Establishing a functional vascular access while minimizing the risk of dialysis access-associated ischemic steal syndrome (DASS) may present a challenging problem in patients with severe peripheral ...vascular disease where even a low-flow arteriovenous fistula (AVF) may lead to severe symptoms and physical findings of DASS. Proximalization of arterial inflow for an existing vascular access is established as an effective treatment for DASS. We hypothesized that a primary proximal arterial inflow procedure for vascular access in patients judged to be at high risk for DASS would result in a successful hemodialysis access and mitigate the risk of steal syndrome. We report four such patients considered to be at significant risk for DASS after construction of a new vascular access. An axillary artery AVF inflow anastomosis was constructed in each patient. The access outflow configuration varied with the available venous outflow conduit identified during the preoperative ultrasound evaluation. In all four patients in this report, a functional autogenous dialysis access was established without DASS.
Percutaneously created sutureless anastomosis Mallios, Alexandros; Jennings, William C.
Journal of vascular surgery cases and innovative techniques,
12/2020, Letnik:
6, Številka:
4
Journal Article
Background Obesity in the hemodialysis population is roughly twice that of the general population. An arteriovenous fistula (AVF) remains the recommended vascular access; however, obesity results in ...fewer autogenous accesses, more complexity, and higher AVF failure rates. We reviewed our vascular access experience in obese individuals in whom the depth of an AVF prevented reliable cannulation. Study Design We reviewed our database of consecutive vascular access patients, identifying individuals in whom the planned venous outflow cannulation segments were too deep and required additional surgical procedures to establish a functional hemodialysis access. These additional procedures included lipectomy, outflow elevation, cephalic transposition, liposuction, or an implantable cannulation guide. Results During the study period, 1,874 consecutive new patients had an autogenous vascular access constructed. We identified 120 patients in whom an additional procedure was required due to the depth of the cannulation sites; these comprised this study group. Ninety-nine (83%) were female, 85 (71%) were diabetic, and 53 (45%) had previous access operations. Body mass index was 25.4 to 62.8 kg/m2 (mean 40.8 kg/m2 ), age range was 27 to 81 years (mean 54 years), and follow-up was 1 to 101 months (mean 25 months). Primary and cumulative patency rates for all patients were 63% and 93% at 1 year and 46% and 91% after 2 years, respectively. The most common additional procedure performed was a lipectomy (n = 78), with 1-year primary and cumulative patency rates of 78% and 97% and 2-year rates of 69% and 91%, respectively. Conclusions A variety of surgical options were found to be successful in establishing a functional autogenous vascular access for individuals in whom cannulation sites were simply too deep. Cumulative patency rates for all patients were 93% at 1 year and 91% after 2 years.
We performed a single-center retrospective study of prospectively collected data for all patients who had flow reduction surgery with FRAME FR between November 2020 and January 2021. Ten patients had ...arteriovenous fistula flow reduction surgery with this technique. One patient had a distal fistula, whereas nine were within the cubital fossa. In nine patients the device was applied over the postanastomotic arteriovenous fistula outflow vein and in one in the preanastomotic radial artery. Technical success was achieved in all patients with a median flow reduction from 2150 to 825 mL/min. There were no wound or device-specific complications.
Abstract Public reporting of health care data continues to proliferate as consumers and other stakeholders seek information on the quality and outcomes of care. Medicare’s Hospital Compare website, ...the U.S. News & World Report hospital rankings, and several state-level programs are well known. Many rely heavily on administrative data as a surrogate to reflect clinical reality. Clinical data are traditionally more difficult and costly to collect, but more accurately reflect patients’ clinical status, thus enhancing the validity of quality metrics. We describe the public reporting effort being launched by the American College of Cardiology and partnering professional organizations using clinical data from the National Cardiovascular Data Registry (NCDR) programs. This hospital-level voluntary effort will initially report process of care measures from the percutaneous coronary intervention (CathPCI) and implantable cardioverter-defibrillator (ICD) registries of the NCDR. Over time, additional process, outcomes, and composite performance metrics will be reported.
Background Hemodialysis access by autogenous arteriovenous fistulas (AVFs) is generally recommended due to lower mortality, morbidity, and cost vs graft and catheter use. Many dialysis patients lack ...the common superficial veins used for standard AVF options and require transposition of a deep vein for autogenous dialysis access through a long open incision (open/AVF-T). These operations may require prolonged time for healing, thus extending catheter-based dialysis. We report our experience with minimally invasive techniques for creating AVF-Ts using an endoscopic procedure (endo/AVF-T). Methods We reviewed our vascular access database of consecutive access operations to identify consecutive patients with endo/AVF-Ts. For comparison, we also reviewed the immediate preceding traditional open/AVF-T operations that we previously reported. We evaluated demographics, time to access use, and primary, assisted, and cumulative patency. Results We identified 100 consecutive endo/AVF-T operations attempted, and 98 were technically successful. The analysis excluded two conversions to successful open/AVF-T. The mean age of the 98 patients in the endo/AVF-T study group was 60 years (range, 22-94 years), 59 (60.2%) were women, 48 (49.0%) were diabetic, 20 (20.4%) were obese, and 52 (53.1%) had had previous access surgery. Mean time to initial use of the access for endo/AVF-Ts was 6 weeks for primary and 12 weeks for staged transpositions. Mean follow-up was 14 months (range, 1-30 months). The 12- and 24-month cumulative patencies were 95.5% and 88.6%. The 78 traditional open/AVF-T operations from our previous report were reviewed for comparison. The mean age was 62 years (range, 18-83 years), 57 (73.1%) were women, 44 (56.4%) were diabetic, 15 (19.2%) were obese, and 46 (59.0%) had previous access surgery. Mean time to initial use of the access for open/AVF-Ts was 8 weeks for primary and 16 weeks for staged operations. Mean follow-up was 18 months (range, 3-48 months). The 12- and 24-month cumulative patencies were 96.0 and 88.9%. No grafts were used in any patient during the study period. Conclusion Time to access use was less with endoscopic AVF-T ( P < .01) for both primary and staged operations. Primary, assisted, and cumulative patency rates were the same for open and technically successful endoscopic transpositions. Endoscopic AVF-Ts offer a viable alternative to open AVF-Ts.
This report documents the effects of photorefractive keratectomy (PRK) in an astronaut during a 12-day Russian Soyuz mission to the International Space Station in 2008. Changing environmental ...conditions of launch, microgravity exposure, and reentry create an extremely dynamic ocular environment. Although many normal eyes have repeatedly been subject to such stresses, the effect on an eye with a relatively thin cornea as a result of PRK has not been reported. This report suggests that PRK is a safe, effective, and well-tolerated procedure in astronauts during space flight.
No author has a financial or proprietary interest in any material or method mentioned.
An autogenous arteriovenous hemodialysis access (AVF) remains the consensus-recommended vascular access for individuals requiring hemodialysis. Surgical options, strategies, and guidelines have been ...established by several organizations, including the National Kidney Foundation, the Fistula First Breakthrough Initiative, and the Society for Vascular Surgery. Establishing a successful AVF in a high percentage of patients requires a thorough knowledge of the many access options and clinical practice recommendations, in addition to a careful clinical history/physical examination, pre- and postoperative ultrasound, and further vascular imaging in select patients. The more common AVF configurations may not be possible in complex patients because of limited venous outflow, arterial insufficiency, or both. However, the vascular access surgeon may still be able to construct a successful AVF in these challenging patients by utilizing one of several alternative procedures. Avoiding prosthetic arteriovenous accesses and central venous catheter-based dialysis is feasible in most patients. This article reviews some of the alternative options for establishing successful AVFs.
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