RESUMEN
The number of patients with end-stage renal disease (ESRD) requiring hemodialysis is increasing worldwide. Although arteriovenous fistula (AVF) is the best and most important vascular access (VA) for hemodialysis, its primary maturation failure rate is as high as 60%, which seriously endangers the prognosis of hemodialysis patients. After AVF establishment, the venous outflow tract undergoes hemodynamic changes, which are translated into intracellular signaling pathway cascades, resulting in an outward and inward remodeling of the vessel wall. Outward remodeling refers to the thickening of the vessel wall and the dilation of the lumen to accommodate the high blood flow in the AVF, while inward remodeling is mainly characterized by intimal hyperplasia. More and more studies have shown that the two types of remodeling are closely related in the occurrence and development of, and jointly determining the final fate of, AVF. Therefore, it is essential to investigate the underlying mechanisms involved in outward and inward remodeling for identifying the key targets in alleviating AVF dysfunction. In this review, we summarize the current clinical diagnosis, monitoring, and treatment techniques for AVF dysfunction and discuss the possible pathological mechanisms related to improper outward and inward remodeling in AVF dysfunction, as well as summarize the similarities and differences between the two remodeling types in molecular mechanisms. Finally, the representative therapeutic targets of potential clinical values are summarized.
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Fístula Arteriovenosa , Diálisis Renal , Humanos , Fístula Arteriovenosa/metabolismo , Fístula Arteriovenosa/terapia , Fístula Arteriovenosa/patología , Remodelación Vascular , Fallo Renal Crónico/terapia , Fallo Renal Crónico/patología , Fallo Renal Crónico/metabolismo , Derivación Arteriovenosa Quirúrgica/efectos adversos , Animales , Hemodinámica , Transducción de Señal , Terapia Molecular DirigidaRESUMEN
AIMS: To determine the effect of virtual reality glasses intervention on pain, vital signs, and patient satisfaction of hemodialysis patients undergoing AVF catheter puncture. DESIGN: Randomized controlled study. METHODS: The study was conducted in 60 patients receiving dialysis treatment in the HD unit of a public hospital in Turkey. The data were collected via the "Patient Identification Form", "Visual Analog Scale/VAS" and "Hemodynamics Variables Inspection Form". The patients in the experiment group watched videos through the virtual reality glasses for totally 5 minutes in average, 2 minutes before the AVF cannulation process and 3 minutes during the process. No intervention was applied to the patients in the control group other than the normal nursing interventions in the HD unit. RESULTS: In the intra-group comparisons, the 2nd and 3rd measurement average pain level scores of the patients with in the experimental group were determined to be statistically significantly lower compared to their 1st measurement (p < 0.05); the 3rd measurement average pain level scores of the control group were determined to be statistically significantly lower compared to their 1st and 2nd measurements (p < 0.05). CONCLUSIONS: It was determined that the virtual reality glasses decreased the pain that emerges during the AVF cannulation process and increased the patient satisfaction level. It is suggested that the virtual reality glasses should be used by the nurses in the HD unit since it is easily applicable in coping with pain in the patients and since it is an invasive method.
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Satisfacción del Paciente , Realidad Virtual , Humanos , Satisfacción del Paciente/estadística & datos numéricos , Femenino , Masculino , Persona de Mediana Edad , Adulto , Anciano , Turquía , Dolor/psicología , Dolor/prevención & control , Manejo del Dolor/métodos , Cateterismo/métodos , Fístula Arteriovenosa , Diálisis Renal/métodos , AnteojosRESUMEN
Depression is a common psychiatric disorder among patients undergoing maintenance haemodialysis (MHD). Depression may reportedly contribute to poor prognosis in several ways, including its effects on platelet function. We hypothesised that depression contributes to the occurrence of cardiocerebral vascular events (CCVE) and dysfunction of arteriovenous fistula (DAVF) in patients undergoing MHD through its effects on platelets. In this prospective cohort study, patients undergoing MHD were recruited and divided into depression and non-depression groups according to their Hamilton Depression Scale (HAMD) scores. The 286 enrolled patients had 103 occurrences of depressive symptoms (prevalence = 36.01%). Compared with the non-depression group, depression group had a significantly higher cumulative prevalence of CCVE and DAVF during follow-up. Cox regression analysis indicated that higher HAMD scores and lower plasma platelet distribution width (PDW) were common risk factors for CCVE and DAVF. Furthermore, HAMD scores were significantly negatively correlated with plasma PDW and was the main variable affecting changes in PDW, as indicated by multiple linear regression analysis. Depression may increase the risk of CCVE and DAVF in patients undergoing MHD by activating platelets. Plasma PDW may be a convenient indicator of platelet activation status and may predict the risk of CCVE and DAVF.
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Depresión , Activación Plaquetaria , Diálisis Renal , Humanos , Masculino , Femenino , Diálisis Renal/efectos adversos , Depresión/sangre , Depresión/etiología , Persona de Mediana Edad , Anciano , Estudios Prospectivos , Fístula Arteriovenosa , Factores de Riesgo , PlaquetasRESUMEN
RATIONALE: Uterine arteriovenous fistula (UAVF) is a rare vascular abnormality that can cause severe and potentially life-threatening hemorrhage. Uterine artery embolization is a common treatment that may affect ovarian and uterine perfusion and cause fertility problems. We herein report our experience treating 2 patients with UAVF who underwent resection after temporary occlusion of both internal iliac arteries. PATIENT CONCERNS: Both patients presented with a large UAVF after incomplete miscarriages in the second trimester. Magnetic resonance imaging revealed a UAVF measuring 3.6â ×â 2.6â ×â 2.1 cm over the myometrium of the posterior uterine in case 1, and a UAVF of 7.1â ×â 4.1â ×â 4.5 cm was identified in case 2. DIAGNOSIS: Uterine arteriovenous fistula, retained products of conception. INTERVENTIONS: The patients underwent resection of UAVF with temporary occlusion of the internal iliac arteries and hysteroscopic removal of the retained products of conception. OUTCOMES: Intraoperative bleeding were minimal. Neither patient exhibited abnormal uterine bleeding at the 6-month follow-up. Follow-up ultrasonography and magnetic resonance imaging showed normal uterine myometrium and endometrium and no residual disease. LESSONS: UAVF resection after temporary occlusion of the internal iliac arteries is a promising treatment approach for UAVF. This technique can reduce intraoperative bleeding and remove the potential hemorrhage-related lesion while preserving fertility.
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Fístula Arteriovenosa , Arteria Ilíaca , Humanos , Femenino , Arteria Ilíaca/cirugía , Arteria Ilíaca/diagnóstico por imagen , Fístula Arteriovenosa/cirugía , Adulto , Arteria Uterina/cirugía , Arteria Uterina/diagnóstico por imagen , Embarazo , Hemorragia Uterina/etiología , Hemorragia Uterina/cirugía , Embolización de la Arteria Uterina/métodos , Imagen por Resonancia Magnética , Útero/irrigación sanguínea , Útero/cirugíaRESUMEN
A 12-year-old Saluki was presented with acute lameness and plantar swelling of the right metatarsus following an episode of free running. Radiographs showed soft tissue swelling only, the involved bone and joint structures were unremarkable. The lesion recurred several months later. Ultrasonographic imaging of the lesion revealed a well-vascularized cavernous structure. Subsequent surgical removal and histopathological examination of the structure raised the initial suspicion of an arteriovenous fistula, which was then confirmed histologically following a second surgical removal of another recurrence. The purpose of this case report is to illustrate the potential complexity of what initially appears to be a simple lameness. At the same time, attention is focused on the possibility that arteriovenous fistulas may tend to recur.
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Fístula Arteriovenosa , Cojera Animal , Metatarso , Fístula Arteriovenosa/veterinaria , Fístula Arteriovenosa/cirugía , Fístula Arteriovenosa/diagnóstico por imagen , Animales , Cojera Animal/etiología , Metatarso/cirugía , Metatarso/anomalías , Metatarso/diagnóstico por imagen , Masculino , Recurrencia , Ultrasonografía , Edema/veterinariaRESUMEN
BACKGROUND: To report the diagnosis and treatment of a rare disease of intravenous leiomyomatosis (IVL) originating from the uterus, growing in the inferior vena cava (IVC) and extending into the right atrium (RA) associated with a pelvic arteriovenous fistula (AVF). This is the first reported case of IVL in the IVC and RA with pulmonary benign metastasizing leiomyoma (PBML) secondary to a pelvic AVF despite the use of GnRH agonists in a nonmenopausal woman. CASE PRESENTATION: The patient was a 50-year-old premenopausal woman with a history of surgical resection for and antiestrogen conservative drug for pulmonary benign metastasizing leiomyoma (PBML) 5 years. The patient nevertheless developed IVL in the IVC, internal iliac vein and RA accompanied by AVF. Vaginal ultrasound combined with echocardiography and computerized tomographic venography imaging assists in the diagnosis of IVL combined with AVF, with histopathology and immunohistochemistry ultimately confirming the diagnosis. The patient ultimately was performed with a combination of hysterectomy, bilateral adnexectomy, and resection of tumors in the IVC and RA without cardiopulmonary bypass and sternotomy. CONCLUSION: BML may be difficult to control with incomplete removal of the uterus and ovaries even with the use of antiestrogenic medications, and medically induced AVF resulting from fibroid surgery may accelerate this process and the development of IVL.
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Fístula Arteriovenosa , Atrios Cardíacos , Leiomiomatosis , Neoplasias Pulmonares , Neoplasias Uterinas , Neoplasias Vasculares , Vena Cava Inferior , Humanos , Femenino , Vena Cava Inferior/patología , Vena Cava Inferior/cirugía , Vena Cava Inferior/diagnóstico por imagen , Persona de Mediana Edad , Neoplasias Uterinas/patología , Neoplasias Uterinas/cirugía , Fístula Arteriovenosa/cirugía , Fístula Arteriovenosa/etiología , Fístula Arteriovenosa/diagnóstico por imagen , Fístula Arteriovenosa/patología , Atrios Cardíacos/patología , Atrios Cardíacos/cirugía , Atrios Cardíacos/diagnóstico por imagen , Leiomiomatosis/patología , Leiomiomatosis/cirugía , Leiomiomatosis/diagnóstico por imagen , Neoplasias Pulmonares/secundario , Neoplasias Pulmonares/patología , Neoplasias Vasculares/patología , Neoplasias Vasculares/cirugía , Neoplasias Vasculares/diagnóstico por imagen , Neoplasias Cardíacas/secundario , Neoplasias Cardíacas/patología , Neoplasias Cardíacas/cirugía , Neoplasias Cardíacas/complicaciones , Resultado del Tratamiento , Histerectomía , Vena Ilíaca/patología , Vena Ilíaca/diagnóstico por imagenRESUMEN
The authors report their experience with twenty-one consecutive patients who presented with symptoms and imaging characteristics of a herniated lumbar disc; of whom, at the time of surgery had a vascular loop instead. The procedure was performed on 14 women and seven men with a mean age of 39 years. Clinical complaints included lumbar aching with one limb overt radiculopathy in all patients; with additional sphincter dysfunction in two cases. Symptoms had developed within a mean period of three months. In all patients, the disc was exposed through an L5-S1 (n = 10); L4-L5 (n = 5) and L3-L4 (n = 6) open minimal laminotomy. In 16 patients, rather than a herniated disc they had a lumbar epidural varix, while an arterio-venous fistula was found in the remaining five cases. In all cases, the vascular disorder was resected and its subjacent disc was left intact. One patient had a postoperative blood transfusion. While the radiculopathy dysfunction improved in all patients, four patients reported lasting lumbar pain following surgery. The postoperative imaging confirmed the resolution of the vascular anomaly and an intact disc. The mean length of the follow-up period was 47 months. Either epidural varix or arterio-venous fistula in the lumbar area may mimic a herniated disc on imaging studies. With the usual technique they can be operated safely. Resection of the anomaly can be sufficient for alleviating radiculopathy symptoms.
Asunto(s)
Desplazamiento del Disco Intervertebral , Vértebras Lumbares , Humanos , Desplazamiento del Disco Intervertebral/cirugía , Desplazamiento del Disco Intervertebral/diagnóstico , Masculino , Adulto , Femenino , Vértebras Lumbares/cirugía , Persona de Mediana Edad , Radiculopatía/cirugía , Radiculopatía/diagnóstico , Imagen por Resonancia Magnética , Diagnóstico Diferencial , Laminectomía/métodos , Adulto Joven , Fístula Arteriovenosa/cirugía , Fístula Arteriovenosa/diagnósticoRESUMEN
BACKGROUND AND OBJECTIVES: Craniocervical junction (CCJ) arteriovenous fistulas (AVFs) are rare. Variability in clinical manifestations and treatment strategies for CCJ AVFs stems from differences in their angioarchitecture. Our study aims to categorize CCJ AVFs based on their angioarchitecture and explore the associated clinical features and treatment modalities for distinct CCJ AVF types. METHODS: The authors conducted a retrospective analysis of patients with CCJ AVFs treated at a single neurosurgical facility over the past decade. These patients were classified based on the angioarchitecture of their CCJ AVFs. The analysis included an evaluation of angioarchitecture, clinical characteristics, treatment strategies, and outcomes. RESULTS: The study included 155 patients, with a median age of 56 years, collectively manifesting 165 CCJ AVFs. Our classification identified 4 distinct CCJ AVF types: epidural AVFs (19 [11.5%]), dural AVFs (98 [59.4%]), radicular AVFs (33 [20.0%]), and perimedullary AVFs (15 [9.1%]). Further differentiation was applied based on the presence of pial feeders. The predominant fistula location was at cervical-1 (77.0%). Ascending intradural drainage (52.7%) and descending intradural drainage (52.1%) were frequently observed drainage patterns. Patients with dural AVF predominantly presented with venous hypertensive myelopathy, whereas patients with other types of CCJ AVFs showed a higher incidence of subarachnoid hemorrhage (P = .012). Microsurgery was the predominant treatment, applied in the management of 126 (76.4%) AVFs, whereas 8 (4.8%) AVFs exclusively underwent interventional embolization and 25 (15.2%) received a combination of interventional embolization and microsurgical treatment. CONCLUSION: CCJ AVFs can be distinguished based on the fistula location and the arterial feeders. Currently, microsurgery stands as the preferred treatment strategy for CCJ AVFs, whereas interventional embolization plays a distinctive role in cases with specific angioarchitecture or as a pretreatment measure before microsurgery.
Asunto(s)
Fístula Arteriovenosa , Humanos , Persona de Mediana Edad , Femenino , Masculino , Adulto , Anciano , Estudios Retrospectivos , Fístula Arteriovenosa/cirugía , Fístula Arteriovenosa/terapia , Fístula Arteriovenosa/diagnóstico por imagen , Estudios de Cohortes , Embolización Terapéutica/métodos , Resultado del Tratamiento , Adulto Joven , Adolescente , Anciano de 80 o más AñosRESUMEN
Hemodialysis therapy is an extracorporeal circulation treatment that serves as a substitute for renal function. In Japan, patients receive this efficient four-hour treatment, three times per week, allowing them to maintain a social life nearly equivalent to that of healthy individuals. Before the treatment, two punctures are performed to establish extracorporeal circulation, and a high blood flow rate is essential to ensure efficient therapy. Specialized blood vessels created through arteriovenous fistula (AVF) surgery are utilized to achieve high blood flow rates. Although the AVF allows safe and efficient dialysis treatment, AVF stenosis leads to a serious problem in dialysis. To early detect this abnormal blood flow, auscultation and palpation methods are widely used in hospitals. However, these methods can only provide qualitative judgment of the AVF condition, so the results cannot be shared among other doctors and staff. Additionally, since the conventional methods require contact with the skin, some issues require consideration regarding infection and low reproducibility. In our previous study, we proposed an alternative method for auscultation using non-contact optical imaging technology. This study aims to construct a reliable AVF stenosis detection method using Thrill waveform analysis based on the developed non-contact device to solve the problem with the contact palpation method. This paper demonstrates the performance validation of the non-contact imaging in the normal AVF group (206 total data, 75 patients, mean age: 69.1 years) and in the treatable stenosis group (107 total data, 17 patients, mean age: 70.1 years). The experimental results of the Mann-Whitney U test showed a significant difference (p=0.0002) between the normal and abnormal groups, which indicated the effectiveness of the proposed method as a new possible alternative to palpation.
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Diálisis Renal , Humanos , Constricción Patológica , Fístula Arteriovenosa/diagnóstico por imagen , Derivación Arteriovenosa Quirúrgica , Anciano , Masculino , FemeninoRESUMEN
BACKGROUND: Pulmonary arteriovenous malformations are a relatively uncommon medical condition, affecting roughly 1 in every 2500 individuals. Of those suffering from pulmonary arteriovenous malformations, 80% have an underlying genetic condition: hereditary hemorrhagic telangiectasia. CASE PRESENTATION: We present the case of a 20-year-old Pakistani male with a history of persistent slower-onset frontal headaches that increased in severity within the course of the day. His hemoglobin was 18 g/dl, indicating polycythemia, for which he had undergone seven venesections in a month previously. His physical examination was unremarkable. His computed tomography scan depicted multiple dilated tortuous vessels with branching linear opacities in the right lower lobe of the lungs. The multiple feeding arteries were supplied by the right main pulmonary artery, and the large draining veins led to the right inferior pulmonary vein. This was identified as a diffuse pulmonary arteriovenous malformation. He was recommended for a right pulmonary artery angiogram. It showed multiple tortuous vessels with a nidus and large draining veins-features of a diffuse arteriovenous malformation in the right lower lobe of the lung consistent with the computed tomography scan. Embolization of two of these vessels feeding the arteriovenous malformation was conducted, using Amplatzer Vascular plug 2, whereas multiple pushable coils (five coils) were used for embolizing the third feeding vessel. This achieved 70-80% successful embolization of right pulmonary AVM; however, some residual flow was still seen in the arteriovenous malformation given the complexity of the lesion. Immediately after, his oxygen saturation improved from 78% to 96%. CONCLUSION: Diffuse pulmonary arteriovenous malformations, as seen in this patient, are rare, accounting for less than 5% of total pulmonary arteriovenous malformations diagnosed. The patient presented with a complaint of progressive frontal headaches, which can be attributed to low oxygen saturation or the presence of a cerebral arteriovenous malformation. There was no history of hereditary hemorrhagic telangiectasia in the patient's family. Furthermore, although most patients with hereditary hemorrhagic telangiectasia and hence pulmonary arteriovenous malformation have complaints of iron-deficiency anemia, our patient in contrast was suffering from polycythemia. This can be explained as a compensatory mechanism in hypoxemic conditions. Moreover, the patient had no complaint of hemoptysis or epistaxis, giving a varied presentation in comparison with a typical pulmonary arteriovenous malformation.
Asunto(s)
Malformaciones Arteriovenosas , Embolización Terapéutica , Cefalea , Policitemia , Arteria Pulmonar , Venas Pulmonares , Humanos , Masculino , Policitemia/complicaciones , Venas Pulmonares/anomalías , Venas Pulmonares/diagnóstico por imagen , Arteria Pulmonar/anomalías , Arteria Pulmonar/diagnóstico por imagen , Adulto Joven , Malformaciones Arteriovenosas/complicaciones , Malformaciones Arteriovenosas/diagnóstico por imagen , Cefalea/etiología , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Fístula ArteriovenosaRESUMEN
We present a compelling case of an elderly male with a complex medical history who presented with sepsis secondary to a urinary tract infection. During admission, changes in his abdominal exam prompted imaging studies, which revealed a grade IV splenic laceration with a giant splenic artery pseudoaneurysm containing a suspected arteriovenous fistula component. Multidisciplinary discussion was had regarding patient management which resulted in the decision to perform an emergent splenectomy. Learning points from this case underscore the crucial role of interdisciplinary collaboration in the treatment of this pathology. Additionally, we discuss the decision-making process to support surgical intervention in the absence of clear guidelines in this exceedingly rare condition.
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Aneurisma Falso , Fístula Arteriovenosa , Esplenectomía , Arteria Esplénica , Humanos , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/terapia , Aneurisma Falso/etiología , Aneurisma Falso/diagnóstico , Aneurisma Falso/cirugía , Masculino , Arteria Esplénica/diagnóstico por imagen , Fístula Arteriovenosa/diagnóstico por imagen , Fístula Arteriovenosa/diagnóstico , Fístula Arteriovenosa/complicaciones , Fístula Arteriovenosa/cirugía , Fístula Arteriovenosa/terapia , Fístula Arteriovenosa/etiología , Bazo/irrigación sanguínea , Bazo/diagnóstico por imagen , Bazo/lesiones , Anciano , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: This study investigated the expression of TGF-ß/Smad pathway-related indices in patients with isolated iliac artery aneurysms (IIAA) complicated with iliac arteriovenous fistula (IAVF) and their relationship with prognosis. METHODS: From January 2016 to June 2022, 83 patients with IIAA complicated with IAVF (Study group) and 54 patients with IIAA not complicated with IAVF (control group) were studied. The related indices of TGF-ß/Smad pathway were evaluated, and the effects of each index on the formation of IAVF were analyzed. The patients were divided into the survival group (64 cases) and death group (19 cases), and the prognostic value of indices in combination was analyzed. RESULTS: TGF-ß, p-Smad2, p-Smad3, p-JNK, and p-ERK in the study group were higher than those in the control group. Abnormal increase of pSmad3 expression was a risk factor for IAVF formation in patients with IIAA. TGF-ß level in the death group was higher than that in the survival group, and p-Smad3 and p-JNK proteins were higher than those in the survival group. The AUC value of indices in the TGF-ß/Smad pathway in combination was greater than that of each index alone. Abnormal increased expression of pSmad3 was a risk factor for prognosis of patients with IIAA complicated with IAVF. CONCLUSION: The abnormal increase of TGF-ß/Smad pathway-related indices is related to poor prognosis of patients with IIAA complicated with IAVF, and the combined detection of all indices has a predictive value for patients' prognosis.
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Fístula Arteriovenosa , Aneurisma Ilíaco , Arteria Ilíaca , Factor de Crecimiento Transformador beta , Humanos , Masculino , Femenino , Persona de Mediana Edad , Pronóstico , Factor de Crecimiento Transformador beta/metabolismo , Fístula Arteriovenosa/complicaciones , Fístula Arteriovenosa/metabolismo , Anciano , Aneurisma Ilíaco/complicaciones , Transducción de Señal , Proteína smad3/metabolismo , Proteínas Smad/metabolismo , Proteína Smad2/metabolismo , Vena IlíacaRESUMEN
INTRODUCTION: Here, we describe a rare case of a spinal arteriovenous fistula in a patient with known hereditary hemorrhagic telangiectasia (HHT) and spontaneous intraspinal hemorrhage. Furthermore, we provide a brief review of the literature on the formation of spinal arteriovenous malformations (AVM) in relation to this disease. CASE PRESENTATION: The case involves a 54-year-old male with known HHT. At the age of 49, the patient experienced recurrent cystitis. Urological evaluation ruled the cause to be neurological and subsequent imaging revealed a thoracic AVM. Four years later, the patient was admitted to A&E with chest pain and loss of function of the lower extremities and right arm, suspicious for ruptured aortic dissection. Trauma-CT excluded this and a final diagnosis of ruptured spinal AVM was made. Seven months post-injury, a spinal angiography was performed confirming the AVM. The remaining AVM was embolized under general anesthesia with acceptable results. DISCUSSION: Spinal involvement in HHT is exceedingly rare but remains an important differential diagnosis, especially when patients present autonomic symptoms as these could potentially progress to life-threatening complications. The literature and the presented case indicate the prudence of closing spinal AVMs in HHT in case of symptoms, including autonomic, such as bladder dysfunction.
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Fístula Arteriovenosa , Telangiectasia Hemorrágica Hereditaria , Humanos , Masculino , Persona de Mediana Edad , Telangiectasia Hemorrágica Hereditaria/complicaciones , Telangiectasia Hemorrágica Hereditaria/diagnóstico , Fístula Arteriovenosa/complicaciones , Fístula Arteriovenosa/diagnóstico , Médula Espinal/irrigación sanguínea , Médula Espinal/diagnóstico por imagenRESUMEN
The number of victims with damage to the great vessels has increased in recent years due to escalation of armed conflicts. Vascular damages comprise 3% of traumatic injuries in peacetime, and their incidence increases to 15% during hostilities. False aneurysms and traumatic arteriovenous fistulas follow vascular injury in 48.9-68.7% of cases. We present open surgical treatment of traumatic arteriovenous fistulas. The issues of diagnosis, surgical tactics, algorithm of intervention and options for successful treatment are described.
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Fístula Arteriovenosa , Procedimientos Quirúrgicos Vasculares , Lesiones del Sistema Vascular , Humanos , Fístula Arteriovenosa/cirugía , Fístula Arteriovenosa/etiología , Fístula Arteriovenosa/diagnóstico , Lesiones del Sistema Vascular/cirugía , Lesiones del Sistema Vascular/diagnóstico , Lesiones del Sistema Vascular/etiología , Procedimientos Quirúrgicos Vasculares/métodos , Masculino , Resultado del Tratamiento , Adulto , Extremidades/irrigación sanguínea , Extremidades/lesionesRESUMEN
Intradural spinal cord arteriovenous shunts are challenging vascular lesions with poor prognosis if left untreated. Therapeutic options include endovascular treatment, microsurgery or a combined approach. Surgical approaches are more complex if the lesions are located anteriorly and supplied by the anterior spinal artery (ASA). ASA can also vascularize shunts located on the posterior surface of the spinal cord either by transmedullary arteries, pial circumferential arteries or, if affecting the lower portions of the cord, by the anastomotic channels of the basket. Each of these vessels can be used for endovascular navigation to reach the shunts with good results if appropriate anatomical rules are followed. We describe here some technical considerations based on the anatomical analysis for the embolization of posterior spinal cord arteriovenous shunts vascularized by the anterior spinal artery.
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Procedimientos Endovasculares , Médula Espinal , Humanos , Fístula Arteriovenosa/cirugía , Fístula Arteriovenosa/diagnóstico por imagen , Fístula Arteriovenosa/terapia , Embolización Terapéutica/métodos , Procedimientos Endovasculares/métodos , Médula Espinal/irrigación sanguínea , Médula Espinal/cirugía , Médula Espinal/diagnóstico por imagenRESUMEN
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-ß 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.
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Células Endoteliales , Arteria Pulmonar , Venas Pulmonares , Telangiectasia Hemorrágica Hereditaria , Humanos , Telangiectasia Hemorrágica Hereditaria/genética , Telangiectasia Hemorrágica Hereditaria/patología , Niño , Arteria Pulmonar/anomalías , Arteria Pulmonar/patología , Venas Pulmonares/anomalías , Venas Pulmonares/patología , Células Endoteliales/metabolismo , Células Endoteliales/patología , Masculino , Mutación , Malformaciones Arteriovenosas/genética , Malformaciones Arteriovenosas/patología , Malformaciones Arteriovenosas/metabolismo , Transición Epitelial-Mesenquimal/genética , Trasplante de Pulmón , Fístula Arteriovenosa/patología , Fístula Arteriovenosa/genética , Pulmón/patología , Pulmón/irrigación sanguínea , FemeninoRESUMEN
Intraosseous arteriovenous malformations (AVM) are uncommon high-flow vascular malformation that can affect the maxilla or mandible. AVM may present with aspecific and misleading signs and symptoms. The diagnosis is often accidental and bleeding may represent the first symptom. Radiographically, there are few characteristic features and misdiagnosis is easy. Here we report the case of a young male affected by arteriovenous fistula on the right side of the mandible initially misdiagnosed as a cystic lesion. The patient underwent transarterial embolization of the vascular malformation and subsequently the lesion was surgically removed. 1-year follow-up showed complete healing of the mandibular bone and absence of recurrence. Intraosseous arteriovenous malformations are rare entities. However, due to their harmfulness, both clinicians and radiologists must be aware of this type of lesion and should always consider them in the differential diagnosis of osteolytic lesions.
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Fístula Arteriovenosa , Embolización Terapéutica , Mandíbula , Humanos , Masculino , Fístula Arteriovenosa/diagnóstico por imagen , Fístula Arteriovenosa/terapia , Mandíbula/diagnóstico por imagen , Diagnóstico Diferencial , Adulto , Radiografía PanorámicaRESUMEN
BACKGROUND: Pulmonary arteriovenous malformation (PAVM), also known as pulmonary arteriovenous fistula, is a rare vascular developmental anomaly. Most cases of PAVM are associated with hereditary hemorrhagic telangiectasia (HHT). Hemothorax associated with PAVM is even rarer, and management concerning this complication still challenges. CASE PRESENTATION: A 55-year-old man with sudden onset of dyspnea and chest pain was admitted to our hospital. He had a medical history of epistaxis, intraperitoneal germ cell tumor and PAVM. Chest unenhanced CT revealed the left-sided pleural effusion together with partial passive atelectasis and gradual increase at the interval of six days. Diagnostic thoracocentesis further revealed hemorrhagic effusion. CT angiography (CTA) showed tortuously dilated lumen of the left lower pulmonary artery and PAVM with the formation of aneurysm. Due to his family's refusal of surgery, the patient underwent transcatheter embolization therapy. However, the left pleural effusion did not significantly reduce and there was a slow drop in hemoglobin value even after interventional treatment, indicating the possibility of ongoing active bleeding. Eventually, the patient received lobectomy of the left lower lobe with a satisfactory outcome. CONCLUSIONS: Massive hemothorax resulting from PAVM rupture into the pleural space can lead to fatal outcomes. CTA can accurately diagnose this pathologic condition. Transcatheter embolization is frequently used in the treatment of PAVM, but it may be challenging to achieve the desirable effect in patients with hemothorax. Combined with our case and literature review, direct radical surgery can lead to a successful outcome when PAVM complicated with hemothorax and a large diameter of the draining vein.
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Fístula Arteriovenosa , Hemotórax , Arteria Pulmonar , Venas Pulmonares , Humanos , Hemotórax/etiología , Masculino , Persona de Mediana Edad , Arteria Pulmonar/anomalías , Arteria Pulmonar/diagnóstico por imagen , Arteria Pulmonar/cirugía , Venas Pulmonares/anomalías , Fístula Arteriovenosa/complicaciones , Fístula Arteriovenosa/cirugía , Malformaciones Arteriovenosas/complicaciones , Angiografía por Tomografía Computarizada , Embolización Terapéutica/métodos , Rotura Espontánea/complicaciones , Tomografía Computarizada por Rayos XRESUMEN
In the context of arteriovenous fistula (AVF) failure, local delivery enables the release of higher concentrations of drugs that can suppress neointimal hyperplasia (NIH) while reducing systemic adverse effects. However, the radiolucency of polymeric delivery systems hinders long-term in vivo surveillance of safety and efficacy. We hypothesize that using a radiopaque perivascular wrap to deliver anti-NIH drugs could enhance AVF maturation. Through electrospinning, we fabricated multifunctional perivascular polycaprolactone (PCL) wraps loaded with bismuth nanoparticles (BiNPs) for enhanced radiologic visibility and drugs that can attenuate NIHârosuvastatin (Rosu) and rapamycin (Rapa). The following groups were tested on the AVFs of a total of 24 Sprague-Dawley rats with induced chronic kidney disease: control (i.e., without wrap), PCL-Bi (i.e., wrap with BiNPs), PCL-Bi-Rosu, and PCL-Bi-Rapa. We found that BiNPs significantly improved the wraps' radiopacity without affecting biocompatibility. The drug release profiles of Rosu (hydrophilic drug) and Rapa (hydrophobic drug) differed significantly. Rosu demonstrated a burst release followed by gradual tapering over 8 weeks, while Rapa demonstrated a gradual release similar to that of the hydrophobic BiNPs. In vivo investigations revealed that both drug-loaded wraps can reduce vascular stenosis on ultrasonography and histomorphometry, as well as reduce [18F]Fluorodeoxyglucose uptake on positron emission tomography. Immunohistochemical studies revealed that PCL-Bi-Rosu primarily attenuated endothelial dysfunction and hypoxia in the neointimal layer, while PCL-Bi-Rapa modulated hypoxia, inflammation, and cellular proliferation across the whole outflow vein. In summary, the controlled delivery of drugs with different properties and mechanisms of action against NIH through a multifunctional, radiopaque perivascular wrap can improve imaging and histologic parameters of AVF maturation.
Asunto(s)
Bismuto , Ratas Sprague-Dawley , Rosuvastatina Cálcica , Sirolimus , Animales , Ratas , Sirolimus/química , Sirolimus/farmacología , Rosuvastatina Cálcica/química , Rosuvastatina Cálcica/farmacología , Rosuvastatina Cálcica/farmacocinética , Bismuto/química , Bismuto/farmacología , Poliésteres/química , Masculino , Fístula Arteriovenosa/patología , Nanopartículas del Metal/química , Neointima/patología , Nanopartículas/química , Humanos , Liberación de FármacosRESUMEN
Arteriovenous fistula (AVF) is the optimal form of vascular access for most haemodialysis dependant patients; however, it is prone to the formation of stenoses that compromise utility and longevity. Whilst there are many factors influencing the development of these stenoses, pathological flow-related phenomena may also incite the formation of intimal hyperplasia, and hence a stenosis. Repeated CFD-derived resistance was calculated for six patient who had a radiocephalic AVF, treated with an interwoven nitinol stent around the juxta-anastomotic region to address access dysfunction. A three-dimensional freehand ultrasound system was used to obtain patient-specific flow profiles and geometries, before performing CFD simulations to replicate the flow phenomena in the AVF, which enabled the calculation of CFD-derived resistance. We presented six patient cases who were examined before and after treatment and our results showed a 77% decrease in resistance, recorded after a surgical intervention to address access dysfunction. Problematic AVFs were found to have high resistance, particularly in the venous segment. AVFs with no reported clinical problems, and clinical patency, had low resistance in the venous segment. There did not appear to be any relationship with clinical problems/patency and resistance values in the arterial segment. Identifying changes in resistance along the circuit allowed stenoses to be identified, independent to that determined using standard sonographic criteria. Our exploratory study reveals thatCFD-derived resistance is a promising metric that allows for non-invasive identification of diseased AVFs. The pipeline analysis enabled regular surveillance of AVF to be studied to aid with surgical planning and outcome, further exhibiting its clinical utility.