Introduction: Thrombectomy is the most common surgical method used to re-establish thrombosed vascular access, particularly in hemodialysis patients. To achieve better patient outcomes and to improve the prognosis for surgical thrombectomy, fistulography with balloon angioplasty to assist during surgery has been introduced in recent years. Methods:In this study, the results of hybrid therapy in 53 patients with thrombosed vascular access were examined. The success rate for re-opening vascular access and dialysis success were recorded, immediately, and at 1 m and 6 m after the surgical procedure.Results: Of 53 patients, 40 patients underwent balloon angioplasty. The success rate in the first session of dialysis after surgery was 85%. At 1 m and 6 m, the dialysis success rates were 75% and 55%, respectively. Conclusion:The use of hybrid method to re-establish vascular access in hemodialysis patients was not only quite effective but also showed several advantages over other conventional methods. Using this method, possible thrombotic lesions were evaluated and corrected with balloon angioplasty. In addition to reducing the risk of recurrent path failure, all these procedures can be performed during one session in the operating room, which led to reductions in surgical and recovery time and costs for both the surgeons and the patients.
Introduction: It is routine to do physical examination to determine the most suitable place for AV access for haemodialysis. Duplex ultrasonography is a high sensitive modality for the evaluation of vessels and can determine vascular diameter. This study was aimed to evaluate the diagnostic power of physical examination for AV access surgical planning in comparison with Duplex ultrasonography (as the gold standard diagnostic tool). Methods: Physical examination and duplex ultrasonography were done and results were recorded. 117 patients were included on the study. With 95% confidence interval data were analyzed by SPSS 16.0 and sensitivity and specificity of physical examination were calculated. Results: Out of 117 patients, in 60 patients (51.3%), include 33 males and 27 females, physical examination results consistent with Duplex ultrasonography (true positive), with 64.22%, 65% and 86.96% sensitivity, specificity, and positive predictive value, respectively. AVF failure was significantly more observed in snuffbox (forearm) AVF surgery site. Conclusion: Preoperative physical examination can be used initially for patients to evaluate a suitable site for AVF surgery. For better AVF outcome, it's suggested to perform duplex ultrasonography study in patients with insufficient clinical findings, 60 years and older, BMI 25-30, diabetes, and hypertension.
Background: Supracondylar fractures of the humerus are common elbow fractures in children. Supracondylar fractures have two subtypes: flexion, which makes up less than 2% of all such fractures, and extension, which makes up more than 98% of supracondylar fracture of the humerus. Supracondylar fractures of the humerus can develop vascular and neurological complications, either following the fracture itself due to the detached pieces of bone or after reduction or K-wire fixation therapy. The most common complication is damage to the brachial artery. Case Presentation: Our patient is a healthy 7-year-old right dominant boy who sustained a Gartland type III fracture following a fall and was admitted to the Emergency Ward. At first, a weak pulse was detected in the distal part of the right upper extremity. After the reduction using 2 K-wires, the distal pulse of the limb became undetectable. Vascular examination revealed that the adventitia of the brachial artery was trapped between the condyle parts. The artery was then released, and the distal pulse returned. Conclusions: This case shows that although entrapment and pulling of the adventitia of the brachial artery between the condyles of the humerus following a supracondylar fracture is a rare occurrence, it can happen in this type of fracture. After reduction using K-wires percutaneously, a neurovascular examination in all cases of supracondylar fractures is necessary. In supracondylar fractures with pink pulseless limbs, immediate arterial exploration can achieve a markedly better outcome than simply monitoring.
Splenic artery aneurysm occurs in 1% of the population. Most splenic artery aneurysms are asymptomatic and are diagnosed incidentally Symptomatic splenic artery aneurysm is usually detected due to rupture, while non-ruptured splenic artery aneurysm is rare We present the case of a 69-year-old female who presented with signs of left abdominal pain and vomiting, and was diagnosed with splenic artery aneurysm. Diagnosis was made by CT scan and revealed a non-ruptured splenic artery aneurysm. Open abdominal surgery, endovascular treatment and laparoscopic surgery are treatment options for splenic artery aneurysms. Immediate treatment after diagnosis of symptomatic splenic artery aneurysm is recommended.
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