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hemodialysis vascular access

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https://www.readbyqxmd.com/read/28339557/deficiency-of-circulating-progenitor-cells-associated-with-vascular-thrombosis-of-hemodialysis-patients
#1
Mu-Yang Hsieh, Tsung-Yan Chen, Lin Lin, Shao-Yuan Chuang, Shing-Jong Lin, Der-Cheng Tarng, Po-Hsun Huang, Chih-Cheng Wu
Background.: Hemodialysis (HD) patients have an increased risk of thrombosis. Endothelial progenitor cells (EPCs), which function in vascular repair, are deficient in HD patients. Nonetheless, the relationship between EPC deficiency and thrombosis in HD patients is unknown. Methods.: From January 2010 to December 2012, circulating levels of EPCs that were positive for CD34 and kinase insert domain receptor (KDR) were measured in 269 HD patients. Patients received prospective follow-ups at 6-month intervals until May 2015...
January 17, 2017: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/28335676/physiopathological-approach-to-infective-endocarditis-in-chronic-hemodialysis-patients-left-heart-versus-right-heart-involvement
#2
Yassamine Bentata
Infectious endocarditis (IE), a complication that is both cardiac and infectious, occurs frequently and is associated with a heavy burden of morbidity and mortality in chronic hemodialysis patients (CHD). About 2-6% of chronic hemodialysis patients develop IE and the incidence is 50-60 times higher among CHD patients than in the general population. The left heart is the most frequent location of IE in CHD and the different published series report a prevalence of left valve involvement varying from 80% to 100%...
November 2017: Renal Failure
https://www.readbyqxmd.com/read/28326557/analysis-of-blood-flow-characteristics-in-a-model-of-a-mature-side-to-side-arteriovenous-fistula
#3
Ashkan Javadzadegan, Nay Myo Lwin, Muhammad Asyraf, Anne Simmons, Tracie Barber
The creation of an arteriovenous fistula (AVF) is a common surgical procedure in hemodialysis patients suffering from end-stage renal disease (ESRD). However, several complications may occur after surgery, including thrombosis, stenosis, and aneurysm. These complications are attributed to hemodynamics perturbations including pathophysiological wall shear stress (WSS) and flow recirculation zones. In this study, we present a computational hemodynamic analysis in a model of a mature side-to-side AVF, which is then validated by experimental measurements...
March 21, 2017: Artificial Organs
https://www.readbyqxmd.com/read/28325945/surveillance-of-dialysis-events-one-year-experience-at-33-outpatient-hemodialysis-centers-in-china
#4
Hui Zhang, Liuyi Li, Huixue Jia, Yunxi Liu, Jianguo Wen, Anhua Wu, Qun Lu, Tieying Hou, Yun Yang, Huai Yang, Weiguang Li, Zhiyong Zong
A multicenter prospective surveillance on dialysis events was carried in 33 dialysis centers in China. Maintenance hemodialysis (HD) outpatients who were dialyzed on the first two days of each month during 2014 were monitored for dialysis events and other infections. During the one-year period, 52,680 patient-months were monitored. Fistula and tunneled or non-tunneled central line were used for 73.70%, 15.70% and 8.85% of vascular access, respectively. There were 773 dialysis events occurred in 671 patients including 589 IV antimicrobial starts, 74 positive blood cultures and 110 local access site infections (LASI)...
March 21, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28297070/elbow-avf-configurations-and-indications
#5
Selcuk Baktiroglu, Fatih Yanar, Sercan Yuksel, Burak Celik, Halime G Kilic
INTRODUCTION: Brescia-Cimino radiocephalic arteriovenous fistula (AVF) remains the first-choice vascular access procedure for patients in need of long-term hemodialysis. The average life expectancy of patients receiving hemodialysis has increased in recent years and many patients now live longer and require secondary or tertiary procedures. Elbow fistulas should only rarely be constructed as primary fistulas. The aim of the surgeon must be not only to achieve a functioning fistula, but to avoid possible complications other than failure to mature (FTM), like distal ischemia and cardiac failure and to save the vessels as much as possible for future procedures...
March 6, 2017: Journal of Vascular Access
https://www.readbyqxmd.com/read/28297068/drug-eluting-balloons-for-resistant-arteriovenous-dialysis-access-stenosis
#6
Dimitrios Karnabatidis, Panagiotis Kitrou
Vascular access maintenance is vital for hemodialysis patients. Conventional balloon angioplasty is the gold standard of treatment in endovascular therapy according to published guidelines, accompanied by bare metal stents as a bail-out method. Several devices have been used so far with a view to improve patency outcomes, but only covered stents have been proposed as a valid alternative and only for venous juxta-anastomotic stenosis of arteriovenous grafts. Paclitaxel-coated balloons (PCBs) have been extensively investigated in the last few years in pilot studies with small numbers of patients in dialysis access...
March 6, 2017: Journal of Vascular Access
https://www.readbyqxmd.com/read/28297067/optiflow-anastomotic-device-for-hemodialysis-vascular-access-creation
#7
Marc Glickman
The need to have consistent methods and consistent technique to optimize hemodialysis outcomes is behind the concept of the Optiflow™ device. This device was created to allow for consistency in size of the arterial anastomosis and consistency in angle of the vein to the artery at the anastomosis. Early data suggest that allowing these two technical entities can improve outcomes in regards to flow and maturity in arteriovenous fistula creation. This article is a summary of early data that demonstrate the impact the Optiflow device on brachial cephalic fistulas...
March 6, 2017: Journal of Vascular Access
https://www.readbyqxmd.com/read/28297061/bioengineered-hemodialysis-access-grafts
#8
Shawn M Gage, Jeffrey H Lawson
There is a need for bioengineered therapies to improve the overall health of the growing and aging world population. Patients with renal failure have a life-long requirement for a durable form of hemodialysis vascular access. In this article, we review the history of tissue engineering as it pertains to bioengineered grafts and vessels for hemodialysis access. Over the years, various strategies have been utilized to develop ideal, humanized vessels for vascular replacement such as fixation of animal or human vessels, cell seeding of synthetic materials, and the synthesis of completely autologous or allogeneic bioengineered vessels...
March 6, 2017: Journal of Vascular Access
https://www.readbyqxmd.com/read/28297057/dialysis-access-issues-related-to-conversion-from-peritoneal-dialysis-to-hemodialysis-and-vice-versa
#9
Maurizio Gallieni, Antonino Giordano, Anna Ricchiuto, Davide Gobatti, Maurizio Cariati
ABSTRACTHemodialysis (HD) and peritoneal dialysis (PD) represent two complementary modalities of renal replacement therapy (RRT) for end-stage renal disease patients. Conversion between the two modalities is frequent and more likely to happen from PD to HD. Every year, 10% of PD patients convert to HD, suggesting the need for recommendations on how to proceed with the creation of a vascular access in these patients. Criteria for selecting patients who would likely fail PD, and therefore take advantage of a backup access, are undefined...
March 6, 2017: Journal of Vascular Access
https://www.readbyqxmd.com/read/28297054/optimal-timing-for-vascular-access-creation
#10
Tamara K Jemcov, Wim Van Biesen
Many guidelines recommend that end-stage renal disease (ESRD) patients should have a permanent vascular access, preferably an autologous arteriovenous fistula (AVF), at the start of renal replacement therapy. Nevertheless, a large proportion of patients still start hemodialysis with a central venous catheter (CVC). On the other hand, there are increasing numbers of patients in whom an AVF has been created, but who never actually end up on dialysis, as well as a substantial number of patients in whom creation of a vascular access has been attempted unsuccessfully...
March 6, 2017: Journal of Vascular Access
https://www.readbyqxmd.com/read/28297053/general-regional-or-local-anesthesia-for-successful-radial-cephalic-arteriovenous-fistula
#11
David Shemesh, Yefim Raikhinstein, Ilya Goldin, Oded Olsha
Autogenous fistulas and in particular radiocephalic fistulas are recommended as the first vascular access for hemodialysis. Unfortunately, the rates of early failure and non-maturation are very high. For more than a decade, brachial plexus block has been proposed as the anesthesia of choice for fistula creation due to its beneficial sympathectomy-like effect, causing vasodilation and attenuation of spasm. Until recently, there was not a single randomized clinical study supporting this proposition. Because performing regional anesthesia is time-consuming and requires expertise, many surgeons prefer local or general anesthesia for vascular access surgery...
March 6, 2017: Journal of Vascular Access
https://www.readbyqxmd.com/read/28297050/preoperative-computer-simulation-for-planning-of-vascular-access-surgery-in-hemodialysis-patients
#12
Niek Zonnebeld, Wouter Huberts, Magda M van Loon, Tammo Delhaas, Jan H M Tordoir
INTRODUCTION: The arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis patients. Unfortunately, 20-40% of all constructed AVFs fail to mature (FTM), and are therefore not usable for hemodialysis. AVF maturation importantly depends on postoperative blood volume flow. Predicting patient-specific immediate postoperative flow could therefore support surgical planning. A computational model predicting blood volume flow is available, but the effect of blood flow predictions on the clinical endpoint of maturation (at least 500 mL/min blood volume flow, diameter of the venous cannulation segment ≥4 mm) remains undetermined...
March 6, 2017: Journal of Vascular Access
https://www.readbyqxmd.com/read/28297046/is-shear-stress-the-key-factor-for-avf-maturation
#13
Andrea Remuzzi, Michela Bozzetto, Paolo Brambilla
Autologous arteriovenous fistula (AVF) is the preferred choice for providing vascular access to hemodialysis (HD) patients, but it is still affected by high incidence of non-maturation or early failure. After creation, AVF must undergo vascular remodeling, a process characterized by an increase in blood vessel diameter and wall thickness, to allow efficient and adequate HD. A growing body of evidence indicates that AVF maturation is related to the response of endothelial cells (ECs) to changes in wall shear stress (WSS), and in particular, to changes of its peak value...
March 6, 2017: Journal of Vascular Access
https://www.readbyqxmd.com/read/28297045/surgical-technique-determines-the-outcome-of-the-brescia-cimino-avf
#14
Surendra Shenoy
Over the past 50 years, since Dr. Appel performed the first internal vascular access procedure for hemodialysis, the distal radiocephalic arteriovenous fistula continues to be the access of choice. Over time, failure to maturation has evolved as a major problem associated with this procedure depriving its benefits to many patients with end-stage renal disease. A variable incidence of this problem within similar patients suggests that surgical technique may play an important role in the development of non-maturation...
March 6, 2017: Journal of Vascular Access
https://www.readbyqxmd.com/read/28288599/clinical-use-of-computational-modeling-for-surgical-planning-of-arteriovenous-fistula-for-hemodialysis
#15
Michela Bozzetto, Stefano Rota, Valentina Vigo, Francesco Casucci, Carlo Lomonte, Walter Morale, Massimo Senatore, Luigi Tazza, Massimo Lodi, Giuseppe Remuzzi, Andrea Remuzzi
BACKGROUND: Autogenous arteriovenous fistula (AVF) is the best vascular access (VA) for hemodialysis, but its creation is still a critical procedure. Physical examination, vascular mapping and doppler ultrasound (DUS) evaluation are recommended for AVF planning, but they can not provide direct indication on AVF outcome. We recently developed and validated in a clinical trial a patient-specific computational model to predict pre-operatively the blood flow volume (BFV) in AVF for different surgical configuration on the basis of demographic, clinical and DUS data...
March 14, 2017: BMC Medical Informatics and Decision Making
https://www.readbyqxmd.com/read/28281281/hemodialysis-disparities-in-african-americans-the-deeply-integrated-concept-of-race-in-the-social-fabric-of-our-society
#16
REVIEW
Keith C Norris, Sandra F Williams, Connie M Rhee, Susanne B Nicholas, Csaba P Kovesdy, Kamyar Kalantar-Zadeh, L Ebony Boulware
End-stage renal disease (ESRD) is one of the starkest examples of racial/ethnic disparities in health. Racial/ethnic minorities are 1.5 to nearly 4 times more likely than their non-Hispanic White counterparts to require renal replacement therapy (RRT), with African Americans suffering from the highest rates of ESRD. Despite improvements over the last 25 years, substantial racial differences are persistent in dialysis quality measures such as RRT modality options, dialysis adequacy, anemia, mineral and bone disease, vascular access, and pre-ESRD care...
March 9, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28279412/image-guided-approach-to-peritoneal-dialysis-catheter-placement
#17
Igor Latich, Randy L Luciano, Ali Mian
Peritoneal dialysis (PD) is a vastly underused form of renal replacement therapy that offers great flexibility to the patient, breaks the cycle of tri-weekly visits to a hemodialysis center, and is associated with fewer interventions to maintain functional dialysis access. PD catheter placement allows for urgent initiation of dialysis and minimizes the unnecessary use of temporary vascular access catheters. Image-guided placement of a PD catheter by interventional radiologists that combines ultrasound and fluoroscopy is an elegant, cost saving, safe, less invasive, and at least as effective an option when compared with traditional surgical placement...
March 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/28279411/dialysis-catheter-placement-in-patients-with-exhausted-access
#18
Syed Rahman, Joshua D Kuban
Patients with end-stage renal disease undergo renal transplant, peritoneal dialysis, or intermittent hemodialysis for renal replacement therapy. For hemodialysis, native fistulas or grafts are preferred but hemodialysis catheters are often necessary. Per KDOQI, the right jugular vein is the preferred vessel of access for these catheters. However, in patients with long-standing end-stage renal disease vein thrombosis, stenosis and occlusion occurs. In these patients with end-stage vascular access, unconventional routes of placement of dialysis catheters are needed...
March 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/28279409/central-venous-interventions
#19
Masahiro Horikawa, Keith B Quencer
Central venous stenosis or occlusion is a common and vexing problem in patients undergoing hemodialysis. Typical presenting symptoms include arm swelling and prolonged bleeding after hemodialysis. Despite multiple treatment approaches, these stenoses tend to recur and progress over time. A thorough preprocedure evaluation, methodical procedural approach and awareness of potential complications are all essential to try to preserve vascular access and improve patients' quality of life.
March 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/28279404/strategies-for-hemodialysis-access-a-vascular-surgeon-s-perspective
#20
Larry A Scher, Saadat Shariff
Problems related to hemodialysis access are a significant cause of morbidity and mortality in patients with end-stage renal disease. Physicians of all specialties who are involved in the placement and maintenance of vascular access for hemodialysis must have a long-term strategy for sequential placement of autogenous fistulas, transpositions, and prosthetic grafts to preserve access sites and to avoid long-term use of tunneled dialysis catheters. The Fistula First and KDOQI initiatives have provided strategies and algorithms for access placement in patients with chronic kidney disease...
March 2017: Techniques in Vascular and Interventional Radiology
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