Which technique is superior for long-term patency of arteriovenous fistulas formed by small-diameter vessels? A Prospective Randomized Controlled Study

INTRODUCTION: When creating an arteriovenous fistula (AVF), it is crucial that the patient has a vein of the appropriate diameter. Vein dilatation is used to provide fistula patency in patients with a cephalic vein <2.5 cm. We used hydrostatic dilation (HD) and primary balloon angioplasty (PBA) methods for vein dilatation in our patients. In our study, we aimed to determine the results of venous dilatations performed with different techniques, the effect on fistula patency, and the superiority of the procedures. METHODS: A prospective randomized controlled study was conducted with patients in whom AVF was to be established. 100 patients who will undergo ven dilatation were divided into 2 groups. HD was applied to the first group and PBA was applied to the second group. RESULTS: There were 51 (51%) patients in group 1 and 49 (49%) patients in group 2. At the end of the 1st week, 1st month, and 6th month, fistula opening and the presence of trill were recorded. In the first month after the procedure, 44 (66.7%) of those who received trill underwent PBA, 22 (33.3%) HD. The presence of trillin at 1 month was found to be associated with the procedure applied (p=0.001). DISCUSSION AND CONCLUSION: PBA of veins <2.5 cm in diameter is an effective method of dilation. Fistula patency and maturation results were good and superior to the HD technique

Evaluation of Health Workers with Chronic Venous Disease by CIVIQ-20 Questionnaire

Aim:Chronic venous disease (CVD) is an important health problem with its wide spectrum ranging from varicose veins to venous ulcers, with its high prevalence, diagnosis and treatment cost, loss of labor force and quality of life of patients as in the Western world. The aim of this study was to evaluate the quality of life of healthcare workers with CVD by the Chronic Venous Insufficiency Quality of Life Questionnaire (CIVIQ-20) and to examine the related risk factors.Materials and Methods:The CIVIQ-20 questionnaire, which consisted of 20 questions, was applied to 207 subjects (medical secretary = 69, nurse = 69, physician = 69) who were diagnosed with venous Doppler ultrasonography results in our Hospital.Results:The median age of the study group was 32 (29-37). The demographic characteristics and GIS scores of the health workers included in the study were compared according to occupational groups. When the relationship between age and Global Index Score (GIS) was evaluated in the study group, there was no statistical correlation between age and GIS score in males ( p = 0, 033 r = -0,194).Conclusion:Health workers are at risk for CVD. It was determined that the pain levels of the health workers with CVD affected the quality of life negatively. In order to reduce the symptoms related to CVD and increase the quality of life of health workers, it is very important to use compression stockings, exercise that increases ankle mobility, and training on lifestyle change

Treatment of lymphatic malformations: How, to whom, and when should be made?

OBJECTIVE. Lymphatic malformations (LMs), result from abnormal development ofthe lymphatic channels, are one of the most common forms of congenital vascularmalformations (CVMs) when you should include both truncular (T-LMs) andextratruncular (ET-LMs) lesions according to the new Hamburg classification (TableI). Both are consequences of a developmental arrest at the different stages ofembryonal life as a result of defective genes. The aim of this study was to evaluatethe current treatment results of LMs.METHODS. A retrospective review of the clinical data of 186 patients(female/male=96/90) with a median age of 9 years (range, 2 days to 80 years) whohad been treated with the diagnosis of LM in the last decade was performed.Ultrasound, lymphoscintigraphy, and MRI were frequently used diagnostic tests. Thepatients with ET-LM were treated with sclerotherapy and/or surgical excision.Combinations of complex decongestive physiotherapy (CDP) and/orcompressotherapy were used to treat all the T-LM patients (Figure 1). The results ofLM management were evaluated twice a year.RESULTS. Among total 1312 patients with CVM, 186 were confirmed to have LMs,either as the T-LM (n=114, 64.2%) or the ET-LM (n=72, 35.8%) (Table II). Elevenpatients had both truncal and ET forms (Figure 2). Another 38 (20.3%) LMs werediagnosed with hemolymphatic malformations (HLM) (Figure 3). The T-LMs werelocated to the extremities, mostly to the lower extremity (86.8%), and they includedlymphatic aplasia and/or obstruction (76.3%). Most of the ET-LMs were the cystictype (91.6%). The ET-LMs were most frequent in the extremities and axillary-cervicofacial region (75.6%). ET-LMs were treated with sclerotherapy (~37%) and/orsurgical excision (30.1%)(Figure 4). The ET-LMs in patients undergoing surgerylocated to extremity (72.7%), trunk (22.7%), axillary fossa (13.6%), buttocks (4.5%),and retroperitoneum (4.5%)(Video 1). Transcutaneous radiofrequency ablation(TRFA) was performed in three patients. A patient with HLM was followed byaspiration and compression. The clinical response of the T-LMs at the extremity toCDP was good (Figure 5).CONCLUSION. Multimodal treatment of LMs continues to develop as new knowledgeabout the molecular biology and genetics of these complicated lesions is discovered,along with data obtained from clinical practice. A patient-centered multidisciplinarymedical and surgical team approach should guide modality and timing of treatment,which includes surgery, sclerotherapy with various scleroagents, TRFA, CDP, drugtherapies such sirolimus, and observation. The main objective of all these treatmentsis to support and optimize LM patients' quality of life.&nbsp;</div