Fistula flow, PAP and EF of all patients should be checked at least 6 months after fistula creation. Patients with higher fistula flow rates and patients with diabetes mellitus need to be more closely observed. In addition, elderly patients with significant cardiac and other comorbidities may be more prone to develop symptoms after AVF creation.
Background:The number of patients with End-Stage Renal Disease (ESRD) has progressively increased in the population. Kidney transplantation is the specific treatment for such patients; however a majority of patients will require hemodialysis before kidney transplantation. The present study aims to investigate using the external jugular vein (EJV) for Permcath placement in these patients.Materials and Methods:This descriptive and analytical study was conducted in Alzahra Medical Center, Isfahan, in 2012. Catheters were inserted by cutting down the right EJV. The patency rate and potential complications were studied. The obtained data was analyzed using SPSS 21.0.Results:Out of 45 live patients, within three months of surgery, 40 patients (81.6%) had no complications and dialysis continued through Permcath. Permcath Thrombosis occurred in two patients (4.4%). Catheter infection led to the removal of it in one patient (2.2%) 1.5 months after surgery. And accidental catheter removal occurred in one patient.Conclusion:Placement of the permcath in the external jugular vein can be a safe, uncomplicated, and reliable method for patients requiring hemodialysis, and can be a life-saving alternative in patients without accessible internal jugular vein.
Background:Heparin has long been used to prevent thrombosis in the permanent central venous hemodialysis catheters (PermCath). Other alternatives for heparin with fewer side-effects have recently been considered. We compared normal saline (0.9%) with heparin for flushing PermCath with regards to catheter patency and prevention of heparin complications.Materials and Methods:Chronic kidney disease patients who were candidate of PermCath placement were randomly assigned into two groups of heparin and saline. In the heparin group, the PermCath was flushed with heparin (1000 IU), and in the saline group, it was flushed with saline 0.9%. Patients were followed for 24 hours, and outcomes included catheter thrombosis, maneuver needed to maintain catheter patency, and bleeding from catheter site.Results:Ninety six patients were included (age = 63.1 ± 11.2 years, 54.2% male). No one experienced catheter thrombosis. Two patient (4.2%) in the heparin and three ones (6.1%) in the saline group required catheter manipulation (P = 0.520). Four patients (8.5%) in the heparin and three ones (6.1%) in the saline group experienced bleeding (P = 0.476); differences between heparin and saline groups in the amount of bleeding (225.0 ± 62.4 vs. 200.0 ± 113.5 cc, P = 0.721) and bleeding time (6.5 ± 1.2 vs. 5.3 ± 1.5 min, P = 0.322) were not significant. In the heparin group, no significant increase was observed in PTT over time; baseline 30.9 ± 3.4, 12 h 31.8 ± 3.4, 24 h 31.2 ± 6.6 (P = 0.628).Conclusions:Flushing PermCath with normal saline 0.9% is as effective as heparin in maintaining patency of the catheter, while it may reduce the risks associated with heparin.
Neurogenic tumors, especially paraganglioma of larynx, are rare. In this article, we present a 64-year-old woman who complained of intermittent dysphagia to solid foods. Further evaluation revealed a supraglottic paraganglioma and she was treated successfully by total excision of tumor.
Background:This study was performed to compare the outcome and complications of axillobrachial and femorofemoral graft as upper and lower limb arteriovenous shunt prostheses.Materials and Methods:In a prospective cohort study, we observed and followed-up all cases with a new insertion of ePTFE between February 2006 and February 2009. Assessment of patency and the complication rates of their prostheses were the essential parts of this observation.Methods:In a prospective cohort study, we observed and followed-up all cases with a new insertion of ePTFE between February 2006 and February 2009. Assessment of patency and the complication rates of their prostheses were the essential parts of this observation.Results:A total of 69 grafts were performed. Forty-nine of them were successfully followed-up (18 femorofemoral and 31 axillobrachial grafts). Immediate primary patency was 100%. For axillobrachial type, primary patency at 1, 3, and 6 months, respectively, was 86%, 60%, and 47%. Secondary patency at 1, 3, and 6 months was 86%, 75%, and 50%, respectively. For femorofemoral type, primary patency at 1, 3, and 6 months, respectively, was 88%, 40%, and 34%. Secondary patency at 1, 3, and 6 months was 94%, 47%, and 41%, respectively. (P > 0.05) Complications included a puncture-site hematoma, thrombosis, infection, venous hypertension, need of an excision and pseudoaneurysm formation. Pseudoaneurysm rate difference between the two groups was interestingly significant, while others were relatively similar; however, the rates were different.Conclusion:The significant difference of aneurysm rate among our two groups, besides the insignificant difference of other complications and also the similar primary and secondary patency rates, manifest a brilliant guidance chart for the surgeons in order to choose the most compatible site for inserting ePTFE grafts (Gore-tex) as arteriovenous shunt prostheses for HD accessing.
Acupuncture is claimed to be an effective therapy for a broad range of medical problems with minimal side-effects. However, regardless of its efficacy, it can be associated with complications including bacterial infection. 1 2 We describe a case of unilateral foot oedema with negative culture as a complication of catgut embedding (a therapy related to acupuncture) which has not, as far as we know, been reported previously.
Introduction: One of the main complications of End Stage Renal Disease (ESRD) is pulmonary hypertension. In fact creation of temporary Artery-Venous Fistula (AVF) for dialysis considerably, accelerates the rise in cardiac output and pulmonary artery pressure in these patients. We have evaluated the effect of kidney transplantation on improving cardiac indices such as Pulmonary Artery Pressure (PAP) and Cardiac Output (CO) post transplantation. Material and Method: 50 patients with ESRD were included in the retrospective clinical trial study. Echocardiography was performed to evaluate systolic PAP, CO and Ejection Fraction (EF) prior to creating AVF. 12 patients underwent kidney transplantation. None of the AV fi stulas of graft recipients were subjected to surgical closure post-transplantation. After a follow up interval of at least 6 months, second echocardiography assessments and Doppler sonogram of their fi stula fl ow were done. Transplanted and non transplanted cases were compared. The two groups were matched on age, medical co-morbidities and AVF creation surgical technique and fl ow. P-values were obtained using the Student's t-test. Results: The mean systolic PAP was 20.7 mmHg prior to AVF creation in graft recipients (n=12); which has signifi cantly decreased to 14.8 mmHg posttransplantation (P=0.016). Post-transplant systolic PAP increased in none of the recipients compared to pre-transplant values. In non-transplanted group (n=38) a signifi cant rise in the mean systolic PAP from 21.3 mmHg to 25.16 mmHg pre and post AVF creation was observed. There was no signifi cant change observed in CO post-transplant compared to pre-AVF creation value (6120 ml/min). Mean CO was 510 ml/min less in those who were not transplanted (5610 ml/min). No considerable decrease in CO may be explained by levels of still-existing AVF fl ow in transplanted group (P=0.32). The non-transplanted group has shown a 7% decrease in mean EF during the study period, whereas the recipients had 7.5% increase in mean EF, which was signifi cantly different (P=0.03). Conclusion: The outcomes of this study are in accordance with other studies', confi rming that kidney transplantation should be regarded as the best available method to control the end organ damage of renal failure including complications caused by AVF creation . Improvements in Cardiac indices after kidney transplantation even with open AVF can reverse clinical manifestations of ESRD. Moreover, surgical closure of the temporary AVF in suitable candidates after reassurance of graft acceptance can improve the complications; however more investigations are required to affi rm the accuracy.
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