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All Journal Indonesian Journal of Cardiology Heart Science Journal Jurnal Klinik dan Riset Kesehatan Journal of Indonesia Vascular Access Deka in Medicine
Kurnianingsih, Novi
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Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Nursing Public Health

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Journal : Heart Science Journal

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An alternative retrograde access puncture for EVLA: a case report Kurniawan, Catur Rizky; Kurnianingsih, Novi; Widito, Sasmojo
Heart Science Journal Vol. 6 No. 1 (2025): Challenges in Managing Acute Heart Failure
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.01.18

Abstract

Background: CVI manifests with a variety of clinical symptoms, spanning from varicose veins to venous ulcers, significantly impacting patients' daily lives. While traditional treatments such as compression therapy and surgery remain options, on endovenous laser treatment (EVLT) has emerged as a viable alternative.  This article delves into the management of CVI, with a particular focus EVLT as a minimally invasive intervention. Through two case illustrations, it sheds light on the difficulties encountered when accessing the great saphenous vein (GSV) using the conventional antegrade approach, particularly in cases involving obesity and vasospasm. Consequently, a retrograde EVLT technique utilizing proximal GSV access, resulting in successful vein ablation with minimal complications. Overall, this approach presents a promising addition to the management of CVI, offering enhanced patient care and improved outcomes. Case Presentation: Two patients with CVI and challenging antegrade GSV access underwent retrograde EVLT using proximal GSV access. Despite initial difficulties, including obesity and vasospasm, successful vein ablation was achieved with minimal complications. Post-procedural evaluations demonstrated significant symptomatic improvement, highlighting the efficacy of the retrograde technique. Conclusion: Retrograde EVLT utilizing proximal GSV access proves to be a safe and effective alternative in cases where antegrade access is challenging. The technique offers simplicity, minimal complications, and high patient satisfaction, with outcomes comparable to traditional approaches. Extended follow-up studies are needed to confirm the long-term effectiveness of retrograde EVLT compared to antegrade methods. Overall, retrograde EVLT presents a valuable option for managing CVI, particularly in patients with anatomical complexities or vasospasm, contributing to improved patient care and outcomes.
Technical procedure of endovenous laser ablation for chronic venous insufficiency Suprayoga, Imam Mi'raj; Kurnianingsih, Novi
Heart Science Journal Vol. 6 No. 2 (2025): The Complexity in the Management of Heart Rhythm Disorder
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.02.5

Abstract

Venous insufficiency is an often-encountered medical issue. In recent years, a number of procedures have been developed for the treatment of venous insufficiency within the context of minimally invasive surgery. Endovenous laser ablation (EVLA) is a commonly used contemporary method. The ultimate outcome is the formation of fibrotic tissue that seals the lumen of the treated vein. Vein ablation procedures are often performed with local-tumescent anaesthesia, allowing patients to be treated in an office environment and resume full activity immediately afterwards. The use of EVLA is strongly recommended above surgical intervention or foam sclerotherapy, as indicated by a 1A class recommendation. The approach seems to possess significant attributes and benefits in terms of safety and efficacy. This article provides an overview of the technical technique involved in EVLA for the treatment of venous insufficiency. Additionally, it emphasises the significance of EVLA in managing venous insufficiency.
Navigating backward, healing forward: The impact of retrograde EVLT in venous ulcer management: A case report Sekarsari, Calysta Citra; Kurnianingsih, Novi; Kurniawan, Dea Arie
Heart Science Journal Vol. 6 No. 2 (2025): The Complexity in the Management of Heart Rhythm Disorder
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.02.19

Abstract

Background: Chronic venous insufficiency (CVI) is a condition caused by venous reflux (backward flow) or obstruction, leading to significant morbidity and negatively impacting patients' quality of life (QoL). One recognized treatment for CVI is Endovenous Laser Treatment (EVLT). The antegrade conventional approach of EVLT is typically straightforward, but distal vein access can sometimes be difficult to achieve. Case Illustration: A 50-year-old man presented with bilateral lower extremity swelling and a chronic ulcer on his left leg that had persisted for one year without improvement. Doppler ultrasonography confirmed CVI in both lower extremities, with a great saphenous vein (GSV) reflux time exceeding 1500 ms. The patient was diagnosed with CVI C6EpAsPr and underwent EVLT. However, the small diameter of the distal GSV and vasospasm made antegrade access challenging. A retrograde approach was employed for EVLT on his left lower extremity, resulting in a successful outcome. Conclusion: This case highlights the use of the retrograde approach in EVLT as a viable alternative for accessing distal lesions when antegrade access is difficult, leading to successful wound healing. The retrograde technique can be considered a valuable option for CVI patients facing such challenges.
Precision in practice, save the limb, save the life: Early detection of grade IIA acute limb ischemia and management using catheter-directed thrombolysis - A case report Niazta, Nisa Amnifolia; Kurnianingsih, Novi; Kurniawan, Dea Arie
Heart Science Journal Vol. 6 No. 2 (2025): The Complexity in the Management of Heart Rhythm Disorder
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.02.20

Abstract

Background: Acute limb ischemia is an emergency condition that causes high morbidity and mortality. Endovascular revascularization in acute limb ischemia showed better in-hospital clinical outcomes than surgical revascularization. Case illustration: A 67-year-old man was referred by internal medicine at the rural area hospital with a diagnosis of acute limb ischemia. He complained of sudden left leg pain and numbness of the left leg 2 days prior to hospital admission. He was a heavy smoker and had a predisposition for atrial fibrillation. He received heparinization at the previous hospital. Upon arriving at Saiful Anwar Hospital, a physical examination showed severe left leg pain and was difficult to move. His left leg was pulseless, paresthesia and poikilothermia. Duplex ultrasound revealed a thrombus in the left popliteal artery with no flow downwards. We diagnosed the patient with Acute Limb Ischemia Rutherford IIA left inferior extremity. We decided to perform catheter-directed thrombolysis with the Alteplase regiment. Post catheter-directed thrombolysis angiography evaluation showed TIMI flow II at the left leg after 24-hour catheter-directed thrombolysis. The patient did not complain of leg pain or numbness anymore. Conclusion: Good outcomes in this patient were obtained through the ability to make correct initial diagnosis, early administration of heparin, and immediate referral to a cardiovascular center that can provide endovascular treatment. Catheter-directed thrombolysis is the right choice for grade IIA acute limb ischemia
Rapid heparinization as a decisive strategy for acute upper limb ischemia: a case report Veliawan, Zhafran; Kurnianingsih, Novi
Heart Science Journal Vol. 6 No. 2 (2025): The Complexity in the Management of Heart Rhythm Disorder
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.02.21

Abstract

Background: Acute upper limb ischemia is a rare clinical presentation of thromboembolism, mostly known in patients with atrial fibrillation. Both conservative and surgical procedures are available as alternatives to therapy. In this case report, a patient who had been diagnosed with acute upper limb ischemia received immediate heparin administration in order to protect the upper limb and restore its functional capabilities. Case Illustration: A 60-year-old male presented with acute pain and numbness, along with bluishness and a cold sensation in the right hand. He has unrestricted arm mobility. The patient has a medical background of atrial fibrillation for over 11 years. The right hand exhibited reduced peripheral saturation, pulselessness, pain, pallor, and poikilothermy, but neither paresthesia nor paralysis. Duplex ultrasonography showed no detectable blood flow from the right brachial artery up to the distal arteries. However, the vein remained audible. The patient received heparinization immediately. Conclusion: Immediate identification and administration of heparin in instances of acute upper limb ischemia (AULI) are crucial for achieving favorable outcomes and a good prognosis. Continued treatment with anticoagulants is necessary for the therapeutic intervention in order to enhance limb preservation, minimize complications, and ensure patients have an excellent quality of life subsequent to conservative treatment.
Vascular complications post invasive cardiovascular procedures Newary, Yola; Kurnianingsih, Novi
Heart Science Journal Vol. 6 No. 4 (2025): The Pursuit of Precision: Navigating Risks, Refining Diagnosis, and Securing Lo
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.04.2

Abstract

Vascular complications following intracoronary or intracardiac surgeries, such as hematoma, pseudoaneurysm, and arteriovenous fistula, significantly contribute to morbidity and occasionally. Furthermore, these complications not only escalate treatment costs but also prolong hospital stays. Several risk factors have been associated with vascular issues post-coronary procedures, including prolonged femoral sheath use, excessive anticoagulation, multiple interventions during a single admission, catheter placement in the superficial or deep femoral artery, larger catheter sizes, and complex procedures such as atherectomy or stent placement. Strategies to mitigate procedural risks, ensure early detection of vascular injuries, and facilitate timely management can prevent long-term disabilities.
Endovascular coil embolization for accessory veins in dialysis AVF: A pioneering case series from Saiful Anwar Hospital, Malang Fahmi, Hanim Isyfi; Kurnianingsih, Novi
Heart Science Journal Vol. 6 No. 4 (2025): The Pursuit of Precision: Navigating Risks, Refining Diagnosis, and Securing Lo
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.04.15

Abstract

  Background: The optimal vascular access for hemodialysis is an arteriovenous fistula (AVF), yet the failure rates range from 30% to 40%. Accessory veins modify blood flow, contributing to 40% of early failures. The treatment for stenosis is clearly established, whereas accessory vein treatment is not. Case Illustration: Two cases of endovascular coil embolization for accessory vein obliteration were performed at Saiful Anwar Hospital, Malang. The first case involved a 47-year-old female with late arteriovenous fistula failure, which was fixed with a percutaneous transluminal angioplasty and coil embolization. The second case involved a 58-year-old male with early radiocephalic arteriovenous fistula failure, which was also treated with a percutaneous transluminal angioplasty and coil embolization. Both procedures achieved complete elimination of the accessory vein and showed no signs of retrograde flow. The first and second cases have different onsets of early and late failure. Both patients required PTA and coil embolization simultaneously. Conclusion: Endovascular coil embolization is a safe and effective technique for occluding accessory veins in AVF, which helps improve their function in both early and late failures and shows higher success rates.
Factors that influence the clinical and technical success of venoplasty in patients with central venous stenosis at Saiful Anwar hospital Kurnianingsih, Novi; Akbar, Akita Rukmana
Heart Science Journal Vol. 6 No. 4 (2025): The Pursuit of Precision: Navigating Risks, Refining Diagnosis, and Securing Lo
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.04.8

Abstract

Background: Central venous stenosis (CVS) is a common complication in long-term hemodialysis patients, particularly those with a history of central venous catheterization. Percutaneous transluminal venoplasty is the primary treatment modality; however, its success varies depending on anatomical and procedural factors. Objectives: This study aimed to evaluate the procedural success of venoplasty in CVS patients and to identify anatomical and procedural factors associated with wire-crossing failure and residual stenosis of less than 30%. Materials and Methods: A retrospective study was conducted involving 55 patients with CVS who underwent venoplasty at Dr. Saiful Anwar General Hospital, Malang, between 2021 and 2025. Data collected included patient demographics, lesion characteristics, and procedural variables. Data were analyzed using SPSS version 27. Descriptive statistics were used to summarize baseline characteristics. Chi-square or Fisher’s exact tests were used for bivariate analysis, followed by multivariate logistic regression to determine independent predictors of procedural success. Results: Wire crossing was successfully achieved in 76.4% of cases, while balloon venoplasty resulted in residual stenosis <30% in 74.5% of patients. Multivariate analysis revealed that total occlusion (OR 1.619; 95% CI: 1.243–2.109; p = 0.001), presence of venous collaterals (OR 1.429; 95% CI: 0.974–2.094; p = 0.048), and vessel tortuosity (OR 2.237; 95% CI: 1.258–3.978; p = 0.000) were significantly associated with wire-crossing failure. Clinical success (residual stenosis <30%) was significantly associated with non-total occlusion (OR 1.542; 95% CI: 1.164–2.043; p = 0.014) and absence of vessel tortuosity (OR 2.610; 95% CI: 1.362–5.001; p = 0.000). No significant associations were found between procedural outcomes and factors such as wire type, balloon pressure, or puncture technique. Conclusion: Anatomical characteristics—including total occlusion, vessel tortuosity, and collateral formation—are the key determinants of venoplasty success in patients with CVS, outweighing the influence of procedural variables. Comprehensive anatomical assessment prior to intervention is essential to optimize procedural outcomes.
Beyond the procedure: A call for precision in diagnosis, risk mitigation, and sustainability of endovascular intervention in peripheral artery disease Kurnianingsih, Novi
Heart Science Journal Vol. 6 No. 4 (2025): The Pursuit of Precision: Navigating Risks, Refining Diagnosis, and Securing Lo
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.04.1

Abstract

Endovascular interventions have made a lot of advancements in managing peripheral arterial disease (PAD). The interventions of PAD were limited only to medical therapy or surgery, but as for now, it has undergone changes because of improvements in the tools used for intervention and the improved operator skill, so the patients are able to gain benefits, even if the intervention is minimally invasive. The benefit does not stop at the technical success; it extends to the precision in diagnosing, extensive risk mitigation, and sustainable outcomes. Duplex ultrasonography is now popularly used because of its ease of use, following more advanced examinations such as CT or MR angiography, resulting in accurate, on-time, and precise interventions. But, there are several challenges left, such as the low rate of use of guideline-directed medical therapy that may lead to an increased number of mortality and amputation risk. Furthermore, multidisciplinary collaboration is deemed essential in optimizing sustainability. Patency or angiography, which are usually used as parameters traditionally, are not enough to measure the success of the therapy; instead, limbs preserved, improvement of the function, and the quality of life may define success in therapy, where endovascular interventions may directly affect those parameters mentioned. In order to achieve sustainable and meaningful outcomes affecting the long-term well-being of patients, patient-centered strategies, early detection, and maximizing the use of resources are a must.
The Effect of HbA1C Variability and Lipid Profile on Carotid Intima-Media Thickness (cIMT) and Flow-mediated Dilatation (FMD) in children and adolescent with Type 1 Diabetes Mellitus at Saiful Anwar Hospital Malang Ikeningrum, Dyah Ayu; Tjahjono, Cholid Tri; Kurnianingsih, Novi; Widito, Sasmojo; Putri, Valerina Yogibuana Swastika
Heart Science Journal Vol. 3 No. 3 (2022): Cardiovascular Disease in Young Adulthood: Who, When, and How to Screen?
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2022.003.03.4

Abstract

BackgroundThere is a correlation between diabetes mellitus type 1 (T1DM) and a higher risk of heart disease. Atherosclerosis, which can be discovered early with cIMT (Carotid Intima-Media Thickness) and Flow Mediated Dilation (FMD) tests, contributes to the development of cardiovascular disease. HbA1c fluctuation and lipid profile can have an impact on cIMT and FMD.AimThe aim of this study is to determine the influence of HbA1c variability and lipid profile on cIMT and FMD levels in children T1DM patients treated at Dr Saiful Anwar Hospital Malang.MethodsThe study utilized a cross-sectional design and included 82 participants with Type 1 Diabetes Mellitus who were routinely treated at the Dr. Saiful Anwar Hospital Malang's pediatric outpatient clinic between January - July 2019 and December 2021 and- January 2022.ResultsThe correlation test revealed no significant connection between HDL (ρ=-0,029; p=0,796), LDL (ρ=-0.213; p=0.055), TG (ρ= -0.179; p= 0.107), and total cholesterol (ρ=-0.182; p= 0.101). Association tests revealed a positive correlation between LDL (ρ=0,318; p=0,004) and total cholesterol (ρ=0,230; p=0,038) levels and IMT. The correlation coefficient between HbA1C variability and FMD as evaluated by HVS was -0.498 (ρ=0.000; p=0.05), as was the correlation coefficient between HbA1c-SD (ρ=-0.467; p=0.000) and HbA1c-CV (ρ=-0.400; p=0.000). Additionally, a significant positive connection was discovered between IMT and the value of HbA1c variability utilizing HVS (ρ=0.455; p=0.000), HbA1c-SD (ρ=0.434; p=0.000), and HbA1c-CV (ρ=0.325; p=0.003). The linear regression analysis revealed that the three variables with the greatest influence on FMD were HVS (R=0.398), LDL (R=0.316), and HbA1c-SD (R=0.293). HVS (R=0.468), LDL (R=0.268), and total cholesterol (R=0.198) were the three most impactful variables on IMT. It is known that the combination of lipid profile and HbA1c fluctuation contributes 25.1% to FMD using this model. Meanwhile, the lipid profile and HbA1c variability together accounted for 34.5% of the variance in IMT.ConclusionVariability in HbA1c and lipid profile (LDL and total cholesterol) can contribute to an increase in intima-media thickness and a decrease in brachial artery FMD in children with T1DM.  
Co-Authors Abusari, Muchamad ACHMAD RIFAI Afifuddin, Mokhammad AJI, BAYU Akbar, Akita Rukmana Anjarwani, Setyasih Arif Wicaksono Astiawati, Tri Atma Gunawan Bahar, Mokhamad Aswin Cholid Tri Tjahjono Djanggan Sargowo Elizabeth Damanik, Gracelia Ruth Erickatulistiawan, Gallusena Fahmi, Hanim Isyfi Fathurohim, Zainal Firdaus, Achmad Jauhar Galih Prakosa, Ardani Haryanto, Ahmad Farid Ikeningrum, Dyah Ayu Indra Prasetya Karolina, Wella Kemala, Yuke Fawziah Kurniawan, Catur Rizky Kurniawan, Dea Kurniawan, Dea Arie Lestari, Defyna Dwi Lestari, Puspa Maimun Zulhaidah Arthamin, Maimun Zulhaidah Martini, Heny Mohammad Saifur Rohman Newary, Yola Niazta, Nisa Amnifolia Noverike, Nikhen Nugroho, Ira Vori Pamuna, Oktafin Srywati Putri, Valerina Yogibuana Swastika Rahimah, Anna Fuji Rizal, Ardian Ruspiono, Evit Satrijo, Budi Satwikajati, Sawitri Sekarsari, Calysta Citra Suprapta, Aloysius Yuwono Suprayoga, Imam Mi'raj Swastikaputri, Valerina Yogibuana Titin Andri Wihastuti Tjahjono, Cholid Veliawan, Zhafran Vori, Ira Widito, Sasmojo zunardi, Lutfi hafiz