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Vascular access in lipoprotein apheresis: a retrospective analysis from the UK's largest lipoprotein apheresis centre.
Doherty, Daniel J; Pottle, Alison; Malietzis, George; Hakim, Nadey; Barbir, Mahmoud; Crane, Jeremy S.
Afiliação
  • Doherty DJ; 1 Imperial College Healthcare NHS Trust, Department of Surgery and Cancer, Hammersmith Hospital, London - UK.
  • Pottle A; 2 Royal Brompton & Harefield NHS Foundation Trust, Lipoprotein-Apheresis Unit, Cardiology Department, Harefield Hospital, Harefield, Middlesex - UK.
  • Malietzis G; 1 Imperial College Healthcare NHS Trust, Department of Surgery and Cancer, Hammersmith Hospital, London - UK.
  • Hakim N; 1 Imperial College Healthcare NHS Trust, Department of Surgery and Cancer, Hammersmith Hospital, London - UK.
  • Barbir M; 2 Royal Brompton & Harefield NHS Foundation Trust, Lipoprotein-Apheresis Unit, Cardiology Department, Harefield Hospital, Harefield, Middlesex - UK.
  • Crane JS; 1 Imperial College Healthcare NHS Trust, Department of Surgery and Cancer, Hammersmith Hospital, London - UK.
J Vasc Access ; 19(1): 52-57, 2018 Jan.
Article em En | MEDLINE | ID: mdl-29076516
INTRODUCTION: Lipoprotein apheresis (LA) has proven to be an effective, safe and life-saving therapy. Vascular access is needed to facilitate this treatment but has recognised complications. Despite consistency in treatment indication and duration there are no guidelines in place. The aim of this study is to characterise vascular access practice at the UK's largest LA centre and forward suggestions for future approaches. METHODS: A retrospective analysis of vascular access strategies was undertaken in all patients who received LA treatment in the low-density lipoprotein (LDL) Apheresis Unit at Harefield Hospital (Middlesex, UK) from November 2000 to March 2016. RESULTS: Fifty-three former and current patients underwent 4260 LA treatments. Peripheral vein cannulation represented 79% of initial vascular access strategies with arteriovenous (AV) fistula use accounting for 15%. Last used method of vascular access was peripheral vein cannulation in 57% versus AV fistula in 32%. Total AV fistula failure rate was 37%. CONCLUSIONS: Peripheral vein cannulation remains the most common method to facilitate LA. Practice trends indicate a move towards AV fistula creation; the favoured approach receiving support from the expert body in this area. AV fistula failure rate is high and of great concern, therefore we suggest the implementation of upper limb ultrasound vascular mapping in all patients who meet treatment eligibility criteria. We encourage close ties between apheresis units and specialist surgical centres to facilitate patient counselling and monitoring. Further prospective data regarding fistula failure is needed in this expanding treatment field.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Remoção de Componentes Sanguíneos / Cateterismo Periférico / Derivação Arteriovenosa Cirúrgica / Dislipidemias / Lipoproteínas Tipo de estudo: Diagnostic_studies / Etiology_studies / Guideline / Observational_studies / Risk_factors_studies Limite: Adolescent / Adult / Aged / Child / Female / Humans / Male / Middle aged País/Região como assunto: Europa Idioma: En Revista: J Vasc Access Assunto da revista: ANGIOLOGIA Ano de publicação: 2018 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Remoção de Componentes Sanguíneos / Cateterismo Periférico / Derivação Arteriovenosa Cirúrgica / Dislipidemias / Lipoproteínas Tipo de estudo: Diagnostic_studies / Etiology_studies / Guideline / Observational_studies / Risk_factors_studies Limite: Adolescent / Adult / Aged / Child / Female / Humans / Male / Middle aged País/Região como assunto: Europa Idioma: En Revista: J Vasc Access Assunto da revista: ANGIOLOGIA Ano de publicação: 2018 Tipo de documento: Article