Venous pressure monitoring is an important indicator for the arteriovenous fistula evaluation. Direct static venous pressure monitoring is recognized as the most accurate way of venous pressure monitoring, which is widely used in the functional monitoring, functional evaluation of arteriovenous fistula, the diagnosis of complications and the evaluation of surgical efficacy. Venous pressure monitoring has obvious advantages and disadvantages, so it is necessary to improve relevant knowledge to correctly guide clinical diagnosis and treatment. In this paper, the study of static venous pressure monitoring of arteriovenous fistula was summarized, in order to improve the understanding of the significance and clinical application of static venous pressure monitoring of arteriovenous fistula.
At present, the whole lifecycle management of vascular access for hemodialysis in China is still in its early stages. Faced with a large group of chronic kidney disease patients, hospitals at all levels lack systematic and continuous nursing management models. To address the issue of lacking continuous and effective nursing management of vascular access for dialysis during the period from hospitalization for autologous arteriovenous fistula surgery to outpatient maintenance hemodialysis treatment, this article introduces the background, specific implementation methods, and preliminary results of the new model of integrated medical and nursing follow-up management of vascular access for patients with hemodialysis during hospitalization and outpatient period constructed by the Wenjiang Hemodialysis Center of West China Hospital, Sichuan University. The purpose is to explore a new model for continuous and effective management of vascular access for hemodialysis patients.
ObjectiveTo summarize the diagnosis and treatment experience of one case of abdominal aortic aneurysm with iliac arteriovenous fistula.MethodsA case of abdominal aortic aneurysm with left iliac arteriovenous fistula admitted to Nanchong Central Hospital in December 2019 was retrospectively analyzed. The diagnosis and treatment of the patient and the MDT discussion results were summarized.ResultsThe clinical manifestations of this patient was refractory heart failure, and he received heart medicine treatment in Nanchong Center Hospital. The patient diagnosed as abdominal aortic aneurysm with left iliac arteriovenous fistula after computed tomography angiography (CTA), abdominal aorta lumen coated stents isolation (EVAR) during operation was performed after the MDT discussion. Postoperative imaging revealed a tumor cavity abdominal aortic aneurysm and left iliac arteriovenous fistula completely closed, then the heart failure symptoms of the patient was quickly relieved. The whole operation went smoothly, with a duration of about 120 min and intraoperative blood loss of about 100 mL. The patient was discharged from hospital on the 7th day after the operation. CTA and color doppler ultrasound were rechecked in 3 months after the operation, and the stent was found to have unobtrusional blood flow and no internal leakage, and the pseudoaneurysm of the left iliac artery disappeared.ConclusionsFor patients with refractory heart failure, if accompanied by lower limb swelling, the possibility of arteriovenous fistula of the great vessels should be taken into account, and the medical history and physical examination should be collected comprehensively, and necessary examinations should be carried out timely to avoid missed diagnosis or misdiagnosis. Meanwhile, compared with traditional surgery, EVAR is a more reliable, minimally invasive, and safe treatment for abdominal aortic aneurysm with iliac arteriovenous fistula.
ObjectiveTo explore the clinical characteristics and improve the knowledge of diagnosis and treatment of complex pulmonary arteriovenous fistula (PAVF) as well as enrich the experience of diagnosis and treatment of the disease.MethodsA retrospective analysis of pathogenetic process clinical manifestations, imaging features and diagnosis and treatment was conducted on one case of complex PAVF. The literature review was carried out with " complex pulmonary arteryovenous fistula (malformation)” as the research terms in English and Chinese respectively in CNKI, WanFang and PubMed database. Search time ranged from January 1997 to April 2018, and the literature was screened and reviewed.ResultsThe patient was a 47-year-old female complained of recurrent epistaxis for 40 years, intermittent hemoptysis for 20 years, headache, dizziness, chest pain, chest tightness for 4 years and the symptoms were aggravated by 3 months, visiting this hospital on January 23, 2018. Pulmonary CT angiography revealed multiple nodules in internal and external segment and outer basal segment of right lung, anterior basal segment and outer basal segment of left lung. CT enhanced scan showed that the thickened pulmonary artery was connected with the above lesion, and the edge was accompanied by large draining veins. Pulmonary artery revascularization showed complex PAVF abnormal branches. The diagnosis was complex PAVF, and interventional embolization therapy was carried out and curative effect was satisfactory during the follow-up. A total of 6 literatures were reviewed in above-mentioned databases, including 4 Chinese literatures and 2 English literatures, containing 10 patients, including 8 males and 2 females, with an average age of (9.7±7.0) years. Most of the clinical manifestations were shortness of breath after exercise, cyanosis and hemoptysis and all patients were cured and discharged after interventional embolization treatment except for 1 patient refused treatment.ConclusionsComplex PAVF is a very rare pulmonary vascular malformation. The clinical manifestations mainly include hypoxemia, dyspnea, hemoptysis, and the preferred treatment is interventional embolization, which has a satisfactory clinical effect at a short-term follow-up.
Objective To develop and validate a nomogram based on Doppler ultrasound hemodynamics at 2 weeks post-surgery for predicting autogenous arteriovenous fistula (AVF) maturation failure. Methods Patients with end-stage renal disease who underwent first-time AVF surgery between March 2023 and September 2025 were selected. Patients were classified into the maturation group and maturation failure group according to AVF status at 6 weeks post-surgery. Predictive variables were screened using LASSO regression, and a nomogram was constructed via multivariable logistic regression. Model performance was evaluated using area under the curve (AUC), calibration curves, and decision curve analysis. Results A total of 260 patients were included. Among 260 patients, 94 (36.2%) experienced AVF maturation failure. Seven variables were selected by LASSO regression: female gender, diabetes, draining vein diameter, vascular access blood flow, pulsatility index, vein depth, and anastomotic stenosis. Multivariable logistic regression demonstrated that female gender, diabetes, smaller draining vein diameter, lower vascular access blood flow, and higher pulsatility index were independent predictors (P<0.05). The nomogram yielded an AUC of 0.924 [95%CI (0.893, 0.956)], with a bootstrap-corrected AUC of 0.912. The model showed good calibration (χ2=3.703, P=0.883) and clinical net benefit. Conclusion The established nomogram exhibits robust performance and can be integrated into the routine 2-week post-operative follow-up to facilitate early identification and individualized management of AVF maturation failure.
Objective To explore the application of multiple needle puncture technique in maintenance hemodialysis (MHD). The clinical value of autologous arteriovenous fistula (AVF) puncture in patients with MHD, analyze the impact of this technique on vascular complications, puncture pain, and nursing effectiveness, and optimize the long-term standardized puncture management of AVF. Methods Patients with AVF who were enrolled in the Department of Nephrology of the First People’s Hospital of Longquanyi District Chengdu in November 2024 were selected. Patients were categorized into the multiple needle puncture group and the rope ladder puncture group according to puncture methods. All enrolled patients completed the 18-month follow-up period, with a follow-up deadline of May 2026. The incidence of AVF vascular complications (vascular stenosis, aneurysm, thrombus), puncture pain scores, and the one-time puncture success rate of junior nurses were analyzed between the two groups at 1, 6, 12 and 18 months after intervention. ResultsA total of 102 patients were included, with 51 in each group. The results of generalized estimating equations showed that there were time effects, inter-group effects, and time-group interaction effects on vascular access complications of fistula between the two groups (P<0.05). Compared with the rope ladder puncture group, the multiple needle puncture group exhibited a lower incidence of fistula vascular stenosis, aneurysm and thrombus, and puncture pain score (P<0.05). In addition, the one-time puncture success rate of junior nurses was higher (P<0.05). Conclusions Multiple needle puncture can protect the blood vessels of internal fistula, alleviate puncture-related pain, reduce the risk of vascular access-related complications, maintain the long-term smoothness of internal fista, and improve the effectiveness of clinical care. However, this technique has some shortcomings, so the clinical choice of a puncture regimen needs to be tailored to the patient’s vascular conditions.
Objective To analyze the results of the 2024 annual competency assessment of the Hemodialysis Vascular Access Intervention Technique Specialized Training Program, evaluate trainees’ current operational competence, identify weaknesses in the training system, and provide evidence for optimizing the training curriculum. Methods From August to September 2024, trainees underwent offline practical ultrasound examinations at two sites: Chongqing (southern region) and Shijiazhuang (northern region). The examination assessed functional evaluation of arteriovenous fistulas in real maintenance hemodialysis patients, including physical examination and ultrasound evaluation. domestic mainstream ultrasound systems were used, and faculty members conducted one-on-one proctoring. Anonymous questionnaires were administered to examiners and trainees after the examination. Common problems and learning needs were ranked and scored according to severity. Results A total of 223 trainees actually participated in the offline examination, with 17 faculty members supervising the test. Among the 223 trainees, 209 passed the examination, with a pass rate of 93.7%. Examiner survey results indicated that the most prominent common problem was poor ultrasound image quality (score ratio 80.15%), followed by failure to detect clinically significant stenosis during physical examination (69.12%) and unfamiliarity with ultrasound probe manipulation (64.71%). Enhanced practical ultrasound training was identified as the most urgent learning need. Trainee survey results revealed that the most difficult examination item was visualization and diameter measurement of the anastomosis (score ratio 67.94%), while the most significant adverse factor was unfamiliarity with the ultrasound machine brand and operating interface (91.03%). A total of 76.47% of examiners and 80.92% of trainees agreed that standardized operating procedures for arteriovenous fistula physical examination and ultrasound assessment should be established as soon as possible. Conclusions Notable deficiencies were observed in ultrasound image acquisition, accuracy of physical examination, and proficiency in equipment operation. It is recommended to establish standardized operating procedures promptly, strengthen practical ultrasound training and physical examination education, refine scoring criteria, and unify training materials to improve training quality and assessment uniformity.