bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Role of the Staphylococcus Aureus Nasal Carriage and Type of Vascular Access in the Outcome of High-Risk Patients on Hemodialysis
Authors: Saxena A.K. , Panhotra B.R. , Uzzaman W. , Venkateshappa C.K. 
Published: January 2018

Background Populations of elderly and type-II diabetics are increasing worldwide. Therefore elderly diabetics on hemodialysis (HD), known to have higher nasal carriage rates, are also increasing. These patients are more often dialyzed through central venous catheters (CVCs). They represent the high-risk groups for Staphylococcus aureus linked vascular access-related septicemia (VRS) and ensuing mortality. The outcome of VRS in terms of mortality was studied in the three high-risk groups: elderly; type-II diabetics; elderly diabetics, following optimization of arteriovenous fistula (AVF) prevalence to at least 50%. Methods Persistent nasal carriage was defined by two or more positive standardized nasal swab cultures performed on 187 ESRD patients undergoing HD from July 1997 to July 2000. Peripheral blood samples were collected for culture and sensitivity on clinical suspicion of septicemia. Overall, AVF prevalence of over 50% was achieved through joint efforts of nephrology and vascular surgery departments. Results A nasal carriage rate of 47.6% was observed in this HD cohort. This included nasal carriage rates of 16.4% in <65 years non-diabetic (reference) group, 55.8% in elderly and 70.7% among type-II diabetics along with that of 75.5% in elderly-diabetic group. We achieved an overall AVF prevalence of 72.7% inclusive of 66.17% in elderly, 65.5% in type-II diabetics and 86.8% in reference group along with 37.7% in elderly-diabetic group. We recorded a mortality due to S. aureus nasal carriage-related VRS of 6.86% in elderly (RR-1.50, p-NS), 10.91% in type-II diabetics (RR-1.52, p<0.02) and 13.20% in the elderly-diabetic group (RR-2.87, p<0.0004) as compared to that of 4.4% per year in the reference group (assigned RR of one) with overall mortality of 7.3% per year. Conclusions AVF prevalence of over 50% is achievable in all the high-risk groups except among elderly-diabetics due to the predominance of peripheral vasculopathy. Optimizing AVF placement is a physiological and safer approach for achieving significant reductions in mortality associated with S. aureus nasal carriage-related VRS among high-risk groups.
Aneurysm of Arteriovenous Fistula in Uremic Patients: Is Endograft a Viable Therapeutic Approach?
Authors: Allaria P.M. , Costantini E. , Lucatello A. , Gandini E. , Caligara F. , Giangrande A. 
Published: January 2018

One of the complications of arteriovenous fistulas in chronic hemodialyzed patients is the onset of an aneurysm which can be at risk of rupture. Traditional surgical repair is not always feasible and may not be successful in these cases, leading therefore to the loss of a functioning vascular access and requiring in any case the temporary use of a central venous catheter to allow regular hemodialysis sessions. We applied to this kind of aneurysm the same experience developed in the management of major arterial aneurysms and we considered endografting repair a good alternative in this case. In this paper we present the successful treatment of an arteriovenous fistula aneurysm using that technique. A distal radio-cephalic arteriovenous fistula in one of our patients presented an aneurysm with high risk of rupture. The endografting repair with percutaneous insertion of a Wallgraft™ endoprosthesis was well tolerated and the vascular access could be used the day after, without the need for a central venous catheter insertion.
Haemodialysis Access: A Single Centre UK Experience
Authors: Fan S.L-S. , Naqvi R. , Ahmad R. , Thuraisingham R. , Raftery M.J. , Rudge C.J. , Sobeh M. , Yaqoob M.M. 
Published: January 2018

Background The aim of this study was to determine whether the US National Kidney Foundation Disease Outcome Quality Initiative (K/DOQI) guidelines on haemodialysis access could be achieved and to examine its relevance to patients on dialysis in the UK. Method A cross sectional study of chronic haemodialysis patients at our institution which involved case note review and measurements of biochemical parameters and dynamic venous pressure (dVP) was performed. Patients with polytetrafluoroethylene (PTFE) grafts were followed prospectively for 18 months. Results 262 patients were studied - 12%, 43%, 30% and 15% underwent dialysis through dialysis catheters, radial-cephalic fistulae (rAVF), brachial-cephalic fistulae (bAVF) and PTFE grafts respectively. RAVFs, bAVFs and PTFE grafts were the primary access (i.e. the first access created for the patient) in 58%, 35% and 7% respectively. Compared with patients of Caucasian origin, patients of Afro-Caribbean race were 3.80 times (95% confidence limit: 1.51 – 9.53) more likely to have a PTFE graft. Patients with higher “dry weights” were more likely to have PTFE grafts (p<0.005 by ANOVA). Dialysis adequacy was similar irrespective of type and site of access. We found that 64% of PTFE grafts, 46% of bAVFs and 13% of rAVF had dVPs greater than 150 mmHg, (p<0.0001 by χ2). This threshold recommended by DOQI predicted 12 of 13 dysfunctional grafts, but had a positive predictive value of only 50%. Conclusion We have demonstrated that the K/DOQI guidelines are not only achievable, but that they can be exceeded by a considerable margin. Our data also suggest that the demographic details of patients within a unit will influence the achievable proportion of AVF: PTFE grafts (the proportion of PTFE grafts in Afro-Caribbeans being 3 times higher than in Whites). Although a dVP >150 mmHg proved sensitive in predicting future graft dysfunction, it had low specificity.
Emerging Role of Enterococcus Spp in Catheter-Related Infections: Biofilm Formation and Novel Mechanisms of Antibiotic Resistance
Authors: Donelli G. , Guaglianone E. 
Published: January 2018

Enterococci are gram-positive bacteria that are part of the normal human intestinal flora and can colonize the upper respiratory tract, biliary tract and vagina of otherwise healthy people. Although their virulence is relatively low, recently enterococci have emerged as significant nosocomial pathogens and are currently the 4th leading cause of hospital-acquired infections, including those associated with intravascular catheter and biliary stent implants. The frequent use of these medical devices is often associated with severe complications, including catheter-related bloodstream infections (CRBSIs) and biliary stent occlusions, because of microbial biofilm formation on the device surface. Furthermore, other than a high level of resistance to penicillin, ampicillin and aminoglycosides, a dramatic increase in vancomycin resistance of enterococci has been recently observed in most clinical settings. Clinical strains exhibiting novel mechanisms of acquired resistance to antimicrobials are frequently isolated. In addition, enterococci have a great ability to transmit these resistance traits to other species and even to other genera. Due to their associated morbidity and mortality, enterococcal infections related to medical devices currently represent a major challenge for clinicians, especially for the management of critically ill patients, resulting in prolonged hospitalization and additional health costs.
Steal Syndrome of the Hemodialysis Vascular Access: Diagnosis and Treatment
Authors: Henriksson A.E. , Bergqvist D. 
Published: January 2018

Purpose Steal syndrome is an uncommon but serious condition of arterial insufficiency distal to a permanent hemodialysis fistula. The management of the condition is a great challenge to the surgeon because of the conflicting goals of preserving the fistula and treat the ischemia. In this review the purpose was to analyze the clinical problem and treatment possibilities. Methods Medline and Embase databases were searched for studies relevant to diagnosis and management of steal syndrome of the hemodialysis vascular access. Results The diagnosis of steal syndrome is largely based on clinical features and non-invasive studies. In same cases angiography may be necessary to find out the real causes of the steal syndrome. The cause is usually high fistula flow but other causes as steal phenomenon, inflow, outflow or anastomotic stenosis have to be considered and even combination of causes. The main treatment options are some form of flow reducing procedure or the distal revascularization interval ligation method. In some cases simple distal arterial ligation is the method of choice. Furthermore, in some patients a stenosis has to be treated as the first treatment option. Conclusion For an appropriate treatment of a steal syndrome a careful analysis of the cause is important.
Evaluation of Vascular Access Complications in Acute and Chronic Hemodialysis
Authors: El Minshawy O. , Abd El Aziz T. , Abd El Ghani H. 
Published: January 2018

Purpose This work aimed to determine the incidence of vascular access (VA)-related complications of temporary venous catheters in acute hemodialysis (HD) prescription, to study the survival rate of chronic HD patients who began HD with a catheter insertion and to evaluate associated complications. Methods The patients were classified into two groups. Group I, patients in whom venous catheters were inserted (652 patients). Group II, 80 patients with end-stage renal disease (ESRD) in whom an arteriovenous fistula (AVF) was established. Results Complications in the femoral approach were bleeding from a femoral artery wall laceration in only 6/600 patients (1%), successfully repaired in all patients, bleeding from a punctured femoral artery in 30 patients (5%), the incidence of infection and removal was 40%. Other complications included groin hematoma in 3 patients (0.5%) and catheter thrombosis in 45 patients (7.5%). In the jugular vein approach, infection occurred in 6/30 patients (20%), thrombosis in 9 patients (30%), and accidental withdrawal in 2 patients (6.7%). In the subclavian vein approach, catheter dysfunction was found in 7/22 patients (32%), infection in 10 patients (45.5%), and failure to cannulate the vein in 3 patients (13.6%). In group II, limb edema was found in 14/80 patients (17.5%), hematoma in 5 patients (6.3%), accidental trauma to the fistula in 2 patients (2.5%) and fistula stenosis in 15 patients (18.8%). Patients who began HD with a catheter had higher mortality than those who began with an AVF (12 months survival, respectively, 60 vs. 83%). Conclusion Patients who began HD with a catheter had more complications and higher mortality. Routine quality assessment of AVF by Doppler ultrasound is recommended.
Experience with the use of uncuffed double-lumen silicone hemodialysis catheters
Authors: Sombolos K.I. , Christidou F.N. , Bamichas G.I. , Anagnostopoulos T.C. , Megalopoulos A.A. , Kalpakidis V.I. , Natse T.A. 
Published: January 2018

Aim This study aimed to describe our experience with the use of uncuffed double-lumen silicone hemodialysis catheters (USHDCs) that were used in 54 cases as a temporary vascular access (VA). Subjects and methods: We recorded, retrospectively, all the USHDCs (size 13.5 French (F), length 15, 20 and 24 cm) that were inserted in our dialysis unit from July 2003 to September 2004. Catheter and patient characteristics, as well as catheter related complications, were recorded. Results There were 88 catheters used in 54 cases (44 patients). The catheters remained in place for a total of 2537 days (range 8–127 days, mean 46.9 ± 31.1). For catheter placement, the internal jugular veins (group A) or the femoral veins (group B) were used in a non-randomized manner. In group A, in 17 cases, 31 catheters were used for a total of 1169 days (mean 68.7 ± 28.5), while in group B, in 37 cases, 57 catheters were used for a total of 1368 days (mean 36.9 ± 27.1; p<0.001). In group B, 81% of cases (30/37) were ambulatory from the time of insertion. Mean urea reduction ratio (URR) in well functioning catheters (blood flow ≥200 ml/min) was 65.5 ± 4.6% in group A and 56.9 ± 6.2% in group B; p<0.001. Catheter-related bacteremia was observed in five group A cases and in seven group B cases (p=ns). Three cases of minor bleeding at the insertion site and three cases of ipsilateral leg edema were recorded in group B patients. In group A, only one case of bleeding at the insertion site was recorded. Conclusion Uncuffed double-lumen silicone hemodialysis catheters (USHDCs), 13.5 F in size, provided a very efficient temporary VA when placed in the jugular vein. Femoral placement of these catheters can also be used successfully in non bed-ridden patients, but delivering a lower dialysis dose.
Incidence of Sepsis in Central Venous Catheter-Bearing Patients with Hematologic Malignancies: Preliminary Results
Authors: Nosari A. , Nichelatti M. , De Gasperi A. , Nador G. , Anghilieri M. , Mazza E. , Cozzi P. , Mancini V. , Miqueleiz S. , Bettinelli L. , Lucchesini C. , Baraté C. , Ricci F. , Ciapanna D. , Ravelli E. , Morra E. 
Published: January 2018

Background Indwelling central venous catheters (CVCs) are essential devices in the management of patients with hematological disorders treated with chemotherapy. However, their nature predisposes patients to unwanted complications. Methods CVC-related complications were retrospectively analyzed in 227 hematologic patients who were consecutively admitted to our hematology department between May 2002 and April 2004. Patients’ diagnoses comprised acute myeloid leukemia (36.8%), acute lymphoid leukemia (7.3%), lymphoproliferative disorders (28.3%), multiple myeloma (19.5%), myeloproliferative syndromes (5%) and others (3.1%). The CVCs used were polyurethane three lumen 7-Fr (111 patients) for chemotherapy and 12-Fr (114 patients) for chemotherapy and peripheral blood stem cell apheresis, plus two tunneled catheters. Results The pathological events were: bacteriaemias (n=46); occlusions (n=10); exit tunnel infections (n=8); thrombosis (n=6); lung emboli (n=2). Among febrile patients the bacteriemia frequency was 20%, of which 13.6% were CVC-related (with a higher incidence in leukemia patients (p=0.027). Among the isolates, gram-positive bacteria were found in 29 cases (23 CVC-related cases), and gram-negative bacteria in 16 cases (8 CVC-related cases). Only one patient had Candida albicans sepsis. At univariate and multivariate analysis significant risk factors for infection (p<0.0001) were only the number of days/catheters and neutropenia duration. Conclusions In our hematologic patients, the CVC complications were mainly septic, with only 10.1% of CVC-related bacteriemias, despite prolonged catheterization duration. Acute leukemia patients were at major risk for sepsis, probably due to a more severe neutropenia and prolonged catheterization duration.
AV Fistula Rates: Changing the Culture of Vascular Access
Authors: Mcgill R.L. , Marcus R.J. , Healy D.A. , Brouwer D.J. , Smith B.C. , Sandroni S.E. 
Published: January 2018

Purpose Data from the United States Renal Data System show about 30% of prevailing hemodialysis (HD) patients use arteriovenous fistulae (AVF), which falls far short of the Kidney Disease Outcomes Quality Initiative (K/DOQI) goals of 40–50%. Recent initiatives to increase the use of AVF in HD patients have been criticized as unachievable under realistic practice conditions. Methods A multidisciplinary effort to increase AVF use was undertaken at an outpatient HD center beginning in 1998. Strategies focused on education and recruitment of patients in both inpatient and outpatient settings, preservation of veins, pre-operative vein mapping, and education of staff. Results AVF rates increased from 32%, to 72% over 6 years. The percentage of prosthetic grafts decreased from 40% to 13%. Central venous catheters fell from 28% to 15%. Among residual patients with catheters, 77% had maturing fistulae, as well. Infection rates in the dialysis unit decreased by 39%. Bacteremia declined by 47%. These improvements have been sustainable over the past 12 months. Conclusions Adherence to a strategic program similar to the Fistula First Initiative can increase fistula rates under ordinary practice conditions. High fistula rates can be achieved in male and female patients. Unanimous commitment among all members of the health care team is needed. Reduction in the risks of infection, bacteremia, endocarditis, and death may be derived from achievable changes in practice.
Clopidogrel Diminishes Hemodialysis access Graft Thrombosis
Authors: Trimarchi H. , Young P. , Forrester M. , Schropp J. , Pereyra H. , Freixas E. 
Published: January 2018

Background The most common complication of hemodialysis access graft is thrombosis. Clopidogrel, an inhibitor of platelet aggregation, was assessed to prevent this serious complication. Methods Nineteen patients on chronic hemodialysis whose vascular accesses were grafts were divided into two groups: Group A (n=11, 58%) consisted of patients who did not receive anti-thrombotic therapy after graft placement; Group B (n=8, 42%) received clopidogrel 75 mg/day from two days after surgery onwards. Both groups were well matched with respect to age, gender, cause of renal failure, hematocrit, platelet count and Kt/V. All patients’ thrombotic episodes were followed up from the day of graft surgery until thrombosis was diagnosed. Finally, the survival difference between both groups was determined. Results Ten thrombotic episodes were diagnosed in Group A while no events were reported in Group B (p<0.001). Graft access days of patency were significantly more in Group B than in Group A (350.8±166 vs 86.8±69, p<0.001). The time elapsed from dialysis initiation to graft placement was not different (Group A: 18±12 days; Group B: 20±10 days). Days in hemodialysis were different between both groups (Group A: 195.9±96; Group B: 545.5±291, p<0.001) and all patients of Group A (n=11, 57.9%) and two patients of Group B (25%) died (p=0.001). No major bleeding events were reported. Conclusions Clopidogrel significantly decreased thrombotic graft episodes. Patients on clopidogrel had a prolonged vascular access patency, longer time on hemodialysis and longer survival.
Vascular access in Cystic Fibrosis - Does Size Matter?
Authors: Carroll W.D. , Anderson M. , Reddy R.V. , Pantin C. , Lenney W. 
Published: January 2018

Vascular access is an important part of patient management in cystic fibrosis. In most instances, vascular access is straightforward. However, a single bad experience with venepuncture has a lasting impact. Clinical experience suggested that for some individuals a smaller, shorter intravenous catheter (Leaderflex 22G, 0.7 mm × 8.0 cm, Vygon) might be a suitable alternative to standard vascular access via a standard long-line (2 Fr or 3 Fr Nutriline, Vygon). Methods Between September 2002 and May 2004 we offered a free, fully informed choice between a standard 30 cm long line or a shorter (8 cm) Leaderflex line and audited this change in practice. Results A total of 56 lines were inserted over the study period. Data were available for 54 of these (22 Leaderflex and 32 standard long lines). Mean and median line survival was comparable. Leaderflex lines survived for a mean of 12.2 days and median of 14 days. Standard long lines survived for a mean of 12.6 days and median of 14 days. Discussion Leaderflex lines offer a well-tolerated alternative to standard long lines for the administration of a 14-day course of intravenous antibiotics. Their reduced size and cost offer advantages to patients and doctors.
Efficacy of Low-Dose Alteplase for Treatment of Hemodialysis Catheter Occlusions
Authors: Haymond J. , Shalansky K. , Jastrzebski J. 
Published: January 2018

Background Traditionally, alteplase 2 mg/lumen doses have been used to treat central venous catheter (CVC) occlusions. On January 20, 2004, our hemodialysis (HD) unit implemented a new protocol to utilize alteplase 1 mg/lumen doses for catheter occlusion. Objectives The objectives were to 1) assess the efficacy of low-dose alteplase in restoring HD catheter patency; 2) determine the duration of CVC patency as determined by need for further alteplase doses, or radiological or surgical line interventions; and 3) evaluate the financial implications of the new protocol. Methods The study was a prospective, open-label trial of 50 consecutive HD patients with permanent, tunnelled CVC lines. A treatment course consisted of 1 or 2 doses of alteplase instilled for 60 minutes then aspirated or as an overnight (48–72 hour) dwell until the next HD. The patient's first alteplase dose following implementation of the new protocol was evaluated. Patients were followed for two months to record need for further alteplase treatment courses, and four months to document radiological or surgical line interventions. The primary outcome was to assess successful restoration of catheter patency defined as the ability of alteplase to restore or maintain HD blood flow rate at or above 300 mL/minute. A financial analysis compared alteplase costs for 11 months prior to and after implementation of the new protocol. Results Alteplase 1 mg/lumen doses restored catheter patency in 72% of HD patients with one dose, increasing to 83% with a second dose. Sixty-two percent of patients required a subsequent alteplase course with a median time to next treatment of 14 days and a median of 2 courses/patient. Radiological interventions were ordered in 38% of patients resulting in 8 lines replacements and 7 line strippings. Financial savings with the new low-dose protocol were ~CDN$22,000. Conclusion Low dose alteplase 1 mg/lumen successfully treated occlusion of permanent hemodialysis catheters, with a resulting cost reduction.
Arteriovenous Fistulas for Hemodialysis Created using a Long-Term Absorbable Suture: A Safe Solution and a Measure to Minimize Myointimal Hyperplasia
Authors: Occhionorelli S. , De Tullio D. , Pellegrini D. , Ascanelli S. , Resta G. , Stano R. , Messina F. , Azzena G. 
Published: January 2018

Background/aims The goal of the therapeutic management of patients affected by end-stage renal disease (ESRD) is to maintain the vascular access (VA) as long as possible. Myointimal hyperplasia development in the vascular walls of arteriovenous fistulas (AVFs) is considered one of the most important factors responsible for procedure failure. These alterations could be linked to hemodynamic changes in the anastomosis and to the presence of the surgical suture itself. We report our preliminary experience, discussing the use and the possible benefits of an absorbable suture in polyglycolide trimethylene carbonate (PTC) in AVF creation. Methods Seventy-four AVFs were created as primary access for hemodialysis (HD), using PTC, over 4 years. Age, gender, ESRD etiology, artery and vein preoperative diameters, AVF survival outcome, and the number of AVFs created per year were recorded. The Kaplan-Meier method was used to analyze AVF survival rates. Results No dehiscences, pseudoaneurysms, or failures in the “critical” period related to PTC absorption were recorded. Kaplan-Meier analysis was used to evaluate AVF survival; 12-month primary AVF survival (74.33%) and AVF failure (25.67%) rates, 9 “early” (8.22%) and 10 “late” failures (13.51%), and a 360-day mean survival were found. Conclusions Our data indicate that PTC, a well known and widely used material for sutures in vascular surgery, is safe and effective in AVF creation. Potential advantages of PTC sutures are represented by a reduced myointimal hyperplasia formation in the AVF vascular walls, prolonging the AVF lifespan and avoiding re-interventions.