Saphenous Vein Arteriovenous Fistulas

Abstract

analysis of all our phlebotomytreated patients to determine the du¬ ration of induced remissions was made. Follow-up data were available from 24 patients (Fig 3). At one year after attainment of a marked remis¬ sion, all of the 23 patients tested con¬ tinued to be in remission, and at two years all of the 16 patients, including one who had not been tested at one year, demonstrated sustained remis¬ sions. At three years or more, all of the seven patients tested had normal or near normal values. CommentTwo possible mechanisms to ex¬ plain the response to phlebotomy in PCT have been offered: the removal of iron per se, or the removal of a plasma factor. Our studies provide evidence favoring the former. A marked reduction of uroporphyrin ex¬ cretion followed removal of packed RBC only (erythropheresis) in six pa¬ tients with PCT. Moreover, a bio¬ chemical exacerbation followed the administration of iron in two patients in remission that had been induced by previous phlebotomy. Recently Lundvall" reported biochemical relapses oc¬ curring after prolonged oral adminis¬ tration of iron in four patients and after intravenous administration of iron in one patient with PCT. Our data regarding the duration of phlebotomy-induced remissions sup-ports the conclusion that the inter¬ ruption of the biochemical remission following the administration of iron is not a coincidental event.Depletion of total body iron stores involves the plasma as well as the he¬ patic compartments. However, only alterations of the hepatic iron stores seem to be relevant to the develop¬ ment of PCT. For example, we found hepatic siderosis, even of a mild de¬ gree, to be three times more common than hypersideremia. Moreover, se¬ rum iron concentration becomes nor¬ mal during the course of a sustained remission and need not be markedly elevated when a biochemical relapse occurs after the administration of iron.Although it seems clear that he¬ patic iron plays a critical role in porphyrin metabolism in PCT, the exact mechanism involved is not known.One might speculate about two possi¬ bilities. First, iron may in some man¬ ner cause an increase in the hepatic oxidation of the octa-through tetracarboxyl porphyrinogens to their re¬ spective porphyrins. Second, iron might cause a slight, but immea¬ surable, increase in hepatic delta-amino levulinic acid-synthetase7 resulting in increased porphyrin syn¬ thesis, without accumulation of porphyrin precursors because of the lack of an associated block in the heme biosynthetic pathway. Whatever the cause for increased porphyrin synthesis in PCT, iron it¬ self cannot be the sole factor in¬ volved. Alteration of uroporphyrin metabolism is an unusual complica¬ tion of classic hemochromatosis, alco¬ holic hepatic siderosis, or other iron storage diseases. It seems reasonable to conclude that in PCT there is an underlying metabolic defect, perhaps genetically determined, which re¬ quires the participation of certain ac¬ quired factors to result in excessive hepatic porphyrin synthesis. One of these acquired, extrinsic...

Iatrogenic Arteriovenous Fistula Following Routine Venipuncture in an Adult Without Coagulopathy: An Uncommon Consequence of a Common Procedure

“…Factors identified for successful venipuncture included site selection and technique. 6 Upton et al, cited [7][8][9][10][11][12] Feusner JH (1988), Sussman LN (1974), Ries CA (1979), Tamir A (1984), Gilbert MS (1986), and Hyshaw C (1979), who state that patients with coagulation deficiencies, such as hemophilia, are some of the most vulnerable in terms of the development of AV fistulas from penetrating traumas, including routine venipuncture. This is due to hematomas in the setting of coagulation deficiencies being less likely to resist the arterial pressure as a shunt develops.…”

Implantable central venous access device procedures in haemophilia patients without an inhibitor: systematic review of the literature and institutional experience

“…The references from these nine articles, as well as the meta‐analysis and the consensus articles, were then further reviewed to identify additional publications regarding factor delivery, central venous access, or care of haemophilia patients. From these bibliographies, 76 additional articles were identified [79–154] of which 17 were excluded because they dealt only with inhibitor patients ( n = 11) [80,87–95,148] or arteriovenous fistula use ( n = 4) [83–86] or could not be obtained [144,152]. Of the remaining 59 articles, five met our inclusion criteria [132–136].…”

ΑΙΜΟΔΥΝΑΜΙΚΗ ΜΕΛΕΤΗ ΤΗΣ ΤΑΥΤΟΧΡΟΝΗΣ ΔΗΜΙΟΥΡΓΙΑΣ ΕΞΩΤΕΡΙΚΗΣ (SHUNT) & ΕΣΩΤΕΡΙΚΗΣ(FISTULA) ΑΡΤΗΡΙΟΦΛΕΒΙΚΗΣ ΕΠΙΚΟΙΝΩΝΙΑΣ ΣΤΑ ΜΗΡΙΑΙΑ ΑΓΓΕΙΑ ΣΚΥΛΟΥ (ΠΕΙΡΑΜΑΤΙΚΗ ΕΡΓΑΣΙΑ)

“…1969, Mozes, Hurwich, Adar 1970, Bussen, Abbott, Lim 1971, Ehrenfeld KCIL συν. 1972, Cerei li και Limbut 1973, Ries, Perkins, Ehrenfeld 1973, Haimov, Borrows, Baez 1974, KarmodyKai Lempert 1974, Mindich, Dunn, Frunkin 1974, Petrella, Orlandini, Poisetti 1975, Geis, Giacchino 1977. '…”