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Vascular access in the elderly

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https://www.readbyqxmd.com/read/30339192/should-a-fistula-first-policy-be-revisited-in-elderly-haemodialysis-patients
#1
Carlo Lomonte, Carlo Basile, Sandip Mitra, Christian Combe, Adrian Covic, Andrew Davenport, Dimitrios Kirmizis, Daniel Schneditz, Frank van der Sande
Life-sustaining haemodialysis requires a durable vascular access (VA) to the circulatory system. The ideal permanent VA must provide longevity for use with minimal complication rate and supply sufficient blood flow to deliver the prescribed dialysis dosage. Arteriovenous fistulas (AVFs) have been endorsed by many professional societies as the VA of choice. However, the high prevalence of comorbidities, particularly diabetes mellitus, peripheral vascular disease and arterial hypertension in elderly people, usually make VA creation more difficult in the elderly...
October 17, 2018: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/30306819/anatomical-variants-of-upper-arm-veins-on-preoperative-mapping-venography-for-hemodialysis-access-in-korean-adults
#2
Hyung Seok Lee, Young Rim Song, Jwa Kyung Kim, Sun Ryoung Choi, Narae Joo, Hyung Jik Kim, Pyoungju Park, Sung Gyun Kim
INTRODUCTION: The number of elderly patients requiring hemodialysis has increased, along with the need for multiple vascular access placements. Thus, the frequency of access creation using the upper arm veins, including transposed basilic arteriovenous fistula, has also increased. The purpose of this study was to identify the prevalence of anatomical variations in the upper arm veins on preoperative mapping venography and to investigate the implications of such variants on access creation...
October 11, 2018: Journal of Vascular Access
https://www.readbyqxmd.com/read/30297628/prescribing-hemodialysis-or-hemodiafiltration-when-one-size-does-not-fit-all-the-proposal-of-a-personalized-approach-based-on-comorbidity-and-nutritional-status
#3
Giorgina Barbara Piccoli, Louise Nielsen, Lurilyn Gendrot, Antioco Fois, Emanuela Cataldo, Gianfranca Cabiddu
There is no simple way to prescribe hemodialysis. Changes in the dialysis population, improvements in dialysis techniques, and different attitudes towards the initiation of dialysis have influenced treatment goals and, consequently, dialysis prescription. However, in clinical practice prescription of dialysis still often follows a "one size fits all" rule, and there is no agreed distinction between treatment goals for the younger, lower-risk population, and for older, high comorbidity patients. In the younger dialysis population, efficiency is our main goal, as assessed by the demonstrated close relationship between depuration (tested by kinetic adequacy) and survival...
October 8, 2018: Journal of Clinical Medicine
https://www.readbyqxmd.com/read/30210903/one-burr-hole-craniotomy-suboccipital-midline-approach-to-the-fourth-ventricle-in-helsinki-neurosurgery
#4
Joham Choque-Velasquez, Juha Hernesniemi
Background: In this video-abstract, we present one burr-hole craniotomy for the standard suboccipital midline approach developed in Helsinki neurosurgery for the microsurgical management of forth ventricle lesions, distal posterior inferior cerebellar artery aneurysms, and tumoral and vascular lesions of the vermis, cisterna magna region, and posterior brainstem as well. Case Description: We prefer to position the patient in sitting praying position. A midline straight single-layer incision starts on the inion and extends caudally toward the level of C2...
2018: Surgical Neurology International
https://www.readbyqxmd.com/read/30112210/the-factors-affecting-survival-in-geriatric-hemodialysis-patients
#5
Murat Tuğcu, Umut Kasapoğlu, Gülizar Şahin, Süheyla Apaydın
Introduction: The number of geriatric patients is increasing in hemodialysis population over the years and mortality is higher in this group of patients. This study evaluated the factors affecting geriatric hemodialysis patient survival. Materials and Methods: This retrospective cohort study enrolled patients discharged from our nephrology clinic from 2009 to 2014. Data collected included demographics, Eastern Cooperative Oncology Group-Performance Status, vascular access type, and metabolic parameters...
2018: International Journal of Nephrology
https://www.readbyqxmd.com/read/30107906/evolution-of-length-of-stay-after-surgical-and-transcatheter-aortic-valve-implantation-over-8-years-in-1-849-patients-75-years-of-age-and-comparison-between-transfemoral-and-transsubclavian-transcatheter-aortic-valve-implantation
#6
Amedeo Anselmi, Annamaria Dachille, Vincent Auffret, Majid Harmouche, Antoine Roisne, Marc Bedossa, Hervé Le Breton, Jean-Philippe Verhoye
Minimized length of hospitalization (LoS) and lower risk of hospitalization-related complications are key requirements in the treatment of aortic valve disease, mainly in the elderly candidates. Our objective was to evaluate evolution of LoS after surgical (SAVR) or transcatheter aortic valve implantation (TAVI) and its predictors. We enrolled 1,849 elderly (aged >75) patients receiving SAVR or TAVI from 2009 to 2016. In the surgical cohort (n = 1,006) the mean LoS slightly decreased from 13.81 ± 9.27 days (2009) to 10...
July 20, 2018: American Journal of Cardiology
https://www.readbyqxmd.com/read/30107612/vascular-access-placement-and-mortality-in-elderly-incident-hemodialysis-patients
#7
Gang Jee Ko, Connie M Rhee, Yoshitsugu Obi, Tae Ik Chang, Melissa Soohoo, Tae Woo Kim, Csaba P Kovesdy, Elani Streja, Kamyar Kalantar-Zadeh
Background: Arteriovenous fistulas (AVFs) are the preferred vascular access type in most hemodialysis patients. However, the optimal vascular access type in octogenarians and older (≥80 years) hemodialysis patients remains widely debated given their limited life expectancy and lower AVF maturation rates. Methods: Among incident hemodialysis patients receiving care in a large national dialysis organization during 2007-2011, we examined patterns of vascular access type conversion in 1 year following dialysis initiation in patients <80 versus ≥80 years of age...
August 9, 2018: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/30065928/access-sites-for-tavi-patient-selection-criteria-technical-aspects-and-outcomes
#8
REVIEW
Luigi Biasco, Enrico Ferrari, Giovanni Pedrazzini, Francesco Faletra, Tiziano Moccetti, Francesco Petracca, Marco Moccetti
During the last ten years, transcatheter aortic valve implantation (TAVI) has become a reliable and valid alternative treatment for elderly patients with severe symptomatic aortic valve stenosis requiring valve replacement and being at high or intermediate surgical risk. While common femoral arteries are the access site of choice in the vast majority of TAVI patients, in up to 15-20% of TAVI candidates this route might be precluded due to the presence of diffuse atherosclerotic disease, tortuosity or small vessel diameter...
2018: Frontiers in Cardiovascular Medicine
https://www.readbyqxmd.com/read/29957644/making-it-stick-developing-and-testing-the-difficult-intravenous-access-diva-tool
#9
Barbara Smith Ehrhardt, Kelley E A Givens, Rebecca C Lee
: Background: Establishing peripheral IV access for infusions is one of the most common invasive procedures performed in the hospital setting, but it isn't always successful on the first attempt. Multiple attempts delay treatment and cause stress in patients and nurses. The literature reports that venipuncture skills are among the most challenging for novice nurses to master. OBJECTIVES: The goal of this quality improvement (QI) initiative was to develop, validate, and refine a simple evidence-based tool that novice nurses can use in the clinical setting to better identify those patients with preexisting conditions or anatomical variances that result in difficult IV access...
July 2018: American Journal of Nursing
https://www.readbyqxmd.com/read/29956884/safety-and-efficacy-of-nivolumab-for-metastatic-renal-cell-carcinoma-real-world-results-from-an-expanded-access-programme
#10
Ugo De Giorgi, Giacomo Cartenì, Diana Giannarelli, Umberto Basso, Luca Galli, Enrico Cortesi, Claudia Caserta, Sandro Pignata, Roberto Sabbatini, Alessandra Bearz, Sebastiano Buti, Giovanni Lo Re, Alfredo Berruti, Sergio Bracarda, Francesco Cognetti, Francesca Rastelli, Giuseppe Fornarini, Camillo Porta, Daniele Turci, Cora N Sternberg, Giuseppe Procopio
OBJECTIVE: To report the safety and efficacy results of patients enrolled in the Italian Nivolumab Renal Cell Cancer Expanded Access Programme. PATIENTS AND METHODS: Patients with metastatic renal cell cancer (mRCC) previously treated with agents targeting the vascular endothelial growth factor pathway were eligible to receive nivolumab 3 mg/kg once every 2 weeks. Patients included in the analysis had received ≥1 dose of nivolumab and were monitored for adverse events (AEs) using Common Terminology Criteria for Adverse Events (CTCAE) v...
June 29, 2018: BJU International
https://www.readbyqxmd.com/read/29938243/effects-of-anticoagulation-therapy-with-vitamin-k-antagonists-on-hospitalizations-and-emergency-room-accesses-in-grosseto-italy
#11
F NISTICò, G Troiano, N Nante, S Dei, P Piacentini
Introduction: A lot of drug groups are associated with preventable drug-related admissions. Coumarin derivatives, prescribed for the treatment and prevention of deep vein thrombosis or pulmonary embolism or prevention of systemic embolism or stroke in patients with prosthetic heart valves or atrial fibrillation, are often associated with bleeding. The aim of our study was to analyze how the anticoagulant therapy with VKAs could affects the hospitalizations and the visits to emergency room in the elderly population (> 65 years old)...
March 2018: Journal of Preventive Medicine and Hygiene
https://www.readbyqxmd.com/read/29873698/evolut-r-implantation-via-the-brachial-artery
#12
Giuseppe Bruschi, Bruno Merlanti, Paola Colombo, Claudio F Russo
Transfemoral transcatheter aortic valve implantation is an established therapy to treat elderly patients affected by severe aortic stenosis, who are considered to be at high or extreme risk for surgical aortic valve replacement. The transfemoral approach is contraindicated in patients with severe peripheral artery disease, small vessel size or severe tortuosity. In these patients, other vascular access routes such as transapical, subclavian or direct-aortic access may be considered. We describe the first case of a Medtronic Evolut R (Medtronic, Minneapolis, MN, USA) implantation made through the brachial artery in a 75-year-old patient affected by severe aortic stenosis...
June 4, 2018: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/29860739/-endovascular-intervention-in-central-venous-stenosis-and-obstructions-in-the-middle-aged-and-elderly-hemodialysis-patients-a-single-center-experience
#13
Yu Yu Garin, K L Kozlov, D S Medvedev
Central vein stenosis and obstruction is one of the main risk factors in vascular access failure among hemodialysis patients. The elderly patients are in a particularly group because of some problems of arteriovenous fistula creation and maintenance. To evaluate the effectiveness and safety of percutaneous transluminal angioplasty for the treatment of central vein stenosis and obstruction in the middle aged and elderly hemodialysis patients. Forty eight hemodialysis patients with central vein stenosis and obstruction were treated from 2010 to 2016...
2018: Advances in Gerontology, Uspekhi Gerontologii
https://www.readbyqxmd.com/read/29784614/tradeoffs-in-vascular-access-selection-in-elderly-patients-initiating-hemodialysis-with-a-catheter
#14
Timmy Lee, Joyce Qian, Mae Thamer, Michael Allon
RATIONALE & OBJECTIVE: National vascular access guidelines recommend placement of arteriovenous fistulas (AVFs) over grafts (AVGs) in hemodialysis patients, but have not been comprehensively assessed in the elderly. We evaluated clinically relevant vascular access outcomes in elderly patients receiving an AVF or AVG after hemodialysis therapy initiation. STUDY DESIGN: Retrospective cohort study using national administrative data. SETTINGS & PARTCIPANTS: Claims data from the US Renal Data System of 9,458 US patients 67 years and older who initiated hemodialysis therapy from July 1, 2010, to June 30, 2011, with a catheter and received an AVF (n=7,433) or AVG (n=2,025) within the ensuing 6 months...
October 2018: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/29736915/planning-and-evaluation-for-vascular-access-in-the-elderly
#15
Candice Halinski, Holly M Koncicki
Vascular access is of vital importance for patients requiring dialysis therapies. AV fistulas have been endorsed by many professional societies as the access of choice, however, subsequent creation does not go without consequences. As the population ages and patients become more medically complex, access failure has become a major cause of treatment complication. For the elderly, this is especially true and there are multiple decision points that require careful reflection before an AVF is placed. This article reviews access considerations for AVF placement in the elderly population and considers the possibility that the fistula first approach to vascular access should not be an absolute...
July 2018: Seminars in Dialysis
https://www.readbyqxmd.com/read/29703177/functional-status-pre-dialysis-health-and-clinical-outcomes-among-elderly-dialysis-patients
#16
Silvi Shah, Anthony C Leonard, Charuhas V Thakar
BACKGROUND: Elderly patients comprise the fastest growing population initiating dialysis in United States. The impact of poor functional status and pre-dialysis health status on clinical outcomes in elderly dialysis patients is not well studied. METHODS: We studied a retrospective cohort of 49,645 incident end stage renal disease patients that initiated dialysis between January 1, 2008 and December 31, 2008 from the United States Renal Data System with linked Medicare data covering at least 2 years prior to dialysis initiation...
April 27, 2018: BMC Nephrology
https://www.readbyqxmd.com/read/29602630/medicare-costs-associated-with-arteriovenous-fistulas-among-us-hemodialysis-patients
#17
Mae Thamer, Timmy C Lee, Haimanot Wasse, Marc H Glickman, Joyce Qian, Daniel Gottlieb, Scott Toner, Timothy A Pflederer
BACKGROUND: An arteriovenous fistula (AVF) is the recommended vascular access for hemodialysis (HD). Previous studies have not examined the resources and costs associated with creating and maintaining AVFs. STUDY DESIGN: Retrospective observational study. SETTING & PARTICIPANTS: Elderly US Medicare patients initiating hemodialysis therapy during 2010 to 2011. PREDICTOR: AVF primary and secondary patency and nonuse in the first year following AVF creation...
July 2018: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/29424185/predictors-of-early-failure-and-secondary-patency-in-native-arteriovenous-fistulas-for-hemodialysis
#18
Rui Abreu, Sara Rioja, Joaquin Vallespin, Xavier Vinuesa, Ruben Iglesias, Jose Ibeas
BACKGROUND: Native arteriovenous fistula (AVF) is considered the gold standard of vascular access for hemodialysis due to its longer survival, fewer complications, lower mortality and costs. Patency is important for effective dialysis treatment and this remains a challenge in nephrology. There are no well-defined prognostic factors for early and long-term AVF survival. The aim of this study was to evaluate comorbidity, analytical and ultrasound (US) variables as prognostic factors for early failure and AVF patency...
August 2018: International Angiology: a Journal of the International Union of Angiology
https://www.readbyqxmd.com/read/29299627/3d-vascular-anatomy-of-the-presacral-space-impact-of-age-and-adiposity
#19
Alexander A Berger, Steven Abramowitch, Pamela A Moalli
INTRODUCTION AND HYPOTHESIS: Defining patient characteristics that alter vascular anatomy at the sacrum is critical for avoiding life-threatening bleeding at the time of sacrocolpopexy. We tested the hypothesis that in thinner/older women, the bifurcations of the aorta and inferior vena cava (IVC) are lower relative to S1 resulting in less space accessible for suture/mesh placement, placing this group at increased risk of major vascular injury. METHODS: In a retrospective cross-sectional study, CT scans were used to make 2D measurements and a 3D model of the aorta/IVC, intervertebral disc space, and bony anatomy using segmentation and modeling software...
January 3, 2018: International Urogynecology Journal
https://www.readbyqxmd.com/read/29275608/-application-of-the-supine-position-in-microsurgery-for-lesions-of-the-cerebellopontine-angle
#20
J Q Li, G Chen, X Li, Z Wang, D Zhou
Objective: To validate the usefulness of the supine position in microsurgery for lesions of the cerebellopontine angle (CPA) by the retrosigmoid approach. Methods: Thirty-nine patients with lesions (22 cases of tumor, 11 cases of trigeminal neuralgia and 6 cases of hemifacial spasm) of the CPA underwent tumor resection surgery or microvascular decompression surgery (MVDS). The patients were operated on in the supine position by retrosigmoid approach with the head turned 50 to 60 degrees away from the lesion and with slight forward flexion of the neck...
December 12, 2017: Zhonghua Yi Xue za Zhi [Chinese medical journal]
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