Arteriovenous fistula thrombosis

In 173 renal patients with anemia, in which once-weekly administration of subcutaneous epoetin beta was compared with thrice-weekly administration, there were seven serious adverse events, possible related to epoetin beta (98). There were two cases of arteriovenous fistula thrombosis in the once-weekly group and three in the thrice-weekly group. A transient ischemic attack and a hypertensive crisis occurred in one patient in the once-weekly group. 

Penetrating and non-penetrating neck injuries are more likely to damage the carotid than the better protected vertebral artery. The vertebral artery appears to be more vulnerable to rotational and hyperextension injuries of the neck, particularly at the level of the atlas and axis. Laceration, dissection and intimal tears may be complicated by thrombosis and then embolism and, therefore, ischemic stroke at the time of the injury or some days or even weeks after the injury. Later stroke may be a consequence of the formation of a traumatic aneurysm, arteriovenous fistula or a fistula between the carotid and vertebral arteries (Davis and Zimmerman 1983). 

Due to fewer complication and longer survival rates, the native arteriovenous fistula is the preferred access for hemodialysis. Venous catheters are plagued by complications such as infection and thrombosis and often deliver relatively poor blood flow rates. 

Complications that can occur at the common femoral artery puncture site include formation of a hematoma, pseudoaneurysm, or arteriovenous fistula, dissection or thrombosis of the common femoral artery, and infection [53, 56]. Vessel perforation is even more unusual than arterial dissection but may be problematic in that it could either cause occlusion of the uterine artery prior to embolization or can cause bleeding from the perforated vessel which may itself require embolization as treatment (Fig. 10.4.4) [56],... 

Barnwell SL, Halbach VV, Dowd CF et al (1991a) Multiple dural arteriovenous fistulas of the cranium and spine. AJNR Am J Neuroradiol 12 441-445 Barnwell SL, Higashida RT, Halbach VV et al (1991b) Direct endovascular thrombolytic therapy for dural sinus thrombosis. Neurosurgery 28 135-142 Benndorf G, Bender A, Lehmann R et al (2000) Transvenous occlusion of dural cavernous sinus fistulas through the thrombosed inferior petrosal sinus report of four cases and review of the literature. Surg Neurol 54 42-54 Benndorf G, Bender A, Campi A et al (2001) Treatment of a cavernous sinus dural arteriovenous fistula by deep orbital puncture of the superior ophthalmic vein. Neuroradiology 43 499-502... 

Convers P, Michel D, Brunon J et al (1986) Dural arteriovenous fistulas of the posterior cerehral fossa and thrombosis of the lateral sinus. Discussion of their relations and treatment apropos of 2 cases. Neurochirurgie 32 495-500... 

Kallmes DF, Cloft HJ, Jensen ME et al (1998) Dural arteriovenous fistula a pitfall of time-of-flight MR venography for the diagnosis of sinus thrombosis. Neuroradiology 40 242-244... 

Pierot L, Chiras J, Duyckaerts C et al (1993) Intracranial dural arteriovenous fistulas and sinus thrombosis. Report of five cases. J Neuroradiol 20 9-18 Pollock BE, Nichols DA, Garrity JA et al (1999) Stereotactic radiosurgery and particulate embolization for cavernous sinus dural arteriovenous fistulae. Neurosurgery 45 459-466 discussion 466-457... 

Usual complications that may occur at the puncture site include venous thrombosis, arteriovenous fistula, and venous pseudoaneurysm. 

Arterial cut-off Mural irregularities or flap Laceration Thrombosis Dissection Free-flow contrast extravasation Stagnant intraparenchymal accumulation of contrast Parenchymal blush Stagnant arterial or venous flow Diffuse vasoconstriction Pseudoaneurysm Arteriovenous fistula Vessel displacement Free-flow contrast extravasation Stagnant intraparenchymal accumulation of contrast Disruption of visceral contour Displaced organ Intraparenchymal avascular zones... 

The number of percutaneous femoral arterial catheterizations has increased exponentially in recent years with several million procedures performed worldwide annually. A direct consequence of that explosion in number of percutaneous diagnostic and interventional catheterizations is the increasing number of vascular complications due to the percutaneous creation of that vascular access mainly using the femoral artery. Potential complications are pseudoaneurysm, arteriovenous fistula, uncontrollable groin and/or retroperitoneal bleeding, in situ arterial thrombosis, and peripheral embolization. In order to deal with these complications, there is an increasing need for quick and optimal diagnosis and for efficient and, by preference, minimally invasive treatment. 

Considerable morbidity exists when dealing with vascular access (VA) creation. Native arteriovenous fistulae (AVF) are the desired VA for patients on dialysis due to their comparably low morbidity and fairly good long-term patency. However, they are also at risk for nonmaturation, stenosis, thrombosis, infection, aneurysm formation, and steal syndrome [ 1 ]. Fistula success is dependent on the center of access creation. Hence, the vascular surgeon s skills and decisions are key [2]. Furthermore, success is also determined by preoperative, technical, and postoperative factors that will be discussed in this chapter (fig. 1). 

Fistula banding or plication is aimed to increase the resistance of the fistula to divert flow below the fistula to the native artery [24-26]. This reduces flow in the fistula and threatens its survival. However, most of these techniques are empirical, not well codified and reproducible and pose many questions (1) It is not clear where the reduction should be placed, whether on the arteriovenous anastomosis or the vein or both. (2) What is the optimal percentage of surface reduction in order to satisfactorily reduce flow without taking the risk of having a fistula thrombosis For these reasons, many reports of banding show high rates of fistula thrombosis, and these techniques have been abandoned by most authors [1-8,16]. 

Coleman Cl. Tuttle LA, Teevan C, Baker WL, White CM. Reinhart KM Antiplatelet agents for the prevention of arteriovenous fistula and graft thrombosis a meta analysis. Int) Chn Pract 2010 64 1239 1244. 

US and Doppler techniques are accurate means to diagnose injuries to the femoral vessels in the groin. These usually occur as a result of iatrogenic procedures (arterial catheterization), but may also be involved in displaced fractures of the pubis and the femoral neck, crush injuries, blunt trauma and so forth. The most common site for arterial injuries is the common and proximal superficial femoral artery. The main complication is a pseudoaneurysm. Other less frequent complications include thrombosis, arteriovenous fistula, dissection, intimal flaps and perivascular hematoma. Pseudoaneurysms of the femoral artery follow a tear of the vessel wall followed by leakage of blood from the artery into the adjacent tissue and usually appear as pulsatile well-defined anechoic masses located closely to the artery (Fig. 12.41). Mural thrombus is often present and partially fills the pseudoaneurysm sac. Blood flow inside the pseudoaneurysm is typically swirling with alternating red and... 

Thrombosis of the cavernous sinus is characterized by proptosis, chemosis, impaired vision and ophthalmoplegia. If it is not septic, prognosis is good because of collateral drainage and spontaneous recanalization. The same symptoms, with the exception of a possible bruit, may result from arteriovenous shunting in carotid-cavernous fistulae. The treatment of choice in this case is endovascular occlusion (thrombosis ) of the cavernous sinus. 

Arteriovenous shunts, arterioportal fistula Portal vein thrombosis... 

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