[ Diabetes Type 1 ]

Angiographic mapping of AV fistula related vascular complications in ESRD via multislice CT; adjuvant role

Worldwide, older diabetic patients represent the most rapidly growing group of patients treated for end-stage renal disease (ESRD). Unfortunately, the wrist fistula is often not practical and the upper arm fistula is hindered by several complications. The aim of our study was to compare outcomes of diabetic and non-diabetic patients undergoing formation of a new upper limb arteriovenous fistula (AVF) to assess whether diabetes has a prognostic effect on outcome. Strategies. A review of current published literature demonstrates variability in the definition of primary failure3. To overcome this drawback, a brachiocephalic jump graft fistula was designed. The particles that are filtered include the toxins that need to be removed from the body such as urea, creatinine and potassium, while larger blood cells and protein the body needs cannot pass through.

When these two vessels are connected, the vein grows larger and is able to handle more blood volume. Usually an AV fistula is made in the arm or leg so it is easily accessible for dialysis treatment. Serum glucose level was 20.2 mmol/l, haemoglobin A1C was 11.2%, white blood cell count was 18,600/μl. The patient is taught to do exercises—such as squeezing a rubber ball—to help the fistula mature for use. The exercises your doctor recommends will depend on where your fistula is located. Access decisions have a significant impact on patient outcome1. Conclusions: This study showed a marked difference between patency and functional patency, likely to be explained by high primary failure rates.

The equipment is less expensive, requiring fewer personnel and less demanding facilities than angiography that provides direct visual imaging of the access and measurement of access flow (7). There were 13 males and 19 females. Radiologists familiar with these techniques can help to improve the prognosis and quality of life for hemodialysis patients (8). Mean age differed between the two groups, at 59.97 years (± 10.12) for the diabetic patients and 52.54 years (± 14.83) for non-diabetic patients (p = 0.0010). 2). Agreement between CDUS and CTA results was performed. Then CDUS and CTA results were compared with gold standard surgery results.

(B) Following 5 mm angioplasty, … Provide a visual inspection of the limb and access site noting areas of redness, swelling, dilatation, presence of collateral vessels, and palpable prominent localized areas of pulsations (suggesting pseudo aneurysm). Color Doppler examination: patient is most often supine, with arm relaxed and extended out to the side with area to be evaluated closest to the sonographer, or examined in the sitting position. With peritoneal dialysis, there’s also a risk of peritonitis, an infection of the peritoneal cavity. CT angiography: patient is placed supine, with the AVF arm placed beside the body leaving a small gap between the arm and the body to avoid vein compression, while an IV catheter is placed in the opposite arm which is raised above the head to reduce artifacts. The reason we suggest the arm-down rather the arm-up position is that the arm-down position is the neutral position of the upper limb. When the arm is up, motion artifact is usually observed because the patients, who are usually older and have joint motion limitations, are uncomfortable.

The contrast is injected into a peripheral vein in the opposite arm, thus avoiding any damage to the access site. Doppler ultrasound device was utilized (Elegra; Siemens Medical Systems, Erlangen, Germany) with linear array transducers (5–10 MHz) were used for superficial vascular imaging (the access itself) while curved and phased arrays transducers were used for deeper vascular imaging such as inflow arteries, central veins in the neck and shoulder, or in obese patients. Venous study: arm is scanned from proximal to distal. Essential parameters to be measured: venous depth, internal diameter, compliance/ability to dilate, continuity with deep system, presence of stenosis/ thrombosis. Normal change of the signal during deep Inspiration and Expiration (Respiratory filling of the vein) indicates patency of the Superior Vena Cava. Arterial study: Standard arterial Doppler protocol should be used, with Doppler angle correct of less than or equal to 60 degrees, and parallel to vessel walls. Measured arterial parameters should include internal diameter, presence of calcifications or stenosis, thickness/disease of vessel wall, peak systolic velocity (PSV), end-diastolic velocity (EDV) and flow rate.

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