Search

Stent strut protrusion through the skin is a rare and a potentially dangerous complication from the cannulation of stents placed within arterio-venous fistulas and grafts. Such cases are usually managed surgically. We present a case wherein strut penetration of an arterio-venous fistula was noted at the distal (uncovered) end of a Fluency Plus(®) tracheo bronchial stent graft. After analyzing the various reasons why this may have happened, a nonsurgical approach was taken to preserve the access and manage strut protrusion., (© 2014 Wiley Periodicals, Inc.)

The use of stents has become common practice in various interventional fields. The purpose of this article is to provide the interventionalist with an understanding of the basic structure stent. We describe the etymology, the classification and describe various terms used by engineers as they strive to develop that "ideal" stent. We also describe the fabrication process briefly and finally elaborate on the characteristic "build and cut" of some commonly used stents., (© 2013 Wiley Periodicals, Inc.)

Distal artery embolization is a well-known complication after mechanical thrombectomy, manifesting as limb ischemia. We describe a case of ischemia that developed after mechanical thrombectomy and stent placement in the venous anastomosis of a brachio- basilic arterio-venous graft. Subsequent investigations revealed that the stent had extrinsically compressed the adjacent brachial artery. Although balloon angioplasty of the artery initially restored flow, the patient needed surgical removal of the graft and stent to prevent persistent ischemia., (© 2013 Wiley Periodicals, Inc.)

Hemodialysis catheterization through the right internal jugular vein (IJV) is widely used for mid- to long-term hemodialysis for patients with renal failure. The purpose of this report is to address a serious complication in conjunction with this procedure. This is a case report of an iatrogenic jugular-carotid fistula (JCF) and a method for rectifying such a vascular conundrum, using endovascular techniques. We describe the technique used to achieve closure of the fistula as well a review of the literature. An 82-year-old woman with history of congestive heart failure, chronic renal failure, and diabetes mellitus developed an iatrogenic arteriovenous fistula, following an attempt of canalizing the right IJV. The patient was treated using three different stents, which achieved closure of the fistula. Venous catheter misplacement into an artery is a serious complication. Early endovascular treatment should be considered for a JCF., (© 2011 Wiley Periodicals, Inc.)

Use of long-term dialysis catheters (e.g., tunneled dialysis catheters) predisposes patients to complications. While catheter-related bacteremia is one of the commonest encountered complication, there are a series of rare complications, namely catheter adherence to the vessel wall, catheter fracture, and vessel perforation, that can occur. This article attempts to discuss such complications with emphasis on potential risk factors, clinical presentations, and management options.

While hemodialysis access ligation has been used to manage pacemaker (PM) and implantable cardioverter-defibrillator (ICD) lead-induced central venous stenosis (CVS), percutaneous transluminal balloon angioplasty (PTA) has also been employed to manage this complication. The advantages of PTA include minimal invasiveness and preservation of arteriovenous access for hemodialysis therapy. In this multi-center study we report the patency rates for PTA to manage lead-induced CVS. Consecutive PM/ICD chronic hemodialysis patients with an arteriovenous access referred for signs and symptoms of CVS due to lead-induced CVS were included in this analysis. PTA was performed using the standard technique. Technical and clinical success was examined. Technical success was defined as the ability to successfully perform the procedure. Clinical success was defined as the ability to achieve amelioration of the signs and symptoms of CVS. Both primary and secondary patency rates were also analyzed. Twenty-eight consecutive patients underwent PTA procedure. Technical success was 95%. Postprocedure clinical success was achieved in 100% of the cases where the procedure was successful. The primary patency rates were 18% and 9% at 6 and 12 months, respectively. The secondary patency rates were 95%, 86%, and 73% at 6, 12, and 24 months, respectively. On average, 2.1 procedures/year were required to maintain secondary patency. There were no procedure-related complications. This study finds PTA to be a viable option in the management of PM/ICD lead-induced CVS. Additional studies with appropriate design and sample size are required to conclusively establish the role of PTA in the management of this problem.

Nephrologists have to place temporary dialysis catheters for hemodialysis in emergency situations. Since there is a dearth of literature on this subject, the authors have written guidelines for the safe and successful placement of these catheters. These instructions should be of help to nephrology trainees who want to master the art of central venous line placement. Based on their experience, the authors have provided a number of tips and techniques for temporary catheter placement in the femoral, internal jugular, and subclavian veins, with and without ultrasound guidance. Patient positioning, preparation of the catheter insertion tray, handling of ultrasound probe, cannulation of the central veins, and guide wire and dilator insertion are described in detail. These guidelines should assist the novice in placing temporary catheters with ease and with minimal complications.

We retrospectively reviewed all subcutaneous single- and double-lumen port catheters (PCs) inserted by interventional nephrologists at our institution to determine the success rate, immediate and late complications, and functional life. From January 2000 to August 2002, 187 PCs were placed in 187 patients (42% males, 51% Caucasians, mean age 50 +/- 14 years). There were no immediate complications related to the procedure such as hemorrhage, pulmonary embolism, or pneumothorax. There were a total of 35,078 catheter-days of follow-up. Sixteen catheters were removed during the observation period: three because of infection, seven after completion of chemotherapy, and six for other reasons. The remaining PCs are either functioning or the patients have died. The initial success rate was 100%. Kaplan-Meier analysis showed a 30-day survival of 97% and a 1-year survival of 92%. Interventional nephrologists, who have adequate training in central venous tunneled cuffed catheter placements, can successfully place PCs, with excellent success and minimal complications.