Mean Primary Patency Research Articles

Bifurcated Endografts for the Treatment of Aortoiliac Disease a Systematic Review and Individual Patient Data (IPD) Meta-Analysis.

This review aimed to assess the efficacy and safety of bifurcated endografts in the treatment of aortoiliac disease (AOID). A systematic search on PubMed, Scopus, and Web of Science was performed. The primary endpoint was primary patency, whereas secondary endpoints included reintervention, technical, clinical success, and overall postoperative complications. Ten studies with a total of 365 patients were included in this review. Most included studies used the AFX unibody endograft, one study the Excluder endograft, and one the Powerlink endograft. The majority of included patients displayed TransAtlantic InterSociety Consensus (TASC) D aortoiliac lesions (56.1% 205/365). The pooled primary patency estimates at 12, 24, and 36 months were 93.93% (95% confidence interval [CI]: 87.7-100), 91.46% (95% CI: 84.6-98.8), and 90.25% (95% CI: 82.6-98.6), respectively. The mean primary patency time was 85.74 months (95% CI: 71.99-86.88). The pooled freedom from reintervention estimates at 12, 24, and 36 months were 91.94% (95% CI: 81.4-100), 91.03% (95% CI: 79.8-100), and 91.03% (95% CI: 79.8-100), respectively. The pooled estimates of major complications (rupture, graft thrombosis, amputation) were 11.12% (95% CI, 0.05%-3.03%), 3.76% (0.32%-9.45%), and 0.38% (0%-2.59%), whereas the pooled estimates for minor complications (hematoma, groin infection, dissection) and overall mortality were 5.27% (95% CI, 1.11%-11.38%), 6.93% (95% CI, 2.94%-12.16%), 2.19% (95% CI, 0.06%-6.14%), and1.57% (95% CI, 0.13-3.97), respectively. Technical and clinical success estimates were 99.92% (95% CI: 98.86%-100%) and 99.47% (95% CI: 94.92%-100%), respectively. The application of bifurcated endografts may present a safe and viable option in the treatment of AOID, with preliminary results indicating promising primary patency outcomes. However, the definitive assessment of their efficacy and safety will be better determined through long-term follow-up studies and high-quality randomized controlled trials, which are essential to substantiate these initial findings. Bifurcated endograft application may be a safe and viable alternative for high-risk patients with complex AOID TASC C and D lesions with encouraging primary patency outcomes potentially comparable to those of open surgery. Non-negligible postoperative complication rates were also noted. High-quality randomized controlled trials and studies comparing CERAB, kissing stenting, and the use bifurcated endografts for the treatment of AOID is necessary to draw more definite conclusions.

Early Experience With the Iliac Branch Endoprosthesis (IBE) in Managing Iliac Aneurysms.

Aim The objective of this study is to evaluate the feasibility of using iliac branch endoprosthesis (IBE) devices and to examine their short-term outcomes. Materials and methods This was a descriptive, retrospective observational study involving 15 patients diagnosed with either aortoiliac or isolated iliac artery aneurysms and treated with an IBE device. Data were collected for patients who received IBE devices at Glan Clwyd Hospital in Rhyl, United Kingdom, from February 2020 to May 2023. Results Most patients presented with asymptomatic aneurysms; 86.7% (n = 13) had bilateral common iliac artery (CIA) aneurysms. The mean diameter of the CIA was 38.7 ± 8.8 mm, and the mean diameter of the abdominal aortic aneurysm (AAA) was 39.8 ± 23 mm. For the indications of IBE use, 60% (n = 9) of the patients had iliac aneurysms reaching the intervention threshold, 20% (n = 3) had AAA reaching the threshold, and 20% (n = 3) had aortoiliac aneurysms reaching the threshold. The majority of patients underwent bilateral femoral access (86.7%; n = 13), while 13.3% (n = 2) required both femoral and brachial access. Technical success was achieved in all cases. Aside from 20% (n = 3) of cases where the sac size remained static, the majority of patients (80%; n = 12) experienced sac regression. All patients were free from buttock claudication. A type II endoleak was observed in 33.3% (n = 5) of patients. No reinterventions were reported. The mean primary patency was 30.9 ± 0.7 months, and the follow-up period ranged from 12 to 36 months. Conclusions IBEs are an effective medical device, demonstrating a high rate of technical success, minimal need for additional procedures, and a low incidence of complications while maintaining a satisfactory rate of primary patency.

Usage of rotational atherectomy and drug-coated balloon angioplasty for isolated popliteal artery lesions: two-year results of a retrospective study

Objectives In this study, perioperative properties and early and mid-term clinical outcomes of endovascular revascularization with a combined usage of rotational atherectomy (RA) and drug-coated balloon angioplasty (DCB) angioplasty for isolated popliteal artery lesion were reported. Methods A total of 28 patients with isolated popliteal artery stenosis who underwent combined RA and DCB angioplasty between December 2018 and September 2022 were analyzed retrospectively. Temren atherectomy system (Invamed, Ankara, Turkey) and Extender paclitaxel-coated drug-coated balloon catheter (Invamed, Ankara, Turkey) were used in all cases. The main outcome was primary patency; secondary outcomes were technical success, freedom from amputation, and mortality. Results The mean age of patients was 64.2 ± 9.1 years and the majority of the patients were male (n = 20; 71.4%). Types of the lesions were total occlusion in 24 limbs and critical stenosis in 4 limbs. The mean total occlusion length was 65.2 ± 14.2 mm. Flow-limiting dissection was seen in lesions of 2 patients (7.1%) and treated with prolonged balloon dilatation without bail-out stenting requirement. Technical success defined as an adequate vascular lumen (less than 30% stenosis) was achieved in 26 (92.8%) with a mean follow-up of 17.2 ± 8.2 months. The mean primary patency rates at 12 months and 24 months were 92.3% ± 3.2 and 81.2% ± 3.2, respectively. Complications included 1 distal embolization following RA, 2 flow-limiting dissections, and 3 puncture site hematomas. Conclusions Endovascular procedures using combined RA and DCB angioplasty seem to be effective alternative treatment modalities for the treatment of popliteal artery lesions with high rates of primary patency and freedom from TLR.

Clinical characteristics and preoperative ultrasound parameters related to low patency in radio-cephalic arteriovenous fistulas.

Our objective is to describe the clinical characteristics and preoperative ultrasound mapping parameters associated with primary and secondary patency of radio-cephalic arteriovenous fistulas (RCF). A retrospective, single-center, descriptive study, including patients undergoing a RCF creation between 2015 and 2019. Socio-demographic data and ultrasound parameters were collected and an analysis of primary and secondary patency was performed. Eighty-four patients were included in this study. Mean age was 65.6 (±13.9) years; 76.6% were male. Mean preoperative ultrasound parameters: forearm cephalic vein diameter was 2.8 (±0.57) mm, radial artery diameter was 2.6 (±0.42) mm, radial artery systolic peak velocity was 68 (±14.3) cm/s radial artery resistance index was 0.76 (±0.9). At the end of the 4 years the follow-up, the mean primary and secondary patency were 47.2% and 80% respectively. Only female sex was significantly associated with a decrease in both primary patency (p = 0.043, HR = 0.48) and secondary patency (p = 0.021, HR = 0.023). Furthermore, radial artery systolic peak velocity (p = 0.007, HR = 2.6) showed a significant association with decreased primary patency and forearm cephalic vein diameter showed a borderline significant association with decreased secondary patency (p = 0.046, HR = 8.2). A standardized evaluation by a vascular surgeon or nephrologist represent a key in the preoperative assessment of AVF candidates. Based on our results, we will consider to avoid distal vascular access in both female patients with lower radial artery systolic peak velocity (less than 68 cm/s) and borderline forearm cephalic vein diameter (less than 2.8 mm) after initial assessment in our clinical practice. Our results could encourage new studies in order to stablish the potential role of these parameters in the RCFs patency rates.

Kalıcı diyaliz kateterlerinin uzun dönem sonuçları: tek merkez tecrübemiz

Aim: Tunneled dialysis catheters are generally not used as a primary dialysis access but as bridging therapy until a permanent dialysis access is available. However, it has been stated that long-term use may be appropriate if needed. In our study, we aimed to reveal the long-term patency rates of tunneled dialysis catheters and the frequency of catheter-related diseases in a large patient group.
 Material and Method: Patients who referred to our center for tunneled dialysis catheter insertion procedure between 2017 and 2022 were retrospectively analyzed with respect of catheter patency durations. The duration between the patients’ repetitive admissions to our center due to catheter dysfunction, the cause of the dysfunction and the procedure applied to achieve the patency were noted. Kaplan- Meier survival analysis was used to calculate patency rates of catheters.
 Results: 1010 procedures were performed on 464 patients who applied to our center for tunneled dialysis catheter creation or dysfunction. 309 patients were excluded from the study due to short-term follow-up or lack of data. Of the remaining 155 patients with 211 catheter sites included to the study and 467 interventional procedures data analyzed. The mean primary patency duration of the tunneled dialysis catheters was 10.50±10.25 months and the secondary patency duration was 18.00±13.77 months. The 6, 12, and 24-month patency rates of the overall tunneled dialysis catheters were 91.1 %, 83.9 % and 77.9% respectively
 Conclusion: Although permanent dialysis catheters, which should not be the first choice for arteriovenous access, have associated comorbidities, they are a method with satisfactory patency rates when other access types are not suitable.

Comparing Patency Rates of Arteriovenous Dialysis Access following Percutaneous Thrombectomy Using Various Catheter Directed Therapies

Arteriovenous fistulas often require frequent interventions to maintain patency for hemodialysis. Interventions may include open or percutaneous thrombectomy with additional targeted interventions as indicated. We evaluated the primary and cumulative functional patency rates following three unique approaches to percutaneous thrombectomy of thrombosed dialysis access. A retrospective review of 236 unique patients who presented with thrombosed hemodialysis access was analyzed over a period of 4 years from 2016-2020. We analyzed a total of 413 procedures that utilized 3 separate percutaneous thrombectomy devices to assist with restoring patency. The Indigo System CAT-D Aspiration Thrombectomy Catheter (Penumbra; Alameda, CA), the Arrow-Trerotola Rotational Thrombectomy System (Teleflex; Wayne, PA) and the Angiojet Rheolytic Thrombectomy Catheter (Boston Scientific, Marlborough, MA) devices were compared for primary and cumulative functional patency. Primary Patency was defined as time from percutaneous thrombectomy to next intervention (Angioplasty, stenting, repeat thrombectomy). Cumulative functional patency was defined as time from percutaneous thrombectomy to time of access abandonment. Medical record chart review was utilized to determine patency rates. A total of 413 percutaneous thrombectomy procedures were performed. Of the procedures performed, 98 utilized Angiojet, 103 utilized Trerotola, and 212 used Penumbra. Mean primary patency rates in (days) for the devices was as follows: Angiojet (194), Trerotola (204), and Penumbra (107). Mean cumulative functional patency rates (in days) for the devices was as follows: rheolytic thrombectomy (450 days), aspiration thrombectomy (292 days), rotational thrombectomy (475 days). Angiojet vs Penumbra and Trerotola vs Penumbra both showed diminished patency rates when using the Penumbra Catheter that were statistically significant (P<.05) CONCLUSION: All percutaneous thrombectomy approaches do not result in the same primary or cumulative functional patency rates. Approaches with Trerotola and Angiojet resulted in improved primary and cumulative functional patency rates compared to those using Penumbra.

Polymer Free Amphilimus Drug Eluting Stent for Infrapopliteal Arterial Disease in Patients with Critical Limb Ischemia: A New Device in the Armamentarium.

Background and Objectives: Endovascular technologies have significantly improved the outcome of patients with critical limb ischemia (CLI). Drug eluting stents (DES) have documented their efficacy against percutaneous transluminal angioplasty (PTA) and bare metal stents (BMS) in infrapopliteal arterial occlusive disease. However, late in-stent neoatherosclerosis may lead to vascular lumen loss and eventually thrombosis. Polymer free DES constitute a new technology aiming to improve long term patency which their action is still under investigation. The purpose of this study is to report the mechanism of action and to provide a literature review of a novel polymer free amphilimus eluting stent (Cre8, Alvimedica, Instabul, Turkey) in infrapopliteal arterial disease. Methods: Publications listed in electronic databases, European Union Drug Regulating Authorities Clinical Trials Database, as well as scientific programmes of recent interventional vascular conferences were searched. Three studies were included. We analyzed primary and secondary patency, major amputation rate, freedom from CD-TLR, and mortality. Results: Cre8 was implanted in 79 patients with CLI. Most of the patients (n = 65) were Rutherford class 5-6 (82.3%), and diabetes mellitus (DM) was present in 66 patients (83.5%). Mean primary patency was 82.5% at 12 months. Mean lesion stented length was 20 mm and 35 mm in two studies. Mean limb salvage was 91.3% at 12 months. Freedom from CD-TLR was reported in two out of the three studies and was 96% and 83.8%. Mortality was 15% and 23.8% in the same studies, whilst it was not reported in one study. Conclusion: Stenting of infrapopliteal arteries with Cre8 is safe and feasible in patients with CLI and diabetes. All studies have shown very good primary patency and freedom from CD-TLR at 12 and 24 months. Larger observational prospective studies and randomized trials are necessary to establish long term effectiveness and clinical outcomes using the non-polymer Cre8 DES.

MICROSURGERY FOR THE CREATION OF ARTERIOVENOUS FISTULAS IN PATIENTS WITH RADIAL ARTERIES DIAMETER SMALLER THAN 1.6 MM

In End-stage Renal Disease patients, the distal forearm is the preferred site for hemodialysis access, however forearm vessels have small diameter and according to Guidelines a radial artery internal diameter smaller than 1.6-2 mm is strongly predictive of early failure of the arteriovenous fistula (AVF) because of stenosis and obstruction. It could happen for some patients to not be considered suitable for distal forearm AVF because of poor peripheral vessels, so in these cases the micrusurgical technique can be very helpful in handling such “inadequates” vessels for lower-arm fistula creation. This study is an investigation of long-term patency of distal radio-cephalic AVFs created under microscopic guidance by using small radial arteries (less the 1.6 mm diameter) in adult patients with chronic renal failure and without severe comorbidities. In a sample of 31 patients, at 1 year postoperatively, the mean primary patency rate was 67.7% (21 functioning AVFs out of 31) and that is quite the same result of AVFs’ made with arteries larger than 2 mm.

Percutaneous transluminal angioplasty for symptomatic hepatic vein-type Budd-Chiari syndrome: feasibility and long-term outcomes

For management of Budd-Chiari syndrome (BCS), a step-wise therapeutic approach starting with medical treatment, followed by endovascular recanalization, transjugular intrahepatic portosystemic shunt, and finally liver transplantation has been adopted. We retrospectively analyzed 51 patients with symptomatic short segment (≤ 30 mm) hepatic vein (HV)-type BCS who underwent percutaneous transluminal balloon angioplasty (PTBA) with/without stenting to determine the feasibility, clinical effectiveness, and long-term outcomes. The intervention was technically successful in 94.1% of cases (48/51)—32 patients underwent PTBA and 16 patients underwent HV stenting. Procedure-related complications occurred in 14 patients (29.1%). The clinical success rate at 4 weeks was 91.7% (44/48). Nine patients underwent reintervention, six patients due to restenosis/occlusion and three patients with clinical failure. The mean primary patency duration was 64.6 ± 19.9 months (CI, 58.5–70.8; range, 1.2–81.7 months). The cumulative 1-, 2-, and 5-year primary patency rates were 85.4, 74.5, and 58.3%, respectively. The cumulative 1-, 2-, and 5-year secondary patency rates were 93.8, 87.2, and 75%, respectively. The cumulative 1-, 2-, and 5-year survival rates were 97.9, 91.5, and 50%, respectively. Percutaneous transluminal angioplasty with and without stenting is effective and achieves excellent long-term patency and survival rates in patients with symptomatic HV-type BCS. With its lower incidence of re-occlusion and higher clinical success rate, HV angioplasty combined with stenting should be the preferred option especially in patients with segmental HV-type BCS.

Cephalic arch stenosis in autologous hemodialysis fistula; to stent or not to stent? Long-term follow up

BackgroundA retrospective study of 44 patients with autologous arteriovenous fistula (AVF) presenting with cephalic arch stenosis was carried out. The aim is to assess the effectiveness of angioplasty and stenting in cephalic arch stenosis in autologous AVF in hemodialysis patients and also to assess the outcome of metal stents at this distinctive anatomical site. All patients were subjected to Doppler examination, where the stenotic lesion and the AVF flow volume were assessed prior to intervention. The follow-up period reached up to 57 months in some patients. All patients were under surveillance and were assessed for patency and flow volume. The primary and secondary stenosis-free rates were calculated. Re-intervention during the follow-up period was recorded.ResultsThe technical success rate was 100%. Twenty-six patients had balloon angioplasty. Eighteen patients had primary and/or secondary stents inserted. The primary patency rate at 6 and 12 months for the balloon angioplasty group was 80% and 60% and for the stent group was 86% and 71%, respectively. The mean primary patency rate in balloon angioplasty patients was 12.9 months, while in the primary stented patients was 19.9 months. Twenty-six patients had secondary intervention. The average secondary patency rate for patients with balloon angioplasty was 25.5 months, while it was 33.6 months in the stented patients.ConclusionCephalic arch angioplasty and stenting is an effective intervention increasing the longevity of the AVF that is crucial for hemodialysis patients. The use of metal stents whether bare metal stents or covered stents is safe and adds significant increase in patency rates.

The combination of endoluminal radiofrequency ablation and metal stent implantation for the treatment of malignant biliary stenosis – Randomized study

PurposeTo analyse whether endobiliary radiofrequency ablation prior metal stent insertion in malignant biliary stenosis show improved survival or stent patency. Methods76 patients with histologically proven malignant biliary stenosis have been enrolled in a prospective, randomized study. In control arm, 40 patients underwent self-expandable metal stent insertion. In experimental arm, the endoluminal ablation with a bipolar radiofrequency catheter was performed immediately before stent insertion. A subgroup analysis of cholangiocarcinoma was performed (22 vs 21 patients). The objective of the study was to determine the rate of complications, duration of the stent patency and the survival of patients (Kaplan-Meier analysis). ResultsNo major complications related to the stent insertion and the endoluminal ablation were found. The mean primary stent patency was 5.2 (95% CI 0.7–12.8) vs 4.8 months (95% CI 0.8–18.2) months (p = 0.79) in control and experimental group, respectively, in the subgroup analysis with cholangiocarcinoma 4.5 (95% CI 0.8–10.3) and 9.6 (95% CI 5.2–11.2) months (p = 0.029). The median survival since the insertion of the stent was 6.8 (95 %CI 3.0–10.6) vs 5.2 (95 %CI 2.4–7.9) months (p = 0.495) and since the initial drainage 9.8 (95 %CI 6.9–12.7) vs 9.1 (95 %CI 5.4–12.7) months (p = 0.720) in the control and experimental arm. ConclusionEndobiliary radiofrequency ablation prior metal stent insertion showed increased patency rate only in patients with cholangiocarcinoma, on the other hand, no improvement in survival was demonstrated in this randomized clinical study.

Farklı Vasküler Giriş Yollarında Tünelli Hemodiyaliz Kateterlerinin Değerlendirilmesi

Objective: To determine the patency rates and reasons for failure using different access routes for tunneled hemodialysis catheters. &#x0D; Methods: The records of patients who underwent insertion of 14 French tunnelled hemodialysis catheters were retrospectively analyzed. Catheter patency survival was demonstrated using Kaplan-Meier survival curve. Catheter failure and exchange reasons were evaluated. &#x0D; Results: One hundred and six patients underwent 474 catheter exchanges (mean/patient 4.47±1.62). Access was via right internal jugular vein (IJV) n=40, left IJV n=23, right femoral vein (FV) n=18, left FV n=11 and transhepatic vein n=14. The causes of catheter failure and exchange were: catheter-associated infection, catheter thrombosis, fibrin sheath and catheter tip malposition. Mean primary and cumulative catheter patency time was higher in the right IJV group (732 and 1337 days, respectively) compared with the others (p

Transrenal Hemodialysis Catheter Insertion and Replacement in Patients with Upper Extremity Central Venous Access Exhaustion.

Patients undergoing long-term hemodialysis may suffer upper extremity central venous access failure and require an alternative route. This study aimed to evaluate the safety and efficacy of transrenal hemodialysis catheter insertion/replacement in patients with upper extremity central venous access failure. A multicenter retrospective cohort study was made of transrenal hemodialysis catheter insertion/replacement performed between 2014 and 2020. The history of renal replacement therapy and central venous catheters and the technical details of transrenal hemodialysis catheter insertion/replacement, patency, removal and complications were obtained for all patients. Six insertion and four replacement procedures involving transrenal hemodialysis catheters were evaluated in six patients (M:F = 3:3; median age, 49.5years). Percutaneous transrenal (right:left = 1:5) hemodialysis catheter insertion was technically successful without complication in all six patients. In two patients, the tract was not lost because the safety guidewire was still in place, so no second puncture was required. The mean procedure time was 33.0 ± 9.2min. The mean primary patency duration was 107.3 ± 70.9days. During the mean follow-up duration of 141.2 ± 137.1days, four hemodialysis catheter replacement procedures were successfully performed for catheter malfunction (n = 2) and dislodgement (n = 2). Catheter removal was successfully performed in four patients after confirming normal coagulation, followed by subsequent renal replacement therapy. Percutaneous insertion/replacement of transrenal hemodialysis catheters is feasible, safe, and effective when upper extremity central venous access is exhausted, and the catheters can be maintained for a reasonable period of time. Level 4, Case Series.

The Cleaner XT™ Device as an Endovascular Adjunct for Pharmacomechanical Thrombolysis of Thrombosed Arteriovenous Fistulas and Grafts

Objective: This paper documents our experience using the Cleaner XT™ device (Argon Medical Devices, Plano, TX, USA) for pharmacomechanical thrombolysis (PMT) of thrombosed haemodialysis arteriovenous grafts (AVG) and fistulas (AVF).Materials and Methods: This was a retrospective case series (n=17) over six months at Singapore General Hospital. We evaluated demographics, procedural data, technical and procedural success, patency rates and complications.Results: There were 8 (47%) males and the patients’ mean age was 66 (± 5.7) years. The mean age of AVF/AVG was 1605 (± 1099) days. All procedures were performed under local anaesthetic. PMT was performed within a mean time of 40 (±34.3) hours from the presentation. Technical, clinical and procedural success was 15/17 (88%). The thrombolysis agents used were tissue plasminogen activator (52.9%) and urokinase (41.2%). Mean primary patency time was 114 (± 116) days, with a 65% 1-month and 47% 3-month primary patency rates. The mean secondary patency time was 155 (±132) days, with 76% one-month and 65% three-month secondary patency rates, respectively. AVF rupture occurred in 3/17 (18%) cases but did not involve loss of the access circuit.Conclusion: The Cleaner XT™ device is a safe, minimally invasive endovascular tool for PMT in thrombosed AVF/AVG, with relatively high success and low complication rates.

Patency of ePTFE Arteriovenous Graft Placements in Hemodialysis Patients: Systematic Literature Review and Meta-Analysis.

Arteriovenous grafts (AVGs) are an appropriate option for vascular access in certain hemodialysis patients. Expanded polytetrafluoroethylene (ePTFE) has become the dominant material for such grafts, due in part to innovations in graft design and surgical interventions to reduce complications and improve patency rates. Comprehensive evidence syntheses have not been conducted to update AVG performance in an era in which both access choice and ePTFE graft functioning may have changed. We conducted a systematic review and meta-analysis summarizing outcomes from recent studies of ePTFE AVGs in hemodialysis, following PRISMA standards. Literature searches were conducted in multiple databases to identify observational and interventional studies of AVG patency and infection risk. Primary, primary-assisted, and secondary patency rates were analyzed at 6, 12, 18, and 24 months postplacement. Kaplan-Meier graft survival plots were digitized to recreate individual patient-level data. Patency rates were pooled using a random effects model. We identified 32 studies meeting our selection criteria that were published from 2004 through 2019. A total of 38 study arms of ePTFE grafts were included, representing 3381 AVG accesses placed. The mean primary, primary-assisted, and secondary patency rates at 1 year were 41% (95% CI, 35% to 47%), 46% (95% CI, 41% to 51%), and 70% (95% CI, 64% to 75%), respectively. Mean 24-month patency rates were 28% (95% CI, 22% to 33%), 34% (95% CI, 27% to 41%), and 54% (95% CI, 47% to 61%), respectively. A high degree of heterogeneity across studies was observed. Overall risk of infection was not consistently reported, but among available studies the pooled estimate was 9% per patient-year (95% CI, 6% to 12%). This meta-analysis provides an up-to-date estimate of the performance of ePTFE AVGs, within the context of improved graft designs and improved interventional techniques.

Effect of short-term low molecular weight heparin on patency following successful salvage of arteriovenous access with recurrent thrombosis.

This study aims to investigate the effect of low molecular weight heparin (LMWH) in maintaining the patency of arteriovenous (AV) access with recurrent thrombosis. Following successful thrombectomy, 66 patients with recurrent thrombosis were included in the study. The primary, assisted primary and secondary patency rates of patients who received LMWH (n = 24) were compared with those who did not receive anticoagulant (n = 42) using Kaplan-Meier analysis. Cox-regression analysis was performed to investigate potential predictors of patency rates. The mean dose of enoxaparin used was 40 ± 13.1 mg or 0.74 ± 0.2 mg/kg daily for a median duration of 14 (IQR 7,28) days. The mean trough anti-Xa concentrations measured after two doses of LMWH was 0.17 ± 0.13 IU/mL. Kaplan-Meier analyses for mean primary, assisted primary and secondary patency rates of LMWH vs no anticoagulation groups were 149 (95% CI: 91 - 207) vs 87 (95% CI: 42-132) days (P < .006), 230 (95% CI: 142-320) vs 107 (95% CI: 62-150) days (P = .01) and 438 (299-579) vs 294 (95% CI: 197-392) days (P = .08) respectively. LMWH remained a significant protective predictor of primary (HR: 0.49; 95% CI: 0.25-0.86; P = .02) and assisted primary patency rates (HR: 0.51; 95% CI: 0.27-0.98; P = .04) after adjusting for patient age, access age, type of AV access, presence of peripheral vascular disease and haemoglobin levels. LMWH may improve short and mid-term patency rates for AV accesses with recurrent thrombosis.

Temporary Covered Metallic Ureteral Stent Placement for Ureteral Strictures following Kidney Transplantation: Experience in 8 Patients

This brief report presents 8 patients with silicone-covered metallic stent placement for ureteral strictures refractory to double-J stent placement, following kidney transplantation. Stent removal was successfully performed in 7 patients via antegrade (n = 4) or retrograde (n = 3) access 6 weeks to 6 months after stenting for elective removal (6-month interval, n = 3), urothelial hyperplasia (n = 2), or stent migration (n = 2), and their mean primary ureteral patency after stent removal was 15.4 months (range, 2–27 months). Hematuria (n = 2) and pain (n = 3) occurred, but resolved within 1 week. One stent was removed during reconstructive surgery. During follow-up of mean 22.6 months after stent removal, ureteral strictures recurred in 2 patients.

Long-term outcome of posterior approach insertion of tunneled cuffed catheter: A single clinic retrospective analysis.

For patients who rely on a tunneled cuffed catheter, the internal jugular vein is the preferred site of insertion. A few studies have suggested that the posterior approach for central lines is equivalent or better in comparison to the conventional central approach. However, there have been fewer studies examining tunneled cuffed catheter insertion using the posterior approach. We have performed many posterior insertions of tunneled cuffed catheters in our practice, and because the technique has not yet been comprehensively studied for long-term use, we performed a retrospective study to evaluate the safety and efficacy of posterior approach for tunneled cuffed catheter in maintained hemodialysis patients. A retrospective review was conducted of 200 hemodialysis patients who were treated with tunneled cuffed catheters over a period of 3 years. There were 104 patients in the study group, as well as a 96-patient control group, who underwent catheter insertion by central approach. The clinical follow-up data were collected and analyzed. All catheters were successfully placed. The mean primary patency days per catheter were 712 catheter days for the study group and 585 catheter days for the control group. The episode of catheter infection was similar in both groups (p = 0.874), but the case of total catheter dysfunction was significantly lower in the study group compared to the control group (p = 0.006). The cumulative patency of catheters was higher in the study group than that in the control group (p = 0.02), while patient survival was the same in the two groups (p = 0.325). The posterior approach is safe, and similar infection rates were observed with lower dysfunction rates compared to tunneled catheter insertion by the conventional central approach.

Use of Paclitaxel Coated Drug Eluting Technology to Improve Central Vein Patency for Haemodialysis Access Circuits: Any Benefit?

PurposeCentral venous stenosis is a recurring problem affecting dialysis access patency. Increasing evidence suggests that the use of drug-coated balloons (DCBs) improves target lesion primary patency (TLPP) in dialysis access. However, few studies have investigated the use of DCBs specifically in central venous stenosis. Thus, this study presents our initial experience with DCBs in the central vein of a dialysis access circuit.Materials and MethodsThis is a retrospective cohort study of all hemodialysis patients who underwent central vein angioplasty with DCB between February 2017 and March 2018 at Singapore General Hospital. We compared the primary patency post DCB angioplasty to the primary patency of the patient’s previous plain old balloon angioplasty (POBA).ResultsWe observed a 100% anatomic and procedural success rate with no complications. The median follow-up period was 151 days (interquartile range, 85.5-234 days) and no patients were lost to follow-up. The 30- and 90-day TLPPs after DCB were 93.3% and 75.7%, respectively. The mean primary patency in our study group post-DCB during the follow-up period was 164 days (vs. 140 days in the POBA group). However, no statistically significant difference was detected. ConclusionDCB showed a similar TLPP to that for POBA in treating central venous stenosis with a trend toward a longer re-intervention-free period for DCB. However, there were numerous confounding factors and a well-designed randomized controlled trial is warranted to assess the true utility of DCB in treating central venous stenosis.

Stent performance in palliative transhepatic treatment of malignant biliary obstruction: a randomized study comparing covered versus uncovered stents.

Considering the limitations in both uncovered self-expandable metallic stents (USEMS) and covered self-expandable metallic stents (CSEMS), it is difficult to make a general recommendation for their application in percutaneous decompression of malignant biliary obstruction (MBO). To compare percutaneous transhepatic CSEMSs versus USEMSs for the palliative treatment of MBO in terms of technical success, clinical success, stent patency, patient survival, complications, and stent dysfunction. This prospective randomized study included 66 patients with unresectable MBO. CSEMSs were inserted in 31 patients (26 men, 5 women; mean age = 63.8 ± 7.96 years) and USEMSs were inserted in 35 patients (26 men, 9 women; mean age = 62.3 ± 11.7 years). Mean primary stent patency duration was 138 ± 92.7 days in CSEMSs versus 150 ± 77.9 days in USEMSs (P = 0.578). Tumor overgrowth occurred exclusively in one patient with CSEMS (P = 0.470) and tumor ingrowth exclusively in two patients with USEMS (P = 0.494). Stent migration occurred in two patients with CSEMSs versus one patient with USEMSs (P = 0.579). Hemobilia occurred in five patients with CSEMSs versus three patients with USEMSs while bile leakage occurred in one patient in each group despite the larger introducer sheath caliber with CSEMSs (9 F vs. 6-7 F). There was no significant difference regarding patient survival (P = 0.969). In our cohort of patients with rather poor life expectancy, there was no significant difference between covered and uncovered stents for the palliative treatment of MBO. However, considering the higher cost of CSEMs and the larger introducer diameter necessary for their placement, USEMSs can be preferred.