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Background Occlusive lesions of superficial femoral artery (SFA) in endovascular candidate patients are treated with balloon angioplasty with or without stenting. Recently, introduction of drug-coated balloon (DCB) angioplasty as a superior treatment option to plain balloon (PB) has been challenging. Objective The purpose of this study was to compare the effectiveness of DCB versus PB angioplasty in chronic lower extremity ischemia patients. Patients and methods In this clinical trial, 2 groups were matched at baseline; among 68 patients with peripheral artery disease, 23 patients were treated by DCB and 45 by PB. They were followed up for 6 months. Our findings of ABI, Rutherford and WIFI class changes, mortality, limb amputation, re-intervention and primary patency (PP) were collected and analyzed in comparative fashion between 2 groups. Results Mean patients age was 68.5 years (77.9% male). At 6 months, the increase in ABI in DCB was 0.37 and in PB was 0.32 (P>0.05). Mean decrease in Rutherford class in DCB and PB were 2.56, 2.28 (P>0.05). Mean decrease in WIFI class in DCB and PB were 1.48, 1.11 (P>0.05). In DCB group, 1 (4.3%) limb amputation, 3 (13%) re-interventions and no mortality with 87% PP were seen. In PB group, 2 (4.4%) limb amputation, 7 (15.6%) re-interventions, 1 (2.2%) mortality with 84.4% PP were seen. Conclusion Treatment of occlusive lesions of SFA with DCB probably may leads to improvement in ABI, Rutherford and WIFI class, higher pp and lower rate of re-interventions. Since Rutherford class and pp in DCB group have improved during 6 months compared to 1 month follow up (in our study), this improvement seems to be more significant statistically in longer term of follow up.

Introduction: Chronic Kidney Disease (CKD) is a global health problem which is growing in prevalence. Hemodialysis is the most common treatment for end-stage renal disease (ESRD) which requires a permanent vascular access. Vascular accesses should have a good patency and low complication. Objectives: The present study aimed to compare side-to-side (STS) versus end-to-side (ETS) methods in antecubital arteriovenous fistulas in dialysis patients. Patients and Methods: In this randomized, single-blind clinical trial, 100 ESRD patients who scheduled for hemodialysis were divided into two groups. STS arteriovenous anastomosis was employed in one group and in the other, the ETS approach was conducted. Follow ups were done after 1, 8, and 24 weeks to detect fistula maturation and immediate or delayed complications. Results: The STS anastomosis group demonstrated higher rates of delayed maturation, vascular aneurism, and venous hypertension syndrome than ETS anastomosis group. The ETS group, however, showed higher rates of venous thrombosis and vascular stenosis. Overall, the rate of complications was 24% and 8% for STS and ETS anastomosis group respectively (P =0.03). Conclusion: In comparison, ETS arteriovenous fistulas involve less complications than STS method in ESRD patients. However, more thrombosis and stenosis detected by ETS method. ETS arteriovenous fistulas had less delayed maturation, aneurism, venous hypertension and overall complications than STS approach. ETS arteriovenous fistulas contributes to establishing a more stable connection to hemodialysis machine to conduct a more effective hemodialysis.

Central venous cannulation (CVC) is required for management of critically ill and hemodialysis patients which has different complications in conventional procedure. The aim of this study was to compare the outcomes and complication of central venous cannulation using both conventional and ultrasound guide. A randomized controlled trial study of 336 recently hospitalized hemodialysis patients was conducted (168 in intervention group and 168 in control group). CVC was done by an ultrasound machine in intervention group that the needle was inserted perpendicular to the skin under visualization on the US screen while CVC was performed by the conventional landmark approach in the other group. The time for insertion, attempts required, and complications were measured in both groups. Data were analyzed with ANOVA Repeated Measure. In intervention group 22 patients (13.09) required more than one attempt, while in the control group 75 patients (44.6) required more than one attempt. Statistically this difference was significant (P.V = 0.000). In the control group, arterial puncture was happened in 10 patients (5.9), and hematoma in 5 patient (2.9), while were 2 patients (1.1) and 1 patients (0.59) in the ultrasound group respectively (P.V = 0.04 and P.V = 0.05). The results of our study showed that USG approach took lesser time, required lesser attempts, and had lower incidence of complications for cannulation of the internal jugular vein.

Despite significant advances in the treatment of diabetic foot ulcers and below-the-knee critical ischemia, there are ongoing efforts to achieve a method with low complication, high success rate and persistence of long-term effects.was to examine the outcome of angioplasty in patients with below-the-knee critical ischemia referred to Hospital.. This semi-experimental study conducted on diabetics patients treated with PTA (Percutaneous transluminal angioplasty) with critical ischemia of lower limbs referred to Sina Hospital. After discharge, the patients were followed weekly for the first month and then monthly up to 12 months. The procedure short-term effects were examined through evaluation of wound healing as well as patients' recovery and pain relief, after one month. Given the distribution type, parametric and non-parametric test were used to compare the results before and after treatment. Pearson's correlation coefficient was used to determine the correlation between variables.. Twenty four patients participated in this study. The mean ankle-brachial index (ABI) at baseline was 0.55±0.17. A month after angioplasty, the index increased statistically significant to 0.93±0.16. The mean health score expressed by the patients at baseline was 5.48±1.39. A month after angioplasty, it was significantly increased (6.32±1.24). The mean pain score before enrollment was 6.68±2.52 (according to VAS scale). There was a significant decrease over time (3.45±1.13). The overall mean score of all patients at Rutherford Classification was 3.88±0.63 at baseline. During the 1st month and 6th month follow-up, it was changed to Class 0 that was statistically significant in the first month.. This study represents the mid-term outcomes of PTA. Although PTA treatment was associated with improved pain scores, satisfaction with health, classification of limb ischemia and diabetic foot ulcers, the effects only remain short-term and mid-term. However, long-term efficacy of PTA needs to be investigated further.

Avoidance of hand ischemia in the construction of prosthetic access for hemodialysis in diabetics that have no suitable vein for arteriovenous fistula is appreciated. Taper type may be an appropriately matched conduit to prevent its occurrence. This is a prospective controlled trial of 38 selected diabetics requiring hemodialysis, who were referred to our clinic during a period of 6 months. The aim of the study was to evaluate the efficacy of tapered grafts in preventing distal hand hypoperfusion and determining its most likely contributors. In 18 intervening cases, taper 4 mm × 7 mm and in twenty cases (control group), standard 6 mm polytetrafluoroethylene as straight Brachial-Axillary access was used. Graft flow rates, artery and vein diameters, and mean arterial pressure were included for evaluation. Within the control group, 11 patients (55%) (7 cases Grade 1, 3 Grade 2, 1 Grade 3) and in intervening group, 2 cases (11%) (Grade 1, Grade 3) developed Steal syndrome. There was no significant difference in the mean flow rates (P = 0.82). Increased risk of distal hypoperfusion was observed in the control group when flow rates were more than 1000 ml/min. Arterial diameters (P = 0.011) and mean arterial pressure (P = 0.05) were found to be important contributing factors. Taper grafts causes reduced incidence of distal hand hypoperfusion. When artery diameter was

Aim of the study was to comparison between internal jugular vs. subclavian vein cuffed tunnel catheter placement for dialysis. Material and methods Cases who required central venous catheter for dialysis were included in this study. Forty cases were included in this study and divided to two groups. Catheters were placed randomly in internal jugular vein or subclavian. Patients were followed for 6 months. Early and late complications of catheter's placement were recorded. Analysis was done using Spss ver 13.0 (Chicago, IL, USA). Results There were no significant differences between subclavian and internal jugular vein regarding occurrence of infection resulted in extraction or treatment. Also there were no significant differences regarding occurrence of thrombosis resulted in extraction or treatment. Failure rate was significantly higher in cases with internal jugular vein catheter compared to cases with subclavian vein catheter (p=0.04). Conclusion Failure rate was significantly higher in cases with internal jugular vein catheter compared to subclavian cathether. Subclavian catheter is more appropriate route for catheter placement.