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Biomedical subjects

M A Elsharawy

Publications and source records attributed to M A Elsharawy.

6 recordsLinked to original sources
PubMed2005

Pre-operative evaluation of hemodialysis access fistula. A multidisciplinary approach.

Recent guidelines published by the National Kidney Foundation Dialysis Outcome Quality Initiative (DOQI) on vascular access has suggested that for patients requiring chronic hemodialysis, the preferred site for access is a native arteriovenous fistula (AVF). The recommendation of DOQI may cause an aggressive approach for creation of fistula rather than a graft. Although fistulae have longer patency as compared to grafts, a substantial number of fistulae do not function adequately either due to failing maturation or to thrombosis directly after the operation. We analyse the perioperative factors that are associated with early failure of hemodialysis access fistulae,in order to improve their functional patency. We also highlight the importance of multi-disciplinary approach including nephrologists, vascular surgeons and radiologists in ensuring optimal vascular access for hemodialysis patients.

Arteriovenous Shunt, Surgical↗
PubMed2000

Effect of left renal vein division during aortic surgery on renal function.

A total of 398 consecutive patients underwent surgery for an aneurysm or occlusive disease of the aorta at Norfolk and Norwich Hospital between December 1994 and October 1998. It was necessary to divide the left renal vein in 58 (14.6%) cases. We examined the effect of this division on the mortality rate and renal function. Renal function was assessed by measuring serum creatinine pre-operatively, peri-operatively and long-term postoperatively. There was no significant difference in the mortality rate between patients who had the left renal vein divided (LRVD) and in whom the left renal vein remained intact (LRVI)--31% versus 32%, P = 0.83. There was no significant difference in the pre-operative serum creatinine level between both groups (107 +/- 21 mumol/l in LRVD versus 103 +/- 29 mumol/l in LRVI, P = 0.14). There was an insignificant rise in the mean serum creatinine 7 days postoperatively (111 +/- 21 mumol/l in LRVD versus 107 +/- 31 mumol/l in LRVI, P = 0.05). The mean serum creatinine returned back to the pre-operative level at 30 days postoperatively (106 +/- 16 mumol/l in LRVD and 105 +/- 29 mumol/l, P = 0.20). After 1 month, there was no significant difference in the number of patients who had a sustained elevation of serum creatinine level (7.5% in LRVD versus 2.7% in LRVI, P = 0.11). We feel that division of the left renal vein is a safe and helpful procedure during juxtarenal aortic surgery.

Aged↗
PubMedDate not supplied

Can multi-detector computed tomographic angiography replace conventional angiography prior to lower extremity arterial reconstruction?

UNLABELLED: Computed tomographic (CT) angiography has become a valuable diagnostic technique prior to lower extremity arterial reconstruction. The purpose of this study is to evaluate its accuracy, compared to conventional angiography for planning lower limb revascularization procedures. PATIENTS AND METHODS: A prospective study was performed on all patients who underwent lower extremity arterial reconstruction procedures and had both CT angiography and conventional angiography between October 2003 and November 2005. We compared both modalities of angiography to intra-operative findings and whether a change in operative procedure would have resulted. The time for performance of both techniques and their complications were also reported. RESULTS: Sixty nine patients were included in this study. Discrepancies between intra-operative findings and CT angiography were noted in four (6%) cases while there was none with conventional angiography (p = 0.127). Disagreements between intra-operative findings and CT angiography have lead to a different procedure in three (4.5%) cases and all were infra-inguinal. The time for performance of CT angiography was significantly shorter than that for conventional angiography (2.5 +/- 0.3 minutes vs 37.5 +/- 5.2, p = 0.006). CONCLUSION: For arterial reconstructive procedures CT angiography provides a less invasive and accurate imaging with short examination time. It can be used as a primary imaging modality in evaluation of lower limb ischemia.

Angiography↗
PubMedDate not supplied

Impact of pre-operative venography on the planning and outcome of vascular access for hemodialysis patients.

OBJECTIVE: Pre-operative venous mapping has increased dramatically in most dialysis units since the Dialysis Outcome Quality Initiative (DOQI) guidelines recommended a native arteriovenous venous fistula (AVF) rather than a graft for hemodialysis (HD) access procedures. However, there are conflicting consequences as a result of this policy. Some studies have showed that routine mapping has resulted in a marked increase in maturation rate while others have observed the reverse. This study aimed to evaluate the impact of pre-operative venography on the planning and outcome of AVF for our HD patients. PATIENTS AND METHODS: A prospective study was performed on all patients with end-stage renal disease (ESRD) who had HD access procedures and pre-operative venography between October 2003 and November 2005. Upper limb venography was done for all patients except those that required primary access and had visible veins. All patients had HD immediately after the venography. Access procedure selection was based on the result of the venography. The complications of venography, the surgical procedure and the outcome were recorded. RESULTS: One hundred and twenty-nine patients with ESRD who had pre-operative venography were included in this study. They were mostly middle age (mean age +/- SD = 41 +/- 15.5 yrs) with a high rate of diabetes mellitus (53%). No single complication was reported. A graft was placed in six patients (5%) only. Unsuccessful surgical exploration was 0%. Early failure was in 10 patients (8%). CONCLUSION: Pre-operative venography resulted in an increase in the number of AVFs. It can improve the results of HD access procedures by selecting the most suitable veins.

Adolescent↗