ObjectiveTo explore the value of ultrasound evaluation and marking before arteriovenous internal fistula in end-stage renal disease hemodialysis patients. MethodsTwenty-five uremia end-stage patients were admitted into our nephrology department from January 2012 to July 2012. All of the patients had encountered several times of fistula failure or had difficulty in establishing the forearm arteriovenous fistula. We focused on observing the brachial artery, radial artery, cephalic vein, the basilica vein and great saphenous vein. We measured the diameter of the vessels and marked the trend of arteries and veins in the body surface under the ultrasonic navigation. Our goal was to look for appropriate bypass vessels in the elbow and the upper arm. ResultsFourteen patients had endured several times of fistula failure. Among the 14 patients, 9 patients completed the surgery of reengineering fistula and autogenous great saphenous vein transplantation, 2 accepted artificial vascular transplantation, 1 completed the removal of blood clots in the left upper limb artificial blood vessels and arteriovenous internal fistula molding, and 2 gave up surgery. Eleven patients could not complete the arteriovenous fistula operation for the fine forearm superficial vein. Of them, 2 patients accepted artificial vascular operation, 6 underwent autogenous great saphenous vein transplantation, 1 with slender radial artery in diameter completed higher position fistula between the brachial artery and median cubital vein, and 2 gave up surgery. ConclusionArteriovenous internal fistula preoperative ultrasound assessment and marking have very important value in improving the success rate of operation in end-stage uremia patients.
ObjectiveTo explore the ultrasonic morphological indexes influencing the effectiveness of ultrasound-guided thrombin injection (UGTI) in the treatment of iatrogenic femoral artey pseudoaneury (IFAP).MethodsThe patients with IFAP treated by UGTI in the West China Hospital of Sichuan University from 2015 to 2017 were collected according to the inclusion criteria. The demographic data, comorbidities, clinical symptoms, ultrasonic morphological parameters, thrombin dosage, and postoperative complications were analyzed. The risk factors of technical success of UGTI were analyzed by logistic regression analysis. The technical success was defined as absence of flow within the FAP immediately after UGTI. ResultsA total of 53 patients who met the criteria of inclusion were included in this study. The technical and treatment success rates of UGTI were 84.9% (45/53) and 96.2% (51/53), respectively. No deep venous thrombosis, arterial thromboembolism, infection, bleeding, allergy, and other complications or death occurred in all patients. There were no statistical differences in the age, clinical symptoms, comorbidities (except hypertension, P=0.040), ultrasonic morphological parameters (except femoral artery diameter, P<0.001), and thrombin dosage between the patients with technical success and failure (P>0.05). Multivariate logistic regression analysis showed that the smaller femoral artery diameter was the risk factor of the technical failure [OR=0.350, 95%CI (0.165, 0.743), P=0.006]. Further adjustment of thebaseline data of patients (excluding patients with hypertension), the logistic regression analysis still found that smaller femoral artery diameter was the risk factor of the technical failure [OR=0.419, 95%CI (0.205, 0.860), P=0.018].ConclusionsUGTI in treatment of IFAP is minimally invasive and has a higher technical success rate. Smaller femoral artery diameter might affect technical success rate of UGTI.