Objective: The study aims to assess primary and secondary patency rates and the need for reintervention after drug-coated balloon (DCB) angioplasty performed for juxta-anastomotic AVF stenoses. Methods: This retrospective observational study included patients who underwent DCB angioplasty for AVF stenosis between May 2019 and December 2023. Information on reinterventions was obtained from medical records, while AVF functional patency was assessed through Duplex Ultrasound Scanning. The primary outcomes measured were patency rates at 6, 12, and 24 months. Results: The study included 69 patients. The average age was 61.4 ± 12.7 years, with 45 (65.2%) being male. Primary patency rates were 72.5% (50/69), 46.4% (32/69), and 30.4% (21/69) at 6, 12, 24 months, respectively. Secondary patency rates were 85.5% (59/69), 59.4% (41/69), and 46.4% (32/69). Discussion: DCB angioplasty shows acceptable mid-term primary patency and sustained longer-term secondary patency for treating juxta-anastomotic stenosis in primary RC AVFs. Notably, the secondary patency rates indicate that re-interventions can help preserve the access circuit.
Background: Intravenous (IV) cannulation is a common invasive procedure associated with pain and discomfort. This study compared the short-term effects of topical Piroxicam gel, Diclofenac gel, and EMLA cream on pain during IV cannulation. Methods: This participant- and outcome assessor-blinded randomized clinical trial included 123 hospitalized patients randomly allocated to three equal groups receiving topical Diclofenac gel, Piroxicam gel, or EMLA cream ( n = 41/group). Pain intensity was assessed using the Visual Analogue Scale immediately after cannulation and at 5, 10, 15, 30, and 45 min. Data were analyzed using linear mixed-effects models, with Kruskal–Wallis/Dunn and Friedman tests performed as sensitivity analyses. Categorical variables were analyzed using Chi-square or Fisher’s exact tests. Results: Baseline characteristics were comparable among groups (all p > .05). The linear mixed-effects model showed significant effects of treatment group ( p = .002), time ( p < .001), and treatment-by-time interaction ( p < .001). Bonferroni-adjusted pairwise comparisons showed lower pain intensity in the Diclofenac and EMLA groups than in the Piroxicam group immediately after cannulation and at 5 min; no significant pairwise differences were observed from 10 to 45 min. Sensitivity analyses supported the overall temporal decline in pain but showed some differences in individual pairwise comparisons. No serious adverse events were reported. Conclusion: Pain intensity declined substantially over time in all groups. In the primary analysis, Diclofenac and EMLA were associated with lower early pain intensity than Piroxicam, although some pairwise findings were sensitive to the analytical approach. Because no placebo control was included, findings should be interpreted as relative rather than absolute treatment effects. Trial registration: The trial was prospectively registered with the Iranian Registry of Clinical Trials (IRCT) under registration number IRCT20180107038251N8 on June 12, 2023 (1402/03/22), prior to the initiation of participant recruitment in October 2025. Available at: https://www.irct.ir/search/result?query=IRCT20180107038251N8
Cephalic arch stenosis is a well-recognised cause of brachiocephalic arteriovenous fistula (AVF) dysfunction, whereas congenital anomalies of cephalic vein termination are rare and may produce atypical mechanisms of dialysis access failure. We report a 60-year-old man with end-stage renal disease and a left brachiocephalic AVF who developed recurrent access dysfunction despite repeated technically successful endovascular interventions. Duplex ultrasound demonstrated a haemodynamically significant outflow stenosis. Fistulography revealed an aberrant cephalic vein coursing far medially and entering the subclavian vein from a caudal direction. Three-dimensional angiographic imaging and computed tomography demonstrated focal compression of the terminal cephalic vein between the clavicle and first rib, while the central venous system remained patent. Repeated balloon angioplasty, including drug-coated balloon angioplasty, produced only temporary improvement because of persistent extrinsic compression. Stent implantation was avoided because of the anticipated risk of mechanical compression, deformation, fracture, and poor long-term durability. Definitive treatment consisted of surgical transposition of the cephalic vein to the axillary vein, resulting in immediate haemodynamic improvement and restoration of satisfactory dialysis access function. Aberrant retroclavicular termination of the cephalic vein into the subclavian vein should be considered in patients with recurrent cephalic outflow stenosis, particularly when endovascular treatment repeatedly fails despite a patent central venous system. To our knowledge, this is the first reported case of recurrent haemodialysis access dysfunction caused by this anatomical variant and successfully treated by surgical cephalic vein transposition.
Introduction: Central venous access procedures are among the most frequently performed invasive procedures worldwide, yet they remain associated with measurable complication rates and technical challenges. Despite the widespread adoption of ultrasound guidance, limitations in needle visualization, needle stability and workflow inefficiencies persist. Methods: This study presents the first in-human feasibility evaluation of an integrated guidewire Seldinger-based central venous access system with enhanced echogenic feedback. Three experienced physicians performed central venous access on forty patients using the Seldinger-based 510k-approved Primero device vascular access system under ultrasound guidance. Results: The device demonstrated a procedural success rate of 97.5%, a successful first attempt placement rate of 95%, and a median time from skin puncture to guidewire placement of 103.5 s. Physicians reported qualitatively improved visualization, ease of use, enhanced control, and reduced hand transitions, which improved workflow during vascular access. Conclusions: These findings support feasibility and justify further controlled prospective evaluation.
