bluuebunny/crossref_metadata_2025 huggingface dataset:
A Reproducible and Inexpensive Method of Measuring Hip Abductor Strength
Authors: Traina Francesco , Cristofolini Luca , De Fine Marcello , Brunetti Ludovico , Frakulli Ideal , Abati Caterina Novella , D'Uva Lorenzo , Toni Aldo
Published: January 2018

The evaluation of hip abductor strength is useful in assessing of the outcome of hip surgery. Hand-held dynamometers are available, but they are less reliable in assessing hip abductor strength than some other muscle groups. We describe a new device designed to measure hip abductor strength, which is practical in a clinical setting. A system of constraints, pads and reference points was devised to make force measurements as little examiner–dependent as possible. Reproducibility was assessed in a controlled setting. The abductor strength of ten healthy young subjects (average age 28 years) was tested twice on each side by two independent examiners. Tests were performed in a supine position, eliminating the influence of gravity and examiner intervention. The results indicated high reproducibility, the maximal measurement uncertainty being within 1 N. Intra-class correlation coefficients ranged from 0.85–0.98 for intra-rater reproducibility, and 0.81–0.96 for inter-rater reporoducibility. The coefficient of variation was lower than 10%.

The device described may be suitable for routine clinical assessment of patients after hip surgery.
The Influence of Aetiology of Hip Instability on the Results of Pelvic Support Osteotomy
Authors: Gursu Sarper , Demir Bilal , Yildirim Timur , Oke Ramadan , Bursali Aysegul , Sahin Vedat
Published: January 2018

Pelvic support osteotomy and femoral lengthening are sometimes employed in cases of hip instability. We assessed the efficacy of surgery following sepsis and congenital dislocation in relation to functional results.

Between March 2005 and May 2007 we performed pelvic support osteotomy and femoral lengthening for 21 hips in 20 patients. Preceding pathology included congenital dislocation in 13 hips (12 patients) and sequelae of sepsis in 8 hips. All surgical procedures were performed as described by Ilizarov. The mean follow-up period was 33.5 months.

There was no significant difference between the final Harris Hip Scores of the 2 groups. The number of patients with persisting abductor weakness was similar between the 2 groups. Complications were more frequent following congenital dislocation, and additional physiotherapy to restore knee motion was required in almost half of these. Patient satisfaction was higher in cases with sequelae of sepsis.
A Modified Technique for Reconstruction of the Femoral Neck in Paediatric Patients
Authors: Libri Rolando , Reggiani Leonardo Marchesini
Published: January 2018

Hip deformities during early childhood following Perthes' disease, congenital dislocation or septic arthritis are not rare, causing limitation of motion and limping. A number of proximal femoral osteotomies to address residual deformities have been described, but the outcome has been variable. We describe a proximal femoral osteotomy aimed at restoring a more anatomic insertion of the gluteus medius. The clinical and radiographic results thus far are promising. We believe that the technique improves both the anatomy and biomechanics of the hip.
Incidence of Deep Infection in Aseptic Revision THA using Vancomycin-Impregnated Impacted Bone Allograft
Authors: Buttaro Martin A. , Guala Agustin J. , Comba Fernando , Suarez Federico , Piccaluga Francisco
Published: January 2018

The addition of antibiotic to cement is a frequent practice in aseptic revision hip surgery There is concern about adding vancomycin to cement due to potential effects on mechanical properties and prolonged elution of subtherapeutic levels antibiotic. Bone allografts can store and provide high levels of vancomycin to surrounding tissues. We analyzed the incidence of infection after one-stage aseptic revision hip reconstruction utilizing acetabular and/or femoral vancomycin-impregnated impacted bone allograft and a THA fixed with cement containing no antibiotic. We hypothesized that the infection rate may be similar to that reported in the literature following traditional impaction grafting using antibiotic loaded cement.

Seventy five consecutive patients (80 hips) with a preoperative Merle D'Aubigné and Postel functional score averaging 4.8 points were followed up for a mean of 36 months (range 24 - 59 months).

The incidence of infection was 1.25% (CI 95%=96.26–100%). A deep infection (thought to be haematognous in origin) occurred in 1 patient 2 years after the index surgery. The average postoperative Merle D'Aubigne score was 16.2 points. The last radiographic evaluation demonstrated a less than 5 mm acetabular migration and a less than 5 mm femoral subsidence in all cases.

Vancomycin-supplemented allografts restored bone stock and provided sound fixation with a low incidence of infection. This incidence of deep sepsis is similar to that reported with antibiotic-loaded PMMA but without the reported mechanical and pharmacological disadvantages.
Broken Kirschner or Guide-Wire Retrieval: A Report of 4 Cases
Authors: Sen Ramesh Kumar , Tripathy Sujit Kumar , Aggarwal Sameer , Agarwal Amit , Goyal Tarun , Tahasildar Naveen , Dhatt Sarvdeep
Published: January 2018

Migration of a broken wire into the hip joint or pelvis during surgery is rare, but it can cause significant complications. Retrieval can be extremely difficult and hazardous. We report 4 cases of broken Kirschner or guide wire removal around the hip joint. Two wires were inside the hip joint and two had protruded into the pelvis. The problems encountered and techniques used for retrieval are discussed.
Patient Compliance with Extended Low Molecular Weight Heparin Injections following Hip and Knee Arthroplasty
Authors: Deakin Dan E. , Mishreki Andrew , Aslam Nadim , Docker Charles
Published: January 2018

The use of extended duration thromboprophylaxis following hip and knee arthroplasty is becoming widespread. The aim of our study was to determine patient compliance with extended duration thromboprophylaxis using low molecular weight (LMWH) injections following hip and knee arthroplasty.

42 consecutive patients undergoing hip and knee arthroplasty were prospectively contacted during their fifth post operative week. A fully anonymised questionnaire was completed by each patient. All patients responded. One was excluded having been prescribed warfarin for pre existing atrial fibrillation. Twenty nine (71%) patients were discharged with the intention of self administering LMWH injections. Eight (20%) and four (9%) patients were discharged with the intention of administration by a relative or district nurse respectively. No patient required the person administering the injections to be changed after discharge from hospital. 90% (n=37) of patients reported not missing any doses. 10% (n=2) of patients missed one dose and 10% (n=2) missed two doses. Patient compliance with extended duration thromboprophylaxis using LMWH injections is extremely high. Oral thromboprophylaxis may be useful in the minority of patients requiring daily visits by a nurse to administer injections.
Total Hip Arthroplasty in a Patient with Arthrogryphosis and an Ipsilateral Above Knee Amputation
Authors: Leonard Michael , Nicholson Paul
Published: January 2018

The authors present the case of a young man with arthrogryphosis multiplex congenita and an above knee amputation who underwent an ipsilateral total hip replacement. The unique aspects of the case and technical difficulties are highlighted. Follow-up at five years revealed an excellent clinical and radiological outcome.
Simultaneous ilioinguinal and Kocher-Langenbeck approaches for the treatment of complex acetabular fractures
Authors: Guerado Enrique , Cano Juan Ramón , Cruz Encarnación
Published: January 2018

Complex acetabular fractures are best treated by a surgical approach. Although some other variables such as comminution or cartilage lesion of the femoral head are related to the final outcome, early anatomic reduction is the only way to get good results; this has made the appropriate type of surgical approach of overwhelming importance. Seeing the fracture and also having the possibility of manoeuvring its fragments as much as required are the keys for reduction of these sort of fractures. In this paper we have studied the results of the treatment of complex acetabular fractures by simultaneous ilioinguinal and Kocher-Langenbeck approaches. Ten cases of complex fractures out of 260 surgically treated acetabular fractures were chosen for simultaneous combined approaches. In cases of comminution of both the anterior and the posterior columns together with circumferential shortening of the pelvic ring, reduction and stable internal fixation could be accomplished only by simultaneous combined accesses.
Vascular complications in floating hip
Authors: Zamora-Navas Placido , Guerado Enrique
Published: January 2018

The so-called floating hip involves a pelvis or an acetabular fracture together with an ipsilateral femur bone fracture. Concurrent injuries are also common in these cases, with the evolution and outcome worse than expected when these fractures exist in isolation. We studied a series of 11 patients with floating hip lesions. They all presented within a general polytrauma diagnosis. Diaphyseal femur fracture together with ipsilateral acetabular fracture was the most common combination. Supracondylar fracture occurred in 3 cases; these patients also had a popliteal vascular injury, and underwent a subsequent vascular repair. Although that treatment was promptly performed by a vascular surgeon, all of these patients in the end underwent an above-knee amputation. Bladder lesion, sciatic nerve injury, myositis ossificans, and skin injuries were also associated with these patients with a floating hip. Although vascular injuries in a floating hip have not been previously described in the literature, in our series these constituted the most severe complication. Whenever a major lower limb vascular injury coexists with a floating hip, prompt vascular repair must be accomplished. However, according to our experience, the nature of these lesions makes any expectation of limb viability very unlikely.
How to avoid injuries of the superior gluteal nerve
Authors: Miguel-Pérez Maribel , Ortiz-Sagristà Juan Carlos , López Ingrid , Pérez-Bellmunt Albert , Llusé Manuel , Alex Lazaro , Combalia Andrés
Published: January 2018

Background

Injuries to the superior gluteal nerve are a common complication in hip replacement surgery. They can be avoided with a good anatomical knowledge of the course of the superior gluteal nerve.

Methods

We dissected 29 half pelvises of adult cadavers. The distance and the angle from the entry points of branches of the superior gluteal nerve into the deep surface of the gluteus medium and minimus muscles to the midpoint of the superior border of the greater trochanter were measured.

Results

The dissections revealed that the nerve divided into 2 branches (86.20%) or 3 branches (13.8%). The more caudal branch was responsible for innervation of the tensor fascia latae.

Conclusions

A 2-3-cm safe area above the greater trochanter is appropriate to prevent nerve damage.
Comparative study of accuracy of Ranawat's and Pierchon's methods to determine hip centre with informatics tools
Authors: Olmedo-Garcia Nuria , Sevilla Alexandra
Published: January 2018

We compare 2 methods (Ranawat's and Pierchon's) used to determine the centre of rotation of the hip, and attempt to establish which method calculates a position nearer to the real centre of rotation using informatics tools. We selected 17 patients with at least 1 healthy hip and made a pelvis anteroposterior X-ray. We obtained the image by picture archiving and communication systems (PACS) and applied the informatics tools provided by Alma IT Systems software. The centre of rotation of the healthy hip was determined and referenced to the teardrop image by vertical (A) and horizontal (C) distances. Then, both methods were applied to the same radiograph to determine which established a centre of rotation nearer to the anatomical centre identified. When the values for the healthy hip were compared with those obtained using Ranawat's method, highly significant differences were observed for both A (p<0.0001) and C (p<0.0001). When the results for the healthy hip were compared with the values obtained using Pierchon's method, neither the A (p=0.5258) nor the C values (p=0.3463) showed any significant differences. It would be advisable to use Pierchon's method to determine the centre of rotation during preoperative planning for a total hip arthroplasty when the anatomical alteration is bilateral.
Bedding-in and true wear in two different generations cementless porous-coated acetabular cups
Authors: García-Rey Eduardo
Published: January 2018

Radiographic measurement of polyethylene wear cannot distinguish between so-called bedding-in and true wear in porous-coated cups. In this study, sequential wear performance was compared in two different generations of two cementless porous-coated cups. Group 1 consisted of 42 Harris-Galante I cups (HG I; 32-mm femoral head) and 37 Harris-Galante II cups (HG II; 28 mm); group 2 comprised 30 ACS liners using Profile or Trilock cups (32 mm) and 53 Duraloc cups (28 mm). All liners were made of conventional polyethylene sterilised by gamma irradiation in air. All cups showed radiographic bone ingrowth. Follow-up ranged from 5 to 17 years. Anteroposterior pelvic radiographs were scanned digitally and sequential femoral head penetration was estimated using a software package based on Kim's method.

Bedding-in was 0.17±0.09 mm for HG I and 0.09±0.02 for HG II cups (p=0.035) in group 1, and 0.60±0.50 for the ACS liners and 0.11±0.41 for the Duraloc cups (p<0.01) in group 2. Femoral head penetration at the end of follow-up was 1.50±0.28 mm for HG I (mean 14 years) and 0.85±0.01 for HG II (8 years) in group 1, and 2.86±0.68 for ACS (12 years) and 0.90±0.41 for Duraloc (8 years) in group 2. Mean wear was 0.09 mm/year for HG I and 0.10 for HG II in group 1, and 0.20 for the ACS liners and 0.09 for the Duraloc cups in group 2.

In conclusion, sequential femoral head penetration using Kim's digitised method allows us to distinguish between bedding-in and true wear.
Alumina-on-alumina hip replacement in developmental dysplasia of the hip
Authors: Cruz-Pardos Ana , García-Rey Eduardo , Ortega-Chamarro Jose , Castro-García Felix
Published: January 2018

Total hip arthroplasty (THA) in patients with developmental dysplasia of the hip (DDH) requires complex reconstructive techniques and presents an increased risk of complications. Because of these patients' young age, alternative bearing surfaces such as alumina-on-alumina couples could be an option. We asked whether moderate or severe congenital dysplasia of the hip would influence the clinical outcome and rates of cup loosening in our patients. We prospectively compared 50 hips in patients with dysplastic hip (group 1) and 22 hips in patients with a low or high dislocation (group 2) using an alumina-on-alumina THA. The minimum follow-up was 5 years (range 5–10 years). Age, activity level, and implant size were greater in group 1. Preoperative function and range of mobility were worse in group 2. The survival rate for cup loosening at 5 years was 89.8% (95% confidence interval, 78.7%-100%) for group 1 and 81.7% (95% confidence interval, 57.6%-100%) for group 2. An alumina-on-alumina THA provides a high level of pain relief and functional improvement in hip dysplasia. Continued follow-up will be required to determine if the alumina-on-alumina bearings in these patients result in less osteolysis and loosening.
Hemispheric hydroxyapatite-coated cups with impacted graft for severe bone defects in acetabular reconstruction: ten year follow-up
Authors: Navarro Rogelio Sancho , Gonzàlez Ferran Abat , Sererols Xavier Crusi , Rodríguez Julio De Caso , Pertegàs Màrius Valera
Published: January 2018

Cementless acetabular reconstruction with bone grafting has been limited to moderate bone defects. We report the outcomes of 57 acetabular revisions in 45 patients with severe bone defects (Paprosky type IIIA) using hemispheric hydroxyapatite (HA)-coated cups and impacted graft. After a mean follow-up of 10 years, all but 2 cups (3.5%) remained radiologically stable. There was clear radiological consolidation and medial wall remodelling of the graft in 62% of the cases. In 2 cases (3.5%), nonprogressive lucencies were found; in 3 cases (5.3%) a medial gap of 2 mm, detected postoperatively, was progressively filled by newly formed bone during follow-up. Mean MDA score rose from 7.3 points preoperatively to 16.8 points in the last evaluation, with an excellent pain relief report. These results suggest that the combined use of HA-coated hemispheric cups with impacted graft to treat Paprosky IIIA defects provides a long-lasting stable implant, restores bone stock, and yields excellent clinical results.
Burch-Schneider antiprotrusio cage for acetabular revision: a 5- to 13-year follow-up study
Authors: Coscujuela-Mañá Antonio , Angles Francesc , Tramunt Carles , Casanova Xavier
Published: January 2018

Ninety-six acetabular revisions using a Burch-Schneider antiprotrusio cage (BSAC) in 91 patients (53 women and 38 men), were evaluated retrospectively with a mean follow-up of 8.1 years (range 5–13 years). The mean age at surgery was 67.3 years (range 35–85 years). There were 3 re-revisions: 1 because of aseptical loosening and 2 because of deep infection. The Kaplan-Meier survivorship rate, with aseptic component loosening as the criterion of failure, was 92.4% (95% confidence interval, 85.1%-99.8%) at 13 years. Clinical evaluation of the surviving patients showed an increase in mean Merle d'Aubigné-Postel hip score of 8.8 points before surgery, to 15.1 points at the time of the last follow-up. Radiographic evaluation determined that 3 cages were considered definitely loose. The rotation centre of the hip was lowered an average of 4.3 mm and lateralised an average of 1.3 mm in this series. In the most severe cases (Paprosky 2C, 3A, and 3B), the hip centre was lowered 7.8 mm and lateralised 0.8 mm. The Burch-Schneider antiprotrusio cage long-term survival rate compares favourably with that for other devices. Acetabular reconstruction allows anatomic positioning of the cups and promotes good final results.
Trabecular Metal buttress augment and the Trabecular Metal cup-cage construct in revision hip arthroplasty for severe acetabular bone loss and pelvic discontinuity
Authors: Alfaro Juan José Ballester , Fernández José Sueiro
Published: January 2018

Large acetabular defects can be reconstructed using a tantalum Trabecular Metal acetabular component with Trabecular Metal buttress augments. We asked if these reconstructions survived at short-term follow-up. Of 35 patients undergoing acetabular reconstruction with a Trabecular Metal acetabular revision system from 2006, 19 acetabular revisions associated with major bone loss in which we reconstructed the acetabulum with buttress tantalum augments or cup-cage construct combined with a Trabecular Metal shell, were available for evaluation. Mean follow-up was 26 months (range 18–43 months). Mean patient age was 63 years, and 12 patients were women. All defects were classified according to Paprosky and Saleh classifications; there were 13 type IIIA and 6 type IIIB acetabular defects. Five chronic pelvic discontinuities were preoperatively or intraoperatively assessed (Saleh type 5) and a cup-cage construction was employed. No mechanical failure has occurred in any hip, and all patients have radiographically stable cups. Radiographic assessment showed an improvement in the position of the rotation centre of the hip, from a vertical position a mean of 3.5 cm (range 1.6–5.5 cm), to 1.4 cm (range 0.5–2.7 cm) postoperatively. The centre of the femoral head was relocated from a mean of 1.4 cm (range, –3 to 2.6 cm) lateral from the vertical at the teardrop to 3 cm (range 0.2–4 cm). Our early results suggest that buttress tantalum augments, with cup-cage construct for severe bone defects, may be an alternative to other treatment options, but a longer follow-up is necessary.
A Novel Fluoroscopic-Assisted Balloon Thrombectomy: Technique for Thrombosed Hemodialysis Prosthetic Grafts
Authors: Kakkos Stavros K. , Haddad Joseph A. , Haddad Georges K.
Published: January 2018

Background

Previous studies have shown that stenosis of the arterial anastomosis of thrombosed hemodialysis (HD) grafts, unmasked after conventional thrombectomy, very often necessitate subsequent arterial angioplasty. The aim of this study was to describe a novel fluoroscopic-assisted balloon thrombectomy technique which permits simultaneous arterial angioplasty (should this is required) for thrombosed HD grafts.

Methods

Thirty patients with 36 thrombotic episodes of their prosthetic HD grafts participated in this study. A balloon angioplasty catheter is placed beyond the arterial anastomosis, over a guidewire; the balloon is inflated with contrast solution under fluoroscopy and pulled back to remove the arterial thrombus from the anastomosis. Any coexisting stenosis revealed by balloon indentation is completely dilated at that time, rather than after the thrombectomy. Mechanical thrombolysis of the graft and venous outflow is then performed with the AngioJet catheter (Possis Medical, Inc).

Results

Technical and clinical success rates (the latter defined as one subsequent HD session) of the procedure were 100% and 94%, respectively. No complications, including arterial embolism, vessel rupture or pulmonary embolism, were encountered. Primary assisted patency at 3 and 6 months was 51% and 32%, respectively, while functional secondary patency at the same follow-up points was 78%.

Conclusions

our technique is safe and also effective in both short- and long-term follow-up. Because it offers convenience, since the treatment of arterial anastomotic stenoses is accomplished in one (rather than two) steps, this method deserves further investigation.
Long-Term Effect of an Ethanol/Sodium Citrate Locking Solution on the Mechanical Properties of Hemodialysis Catheters
Authors: Vercaigne Lavern M. , Takla Teresa A. , Raghavan J.
Published: January 2018

Purpose

To investigate the effect of a 30% ethanol/4% sodium citrate catheter locking solution on the mechanical properties of hemodialysis (HD) catheters over 36 weeks.

Methods

Twenty-one HD catheters were used in this study. Three catheters, not exposed to locking solutions, underwent mechanical testing to determine baseline properties. Nine of the remaining 18 catheters were filled with normal saline and underwent mechanical testing in groups of three at 12, 24 and 36 weeks. Similarly, nine catheters were filled with the 30% ethanol/4% sodium citrate locking solution and tested in a similar manner.

Results

The average force required to break the catheter lumens tended to be smaller in the catheters exposed to 30% ethanol/4% sodium citrate compared to saline controls at 12 and 24 weeks; however, there were no statistically significant differences between the groups after 36 weeks of exposure. The forces required to break these HD catheters are magnitudes greater than forces generated during a typical HD session.

Conclusions

We conclude that the 30% ethanol/4% sodium citrate locking solution had an effect on the mechanical properties of the catheters investigated, but not to the degree that would preclude further in vivo investigation. Further studies are necessary to determine the safety and efficacy of this catheter locking solution.
Totally Implantable Ports Connected to Valved Catheters for Chemotherapy: Experience from 350 Groshong Devices
Authors: Nishinari Kenji , Wolosker Nelson , Vinicius Bernardi Christiano , Yazbek Guilherme
Published: January 2018

Purpose

There are few studies regarding the use of totally implantable valved ports for chemotherapy. The objective of this study was to analyze the results obtained from consecutive implantation of 350 devices.

Methods

Adult patients submitted to port insertion in veins of the superior vena cava system over a 17-month period (July 2006 to December 2007) were considered. The device used was composed of a titanium and silicone rubber port (Dome Port™; Bard Inc, Salt Lake City, UT) connected to an 8.0 Fr silastic Groshong™ catheter tube. Follow-up was conducted on outpatient data and during clinical readmissions, until the device was removed or the patient died.

Results

Three hundred and fifty devices, total of 74,691 days in situ, were inserted, with a median follow-up of 176 days. There were 11 early complications (3.1%) and 49 late complications (14%), 21 of these (6%) were considered major ones. Early complications comprised four instances of phlebitis of the external jugular, three of pocket infection, two of technical failure and two of ecchymosis. Late complications comprised 33 instances of withdrawal difficulty, 12 of port-related bacteremia, two of deep venous thrombosis, one of occlusion and one of catheter fracture. Out of the 350 catheters implanted, 258 (73.5%) were still being used, 73 (21%) remained in use until the patient died, five (1.5%) were removed at the end of the treatment and 14 (4%) were removed because of complications.

Conclusions

There was a low rate of major complications associated with this valved system justifying its use.
The Brachio-Brachial Arteriovenous Fistula: Mid-Term Results
Authors: Florin Dorobantu Lucian , Anton Iliescu Vlad , Stiru Ovidiu , Bubenek Serban , Novelli Eugenio
Published: January 2018

Objective

To evaluate the mid-term results of the brachio-brachial arteriovenous fistula in patients without adequate superficial venous circulation in the upper limb.

Methods

Retrospective analysis included 49 patients, in whom a brachio-brachial fistula had been created in an end-to-side configuration. After the maturation period (1 month), the brachial vein was transposed into the subcutaneous tissue. Follow-up study was performed in patients with functional brachio-brachial fistula after the superficialization.

Results

Forty-nine patients underwent 49 brachio-brachial fistula constructions. All fistulas were functional. One month after surgery, 40 (81.6%) of these patients had a functional fistula, but in only 39 (79.6%) cases was the fistula suitable for hemodialysis (HD) following transposition to subcutaneous tissue. During the 1–month maturation period, the fistula became occluded in nine patients, and in one case the vein was permeable, so the fistula was functional, but too small to permit HD. Seventeen patients developed temporary edema of the forearm during the first month, in three cases the edema was extended to the entire arm, but no other complications were associated with the procedure. Follow-up lasted 18.0 ± 11.1 (3–37) months, during which 7/39 patients presented with fistula occlusion. Three patients died and another three were out of the study for various reasons.

Conclusions

the brachio-brachial fistula is a good alternative to prosthetic grafts in patients without superficial venous circulation in the upper limb.
Patient-Centric Analysis of Dialysis Access Outcomes
Authors: Solesky Beverly C. , Huber Thomas S. , Berceli Scott A.
Published: January 2018

Objective

Dialysis access literature has traditionally focused on fistula patency as the primary outcome measure, but this approach falls short in describing the entire spectrum of dialysis access care. Using our prospectively maintained vascular access data base, a comprehensive, patient-centered analysis of arteriovenous access placement and interventions, central venous catheter use, and associated complications is performed.

Methods

Twenty-six patients receiving 39 arteriovenous fistula (AVF), eight prosthetic grafts and 52 catheters were followed longitudinally for an average of 4.1 yrs to determine the time of initial cannulation, need for revision, and the time of abandonment for each AV access. Access complications secondary to infection, thrombosis, stenosis, and aneurysmal degeneration were tabulated. The time of permanent dialysis catheter placement and removal was collected, along with infection and thrombotic complications related to their use.

Results

Fifty-four percent of the AVFs matured without the need for intervention, while 13% required revision to promote maturation. One-third of the AVFs failed primarily or following revision and were never used for dialysis. Fistulae were initially cannulated an average of 9.5 months following implantation and lasted 27.2 months before abandonment. AVF revisions were performed an average of 7.5 months following maturation and provided an additional 19.8 months of usability. Fifty percent of prosthetic grafts could be used without intervention, while 25% were used only after revision and 25% were abandoned without being used. Grafts were accessed an average of 2.7 months after implantation and lasted 14.1 months after the initial cannulation. Twenty-three patients received a total of 52 catheters during the study, with an average implantation time of 6.5 months. Sixty-three percent of the catheters developed one or more complications, for a rate of 1.3 complications per year of indwelling catheter.

Conclusion

The current study provides a novel approach for the comprehensive evaluation of access care for patients undergoing hemodialysis through the development of a patient-centric approach to examine the complexities and shortcomings in dialysis access care. Despite some difficulties in achieving fistula maturation, an AVF prevalence rate was 66%, meeting the 65% goal set by the Fistula First Initiative. Unfortunately, a significant portion of the remainder of the dialysis support was provided by catheters, with a 27% catheter prevalence rate.
An Easy Technique for the Removal of a Hemodialysis Catheter Stuck in Central Veins
Authors: Hong Joon H.
Published: January 2018

Background

Central venous catheters are currently used for long-term hemodialysis (HD) in a large number of patients. When the catheter needs to be removed, the removal is usually achieved without difficulty after dissection of the cuff from the tunnel. However, when the catheter is stuck in the central vein, the removal becomes complex or unsuccessful. Herein, a simple and easy technique is described for the removal of an HD catheter stuck in the central vein.

Case Report

Attempts were made to remove an HD catheter from a 65-year-old male by making an incision in the skin over the exit site of the catheter to dissect the cuff from the tunnel and by pulling the catheter, but without success because the catheter was stuck in the central vein. Through a second skin incision in the neck, the subcutaneous portion of the catheter was retrieved from the tunnel and then an introducer sheath was inserted over the catheter into the internal jugular vein while the catheter was held in place. The sheath was advanced around the catheter into the central vein. The catheter was then easily pulled out from the central vein.

Comment

The reported cases of stuck catheters in the literature were reviewed to acknowledge the difficulties encountered in the removal attempts. The technique described herein can be used for the removal of a variety of catheters and wires stuck in the central vein.
Asymptomatic High Flow Subclavian Steal in a Patient with Hemodialysis Access
Authors: Bron Cédric , Hirt Lorenz , Halabi Georges , Saucy François , Qanadli Salah D. , Haesler Erik
Published: January 2018

Introduction

Subclavian steal phenomenon due to proximal subclavian artery stenosis or occlusion is not uncommon but often remains asymptomatic.

Case Report

We describe the case of a 66-year-old man with end-stage renal disease hemodialysed through a brachio-brachial loop graft of the left forearm. Echo-Doppler precerebral examination showed a high reversed flow of 570 ml/min in the ipsilateral vertebral artery. After successful endovascular recanalization of the subclavian artery, access blood flow increased and vertebral flow decreased to 30 ml/min. Complete neurological examination was normal both before and after endovascular treatment.

Discussion

This case demonstrates how high a subclavian steal can be without causing symptoms and how well precerebral and cerebral circulation can adapt to hemodynamic changes.
Use of Bovine Mesenteric Vein in Rescue Vascular Access Surgery
Authors: Benedetto Filippo , Carella Giuseppe , Lentini Salvatore , Barillà David , Stilo Francesco , De Caridi Giovanni , Spinelli Francesco
Published: January 2018

We describe a technique for rescue surgery of autologous arterovenous fistula (AVF), using Bovine Mesenteric Vein (BMV), which may be used in patients with autologous AVF malfunction caused by steno-occlusion on the arterial side or by fibrosis of the first portion of the vein. To preserve the autologous AVF, we replaced the diseased portion of the artery, or the first centimeters of the vein, by a segment of BMV, with the aim of saving the patency and functionality of the access. We used this technique in 16 cases. All patients underwent hemodialysis treatment immediately after the procedure. Infection or aneurismal dilatation of the graft in implanted BMV was never observed.
Long Thoracic Vein Embolization for the Treatment of Breast Edema Associated with Central Venous Occlusion and Venous Hypertension
Authors: Arthur Miller Gregg , Friedman Alexander , Khariton Aleksandr , Jotwani Manish C. , Savransky Yevgeny
Published: January 2018

Purpose

Breast edema is a rare complication in hemodialysis patients with central venous occlusions. The present study sought to determine whether coil embolization of the long thoracic vein is an effective long-term treatment for this pathology.

Methods

The study patients were 6 female hemodialysis patients whose primary clinical manifestation of central vein occlusion was breast edema. When conservative treatment (allowing collaterals to dilate over time), as well as recanalization of occlusions through angioplasty with or without stent placement, failed to alleviate symptoms, patients underwent coil embolization of the long (lateral) thoracic vein.

Results

In 4 of the 6 cases, the breast edema was completely resolved without recurrence, while the other 2 patients experienced durable symptomatic improvement with only mild residual swelling. Average follow-up was 22 months. There were no adverse sequelae and none of the patients experienced increased swelling elsewhere following the coil embolization procedure.

Conclusions

Coil embolization of the long thoracic vein effectively alleviates breast edema in hemodialysis patients with elevated venous hydrostatic pressure due to central venous occlusions.
Small dose Contrast Venography as Venous Mapping in Predialysis Patients
Authors: Dong Won Yoo , Young Lee Ja , Shin Shin Young , Soo Kim Young , Ae Yoon Sun , Soo Kim Yong , Tai Hahn Seong , Cheol Park Sun , Ok Kim Young
Published: January 2018

Purpose

This study was designed to evaluate radiocontrast-induced nephrotoxicity (RIN), and the image quality and findings of venography using small doses of radiocontrast as a venous mapping method in pre-dialysis patients.

Methods

Twenty-eight patients with stage 4 and 5 chronic kidney disease underwent arm venography with 10–15 ml of dilute contrast medium. Image quality, venographic findings and glomerular filtration rate (GFR) before and after the procedure were evaluated.

Results

Mean GFR was 19.3±5.8 ml/min/1.73 m2 (7–30 ml/min/1.73 m2). Image quality of venography in the forearm and upper arm veins was good in all patients. Central veins were visualized well in 26 (92.8%) patients. Eight (28.5%) patients showed cephalic veins inadequate for creation of radiocephalic arteriovenous fistula (AVF) because of occlusion or small diameter veins. There was no significant difference in GFR between the pre- and post-study (19.3±5.8 vs. 19.2±6.2 ml/min/1.73 m2, p=0.693). RIN developed (GFR: 17 to 13 ml/min/1.73 m2) in only one patient but without sequelae, and the GFR completely recovered to baseline level 7 days after the study.

Conclusion

Small dose venography is safe and effective for venous mapping in pre-dialysis patients.
High Brachial Artery Bifurcation is Associated with Failure of Brachio-Cephalic Autologous Arteriovenous Fistulae
Authors: Lioupis Christos , Mistry Hiren , Junghans Cornelia , Haughey Niamh , Freedman Ben , Tyrrell Mark , Valenti Domenico
Published: January 2018

Objective

Although European Best Practice Guidelines on vascular access recommend universal pre-operative duplex scan in patients receiving brachio-cephalic (BC) arteriovenous fistulae (AVF), this is not widespread practice. Furthermore, cadaveric and angiographic studies suggest that variation in upper limb arterial anatomy is common. Our aim was to investigate the prevalence of high brachial artery bifurcation (HB) and its impact on BC AVF patency.

Methods

A retrospective analysis of consecutive autologous BC AVF created over an 18-month period (January 2008 to June 2009). Patients with high bifurcations identified at duplex scan were compared with a control group who had normal bifurcations. All patients were followed up at 1, 6 and 12 weeks post-operatively. The study endpoint was AVF patency.

Results

One hundred and five autologous BC AVF procedures were performed in our institution, of which 29 (27.6%) were identified as having a high brachial bifurcation on pre-operative duplex scan. The bifurcation was axillary in six patients and located at the proximal, middle and distal third of the humerus in nine, seven and seven patients, respectively. The actuarial functional patency rate was 53.2% (standard error = 9.6%) in the HB group and 76.2% (standard error = 4.9%) in the control group (log-rank test, p=0.027).

Conclusions

These data show that aberrant brachial artery anatomy is both common (12%) and a predictor of autologous BC AVF failure. These data support the universal use of pre-AVF duplex scanning.
Insertion of Tunneled Hemodialysis Catheters without Fluoroscopy
Authors: Motta Elias Rosilene , Cristina da Silva Makida Sonia , Abensur Hugo , Carlos Martins Castro Manuel , Maria Affonso Moysés Rosa , Jorge Pereira Benedito , Bueno de Oliveira Rodrigo , Luders Cláudio , João Egidio Romão
Published: January 2018

Background

The tunneled cuffed catheter (TCC) is used as a bridge access for hemodialysis. Few prospective studies have been designed to evaluate conversion from non-tunneled to TCC without the use of fluoroscopy when performed by nephrologists.

Methods

We performed an observational prospective cohort in incident patients receiving hemodialysis through a non-tunneled right jugular vein catheter.

Results

130 procedures were performed in 122 patients (51±18 years). The success rate was 100%. There was a total of 26,546 catheter days. Ninety-one of the 130 catheters were removed during the study period. Life table analysis revealed primary patency rates of 92%, 82%, and 68% at 30, 60, and 120 days, respectively. Infection requiring catheter removal occurred at a frequency of 0.09 per 100 catheter days. Catheter malfunction requiring intervention occurred at a rate of 0.03 per 100 catheter days. Hypertension and duration of existing non-tunneled catheter of less than 2 weeks were independently associated with better TCC survival.

Conclusion

The conversion from non-tunneled to TCC performed by nephrologists and without fluoroscopy may be safe by using the internal right jugular vein. The ideal time to do this procedure is within less than 2 weeks of existing non-tunneled catheter.
Proximalization of the Arterial Inflow (PAI) in Patients with Dialysis Access-Induced Ischemic Syndrome: First Report on Long-Term Clinical Results
Authors: Thermann Florian , Wollert Ulrich , Ukkat Jörg , Dralle Henning
Published: January 2018

Purpose

Proximalization of the arterial inflow (PAI) is a promising technique which was introduced several years ago as a treatment option for patients with dialysis access-induced ischemic syndrome (DAIIS). In our institutions we have been performing PAI since 2003 and have seen positive clinical results. The aim of this prospective survey is to present the long-term results of PAI.

Methods

Between 2003 and 2008, forty PAI operations were performed in our institutions: 4 patients had acute pain and sensorimotor dysfunction with no lesions, 33 had small acral lesions, and 3 had extended lesions following the creation of autogenous fistulas. In 22 cases a heparinized graft was used and in 18 cases a regular PTFE-graft. Criteria for successful treeatment of the disease course were evaluated by clinical and ultrasound examinations.

Results

In 36 cases (90%), PAI led to clinical success which was permanent in 33 patients (82%) seen in the follow-up period of 9 to 40 months. Primary patency was 62% after 12 months and secondary patency was 75% after 18 months. Heparinized grafts led to better patency rates. In 3 out of the 4 patients with large acral lesions, graft explantation was necessary due to infection or failing success.

Conclusions

Based on our experience, clinical long-term results are successful in certain patients with DAIIS. The aim for the near future should be a better patency rate to minimize the need for reoperations. In cases of extended limb necrosis/gangrene results were poor. In such patients primary closure of the access must be discussed.
Retained Catheter: A Rare Complication Associated with Totally Implantable Venous Ports
Authors: Nishinari Kenji , Vinicius Bernardi Christiano , Wolosker Nelson , Yazbek Guilherme
Published: January 2018

Totally implantable venous ports are the main access for chemotherapy. The complications associated with these devices occur most frequently over the course of their use. We report two cases of a complication that had only been described in patients with partially implantable catheters for hemodialysis: retention of a catheter fragment within a vessel during port removal. Both patients underwent adjuvant chemotherapy through the port and even after indication of catheter removal because at the end of treatment, they remained with the devices for long periods of time (7 and 8 yrs, respectively). Due to adherence of the catheters along their intravascular portions, complete removal was impossible. The catheters were sectioned and ligated close to the site where it entered the access vein. After 1 yr of follow-up, both patients were asymptomatic and imaging examinations showed the retained catheters. We believe that an implantable port should be removed after appropriate oncological follow-up.
Duplication of the Inferior Vena Cava in a Patient Presenting for IVC Filter Placement
Authors: Cheng Danny , Zangan Steven M.
Published: January 2018

Given the complex embryogenesis of the inferior vena cava (IVC), anatomic variations are commonly encountered. Duplication of the IVC occurs in up to 2.8% of the population. Though asymptomatic, a duplicated IVC has important clinical implications when attempting caval filtration. We present the case of a 45- year-old male with factor V leiden and protein C deficiency, who required cessation of warfarin anticoagulation in preparation for cervical laminectomy. The patient had a duplicated IVC and required placement of a caval filter in each IVC.
Impact of ageing on problem size and proactive interference in arithmetic facts solving
Authors: Archambeau Kim , De Visscher Alice , Noël Marie-Pascale , Gevers Wim
Published: January 2018

Arithmetic facts (AFs) are required when solving problems such as “3 × 4” and refer to calculations for which the correct answer is retrieved from memory. Currently, two important effects that modulate the performance in AFs have been highlighted: the problem size effect and the proactive interference effect. The aim of this study is to investigate possible age-related changes of the problem size effect and the proactive interference effect in AF solving. To this end, the performance of young and older adults was compared in a multiplication production task. Furthermore, an independent measure of proactive interference was assessed to further define the architecture underlying this effect in multiplication solving. The results indicate that both young and older adults were sensitive to the effects of interference and of the problem size. That is, both interference and problem size affected performance negatively: the time needed to solve a multiplication problem increases as the level of interference and the size of the problem increase. Regarding the effect of ageing, the problem size effect remains constant with age, indicating a preserved AF network in older adults. Interestingly, sensitivity to proactive interference in multiplication solving was less pronounced in older than in younger adults suggesting that part of the proactive interference has been overcome with age.
Relationships and Health: The Critical Role of Affective Science
Authors: Sbarra David A. , Coan James A.
Published: January 2018

High-quality social relationships predict a range of positive health outcomes, but no broadly accepted theory can explain the mechanisms of action in this area. The central argument of this article is that affective science can provide keys for integrating the diverse array of theoretical models concerning relationships and health. From nine prominent theories, we cull four components of relational affect that link social resources to health-related outcomes. This component model holds promise for integrating research from the different theoretical perspectives and for generating new, mechanistic questions about the connection between relationships and health. The article closes by outlining three empirical study ideas that illustrate ways in which the different components can be studied together in the context of mechanism-focused research.
Comment: Homing in on a Balanced Psychology
Authors: Larsen Jeff T.
Published: January 2018

Hernandez et al.’s (2018) review provides clear evidence that positive affect can contribute to well-being and fits nicely within the positive psychology framework. The emergence of positive psychology has been valuable for understanding well-being, but I suggest that a balanced psychology can prove even more valuable in the years to come. A balanced psychology requires giving as much attention to negative emotion as to positive emotion. It also requires considering whether there are circumstances in which positive emotions can be detrimental and negative emotions can be beneficial. Along those lines, evidence reviewed here indicates that healthy coping with severe stressors involves experiencing a combination of positive and negative emotions.
Comment: The Emotional Basis of Toxic Affect
Authors: Fischer Agneta H.
Published: January 2018

I focus on some differences between negative emotional states and how they are coped with in explaining different cardiac risks. The different cognitive, motivational, and physiological characteristics of emotions imply different appraisals of the negative event, and different resources to cope with the event. Cardiovascular activity depends on these different appraisals and coping strategies. For example, cortisol levels have shown to be differently associated with anger and fear responses to social stress. In addition, different ways to regulate one’s emotions are also associated with different bodily responses that may increase or decrease cardiac risks. Future research should not only examine different emotions to stressors, but also more long-term regulation strategies and coping resources, such as self-esteem.
Comment: Comorbidity Between Mental and Somatic Pathologies: Deficits in Emotional Competence as Health Risk Factors
Authors: Scherer Klaus R.
Published: January 2018

I strongly endorse many of the suggestions made by the authors of the extremely useful reviews in this issue. In particular, the need to identify the complex causal mechanisms underlying the major health risk factors requires urgent attention of the research community. I suggest considering the important role of emotional disturbances as contributors to health risks given the empirically established comorbidity between mental and somatic illness. Better knowledge of these mechanisms is an essential prerequisite to develop tailored personalized prevention and intervention programs, including reliable and valid assessment of deficits.