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Hemodialysis
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Hemodialysis Management provides kidney replacement therapy to patients with kidney failure either as a regular maintenance or on an emergency basis.
Internal Jugular Salvage for Tunneled Hemodialysis Catheter Placement
Internal Jugular Salvage for Tunneled Hemodialysis Catheter Placement Case Study: Internal Jugular Salvage for Tunneled Hemodialysis Catheter Placement - Alexander S. Yevzlin, MD, Micahq Chan, MD, Matthew Wolf, MD Background The delivery of adequate hemodialysis requires dependable access to the vascular system of end stage renal disease patients. She had had tunneled internal jugular (IJ) dialysis catheters bilaterally in the past as well as multiple femoral catheters and a peritoneal ...
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Cutting Balloon Angioplasty for the Treatment of Stenosis in Hemodialysis Arteriovenous Fistulas
Objective. To assess the effectiveness of cutting balloon angioplasty in the treatment of stenosis in hemodialysis arteriovenous fistulas (AVF). Materials and Methods. Over the past two years, we have observed 75 patients with hemodialysis AVFs. Twenty-one patients (mean age 66.4 years, range 51?81) with AVF stenosis (19 Cimino-Brescia fistulas and 2 loop grafts) were selected for cutting balloon angioplasty. In 10 cases, the cutting balloon device was used after failure of dilatation with a high-pressure balloon, while in 11 cases (9 focal stenosis and 2 restenosis), it was used as a primary approach. We utilized cutting balloons with the following diameters: 8 mm (n = 2), 6 mm (n = 10), 5 mm (n = 8) and 4 mm (n = 1). The follow-up was performed by color Doppler ultrasound (CDU) and clinical evaluation at 1, 3, 6, 12, 18 and 24 months. Results. In all patients, the post-procedure angiography demonstrated an immediate technical success. No peri-procedural complications occurred. In all cases, follow-up examinations (range 3?24 months, mean 11.1 months) demonstrated the patency of AVFs with CDU. All patients showed good function of the AVF during their dialysis. No further procedures were necessary. In one case, restenosis was observed, but it was not hemodynamically significant and did not result in flow reduction during dialysis. Conclusion. Cutting balloon angioplasty is safe and can be utilized as an alternative treatment for stenosis in hemodialysis AVFs, especially in cases of severe stenosis, with a low restenosis rate both in the short and medium term. However, further studies are necessary to assess the effectiveness of the device in improving the long-term AVF patency.
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Economics of an Interrupted, Non-Penetrating Clip Anastomosis for Vascular Access Procedures
Economics of an Interrupted, Non-Penetrating Clip Anastomosis for Vascular Access Procedures Feature: Economics of an Interrupted, Non-Penetrating Clip Anastomosis for Vascular Access Procedures - A. Frederick Schild, MD and Erin Gillaspie, BS Introduction End-stage renal disease (ESRD) is increasing in epidemic proportions worldwide. His Vessel Closure System (Anastoclip VCS, LeMaitre Vascular, Burlington, Massachusetts) has been evaluated to replace sutures in creating autologous ...
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Nephrogenic Systemic Fibrosis: A Devastating Complication of Gadolinium in Patients with Severe Renal Impairment
1Mark A. Perazella, MD and 2Roger A. Rodby, MD "> Nephrogenic Systemic Fibrosis: A Devastating Complication of Gadolinium in Patients with Severe Renal Impairment Clinical Review: Nephrogenic Systemic Fibrosis: A Devastating Complication of Gadolinium in Patients with Severe Renal Impairment - 1Mark A. Perazella, MD and 2Roger A. Rodby, MD Physicians are constantly introduced to new diagnostic and therapeutic modalities developed to enhance patient care. 8 Gadolinium exposure in these ...
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Stabilization of Renal Function Following Renal Artery Stent Revascularization
This study evaluates the effect of renal artery stenting on renal function in 72 consecutive patients. Baseline renal function was considered ?abnormal? if creatinine was >= 1.5 mg/dl. ?Improvement? was defined as decrease in creatinine by >= 20%, ?unchanged? if variation was <= 20%, and "worse" if creatinine increased by >= 20%. Two patients (2/72 = 2.8%) had in-hospital death. Follow-up creatinine was available in 61/70 (87%) patients at 21 ± 11 months (9 patients lost to follow-up). Forty-four (44/61, 72%) patients had normal baseline creatinine that remained ?unchanged? in 42/44 (95%, p = ns). Seventeen (17/61, 28%) patients had "abnormal" baseline creatinine. The renal function ?improved? in 3/17 (18%), from 2.7 ± 1 to 1.6 ± 0.6 mg/dl (p = 0.06). Creatinine remained "unchanged" in 9/17 (53%), and was ?worse? in 5/17 (29%, 2.0 ± 0.51 to 3.3 ± 0.34 mg/dl, p = 0.005). In conclusion, the renal function remained stable in 89% of patients and worsened in 11% of patients at 21 months (follow-up available in 87% of the eligible patients) following renal artery stenting. In patients with baseline renal insufficiency (serum creatinine > 1.5 mg/dl), the renal function remained stable in 71% of patients. Reprinted with permission from J INVAS CARDIOL 2004;16:703?706
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The Role of Embolic Protection Devices in Renal Angioplasty and Stenting
Purpose. A renal artery stenosis is frequent and usually caused by atherosclerosis. Renal artery angioplasty and stenting (RAAS) is now the first treatment to be proposed, giving good immediate and long-term results. But one concern is the postprocedural deterioration of the renal function, which may occur in 20?40% of the patients, and therefore limits the immediate benefits of the technique. Atheroembolism seems to play an important role. We postulated that the use of renal embolic protection devices could reduce the risk of renal embolism and avoid deterioration of the renal function. Methods. In 105 hypertensive patients (M:72), mean age: 65.4 ± 11.7 years (22?87) with atherosclerotic renal artery stenosis (18 bilateral), 124 RAAS were performed under protection. Nine patients had solitary kidneys and 38 had renal insufficiency. We used occlusion balloons (n = 46) or filters (n = 78), which allow a continuous flow. We recently experimented with a new filter (FiberNet®), which can capture particles of 30?40 microns without compromising the flow. Generated debris were removed and analyzed. Blood pressure and serum creatinine levels were followed. Results. Immediate technical success was 100%. Of the lesions, 96/124 were stented directly. Visible debris were aspirated with Percusurge from all patients and removed with filters in 80% of the cases (100% with FiberNet). Mean particle number: 98.1 ± 60.0. Mean diameter: 201 ± 76 (38?6206). Mean occlusion time: 6.55 ± 2.46 min (Percusurge). Mean time in situ (filters): 4.2 ± 1.1 min. With the FiberNet, five times more particles were removed. We observed one acute renal function (RF) deterioration. Mean follow-up: 18.2 ± 8 months. Mean creatinine level remained constant during follow-up. At 6 months follow-up in 91 patients, 69 patients had stabilized, 21 with baseline renal insufficiency improved and there was only one RF deterioration (1.1%) in a patient with moderate renal insufficiency. At 2 years, 54 patients were stabilized, 19
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Current Clinical Applications of Bivalirudin: An Overview
Bivalirudin is a specific and reversible direct thrombin inhibitor with predictable anticoagulation. It is cleared by both proteolytic cleavage and renal mechanisms. Bivalirudin with provisional glycoprotein (GP) IIb/IIIa inhibition is indicated in elective contemporary percutaneous coronary interventions (PCI). It has been shown to be non-inferior to unfractionated heparin and planned GP IIb/IIIa inhibitors during PCI for the ischemic and hemorrhagic combined endpoints of death, myocardial infarction, unplanned urgent revascularization and major bleeding, including subgroups of patients with renal impairment and diabetes. In addition, bivalirudin has consistently been shown to have significantly less in-hospital major bleeding than heparin alone or heparin-GP IIb/IIIa inhibitor combination, and appears to be safe and effective in patients with heparin-induced thrombocytopenia and undergoing PCI. The role of bivalirudin in high-risk acute coronary syndrome patients is currently being tested in the Acute Catheterization and Urgent Intervention Triage StrategY (ACUITY) trial. Finally, data from peripheral percutaneous interventions also support the hypothesis that bivalirudin is safe and effective, but direct randomized comparison with unfractionated heparin is lacking.
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Reversal of Refractory Hypertension due to the Goldblatt Kidney Phenomena from a Descending Aortic Dissection Using a Stent and Filter Device
1Mohan Nandalur, MD 2Bruce Abramowitz, MD, 2Surendra Avula, MD, 2Nausheen Akhter, MD"> Reversal of Refractory Hypertension due to the Goldblatt Kidney Phenomena from a Descending Aortic Dissection Using a Stent and Filter Device Case Study and Review: Reversal of Refractory Hypertension due to the Goldblatt Kidney Phenomena from a Descending Aortic Dissection Using a Stent and Filter Device - 1Mohan Nandalur, MD 2Bruce Abramowitz, MD, 2Surendra Avula, MD, 2Nausheen Akhter, MD Introduction ...
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Use of Bivalirudin for Suspected Heparin-Induced Thrombocytopenia during Lower Extremity Revascularization
Heparin-induced thrombocytopenia is an unusual but major problem during peripheral vascular surgery. The direct thrombin inhibitors provide an alternative to heparin but experience with bivalirudin during peripheral vascular procedures is limited. In this case report, bivalirudin was used to successfully achieve and maintain anticoagulation during femoral and tibial thromboembolectomy, as well as in the post-operative period until anticoagulation with warfarin could be achieved. To our knowledge, this is only the second case report of the intraoperative use ? and first case report of peri-operative use ? of bivalirudin during peripheral vascular revascularization. Advantages of various direct thrombin inhibitors, a modified dosing schedule for bivalirudin, and experience with monitoring parameters are described.
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Below-the-Knee Intervention: Promises and Reality
Below-the-Knee Intervention: Promises and Reality Commentary: Below-the-Knee Intervention: Promises and Reality - Frank J. Criado, MD Occlusive disease affecting the below-the-knee (BTK) arteries is a common and often serious manifestation of atherosclerosis. including the significant costs many patients face after the operation (Table 4). Contemporary vascular surgeons, mainly those with endovascular skills and an ongoing interventional practice, are rapidly evolving in the manner they ...
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