Sequential measurement of AV access flow is an acceptable means of both monitoring for the development of access stenoses and assessing response to therapy. PTAs of AVF are more durable than PTAs of AV grafts.

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Successful management of bile duct injury after laparoscopic cholecystectomy requires careful understanding of the mechanisms, considerable preoperative assessment by experts, and a multidisciplinary approach.

Central venous stenoses are a frequent complication in hemodialysis patients. These lesions lead to fistula thromboses, arm swelling, and limit future vascular access. Stenoses are characterized by excellent initial response to transluminal angioplasty but rapid recurrence. Response to angioplasty allows classification of stenoses as elastic or nonelastic. The success of angioplasty alone in 30 patients with central venous stenoses was compared to angioplasty and Wallstent placement in 11 patients with recurrent stenoses. In those who had angioplasty alone, 7%+ failed angioplasty, 70% had > or = 50% improvement in the luminal diameter while 23% showed no improvement due to elastic lesions. Subsequently, 81% of those with a successful result restenosed at an average of 7.6 months while 100% of elastic lesions occluded in an average of 2.9 months. In the 10 patients who underwent angioplasty and Wallstent placement, 5 were due to elastic lesions with four recurrences at a mean of 8.6 months. Four of five patients (80%) stented with nonelastic lesions had reappearance of symptoms at a mean of 4.2 months. We conclude that vascular stents should be reserved for those lesions that show elastic recoil after standard angioplasty.

Transjugular intrahepatic portosystemic shunt (TIPS) insertion has been well established as an effective treatment in the management of sequelae of portal hypertension. There are a wide variety of complications that can be encountered, such as hemorrhage, encephalopathy, TIPS dysfunction, and liver failure. This review article summarizes various approaches to preventing and managing these complications.

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Cuffed venous access catheters have become commonplace for hemodialysis access. The major complications of these catheters are catheter thrombosis, catheter fibrin sheathing and infection. When catheter associated bacteremia occurs treatment with antimicrobial therapy alone has been unsuccessful in providing acceptable cure rates. Failed antimicrobial therapy exposes the patient to the risks of prolonged bacteremia, while the alternative, catheter replacement at a new site can lead to central venous stenosis and compromise future long-term upper extremity access. Catheter guidewire exchange when the tunnel tract is clinically not infected theoretically allows the preservation of future access sites and yields a higher treatment success rate while avoiding temporary non-cuffed access placement. We report a series of 23 cases of hemodialysis patients with tunneled cuffed catheters and bacteremia related to the catheter who were treated with the exchange of a new catheter over a guidewire combined with three weeks of systemic antibiotics. Patients eligible for the study required no evidence of tunnel tract infection and defervescence within 48 hours of antimicrobial therapy. Technique failure was defined as repeat infection from any organism within 90 days of catheter exchange. Four patients (18%) redeveloped bacteremia within 90 days of the exchange. The bacteremias developed at 4, 19, 63 and at 74 days days after the exchange. Guidewire exchange in combination with intravenous antibiotics in cases of catheter related bacteremia has an acceptable rate of treatment success and is a viable treatment option in a carefully selected patient population.