{"id":8407,"date":"2024-01-05T14:36:01","date_gmt":"2024-01-05T06:36:01","guid":{"rendered":"https:\/\/www.brosmed.com\/?post_type=clinical&p=8407"},"modified":"2024-01-05T15:32:01","modified_gmt":"2024-01-05T07:32:01","slug":"case-interpretation-application-of-tri-wedge-in-juxta-anastomotic-stenosisjas-of-avf","status":"publish","type":"clinical","link":"https:\/\/www.brosmed.com\/en\/Clinicals\/case-interpretation-application-of-tri-wedge-in-juxta-anastomotic-stenosisjas-of-avf\/","title":{"rendered":"Case Interpretation| Application of Tri-Wedge\u2122 in Juxta-anastomotic Stenosis(JAS) of AVF"},"content":{"rendered":"\n<p><span style=\"color:#000000\" class=\"tadv-color\">In the previous issue of case sharing, we presented a complex coronary intervention case, in which the Alveo HP \u03a60.75 balloon, independently developed by BrosMed Medical, demonstrated excellent performance in crossing the lesion and dilation, showcasing exquisite craftsmanship of innovation.<\/span><\/p>\n\n\n\n<p>Today, we bring you a new case. Let&#8217;s take a look at what other innovative product will help clinical practitioners in this case&#8230;&#8230;<\/p>\n\n\n\n<p class=\"has-text-align-center has-white-color has-vivid-cyan-blue-background-color has-text-color has-background has-medium-font-size\"><strong>Case information<\/strong><\/p>\n\n\n\n<p class=\"has-black-color has-text-color\"><strong>Patient Information:<\/strong> Male, 62 years old, 68 kg.<\/p>\n\n\n\n<p class=\"has-black-color has-text-color\"><strong>Visiting time:<\/strong> June 9, 2020.<\/p>\n\n\n\n<p class=\"has-black-color has-text-color\"><strong>Chief complaint:<\/strong> Hemodialysis for 3 years, and arteriovenous fistula (AVF) dysfunction found for 1 week.<\/p>\n\n\n\n<p class=\"has-black-color has-text-color\"><strong>History of present illness:<\/strong> The patient had failed left forearm AVF formation 3 years ago, and subsequently underwent a right upper extremity AVF formation. After the maturation of AVF in the right upper extremity, maintenance hemodialysis treatment was initiated. One week ago, the dialysis nurse reported an &#8220;arterial pressure alarm&#8221;, and outpatient ultrasound examination revealed localized stenosis in the AVF.<\/p>\n\n\n\n<p class=\"has-black-color has-text-color\"><strong>Past medical history:<\/strong> Hypertension, and type 2 diabetes mellitus.<\/p>\n\n\n\n<p class=\"has-text-align-center has-white-color has-vivid-cyan-blue-background-color has-text-color has-background has-medium-font-size\"><strong>Admission examination<\/strong><\/p>\n\n\n\n<p class=\"has-black-color has-text-color\"><strong>Physical examination:<\/strong> No obvious abnormalities were found in general physical examination. A surgical scar was seen on the right forearm, and high-pitched vascular bruit could be heard at the juxta-anastomotic site of the AVF. Palpation revealed tremors and a weak pulsation. No apparent aneurysmal dilation was found in the AVF region of the right upper extremity.<\/p>\n\n\n\n<p class=\"has-black-color has-text-color\"><strong>Laboratory tests:<\/strong> Hb 117g\/L, Alb 40.0g\/L, Cr 1205 \u03bcmol\/L, Ca 2.08 mmol\/L, P 1.39 mmol\/L, K 4.65 mmol\/L, CO2 23.5 mmol\/L.<\/p>\n\n\n\n<p class=\"has-black-color has-text-color\"><strong>Ultrasound examination:<\/strong><\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter size-large\"><img loading=\"lazy\" width=\"521\" height=\"373\" src=\"https:\/\/www.brosmed.com\/wp-content\/uploads\/2023\/12\/image-30.png\" alt=\"\" class=\"wp-image-8484\"\/><\/figure><\/div>\n\n\n\n<p class=\"has-black-color has-text-color\"><strong>Diagnostic result:<\/strong><\/p>\n\n\n\n<p class=\"has-black-color has-text-color\">\u25aa Stenosis in autologous AVF and maintenance hemodialysis<\/p>\n\n\n\n<p class=\"has-black-color has-text-color\">\u25aa Stenosis at the juxta-anastomotic site measured 1.2 mm, intimal hyperplasia, and estimated Qa 250 mL\/min<\/p>\n\n\n\n<p class=\"has-text-align-center has-white-color has-vivid-cyan-blue-background-color has-text-color has-background has-medium-font-size\"><strong>Surgical procedure<\/strong><\/p>\n\n\n\n<p class=\"has-vivid-cyan-blue-color has-text-color\"><strong>01 Balloon dilatation<\/strong><\/p>\n\n\n\n<p class=\"has-black-color has-text-color\">The Tri-Wedge\u2122 scoring balloon could dilate the narrowed area by passing through the lesion, exerting pressure up to 12 ATM, and then withdrawing.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large is-resized\"><img loading=\"lazy\" src=\"https:\/\/www.brosmed.com\/wp-content\/uploads\/2023\/12\/image-31.png\" alt=\"\" class=\"wp-image-8486\" width=\"538\" height=\"385\"\/><\/figure>\n\n\n\n<p class=\"has-vivid-cyan-blue-color has-text-color\"><strong>02 Ultrasound imaging<\/strong><\/p>\n\n\n\n<p class=\"has-black-color has-text-color\">The scoring balloon catheter with three triangular metallic wires was well-defined, allowing for accurate positioning under ultrasound.<\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter size-large is-resized\"><img loading=\"lazy\" src=\"https:\/\/www.brosmed.com\/wp-content\/uploads\/2023\/12\/\u8d85\u58f0\u663e\u5f7102-2.png\" alt=\"\" class=\"wp-image-8399\" width=\"534\" height=\"322\"\/><figcaption>The balloon catheter was well-defined<\/figcaption><\/figure><\/div>\n\n\n\n<p class=\"has-vivid-cyan-blue-color has-text-color\"><strong>03 Postoperative blood flow monitoring<\/strong><\/p>\n\n\n\n<p class=\"has-black-color has-text-color\">\u25aa&nbsp;Estimated Qa 824 mL\/min immediately after operation<\/p>\n\n\n\n<figure class=\"wp-block-gallery aligncenter columns-2 is-cropped\"><ul class=\"blocks-gallery-grid\"><li class=\"blocks-gallery-item\"><figure><img loading=\"lazy\" width=\"451\" height=\"326\" src=\"https:\/\/www.brosmed.com\/wp-content\/uploads\/2023\/12\/\u672f\u540e\u5373\u523b-1.jpg\" alt=\"\" data-id=\"8400\" data-full-url=\"https:\/\/www.brosmed.com\/wp-content\/uploads\/2023\/12\/\u672f\u540e\u5373\u523b-1.jpg\" data-link=\"https:\/\/www.brosmed.com\/?attachment_id=8400\" class=\"wp-image-8400\"\/><\/figure><\/li><li class=\"blocks-gallery-item\"><figure><img loading=\"lazy\" width=\"452\" height=\"326\" src=\"https:\/\/www.brosmed.com\/wp-content\/uploads\/2023\/12\/\u672f\u540e\u5373\u523b-2.jpg\" alt=\"\" data-id=\"8401\" data-full-url=\"https:\/\/www.brosmed.com\/wp-content\/uploads\/2023\/12\/\u672f\u540e\u5373\u523b-2.jpg\" data-link=\"https:\/\/www.brosmed.com\/?attachment_id=8401\" class=\"wp-image-8401\"\/><\/figure><\/li><\/ul><\/figure>\n\n\n\n<p class=\"has-black-color has-text-color\">\u25aa&nbsp;Estimated Qa 981 mL\/min 24h after operation \u25aa&nbsp;Estimated Qa 920 mL\/min 1 month after operation<\/p>\n\n\n\n<figure class=\"wp-block-gallery aligncenter columns-2 is-cropped\"><ul class=\"blocks-gallery-grid\"><li class=\"blocks-gallery-item\"><figure><img loading=\"lazy\" width=\"440\" height=\"331\" src=\"https:\/\/www.brosmed.com\/wp-content\/uploads\/2023\/12\/\u672f\u540e24\u5c0f\u65f6-1.jpg\" alt=\"\" data-id=\"8402\" data-full-url=\"https:\/\/www.brosmed.com\/wp-content\/uploads\/2023\/12\/\u672f\u540e24\u5c0f\u65f6-1.jpg\" data-link=\"https:\/\/www.brosmed.com\/?attachment_id=8402\" class=\"wp-image-8402\"\/><\/figure><\/li><li class=\"blocks-gallery-item\"><figure><img loading=\"lazy\" width=\"440\" height=\"330\" src=\"https:\/\/www.brosmed.com\/wp-content\/uploads\/2023\/12\/\u672f\u540e24\u5c0f\u65f6-2.jpg\" alt=\"\" data-id=\"8403\" data-full-url=\"https:\/\/www.brosmed.com\/wp-content\/uploads\/2023\/12\/\u672f\u540e24\u5c0f\u65f6-2.jpg\" data-link=\"https:\/\/www.brosmed.com\/?attachment_id=8403\" class=\"wp-image-8403\"\/><\/figure><\/li><\/ul><\/figure>\n\n\n\n<p class=\"has-black-color has-text-color\">\u25aa Estimated Qa 920 mL\/min 1 month after operation<\/p>\n\n\n\n<figure class=\"wp-block-gallery aligncenter columns-2 is-cropped\"><ul class=\"blocks-gallery-grid\"><li class=\"blocks-gallery-item\"><figure><img loading=\"lazy\" width=\"426\" height=\"319\" src=\"https:\/\/www.brosmed.com\/wp-content\/uploads\/2023\/12\/\u672f\u540e1\u6708-1.jpg\" alt=\"\" data-id=\"8404\" data-full-url=\"https:\/\/www.brosmed.com\/wp-content\/uploads\/2023\/12\/\u672f\u540e1\u6708-1.jpg\" data-link=\"https:\/\/www.brosmed.com\/?attachment_id=8404\" class=\"wp-image-8404\"\/><\/figure><\/li><li class=\"blocks-gallery-item\"><figure><img loading=\"lazy\" width=\"427\" height=\"319\" src=\"https:\/\/www.brosmed.com\/wp-content\/uploads\/2023\/12\/\u672f\u540e1\u6708-2.jpg\" alt=\"\" data-id=\"8405\" data-full-url=\"https:\/\/www.brosmed.com\/wp-content\/uploads\/2023\/12\/\u672f\u540e1\u6708-2.jpg\" data-link=\"https:\/\/www.brosmed.com\/?attachment_id=8405\" class=\"wp-image-8405\"\/><\/figure><\/li><\/ul><\/figure>\n\n\n\n<p class=\"has-text-align-center has-white-color has-vivid-cyan-blue-background-color has-text-color has-background has-medium-font-size\"><strong>Postoperative summary<\/strong><\/p>\n\n\n\n<p class=\"has-black-color has-text-color\"><strong>Case characteristics:<\/strong><\/p>\n\n\n\n<p class=\"has-black-color has-text-color\">The patient underwent autologous AVF hemodialysis. During the process, inadequate blood flow was observed. Physical examination revealed a high-pitched vascular bruit and weak palpable tremors.<\/p>\n\n\n\n<p class=\"has-black-color has-text-color\"><strong>Assessment of preoperative points:<\/strong><\/p>\n\n\n\n<p class=\"has-black-color has-text-color\">The physical examination and imaging evaluation of the AVF were performed to determine the site of lesion and estimate the brachial artery blood flow.<\/p>\n\n\n\n<p class=\"has-black-color has-text-color\"><strong>Surgical points:<\/strong><\/p>\n\n\n\n<p class=\"has-black-color has-text-color\">The appropriate vascular access route and balloon catheter model were selected. The balloon was accurately located to the target lesion under imaging guidance, and then gradually inflated by pressure, followed by the withdrawal of balloon catheter. Finally, the surgical outcome was assessed.<\/p>\n\n\n\n<p class=\"has-black-color has-text-color\"><strong>Device use points: <\/strong><\/p>\n\n\n\n<p class=\"has-black-color has-text-color\">The scoring balloon catheter, featured by three triangular metallic wires, is designed for accurate positioning under ultrasound guidance. The balloon is gradually inflated by pressure, enabling the scoring wires to exert the collected pressure on the vessel wall, which improves the success rate of the operation while reducing the expansion pressure.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The scoring balloon catheter, featured by three triangular metallic wires, is designed for accurate positioning under ultrasound guidance. The balloon is gradually inflated by pressure, enabling the scoring wires to exert the collected pressure on the vessel wall, which improves the success rate of the operation while reducing the expansion pressure.<\/p>\n","protected":false},"featured_media":8498,"template":"","acf":[],"lang":"en","translations":{"en":8407},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v15.8 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Case Interpretation| Application of Tri-Wedge\u2122 in Juxta-anastomotic Stenosis(JAS) of AVF - \u535a\u8fc8\u533b\u7597<\/title>\n<meta name=\"description\" content=\"The scoring balloon catheter, featured by three triangular metallic wires, is designed for accurate positioning under ultrasound guidance. 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