Objective: To assess vascular access maturation outcomes between frail and nonfrail patients undergoing hemodialysis (HD) access creation. Materials and Methods: All consecutive patients of chronic kidney disease, aged >18 years, who were planned for HD access were included in the study and were prospectively assessed for frailty using the Program of Research on the Integration of Services for the Maintenance of Autonomy-7 (PRISMA-7) frailty questionnaire and were subsequently grouped into frail and nonfrail cohorts for outcome evaluation, during the 2 years of the study. A PRISMA-7 score of ≥3 was used to define frailty. Follow-up data were obtained through outpatient visits and inpatient records. HD access nonmaturation was assessed and recorded clinically and sonologically, along with 30 days, 60-day readmission, and 180-day all-cause mortality. Results: The cohort of the study comprised 50 patients. The mean (standard deviation [SD]) age in the frail and nonfrail group was 66.5 (11.6) years and 51.3 (9.3) years, respectively. The cohort comprised 30 males (60%) and 20 females (40%). The mean (SD) body mass index was 26.3 (4.6) kg/m2. Comorbidities like hypertension, diabetes mellitus, chronic obstructive pulmonary disease, congestive heart failure, coagulopathy, and malignancy were observed in 46, 31, 13, 23, 15 and 8 patients, respectively. The preoperative mean (SD) arterial diameter and vein diameter for the HD access were 4.18 (0.6) mm and 3.6 (0.7) mm, respectively. A total of 33 (66%) HD accesses were arteriovenous fistulas (AVFs), and 17 (34%) were arteriovenous grafts. Among the various AVFs, brachio-basilic, snuffbox, radiocephalic and brachio-cephalic fistulas were created in 6, 5, 18, and 16 patients, respectively. Myocardial infarction was seen in 40% of the frail group and none of the nonfrail group (P = 0.0002). The all-cause 180-day mortality was in 2% cohort, with one surgical site infection in each group. The 30-day and 60-day readmission was seen in 8 (16%) and 12 (24%), respectively. On multivariate logistic regression analysis, frail patients had 4.56 times higher odds of nonmaturation compared to nonfrail patients. Conclusion: The findings of this study highlight frailty as a clinically relevant, patient-centered risk factor associated with poorer HD access maturation even in the presence of comparable vascular anatomy and access planning. Routine frailty screening using simple tools such as PRISMA-7 may enhance preoperative risk stratification, facilitate informed shared decision-making, and support individualized dialysis access planning.
Accidental arterial cannulation is an uncommon but potentially catastrophic complication of central venous catheterization, even in the era of routine ultrasound guidance. We report a case of inadvertent right common carotid artery cannulation during ultrasound-guided central venous access in a critically ill patient in a peripheral hospital. The catheter was advanced intraluminally with its tip projecting into the aortic arch. The patient was transferred to a tertiary vascular center, where computed tomography angiography (CTA) precisely delineated the catheter course and excluded associated vascular injury. Open surgical carotid exploration with controlled catheter removal and primary arterial repair was performed with an uneventful outcome. This case highlights the importance of early recognition, avoidance of blind catheter removal, and imaging-guided decision-making. In particular, the report demonstrates how CTA can accurately define catheter trajectory when the catheter tip extends into the aortic arch, allowing safe operative planning and definitive repair.
A 22-year-old male was treated for Grade 3 blunt thoracic aortic trauma by thoracic endovascular aortic repair in November 2024. He presented about 6 months later with high blood pressure, dizziness, and absent lower limb pulses. A computed tomography angiography showed evidence of distal stent-induced new entry tear, which was treated successfully with a tapered endovascular stent graft.
Nutcracker syndrome (NCS) is a rare vascular compression disorder caused by extrinsic compression of the left renal vein (LRV), most commonly between the aorta and superior mesenteric artery. This leads to venous hypertension and the development of collateral venous channels, such as varicocele in men. We present the case of a 21-year-old male who presented with isolated left hemiscrotal pain and low sperm count. He was diagnosed with NCS based on imaging. Contrast-enhanced computed tomography (CT) and CT angiography revealed a narrowed aortomesenteric angle, LRV compression with a compression ratio of 3.75, and dilated gonadal and prostatic veins. Due to persistent symptoms and oligospermia, he underwent gonadal vein transposition. The case emphasizes considering NCS in varicocele and highlights surgical solutions in venous compression syndromes.
