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Vascular access stenosis

Hacı Ahmet Kasapkara, Abdullah Nabi Aslan, Hüseyin Ayhan, Serdal Baştuğ, Hakan Süygün, Telat Keleş, Tahir Durmaz, Engin Bozkurt
OBJECTIVE: Transcatheter aortic valve replacement (TAVR) has been accepted as an alternative to surgery in high risk or inoperable patients with severe aortic stenosis (AS). Although transfemoral approach is the most often preferred means of access, in patients with severe ilio-femoral arteriopathy, other vascular access sites may be required. The aim of the present study was to report our experience with trans-subclavian approach for TAVR using different valve systems. METHODS: Among 273 patients undergoing TAVR between June 2011 and May 2016, 10 patients (mean age: 68...
October 2016: Türk Kardiyoloji Derneği Arşivi: Türk Kardiyoloji Derneğinin Yayın Organıdır
Manar Khashram, Rachel Falconer, Afif Mahmud, Adib Khanafer, Peter Laws, Tim Beresford, Justin Roake
AIMS: Rapid access carotid endarterectomy (RACE) is the gold standard for stroke prevention in symptomatic patients with 50-99% internal carotid artery stenosis. Diagnosis and referral of eligible patients may be delayed by disruption to local health services. The aim of this study was to evaluate whether service provision was maintained at an appropriate standard (<2 weeks) following a natural disaster. METHODS: Consecutive symptomatic patients who underwent carotid endarterectomy (CEA) at a tertiary hospital between January 2006 and December 2014 were identified...
October 14, 2016: New Zealand Medical Journal
Takeo Ishii, Yasunobu Suzuki, Takuji Nakayama, Miki Ohmori, Shinichi Masai, Naru Sasagawa, Kunio Ohyama
OBJECTIVE: To determine if duplex ultrasound (US) for arteriovenous fistulas (AVFs) can predict vascular events (VEs; thrombosis and stenosis). METHODS: Duplex US was performed for vascular access evaluation in 2557 maintenance hemodialysis (HD) patients between October 1, 2013 and March 31, 2016. Of these patients, 2184 patients were finally included in this study. AVF dysfunction was assessed using the brachial artery blood flow volume (Qa; mL/min), arterial blood flow resistance index (RI), and residual diameter of the fistula vein (RD; mm)...
September 27, 2016: Journal of Vascular Access
Maria Guedes-Marques, Pedro A Maia, Fernando Neves, Aníbal Ferreira, João Cruz, Dulce Carvalho, Carlos Oliveira, Carlos Barreto, Telmo Carvalho, Pedro Ponce
BACKGROUND: Kidney Disease - Improving Global Outcomes (KDIGO) recommends post-percutaneous transluminal angioplasty (PTA) <30% residual stenosis (RS) and hemodynamic parameters improvement. Primary end point: how post-PTA access blood flow (ABF) improvement predicts vascular access (VA) outcome. Secondary: compare Doppler ultrasound (DU) and angiography diagnostic accuracy; determine how other factors predict outcome. METHODS: Eighty patients. DU evaluation performed pre- and post-PTA...
September 24, 2016: Journal of Vascular Access
Pranav Loyalka, Angelo Nascimbene, Michael Schechter, Marija Petrovic, Ajay Sundara Raman, Igor D Gregoric, Biswajit Kar
INTRODUCTION: Transcatheter aortic valve implantation (TAVI) in patients with degenerated bioprosthetic aortic valve has been successfully performed as an alternative to surgery. We describe our initial experience of valve-in-valve TAVI in five patients, using new generation Edwards Sapien 3 transcatheter heart valves implanted into degenerated 19 mm bioprosthetic valves. 20-mm Edwards S3 valves were offered for compassionate use. All patients had significant aortic valve stenosis. METHODS AND RESULTS: The main vascular access was achieved and pre-closed with two Proglide closure devices in one patient and Prostar closure devices in four patients...
October 3, 2016: Catheterization and Cardiovascular Interventions
Lisa Kabelitz, Andrea Nonn, Kay W Nolte, Omid Nikoubashman, Ahmed Othman, Sarah Heringer, Martin Kramer, Martin Wiesmann, Marc A Brockmann
Minipigs are frequently used in (neuro-)interventional research. Longitudinal experiments may require repeated vessel access via the femoral artery. Anticoagulation and incompliance of the animals necessitates the use of a vascular closure device (VCD). The effects of the Angio-Seal VCD in minipigs were longitudinally assessed. Minipig (42±8.4 kg body weight) femoral arteries were sealed using the 8F (n = 6) or 6F (n = 7) Angio-Seal VCD. The pre-interventional femoral artery diameter was 5.1±0.4 mm (4.3-5...
2016: PloS One
Takayuki Adachi, Tsutomu Sakurada, Takanori Otowa, Keita Uehara, Shina Sueki, Shigeki Kojima, Nagayuki Kaneshiro, Katsuomi Matsui, Tadahisa Tomohiro, Yugo Shibagaki
Vascular access intervention therapy (VAIVT) has been positioned as the first choice of treatment for stenosis lesions frequently observed in arteriovenous fistula (AVF) for hemodialysis patients in Japan. Furthermore, increased blood flow can provide a stable dialysis. In contrast, it has been reported that excess blood flow of AVF causes high-output heart failure. Although VAIVT is used to increase blood flow of AVF, the impact of VAIVT on cardiac load has been rarely reported. We examined the factors associated with cardiac load in hemodialysis patients undergoing VAIVT by measuring levels of α human atrial natriuretic polypeptide (hANP) and brain natriuretic peptide (BNP) before and after VAIVT...
October 2016: Hemodialysis International
Kemal Nişli, Serra Karaca, Aygün Dindar
Balloon valvuloplasty is an effective therapy for severe congenital aortic valve stenosis, with mild aortic insufficiency and minimal intermediate-term restenosis. No consensus currently exists regarding optimal vascular approach for balloon dilatation in newborns with critical or severe aortic valve stenosis. Critical aortic valve stenosis in newborns must be treated promptly and effectively. Transcatheter therapy may offer marked advantages, as surgical therapy has been associated with significant rates of morbidity and mortality...
September 2016: Türk Kardiyoloji Derneği Arşivi: Türk Kardiyoloji Derneğinin Yayın Organıdır
Vinayak Bapat, Derk Frank, Ricardo Cocchieri, Dariusz Jagielak, Nikolaos Bonaros, Marco Aiello, Joel Lapeze, Mika Laine, Sidney Chocron, Douglas Muir, Walter Eichinger, Matthias Thielmann, Louis Labrousse, Kjell Arne Rein, Jean-Philippe Verhoye, Gino Gerosa, Hardy Baumbach, Peter Bramlage, Cornelia Deutsch, Martin Thoenes, Mauro Romano
OBJECTIVES: The Registry of the Utilization of the TAo-TAVR approach using the Edwards SAPIEN Valve (ROUTE) was established to assess the effectiveness and safety of the use of transaortic (TAo) access for transcatheter aortic valve replacement (TAVR) procedures (NCT01991431). BACKGROUND: TAVR represents an alternative to surgical valve replacement in high-risk patients. Whereas the transfemoral access route is used commonly as the first-line approach, transapical access is an option for patients not suitable for transfemoral treatment mainly due to anatomic conditions...
September 12, 2016: JACC. Cardiovascular Interventions
Anna Maria Ierardi, Marco Franchin, Federico Fontana, Gabriele Piffaretti, Ejona Duka, Massimo Tonolini, Vittorio Miele, Matteo Tozzi, Gianpaolo Carrafiello
AIM: To evaluate the technical and clinical success, primary patency (PP) and complications of angioplasty performed with paclitaxel-coated balloon (PCBs) associated with cutting balloon and for the treatment of the outflow stenoses of failing hemodialysis arteriovenous shunt. MATERIAL AND METHODS: From September 2014 to September 2015, 50 patients with 66 stenoses were registered. Vascular accesses were autogenous (n = 20) and prosthetic (n = 30). Stenosis were documented during follow-up with routine echo-color Doppler, clinical evaluation and in the remaining incidentally during fistulography...
September 6, 2016: La Radiologia Medica
Dr Charlotte Ratcliff, Miss Monica Hansrani
INTRODUCTION: This case report intends to highlight the Haemodialysis Reliable Outflow (HeRO) graft as a potential long term option for ongoing dialysis in patients with central venous stenosis. PRESENTATION OF CASE: A 55year old patient, who developed end stage renal failure (ESRF) after chemotherapy treatment for breast cancer, presented at the limit of her dialysis access after a 15year haemodialysis history causing central vein stenosis. The patient was initially started on peritoneal dialysis but after repeated peritonitis was switched to haemodialysis...
2016: International Journal of Surgery Case Reports
Ohad Oren, Michal Oren, Yoav Turgeman
This study aims to compare the clinical and procedural characteristics, including iatrogenic complications, of transradial versus transfemoral approach in patients who underwent peripheral arterial interventions. We retrospectively analyzed data of 72 patients who had undergone interventions of peripheral arteries in the preceding 3 years. Of all the procedures, 39 were performed using the transfemoral approach and 33 using the transradial approach. We assessed baseline clinical factors as well as procedure-related parameters (volume of contrast media, the amount of radiation, and duration of radiation exposure), rates of primary success, and acute vascular, access-site, or neurological complications...
September 2016: International Journal of Angiology: Official Publication of the International College of Angiology, Inc
Corinna Storz, Tobias Geisler, Mike Notohamiprodjo, Konstantin Nikolaou, Fabian Bamberg
Transcatheter aortic valve replacement (TAVR) has emerged as an effective treatment alternative in patients with severe aortic stenosis (AS) who are deemed surgically high-risk or ineligible for surgery. Pre-procedural imaging, in particular computed tomography (CT), plays an integral part in the planning and performance of TAVR and is crucial for a successful treatment. Novel technological advances in CT include high-pitch, low kV acquisitions, and iterative reconstruction resulting in high image quality at substantially reduced scan duration, contrast volume, and radiation exposure...
October 2016: Current Treatment Options in Cardiovascular Medicine
Gianluca Lucchese, Nicholas Montarello, Vinayak Bapat
Transcatheter aortic valve implantation (TAVI) is now routinely performed to treat inoperable and high-risk patients with severe aortic stenosis (AS). Transapical or transaortic approaches are alternative routes used when peripheral accesses are unsuitable.Correct placement of the device is achieved with the help of an angiography performed with a pigtail catheter to identify the deployment view. However, in patients with severe vascular disease, placement of a pigtail catheter may not be possible.We report a modified single-puncture technique, whereby a single access point is used to perform both angiography and TAVI by using visible calcification landmarks as reference points...
August 12, 2016: Thoracic and Cardiovascular Surgeon
Alexander Sedaghat, Nils Neumann, Nadjib Schahab, Jan-Malte Sinning, Christoph Hammerstingl, Simon Pingel, Christian Schaefer, Fritz Mellert, Wolfgang Schiller, Armin Welz, Eberhard Grube, Georg Nickenig, Nikos Werner
BACKGROUND: Access-site and access-related vascular injury (ASARVI) is still a major limiting factor in transcatheter aortic valve implantation and affects the outcome of patients. Management strategies for ASARVI include manual compression, stent grafts, and vascular surgery. We hypothesized that the standard use of a self-expanding stent graft for the management of ASARVI is feasible and safe. METHODS AND RESULTS: Of 407 patients treated by transfemoral transcatheter aortic valve implantation, 110 experienced ASARVI (27...
August 2016: Circulation. Cardiovascular Interventions
Vinay Narasimha Krishna, Joseph B Eason, Michael Allon
Central venous stenosis (CVS) is encountered frequently among hemodialysis patients. Prior ipsilateral central venous catheterization and cardiac rhythm device insertions are common risk factors, but CVS can also occur in the absence of this history. Chronic CVS can cause thrombosis with partial or complete occlusion of the central vein at the site of stenosis. CVS is frequently asymptomatic and identified as an incidental finding during imaging studies. Symptomatic CVS presents most commonly as an upper- or lower-extremity edema ipsilateral to the CVS...
August 1, 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Alaide Chieffo, Anna Sonia Petronio, Julinda Mehilli, Jaya Chandrasekhar, Samantha Sartori, Thierry Lefèvre, Patrizia Presbitero, Piera Capranzano, Didier Tchetche, Alessandro Iadanza, Gennaro Sardella, Nicolas M Van Mieghem, Emanuele Meliga, Nicholas Dumonteil, Chiara Fraccaro, Daniela Trabattoni, Ghada W Mikhail, Samin Sharma, Maria Cruz Ferrer, Christoph Naber, Peter Kievit, Michela Faggioni, Clayton Snyder, Marie Claude Morice, Roxana Mehran
OBJECTIVES: The study sought to examine the safety and performance of transcatheter aortic valve replacement (TAVR) using an all-female registry and to further explore the potential impact of female sex-specific characteristics on clinical outcomes after TAVR. BACKGROUND: Although women comprise 50% of patients with symptomatic severe aortic stenosis undergoing TAVR, the optimal treatment strategy remains undetermined. METHODS: The WIN-TAVI (Women's INternational Transcatheter Aortic Valve Implantation) registry is a multinational, prospective, observational registry of women undergoing TAVR for aortic stenosis, conducted without any external funding...
August 8, 2016: JACC. Cardiovascular Interventions
Sedat Develi, Bulent Yalcin, Fatih Yazar
Cricothyroidotomy is a surgical procedure involving penetration through the skin and cricothyroid membrane to maintain airway patency during life-threatening emergency conditions. Complications such as bleeding and laryngeal stenosis can result from it. Our aim in this study was to identify the anatomical structures located on the membrane and to ascertain whether there is a safe area on the membrane for this procedure. Thirty larynx specimens fixed with 10% formaldehyde in the Department of Anatomy were dissected...
October 2016: Clinical Anatomy
Omar K Khalique, Todd C Pulerwitz, Sandra S Halliburton, Susheel K Kodali, Rebecca T Hahn, Tamim M Nazif, Torsten P Vahl, Isaac George, Martin B Leon, Belinda D'Souza, Andrew J Einstein
Transcatheter aortic valve replacement (TAVR) is performed frequently in patients with severe, symptomatic aortic stenosis who are at high risk or inoperable for open surgical aortic valve replacement. Computed tomography angiography (CTA) has become the gold standard imaging modality for pre-TAVR cardiac anatomic and vascular access assessment. Traditionally, cardiac CTA has been most frequently used for assessment of coronary artery stenosis, and scanning protocols have generally been tailored for this purpose...
September 2016: Journal of Cardiovascular Computed Tomography
Anna Mudoni, Francesco Caccetta, Maurizio Caroppo, Fernando Musio, Antonella Accogli, Maria Dolores Zacheo, Maria Domenica Burzo, Maurizio Gallieni, Vitale Nuzzo
A functioning vascular access is a critical requirement to improve the quality of life in hemodialysis patients, so monitoring and surveillance of vascular access play key roles in identifying all dysfunctions and reducing the huge economic cost as well as adequacy of dialysis.In our five-year experience, a study protocol has been used and improved with the help of ultrasonography.Doppler ultrasound is an excellent and sensitive modality for hemodialysis access evaluation, one of techniques employed for arteriovenous fistulae (AVF) study, not only as a preoperative tool, but also in post-operative monitoring of AVF maturation...
July 27, 2016: Journal of Vascular Access
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