Coronary artery disease (CAD), one of the most prevalent and harmful illnesses, is directly caused by the insidious presence of atherosclerosis. Coronary computed tomography angiography (CCTA), invasive coronary angiography (ICA), and coronary magnetic resonance angiography (CMRA) represent three modalities that can be utilized in diagnostics. The intent of this prospective study was to assess the possibility of employing 30 T free-breathing whole-heart non-contrast-enhanced coronary magnetic resonance angiography (NCE-CMRA).
Upon Institutional Review Board authorization, the NCE-CMRA datasets from 29 patients, acquired at 30 T, were independently examined by two masked readers, focusing on the visualization and image quality of the coronary arteries, graded subjectively. Meanwhile, the acquisition times were documented. A selection of patients underwent CCTA, where stenosis was scored, and the consistency between CCTA and NCE-CMRA measurements was assessed by evaluating the Kappa score.
Severe artifacts negatively impacted the diagnostic image quality of six patients. Both radiologists agreed that the image quality score reached 3207, unequivocally indicating that the NCE-CMRA provides excellent visualization of the coronary arteries. NCE-CMRA images offer a reliable means of evaluating the major coronary arteries. A full NCE-CMRA acquisition cycle consumes 8812 minutes of time. see more Stenosis detection using both CCTA and NCE-CMRA achieved a Kappa value of 0.842, statistically significant (P<0.0001).
Coronary artery visualization parameters and image quality are reliably produced by the NCE-CMRA in a short scan time. The NCE-CMRA and CCTA findings exhibit a considerable degree of overlap in terms of detecting stenosis.
The NCE-CMRA technique yields reliable visualization parameters and image quality of coronary arteries, all within a short scan duration. There is a substantial concordance between the NCE-CMRA and CCTA in identifying stenosis.
The interplay of vascular calcification and consequent vascular disease plays a significant role in the cardiovascular complications and mortality seen in chronic kidney disease. Cardiac and peripheral arterial disease (PAD) is increasingly recognized as a risk factor exacerbated by the presence of chronic kidney disease (CKD). This paper examines the composition of atherosclerotic plaques, focusing on the endovascular management challenges unique to end-stage renal disease (ESRD) individuals. In patients with chronic kidney disease, a literature review investigated the current state of medical and interventional approaches to arteriosclerotic disease management. Lastly, three case studies, each displaying a common endovascular treatment option, are supplied.
A search of the PubMed database, encompassing publications up to September 2021, was performed and complemented by discussions with leading experts in the specific field.
Patients with chronic kidney disease often have a substantial number of atherosclerotic lesions, alongside frequent (re-)narrowing events. Consequently, medium- and long-term problems arise, since vascular calcium deposits are among the most prevalent indicators of failure in endovascular peripheral artery disease treatment and upcoming cardiovascular incidents (e.g., coronary calcification scores). Major vascular adverse events and worse revascularization results following peripheral vascular interventions are more prevalent among patients with chronic kidney disease (CKD). In peripheral artery disease (PAD), a correlation between calcium deposits and drug-coated balloon (DCB) effectiveness necessitates the exploration of additional strategies for managing vascular calcium, including endoprostheses or braided stents. Patients diagnosed with chronic kidney disease have a greater likelihood of experiencing contrast-induced nephropathy. Not only are intravenous fluids recommended, but also the management of carbon dioxide (CO2) levels.
An alternative to iodine-based contrast media, angiography, is potentially effective and safe for patients with CKD, as well as for those with iodine allergies.
The intricate task of managing and performing endovascular procedures in patients with ESRD demands careful consideration. Through the evolution of time, new endovascular therapies, such as directional atherectomy (DA) and the pave-and-crack technique, have been introduced to address high levels of vascular calcium. Vascular patients with chronic kidney disease (CKD) experience improved outcomes when interventional therapy is combined with a proactively managed medical approach.
Patients with ESRD face complex endovascular procedures and management. Throughout the years, advanced endovascular techniques, such as directional atherectomy (DA) and the pave-and-crack approach, have been developed to address high vascular calcium deposition. Interventional therapy, while important, is augmented by aggressive medical management for vascular patients with CKD.
A substantial number of patients suffering from end-stage renal disease (ESRD) and requiring hemodialysis (HD) access the procedure through an arteriovenous fistula (AVF) or graft. Dysfunction related to neointimal hyperplasia (NIH), and the resulting stenosis, adds to the complexity of both access points. Percutaneous balloon angioplasty with plain balloons, while effective in the initial management of clinically significant stenosis, unfortunately shows poor long-term patency, necessitating frequent reintervention procedures to maintain adequate blood flow. Recent studies have examined antiproliferative drug-coated balloons (DCBs) as a means to bolster patency rates, yet their clinical significance in treatment remains undetermined. Our review, commencing with this first part of two, delves into the mechanisms of arteriovenous (AV) access stenosis, examining evidence supporting high-quality plain balloon angioplasty techniques, and addressing treatment considerations specific to various stenotic lesions.
To locate suitable articles published between 1980 and 2022, an electronic search was carried out on both PubMed and EMBASE. Included in this narrative review were the highest-level evidence findings on stenosis pathophysiology, angioplasty procedures, and approaches to treating various lesion types present in fistulas and grafts.
A combination of vascular-damaging upstream events and subsequent biological responses, indicated by downstream events, are responsible for the development of NIH and subsequent stenoses. Utilizing high-pressure balloon angioplasty effectively treats the substantial portion of stenotic lesions, and ultra-high pressure balloon angioplasty is employed for challenging lesions, alongside progressive balloon upsizing for those that necessitate prolonged interventions. Treating specific lesions, including cephalic arch and swing point stenoses in fistulas and graft-vein anastomotic stenoses in grafts, necessitates taking additional treatment considerations into account.
The majority of AV access stenoses are successfully treated by a high-quality plain balloon angioplasty procedure, which is performed using the current evidence regarding lesion-specific considerations and techniques. Initially successful, yet the patency rates ultimately prove unreliable and short-lived. This review's second part will explore the evolving function of DCBs, whose commitment is to ameliorate the outcomes of angioplasty procedures.
The majority of AV access stenoses are successfully addressed by high-quality, plain balloon angioplasty, which is meticulously performed in accordance with the available evidence on technique and location-specific factors. see more Although successful at first, patency rates demonstrate a lack of sustained efficacy. Part two of this evaluation scrutinizes the transformative role of DCBs in their pursuit of better angioplasty results.
The surgical procedure of creating arteriovenous fistulas (AVF) and grafts (AVG) remains the cornerstone of access for hemodialysis (HD). Worldwide efforts persist in avoiding reliance on dialysis catheters for access to dialysis. Importantly, a universal hemodialysis access method is unsuitable; each patient requires a personalized and patient-centric creation of access. This paper aims to investigate the literature and current guidelines concerning upper extremity hemodialysis access types and their reported patient outcomes. In addition, we will detail our institutional knowledge pertaining to the surgical creation of upper extremity hemodialysis access.
The literature review is comprised of twenty-seven relevant articles published from 1997 to the current date, and one case report series originating from 1966. Data collection involved an exhaustive search of electronic databases, including PubMed, EMBASE, Medline, and Google Scholar, for relevant sources. Only articles published in English were examined, with the study designs varying from standard clinical practice guidelines to systematic and meta-analyses, randomized controlled trials, observational studies, and two key vascular surgery textbooks.
Surgical approaches to creating upper extremity hemodialysis accesses are the exclusive concentration of this review. The existing anatomical design and the patient's necessities dictate the course of action when considering a graft versus fistula procedure. Prior to the surgical procedure, a comprehensive patient history and physical examination are crucial, particularly focusing on any prior central venous access placements, along with an ultrasound-guided evaluation of the vascular structures. The fundamental principles of access creation involve, whenever possible, selecting the most distant point on the non-dominant upper limb, and an autogenous conduit is favored over an artificial graft. The surgeon author's review covers a range of surgical methods for creating hemodialysis access in the upper extremities, as well as the institution's procedural guidelines. see more Preserving a functioning surgical access requires close postoperative monitoring and surveillance.
The latest guidelines in hemodialysis access maintain arteriovenous fistulas as the primary target for patients with appropriate anatomical characteristics. For a successful access surgery, meticulous technique, preoperative patient education, intraoperative ultrasound, and careful postoperative management are all essential components.