Julio C. Vasquez

Conversion of Tunneled Hemodialysis Catheter into HeRO Device Can Provide Immediate Access for Hemodialysis

Patients with central venous occlusion who are ‘‘tunneled catheter dependent’’ are a challenge for hemodialysis access. A relatively new option for them is the hemodialysis reliable outflow (HeRO) device that can be totally implanted subcutaneously. However, patients still require a tunneled hemodialysis catheter that is used until the HeRO device is mature, 4 to 6 weeks later. Here, we describe a conversion of an existing tunneled hemodialysis catheter into a HeRO device, which was combined with a ‘‘self-sealing’’ Flixene graft. This allowed almost immediate use of the HeRO device without the need for placement of a catheter.

Percutaneous Endovascular Management of Occluded HeRO Dialysis Access Device

The Hemodialysis Reliable Outflow (HeRO) device is a novel alternative for dialysis access in patients with no suitable veins in the upper extremities. We placed a HeRO device in a 67-year-old woman with end-stage renal disease and 2 months later, it was being used for hemodialysis. After 1 month of uneventful use, the device thrombosed and it was rescued with a percutaneous endovascular approach. The device remains patent 6 months after the intervention.

Staged Approach for Surgical Management of External Iliac Vein Aneurysm Associated With Traumatic Femoral Arteriovenous Fistula

Aneurysms of the iliac vein are rare. They can occur in association with arteriovenous fistulae located elsewhere. Here, we present a 30-year-old man who developed a large left external iliac vein aneurysm in association with a chronic traumatic arteriovenous fistula in the left thigh. Less than 25 cases of iliac vein aneurysms have been reported in the last 40 years. The presentation and treatment of this condition has been heterogeneous. We suggest that adequate surgical treatment can be offered in a staged approach: aneurysm resection with reconstruction should be done first, followed by closure of the arteriovenous fistula 6 months later.

Hemoptysis in a Healthy Young Man after a Stab Wound to the Chest

A 23-year-old man presented with persistent mild to moderate hemoptysis for the last 3 months. Six months prior, he was attacked with a knife and sustained a wound with entrance point in the right posterior chest wall, 2 cm medial to the tip of the scapula. Several hours after the attack, he was seen in an emergency room elsewhere, where a 2-cm wound with minor bleeding was noted in the referred location. The patient did not know the characteristics of the knife used. A frontal chest X-ray was obtained and showed no hemoor neumothorax; a ‘funny-looking’ metallic necklace ( fig. 1 ) was described by the radiologist, which was not removed at the time the radiograph was taken. No lateral chest X-ray was obtained. He was placed in observation and released 18 h later. The patient did not attend follow-up visits until he came to see us for hemoptysis. What is your diagnosis? What is your next diagnostic step? Received: February 15, 2007 Accepted after revision: March 1, 2007 Published online: May 24, 2007