ObjectiveIt is unclear if brachio-basilic vein fistula should be performed as a primary or staged procedure, particularly for smaller basilic veins. Our aim was to report on a randomized controlled trial comparing these two techniques.MethodsSixteen patients with a basilic vein ≥2.5 mm were randomized into primary transposed brachio-basilic vein (TBBV) fistula (n = 9) and staged TBBV fistula (n = 7). Patients with basilic veins enlarged by previous arteriovenous fistulas were excluded. Baseline characteristics of the two study groups, including vein size, were comparable (median basilic vein diameter 3.5 mm, range 2.8–4.1 mm). The staged group had a brachio-basilic vein fistula performed first followed by the transposition procedure performed at least 6 weeks later to allow the basilic vein to enlarge. TBBV fistula maturation at 10 weeks, primary, assisted-primary, and secondary patency were the primary outcome measures. Early failures were included in the calculation of patency rates.ResultsTransposed brachio-basilic vein fistula maturation rate after primary procedures (3/9, 33%) was lower compared to maturation rate after staged procedures (7/7, 100%, P = 0.011, Fisher’s exact test), which led to premature termination of the trial. Time to hemodialysis [median (interquartile range)] of primary and staged procedures was 54 (51.5–113.5) days and 97 (93–126) days, respectively (P = 0.16). One-year primary and assisted-primary patency rates of primary and staged procedures were equivalent (44 vs 57%, P = 0.76 and 44 vs 71%, P = 0.29, respectively); however, there was a trend toward a better 1-year secondary patency after staged procedures (86 vs 44% for primary procedures, P = 0.09).ConclusionsAmong candidates for TBBV fistula with a small basilic vein, staged transposition achieves higher maturation rates compared to primary procedures, a difference reflected in long-term secondary patency.Trial registration, identifier NCT01274117.
Among patients undergoing radiocephalic AVFs, a tourniquet derived cephalic vein diameter <4.3 mm was the single independent predictor of inferior secondary and functional secondary patency. Among patients undergoing brachiocephalic AVFs, all patency rates were inferior in the presence of a brachial artery diameter ≤4.1 mm and secondary patency was inferior in the presence of multiple risk factors.
Among patients with varicose veins, GECS seem effective in ameliorating symptoms, particularly pain or aching, compared with placebo stockings after 1 week of use. Long-term studies are justified.
There is currently a lack of information on presentation patterns and the appropriate investigation and treatment of aortic brucellosis. Herein a case affecting the iliac component of an aorto-iliac aneurysm, managed successfully with in situ graft repair, is reported. A review of the literature identified 25 cases, with the infrarenal abdominal aorta (65%) followed by the ascending thoracic aorta (23%) being mostly affected; only our case involved the iliacs. Aortic brucellosis affected mostly older men, caused pain more often than fever (in 73% and 57%, respectively), and involved frequently the spine or the aortic valve (n = 14, 56%). Preoperative diagnosis was made more often in the presence of fever (67% versus 18% in afebrile patients, P = 0.021). In situ aneurysm repair in the form of open (54%) or endovascular (8%) grafting was mostly performed. Mortality was 12% and graft infection was 13% at two years. In conclusion, aortic brucellosis has unique presentation patterns, usually affecting an abnormal or aneurysmal aorta and/or due to a contiguous spinal or aortic valve infection. Acute symptomatology with pain and/or fever occurs very often and should raise suspicion for aortic infection. Despite the seriousness of aortic involvement, mortality and reinfection rates are within acceptable levels.
Endovascular aneurysm repair of IAAAs is associated with decreased procedure duration, transfusion needs, hospitalization, and morbidity compared to OSR.
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