bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ultrasound-Guided Direct Basilic-Axillary Approach in Preoperative Venography for Hemodialysis Access
Authors: Shemesh D. , Goldin I. , Cytter-Kuint R. , Zaghal I. , Berelowitz D. , Olsha O. 
Published: March 2018

Purpose Hemodialysis patients with suspected central vein stenosis or occlusion require venographic assessment before access surgery. Conventional venography may be unsatisfactory because of the limited ability to image central veins via peripheral arm veins that are inadequate or that have been damaged by multiple cannulations. Imaging of the central veins requires high flow contrast injection, which may be unattainable through small peripheral veins. We suggest a simple technique to improve central vein imaging by ultrasound-guided direct puncture of the basilic vein at its entry to the axilla. Methods We studied 20 patients in whom upper limb venography via peripheral veins was inadequate for the satisfactory demonstration of central vein anatomy and they underwent direct basilic-axillary vein puncture with Doppler ultrasound guidance. A 4Fr micropuncture catheter was used for manual injection of the contrast agent to image the central veins. Results All patients had inadequate upper limb venography via peripheral vein cannulation, and stenosis could not be ruled out due to poor visualization of the central veins. In all cases, venography by Doppler ultrasound-guided direct basilic-axillary vein puncture was very easy for both the radiologist and the patient, consistently providing high quality imaging without the need for repeated attempts at cannulation and without the need for infusion pumps. No complications were noted during or after the procedure. Conclusions Venography by Doppler ultrasound-guided direct basilic-axillary vein puncture is a simple and rapidly performed technique that improves the visualization of the central veins.
Plasminogen Activator Inhibitor-1 Activity and 4G/5G Polymorphism in Hemodialysis
Authors: Trimarchi H. , Duboscq C. , Genoud V. , Lombi F. , Muryan A. , Young P. , Schwab M. , Castañón M. , Rodríguez-Reimundes E. , Forrester M. , Pereyra H. , Campolo-Girard V. , Seminario O. , Alonso M. , Kordich L. 
Published: March 2018

Introduction Chronic insufficiency alters homeostasis, in part due to endothelial inflammation. Plasminogen activator inhibitor-1 (PAI-1) is increased in renal disease, contributing to vascular damage. We assessed PAI-1 activity and PAI-1 4G/5G polymorphism in hemodialysis (HD) subjects and any association between thrombotic vascular access (VA) events and PAI-1 polymorphism. Methods Prospective, observational study in 36 HD patients: mean age: 66.6 ± 12.5 yr, males n=26 (72%), time on HD: 28.71 ± 22.45 months. Vascular accesses: 10 polytetrafluoroethylene grafts (PTFEG), 22 arteriovenous fistulae (AVF), four dual lumen catheters (CAT). Control group (CG): 40 subjects; mean age: 60.0 ± 15 yrs, males n=30 (75%). Group A (GA): thrombotic events (n=12), and group B (GB): No events (n=24). Groups were no different according to age (69.2 ± 9.12 vs. 65.3 ± 14.5 yrs), gender (males: 7; 58.3% vs. 18; 81.8%), time on HD (26.1 ± 14.7 vs. 30.1 ± 38.7 months), causes of renal failure. Time to follow-up for access thrombosis: 12 months. Results PAI-1 levels in HD: 7.21 ± 2.13 vs. CG: 0.42 ± 0.27 U/ml (p<0.0001). PAI-1 4G/5G polymorphic variant distribution in HD: 5G/5G: 6 (17%), 4G/5G: 23 (64%); 4G/4G: 7 (19%) and in CG: 5G/5G: 14 (35%); 4G/5G: 18 (45%); 4G/4G: 8 (20%). C-reactive protein (CRP) in HD: 24.5 ± 15.2 mg/L vs. in CG 2.3 ± 0.2 mg/L (p<0.0001). PAI-1 4G/5G variants: GA: 5G/5G: 3; 4G/5G: 8; 4G/4G: 1; GB: 5G/5G: 3; 4G/5G: 15; 4G/4G: 6. Thrombosis occurred in 8/10 patients (80%) with PTFEG, 3/22 (9%) in AVF, and 1/4 (25%) in CAT. Among the eight PTFEG patients with thrombosis, seven were PAI 4G/5G. Conclusions PAI-1 levels were elevated in HD patients, independent of their polymorphic variants, 4G/5G being the most prevalent variant. Our data suggest that in patients with PTFEG the 4G/5G variant might be associated with an increased thrombosis risk.
Arteriovenous Fistulae vs. Arteriovenous Grafts: A Retrospective Review of 1,700 Consecutive Vascular access Cases
Authors: Schild A.F , Perez E. , Gillaspie E. , Seaver C. , Livingstone J. , Thibonnier A. 
Published: March 2018

Objective Vascular access (VA) procedures are rapidly becoming the most prevalent surgery in the United States. It is estimated that there will be over 500,000 VA procedures done this year. Previously, surgeons in the US were attempting many more non-autogenous grafts than autogenous fistulae. In recent years, there has been a great push called “Fistula First” to promote arteriovenous fistulae (AVF) as the first line of treatment vs. non-autogenous grafts. The goal of this investigation is to determine if too many fistulae are now being performed without attention to specific patient profiles. Methods A retrospective review of 1700 consecutive cases was performed by one surgeon at one institution between 1997 and 2005. Patients were categorized by demographics, co-morbidities, previous access procedures, access location, and type of graft. Patency was calculated. Kaplan-Meier, Cox regression and the Log Rank Test were used to analyze data. Access endpoints and complications were also documented. Results The study reviewed 1700 procedures. The median age was 52 (60.2% male) with 58.7% fistulae and 41.3% grafts. Median patency time was 10 months, with no statistically significant difference between access types. There was no significant difference in length of patency when comparing upper arm (70.1%), lower arm (24.5%) and thigh (5.4%). Graft infection rate was 9.5% and fistula infection rate was 0.9% (p<0.001). The overall infection rate was 4.5%, and decreased patency significantly (4 vs. 11 months). Thrombosis occurred in 24.7% of grafts and 9.0% of fistulae. Thrombosed grafts had better salvage rates (8 vs. 4 months, p<0.001). The data showed diabetes, HTN and HIV have no overall impact on patency. Conclusions AVF and grafts are both useful in providing VA for patients requiring hemodialysis. Our data shows that grafts are equivalent in long-term patency. Therefore, it is apparent in those patients who are not candidates for an AV fistula; an AV graft for VA should be placed.
Reducing Catheter Infections through use of the CD-1000: A Retrospective Review of a Unique Catheter Specific Composite Dressing
Authors: Altman S.D. , Ross J.J. , Work J. 
Published: March 2018

Purpose Catheter-related blood stream infections pose a significant risk for patients living with vascular catheters. The cost to manage these infections is substantial. Although the etiology of these infections is multifactorial, tap water has been implicated as a significant causative factor. This retrospective review evaluates the effectiveness of a surgical dressing, the CD-1000, at protecting catheters and exit site wounds from fluid and debris when patients engage in high risk activities like showering. Methods All patients who received the CD-1000 from a single national medical supplier from September 2006 through to March 2007 were contacted to participate in this retrospective review; 209 patients, representing 34 states and 175 unique physicians, participated in this study. Effectiveness of the dressing along with prior and current history of catheter events was queried. Results The CD-1000 was 95% effective at keeping the catheter and exit site dry while patients engaged in high risk activities like showering. Prior to using the CD-1000, the 209 patients reported a historical catheter infection rate of 1.83 per 1000 catheter days. While using the CD-1000 the 209 patients reported a catheter infection rate of 0.47 per 1000 catheter days. Conclusion The CD-1000 catheter specific composite dressing adequately protects vascular catheters and exit sites when patients engage in high risk activities like showering. In this geographically diverse retrospective review, use of the CD-1000 was associated with a 75% reduction in catheter associated infections.
A Dedicated Vascular access Program can Improve Arteriovenous Fistula Rates without Increasing Catheters
Authors: Kiaii M. , MacRAE J.M. 
Published: March 2018

Purpose We describe the development and implementation of a comprehensive multidisciplinary vascular access (VA) program and describe its impact on VA distribution rates. Methods A retrospective review of all incident and prevalent patients in our hemodialysis (HD) unit was conducted in September 2001 to determine baseline data including: type of VA along with patient characteristics and comorbidities. Similar data was extracted from the database in 2005 for incident and prevalent patients. Results The VA program had a significant impact on arteriovenous fistulae (AVF) rates in both incident and prevalent HD patients: incident AVF rates increased from 14 to 39% (p=0.04) and prevalent AVF rates from 60 to 64% (p=0.015). Multivariate analysis revealed that male gender (OR 1.79 [CI 0.85–0.98, p=0.006]) and year of dialysis initiation 2005 vs. 2001 (OR 1.65 [CI 1.09–2.5, p=0.017]) were associated with AVF use among prevalent HD patients. Furthermore, age (per 5 years over 70) is associated with a decreased likelihood of having an AVF (OR 0.91 [CI 0.85–0.98, p=0.009]) whereas comorbidities of cardiovascular disease and diabetes had no impact. Conclusion We demonstrate that a structured VA program can increase the number of functioning fistulas without a corresponding increase in catheters in incident and prevalent HD patients.
Vein rupture by Arrow-Trerotola percutaneous thrombolytic device in a treatment of thrombosed arteriovenous graft
Authors: Hong Yong Kook , Kang Kyung Hoon , Kim Tae Hwan , Yang Hee Chul 
Published: March 2018

Introduction: We report a case of vein rupture by Arrow-Trerotola percutaneous thrombolytic device (Trerotola PTD) during a treatment of thrombosed arteriovenous graft (AVG). Case Description: A 77-year-old woman with a problem of thrombosed AVG underwent an endovascular treatment including a procedure of angioplasty of axillary vein. After angioplasty of axillary vein, we found a newly developed thrombus in axillary vein and performed thrombolysis using an over-the-wire 7F Trerotola PTD. When the rotating cage of the device arrived at axillary vein, it suddenly stopped, fixed at the angioplasty site, and didn’t move at all. Venogram showed an extravasation of contrast media at axillary vein, suggesting vein rupture. The patient underwent an emergency operation. Conclusions: It could be dangerous to use Trerotola PTD in a native vein immediately after angioplasty.
Ultrasound-guided internal jugular vein cannulation in the obese patient in a forced semi-sitting position
Authors: Kasatkin Anton A , Urakov Aleksandr L , Nigmatullina Anna R 
Published: March 2018

Introduction: Central venous cannulation may be difficult in morbidly obese patients. We present a case of successful right internal jugular vein catheterization under real-time ultrasound guidance in an obese patient in a forced semi-sitting position. Case report: A 43-year-old male patient with body mass of 182 kg (body mass index, 52.2 kg/m2) was admitted to the clinic 48 h after the trauma. The patient was in a forced semi-sitting position (37° head elevation). The patient was not able to perform the Valsalva maneuver. In the reported case, the lateral access for right internal jugular vein catheterization was chosen. We selected a lateral-oblique probe position for the ultrasound-guided internal jugular vein cannulation. Internal jugular vein catheterization was successful at the first attempt. Conclusion: Ultrasound imaging enables us to choose a desirable access for successful internal jugular vein cannulation in the obese patient without head-down tilt position. The lateral-oblique probe position for internal jugular vein cannulation may have advantages in certain clinical situations.
Prevalence of chronic kidney disease among patients undergoing transradial percutaneous coronary interventions
Authors: Hossain Mohammad A , Quinlan Amy , Heck-Kanellidis Jennifer , Calderon Dawn , Patel Tejas , Gandhi Bhavika , Patel Shrinil , Hetavi Mahida , Costanzo Eric J , Cosentino James , Patel Chirag , Dewan Asa , Kuo Yen-Hong , Salman Loay , Vachharajani Tushar J 
Published: March 2018

Background: While transradial approach to conduct percutaneous coronary interventions offers multiple advantages, the procedure can cause radial artery damage and occlusion. Because radial artery is the preferred site for the creation of an arteriovenous fistula to provide dialysis, patients with chronic kidney disease are particularly dependent on radial artery for their long-term survival. Methods: In this retrospective study, we investigated the prevalence of chronic kidney disease in patients undergoing coronary interventions via radial artery. Stage of chronic kidney disease was based on estimated glomerular filtration rate and National Kidney Foundation - Kidney Disease Outcomes Quality Initiative guidelines. Results: A total of 497 patients undergoing transradial percutaneous coronary interventions were included. Over 70.4% (350/497) of the patients had chronic kidney disease. Stage II chronic kidney disease was observed in 243 (69%) patients (estimated glomerular filtration rate = 76.0 ± 8.4 mL/min). Stage III was observed in 93 (27%) patients (estimated glomerular filtration rate = 49 ± 7.5 mL/min). Stage IV chronic kidney disease was observed in 5 (1%) patients (estimated glomerular filtration rate = 25.6 ± 4.3 mL/min) and Stage V chronic kidney disease was observed in 9 (3%) patients (estimated glomerular filtration rate = 9.3 ± 3.5 mL/min). Overall, 107 of 350 patients (30%) had advanced chronic kidney disease, that is, stage III–V chronic kidney disease. Importantly, 14 of the 107 (13%) patients had either stage IV or V chronic kidney disease. Conclusion: This study finds that nearly one-third of the patients undergoing transradial percutaneous coronary interventions have advanced chronic kidney disease. Because many of these patients may require dialysis, the use of radial artery to conduct percutaneous coronary interventions must be carefully considered in chronic kidney disease population.
Ultrasound-guided intravenous access in adults using SonoStik®, a novel encapsulated sterile guidewire: A prospective cohort trial
Authors: Boniface Keith S , LeSaux Maxine A , Mandoorah Sohaib , Patel Amit , Neander Kai L , Shokoohi Hamid 
Published: March 2018

Purpose: We evaluated the performance of an encapsulated guidewire designed for single-handed use with ultrasound-guided vascular access (SonoStik) with Seldinger technique, as compared with conventional intravenous catheters placed under ultrasound guidance in healthy subjects. Methods: This is a prospective cohort trial in healthy subjects in which each subject served as his/her own control by having a SonoStik ultrasound intravenous cannulation placed in one arm and a conventionally placed, standard ultrasound intravenous cannulation placed in the other arm. The basilic vein was used because it is a non-visible and non-palpable vein. Emergency department technicians with extensive experience in ultrasound-guided intravenous access performed the procedures. The first-attempt success rate of intravenous-guided intravenous by using the SonoStik was compared to the standard ultrasound intravenous cannulation in adult healthy subjects. The secondary outcomes including time of procedure, technicians’ and subjects’ satisfaction, and complications were compared in both arms of the study. Results: A total of 24 volunteers with a mean age of 22.7 years were enrolled. Four emergency department technicians with extensive prior experience with ultrasound-guided intravenous access but with no prior experience using the SonoStik device performed the procedures. The first-attempt success was 83.3% with the use of SonoStik ultrasound intravenous cannulation compared to 95.8% with the standard ultrasound intravenous cannulation. There was a mean of 1.14 insertions per each successful placement in the SonoStik group compared to 1.04 insertions by using the standard catheters (mean differences = –0.1; 95% confidence interval = –0.6 to 0.4). There were no complications in either SonoStik or the standard ultrasound intravenous cannulation group. The mean time of insertion using SonoStik was slightly longer compared to standard ultrasound intravenous cannulation (143.3 vs 109.7 s). Conclusion: This study demonstrated that emergency department technicians skilled in ultrasound-guided intravenous access could successfully place SonoStik 83.3% of the time in vessels that were unable to be palpated or visualized. Compared to standard ultrasound intravenous cannulation, the odds ratio of successful cannulation with SonoStik was 0.91 (95% confidence interval = 0.04–17.5). In all cases, the time required to successfully insert SonoStik was less than 4 min from tourniquet application to catheter advancement to hub, with a mean time of less than 2.5 min.
Reasons of unsuccessful implantation of short-term hemodialysis catheters in jugular veins using real-time ultrasound
Authors: Martins Marrocos Mauro Sergio , S Gentil Thais Marques , de C Lima Fernanda , R Laranja Sandra Maria 
Published: March 2018

Purpose: Real-time ultrasound is indicated for hemodialysis catheters’ insertion in internal jugular veins. We evaluated unsuccessful implantation of short-term hemodialysis catheters in internal jugular veins using real-time ultrasound between patients with and without previous short-term catheters. Methods: Observational open-label study of unsuccessful implantation of short-term hemodialysis catheters in internal jugular veins using real-time ultrasound from July 2013 to August 2014. Results: A total of 185 procedures were compared in 122 individuals; 120 (64.86%) had previously used short-term catheters. There were 5 (8%) unsuccessful implantation among 62 catheterizations without previous short-term catheter and 41 (33.6%) among 122 with previous short-term catheter (p = 0.001 Pearson’s chi-squared, odds ratio = 5.77, 95% confidence interval = 2.15–15.50, p = 0.001). Non-progressing guidewire occurred in 2 (3.2%) of 62 patients without previous short-term catheter and in 18 (14.8%) of 122 with previous short-term catheter (p = 0.018 Pearson’s chi-squared, odds ratio = 5.19, 95% confidence interval = 1.16–23.15, p = 0.031). No difference was observed between size of the veins with or without non-progressing guidewire. All 11 cases of venous thrombosis occurred in patients who had previous short-term catheter removed due to infection. Conclusion: Previous use of short-term catheter is pivotal in the occurrence of unsuccessful implantation of short-term catheter in internal jugular veins using real-time ultrasound.
Use of 8-cm 22G-long peripheral cannulas in pediatric patients
Authors: Pacilli Maurizio , Bradshaw Catherine J , Clarke Simon A 
Published: March 2018

Introduction: Medium-term intravenous access in children is normally achieved by means of repeated multiple peripheral intravenous cannula insertions or peripherally inserted central catheters. Long peripheral cannulas might offer an alternative to these devices in children. Our aim was to clarify whether long peripheral cannulas provide reliable medium-term intravenous access avoiding the need for multiple peripheral intravenous cannulations or peripherally inserted central catheter insertion in children undergoing surgery. Methods: Following ethical approval, we prospectively collected data in children requiring medium-term intravenous access. The 22G-8-cm-long peripheral cannulas were inserted with a Seldinger technique in a peripheral vein. Position was checked by flushing and aspirating the catheter. Results are reported as mean ± standard deviation. Results: A total of 18 children were included. Indications for medium-term intravenous therapy included perforated appendicitis (n = 14), infected central venous port (n = 2), fungal infection (n = 1) and septic arthritis (n = 1). In all, 15 (83%) patients underwent the procedure under general anaesthetic. The procedure failed in an 8-year-old patient. Insertion time was 8 ± 3.7 min. Age at insertion was 6.3 ± 4.9 years. Duration of intravenous therapy was 6.4 ± 5.1 days. About 13 (76%) patients completed the treatment with no complications. Three (17%) lines occluded by day 3 needed removal; one (7%) line needed removal on day 3 because of redness/pain noted around the insertion site. Conclusion: Long peripheral cannulas represent a valid option for medium-term intravenous access in children undergoing surgery. Majority of patients will be successfully treated with one long peripheral cannula for the duration of their treatment without the need for further cannulation.
Subclavian steal syndrome in a hemodialysis patient after percutaneous transluminal angioplasty of arteriovenous access
Authors: Kaneko Yoko , Yanagawa Takamoto , Taru Yoshinori , Hayashi Sonoko , Zhang Hong , Tsukahara Tomoki , Matsunaga Tsuneaki , Ishizu Takashi 
Published: March 2018

Introduction: We describe a hemodialysis patient who developed subclavian steal syndrome via an arteriovenous fistula after percutaneous transluminal angioplasty. Case description: A 55-year-old female with end-stage renal failure due to polycystic kidney disease had been treated with hemodialysis for 10 years. Because of an autologous arteriovenous fistula stenosis, percutaneous transluminal angioplasty was performed. After successful treatment with percutaneous transluminal angioplasty, the patient developed dizziness. Magnetic resonance imaging with angiography of the brain and neck revealed normal bilateral subclavian and carotid arteries. However, flow in the left vertebral artery was not detected in time-of-flight magnetic resonance angiography. The left vertebral artery showed completely reversed blood flow as detected by color duplex ultrasound. We also confirmed anterograde flow in the left vertebral artery by color duplex ultrasound with arteriovenous fistula compression. Arteriovenous flows before the arteriovenous fistula stenosis and post-percutaneous transluminal angioplasty were 1146 and 2239 mL/min, respectively. These findings suggested high-flow arteriovenous fistula led to the subclavian steal syndrome. The patient was subsequently treated by a flow reduction in the high-flow arteriovenous access using a modified graft inclusion technique. We decreased the arteriovenous fistula flow to 851 mL/min, which remained under 850 mL/min, 1 year later. The brain natriuretic peptide level and right-ventricular pressure also decreased after treatment. A modified graft inclusion technique was successful in decreasing the high flow of the arteriovenous fistula, and improved subclavian steal syndrome symptom and cardiac overload. Conclusion: This case shows that percutaneous transluminal angioplasty for an arteriovenous fistula may induce subclavian steal syndrome, and a modified graft inclusion technique was useful in improving the high flow of an arteriovenous fistula.