Journal of Vascular Access最新文献

Objective: To evaluate the use of the device of mechanical thrombectomy aspiration in the salvage of the fistula for hemodialysis access (HD) with acute thrombosis.

Method: The study model used was a retrospective cohort in which 35 patients, who underwent 44 percutaneus thrombectomy in a tertiary hospital between October 2018 and March 2020, were evaluated. The surgical time of the thrombectomy, the technical success (TS) and the clinical success (CS) were evaluated, as well as the occurrence of surgical complications. Additional adjunct therapy, such balloon angioplasty or thrombolytic therapy when performed was not evaluated.

Results: Among the 35 evaluated patients, 24 (66.8%) were male. In 33 of these cases (75%), the fistula used an autologous vein (AV fistula). The average thrombectomy time was 20.2 min and median was 15 min, with a difference between the AV fistula and synthetic graft (Graft) (p = 0.001), being shorter in the Graft. The TS rate was of 86.4% and the CS rate was of 84.1% with no statistical difference between the groups. The rate of surgical complications was of 13.6%. Blood loss in most cases ranged from 100 to 300 ml in the majority of the cases.

Conclusion: The Device showed a short operation time in its use, a high rate of technical success and clinical success, as well as a similar rate of immediate surgical complications found in the literature.

To overcome the limitations of central venous occlusion or stenosis (CVO) in complex chronic hemodialysis patients, the Hemodialysis Reliable Outflow (HeRO) vascular access graft was created as an alternative means of vascular access that bypasses the CVO and provides an additional upper extremity access option. The super-HeRO adapter was created to allow for the use of early cannulation grafts in the HeRO graft thereby enabling early cannulation and reducing tunneled dialysis catheter dependence time. Some complications have been previously reported for the traditional HeRO and the modified HeRO grafts. We report, a complication of spontaneous and delayed dehiscence/disconnection of the arterial graft from the venous outflow of a modified HeRO graft leading to massive hemorrhage. This complication has never been reported in literature. Our patient suffered this complication 4 weeks after implantation without any known inciting events. While it is unclear why this complication occurred, we must consider potential factors such as technical error of securing the arterial graft to the super-HeRO adapter coupler. Management involved immediate graft ligation given that the patient was in extremis upon presentation. Although deviations from instructions for use (IFU) are common in vascular surgery, particularly in endovascular cases for dialysis access, peripheral arterial disease, and aortic aneurysms, we recommend strict adherence to IFU for HeRO graft placement. Although rare, the sequalae of coupler dehiscence can be catastrophic and even fatal. Despite this complication, modification of the HeRO graft with the super-HeRO adapter remains a safe and feasible approach for establishing upper extremity dialysis access in complex ESRD patients with central venous pathology; we strongly caution that these cases should be performed in strict adherence with IFU using a 6 mm graft and the support seal system.

Background: VenoArterial (VA)-ExtraCorporeal Membrane Oxygenation (ECMO) decannulation was traditionally performed surgically, often resulting in high rates of periprocedural complications such as surgical site infections, bleeding, and elevated patient mobilization costs. The advent of percutaneous techniques, particularly the MANTA^® vascular closure device (MVCD), has significantly reduced these risks by enabling faster and safer decannulation. This study aimed to systematically review the success rates and complications associated with the use of percutaneous closure devices for VA-ECMO decannulation.

Objective: Therefore, this systematic review with meta-analysis aims to evaluate the success rates and complications associated with the use of MVCD device for VA-ECMO decannulation.

Materials and methods: A systematic search was conducted across Pubmed, Web of Science, and Cochrane databases to identify studies evaluating postoperative outcomes in patients undergoing VA-ECMO decannulation using the MANTA^® vascular closure device. The MANTA^® efficacy, incidence of emergent open repair, arterial thrombosis, acute limb ischemia, pseudoaneurysms, and major bleeding were pooled by fixed-effects meta-analysis, with sources of heterogeneity being explored by meta-regression. Assessment of studies' quality was performed using the National Heart, Lung, and Blood Institute (NHLBI) Study Quality Assessment Tool for observational cohorts and case-series studies.

Results: Seven observational studies with 235 patients were included in the final analysis. Overall efficacy of MVCD in VA-ECMO decannulation was 94.8% (95% CI 91.8%-97.9%). In 235 patients, the incidence of emergency open repair after MVCD failure was 3.7% (95% CI 1.3%-6.1%), the incidence of arterial thrombosis was 7.1% (95% CI 2.9%-11.3%), the incidence of pseudoaneurysms was 3.2% (95% CI 0.9%-5.5%), the incidence of acute limb ischemia was 5.0% (95% CI 2.3%-7.8%), and the incidence of major arterial bleeding was 4.1% (95% CI 1.6%-6.7%).

Conclusion: This systematic review and meta-analysis highlights the safety and efficacy of the MANTA^® vascular closure device in achieving hemostasis following VA-ECMO decannulation, demonstrating an acceptable success rate and a low incidence of major complications. Further studies with larger cohorts are necessary to validate these findings and to address the limitations of this preliminary experience.

The dislodgment of the catheter in an implanted venous port is a rare but challenging complication. A 50-year-old lady receiving venous port implantation for chemotherapy was found with a catheter disconnected from the port and dislodged into the right ventricle. As the proximal end of the dislodged catheter in the axillary vein could be detected by ultrasound, we successfully used disposable biopsy forceps to grab the dislodged catheter back with ultrasound guidance and reconnect it back to the port. Biopsy forceps with ultrasound guidance could provide a cheap and efficient strategy for catheter dislodgement for specific scenarios.

Central venous catheters are commonly used for hemodialysis, but prolonged use can lead to complications such as central venous occlusion, resulting in catheter-dependent dialysis patients being unable to undergo dialysis. Herein, we present the case of a 57-year-old female patient who had been dependent on catheter-based hemodialysis for 8 years. Her tunneled central venous catheter (TCC) had been replaced three times and she had developed severe central venous occlusion. For this patient, a procedure was performed involving a percutaneous puncture through the site of superior vena cava occlusion to gain access to the right atrium. The intervention utilized multiple surgical instruments, including a transseptal needle in combination with the stiffening cannula from the RUPS-100 Suite, to facilitate re-catheterization for maintenance hemodialysis. We discuss the feasibility of such procedures as a last-resort option while emphasizing the associated risks.

The following is a response to the Letter to the Editor: Juxta-anastomotic stenosis in the forearm native arteriovenous fistula: Open surgery or angioplasty? By Xu, Cai et al. The letter replies to questions about the selection criteria of patients with juxta-anastomotic stenosis (JAS) and describes our protocols regarding the use of percutaneous transluminal angioplasty (PTA) balloons.

Objectives: Cetuximab-based therapy is prone to develop skin complications. Our study aims to identify the impact on the central venous access by cetuximab-based therapy in patients with head and neck squamous cell carcinoma (HNSCC).

Methods: We conducted a single center retrospective study to explore the prevalence and type of skin complications between totally implantable venous port (TIVP) implanted in the subcutaneous tissue of the anterior chest wall and peripherally inserted central catheter (PICC) for patients with HNSCC who received cetuximab-based therapy.

Results: In the current study, 34 patients had TIVP and 34 patients had PICC. 32.4% (11/34) patients with TIVP had skin complications, while only 11.8% (4/34) skin complications occurred in patients with PICC. Most patients with skin complications were grade 1. However, two patients with TIVP suffered infection by skin complications and experienced TIVP removal. In the correlation analysis, significant (p < 0.05) risk factors for skin complications were prophylactic use of topical steroid ointment and male sex.

Conclusion: TIVP implanted in the anterior chest wall was potentially related with higher incidence of cutaneous complications in patients with R/M HNSCC who received cetuximab based therapy, that requires cancer nurses deep concern and uses evidence-based preventative and treatment strategies.

Based on the patient's life planning, arteriovenous fistula (AVF) and arteriovenous graft (AVG) is better than tunnel-cuffed catheter (TCC) due to catheter-related central venous disease. However, the successful establishment of AVF or AVG requires sufficient vascular conditions. This case report described the reconstruction of an abandoned AVG in a young patient with a small-caliber and high bifurcation artery that was initially unsuitable for AVG creation. We designed a procedure in which an AVF was first established to achieve arterial dilation, and after sufficient enlargement of the artery in a few days, the abandoned graft was reutilized by graft interposition in arterial and venous side separately. We salvaged an AVG by using a simple and inexpensive method to create sufficient arterial condition for AVG establishment making a young patient able to transition from a TCC to an AVG.

Atrial flutter (AFL) is a rare, yet potentially life-threatening tachyarrhythmia of newborns, typically associated with structural heart disease or cardiac surgery. Rarely, AFL might occur as a complication of central venous catheter (CVC) insertion, though data on its incidence and management are limited. Herein, we report the case of a full-term male newborn in therapy with heparin for left iliac thrombosis who developed AFL after a CVC placement. The persistent tachycardia (220 beats per minute) had a narrow QRS and was diagnosed as AFL based on the ECG following adenosine administration; an electrical cardioversion was needed in order to restore the sinus rhythm. Such case highlights the crucial role of real-time tip location techniques in supporting the CVC placement. Indeed, the real-time ultrasound at the bedside might be extremely helpful to promptly assess a CVC mispositioning, allowing for timely and correct management. In conclusion, this case underscores the critical role of real-time ultrasound or intracavitary ECG (IC-ECG) to prevent CVC-related complications and the need for further research into optimizing management strategies for such complications.

Angiosarcomas are rare, aggressive tumors with a poor prognosis. Early detection is essential, as surgically removing localized tumors gives the best chance for a cure. While angiosarcomas predominantly occur in the head and neck region, they can arise from endothelial cells lining blood or lymphatic vessels throughout the body. This case study highlights a rare instance of angiosarcoma developing in a non-functioning arteriovenous fistula (AVF) many years post-renal transplantation. A 50-year-old male with a history of end-stage renal disease (ESRD), initially treated with hemodialysis through a left brachiocephalic AVF, underwent a deceased donor kidney transplant in 2016. In March 2023, patient developed pain and numbness in his left hand, revealing a thrombosed AVF and chronic arterial occlusions. Surgical interventions included a left brachial-brachial artery bypass and ulnar endarterectomy, but his condition deteriorated, leading to the identification of a 4.9 × 3.1 × 2.4 cm mass in the proximal ulnar shaft in January 2024. Biopsy results confirmed epithelioid angiosarcoma, which was subsequently treated with left upper extremity amputation and tumor resection. Metastatic disease was detected in the right lung, necessitating further surgical interventions. This case underscores the necessity for vigilance in monitoring AVFs in transplant patients. We further completed a comprehensive literature review, using PubMed, Cochrane, and Google Scholar, from 2000 to 2024, focused on angiosarcoma arising from AVFs to provide further insights into the rare association between AVFs and angiosarcoma.