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MILLER Banding
MILLER (Minimally Invasive Limited Ligation Endoluminal-assisted Revision) banding is a minimally invasive technique for banding dialysis accesses in cases of Dialysis-associated Steal Syndrome. MILLER banding was first proposed in 2006 by Goel N., Miller G.A., and colleagues. Procedure A fistula or graft is dissected away through a small incision. An inflated intra-luminal balloon is used to provide a solid structure (thus allowing for precise sizing of the band), and a Prolene Prolene is a synthetic, monofilament, nonabsorbable polypropylene suture. It is indicated for skin closure and general soft tissue approximation and ligation. Its advantages include minimal tissue reactivity and durability. Disadvantages incl ... suture is tied around the access in the region of the balloon. References * Nephrology Renal dialysis {{treatment-stub ...
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Minimally Invasive
Minimally invasive procedures (also known as minimally invasive surgeries) encompass surgical techniques that limit the size of incisions needed, thereby reducing wound healing time, associated pain, and risk of infection. Surgery by definition is invasive and many operations requiring incisions of some size are referred to as ''open surgery''. Incisions made during open surgery can sometimes leave large wounds that may be painful and take a long time to heal. Advancements in medical technologies have enabled the development and regular use of minimally invasive procedures. For example, endovascular aneurysm repair, a minimally invasive surgery, has become the most common method of repairing abdominal aortic aneurysms in the US as of 2003. The procedure involves much smaller incisions than the corresponding open surgery procedure of open aortic surgery. Interventional radiologists were the forerunners of minimally invasive procedures. Using imaging techniques, radiologists w ...
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Kidney Dialysis
Kidney dialysis (from Greek , , 'dissolution'; from , , 'through', and , , 'loosening or splitting') is the process of removing excess water, solutes, and toxins from the blood in people whose kidneys can no longer perform these functions naturally. This is referred to as renal replacement therapy. The first successful dialysis was performed in 1943. Dialysis may need to be initiated when there is a sudden rapid loss of kidney function, known as acute kidney injury (previously called acute renal failure), or when a gradual decline in kidney function, chronic kidney disease, reaches stage 5. Stage 5 chronic renal failure is reached when the glomerular filtration rate is 10–15% of normal, creatinine clearance is less than 10 mL per minute and uremia is present. Dialysis is used as a temporary measure in either acute kidney injury or in those awaiting kidney transplant and as a permanent measure in those for whom a transplant is not indicated or not possible.Pendse S, Sin ...
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Vascular Access Steal Syndrome
In nephrology, vascular access steal syndrome is a syndrome caused by ischemia (not enough blood flow) resulting from a vascular access device (such as an arteriovenous fistula or synthetic vascular graft–AV fistula) that was installed to provide access for the inflow and outflow of blood during hemodialysis. Signs * Pallor * Diminished pulses (distal to the fistula) * Necrosis * Decreased wrist-brachial artery, brachial index (ratio of blood pressure measured in the wrist and the blood pressure measured in the upper arm), especially if below 0.6 Symptoms * Pain and nociception, Pain distal to the fistula. Symptoms are graded by their severity: * Grade 0: No symptoms of steal * Grade 1: Mild - cool extremity, improvement in hand pulse with access occlusion * Grade 2: Moderate - Ischemic symptoms during dialysis * Grade 3: Severe - Ischemic hand pain outside of dialysis; Ulcers or gangrene of the fingers Diagnosis * History and physical exam - relief of symptoms with compression ...
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Fistula
A fistula (plural: fistulas or fistulae ; from Latin ''fistula'', "tube, pipe") in anatomy is an abnormal connection between two hollow spaces (technically, two epithelialized surfaces), such as blood vessels, intestines, or other hollow organs. Types of fistula can be described by their location. Anal fistulas connect between the anal canal and the perianal skin. Anovaginal or rectovaginal fistulas occur when a hole develops between the anus or rectum and the vagina. Colovaginal fistulas occur between the colon and the vagina. Urinary tract fistulas are abnormal openings within the urinary tract or an abnormal connection between the urinary tract and another organ such as between the bladder and the uterus in a vesicouterine fistula, between the bladder and the vagina in a vesicovaginal fistula, and between the urethra and the vagina in urethrovaginal fistula. When occurring between two parts of the intestine, it is known as an enteroenteral fistula, between the sma ...
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Graft (surgery)
Grafting refers to a surgical procedure to move tissue from one site to another on the body, or from another creature, without bringing its own blood supply with it. Instead, a new blood supply grows in after it is placed. A similar technique where tissue is transferred with the blood supply intact is called a flap. In some instances, a graft can be an artificially manufactured device. Examples of this are a tube to carry blood flow across a defect or from an artery to a vein for use in hemodialysis. Classification Autografts and isografts are usually not considered as foreign and, therefore, do not elicit rejection. Allografts and xenografts may be recognized as foreign by the recipient and rejected. * Autograft: graft taken from one part of the body of an individual and transplanted onto another site in the same individual, e.g., skin graft. * Isograft: graft taken from one individual and placed on another individual of the same genetic constitution, e.g., grafts bet ...
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Dissection
Dissection (from Latin ' "to cut to pieces"; also called anatomization) is the dismembering of the body of a deceased animal or plant to study its anatomical structure. Autopsy is used in pathology and forensic medicine to determine the cause of death in humans. Less extensive dissection of plants and smaller animals preserved in a formaldehyde solution is typically carried out or demonstrated in biology and natural science classes in middle school and high school, while extensive dissections of cadavers of adults and children, both fresh and preserved are carried out by medical students in medical schools as a part of the teaching in subjects such as anatomy, pathology and forensic medicine. Consequently, dissection is typically conducted in a morgue or in an anatomy lab. Dissection has been used for centuries to explore anatomy. Objections to the use of cadavers have led to the use of alternatives including virtual dissection of computer models. Overview Plant and ...
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Surgical Incision
In surgery, a surgical incision is a cut made through the skin and soft tissue to facilitate an operation or procedure. Often, multiple incisions are possible for an operation. In general, a surgical incision is made as small and unobtrusive as possible to facilitate safe and timely operating conditions. Anatomy Surgical incisions are planned based on the expected extent of exposure needed for the specific operation planned. Within each region of the body, several incisions are common. Head and neck * Wilde's incision – This post-aural incision is used for a variant mastoiditis drainage, and was named after Sir William Wilde, an ENT surgeon in Dublin who first described it at the end of the nineteenth century. His son, Oscar Wilde's, death was stated by his doctors to be due to meningitis stemming from an ear infection. He had recently had an operation, believed by some to be a mastoidectomy. Chest * Median sternotomy – This is the primary incision used for cardiac p ...
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Intraluminal
In biology, a lumen (plural lumina) is the inside space of a tubular structure, such as an artery or intestine. It comes . It can refer to: *The interior of a vessel, such as the central space in an artery, vein or capillary through which blood flows. *The interior of the gastrointestinal tract *The pathways of the bronchi in the lungs *The interior of renal tubules and urinary collecting ducts *The pathways of the female genital tract, starting with a single pathway of the vagina, splitting up in two lumina in the uterus, both of which continue through the Fallopian tubes In cell biology, a lumen is a membrane-defined space that is found inside several organelles, cellular components, or structures: *thylakoid, endoplasmic reticulum, Golgi apparatus, lysosome, mitochondrion, or microtubule Transluminal procedures ''Transluminal procedures'' are procedures occurring through lumina, including: * Natural orifice transluminal endoscopic surgery in the lumina of, for example, t ...
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Prolene
Prolene is a synthetic, monofilament, nonabsorbable polypropylene suture. It is indicated for skin closure and general soft tissue approximation and ligation. Its advantages include minimal tissue reactivity and durability. Disadvantages include fragility, high plasticity, high expense, and difficulty of use compared to standard nylon sutures. Composed of an isotactic crystalline stereoisomer of polypropylene, Prolene sutures are intended to be durable and long lasting. They are dyed blue, allowing for easy visibility against skin and when operating. It is composed of a single filament. A polypropylene mesh is also marketed under the name Prolene by Ethicon. It is used for repairing hernias and other injuries to the fascia. Prolene commonly is used in both human and veterinary medicine for skin closure. In human medicine it is used in cardiovascular, ophthalmic and neurological procedures. It is often used in conjunction with the absorbable suture Monocryl. Prolene is man ...
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Surgical Suture
A surgical suture, also known as a stitch or stitches, is a medical device used to hold body tissues together and approximate wound edges after an injury or surgery. Application generally involves using a needle with an attached length of thread. There are numerous types of suture which differ by needle shape and size as well as thread material and characteristics. Selection of surgical suture should be determined by the characteristics and location of the wound or the specific body tissues being approximated. In selecting the needle, thread, and suturing technique to use for a specific patient, a medical care provider must consider the tensile strength of the specific suture thread needed to efficiently hold the tissues together depending on the mechanical and shear forces acting on the wound as well as the thickness of the tissue being approximated. One must also consider the elasticity of the thread and ability to adapt to different tissues, as well as the memory of the threa ...
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Nephrology
Nephrology (from Greek'' nephros'' "kidney", combined with the suffix ''-logy'', "the study of") is a specialty of adult internal medicine and pediatric medicine that concerns the study of the kidneys, specifically normal kidney function (renal physiology) and kidney disease (renal pathophysiology), the preservation of kidney health, and the treatment of kidney disease, from diet and medication to renal replacement therapy (dialysis and kidney transplantation). The word “ renal” is an adjective meaning “relating to the kidneys”, and its roots are French or late Latin. Whereas according to some opinions, "renal" and "nephro" should be replaced with "kidney" in scientific writings such as "kidney medicine" (instead of nephrology) or "kidney replacement therapy", other experts have advocated preserving the use of renal and nephro as appropriate including in "nephrology" and "renal replacement therapy", respectively. Nephrology also studies systemic conditions that ...
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