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Vascular Access

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14 papers 0 to 25 followers
By Isabel Acosta-Ochoa Nephrology senior staff. Valladolid. Spain
https://www.readbyqxmd.com/read/28111198/institution-of-a-hospital-based-central-venous-access-policy-for-peripheral-vein-preservation-in-patients-with-chronic-kidney-disease-a-12-year-experience
#1
Jeffrey Forris Beecham Chick, Shilpa N Reddy, Benjamin L Yam, Sidney Kobrin, Scott O Trerotola
PURPOSE: To describe the implementation of nursing-based venous access team (VAT) and standardized interventional radiology (IR) protocols in accordance with Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines to provide central venous access while preserving peripheral veins in patients with chronic kidney disease (CKD). MATERIALS AND METHODS: Review of peripherally inserted central catheter (PICC) and small-bore central catheter (SBCC) referral and placement data from VAT and IR databases was conducted over a 12-year period...
January 19, 2017: Journal of Vascular and Interventional Radiology: JVIR
https://www.readbyqxmd.com/read/28135701/catheter-failure-and-mortality-in-hemodialysis-patients-with-tunneled-cuffed-venous-catheters-in-a-single-center
#2
Min Shi, Tianlei Cui, Liang Ma, Li Zhou, Ping Fu
BACKGROUND: As of now, only a few studies have focused on the failure of tunneled cuffed venous catheter (tCVC) and mortality of hemodialysis (HD) patients using tCVC as long-term vascular access, whose vascular condition for arteriovenous fistula was not very satisfactory. In this study, we aimed to provide information about the first tCVC failure and survival rates of patients in this population. METHODS: Fifty-nine patients who used tCVC from January 1, 2009 to December 31, 2014 in our HD center were analyzed in this retrospective study and followed up either until their death or until December 31, 2015...
January 31, 2017: Blood Purification
https://www.readbyqxmd.com/read/28032484/treatment-of-methicillin-resistant-staphylococcus-aureus-bacteremia
#3
REVIEW
Eun Ju Choo, Henry F Chambers
Methicillin-resistant Staphylococcus aureus (MRSA) is a significant cause of health care-associated infections. Vancomycin remains an acceptable treatment option. There has been a welcome increase in the number of agents available for the treatment of MRSA infection. These drugs have certain differentiating attributes and may offer some advantages over vancomycin, but they also have significant limitations. These agents provide some alternative when no other options are available.
December 2016: Infection & Chemotherapy
https://www.readbyqxmd.com/read/28084215/dialysis-arteriovenous-fistula-failure-and-angioplasty-intimal%C3%A2-hyperplasia-and-other-causes-of-access-failure
#4
Juan C Duque, Marwan Tabbara, Laisel Martinez, Jose Cardona, Roberto I Vazquez-Padron, Loay H Salman
The arteriovenous fistula (AVF) is the preferred hemodialysis access type because it has better patency rates and fewer complications than other access types. However, primary failure remains a common problem impeding AVF maturation and adding to patients' morbidity and mortality. Juxta-anastomotic (or inflow) stenosis is the most common reason leading to primary failure, and percutaneous transluminal angioplasty continues to be the gold-standard treatment with excellent success rates. Intimal hyperplasia (IH) has been traditionally blamed as the main pathophysiologic culprit, but new evidence raises doubts regarding the contribution of IH alone to primary failure...
January 2017: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/28064472/arteriovenous-grafts-much-maligned-but-in-need-of-reconsideration
#5
Michael Allon
There are substantial variations in arteriovenous fistula (AVF) use among hemodialysis patients in different countries, in different regions of the U.S., and even in different hemodialysis units within a single metropolitan area. These variations persist after adjustment for patient demographics and comorbidities, suggesting that practice patterns play a major role in determining the frequency of AVF use. These observations led to vascular access guidelines urging nephrologists and surgeons to increase AVF creation in patients with chronic kidney disease...
January 8, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28031406/complications-of-the-arteriovenous-fistula-a-systematic-review
#6
Ahmed A Al-Jaishi, Aiden R Liu, Charmaine E Lok, Joyce C Zhang, Louise M Moist
The implementation of patient-centered care requires an individualized approach to hemodialysis vascular access, on the basis of each patient's unique balance of risks and benefits. This systematic review aimed to summarize current literature on fistula risks, including rates of complications, to assist with patient-centered decision making. We searched Medline from 2000 to 2014 for English-language studies with prospectively captured data on ≥100 fistulas. We assessed study quality and extracted data on study design, patient characteristics, and outcomes...
December 28, 2016: Journal of the American Society of Nephrology: JASN
https://www.readbyqxmd.com/read/27951576/future-trends-in-vascular-access-creation
#7
Surendra Shenoy
Delivery of a prescribed dialysis dose, which is critical for longevity on hemodialysis, is directly dependent on vascular access (VA). However, VA is fraught with high failure rates and has room for innovation. Arteriovenous fistula (AVF), considered the 'best choice', has a high 'failure to mature' rate. Arteriovenous grafts (AVGs) are considered when patients are poor candidates for or have failed AVF, but have a high incidence of infections and thrombosis. Due to associated morbidity and mortality from complications, central venous catheters are considered only as 'bridging short-term access' when there is an urgent need for dialysis...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/27866375/pre-operative-assessment-for-arteriovenous-fistula-placement-for-dialysis
#8
REVIEW
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
https://www.readbyqxmd.com/read/27630181/predictors-of-initiation-for-predialysis-arteriovenous-fistula
#9
Alian Al-Balas, Timmy Lee, Carlton J Young, Jill Barker-Finkel, Michael Allon
BACKGROUND AND OBJECTIVES: The optimal timing of predialysis arteriovenous fistula surgery remains uncertain. We evaluated factors associated with hemodialysis initiation in patients undergoing predialysis arteriovenous fistula surgery and derived a model to predict future initiation of dialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Our study retrospectively identified 308 patients undergoing predialysis arteriovenous fistula creation at a large medical center in 2006-2012 to determine whether they initiated hemodialysis...
September 14, 2016: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/27605542/the-survival-benefit-of-fistula-first-catheter-last-in-hemodialysis-is-primarily-due-to-patient-factors
#10
Robert S Brown, Bhanu K Patibandla, Alexander S Goldfarb-Rumyantzev
Patients needing hemodialysis are advised to have arteriovenous fistulas rather than catheters because of significantly lower mortality rates. However, disparities in fistula placement raise the possibility that patient factors have a role in this apparent mortality benefit. We derived a cohort of 115,425 patients on incident hemodialysis ≥67 years old from the US Renal Data System with linked Medicare claims to identify the first predialysis vascular access placed. We compared mortality outcomes in patients initiating hemodialysis with a fistula placed first, a catheter after a fistula placed first failed, or a catheter placed first (n=90,517; reference group)...
February 2017: Journal of the American Society of Nephrology: JASN
https://www.readbyqxmd.com/read/27492146/central-venous-occlusion-in-the-hemodialysis-patient
#11
Vinay Narasimha Krishna, Joseph B Eason, Michael Allon
Central venous stenosis (CVS) is encountered frequently among hemodialysis patients. Prior ipsilateral central venous catheterization and cardiac rhythm device insertions are common risk factors, but CVS can also occur in the absence of this history. Chronic CVS can cause thrombosis with partial or complete occlusion of the central vein at the site of stenosis. CVS is frequently asymptomatic and identified as an incidental finding during imaging studies. Symptomatic CVS presents most commonly as an upper- or lower-extremity edema ipsilateral to the CVS...
November 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/27401525/new-insights-into-dialysis-vascular-access-impact-of-preexisting-arterial-and-venous-pathology-on-avf-and-avg-outcomes
#12
Roberto I Vazquez-Padron, Michael Allon
Despite significant improvements in preoperative patient evaluation and surgical planning, vascular access failure in patients on hemodialysis remains a frequent and often unforeseeable complication. Our inability to prevent this complication is, in part, because of an incomplete understanding of how preexisting venous and arterial conditions influence the function of newly created arteriovenous fistulas and grafts. This article reviews the relationship between three preexisting vascular pathologies associated with CKD (intimal hyperplasia, vascular calcification, and medial fibrosis) and hemodialysis access outcomes...
August 8, 2016: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/27401524/new-insights-into-dialysis-vascular-access-what-is-the-optimal-vascular-access-type-and-timing-of-access-creation-in-ckd-and-dialysis-patients
#13
Karen Woo, Charmaine E Lok
Optimal vascular access planning begins when the patient is in the predialysis stages of CKD. The choice of optimal vascular access for an individual patient and determining timing of access creation are dependent on a multitude of factors that can vary widely with each patient, including demographics, comorbidities, anatomy, and personal preferences. It is important to consider every patient's ESRD life plan (hence, their overall dialysis access life plan for every vascular access creation or placement). Optimal access type and timing of access creation are also influenced by factors external to the patient, such as surgeon experience and processes of care...
August 8, 2016: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/27203778/bioengineered-human-acellular-vessels-for-dialysis-access-in-patients-with-end-stage-renal-disease-two-phase-2-single-arm-trials
#14
MULTICENTER STUDY
Jeffrey H Lawson, Marc H Glickman, Marek Ilzecki, Tomasz Jakimowicz, Andrzej Jaroszynski, Eric K Peden, Alison J Pilgrim, Heather L Prichard, Malgorzata Guziewicz, Stanisław Przywara, Jacek Szmidt, Jakub Turek, Wojciech Witkiewicz, Norbert Zapotoczny, Tomasz Zubilewicz, Laura E Niklason
BACKGROUND: For patients with end-stage renal disease who are not candidates for fistula, dialysis access grafts are the best option for chronic haemodialysis. However, polytetrafluoroethylene arteriovenous grafts are prone to thrombosis, infection, and intimal hyperplasia at the venous anastomosis. We developed and tested a bioengineered human acellular vessel as a potential solution to these limitations in dialysis access. METHODS: We did two single-arm phase 2 trials at six centres in the USA and Poland...
May 14, 2016: Lancet
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