New insights into HIV-1-primary skin disorders

Since the first reports of AIDS, skin involvement has become a burdensome stigma for seropositive patients and a challenging task for dermatologist and infectious disease specialists due to the severe and recalcitrant nature of the conditions. Dermatologic manifestations in AIDS patients act as markers of disease progression, a fact that enhances the importance of understanding their pathogenesis

Transhepatic Tunneled Catheter Using Left Hepatic Vein: The Last Resort for Dialysis

Vascular access is the Achilles tendon of hemodialysis and is considered the lifeline for patients with end stage renal disease. Arteriovenous fistulas and grafts are the preferred traditional access for performing dialysis therapy. However, some patients exhaust the traditional routes of dialysis vascular access for different reasons. In search for alternatives, other unusual vascular routes have been explored, such as transhepatic and translumbar approaches, as the last resort to preserve life in this unfortunate population. Here, we present the unusual case of a 66-year-old female who ran out of the traditional vascular access options and became catheter dependent via the right femoral vein. However, due to recurrent femoral catheter infections, extensive skin calciphylactic lesions and her body habitus, other routes were explored and the decision was to use the transhepatic approach. Traditionally, the right and middle hepatic veins are used to insert these catheters. However, the use of the left hepatic vein was not reported in the literature. Hence, in order to avoid the skin lesions seen in our patient, the dialysis catheter was inserted using the left hepatic vein. Overall, this case highlights the challenges of securing a reliable vascular access to perform dialysis therapy and brings attention to other vascular dialysis routes in certain clinical scenarios. </jats:p

Endovascular Management of Thrombosed Dialysis Vascular Circuits

AbstractA functional hemodialysis vascular access is the lifeline for patients with end-stage kidney disease and is considered a major determinant of survival and quality of life in this patient population. Hemodialysis therapy can be performed via arteriovenous fistulas, arteriovenous grafts, and central venous catheters (CVCs). Following dialysis vascular access creation, the interplay between several pathologic mechanisms can lead to vascular luminal obstruction due to neointimal hyperplasia with subsequent stenosis, stasis, and eventually access thrombosis. Restoration of the blood flow in the vascular access circuit via thrombectomy is crucial to avoid the use of CVCs and to prolong the life span of the vascular access conduits. The fundamental principles of thrombectomy center around removing the thrombus from the thrombosed access and treating the underlying culprit vascular stenosis. Several endovascular devices have been utilized to perform mechanical thrombectomy and have shown comparable outcomes. Standard angioplasty balloons remain the cornerstone for the treatment of stenotic vascular lesions. The utility of drug-coated balloons in dialysis vascular access remains unsettled due to conflicting results from randomized clinical trials. Stent grafts are used to treat resistant and recurrent stenotic lesions and to control extravasation from a ruptured vessel that is not controlled by conservative measures. Overall, endovascular thrombectomy is the preferred modality of treatment for the thrombosed dialysis vascular conduits.</jats:p

Long-term outcomes of thigh arteriovenous graft stenting

Background: Stents have been increasingly used for treating venous anastomosis stenosis seen in arteriovenous grafts (AVGs). A major reason for this trend is that stents can potentially confer a better patency rate compared to angioplasty. However, limited data are available about the outcomes of stents that are used to treat thigh AVG dysfunction. This study sought to assess the primary and secondary patency rates of stents used to treat thigh AVGs dysfunction at one year. Methods: This is a retrospective study of dialysis patients who received therapy via thigh grafts (N=50) and underwent stent placement between January 2005 and June 2017 at our center. Data on demographics and baseline characteristics of the study population were collected. The primary and secondary patency rates were defined as the time between stent deployment and the first intervention and second intervention, respectively. Patency and re-intervention rates were estimated using Kaplan-Meier survival analysis. Results: This study included 50 patients with thigh AVGs; mean age was 50.5± 15.5 years; 52% were female; 80% were black; and 90% had hypertension. The main indication for stenting was thrombosis due to venous anastomosis stenosis (74%). The number (mean ± SD) of stents deployed was 1.24 ± 0.8. The primary patency rate at three months and one year was 58.7% and 30.7%. In comparison, the secondary patency rate at three months and one year was 68.2% and 40.7% (p=0.04) Conclusions: Thigh AVG stenting can be successfully used to improve the overall patency rates of failing AVGs.</jats:p

Peritoneal Dialysis Catheter Placement: Percutaneous and Peritoneoscopic Techniques

AbstractChronic peritoneal dialysis (PD) is an underutilized renal replacement therapy in treating end-stage renal disease that has several advantages over hemodialysis. The success of continuous ambulatory PD is largely dependent on a functional long-term access to the peritoneal cavity. Several methods have been developed to place the PD catheter using both surgical and percutaneous techniques. The purpose of this article is to describe the percutaneous techniques using fluoroscopy guidance and peritoneoscope method. While fluoroscopic method uses fluoroscopy guidance and a guidewire to place the PD catheter, the peritoneoscopic technique utilizes a needlescope to directly visualize the peritoneal space to avoid adhesions and omentum during catheter placement. These percutaneous approaches are minimally invasive procedures that can be performed on an outpatient basis without the need for general anesthesia.</jats:p