Ali Kemal Gür

Comparison of one- and two-stage basilic vein transposition for arterio-venous fistula formation in haemodialysis patients: preliminary results.

Summary Objective This study aimed to compare the results of one-and two-stage basilic vein transposition (BVT) in haemodialysis patients. Methods This was a non-randomised, retrospective study between January 2007 and January 2012 on 96 patients who were diagnosed with end-stage renal failure (ESRF) (54 males, 42 females; mean age 43.6 ± 14 years) and underwent one- or two-stage BVT in our clinic. All patients who were not eligible for a native radio-cephalic or brachio-cephalic arterio-venous fistula (AVF) were scheduled for one- or two-stage BVT after arterial (brachial, radial and ulnar) and venous (basilic and cephalic) Doppler ultrasonography. Patients were retrospectively divided into two groups: group 1, basilic vein diameter > 3 mm and patients who underwent one-stage BVT; and group 2, basilic vein diameter < 3 mm and patients who underwent two-stage BVT. In group 1, the basilic vein with a single incision was anastomosed to the brachial artery, followed by superficialisation. In group 2, the basilic vein was anastomosed to the brachial artery and they underwent the superficialisation procedure one month postoperatively. Fistula maturation and postoperative complications were assessed. Results The mean diameter of the basilic vein was statistically significantly higher in group 1 (3.46 ± 0.2 mm) than in group 2 (2.79 ± 0.1 mm) (p < 0.05). In terms of postoperative complications, thrombosis, haemorrhage and haematoma were significantly higher in group 1 (34, 36 and 17%, respectively) than in group 2 (23, 14 and 6%, respectively) (p < 0.05). The rate of fistula maturation was significantly lower in group 1 (66%), compared to group 2 (77%) (p < 0.05). Time to fistula maturation was significantly shorter in group 1 (mean 41 ± 14 days), compared to group 2 (mean 64 ± 28 days) (p < 0.05). Conclusion Two-stage BVT was superior to one-stage BVT due to its lower rate of postoperative complications and higher fistula maturation, despite its disadvantage of late fistula use. Although the diameter of the basilic vein was larger in patients who underwent one-stage BVT, we observed that one-stage BVT was disadvantageous in terms of postoperative complications and fistula maturation.

Cocaine-Related Acute Aortic Dissection: Case Report

54 ortic dissection is defined as longitudinal cleavage of the aortic media layer by a dissecting column of blood. If untreated, it is associated with mortality rates of 1-2% per hour for the first 24-48 hours, 33% within 24 hours, 50% within 48 hours, 75% within the first 2 weeks and 90% at 1 year. Factors known to predispose to aortic dissection include hypertension, inherited arteriopathies often characterized by cystic medial necrosis, trauma, pre-existent aortic aneurysm, a bicuspid aortic valve, aortic coarctation and various vasculites.1,2 A less known cause of aortic dissection is cocaine use.3 Cocaine, particularly crack cocaine, may have a significant role in precipitating aortic dissection in the young (age 41±8.8 years), predominantly black and hypertensive individuals.4 Cocaine-Related Acute Aortic Dissection: Case Report

Penetration of arcus aorta by tunneled cuffed catheter: should fluoroscopic guidance be preferred?

to overcome the issue. Finally TCC was placed but the squirt of high-pressure arterial blood was observed from both spouts. The penetration of arcus aorta was revealed by control CT (Fig. 2). In the surgery room, the patient was monitored, the preparation for an urgent intervention was made and the catheter was withdrawn gently under the surveillance of the surgeon and the anesthesiologist. The patient was monitored in the ICU for the following 24 hours and no additional complication was observed. In our opinion, although the negligence of fluoroscopic guidance while initial placement of CVC or conversion to TCC may be tolerated especially when performing the DOI: 10.5301/jva.5000244

Successful Retrieval of the Detached Porous Metallic Tip of a Mechanical Aspiration Catheter during Thrombectomy in a Case with May–Thurner Syndrome: A Case Report

Modern, minimally invasive techniques used to treat deep venous thrombosis, such as percutaneous mechanical thrombectomy (PMT) and catheter-directed thrombolysis, have gained worldwide acceptance. PMT has the advantage of speed and is also associated with improved outcomes, shortened hospital stays, and low complication rates. The main complications associated with PMT have been primarily due to iatrogenic vascular damage resulting in perforation, embolic occlusion, and arteriovenous fistula formation; to date, there has been no publication in the literature describing complications resulting from device failure. We present an unusual complication of PMT resulting from detachment of the catheter tip during thrombectomy and bailout technique employed.