جستجوی مقالات مرتبط با کلیدواژه « arteriovenous fistula » در نشریات گروه « پزشکی »

Pain experienced during the insertion of a catheter into the arteriovenous fistula (AVF) and restless legs syndrome (RLS) are prevalent issues amongHemodialysis (HD) patients. The primary objective of this systematic review and meta-analysis was to consolidate the findings from randomized clinical trial (RCT) studies examining the impact of aromatherapy with lavender on the pain associated with AVF catheter insertion and RLS in HD patients.

A systematic search was conducted on PubMed,Web of Science, Scopus, Cochrane, Embase, ClinicalTrials.gov, andGoogle Scholar search engine from inception to August 1, 2022, using keywords extracted fromMedical Subject Headings, such as “Aromatherapy”, “Lavender”, “Arteriovenous fistula”, “Pain”, “Restless legs syndrome”, and “Hemodialysis”.

Finally, eleven articleswere included in this systematic review and meta-analysis. The results showed that aromatherapy reduced the average pain of catheter insertion in AVF compared to the control group (StandardMean Difference: -1.60, 95% Confidence Interval: -2.32 to -0.87, Z=4.32, I2:90.3%, P<0.001). Also, aromatherapy massage reduced the average severity of RLS compared to the control group, which was statistically significant (Weighted Mean Difference: -13.21, 95% Confidence Interval: -17.50 to -8.91, Z=6.03, I2:93.0%, P<0.001). Also, the subgroup analysis showed that lavender in the intervention group significantly decreased the pain intensity compared to the "no intervention" group (P<0.001), yet it was not significant compared to the placebo group (P=0.12).

In summary, the findings indicate a notable reduction in catheter insertion pain in AVF and relief from RLS among HD patients through the use of lavender essential oil. As a result, future research is encouraged to include a comparison of lavender’s effects with those of a placebo group.

This systematic review and meta-analysis aimed to summarize the evidence regarding the impact of nee-dle direction and distance of arteriovenous fistula (AVF) cannulation on KT/V (where k is the dialyzer urea clearance, t,the duration of dialysis, and V, the volume of distribution of urea) and access recirculation (AR) as hemodialysis (HD) ad-equacy criteria.

A comprehensive systematic search was performed on international and domestic electronicdatabases from the earliest to June 4, 2022 using keywords. Analysis was performed in STATA software v.14.

Three randomized control trials (RCTs) and four non-RCT articles were included in the final review. Six studies reportedthe effects of direction, while four mentioned the effects of distances of AVF cannulation on outcomes of HD adequacybased on KT/V or AR. Results of three non-RCT studies showed that retrograde direction decreased KT/V more than an-tegrade direction (ES: 0.44, 95% CI: -0.38 to 1.27). Two non-RCT studies showed that antegrade decreased AR comparedto the retrograde direction (ES: -0.64, 95%CI: -1.94 to 0.67). However, the results of two RCTs indicated uncertainty aboutthis issue. Two of the four studies suggested that a distance of 5 cm or more in arterial and venous needles had greateradequacy than a distance of less than 5 cm. However, other studies did not confirm this finding.

Overallcomparison of the results qualitatively and quantitatively indicated uncertainty about the effects of direction and dis-tance of AVF cannulation on HD adequacy outcomes. More studies with high-quality designs, such as RCTs, are requiredto better understand and adjudicate the effects of needle direction and distance of AVF cannulation on HD adequacyoutcomes.

 Hemodialysis patients suffer from pain caused by needle insertion into the fistula site. Non-pharmacological methods may be associated with acceptable effects.

 The present study aimed to compare the effects of two interventions on pain intensity during needle insertion into the arteriovenous fistula in hemodialysis patients.

 This self-controlled, single-blind clinical trial was conducted on 54 hemodialysis subjects with arteriovenous fistula in Mashhad in 2021. In this regard, the patients were selected according to the inclusion criteria and randomly assigned to two groups (lidocaine spray and rhythmic breathing). In each group, pain intensity was assessed based on the visual analogue scale (VAS) before the intervention, followed by measuring the post-intervention pain intensity during three consecutive hemodialysis sessions every other day. Regarding the lidocaine spray group, two puffs of 10% lidocaine spray (20 mg) were sprayed on the needle insertion site five minutes before cannulation. However, the patients in another group took a long deep breath through the nose with three numbers, held their breath in the lungs for three numbers, and slowly exhaled through the mouth with three numbers two minutes before cannulation. The data were analyzed using SPSS software version 20, and Mann-Whitney U, Wilcoxon, chi-squared, and paired t-tests were run. In this study, P < 0.05 was considered significant.

 The results represented a significant decrease in the pain severity scores of both rhythmic breathing (P = 0.023) and lidocaine spray (P < 0.001) groups after the intervention. Moreover, a more significant difference was observed between pre-and post-intervention pain intensity scores in the group treated with lidocaine spray (1.16 ± 1.56) compared to the other group (0.508 ± 1.25).

 The lidocaine spray group had a larger difference in the pre-and post-intervention pain intensity scores than the rhythmic group; however, the difference was not significant. The rhythmic breathing can be used by nurses as a non-pharmacological method with low complications in hemodialysis departments because of declining pain.

 Chronic kidney disease is irreversible and may result in end-stage renal failure (ESRF). The kidney replacement program is determined by calculating Kt/V ratios, one of the dialysis efficiency indicators in treatment planning in routine dialysis applications in ESRF patients. We aimed to investigate whether there is a correlation between flow rate and Kt/V ratio.

 All patients were evaluated by B-mode ultrasonography (US) and color doppler ultrasonography (CDUS). The anastomosis line diameter was measured in the B-mode US. The fistula flow rate was calculated in a spectral examination at the anatomical location where the fistulized flow was best obtained at the anastomosis level. Patients with a fistula flow rate above 300 mL/min in CDUS examinations were considered reasonable flow rates. The fistula flow rate in these patients was compared with the Kt/V ratios. Spearman’s rank correlation coefficient was calculated since the normal distribution condition was not met to determine the relationship between variables.

 The results of this study showed a high level (r=0.72, P=0.001) of positive and statistically significant correlation between flow rate and Kt/V ratio in upper arm arteriovenous fistula in patients with end stage renal failure.

 We found a highly positive and statistically significant correlation between fistula flow rate and Kt/V ratio. Low Kt/V ratios have different causes. Low fistula flow should be considered first in low Kt/V values.

Oximetry is a method for measuring the arterial hemoglobin saturation (SpO2) using pulse oximeter and is essential in any type of anesthetic procedures. The growing population of geriatrics in the recent decades in combination with an increase in the prevalence of chronic diseases including diabetes and hypertension are some of the leading causes for an increase in the prevalence of chronic kidney disease and end-stage renal disease (ESRD). The definite treatment for ESRD is renal transplant but unfortunately, it may take a long time to find a suitable kidney and continuing the patient’s life may depend on dialysis. Arteriovenous fistula (AVF) formation is one of the first steps to prepare the patient for hemodialysis. ESRD itself is a reason for physical and psychosocial issues. Preparing a favorable condition for AVF surgery is essential to decrease the burden of the underlying disease. An efficient respiratory supply is necessary in all parts of an anesthetic procedures. Aims and

This study is a double-blind clinical trial to compare two anesthetic agents, dexmedetomidine and remifentanil in patients with ESRD who underwent AVF formation.

SpO2 was measured on different phases including the time of initial incision, and after 10, 30, 60, 90, and 120 min of finishing the surgery. The data were analyzed using SPSS version 22, two-way repeated measures (ANOVA), and independent t-test.

This study showed that there was no any significant difference in using any of these two agents with regard to SpO2 in the different times of measurements during the anesthetic procedure and after the surgery in the recovery phase.

This study showed that there is not any superiority in using DEX or REM in the patients undergo AVF formation. More studies on the other groups of the patients with different surgeries.

Angioaccess is considered the "Tendon of Achilles" for hemodialysis. Arteriovenous fistula (AVF) is the commonly entailed vascular access for hemodialysis.

The present study evaluates the outcomes of anatomical snuffbox AVF by preoperative and postoperative color Doppler scans. It also determines the anatomical snuffbox AVF maturation rate concerning preoperative radial artery diameter (RAD), cephalic vein diameter (CVD), cephalic vein distensibility, and peak systolic velocity (PSV).

This study was conducted from April 2020 to January 2021 on end-stage renal diseases (ESRD) patients undergoing an operation for anatomical snuffbox AVF creation at our center after taking permission from the institutional ethics committee and written informed consent from patients.

Thirty-five ESRD patients underwent snuffbox arteriovenous fistula (SBAVF) creation, including 68% males and 32% females. Diabetes mellitus was noted in 40% and hypertension in 80%. Successful AVF maturation was noted in 92% (69.57% of males and 30.43% of females). The mean RAD assessed on color Doppler ultrasonography (CDUS) preoperatively was 1.79 mm, while the peak velocity of the radial artery at the snuffbox was 23.80 cm/s.

We recommend applying the side-to-side configuration as its anastomosis angle is less owing to the lesser kink on the anastomotic site. A longer segment of anastomosis is achieved, and better fluid dynamics and WSS profiles are seen in this configuration with good outcomes.

This study aimed to determine changes in microvascular endothelial function with upper arm arteriovenous fistula (AVF) creation and maturation in patients with chronic kidney disease (CKD).

This prospective cross?sectional study was performed at Hospital Universiti Sains Malaysia, a tertiary hospital in Malaysia. Forty CKD patients (stage 4–5) who were scheduled for elective AVF creation over the upper extremity for maintenance hemodialysis were recruited using conveniencesampling method. Microvascular endothelial?dependent vasodilation was measured using laser Doppler flowmetry and the process of iontophoresis preoperatively and postoperatively at weeks 2 and 6. Fistula maturation was assessed at week 6.

Thirty?two patients had successful AVF maturation. Endothelial?dependent vasodilation (acetylcholine (Ach)%) was higher (246.48 [standard deviation (SD) 209.38] vs. 104.95 [SD 43.29], P = 0.001) while systolic blood pressure was lower (142.25 [SD 21.50] vs. 162.25 [SD 13.26], P = 0.017) in this group as compared to unsuccessful AVF group. No significant changes were seen in overall microvascular endothelial?dependent vasodilation during the 6?week study period (day 0, 246.48 [SD 209.38]; week 2, 201.14 [SD 198.19]; and week 6, 203.53 [SD 145.89]).

Upper arm AVF creation does not affect microvascular endothelial function up to 6 weeks post operation and may not contribute to the success of AVF maturation. However, the lower microvascular endothelial?dependent vasodilation and higher systolic blood pressure in unsuccessful AVF subjects need to be further studied.

Right-sided heart failure may occur during or after cardiac and noncardiac surgeries. One reason for right-sided heart failure in noncardiac surgeries is pulmonary hypertension (PH). In this report, we describe a 51-year-old man suffering from complications of right-sided heart failure, with an unknown cause. The patient had dyspnea (WHO functional class III), abdominal pain, anorexia, weight loss, bilateral lower limb swelling, icteric sclera, and elevated jugular venous pressure. Echocardiography showed mild enlargement and systolic dysfunction of the left ventricle, moderate enlargement and dysfunction of the right ventricle, and a systolic pulmonary arterial pressure of 60 mm Hg. After several workups, it was diagnosed that his previous lumbar disc surgery had resulted in an arteriovenous fistula and the consequent PH, leading to right-sided heart failure. After the occlusion of the arteriovenous fistula, all signs and symptoms were resolved. Accordingly, iatrogenic arteriovenous fistulae should be considered a reversible cause of right-sided heart failure.

Hemodialysis is the most commonly used method for dialysis; nonetheless, it causes some problems, such as the pain associated with fistula needle insertion. Pain relief is one of the main skills of nurses, and reflexology can be used as a golden key for this puzzle.

The present study aimed to assess the effect of foot reflexology on the pain of arteriovenous fistula (AVF) access.

This parallel double-blind clinical trial study was conducted on 50 female patients referring to Imam Reza Medical Center in Tabriz, Iran, in 2020-2021. The participants were randomly allocated to two groups of intervention and control using block randomization in a 1: 1 ratio. The intervention group received foot reflexology before hemodialysis for 20 min (10 min for each foot), while the control group received routine ward care. The data were collected through demographic characteristics and visual analog scale (VAS) questionnaires. Data were analyzed in SPSS 23.

In terms of place of residence, 96% and 88% of participants in the intervention and control groups lived in urban areas, respectively. Moreover, 72% and 64% of patients in the two groups of intervention and control had a history of hypertension, respectively. Furthermore, foot reflexology had a statistically significant effect on the mean score of pain intensity during three sessions of reflexology over time.Implications for Practice: It is recommended that foot reflexology be used to reduce the pain of needle entry into the arteriovenous fistula in hemodialysis patients since reflexology is non-invasive nursing care with an easy procedure and effective in pain relief.

Chronic kidney disease is an ailing condition that in the final stages can lead the patient to renal replacement therapies such as dialysis. An arteriovenous fistula (AVF) with proper function and maturation is needed with this regard. The aim of this study was to evaluate the effect of blood pressure on the function and maturation of AVF and AVG.

This retrospective cross-sectional study was performed between September 2016 and March 2019 on all patients with chronic renal failure, who referred to the Alavi Vascular Surgery Hospital as candidates for hemodialysis and underwent AVF implementation by the researchers. Using a predesigned checklist, the hospital records of all patients were reviewed and data including the demographic information of patients (age and sex), previous medical history (diabetes, hypertension), smoking status and blood pressure of the patient before and after surgery were extracted. In order to follow the patients and evaluate the function and maturation of the fistula, the dialysis centers in Mashhad were contacted and information about the successful dialysis of the patients was recorded. Data were extracted from the forms and entered into SPSS software and at the end, patients' blood pressure was compared between functional and unfunctional groups and also in terms of access type.

Totally, 298 cases were enrolled in the study and classified into two groups including 242 (81.2%) functional AVFs and 56 (18.8%) unfunctional AVFs. The mean age of the patients was 55.15±17.93 years and the median was 58.5 (67.0-43.0) years old. Moreover, 152 patients (51.0%) were male and 146 patients (49.0%) were female. There was no significant difference regarding age (p=0.057) and gender (p=0.290) between the two study groups. Furthermore, underlying diseases (diabetes and hypertension) showed significant difference between the two study groups (p<0.001). Only, diabetes relative frequency showed significant difference between fistula and graft groups (p=0.022). The median systolic (SBP) and diastolic blood pressure (DBP) was significantly higher in functional group compared to the unfunctional (p<0.05). However. There was no significant difference regarding the median SBP and DBP between the two types of access including fistula and graft (p>0.05).

Our study revealed that probably blood pressure paly and important role in the function and maturation of AVF.

Autogenous arteriovenous fistulas (AVFs) are the recommended type of vascular access for hemodialysis (HD). Nonetheless, the precise outcome of Proximal Radial Artery Arteriovenous (PRAAVF), as well as its risk of failure and complication, has yet to be determined.

In the current single-center, by retrospective analysis of prospectively collected data, we compared the outcome of Brachial Artery AVF (BAAVF) and Proximal Radial Artery Arteriovenous (PRAAVF) in end-stage renal disease (ESRD) patients who were referred to our center between 2010 to 2018. The outcome of the fistula was routinely assessed for all patients at least two years after the surgery. All data were analyzed in SPSS software (version 16). The success rate for each procedure was reported as a percentage. The Chi-square test was used to compare the success rate between the groups.

A total of 146 patients (86 males, and 60 females) with a mean age of 55.79±17.03 years were included in the study. The results demonstrated that men and women did not significantly differ in the success rate of PRAAVF (P=0.076). The PRAAVF showed a significantly higher success rate in the 30-39 age range (P=0.03). The success rate of BCAVF did not display a significant difference between different age and gender groups (P> 0.05 for both). The success rate of PRAAVF was lower in both diabetic patients and smokers, as compared to that in healthy individuals (P=0.032 and P=0.001, respectively). None of the patients who underwent PRAAVF implementation had steal syndrome (as compared to the 2.8% rate of steal syndrome following BAAVF implementation)

As evidenced by the obtained results, PRAAVFs, which are associated with a very low risk of ischemic steal syndrome, can be regarded as safe and suitable vascular access. Accordingly, when it is anatomically feasible, PRAAVFs should be preferred over BAAVFs due to their superior clinical outcomes.

Spinal dural arteriovenous fistulas (SDAVFs) are characterized by an abnormal connection between a spinal radicular artery and a perimedullary vein, mainly fed by a radicular artery at the nerve root sleeve. Here, we describe the case of a 40-year-old woman, presenting with progressive weakness of the lower extremities and the sphincter. Thoracic magnetic resonance imaging (MRI) showed spinal cord edema and signal voids on the dorsal surface of the cord. Spinal angiography demonstrated a SDAVF with a nidus at the sacral level; the feeder of the arteriovenous fistula was a lateral sacral artery, as a branch of the internal iliac artery. The lateral sacral artery was subselectively catheterized, and SDAVF was embolized with 25% n-butyl cyanoacrylate (NBCA) glue (glue: lipiodol ratio, 1:3). After embolization, no definite residual connection was visualized between the arterial and venous systems.

Percutaneous-nephrolithotomy (PCNL), is the current modality of choice for large renal stones. Delayed post-op bleeding may herald pseudo aneurysm (PA) or arteriovenous fistula (AVF) necessitating costly and incon-sistently available angioembolization, or prolonged hospitalization. The goal of this study is to identify criteria that may predict response to conservative therapy, for delayed bleeding from post PCNL intrarenal vascular lesions.

We reviewed all data on patients re-admitted for post PCNL gross hematuria at our high volume center between 2011 and 2016. Perioperative findings, factors related to the stone and management details, were subjected to multifactorial analysis. Logistic regression for multivariable analysis and ROC curves to find thresholds predicting mandatory angioembolization.

Of 4403 PCNLs, 83 (1.9%) with delayed bleeding were diagnosed with intrarenal vascular lesions: Ar-teriovenous fistulas in 54 (AVF, 65%) and pseudoaneurysm in 29 (PA, 35%). Overall 49 (59%) responded to conservative management but 34 (41%) eventually required angioembolization. On multivariable analysis, pre-dictive factors for poor response to conservative treatment were requiring transfusion beyond initial stabilization, pseudoaneurysm, history of open renal surgery, longer interval-to-second-admission, and size of vascular lesion. The proposed POPVESL score (short for Post PNL Vascular Embolization selection) when below 11, correctly predicts success of conservative management with 81.6% sensitivity & 100% specificity.

Our findings including the proposed POPVESL score have the potential for clinical application and enhancing practical guidelines on the management of post-PCNL bleeding.

We described a rare case of arteriovenous (AV) fistula after mandibular fracture in a 64-year-old man with chronic schizophrenia. The diagnosis was made by CT angiography. The patient suffered two episodes of mandibular fracture 3 months and 12 months ago. He was found to have a large AV fistula in left side of his neck. So the patient was scheduled for operation to correct fistula.

Population aging has brought a rise in the prevalence of diabetes and hypertension, leading to more cases of renal failure. Hemodialysis, as a method of renal replacement therapy, by far prevails over peritoneal dialysis (93.5% vs. 6.5%). Although arteriovenous fistula (AVF) is frequently chosen as the vascular access route for chronic hemodialysis; it has limitations including non-maturation. As maintenance of an AVF is much more costly than its creation, foreseeing maturation failure can lead to a wiser allocation of patients to AVF surgery or other alternatives, with potential for significant cost containment. Previous studies have some challenges: they used intraoperative and postoperative parameters (AVF blood flow, diameter, and depth) or parameters that are costly to collect (morphologic and functional vessels characteristics), and they used statistical analysis that puts restrictions on data. In this study, we aim to provide a data mining framework for predicting AVF non-maturation using routinely available preoperative parameters, such as serum metabolic values and inflammatory markers.

We investigated the relationship of routinely available systemic inflammatory markers and baseline metabolic values in 114 end-stage renal disease patients (over 35 years of age undergoing their first radio-cephalic AVF access surgery at wrist level for chronic hemodialysis). In this study, for the first time to our knowledge, we applied predictive analytic tools such as Random Forest for retrospective analysis of prospectively collected data between 2011 and 2018.

Our results showed that a combination of inflammatory markers and serum metabolic values can prognosticate AVF maturation outcomes with an accuracy of 0.723, by the 95% confidence interval of (0.715, 0.731) and AUC of 0.853. Also, a combination of inflammatory markers, including albumin, c-reactive protein, erythrocyte sedimentation rate, hemoglobin, lymphocytes, neutrophils, white blood cells, platelets, and red blood cell distribution width, can prognosticate AVF maturation outcomes with an accuracy of 0.674, by the 0.95 confidence interval of (0.665, 0.684) and AUC of 0.824.

Risk stratification of patients for AVF non-maturation before attempting the first AVF surgery may help prevent multiple surgical failures and costly endovascular interventions by allowing vascular surgeons to make an individualized choice of vascular access method for new patients.