RESULTSA total of 330 stenoses were found in 228 patients. PTA was technically successful in 96.3% of the stenoses (n=319). Clinical success was achieved in 97.2% (n=321). Early dysfunction (within six months) was positively correlated with patient age (P < 0.001) and diabetes (P < 0.005). Older age (P < 0.001) and diabetes (P = 0.002) were associated with a lower primary patency rate. Patient age (P < 0.001), presence of diabetes (P = 0.023), length of stenosis (P = 0.003), early recurrence (P = 0.003) and presence of residual stenosis (P = 0.014) were associated with a lower secondary patency rate. CONCLUSION Patency of dysfunctional hemodialysis fistulas can be maintained safely with continuous follow-up and repeated interventions without shortening the venous segment by surgical revision. Percutaneous approach to hemodialysis access stenosis is an alternative to the conventional surgical approach and PTA is an effective treatment method for dysfunctional AVF.H emodialysis, and therefore patent hemodialysis access, is of great importance to patients with end-stage renal disease (ESRD). The preferred type of access in patients undergoing hemodialysis is an arteriovenous fistula (AVF) (1). The Kidney Disease Outcomes Quality Initiative provides evidence-based clinical practice guidelines for all stages of ESRD and reports autogenous AVF as the reference standard for primary vascular access, due to their longevity and low infection rates (2, 3). Sands et al. (4) and Schwab et al. (5) demonstrated a 10-fold increase in thrombosis rate of synthetic polytetrafluoroethylene (PTFE) accesses when compared to AVFs. Despite proven advantages of AVF over PTFE, both types of access eventually fail and contribute to multiple hospital admissions, radiological and surgical interventions, and overall morbidity associated with chronic hemodialysis. Significant stenosis causing access dysfunction is a frequent complication in hemodialysis and requires repeated percutaneous transluminal balloon angioplasty (PTA) to maintain patency (6-9). The patency of PTA is limited, however, with first year primary patency rates ranging between 26% and 62% (6-8). Many factors influencing the patency rate have been studied in previously reported series (7,8). Our study is the first to investigate the effect of early recurrence on secondary patency. MethodsThe records of 228 patients (129 men, 99 women; mean age, 56.8±14.6 years) who underwent first time PTA for a dysfunctional native AVF between January 2007 and January 2011 were retrospectively reviewed. Inclusion criteria were presence of a dysfunctional native AVF referred for fistulography and treatment, no previous history of stenosis or thrombosis, and only stenosis of the AVFs on fistulography. Patients who had synthetic dialysis, composite grafts, or autogenous fistulas that were already thrombosed were excluded from our study. Indications for fistulography included decreased flow rate, difficult cannulation, increased venous pressure, edema of the upper extremity, or pain during dialy...

For hemodialysis patients with increased level of NLR and decreased level of HDL, regular monitoring with regard to the development of AVF stenosis may be beneficial. Our study suggests that the mechanism of AVF stenosis might have similarities to that of atherosclerosis.

OBJECTIVE:The aim of the present study was to investigate the relationship between pericoronary fat and the severity and extent of atherosclerosis, quantified using 64-multidetector computed tomography, in patients with suspected coronary artery disease.METHODS:The study population consisted of 131 patients who were clinically referred for noninvasive multislice computed tomography coronary angiography for the evaluation of coronary artery disease. Patients were classified as follows: no atherosclerosis, Group 1; nonobstructive atherosclerosis (luminal narrowing <50% in diameter), Group 2; and obstructive atherosclerosis (luminal narrowing ≥50%) in a single vessel or obstructive atherosclerosis in the left main coronary artery and/or multiple vessels, Group 3. Epicardial adipose tissue was defined as the adipose tissue between the surface of the heart and the visceral layer of the pericardium (visceral epicardium). Epicardial adipose tissue thickness (mm) was determined in the right ventricular anterior free wall. The mean thickness of the pericoronary fat surrounding the three coronary arteries was used for the analyses.RESULTS:The average thickness over all three regions was 13.2 ± 2.1 mm. The pericoronary fat thickness was significantly increased in Group 3 compared with Groups 2 and 1. The epicardial adipose tissue thickness was significantly increased in Group 3 compared with Groups 2 and 1. A receiver operating characteristic curve for obstructive coronary artery disease was assessed to verify the optimum cut-off point for pericoronary fat thickness, which was 13.8 mm. A receiver operating characteristic curve for obstructive coronary artery disease was also assessed to verify the optimum cut-off point for epicardial adipose tissue, which was 6.8 cm.CONCLUSION:We showed that the epicardial adipose tissue and pericoronary fat thickness scores were higher in patients with obstructive coronary artery diseases.

Objectives This study aimed to compare sonoelastographic findings for the quadriceps tendon in patients with chronic renal failure who were in a dialysis program to findings in a control group. Methods Fifty‐three randomly allocated patients (mean age, 54.3 years; range, 27–86 years) with chronic renal failure who were in a dialysis program 3 days a week between January and May 2012 were included. The measurements were performed in both knees of 53 patients undergoing dialysis and 25 individuals in the control group. The tendons were classified as follows: type 1, very stiff tissue (blue); type 2, stiff tissue (blue‐green); and type 3, intermediate tissue (green‐yellow) according to color mapping. Results The mean quadriceps tendon thicknesses in the patient group were 4.9 mm (range, 1.9–6.5 mm) for the right knee and 4.9 mm (1.4–6.5 mm) for the left knee; the values in the control group were 5.4 mm (3.6–7.0 mm) for the right knee and 5.4 mm (3.4–7.0 mm) for the left knee. The mean elasticity scores in the patient group were 3.14 (1.03–5.23) for the right knee and 3.33 (1.29–5.00) for the left knee; in the control group, the values were 3.79 (1.73–5.23) and 3.69 (1.23–5.53) for the right and left knees, respectively (right knee, P = .025; left knee, P = .018; Mann‐Whitney U test). The quadriceps tendons were significantly thinner in the patient group (right knee, P = .054; left knee, P = .015; Mann‐Whitney U test). Conclusions Quadriceps tendons in patients with chronic renal failure are thinner and have lower elasticity scores compared to controls.

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SummaryBackground:Persistent left superior vena cava is a rare but important congenital vascular anomaly. However, PLSVC with absent RSVC (isolated PLSVC) is a very rare venous malformation We report on a rare case of persistent left superior vena cava (PLSVC) with absent right superior vena cava (RSVC).Case Report:This venous malformation was identified incidentally in a 69-year-old woman during chest multi-detector computed tomography (MDCT). On chest MDCT, the SVC was noted on the left side. A bridging vein drained the right jugular and right subclavian veins and joined the left brachiocephalic vein in order to form the PLSVC, which descended on the left side of the mediastinum and drained into the left atrium (LA). The patient had no additional cardiac anomaly.Conclusions:Isolated PLSVC is usually asymptomatic but it can pose difficulties for establishing central venous access, pacemaker implantation and cardiothoracic surgery. This condition is also associated with an increased incidence of congenital heart disease, arrhythmias and conduction disturbances. A wide spectrum of clinicians should be aware of this anomaly, its variations and possible complications.

Common genetic mutations encountered in folate metabolism may result in increased homocysteine (Hcy) levels. It has been reported that increased serum Hcy levels may affect the intracellular fat metabolism and may cause enhanced fatty infi ltration in the liver resulting in non-alcoholic fatty liver disease (NAFLD). In total, 150 patients diagnosed with FLD by ultrasound examination and 136 healthy control patients that do not have any fatty infi ltration in the liver were included in the study. Patients were grouped as mild (n=88), moderate (n=38) or severe (n=24) according to the stage of fatty liver in ultrasound. Serum liver function tests, Hcy, folic acid and vitamin B12 levels of the patients were studied. The genetic MTHFR C677T and A1298C polymorphisms of the patients were also evaluated. Although there was no signifi cant difference in vitamin B12 and folic acid levels, in the severe group, Hcy levels were signifi cantly higher than that of control and mild groups (p<0.001). By contrast, there was no signifi cant difference in heterozygote MTHFR 677C/T and 1298A/C mutations, both MTHFR 677C/T and MTHFR 1298A/C mutations were more common in NAFLD groups compared with the control patients (p<0.001). We have determined increased Hcy levels and increased prevalence of homozygote MTHFR 677C/T and MTHFR 1298A/C mutations in patients with NAFLD compared with healthy controls. Larger studies are warranted to clarify the etiological role of the MTHFR mutations and Hcy levels in FLD.

sE-selectin and the LDL were the most important predictors of late AVF stenosis. In addition, sE-selectin correlated with the degree of AVF stenosis. We suggested that atherosclerosis might be contributing factor for development of late AVF stenosis.