.CONCLUSION TIA induced by PAVF in children is rare,lacks typical clinical manifestations,and should not be ignored.
基金funding from the National Natural Science Foundation of China (Grant No.81771242)the Shanghai Pujiang Program (Grant No.20PJ1402200)。
文摘A dural arteriovenous fistula(DAVF) is an abnormal linkage connecting the arterial and venous systems within the intracranial dura mater. A basicranial emissary vein DAVF drains into the cavernous sinus and the ophthalmic vein, similar to a cavernous sinus DAVF. Precise preoperative identification of the DAVF location is a prerequisite for appropriate treatment. Treatment options include microsurgical disconnection, endovascular transarterial embolization(TAE), transvenous embolization(TVE), or a combination thereof. TVE is an increasingly popular approach for the treatment of DAVFs and the preferred approach for skull base locations, due to the risk of cranial neuropathy caused by dangerous anastomosis from arterial approaches. Multimodal magnetic resonance imaging(MRI) can provide anatomical and hemodynamic information for TVE. The therapeutic target must be precisely embolized in the emissary vein, which requires guidance via multimodal MRI. Here, we report a rare case of successful TVE for a basicranial emissary vein DAVF, utilizing multimodal MRI assistance. The fistula had vanished, pterygoid plexus drainage had improved, and the inferior petrosal sinus had recanalized, as observed on 8-month follow-up angiography. Symptoms and signs of double vision, caused by abduction deficiency, disappeared. Detailed anatomic and hemodynamic assessment by multimodal MRI is the key to guiding successful diagnosis and treatment.
文摘In dialysis treatment, the radio-cephalic arteriovenous fistula (RCAVF) is a commonly used fistula, yet its low maturation rate remains a challenge. To enhance surgical outcomes, the relationship between stenosis-prone locations and RCAVF anastomosis angle is studied during maturation by developing two sets of RCAVF models for early (non-mature) and mature RCAVFs at five anastomosis angles. The impact of hemodynamics and wall shear stress (WSS) is examined to determine optimal anastomotic angles. Results indicate that acute angles produce more physiological WSS distributions and fewer disturbed regions, with early stenosis-prone regions located near the anastomosis that shift to the bending venous segment during remodeling. A pilot study comparing clinical and numerical results is conducted for validation.
文摘Arteriovenous fistulas have a substantial impact on systemic hemodynamics, however their effect on extracorporeal circulation is not well understood. We report our clinical observation on the management under extracorporeal circulation of a patient with renal insufficiency with a high-flow arteriovenous fistula. This is a 59-year-old man who was referred to us for surgical treatment of ischemic coronary artery disease in a context of anuric chronic renal failure. Hypothermia at 32°C is started from the start in CEC due to hyperflow at the level of the arteriovenous fistula. We performed two coronary artery bypasses of the marginal and IVA via the two internal thoracic arteries. The patient is hemofiltered in order to avoid hyperkalaemia and possibly avoid fluid overload related to filling per CEC. The clamping time was 71 minutes and the SCC lasted 141 minutes. There was no homologous transfusion in the operating room. It turns out that the input/output balance is zero at the end of the CEC. The postoperative course was simple.
文摘Objective: To evaluate the effectiveness of cryotherapy in managing the pain at the puncture site of Arterio-Venous Fistula (AVF) among children undergoing maintenance hemodialysis (HD).Methods: A one-group pre-post quasi-experiment was performed in two HD centers affiliated with Cairo University.The experiment involved 40 children with AVF undergoing HD.Before puncturing,cryotherapy was applied using 2 cm-3 cm pieces of frozen distilled water in a plastic bag.Pain was assessed subjectively and objectively in two dialysis sessions before and after cryotherapy.A part from a physiological assessment of vital signs,pain was assessed using the Wong-Baker Faces Pain and the Observed Pain Behavior rating scales.All research ethics were applied.Results: HD had a median duration of four years,while cryotherapy had a median application time of 8.8 min.The Wong-Baker Faces Pain score and almost all observed pain behaviors significantly decreased after cryotherapy.Significant improvements were observed in respiratory rate before and after needle puncture and in oxygen saturation after needle puncture.A lower skin dryness was observed after cryotherapy (12.5%) than before cryotherapy (52.5%;p < 0.001).Conclusions: Cryotherapy can effectively reduce the venipuncture pain among children with AVF undergoing maintenance HD.However,the confounding effects of distraction and the non-randomized design used must be both considered when interpreting the findings.This study recommends the use of cryotherapy in managing needle puncture pain.Further research must adopt a randomized trial design with a placebo to support further the benefits of this procedure.
文摘<span style="font-family:Verdana;">The main reason for the early failure of radio-cephalic arteriovenous fistula (RCAVF) is non-maturity, which means that the blood flow rate in the fistula cannot increase to the expected value for dialysis. From a mechanical perspective, the vascular resistance at the artificially designed anastomosis causes an energy loss that affects blood flow rate growth and leads to early failure. This research studied how to maximize the RCAVF maturity and primary patency by controlling the energy loss rate. We theoretically analyzed and derived a model that evaluates the energy loss rate <em>E</em><sub><em>avf</em></sub> in RCAVF as a function of its blood vessel geometric parameters (GPs) for given flow rates. There was an aggregate of five controllable GPs in RCAVF: radial artery diameter (<em>D</em><sub><em>ra</em></sub>), cephalic vein diameter (<em>D</em><sub><em>cv</em></sub>), blood vessel distance between artery and vein (<em>h</em>), anastomotic diameter (<em>D</em><sub><em>a</em></sub>), and anastomotic angle (<em>θ</em>). Through this analysis, it was found that <em>E</em><sub><em>avf</em></sub> was inversely proportional to <em>D</em><sub><em>ra</em></sub>, <em>D</em><sub><em>cv</em></sub>, <em>D</em><sub><em>a</em></sub>, and <em>θ</em>, whereas proportional to <em>h</em>. Therefore, we recommended surgeons choose the vessels with large diameters, close distance, and increase the diameter and angle of the anastomosis to decrease the early failure of RCAVF. Simultaneously, we could explain the results of many clinical empiricisms with our formula. We found that increasing <em>D</em><sub><em>cv</em></sub> and <em>θ</em> was more significant in reducing <em>E</em><sub><em>avf</em></sub> than increasing <em>D</em><sub><em>ra</em></sub> and <em>D</em><sub><em>a</em></sub>. Based on our model, we could define two critical energy loss rates (<em>CEL</em><sub><em>a</em></sub>, <em>CEL</em><sub><em>b</em></sub>) to help surgeons evaluate the blood vessels and choose the ideal range of <em>θ</em>, and help them design the preoperative RCAVF plan for each patient to increase the maturity and the primary patency of RCAVF.</span>
文摘BACKGROUND Arteriovenous fistula of the sigmoid sinus is an abnormal connection of arteries with the sigmoid sinus.Endovascular treatments of such lesions are considered safe and with low rates of complications.CASE SUMMARY A 62-year-old female patient underwent endovascular treatment of an arteriovenous fistula of the right sigmoid sinus on February 7,2017,but her tinnitus was not cured.She was admitted to the Beijing Tiantan Hospital,Capital Medical University,on March 20,2017,and her pre-operative diagnosis,by digital subtraction cerebral angiography,was arteriovenous fistula of the sigmoid sinus.She underwent endovascular embolization of the distal occipital artery and posterior auricular artery using Onyx-18.The arteriovenous fistula of the sigmoid sinus was cured,and her tinnitus disappeared,but ischemia of the upper 2/3 of the right auricle occurred without hearing loss.The patient received treatment to improve microcirculation,in addition to fluid supplementation,analgesia,and hyperbaric oxygen,and the swelling due to ischemia in the right auricle did not progress further.The patient reported no tinnitus,and the right auricle had returned to normal 3 years later.CONCLUSION Ischemic complications of vital organs should be considered when performing embolization procedures for arteriovenous fistulas of cerebral sinuses.Compensation of the organs should be evaluated before the operation,and the related treatment regimens should be planned.
文摘Dural arteriovenous fistulas(DAVFs)include a wide range of pathological conditions that are associated with intracranial vessel abnormalities.While some types of DAVFs present with typical neuroimaging characteristics,others share overlapping pathological and neuroimaging features that can hinder accurate differentiation.Hence,misclassification of the various types of DAVFs is common.Thorough knowledge of DAVF imaging findings is essential to avoid such misinterpretations.Traditional digital subtraction angiography(DSA)is considered the gold standard for diagnosing and evaluating DAVFs.However,angiography cannot detect changes in a patient’s brain structure.Conventional magnetic resonance imaging(MRI)sequences,including MR angiography(MRA),allow the evaluation of DAVFs without ionizing radiation or invasiveness.Advanced MRI techniques,such as susceptibility-weighted imaging(SWI)and dynamic contrast-enhanced MRA,provide added value to real-time physio-pathological data regarding the hemodynamics of DAVFs.Beyond these techniques,new insights using high-resolution vascular wall MRI are incorporated for the noninvasive evaluation of DAVFs.This article reviews the pathophysiology of DAVFs,focusing on the specifics of MRI findings that facilitate their classification.The role of conventional and advanced MRI sequences for DAVFs was assessed using insights derived from the data provided by structured reports of multimodal MRIs to evaluate DAVFs.
文摘Chronic lower limb wounds are common. They can be of arterial or venous origin. In this article, we will present a clinical case of a 30-year-old patient with a chronic injury to the right medial malleolus. In his history, we can note a gunshot wound to the right leg. Ultrasonography and CT angiography helped in the diagnosis of traumatic arteriovenous fistula. The patient underwent a fistula embolization which allowed the wound to heal. The clinical presentation, additional examinations and the latest treatment recommendations will be discussed in this article.
基金the National Natural Science Foundation of China (Grant No. 81771242)。
文摘Spinal epidural hemorrhages(SEDH)caused by spinal epidural arteriovenous fistulas(SEAVFs)are rare;thus,their specific pathogenesis has not been explained.Furthermore,the standard treatment for SEAVFs has not yet been defined.Here we report the case of a 36-year-old Chinese man who experienced acute onset chest pain and tightness.His symptoms rapidly aggravated until the lower limbs were unable to support him.Spinal magnetic resonance angiography(MRA)revealed a localized SEAVF and a secondary spinal cord lesion at the T4 level.Digital subtraction angiography(DSA)confirmed the presence of the SEDH/SEAVF at the T3–4 level with the left radicular artery feeding the fistula.Based on DSA and MRA findings,SEDH,local spinal cord infarction,and spinal venous reflux disorder were conditionally diagnosed.Using the arterial route,Onyx-34 was injected into the fistula to embolize the feeding arteries and the venous system.Angiography was performed after the microcatheter was withdrawn,and no residual fistula or anterior spinal artery was observed.The six-week follow-up MRI showed acceptable healing of the SEAVF,and the patient improved neurologically.This case suggests that endovascular treatment with Onyx-34 embolization should be considered a promising treatment strategy for this type of complicated SEAVF.
文摘The arteriovenous fistula (AVF) has been considered for several decades as the preferred approach for hemodialysis because of its longevity and its lower morbidity and mortality rate. However, it can be the cause of several infectious and especially cardiovascular complications. Stenosis is the most common complication of AVF. It is favored by several hemodynamic, cellular and mechanical factors. Reduced dialysis performance and thrombosis are the main risks associated with stenosis. Intervention for dilation is indicated in the presence of any pre-thrombotic stenosis or stenosis that alters the quality of dialysis. However, in patients with heart disease, an assessment of the risk of decompensation is mandatory before considering any gesture of dilation of a fistula. We report a case of acute cardiac decompensation in an 85-year-old patient with severe but stable dilated cardiomyopathy after dilatation of an AVF stenosis. This observation shows that particular attention should be given to elderly subjects with AVF stenosis, especially in the presence of underlying heart disease where closure of the AVF with placement of a tunneled catheter is an alternative that should always be discussed.
文摘Introduction: Arteriovenous fistula (AVF) operation is recognized a gold standard of hemodialysis for end-stage renal disease. Because various complications may occur during perioperative period, medical care plays an important role in improving the possibility of AVF operation. The objective of the study was to explore the effect of the mode of multiple disciplinary team (MDT) medical care on the patients with end-stage renal disease treated by arteriovenous fistula (AVF) operation. Method: 98 patients with end-stage renal disease under the AVF operation were divided into observation group and control group. The control group was performed with regular medical care and for the observation group was treated under the mode of MDT medical care. Complications after operation, hospitalized time and medical satisfaction were comprehensively compared between the both groups. Results: The overall complications including swelling, bleeding, infection and thrombosis in observation group accounted for 5%, however, 19% of patients suffered different complications in the control group. The total complications significantly decreased in the observation group compared with control group (P < 0.001). The hospitalization time was shortened to 9.8 ± 5.6 days in the observation group, and the average hospitalization in control group was 17.8 ± 8.9 days. The medical satisfaction was increased by 20.83 percent in the observation group compared with the control group (P < 0.001). 75% patients in control group were satisfied with medical care, and 98.53% patients were satisfied for observation group. Conclusion: The mode of MDT medical care was beneficial for patients with end-stage renal disease after AVF operation, which could significantly reduce complications, hospitalized time and improve patients’ degree of satisfaction. Thus, it should be recommended in the clinical work.
文摘<div style="text-align:justify;"> <span style="font-family:Verdana;">Posterior approach lumbar disc surgeries (LDS) can be associated with serious iatrogenic vascular complications which could be a serious life threatening condition. We report a rare case of right sided acute iliac vessels iatrogenic arteriovenous fistula (IAVF) which was diagnosed and managed in 24 hours duration in a 45 years old healthy female who underwent surgical posterior approach L4-5 discectomy. Intraoperative, she developed sudden hypotension, tachycardia, wide pulse pressure and acute drop of hemoglobin level without obvious operative site bleeding which raise the index of suspicion of vascular injury and urge the team for doing emergency CT angiography (CTA), vascular and endovascular team consultation for digital subtraction angiography (DSA) and endovascular management. Endovascular stenting is nowadays the modality of choice of intervention. We provide case report with literature review.</span> </div>
基金funded by the Scientific Research Program of the Hubei Provincial Department of Education in 2019(Q20192103)the 2019 National College Students'innovation and Entrepreneurship Training Project(201910929012).
文摘Objective:to describe the clinical features of bilateral multiple pulmonary arteriovenous fistulas(PAF)with paroxysmal aphasia as the first symptom.Methods:we collected the clinical history and examination data of a patient with paroxysmal aphasia.In order to trace the etiology,we performed chest computed tomography(CT)and pulmonary CT angiography(CIA).Results:the patient had paroxysmal aphasia with dizziness,brain magnetic resonance imaging(MRI)showed cerebral infarction,the transcranial Doppler(TCD)foaming test was positive,transesophageal ultrasound showed no patent foramen ovale,and chest CT and CIA showed bilateral multiple PAF.Conclusion:bilateral multiple PAF are rare in clinic.When patients have paroxysmal neurological symptoms,the possibility of PAF leading to embolism should be considered.
文摘This study aimed to evaluate pain intensity in chronic renal patients under hemodialysis during the arteriovenous fistula cannulation. It was a cross-sectional study conducted in a hemodialysis clinic in the second semester of 2014. 70 individuals participated in the research and were assessed by the visual analogue scale. The project was approved with opinion number 453.508-2013. During cannulation, the pain reported was moderate in 58.5% of patients, intense in 30% and mild in 11.5%. There was no association between the occurrence of pain in relation to gender, shift and time of hemodialysis. The study points out to the need for pre-cannulation analgesia to improve comfort during the procedure.
文摘Arthroscopically assisted reconstruction of the anterior cruciate ligament (LCA) is generally a safe and effective procedure with a low rate of vascular complications. We report on a case of a 33-year-old woman with a combined arteriovenous fistula (AVF) and venous popliteal aneurysm that developed 6 months after arthroscopic anterior cruciate ligament reconstruction. At clinical exam the patient presented with left popliteal and calf pain, a tender pulsatile mass posterior to her left knee, popliteal bruit and a thrill at the popliteal fossa. CT scan showed an AVF arising from the left popliteal artery. An aneurysm was seen to fill at the same time as the popliteal vein. Findings at open surgical revision included AVF between the tibioperoneal trunk and the popliteal vein and a venous popliteal aneurysm at the level of the arteriovenous communication. The aneurysm and fistula were repaired. The patient had an uneventful follow up with complete recovery. We also report an endovascular treatment of a iatrogenic arterio-venous fistula.
文摘Objective To evaluate the clinical significance of intraoperative indocyanine green (ICG) videoangiography in surgical management of spinal dural ateriovenots fistulae (dAVFs) . Methods In this retrospective analysis we examined nine cases of dAVFs,diagnosed by complete spinal angiography,in which laminoplasty were performed through posterior approach. An operating microscope-integrated light
文摘Autogenous arteriovenous fistula(AVF)is a lifeline for maintenance hemodialysis patients.In 2006,the vascular access guidelines issued by the Kidney Disease Outcomes Quality Initiative(KDOQI)introduced the concept of“Fistula first”.1 In 2019,the same organization updated these vascular access guidelines and proposed the concept of“Patient first”,2 sparking a wide range of controversy and discussion on whether to abandon the“Fistula first”principle.Given this context,experts from across China mainland conducted a comprehensive and systematic evaluation of the relevant literature,evidence-based medical guidelines,and international guidelines.
