12 research outputs found
An asymptomatic double aortic arch with separate right vertebral artery and left subclavian artery originating from Kommerell Diverticulum combined with congenital asplenia and absence of celiac trunk
This report describes the unique case of a completely patent Double Aortic Arch (DAA) combined with Kommerell Diverticulum (KD), absence of celiac trunk and congenital asplenia. The anatomical variants described were identified and assessed in a 51-year old female from a computed-tomography angiography (CTA) images with 3D-volume rendered reconstructions during her follow-up after hysterectomy. The reconstructed CTA images showed a DAA with the left common carotid artery stemming from the hypoplastic left aortic arch while the left subclavian artery originated from a KD in the descending thoracic aorta. A symmetric arrangement of the aortic arch branches was demonstrated, comprising a full vascular ring. Since the patient had been completely asymptomatic and with no symptoms of compression of the esophagus or trachea, no surgical management was advised. The abdomen CTA imaging revealed absence of the celiac trunk with direct origin of the common hepatic and the left gastric artery from the superior mesenteric artery as well as asplenia. We presented a case of asymptomatic DAA of completely patent arches with the right vertebral artery branching separately of and the left SCA originating from KD in the descending aorta. The term KD can be identified also in other arch anomalies than the one originally described. Since anatomical anomalies can be frequently combined, thorough imaging inspection with CTA of both thorax and abdomen is suggested
Correlation of pre-existing radial artery macrocalcifications with late patency of primary radiocephalic fistulas in diabetic hemodialysis patients
ObjectiveThe aim of this study was to evaluate the impact of pre-existing radial artery macrocalcification (Mönckeberg type of arteriosclerosis) on patency rates of radiocephalic fistulas (RCFs) in diabetic end-stage renal disease (ESRD) patients undergoing hemodialysis.MethodsIn this observational prospective study, the long-term patency rates (primary outcome measures) of RCFs in ESRD diabetics who had Mönckeberg radial (±brachial) artery disease (calcified [C] group) were compared with those obtained in ESRD diabetics who had healthy, noncalcified vessels before RCF construction (healthy [H] group). Vessel calcification was assessed by plain two-dimensional radiography. For inclusion in the C-group, uniform linear railroad track-type macrocalcifications of at least 6 cm in length, in the medial wall of the radial artery ipsilateral to RCF creation, were required. Patients were included in the H-group if the radial artery ipsilateral to the RCF creation was free of any macrocalcification, of either intima or media type. Any intimal-like plaque with irregular and patchy distribution was an exclusion criterion for both groups. Patients in both groups also were required to have suitable upper limb vascular anatomy on the basis of ultrasound imaging before RCF creation (cephalic vein of minimum diameter of 1.6 mm, without stenosis or thrombosis in all outflow areas, and radial artery of minimum diameter of 1.5 mm, without proximal hemodynamically significant stenosis). Secondary outcome measures included all-cause mortality. Kaplan-Meier statistics were used for comparison between groups.ResultsThe arm radiograph at the site of possible fistula construction showed abnormality in 39 patients (C-group, 47 RCFs), whereas 33 patients had noncalcified (“healthy”) vascular anatomy (H-group, 40 RCFs). Mean duration of the diabetic disease at the time of RCF creation was 8.9 ± 5.6 years (range, 2-25 years) for the H-group and 14 ± 9.9 years (range, 1-40 years) for the C-group (P = .018). The mean follow-up period for H-group and C-group was 51.9 ± 35.9 months (range, 0.1-126 months) and 26.1 ± 31.6 months (range, 0.1-144 months), respectively (P = .0006). Forty-four patients died during the follow-up period. Primary patency rates at 12, 24, 36, and 48 months for C-group vs H-group were 50.2% vs 80%, 36.5% vs 72.3%, 32.4% vs 67.9%, and 29.1% vs 59.3% (P = .0019). Respective values for secondary patency rates were 52.4% vs 87.5%, 40.9% vs 82.4%, 36.6% vs 78.1%, and 33.2% vs 72.8% (P = .00064). Patient survival rates at 24 and 48 months were 56.1% and 46.4% for C-group and 92.4% and 67.4% for H-group, respectively (P = .05).ConclusionsESRD diabetics with radial artery Mönckeberg calcifications receiving RCFs had worse late clinical outcomes compared with ESRD diabetics with healthy distal arm vessels receiving the same access. The long-term benefit of RCFs may be lost in diabetics with extensively calcified vessels, and preferably the brachial artery should be used instead
Which is the most powerful adverse factor for autogenous access patency between diabetes and high arterial calcification burden?
Which is the most powerful adverse factor for autogenous access patency between diabetes and high arterial calcification burden?
Valve-Like and Protruding Calcified Intimal Flap Complicating Common Iliac Arteries Kissing Stenting
Endovascular therapy for iliac artery chronic total occlusions is nowadays associated with low rates of procedure-related complications and improved clinical outcomes, and it is predominantly used as first-line therapy prior to aortobifemoral bypass grafting. Herein, we describe the case of a patient presenting with an ischemic left foot digit ulcer and suffering complex aortoiliac lesions, who received common iliac arteries kissing stents, illustrating at final antegrade and retrograde angiograms the early recognition of a blood flow obstructing valve-like calcified intimal flap protruding through the stent struts, which was obstructing antegrade but not retrograde unilateral iliac arterial axis blood flow. The problem was resolved by reconstructing the aortic bifurcation at a more proximal level. Completion angiogram verified normal patency of aorta and iliac vessels. Additionally, a severe left femoral bifurcation stenosis was also corrected by endarterectomy-arterioplasty with a bovine patch. Postintervention ankle brachial pressure indices were significantly improved. At the 6-month and 2-year follow-up, normal peripheral pulses were still reported without intermittent claudication suggesting the durability of the procedure. Through stent-protruding calcified intimal flap, is a very rare, but existing source of antegrade blood flow obstruction after common iliac arteries kissing stents
An overview of the hemodynamic aspects of the blood flow in the venous outflow tract of the arteriovenous fistula
Upper limb vein aneurysms complicate all types of autogenous
arteriovenous fistulae (AVF) and comprise false aneurysms secondary to
venipuncture trauma as well as true aneurysms, characterized by
dilatation of native veins. The dilatation of a normal vein and the
development of a true aneurysm are strongly influenced by local
hemodynamic factors affecting the flow in the drainage venous system and
are also the target of operative interventions. This review article
focuses on the description of these hemodynamic aspects which all
physicians involved in the management of dialysis patients should be
aware of. Furthermore, it delineates their complicated interactions and
also highlights their utility in clinical decision-making and
therapeutic management
Endovascular repair for ruptured abdominal aortic aneurysm confers an early survival benefit over open repair
Background: Despite the intuitive advantages of endovascular repair
(EVAR) of ruptured abdominal aortic aneurysms (AAAs), uncertainty
remains about the optimal management in the absence of convincing
high-quality evidence. Our objective was to undertake a comprehensive
literature review and perform a meta-analysis of outcome data of
treatment modalities for ruptured AAAs.
Methods: Systematic searches were conducted of electronic information
sources to identify studies comparing perioperative outcomes of EVAR and
open repair for AAA rupture. Summary estimates of odds ratios (ORs) or
standardized mean difference and 95% confidence intervals (CIs) were
obtained with a random-effects model. Meta-regression models were formed
to explore potential heterogeneity as a result of changes in practice
over time.
Results: We selected 41 studies for analysis. The entire meta-analysis
population comprised 59,941 patients (8201 EVAR patients and 51,740 open
repair patients). EVAR was associated with a significantly lower
incidence of in-hospital mortality (OR, 0.56; 95% CI, 0.50-0.64; P <
.01; meta-analysis of risk-adjusted observational studies and randomized
controlled trials: OR, 0.58; 95% CI, 0.46-0.73; P < .01). EVAR patients
had a significantly decreased risk of developing respiratory
complications (OR, 0.59; 95% CI, 0.49-0.69; P < .01) and acute renal
failure (OR, 0.65; 95% CI, 0.55-0.78; P < .01) and a trend toward a
reduced incidence of cardiac complications (OR, -0.02; 95% CI, -0.03 to
0.00; P = .05) and mesenteric ischemia (OR, 0.66; 95% CI, 0.44-1.00; P
= .05). Patients treated with EVAR had significantly less requirements
of intraoperative blood transfusion (standardized mean difference,
-0.88; 95% CI, -1.06 to -0.70; P < .01). Random-effects meta-regression
revealed no statistical evidence for an association between death and
year of publication (P = .19).
Conclusions: Our analysis provides evidence to motivate the adoption of
an EVAR-first policy in a nonelective setting and the establishment of
standardized protocols for the management ruptured AAAs