Pub Date : 2023-07-01DOI: 10.4103/ijves.ijves_39_23
RRahul Singh, AjayB Mosur, Rahul Lakshminarayanan, R. Anandasu, P. Ragaveena, MSanthoshi Mounika, Narendranadh Meda
A pseudoaneurysm is a rare complication involving the vasculature and may be limb threatening if not treated. Pseudoaneurysm typically occurs when there is a breach in the vessel wall such that the blood leaks through the inner wall but is contained by the adventitia or surrounding perivascular soft tissue. These may be caused due to trauma to the vessel (either due to fractures, bony fragments), following endovascular therapy , or infective etiology, or other causes. Tibial and pedal artery aneurysms occur in the setting of penetrating trauma, fractures, or iatrogenic injury during orthopaedic surgery or peripheral interventions. Those causing significant symptoms must be repaired with autologous vein bypass grafts if there is distal ischemia. If other tibial arteries are patent, a simple ligation will also suffice. Coil embolization and conservative management resulting in spontaneous thrombosis of small pseudoaneurysms, have also been reported. We report a case of a 51 year old male with right Anterior Tibial Artery pseudoaneurysm which had developed over several years after a trauma with the patient presenting to us only after he started having symptoms of distal ischemia.
{"title":"Delayed presentation of anterior tibial artery pseudoaneurysm causing distal ischemia – A case report with review of literature","authors":"RRahul Singh, AjayB Mosur, Rahul Lakshminarayanan, R. Anandasu, P. Ragaveena, MSanthoshi Mounika, Narendranadh Meda","doi":"10.4103/ijves.ijves_39_23","DOIUrl":"https://doi.org/10.4103/ijves.ijves_39_23","url":null,"abstract":"A pseudoaneurysm is a rare complication involving the vasculature and may be limb threatening if not treated. Pseudoaneurysm typically occurs when there is a breach in the vessel wall such that the blood leaks through the inner wall but is contained by the adventitia or surrounding perivascular soft tissue. These may be caused due to trauma to the vessel (either due to fractures, bony fragments), following endovascular therapy , or infective etiology, or other causes. Tibial and pedal artery aneurysms occur in the setting of penetrating trauma, fractures, or iatrogenic injury during orthopaedic surgery or peripheral interventions. Those causing significant symptoms must be repaired with autologous vein bypass grafts if there is distal ischemia. If other tibial arteries are patent, a simple ligation will also suffice. Coil embolization and conservative management resulting in spontaneous thrombosis of small pseudoaneurysms, have also been reported. We report a case of a 51 year old male with right Anterior Tibial Artery pseudoaneurysm which had developed over several years after a trauma with the patient presenting to us only after he started having symptoms of distal ischemia.","PeriodicalId":13375,"journal":{"name":"Indian Journal of Vascular and Endovascular Surgery","volume":"1 1","pages":"212 - 215"},"PeriodicalIF":0.1,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70769130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-01DOI: 10.4103/ijves.ijves_13_23
DeepJyoti Chaudhuri, Pranati Swain, V. Nair, B. Vasudevan, YuganPrakash Yadav
Veinous thrombosis is a rare manifestation of leprosy (Hansen's disease). In this case report, we bring to notice this extremely rare presentation and challenges faced during management. A 26-year-old young healthy individual presented with painless cord-like swellings on both sides of the neck for 1 month. This was evaluated to be external jugular vein (EJV) thrombosis on ultrasonography Doppler. Trying to evaluate the cause of the thrombosis, there was no specific etiology found. On further detailed evaluation, it was found that he had hypopigmented skin patches. This led to the diagnosis of borderline tuberculoid leprosy downgrading to borderline lepromatous in type 1 lepra reaction. He responded to rifampicin, clofazimine, and dapsone with progressive resolution of skin lesions. Simultaneous treatment with apixaban caused complete resolution of EJV thrombosis. Further evaluation revealed heterozygous methylenetetrahydrofolate reductase mutation and beta-2-glycoprotein immunoglobulin M positivity. An extensive literature review suggested that intimal damage caused by lepra bacilli can lead to veinous thrombosis in Hansen's disease. However, the interplay of genetic procoagulant predispositions in phenotypic presentation is yet to be determined.
{"title":"External jugular veinous thrombosis: A rare presentation of Hansen's disease","authors":"DeepJyoti Chaudhuri, Pranati Swain, V. Nair, B. Vasudevan, YuganPrakash Yadav","doi":"10.4103/ijves.ijves_13_23","DOIUrl":"https://doi.org/10.4103/ijves.ijves_13_23","url":null,"abstract":"Veinous thrombosis is a rare manifestation of leprosy (Hansen's disease). In this case report, we bring to notice this extremely rare presentation and challenges faced during management. A 26-year-old young healthy individual presented with painless cord-like swellings on both sides of the neck for 1 month. This was evaluated to be external jugular vein (EJV) thrombosis on ultrasonography Doppler. Trying to evaluate the cause of the thrombosis, there was no specific etiology found. On further detailed evaluation, it was found that he had hypopigmented skin patches. This led to the diagnosis of borderline tuberculoid leprosy downgrading to borderline lepromatous in type 1 lepra reaction. He responded to rifampicin, clofazimine, and dapsone with progressive resolution of skin lesions. Simultaneous treatment with apixaban caused complete resolution of EJV thrombosis. Further evaluation revealed heterozygous methylenetetrahydrofolate reductase mutation and beta-2-glycoprotein immunoglobulin M positivity. An extensive literature review suggested that intimal damage caused by lepra bacilli can lead to veinous thrombosis in Hansen's disease. However, the interplay of genetic procoagulant predispositions in phenotypic presentation is yet to be determined.","PeriodicalId":13375,"journal":{"name":"Indian Journal of Vascular and Endovascular Surgery","volume":"1 1","pages":"219 - 221"},"PeriodicalIF":0.1,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70768269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-01DOI: 10.4103/ijves.ijves_36_22
Devender Singh, S. Aryala
Median artery is usually a transient vessel during the embryonic period and may persist in adult life as the persistent median artery (PMA) in the upper limbs. It remains asymptomatic in most people; however, thrombosis leading to features of carpal tunnel syndrome is one of the known complications. We report a case of pseudoaneurysm of PMA following a trivial injury. This case report highlights the importance of being aware of this anatomical variation, to avoid complications during hand surgeries.
{"title":"Pseudoaneurysm of the persistent median artery: A rare vascular injury","authors":"Devender Singh, S. Aryala","doi":"10.4103/ijves.ijves_36_22","DOIUrl":"https://doi.org/10.4103/ijves.ijves_36_22","url":null,"abstract":"Median artery is usually a transient vessel during the embryonic period and may persist in adult life as the persistent median artery (PMA) in the upper limbs. It remains asymptomatic in most people; however, thrombosis leading to features of carpal tunnel syndrome is one of the known complications. We report a case of pseudoaneurysm of PMA following a trivial injury. This case report highlights the importance of being aware of this anatomical variation, to avoid complications during hand surgeries.","PeriodicalId":13375,"journal":{"name":"Indian Journal of Vascular and Endovascular Surgery","volume":"10 1","pages":"145 - 147"},"PeriodicalIF":0.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49101069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-01DOI: 10.4103/ijves.ijves_51_22
Maheshri Deshpande, Geet Bhuyan
A 34-year-old man came to the outpatient department with subcutaneous nodules in the temporal area. He did not complain of any other symptoms. Computed tomography scan revealed a nodule of 40.5 HU in the temporal region of the scalp. A possibility of an epidermal inclusion cyst was given. The lesion was excised and the biopsy revealed vasculitis with eosinophilia without giant cell formation. A final diagnosis of juvenile temporal arteritis with hypereosinophilic syndrome was given based on the clinical, radiological, and histopathological findings.
{"title":"Juvenile temporal arteritis with hypereosinophilic syndrome masquerading as an epidermal inclusion cyst of the scalp","authors":"Maheshri Deshpande, Geet Bhuyan","doi":"10.4103/ijves.ijves_51_22","DOIUrl":"https://doi.org/10.4103/ijves.ijves_51_22","url":null,"abstract":"A 34-year-old man came to the outpatient department with subcutaneous nodules in the temporal area. He did not complain of any other symptoms. Computed tomography scan revealed a nodule of 40.5 HU in the temporal region of the scalp. A possibility of an epidermal inclusion cyst was given. The lesion was excised and the biopsy revealed vasculitis with eosinophilia without giant cell formation. A final diagnosis of juvenile temporal arteritis with hypereosinophilic syndrome was given based on the clinical, radiological, and histopathological findings.","PeriodicalId":13375,"journal":{"name":"Indian Journal of Vascular and Endovascular Surgery","volume":"10 1","pages":"155 - 157"},"PeriodicalIF":0.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48860950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-01DOI: 10.4103/ijves.ijves_49_22
J. Patel, Alisha Akhani, Nirav Chhabhaya, Arya Patel
Arteriovenous malformation most commonly affects the central nervous system but can involve any organ. A 28 year old woman presented with complaints of on and off pain in epigastric region since 3 month.skin lesion in epigastric region since one month. local examination, there was multiple clear to hemorrhagic fluid filled blister present in epigastric region. An ill defined mass in the epigastric region, soft to firm in consistency and immobile. On leg raising test, the swelling became prominent. MDCT scan of whole abdomen showed a single lobulated hypodense lesion in anterior abdominal wall. Arterial supply was from superior epigastric artery from both sides and inferior epigastric artery from left side. There was no involvement of rectus sheath or evidence of intra-peritoneal extension. Excision of the epigastric AVM was performed after ligating all the feeders. To our best knowledge, this is the first case of epigastric subcutaneous AVM and such an entity has not been reported in the literature so far. Epigastric AVMs can easily be misdiagnosed as lipoma or epigastric hernia. Ultrasonography is useful as an initial imaging modality, however a CT scan is required to determine the peritoneal and visceral involvement of an epigastric mass.
{"title":"A rare case of anterior abdominal wall arteriovenous malformation","authors":"J. Patel, Alisha Akhani, Nirav Chhabhaya, Arya Patel","doi":"10.4103/ijves.ijves_49_22","DOIUrl":"https://doi.org/10.4103/ijves.ijves_49_22","url":null,"abstract":"Arteriovenous malformation most commonly affects the central nervous system but can involve any organ. A 28 year old woman presented with complaints of on and off pain in epigastric region since 3 month.skin lesion in epigastric region since one month. local examination, there was multiple clear to hemorrhagic fluid filled blister present in epigastric region. An ill defined mass in the epigastric region, soft to firm in consistency and immobile. On leg raising test, the swelling became prominent. MDCT scan of whole abdomen showed a single lobulated hypodense lesion in anterior abdominal wall. Arterial supply was from superior epigastric artery from both sides and inferior epigastric artery from left side. There was no involvement of rectus sheath or evidence of intra-peritoneal extension. Excision of the epigastric AVM was performed after ligating all the feeders. To our best knowledge, this is the first case of epigastric subcutaneous AVM and such an entity has not been reported in the literature so far. Epigastric AVMs can easily be misdiagnosed as lipoma or epigastric hernia. Ultrasonography is useful as an initial imaging modality, however a CT scan is required to determine the peritoneal and visceral involvement of an epigastric mass.","PeriodicalId":13375,"journal":{"name":"Indian Journal of Vascular and Endovascular Surgery","volume":"10 1","pages":"152 - 154"},"PeriodicalIF":0.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42769471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-01DOI: 10.4103/ijves.ijves_5_23
A. Çolak, Izatullah Jalalzai
Aim: Our aim is to evaluate the relationship between the survival time of arteriovenous (AV) fistula whose flows are measured with flow meter in patients with chronic renal failure who were operated for AV fistula (AVF) and present the results. Materials and Methods: In our clinic, we evaluated the flow meter measurement results with patency rates and usability after 6 months of AVF in 100 patients who underwent AVF operation due to chronic renal failure. Findings: In February 2012, transit-time flow measurement was put into use in our clinic. The last 50 consecutive patients with the same characteristics before this date constituted the control group (Group A) and the first 50 consecutive patients after this date constituted the study group. Radiocephalic fistula was made the most common (Group A, n = 50; Group B, n = 50). Nondominant upper extremity was selected when planning AVF for patients. First radiocephalic, then brachiocephalic AVF was performed. Fistulas flow was measured with an intraoperative flow meter. Those with bad flow were revised during the operation. Embolectomy was performed in one patient at the 2nd month due to fistula thrombosis, but it was not successful in one patient, and an AVF was opened with a graft. Results: While creating AVF, our aim is to use it effectively for a long time. By evaluating the fistula flows with the flow meter and make an intraoperative revision if necessary we ensure to extend the lifespan of a fistula.
{"title":"The importance of perioperative flow evaluation and prevention of steal syndrome in arteriovenous fistula surgery using transit-time flow measurement","authors":"A. Çolak, Izatullah Jalalzai","doi":"10.4103/ijves.ijves_5_23","DOIUrl":"https://doi.org/10.4103/ijves.ijves_5_23","url":null,"abstract":"Aim: Our aim is to evaluate the relationship between the survival time of arteriovenous (AV) fistula whose flows are measured with flow meter in patients with chronic renal failure who were operated for AV fistula (AVF) and present the results. Materials and Methods: In our clinic, we evaluated the flow meter measurement results with patency rates and usability after 6 months of AVF in 100 patients who underwent AVF operation due to chronic renal failure. Findings: In February 2012, transit-time flow measurement was put into use in our clinic. The last 50 consecutive patients with the same characteristics before this date constituted the control group (Group A) and the first 50 consecutive patients after this date constituted the study group. Radiocephalic fistula was made the most common (Group A, n = 50; Group B, n = 50). Nondominant upper extremity was selected when planning AVF for patients. First radiocephalic, then brachiocephalic AVF was performed. Fistulas flow was measured with an intraoperative flow meter. Those with bad flow were revised during the operation. Embolectomy was performed in one patient at the 2nd month due to fistula thrombosis, but it was not successful in one patient, and an AVF was opened with a graft. Results: While creating AVF, our aim is to use it effectively for a long time. By evaluating the fistula flows with the flow meter and make an intraoperative revision if necessary we ensure to extend the lifespan of a fistula.","PeriodicalId":13375,"journal":{"name":"Indian Journal of Vascular and Endovascular Surgery","volume":"10 1","pages":"104 - 108"},"PeriodicalIF":0.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42437013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-01DOI: 10.4103/0972-0820.382351
P. Ilayakumar
{"title":"Anthologies in Vascular Surgery-14","authors":"P. Ilayakumar","doi":"10.4103/0972-0820.382351","DOIUrl":"https://doi.org/10.4103/0972-0820.382351","url":null,"abstract":"","PeriodicalId":13375,"journal":{"name":"Indian Journal of Vascular and Endovascular Surgery","volume":"10 1","pages":"165 - 166"},"PeriodicalIF":0.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47743620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-01DOI: 10.4103/ijves.ijves_60_22
K. Nagarajan, S. Sabarish, Ankusha Yadav, Nelamangala Prasad
Splenic artery aneurysms (SAAs) are commonly related to high flow in the splenic artery and can remain asymptomatic for a long time. However, their natural course is a progressive increase in size, so treatment is always indicated if their size is >2 cm and even if they are asymptomatic. Endovascular treatment of these aneurysms is successful and safe either as an alternative to or as an adjunct to surgery. We present a case of SAA in a patient of noncirrhotic portal hypertension treated successfully by an endovascular Amplatzer plug followed by surgery.
{"title":"Vascular plug as adjunct in the treatment of giant serpentine splenic artery aneurysm","authors":"K. Nagarajan, S. Sabarish, Ankusha Yadav, Nelamangala Prasad","doi":"10.4103/ijves.ijves_60_22","DOIUrl":"https://doi.org/10.4103/ijves.ijves_60_22","url":null,"abstract":"Splenic artery aneurysms (SAAs) are commonly related to high flow in the splenic artery and can remain asymptomatic for a long time. However, their natural course is a progressive increase in size, so treatment is always indicated if their size is >2 cm and even if they are asymptomatic. Endovascular treatment of these aneurysms is successful and safe either as an alternative to or as an adjunct to surgery. We present a case of SAA in a patient of noncirrhotic portal hypertension treated successfully by an endovascular Amplatzer plug followed by surgery.","PeriodicalId":13375,"journal":{"name":"Indian Journal of Vascular and Endovascular Surgery","volume":"10 1","pages":"161 - 164"},"PeriodicalIF":0.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48420573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-01DOI: 10.4103/ijves.ijves_19_23
H. Mahapatra, D. Kushal, N. Kaur, M. Bhardwaj, L. Pursnani, B. Muthukumar, Anamika Singh, C. Krishnan, Adarsh Kumar, Renju Binoy
Introduction: Nonmaturation of arteriovenous fistula (AVF) is a common obstacle due to neointimal hyperplasia (NIH). The present study evaluated the clinical and histopathological factors predicting AVF nonmaturation. Methodology: This prospective observational study was conducted over 18 months in 100 patients. AVF site venous tissue samples of 55 4/5 chronic kidney disease stages patients were collected. Histopathological analysis was done to detect four immunohistochemistry (IHC) markers, namely cluster of differentiation (CD68), CD31, α-SMA, and Ki67. IIntimal composition, hyperplasia, and calcification were also assessed. Fistulae were followed up at the 2nd, 6th, and 12th weeks and classified into mature and nonmature groups at 12 weeks based on clinical and Doppler examination. A comparison between the two groups was done and an association of radiological, histopathological, and IHC parameters of nonmature AVF was also carried out. Results: Among 55 patients, 35 (63.6%) had mature AVF and 26 (47%) had preexisting NIH. Preexisting NIH had no significant association with maturation (odds ratio: 0.44). Subjects without preexisting NIH had a significantly higher luminal diameter in 2nd week (P ≤ 0.05). There was a significant increase in blood flow both between the 2nd and 6th and between the 6th and 12th week (P < 0.05). Of the four IHC markers, three markers viz., CD68 (ρ = 0.525), CD31 (ρ = 0.420), and α-smooth muscle actin (ρ = 0.718) correlated significantly (P < 0.05) with the NIH. The mean AVF diameter and blood flow in the matured arm were more than that in the nonmatured arm at all the follow-ups (P < 0.09). Conclusion: The presence of CD68, CD31, and α-smooth muscle actin in the venous tissue suggests preexisting NIH which postoperative luminal diameter and blood flow may have long-term consequences in AVF functioning.
{"title":"Comparative clinical and histopathological evaluation of mature and nonmature arteriovenous fistula","authors":"H. Mahapatra, D. Kushal, N. Kaur, M. Bhardwaj, L. Pursnani, B. Muthukumar, Anamika Singh, C. Krishnan, Adarsh Kumar, Renju Binoy","doi":"10.4103/ijves.ijves_19_23","DOIUrl":"https://doi.org/10.4103/ijves.ijves_19_23","url":null,"abstract":"Introduction: Nonmaturation of arteriovenous fistula (AVF) is a common obstacle due to neointimal hyperplasia (NIH). The present study evaluated the clinical and histopathological factors predicting AVF nonmaturation. Methodology: This prospective observational study was conducted over 18 months in 100 patients. AVF site venous tissue samples of 55 4/5 chronic kidney disease stages patients were collected. Histopathological analysis was done to detect four immunohistochemistry (IHC) markers, namely cluster of differentiation (CD68), CD31, α-SMA, and Ki67. IIntimal composition, hyperplasia, and calcification were also assessed. Fistulae were followed up at the 2nd, 6th, and 12th weeks and classified into mature and nonmature groups at 12 weeks based on clinical and Doppler examination. A comparison between the two groups was done and an association of radiological, histopathological, and IHC parameters of nonmature AVF was also carried out. Results: Among 55 patients, 35 (63.6%) had mature AVF and 26 (47%) had preexisting NIH. Preexisting NIH had no significant association with maturation (odds ratio: 0.44). Subjects without preexisting NIH had a significantly higher luminal diameter in 2nd week (P ≤ 0.05). There was a significant increase in blood flow both between the 2nd and 6th and between the 6th and 12th week (P < 0.05). Of the four IHC markers, three markers viz., CD68 (ρ = 0.525), CD31 (ρ = 0.420), and α-smooth muscle actin (ρ = 0.718) correlated significantly (P < 0.05) with the NIH. The mean AVF diameter and blood flow in the matured arm were more than that in the nonmatured arm at all the follow-ups (P < 0.09). Conclusion: The presence of CD68, CD31, and α-smooth muscle actin in the venous tissue suggests preexisting NIH which postoperative luminal diameter and blood flow may have long-term consequences in AVF functioning.","PeriodicalId":13375,"journal":{"name":"Indian Journal of Vascular and Endovascular Surgery","volume":"10 1","pages":"118 - 125"},"PeriodicalIF":0.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48666112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-01DOI: 10.4103/ijves.ijves_61_22
M. Jha, Anand Vembu, R. Dhillan
Background: Dialysis access in patients of chronic kidney disease (CKD) on long-term hemodialysis is a problem area. Patients with poor caliber veins distally on initial evaluation or with multiple fistula failures, basilic vein transposition is a good alternative. We present our experience with basilic vein transposition at our center. Methods: This study was a single-center observational study. A retrospective review of prospectively collected data from December 2013 to June 2019 was done. Qualitative variables were expressed as frequencies/percentages and compared between groups using the Chi-square test. Quantitative variables were expressed as mean ± standard deviation and compared between groups using unpaired t-test between groups and paired t-test within groups across follow-ups. Multiple linear regression analysis using a stepwise model selection tool was used to assess factors affecting the first cannulation. The best model was arrived in four steps where explanatory power (R2) increased from 66.6% to 79.3% (P < 0.001). Results: One hundred and eighty-eight patients formed a part of the study. One hundred and sixty-four patients underwent single stage, whereas 24 underwent two-stage transposition. Ninety-four each were male and female. The mean age was 51.38 ± 14.74 years. About 96.27% of fistulas underwent successful cannulation. The overall mean maturation time was 44.46 ± 7.21 days. It was 42.28 ± 3.71 for single and 60.27 ± 6.66 days for two-stage procedures. Primary patency at 6 months and 1 year were 92.82% and 85.67%, whereas primary-assisted patency rates were 94.6% and 91%. The secondary patency rate at 1 year was 60.77%. Salvage procedures included thrombolysis in 2, thrombectomy in 18, and thrombectomy with venoplasty in four cases. There were 28 failures. Fistula thrombosis was the most common cause. Complications included transient arm edema in 36.7%, late thrombosis in 7.7%, wound infection in 4.4%, and lymphorrhea in 6.9% of patients. Conclusion: The smallest basilic vein diameter for successful transposition is 2.5 mm. Factors used to predict successful maturation are initial vein diameter ≥2.5 mm, preoperative Peak systolic velocity (PSV) in brachial artery >70 cm/s, fistula flow rate of >400 ml/min at 6 weeks, and fistula diameter >4.5 mm at 06 weeks.
{"title":"An observational study on transposed brachial artery ‒ Basilic vein AV fistula in vascular access for hemodialysis","authors":"M. Jha, Anand Vembu, R. Dhillan","doi":"10.4103/ijves.ijves_61_22","DOIUrl":"https://doi.org/10.4103/ijves.ijves_61_22","url":null,"abstract":"Background: Dialysis access in patients of chronic kidney disease (CKD) on long-term hemodialysis is a problem area. Patients with poor caliber veins distally on initial evaluation or with multiple fistula failures, basilic vein transposition is a good alternative. We present our experience with basilic vein transposition at our center. Methods: This study was a single-center observational study. A retrospective review of prospectively collected data from December 2013 to June 2019 was done. Qualitative variables were expressed as frequencies/percentages and compared between groups using the Chi-square test. Quantitative variables were expressed as mean ± standard deviation and compared between groups using unpaired t-test between groups and paired t-test within groups across follow-ups. Multiple linear regression analysis using a stepwise model selection tool was used to assess factors affecting the first cannulation. The best model was arrived in four steps where explanatory power (R2) increased from 66.6% to 79.3% (P < 0.001). Results: One hundred and eighty-eight patients formed a part of the study. One hundred and sixty-four patients underwent single stage, whereas 24 underwent two-stage transposition. Ninety-four each were male and female. The mean age was 51.38 ± 14.74 years. About 96.27% of fistulas underwent successful cannulation. The overall mean maturation time was 44.46 ± 7.21 days. It was 42.28 ± 3.71 for single and 60.27 ± 6.66 days for two-stage procedures. Primary patency at 6 months and 1 year were 92.82% and 85.67%, whereas primary-assisted patency rates were 94.6% and 91%. The secondary patency rate at 1 year was 60.77%. Salvage procedures included thrombolysis in 2, thrombectomy in 18, and thrombectomy with venoplasty in four cases. There were 28 failures. Fistula thrombosis was the most common cause. Complications included transient arm edema in 36.7%, late thrombosis in 7.7%, wound infection in 4.4%, and lymphorrhea in 6.9% of patients. Conclusion: The smallest basilic vein diameter for successful transposition is 2.5 mm. Factors used to predict successful maturation are initial vein diameter ≥2.5 mm, preoperative Peak systolic velocity (PSV) in brachial artery >70 cm/s, fistula flow rate of >400 ml/min at 6 weeks, and fistula diameter >4.5 mm at 06 weeks.","PeriodicalId":13375,"journal":{"name":"Indian Journal of Vascular and Endovascular Surgery","volume":"10 1","pages":"98 - 103"},"PeriodicalIF":0.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48768512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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