RESUMEN
Thrombectomy of a clotted upper arm access may be complicated by brachial artery embolization. A number of techniques have been described to relieve the embolization that may not always be successful. Backbleeding is one such technique. We describe a minimal modification that makes backbleeding more effective.
Asunto(s)
Derivación Arteriovenosa Quirúrgica/efectos adversos , Arteria Braquial , Embolectomía/métodos , Embolia/cirugía , Diálisis Renal/métodos , Anciano , Embolia/etiología , Humanos , Masculino , Diálisis Renal/efectos adversos , Reproducibilidad de los ResultadosRESUMEN
Balloon rupture during angioplasty is an uncommon event. The ruptured balloon usually is removed through its introducer sheath without any problems. However, there may be occasions when a ruptured balloon cannot be withdrawn from an access. We describe a simple technique that can be used to extricate a stuck ruptured angioplasty balloon.
Asunto(s)
Angioplastia de Balón/efectos adversos , Angioplastia de Balón/instrumentación , Remoción de Dispositivos/métodos , Falla de Equipo , HumanosRESUMEN
Stent strut protrusion through the skin is a rare and a potentially dangerous complication from the cannulation of stents placed within arterio-venous fistulas and grafts. Such cases are usually managed surgically. We present a case wherein strut penetration of an arterio-venous fistula was noted at the distal (uncovered) end of a Fluency Plus(®) tracheo bronchial stent graft. After analyzing the various reasons why this may have happened, a nonsurgical approach was taken to preserve the access and manage strut protrusion.
Asunto(s)
Derivación Arteriovenosa Quirúrgica , Diálisis Renal , Stents/efectos adversos , Anciano , Humanos , Masculino , Diseño de Prótesis , Falla de PrótesisRESUMEN
Physical examination has recently been demonstrated to detect vascular access stenosis in patients with arteriovenous fistulae. However, its accuracy in the identification of stenoses when compared with the gold standard (angiography) in patients with arteriovenous grafts has not been studied in a systematic fashion. We conducted a prospective study to examine the accuracy of physical examination in the detection of stenotic lesions when compared with angiography. Forty-three consecutive cases referred for an arteriovenous graft dysfunction were included in this analysis. Preprocedure physical examination was performed. The findings of the examination and diagnosis were recorded and secured in a sealed envelope. Angiography from the feeding artery to the right atrium was performed. The images were reviewed by an independent interventionalist with expertise in endovascular dialysis access procedures and the diagnosis was rendered. The reviewer was blinded to the physical examination. Cohen's Kappa was used as a measurement of the level of agreement beyond chance between the diagnosis made by physical examination and angiography. There was a strong agreement between the physical examination and the angiography in the diagnosis of vein-graft anastomotic stenosis (kappa = 0.52). The sensitivity and specificity for this lesion was 57% and 89%, respectively. There was a moderate agreement beyond chance regarding the diagnosis of intragraft (kappa = 0.43) and inflow stenoses (kappa = 0.40). The sensitivity and specificity for the intragraft and inflow stenosis was 100%, 73% and 33%, 73%; respectively. The findings of this study demonstrate that physical examination can assist in the detection and localization of stenoses in arteriovenous grafts.
Asunto(s)
Derivación Arteriovenosa Quirúrgica/efectos adversos , Oclusión de Injerto Vascular/diagnóstico , Examen Físico/normas , Diálisis Renal/métodos , Diagnóstico Diferencial , Humanos , Fallo Renal Crónico/terapia , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
BACKGROUND AND OBJECTIVES: Physical examination has been highlighted to detect vascular access stenosis; however, its accuracy in the identification of stenoses when compared with the gold standard (angiography) has not been validated in a systematic manner. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A prospective study was conducted of 142 consecutive patients who were referred for an arteriovenous fistula dysfunction to examine the accuracy of physical examination in the detection of stenotic lesions when compared with angiography. The findings of a preprocedure physical examination and diagnosis were recorded and secured in a sealed envelope. Angiography from the feeding artery to the right atrium was then performed. The images were reviewed by an independent interventionalist who had expertise in endovascular dialysis access procedures and was blinded to the physical examination, and the diagnosis was rendered. Cohen's kappa was used as a measurement of the level of agreement beyond chance between the diagnosis made by physical examination and angiography. RESULTS: There was strong agreement between physical examination and angiography in the diagnosis of outflow (agreement 89.4%, kappa = 0.78) and inflow stenosis (agreement 79.6%, kappa = 0.55). The sensitivity and specificity for the outflow and inflow stenosis were 92 and 86% and 85 and 71%, respectively. There was strong agreement beyond chance regarding the diagnosis of coexisting inflow-outflow lesions between physical examination and angiography (agreement 79%, kappa = 0.54). CONCLUSIONS: The findings of this study demonstrate that physical examination can accurately detect and localize stenoses in a great majority of arteriovenous fistulas.