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Abstract Background We evaluated restenosis rates at the cephalic arch after percutaneous angioplasty and stenting procedures in patients with brachial artery to cephalic vein arteriovenous fistula (BCAVF) hemodialysis access. Methods We used data from adult hemodialysis patients treated at a national network of 44 outpatient interventional facilities during Oct 2011–2015. We included data from patients with BCAVF who received an exclusive angioplasty, or stent with angioplasty, for treatment of cephalic arch stenosis and had ≥1 subsequent evaluation of the cephalic arch. Median percent restenosis per month at cephalic arch and days between encounters was calculated from the 1st index to 2nd procedure, and for up to 4 subsequent encounters. Analyses were stratified by intervention and device types. Results We identified a cohort of 3301 patients (mean age 62.2 ± 13.9 years, 58.5% male, 33.2% white race) with a BCAVF who had an angioplasty, or stent, at the cephalic arch for an index and ≥ 1 follow-up procedure. Between the 1st index to 2nd procedure, patients who received an angioplasty (n = 2663) or stent (n = 933) showed a median decrease of 18.9 and 16.5% in luminal diameter per month and a median time of 93 and 91 days between encounters, respectively. Restenosis and day rates were similar for standard versus high-pressure angioplasties. Bare metal stents showed 10.1 percentage point higher restenosis rate compared to stent grafts. Restenosis rates and time to restenosis were relatively consistent across subsequent encounters. Conclusions Findings suggest hemodialysis patients with a BCAVF who require an angioplasty or stent to treat a stenosis at the cephalic arch will have stenosis reformed at a rate of 18.9 and 16.5% per month after the first intervention, respectively. Findings suggest patients are at risk of having significant lesions at the cephalic arch within 3 months after the previous intervention.

Haiti has experienced an explosion of the use of motorcycles by young, inexperienced drivers fueled by the departure of aid workers leaving them behind after assisting with disaster relief. The consequence is a strain on Haiti’s already fragile medical system due to the overwhelming number of traumas presenting for treatment. The motorcycles have become an indispensible form of transportation but lack of governmental oversight predisposes an environment that is primed to strain the country’s already limited medical assets.

Introduction: Cerebral edema, as assessed by computer-assisted tomography, has beenproposed as a prognosis factor of poor outcome following aneurysmal subarachnoidhemorrhage. However, this radiological finding might wrongly influence the decision tomaintain or withdraw treatment in critically ill patients.Case Report: We present the case of a 63-year-old female presenting with poor clinicalgrade after an aneurysmal rupture that developed extensive right hemispheric cytotoxicedema. With appropriate treatment, the brain edema progressively resolved and theclinical state improved.Conclusion: We discuss the importance of recognizing the possible reversibility of suchextensive hemispheric edema and its relevance to patient management. [ABSTRACT FROM AUTHOR]