bluuebunny/crossref_metadata_2025 huggingface dataset:
Cyst-like lesion of the acetabular roof – an abnormal finding or an anatomical variant?
Authors: Tzaveas Alexandros P. , Villar Richard N.
Published: January 2018

Cyst-like lesions are frequently found in the area of the acetabulum on MRI scans. However, their presence is not always abnormal. We report four patients with such lesions found on MRI where, during hip arthroscopy, an area resembling a horseshoe-like extension of the cotyloid fossa was found. Clinicians must be aware that not all cystic acetabular lesions are pathological and may simply represent a normal anatomical or developmental variant of the hip joint. They do not always represent an indication for hip arthroscopic surgery.
Severe heterotopic ossification after total hip arthroplasty in Schnitzler syndrome
Authors: Romanini Emilio , Magaletti Massimiliano , D'Aviera Lucrezia , Antonelli Stefano
Published: January 2018

Schnitzler syndrome is a rare disorder characterized by monoclonal IgM gammopathy, urticaria, recurrent fever, evidence of inflammation, bone pain, and arthralgia. We present the case of a patient affected by Schnitzler syndrome who developed Della Valle type C heterotopic ossification after total hip arthroplasty. A relationship between the underlying syndrome and the considerable heterotopic ossification observed is compatible with the patient's clinical history and incidental findings. We suggest prophylaxis against heterotopic ossification when performing hip arthroplasty on patients with Schnitzler syndrome.
Bilateral Simultaneous Femoral Neck Fractures Secondary to a Post-infarct Generalized Tonic-clonic Seizure. A Case Report
Authors: Yüksel Halil Yalçin , Hapa Onur , Can Murat , Kürklü Mustafa
Published: January 2018

Bilateral femoral neck fractures are generally associated with high-energy trauma or defects in bone metabolism. We present a patient who had not been subjected to high-energy trauma and in whom there was no bone metabolism disorder.
A technique for extracting a buried Kuntscher nail from the femur during total hip arthroplasty
Authors: Ng Aaron B. , Jivanjee Aliasgar J.H. , Jasani Kirti M. , Purbach Bodo
Published: January 2018

We describe a novel technique that allows safe extraction of a buried Kuntscher nail during total hip arthroplasty in a patient with ipsilateral, symptomatic post-traumatic osteoarthritis of the hip. This method allows the surgeon to visualise the antegrade entry point of the nail allowing safe extraction of the device without compromising the result of the hip arthroplasty.
Transient Osteoporosis of the Hip
Authors: March Massimiliano Rocchietti , Tovaglia Venceslao , Meo Antonella , Pisani Daniela , Tovaglia Priscilla , Aliberti Giuseppe
Published: January 2018

Transient osteoporosis of the hip (TOH) is not an uncommon condition, usually with a benign course. The syndrome classically affects women during the last trimester of pregnancy, but also middle aged men. Recently, TOH has been described in non pregnant women. The pathophysiology of the disease is uncertain, though several hypotheses have been suggested. Joint pain is the main symptom. TOH is a self-limited condition, which resolves spontaneously with complete recovery within several months in most cases.
Use of the Harmonic System in Total Hip Arthroplasty: A prospective, Comparative, Observational Study
Authors: Tomáš Tomáš , JaníčEk Pavel , Nachtnebl Luboš , OndrůšEk ŠTěPáN , Kunovský Radek
Published: January 2018

We compared technical issues, postoperative outcomes and surgical complications of total hip arthroplasty when using the harmonic scalpel (HS) when compared with conventional techniques (CT) in a prospective, comparative observational study. Thirty patients undergoing total hip arthroplasty were assessed. Operative time, blood loss in drains, postoperative pain, soft tissue injury and complications were recorded. We found no significant differences between the HS and CT groups at baseline. Mean operative time was longer in the HS group compared with the CT of total hip arthroplasty (61 minutes vs. 54 minutes; P<0.05). We found no difference in postoperative pain using a visual analogue scale score, or use of paracetamol. The use of tramadol was reduced in the HS group compared to CT group at the 7th day (83.3mg vs. 113.3 mg; P<0.05). Drainage volume was significantly lower in the HS group at 24 hours (332 ml vs. 429 ml; P<0.05) and at 48 hours (429 vs. 537 ml; P<0.05). C-reactive protein blood levels were significantly lower in the HS group 75mg/l vs. 96mg/l at the third day (P<0.05) and 26mg /l vs. 54mg /l at the seventh day (P<0.01). Creatine kinase blood levels were significantly lower in the HS group at 3 and 7 days (2.4 ukat/l compared to 5.3 ukat/l at the 3rd day (P<0.01), respectively 1.1 ukat/l compared to 1.8 ukat/l at the 7th day (P<0.01). We found no significant differences in blood myoglobin levels between the two groups. The use of the HS may reduce postoperative pain, drainage volume, and soft tissue injury in patients undergoing total hip arthroplasty, which may justify the cost of the technique. The use of HS may have further applications in revision hip arthroplasty and tumour surgery.
Two-stage Treatment Protocol for Isolated Septic Acetabular Cup Loosening
Authors: Anagnostakos Konstantinos , Jung Jochen , Kelm Jens , Schmitt Eduard
Published: January 2018

The aim of this study was to evaluate the treatment of isolated septic acetabular cup loosening without involvement of the prosthesis stem by insertion of an antibiotic-loaded spacer head and stem retention.

Between 1999 and 2008, 13 patients (5 men, 8 women, mean age 69 years) were treated according to this regimen. S. epidermidis and S. aureus were the two most commonly identified pathogens. In 12 cases the polymethylmethacrylate spacers were impregnated with 0.5 g gentamicin + 2 g vancomycin per 40 g bone cement, except in one patient with vancomycin allergy, in whom 0.5 g gentamicin + 0.4 g teicoplanin were used. The spacers acted as hemiarthroplasties. The mean spacer head implantation time was 88 (35–270) days.

At a mean follow-up of 55 (12–83) months, infection eradication was achieved in 11 out of 12 cases (91.6%). Complications included a draining sinus, and one spacer and one definitive prosthesis dislocation. One patient died after reimplantation due to cardiopulmonary decompensation.
Long Term Survival of an hydroxyapatite-Coated Threaded Cup in the Presence of a high Polythene Wear Rate
Authors: Datir Sandeep P. , Angus Peter D.
Published: January 2018

We describe the long term clinical results and polythene wear rate measurement of 144 uncemented total hip arthroplasties in 118 patients (Male: Female-65: 53, Mean age: 52.8 years (range 21–78 years) performed between 1988 and 2000 using the Furlong HAC coated threaded acetabular cup. The mean follow-up for the group was 10.2 years (range: 5–17.5, median: 9.7). One femoral stem and two acetabular shells were revised due to aseptic loosening. The mean polythene wear rate was 0.24 mm/year. Ten-year survival for the acetabular and femoral components with radiological evidence of aseptic loosening as an end point was 99.15 (CI: 98.3–99.9) and 99.28 (CI: 98.5–99.9). There was no evidence of osteolysis around the femoral or acetabular components in spite of a relatively high polythene wear rate (0.24mm/year). Our study demonstrates excellent survival of threaded HAC coated acetabular sockets at 10 years in spite of a relatively high polythene wear rate.
Transient Bone Marrow Oedema Syndrome: A Report of Two Cases
Authors: Bilgici Ayhan , Sakarya ŞüKran , SelçUk Mustafa Bekir , Sakarya ÖZgüR
Published: January 2018

Transient bone marrow edema syndrome (TBMES) is a disorder with unknown etiology and must be included in the differential diagnosis of hip pain. TBMES generally has a good prognosis but, it can be result in avascular necrosis (AVN). We present two cases diagnosed with TBMES, one of whom experienced full remission and the other who developed AVN.
Central Vein Catheterization of Dialysis Patients with Real Time Ultrasound Guidance
Authors: Gallieni M.
Published: January 2018

Internal jugular vein cannulation has become a routinary and clinically important aspect of medical care in critically ill patients. The landmark-guided technique usually affords rapid and easy vascular access, but it is not always successful and may be complicated by arterial puncture, hematoma, pneumothorax.

A prospective, descriptive study is reported on the use and success of ultrasound-assisted central vein catheterization in dialysis patients who had an indication for internal jugular vein catheterization.

Data were collected prospectively on number of punctures, needle passes, and success rates. Over a 6-year period, there were 220 attempts at internal jugular catheterization in 205 patients and ultrasound guidance was used in 210 of the 220 (95%) attempts. Incidences of successful puncture and cannulation using ultrasound were 100% (210 out of 210) and 99.5% (209 out of 210), respectively, compared with 80% (8 out of 10) and 80% (8 out of 10) in the landmark group. With the availability of the ultrasound device complication rates also improved markedly, suggesting that the ultrasound technique is an easily learned technique that rapidly produces an improvement over the external landmark method. First attempt success improved from 20% to 85%, carotid punctures decreased from 33% to 2.9% (6 out of 210). The patient population also included 32 patients with several high risk conditions, such as no visual or palpable landmarks, severe coagulopathies due to hepatic failure or excess of anticoagulation treatment. In these patients, cannulation was successful in 100% (32 out of 32) using ultrasound guidance. In 9 patients (9/195, 4.6%), preliminary ultrasound evaluation of the neck vessels failed to identify a right internal jugular vein suitable for cannulation, because of thrombosis or a small diameter of the vein. In all cases, the left internal jugular vein could be cannulated without difficulties.

Our results confirm that ultrasound-guided cannulation of the internal jugular vein offers several advantages over the external landmarks technique: higher success rate in both vein puncture and catheter placement, lower complications, lower patient discomfort during the procedure because of a low number of needle passes. Ultrasound-assisted cannulation of the internal jugular vein may become the standard approach to dialysis catheter placement in the future.
Vascular Access for Chronic Haemodialysis in Lombardy
Authors: Limido A. , Galli F. , Baiardi P. , Piazza V. , Cantú P. , Salvadeo A.
Published: January 2018

To evaluate the organisation of vascular access surgery, the techniques used to monitor surgical access and the central catheters, a survey was conducted amongst dialysis Units of Lombardy. A questionnaire was sent out to the 43 dialysis centres in Lombardy, 96% of which replied.

In almost 90% of dialysis units nephrologists perform vascular access albeit in close cooperation with vascular surgeons for the more complex cases.

First choice access is by distal arteriovenous fistula (AVF): 36% end-to-end, 31.7% side-to-end, and 19.5% side-to-side with distal ligature of the vein.

As second choice proximal AVF is more widely used than AV grafts, which are implanted only when all native vessels and related surgical procedures are exhausted.

Central venous catheters offer valid solutions not only as temporary access, but also as an alternative permanent one. In both cases the jugular vein is the most frequent site of insertion. Despite the documented incidence of related episodes of stenosis/obstruction, the subclavian vein is used as a temporary access in quite a high percentage of cases.

Only in selected cases are diagnostic procedures (mainly Venography and Doppler studies) performed prior to permanent access choice. Similarly vascular access is monitored mainly using a recirculation test albeit not routinely. In case of vascular access thrombosis, surgical revision is the most common approach.
Catheter Rupture and Distal Embolisation: A Rare Complication of Central Venous Ports
Authors: Biffi R. , Pozzi S. , Orsi F. , Grasso F. , De Braud F. , Cenciarelli S. , Andreoni B.
Published: January 2018

Central venous access devices placed through a percutaneous subclavian approach may be compressed by neighbouring bony structures, leading to biomaterial fatigue, catheter fracture at the compression site, and possible embolisation of distal fragment into the central veins. The aim of this paper is to review the experience of the authors, including more than 1300 subclavian port placements, carried out during a five-year period, discussing possible causes and therapeutic options of this rare complication. Nine patients out of 1320 (0.68%) experienced this complication during the five-year period of this study. Two patients only showed a retrospective radiologic evidence of the “pinch-off sign” (e.g. initial compression of the catheter at the costo-clavicular junction). No patients had symptoms from the embolised catheter fragment; the most frequent symptom (8 out of 9 cases) was a painful swelling around the port area during infusion, related to the extravasation of medications or fluids into the subcutaneous tissue. The site of embolised segment varied from azygos vein to right pulmonary artery; however, these findings did not affect the outcome, and all the embolised fragments were successfully retrieved through a transfemoral approach using a radiologic interventional technique. No fatality occurred.

The catheter fracture and embolisation of the distal fragment are a well-known complication of subclavian central venous long-term cannulation, whose estimated overall incidence is 0.5–1%. Diagnosis is usually based on the radiologic appearance of the catheter compression (so called “pinch-off sign”), which is far from being constant; a clinical suspicion can derive from intermittent malfunction, which claims differential diagnosis with the presence of a fibrin sleeve around the tip of the catheter. Once diagnosed, the treatment is always an interventional radiologic approach, which has a very high success rate. When it fails, the possibility to leave the fragment embolised in the central veins, heart or pulmonary arteries, should be considered, being the thoracotomy and open catheter retraction questionable, at present time, in patients who have no symptoms and limited life-expectancy.
Percutaneous Intravascular Retrieval of Embolised Fragments of Long-Term Central Venous Catheters
Authors: Pittiruti M. , Cina A. , Cotroneo A. , Di Stasi C. , Malerba M. , Cina G.
Published: January 2018

Embolisation of a catheter fragment is a rare mechanical complication of long-term central venous access devices. From 1995 to 1999 we observed 10 cases: the cause of embolisation was the ‘pinch-off syndrome’ in half of the cases, and in 8 cases out of 10 the fragment had embolised in the pulmonary arterial vessels. Percutaneous transvenous retrieval was successful in all cases; it was performed mainly (8 cases out of ten) through the left transfemoral route, using a single-snare-loop device sometimes associated with a pig-tail catheter. We had no mortality and no major complications. On the basis of our experience, we believe that catheter embolisation of long-term central venous devices can be effectively prevented by adequate insertion technique, proper management of the device during its clinical use, and accurate removal technique. Nonetheless, should catheter embolistion occur, the patient should be referred to a Centre with adequate experience in the field of interventional radiological techniques. Should the radiological retrieval procedure fail, evidence from the literature suggests that leaving the fragment in embolisation site might be safer than open extraction by surgical thoracotomy, particularly in oncological patients with reduced life expectancy.
Vascular Access in Patients Affected by Short Bowel Syndrome
Authors: Fusaro F. , Gamba P.G. , Orzali A. , De Coppi P. , Scarpa M.G. , Zanon G. F.
Published: January 2018

The aim of this study was to evaluate the problems induced by the use of a central venous catheter (CVC) in a series of patients with short bowel syndrome observed at the university of Padua (Italy) between January 1981 and June 1997. During this period, 14 patients required central venous access for parenteral nutrition (PN); 55 catheters were inserted, 6 with percutaneous and 49 with surgical techniques. We divided the patients into two groups according to PN duration. The first group includes 11 children with short/medium-term PN 8 are now eating, and 3 died from respiratory failure) while the second group includes 3 patients on home long-term PN.

Thirteen catheters were placed in the first group, and the mean PN duration was 173 days; the three patients on home PN required 42 catheters. It is our experience that the use of catehters in patients requiring short/medium - term PN is a safe procedure with few complications; patients on home long-term PN present an increasing number of complications, and the vascular access could become a serious problem as the number of PN-dependent increases.
Blood Flowrate and Dialysis Adequacy in Patients with Permanent Central Venous Catheters
Authors: Mandolfo S. , Galli F. , Piazza V. , Imbasciati E.
Published: January 2018

Vascular access efficiency is a major determinant of an adequate dialytic treatment and reports from literature indicates a growing interest in the field of central venous catheterisation as permanent vascular access for hemodialysis. The main reasons are the continuous improvement in design and biomaterials along with the increased number of patients with failure of their vascular beds. In this paper it is presented and commented a series of negative crucial factors which can reduce the quality of the hemodialysis treatment: the problem of recirculation and the catheter related (and the patient related) causes of inadequate flowrate. Finally the Authors conclude with a short presentation of their clinical experience in the field.
Slow Maturation of Arterio-Venous Fistula in Seven Uremic Patients: Use of Ash Split Cath® as Temporary, Prolonged Vascular Access
Authors: Conz P. A. , Crepaldi C. , La Greca G.
Published: January 2018

The temporary vascular access is the essential condition required to perfrom hemodialysis in uremic patients in the absence of a permanent and utilizable vascular access. The cannulation of a central vein with a dual lumen catheter may be useful when a few weeks are required for the maturation of AVF. Longer times for AVF maturation (such as in diabetic patients and in aged patients) impose the use of a tunnelled catheter such as Tesio Catheter or Hickman Catheter which lead to minor complications and more efficient dialysis treatment. The Ash Split Cath®, a recently introduced chronic hemodialysis catheter, provides dialysis via a transcutaneous portion containing a 14 French cylindrical shaped catheter with D-shaped lumens and a dacron cuff.

Due to the slow maturing of AVF, in our Department the Ash Split Cath has been used in 7 uremic patients (3 males and 4 females) who required hemodialysis.

The cannulation of the internal jugular vein was performed by an ultrasound assisted technique and the correct catheter position was verified by standard chest X-rays.

The average blood flowrates were 250 ml/min, and the mean KT/V calculated in all patients one month after the beginning of the dialytic therapy was 1.09 ± 0.02. In six patients the catheter was utilized for at least 4 months, in one patient for 8 months. The devices were easily removed when the patient's AVF was functional and usable.

We found that the use of the Ash Split Cath as a temporary, prolonged vascular access in uremic patients was optimal allowing for flexibility in organizing the dialysis treatment schedule and in yielding a good performance in the initial dialysis therapy. Moreover, this device allows, in these patients, a satisfactory dialysis efficiency.
Haemodynamics of Brachial Arteriovenous Fistula Development
Authors: Martin A.G. , Grasty M. , Lear P.A.
Published: January 2018

This study observes the development of brachial arteriovenous fistulae, and assesses methods of predicting potential usefulness for haemodialysis. Creation of an adequate brachial fistula causes significant changes in blood flow to the forearm and hand.

A prospective study of fifteen consecutive patients undergoing brachial arteriovenous fistula formation for haemodialysis was undertaken. Clinical measurements and coloured flow Doppler measurements were performed pre operatively, immediately post operatively and at two and eight weeks after surgery. The morphology of the fistula was studied and the volume flow was measured. Digital pressure was measured pre and post exercise at each visit.

Fourteen fistulae worked well by eight weeks. There was an immediate large increase in brachial artery blood flow and by two weeks all fistulae that went on to develop well had a brachial artery flow of more than 700 mls/minute. The cephalic vein mean diameter pre operatively was 2.39 mm and increased to 5.4 mm by two weeks post operatively. Fistulae with flows over 400 mls/minute at two weeks had a good outcome. There were significant differences in digital pressure after fistula formation (P ≤ 0.05). Digital mean arterial pressure dropped from 118 mm Hg pre-operatively to 98 mm Hg post operatively, at rest, and 89 mm Hg after exercise. Four patients developed forearm/hand claudication on exercise or signs of distal ischaemia. Three of these were diabetic with calcified vessels.

All patients with a suitable cephalic vein should have attempted fistula formation rather than recourse to use of a synthetic graft. In diabetics creating a shunt in an already marginally competent vascular tree exposes the patient to risk of significant hand ischaemia.
Jugular Vein Catheterization for Hemodialysis: Correct Positioning Control using Real-Time Ultrasound Guidance
Authors: Santarsia G. , Casino F.G. , Gaudiano V. , Mostacci S.D. , Bagnato C. , Latorraca A. , Lopez T.
Published: January 2018

The jugular vein catheterism (JVC) is adopted for blood access in patients with acute renal failure, in chronic renal failure and when patients show failure of traditional vascular access. The technique of catheter insertion in the jugular vein is quick and easy. Usually correct catheter positioning, before starting the dialytic procedure, is controlled by chest X-ray or by intra-cavitary electrocardiogram. The aim of this work is to evaluate the feasibility of the real-time ultrasound guidance to control the correct positioning of the catheter instead of the usual chest X-ray control. We have studied 158 patients with JVC insertion before the hemodialytic procedure; 54 patients have undergone both ultrasound and a chest X-ray control while 104 were only submitted to ultrasound control. The ultrasound procedure includes an under xifoid scanning, with a convex 3.5 Mhz drill to evaluate the four heart cavities. When the right atrium is identified a second operator rapidly infuses in the venous catheter 15 ml of physiological solution thus creating a blood turbolence easily observed in real time as a light jet inside the atrium. This turbolence appears to be the main evidence for good catheter positioning and we were able to show the light jet in 156 (98%) patients. All light jet positive patients were submitted to the hemodialytic procedure without any complications during and after dialysis. We concluded that the intraoperative ultrasound control technique is an alternative to the chest X-ray evaluation because it offers the possibility for safe intraoperative immediate control thus reducing the total costs of the procedure.
Catheter Malfunction Due to Spontaneous Permcath Displacement into Medium Suprahepatic Vein
Authors: Barril G. , Cigarrán S. , Friera A. , Gallego C. , Perpen A. Fernandez , Cirugeda A. , Selgas R.
Published: January 2018

One of the last options, when the other possibilities of vascular access present malfunction, is the insertion of a permanent catheter in a central vein, preferentially internal jugular vein. This option is considered when arteriovenous access is impossible. We report a case of malfunction due to a permanent catheter displacement solved by vascular interventional radiology.
Which is the Easiest and Safest Technique for Central venous Access? A Retrospective Survey of more than 5,400 Cases
Authors: Pittiruti M. , Buononato M. , Malerba M. , Carriero C. , Tazza L. , Gui D.
Published: January 2018

There is an ongoing debate on the technique for central venous catheterization associated with the lowest complication rate and the highest success rate. In an attempt to better define the easiest and safest venous approach, we have reviewed our 7-year experience with 5479 central venous percutaneous punctures (by Seldinger's technique) for the insertion of short-term (n=2109), medium/long-term (n=2627) catheters, as well as double-lumen, large-bore catheters for hemodialysis and/or hemapheresis (n=743). We have analyzed the incidence of the most frequent insertion-related complications by comparing seven different venous approaches: jugular vein, low lateral approach; jugular vein, high lateral approach; jugular vein, low axial approach; subclavian vein, infraclavicular approach; subclavian vein, supraclavicular approach; external jugular vein; femoral vein.

The results of our retrospective study suggest that the ‘low lateral’ approach to the internal jugular vein, as described by Jernigan and modified according to our protocol, appears to be the easiest and safest technique for percutaneous insertion of central venous access, being characterized by the lowest incidence of accidental arterial puncture (1.2%) and malposition (0.8%), no pneumothorax, and an extremely low rate of repeated attempts (i.e. more than two punctures before successful cannulation) (3.3%). We advocate the ‘low lateral’ approach to the internal jugular vein as first-choice technique for venipuncture in both adults and children, for both short-term and long-term central venous percutaneous cannulation.
Groshong PICC and Home Care: An Opportunity. Clinical Experience after the First 200 Implants
Authors: Spaziani S. , Micheli T. , Vincenzi B. , Campisi C.
Published: January 2018

Peripherally Inserted Central Catheters (PICC) represent an alternative for critical patient care, and are safer to implant in home patients.

The authors report on their experience with the first 200 4 Fr Groshong PICC implanted during the last 18 months. The procedure can be easily applied at home (98% successful implant rate), without the need for fluoroscopic or ultrasound guidance. Moreover, the authors believe that the X-ray control after implant is not strictly necessary. After 11,570 days/catheters, only 5 devices were explanted because of complications: 4 because of sepsis and peripheral phlebitis, and the last was explanted by another medical staff for unclear reasons. The complications needing no explanation were a total of 32: for 12 of them the external portion of tube was damaged during use, while for the other 20 the internal clots were resolved with forced flushing.

The authors conclude that Groshong PICC can be considered the gold standard for home care management of critical patients, taking into account the quality of pure silicon, the presence of a valve and the specially-made closed-tip.
Relapsing Seroma in a Uremic Patient Bearing a PTFE Graft as Vascular Access
Authors: Allaria P.M. , Lucatello A. , Gandini E. , Battaglia C. , Giangrande A.
Published: January 2018

Seroma is one of the most frequent complications of PTFE vascular grafts and its etiology is still unclear. Case report: A 51 year-old male on regular dialytic treatment for seven years underwent the surgical implantation of a vascular prosthesis of homologous safena due to the thrombosis of his native artero-venous fistula. Several years earlier the patient had suffered the amputation of the left forearm because of electric shock. A few months later the vascular prosthesis was replaced with a PTFE vascular graft as a result of aneurysm formation and thrombosis. During the following days a non pulsating swelling occurred near the arterial anastomosis. Ultrasonography, doppler sonography and aspiration confirmed the diagnosis of seroma and it was surgically removed. Some weeks later a new seroma was observed in the same site and associated with a skin ulcer. A new surgical removal had no benefit and about one month later a perigraft collection was found along with signs of bacterial infection.

For this reason the patient underwent the surgical excision of the PTFE graft and a vascular access was warranted by placing a Tesio™ catheter.

Usually surgery is considered mandatory in seromas larger than 2 cm in diameter and showing continuous growth. In our patient the poor vascular status might have suggested a more conservative management even with a seroma diameter of about 7 cm. Nevertheless the high risk of systemic infection prompted us to remove the PTFE graft.
Vascular Calcification of the Venous Side of an Arterious-Venous Fistula
Authors: Fabbian F. , Catalano C. , Davì L. , Normanno M. , Rizzioli E. , Conz P. A.
Published: January 2018

While reports of venous calcifications are scarce, vascular calcifications frequently occur in the arteries of uraemic patients. Venous calcification of an aged arterious-venous (a-v) fistula in a young patient with a long-standing history of hyperparathyroidism was detected on a forearm X-ray. Risk factors for vascular calcifications are still under debate, but calcium-phosphate product appears to be involved in its pathogenesis. We suggest that a-v fistula of patients with hyperparathyroidism history should be monitored as calcifications could be a risk factor for access thrombosis.
Real-Time Ultrasound and Endocavitary Electrocardiography for Venous Catheter Placement
Authors: Cavatorta F. , Zollo A. , Galli S. , Dolla D.
Published: January 2018

The authors report on their experience with internal jugular vein catheterization with temporary and tunnelled cuffed hemodialysis catheters in 527 patients from 1991 to 2001, using ultrasound guidance and monitoring of catheter placement by endocavitary electrocardiography. The incidence of successful puncture and cannulation using ultrasound was 99.62%. The majority of patients had catheters inserted on the first pass (93%) and fewer attempts were required (range, 2 to 5). In the first year of the procedure in 1991, we observed two cases of accidental puncture of the carotid artery because of an error in ultrasound localization of the neck vessel.

Arrhythmias were not observed during this procedure. Right atrial electrocardiography was successful on 504 occasions (96.83%), and correct catheter placement was confirmed by plain chest-X-ray in the first 100 patients. The results confirm that real-time ultrasound guidance for catheter insertion is superior to traditional techniques relying on anatomic landmarks and should be adopted as the standard of care. Ultrasound guidance and EC-ECG improves both the success and the safety of internal jugular catheter insertion. The authors propose that EC-ECG be validated as a technique in compliance with recent Food and Drug Administration guidelines regarding the location of central venous catheter tips.
Ultrasound-Guided Cannulation of the Femoral Vein for Acute Hemodialysis Access with Silicone Catheters
Authors: Zollo A. , Cavatorta F. , Galli S.
Published: January 2018

The percutaneous femoral approach for temporary central venous hemodialysis access is a mandatory part of patient management in many clinical settings. It is usually achieved with a blind, external landmark-guided technique.

The aim of this study is to evaluate whether an ultrasound technique can improve on the external landmark method. From 1990 to January 2000, cannulation of the femoral vein was performed on 230 patients (125 male, 105 female, mean age 72 years, range 52–95 years) for temporary vascular access for hemodialysis (172 patients with acute renal failure and 58 patients in end-stage renal disease), using landmark localization with semi-rigid, uncuffed catheters. Between January 2000 and February 2001, ultrasound-guided cannulation of the femoral vein was utilized in 38 patients (20 male, 13 female, mean age 71, range 55–93 years) for temporary vascular access for hemodialysis (28 patients with acute renal failure and 10 patients in end-stage-renal failure). Uncuffed, dual-lumen silicone catheters were used.

Cannulation of the femoral vein was achieved in 100% of cases using ultrasound, and in 87% using the landmark-guided technique. Using ultrasound, puncture of the femoral artery occurred in 2.6% of patients, and hematoma in 0%. Using the “blind” technique, puncture of the femoral artery occurred in 11.2% of patients, and hematoma in 3.9%.

The average catheter dwell time, in accordance with NKF-DOQI guidelines, was 5 days (range 2 - 14 days) for semi-rigid catheters and 45 days (range 5–120 days) for silastic catheters. The number of complications rose significantly in the patients with semi-rigid catheters. In this group, local exit infection occurred in 105 persons (45% of cases), total catheter thrombosis in 46 (20%), bacteriemia in 28 (12%), and phlebitis of the leg in 6 (2.6%). In the group with silicone catheters local exit infection occurred in 4 patients (10 % of cases), total catheter thrombosis in 1 (2.6%), bacteriemia in 2 (5.2%) and phlebitis in 0 (0%). The result of the study suggests that ultrasound-guided cannulation of the femoral vein is superior to traditional techniques relying on anatomic landmark; it reduces the numbers of unsuccessful attempts and the possible acute complications of the procedure.

We believe that femoral cannulation with modern flexible silicone catheters can be considered as a reliable temporary access, even for extended periods.
Anatomical variations of the Internal Jugular Vein in Non-Uremic Outpatients
Authors: Dolla D. , Cavatorta F. , Galli S. , Zollo A. , Ervo R.
Published: January 2018

The internal jugular vein (IJV) should be the preferred form of venous vascular access for the placement of dialysis catheters. “Blind” puncture or “skin mark” ultrasound technique puncture present multiple complications due to the significant variations in IJV location in normal subjects and even more so in uremic patients. The aim of this study is to demonstrate the important rate of IJV site variations in a random healthy population.

We tested 450 subjects (244 male, 206 female) in our hospital Ultrasound Ambulatory using an Ansaldo AUS ultrasound device with linear 10 MHz probe on both sides at the Sedillot triangle level and noticed the relations between IJV and carotid artery course.

The most frequent location of IJV was the anterior lateral (79.3% on the right side, 83.5% on the left). The remaining options were lateral, anterior, posterior-lateral, anterior-medial.

We found no significant difference in IJV diameter on either side of the neck.

We therefore consider IJV puncture with ultrasound guidance to be the first choice in central venous cannulation for hemodialysis treatment.

This procedure helps avoid incorrect puncture of the carotid artery related to its abnormal location.
Accidental Migration of ASH-Split Catheter during Central Venous Catheter Replacement: Retrieval using an Interventional Radiology Approach
Authors: Galli S. , Zollo A. , Cavatorta F. , Gazzo P.
Published: January 2018

Catheter fracture and embolization of the distal fragment are well-known complications of subclavian central venous long-term cannulation. In hemodialysis it is an exceptional event. We report a case of accidental rupture of a cuffed hemodialysis catheter with distal migration of a fragment during a procedure of catheter exchange via guide-wire. According to most reported cases, intravascular catheter separation usually occurs completely asymptomatically; our report confirms that catheter embolization itself is usually asymptomatic. Less than one third of the literature-reported cases have associated symptoms, such as palpitations or chest discomfort. Once diagnosed, treatment is an interventional radiological approach, which has a very high success rate. The replacement of permanent cuffed hemodialysis catheters via guide-wire is a delicate procedure and if catheter embolization is diagnosed, the patient must be referred to a center with specific experience in the retrieval of intravascular objects.
Dialock® Subcutaneous Port for Hemodialysis: A Twelve-Month Experience in a Single Center
Authors: Quarello F. , Forneris G. , Formica M. , Pozzato M. , Borca M. , Vallero A. , Cesano G.
Published: January 2018

Background

The arteriovenous fistula (AVF) is still considered the golden standard form of vascular access for hemodialysis. However, the increasing use of central venous catheters mirrors the growing difficulty in planning an AVF. A totally implantable new device, the Dialock® system (Biolink Corporation, Norwell, MA), allowed us to conduct the first Italian experience.

Methods

From February 1st 2000 to January 31st 2001, we implanted 21 devices in 12 males and 9 females, median age 66±12 years, with a dialysis duration ranging from 0 to 22 years. In 6 cases the Dialock® was first choice access, in 5 it replaced a malfunctioning tunneled central venous catheter, and in 10 cases it was the rescue access after previous AVF failures.

Results

On average, the device was accessed 3.5 days after implantation. Median duration of use was 142 days (range 29–365), for a global observation period of 118.2 pt-months. Nineteen devices are currently working without any problem. One port was removed after 60 days due to thrombosis, and another after 9 months of use due to sepsis. Another patient had a systemic infection with cardiac and vertebral involvement with complete remission after 4 months of antibiotic therapy and salvage of the device. The infection rate was 1.3 per 1000 catheter-days. Prescribed blood flow was achieved in 95.7% of the sessions.

Conclusion

Our short-term results confirm the efficacy and reliability of the new device. In order to assess the true indication for implanting Dialock®, a more prolonged observation period is needed.
Large Bore Catheters with Surface Treatments versus Untreated Catheters for Blood Access
Authors: Bambauer R. , Mestres P. , Schiel R. , Schneidewind-Müller J.M. , Bambauer S. , Sioshansi P.
Published: January 2018

Infection, thrombosis, and stenosis are among the most frequent complications associated with blood contacting catheters. Because these problems are usually related to surface properties of the base catheter material, surface treatment processes, such as ion implantation and ion beam assisted deposition (IBAD) (silver based coatings), can be used to mitigate such complications. Because these ion beam based processes affect only the near-surface region (approximately the outer 1 μm), there is little effect on bulk material properties. This study evaluated silver coated and implanted large bore catheters used for extracorporeal detoxification. In a 186 patient prospective study, 225 large bore catheters were inserted into the internal jugular or subclavian veins. 85 surface treated catheters (Spi-Argent, Spire Corporation, Bedford, MA-USA; n=39 acute catheters, n= 46 long-term catheters) and 28 catheters with surface treatment (Spi-Silicone, Spire Corporation, Bedford, MA-USA) were inserted in 90 patients. 112 untreated catheters placed in 96 patients served as controls (n = 62 acute catheters, n = 58 long-term catheters). After removal, the catheters were cultured for bacterial colonization using standard microbiologic assays. They also were examined using a scanning electron microscope (SEM). Bacterial colonization was observed in 8% of the treated catheters compared with 46.4% of untreated catheters. The SEM investigations showed all treated catheters to possess low thrombogenicity. Results of the study indicate that ion beam based processes can be used to improve thrombus and infection resistance of blood contacting catheters.
The Effect of Age on Radiocephalic Fistula Patency
Authors: Burt C.G. , Little J.A. , Mosquera D.A.
Published: January 2018

Background

Inferior patency rates for radiocephalic fistulae in the elderly have been reported and may explain the increasing use of prosthetic grafts for vascular access. The aim of this study was to assess whether the patency rates of primary radiocephalic fistulae are affected by age.

Methods

A retrospective casenote review of 53 consecutive patients undergoing primary fistula formation between 1995 and 1998 under the care of a single consultant vascular surgeon. The setting was a specialist vascular surgical unit where the protocol is to offer all new patients a radiocephalic fistula. Fistula patency was defined as successful use for dialysis.

Results

Cumulative patency rates at 2 years were 60% in patients over 60 years (n=27), and 53% in patients under 60 years (n=26). The higher patency rates in the older age group were not significant on log rank testing (p=0.39).

Conclusion

Age over 60 years did not influence patency rates of primary radiocephalic fistulae, which should remain the haemodialysis access procedure of choice at all ages.
Early Failure Rates of Arterovenous Fistulas for Hemodialysis: Evaluation of Six-Year Activity
Authors: Ravani P. , Marcelli D. , Pecchini P. , Malberti F.
Published: January 2018

Maintenance and complications of vascular access (VA) for hemodialysis (HD) represent the leading cause of morbidity and health care cost among end stage renal disease population.

To define the reasons for the use of a particular VA at the beginning of replacement treatment, we prospectively evaluated the early failure rate and survival of arterovenous fistula (AVF) in 183 patients. These patients had high prevalence of cardiovascular risk factors and co-morbid conditions, and began HD in our renal unit from the 1st of January 1995. As a part of this study the present analysis focuses on potential predictors of early failure of the first AVF (within the first 7 days after the operation).

Overall, 279 AVF were prepared: 193 at the wrist and 86 at the upper arm, including 11 prosthetic grafts; 150 patients (82%) were given a distal AVF in the first operation. Our conservative policy resulted in a relatively high prevalence of native AVF in use among our prevalent HD patients (84.3%).

Early failure of the first VA was 10.4%. Multivariate analysis showed that this event was neither significantly associated with all traditional risk factors and co-morbids tested, nor with the operating surgeon.

We conclude that in this prospectively studied cohort, the high rate of native AVF created in order to preserve the vascular bed, though associated with a high early failure rate unaffected by traditional cardiovascular risk factors, resulted in a low proportion of permanent catheters and arterovenous grafts in use among prevalent HD patients.
Combining Novel Technologies with Improved Logistics to Reduce Hemodialysis Vascular Access Dysfunction
Authors: Roy-Chaudhury P. , Lee T. , Duncan H. , El-Khatib M.
Published: January 2018

Hemodialysis (HD) vascular access dysfunction is currently a huge clinical problem for which there are no effective therapies. There are, however, a number of promising technologies that are currently at the experimental or clinical trial stage. We believe that the application of these novel technologies in combination with better clinical protocols for vascular access care could significantly reduce the current problems associated with HD vascular access.
Central Venous Port Catheters: Evaluation of Patients' Satisfaction with Implantation under Local Anesthesia
Authors: Maurer M.H. , Beck A. , Hamm B. , Gebauer B.
Published: January 2018

Purpose

Evaluation of pain perception and patient satisfaction after implantation of a central venous port catheter system under local anesthesia.

Methods

A total of 100 consecutive patients (25 outpatients, 75 inpatients) who underwent successful implantation of a port catheter into the internal jugular vein from May through August 2007 were given an 8-item questionnaire. The extent of information about the implantation, the pain perception during implantation and the friendliness of the physician and nurse were evaluated. Furthermore, the patients were asked to assess their degree of anxiety and the pain they experienced during the intervention and to give an appraisal of whether local anesthesia was adequate. Each question was assessed on a 10–point scale (10 = very true to 1 = not at all true). In addition, the overall duration of the intervention (including patient preparation, implantation, patient aftercare, disinfection of the room) was documented.

Results

Patients felt highly satisfied with the way they were informed (mean score of 9.65) and considered the treating physician (9.89) and nurse (9.9) extremely friendly. Local anesthesia was rated as nearly completely adequate (9.56) and the degree of pain experienced was low (9.05; 10 = no pain). The average anxiety score was 8.56 (10 = not afraid at all). Overall satisfaction with the treatment was very high (9.62; outpatients: 9.72) and patients would recommend port catheter implantation at our department to others (9.77). The mean overall duration of the intervention was 76 min (range 40–120 min).

Conclusion

Positive patient reactions indicate that radiologic port catheter implantation under local anesthesia is a minimally invasive intervention with high patient satisfaction that can be performed on an outpatient basis and is a valid alternative to surgical implantation.
Pulmonary Embolism following Successful Thrombectomy of an Arteriovenous Dialysis Fistula
Authors: Grebenyuk L.A. , Marcus R.J. , Nahum E. , Spero J.A. , Srinivasa N.S. , McGill R.L.
Published: January 2018

A hemodialysis patient was diagnosed with pulmonary embolism, shortly after successful thrombectomy of an autogenous arteriovenous fistula. Diagnostic testing revealed no alternative source for thromboembolism. Increased recognition of hypercoagulability as a common consequence of end-stage renal disease would suggest that dialysis patients would be at risk for thromboembolic events. A fully developed dialysis fistula may have sufficient luminal diameter to harbor subclinical or clinically significant venous thrombi. Clinicians should be alert to the possibility of venous emboli after fistula manipulation.
Revision Using Distal Inflow for Treatment of Heart Failure Secondary to Arteriovenous Fistula for Hemodialysis
Authors: Parmar C.D. , Chieng G. , Abraham K.A. , Kumar S. , Torella F.
Published: January 2018

In patients on hemodialysis, cardiovascular disease can be precipitated or worsened by the presence of a high flow arteriovenous fistula. Fistula closure and banding are the traditional treatment methods of dialysis associated high output cardiac failure. We present a case of fistula-related high output cardiac failure treated by revision using distal inflow (RUDI).
Dialysis Needle Hemodynamics in Arterio-Venous Fistulae: A Technical Report
Authors: Tuka Vladimir , Wijnen Edwin , van der Sande Frank M. , Hm Tordoir Jan
Published: January 2018

Background

Vascular access is the lifeline for end-stage renal disease patients needing hemodialysis treatment. For dialysis treatment two needles are placed into the vascular access. Few studies on needle hemodynamics have been published.

Methods

We investigated needle hemodynamics by means of Doppler ultrasonography, both in B-mode and in pulsed Doppler mode.

Results

Direct visualization of the needles, turbulence around the arterial needle and blood flow jet from the venous needle are presented.

Conclusions

Ultrasound investigation of the hemodynamics of the dialysis needles is feasible. The extreme blood flow jet through the arterial needle was directed in all patients to the anterior vessel wall.