Comparative outcomes of vascular access in patients older than 70 years with end-stage renal disease

Objective

The advantage of arteriovenous fistulas (AVFs) in older patients requiring dialysis is controversial. We reviewed our vascular access experience in patients ≥70 years of age (older group) compared with younger patients.

Angiodysplasia as the cause of massive lower gastrointestinal hemorrhage in a young adult

PURPOSE: This study was undertaken to clarify the importance of bleeding vascular ectasia of the colon as the etiology of massive lower gastrointestinal hemorrhage in patients 40 years of age or younger. METHODS: An otherwise healthy 21-year-old male was admitted to a tertiary medical center with massive lower gastrointestinal hemorrhage. Technetium-labeled red blood cell scan, selective visceral angiography, and colonoscopy identified the source of bleeding as vascular abnormality of the descending colon. Segmental colonic resection was performed. RESULTS: Histologic review of the specimen demonstrated a vascular ectasia. The patient recovered uneventfully and has had no further stigmata of hemorrhage. A review of the literature was undertaken to make clear the significance of vascular ectasia as the source for massive colonic hemorrhage in the young adult. CONCLUSION: This is the first report that documents histologically a vascular ectasia as the source of massive lower gastrointestinal hemorrhage in an otherwise healthy patient less than 40 years of age. Vascular ectasia is an uncommon cause of lower gastrointestinal hemorrhage in the young adult.The Chief, Bureau of Medicine and Surgery, Navy Department, Washington, DC, Clinical Investigation Program sponsored this report #84-16-1968-532, as required by HSETCINST 6000.41A. The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government.     

Cervical intramedullary cavernous angioma with MRI-proven haemorrhages

Summary Two contrasting cases of cervical intramedullary cavernous angioma in young female patients are reported. One patient had a 3-year course of step-wise progressive tetraparesis; at each of the five events intramedullary bleeding from a cryptic vascular malformation at C6–7 level was diagnosed by MRI. The other patient presented with one episode which led to MRI diagnosis of a vascular malformation at the C2 level. Both patients eventually underwent complete surgical excision of the angioma with subsequent steady improvement of the neurological deficit.     

Intra-articular arteriovenous malformation of the knee

Two young men with longstanding suprapatellar masses are presented. The initial clinical diagnosis was of a synovial or soft tissue tumour. Magnetic resonance imaging showed the features of an arteriovenous malformation (AVM). Surgical exploration and biopsy confirmed the diagnosis. AVMs, although rare, should be considered as a possible diagnosis of a peri-articular swelling of the knee.     

肝动脉栓塞治疗肝癌肝动脉-门静脉瘘所致的大量腹腔积液

目的:探讨肝动脉栓塞治疗肝癌肝动脉-门静脉瘘(APF)所致大量腹腔积液的临床应用价值。方法:并发高流量APF和大量腹腔积液的肝癌患者9例,以明胶海绵颗粒栓塞载瘘动脉,消除或减少APF,用碘化油尽量栓塞肝癌病灶。结果:APF消失7例,少量残留2例;门静脉血流方向全部由逆肝转为向肝;肝癌病灶内碘化油沉积良好6例;术后2周内腹腔积液完全消失5例,少量残余4例;2周后肝功复查,5例肝功能原有明显损害者全部明显改善;全部病例原有腹胀、腹痛、厌食、乏力症状不同程度缓解。结论:对肝癌并高流量APF所致腹腔积液,动脉栓塞治疗简单、安全、有效。     

小血管套叠粘接吻合法在血液透析者中建立动静脉内瘘的应用

慢性肾病患者常需要建立动静脉内瘘进行透析，常规间断缝合法吻合动静脉难度大、耗时长。为了缩短吻合时间，提高远期通畅率，进行了套叠粘接吻合法建立动静脉内瘘的实验研究，并将这一方法应用于透析患者建立动静脉内瘘的血管吻合。将动脉端套入静脉端，只需吻合两针，用医用胶封闭吻合口。经８个月观察，通畅率达１００％，血流量均超过３００ｍｌ／ｍｉｎ。达到了透析需要。     

Post-biopsy arteriovenous fistulas of the native kidneys diagnosed by Doppler US

Two patients with arteriovenous fistulas of the native kidney occurring after needle biopsy were evaluated using duplex and color Doppler ultrasonography. The first patient had a fistula with associated pseudoaneurysm: color Doppler showed the lesion as a small rounded area with whirling flow; spectral analysis allowed recognition of both the afferent artery with low impedance flow and the draining vein with pulsatile, arterialized flow. The second patient had a normal color Doppler study; however, spectral analysis demonstrated signals with low vascular impedance from an intra-parenchymal artery at the lower pole, and a jet of turbulent flow. Following disappearance of clinical findings, such Doppler abnormalities were no longer detectable. When a iatrogenic arteriovenous fistula is considered on clinical grounds, both color and Doppler spectral analysis of waveforms from intra-parenchymal vessels should be performed. Possibly, further advances in color Doppler technology will permit the use of this examination as the first imaging procedure in these clinical situations.Correspondence to: L. E. Derchi     

脑动静脉畸形实验动物模型的建立

脑动静脉畸形(AVM)实验性动物模型建立是研究AVM必不可少的。建立脑AVM实验性动物模型最常用的动物是猪，目前主要有如下几种猪的脑AVM模型建立的方式：利用猪的自然奇网模式，颈动脉一颈内静脉瘘模式，奇网一海绵窦交通模式，利用导管形成AVM模型以及颈总动脉与颈外静脉端一端吻合模式。随着此项工作的不断完善，对脑AVM的病理生理、血流动力学的认识定会进一步提高，这将会更有力地有助于AVM的治疗。     

Embolization of dural arteriovenous fistulas draining into the transverse or sigmoid sinus

The results of embolisation of dural arteriovenous fistulas draining into the transverse or sigmoid sinus were evaluated in 20 patients. Tinnitus was the main symptom in all patients although one also suffered from vertigo and sudden deafness. Nine patients were treated with PVA (polyvinylalcohol) alone and 11 with combined PVA and bucrylate (isobutyl-2-cyanoacrylate) in 1–9 procedures. Recurrence of symptoms, requiring repeated procedures was common but at subsequent clinical follow up 10 patients had no tinnitus, 5 were improved and only 5 experienced no change. Complications occured in six patients: four had transient neurological symptoms and one of these also developed a necrotic wound which later healed. One patient suffered from a cranial nerve palsy and one had an intracranial haemorrhage after a transvenous embolisation. This last patient recovered completely. The best clinical results were achieved in small fistulas and fistulas treated with combined bucrylate and PVA.     

Retinal arteriovenous communication in retinitis pigmentosa with Refsum's disease-like findings

In this report we describe, herewith, a patient with primary pigmentary dystrophy of the retina (retinitis pigmentosa) associated with unilateral retinal arteriovenous communication and exudative retinal detachment. The patient had complete resolution of the retinal detachment following laser photocoagulation treatment. Such association has not been previously reported.