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AV fistula assessment

Erica Simon, Brit Long, Kyle Johnston, Shane Summers
BACKGROUND: Chronic kidney disease is common in the United States, with many patients maintained on hemodialysis (HD). The process of HD requires vascular access through an arteriovenous (AV) fistula, AV graft, or central venous catheter. Today, as a result of the National Kidney Foundation's "Fistula First" initiative, nearly 55% of HD patients utilize an AV fistula. As there is significant morbidity and mortality associated with fistula placement and recurrent fistula cannulation, emergency physicians must be equipped to recognize and treat fistula complications...
December 10, 2016: Journal of Emergency Medicine
Rita L McGill, Robin Ruthazer, Eduardo Lacson, Klemens B Meyer, Dana C Miskulin, Daniel E Weiner
Introduction Central venous catheters (CVC) increase risks associated with hemodialysis (HD), but may be necessary until an arteriovenous fistula (AVF) or graft (AVG) is achieved. The impact of vascular imaging on achievement of working AVF and AVG has not been firmly established. Methods Retrospective cohort of patients initiating HD with CVC in 2010-2011, classified by exposure to venography or Doppler vein mapping, and followed through December 31, 2012. Standard and time-dependent Cox models were used to determine hazard ratios (HRs) of death, working AVF, and any AVF or AVG...
November 20, 2016: Hemodialysis International
Maria G Marques, Pedro Ponce
Native AV fistulas are considered to be the best VA for most dialysis patients. A careful preoperative process of care is essential to maximize the proportion of fistulas that achieve adequacy for dialysis. An individualized and timely evaluation of patients starts early with the identification of risk factors, followed by a physical examination which should be complemented by ultrasound vascular mapping in most cases. Vascular mapping includes any technique that leads to information on patient's inflow and outflow anatomy (± hemodynamics) as they relate to arteriovenous access creation and may predict maturation...
January 2017: Seminars in Dialysis
Asaf Honig, Ruth Eliahou, Roni Eichel, Ari Aharon Shemesh, Tamir Ben-Hur, Eitan Auriel
Bilateral thalamic infarction (BTI) typically presents as a sleep-like coma (SLC) without localizing signs, posing a diagnostic challenge that may lead the treating physician to search for toxic or metabolic causes and delay treatment. We review our experience with BTI of different etiologies, and emphasize the critical role of timely imaging, diagnosis, and management in a series of 12 patients with a presentation of SLC and acute BTI who were managed in our Medical Centers from 2006-2015. In 11/12, urgent head CT scans showed normal brain tissue, while diffusion-weighted (DWI) MRI revealed symmetric bilateral thalamic hyperintense lesions with variable degrees of brainstem involvement...
December 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Pankaj Chaturvedi, Suresh C Tyagi
Tissue inhibitor of matrix metalloprotease 4 (TIMP4) is endogenously one of the key modulators of matrix metalloprotease 9 (MMP9) and we have reported earlier that cardiac specific TIMP4 instigates contractility and helps in differentiation of cardiac progenitor cells. Although studies show that the expression of TIMP4 goes down in heart failure but the mechanism is unknown. This study aims to determine the mechanism of silencing of TIMP4 in heart failure progression created by aorta-vena cava (AV) fistula...
July 11, 2016: Journal of Cellular and Molecular Medicine
Patrícia Barreto, Paulo Almeida, Norton de Matos, José Alexandre Queirós, Joaquim Pinheiro, Fernanda Silva, Telmo Carvalho, Rui Almeida, António Cabrita
PURPOSE: Hemodialysis (HD) is the main treatment modality in stage 5 chronic kidney disease, and vascular access planning is a crucial step in the path to dialysis treatment. Beyond detailed patient history and physical examination, duplex ultrasound (DU) evaluation is essential in preoperative vascular mapping. METHODS: A retrospective descriptive nonrandomized study was performed and included 108 end-stage kidney disease patients referred from eight HD centers to be assessed for creation of an arteriovenous (AV) access (AV fistula or AV graft)...
July 12, 2016: Journal of Vascular Access
Awad Magbri, Patricia McCartney, Eussera El-Magbri, Mariam El-Magbri, Taha El-Magbri
BACKGROUND & OBJECTIVES: Access monitoring and pre-emptive angioplasty is known to decrease the incidence of AVF/AVG thrombosis. The effect on increase the longevity and functionality of Arterial-Venous access (AV access) in end-stage renal disease (ESRD) patients is not settled. Thrombosis is the leading cause of vascular access complications and is almost always associated with the presence of stenosis. Percutaneous transluminal angioplasty (PTA) is an accepted treatment of stenotic lesions in AV access (NKF 2001)...
October 1, 2016: Global Journal of Health Science
Chi-Hsiao Yeh, Ting-Shuo Huang, Yao-Chang Wang, Pin-Fu Huang, Tzu-Yen Huang, Tzu-Ping Chen, Shun-Ying Yin, Yu-Wei Yu
OBJECTIVES: To study the effect of antiplatelet agents on preventing arteriovenous (AV) fistulae thrombosis in hemodialysis (HD) patients after surgical thrombectomy (ST) for acute AV fistulae occlusion. Whether post-operative antiplatelet drugs have similar effects on the patency of AV fistula after surgical thrombectomy in patients with end-stage renal disease who undergo HD has not been investigated. DESIGN, MATERIALS AND METHODS: We employed the Taiwan National Health Insurance Research Database (NHIRD) from 1999 to 2010 to assess the recurrent occlusion requiring ST and longevity of AV fistula after ST in 1049 patients on regular HD, with or without antiplatelet drugs...
2016: Current Vascular Pharmacology
Aurang Z Khawaja, Deirdre B Cassidy, Julien Al Shakarchi, Damian G McGrogan, Nicholas G Inston, Robert G Jones
BACKGROUND: Native or prosthetic arteriovenous (AV) fistulas are preferred for permanent haemodialysis (HD) access. These are marked with circuit steno-occlusive disease leading to dysfunction or even failure. Late failure rates have been reported as high as 50%. Standard angioplasty balloons are an established percutaneous intervention for HD access stenosis. Reported restenosis rates remain high and practice guidelines recommend a wide 6-month primary patency (PP) of at least 50% for any intervention...
March 2016: Journal of Vascular Access
Irma L Geenen, Felix F Kolk, Daniel G Molin, Allard Wagenaar, Mathijs G Compeer, Jan H Tordoir, Geert W Schurink, Jo G De Mey, Mark J Post
BACKGROUND: Autologous arteriovenous (AV) fistulas are the first choice for vascular access but have a high risk of non-maturation due to insufficient vessel adaptation, a process dependent on nitric oxide (NO)-signaling. Chronic kidney disease (CKD) is associated with oxidative stress that can disturb NO-signaling. Here, we evaluated the influence of CKD on AV fistula maturation and NO-signaling. METHODS: CKD was established in rats by a 5/6th nephrectomy and after 6 weeks, an AV fistula was created between the carotid artery and jugular vein, which was followed up at 3 weeks with ultrasound and flow assessments...
2016: PloS One
Naveed Ul Haq, Mohammed Mahdi Althaf, Timmy Lee
Early fistula failure (EFF) is a significant clinical problem causing lower rates of arteriovenous fistulae (AVFs) use in patients with ESRD on hemodialysis. The 2 main factors amenable to treatment and widely accepted to cause EFF are stenosis anywhere in the AVF circuit and/or presence of accessory vein (av). The role of stenotic lesions in causing EFF and their treatment options are relatively better defined with clear guidelines. On the other hand, assessing the significance of an av in causing EFF and the indications for its treatment seem to lack scientific recommendations based on robust clinical data...
November 2015: Advances in Chronic Kidney Disease
Stanislaw Przywara, Marek Ilzecki, Piotr Terlecki, Tomasz Zubilewicz
We describe a novel surgical technique to facilitate the second-stage elevation of the basilic or brachial vein in patients with first-stage brachial-basilic or autogenous brachial-brachial arteriovenous fistula by axial splitting of the medial antebrachial cutaneous nerve (MABCN). Filaments of the MABCN typically traverse the anterior aspect of the basilic and brachial veins. The second-stage elevation/shelf superficialization of the basilic or brachial vein, so as not to cause an injury to the MABCN, requires division of these veins with transposition over the nerve branches and subsequent reanastomosis...
November 2015: Journal of Vascular Surgery
Theodore H Yuo, Rabih A Chaer, Ellen D Dillavou, Steven A Leers, Michel S Makaroun
OBJECTIVE: Current guidelines suggest that arteriovenous fistula (AVF) is associated with survival advantage over arteriovenous graft (AVG). However, AVFs often require months to become functional, increasing tunneled dialysis catheter (TDC) use, which can erode the benefit of an AVF. We sought to compare survival in patients with end-stage renal disease after creation of an AVF or AVG in patients starting hemodialysis (HD) with a TDC and to identify patient populations that may benefit from preferential use of AVG over AVF...
December 2015: Journal of Vascular Surgery
Christie Fitch, Rosie Earle, Andrew Sawka, Himat Vaghadia
No abstract text is available yet for this article.
December 2015: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Vidyanand Tripathi, Savita Bansal, Sharma Alok, Bansal Ravi, Amit K Devra, Sanjiv Saxena
Vascular complications arise in uremic patients in the absence of clinically significant atherosclerotic disease. Elevated serum parathyroid hormone (PTH) and abnormal calcium (Ca) and phosphorus (P) balance have been implicated in vascular damage in chronic kidney disease (CKD) patients, but there is lack of histo-pathological studies. Patients with CKD stage 5 and 5D who underwent arterio-venous fistula were included in this study. Baseline and laboratory parameters including assessment of total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, uric acid, albumin, calcium, phosphorus, intact PTH (iPTH) and vitamin D level were documented...
September 2015: Saudi Journal of Kidney Diseases and Transplantation
Tiago Pereira-da-Silva, José Diogo Martins, Lídia de Sousa, António Fiarresga, Conceição Trigo Pereira, Rui Cruz Ferreira, Fátima Ferreira Pinto
OBJECTIVE: A case series on different vascular malformations (VM) treated with percutaneous occlusion in children and adults is presented. BACKGROUND: Percutaneous occlusion is usually the preferred treatment method for VM. Previous series have mostly focused on single types of devices and/or VM. METHODS: Retrospective analysis of all patients who underwent percutaneous occlusion of VM in a single center, from 1995 to 2014, excluding patent ductus arteriosus...
February 1, 2016: Catheterization and Cardiovascular Interventions
Rishi Gupta, Marissa Manuel, Kumiko Owada, Samish Dhungana, Leslie Busby, Brenda A Glenn, Debbie Brown, Susan A Zimmermann, Christopher Horn, Dustin Rochestie, Joseph T Hormes, Andrew K Johnson, Ahmad Khaldi
INTRODUCTION: With the publication of the recent trials showing the tremendous benefits of mechanical thrombectomy, opportunities exist to refine prehospital processes to identify patients with larger stroke syndromes. MATERIALS AND METHODS: We retrospectively reviewed consecutive patients who were brought via scene flight from rural parts of the region to our institution, from December 1, 2014 to June 5, 2015, with severe hemiparesis or hemiplegia. We assessed the accuracy of the diagnosis of stroke and the number of patients requiring endovascular therapy...
August 2016: Journal of Neurointerventional Surgery
Tomasz Gołębiowski, Wacław Weyde, Mariusz Kusztal, Tomasz Porażko, Hanna Augustyniak-Bartosik, Katarzyna Madziarska, Magdalena Krajewska, Przemysław Koniński, Antoni Sydor, Krzysztof Letachowicz, Marian Klinger
Diabetics with stage V chronic kidney disease (CKD) on hemodialysis (HD) are considered as "difficult patients", because of problems with creation of the vascular access. There is controversy regarding the results and recommendations for preparation of the vascular access in these patients. The aim of this retrospective study was to evaluate the results of creating different types of arteriovenous fistula (AVFs) in consecutive series of patients starting dialysis treatment. The analysis was performed in 741 patients (385 females and 356 males), average age 61...
2015: Postȩpy Higieny i Medycyny Doświadczalnej
Aaron J Gonzalez, Kevin M Casey, Benjamin J Drinkwine, Jeffrey S Weiss
BACKGROUND: Successful maturation of arteriovenous fistulas (AVFs) remains a challenge for those managing patients with end-stage renal disease. Time-of-flight magnetic resonance angiography (TOF-MR) can be used to evaluate AVFs without the risk of radiation exposure, intravenous contrast, or reliance on the operator-dependent modality of color Doppler ultrasonography (CDUS). The objective of our study was to assess the utility of TOF-MR in the evaluation of nonmaturing AVFs and to identify the best clinical situations to use this technology...
January 2016: Annals of Vascular Surgery
Guillaume Jean, Samuel Granjon, Eric Zaoui, Patrik Deleaval, Jean-Marc Hurot, Christie Lorriaux, Brice Mayor, Charles Chazot
BACKGROUND: Measuring blood calcium level is recommended in haemodialysis (HD) patients. The Kidney Disease Improving Global Outcomes position states that the measurement of ionized calcium (ICa) level is preferred, but in the clinical setting, due to technical difficulties, total calcium (tCa) level is preferred to ICa. AIM: The aim of this study was to test the possibility of delayed ICa analysis using frozen serum, and so to identify the factors associated with predialysis ICa level and compare the ability of tCa and Alb-Ca to predict ICa level and finally to compare the survival rate according to the three calcium measurements...
August 2015: Clinical Kidney Journal
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