Atherosclerosis, a prevalent cause of coronary artery disease (CAD), is severely detrimental to human health, causing significant issues. Coronary magnetic resonance angiography (CMRA) offers a contrasting approach to coronary computed tomography angiography (CCTA) and invasive coronary angiography (ICA), providing another avenue for examination. A prospective evaluation of the viability of 30 T free-breathing, whole-heart, non-contrast-enhanced coronary magnetic resonance angiography (NCE-CMRA) was the objective of this investigation.
With Institutional Review Board approval in place, the independently collected NCE-CMRA data sets of 29 patients at 30 T were assessed by two masked readers for coronary artery visualization and image quality using a subjective grading system. At the same time, the acquisition times were observed and recorded. A percentage of the patients underwent CCTA procedures. We quantified stenosis using scores, and the concordance between CCTA and NCE-CMRA was evaluated using the Kappa statistic.
Severe artifacts prevented six patients from obtaining diagnostic image quality. The image quality, assessed by both radiologists, attained a score of 3207, which underscores the NCE-CMRA's remarkable capacity for portraying the coronary arteries effectively. The reliability of assessment for the principal coronary vessels on NCE-CMRA images is considered high. A full NCE-CMRA acquisition cycle consumes 8812 minutes of time. Selleck IK-930 The Kappa statistic for CCTA and NCE-CMRA in stenosis detection is 0.842 (P<0.0001).
In a short scan time, the NCE-CMRA provides reliable visualization parameters and image quality related to coronary arteries. The NCE-CMRA and CCTA findings exhibit a considerable degree of overlap in terms of detecting stenosis.
A short scan time is sufficient for the NCE-CMRA to produce reliable image quality and visualization parameters for coronary arteries. The NCE-CMRA and CCTA yield comparable results for the detection of stenosis.
The development of vascular calcification and subsequent vascular disease stands as a substantial factor in the cardiovascular burden faced by individuals with chronic kidney disease, impacting both morbidity and mortality. Peripheral arterial disease (PAD) and cardiac disease risk are significantly amplified by the presence of chronic kidney disease (CKD). Investigating the atherosclerotic plaque's elements and their associated endovascular considerations within the population of end-stage renal disease (ESRD) patients is the aim of this paper. A critical analysis of the literature assessed the current state of medical and interventional treatments for arteriosclerotic disease in patients with chronic kidney disease. 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.
The presence of numerous atherosclerotic lesions in chronic renal failure patients, combined with high rates of (re-)stenosis, results in problems over the mid- and long-term periods. Vascular calcium buildup frequently predicts treatment failure in endovascular procedures for peripheral artery disease and future cardiovascular issues (such as coronary artery calcium measurement). Peripheral vascular intervention procedures, particularly in patients with chronic kidney disease (CKD), frequently result in poorer revascularization outcomes and a greater predisposition towards major vascular adverse events. Drug-coated balloons (DCBs) in PAD show varying efficacy based on calcium burden, mandating the design of advanced tools for calcium removal and vascular support, including endoprostheses and braided stents. Patients bearing a chronic kidney disease diagnosis are more vulnerable to developing contrast-induced nephropathy. Recommendations, including the intravenous administration of fluids, and the consideration of carbon dioxide (CO2), are crucial.
One option to potentially provide a safe and effective alternative to iodine-based contrast media allergies, and its use in CKD patients, is angiography.
There are considerable complexities inherent in the management and endovascular procedures of individuals with ESRD. The development of newer endovascular therapeutic methods, such as directional atherectomy (DA) and the pave-and-crack technique, has occurred over time to effectively target substantial vascular calcium burden. Vascular patients with CKD, beyond interventional therapy, gain significant advantages from an aggressive medical approach.
Endovascular procedures and the management of ESRD patients are multifaceted. During the course of time, new endovascular therapies, including directional atherectomy (DA) and the pave-and-crack technique, have been created to handle substantial vascular calcium levels. For vascular patients with CKD, aggressive medical management is crucial, alongside interventional therapy.
Hemodialysis (HD), a crucial treatment for end-stage renal disease (ESRD) patients, is frequently performed using an arteriovenous fistula (AVF) or graft. Dysfunction from neointimal hyperplasia (NIH) and the subsequent stenosis create difficulties for both access points. The primary treatment for clinically significant stenosis, percutaneous balloon angioplasty using plain balloons, demonstrates high initial success rates; however, long-term patency is often poor, prompting a requirement for frequent reintervention. 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 initial examination, part one of a two-part review, scrutinizes the mechanisms behind arteriovenous (AV) access stenosis, emphasizing the supporting evidence for high-quality plain balloon angioplasty interventions, and focusing on tailored treatment strategies for specific stenotic lesions.
An electronic search of PubMed and EMBASE databases yielded relevant articles published between 1980 and 2022. A review of the highest available evidence on stenosis pathophysiology, angioplasty methods, and treatment strategies for different fistula and graft lesions was included in this narrative review.
Vascular damage, triggered by upstream events, and the subsequent biological response, indicated by downstream events, are essential components of the development of NIH and subsequent stenoses. Employing high-pressure balloon angioplasty is the primary treatment for the majority of stenotic lesions, with ultra-high pressure balloon angioplasty reserved for resistant instances and prolonged, progressive balloon upsizing for flexible lesions. Lesions such as cephalic arch and swing point stenoses in fistulas, and graft-vein anastomotic stenoses in grafts, require consideration of additional treatment methods, among other specific conditions.
Successfully treating the majority of AV access stenoses often involves high-quality plain balloon angioplasty, meticulously performed based on the available evidence regarding technique and lesion-specific considerations. Though initially promising, patency rates exhibit a lack of lasting effect. In the subsequent portion of this analysis, we will examine the dynamic function of DCBs, entities aiming to enhance angioplasty results.
Plain balloon angioplasty, high-quality and informed by the available evidence on both technique and lesion-specific factors, proves successful in managing the majority of stenoses in AV access. Selleck IK-930 While the initial patency rates were encouraging, they failed to demonstrate long-term persistence. Concerning DCBs, the second part of this review examines their evolving role in improving angioplasty outcomes.
Arteriovenous fistulas (AVF) and grafts (AVG) continue to be the principal surgical method for obtaining hemodialysis (HD) access. The global pursuit of dialysis access independent of catheters endures. Crucially, a universal hemodialysis access method is not applicable; each patient necessitates a tailored, patient-centric access creation process. The paper undertakes a comprehensive review of the literature and current guidelines on upper extremity hemodialysis access types and their respective outcomes. In addition, we will detail our institutional knowledge pertaining to the surgical creation of upper extremity hemodialysis access.
The literature review draws upon 27 relevant articles published between 1997 and today, along with a single case report series from 1966. Electronic databases, such as PubMed, EMBASE, Medline, and Google Scholar, were diligently searched to compile the required sources. Articles in English were the only ones considered, with the study designs ranging from current clinical guidelines to systematic and meta-analyses, randomized controlled trials, observational studies, and two primary vascular surgery textbooks.
Surgical approaches to creating upper extremity hemodialysis accesses are the exclusive concentration of this review. The patient's anatomy, and the critical need for a graft versus fistula, are the foundational components in the decision-making process. The patient's pre-operative assessment must encompass a complete history and physical examination, paying particular attention to previous central venous access attempts and the precise depiction of vascular anatomy through ultrasound imaging. When constructing an access point, the farthest location on the non-dominant upper limb is often recommended, and autogenous access is more desirable than a prosthetic one. The author's review discusses a variety of surgical approaches for establishing upper extremity hemodialysis access, and the related practices implemented at the institution. Selleck IK-930 For optimal access function, meticulous postoperative follow-up and surveillance are mandatory.
Despite evolving approaches to hemodialysis access, arteriovenous fistulas remain the primary focus for patients with compatible anatomy, as per the latest guidelines. Preoperative patient education, meticulous surgical technique, intraoperative ultrasound assessment, and cautious postoperative management are indispensable for achieving success in access surgery.