The detrimental effects of coronary artery disease (CAD), a widespread condition stemming from atherosclerosis, are profound and affect human health greatly. Coronary magnetic resonance angiography (CMRA) joins coronary computed tomography angiography (CCTA) and invasive coronary angiography (ICA) as an alternative investigative method. This study aimed to prospectively assess the practicality of performing 30 T free-breathing, whole-heart, non-contrast-enhanced coronary magnetic resonance angiography (NCE-CMRA).
Following Institutional Review Board approval, two blinded readers independently assessed the quality and visualization of coronary arteries in the NCE-CMRA data sets of 29 patients, acquired successfully at 30 Tesla, using a subjective quality grade. While other activities transpired, the acquisition times were meticulously recorded. Some patients underwent CCTA; stenosis was graded, and the degree of consistency between CCTA and NCE-CMRA was evaluated using the Kappa statistic.
Six patients' diagnostic imaging was hampered by severe artifacts, failing to achieve the necessary image quality. The radiologists independently evaluated image quality, recording a score of 3207, a testament to the NCE-CMRA's superb depiction of coronary arteries. The reliability of assessment for the principal coronary vessels on NCE-CMRA images is considered high. NCE-CMRA acquisition takes 8812 minutes to complete. see more The reliability of stenosis detection using both CCTA and NCE-CMRA is substantial, indicated by a Kappa of 0.842 (P<0.0001).
The NCE-CMRA's short scan time results in reliable visual parameters and image quality pertaining to the coronary arteries. The NCE-CMRA and CCTA show a satisfactory level of alignment in the identification of stenotic regions.
Reliable image quality and visualization parameters of coronary arteries are achieved by the NCE-CMRA, all within a brief scan time. Both the NCE-CMRA and CCTA provide a reliable assessment of stenosis.

Vascular calcification's role in the development of vascular disease constitutes a primary reason for elevated cardiovascular morbidity and mortality rates in patients with chronic kidney disease. The growing understanding of CKD positions it as a significant risk factor for both cardiac disease and peripheral arterial disease (PAD). The atherosclerotic plaque's makeup and its associated endovascular implications for patients with end-stage renal disease (ESRD) are the subject of this study. An overview of the literature on arteriosclerotic disease in patients with chronic kidney disease considered the current landscape of medical and interventional strategies. Lastly, three case studies illustrating representative endovascular treatment approaches are showcased.
A PubMed literature review, encompassing publications up to September 2021, was carried out, alongside consultations with subject matter experts.
The high incidence of atherosclerotic lesions in chronic renal failure patients, alongside significant rates of (re-)stenosis, causes difficulties in the medium and long run. Vascular calcium accumulation is a prevalent predictor of failure for endovascular treatments of PAD and subsequent cardiovascular complications (such as coronary calcium scores). Patients with chronic kidney disease (CKD) are at a considerably higher risk of significant vascular complications, and the results of revascularization procedures following peripheral vascular interventions are frequently worse for this population. In peripheral artery disease (PAD), a correlation between calcium deposits and drug-coated balloon (DCB) effectiveness necessitates the exploration of additional strategies for managing vascular calcium, including endoprostheses or braided stents. Contrast-induced nephropathy is a greater concern for patients having chronic kidney disease. The administration of intravenous fluids, in conjunction with assessments of carbon dioxide (CO2), forms part of the recommendations.
One option to potentially provide a safe and effective alternative to iodine-based contrast media allergies, and its use in CKD patients, is angiography.
Endovascular procedures and management strategies for patients with ESRD are inherently complex. With the passage of time, innovative endovascular therapies, including directional atherectomy (DA) and the pave-and-crack procedure, have been designed to manage significant vascular calcium deposits. For vascular patients with CKD, aggressive medical management complements and enhances the effectiveness of interventional therapy.
Complex issues arise in managing and performing endovascular procedures on individuals with end-stage renal disease. Subsequent to many years of research and development, advanced endovascular treatment modalities, including directional atherectomy (DA) and the pave-and-crack technique, have been created to effectively manage a high vascular calcium burden. Proactive medical management, coupled with interventional therapy, proves advantageous for vascular patients experiencing CKD.

In the treatment of end-stage renal disease (ESRD) patients requiring hemodialysis (HD), arteriovenous fistulas (AVF) and grafts are frequently utilized as access points. Both access points are further complicated by the dysfunction of neointimal hyperplasia (NIH) leading to subsequent stenosis. Percutaneous balloon angioplasty utilizing plain balloons is the standard first-line approach for clinically significant stenosis, displaying encouraging initial outcomes, yet accompanied by a deficiency in long-term patency and the requirement for frequent subsequent interventions. Despite efforts to enhance patency rates through the use of antiproliferative drug-coated balloons (DCBs), their complete impact on treatment outcomes is still subject to further investigation. This first portion of our two-part review meticulously investigates the mechanisms of arteriovenous (AV) access stenosis, presenting the supporting evidence for high-quality plain balloon angioplasty treatment strategies, and highlighting considerations for specific stenotic lesion management.
PubMed and EMBASE were electronically searched for articles relevant to the study, published between 1980 and 2022. This narrative review encompassed the highest level of evidence pertaining to fistula and graft lesion treatment strategies, along with the pathophysiology of stenosis and angioplasty techniques.
Vascular damage caused by upstream events, in conjunction with the subsequent biological response represented by downstream events, contributes to the formation of NIH and subsequent stenoses. A significant proportion of stenotic lesions respond favorably to high-pressure balloon angioplasty, with ultra-high pressure balloon angioplasty strategically used in refractory situations and prolonged angioplasty with progressive balloon expansion for elastic lesions. Additional treatment considerations are imperative when dealing with specific lesions, like cephalic arch and swing point stenoses in fistulas and graft-vein anastomotic stenoses in grafts, and others.
Employing high-quality balloon angioplasty, informed by the current evidence base on technique and site-specific lesion considerations, effectively addresses the vast majority of AV access stenoses. Initially successful, yet the patency rates ultimately prove unreliable and short-lived. The second section of this review investigates the evolving responsibilities of DCBs, whose objectives are to refine outcomes connected to angioplasty.
By applying the current evidence base concerning technique and specific lesion characteristics, high-quality plain balloon angioplasty successfully manages a considerable number of AV access stenoses. see more Despite an initial success, the rates of patency have not proven to be permanent. Concerning DCBs, the second part of this review examines their evolving role in improving angioplasty outcomes.

Surgical creation of arteriovenous fistulas (AVF) and grafts (AVG) is still the standard approach for hemodialysis (HD) access. The global need for dialysis access that does not depend on catheters persists as a critical objective. In essence, a standardized hemodialysis access protocol is inadequate; a patient-centric and individualized access creation strategy must be followed for each patient. The paper undertakes a comprehensive review of the literature and current guidelines on upper extremity hemodialysis access types and their respective outcomes. We will additionally impart our institutional expertise concerning the surgical establishment of upper extremity hemodialysis access.
The literature review is comprised of twenty-seven relevant articles published from 1997 to the current date, and one case report series originating from 1966. The compilation of sources involved systematically searching electronic databases, including PubMed, EMBASE, Medline, and Google Scholar. Consideration was limited to articles published in English; study designs varied widely, including current clinical guidelines, systematic and meta-analyses, randomized controlled trials, observational studies, and two authoritative vascular surgery textbooks.
Surgical approaches to creating upper extremity hemodialysis accesses are the exclusive concentration of this review. A graft versus fistula's ultimate realization is contingent on the existing anatomy, shaped by the patient's needs. Before the operation, a detailed patient history and physical examination, emphasizing prior central venous access experiences and vascular anatomy delineation via ultrasound, are essential. The fundamental principles of access creation involve, whenever possible, selecting the most distant point on the non-dominant upper limb, and an autogenous conduit is favored over an artificial graft. This review describes a variety of surgical techniques used in creating hemodialysis access in the upper extremities, alongside the institutional protocols employed by the authoring surgeon. see more Preservation of a functional access necessitates diligent postoperative follow-up and surveillance.
For patients with suitable anatomical features, the recent hemodialysis access guidelines continue to highlight arteriovenous fistulas as the preferred method. The success of access surgery is inextricably linked to precise intraoperative ultrasound assessment, careful postoperative management, meticulous surgical technique, and thorough preoperative patient education.