Journal of Indonesia Vascular Access

The effect of bicuspid aortic valve versus tricuspid aortic valve as a risk factor for aortic dilatation: a systematic review and meta-analysis

2025-08-21T03:17:13+00:00

Background: The enlargement of the ascending aorta (AA) is a frequent finding in clinical practice. Age, gender, and body size have been shown to be important determinants of AA diameter. One of the most prevalent congenital heart conditions is bicuspid aortic valve (BAV) disease, which primarily affects male subjects and has a population prevalence of 0.5% to 2.0%. Purely severely stenotic BAVs developed a moderate dilation of the aorta at an early age, while TAVs (Tricuspid Aortic Valves) did not. This study aims to compare BAV and TAV as risk factors for aortic dilatation.

Methods: A systematic literature search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines by using PubMed/Medline, Scopus, and ScienceDirect databases according to PICO. The studies obtained were adjusted to the eligibility criteria. We conducted a journal appraisal assessment using the CASP 2024 tools for the 10 included studies. Meta-analysis was performed using Review Manager 5.4.

Result: Out of 208 studies, 10 studies are included for a systematic review according to eligibility criteria. From the baseline characteristics, BAV with aortic dilatation is often seen at a younger age compared to TAV. 5 studies are analyzed for the incidence risk of aortic dilatation between BAV and TAV group (OR 5.16; 95% CI 2.69, 9.92; p<0.001) and 6 studies are analyzed for the aortic diameter between BAV and TAV group (OR 0.55; 95% CI -1.37, 2.46; p<0.58).

Conclusion: Our systematic review-meta-analysis study found that there is an increase in ithe ncidence risk of aortic dilatation in BAV patients compared to TAV patients. Our study result supports the guideline designed by the American Association for Thoracic Surgery that suggests patients undergoing concurrent heart surgery, concomitant ascending aorta/root repair should be actively performed when the aortic diameter is 45 mm.

The wound-healing potential of honey and propolis from stingless bees in acute wounds

2025-08-21T03:24:09+00:00

Introduction: Honey and propolis from stingless bees have been reported to promote wound healing due to their anti-inflammatory, antioxidant, antibacterial, and moisturizing activities. However, variations in compounds and biological activities of these products can arise due to geographical and bee origin differences. This study aimed to investigate the wound-healing potential of stingless bee honey and propolis from East Kalimantan in an acute wound animal model. Honey and propolis from stingless bees have been reported to promote wound healing due to their anti-inflammatory, antioxidant, antibacterial, and moisturizing activities. However, variations of compounds and biological activities of these products can arise due to geographical and bee origin differences. This study aimed to investigate the wound-healing potential of stingless bee honey and propolis from East Kalimantan in an acute wound animal model.

Method: A post-test-only control group design was employed in this study. Fifteen Wistar rats were divided into 3 groups, i.e., a control receiving tulle and treatment groups receiving stingless bee honey and propolis, respectively. Wound healing activity was evaluated from wound diameter changes and histological evaluations following a hole punch wound.

Result: Kruskal Wallis test results showed no significant changes in the proliferation phase of wound healing, as reflected by the diameter changes (p = 0.989), the rate of histopathological re-epithelization (p = 0.730) as well as number of fibroblasts (p = 0.779), collagen (p = 0.779), and neovascularization (p = 0.756) among the groups.

Conclusion: Honey and propolis from stingless bees have the potential to treat acute wounds in the proliferation phase, where their wound healing properties are equivalent to tulle.

Restenosis risk factor and the primary patency rate of arteriovenous fistula after initial percutaneous transluminal angioplasty: a retrospective cohort study

2025-08-21T03:30:12+00:00

Background: Arteriovenous fistula (AVF) is the optimal vascular access for patients because of its prolonged patency and limited problems. Nevertheless, maintenance is sometimes obstructed by stenosis. This study aimed to determine the factors associated with restenosis and primary patency rate in 12 months after Percutaneous Transluminal Angioplasty (PTA).

Method: A retrospective study of patients who underwent initial PTA between January 2018 and October 2023. The clinical variables, laboratory indicators, and surgical data were observed in this study. The restenosis factors were analyzed by univariate analysis, Cox - Regression test, and Hosmer-Lemeshow test. The Receiver Operating Characteristic (ROC) Analysis identified the cut-off Platelet Count (PC). The primary patency of AVF with restenosis risk was evaluated using the Kaplan-Meier analysis and log-rank test.

Result: A total of 54 patients were included. The Cox proportional hazard model revealed PC (p=0.004) was a risk factor for AVF restenosis. The Hosmer-Lemeshow test (χ2 = 11.130, p = 0.194) indicates our logistic regression model fits the data. Analysis of ROC identified a cut-off value of PC ≥ 210.5 x 10⁹/L (sensitivity 85.7 %, specificity 46.2%). Primary patency rates of AVF with PC ≥ 210.5 x 10⁹/L at 6 and 12 months (64.1% and 35.8%) were lower than those with PC< 210.5 x 10⁹ /L (80.0%, 66.6%).

Conclusion: Balloon type (Drug Coated Balloon and Plain Balloon), predilating balloon, balloon diameter, and inflammatory markers showed no association with restenosis in 12 months after PTA. Platelet Count is statistically significant associated with AVF restenosis, which can predict the primary patency of AVF after initial PTA. It assists physicians in establishing the follow-up schedule and appropriate intervention to prevent HD vascular access failure within 12 months post-PTA.

Risk factors associated with the incidence of Arteriovenous (AV) shunt stenosis in Chronic Kidney Disease (CKD) patients on hemodialysis

2025-10-30T03:04:04+00:00

Background: Arteriovenous (AV) shunt stenosis is a significant complication in chronic kidney disease (CKD) patients undergoing hemodialysis with AV shunt access. The risk factors associated with this event are still not fully understood. This study aims to identify factors associated with the incidence of AV shunt stenosis in CKD patients undergoing dialysis.

Methods: A cross-sectional study was conducted involving 236 patients undergoing hemodialysis at Dr. Saiful Anwar General Hospital, Malang. Risk factors analyzed included age, gender, diabetes mellitus, hypertension, obesity, and AV shunt location.

Results: Bivariate analysis using the Chi-square test showed significant associations between stenosis and age (p=0.020), gender (p=0.001), diabetes mellitus (p=0.001), and hypertension (p=0.031). However, obesity (p=0.608) and AV shunt location (p=0.552) were not significantly associated. Logistic regression analysis indicated that diabetes mellitus increased the risk of AV shunt stenosis by 2.46 times (95% CI: 1.42-4.26), hypertension by 2.05 times (95% CI: 1.06-3.96), and age above 60 years by 1.93 times (95% CI: 1.10-3.37)

Conclusion: Diabetes mellitus, hypertension, advanced age, and smoking are key risk factors for AV shunt stenosis in CKD patients undergoing dialysis

Negative Pressure Wound Therapy (NPWT)-assisted blowhole incisions in treating extensive subcutaneous emphysema: a literature review

2025-11-01T02:44:32+00:00

Background: Subcutaneous emphysema (SE) is defined as the generation or infiltration of air in the subcutaneous tissues (beneath the dermal layer) of skin, cause by various etiologies. Untreated extensive SE can lead to respiratory and cardiovascular collapse. There are various treatments for treating SE. Blowhole incisions are considered one of the minimally invasive methods, with their variation by combining the incision with the usage of negative wound pressure therapy (NPWT). This literature study aims to evaluate the NPWT blowhole incisions in treating extensive subcutaneous emphysema

Methods: Literature was sourced from PubMed, ProQuest, and Google Scholar databases. This review used case reports, case series, and systematic reviews, and each study underwent quality appraisal with the Joanna Briggs Institute (JBI) Critical Appraisal Checklist. In this study, we will compare the various settings used in NPWT-assisted blowhole incisions in treating extensive SE and the outcomes from the method used. The final list for review consisted of 14 studies.

Results: Fourteen studies met the inclusion criteria. The most common causes of extensive subcutaneous emphysema were pneumothorax and rib fractures following chest trauma. The most frequently applied intervention was bilateral infraclavicular blowhole incisions measuring 3–5 cm, combined with NPWT at approximately −125 mmHg. Regression of subcutaneous emphysema, assessed clinically and/or with chest X-ray or CT, was typically observed within the first 24 hours, with NPWT removal possible after 96 hours. No complications or recurrences were reported across the included studies.

Conclusion: NPWT-assisted blowhole incisions are a minimally invasive, safe, and effective method for managing extensive SE. Bilateral infraclavicular incisions measuring 3–5 cm combined with NPWT at continuous −125 mmHg appear to be a practical approach, typically resulting in regression within 4–72 hours, with device removal often after 96 hours. No significant complications or deaths were reported. The technique’s low cost, minimal infection risk, and practicality make it a viable alternative to more invasive interventions.

Endovascular salvage of an immature radiocephalic arteriovenous fistula: a case report

2025-10-29T19:37:34+00:00

Background: Autogenous arteriovenous fistulas (AVFs) are the preferred vascular access for hemodialysis, offering superior patency and lower complication rates compared to grafts or catheters. However, non-maturation occurs in 20–40% of cases, often due to juxta-anastomotic stenosis or accessory venous runoff, leading to prolonged catheter dependence and increased morbidity. Endovascular salvage strategies such as balloon-assisted maturation (BAM) and coil embolization achieve technical success rates exceeding 90% and are now central to access preservation.

Case Presentation: We report a 66-year-old male with stage V chronic kidney disease on regular hemodialysis who developed an immature left radiocephalic AVF four months post-creation, complicated by ipsilateral hand edema. Duplex ultrasonography revealed draining vein diameters of 0.42–0.54 cm and flow volumes of 130–150 mL/min. Venography confirmed juxta-anastomotic stenosis with competitive runoff into the distal cephalic vein. The patient underwent endovascular salvage consisting of coil embolization of the cephalic runoff and balloon angioplasty of the draining vein using sequential 4.0 and 6.0 mm balloons. Post-procedural venography demonstrated elimination of distal runoff and restoration of antebrachial flow. Clinically, hand edema regressed, and AVF patency was preserved.

Conclusion: Combined coil embolization and angioplasty can successfully salvage immature AVFs with venous stenosis and accessory runoff. This case underscores the importance of structured duplex surveillance, early identification of failing maturation, and timely endovascular intervention to preserve autogenous vascular access.