Intraoperative blood flow measurement is a predictor of the primary and secondary patency of autogenous radiocephalic AVFs. Awareness of the significant correlation between intraoperative AVF blood flow and the short-term outcome would enhance the surgical efficiency and maximize the usefulness of autogenous AVF.

IntroductionTotal aortic arch repair represents a high-risk operation and may compromise the surgical decision due to the increased mortality and cerebral complications. The arch first technique with retrograde cerebral perfusion or selective antegrade cerebral perfusion was introduced to extend the safety period from cerebral ischemia during deep hypothermic circulatory arrest. However, profound hypothermia prolonged the myocardial ischemic time and cardiopulmonary bypass (CPB) time, and induced coagulopathy which resulted in deteriorated myocardial function, end-organs dysfunction and excessive postoperative bleeding, 1) and the complex manipulation of antegrade cerebral perfusion may release debris from endo-clamping or snaring of arch vessels and the clustered tubes interrupted the operative field. Our modified four-branched graft technique for arch surgery had been reported in 2012, with advantages to evade selective antegrade cerebral perfusion and deep hypothermia.

A 74-year-old male with chronic kidney disease presented to the emergency department with asystole. Mechanical chest compression was started immediately using a piston-type thumper device. The initial potassium level was 7.7 mEq/L and bedside point-of-care ultrasound (POCUS) revealed no pericardial fluid. With standard resuscitation and anti-hyperkalemia treatment, return of spontaneous circulation (ROSC) was achieved within 10 minutes of compressions. At 15 minutes post-ROSC, the patient went into pulseless electrical activity. A repeated POCUS discovered massive pericardial fluid suggesting the presence of cardiac tamponade. Bedside pericardiotomy was performed followed by open thoracotomy. Laceration of the right ventricular wall adjacent to the fracture site of sternum was found, implicating that it was the complication of mechanical chest compression. After surgical repair and intensive post-operative care, the patient survived with full conscious recovery at day 6 of admission. Our case emphasizes the importance of POCUS in resuscitation, especially when the patient's condition deteriorates unexpectedly.

Our data can help to improve outcomes in haemodialysis patients treated with stent-grafts for venous anastomosis of an arteriovenous graft.

BACKGROUNDComplications associated with upper gastrointestinal (UGI) endoscopy are uncommon, and rarely involve those of cardiovascular nature. We report herein a unique case of spontaneous superior mesenteric artery dissection (SMAD) after UGI pandenoscopy.CASE SUMMARYA 45-year-old man who had previously undergone UGI panendoscopy and colonoscopy during a voluntary health check-up at our facility was admitted to the emergency room (ER) at the same facility due to persistent epigastric pain with radiation to the back. At the ER, the patient did not present notable abnormalities upon physical, conscious, or laboratory examinations apart from mild tenderness in the epigastric abdomen. Acute abdominal aortic dissection was suspected, and abdominal contrast-enhanced computed tomography confirmed SMAD. He was then transferred to the cardiovascular ward and treated conservatively with fasting, prostaglandin E1, and aspirin. The patient recovered and returned home soon after, and was symptom-free 6 months after discharge from the facility.CONCLUSIONSMAD after UGI panendoscopic procedure is a previously unreported complication. Awareness of this complication and associated sequela is warranted.

Purpose: To report the patency rates after implantation of an interwoven nitinol stent to salvage failing arteriovenous grafts (AVGs) caused by intragraft stenoses. Methods: Between May 2018 and May 2020, 21 Supera stents were placed in 20 patients (18 women; mean age: 79.9 years) who had a failing AVG due to repeat intragraft stenoses. Recurrent AVG dysfunction with same intragraft stenosis within 3 months after first time angioplasty was a criterion for stenting. Those with concurrent treatment for other lesions were excluded. Results: The technical success rate was 100%. Intragraft stenoses were treated at a median of 19.7 (interquartile range: 6–36) months after graft creation. Access circuit primary patency rates after stent placement were 84% and 35% at 6 and 12 months, respectively. Access circuit secondary patency rates were 100% at 6 and 12 months and 89% at 18 months. Only one patient presented with graft failure due to proximal drainage vein occlusion. The target lesion patency rates were 100% at 6 months and 75% at 12 months. The rate of reintervention for intragraft lesion was 0.15 procedures per year. Stent distortion did not occur under regular cannulation. Conclusion: The interwoven nitinol stent is a promising treatment for failing AVGs with recurrent intragraft stenoses. The 1-year access circuit primary, secondary, and target lesion patency rates were acceptable, with a low reintervention rate. Stent fracture does not occur in areas of needle puncture.