Impact of stage-specific limb function exercises guided by a selfmanagement education model on arteriovenous fistula maturation status

BACKGROUND The exercise of limb function is the most economical and safe method to promote the maturation of arteriovenous fistula(AVF).However,due to the lack of a uni-fied exercise standard in China,many patients have insufficient awareness of the importance of AVF,leading to poor effectiveness of limb function exercise.The self-management education model can effectively promote patients to take pro-active health-related actions.This study focuses on the characteristics of patients during the peri-AVF period and conducts a phased limb function exercise under the guidance of the self-management education model to observe changes in fac-tors such as the maturity of AVF.AIM To assess the impact of stage-specific limb function exercises,directed by a self-management education model,on the maturation status of AVFs.METHODS This study is a randomized controlled trial involving 74 patients with forearm AVFs from the Nephrology Department of a tertiary hospital in Sichuan Province,China.Patients were randomly divided into an observation group and a control group using a random number table method.The observation group underwent tailored stage-specific limb func-tion exercises,informed by a self-management education model which took into account the unique features of AVF at various stages,in conjunction with routine care.Conversely,the control group was given standard limb function exercises along with routine care.The assessment involves the maturity of AVFs post-intervention,post-operative complications,and the self-management level of the fistula in both groups patients.Analyses were conducted using SPSS version 23.0.Count data were represented by frequency and percentage and subjected to chi-square test comparisons.Measurement data adhering to a normal distribution were presented as mean±SD.The independent samples t-test was utilized for inter-group comparisons,while the paired t-test was used for intra-group comparisons.For measurement data not fitting a normal distribution,the median and interquartile range were presented and analyzed using the Wilcoxon rank sum test.RESULTS At the 8-wk postoperative mark,the observation group demonstrated significantly higher scores in AVF symptom recognition,symptom prevention,and self-management compared to the control group(P<0.05).However,the variance in symptom management scores between the observation and control groups lacked statistical signi-ficance(P>0.05).At 4 wk after the operation,the observation group displayed a superior vessel diameter and depth from the skin of the drainage vessels in comparison to the control group(P<0.05).While the observation group did manifest elevated blood flow rates in the drainage vessels relative to the control group,this distinction was not statistically significant(P>0.05).By the 8-wk postoperative interval,the observation group outperformed the control group with notable enhancements in blood flow rates,vessel diameter,and depth from the skin of drainage vessels(P<0.01).Seven days following the procedure,the observation group manifested significantly diminished limb swelling and an overall reduced complication rate in contrast to the control group(P<0.05).The evaluation of infection,thrombosis,embolism,arterial aneurysm stenosis,and incision bleeding showed no notable differences between the two groups(P>0.05).By the 4-wk postoperative juncture,complications between the observation and control groups were statistically indistinguishable(P>0.05).CONCLUSION Stage-specific limb function exercises,under the guidance of a self-management education model,amplify the capacity of AVF patients to discern and prevent symptoms.Additionally,they expedite AVF maturation and miti-gate postoperative limb edema,underscoring their efficacy as a valuable method for the care and upkeep of AVF in hemodialysis patients.

Application of Clinical Care Pathway in Perioperative Patients with Autologous Arteriovenous Fistula Balloon Expansion

[Objective] To explore the effect of clinical care pathways in perioperative patients with autologous arteriovenous fistula balloon expansion. [Method] 202 patients undergoing autologous arteriovenous fistula from July 2021 to June 2022 were randomly divided into a control group (101 cases) and an observation group (101 cases) to compare the incidence rates of postoperative complications, hospitalization days, hospitalization expenses, knowledge of self-management of arteriovenous fistula and nursing satisfaction. [Results] In the observation group, the incidence of arteriovenous fistula was higher than that of the control group, and the hospitalization days and hospitalization costs were lower than that of the control group. The difference between the two groups was statistically significant (P < 0.05). [Conclusion] The application of the clinical nursing path to intervene in patients with autologous arteriovenous fistula balloon dilation can reduce the incidence of postoperative complications, shorten the hospital length of time, reduce hospitalization costs and improve patient satisfaction, which is clinical promotion significance.

The Preventive Effect of Comprehensive Nursing Intervention on Arteriovenous Fistula Failure in Patients in the Hemodialysis Room

Objective:To explore the preventive effect of comprehensive nursing intervention on arteriovenous fistula failure in patients in the hemodialysis room.Methods:82 patients with arteriovenous fistula in the hemodialysis chamber treated in our hospital from July 2022 to October 2023 were selected as the research subjects.The random number table method divided them into a control group and an experimental group of 41 cases each.The control group received general nursing intervention measures,while the experimental group underwent comprehensive nursing intervention.The incidence of complications(internal fistula failure,bleeding,thrombosis,infection),psychological emotions(SAS scale,SDS scale),quality of life(physical pain,physiological function,emotional function,social function),and nursing satisfaction(very satisfied,basically satisfied,satisfied,dissatisfied)were compared between the two groups of patients.Results:The incidence of complications in the experimental group(4,9.76%)was significantly lower than that in the control group(29,70.73%);the SAS scores and SDS scores of the patients in the experimental group after intervention were both lower than those in the control group;the quality of life score(physical pain,physiological function,emotional function,and social function)was all higher than those of the control group;the post-intervention nursing satisfaction of the experimental group(40,97.57%)was also significantly higher than that of the control group(29,73.17%);and the listed differences were statistically significant(P<0.01).Conclusion:For patients with hemodialysis ventricular arteriovenous fistula failure,comprehensive nursing intervention can reduce the incidence of complications,relieve anxiety and stress,improve quality of life and nursing satisfaction,and achieve better preventive effects.

Delayed versus immediate intervention of ruptured brain arteriovenous malformations:A case report

BACKGROUND Brain arteriovenous malformations(bAVMs)remains one of the most prevalent causes of intracranial hemorrhage and stroke-like syndromes in the young adult population.Although it has been agreed upon that definitive treatment using either single or multi-modal approach is warranted for successful bAVM management,much debate still revolves regarding the optimal timing of definitive treatment.CASE SUMMARY In this report,we present a case of delayed,definitive endovascular treatment for ruptured bAVM in a 21-year-old female,3 mo post-ictus.The bAVM,with a left pericallosal feeding artery and cortical draining veins,was successfully obliterated through embolization using the Onyx 18.On follow-up the patient has recommenced her daily activities and experiences only mild occasional headaches with mild motor deficits.The report leads to our review on an important issue regarding the optimal timing of ruptured bAVM definitive management and bring forward the current evidence available on delayed vs immediate definitive bAVM intervention.We also highlight current issues that need to be addressed for clearer guidelines on definitive therapy initiation.CONCLUSION Current treatment paradigms of ruptured bAVM remains elusive,with substantial heterogeneity in the current literature.A consensus on the definition of“acute”vs“delayed”,management goal,follow-up length and outcome parameters are required to support formation of a clear paradigm.

Overview of peripheral arteriovenous malformations:From diagnosis to treatment methods

Based on the latest classification by the International Society for the Study of Vascular Anomalies in 2018,vascular malformations(VMs)can be categorized into simple,combined,VMs of major named vessels,and VMs associated with other anomalies.Simple VMs include lymphatic,venous,capillary,and arteriovenous malformations(AVMs).AVMs represent disorders of direct arteriovenous shunts caused by the absence of a capillary bed between the involved arteries and veins.This abnormal vascular communication causes arterial blood to accumulate in the venous vessels,thus resulting in venous hypertension and characteristic clinical manifestations,such as pulsation,tremors,and elevated temperature.AVMs can occur sporadically or as manifestations of syndromic lesions and are considered among the most complex and challenging VMs.The diagnosis and treatment of AVMs can vary depending on the lesion location and associated clinical symptoms,thus complicating their management.Herein,we discuss peripheral AVMs in terms of their clinical manifestations,imaging examinations,and staging systems to provide a comprehensive reference for the treatment,evaluation methods,and follow-up procedures for this vascular anomaly.

Endoplasmic Reticulum Stress-induced Endothelial Dysfunction Promotes Neointima Formation after Arteriovenous Grafts in Mice on High-fat Diet

Objective Endothelial dysfunction is one candidate for triggering neointima formation after arteriovenous grafts(AVGs),but the factors mediating this process are unclear.The purpose of this study was to investigate the role of endoplasmic reticulum stress(ERS)-induced endothelial dysfunction in neointima formation following AVGs in high-fat diet(HFD)mice.Methods CCAAT-enhancer-binding protein-homologous protein(CHOP)knockout(KO)mice were created.Mice were fed with HFD to produce HFD model.AVGs model were applied in the groups of WT ND,WT HFD,and CHOP KO HFD.Human umbilical vein endothelial cells(HUVECs)were cultured with oxidized low density lipoprotein(ox-LDL)(40 mg/L)for the indicated time lengths(0,6,12,24 h).ERS inhibitor tauroursodeoxycholic acid(TUDCA)was used to block ERS.Immunohistochemical staining was used to observe the changes of ICAM1.Changes of ERS were detected by real-time RT-PCR.Protein expression levels and ERS activation were detected by Western blotting.Endothellial cell function was determined by endothelial permeability assay and transendothelial migration assay.Results HFD increased neointima formation in AVGs associated with endothelial dysfunction.At the same time,ERS was increased in endothelial cells(ECs)after AVGs in mice consuming the HFD.In vitro,ox-LDL was found to stimulate ERS,increase the permeability of the EC monolayer,and cause endothelial dysfunction.Blocking ERS with TUDCA or CHOP siRNA reversed the EC dysfunction caused by ox-LDL.In vivo,knockout of CHOP(CHOP KO)protected the function of ECs and decreased neointima formation after AVGs in HFD mice.Conclusion Inhibiting ERS in ECs could improve the function of AVGs.

MEK inhibitors for the treatment of extracranial arteriovenous malformations

Arteriovenous malformations(AVMs)are serious congenital vascular anomalies in which the arteries connect directly with veins without capillaries.This condition will continue to worsen without proper intervention and cause ulcers,repeated hemorrhages,and even cardiac insufficiency.Primary treatment options for AVMs include surgery and interventional treatment;however,they are associated with high risk and recurrence rates.Recent studies revealed that excessive activation of the Ras/MAPK pathway can induce the formation and development of peripheral AVM,whereas MEK inhibitors can effectively control nidus progression,making them a potential novel treatment for AVM.This review provides an up-to-date overview of correlated laboratory and clinical research to provide information for further research and clinical practice.

Transient ischemic attack induced by pulmonary arteriovenous fistula in a child:A case report

BACKGROUND Cerebral ischemic stroke is attributed to paradoxical cerebral embolism.Pulmonary arteriovenous fistula(PAVF)is a rare potential cause of cerebral ischemic stroke,and cerebral ischemic stroke induced by PAVF in children is rare.CASE SUMMARY We report a case of right PAVF that presented as a transient ischemic attack(TIA)in a 13-year-old boy.The patient underwent embolization therapy and remained clinically stable for 2 years after treatment.CONCLUSION TIA induced by PAVF in children is rare,lacks typical clinical manifestations,and should not be ignored.

Absolute ethanol embolization for treatment of peripheral arteriovenous malformations

Arteriovenous malformations(AVMs)are aggressive congenital high-flow vascular anomalies,in which the feeding artery and draining vein are connected through fistulas without normal capillary networks.In severe cases,the condition may cause swelling,ulceration,bleeding,and even heart failure.Various treatment options are available for AVMs,including laser,surgical resection,embolization,and targeted drug therapy.With the development of endovascular treatment technology,absolute ethanol embolization of AVMs has become one of the first-line therapies owing to its sustained efficacy and low recurrence rate.However,administration of this therapy is challenging and may lead to serious complications if inappropriately managed.In this article,we reviewed and summarized previous clinical articles,literature reviews,and clinical trial data to comprehensively describe clinical manifestations of AVMs,the mechanism of ethanol embolotherapy,key points in treatment and management of complications,and issues that need to be addressed.We expect to provide a reliable information reference source for clinical physicians and researchers.

A Rare Case: Multiple Mandibular Arteriovenous Malformation with High Output: May a Tooth Extraction Alone Turn to a Catastrophic Condition?

Background: Arteriovenous malformations (AVM) in mandible and neck are potentially life-threatening conditions because of possible massive hemorrhage. They are often first diagnosed by dentists as bleeding. In this case, we report how a tooth extraction turned to a catastrophic condition in a patient with multiple AVMs in the mandibular, submandibular and hyoid region. Case: A 19-year-old male patient diagnosed with AVMs in the mandibular and submandibular regions was admitted to our hospital with the complaint of leaky hemorrhage around the lower left 3rd molar tooth. Tooth extraction was planned after embolization procedure. The patient was intubated uneventfully using video laryngoscope. However, an acute bleeding of more than 1600 ml occurred in one minute just after the mouth opener was inserted. The patient was transferred to the Interventional Radiology and other branches of the high-flow AVM were embolized. The patient was taken back to the operating room and the tooth was extracted uneventfully. Conclusion: In AVM cases, trauma should be minimized during induction of general anesthesia and intubation should be performed gently with fiberoptic bronchoscopy or video laryngoscopy. We conclude that a multidisciplinary approach as applied to our patient would be valuable in such cases.

Embolization of brain arteriovenous malformations with squid co-polymer embolic material:Initial experience

Objective:To analyze the safety and effectiveness of the ethylene-vinyl alcohol copolymer(EVOH)liquid embolic agent Squid(Emboflu,Switzerland)for the treatment of brain arteriovenous malformations.Materials and procedures:Between April 2015 and July 2017,46 embolization treatments for brain arteriovenous malformations(BAVM)were performed in 25 patients using two Squid formulations(18 and 12).Six female and 19 male patients with a mean age of 34 years(range,9–62 years)were included.A total of 46 procedures were performed.The BAVMs were classified as Spetzler-Martin gradeⅡin 4 procedures,Ⅲin 27 procedures,and 1V in 15 procedures.Among the 25 patients,15 presented with hemorrhage,5 with seizures,and 5 with headache and neurology.The BAVMs were located in the temporal lobe in 5 patients,parietal lobe in 7 patients,frontal lobe in 3 patients,posterior fossa in 6 patients,basal ganglia in 3 patients,and parasagittal lobe in 1 patient.Results:The obliteration rate of the BAVMs ranged from 10%to 100%,with a mean of 33%.Most patients underwent their first or second embolization procedure.Four patients(8%)developed intracranial bleeding post procedure,with one death(2%).One patient(2%)experienced a seizure during the procedure;however,no intracranial bleeding was observed.Seven patients(15%)experienced perforations during catheter manipulation.One case(2%)of fractured catheter was recorded,but no significant complications were observed.The average volume of copolymer injected was 0.6 ml per nidus.Thirteen procedures used the Squid-12 formulation,29 procedures used the Squid-18 formulation,and 3 procedures used a combination of Squid-12 and-18 formulations.Conclusion:Squid is a safe and effective embolic agent for treating BAVMs.

Pancreatic arteriovenous malformation treated with transcatheter arterial embolization:Two case reports and review of literature

BACKGROUND Various treatment methods are available for the treatment of pancreatic arteriovenous malformation(P-AVM);however,there are no established treatment options for asymptomatic P-AVM.CASE SUMMARY A 47-year-old and a 50-year-old male patients sought treatment for P-AVM in the pancreas,which was incidentally detected during routine abdominal computed tomography and magnetic resonance imaging conducted as part of a health check-up.They underwent transcatheter arterial embolization(TAE),and over the course of a 9-year follow-up period,the AVM did not worsen and was asymptomatic.CONCLUSION TAE can be considered as an alternative treatment option for P-AVM in selective cases where patients are asymptomatic or have a high surgical risk.

A Computational Analysis of the Influence of Anastomosis Angle on Stenosis-Prone Locations during Radio-Cephalic Arteriovenous Fistula Maturation

In dialysis treatment, the radio-cephalic arteriovenous fistula (RCAVF) is a commonly used fistula, yet its low maturation rate remains a challenge. To enhance surgical outcomes, the relationship between stenosis-prone locations and RCAVF anastomosis angle is studied during maturation by developing two sets of RCAVF models for early (non-mature) and mature RCAVFs at five anastomosis angles. The impact of hemodynamics and wall shear stress (WSS) is examined to determine optimal anastomotic angles. Results indicate that acute angles produce more physiological WSS distributions and fewer disturbed regions, with early stenosis-prone regions located near the anastomosis that shift to the bending venous segment during remodeling. A pilot study comparing clinical and numerical results is conducted for validation.

Multimodal MRI diagnosis and transvenous embolization of a basicranial emissary vein dural arteriovenous fistula:A case report

A dural arteriovenous fistula(DAVF) is an abnormal linkage connecting the arterial and venous systems within the intracranial dura mater. A basicranial emissary vein DAVF drains into the cavernous sinus and the ophthalmic vein, similar to a cavernous sinus DAVF. Precise preoperative identification of the DAVF location is a prerequisite for appropriate treatment. Treatment options include microsurgical disconnection, endovascular transarterial embolization(TAE), transvenous embolization(TVE), or a combination thereof. TVE is an increasingly popular approach for the treatment of DAVFs and the preferred approach for skull base locations, due to the risk of cranial neuropathy caused by dangerous anastomosis from arterial approaches. Multimodal magnetic resonance imaging(MRI) can provide anatomical and hemodynamic information for TVE. The therapeutic target must be precisely embolized in the emissary vein, which requires guidance via multimodal MRI. Here, we report a rare case of successful TVE for a basicranial emissary vein DAVF, utilizing multimodal MRI assistance. The fistula had vanished, pterygoid plexus drainage had improved, and the inferior petrosal sinus had recanalized, as observed on 8-month follow-up angiography. Symptoms and signs of double vision, caused by abduction deficiency, disappeared. Detailed anatomic and hemodynamic assessment by multimodal MRI is the key to guiding successful diagnosis and treatment.

Imaged guided surgery during arteriovenous malformation of gastrointestinal stromal tumor using hyperspectral and indocyanine green visualization techniques:A case report

BACKGROUND This case report demonstrates the simultaneous development of a gastrointestinal stromal tumour(GIST)with arteriovenous malformations(AVMs)within the jejunal mesentery.A 74-year-old male presented to the department of surgery at our institution with a one-month history of abdominal pain.Contrast-enhanced computed tomography revealed an AVM.During exploratory laparotomy,hyperspectral imaging(HSI)and indocyanine green(ICG)fluorescence were used to evaluate the extent of the tumour and determine the resection margins.Intraoperative imaging confirmed AVM,while histopathological evaluation showed an epithelioid,partially spindle cell GIST.CASE SUMMARY This is the first case reporting the use of HSI and ICG to image GIST intermingled with an AVM.The resection margins were planned using intraoperative analysis of additional optical data.Image-guided surgery enhances the clinician’s knowledge of tissue composition and facilitates tissue differentiation.CONCLUSION Since image-guided surgery is safe,this procedure should increase in popularity among the next generation of surgeons as it is associated with better postoperative outcomes.

Impact and Management under Extracorporeal Circulation of a Patient with Renal Insufficiency on Dialysis with a High-Flow Arteriovenous Fistula in the Cardiac Surgery Department of the Angers Teaching Hospital about a Case and Review of the Literature

Arteriovenous fistulas have a substantial impact on systemic hemodynamics, however their effect on extracorporeal circulation is not well understood. We report our clinical observation on the management under extracorporeal circulation of a patient with renal insufficiency with a high-flow arteriovenous fistula. This is a 59-year-old man who was referred to us for surgical treatment of ischemic coronary artery disease in a context of anuric chronic renal failure. Hypothermia at 32°C is started from the start in CEC due to hyperflow at the level of the arteriovenous fistula. We performed two coronary artery bypasses of the marginal and IVA via the two internal thoracic arteries. The patient is hemofiltered in order to avoid hyperkalaemia and possibly avoid fluid overload related to filling per CEC. The clamping time was 71 minutes and the SCC lasted 141 minutes. There was no homologous transfusion in the operating room. It turns out that the input/output balance is zero at the end of the CEC. The postoperative course was simple.

DSA analysis of hepatic arteriovenous fistula concurrent with hepatic cancer and its clinical significance

INTRODUCTIONIntervention therapy has become one of the maintherapies of hepatic cancer.Theintroduction of hepatic arterial perfusion andembolization has provided opportunities for asecondary operation on patients with intermediateand advanced cancer,thus

Inferior mesenteric arteriovenous fistula: Case report and world-literature review

Arteriovenous fistulas between the inferior mesenteric artery and vein are rare, with only 26 primary and secondary cases described in the literature. Secondary fistulas occur following operations of the left hemicolon and manifest as abdominal pain, abdominal mass, gastrointestinal bleeding, colonic ischemia and portal hypertension. Symptom intensities are flow-dependent, and can range from minimal symptoms to severe heart failure due to left to right shunt. Diagnosis is usually established by radiological or intraoperative examination. Treatment options include embolization and/or surgical resection. Therapeutic decisions should be adapted to the unique characteristics of the fistula on an individual basis. A new case of a primary arteriovenous fistula is described and discussed along with a complete review of the literature. The patient in this report presented with signs and symptoms of colonic ischemia without portal hypertension. The optimal treatment for this pa-tient required a combination of embolization and surgical operation. The characteristics of these rare inferior mesenteric arteriovenous fistulas are examined and some considerations concerning diagnostic and therapeutic strategies that should be followed are presented.

Endovascular treatment of post-laparoscopic pancreatectomy splenic arteriovenous fistula with splenic vein aneurysm

Splenic arteriovenous fistulas(SAVFs) with splenic vein aneurysms are extremely rare entities. There have been no prior reports of SAVFs developing after laparoscopic pancreatectomy. Here, we report the first case. A 40-year-old man underwent a laparoscopic, spleen-preserving, distal pancreatectomy for an endocrine neoplasm of the pancreatic tail. Three months after surgery, a computed tomography(CT) scan demonstrated an SAVF with a dilated splenic vein. The SAVF, together with the splenic vein aneurysm, was successfully treated using percutaneous transarterial coil embolization of the splenic artery, including the SAVF and drainage vein. After the endovascular treatment, the patient's recovery was uneventful. He was discharged on postoperative day 6 and continues to be well 3 mo after discharge. An abdominal CT scan performed at his 3-mo follow-up demonstrated complete thrombosis of the splenic vein aneurysm, which had decreased to a 40 mm diameter. This is the first reported case of SAVF following a laparoscopic pancreatectomy and demonstrates the usefulness of endovascular treatment for this type of complication.

Treatment of cavernous sinus dural arteriovenous fistula using different surgical approaches:Analysis of 32 consecutive cases

Objective:Transarterial and transvenous embolization methods are considered effective and safe approaches for the treatment of cavernous sinus dural arteriovenous fistula(CSDAVF).Here.,we report the angioarchitectural features and clinical outcomes of CSDAVF in patients treated with either the inferior arterial approach(IAA) or the inferior petrosal sinus approach(IPSA).Methods:The clinical data of 32 patients with CSDAVF treated at our institution from May 2008 to May 2014 were retrospectively analyzed.All patients underwent routine diagnostic digital subtraction angiography(DSA) before surgery.Embolization was performed using the IPSA through the internal jugular vein or IAA,based on angioarchitectural features.Results:Of the 32 patients with CSDAVF,24 underwent embolization treatment through the internal jugular veinIPSA and 8 patients underwent treatment through IAA.Nineteen patients in the IPSA group experienced mild headache,which improved after specific treatment.The immediate postembolization angiographic results revealed complete occlusion in 26 cases(18 IPSA and 8 IAA) and almost complete occlusion in 6 cases(IPSA).Complications that occurred during the procedure included abducens nerve palsy(n=1,IPSA) and prosopoplegia(n=1,IAA).One patient developed tinnitus,which was diagnosed as anterior cranial fossa new-onset dural arteriovenous fistula on DSA,whereas the symptoms of other patients all improved with no recurrence.Conclusions:On the basis of the angioarchitectural features of CSDAVF,IAA can be considered the primary treatment when the blood-supplying artery and fistula are relatively singular,and when the microcatheter can easily reach the fistula through the artery.The venous approach should be selected as the primary approach when the fistula is indistinguishable and blood is supplied by multiple arteries through small plexiform vessels.Choosing the optimal surgical approach may increase the success rate of intravascular CSDAVF surgery and may help avoid complications.