The number of patients in dialysis increases every year. In this review, we will evaluate the role of percutaneous transluminal angioplasty (PTA) according to patency of arteriovenous fistula and grafts. The main indication of PΤΑ is stenosis > 50% or obstruction of the vascular lumen of an arteriovenous fistula and graft. It is usually performed under local anesthesia. The infection rate is as low as the number of complications. Fistula can be used in dialysis in the same day without the need for a central venous catheter. Primary patency is >50% in the first year while primary assisted patency is 80–90% in the same time period. Repeated PTA is as durable as the primary PTA. An early PTA carries a risk of new interventions. Cutting balloon can be used as a second-line method. Stents and covered stents are kept for the management of complications and central outflow venous stenosis. PTA is the treatment of choice for stenosis or obstruction of dialysis fistulas. Repeated PTA may be needed for better patency. Drug eluting balloon may become the future in PTA of dialysis fistula, but more trials are needed.
Abstract. Background/Aim: Cytomegalovirus (CMV) infection is a common disease especially in young adults. Thromboembolism like deep vein thrombosis and pulmonary embolism is increased among patients with CMV infection. Most cases represent immunocompromised patients usuallyCytomegalovirus (CMV) infection is usually asymptomatic or resembles infectious mononucleosis syndrome, which is characterized by fever, malaise, muscular-skeletal pain, lymphadenopathy and atypical lymphocytosis. Of note, the reports of thromboembolic events such as pulmonary embolism (PE) associated to acute CMV infection are increasing (1). Venous thromboembolism has been reported in association with CMV infection both in immunocompromised and immunocompetent patients. In the latter population, it is yet not determined whether CMV alone provokes venous thromboembolism (VTE) or other predisposing conditions are involved (2, 3). The correct assessment of the patient's clinical status, in association with the procoagulant risk factors could be useful to reach the diagnosis of PE. We present and analyze the first -to our knowledge-case of CMV related PE in an immunocompetent young patient, treated with novel oral anticoagulants (NOACs). Case ReportA 25-year-old male presented to the emergency room with sudden onset of chest pain. One month prior to the admission, he had developed persistent fever and cough, and following detailed assessment, diagnosis of CMV infection was established. There was no history of smoking, alcohol intake or other comorbidities. His temperature was 36.9˚C, blood pressure was 125/55, heart rate 125/min, respiratory rate 22/min with oxygen saturation 100% at 2lt of oxygen.
Background Postoperative parotitis is a rare complication that occurs usually after abdominal surgery. Parotitis has never been described as a complication of vascular operations, in literature. In the present article, we describe a case of a postamputation parotitis along with its management and its possible pathogenesis. Case Report An 83-year-old diabetic man was emergently admitted to hospital because of gangrene below the right ankle and sepsis. The patient underwent a lower limb amputation above the knee. On the 5th postoperative day, he was diagnosed with right parotitis probably because of dehydration, general anesthesia, and immunocompromisation. A CT scan confirmed the diagnosis. He received treatment with antibiotics and fluids. His condition gradually improved, and he was finally discharged on 15th postoperative day. Conclusions Postoperative parotitis can possibly occur after any type of surgery including vascular. Clinicians should be aware of this complication although it is rare. Several risk factors such as dehydration, general anesthesia, drugs, immunocompromisation, head tilt during surgery, and stones in Stensen's duct may predispose to postoperative parotitis. Treatment consists of antibiotics and hydration.
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