Background and Objectives: An increase in the incidence of end-stage renal disease (ESRD) is associated with the need for a wider use of vascular access. Although arteriovenous (A-V) fistula is a preferred form of vascular access, for various reasons, permanent catheters are implanted in many patients. Materials and Methods: A retrospective analysis of clinical data was carried out in 398 patients (204 women) who in 2010–2016 were subjected to permanent dialysis catheters implantation as first vascular access or following A-V fistula dysfunction. The factors influencing the risk of complications related to vascular access and mortality were evaluated and the comparison of the group of patients with permanent catheter implantation after A-V fistula dysfunction with patients with first-time catheter implantation was carried out. Results: The population of 398 people with ESRD with mean age of 68.73 ± 13.26 years had a total of 495 permanent catheters implanted. In 129 (32.6%) patients, catheters were implanted after dysfunction of a previously formed dialysis fistula. An upward trend was recorded in the number of permanent catheters implanted in relation to A-V fistulas. Ninety-two infectious complications (23.1%) occurred in the study population in 65 patients (16.3%). Multivariate analysis showed that permanent catheters were more often used as the first vascular access option in elderly patients and cancer patients. Mortality in the mean 1.38 ± 1.17 years (min 0.0, max 6.70 years) follow-up period amounted to 50%. Older age and atherosclerosis were the main risk factors for mortality. Patients with dialysis fistula formed before the catheter implantation had a longer lifetime compared to the group in which the catheter was the first access. Conclusion: The use of permanent catheters for dialysis therapy is associated with a relatively high incidence of complications and low long-term survival. The main factors determining long-term survival were age and atherosclerosis. Better prognosis was demonstrated in patients after the use of A-V fistula as the first vascular access option.
The paper presents vascular accesses used for the purpose of haemodialysis in patients with end-stage renal disease. The recommendations of the NKF K/DOQI concern performing a first-time permanent access in the form of an autogenous fistula. Attention has been paid to accurate diagnostic imaging of blood vessels. Early and long-term complications of functioning fistulas are presented, together with the manner of their treatment. Dialysis catheters are also described as the only possibility of dialysis in patients with contraindications to the creation of fistulas. Bloodstream infections are the most common complication of dialysis with catheters. An important element of prevention is monitoring the function of catheters, which reduces the need for medical intervention. New solutions improving the functioning of vascular access have also been presented. Careful use of vascular access, as well as fistula and catheter site function monitoring, contributes to extending the lifespan of an access and reduces complications. Streszczenie W pracy przedstawiono dostępy naczyniowe używane w celu prowadzenia hemodializ u chorych ze schyłkową niewydolnością nerek. Uwzględniono zalecenia NKF K/DOQI dotyczące wytworzenia pierwszorazowego dostępu, jakim jest autogenna przetoka. Zwrócono uwagę na dokładną diagnostykę obrazową naczyń. Przedstawiono powikłania wczesne oraz odległe funkcjonujących przetok z uwzględnieniem sposobu ich leczenia. Opisano również cewniki dializacyjne jako jedyny możliwy dostęp do dializy u chorych z przeciwwskazaniami do wytworzenia przetok. Powikłania infekcyjne u osób dializowanych przez cewnik występują bardzo często, dlatego ważnym elementem profilaktyki infekcji jest monitorowanie i utrzymanie drożności cewników dializacyjnych. W artykule przedstawiono nowe rozwiązania, które poprawiają działanie dostępów naczyniowych. Ostrożność przy korzystaniu z dostępów naczyniowych, monitorowanie ich funkcji i miejsc wkłucia sprzyja wydłużeniu żywotności dostępów i ogranicza powikłania.
Objectives: This paper presents new possibilities of treatment of acute thrombosis located in proximal segments of upper and lower limb veins using transcutaneous mechanical thrombectomy and transcatheter thrombolysis. Material and methods: The procedures were carried out in patients hospitalised in the Department of Vascular Surgery of the Provincial Hospital Complex in Kielce. Qualification for the procedure was based on the prevention and treatment guidelines for venous thromboembolism in Poland and worldwide. The treatments were performed using a Penumbra Indigo thrombectomy device. The observation covers the first half of 2017. Results: Out of 24 patients hospitalised in this period due to deep vein thrombosis, six had aspiration thrombectomy; the remaining patients were treated with the traditional method. In five patients a very good treatment effect was obtained and immediate regression of swelling and pain of the limb was observed. The applied treatment significantly shortened the hospitalisation time by half on average compared to traditional treatment and did not cause significant complications except minor bleeding. During the half-year follow-up period, patients undergoing treatment did not experience any recurrence of pain, swelling, or recent thrombosis. Conclusions: Aspiration thrombectomy combined in some cases with transcatheter thrombolysis allows rapid removal of thrombi and resection of veins and leads to quick relief of symptoms, at the same time reducing hospitalisation time and immobilisation at home. Given the novel nature of the device, further observation is needed to demonstrate the safety and comparable efficacy of this method, including randomised, controlled clinical trials before any recommendations for its use can be made.
Aneurysms of the extracranial segment of the internal carotid artery may be treated with open or endovascular surgery with the use of the covered stent. This paper presents an exceptionally large (50 × 40 × 33 mm) aneurysm of the right internal carotid artery treated with open surgery.
Introduction: Progression of renal failure leads to an increase in the number of patients who require forming dialysis access. Old age and rising morbidity make it impossible to form a native arteriovenous fistula and a permanent catheter becomes the first choice. The presence of a catheter frequently generates complications, including infections, which may result in a higher mortality rate. Material and methods: A retrospective analysis data has been conducted, involving 398 patients who had permanent catheters implanted from 2010 to 2016. Out of this group, 65 patients who suffered infectionrelated complications have been identified. Risk factors for infection and a survival rate of the population have been estimated. Results: Between 2010 and 2016, 495 catheters were implanted for 398 patients aged 68.73 (13.26) years on average. 92 catheter-related infections (23.1%) were recorded in 65 patients. Multivariate logistic regression showed, that the risk factors of infectious complications were: younger age (P = 0.000), coronary artery disease (P = 0.006) and heart failure (P = 0.000). Mortality in the mean 1.38 ± 1.17 years followup period was comparable in infectious and non-infectious subgroups (53.85% vs 49.25%; P = 0.588). A higher risk of death in the infectious population was associated with the presence of additional intravascular and intracardiac implanted materials (P = 0.027) and a severe course of infection with hypotension (P = 0.027), thrombocytopenia (P = 0.029) and a high leucocytes/platelets ratio (0.017). Conclusion: Infectious complications in patients dialyzed with permanent catheters are dangerous especially in patients with severe clinical course. The mortality rate is high, although similar to all dialyzed by permanent catheters.
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