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Biomedical subjects

B Funaki

Publications and source records attributed to B Funaki.

At least 37 records · Page 2Linked to original sources
PubMed1999

Reinsertion of accidentally removed tunneled central venous catheter via the existing subcutaneous tract.

BACKGROUND: A technique for reinsertion of an inadvertently removed tunneled central venous catheter is presented. A 6-year-old boy with short-gut syndrome caused by necrotizing enterocolitis accidentally removed his tunneled central venous catheter. MATERIALS AND METHODS: The existing subcutaneous catheter tract was recanalized using a hydrophilic guidewire and 5-French end-hole catheter with the child unter conscious sedation, and a new catheter was placed over a guidewire. RESULTS: This obviated the need for a new venipuncture and creation of a new subcutaneous tunnel, which are performed under general anesthesia in our hospital.

Catheterization, Central Venous↗
PubMed1999

Angioplasty and bolus urokinase infusion for the restoration of function in thrombosed Brescia-Cimino dialysis fistulas.

PURPOSE: To evaluate the use of urokinase and angioplasty in treatment of thrombosed Brescia-Cimino fistulas. MATERIALS AND METHODS: From January 1994 to April 1997, 17 patients (10 women and seven men; age range, 17-78 years; mean 54 years) with complete thrombosis of their Brescia-Cimino fistulas were referred to our department for thrombolysis and angioplasty. Thrombosis of the fistula had occurred within 24 hours of attempted thrombolysis in 11 patients and between 24 and 72 hours in six patients. Urokinase was given as a bolus into the fistula, and heparin was administered into the central venous vasculature. Angioplasty was performed at the arterial inflow and the fistula itself. RESULTS: Procedural success was 82% (14 of 17 patients). Primary patency was 71% at 6 months and 64% at 12 months. Primary assisted patency was 93% at 6 and 12 months. Secondary patency was 100% at 6 and 12 months. One fistula thrombosed within 24 hours of the initial procedure, and a repeat procedure was successfully performed. All other fistulas have remained patent with a maximum follow-up of 40 months (average function of 16 months). Two patients have died of unrelated causes. One Wallstent was deployed for treatment of an angioplasty-induced venous rupture. CONCLUSION: Long-term function of Brescia-Cimino fistulas after thrombolysis and angioplasty is excellent with patency rates similar to those of newly placed, mature Brescia-Cimino fistulas.

Adolescent↗
PubMed1999

Experience with tunneled femoral hemodialysis catheters.

OBJECTIVE: The purpose of this study was to evaluate the use and complication rate of tunneled femoral hemodialysis catheters placed in patients with no remaining thoracic venous access sites. MATERIALS AND METHODS: Over a 3-year period, 41 tunneled femoral vein catheters (35 right, six left) were placed in 21 patients (15 women, six men; 21-89 years old; mean, 52 years). Catheters ranged in length from 40 to 60 cm. Tips were positioned immediately above the iliac bifurcation, at the mid inferior vena cava (IVC), or at the junction of the IVC and right atrium. Catheters were exchanged through the existing tract if the flow rate decreased to less than 200 ml/min. Catheters were removed if an episode of bacteremia did not resolve with antibiotics or if the insertion site became infected. RESULTS: Technical success of placement was 100%. The 30-, 60-, and 180-day primary patency rates were 78%, 71%, and 55%, respectively. The 30-, 60-, and 180-day secondary patency rates were 95%, 83%, and 61%, respectively. Average time of function per intervention was 61 days. Infections requiring catheter removal occurred at a rate of 2.4 per 1000 catheter days. One episode of partial IVC thrombosis occurred after a catheter infection developed 78 days after initial catheter placement. No episodes of symptomatic pulmonary embolism occurred. Total length of follow-up was 2506 catheter days. CONCLUSION: Femoral vein catheters require more frequent interventions than do thoracic catheters and are more susceptible to infection. However, in patients with difficult central venous access, the common femoral vein may be successfully used for permanent tunneled hemodialysis access.

Catheterization, Central Venous↗
PubMed1999

Treatment of venous outflow stenoses in thigh grafts with Wallstents.

OBJECTIVE: We studied the effectiveness of Wallstent deployment to treat elastic femoral and iliac vein stenoses in patients with lower extremity hemodialysis grafts. MATERIALS AND METHODS: Between August 31, 1992, and October 13, 1997, 44 metallic stents were deployed in 20 patients to treat stenoses exhibiting immediate, significant elastic recoil after angioplasty. Twenty-four stents were placed in the femoral and saphenous veins, and the remaining 20 stents were placed in the iliac veins. Follow-up was provided by the nephrology and surgical service at our institution and by electronic review of patients' charts. The follow-up period was from August 31, 1992, until October 1, 1998. RESULTS: Stents were successfully inserted and stenotic lesions dilated in 100% of procedures. Each patient successfully completed at least one session of dialysis after the procedure. The primary patency rate of stents was 87% 60 days after the procedure, 51% 180 days after, 39% 1 year after, and 20% 2 years after. The secondary patency rate was 95% 60 days after the procedure, 92% 180 days after, 81% 1 year after, and 62% 2 years after. Complications were limited to two graft infections that developed 5 and 7 days after stent placement. CONCLUSION: Treatment of elastic venous stenoses is effective in patients with lower extremity dialysis grafts using metallic stents. The patency rates of these devices placed in the iliac and femoral veins are comparable with those of metallic stents placed in upper extremity and central veins.

Adolescent↗
PubMed1999

Exchange of poorly functioning tunneled permanent hemodialysis catheters.

OBJECTIVE: The usefulness of exchanging poorly functioning tunneled permanent hemodialysis catheters in patients with end-stage renal disease was evaluated. MATERIALS AND METHODS: We retrospectively reviewed case histories of 51 consecutive patients who underwent 88 catheter exchanges because of poor flow rates. All hemodialysis catheters were initially placed by the radiology service using image guidance. Catheter exchanges were performed through the existing subcutaneous tract over two stiff hydrophilic guidewires and without additional interventions such as fibrin sheath stripping or venoplasty. Life table analysis was performed to evaluate catheter patency rates after initial placement (primary patency) and after multiple exchanges (secondary patency). RESULTS: The technical success rate for hemodialysis catheter exchange was 100%. Primary catheter patency was 42% at 60 days and 16% at 120 days. Secondary patency was 92% at 60 days and 82% at 120 days. The cumulative infection rate was 1.1 per 1000 catheter days. No complications from the procedure occurred. CONCLUSION: Catheter exchange is an effective means of prolonging catheter patency in patients with end-stage renal disease and limited central venous access.

Adult↗
PubMed1999

Percutaneous biliary drainage in patients with nondilated intrahepatic bile ducts.

OBJECTIVE: We evaluated the technical success and complications of percutaneous transhepatic biliary drainage in patients with nondilated intrahepatic bile ducts. MATERIALS AND METHODS: Between January 1, 1996, and August 31, 1998, 130 percutaneous transhepatic biliary drainage procedures were performed on patients with nondilated intrahepatic bile ducts. This group comprised primarily patients who had received liver transplants or who had sustained iatrogenic bile duct injuries. Access in all procedures was performed using a one-step system consisting of a 21-gauge needle and an .018-inch guidewire. The technical success and complications of the procedures were evaluated. RESULTS: Percutaneous biliary drainage was successful in 117 (90%) of 130 attempts. In four patients, two attempts were required to place a drainage catheter. The overall complication rate was 9%. There were seven (5%) minor complications and five major complications (4%). No procedure-related deaths occurred. CONCLUSION: Percutaneous biliary drainage can be performed with a high success rate in patients with nondilated intrahepatic ducts. The incidence and types of complications in this population were similar to those reported in patients with intrahepatic ductal dilatation.

Adult↗
PubMed1998

Are routine chest radiographs necessary after image-guided placement of internal jugular central venous access devices?

OBJECTIVE: The purpose of this study was to determine the value and cost of obtaining routine chest radiographs after image-guided placement of internal jugular central venous catheters. MATERIALS AND METHODS: We reviewed the records of 424 patients in whom 572 internal jugular catheters were placed by sonographic and fluoroscopic guidance over a 2-year period. Inspiratory and expiratory chest radiographs obtained immediately after each procedure were also reviewed. RESULTS: Routine postprocedural chest radiographs revealed no complications and did not alter the treatment of any patient. Delayed pneumothorax was detected after placement of two catheters (0.5%) when patient symptoms prompted additional radiographs. CONCLUSION: Immediate postprocedural chest radiographs are not routinely needed after image-guided insertion of internal jugular central venous catheters and unnecessarily add to the cost of patient care.

Catheterization, Central Venous↗
PubMed1998

Placement of retrograde nephroureteral stents through ileal conduits.

OBJECTIVE: Our objective was to evaluate retrograde nephroureteral stent placement in patients with ileal conduits. CONCLUSION: In patients with ureteral complications after cystectomy and ileal diversion, retrograde nephroureteral stent placement should be the treatment of choice to reduce patient morbidity, increase patient comfort, and facilitate stent care.

Aged↗
PubMed1998

Treatment of inferior vena cava obstruction in hemodialysis patients using Wallstents: early and intermediate results.

OBJECTIVE: The purpose of this study was to evaluate the efficacy of Wallstents in treating inferior vena cava obstruction in hemodialysis patients. CONCLUSION: For the short and intermediate term, percutaneous placement of inferior vena cava Wallstents, followed by balloon angioplasty, is a safe and valuable technique for preserving the often limited central venous access in hemodialysis patients. To maintain patency, recurrent stenosis within the Wallstent can be treated with additional angioplasty.

Angioplasty, Balloon↗