bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment of Osteonecrosis: Treatment by Femoral Osteotomy
Authors: Menschik F. , Schatz K.D. , Kotz R.
Published: March 2018

The purpose of the use of an osteotomy for the treatment of osteonecrosis (ON) of the femoral head is to move the necrotic segment away from the major load-transmitting area of the acetabulum and to redistribute the weight-bearing forces to articular cartilage that is supported by healthy bone. The most common osteotomies are the varus, valgus, flexion, rotational (Sugioka), and combined osteotomies. Their long term outcome, reported in the literature, is quite controversial. We found a decreasing frequency of flexion osteotomies between 1986 and 1996 performed at our department. In 1977 we started with the Sugioka osteotomy in special cases of femoral head ON (necrotic angle in the AP-view about 90 degree) resulting in a total of 51 cases. Forty-one of them have been analyzed regarding complications, reoperations and Harris Hip Scores. Seventeen of 41 patients developed complications and underwent reoperation. Nevertheless the results according to the Harris Hip Score were satisfactoy (excellent and good in 24 patients fair in 10 and poor only in 7 cases). Independently from the size of the necrosis total hip arthroplasties have been performed in 8 cases. The survival curve of 41 Sugioka osteotomies shows a 50% decrease at 6 years. Due to this fact and the regression in the number of osteotomies of the femur in cases of ON of the hip joint we find in our material that the importance of osteotomies has dramatically decreased in contrast to the excellent results of total hip arthroplasty.
Noncemented Hip Replacement using a Conical Screw-In Cup and a Straight Press-Fit Stem. A Six to Eight-Year Clinical and Radiological follow-up Study
Authors: Köster G. , Leib S. , Willert H.-G.
Published: March 2018

Noncemented hip replacement using a conical titanium metal-backed screw-in cup to be implanted with precutting of the threads (TITAN-METAL-BACKED, AlloPro, Baar, Switzerland), in combination with a straight conical press-fit stem (Zweymüller-“hochgezogen”, AlloPro, Baar, Switzerland) was evaluated clinically and radiologically in 64 consecutive primary arthroplasties with an average 7.2 year follow-up. The clinical results compare very favourably with other cementless systems. The Harris hip score revealed an improvement from 45 to 84. The Merle d'Aubigné index showed an increase during the case-control period from 16 to 26. Thigh pain was practically absent except in one patient. A radiographic appearance of bone ingrowth around the acetabular component was found in nearly all cases. Only one cup migrated in a patient with a large cystic lesion in the acetabular roof, which was not grafted, with no other signs of loosening. Additionally this patient had chemotherapy. In all other cases there were no signs of cup migration, significant radiolucency, osteolysis or definite cup loosening. Around the stem, primary cortical contact was mainly located in the distal zones. Radiolucent lines appeared only proximally, with few exceptions, and were, except in four cases, always smaller than 2 mm. They were never circumferential and usually combined with sclerotic lines. Only one stem subsided, but the patient remained asymptomatic. There was a high incidence of proximal bone atrophy, distal cortical thickening and endosteal bone formation, not correlating with radiological loosening or clinical symptoms. Signs of femoral osteolysis were absent. No patient had to be revised.
Transient Osteoporosis and Avascular Necrosis of the Hip in the Same Patient
Authors: Peiró A. , Salom M. , Aroca J. E.
Published: March 2018

We present a case of a 45-year-old woman who developed a transient osteoporosis in her right hip that resolved spontaneously after four months. Three years after she developed an avascular necrosis of her left hip. It is controversial if transient osteoporosis and avascular necrosis are two separate clinical entities or if they are different grades of the same disease. We describe both entities and discuss these two theories based on the findings of our case.
The Histology of Impacted Cancellous Allograft in Acetabular Reconstruction
Authors: Singer G.C. , Muirhead-Allwood S.K.
Published: March 2018

Reconstruction of the acetabulum in the presence of severe bone loss presents challenging problems. Ideally, the acetabulum should be reconstructed with a stable component placed in the anatomical position with reconstitution of bone stock. The clinical and radiological results of using impacted morselised allograft for acetabular reconstruction appear satisfactory in the short term but there is little histological evidence in humans that the bone chips are revascularised and incorporated into the host.

We present two cases of histology of retrieved bone samples, obtained at two years and three years following impaction allografting of the acetabulum. Both samples were taken from cases of aseptic failure, and were obtained during the revision surgery. It showed that the bone was viable, and undergoing the process of creeping substitution, where new bone was being laid down on dead bone. At three years this process was not yet complete, which indicates that the process is significantly slower than that described by Sloof in his animal experiments.
The use of Pulsed Lavage with Integral Suction in Total Hip Replacement
Authors: Tennent T. D. , Tello E. , Blackburne J.S.
Published: March 2018

Both pulsatile lavage and distal femoral plugs are used routinely in preparation of the femoral canal prior to cementing. Using an in-vitro model, two types of pulsed lavage irrigation systems were tested to assess their relative abilities to clear the femoral canal of the polethylene vanes which commonly become detached from the Hardinge type of cement restrictor during insertion. The narrower tipped system, which did not incorporate an integral suction system, performed significantly better. Surgeons should be aware of this potential problem when preparing the femoral canal.
Rehabilitation following Proximal Femoral Fracture: A Comparative Audit of Two Different Regimens
Authors: Dunkley A.B. , Bould M. , Pinch E. , Bannister G.C.
Published: March 2018

The objective of this study was to investigate the effect of rehabilitation policy following proximal femoral fracture at two adjacent hospitals. Patients transferred to a dedicated orthogeriatric rehabilitation unit had a significantly shorter length of stay compared with patients transferred to an elective orthopaedic ward at a distant site. 93% of patients returned to their previous accommodation from the rehabilitation unit, and 66% from the orthopaedic ward. Early discharge planning and co-ordination between members of the health care team are crucial in maximising the efficiency of rehabilitation following hip fractures in the elderly.
Fatigue Fracture of Gamma Nail
Authors: Houshian S. , Freund K. G. , Pedersen J. H.
Published: March 2018

We report a case of a fatigue fracture of a Gamma nail in a patient with an unstable oblique subtrochanteric fracture, together with scanning electron microscopy analysis of the fracture surface. In contrast to other published cases, the fracture was in the part of the nail distal to the insertion point of the lag screw.
Spontaneous Assembly of the Acetabular Component in an Alumina-Alumina Hip Arthroplasty
Authors: Peiró A. , Salom M. , Aroca J.E. , Baixauli F.
Published: March 2018

The use of modular designs of hip prostheses introduces the risk of post-operative disassembly of the components. We report on two cases of alumina-alumina hip arthroplasty in which a spontaneous assembly of the acetabular component occurred. A review of the literature on such complications is also presented.
Radiographic Evaluation of the “Conus” Uncemented Stem
Authors: Castelli C.C. , D'Angelo F. , Molina M. , Ferrario A. , Cherubino P.
Published: March 2018

The purpose of this study was to evaluate 54 “Conus” uncemented stems both clinically and radiologically. The radiological evaluation was carried out to verify the stability of this rounded cross-section stem in terms of bone ingrowth and axial subsidence. Clinically, 39 hips (72%) were rated excellent, 13 (24%) were rated good, 2 (4%) were rated fair or poor. The average Harris Hip Score increased from 53 before operation to 93 at the time of the last follow-up (average FU 22.5 months). None was reoperated. Radiologically, 13 stems (24%) were judged to have subsided using a method described by Loudon and Charnley (6). Calcar modification, observed in 22 hips (41%), consisted of a slight rounding off of the proximal medial edge at the cut femoral neck. These results encourage the use of this versatile stem which revealed good primary and secondary stability, with good load distribution along the femur.
Fibrin Sealant Reduces Blood Loss in Total Hip Arthroplasty
Authors: Crawford R.W. , Giangrande P. , Murray D.
Published: March 2018

The purpose of this study was to investigate the influence of a new fibrin glue spray, Quixil™, on blood loss and blood transfusion requirements in patients undergoing total hip replacement. This fibrin sealant is derived from human cryoprecipitate. It imitates the final stages of coagulation and when sprayed over a wound it prevents bleeding. Thirteen patients received sealant, which was applied at different stages during the surgical procedure. Treatment patients were compared with 12 control patients who were selected according to the same criteria. The average total blood loss of the treatment group was 587 ml, a highly significant reduction in blood loss in comparison with the controls which had an average loss of 1016 ml (p=0.001). No patients in the treatment group needed a blood transfusion, whereas in the control group 5 patients were transfused with a total of 10 units of blood (p=0.015). We conclude that Quixil™ is an effective means of reducing blood loss and blood requirements in total hip arthroplasty surgery.
Bernese Periacetabular Osteotomy: Technical Aspects and Clinical Results
Authors: Leunig M. , Siebenrock Ka. , Mahomed Mn. , Ganz R.
Published: March 2018

The Bernese periacetabular osteotomy is a joint preserving procedure used in young adults to improve acetabular coverage and stabilize the femoral head. This juxta-articular osteotomy respects the vascular blood supply to the acetabular fragment. It facilitates extensive acetabular reorientation and can be combined with a femoral osteotomy. All acetabular osteotomy steps are performed using the modified Smith-Petersen approach. Anterior joint inspection provides information on acetabular rim pathology and allows control of an impingement free range of motion. The posterior column remains mechanically intact allowing minimal internal fixation and early mobilisation. The dimensions of the true pelvis remain unchanged permitting vaginal delivery. Over 700 pelvic osteotomies have been performed since the introduction of the Bernese periacetabular osteotomy. A greater than 10 year follow-up of the first 75 osteotomies revealed hip joint preservation in 82% of cases with a good to excellent result in 73%. Poor results correlated with increased age, pre-existing arthritis, labral pathology and the amount of correction. Treatment of the labral lesions was performed only if unstable and included either refixation or resection.
Early Subsidence of the Exeter Femoral Stem within the Cement Mantle in Primary Arthroplasties and in Revisions Using Impacted Allografts and Cement: A Roentgen Stereophotogrammetric Analysis
Authors: Ornstein E. , Franzén H. , Johnsson R. , Löfqvist T. , Stefánsdóttir A. , Sundberg M.
Published: March 2018

In five primary hip arthroplasties and in six revisions with impacted, morselized allografts and cement, roentgen stereophotogrammetric analysis (RSA) was planned to be used to measure the subsidence of the polished and double-tapered Exeter femoral stem, relative both to the cement and the femur. Only in two primary arthroplasties and in two revisions could the tantalum markers be adequately imaged for RSA evaluation. The stems in the primary arthroplasties subsided 1.4 to 2.0 mm and all the subsidence occurred within the cement mantle. The two revisions subsided 1.9 to 3.1 mm within the cement mantle, but there was also a slight subsidence of the cement in relation to the femur, 0.5 to 0.4 mm, respectively. No radiographic signs of stem loosening were found in any of the hips. Our findings of subsidence of the Exeter femoral stem within the cement mantle with no radiographic signs of loosening are in accordance with those reported by the Exeter group. The present technique using tantalum markers in the medioproximal aspect of the cement mantle must be considered as difficult.
Pathological Anatomy of Developmental Dysplasia of the Hip Joint
Authors: Portinaro Nma , Case Rd , Gargan Mf
Published: March 2018

The pathology of developmental dysplasia of the hip (DDH) is reviewed using post-mortem material and observations at operation. Different patterns of dysplasia, found macroscopically and microscopically, are related to the different stages of foetal maldevelopment. We believe that an understanding of the morbid anatomy and histology is the cornerstone from which a rational treatment protocol can be developed.
Steel's Triple Pelvic Osteotomy in the Treatment of Acetabular Dysplasia
Authors: Şener N. , Şen C. , Tözün I. R. , Boynuk B.
Published: March 2018

Arthrosis is inevitable in patients with acetabular dysplasia. A pelvic osteotomy can prevent secondary degenerative changes in these hips. We have carried out a retrospective review of 12 hips after triple osteotomy with an average follow-up of 6.5 years (5 to 8). In 92% of the patients there was pain improvement, but 42% continued to limp. Radiographic assessment showed improvement of the average centre-edge angle by 24.6 degrees, anterior centre-edge angle by 26.25 degrees and correction of the acetabular index by 16.3 degrees. The degree of osteorthritis improved in six hips over a period of six years. We observed superficial infection in two patients. In two patients the correction was lost because of insufficient osteosynthesis and additional surgery was performed for re-osteosynthesis. In general triple osteotomy can achieve enough correction and coverage. This type of osteotomy is easier than other periacetabular osteotomies. However, it has disadvantages such as acetabular lateralization, pelvic asymmetry and difficulties in correcting the acetabular coverage and stable osteotomy fixation.
Positioning the Infant for a Pelvic Radiograph
Authors: Boniforti F.G. , Fujii G. , Benson M.K.D.
Published: March 2018

It can be difficult to take reproducible radiographs of infants’ hips. We have compared antero-posterior pelvic radiographs when the infant's hips are held in flexion or extension. One hundred and fifty radiographs of infants aged 3 to 12 months have been analysed. Radiographic indicators for the diagnosis of developmental dysplasia of the hip and alignment pelvic indicators have been assessed. There were significant differences using the Student t-test analysis for the symphysis-os ischium angle (p<0.0001) and the pelvic tilt index (p=0.0017) between the positions of the infants’ hips on the x-ray table. Twenty degrees of hip flexion increases the pelvic tilt backward (decreased lumbar lordosis). When positioning infants over 3 months old on the x-ray table the neutral antero posterior position is preferable. The pelvic position is more neutral when the hips are extended.
Pigmented Villonodular Synovitis of the Hip
Authors: Boudouris T. , Fortis A.P. , Pastroudis A. , Varatsos A.
Published: March 2018

Pigmented villonodular synovitis of the hip is a quite rare entity characterised by minimal or no symptoms, until severe pressure into the hip joint leads the patient to seek medical care. A 64 year-old woman presented with spontaneous hip pain and, except for a cystic lesion of the femoral lead on the x-rays, the laboratory investigations were normal. During the operation a bleeding mass eroding the femoral head, with minimal acetabular involvement, was found and histological examination revealed pigmented villonodular synovitis. A total hip replacement was performed and the patient was clinically satisfactory 5 years later.
Capsular Closure to Prevent Posterior Dislocation after Primary Total Hip Arthroplasty through the Posterior Approach
Authors: De Buttet M. , Pasquier G.
Published: March 2018

Posterior dislocation remains the most frequent early complication after Total Hip Arthroplasty (THA) carried out through a posterior approach. In our experience, the preservation of the capsule and its closure after insertion of the prosthetic components significantly reduced our rate of posterior dislocation. We compared 2 groups of patients similar in size (186 versus 174 cases) and characteristics: all cases were done by one surgeon, with the same surgical technique, the same implants and the same post-operative care. The only difference between the 2 groups was the capsulectomy in the group 1 and the capsular closure in the group 2. In this retrospective study, 22 dislocations were noted in group 1 (capsulectomy), but only one dislocation in group 2 (capsular closure). This additional technique preventing posterior dislocation after THA seemed to be efficient.
Wear and Migration of Harris-Galante II Acetabular Cups
Authors: Olofsson A. , Kesteris U. , Önnerfält R.
Published: March 2018

We performed a 3–6 years radiographic follow-up of 28 patients (29 hips) operated on with a Harris-Galante II uncemented acetabular component and a cemented ScanHip® femoral stem. The patients average age when operated on was 50 (36–59) years. The primary aim was to measure wear of the plastic liner, but migration and radiolucency were also evaluated.

In all hips the mean linear wear rate was 0.17 mm/year and the mean volumetric wear rate was 116 mm3/year. The wear rates in hips with a 28 mm head (n=6) were 0.14 mm/year and 83 mm3/year, and in hips with a 32 mm head (n=22) the rates were 0.18 mm/year and 130 mm3/year. The total volumetric wear was significantly higher in hips with 32 mm head than in hips with a 28 mm head. No acetabular component was radiographically loose, but 3 femoral components were radiographically loose and in need of revision.
Placement of Tunnelled Hemodialysis Catheters across Stenotic and Occluded Central Veins
Authors: Falk A. , Alomari A. , Silberzweig J.E.
Published: March 2018

Purpose

The purpose of this study was to evaluate the efficacy of placement of tunneled hemodialysis catheters in patients with occluded or stenotic central veins.

Materials and Methods

Data were prospectively collected for 26 patients (11 male, 15 female, mean age 52 years) referred for placement of tunneled hemodialysis catheters with central venous stenoses or occlusions. The central venous occlusions or stenoses were recanalized using traditional interventional catheter and guidewire techniques.

Results

Thirty central venous access procedures were performed of which 28 (93%) procedures resulted in successful tunneled catheter insertion. Twenty-one internal jugular venous (13 right, 8 left) and 7 subclavian venous (3 right, 4 left) catheters were placed. Eighteen stenotic and 10 occluded venous segments were crossed including the brachiocephalic vein (n = 22), subclavian vein (n = 2), and the superior vena cava (4). One patient required insertion of a metallic stent to facilitate passage of the hemodialysis catheter across an occluded brachiocephalic vein. No procedure-related complications occurred. No episodes of upper extremity swelling or superior vena cava syndrome occurred following catheter insertion.

Conclusion

Insertion of tunneled hemodialysis catheter across occluded or stenotic central veins is technically feasible and safe. The use of occluded or stenotic central veins for catheter access preserves patent central veins for future shunt access.
No Association between Hyperhomocysteinemia and Vascular Access Thrombosis in Chronic Hemodialysis
Authors: Lévesque R. , Dumont M. , Leblanc M.
Published: March 2018

Purpose

Hyperhomocysteinemia, recognized as a risk factor for cardiovascular diseases, has also been related with controversy to vascular access thrombosis in hemodialysis. Our objective was to determine if such an association could be found in our hemodialysis population.

Methods

The survey was conducted in a cohort of 165 chronic hemodialysis patients. Their vascular access history was considered from hemodialysis initiation until November 1999, including the number of vascular accesses created (either native or synthetic fistulae), focussing on vascular access thrombotic events, and excluding primary vascular access dysfunction. Diabetes, hemoglobin, erythropoietin dose, anticoagulation, and methyltetrahydrofolate reductase (MTHFR) status were considered. Serum total homocysteine (tHcy) measures were sampled for all patients in June 1998 and repeated yearly. Patients had not been supplemented routinely with hydrosoluble vitamins until June 1998, after which all received DiaVite® (R&D Laboratories, CA, USA) daily.

Results

Median survival of native fistulae was significantly longer (81 months, 95%CI 35–127) than for synthetic fistulae (31 months, 95%CI 27–51). Median vascular access survival was reduced for diabetics vs non diabetics (28 vs 57 months) (P<0.05), whereas sex, age and smoking had no impact. No correlation was found between tHcy concentration and the number of vascular access thrombotic events; homozygotes for MTHFR had higher tHcy but no more vascular access thrombotic events. The 38 patients with a mean vascular access survival of less than 12 months (6±3 months) were compared to the 127 patients with a mean vascular access survival of ≥ 12 months (39±25 months) (P<0.05): no difference in their respective tHcy concentrations before and after DiaVite® introduction was found (31±13 and 20±8 vs 34±17 and 22±6 μmol/L), but the first group presented more numerous synthetic fistulae (p<0.0001), lower hemoglobin levels, and higher erythropoietin doses.

Conclusions

No significant association between hyperhomocysteinemia and vascular access thrombosis could be found in our population. DiaVite® introduction allowed a significant reduction in tHcy, but had no impact on vascular access survival, except for a slight but not significant reduction in the prevalence of vascular access thrombotic events during the year on DiaVite®. Potential benefits of approaches to reduce tHcy for vascular access time-life prolongation remain to be demonstrated.
Hepatic Abscess and Umbilical Venous Catheter: One Cannot be Cavalier about Proper Position
Authors: Fusaro F. , Piccolo R. LO , Scarpa M.G. , Orzali A. , Trafojer U. , Zanon G.F.
Published: March 2018

Purpose

The umbilical venous catheter (UVC) is routinely used in neonatal intensive care. Incorrect placement may expose the patient to some dangerous complications (i.e. thrombosis, abscesses, etc). We report a case of an hepatic abscess due to incorrect positioning of this device. We describe how the abscess was treated and we emphasize that one cannot be cavalier about proper positioning of the UVC
Native Arterio-Venous Fistula for Hemodialysis: What to Expect Early after Creation?
Authors: Leblanc M. , Saint-Sauveur E. , Pichette V.
Published: March 2018

Native arterio-venous fistulas (AVFs) are preferred for hemodialysis vascular access over synthetic grafts and long-term catheters. However, prevalence rates of native AVFs are variable around the world and have increased only slightly in United States since the DOQI guidelines. To increase rates of native AVFs, pre-operative vascular mapping by ultrasound has been found of major help for appropriate selection of the vessels. The minimal desirable lumen diameter of the artery should be > 2 mm and > 2.5 to 3 mm for the vein at the anatomosis. Early failure can be reduced to less than 10% when the feeding artery is > 2 mm, even in diabetics. If sizes of the vessels are smaller than those targets at the wrist, moving to the upper arm should be considered. The interval between creation and first cannulation varies from 2 weeks to 4 months. There might not be much advantage to wait for more than 4 weeks; however, in large dialysis units, observing a delay of 4 to 6 weeks may be worthwhile to avoid initial problems such as infiltrations and lacerations. Access flow monitoring is essential since it is a reliable predictor of vascular access dysfunction, reducing associated morbidity and costs. Early monitoring of recently created native AVFs has shown that the increase in intra-access blood flow occurs very soon after construction and becomes maximal after a few weeks. A recent prospective study involving all new native AVFs monitored by ultrasound-dilution between weeks 6 and 10 after creation, and every 3 to 6 weeks over 4 months, showed no statistically significant difference in access blood flow between the initial and final measurements (respective values of 1132 ± 681 and 1097 ± 644 ml/min). Access flow was higher in males, and in brachio-cephalic compared to radio-cephalic AVFs. Over the long-term, AVFs are associated with longer patency and lower complication rates, and efforts should be directed at further increasing their prevalence.
Advantages of Totally Implanted Port over Impromptu Short-Term Central Venous Catheter in Oncological Pain Therapy
Authors: Reale C. , Vernaglione E. , Reale C.A. , Mancini A. , Prologo M. , Campisi C.
Published: March 2018

The aim of this paper is to determine if patient controlled analgesia (PCA) by means of programmable pumps improves patients' autonomy and to verify if the short-term central venous catheter - implanted when pain is first evident - makes the quality of life worse in comparison with an early implanted port.

Forty non-terminally ill patients affected by urinary malignant pathologies with visceral and bone metastases were enrolled in a prospective and randomised study at the Urology Department of “La Sapienza” University in Rome, Italy. Intensity of pain and tolerability of venous access were assessed for the first 7 days, and weekly for 3 months. Such data were used to adjust drug therapy.

In this study we hypothesized that a delayed central venous catheter implant, when the pain is at first considerably evident, can interfere negatively with drug treatment. The visual analogue scale (VAS) and the brief pain inventory (BPI) were administered to the patients, and these showed good levels of analgesia in both groups and a greater comfort to the patients with the previously implanted port in comparison with a short-term central venous catheter.

In conclusion, PCA achieves a constant level of drugs and enables the patient to voluntary control the pain by means of supplemental boluses. Both central devices seem to provide similar technical benefits, but the port is much more easily tolerated and the quality of life is increased if it is already available when pain is first evident.
Which Kind of Vascular Access for Hemodialysis in Pediatric Patients?
Authors: Manca O. , Pili G.F. , Murgia M.G. , Martorana A. , Setzu C. , Fonduli P. , Barracca A.
Published: March 2018

The choice of vascular access in hemodialysis pediatric patients can be challenging, due to the small diameter of vessels. In the last 19 years, 38 arteriovenous fistulas (AVF) for hemodialysis have been created on 21 patients; 25 of them were radio-cephalic AVF. The evaluation of the vessels was, in the majority of cases, done by clinical criteria. A local anesthesia was used in all surgical procedures. The percentage of early AVF failure was 24%. Long-term AVF survival was 97%, 65% and 55% at respectively 1, 3 and 5 years. Our data indicate that even in pediatric patients the radio-cephalic fistula is the first choice surgical procedure.
Challenges of Hemodialysis Access for High Risk Patients: Impact of Mesenteric Vein Bioprosthetic Graft
Authors: Glickman M.H. , Lawson J.H. , Katzman H.E. , Schild A.F. , Fujitani R.M.
Published: March 2018

Objective

The purpose of this study is to compare in a prospective fashion the performance of a new bioprosthesis, the mesenteric vein bioprosthesis (MVB), in patients who have had multiple failed ePTFE grafts. Performance measures include primary patency rates, assisted-primary patency rates, secondary patency rates, complications, and the number of interventions required to maintain graft patency. Study: From October 1999 to February 2002, 276 hemodialysis access grafts were implanted in a multicenter study. Of those grafts, 74 were placed in patients with a prior history of ≥ 3 failed prosthetic grafts (mean = 3.5 grafts, range = 3–6 grafts). Fifty-nine grafts were constructed with MVB, and 15 grafts with ePTFE as a concomitant control. Mean follow-up was 11.5 months. In the MVB group, 79.7% were African-Americans, 61% were females, and 23.7% were hypercoagulable. Of the ePTFE group, 86.7% were African-Americans, 46.7% were female, and 13.2% were hypercoagulable.

Results

Per Kaplan-Meier curves, the primary patency rate of the MVB group at 12 months was 33% vs the ePTFE group of 18% (p=0.120); the assisted-primary patency rates at 12 months were 45% MVB vs 18% ePTFE (p=0.011). The secondary patency rates at 12 and 24 months for the MVB group were 67% and 59%, respectively, vs 45% and 15% for the ePTFE group (p=0.006). During the follow-up time period, 80% of the ePTFE grafts were abandoned compared to 34% of the MVB group. Infection and thrombosis rates in the MVB group were lower than the ePTFE group. The infection rate for the MVB group requiring intervention was 0.07 events/graft year (gt/y) compared to 0.30 events/gt-y for ePTFE (p=0.04). A thrombosis rate of 0.69 events/gt-y occurred in the MVB group whereas 2.50 events/gt-y presented in the ePTFE group (p<0.01). Conclusion: In this study, high-risk patients (defined as those having multiple failed prosthetic grafts for hemodialysis) in whom the MVB conduit for hemoaccess was implanted, showed significant improvement in assisted-primary and secondary patency rates compared to the ePTFE cohort. The MVB group, however, did not have a statistically better primary patency rate compared to the ePTFE group. The MVB patient also had fewer thrombotic and infectious events and an overall reduction in the number of interventions while maintaining a permanent access site. This new bioprosthesis should be the conduit of choice in the complex group of patients as it offers assisted-primary and secondary patency rates similar to those commonly experienced by patients without a history of multiple graft failures.
Antimicrobially Impregnated Catheters: An Overview of Randomized Controlled Trials
Authors: Gastmeier P. , Zuschneid I. , Geffers C.
Published: March 2018

In order to acquire an overview of the effectiveness of antimicrobially impregnated catheters on the prevention of catheter related bloodstream infections (CRI), we conducted a systematic review concentrating on randomized controlled trials (RCTs). The analysis end point was CRI; therefore, studies focussing only on catheter colonization were excluded. We did not consider abstracts for analysis. We identified 24 RCTs investigating the effectiveness of antimicrobially impregnated catheters. In addition, we discovered five meta-analyses and four studies investigating cost effectiveness. For the majority of antimicrobially impregnated catheter types only a few studies were available, and not enough to draw conclusions. Therefore, despite a relatively large number of RCTs available, the routine use of antimicrobially impregnated catheters as a measure for CRI prevention remains controversial, with a need for more high quality studies.
A porcine Model of Intimal-Medial Hyperplasia in Polytetrafluoroethylene Arteriovenous Grafts
Authors: Baig K. , Fields R.C. , Gaca J. , Hanish S. , Milton L.G. , Koch W.J. , Lawson J.H.
Published: March 2018

Purpose

Vascular access polytetrafluoroethylene (PTFE) graft failure is a major cause of morbidity in the hemodialysis population. The most common cause of graft failure is thrombosis secondary to stenosis at the venous outflow tract. Venous outflow stenosis is characterized by intimal-medial hyperplasia. We have developed a porcine arteriovenous (AV) graft model that may be used to investigate this proliferative response and aid in the development of new therapies to prevent intimal-medial hyperplasia and improve graft patency.

Methods

Left carotid to right external jugular vein PTFE (6 mm) grafts were implanted in the necks of swine. Immediately following anatomosis, flow rates were recorded. In one group of animals (n = 4) the venous outflow tract was harvested after 7 days and morphometric analysis of intimal and medial area was performed. In a second group (n = 8) the graft patency was monitored until 28 days.

Results

All porcine PTFE fistula grafts were patent at 7 days and 100% patency was maintained until 14 days. After 28 days, 75% of the grafts failed due to thrombosis. The venous outflow tract developed a significant proliferative response. After 7 days the intimal and medial areas were 469 ± 9 μm2 and 875 ± 26 μm2 respectively. At 28 days the intimal and medial areas were 913 ± 55 μm2 and 1437 ± 182 μm2 respectively. Luminal flow rate of the venous outflow tract was reduced significantly (344 ± 11 ml/min at Day 0 to 129 ± 14 ml/min at Day 7, p < 0.05).

Conclusions

This porcine model rapidly, reliably and robustly reproduces the flow reducing stenosis and intimal-medial hyperplasia at the venous outflow tract of PTFE arteriovenous fistula. It represents a promising tool for investigating the mechanisms of intimal-medial hyperplasia, evaluating therapeutic interventions and new graft materials.
Latis™ Catheter: New Technology for Thrombectomy of Vascular access Grafts
Authors: Schild A.F. , Baltodano N.M. , Elias R. , Livingstone J. , Raines J.
Published: March 2018

Purpose

The most common complication of vascular access surgery is thrombosis. This study compared the gold standard Fogarty Thrombectomy Catheter, to the new latis Catheter with an advanced monofilament matrix.

Methods

30 patients with thrombosed access grafts were randomly assigned to undergo thrombectomy with the Fogarty or latis catheter. An angioscope measured remaining graft thrombi.

Results

Twenty-nine of 30 subjects were successfully thrombectomized. No statistical differences in age, gender, race, or extension graft requirements were found. Catheter use in the latis group was: 1 in 14 procedures, and 2 in 1 procedure; Fogarty group: 1 in 10 procedures, 2 in 3 procedures, and 3 in 2 procedures. The average number of catheter passes was: latis 3.06 (1–6 passes) and Fogarty 4.13 (1–9 passes). A trend in favor of the latis catheter was demonstrated; however, statistical significance was not reached (p = 0.067). The overall 6-month primary patency rates were latis (40%) and Fogarty (30%). The estimated patency at the 50th percentile for latis is 120 days and Fogarty 108 days. Statistical significance was not reached with a p-value of the Log-Rank statistic of 0.68 and a p-value of the Wilcoxon statistic of 0.78.

Conclusions

The latis and Fogarty catheters are very similar. However, the latis balloon is more rugged with fewer catheters used and reduced number of passes. A difference in primary patency could not be demonstrated. The angioscope identified significant residual thrombus despite no returning thrombus from the catheter. Consequently, our protocol is modified to include the angioscope.
Carotid Artery Approach as an Alternative to Femoral access for Balloon Dilation of Aortic Valve Stenosis in Neonates and Infants
Authors: Gasparella M. , Milanesi O. , Biffanti R. , Cerruti A. , Sabatti M. , Gamba P.G. , Zanon G.F.
Published: March 2018

Purpose

to evaluate the efficacy of a right common carotid artery cutdown as alternative access in neonates and small infants requiring a balloon dilation of aortic valve stenosis. In infants, the femoral approach is limited by difficulties in advancing the catheter across the valve and by the risk of femoral artery injuries.

Methods

from January 1997 to July 2000, 16 infants at our department underwent balloon dilation through a carotid artery cutdown. Infant weight ranged from 2670 to 6450 g; mean weight 3967 g, and age ranged from 1 to 157 days, mean age 42,8 days. Fifteen of 16 infants had aortic valve stenosis; the remaining infant presented with a aortic coartation relapse.

Results

In 15 infants an adequate dilation of the valve was obtained with no complications. In only one infant an arterial intimal disconnection was caused by inadequate choice of surgical instruments. At the end of the procedure, the carotid arteries were reconstructed with interrupted 7-0 prolene stitches. There were no neurological sequaelae observed. All infants were followed-up and examined by echocolordoppler ultrasound: all carotid arteries were open with no significant stenosis.

Conclusion

Our experience confirms that the carotid access proposed in 1973 by Azzolina et al is a valid and safe alternative to the usual percutaneous femoral access. In particular it could be useful in neonates and infants were the size of femoral vessels could facilitate important and dangerous complications.
Percutaneous Placement of an Implantable Arm Port through an Internal Mammary Venous Pathway: Case Report
Authors: Urbania T. , Hershock D.M. , Clark T.W.I.
Published: March 2018

Current chemotherapeutic regimens often require long-term central venous access for their administration. Obtaining a durable form of vascular access in patients with recurrent cancer can be a challenge due to direct tumor involvement and prior surgical, chemotherapeutic or radiation therapy. We describe a case of a peripherally inserted access port in a patient with recurrent head and neck cancer, in whom radiation therapy planned for metastatic mediastinal disease prevented placement of a chest port. At the time of port implantation, venography revealed central venous occlusion. Using mediastinal venography, a collateral pathway to the superior vena cava was identified between the left and right internal mammary veins. By employing this technique, an arm port system was successfully navigated through the collateral pathway percutaneously with the tip of the port tubing placed at the cavoatrial junction. This case illustrates technical nuances and emphasizes the importance of thorough venography when attempting to achieve difficult vascular access.
Spontaneous Fracture and Pulmonary Embolization of a Central Venous Catheter
Authors: Talwar V. , Pavithran K. , Vaid A.K. , Doval D.C.
Published: March 2018

The use of peripherally inserted central catheter is occasionally complicated by fracture and embolization of the catheter fragment. Here we report a 28 year old male with acute myeloid leukemia, who had spontaneous fracture of the central venous catheter and subsequent migration of the catheter fragment through the heart and into the lower lobe of the right lung. The catheter fragment was retrieved by retrograde femoral vein catheterization.
Polytetrafluoroethylene and Bovine Mesenterial Vein Grafts for Hemodialysis Access: A Comparative Study
Authors: Tahami V.B. , Hakki H. , Reber P.U. , Widmer M.K. , Kniemeyer H.W.
Published: March 2018

Purpose

This study aimed to evaluate the safety and patency rate of bovine mesenterial vein grafts (BMVG) for vascular access (VA) in hemodialysis patients (HDP), compared to expanded polytetrafluorethylene (ePTFE grafts) over a mid- to long-term period.

Methods

Patency and complication rate of 23 consecutive HDP with BMVG for VA were compared to a control group consisting of 23 similar HDP with ePTFE grafts. In both groups, the graft was placed preferably in a forearm loop configuration. The same surgeon performed all procedures. All patients were followed over a period of 4 yrs.

Results

Graft placement was successful in all patients. Patency rates did not differ significantly in both groups. However, there were less severe complications in the BMVG group.

Conclusion

The BMVG is a viable alternative for HD access in patients where autologous construction is not possible, and should be given priority in patients with a failed ePTFE graft or high risk for infection.
Efficacy of ProLumen in Percutaneous Thrombectomy of Clotted Dialysis Access: A Single-Center Prospective Study
Authors: Ahmad I.
Published: March 2018

Purpose

To prospectively evaluate the efficacy of the ProLumen thrombectomy device for declot of dialysis access.

Methods

16 women and 4 men suffering from end-stage renal disease (ESRD) dependent on hemodialysis (mean age, 66.4 years) and presenting with thrombosed dialysis access were enrolled form October 2005 through February 2006. Sixteen patients had synthetic grafts and 4 had native fistulas. Mean age of access was 24.65 months (range, 2 to 96 months). A history of previous intervention was noted for seven patients (6 percutaneous, 1 surgical).

Results

A mean of 2.7 passes of the ProLumen device were required for the venous limb (range, 1 to 6) and 2.35 passes for the arterial limb (range, 0 to 5). Average procedure time was 48 minutes (range 32–81 minutes). Adjunctive thrombectomy devices were utilized in 5 cases. Good angiographic and clinical results were reported in 19 patients; one patient had a poor result. Dialysis flow rate prior to thrombosis was 425 mL/min (range, 300 to 550). The mean post-thrombectomy flow rate was 380 mL/min (range, 200 to 480; n=19). “Ease of use” of Pro Lumen thrombectomy device was rated good in 17 patients. Maneuverability was good in 14 patients and clot removal around the opposite sheath was rated as good in 18 patients.

Conclusions

ProLumen is effective in thrombectomy of dialysis access. The device is easy to use, and effectively removes clot around the opposite sheath.
Fistula Size and Hemodynamics: An Experimental Model in Canine Femoral Arteriovenous Fistulas
Authors: Ramacciotti E. , Galego S.J. , Gomes M. , Goldenberg S. , Gomes P. De Oliveira , Ortiz J. Pinto
Published: March 2018

Purpose

The objective was to evaluate the impact of anastomosis diameter on blood flow in an arteriovenous fistula (AVF), comparing two different anastomosis sizes with a modified side-to-side technique in canine femoral arteries.

Methods

Ten mongrel dogs were subjected to two AVFs each, both using a modified side-to-side technique. On one side, the anastomosis diameter was 1.5 times the arterial diameter and on the other side 3.0 times the arterial diameter. Mean proximal and caudal blood flow and mean venous flow were measured using an electronic flowmeter 15, 20 and 25 min after surgery. The Mann-Whitney, Friedman and Wilcoxon non-parametric tests were used for data analysis (α ≤ 0.05).

Results

Femoral artery flow cranial to the fistula became 5.6 times greater in the 1.5 arterial diameter group, and 8.4 times greater in the 3.0 arterial diameter group, when compared to initial arterial flow. The mean flow in the cranial vein was greater in the 3.0 group (10.09 times greater vs. 6.46 times greater in the 1.5 group). Both in the proximal artery and in the vein there was a significantly greater flow in the group with the larger anastomosis diameter (Wilcoxon test). In the femoral artery caudal to the fistula, the flow in most of the animals was reversed: 3.5 times greater in the 1.5 group and 1.2 times greater in the 3.0 group, without statistical difference.

Conclusions

These results suggest that 3.0 times the arterial diameter for the AVF size in dogs leads to greater venous flow than with 1.5 times the arterial diameter, without increasing the reversed flow.
Intravascular Catheters and Biofilm Control
Authors: Percival S.L. , Kite P.
Published: March 2018

Intravascular catheters are the most common cause of nosocomially acquired bloodstream infections. Bacteria found adhering to the intraluminal surfaces of catheters are the principal source and cause of these infections. Adherent bacteria overtime are known to form multicellular communities which become encased within a three dimensional matrix of extracellular polymeric material known as biofilms, which are thought to be responsible for persistent infections. Consequently, a number of technologies have been developed to help prevent and control biofilms in intravascular catheters. One such approach involves impregnating catheter material with antimicrobial agents. Unfortunately these methods are not universally effective in preventing catheter-related biofilm infections. Technologies that utilise antimicrobials, as catheter locks have been shown to have more potential for preventing biofilm formation and reducing the incidences of catheter related bloodstream infections (CRBSI). This article discusses the significance of biofilms in intravascular catheters and determines whether the treatments available today are proving to be effective for controlling biofilms and draws attention to future avenues which are being investigated to control biofilms and therefore CRBSI.
Hemodialysis Access without a Shunt or a Catheter: The Circulating Port
Authors: Richard T.
Published: March 2018

Purpose

To develop a new type of vascular access (VA) avoiding permanent arteriovenous (AV) shunting and intravenous catheter placement using a silicone plug inserted in the vessel wall.

Method

Four different animal studies were conducted to verify the biologic safety of the concept, to check resistance to infection and accessibility and midterm patency.

Results

The circulating ports were found to be very easy to puncture, extremely resistant to infection and their midterm patency rate was acceptable.

Conclusions

The circulating port seems to be a very promising hemodialysis (HD) access method, but it still has to be tested in clinical situations.
Early Experiences of Intraoperative Ultrasound Guided Angioplasty of the Arterial Stenosis during Upper Limb Arteriovenous Fistula Creation
Authors: Napoli M. , Montinaro A. , Russo F. , De Pascalis A. , Patruno P. , Proia S. , Valletta A. , Vitale O. , Buongiorno E.
Published: March 2018

In recent years the high prevalence of diabetes and atherosclerosis in elderly uremic patients starting hemodialysis (HD) has led to the increase in the risk of vascular access (VA) failure caused by pre-existing arterial diseases, including both VA slow maturation and early failure, and upper limb ischemic symptoms. Recently, in performing radial (R), brachial (B) and ulnar (U) artery (A) percutaneous transluminal angioplasty (PTA) in HD patients affected by access thrombosis, with insufficient blood flow and severe upper limb ischemia, good outcomes have been reported. Nevertheless, these procedures were performed after arteriovenous fistula (AVF) creation. About 2 years ago, we approached an intra-operative ultrasound-guided transluminal angioplasty (IUTA) performed during AVF creation, using the arterial incision, necessary because of the anastomosis, to introduce the necessary devices for the IUTA. The arterial stenosis having undergone IUTA was diagnosed by a preliminary ultrasound examination. Ultrasound guidance during the procedure is necessary for correct balloon location in the stenosis site. We treated seven patients (four diabetics), mean age 76 + 5 yrs. In all cases, the radial arteries because of hyposphygmia, were unfit for AVF creation. Four distal radio-cephalic AVFs at the wrist were created in patients 1, 3, 4 and 5; in the other three patients (2, 6 and 7), with failure or thrombosis of previous distal AVFs, an immediately upstream anastomosis was performed. In all cases, first, the area selected to perform the AV anastomosis was exposed, then the AR was incised, and the introductory metallic guide wire and the angioplasty catheter (with dimensions decided after PUS), were introduced. The balloon was inflated to 8–13 atm for 30–35 sec. In two patients a stent was also positioned. Later, a side-to-side AVF was created, closing the distal venous vessel. Patient follow-up ranged from 6–22 months. The ultrasound evaluation after IUTA showed the correction of all the stenosis treated. AVF maturation was good, except for the stented ones, which were inadequate. In conclusion, our early experience shows IUTA could be an adequate and effective procedure allowing the use of the stenotic arteries (otherwise unsuitable) for AVF creation. In our experience, stenting after IUTA does not add any other advantages.