This is a published report co-written by our own Dr. Jeffrey E. Hull, entitled Supraclavicular Brachial Plexus Block for Arteriovenous Hemodialysis Access Procedures.
“Ultrasound-guided supraclavicular brachial plexus block using 1% and 2% lidocaine in 21 procedures is reported. Average procedure time was 5.1 minutes ( 1.2 min; range, 2–8 min). Average time of onset and duration were 4.8 minutes ( 3.7 min; range, 0–10 min) and 77.9 minutes ( 26.7 min; range, 44–133 min), respectively, for sensory block and 8.4 minutes ( 5.7 min; range, 3–23 min) and 99 minutes ( 40.5 min; range, 45–171 min), respectively, for motor block. The pain scale assessment averaged 0.4 ( 1.1; range, 0–4). There were no complications.
“In summary, the TRAD successfully created functioning percutaneous AVFs with a low rate of complications and acceptable maturation and dialysis rates. In the current paradigm, all percutaneous fistulae require procedures to adjust flow, prevent unwanted deep flow, or direct flow into the target vein for cannulation. Additional investigation is warranted and under way.”
This is a published report co-written by our own Dr. Jeffrey E. Hull, entitled Percutaneous Valvulotomy as an Alternative to Transposition of a Brachiocephalic Fistula.
“Transposition of a deep (9–12 mm) autogenous brachiocephalic vein fistula was required for adequate hemodialysis access in a morbidly obese patient. The patient was a poor candidate for surgical transposition of the upper-arm cephalic vein. As an alternative, retrograde fistula flow was established percutaneously through a 6-F sheath in the forearm cephalic vein with the over-the-wire LeMaitre valvulotome. The retrograde flow in the forearm added 7 cm of superficial vein 6.2–9 mm in diameter with a flow rate of 940–2,868 mL/min, eliminating the need for surgical transposition. The percutaneous technique and required anatomy are described.”
This is a published report co-written by our own Dr. Jeffrey E. Hull entitled Computational Fluid Dynamic Evaluation of the Side-to-Side Anastomosis for Arteriovenous Fistula.
Objective: The goal of this research was to compare side-to-side (STS) and end-to-side (ETS) anastomoses in a computer model of the arteriovenous fistula with computational fluid dynamic analysis.
Methods: A matrix of 17 computer arteriovenous fistula models (SolidWorks, Dassault Systèmes, France) of artery-vein pairs (3-mm-diameter artery D 3-mm-diameter vein and 4-mm-diameter artery D6-mm-diameter vein elliptical anastomoses) in STS, 45 ETS, and 90 ETS configurations with cross-sectional areas (CSAs) of 3.5 to 18.8 mm2 were evaluated with computational fluid dynamic software (STAR-CCMD; CD-adapco, Melville, NY) in simulations at defined flow rates from 600 to 1200 mL/min and mean arterial pressures of 50 to 140 mm Hg. Models and configurations were evaluated for pressure drop across the anastomosis, arterial inflow, venous outflow, arterial outflow, velocity vector, and wall shear stress (WSS) profile.
This is a published report co-written by our own Dr. Jeffrey E. Hull entitled Mapping of the Snuffbox and Cubital Vessels for Percutaneous Arterial Venous Fistula (pAVF) in Dialysis Patients.
Purpose: Report on the anatomic qualification of the snuffbox radial artery (SBRA) and proximal radial artery (PRA) for pAVF.
Methods: Retrospective analysis of upper extremity mapping in 64 limbs in 55 dialysis patients was performed. The radial artery was assessed for diameter, patency, flow and proximity to the adjacent vein to SBRA and PRA. Sites qualified for pAVF on a binary basis when the in situ radial artery and adjacent vein were straight, parallel, greater than 2 mm in diameter and within 1.5 mm of each other. Effect of age, sex, diabetes, systolic blood pressure and obesity were assessed with logistic regression. Mean, median and frequency distribution of vessel diameter and distance were analyzed.
This is a published report co-written by our own Dr. Jeffrey E. Hull entitled Bard Recovery Filter: Evaluation and Management of Vena Cava Limb Perforation, Fracture, and Migration.
PURPOSE: To report on the evaluation and management of Bard Recovery filter limb perforation, fracture, and migration.
MATERIALS AND METHODS: In 2007, all patients who received a Bard Recovery filter at a single institution were contacted for consultation and evaluation by noncontrast computed tomography. Rates of limb perforation, fracture, and migration were evaluated on early (<180 days) and final images. Retrieval success and complications were evaluated.
This is a published report co-written by our own Dr. Jeffrey E. Hull entitled Tenecteplase in Acute Lower-leg Ischemia: Efficacy, Dose, and Adverse Events.
PURPOSE: To prospectively evaluate tenecteplase (TNK) for thrombolysis in acute lower-limb ischemia.
MATERIALS AND METHODS: Forty-three consecutive limbs in 37 patients (15 male, 22 female) were treated for acute lower-limb ischemia. Group 1 included 22 limbs treated with TNK infusion of 0.25 mg/h and group 2 included 21 limbs treated with TNK at 0.125 mg/h. Technical success was defined by 95% clearing of thrombus, and clinical success was defined by Society of Interventional Radiology category for acute ischemia of 1. Complications were ranked by severity and relation to TNK administration. Logistic regression, Student t test, and analysis of variance were performed.
“There was significant fibrinogen depletion with use of reteplase for PAO. The percent decrease in fibrinogen level correlates with lack of complications and incidence of minor and major complications. Abciximab use did not increase the complication rate. Thrombolysis of grafts is associated with increased incidence of complications and worse outcomes compared with thrombolysis of native arteries.”