Type Of Vascular Access Research Articles

Vascular Access Considerations in Home Hemodialysis.

There is a global interest in expanding home dialysis utilization among patients with ESKD. Home hemodialysis (HHD) is an appealing KRT option for this population because of its multiple clinical and quality of life benefits. Central to successful HHD is the establishment and maintenance of a functioning vascular access that serves as a patient's lifeline while on therapy. While the selection of a vascular access type is influenced by individual patient circumstances, the arteriovenous fistula is generally the preferred access method. Training patients to use their dialysis access requires attention to safety, risk management, and monitoring for complications to minimize adverse events and technique failure. Policies incorporating systematic frameworks for quality improvement and assurance, in conjunction with the measurement of metrics relating to vascular access, are tools that should be used by HHD programs to enhance the value of care delivered. In this perspective, we aim to describe what is currently known about the various vascular access options in HHD and to elucidate what needs to be taken into consideration in the selection and care of this access.

Patients, healthcare providers, and general population preferences for hemodialysis vascular access: a discrete choice experiment.

A patient-centered dialysis treatment option requires an understanding of patient preferences for alternative vascular accesses and nephrologists often face difficulties when recommending vascular access to end-stage kidney disease (ESKD) patients. We aimed to quantify the relative importance of various vascular access characteristics to patients, healthcare providers and general population, and how they affect acceptability for patients and healthcare providers. In a discrete choice experiment, patients with maintenance hemodialysis (MHD), healthcare providers, and individuals from the general population were invited to respond to a series of hypothetical vascular access scenarios that differed in five attributes: cumulative patency, infection rate, thrombosis rate, cost, and time to maturation. We estimated the respondents' preference heterogeneity and relative importance of the attributes with a mixed logit model (MXL) and predicted the willingness to pay (WTP) of respondents via a multinomial logit model (MNL). Healthcare providers (n = 316) and the general population (n = 268) exhibited a favorable inclination toward longer cumulative patency, lower access infection rate and lower access thrombosis rate. In contrast, the patients (n = 253) showed a preference for a 3-year cumulative patency, 8% access infection rate, 35% access thrombosis rate and 1.5 access maturity time, with only the 3-year cumulative patency reaching statistical significance. Among the three respondent groups, the general population found cumulative patency less important than healthcare providers and patients did. Patients demonstrated the highest WTP for cumulative patency, indicating a willingness to pay an extra RMB$24,720(US$3,708) for each additional year of patency time. Patients and healthcare providers had a strong preference for vascular access with superior patency. While the general population preferred vascular access with lower thrombosis rates. These results indicate that most patients prefer autogenous arteriovenous fistula (AVF) as an appropriate choice for vascular access due to its superior patency and lower complications than other vascular access types.

Global variations in funding and use of hemodialysis accesses: an international report using the ISN Global Kidney Health Atlas

BackgroundThere is a lack of contemporary data describing global variations in vascular access for hemodialysis (HD). We used the third iteration of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) to highlight differences in funding and availability of hemodialysis accesses used for initiating HD across world regions.MethodsSurvey questions were directed at understanding the funding modules for obtaining vascular access and types of accesses used to initiate dialysis. An electronic survey was sent to national and regional key stakeholders affiliated with the ISN between June and September 2022. Countries that participated in the survey were categorized based on World Bank Income Classification (low-, lower-middle, upper-middle, and high-income) and by their regional affiliation with the ISN.ResultsData on types of vascular access were available from 160 countries. Respondents from 35 countries (22% of surveyed countries) reported that > 50% of patients started HD with an arteriovenous fistula or graft (AVF or AVG). These rates were higher in Western Europe (n = 14; 64%), North & East Asia (n = 4; 67%), and among high-income countries (n = 24; 38%). The rates of > 50% of patients starting HD with a tunneled dialysis catheter were highest in North America & Caribbean region (n = 7; 58%) and lowest in South Asia and Newly Independent States and Russia (n = 0 in both regions). Respondents from 50% (n = 9) of low-income countries reported that > 75% of patients started HD using a temporary catheter, with the highest rates in Africa (n = 30; 75%) and Latin America (n = 14; 67%). Funding for the creation of vascular access was often through public funding and free at the point of delivery in high-income countries (n = 42; 67% for AVF/AVG, n = 44; 70% for central venous catheters). In low-income countries, private and out of pocket funding was reported as being more common (n = 8; 40% for AVF/AVG, n = 5; 25% for central venous catheters).ConclusionsHigh income countries exhibit variation in the use of AVF/AVG and tunneled catheters. In low-income countries, there is a higher use of temporary dialysis catheters and private funding models for access creation.

Survival Rate of Hemodialysis Patients and Its Predictors: A Multicentric Retrospective Cohort Study

Background: Despite advancements in medical and nursing care, the mortality rate among hemodialysis patients remains unexpectedly high. Objectives: This study aimed to evaluate the survival rates and identify mortality predictors among hemodialysis patients in Qazvin Province, Iran, over a five-year period from March 2015 to March 2020. Methods: This historical cohort study involved 378 hemodialysis patients from seven hospitals in Qazvin province, including Bu Ali Sina, Velayat, Razi, Alvand, Valiasr, Bueen Zahra, and Avaj, covering the period from March 21, 2015, to March 20, 2020. The study was based on data extracted from the patient's medical records, offering a detailed overview of their medical history and treatments during this timeframe. Results: The study revealed a median survival time of 38.5 months, with survival rates at 1, 2, 3, 4, and 5 years being 84.3%, 68.1%, 53.2%, 39.8%, and 18.0%, respectively. Cox regression analysis identified several key predictors of mortality. Mortality rates increased with age, higher levels of blood urea nitrogen, and when hemoglobin levels fell below 10 g/dL or calcium levels exceeded 9.5 mg/dL. Conversely, patients who underwent hemodialysis three times a week had higher levels of education, used fistula access, and experienced significantly lower mortality rates. Conclusions: The study highlighted the need for targeted interventions to improve both the survival rates and quality of life for hemodialysis patients in Qazvin Province. It emphasized the importance of careful monitoring and effective management of factors such as age, blood urea nitrogen, hemoglobin, and calcium levels, as well as the patients' educational background, frequency of dialysis sessions, and type of vascular access. By focusing on these aspects, healthcare professionals in the region could significantly enhance patient outcomes and prognoses in hemodialysis care.

Elevated Leukocyte Glucose Index Is Associated with Long-Term Arteriovenous Fistula Failure in Dialysis Patients.

(1) Background: Arteriovenous fistula (AVF) is the preferred type of vascular access for dialysis in patients with end-stage kidney disease (ESKD). However, the primary patency of AVF at one year is under 70% due to several risk factors and comorbidities. Leukocyte glucose index (LGI), a new biomarker based on blood leukocytes and glucose values, has been found to be associated with poor outcomes in cardiovascular disease. The aim of this study is to analyze the impact of LGI on the long-term primary patency of AVF following dialysis initiation. (2) Methods: We conducted a retrospective observational study in which we initially enrolled 158 patients with ESKD admitted to the Vascular Surgery Department of the Emergency County Hospital of Targu Mures, Romania, to surgically create an AVF for dialysis between January 2020 and July 2023. The primary endpoint was AVF failure, defined as the impossibility of performing a chronic dialysis session due to severe restenosis or AVF thrombosis. After follow-up, we categorized patients into two groups based on their AVF status: "functional AVF" for those with a permeable AVF and "AVF failure" for those with vascular access dysfunction. (3) Results: Patients with AVF failure had a higher prevalence of atrial fibrillation (p = 0.013) and diabetes (p = 0.028), as well as a higher LGI value (1.12 vs. 0.79, p < 0.001). At ROC analysis, LGI had the strongest association with the outcome, with an AUC of 0.729, and an optimal cut-off value of 0.95 (72.4% sensitivity and 68% specificity). In Kaplan-Meier survival analyses, patients in the highest tertile (T3) of LGI had a significantly higher incidence of AVF failure compared to those in tertile 1 (p = 0.019). Moreover, we found that patients with higher baseline LGI values had a significantly higher risk of AVF failure during follow-up (HR: 1.48, p = 0.003). The association is independent of age and sex (HR: 1.65, p = 0.001), cardiovascular risk factors (HR: 1.63, p = 0.012), and pre-operative vascular mapping determinations (HR: 3.49, p = 0.037). (4) Conclusions: In conclusion, high preoperative values of LGI are positively associated with long-term AVF failure. The prognostic role of the biomarker was independent of age, sex, cardiovascular risk factors, and pre-operative vascular mapping determinations.

Impact of Vascular Access Type on Inflammatory Biomarkers and Clinical Outcomes in Haemodialysis Patients

Impact of Vascular Access Type on Inflammatory Biomarkers and Clinical Outcomes in Haemodialysis Patients

Therapeutic apheresis: is it safe in children with kidney disease?

BackgroundTherapeutic apheresis (TA) is already used to treat various diseases in the field of nephrology. The aim of this study was to evaluate the frequency and types of complications that occur during TA in children with kidney disease.MethodsRecords of children (≤ 18 years) who underwent TA between 2007 and 2022 were retrospectively reviewed. Children with missing data and those with a diagnosis of nonnephrological disease were excluded.ResultsA total of 1214 TA sessions, including 1147 therapeutic plasma exchange (TPE) sessions and 67 immunoadsorption (IA) sessions, were performed on the 108 patients enrolled in the study. Forty-seven percent of the patients were male, and the mean age was 12.22 ± 4.47 years. Posttransplant antibody-mediated rejection (64.8%) and hemolytic uremic syndrome (14.8%) were the most common diagnoses indicating TA. Overall, 17 different complications occurred in 58 sessions (4.8%), and 53 sessions (4.6%) were not completed because of these complications. The distribution of complications among the patients was as follows: 41.4% had technical complications, 25.9% had allergic complications, and 32.7% had others. The most common technical complication was insufficient flow (37.5%). The incidence of complications was greater in patients aged 3–6 years than in patients in the other age groups (p = 0.031). The primary disease, type of vascular access, and rate of fresh frozen plasma/albumin use were similar between patients with and without complications (p values of 0.359 and 0.125 and 0.118, respectively).ConclusionsOur study showed that complications occurred in only 4.8% of TA sessions. The most common complication was technical problems.Graphical A higher resolution version of the Graphical abstract is available as Supplementary information

Hemodialysis-Related Infections: A 4-Year Surveillance

Objective: To analyze the results from the surveillance of hemodialysis-related infections.Material and Methods: Data was prospectively gathered from outpatients attending a hemodialysis unit from April 2019 until March 2023. The National Healthcare Safety Network (NHSN) Dialysis Event Surveillance was used to identify three types of infection-related dialysis events. Event rates were calculated and stratified by vascular access type, standardized infection ratios for bloodstream infections (BSI), intravenous antimicrobial starts, and described pathogens identified among BSI.Results: A total of 2,288 patient-month follow-ups were included. There were 79 infection-related dialysis events (24 BSI; 46 intravenous antimicrobial starts, nine pus, redness, or increased swelling at the vascular access site). The incidence of BSI per 100 patient-months was 1.05 (0.59 arteriovenous fistula, 0.83 arteriovenous graft, and 2.22 central venous catheter). Seventeen BSI were vascular access-related. Access-related BSI per 100 patient-months was 0.74 (0.39 arteriovenous fistula, 0.41 arteriovenous graft, and 1.85 central venous catheter). Intravenous antimicrobial starts per 100 patient-months was 2.01 (0.98 arteriovenous fistula, 2.62 arteriovenous graft, and 3.14 central venous catheter). Most events occurred in patients with a central venous catheter. When benchmarked with the 2014 NHSN, the standardized infection ratio of BSI, access-related BSI, and intravenous antimicrobial starts were 1.40, 1.26, and 0.55, respectively. The most serious outcome was BSI; resulting in 83.3% hospitalizations, 25% loss of vascular access, and 15.8% deaths. Conclusion: Surveillance of infection-related dialysis events is important for prevention. These events were highest among patients with a central venous catheter compared with other vascular access types.

Does central venous stenosis affects the brachial artery flow volume and peripheral vascular resistive index in patients on maintenance hemodialysis? A retrospective study.

A well-functioning vascular access (VA) is crucial for the patients on maintenance hemodialysis (HD). Central venous stenosis (CVS) is a common, yet, overlooked complication of VA as its diagnosis is challenging. Moreover, its effect on the flow volume (FV) and the peripheral resistive index (RI) was not well discussed before. Despite the availability of doppler ultrasound (DUS) in most centers, direct visualization of central veins using DUS is quite difficult. This is a retrospective single-center self-controlled cohort study that was conducted in a specialized vascular access management tertiary center in Japan and included all patients with CVS who underwent percutaneous transluminal angiography (PTA) with or without vascular stenting in the period from January 2014 to September 2022. The patients were divided according to their VA type into arteriovenous fistula (AVF), and arteriovenous graft (AVG) groups, then subdivided, according to the type of stenosis, into two subgroups: CVS, and mixed central and peripheral venous stenosis (MVS) groups. The FV and RI of the feeding artery were compared in the same procedure before and after PTA to assess the impact of the procedure itself. Data of 485 percutaneous transluminal angiography procedures (PTA), performed in 95 patients during the period from January 2014 to September 2022, were collected. FV and RI were significantly affected in the patients with MVS than patients with CVS. After PTA, both FV and RI were significantly improved. The improvement rate of FV and RI after PTA were significantly higher in patients with MVS than patients with CVS. However, it was difficult to determine the cut-off value to diagnose or to assess the improvement of CVS. Our findings suggest that FV and RI measurement by DUS are good tools, along with the clinical findings for assessment of CVS in certain situations.

Role of Doppler Evaluation in Assessing the Maturation of the Arteriovenous Fistula for Hemodialysis: An Observational Study.

Introduction Arteriovenous fistulas (AVFs) are the preferred type of vascular access for hemodialysis due to their lower risk of complications. This study aimed to determine the role of Doppler evaluation in assessing AVF. Materials and methods We conducted an 18-month prospective observational study of 33 hemodialysis patients who underwent a procedure for the creation of AVF at the Department of Radio-Diagnosis at Sri Devaraj Urs Academy of Higher Education and Research.Patients were evaluated using color Doppler ultrasound. Participants underwent a careful history and clinical examination to diagnose the disease. All relevant parameters were documented in a structured study proforma. AVF maturation was assessed postoperatively at four weeks using Doppler ultrasound color flow evaluation by looking for vascular components (flow volume, vein, and arterial diameter). Data were analyzed using CoGuide V 1.0.3 Statistical Software (CoGuide, Bangalore, India). Results A total of 33 patients, with a mean age of 54.6 ± 7.8 years, were evaluated. Of the 33 participants, 24 (72.7%) were male, and nine (27.3%) were female. The majority (47%, n=16) of participants had diabetes mellitus, eight (24%) had hypertension, and 10 (29%) had both diabetes mellitus and hypertension. A brachiocephalic fistula was created in 45.5% of participants, and 33.33% had radiocephalic anastomoses. Five participants were diagnosed with AVF complications: two had a pseudoaneurysm, and three had a cephalic vein thrombus. Clinical and demographic characteristics (age, vascular components, and complications) were not significantly related to AVF maturation. Conclusions Doppler ultrasound plays an important role in selecting vessels for AVF preoperatively and assessing AVF maturation postoperatively, thus reducing the primary fistula failure rate. The findings suggest that Doppler evaluation can be a reliable tool for assessing AVF maturation and predicting surgical success, which could help healthcare providers make informed decisions about the best course of treatment for their patients. Continued research is warranted in this area to further understand the role of Doppler ultrasound in evaluating AVF surgery.

Preoperative mapping and multidisciplinary team are the key to success of arteriovenous access for hemodialysis

Introduction and objectivesFunctional and durable vascular access is needed for adequate hemodialysis. Arteriovenous fistula is preferred over prosthetic grafts or central venous catheters, but it is associated with high rates of primary failure and maturation failure.Preoperative mapping of arm vessels with color Doppler ultrasound (CDU) has been shown to be helpful in achieving better short and long-term outcomes. Unfortunately, is more time-consuming than a physical examination and requires an experienced examiner and special equipment; some authors defend that CDU should not be part of the routine preoperative assessment.We reported our experience in preoperative vessel mapping using color Doppler ultrasound to purpose a vascular access to the surgical team, surveillance of vascular access, and evaluation of main outcomes (primary failure, maturation failure, and patency). MethodsThis is a single-center retrospective study that includes patients who attended a specific appointment for vascular access planning consultation between January 2019 and December 2021. A nephrologist performed the physical exam and vascular mapping and proposed to the vascular surgeon team a specific type and location of vascular access. Patients were followed until one month after the first hemodialysis through functioning vascular access. ResultsIn this study, 167 patients were evaluated (114 incident patients – chronic kidney disease stage 4 or 5 – and 53 prevalent patients – under hemodialysis through central venous catheter). The vascular accesses proposed by nephrologist were radial-cephalic arteriovenous fistula in 70 patients (41.9%), brachio-cephalic arteriovenous fistula in 50 patients (29.9%), brachio-basilic arteriovenous fistula in 34 patients (20.4%), arteriovenous graft in 8 patients (4.8%) and central venous catheter in 2 patients (1.2%).Vascular access was constructed in 141 patients: distal arteriovenous fistula in 57 patients (40.4%), brachio-cephalic arteriovenous fistula in 54 patients (38.3%), brachio-basilic AVF in 27 patients (19.1%), and arteriovenous graft in 3 patients (2.1%). The created access corresponds to the proposed access in 129 patients (91.5%).Twenty-two (15.6%) primary failures were registered. Distal arteriovenous fistulas and diabetes mellitus were associated with a higher risk of primary failure (OR=3.929 (1.485–10.392), p=0.004; OR=3.867 (1.235–12.113), p=0.014, respectively).The incidence of maturation failure at eight weeks was 4.8%.The primary patency at 6, 12 and 24 months was 76.3%, 70.4% and 49.2%. Primary assisted patency was 84.8% at 6 and 12 months and 81.3% at 24 months. ConclusionsThis study demonstrates that the study of the entire vascular territory performed with color Doppler ultrasound, within a multidisciplinary team of nephrologists and vascular surgeons, is associated with high rates of autologous access and very low rates of primary failure and maturation failure (almost unprecedented in the literature).

Risk of acute kidney injury in elective percutaneous coronary intervention: A comparative study of radial and femoral access

The impact of vascular access type, specifically transradial versus transfemoral, on the occurrence of acute kidney injury (AKI) in patients undergoing percutaneous coronary intervention (PCI) remains uncertain. In this study, we aimed to compare the incidence of AKI between the two access groups.&#x0D; Methods. This prospective observational study involved 164 adult patients undergoing elective PCI. Patients were categorized into transfemoral (n = 100) and transradial (n = 64) groups. Demographic data, including age, sex, body surface area, and preoperative glomerular filtration rate, as well as clinical information such as the presence of baseline ventricular dysfunction, diabetes mellitus, hypertension, postoperative blood loss, and transfusion volume, were recorded. Serum creatinine levels within the first 48-72 hours postoperatively were also documented.&#x0D; Results. Out of 100 patients in the transfemoral group, 12 (12%) developed AKI compared with 2 patients out of 64 (3.13%) in the transradial group. In the logistic multivariate analysis, several independent risk factors for AKI in patients undergoing PCI were identified. These factors included age &gt;55 years (OR 2.88, 95% CI 1.09; 11.97, p = 0.046), diabetes (OR 4.82, 95% CI 1.12; 31.65, p = 0.039), preprocedural creatinine levels &gt; 0.85 mg/dL (OR 3.17, 95% CI 1.54; 17.96, p = 0.019), fluoroscopy time &gt; 10 min (OR 6.55, 95% CI 1.65; 26.03, p = 0.008), Mehran score indicating a risk of contrast-induced nephropathy &gt;8 (OR 4.23, 95% CI 1.25; 14.3, p = 0.020), and transfemoral access (OR 3.22, 95% CI 1.08; 18.54, p = 0.044).&#x0D; Conclusions. Transradial access is associated with a significant independent reduction in the incidence of post-PCI AKI compared with transfemoral access. Age &gt;55 years, diabetes, preprocedural creatinine &gt; 0.85 mg/dL, fluoroscopy time &gt; 10 min, Mehran score &gt;8, and transfemoral access were identified as independent risk factors for AKI in patients undergoing PCI.

НАРУШЕНИЕ ПРОХОДИМОСТИ ВЕН ВЕРХНИХ КОНЕЧНОСТЕЙ У ПАЦИЕНТКИ С ПОКАЗАНИЯМИ К ИМПЛАНТАЦИИ ЭЛЕКТРОКАРДИОСТИМУЛЯТОРА (КЛИНИЧЕСКИЙ СЛУЧАЙ)

Today, permanent cardiac pacing is the most effective way to correct bradyarrhythmia. Most pacemaker leads are implanted through the veins of the upper extremities. Common vein access involves either a cephalic vein cutdown or a puncture of the subclavian or axillary veins. Implantation of leads may become technically difficult or unfeasible if there is an anomaly in the structure of the veins or, more often, occlusion/stenosis of the veins of the upper extremities after thrombosis. The article presents It is illustrated with the case of a 75-year-old patient with indications for pacemaker implantation presented by the article. The first implantation attempt was unsuccessful: extensive occlusion of the left subclavian vein (SCV) and stenosis of the right SCV were detected. The venous obstruction was asymptomatic. The patient underwent venography and was diagnosed with up to 90% luminal narrowing of the right SCV. Percutaneous transluminal angioplasty of the right SCV was performed; the residual stenosis was 50%. Subsequently, a dual-chamber pacemaker was successfully implanted into the patient; the postoperative period was uneventful. The vein obstruction could be related to a history of malignant neoplasm of the uterus. A brief literature review of various types of vascular access for pacemaker implantation and alternative implantation options complements the case report. Keywords: Pacemaker, venous thromboembolic complications, deep vein thrombosis, deep vein stenosis, angioplasty.

Challenges associated with vascular access through the common carotid artery during embalming procedures in humans: A technical note.

The teaching of anatomy is a key component in the training of physicians, and the foundation of this teaching is the human body, which must be properly prepared to be used as a teaching aid. Due to a lack of modern literature on this topic, we decided to write a technical note discussing access to the carotid artery. We pre-qualified 43 donor bodies for the study. The bodies had to meet standards such as no signs of post-mortem decomposition, preservation of body integrity, and the absence of known infections. Carotid artery access was performed based on descriptions of the types of vascular access performed in surgery and our own observations. We consider carotid artery access to be a convenient option due to its ease of location. When performed correctly and with attention to the surrounding structures, it is relatively low in tissue trauma, which translates into a higher quality of preparation. Data analysis has revealed several factors that can have a significant impact on the success of the embalming procedure. Proper execution of minimally invasive access to the common carotid artery minimizes tissue damage and ensures a high success rate of the procedure. Knowledge of the types of vascular access is essential for preparing the highest quality specimens.

Sex-dependent differences in patients treated with regular hemodialysis

&amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Introduction.&amp;lt;/strong&amp;gt; The aims of the study were to find out sex differences among patients starting regular hemodialysis (HD) in 2014 and to check whether these differences change over a five-year period.&amp;lt;/p&amp;gt; &amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Methods.&amp;lt;/strong&amp;gt; The retrospective five-year study included 35 patients (24 men; 11 women) starting HD in HD centers in Leskovac and Pirot in 2014. Demographic data, clinical data, laboratory findings, and medication used for examined patients were taken from medical records.&amp;lt;/p&amp;gt; &amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Results.&amp;lt;/strong&amp;gt; A comparison of patients of different sexes at the beginning of the study showed that women were significantly older (70.55 &amp;amp;plusmn; 13.27 vs. 58.88 &amp;amp;plusmn; 15.27 years), but diabetes and hypertension were more frequent causes of chronic kidney disease in men. Women had significantly lower body mass index and serum creatinine level than men in the first year of the study. During all five years, the HD adequacy index spKt/V was higher in women than in men, but the difference reached statistical significance only in the third year (1.4 &amp;amp;plusmn; 0.2 vs. 1.2 &amp;amp;plusmn; 0.2). Serum iPTH level was higher in women than in men in almost the entire study period. There was no significant sex difference in blood pressure, type of vascular access, number of HD hours per week, in the percentage of patients who used erythropoiesis-stimulating agents or phosphate binders. During the study period 10 (42.7%) men and five (45.5%) women died and the most frequent causes of death were cerebrovascular and cardiovascular diseases.&amp;lt;/p&amp;gt; &amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Conclusion. &amp;lt;/strong&amp;gt;The study revealed several differences between men and women on regular HD, but no treatment inequality was found.&amp;amp;nbsp;&amp;lt;/p&amp;gt;

Integrating vascular access surveillance with clinical monitoring for stenosis prediction.

Arteriovenous fistula and arteriovenous graft are the most common types of vascular access for dialysis; stenosis and thrombosis are major complications leading to access failure andto an incresed risk ofmortality.The aim of the present study wasto assess the results of integrating strictvascular access blood flow surveillance with routine clinical monitoring for predicting vascular access stenosis in chronic hemodialysis patients. In this retrospective study, chronic dialysis patients with arteriovenous fistula or arteriovenous graft were included from a settingin which all patients underwent quarterly blood flow surveillance in 2017. The results of blood flow surveillance were confirmed by thorough physical examination. Predictive performance of blood flow surveillance models in detecting stenosis in patients with arteriovenous fistula or arteriovenous graft was evaluated.The predictive performance of the quarterlyblood flow surveillance model was described by confusion matrix. Differences in accuracy, positive predictive value (PPV), and negative predictive value (NPV) between blood flow surveillance models with distinct blood flow thresholds were evaluated. Of 397 included patients, 336 had anarteriovenous fistula and 61 had anarteriovenous graft. In 2017, 106 percutaneous transluminal angioplasty procedures were performed in patients with anarteriovenous fistula, and 63 in patients with anarteriovenous graft. The results revealed similar predictive performance of surveillance models using an absolute blood flow threshold of < 500 or < 400mL/min in predicting stenosis inpatients with arteriovenous fistula. Blood flow surveillance models for patients with anarteriovenous fistula had significantly higher accuracy than those for patients with anarteriovenous graft. Furthermore, the use ofarelative threshold, defined as blood flow < 1000mL/min and a 25% decline in blood flow, did not affect thepredictive performance of blood flow surveillance models. Blood flow surveillance models using thresholds of < 400 and < 600mL/min, followed by thorough physical examination, showed an accuracy of 91.54% and 72.15% in predicting stenosis inpatients with arteriovenous fistula and arteriovenous graft, respectively. These two blood flow surveillance models may be integrated with routine clinical monitoring to improve early detection and treatment of stenosis in hemodialysis patients.

Sheathless radial approach in contemporary coronary rotational atherectomy: data from two high-volume centers

Aim: To analyze the feasibility and procedural outcome of percutaneous coronary intervention (PCI) using rotational atherectomy (RA), performed via transradial sheathless guiding catheter, as compared to a standard radial and femoral vascular approach. Methods: All consecutive patients undergoing RA at two high-volume PCI centers from May 2011 to May 2023 were included. Comparisons were made between the two transradial approaches and between the three types of vascular access. Results: Two hundred twenty-three patients were enrolled. Baseline characteristics were similar, with the exception of gender. We observed, in percentages, fewer cases of failure for sheathless than standard transradial attempts (7.5% vs. 11.5%, respectively), whereas all trans-femoral attempts were successful. Transfemoral procedures were longer and more frequently performed under mechanical circulatory support. There was no difference in procedural success between the three vascular approaches. A trend towards a higher rate of vascular and bleeding complications was found in the femoral group. Conclusion: Sheathless transradial vascular access is a viable option when performing RA during complex PCI procedures, tending to result in fewer failures than the standard transradial approach and reduced bleeding and vascular complications compared to the femoral method.

Complications according to intrathoracic versus extrathoracic venous access for cardiac device implantation: results from the PLACE (Planning Lead Access for Cardiac Electrostimulation) study

Abstract Background and Aims The choice of the vascular access for cardiac pacing devices (CIED) implant may impact on patients outcome. Recent studies and consensus documents encourage the use of an extra-thoracic access to prevent adverse events. In this large, multicenter, retrospective study we report the impact of leads access on post-procedural outcome. Methods Consecutive patients receiving a CIED from 2008 to 2019 in 4 high-volume Italian hospitals were enrolled. Short- and long-term complications (i.e. pneumothorax, cardiac tamponade, pocket decubitus, pocket hematoma, lead dislodgement, lead failure) were collected and their relationship with the type of vascular access (extra- vs intra-thoracic, i.e. cephalic vein/extra-thoracic axillary vein vs subclavian vein puncture) was analyzed. Primary endpoint was the occurrence of at least one complication during follow-up. Results A total of 4,443 patients were enrolled; 3,374 (75.9%) received a pacemaker (PM) and 1,069 (24.1%) an implantable cardioverter defibrillator (ICD). Mean follow-up was 1,630±1,010 days. At least one complication occurred in 7.6% of patients. At multivariate Cox regression analysis, adjusted for baseline confounders, the presence of structural heart disease (HR 1.59, 95%CI 1.21-2.10; p=0.001), anticoagulant therapy at implantation [HR 1.31, 95%CI 1.0004-1.71; p=0.05) and female gender (HR 0.78, 95%CI 0.63-0.98; p=0.03) were associated with the primary outcome measure. Extra-thoracic access did not reduce the risk of complications compared to intra-thoracic access (HR 0.97, 95%CI 0.76-1.25 p=0.81). The use of both accesses in the same patient conferred a significant increase in the risk of complications (HR vs single approach:1.95, 95%CI 1.41-2.69; p &amp;lt;0.001). Conclusions The choice of a different vascular access (intra- vs extra-thoracic) does not impact on post-procedural complications in patients receiving CIED. In particular, the intra-thoracic subclavian vein puncture by experienced operators is not related to a poorer outcome. The need for both types of access in the same patient (i.e. increased procedure complexity) increases the risk of post-procedural complications.Graphical abstract

Arteriovenous Fistula about 400 Cases

Objective: Native arteriovenous fistula is the choice vascular acces for chronic hemodialysis due to its longevity, low complication rate and mortality compared to arteriovenous bypasses and catheters. The aim of our study is to present our surgical experience, to evaluate our results and show the main complications. Methods: We report our experience of 604 arteriovenous fistulas created in 400 patients undergroing hemodialysis for chronic renal failure. The mean fellow up period varied one day to eight years. Results: We have observed 25% of primary thrombosis and 16% of secondary thrombosis, there were two cases of local sepsis. Conclusion: We conclude that the Cimino-Brescia fistula is superior to any other type of vascular access in patients with renal failure.

Association Between Vascular Access Type and Health-Related Quality of Life

Association Between Vascular Access Type and Health-Related Quality of Life