bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk of Vascular access Thrombosis in Patients with Systemic Lupus Erythematosus on Hemodialysis
Authors: Shafi S.T. , Gupta M.
Published: March 2018

Introduction

Anticardiolipin antibody is associated with increased risk of vascular access thrombosis (VAT) in hemodialysis (HD) patients. Systemic lupus erythematous (SLE) patients have a high prevalence of anticardiolipin antibodies, but it is not clear whether these patients are at high risk of developing vascular access thrombosis.

Methods

Thirty six SLE patients on HD, who had either an arterio-venous (AV) graft or AV fistula as vascular access, and were not on anticoagulation treatment, were retrospectively identified at Henry Ford Hospital. A similar number of patients without SLE, matched for age, sex, race and type of vascular access were selected as a control population. Vascular access thrombosis rate at one year was compared between two groups.

Results

Mean age at dialysis was 36±10 years in 36 SLE patients (28 females, 8 males) and was 38±6.4 years in 36 non-SLE patients (29 females, 7 males). Of all patients, 29/36 (80.5%) SLE and 27/36 (75%) non-SLE patients had AV grafts, whereas the rest had AV fistulas as vascular access (19.5% SLE and 25% non-SLE patients). Out of 36 SLE patients, 24 (66.6%) patients developed VAT at one year as compared to 14 (38.9%) patients in non-SLE group (p<0.05). The odds ratio of VAT in SLE patients was 3.1 (95% CI 1.2–8.2).

Conclusion

SLE patients on hemodialysis are more likely to develop vascular access thrombosis as compared to non-SLE patients.
Jugular Vein-Mammary Artery Fistula after Catheterism for Hemodialysis: Case Report
Authors: Colì L. , Donati G. , Galaverni M.C. , Golfieri R. , Raimondi C. , Cianciolo G. , Comai G. , Piccari M. , Rossi C. , Stefoni S.
Published: March 2018

The demographic characteristics of hemodialysis (HD) patients increase the need for the tunneled cuffed permanent catheter (TCC) as a definitive vascular access (VA) for HD. The internal jugular vein is increasingly being used as a route for TCC or temporary catheter placement and can be associated with serious complications. Among them other authors have described arteriovenous fistula (AVF) creation between the common carotid artery and the right jugular vein. We describe a case of an AVF between the right internal jugular vein and the right internal mammary artery. The fistula was detected during the TCC placement in a patient who underwent several jugular and subclavian catheterisms for HD in her clinical history.
Massaging Thrombosed PTFE Hemodialysis Access Graft - Recipe for Disaster
Authors: Shrestha B.M.
Published: March 2018

Early thrombosis of a polytetrafluoroethylene (PTFE) graft used for hemodialysis vascular access can result from technical error or hypotension and hypovolaemia in the immediate postoperative period. Massaging a graft to dislodge a freshly formed thrombus with a view to restoring blood flow can lead to acute limb ischaemia from embolisation of the artery as a result of migration of the thrombus from the arterial end of the graft, hence massaging of thrombosed grafts should be avoided. This report describes the management of a 35-year-old diabetic male who developed acute ischaemia of hand due to embolisation of the radial artery following massage of a thrombosed brachio-basilic forearm PTFE loop graft.
Salvage of Arteriovenous Fistula by Angioplasty of Collateral Veins Establishing a new Channel
Authors: Ahmad I.
Published: March 2018

Patents with end-stage renal disease depend on the patency of their dialysis access. As these patients have only finite access options, and no access lasts indefinitely, it is imperative that each access should be maintained for as long as possible. This report describes a case of salvage of an upper arm fistula by repeated angioplasty of the collateral veins after the main out flow vein was occluded and could not be recanalyzed.
Percutaneous, Non-Surgical Placement of Tunneled, Cuffed, External Jugular Hemodialysis Catheters: A Case Report
Authors: Yevzlin A.S. , Chan M.R. , Wolff M.R.
Published: March 2018

The right internal jugular vein is widely accepted as the vessel of choice for placement of long-term central venous catheters for hemodialysis. As vascular access sites become progressively depleted, alternate anatomic locations for access must be sought. We describe a non-surgical (fluoroscopy assisted, percutaneous) technique for placement of external jugular, tunneled, cuffed hemodialysis catheters, and provide long-term blood flow and dialysis adequacy data for EJV catheters.
Displacement of the Inferior Vena Cava as a Factor Limiting Catheter Performance in Long-Term Hemodialysis Patients
Authors: Fabbian F. , Malacarne F. , Russo G. , Galeotti R. , Gresta E. , Cantelli S. , Catizone L.
Published: March 2018

We report a case of a lady affected by autosomal dominat polycystic kidney disease who had been on hemodialyis for 24 years. She has exhausted all options for arterious-venous fistula. The presence of an acquired anatomical abnormality was an obstacle in order to get appropriate blood flow from standard tunnelled femoral catheters. The enlarged right kidney was pushing the inferior vena cava to the left side of the abdomen, and the abnormality was demonstrated by phlebography. Only after placing a cuffed catheter 53 cm long in her left femoral vein we could dialyze efficiently. Venography is mandatory before placing a cuffed catheter especially in uremic patients with long history of access failure, because it saves costs.
A Two-Staged Technique for Basilic Vein Transposition
Authors: Pasch A.R.
Published: March 2018

The dilemma of creating a fistula in patients without a useable cephalic vein can be addressed by basilic vein transposition, yet results of the classic single-stage procedure are inconsistent and surgeon utilization of this procedure is variable. This article describes a two-staged technique for basilic vein transposition. The two-staged technique is likely to facilitate higher fistula rates in patients unable to have a direct fistula, and warrants consideration by surgeons striving to achieve higher fistula rates
Primary Thromboprophylaxis with Heparins for Arteriovenous Fistula Failure in Pediatric Patients
Authors: Sharathkumar A. , Hirschl R. , Pipe S. , Crandell C. , Adams B. , Lin J.J.
Published: March 2018

Background

To reduce the incidence of early arteriovenous fistula failure (AVF) due to thrombosis in pediatric hemodialysis (HD) patients, a primary thromboprophylaxis (PTP) protocol was initiated at author's institution in June 2005. The goal of this study is to report author's experience with this protocol one year later.

Methods and Results

19 AVFs (14 patients, Historical group) and 8 AVFs (7 patients, PTP group) were created prior to and after initiation of PTP respectively. PTP consisted of unfractionated heparin (5–10 units/kg/hr) infusion postoperatively, followed by subcutaneous low molecular weigh heparin (LMWH) until AVF was matured. LMWH dosing was “Prophylactic” (0.5 mg/kg/d, anti-factor Xa levels: peak 0.25–0.5 and trough < 0.3 units/mL) and “Therapeutic” (1 mg/kg/d, anti-factor Xa level: peak 0.5-1 and trough < 0.5 units/mL) based on thrombosis predisposition. In Historical group, 12 AVFs did not receive thromboprophylaxis (No-treatment group), 5 received 81 mg aspirin/day (Aspirin group), and 2 received LMWH. In No-treatment group 10/12 AVFs failed: 9 thromboses and 1 stenosis. In Aspirin group 1/5 AVFs failed due to thrombosis. In PTP group 1/8 AVFs failed due to stenosis; the first 2 AVFs developed hematoma prompting a reduction in LMWH dose and monitoring trough anti-factor Xa levels, one AVF required thrombectomy after LMWH was transiently held. The incidence of thrombosis was less in PTP group (12.5%) when comparing to No-treatment group (83%) (p < 0.05).

Conclusion

PTP is a feasible option to prevent early thrombosis at AVF. Close clinical and laboratory monitoring including trough anti-factor Xa levels is required to adjust optimum anticoagulation. Larger studies are needed to clarify safety and efficacy of our PTP protocol.
High Blood flow Rates with Adjustment of Needle Diameter do not Increase Hemolysis during Hemodialysis Treatment
Authors: Techert F. , Techert S. , Woo L. , Beck W. , Lebsanft H. , Wizemann V.
Published: March 2018

Background

Higher blood flow in dialysis therapy is often avoided due to concerns about shear-induced blood damage despite the lack of reliable data.

Objective

This study investigated the influence of higher blood flow rates on plasma free hemoglobin (Hb) concentration after hemodialysis (HD) treatment.

Methods

Thirty-two chronic HD patients were treated once with a blood flow rate of 250 mL/min using a 17G needle, and once with a blood flow rate of 500 mL/min using a 14G needle. Arterial and venous pressure and blood pressure (BP) were recorded before and after treatment. Blood samples were taken before and after treatment for analysis of plasma free Hb, pH, HCO3, base excess, hematocrit value, urea, sodium, potassium and calcium.

Results

HD treatment at blood flow rates of 500 mL/min did not increase plasma free Hb compared to treatments at blood flow rates of 250 mL/min. Frequency of intradialytic BP drops was not different either. By adaptation of the needle size, negative arterial pressure could be kept at a similar level. Urea reduction rates were significantly higher during treatments with higher blood flow rates.

Conclusion

Higher blood flow rates can be applied without an increased hemolysis risk provided that needle sizes are adapted accordingly.
Functional Patency of Autogenous AV Fistulas for Hemodialysis
Authors: Nguyen T.H. , Bui T.D. , Gordon I.L. , Wilson S.E.
Published: March 2018

Background

Although AV fistulas are the preferred access for hemodialysis and have low complication rates, failure to function remains high and time to first dialysis may be several months.

Methods

Data from a Computerized Patient Record System of patients undergoing AV fistula from October 2000 to March 2006 were reviewed for type of fistula, interval from AV fistula construction to first hemodialysis, patency period, and complication rate.

Results

129 patients were identified who underwent 155 autogenous AV fistula constructions. The average age was 62.1 (range 40–84) years old. 114 radiocephalic and 41 brachiocephalic fistulas were performed. 57 (50%) radiocephalic fistulas allowed successful hemodialysis after an average length of 13±5 weeks with a primary patency of 13±4 months. 24 (42%) fistulas subsequently thrombosed, 7 (12%) developed fistula stenosis, and 2 (4%) developed steal syndrome. 28 (68%) brachiocephalic fistulas reached successful hemodialysis after 6±2 weeks with a primary patency of 16±7 months. Eleven (42%) of the brachiocephalic fistulas that reached hemodialysis remained patent while four (15%) thrombosed. Two (8%) brachiocephalic fistulas thrombosed before reaching hemodialysis. There were two incidences (5%) of steal syndrome in the brachiocephalic group with one case being severe leading to tissue loss in the hand.

Conclusion

Brachiocephalic fistulas were superior to radiocephalic in both time to maturity, primary patency, and functional primary patency. Brachiocephalic fistulas had a higher maturation rate and were less likely to fail once hemodialysis began. Vascular surgeons should develop better patient selection to predict which fistulas will function successfully rather than risk complications of prolonged central catheters.
Effect of Upper arm Brachial Basilic and Prosthetic Forearm Arteriovenous Fistula on Left Ventricular Hypertrophy
Authors: Keuter X.H.A. , Kooman J.P. , Habets J. , Van Der Sande F.M. , Kessels A.G.H. , Cheriex E.C. , Tordoir J.H.M.
Published: March 2018

Background

Creation of an arteriovenous fistula (AVF) may increase left ventricular hypertrophy in the hemodialysis population. Aim of this study was to compare the effects of a brachial-basilic (BB) AVF and the prosthetic brachial-antecubital forearm loop access (PTFE) on cardiac performance.

Methods

Patients were randomized to receive BB-AVF or prosthetic brachial-antecubital forearm loop access. Before and three months after AVF creation patients underwent an echocardiographic examination. Mann-Whitney U-test was used to compare relative increase between the measured cardiac parameters for the two groups.

Results

Twenty-seven patients participated in the study. The relative increase in left ventricular parameters was not significantly different between the two groups. Only left ventricular end-diastolic diameter tended to be of significance. Mean blood flow through the brachial artery was 1680±156 and 1450±221 mL/min three months after surgery for the PTFE and the BB-AVF group, respectively.

Conclusion

After three months of follow-up, changes in cardiac structure were comparable between patients with BB and PTFE AVFs. Also access flow was comparable at this time. In general, the effects of creation of a fistula on LV structure were limited. Longer follow up time may be needed to explore the long term effects of different vascular accesses on cardiac function.
Pitfall in Pediatric Dialysis: Malposition of a Dialysis Catheter Mimicking Azygos Continuation Syndrome
Authors: Demant A.W. , Rattunde H. , Abderhalden S. , Von Vigier R. , Wolf R.W.
Published: March 2018

Central venous catheters are established as vascular access in hemodialysis therapy. Vascular catheter misdirection may occur and is a well known problem.

We present a rare catheter malposition in a young dialysis patient with consequent dilatation of the azygos vein system, simulating the appearance of an azygos continuation syndrome (ACS).
Duplex Ultrasound Evaluation for Dialysis access Selection and Maintenance: A Practical Guide
Authors: Davidson I. , Chan D. , Dolmatch B. , Hasan M. , Nichols D. , Saxena R. , Shenoy S. , Vazquez M. , Gallieni M.
Published: March 2018

Detailed case directed history and examination is the mainstay of dialysis access modality selection, ie site and type of access, as well as for maintenance of dialysis access for longevity. As a logical step following history and physical examination, duplex ultrasound evaluation (DUE) is the most cost effective and non-invasive screening tool for evaluation for access placement and for assessment of an established access. Pre-operative vascular mapping allows selection of the optimal dialysis access modality and site. In established accesses, duplex ultrasound testing will diagnose the majority of vascular access complications and direct proper surgical or interventional radiology management. This review outlines a practical decision-making algorithm using DUE for choosing and managing the dialysis access.
Urokinase Lock or Flush Solution for Prevention of Bloodstream Infections Associated with Central Venous Catheters for Chemotherapy: A Meta-Analysis of Prospective Randomized Trials
Authors: Kethireddy S. , Safdar N.
Published: March 2018

Background

Intravascular devices (IVDs) carry significant risk of device-associated bloodstream infection (BSI). Catheter thrombosis increases the likelihood of microbial colonization of the catheter and BSI. Urokinase has been studied for the prevention of BSI associated with IVDs. We undertook a systematic review to determine the efficacy of urokinase-heparin lock or flush solution compared with heparin alone in preventing IVD-associated BSI.

Methods

Computerized databases were searched for relevant publications in English from January 1966 to 1 January 2007. We identified randomized controlled trials comparing a urokinase-heparin lock or flush solution with heparin alone for prevention of BSI associated with long-term IVDs. Summary effect sizes were calculated with assessment of heterogeneity.

Results

Five randomized, controlled trials involving a total of 991 patients being treated with IVDs met the inclusion criteria; all five studies were conducted among patients with cancer; three of these studies were undertaken in children and two in adults. The summary risk ratio with a urokinase-heparin lock solution for IVD-associated BSI was 0.77 (95% confidence interval [CI], 0.60–0.98; p=0.01). Results of the test for heterogeneity were not statistically significant (p=0.53).

Conclusions

Use of a urokinase lock solution in high-risk patient populations being treated with long-term central IVDs may reduce the risk of BSI. However, there are few randomized trials and methodologic limitations of these preclude more robust recommendations regarding the use of urokinase to prevent BSI. Further adequately powered studies should seek to evaluate the efficacy of urokinase and optimize dosage and instillation regimen.
Flow Interruption of the Distal Radial Artery: Treatment for Finger Ischemia in a Matured Radiocephalic AVF
Authors: Miller G.A. , Khariton K. , Kardos S.V. , Koh E. , Goel N. , Khariton A.
Published: March 2018

Purpose

To establish an effective approach for diagnosis and treatment of hand ischemia in matured radiocephalic arteriovenous fistulae (AVF).

Methods

One hundred and fifty end-stage renal disease patients (4% of our practice) presented to our outpatient vascular access facility complaining of a range of symptoms including coldness, numbness and pain in the fingers indicative of ischemia due to steal syndrome. In 15 patients the symptoms of steal syndrome were limited to the fingers, sparing the hand. Physical examination was indicative of steal syndrome caused by shunting of blood from the ulnar artery via the palmar arch, away from the fingers and into the fistula. To confirm the diagnosis, angiography was performed which demonstrated retrograde flow in the distal radial artery (DRA), a hypertrophied palmar arch, and a patent hypertrophied ulnar artery. Ischemia was treated with DRA flow interruption. Transcatheter coil embolization of the DRA (10 patients) was preferred because it proved to be a quick, safe and effective technique. Whenever embolization was not possible ligation of the DRA was performed in accordance with accepted surgical literature (five patients).

Results

DRA flow interruption was effectively accomplished by either ligation or coil embolization in all cases. All patients had symptomatic improvement. Complete symptom resolution was experienced by 100% (10/10) of patients who received DRA embolization and by 3/5 patients who required ligation. The average follow-up period was 9 months. There were no complications during the procedure or during the follow-up period.

Conclusion

Diagnosis using physical examination, angiography and treatment with embolization or ligation of the DRA can be performed with great success in an outpatient setting.
Dialysis Catheter Associated Cardiac Tamponade: Quick Diagnosis by Extemporaneous Echocardiography
Authors: Ervo R. , Angeletti S. , Dertenois L. Turrini , Cavatorta F.
Published: March 2018

We report a case of pericardial tamponade associated with over the wire exchange of a central venous catheter (CVC) for hemodialysis (HD). The complication was quickly diagnosed due to an extemporaneous echocardiogram with a linear probe, before other laboratory and radiologic tests could detect it. The described approach allowed a suitable therapy with a positive result.
Aneurysmorrhaphy is an Easy Technique for Arteriovenous Fistula Salvage
Authors: Balaz P. , Rokosny S. , Klein D. , Adamec M.
Published: March 2018

The life-saving procedures for patients in chronic renal failure (CRF) are hemodialysis (HD) or successful kidney transplantation. HD requires a properly placed and functioning vascular access, most often obtained by creating an arteriovenous fistula (AVF). The long-term patency of AVFs is limited, in addition to other factors, by the development of intimal hyperplasia and the process results in venous wall thickening and progressive fistula occlusion. Another problem is limited patency, due to the development of pseudoaneurysm, which is associated with an increased risk of thrombosis, infection and bleeding, difficult cannulation for dialysis, pain and cosmetic defects. Treatment is focused on rapidly progressing pseudoaneurysms, which can predispose to rupture, technical problems during cannulation because of pseudoaneurysm size or a growing intraluminal thrombus. Most of these patients are scheduled for pseudoaneurysm removal and new fistula construction or, occasionally, an endovascular procedure involving stent graft implantation. This paper describes a simple and inexpensive technique of managing an AVF pseudoaneurysm, i.e. aneurysmorrhaphy. To offset the weakening of the venous wall by suture following aneurysmorrhaphy, an external polyethylene terephthalate (PET) prosthesis was implanted in the vein to prevent the development of intimal hyperplasia in the de novo created AVF.
Radiological Central Vein Treatment in Vascular Access
Authors: Mansour M. , Kamper L. , Altenburg A. , Haage P.
Published: March 2018

In the last decades, the percutaneous interventional approach for the treatment of central venous obstructions (CVO) has become increasingly popular as the treatment of first choice because of its minimal invasiveness and reported success rates. CVOs are caused by a diverse spectrum of diseases which can be broadly categorized into two principal eliciting genera, either benign or malignant obstructions. The large group of benign venous obstructions includes the increasing number of end-stage renal disease patients with vascular access related complications. Due to the invasiveness and complexity of thoracic surgery for benign CVOs, the less invasive percutaneous interventional therapy can generally be considered the preferred treatment option. Initially, the radiological intervention consisted of balloon angioplasty alone, subsequently additional stent placement was applied. This was advocated as either primary placement or secondary in cases of elastic recoil or residual stenosis after percutaneous transluminal angioplasty (PTA). The efficacy of angioplasty of CVO in patients with vascular accesses, either with or without stenting, has been addressed by various studies. Overall, reports indicate an initial technical and clinical success rate above 95% and satisfactory patency rates. However, systematic follow-up and frequent re-interventions are necessary to maintain vascular patency to achieve long-term success.
Vena Cava Filters: A Synopsis of Complications and Related Topics
Authors: Stawicki S.P. , Sims C.A. , Sharma R. , Weger N.S. , Truitt M. , Cipolla J. , Schrag S.P. , Lorenzo M. , Chaar M. EL , Torigian D.A. , Kim P.K. , Sarani B.
Published: March 2018

Deep venous thrombosis and pulmonary embolism constitute common preventable causes of morbidity and mortality. The incidence of venous thromboembolism (VTE) continues to increase. Standard anticoagulation therapy may reduce the risk of fatal PE by 75% and that of recurrent VTE by over 90%. For patients who are not candidates for anticoagulation, a vena cava filter (VCF) may be beneficial. Despite a good overall safety record, significant complications related to VCF are occasionally seen. This review discusses both procedural and non-procedural complications associated with VCF placement and use. We will also discuss VCF use in the settings of pregnancy, malignancy, and the clinical need for more than one filter.
A Successful Scheme for Reducing Waiting Times for Arteriovenous Fistula Formation
Authors: Barlow A.D. , Doughman T.M. , Warwick G.L. , Nicholson M.L.
Published: March 2018

Purpose

In a bid to reduce waiting times for arteriovenous fistula (AVF) formation we introduced a scheme whereby nephrologists were able to place patients directly on the waiting list for surgery. This study evaluated the quality of these direct referrals and assessed the reduction in waiting times.

Methods

Fifty consecutive patients referred directly to the waiting list were compared with 50 patients placed on the waiting list after being assessed in our vascular access clinic.

Results

Forty-nine patients from the direct group and 47 patients from the clinic group underwent surgery. In the direct group 39 patients (80%) underwent the same procedure as they had been originally listed for, compared with 39 patients (83%) in the clinic group (p=0.80). A fistula suitable for needling was created in 37 patients (76%) of the direct group and 38 patients (81%) of the clinic group (p=0.62). The median wait from referral to surgery in the direct group was significantly lower than in the clinic group (62 vs.141 days; p<0.0001).

Conclusion

This study demonstrates that nephrologists are able to effectively assess select patients for AVF formation. This significantly reduces waiting times for surgery, without an increase in cancelled operations, or a reduction in technical success.
The Effect of Hemoglobin Level on Arteriovenous Fistula Survival in Iranian Hemodialysis Patients
Authors: Zadeh M. Khavanin , Gholipour F. , Hadipour R.
Published: March 2018

Objective

End-stage renal disease (ESRD) poses steadily growing challenges to health care systems worldwide. Renal replacement therapy with hemodialysis (HD) or kidney transplantation is the only possibility for ESRD patient survival. A complete correction of anemia in HD patients may lead to an increased risk of vascular arteriovenous fistula (AVF) primary failure; some studies have demonstrated that decreased levels of hemoglobin (Hb) had adverse effects on cardiac and brain function. This study was designed to evaluate the impact of different risk factors, especially the Hb level on AVF survival.

Methods

Prospective observational data were analyzed from a non-randomized sample (n=100) of HD patients who were referred for first AVF creation between April 2005 and December 2006 with <1 month on HD. The relative risk (RR) of access primary failure was evaluated in four different groups of patients divided according to their Hb levels (<8, 8–10, 10–12, and >12 g/dL). Other factors possibly influencing vascular access (VA) survival were also considered including gender, age, smoking, diabetes, hypertension, parathyroid hormone levels, ACE inhibitor intake and triglyceride levels. The analyses were performed using SPSS v.11.5, Kaplan-Meier analysis, Cox's regression and log rank test.

Results

There was a statistically significant higher risk of AVF primary failure in patients with Hb <8 g/dL (RR=1.41; p=0.01), diabetes (RR=1.21; p=0.05), age>60 yrs (RR=1.41; p=0.06) were identified as predictive factors for AVF primary failure. ACE inhibitor intake (RR=0.45; p=0.01) was found to be protective.

Conclusion

Correction of serum Hb level can lead to a better result in VA survival and ACE inhibitor intake was found to be a protective factor.
Ultrasound-Guided Direct Basilic-Axillary Approach in Preoperative Venography for Hemodialysis Access
Authors: Shemesh D. , Goldin I. , Cytter-Kuint R. , Zaghal I. , Berelowitz D. , Olsha O.
Published: March 2018

Purpose

Hemodialysis patients with suspected central vein stenosis or occlusion require venographic assessment before access surgery. Conventional venography may be unsatisfactory because of the limited ability to image central veins via peripheral arm veins that are inadequate or that have been damaged by multiple cannulations. Imaging of the central veins requires high flow contrast injection, which may be unattainable through small peripheral veins. We suggest a simple technique to improve central vein imaging by ultrasound-guided direct puncture of the basilic vein at its entry to the axilla.

Methods

We studied 20 patients in whom upper limb venography via peripheral veins was inadequate for the satisfactory demonstration of central vein anatomy and they underwent direct basilic-axillary vein puncture with Doppler ultrasound guidance. A 4Fr micropuncture catheter was used for manual injection of the contrast agent to image the central veins.

Results

All patients had inadequate upper limb venography via peripheral vein cannulation, and stenosis could not be ruled out due to poor visualization of the central veins. In all cases, venography by Doppler ultrasound-guided direct basilic-axillary vein puncture was very easy for both the radiologist and the patient, consistently providing high quality imaging without the need for repeated attempts at cannulation and without the need for infusion pumps. No complications were noted during or after the procedure.

Conclusions

Venography by Doppler ultrasound-guided direct basilic-axillary vein puncture is a simple and rapidly performed technique that improves the visualization of the central veins.
Plasminogen Activator Inhibitor-1 Activity and 4G/5G Polymorphism in Hemodialysis
Authors: Trimarchi H. , Duboscq C. , Genoud V. , Lombi F. , Muryan A. , Young P. , Schwab M. , Castañón M. , Rodríguez-Reimundes E. , Forrester M. , Pereyra H. , Campolo-Girard V. , Seminario O. , Alonso M. , Kordich L.
Published: March 2018

Introduction

Chronic insufficiency alters homeostasis, in part due to endothelial inflammation. Plasminogen activator inhibitor-1 (PAI-1) is increased in renal disease, contributing to vascular damage. We assessed PAI-1 activity and PAI-1 4G/5G polymorphism in hemodialysis (HD) subjects and any association between thrombotic vascular access (VA) events and PAI-1 polymorphism.

Methods

Prospective, observational study in 36 HD patients: mean age: 66.6 ± 12.5 yr, males n=26 (72%), time on HD: 28.71 ± 22.45 months. Vascular accesses: 10 polytetrafluoroethylene grafts (PTFEG), 22 arteriovenous fistulae (AVF), four dual lumen catheters (CAT). Control group (CG): 40 subjects; mean age: 60.0 ± 15 yrs, males n=30 (75%). Group A (GA): thrombotic events (n=12), and group B (GB): No events (n=24). Groups were no different according to age (69.2 ± 9.12 vs. 65.3 ± 14.5 yrs), gender (males: 7; 58.3% vs. 18; 81.8%), time on HD (26.1 ± 14.7 vs. 30.1 ± 38.7 months), causes of renal failure. Time to follow-up for access thrombosis: 12 months.

Results

PAI-1 levels in HD: 7.21 ± 2.13 vs. CG: 0.42 ± 0.27 U/ml (p<0.0001). PAI-1 4G/5G polymorphic variant distribution in HD: 5G/5G: 6 (17%), 4G/5G: 23 (64%); 4G/4G: 7 (19%) and in CG: 5G/5G: 14 (35%); 4G/5G: 18 (45%); 4G/4G: 8 (20%). C-reactive protein (CRP) in HD: 24.5 ± 15.2 mg/L vs. in CG 2.3 ± 0.2 mg/L (p<0.0001). PAI-1 4G/5G variants: GA: 5G/5G: 3; 4G/5G: 8; 4G/4G: 1; GB: 5G/5G: 3; 4G/5G: 15; 4G/4G: 6. Thrombosis occurred in 8/10 patients (80%) with PTFEG, 3/22 (9%) in AVF, and 1/4 (25%) in CAT. Among the eight PTFEG patients with thrombosis, seven were PAI 4G/5G.

Conclusions

PAI-1 levels were elevated in HD patients, independent of their polymorphic variants, 4G/5G being the most prevalent variant. Our data suggest that in patients with PTFEG the 4G/5G variant might be associated with an increased thrombosis risk.
Understanding the Dialysis access Steal Syndrome. A Review of the Etiologies, Diagnosis, Prevention and Treatment Strategies
Authors: Malik J. , Tuka V. , Kasalova Z. , Chytilova E. , Slavikova M. , Clagett P. , Davidson I. , Dolmatch B. , Nichols D. , Gallieni M.
Published: March 2018

Distal hypoperfusion ischemic syndrome (DHIS), commonly referred to as hand ischemia or “steal” after dialysis access placement, occurs in 5–10% of cases when the brachial artery is used, or 10 times that of wrist arteriovenous fistulas (AVFs) using the radial artery. It is typically seen in elderly women with diabetes, and may carry severe morbidity including tissue or limb loss if not recognized and treated. Three distinct etiologies include (1) blood flow restriction to the hand from arterial occlusive disease either proximal or distal to the AV access anastomosis, (2) excess blood flow through the AV fistula conduit (true steal), and (3) lack of vascular (arterial) adaptation or collateral flow reserve (ie atherosclerosis) to the increased flow demand from the AV conduit. These three causes of steal may occur alone or in concert. The diagnosis of steal is based on an accurate history and physical examination and confirmed with tests including an arteriogram, duplex Doppler ultrasound (DDU) evaluation with finger pressures and waveform analysis. Treatment of steal includes observation of developing symptoms in mild cases. Balloon angioplasty is the appropriate intervention for an arterial stenosis. At least three distinct surgical corrective procedures exist to counteract the pathophysiology of steal. The ultimate treatment strategy depends on severity of symptoms, the extent of patient co-morbidity, and the local dialysis access technical team support and skills available.
Arteriovenous Fistulae vs. Arteriovenous Grafts: A Retrospective Review of 1,700 Consecutive Vascular access Cases
Authors: Schild A.F , Perez E. , Gillaspie E. , Seaver C. , Livingstone J. , Thibonnier A.
Published: March 2018

Objective

Vascular access (VA) procedures are rapidly becoming the most prevalent surgery in the United States. It is estimated that there will be over 500,000 VA procedures done this year. Previously, surgeons in the US were attempting many more non-autogenous grafts than autogenous fistulae. In recent years, there has been a great push called “Fistula First” to promote arteriovenous fistulae (AVF) as the first line of treatment vs. non-autogenous grafts. The goal of this investigation is to determine if too many fistulae are now being performed without attention to specific patient profiles.

Methods

A retrospective review of 1700 consecutive cases was performed by one surgeon at one institution between 1997 and 2005. Patients were categorized by demographics, co-morbidities, previous access procedures, access location, and type of graft. Patency was calculated. Kaplan-Meier, Cox regression and the Log Rank Test were used to analyze data. Access endpoints and complications were also documented.

Results

The study reviewed 1700 procedures. The median age was 52 (60.2% male) with 58.7% fistulae and 41.3% grafts. Median patency time was 10 months, with no statistically significant difference between access types. There was no significant difference in length of patency when comparing upper arm (70.1%), lower arm (24.5%) and thigh (5.4%). Graft infection rate was 9.5% and fistula infection rate was 0.9% (p<0.001). The overall infection rate was 4.5%, and decreased patency significantly (4 vs. 11 months). Thrombosis occurred in 24.7% of grafts and 9.0% of fistulae. Thrombosed grafts had better salvage rates (8 vs. 4 months, p<0.001). The data showed diabetes, HTN and HIV have no overall impact on patency.

Conclusions

AVF and grafts are both useful in providing VA for patients requiring hemodialysis. Our data shows that grafts are equivalent in long-term patency. Therefore, it is apparent in those patients who are not candidates for an AV fistula; an AV graft for VA should be placed.
Reducing Catheter Infections through use of the CD-1000: A Retrospective Review of a Unique Catheter Specific Composite Dressing
Authors: Altman S.D. , Ross J.J. , Work J.
Published: March 2018

Purpose

Catheter-related blood stream infections pose a significant risk for patients living with vascular catheters. The cost to manage these infections is substantial. Although the etiology of these infections is multifactorial, tap water has been implicated as a significant causative factor. This retrospective review evaluates the effectiveness of a surgical dressing, the CD-1000, at protecting catheters and exit site wounds from fluid and debris when patients engage in high risk activities like showering.

Methods

All patients who received the CD-1000 from a single national medical supplier from September 2006 through to March 2007 were contacted to participate in this retrospective review; 209 patients, representing 34 states and 175 unique physicians, participated in this study. Effectiveness of the dressing along with prior and current history of catheter events was queried.

Results

The CD-1000 was 95% effective at keeping the catheter and exit site dry while patients engaged in high risk activities like showering. Prior to using the CD-1000, the 209 patients reported a historical catheter infection rate of 1.83 per 1000 catheter days. While using the CD-1000 the 209 patients reported a catheter infection rate of 0.47 per 1000 catheter days.

Conclusion

The CD-1000 catheter specific composite dressing adequately protects vascular catheters and exit sites when patients engage in high risk activities like showering. In this geographically diverse retrospective review, use of the CD-1000 was associated with a 75% reduction in catheter associated infections.
A Dedicated Vascular access Program can Improve Arteriovenous Fistula Rates without Increasing Catheters
Authors: Kiaii M. , MacRAE J.M.
Published: March 2018

Purpose

We describe the development and implementation of a comprehensive multidisciplinary vascular access (VA) program and describe its impact on VA distribution rates.

Methods

A retrospective review of all incident and prevalent patients in our hemodialysis (HD) unit was conducted in September 2001 to determine baseline data including: type of VA along with patient characteristics and comorbidities. Similar data was extracted from the database in 2005 for incident and prevalent patients.

Results

The VA program had a significant impact on arteriovenous fistulae (AVF) rates in both incident and prevalent HD patients: incident AVF rates increased from 14 to 39% (p=0.04) and prevalent AVF rates from 60 to 64% (p=0.015). Multivariate analysis revealed that male gender (OR 1.79 [CI 0.85–0.98, p=0.006]) and year of dialysis initiation 2005 vs. 2001 (OR 1.65 [CI 1.09–2.5, p=0.017]) were associated with AVF use among prevalent HD patients. Furthermore, age (per 5 years over 70) is associated with a decreased likelihood of having an AVF (OR 0.91 [CI 0.85–0.98, p=0.009]) whereas comorbidities of cardiovascular disease and diabetes had no impact.

Conclusion

We demonstrate that a structured VA program can increase the number of functioning fistulas without a corresponding increase in catheters in incident and prevalent HD patients.
Stent Graft Exclusion of Pseudo-Aneurysm Arising from PTFE Hemodialysis Graft after Recurrence following Ultrasound Guided Thrombin Injection
Authors: Ananthakrishnan G. , Bhat R. , Severn A. , Chakraverty S.
Published: March 2018

There are various non-invasive or minimally invasive techniques for management of pseudoaneurysms including ultrasound guided compression, ultrasound guided thrombin injection and covered stent placement. We report a case where a covered stent graft was successfully used for the treatment of a pseudoaneurysm directly arising from a PTFE graft which recurred 3 months following treatment with ultrasound guided thrombin injection.
Retrieval of Port-A Catheter Fragment from the Main and Right Pulmonary Arteries 3 Years after Dislodgment
Authors: Elkhoury M.I. , Boeckx W.D. , Chahine E.G. , Feghali M.A.
Published: March 2018

Vascular access (VA) is one of the serious problems that chemotherapy recipient cancer patients face. Fractures of catheter and cardiac migration rarely occur; the catheter fragments migrate distally along the blood stream finally lodging anywhere in the vena cava, right atrium, right ventricle, or the main pulmonary artery or one of its branches. Percutaneous retrieval method is always suggested first.
Transvascular Retrieval of a Catheter Remnant from the Peripheral Vein of a Preterm Neonate
Authors: Robbins A.B. , Patel H.
Published: March 2018

We report the first case of transvenous removal of a peripheral inserted central catheter (PICC) fragment embolized to a peripheral vein in a 32-week gestational age 1450 g infant. The technical aspect of this alternative method to surgery is discussed.
Vein rupture by Arrow-Trerotola percutaneous thrombolytic device in a treatment of thrombosed arteriovenous graft
Authors: Hong Yong Kook , Kang Kyung Hoon , Kim Tae Hwan , Yang Hee Chul
Published: March 2018

Introduction:

We report a case of vein rupture by Arrow-Trerotola percutaneous thrombolytic device (Trerotola PTD) during a treatment of thrombosed arteriovenous graft (AVG).

Case Description:

A 77-year-old woman with a problem of thrombosed AVG underwent an endovascular treatment including a procedure of angioplasty of axillary vein. After angioplasty of axillary vein, we found a newly developed thrombus in axillary vein and performed thrombolysis using an over-the-wire 7F Trerotola PTD. When the rotating cage of the device arrived at axillary vein, it suddenly stopped, fixed at the angioplasty site, and didn’t move at all. Venogram showed an extravasation of contrast media at axillary vein, suggesting vein rupture. The patient underwent an emergency operation.

Conclusions:

It could be dangerous to use Trerotola PTD in a native vein immediately after angioplasty.
Ultrasound-guided internal jugular vein cannulation in the obese patient in a forced semi-sitting position
Authors: Kasatkin Anton A , Urakov Aleksandr L , Nigmatullina Anna R
Published: March 2018

Introduction:

Central venous cannulation may be difficult in morbidly obese patients. We present a case of successful right internal jugular vein catheterization under real-time ultrasound guidance in an obese patient in a forced semi-sitting position.

Case report:

A 43-year-old male patient with body mass of 182 kg (body mass index, 52.2 kg/m2) was admitted to the clinic 48 h after the trauma. The patient was in a forced semi-sitting position (37° head elevation). The patient was not able to perform the Valsalva maneuver. In the reported case, the lateral access for right internal jugular vein catheterization was chosen. We selected a lateral-oblique probe position for the ultrasound-guided internal jugular vein cannulation. Internal jugular vein catheterization was successful at the first attempt.

Conclusion:

Ultrasound imaging enables us to choose a desirable access for successful internal jugular vein cannulation in the obese patient without head-down tilt position. The lateral-oblique probe position for internal jugular vein cannulation may have advantages in certain clinical situations.
Prevalence of chronic kidney disease among patients undergoing transradial percutaneous coronary interventions
Authors: Hossain Mohammad A , Quinlan Amy , Heck-Kanellidis Jennifer , Calderon Dawn , Patel Tejas , Gandhi Bhavika , Patel Shrinil , Hetavi Mahida , Costanzo Eric J , Cosentino James , Patel Chirag , Dewan Asa , Kuo Yen-Hong , Salman Loay , Vachharajani Tushar J
Published: March 2018

Background:

While transradial approach to conduct percutaneous coronary interventions offers multiple advantages, the procedure can cause radial artery damage and occlusion. Because radial artery is the preferred site for the creation of an arteriovenous fistula to provide dialysis, patients with chronic kidney disease are particularly dependent on radial artery for their long-term survival.

Methods:

In this retrospective study, we investigated the prevalence of chronic kidney disease in patients undergoing coronary interventions via radial artery. Stage of chronic kidney disease was based on estimated glomerular filtration rate and National Kidney Foundation - Kidney Disease Outcomes Quality Initiative guidelines.

Results:

A total of 497 patients undergoing transradial percutaneous coronary interventions were included. Over 70.4% (350/497) of the patients had chronic kidney disease. Stage II chronic kidney disease was observed in 243 (69%) patients (estimated glomerular filtration rate = 76.0 ± 8.4 mL/min). Stage III was observed in 93 (27%) patients (estimated glomerular filtration rate = 49 ± 7.5 mL/min). Stage IV chronic kidney disease was observed in 5 (1%) patients (estimated glomerular filtration rate = 25.6 ± 4.3 mL/min) and Stage V chronic kidney disease was observed in 9 (3%) patients (estimated glomerular filtration rate = 9.3 ± 3.5 mL/min). Overall, 107 of 350 patients (30%) had advanced chronic kidney disease, that is, stage III–V chronic kidney disease. Importantly, 14 of the 107 (13%) patients had either stage IV or V chronic kidney disease.

Conclusion:

This study finds that nearly one-third of the patients undergoing transradial percutaneous coronary interventions have advanced chronic kidney disease. Because many of these patients may require dialysis, the use of radial artery to conduct percutaneous coronary interventions must be carefully considered in chronic kidney disease population.
Ultrasound-guided intravenous access in adults using SonoStik®, a novel encapsulated sterile guidewire: A prospective cohort trial
Authors: Boniface Keith S , LeSaux Maxine A , Mandoorah Sohaib , Patel Amit , Neander Kai L , Shokoohi Hamid
Published: March 2018

Purpose:

We evaluated the performance of an encapsulated guidewire designed for single-handed use with ultrasound-guided vascular access (SonoStik) with Seldinger technique, as compared with conventional intravenous catheters placed under ultrasound guidance in healthy subjects.

Methods:

This is a prospective cohort trial in healthy subjects in which each subject served as his/her own control by having a SonoStik ultrasound intravenous cannulation placed in one arm and a conventionally placed, standard ultrasound intravenous cannulation placed in the other arm. The basilic vein was used because it is a non-visible and non-palpable vein. Emergency department technicians with extensive experience in ultrasound-guided intravenous access performed the procedures. The first-attempt success rate of intravenous-guided intravenous by using the SonoStik was compared to the standard ultrasound intravenous cannulation in adult healthy subjects. The secondary outcomes including time of procedure, technicians’ and subjects’ satisfaction, and complications were compared in both arms of the study.

Results:

A total of 24 volunteers with a mean age of 22.7 years were enrolled. Four emergency department technicians with extensive prior experience with ultrasound-guided intravenous access but with no prior experience using the SonoStik device performed the procedures. The first-attempt success was 83.3% with the use of SonoStik ultrasound intravenous cannulation compared to 95.8% with the standard ultrasound intravenous cannulation. There was a mean of 1.14 insertions per each successful placement in the SonoStik group compared to 1.04 insertions by using the standard catheters (mean differences = –0.1; 95% confidence interval = –0.6 to 0.4). There were no complications in either SonoStik or the standard ultrasound intravenous cannulation group. The mean time of insertion using SonoStik was slightly longer compared to standard ultrasound intravenous cannulation (143.3 vs 109.7 s).

Conclusion:

This study demonstrated that emergency department technicians skilled in ultrasound-guided intravenous access could successfully place SonoStik 83.3% of the time in vessels that were unable to be palpated or visualized. Compared to standard ultrasound intravenous cannulation, the odds ratio of successful cannulation with SonoStik was 0.91 (95% confidence interval = 0.04–17.5). In all cases, the time required to successfully insert SonoStik was less than 4 min from tourniquet application to catheter advancement to hub, with a mean time of less than 2.5 min.