bluuebunny/crossref_metadata_2025_split huggingface dataset:
Carotid Artery Approach as an Alternative to Femoral access for Balloon Dilation of Aortic Valve Stenosis in Neonates and Infants
Authors: Gasparella M. , Milanesi O. , Biffanti R. , Cerruti A. , Sabatti M. , Gamba P.G. , Zanon G.F. 
Published: March 2018

Purpose to evaluate the efficacy of a right common carotid artery cutdown as alternative access in neonates and small infants requiring a balloon dilation of aortic valve stenosis. In infants, the femoral approach is limited by difficulties in advancing the catheter across the valve and by the risk of femoral artery injuries. Methods from January 1997 to July 2000, 16 infants at our department underwent balloon dilation through a carotid artery cutdown. Infant weight ranged from 2670 to 6450 g; mean weight 3967 g, and age ranged from 1 to 157 days, mean age 42,8 days. Fifteen of 16 infants had aortic valve stenosis; the remaining infant presented with a aortic coartation relapse. Results In 15 infants an adequate dilation of the valve was obtained with no complications. In only one infant an arterial intimal disconnection was caused by inadequate choice of surgical instruments. At the end of the procedure, the carotid arteries were reconstructed with interrupted 7-0 prolene stitches. There were no neurological sequaelae observed. All infants were followed-up and examined by echocolordoppler ultrasound: all carotid arteries were open with no significant stenosis. Conclusion Our experience confirms that the carotid access proposed in 1973 by Azzolina et al is a valid and safe alternative to the usual percutaneous femoral access. In particular it could be useful in neonates and infants were the size of femoral vessels could facilitate important and dangerous complications.
Polytetrafluoroethylene and Bovine Mesenterial Vein Grafts for Hemodialysis Access: A Comparative Study
Authors: Tahami V.B. , Hakki H. , Reber P.U. , Widmer M.K. , Kniemeyer H.W. 
Published: March 2018

Purpose This study aimed to evaluate the safety and patency rate of bovine mesenterial vein grafts (BMVG) for vascular access (VA) in hemodialysis patients (HDP), compared to expanded polytetrafluorethylene (ePTFE grafts) over a mid- to long-term period. Methods Patency and complication rate of 23 consecutive HDP with BMVG for VA were compared to a control group consisting of 23 similar HDP with ePTFE grafts. In both groups, the graft was placed preferably in a forearm loop configuration. The same surgeon performed all procedures. All patients were followed over a period of 4 yrs. Results Graft placement was successful in all patients. Patency rates did not differ significantly in both groups. However, there were less severe complications in the BMVG group. Conclusion The BMVG is a viable alternative for HD access in patients where autologous construction is not possible, and should be given priority in patients with a failed ePTFE graft or high risk for infection.
Efficacy of ProLumen in Percutaneous Thrombectomy of Clotted Dialysis Access: A Single-Center Prospective Study
Authors: Ahmad I. 
Published: March 2018

Purpose To prospectively evaluate the efficacy of the ProLumen thrombectomy device for declot of dialysis access. Methods 16 women and 4 men suffering from end-stage renal disease (ESRD) dependent on hemodialysis (mean age, 66.4 years) and presenting with thrombosed dialysis access were enrolled form October 2005 through February 2006. Sixteen patients had synthetic grafts and 4 had native fistulas. Mean age of access was 24.65 months (range, 2 to 96 months). A history of previous intervention was noted for seven patients (6 percutaneous, 1 surgical). Results A mean of 2.7 passes of the ProLumen device were required for the venous limb (range, 1 to 6) and 2.35 passes for the arterial limb (range, 0 to 5). Average procedure time was 48 minutes (range 32–81 minutes). Adjunctive thrombectomy devices were utilized in 5 cases. Good angiographic and clinical results were reported in 19 patients; one patient had a poor result. Dialysis flow rate prior to thrombosis was 425 mL/min (range, 300 to 550). The mean post-thrombectomy flow rate was 380 mL/min (range, 200 to 480; n=19). “Ease of use” of Pro Lumen thrombectomy device was rated good in 17 patients. Maneuverability was good in 14 patients and clot removal around the opposite sheath was rated as good in 18 patients. Conclusions ProLumen is effective in thrombectomy of dialysis access. The device is easy to use, and effectively removes clot around the opposite sheath.
Fistula Size and Hemodynamics: An Experimental Model in Canine Femoral Arteriovenous Fistulas
Authors: Ramacciotti E. , Galego S.J. , Gomes M. , Goldenberg S. , Gomes P. De Oliveira , Ortiz J. Pinto 
Published: March 2018

Purpose The objective was to evaluate the impact of anastomosis diameter on blood flow in an arteriovenous fistula (AVF), comparing two different anastomosis sizes with a modified side-to-side technique in canine femoral arteries. Methods Ten mongrel dogs were subjected to two AVFs each, both using a modified side-to-side technique. On one side, the anastomosis diameter was 1.5 times the arterial diameter and on the other side 3.0 times the arterial diameter. Mean proximal and caudal blood flow and mean venous flow were measured using an electronic flowmeter 15, 20 and 25 min after surgery. The Mann-Whitney, Friedman and Wilcoxon non-parametric tests were used for data analysis (α ≤ 0.05). Results Femoral artery flow cranial to the fistula became 5.6 times greater in the 1.5 arterial diameter group, and 8.4 times greater in the 3.0 arterial diameter group, when compared to initial arterial flow. The mean flow in the cranial vein was greater in the 3.0 group (10.09 times greater vs. 6.46 times greater in the 1.5 group). Both in the proximal artery and in the vein there was a significantly greater flow in the group with the larger anastomosis diameter (Wilcoxon test). In the femoral artery caudal to the fistula, the flow in most of the animals was reversed: 3.5 times greater in the 1.5 group and 1.2 times greater in the 3.0 group, without statistical difference. Conclusions These results suggest that 3.0 times the arterial diameter for the AVF size in dogs leads to greater venous flow than with 1.5 times the arterial diameter, without increasing the reversed flow.
Hemodialysis Access without a Shunt or a Catheter: The Circulating Port
Authors: Richard T. 
Published: March 2018

Purpose To develop a new type of vascular access (VA) avoiding permanent arteriovenous (AV) shunting and intravenous catheter placement using a silicone plug inserted in the vessel wall. Method Four different animal studies were conducted to verify the biologic safety of the concept, to check resistance to infection and accessibility and midterm patency. Results The circulating ports were found to be very easy to puncture, extremely resistant to infection and their midterm patency rate was acceptable. Conclusions The circulating port seems to be a very promising hemodialysis (HD) access method, but it still has to be tested in clinical situations.
Risk of Vascular access Thrombosis in Patients with Systemic Lupus Erythematosus on Hemodialysis
Authors: Shafi S.T. , Gupta M. 
Published: March 2018

Introduction Anticardiolipin antibody is associated with increased risk of vascular access thrombosis (VAT) in hemodialysis (HD) patients. Systemic lupus erythematous (SLE) patients have a high prevalence of anticardiolipin antibodies, but it is not clear whether these patients are at high risk of developing vascular access thrombosis. Methods Thirty six SLE patients on HD, who had either an arterio-venous (AV) graft or AV fistula as vascular access, and were not on anticoagulation treatment, were retrospectively identified at Henry Ford Hospital. A similar number of patients without SLE, matched for age, sex, race and type of vascular access were selected as a control population. Vascular access thrombosis rate at one year was compared between two groups. Results Mean age at dialysis was 36±10 years in 36 SLE patients (28 females, 8 males) and was 38±6.4 years in 36 non-SLE patients (29 females, 7 males). Of all patients, 29/36 (80.5%) SLE and 27/36 (75%) non-SLE patients had AV grafts, whereas the rest had AV fistulas as vascular access (19.5% SLE and 25% non-SLE patients). Out of 36 SLE patients, 24 (66.6%) patients developed VAT at one year as compared to 14 (38.9%) patients in non-SLE group (p<0.05). The odds ratio of VAT in SLE patients was 3.1 (95% CI 1.2–8.2). Conclusion SLE patients on hemodialysis are more likely to develop vascular access thrombosis as compared to non-SLE patients.
Primary Thromboprophylaxis with Heparins for Arteriovenous Fistula Failure in Pediatric Patients
Authors: Sharathkumar A. , Hirschl R. , Pipe S. , Crandell C. , Adams B. , Lin J.J. 
Published: March 2018

Background To reduce the incidence of early arteriovenous fistula failure (AVF) due to thrombosis in pediatric hemodialysis (HD) patients, a primary thromboprophylaxis (PTP) protocol was initiated at author's institution in June 2005. The goal of this study is to report author's experience with this protocol one year later. Methods and Results 19 AVFs (14 patients, Historical group) and 8 AVFs (7 patients, PTP group) were created prior to and after initiation of PTP respectively. PTP consisted of unfractionated heparin (5–10 units/kg/hr) infusion postoperatively, followed by subcutaneous low molecular weigh heparin (LMWH) until AVF was matured. LMWH dosing was “Prophylactic” (0.5 mg/kg/d, anti-factor Xa levels: peak 0.25–0.5 and trough < 0.3 units/mL) and “Therapeutic” (1 mg/kg/d, anti-factor Xa level: peak 0.5-1 and trough < 0.5 units/mL) based on thrombosis predisposition. In Historical group, 12 AVFs did not receive thromboprophylaxis (No-treatment group), 5 received 81 mg aspirin/day (Aspirin group), and 2 received LMWH. In No-treatment group 10/12 AVFs failed: 9 thromboses and 1 stenosis. In Aspirin group 1/5 AVFs failed due to thrombosis. In PTP group 1/8 AVFs failed due to stenosis; the first 2 AVFs developed hematoma prompting a reduction in LMWH dose and monitoring trough anti-factor Xa levels, one AVF required thrombectomy after LMWH was transiently held. The incidence of thrombosis was less in PTP group (12.5%) when comparing to No-treatment group (83%) (p < 0.05). Conclusion PTP is a feasible option to prevent early thrombosis at AVF. Close clinical and laboratory monitoring including trough anti-factor Xa levels is required to adjust optimum anticoagulation. Larger studies are needed to clarify safety and efficacy of our PTP protocol.
High Blood flow Rates with Adjustment of Needle Diameter do not Increase Hemolysis during Hemodialysis Treatment
Authors: Techert F. , Techert S. , Woo L. , Beck W. , Lebsanft H. , Wizemann V. 
Published: March 2018

Background Higher blood flow in dialysis therapy is often avoided due to concerns about shear-induced blood damage despite the lack of reliable data. Objective This study investigated the influence of higher blood flow rates on plasma free hemoglobin (Hb) concentration after hemodialysis (HD) treatment. Methods Thirty-two chronic HD patients were treated once with a blood flow rate of 250 mL/min using a 17G needle, and once with a blood flow rate of 500 mL/min using a 14G needle. Arterial and venous pressure and blood pressure (BP) were recorded before and after treatment. Blood samples were taken before and after treatment for analysis of plasma free Hb, pH, HCO3, base excess, hematocrit value, urea, sodium, potassium and calcium. Results HD treatment at blood flow rates of 500 mL/min did not increase plasma free Hb compared to treatments at blood flow rates of 250 mL/min. Frequency of intradialytic BP drops was not different either. By adaptation of the needle size, negative arterial pressure could be kept at a similar level. Urea reduction rates were significantly higher during treatments with higher blood flow rates. Conclusion Higher blood flow rates can be applied without an increased hemolysis risk provided that needle sizes are adapted accordingly.
Functional Patency of Autogenous AV Fistulas for Hemodialysis
Authors: Nguyen T.H. , Bui T.D. , Gordon I.L. , Wilson S.E. 
Published: March 2018

Background Although AV fistulas are the preferred access for hemodialysis and have low complication rates, failure to function remains high and time to first dialysis may be several months. Methods Data from a Computerized Patient Record System of patients undergoing AV fistula from October 2000 to March 2006 were reviewed for type of fistula, interval from AV fistula construction to first hemodialysis, patency period, and complication rate. Results 129 patients were identified who underwent 155 autogenous AV fistula constructions. The average age was 62.1 (range 40–84) years old. 114 radiocephalic and 41 brachiocephalic fistulas were performed. 57 (50%) radiocephalic fistulas allowed successful hemodialysis after an average length of 13±5 weeks with a primary patency of 13±4 months. 24 (42%) fistulas subsequently thrombosed, 7 (12%) developed fistula stenosis, and 2 (4%) developed steal syndrome. 28 (68%) brachiocephalic fistulas reached successful hemodialysis after 6±2 weeks with a primary patency of 16±7 months. Eleven (42%) of the brachiocephalic fistulas that reached hemodialysis remained patent while four (15%) thrombosed. Two (8%) brachiocephalic fistulas thrombosed before reaching hemodialysis. There were two incidences (5%) of steal syndrome in the brachiocephalic group with one case being severe leading to tissue loss in the hand. Conclusion Brachiocephalic fistulas were superior to radiocephalic in both time to maturity, primary patency, and functional primary patency. Brachiocephalic fistulas had a higher maturation rate and were less likely to fail once hemodialysis began. Vascular surgeons should develop better patient selection to predict which fistulas will function successfully rather than risk complications of prolonged central catheters.
Effect of Upper arm Brachial Basilic and Prosthetic Forearm Arteriovenous Fistula on Left Ventricular Hypertrophy
Authors: Keuter X.H.A. , Kooman J.P. , Habets J. , Van Der Sande F.M. , Kessels A.G.H. , Cheriex E.C. , Tordoir J.H.M. 
Published: March 2018

Background Creation of an arteriovenous fistula (AVF) may increase left ventricular hypertrophy in the hemodialysis population. Aim of this study was to compare the effects of a brachial-basilic (BB) AVF and the prosthetic brachial-antecubital forearm loop access (PTFE) on cardiac performance. Methods Patients were randomized to receive BB-AVF or prosthetic brachial-antecubital forearm loop access. Before and three months after AVF creation patients underwent an echocardiographic examination. Mann-Whitney U-test was used to compare relative increase between the measured cardiac parameters for the two groups. Results Twenty-seven patients participated in the study. The relative increase in left ventricular parameters was not significantly different between the two groups. Only left ventricular end-diastolic diameter tended to be of significance. Mean blood flow through the brachial artery was 1680±156 and 1450±221 mL/min three months after surgery for the PTFE and the BB-AVF group, respectively. Conclusion After three months of follow-up, changes in cardiac structure were comparable between patients with BB and PTFE AVFs. Also access flow was comparable at this time. In general, the effects of creation of a fistula on LV structure were limited. Longer follow up time may be needed to explore the long term effects of different vascular accesses on cardiac function.
Pitfall in Pediatric Dialysis: Malposition of a Dialysis Catheter Mimicking Azygos Continuation Syndrome
Authors: Demant A.W. , Rattunde H. , Abderhalden S. , Von Vigier R. , Wolf R.W. 
Published: March 2018

Central venous catheters are established as vascular access in hemodialysis therapy. Vascular catheter misdirection may occur and is a well known problem. We present a rare catheter malposition in a young dialysis patient with consequent dilatation of the azygos vein system, simulating the appearance of an azygos continuation syndrome (ACS).
Urokinase Lock or Flush Solution for Prevention of Bloodstream Infections Associated with Central Venous Catheters for Chemotherapy: A Meta-Analysis of Prospective Randomized Trials
Authors: Kethireddy S. , Safdar N. 
Published: March 2018

Background Intravascular devices (IVDs) carry significant risk of device-associated bloodstream infection (BSI). Catheter thrombosis increases the likelihood of microbial colonization of the catheter and BSI. Urokinase has been studied for the prevention of BSI associated with IVDs. We undertook a systematic review to determine the efficacy of urokinase-heparin lock or flush solution compared with heparin alone in preventing IVD-associated BSI. Methods Computerized databases were searched for relevant publications in English from January 1966 to 1 January 2007. We identified randomized controlled trials comparing a urokinase-heparin lock or flush solution with heparin alone for prevention of BSI associated with long-term IVDs. Summary effect sizes were calculated with assessment of heterogeneity. Results Five randomized, controlled trials involving a total of 991 patients being treated with IVDs met the inclusion criteria; all five studies were conducted among patients with cancer; three of these studies were undertaken in children and two in adults. The summary risk ratio with a urokinase-heparin lock solution for IVD-associated BSI was 0.77 (95% confidence interval [CI], 0.60–0.98; p=0.01). Results of the test for heterogeneity were not statistically significant (p=0.53). Conclusions Use of a urokinase lock solution in high-risk patient populations being treated with long-term central IVDs may reduce the risk of BSI. However, there are few randomized trials and methodologic limitations of these preclude more robust recommendations regarding the use of urokinase to prevent BSI. Further adequately powered studies should seek to evaluate the efficacy of urokinase and optimize dosage and instillation regimen.
Flow Interruption of the Distal Radial Artery: Treatment for Finger Ischemia in a Matured Radiocephalic AVF
Authors: Miller G.A. , Khariton K. , Kardos S.V. , Koh E. , Goel N. , Khariton A. 
Published: March 2018

Purpose To establish an effective approach for diagnosis and treatment of hand ischemia in matured radiocephalic arteriovenous fistulae (AVF). Methods One hundred and fifty end-stage renal disease patients (4% of our practice) presented to our outpatient vascular access facility complaining of a range of symptoms including coldness, numbness and pain in the fingers indicative of ischemia due to steal syndrome. In 15 patients the symptoms of steal syndrome were limited to the fingers, sparing the hand. Physical examination was indicative of steal syndrome caused by shunting of blood from the ulnar artery via the palmar arch, away from the fingers and into the fistula. To confirm the diagnosis, angiography was performed which demonstrated retrograde flow in the distal radial artery (DRA), a hypertrophied palmar arch, and a patent hypertrophied ulnar artery. Ischemia was treated with DRA flow interruption. Transcatheter coil embolization of the DRA (10 patients) was preferred because it proved to be a quick, safe and effective technique. Whenever embolization was not possible ligation of the DRA was performed in accordance with accepted surgical literature (five patients). Results DRA flow interruption was effectively accomplished by either ligation or coil embolization in all cases. All patients had symptomatic improvement. Complete symptom resolution was experienced by 100% (10/10) of patients who received DRA embolization and by 3/5 patients who required ligation. The average follow-up period was 9 months. There were no complications during the procedure or during the follow-up period. Conclusion Diagnosis using physical examination, angiography and treatment with embolization or ligation of the DRA can be performed with great success in an outpatient setting.
A Successful Scheme for Reducing Waiting Times for Arteriovenous Fistula Formation
Authors: Barlow A.D. , Doughman T.M. , Warwick G.L. , Nicholson M.L. 
Published: March 2018

Purpose In a bid to reduce waiting times for arteriovenous fistula (AVF) formation we introduced a scheme whereby nephrologists were able to place patients directly on the waiting list for surgery. This study evaluated the quality of these direct referrals and assessed the reduction in waiting times. Methods Fifty consecutive patients referred directly to the waiting list were compared with 50 patients placed on the waiting list after being assessed in our vascular access clinic. Results Forty-nine patients from the direct group and 47 patients from the clinic group underwent surgery. In the direct group 39 patients (80%) underwent the same procedure as they had been originally listed for, compared with 39 patients (83%) in the clinic group (p=0.80). A fistula suitable for needling was created in 37 patients (76%) of the direct group and 38 patients (81%) of the clinic group (p=0.62). The median wait from referral to surgery in the direct group was significantly lower than in the clinic group (62 vs.141 days; p<0.0001). Conclusion This study demonstrates that nephrologists are able to effectively assess select patients for AVF formation. This significantly reduces waiting times for surgery, without an increase in cancelled operations, or a reduction in technical success.
The Effect of Hemoglobin Level on Arteriovenous Fistula Survival in Iranian Hemodialysis Patients
Authors: Zadeh M. Khavanin , Gholipour F. , Hadipour R. 
Published: March 2018

Objective End-stage renal disease (ESRD) poses steadily growing challenges to health care systems worldwide. Renal replacement therapy with hemodialysis (HD) or kidney transplantation is the only possibility for ESRD patient survival. A complete correction of anemia in HD patients may lead to an increased risk of vascular arteriovenous fistula (AVF) primary failure; some studies have demonstrated that decreased levels of hemoglobin (Hb) had adverse effects on cardiac and brain function. This study was designed to evaluate the impact of different risk factors, especially the Hb level on AVF survival. Methods Prospective observational data were analyzed from a non-randomized sample (n=100) of HD patients who were referred for first AVF creation between April 2005 and December 2006 with <1 month on HD. The relative risk (RR) of access primary failure was evaluated in four different groups of patients divided according to their Hb levels (<8, 8–10, 10–12, and >12 g/dL). Other factors possibly influencing vascular access (VA) survival were also considered including gender, age, smoking, diabetes, hypertension, parathyroid hormone levels, ACE inhibitor intake and triglyceride levels. The analyses were performed using SPSS v.11.5, Kaplan-Meier analysis, Cox's regression and log rank test. Results There was a statistically significant higher risk of AVF primary failure in patients with Hb <8 g/dL (RR=1.41; p=0.01), diabetes (RR=1.21; p=0.05), age>60 yrs (RR=1.41; p=0.06) were identified as predictive factors for AVF primary failure. ACE inhibitor intake (RR=0.45; p=0.01) was found to be protective. Conclusion Correction of serum Hb level can lead to a better result in VA survival and ACE inhibitor intake was found to be a protective factor.