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Arteriovenous Shunt for Renal Dialysis

Dialysis Shunt


Presentation

  • Jennifer Robertson, MD, MSEd and Alex Koyfman, MD (@EMHighAK, EM Attending Physician, UTSW Medical Center / Parkland Memorial Hospital) A 78-year-old male with a past medical history of coronary artery disease, hypertension and end stage renal disease presents[emdocs.net]
  • We present a rare and intriguing case of a patient with renal failure on hemodialysis that developed heart failure from his AVF.[omicsonline.org]
  • Quantitative data were presented as mean and SD and were analyzed by analysis of variance test. Qualitative data was presented as numbers and percentages and were analyzed using the χ 2 -test.[ejs.eg.net]
  • If no thrill is present, inflow is reevaluated, and the Fogarty balloon embolectomy or another maneuver is repeated as needed.[emedicine.medscape.com]
  • Therefore, each patient presenting with VASS needs a thorough evaluation of extremity anatomy and access hemodynamics before a treatment regimen can be instituted.[evtoday.com]
Falling
  • This reduction was mainly due to a fall in heart rate from 82 /- 4 beats/min to 76 /- 5 beats/min. The estimated AV fistula flow rate (0.71 /- 0.17 l/m) has been similarly reported in invasive hemodynamic studies.[ncbi.nlm.nih.gov]
  • Discomfort is minimal and patients sometimes fall asleep during the one- to two-hour procedure. Patients are usually able to return home later that same day.[brighamandwomens.org]
  • Discomfort is minimal and you may even fall asleep during the 1 to 2 hour-long procedures. The surgical incision is usually only 2 to 4 inches long. Generally you are able to return home later that same day.[montefiore.org]
  • For the patients with more severe vascular calcification, the vascular intimal is easy to fall off during surgery, the white and small pieces of bone material will deposited in the vessel wall.[alliedacademies.org]
  • […] schedule, such as painful muscle cramps from removing too much fluid too quickly high blood pressure, which can cause a headache or, in rare cases, a stroke low blood pressure, which can make you faint, feel sick to your stomach, or be more likely to fall[niddk.nih.gov]
Inflammation
  • Pareja-Ideal Aja Tonsilremoval Filed Under: pareja-ideal tonsilremoval Eugenetreatment for acute inflammation can depend on cause.[pareja-ideal.eu]
  • Studies suggested that that fibrinogen number of long-term hemodialysis patients are often higher than normal, that may be associated with inflammation, stress and other factors. Increased fibrinogen can promote blood clotting.[alliedacademies.org]
  • […] hemostasis. 1,8 Erythropoietin therapy, often prescribed to address the chronic anemia encountered in ESRD patients, has been noted to increase the risk of thrombotic complications secondary to increased levels of acute phase reactant proteins and chronic inflammation[emdocs.net]
  • The hypothesized pathogenic mechanism would involve repeated microtrauma injuring the endothelium, turbulent blood flow, local uremic context related to the renal failure, chronic inflammation, and activation of the coagulation cascade.[intechopen.com]
  • PLoS One. 2011, 6 (12): e28453-10.1371/journal.pone.0028453. doi:10.1371/journal.pone.0028453 View Article PubMed PubMed Central Google Scholar Wasse H, Huang R, Naqvi N, Smith E, Wang D, Husain A: Inflammation, oxidation and venous neointimal hyperplasia[bmcnephrol.biomedcentral.com]
Gangrene
  • Early revision was performed for massive leaking anastomosis or very narrow anastomosis affecting distal pulsation that might end by distal gangrene [Table 4].[ejs.eg.net]
  • […] disease (CKD) patients requiring hemodialysis is 350,000. 2 The clinical presentation of VASS can range from mild symptoms that are limited to the actual hemodialysis session, such as hand pain and coldness, to more severe symptoms, such as digital gangrene[evtoday.com]

Workup

  • Further workup revealed a cardiac output of 10.6 L/min and access flow of 2.37 L/min. We made a diagnosis of high output heart failure secondary to the AVF.[omicsonline.org]

Treatment

  • Thus echocardiography may offer the opportunity to select those patients who need small AV-fistulae for optimal renal and cardiac treatment.[ncbi.nlm.nih.gov]
  • Level of freedom Less freedom on treatment days. May feel washed out and tired for hours after each treatment. More freedom because you set the treatment schedule to meet the total amount prescribed. Work and travel are much easier.[niddk.nih.gov]
  • Vascular Access for Kidney Dialysis: If you are getting treatment for kidney dialysis in the upcoming months, you should work with the health professional team to know about the performance of the treatments and how to receive the maximum benefit from[veinandendovascularsurgery.sg]
  • treatment to increase the patency of AV fistulae and grafts in the short term.[cochrane.org]
  • Between treatment sessions, the bags are disconnected and the end of the catheter is sealed.[nhs.uk]

Prognosis

  • The long term prognosis of these “difficult” patients is not easy to evaluate.[intechopen.com]
  • Beck JR, Pauker SG (1983) The Markov process in medical prognosis. Med Decis Making 3: 419–458. View Article Google Scholar 15.[journals.plos.org]

Etiology

  • PREVENTING VASS Prevention strategies for VASS rely predominantly on an understanding of the various etiologies.[evtoday.com]
  • When a dialysis patient with an AVF presents repeatedly with volume overload not improved with medical therapy or dialysis, it is imperative to consider high output heart failure secondary to increased blood flow from the access as a possible etiology[omicsonline.org]
  • You instruct the patient to continue holding firm pressure and consider possible etiologies of the bleeding.[emdocs.net]

Epidemiology

  • Epidemiology of kidney disease in the United States. 2015. Available from: Dhingra R, Young E, Hulbert-Shearon T, Leavey S, Port F. Type of vascular access and mortality in US hemodialysis patients. Kidney Int. 2001; 60(4):1443-1451.[emdocs.net]
  • Epidemiology [ edit ] Hemodialysis was one of the most common procedures performed in U.S. hospitals in 2011, occurring in 909,000 stays (a rate of 29 stays per 10,000 population).[en.wikipedia.org]
Sex distribution
Age distribution

Pathophysiology

  • Our relatively poor understanding of the pathophysiology of VASS has resulted in a diverse menu of treatment options depending on the etiology of the "steal." This article reviews the current understanding of the causes and prevention of VASS.[evtoday.com]

Prevention

  • Monitor coagulation studies because heparin is used to prevent clotting during dialysis.[journals.lww.com]
  • It provides analgesia, sympathetic blockade, optimal surgical conditions, and adequate duration of postoperative block that prevents arterial spasm and graft thrombosis.[ejs.eg.net]
  • PREVENTING VASS Prevention strategies for VASS rely predominantly on an understanding of the various etiologies.[evtoday.com]
  • Hospital for Sick Children Health A-Z Search a complete list of child health articles expand_more View All Drug A-Z Search a list of articles about medications expand_more View All Learning Hubs Browse a complete list of content groups Healthy Living & Prevention[aboutkidshealth.ca]
  • DaVita.com Vascular Access: Your Lifeline to Hemodialysis Arteriovenous (AV) Fistula — The Gold Standard Hemodialysis Access External articles and portals Arteriovenous fistula – Merck.com Arteriovenous (AV) fistula – MayoClinic.com Journals Article: Prevention[davita.com]

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