Access Failure Research Articles

N30 Understanding Inflammatory Bowel Disease Emergency Department Admissions in a Tertiary Referral Inflammatory Bowel Disease Centre in England: A quality Improvement project

Abstract Background In February and March 2022, the emergency department (ED) affiliated to a tertiary referral inflammatory bowel disease (IBD) centre in England undertook an audit of ED attendances as part of an IBD-related admission quality improvement project (QUIP). Quality standards recommend review within 5 days of a flare. Patients presenting to ED may reflect failure of urgent GP access or to the IBD advice line a marker of poor-quality care. Methods Patients with suspected IBD presenting to ED during the audit period were identified the initial results generated further questions for the IBD team. A excel data base was created and the electronic patient record for each patient was retrospectively reviewed. Data relating to previous contact with the IBD team, how patients were referred to ED and confirmation of an IBD diagnosis was collected. Descriptive statistical analysis was used to present the data. Results There were N=48 ED attendances with a suspected diagnosis of IBD between February and March 2022. From the N=48 attendances from n=41 patients, n=29 (60.42%) admissions occurred for these patients. n=19 (39.58%) episodes resulted in discharge with five of these being self-discharges. of the n=41 patients n=4(9.76%) did not have a diagnosis of IBD n=1 (2.44%) with a diagnosis of IBD was not known to the IBD interdisciplinary team. Additionally, n=2 (4.88%) were new patients neither were known to the IBD team and n=2 (4.88%) were suspect diagnosis. multiple attendances occurred and n=1 (2.44%) patient attended four times and n=4 (9.76%) patients attended twice each meaning n=5 (12.2%) of the patients were responsible for n=12 (25%) of attendances. Of the original N=48 attendances, n=32 (66.67%) attendances occurred with no contact to the IBD advice line and n=19 (46.34%) of the n=41 patients responsible for these attendances. The outcomes are summarised in Table 1. Conclusion The original QUIP data was incomplete, and the actual IBD ED attendance rate was 66.66% of the original quoted figure, raising the importance of data cleaning and quality in QUIP. Focusing in on the 32 attendances where patients did not call the advice line, improvements to the messaging that IBD advice line service is available has become a priority as has utilising advanced nurse practitioner and specialist registrar skills to support patients therefore avoiding some of this ED attendance in the future. So far, adding advice line details to clinic letters, advertising in clinic, and setting up rapid access flare clinic led by Advanced Nurse Practitioners from the IBD Nursing team have been implemented. There are plans to review the attendance at IBD patients in ED in the same period in 2023.

An Ultrasound Survey of the Radial and Ulnar Arteries in an American Population: Implications for Transradial Access.

Palpation-guided access of the radial artery (RA) has transradial access (TRA) failure rates averaging 6%-7%. This study aimed to measure RA and ulnar artery (UA) diameters by ultrasound in a typical American population, in hopes of elucidating data that may improve TRA success rates. Intraprocedural ultrasound measurements of the RA and UA in 565 consecutive patients undergoing TRA were retrospectively analyzed. The RA is usually larger than the UA, with diameters of 3.0 mm and 2.7 mm, respectively. The UA was larger than the RA in 23% of the population studied, being larger than the RA by ≥20% in 6.5%. Men have larger RAs and UAs than women, with RA/UA diameters of 3.2/2.7 mm and 2.8/2.4 mm, respectively. Body mass index did not correlate with RA diameter. An RA to sheath ratio of <1.0 would have occurred in 6% of men and 16% of women with the use of a 6-Fr slender sheath. The distal RA was 0.5 mm (16%) smaller in diameter than the RA. The RA is usually larger than the UA and will be the artery of choice for access in most patients. The UA was larger than the RA by ≥20% in 6.5% of patients studied, possibly making it the wrist artery of choice for access in many of these patients. No clinical variables predict RA or UA diameters. Ultrasound may improve TRA success rates by allowing accurate sizing of the RA/UA, thereby preventing inadvertent sheath oversizing causing radial artery spasm and TRA failure.

Factors Associated with Hemodialysis Vascular Access Failure: A retrospective study in Colombia

Introduction: Vascular access (VA) remains a major source of morbidity for hemodialysis patients (HD). Few data sources adequately capture longitudinal patency of the VA. This study aimed to evaluate VA failure and its related factors in HD patients. Methods: A retrospective cohort study of 985 incident hemodialysis patients treated in clinics of BRCS in Colombia, from January 1rst ,2016, until December 3 of the same year, was done. The cohort's enrollment was on day 1 of HD, and with follow-up for up to 15 months. Association among a group of independent variables and time to failure of the VA was performed, and adjusted by baseline variables using a Cox regression model. Results: A total of 985 patients were included in the study, requiring 1774 procedures of vascular access during follow-up. The mean age was 61 ± 15.6 years. At day 1, 15% were dialyzing with an arteriovenous fistula (AVF) or AVG; and at day 90, this proportion had increased to 70%. The rate of vascular access procedure was 1.95 per patients-year, 95% CI 1.86-2.04. The rate of vascular access failure was 0.66 per patients-year, 95% CI 0.61–0.72. Risk factors for failure in AVF/AVG were age &gt; 65 (p= 0.008), diabetes (p= 0.019), female sex (p= 0.002) rural housing (p&lt;0.0001) and higher hemoglobin (p= 0.021). Conclusion: Vascular access failure and the requirement for procedures associated with it are frequent in the dialysis population. Several risk factors, some of them modifiable, are related to vascular access failure.

Factors associated with post-mortem notification of tuberculosis cases in Brazil, 2014.

According to the World Health Organization (WHO), 1.6 million deaths and 10.6 million cases of tuberculosis (TB) were reported worldwide in 2021. If treated opportunely with the recommended therapy, 85% of patients with TB are healed. The occurrence of death from TB without prior notification of the disease indicates failure in the timely access to this effective treatment. Therefore, this study aimed to identify TB cases with post-mortem notification in Brazil. This is a nested case-control study using a cohort of new TB cases reported to the Braziliam Information System for Notificable Diseases (SINAN). This study analyzed the following variables: selected characteristics of the individual (gender, age, race/color, education), the municipality (Municipality Human Development Index - M-HDI, poverty rate, size, region, and municipality), health services, and underlying or associated cause of death. Logistic regression was estimated using a hierarchical analysis model. People with TB aged 60 years or older (OR = 1.43), with low educational level (OR = 1.67), and with malnutrition (OR = 5.54), living in municipalities with low M-HDI and medium population size (OR = 1.26), located in the North Region of Brazil (OR = 2.42) had a higher chance of post-mortem notification. Protective factors were HIV-TB coinfection (OR = 0.75), malignant neoplasms (OR = 0.62), and living in cities with broad primary care coverage (OR = 0.79). Vulnerable populations should be prioritized in order to address the obstacles to the access to TB diagnosis and treatment in Brazil.

Fatores associados à notificação pós-óbito de casos de tuberculose no Brasil, 2014

Abstract: According to the World Health Organization (WHO), 1.6 million deaths and 10.6 million cases of tuberculosis (TB) were reported worldwide in 2021. If treated opportunely with the recommended therapy, 85% of patients with TB are healed. The occurrence of death from TB without prior notification of the disease indicates failure in the timely access to this effective treatment. Therefore, this study aimed to identify TB cases with post-mortem notification in Brazil. This is a nested case-control study using a cohort of new TB cases reported to the Braziliam Information System for Notificable Diseases (SINAN). This study analyzed the following variables: selected characteristics of the individual (gender, age, race/color, education), the municipality (Municipality Human Development Index - M-HDI, poverty rate, size, region, and municipality), health services, and underlying or associated cause of death. Logistic regression was estimated using a hierarchical analysis model. People with TB aged 60 years or older (OR = 1.43), with low educational level (OR = 1.67), and with malnutrition (OR = 5.54), living in municipalities with low M-HDI and medium population size (OR = 1.26), located in the North Region of Brazil (OR = 2.42) had a higher chance of post-mortem notification. Protective factors were HIV-TB coinfection (OR = 0.75), malignant neoplasms (OR = 0.62), and living in cities with broad primary care coverage (OR = 0.79). Vulnerable populations should be prioritized in order to address the obstacles to the access to TB diagnosis and treatment in Brazil.

The Role of Ultrasound in Accessing the Distal Radial Artery at the Anatomical Snuffbox for Cardiovascular Interventions.

In an effort to refine transcatheter vascular interventions, radial artery access has moved more distally at the anatomical snuffbox. Here, more challenges appear as the artery is smaller, more angulated, and more difficult to palpate. Including ultrasound guidance as a mandatory step during puncture may encourage more operators to switch to this approach. In the femoral approach, ultrasound guidance is strongly recommended because of bleeding complications, whereas in the proximal (conventional) radial approach, the role of ultrasound remains optional, and in current practice, almost all cases are performed by palpation of the pulse only. However, in distal radial access, the situation is different because the artery differs in caliber and position, and imaging can help the operator for a clean puncture, especially since repeated punctures are not only painful but also any hematoma formation leads to the complete compression of the artery and failure of access. The aim of this review is to investigate the rationale of vascular ultrasound during distal radial access and to establish some techniques and anatomical landmarks for the ultrasonographic exploration of the dorsal area of the hand.

1068 THE IMPACT OF COMMISSURAL ALIGNMENT ON CORONARY ARTERY ACCESS: A META ANALYSIS

Abstract Background The use of TAVR has been spreading out globally due to its favorable safety profile and the excellent efficacy data from randomized controlled trials. With the growing number of treated patients, the attention is rising around specific issues, such as the treatment of intercurrent coronary artery disease. Commissural alignment of transcatheter heart valves (THV) has the potential to reduce the impact of the prosthesis on accessibility of coronary ostia, as misalignment of the neo-commissures could be responsible for partial overlap with coronary artery ostia. However, no definitive evidence is available, despite multiple trials have addressed this issue. Methods The aim of this meta-analysis was to investigate the impact of the commissural alignment on coronary filling. We examined the techniques of commissural alignment and their impact on coronary access and coronary overlap. Eligible studies were searched for on Pubmed and SCOPUS and selected using the PRISMA guidelines. The primary endpoint is a composite of severe coronary overlap and failure of transcatheter coronary access. Odds Ratio were used as the metric for comparison between the groups. A random effects meta-analysis was selected as the calculation model. Results Six studies with a total of 1213 patients were included in this analysis. Of these patients, 757 patients underwent TAVR with commissural alignment and 456 underwent TAVR without commissural alignment. The composite endpoint of coronary overlap and failure of coronary access occurred in 118 patients undergoing TAVR with commissural alignment and in 124 patients without commissural alignment (OR=0.20, 95% CI 0.08-0.48; p= 0.0003). Conclusions Commissural alignment was associated with significantly lower rates of commissure-to-coronary-ostia overlap and failure of coronary access. Therefore, a modified insertion technique could reduce coronary overlap and coronary occlusion, particularly in supra-annular valves. Commissural alignment performed during TAVR could therefore have an important role in coronary re-access and re-intervention especially in younger patients.

1726. Patterns of Isavuconazole Use for Invasive Fungal Infections

Abstract Background Isavuconazole (ISA) is a relatively recent triazole antifungal with several attractive qualities and so increased clinical experience and data on the use of ISA are desirable. However, the data on the pattern of ISA use in invasive fungal infections (IFI) is limited. Methods We conducted a retrospective study of patients with probable or proven IFI treated with ISA at Mayo Clinic from 1/1/2015 to 4/1/2020 to examine temporal trends and characteristics of ISA use. Results The use of ISA rose over this period, from 4 cases in 2015 to 42 cases in 2019. Of 131 patients identified, ISA was used as the initial antifungal in 15 (11.5%) patients and as the secondary agent in 116 (88.5%) patients. The most cited reasons for choosing ISA as first-line therapy were drug-drug interactions (5, 33%) and baseline QTc prolongation (3, 20%). In cases of ISA used as a secondary agent, the reasons for transitioning to ISA were QTc prolongation (22, 19%), followed by judged failure of the primary therapy (20, 17%), drug-drug interactions (12, 10%), and various toxicities with the first agent. ISA was discontinued early in 81 (62%) patients. Common reasons for early discontinuation were patient death or comfort care (27, 33%), intolerance (18, 22%), failure of therapy (17, 21%), cost or access (6, 7%), drug-drug interaction (3, 4%), issues with absorption or drug delivery (3, 4%), and microbe susceptibility (1, 1%). ISA was judged successful and used as definitive treatment in the remaining 50 (38%) patients. About 30 patients took &amp;gt;1 year of ISA, and no major adverse effects from long-term therapy were noted. Conclusion Although ISA is approved for pulmonary aspergillosis and mucormycosis, we found that few patients were treated with ISA as either primary or salvage therapy. In cases where it was used, shortening the QTc and fewer drug-drug interactions were its most attractive qualities. Although it is a newer azole, the morbidity common with other antifungals should prompt more studies on ISA’s efficacy to increase clinicians’ confidence in this option. Disclosures All Authors: No reported disclosures.

Modified proximalization of arterial inflow using a hemodialysis reliable outflow graft in a patient with vascular access failure.

A 63-year-old man with end-stage renal disease and multiple failed vascular accesses (VAs) had been referred for creation of permanent dialysis access. He provided written informed consent for the report of his case details and imaging studies. His medical history included a failed kidney transplantation, aortic valve replacement, severe coronary artery disease requiring two coronary artery bypass grafts, and hypertension. A previous right groin and upper extremity VA had been complicated by chronic deep and central vein thrombosis, requiring stenting of the right innominate and superior vena cava (SVC) due to SVC syndrome.

Jdebug: A Fast, Non-Intrusive and Scalable Fault Locating Tool for Ten-Million-Scale Parallel Applications

This article presents Jdebug, a fast, non-intrusive and scalable fault locating tool for extreme-scale parallel applications. Large-scale debugging has drawn more attention with the increasing scale of supercomputers and applications. To eliminate program intrusion caused by traditional instrumentation or interception during debugging information acquisition, we introduce the out-of-band management into large-scale debugging. We propose a rapid information gathering scheme that separates user and debugging traffic to solve scalability problem and to eliminate program interference during merging data. Observations of Program Counters (PC) and performance characteristics in suspended applications find abnormalities and help locate abnormal threads caused by software errors or hardware failures effectively. Evaluation shows that Jdebug collects PCs of over 20 million cores on the new Sunway supercomputer within 1.97 seconds, and can locate the abnormal threads in 1.4 seconds with an accuracy of 92.5%. In the running test of three fundamental benchmarks (HPL, HPCG, Graph500) and seventeen real-world applications, Jdebug quickly and accurately locates abnormal threads to help find scalability errors and hardware failures including memory access failures, communication failures, and execution component failures, which validates its effectiveness.

Periadventitial biomaterials to improve arteriovenous fistula and graft outcomes.

Periadventitial biomaterials have been employed for nearly three decades to promote adaptive venous remodeling following hemodialysis vascular access creation in preclinical models and clinical trials. These systems are predicated on the combination of scaffolds, hydrogels, and/or particles with therapeutics (small molecules, proteins, genes, and cells) to prevent venous stenosis and subsequent maturation failure. Periadventitial biomaterial therapies have evolved from simple drug delivery vehicles for traditional drugs to more thoughtful designs tailored to the pathophysiology of access failure. The emergence of tissue engineering strategies and gene therapies are another exciting new direction. Despite favorable results in experimental and preclinical studies, no periadventitial therapy has been clinically approved to improve vascular access outcomes. After conducting an exhaustive review of the literature, we identify the seminal studies and clinical trials that utilize periadventitial biomaterials and discuss the key features of each biomaterial format and their respective shortcomings as they pertain to access maturation. This review provides a foundation from which clinicians, surgeons, biologists, and engineers can refer to and will hopefully inspire thoughtful, translatable treatments to finally address access failure.

Abstract 10430: Radial First! Ulnar Next? Forearm Arterial Anatomy Study

Introduction: In patients with small Right Radial Artery ( RRA ), access site failure may result in a radial to femoral crossover. Methods: The arterial anatomy of the distal forearm was studied using ultrasound in 167 hospitalized patients. The radial and ulnar artery dimensions were imaged in triplicates. The average cross-sectional area (CSA) and average diameter (AD) were measured using open-source ImageJ software. Variations in distal forearm arterial anatomy (branches) were documented. Results: The mean CSA and AD for the largest of the bilateral radial and ulnar arteries - Largest Forearm Artery ( LFA ), were 5.4 ± 2.5 mm 2 (1.1 → 13.3 mm 2 ) and 2.6 ± 0.6 mm (1.2 → 4.1 mm) respectively. The mean CSA and AD for RRA were 4.8 ± 2.5 mm 2 (0.7 → 13.3 mm 2 ) and 2.4 ± 0.6 mm (0.9 → 4.1 mm). In 46% of patients, RRA was not the LFA. The ulnar artery was larger than the radial artery in 25% of patients in the right wrist and 29% in the left wrist. The left radial was larger than the right radial in 31% and the left ulnar was larger than the right ulnar in 42%. In 58% of patients, RRA was &lt; 2.5 mm (outer diameter of common radial access sheaths). In 24% of patients, RRA was &lt;2 mm. In patients with RRA &lt; 2.5 mm, 17% had another artery &gt;2.5 mm and 6% had another artery &gt; 3 mm. Men had 53% larger CSA compared to women. Smoking, intravenous drug use, diabetes, hyperlipidemia, peripheral vascular disease, chronic kidney disease (CKD), and hemodialysis predicted smaller-sized forearm arteries. CKD patients had 33% smaller CSA compared to patients without CKD. In 23 patients (14%), one or more of the forearm arteries had branches in the distal forearm. In 12 patients (7%), branches were seen in RRA. Conclusions: Right Radial Artery was not the largest forearm artery in almost half the patients. Right Radial Artery was smaller in size than common radial access sheaths in more than half of the patients. Of these patients, 17% had a different forearm artery &gt; 2.5 mm that could be accessed instead of Femoral Artery. Female sex and CKD predicted smaller forearm artery sizes increasing the risk of radial access failure. Ultrasound use is advisable to identify the best forearm artery for access and avoid accessing smaller accessory branches that were seen in 7% of right radial and 14% of one or more forearm arteries.

The Association Among Carotid Intima-Media Thickness, Pulse Wave Velocity, and Vascular Access Failure in Hemodialysis Patients

The Association Among Carotid Intima-Media Thickness, Pulse Wave Velocity, and Vascular Access Failure in Hemodialysis Patients

Surveillance and monitoring of early failing arteriovenous fistula using Doppler assessment in children on regular hemodialysis

BackgroundA well-functioning vascular access is a mainstay to perform an efficient hemodialysis procedure. Limited lifespan of arteriovenous accesses is one of the major challenges of the current long-term hemodialysis therapy. Vascular access-related morbidity accounts for up to 50% of total dialysis patient’s costs. The pediatric vascular access clinical guidelines published by the National Kidney Foundation Kidney Disease Outcome Quality Initiative recommend establishing a surveillance strategy to detect access stenosis and direct patients for early intervention. The aim of this study was to test the role of using the color Doppler ultrasonography (CDU) as a surveillance method for arteriovenous fistulae in children on regular hemodialysis and its value for detecting the early vascular access failure or dysfunction to avoid access loss.ResultsDuring 10-month duration, we prospectively conducted surveillance for 30 patients on regular hemodialysis through arteriovenous fistulae (AVF) as a vascular access, clinical assessment of AVF and radiological examination using CDU of the upper limbs. Their ages were ranging from 2 to 18 years with 1:1 male: female ratio. Doppler indices were measured in the afferent arteries, at the site of anastomosis, and the draining veins. AVF stenosis was the highest among all the detected complications (n = 9, 30%), aneurysm and pseudoaneurysmal formation (n = 8, 26%) anastomoses diameter reduction in 16.6%, and it was correlated with the dialysis adequacy measured through the Kt/v. Other complications were thrombosis (n = 2, 6.7%), central venous stenosis (n = 2, 6.7%), steal syndrome (n = 1, 3.3%) and calcifications in (n = 1, 3.3%). In total, 26% of the patients have more than one malfunction. Only one case has access failure a month after CDU examination.ConclusionIn conclusion, among pediatric patients CDU can detect early stenosis of AVF in children, which can affect the dialysis adequacy.

Metilen mavisi retroperitonoskopi tekniği: renal akses sağlanamayan perkütan nefrolitotomi vakalarında alternatif

Objective: To present our ‘methylene blue-guided retroperitoneoscopy technique’ that we apply in cases where extravasation develops for various reasons and is complicated as a result in Percutaneous Nephrolithotomy surgery (PNL). Material and Methods: A total of 36 patients, who underwent PNL with the ‘methylene blue technique’ at Bakirkoy Dr. Sadi Konuk Training and Research Hospital between 2014 and 2020, were retrospectively evaluated. The study included only cases in which the ‘methylene blue-guided retroperitoneoscopy technique’ was used due to the inability to advance the Amplatz sheath to the targeted calyx due to renal scarring or a staghorn stone filling the targeted calyx, Amplatz sheath was withdrawn from the kidney with the guidewire due to the inattention of the assistant surgical team or contrast material extravasation. The patients’ demographic, preoperative, perioperative, and postoperative data were recorded, and stone-free and complication rates were noted. Results: The mean age of the patients was 45.1 (36-55) years, the mean body mass index was 27.8±4 kg/m2, the mean stone size was 3.4±0.7 cm, and the mean stone volume was 22.3±10.2 cm3. The mean operation time was calculated as 95.8±30.3 minutes. The stone-free rate was 68% on the postoperative first day and 75% on the third month. Eight patients (22.2%) underwent a secondary procedure (extracorporeal shock wave lithotripsy or flexible ureterorenoscopy). Conclusion: The ‘methylene blue-guided retroperitoneoscopy technique’ we apply under retroperitoneoscopic direct vision is a safe and practical option for re-accessing the kidney by locating the calyx, which is first partially or completely dilated. Keywords: methylene blue, retroperitoneoscopy, renal access failure, percutaneous nephrolithotomy

SERUM LEVEL OF VASCULAR CELL ADHESION MOLECULE AND P SELECTIN AS THROMBOPHILIC RISK FACTOR FOR EARLY VASCULAR ACCESS THROMBOTIC OCCLUSION IN HEMODIALYSIS PATIENTS

Hemodialysis (HD) vascular access (VA) failure is the dominant cause of morbidity and the major cost of care for ESRD patients. The aim of the present work is to assess the serum level of vascular cell adhesion molecule and P- selectin in HD patients as markers for early thrombotic VA event. 90 CKD patients divided into three groups: group I: 10 subjects apparently health, group II: 10 Patients with CKD stage IV-V on medical treatment and group III: 70 Patients with CKD stage V on HD with recent VA insertion divided into 2 subgroups: Subgroup III a: 57 patients with AV shunt and subgroup III b: 13 patients with permanent catheter. Laboratory investigations done (blood urea, serum creatinine, eGFR, CBC, PT, and INR), imaging and serum VCAM 1, P selectin before and 6 months after HD There was positive connection between VCAM and P selectin and dialysis with statistics in form of p value (<0.001). Markers level pre dialysis and after 6 months of dialysis revealed that range of p selectin and VCAM1 level after 6 months are higher than pre dialysis level. Detection of elevated serum level of circulating sVCAM-1 and s P-selectin could be useful in the prediction of native AVF and permanent catheter thrombosis in chronic HD patients. The association between sVCAM-1 and s P-selectin and thrombosis in HD patients increases the evidence of the role of adhesion molecules in VA thrombosis

A Meta-Analysis of Traditional Radial Access and Distal Radial Access in Transradial Access for Percutaneous Coronary Procedures

IntroductionRadial approaches are classified into traditional radial access (TRA) and more contemporary distal radial access (DRA), with recently published comparative studies reporting inconsistent outcomes. As there have been several recent randomized control trials (RCT), we assessed the totality of evidence in an updated meta-analysis to compare outcomes of DRA and TRA. MethodsWe searched PubMed, CENTRAL, Web of Science, EMBASE, and Cochrane Database of Systematic Reviews from inception to August 2022 for studies comparing DRA and TRA for coronary angiography. Primary outcomes were the rate of radial artery occlusion (RAO) and access failure. Secondary outcomes included hematomas and puncture site bleeding. The pooled risk ratio (RR) with 95 % confidence interval (95 % CI) was calculated for each outcome. ResultsA total of 14,071 patients undergoing coronary angiography from 23 studies, including 5488 patients from 10 RCTs. The mean age of the study population was 59.8 ± 5.9 years with 66.2 % men. Outcomes for a total of 6796 (48.3 %) patients undergoing DRA and 7166 (50.9 %) patients undergoing TRA were compared. DRA was associated with a lower rate of RAO (RR = 0.36, 95CI [0.27, 0.48], I2 = 0 %) but an increased risk of vascular access failure (RR = 2.38, 95CI [1.46, 3.87], I2 = 82.7 %). There was no significant difference in the rate of bleeding or hematoma formation. ConclusionIn an updated metanalysis, DRA is associated with lower rates of RAO but with higher rates of access failure.

High Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios Are Associated with a Higher Risk of Hemodialysis Vascular Access Failure.

Our aim was to determine the predictive role of the preoperative neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in vascular access malfunctioning in patients who had undergone their first native arterio-venous fistula (AVF) for hemodialysis. Methods: This was a single-center retrospective observational study. All patients who underwent the procedure of the creation of a first native AVF for hemodialysis from January 2019 to December 2020 were considered eligible to be part of this study. Reinterventions for AVF malfunctioning were registered and the population was subdivided into two groups with respect to AVF malfunctioning. ROC curves were obtained to find the appropriate cut-off values for the NLR and PLR. A multivariate analysis was used to identify the independent predictors for an AVF malfunction. Kaplan–Meier curves were used to evaluate the AVF patency rates. A total of 178 patients were enrolled in the study, of them 70% (n = 121) were male. The mean age was 67.5 ± 12 years. Reinterventions for AVF malfunctioning were performed on 102 patients (57.3%). An NLR > 4.21 and a PLR > 208.8 was selected as the cut-off for AVF malfunctioning. The study population was divided into two groups depending on the NLR and PLR values of the individual. For the NLR < 4.21 group, the AVF patency rates were 90.7%, 85.3%, and 84% at the 3-, 6-, and 12-month follow-up, respectively, and 77.5%, 65.8%, and 39.3% at 3, 6, and 12 months for the NLR > 4.21 group, respectively (p < 0.0001). For the PLR < 208.8 group, the patency rates were 85.6%, 76.7%, and 67.7% at the 3-, 6-, and 12-month follow-up. For the PLR > 208.28 group, the patency rates were 80.8%, 71.2%, and 50.7% for the 3-, 6-, and 12-month follow-up, respectively (p = 0.014). The multivariate analysis highlighted that diabetes mellitus, the neutrophil count, the lymphocyte count, and the NLR were independent risk factors for an AVF failure. In our experience, the NLR and PLR are useful markers for the stratification of vascular access failure in hemodialysis patients. The inexpensive nature and ready availability of the values of these biomarkers are two points of strength for everyday clinical practice.

Meta-analysis of total versus partial graft excision: Which is the better choice to manage arteriovenous dialysis graft infection?

Arteriovenous graft infection (AVGI) is a major cause of hemodialysis access failure. Delayed diagnosis and inappropriate treatment may lead to increased morbidity (3-35%) and mortality up to 12%. Compare the postoperative outcomes of total graft excision (TGE) and partial graft excision (PGE) in the treatment of AVGI. Systematic review and meta-analysis METHODS: The dataset was defined by searching PubMed, EMBASE, Google Scholar, and the Cochrane database for articles outlining the terms arteriovenous graft infection, infected dialysis graft, TGE and PGE published between 1995-2020. The data analysis evaluated the outcomes of TGE and PGE in the management of AVGI. The meta-analysis was performed using Review Manager Software version 5.4.1. 30-day mortality, recurrent infection, and reoperation rate. Eight studies, including 555 AVGI, and 528 patients. PGE showed a significant increase in recurrent graft infection rate (OR=0.23,95% CI=0.13-0.41, P<.00001) and re-operation rate for control of infection (OR=0.14,95% CI=0.03-0.58, P<.007). However, the 30-day mortality rate did not differ significantly between the groups (OR=0.92,95% CI=0.39-2.17, P=.85). TGE remains a safe and effective surgical method for the management of AVGI. PGE is associated with a higher risk of graft infection and need for re-operation. As a result, PGE should only be considered in carefully selected patients. Risk of bias due to the differences in patient characteristics. None.

A Weighted Graph-Based Handover Strategy for Aeronautical Traffic in LEO SatCom Networks

With the development of space-air-ground integrated network (SAGIN), the Low Earth Orbit Satellite Communication (LEO SatCom) network has great potential to provide high rate communication services for aeronautical traffic. To overcome the frequency handovers between aircraft and LEO satellites, we generated a global aeronautical traffic demand map and utilized the graph-based handover (GBH) framework and the multi-attribute decision making (MADM) algorithm jointly to optimize the overall throughput. Moreover, we further propose a new parameter, called channel reservation order (CRO), for MADM algorithm. Simulation results indicate our strategy improves the performance in terms of overall throughput and access failure probability.