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Purpose: To report the patency rates after implantation of an interwoven nitinol stent to salvage failing arteriovenous grafts (AVGs) caused by intragraft stenoses. Methods: Between May 2018 and May 2020, 21 Supera stents were placed in 20 patients (18 women; mean age: 79.9 years) who had a failing AVG due to repeat intragraft stenoses. Recurrent AVG dysfunction with same intragraft stenosis within 3 months after first time angioplasty was a criterion for stenting. Those with concurrent treatment for other lesions were excluded. Results: The technical success rate was 100%. Intragraft stenoses were treated at a median of 19.7 (interquartile range: 6–36) months after graft creation. Access circuit primary patency rates after stent placement were 84% and 35% at 6 and 12 months, respectively. Access circuit secondary patency rates were 100% at 6 and 12 months and 89% at 18 months. Only one patient presented with graft failure due to proximal drainage vein occlusion. The target lesion patency rates were 100% at 6 months and 75% at 12 months. The rate of reintervention for intragraft lesion was 0.15 procedures per year. Stent distortion did not occur under regular cannulation. Conclusion: The interwoven nitinol stent is a promising treatment for failing AVGs with recurrent intragraft stenoses. The 1-year access circuit primary, secondary, and target lesion patency rates were acceptable, with a low reintervention rate. Stent fracture does not occur in areas of needle puncture.

A 74-year-old male with chronic kidney disease presented to the emergency department with asystole. Mechanical chest compression was started immediately using a piston-type thumper device. The initial potassium level was 7.7 mEq/L and bedside point-of-care ultrasound (POCUS) revealed no pericardial fluid. With standard resuscitation and anti-hyperkalemia treatment, return of spontaneous circulation (ROSC) was achieved within 10 minutes of compressions. At 15 minutes post-ROSC, the patient went into pulseless electrical activity. A repeated POCUS discovered massive pericardial fluid suggesting the presence of cardiac tamponade. Bedside pericardiotomy was performed followed by open thoracotomy. Laceration of the right ventricular wall adjacent to the fracture site of sternum was found, implicating that it was the complication of mechanical chest compression. After surgical repair and intensive post-operative care, the patient survived with full conscious recovery at day 6 of admission. Our case emphasizes the importance of POCUS in resuscitation, especially when the patient's condition deteriorates unexpectedly. Keywords: Cardiac rupture, Mechanical chest compression, Ultrasound

Background: We report the initial experience of modified four-branched graft technique for proximal aorta and arch repair, feasibly combined with antegrade thoracic endovascular aortic repair (TEVAR) to extend distal aortic reconstruction in acute type A aortic dissection. Methods: From 2011 to 2013, 12 consecutive patients with acute type A aortic dissection were indicated for arch surgery and underwent surgical replacement of proximal aorta, arch replacement or debranching procedure, and concomitant TEVAR for distal aortic repair. Results: A good surgical field was obtained in all patients. No major complications developed but two hospital deaths were attributed to end-organs damage preoperatively. Good and fast remodeling of thoracic descending aorta was demonstrated in 11 patients in postoperative CT imaging and no aneurysmal dilatation of visceral aorta had been observed in 10 patients during follow-up periods. Conclusion: Modified four-branched graft technique facilitated proximal aorta and arch repair, and provided excellent neurological outcome and favorable short-term results. Single-stage operation combined with antegrade TEVAR is feasible and effective to extend the repair down to the descending aorta, and thus achieved good remodeling of thoracic descending aorta.

Abstract. Background: In this study, we investigated the patency of endovascular stent grafts in haemodialysis patients with arteriovenous grafts, the modes of patency loss, and the risk factors for re-intervention. Patients and methods: Haemodialysis patients with graft-vein anastomotic stenosis of their arteriovenous grafts who were treated with endovascular stent-grafts between 2008 and 2013 were entered into this retrospective study. Primary and secondary patency, modes of patency loss, and risk factors for intervention were recorded. Results: Cumulative circuit primary patency rates decreased from 40.0 % at 6 months to 7.3 % at 24 months. Cumulative target lesion primary patency rates decreased from 72.1 % at 6 months to 22.0 % at 24 months. Cumulative secondary patency rates decreased from 81.3 % at 12 months to 31.6 % at 36 months. Patients with a history of cerebrovascular accident had a significantly higher risk of secondary patency loss, and graft puncture site stenosis jeopardised the results of stent-graft treatment. Conclusions: Our data can help to improve outcomes in haemodialysis patients treated with stent-grafts for venous anastomosis of an arteriovenous graft.

Aberrant right subclavian artery aneurysms are rare but carry a high risk of spontaneous rupture without any treatment. Aggressive early elective treatment is warranted. We present a hybrid endovascular treatment that was used to treat a 77-year-old woman with aberrant right subclavian artery aneurysm for whom surgical treatment would have been associated with high risk. A thoracic stent graft was used to cover the origin of aberrant right subclavian artery at the proximal descending aorta. To prevent any retrograde flow, an Amplatzer septal occluder was deployed at the distal subclavian artery. Axillo-axillary bypass with an 8-mm polytetrafluoroethylene graft was performed due to atherosclerosis change of the common carotid artery to restore the right arm perfusion and prevent vertebrobasilar insufficiency.

BackgroundAutogenous arteriovenous fistula (AVF) has proven to be the optimal vascular access for the majority of hemodialysis patients due to its durability and low complication rates. The purpose of this study is to determine the value of intraoperative blood flow measurement with respect to AVF short-term outcome.MethodsA prospective cohort study enrolled patients undergoing first time AVF creation surgery for hemodialysis from November 2001 to April 2007. Intraoperative blood flow measurements were collected using transit time flowmeter, and primary and secondary patency rates of AVF were examined. Other variables including age, sex, the presence of diabetes, hypertension, or cerebrovascular disease, current smoking, systolic and diastolic blood pressure, heart rate, serum calcium-phosphate product, and triglyceride and cholesterol level were analyzed.ResultsAutogenous radiocephalic AVFs (n = 109) in 109 patients were constructed and followed up for an average of 21 months. Among these, 54% of patients were 60 years or older, 51% were male, and 56% were diabetics. One-year primary and secondary patency rates for the high-flow group (≥200 mL/min) were 69% and 94%, respectively. One-year primary and secondary patency rates for the low-flow group (