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A Case of Venous Neointimal Hyperplasia in the Mid-portion of a Polytetrafluoroethylene Dialysis Graft: Case Report
Volume 43, August 2017
Avoidance of hemodialysis catheters is paramount due to risk from sepsis and central venous stenosis. We describe a case series of creating a new simultaneous AVF, while continuing to use the primary failing aneurysmal AVF. Once the new AVF becomes usable, the primary aneurysmal AVF can be ligated and abandoned. This technique was done on 6 patients, five of which had an ipsilateral proximal AVF created and one had a contralateral AVF created. Insertion of a hemodialysis catheter was avoided in all 6 patients. None of the patients experienced steal syndrome, despite 5/6 having two simultaneous AVFs in the same arm. This method successfully prevented having to insert a hemodialysis catheter while waiting for a new AVF to mature. Close monitoring for skin compromise and bleeding risk in the aneurysmal AVF is recommended while the simultaneous new AVF becomes functional.
Southern California Vascular Surgical Society 35th Annual Meeting 51
DIAGNOSIS AND TREATMENT OF CAROTID ARTERY ANEURYSMS: A SINGLEINSTITUTION PILOT FOR THE VASCULAR LOW-FREQUENCY DISEASE CONSORTIUM (VLFDC) Warren B. Chow, Fernando Motta, Sinan Jabori, Karen Woo, and Peter F. Lawrence David Geffen School of Medicine at UCLA, Los Angeles, CA.
Arteriovenous grafts are used in end-stage renal disease patients who are not candidates for autologous arterioveinous fistula creation due to lower patency rates. Graft neointimal hyperplasia at the anastomotic site leads to graft thrombosis and failure. There are two theories when it comes to the initiating factors that lead to venous intimal hyperplasia at the graft vein anastomosis site. The widely accepted theory is that low shear stress caused by turbulence and compliance mismatch alters smooth muscle cells leading to venous hyperplasia at the anastomotic site. The alternative theory is that of Roy-Chaudhury et al who state that polytetrafluoroethylene (PFTE) graft functions as a foreign body and repeated punctures during dialysis attracts activated macrophages to the site of the lesion. These activated macrophages then produce cytokines, which cause smooth muscle cell proliferation and lead to venous intimal hyperplasia at the anastomotic sites2. We present a case of neointimal hyperplasia within the mid-portion of an AVG leading to graft thrombosis.
Objectives: To examine a single-institution experience in the diagnosis and treatment of extracranial carotid artery aneurysms (ECAAs). Method: We performed a retrospective review of patients diagnosed with ECAAs from 2005 to 2015, examining risk factors, presenting symptoms, diagnostic tests, aneurysms features, medical and surgical treatments, and outcomes. Results: Twenty-one patients (7 men, 14 women) were diagnosed with ECAAs [mean age 61 ± 18 years (range, 19-90 years)]. Average follow-up was 22 months (0-99 months). Risk factors included heart disease (38%), hypertension (81%), diabetes (29%), smoking (33%), and prior neck surgery (38%). Patients commonly presented with painless mass (33%) and TIA or stroke (29%); 19% of aneurysms were incidental findings. Imaging included duplex ultrasound (67%), CT angiogram (43%), and MRI angiogram (48%). ECAAs occurred in the ICA (62%), bifurcation (10%), CCA (19%), ICA and CCA (5%), and ECA (5%); laterality was 62% left, 38% right, and none bilateral. Etiologies included atherosclerosis/ degeneration (52%), pseudoaneurysm (23%), and fibromuscular dysplasia (14%). Treatments included open repair (9), endovascular repair (2), and medical (5). Repairs were ligation (1), repair with patch (1), resection and primary repair (3), resection and interposition graft (4), and covered stents (2). The only postoperative complication was dysphagia after open repair. Except for the ligation, all arteries and grafts were patent at postoperative follow-up. No cerebrovascular events were reported in follow-up. Conclusion: ECAAs are rare condition that may present as a painless mass or cerebrovascular event. Most aneurysms occurred in the ICA, and were due to degenerative disease. Patients underwent open and endovascular repairs with low rates of morbidity and no mortality. The data set will provide a template for the multi-center study of ECAAs for the VLFDC.
http://dx.doi.org/10.1016/j.avsg.2017.06.021
http://dx.doi.org/10.1016/j.avsg.2017.06.022
http://dx.doi.org/10.1016/j.avsg.2017.06.020
A CASE OF VENOUS NEOINTIMAL HYPERPLASIA IN THE MID-PORTION OF A POLYTETRAFLUOROETHYLENE DIALYSIS GRAFT: CASE REPORT Francisco Vega, Allen Murga, Aaron Saunders, Sheela Patel, Jason Chiriano, Christian Bianchi, Ahmed Abou-Zamzam, and Theodore Teruya Loma Linda University, Loma Linda, CA.
Avoidance of hemodialysis catheters is paramount due to risk from sepsis and central venous stenosis. We describe a case series of creating a new simultaneous AVF, while continuing to use the primary failing aneurysmal AVF. Once the new AVF becomes usable, the primary aneurysmal AVF can be ligated and abandoned. This technique was done on 6 patients, five of which had an ipsilateral proximal AVF created and one had a contralateral AVF created. Insertion of a hemodialysis catheter was avoided in all 6 patients. None of the patients experienced steal syndrome, despite 5/6 having two simultaneous AVFs in the same arm. This method successfully prevented having to insert a hemodialysis catheter while waiting for a new AVF to mature. Close monitoring for skin compromise and bleeding risk in the aneurysmal AVF is recommended while the simultaneous new AVF becomes functional.
Southern California Vascular Surgical Society 35th Annual Meeting 51
DIAGNOSIS AND TREATMENT OF CAROTID ARTERY ANEURYSMS: A SINGLEINSTITUTION PILOT FOR THE VASCULAR LOW-FREQUENCY DISEASE CONSORTIUM (VLFDC) Warren B. Chow, Fernando Motta, Sinan Jabori, Karen Woo, and Peter F. Lawrence David Geffen School of Medicine at UCLA, Los Angeles, CA.
Arteriovenous grafts are used in end-stage renal disease patients who are not candidates for autologous arterioveinous fistula creation due to lower patency rates. Graft neointimal hyperplasia at the anastomotic site leads to graft thrombosis and failure. There are two theories when it comes to the initiating factors that lead to venous intimal hyperplasia at the graft vein anastomosis site. The widely accepted theory is that low shear stress caused by turbulence and compliance mismatch alters smooth muscle cells leading to venous hyperplasia at the anastomotic site. The alternative theory is that of Roy-Chaudhury et al who state that polytetrafluoroethylene (PFTE) graft functions as a foreign body and repeated punctures during dialysis attracts activated macrophages to the site of the lesion. These activated macrophages then produce cytokines, which cause smooth muscle cell proliferation and lead to venous intimal hyperplasia at the anastomotic sites2. We present a case of neointimal hyperplasia within the mid-portion of an AVG leading to graft thrombosis.
Objectives: To examine a single-institution experience in the diagnosis and treatment of extracranial carotid artery aneurysms (ECAAs). Method: We performed a retrospective review of patients diagnosed with ECAAs from 2005 to 2015, examining risk factors, presenting symptoms, diagnostic tests, aneurysms features, medical and surgical treatments, and outcomes. Results: Twenty-one patients (7 men, 14 women) were diagnosed with ECAAs [mean age 61 ± 18 years (range, 19-90 years)]. Average follow-up was 22 months (0-99 months). Risk factors included heart disease (38%), hypertension (81%), diabetes (29%), smoking (33%), and prior neck surgery (38%). Patients commonly presented with painless mass (33%) and TIA or stroke (29%); 19% of aneurysms were incidental findings. Imaging included duplex ultrasound (67%), CT angiogram (43%), and MRI angiogram (48%). ECAAs occurred in the ICA (62%), bifurcation (10%), CCA (19%), ICA and CCA (5%), and ECA (5%); laterality was 62% left, 38% right, and none bilateral. Etiologies included atherosclerosis/ degeneration (52%), pseudoaneurysm (23%), and fibromuscular dysplasia (14%). Treatments included open repair (9), endovascular repair (2), and medical (5). Repairs were ligation (1), repair with patch (1), resection and primary repair (3), resection and interposition graft (4), and covered stents (2). The only postoperative complication was dysphagia after open repair. Except for the ligation, all arteries and grafts were patent at postoperative follow-up. No cerebrovascular events were reported in follow-up. Conclusion: ECAAs are rare condition that may present as a painless mass or cerebrovascular event. Most aneurysms occurred in the ICA, and were due to degenerative disease. Patients underwent open and endovascular repairs with low rates of morbidity and no mortality. The data set will provide a template for the multi-center study of ECAAs for the VLFDC.
http://dx.doi.org/10.1016/j.avsg.2017.06.021
http://dx.doi.org/10.1016/j.avsg.2017.06.022
http://dx.doi.org/10.1016/j.avsg.2017.06.020
A CASE OF VENOUS NEOINTIMAL HYPERPLASIA IN THE MID-PORTION OF A POLYTETRAFLUOROETHYLENE DIALYSIS GRAFT: CASE REPORT Francisco Vega, Allen Murga, Aaron Saunders, Sheela Patel, Jason Chiriano, Christian Bianchi, Ahmed Abou-Zamzam, and Theodore Teruya Loma Linda University, Loma Linda, CA.