bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vacuum Loading of the Femoral Cement Gun: The Effect on Mantle Porosity
Authors: Kenny P. , Rice J. , McCormack B. , O'Rourke S.K. 
Published: March 2018

The femoral cement mantle was reproduced in a laboratory model. This model consisted of rigid plastic tubing, 10 cm long, with an internal diameter of 2.5 cm. One end of the tube was sealed to simulate an intramedullary plug. A wooden model was used to simulate the femoral component of a total hip arthroplasty. Bone cement was mixed in a glass bowl with a steel spatula in a standardised manner for two minutes. In all cases the model femur was filled with bone cement and a regular mantle around the wooden “femoral stem” was observed. Pores were present on the cut surface of all of the specimens. The pore density (No. of pores per unit area) was measured using an NIH image programme and was found to be dramatically reduced in the experimental cement mantles, when compared to the control specimens. The porosity in the cement mantles produced by vacuum loading the gun was significantly lower (p< 0.001) than that in the mantles produced by the manually loaded guns.
A Prospective, Randomized Trial Comparing a Transparent Dressing and a Dry Gauze on the Exit Site of Long Term Central Venous Catheters of Hemodialysis Patients
Authors: Le Corre I. , Delorme M. , Cournoyer S. 
Published: March 2018

The objective of this study was to assess the risk of bacteremia, estimate the cost and evaluate the quality of life by using a transparent dressing (TD) versus (vs) a dry gauze (DG) on the exit site of long term central I.V. catheters (LTCC) of hemodialysis patients. This 6-months preliminary study was conducted on 58 patients (pts) randomized to receive DG replaced 3 times/week (29 pts) or TD replaced every 7 days (29 pts). Data on patients, conditions of the exit site, local infection, bacteremia, quality of life and cost related to each type of dressing were collected. Two pts in the DG group experienced bacteremia related to their LTCC vs 1 pt in the group TD. A total of 7 (DG) vs 13 (TD) pts experienced skin condition changes at the catheter exit site. Some skin reactions, erythema and pruritus, did occur initially in the group TD and was due in part to insufficient drying time of the skin preparation solution. The estimated individual, weekly costs for using the DG was $7.60 vs $4.72 Canadian dollars for the TD. The SF-36™ scores did not show a significant difference between the 2 groups during the study (3.8 (PCS), 6.4 (MCS) at study end). Although this study was statistically underpowered, it suggests that the incidence of bacteremia was not increased with the use of a TD. Moreover, the use of a TD allowed fewer dressing changes, lowered total treatment costs, with no observed unfavorable impact on the quality of life and without significant local complications of the exit site. Based on the positive results observed in this pilot study, further study is warranted to examine the cost effectiveness of long-term use of TD dressings on dialysis catheter exit sites.
Evaluating the Impact of an Aggressive Strategy to Create Wrist Arterio-Venous Fistula in Patients on Hemodialysis
Authors: Barama A.A. 
Published: March 2018

Objectives To compare two approaches to hemodialysis arterio-venous fistula (AVF) creation, and to evaluate the benefit of expanding wrist-AVF selection criteria. Background The recommendation summarized under the Dialysis Outcome and Quality Initiative (DOQI) suggests the placement of a wrist-AVF as a first choice for patients starting hemodialysis. However, its benign complications contrast with its high early failure rates. In the absence of predictors of a successful access, decision on whether or not to attempt such an access depends on the subjective clinical judgment. Methods This is a retrospective study of patients with ESRD disease in Southern Alberta who underwent a vascular access creation during the year 2000. The surgery was performed by 2 surgeons each having his own approach to access selection (approach A and B). Approach A had broader criteria (vessels < 3 mm) for wrist-AVF creation, whereas approach B was more conservative, thus limiting the selection to patients with wrist vessels superior to 3 mm. The type of simultaneous access created in the same limb was dependant of this first choice. A Markov decision tree analysis was used to model yearly transition between patent and failed access. The absence of further possibility of access creation in the same arm was taken as a time horizon. Sensitivity analysis was used to test the effect of maximizing a wrist-AVF on overall arm failure. Results In approach A there was 69% of wrist AVF creation as the first type of access compared to 31% in approach B. A two-year wrist-AVF patency was 80% in approach B versus 61% in approach A. The expected mean time to complete limb failure was longer in patients treated with approach A (3.62 versus 3.50 years). Sensitivity analysis showed an ultimate benefit for approach A. Conclusion Wrist vessel size less than 3 mm should not be a limiting factor for the creation of a wrist-AVF. Maximizing the creation of such an access, despite increasing the rate of early failure, prolongs the option of hemodialysis access in the same arm.
Serum LDL Levels are a Major Prognostic Factor for Arteriovenous Fistula Thrombosis (AVFT) in Hemodialysis Patients
Authors: Serati A.R. , Roozbeh J. , Sagheb M.M. 
Published: March 2018

Introduction Arteriovenous fistula thrombosis (AVFT) is still a common cause of morbidity in patients undergoing regular hemodialysis (HD). Many factors have been found to induce AVFT. Some of those factors are local and others are systemic ones. In this study, we evaluated some local and systemic factors simultaneously, to predict the most potent risk factor for AVFT in HD patients. Patients and methods One hundred and eighteen patients aged 20–80 yrs with end-stage renal disease (ESRD) were evaluated prospectively for a period of 14 months. First, anticardiolipin antibodies (ACLA), TG, cholesterol, low density lipoprotein (LDL) and high density lipoprotein (HDL) were analyzed by conventional methods. Other basic data were accessed from patients' medical records. All fistulas were evaluated clinically as patent at the start of this study. Patients were followed-up for any evidence of AVFT within 14 months. Finally, all factors (diabetes, hypertension, presence of ACLA, ultrafiltration ≥3 L, age, gender, weight, hypotension during dialysis, fistula site, epoetin alpha usage, TG, HDL, LDL and total cholesterol) were analyzed in a stepwise regression analysis. Results Eighteen episodes of AVFT documented with Doppler sonography occurred in 17 patients (15.3%). Regression analysis showed only LDL values were the AVFT predictor in our patients (p=0.002, β-coefficient=0.3). Kaplan-Meier analysis showed a significantly lower AVF patency time in patients with LDL >130 mg/dl than those with LDL <130 mg/dl (log rank=0.0014). Discussion LDL value is a major prognostic factor for AVFT in HD patients and lowering it to <130 mg/dl could improve fistula patency.
Venae Comitantes Fistulae: An Option in Patients with Difficult Hemodialysis Access
Authors: Srinivasaiah N. , Yalamuri R.R , Umez-Eronini N.O. , Rix D. , Talbot D. 
Published: March 2018

Objectives To evaluate the outcome of use of venae comitantes vessels in the formation of arterio-venous fistulae as vascular access for hemodialysis, in patients with limited venous anatomy. Methods Twenty patients who underwent arterio-venous anastomosis between brachial artery and venae comitantes were identified (2002 – 2005) and the notes reviewed. Results There was early failure in two (10%) patients (immediate postoperative period) and a further four (20%) failed late (mean 26 weeks, range 7–60). One patient developed a steal syndrome with radial nerve dysfunction requiring ligation of the fistula. Six (30%) patients utilised their fistulae for dialysis successfully without additional surgery and a further 6(30%) required surgical intervention to exteriorise the fistulae by the use of interposition grafts to allow successful use. Conclusion Venae Comitantes arterial fistulae offer an option in patients with limited venous anatomy for standard reconstruction. If access surgery utilizes such veins second stage procedures are often required with overall 70% use.
Stenosis at the area of Transposition – An Under-Recognized Complication of Transposed Brachiobasilic Fistulas
Authors: Beaulieu M.C. , Gabana C. , Rose C. , Macdonald P.S. , Clement J. , Kiaii M. 
Published: March 2018

Background With an increased focus on native AV fistula creation in hemodialysis patients, a transposed brachiobasilic fistula (tBBF) is becoming an increasingly utilized option. This study describes the outcomes of tBBFs in a chronic hemodialysis population. In particular, we focus on the incidence and location of stenosis, and review the impact of angioplasty on these lesions. Methods A retrospective cohort study using all patients with a tBBF created between January 2001 and December 2004. Results Of the 543 fistulas created during the study period, 93 were tBBFs. The mean age of patients was 65 years, 56% were male and 55% were diabetic. Stenosis occurred in 54% (46/85) of fistulas; the location of stenosis in the majority (74%) was at or near the area of basilic vein transposition and 50% of fistulas with stenosis in this location required three or more angioplasties. Primary (unassisted) patency was 42% at one year in this cohort. Secondary patency was 68% at 1 year and 58% and 53% at 2 and 3 years respectively. Conclusion In a cohort of hemodialysis patients who received a tBBF, we describe a reasonable primary and secondary patency rate and a high rate of stenosis at the point of transposition of the basilic vein. Such stenosis usually requires multiple percutaneous or surgical interventions to ensure or reestablish conduit patency. Further study is required regarding the optimal surgical technique, monitoring, and treatment of stenosis of this fistula type including the utility of repeat angioplasty.
Accessory Veins and Radial-Cephalic Arteriovenous Fistula Non-Maturation: A Prospective Analysis Using Contrast-Enhanced Magnetic Resonance Angiography
Authors: Planken R.N. , Duijm L.E. , Kessels A.G. , Leiner T. , Kooman J.P. , Van Der Sande F.M. , Tordoir J.H.M. 
Published: March 2018

Purpose To determine if large caliber accessory veins are associated with radial-cephalic arteriovenous fistula (RC-AVF) non-maturation. Methods RC-AVFs were created in 15 consecutive patients (radial artery and cephalic vein diameter >2 mm, in the absence of arterial inflow or venous outflow stenoses or occlusions). Contrast-enhanced magnetic resonance angiography (CE-MRA) was performed preoperatively for the determination of vessel diameters, stenoses and occlusions. The location and caliber of accessory veins was determined. Vascular access (VA) function was monitored and all interventions required to obtain a functioning VA were recorded. Non-maturation was defined as a nonfunctional VA at 2 months after creation. The predictive value of accessory vein caliber for prediction of RC-AVF non-maturation was evaluated using receiver operating characteristic (ROC) analysis. Results Non-maturation occurred in 10 (67%) out of 15 RC-AVFs. Large caliber accessory veins (n=4), venous stenosis (n=3) or both (n=2) were associated with RC-AVF non-maturation. The presence of large caliber accessory veins was the only significant predictor for RC-AVF non-maturation (p=0.01). Preoperatively detected accessory veins with a diameter >70% of the cephalic vein diameter, had a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 80, 100, 100 and 91% for prediction of RC-AVF non-maturation on patient level. Accessory vein ligation and dilatation of venous stenosis resulted in an overall salvage success rate of 89% (8/9). Conclusion Large caliber accessory veins are associated with RC-AVF non-maturation. Ligation of large caliber accessory veins is a successful salvage procedure in a substantial group of patients. Furthermore, ligation of these accessory veins during initial RC-AVF creation can potentially reduce non-maturation rates; and therefore, preoperative assessment of accessory veins is recommended.
Measurement of Hemodynamic and Anatomic Parameters in a Swine Arteriovenous Fistula Model
Authors: Krishnamoorthy M. , Roy-Chaudhury P. , Wang Y. , Roy A. Sinha , Zhang J. , Khoury S. , Munda R. , Banerjee R. 
Published: March 2018

Purpose Although arteriovenous fistulae (AVFs) are currently the preferred mode of permanent hemodialysis access they do have significant problems due to initial non-maturation and a later venous stenosis. These problems appear to have been exacerbated following a push to increase AVF prevalence in the US. The reasons for both AVF non-maturation and the later venous stenoses are unclear but are thought to be related to abnormal hemodynamic wall shear stress (WSS) profiles. This technical note aims to describe the successful development of measurement techniques that can be used to establish a complete hemodynamic profile in a pig model with two different configurations of AVF. Methods and results The curved and straight AVF configurations were created in an in vivo pig model. Flow and pressure in the AVFs were measured using the perivascular flow probes and Doppler flow wires while the pressure was recorded using a pressure transducer. The anatomical configuration was obtained using two different approaches: a) combination of intravascular ultrasound (IVUS) and angiograms, (b) 64 slice CT angiography. 3D models were reconstructed using image processing and computer modeling techniques. Numerical calculations were then performed by applying the measured flow and pressure data into the configurations to obtain the hemodynamic WSS profiles. Conclusion The described methodologies will allow the calculation and optimization of WSS profiles in animal models. This information could then be translated to the clinical setting where it would have a positive impact on improving the early maturation rates of AVFs as well as reducing the late venous stenoses.
Brachial Vein Transposition Arteriovenous Fistula: Is it an Acceptable Option for Chronic Dialysis Vascular Access?
Authors: Torina P.J. , Westheimer E.F. , Schanzer H.R. 
Published: March 2018

Purpose The aim of this study was to evaluate the midterm performance of brachial vein arteriovenous fistulas (AVFs) and to compare this performance with arteriovenous grafts (AVGs) and basilic vein transposition AVFs. Methods A retrospective analysis was performed. Between December 2002 and October 2006, 149 AV access procedures consisting of brachial vein transposition AVFs (11 one-stage and 2 two-stage procedures), basilic vein transposition AVFs (n=42), and AVGs (n=94) were performed in 141 patients. Results 73% of one-stage brachial vein AVF patients experienced at least one complication during follow-up vs. 52% of the basilic vein transposition AVF group and 55% of the AVG group. The primary patency rates at 12 months for one-stage brachial vein AVFs, basilic vein AVFs, and AVGs were 24, 45 and 50%, respectively. The assisted primary patency rates were 45, 74 and 63%, and the secondary patency rates were 45, 74 and 78%, respectively. A significant difference in the overall secondary patency rates between one-stage brachial vein AVF and AVGs (p=0.015) was detected. Significance was approached between one-stage brachial vein AVFs and basilic vein AVFs overall assisted primary patency (p=0.055) and secondary patency (p=0.055) rates. Conclusion The brachial vein transposition, when done as a one-stage procedure, is associated with inferior patency rates when compared to the basilic vein transposition AVF and AVG. Therefore, in the setting of inadequate cephalic and basilic vein, a prosthetic graft is superior to a brachial vein transposition. A two-stage procedure, as suggested by others, may improve the results of this technique.
Transposed Brachiobasilic Fistula or PTFE Arm Graft - Alternative or Complementary?
Authors: Milburn J.A. , Lo S.T. , Szucs Z.J. , Humphrey A. , Macaulay E.M. 
Published: March 2018

Purpose Our primary aims were (1) to examine the patency of transposed brachiobasilic (TBB) fistulae compared to arm arteriovenous graft (AVG) without prior transposition, and (2) to examine the patency of AVG with and without prior transposition. Methods Single institution; analysis of prospectively collected data between January 2001 and January 2007. Dedicated database and medical records were reviewed and results analyzed with SPSS. Results Ninety-one patients underwent 111 procedures (52 TBB: 39 AVG as index); 28 TBB failed with 17 (60%) being replaced with an ipsilateral AVG. TBB compared to AVG (without prior TBB) had significantly (log rank <0.05) better primary, primary assisted and secondary patency. Secondary patency at 2 yrs was 47% to 33%, respectively. Ipsilateral AVG after TBB to primary AVG had superior patency rates (secondary patency at 2 yrs 52 vs. 33%) but did not reach significance (log rank =0.073). Combined secondary patency of TBB and AVG after TBB was 81% at 2 yrs. Conclusions The TBB offers an autogenous fistula in the upper arm which has superior patency rates to an arm AVG. Once a TBB has failed an ipsilateral AVG is technically feasible and may offer better patency than a primary AVG.
Predicting Arteriovenous Fistula Maturation with Intraoperative Blood Flow Measurements
Authors: Berman S.S. , Mendoza B. , Westerband A. , Quick R.C. 
Published: March 2018

Objective To establish the criteria for intraoperative blood flow measurements taken at the time of autologous arteriovenous fistula (AVF) construction to predict future access maturation and thereby avoid waiting periods for futile fistulas to declare themselves. Methods From April 2006 through to March 2007 consecutive patients undergoing native AVF construction at one institution underwent intraoperative measurements of blood flow using transit-time ultrasound technology. No action was taken based upon the flow measurement at the time of surgery. Patients were followed and data collected comprising demographics and AVF maturation. A fistula was considered mature when it was successfully accessed for hemodialysis (HD) at least three times. Statistical analysis was performed including receiver operating characteristics (ROC), ANOVA, and Chi square using the JMP software package. Results During the 12-month period, 70 autologous AVFs were created including 41 antecubital brachiocephalic, 21 radiocephalic, and 8 basilic vein transpositions in 35 females and 33 males with a mean age of 58 ± 1.7 (mean ± SEM). The group included 37 Hispanic, 17 Native American, 10 Caucasian, 3 African American and 1 Asian patient. The etiology of renal failure comprised 53 diabetics, 13 hypertensives, 1 polycystic kidney disease and 1 congenital abnormality. Complete follow-up was available in 69/70 AVFs in 67 patients. Patients were excluded from analysis if they had not yet started dialysis (n=12), stopped or died (n=4) before their fistula was accessed. Patients whose AVFs were patent, but required a secondary procedure to achieve a functional access were considered non-functional. There was a significant difference between the maximal intraoperative flow rates between functional and non-functional AVFs (573.6 ± 103 mL/min vs. 216.8 ± 35.8 mL/min; p<0.05). There was no difference between groups in regard to age, gender, race or etiology of renal failure. ROC analysis suggested a threshold value of 140 mL/min for radiocephalic and 308 mL/min for brachiocephalic AVFs to predict maturation to a functional access. Conclusion Intraoperative blood flow measurements obtained at the time of autologous AVF construction can identify fistulas that are unlikely to mature; and therefore, that require immediate revision or abandonment which will ultimately expedite the establishment of a useful access in the HD patient. This is the first study to establish the minimal flow values uniquely needed for both radial artery and brachial artery AVFs to expect primary maturation to a functional access.
Cross-Over Endovascular Retrieval of a Lost Guide Wire from the Subclavian Vein
Authors: Struck M.F. , Kaden I. , Heiser A. , Steen M. 
Published: March 2018

Background The lost guidewire in central venous catheterization is a commonly described complication. The percutaneous endovascular retrieval method is safe and has a very low complication rate. Objectives Guidewires extending to the inferior cava vein are usually retrieved via the femoral vein. Under special circumstances, femoral venous access may be impossible and alternative vascular approaches are required. Case report We report a case in which we used an alternative vascular approach, from the subclavian site contralateral to the insertion, in a patient with extensive inguinal burn injuries. Conclusions Cross-over subclavian retrieval can be an alternative approach for retrieval of a lost guidewire, but it involves an increased risk of puncture-related complications such as pneumothorax.
Exchange over the guidewire from non-tunneled to tunneled hemodialysis catheters can be performed without patency loss
Authors: Park Hoon Suk , Choi Joonsung , Kim Hyung Wook , Baik Jun Hyun , Park Cheol Whee , Kim Young Ok , Yang Chul Woo , Jin Dong Chan 
Published: March 2018

Purpose: The exchange from a non-tunneled hemodialysis catheter to a tunneled one over a guidewire using a previous venotomy has been reported to be safe. However, some concerns that it may increase infection risk prevent its clinical application. This approach seems particularly useful for acute kidney injury patients requiring initial renal replacement therapy, in whom we frequently worry about the choice of non-tunneled versus tunneled catheters. Materials and methods: From March 2012 to February 2016, 88 cases to receive the over-the-guidewire exchange method from a non-tunneled to a tunneled catheter and 521 cases to receive de novo tunneled catheter placement from the hemodialysis vascular access cohort were compared retrospectively. Results: The immediate complication, later catheter dysfunction requiring replacement, and infection rates were comparable between the two groups. Newly placed tunneled catheter survival in the over-the-guidewire exchange group was comparable with survival in the de novo tunneled catheter group (p = 0.24). In addition, when we compared the same two methods among only intensive care unit patients; they remained similar (p = 0.19). Conclusion: An exchange with the over-the-guidewire method from a non-tunneled to a tunneled catheter was comparable to a de novo catheter placement technique. Therefore, this method should be viewed more favorably and should especially be considered for acute kidney injury patients.