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1.
Medicina (Kaunas) ; 60(9)2024 Aug 31.
Article in English | MEDLINE | ID: mdl-39336468

ABSTRACT

Background and Objectives: The saphenous vein graft (SVG) remains the most frequently used conduit worldwide, despite its common disadvantage of early graft failure. To solve the problem and reduce the SVG damage, Souza implemented a new technique where a vein is harvested with surrounding fascia and fat tissue (the so-called no-touch technique). Materials and Methods. A prospective study conducted from February 2019 to June 2024 included 23 patients who underwent myocardial revascularization using a no-touch vein, with follow-up control examinations using computed tomographic angiography to detect graft stenosis or occlusion. Results. Of the entire patient group, 17 (73.9%) were male, with a mean age of 67.39 ± 7.71 years. The mean follow-up period was 25 months. There were no major adverse cardiovascular or cerebrovascular events (MACCEs) during hospitalization, although one patient died in the hospital. Another patient died due to malignancy, but no MACCEs occurred during the follow-up period. According to multi-slice CT coronary angiography, the results were impeccable, with an astonishing 100% patency observed in all 20 IMA grafts and 58 no-touch SVGs examined. Conclusions. The excellent patency rate during the early follow-up period confirmed that the no-touch technique is a good option for surgical revascularization.


Subject(s)
Computed Tomography Angiography , Coronary Artery Bypass , Saphenous Vein , Humans , Male , Female , Aged , Prospective Studies , Follow-Up Studies , Saphenous Vein/transplantation , Saphenous Vein/diagnostic imaging , Middle Aged , Coronary Artery Bypass/methods , Computed Tomography Angiography/methods , Serbia , Vascular Patency
2.
EuroIntervention ; 20(18): e1154-e1162, 2024 Sep 16.
Article in English | MEDLINE | ID: mdl-39279516

ABSTRACT

BACKGROUND: Endovascular therapy (EVT) has become the preferred treatment modality for femoropopliteal disease. However, there is limited evidence regarding its procedural and clinical outcomes according to the affected area. AIMS: The aim of this study is to investigate clinical outcomes and device effectiveness according to treatment extent in the superficial femoral artery (SFA), popliteal artery (PA), or both. METHODS: In this study, we analysed EVT for SFA (2,404 limbs), PA (155 limbs), SFA/PA (383 limbs) using the population in the K-VIS ELLA (Korean Vascular Intervention Society Endovascular Therapy in Lower Limb Artery Diseases) registry. The primary endpoint was target lesion revascularisation (TLR) at 2 years. RESULTS: The SFA/PA group exhibited a higher prevalence of anatomical complexity, characterised by long lesions, moderate to severe calcification, and total occlusion. The procedures were successful in 97.2% of SFA, 92.9% of PA, and 95.6% of SFA/PA EVTs. The 2-year TLR rates were 21.1%, 18.6%, and 32.7% in the SFA, PA, and SFA/PA groups, respectively. SFA/PA EVT was associated with a significantly increased risk for TLR compared to the SFA group (adjusted hazard ratio [HR] 1.48 [1.09-2.00]; p=0.008) and a trend towards an increased risk compared to the PA group (adjusted HR 1.80 [1.00-3.27]; p=0.052). After overlap weighting, the use of a drug-coated balloon (DCB) was shown to be beneficial, with the lowest TLR rate after SFA and SFA/PA EVT. CONCLUSIONS: In this large real-world registry, SFA/PA EVT was associated with an increased risk for TLR at 2 years compared to the SFA or PA EVT groups, with favourable outcomes when using a DCB or drug-eluting stent in the SFA/PA EVT group.


Subject(s)
Endovascular Procedures , Femoral Artery , Peripheral Arterial Disease , Popliteal Artery , Humans , Popliteal Artery/surgery , Endovascular Procedures/instrumentation , Endovascular Procedures/adverse effects , Endovascular Procedures/methods , Peripheral Arterial Disease/therapy , Male , Female , Aged , Treatment Outcome , Middle Aged , Registries , Aged, 80 and over , Risk Factors , Vascular Patency
3.
EuroIntervention ; 20(18): e1163-e1172, 2024 Sep 16.
Article in English | MEDLINE | ID: mdl-39279518

ABSTRACT

BACKGROUND: Although femoropopliteal-specific stents have durable patency, stent thrombosis (ST) may occur, which can lead to acute limb ischaemia (ALI). AIMS: We aimed to investigate the clinical features and outcomes of ALI caused by femoropopliteal ST in patients with lower extremity artery disease. METHODS: This multicentre retrospective study included 499 patients with ALI - of whom 108 patients had ALI caused by femoropopliteal ST (ST-ALI) and 391 patients had ALI caused by other aetiologies (de novo ALI) - who underwent treatment between September 2011 and March 2023. Clinical features and outcomes were compared between the two groups. The primary outcome measure was 12-month amputation-free survival; factors associated with amputation or death were investigated using multivariate Cox proportional hazards regression analysis. RESULTS: Patients with ST-ALI were significantly more likely to exhibit conventional atherosclerotic risk factors, including diabetes mellitus (63% vs 26%) and haemodialysis (51% vs 10%) compared to patients with de novo ALI, whereas patients with de novo ALI were older (80 years vs 74 years) and more likely to have atrial fibrillation (49% vs 18%) than patients with ST-ALI. The 12-month amputation-free survival rate was significantly lower in the ST-ALI group than that in the de novo ALI group (51% vs 76%; p<0.001). Multivariate analysis revealed that ST-ALI, older age, haemodialysis, atrial fibrillation, the presence of a wound, peak C-reactive protein level, and non-ambulatory status all have an independent, positive association with death or major amputation. CONCLUSIONS: The current study revealed that patients with ST-ALI had worse clinical outcomes than those with de novo ALI, highlighting the need to maximise ST prevention.


Subject(s)
Amputation, Surgical , Femoral Artery , Ischemia , Peripheral Arterial Disease , Popliteal Artery , Stents , Thrombosis , Humans , Male , Aged , Female , Retrospective Studies , Popliteal Artery/surgery , Ischemia/therapy , Ischemia/mortality , Ischemia/etiology , Ischemia/surgery , Femoral Artery/surgery , Peripheral Arterial Disease/therapy , Peripheral Arterial Disease/complications , Peripheral Arterial Disease/surgery , Peripheral Arterial Disease/mortality , Aged, 80 and over , Middle Aged , Thrombosis/etiology , Thrombosis/mortality , Treatment Outcome , Risk Factors , Limb Salvage , Endovascular Procedures/instrumentation , Endovascular Procedures/adverse effects , Lower Extremity/blood supply , Acute Disease , Vascular Patency
4.
Vasc Health Risk Manag ; 20: 421-434, 2024.
Article in English | MEDLINE | ID: mdl-39324109

ABSTRACT

Purpose: This study aimed to elucidate the impact of three different mapping methods on the outcomes of arteriovenous fistula (AVF), including the traditional physical examination (PE) method, color duplex ultrasonography (CDU) mapping conducted by a radiologist (CDU-R), and CDU mapping performed by the operating surgeon (CDU-S). Patients and Methods: This retrospective study was conducted at a tertiary center in Jordan. Patients were divided into three groups based on the venous mapping method: PE, CDU-R, and CDU-S. Various outcomes were analyzed, including immediate technical success, clinical adequacy at 3 months, and 1-year patency rates. Additional demographic and clinical factors influencing access patency or contributing to early failure were also examined. Results: The study included 303 eligible patients: 100 in the PE group, 103 in the CDU-R group, and 100 in the CDU-S group. The overall immediate technical success rate was 72%, which was highest in the CDU-S group (95%, p < 0.001). Additionally, the CDU-S group had the highest clinical access adequacy rate (78%, p < 0.01). Notably, the mapping method also influenced the anatomical location of the AVF, as none of the patients in the radiologist group had a forearm AVF. CDU-R, forearm location, intraoperative arterial calcifications, and operative duration were identified as predictors of AVF failure. Conclusion: The results suggest that perioperative vascular mapping by the operating surgeon not only results in a higher rate of immediate success but also improves access adequacy and prevents unnecessary delays in providing an effective lifeline for hemodialysis patients. The present study highlights the burden of access failure in these patients and the evolving evidence surrounding preoperative vein mapping.


Subject(s)
Arteriovenous Shunt, Surgical , Predictive Value of Tests , Renal Dialysis , Ultrasonography, Doppler, Color , Vascular Patency , Humans , Female , Male , Retrospective Studies , Middle Aged , Arteriovenous Shunt, Surgical/adverse effects , Jordan , Aged , Treatment Outcome , Time Factors , Risk Factors , Graft Occlusion, Vascular/etiology , Graft Occlusion, Vascular/diagnostic imaging , Graft Occlusion, Vascular/physiopathology , Adult , Physical Examination
5.
Medicine (Baltimore) ; 103(38): e39758, 2024 Sep 20.
Article in English | MEDLINE | ID: mdl-39312318

ABSTRACT

BACKGROUND: To investigate the effect of dilating small blood vessels using a balloon dilation (BD) technique on the occurrence of radio-cephalic autogenous arteriovenous fistulas in terms of patency, blood flow, and vein diameter (VD). METHODS: The subjects included in this study were all patients with chronic renal failure and required radio-cephalic arteriovenous fistula surgery for the first time and had not received dialysis before. Patients with VDs <2 mm were included as study subjects. They were either assigned treatment using a BD group or a control group that received hydrostatic dilation. The differences between the 2 groups were analyzed in terms of patency, blood flow, and VD. RESULTS: A total of 22 patients were enrolled in the balloon dilatation group and 20 patients in the control group. The diameters of cephalic veins (mm) of the experimental and control group were compared at various time points: immediately postoperation, 2.89 ±â€…0.42 versus 1.99 ±â€…0.28 (P < .001); 1 week later, 3.16 ±â€…0.59 versus 2.66 ±â€…0.60 (P = .022); 1 month later, 3.76 ±â€…0.91 versus 3.18 ±â€…0.83 (P = .087); and 2 months later, 4.08 ±â€…1.15 versus 3.38 ±â€…1.13 (P = .169). Brachial artery flows (mL/min) of the 2 groups at various time points were given as follows: immediately postoperation, 413.49 ±â€…145.09 versus 235.61 ±â€…87.77 (P < .001); 1 week later, 563.26 ±â€…206.83 versus 331.30 ±â€…126.78 (P < .001); 1 month later, 679.34 ±â€…218.56 versus 376.79 ±â€…156.25 (P < .001); and 2 months later, 736.31 ±â€…202.61 versus 394.60 ±â€…161.96 (P < .001). The primary patency at 1 year for the experimental group was 61.9% compared to 11.1% for the control group (P = .045). Similarly, the secondary patency rates at 1 year were 90.5% for the experimental group and 55.6% for the control group (P = .030). The results showed that the functional primary patency rate within 1 year was 57.1% versus 16.7% (P = .032), and the functional secondary patency rate within 1 year was 85.7% versus 50.0% (P = .038). CONCLUSION SUBSECTIONS: BD has obvious advantages over hydrostatic dilation for chronic renal failure patients with small veins in establishing arteriovenous fistula in terms of patency and blood flow.


Subject(s)
Arteriovenous Shunt, Surgical , Kidney Failure, Chronic , Vascular Patency , Humans , Arteriovenous Shunt, Surgical/methods , Arteriovenous Shunt, Surgical/adverse effects , Female , Male , Middle Aged , Kidney Failure, Chronic/therapy , Renal Dialysis/methods , Adult , Aged , Dilatation/methods , Radial Artery/surgery , Veins/surgery
6.
Langenbecks Arch Surg ; 409(1): 280, 2024 Sep 17.
Article in English | MEDLINE | ID: mdl-39287782

ABSTRACT

PURPOSE: Blind tunneling of subfascial femoropopliteal bypass grafts may result in inadvertent graft passage through the sartorius. The purpose of this study was to determine whether intramuscular passage of femoropopliteal bypass grafts affects primary patency. METHODS: Patients undergoing femoropopliteal bypass at a Veterans Administration hospital and associated university medical center over a recent 13-year period who also had postoperative cross-sectional imaging adequate to determine graft location were examined. Five-year primary patency of grafts circumferentially enveloped by the muscle was compared with that of both extramuscular subfascial grafts and subcutaneous grafts. RESULTS: 370 femoropopliteal grafts were identified, among which 258 (70%) were subfascial. Vein grafts comprised 51% of the subfascial grafts, and 53% were inserted above the knee. Available postoperative imaging in 110 subfascial grafts demonstrated 74 (67%) to lie completely within the muscle at some point. Among imaged subfascial grafts, primary patency at five years for intramuscular grafts was not significantly worse than extramuscular grafts (P = 0.31). This remained true whether grafts were vein (P = 0.39) or prosthetic (P = 0.31) and whether grafts inserted to the above-knee (P = 0.43) or below-knee (P = 0.21) popliteal artery. Multivariable Cox regression revealed a significant relationship between use of vein grafts (P = 0.013), active smoking (P = 0.01), and hypertension (P = 0.041) and primary patency, but not intramuscular graft location (P = 0.31). CONCLUSION: This study failed to demonstrate significantly inferior primary patency among subfascial femoropopliteal grafts tunneled intramuscularly. Larger studies may be required to adequately detect any differences in patency by muscular entrapment, especially among subgroups.


Subject(s)
Femoral Artery , Popliteal Artery , Vascular Patency , Humans , Popliteal Artery/surgery , Femoral Artery/surgery , Male , Aged , Female , Middle Aged , Muscle, Skeletal/transplantation , Muscle, Skeletal/blood supply , Retrospective Studies , Graft Occlusion, Vascular/etiology , Treatment Outcome
8.
Sci Rep ; 14(1): 21173, 2024 09 11.
Article in English | MEDLINE | ID: mdl-39256427

ABSTRACT

Because there is a lack of comparative studies assessing drug-coated balloon (DCB) and drug-eluting stent (DES) outcomes with respect to intraluminal (IL) and subintimal (SI) approaches in femoropopliteal (FP) total occlusive lesions, we compared the outcomes between DCB (including bailout stenting) and DES treatments for this lesion. A total of 487 limbs (434 patients) were divided into the IL (n = 344, DCB: n = 268, DES: n = 76) and SI (n = 143, DCB: n = 83, DES: n = 60) approach groups. The primary outcome was a major adverse limb event (MALE), defined as above-ankle amputation or repeat revascularization of the index limb. Secondary outcomes included clinically driven target lesion revascularization (TLR), loss of clinical patency, and all-cause death. After adjustment, in each IL and SI approach, the 2-year rates of MALE (p = 0.180 and p = 0.236, respectively), TLR, loss of clinical patency, and all-cause death were similar between the DCB and DES groups. In the DCB and DES groups, both primary and secondary outcomes were similar between the IL and SI approaches. DCB and DES strategies for patients presenting with FP total occlusive lesions demonstrated similar outcomes regardless of the IL or SI approach.Clinical Trial Registration: NCT02748226.


Subject(s)
Drug-Eluting Stents , Femoral Artery , Popliteal Artery , Humans , Male , Female , Aged , Popliteal Artery/surgery , Femoral Artery/surgery , Treatment Outcome , Middle Aged , Peripheral Arterial Disease/therapy , Angioplasty, Balloon/methods , Aged, 80 and over , Retrospective Studies , Vascular Patency
9.
Sci Rep ; 14(1): 21072, 2024 09 09.
Article in English | MEDLINE | ID: mdl-39256543

ABSTRACT

Controversy still exists regarding how much the inflow arterial percutaneous transluminal angioplasty (PTA) contributed to maintaining fistula function for hemodialysis. We aimed to analyze patency and risk factors after inflow arterial PTA. Hemodialysis patients with inflow arterial primary stenosis who were admitted to our institution from January 2017 to December 2022 were examined. One group had arterial-venous fistula with inflow artery stenosis alone (AVF + iAS) and another group had AVF with inflow artery stenosis and any vein stenosis (AVF + iAS + VS). The characteristics of patients, stenotic lesions, and PTA procedures were recorded. Kaplan-Meier analysis was used to compare primary patency, assisted primary patency, and secondary patency in the two groups. Cox proportional hazard analysis was used to identify risk factors associated with patency. We examined 213 patients, 53 in the AVF + iAS group (51 radial arterial stenosis and 2 ulnar arterial stenosis) and 160 in the AVF + iAS + VS group (159 radial arterial stenosis and 1 ulnar arterial stenosis). Kaplan-Meier analysis indicated the AVF + iAS group had better primary patency and assisted primary patency (both P < 0.05), but the groups had similar secondary patency. Cox proportional hazard analysis indicated that none of the analyzed clinical and biochemical indexes had clinically meaningful effects on primary patency, assisted primary patency, or secondary patency in either group. The patency and safety after PTA for inflow arterial stenosis were satisfactory, and none of the examined risk factors had a major clinical impact on patency. We recommend PTA as treatment for inflow stenosis of an AVF.


Subject(s)
Angioplasty , Renal Dialysis , Vascular Patency , Humans , Male , Female , Retrospective Studies , Angioplasty/methods , Angioplasty/adverse effects , Middle Aged , Aged , Constriction, Pathologic , Arteriovenous Shunt, Surgical/adverse effects , Risk Factors , Kaplan-Meier Estimate , Proportional Hazards Models , Treatment Outcome , Radial Artery , Arterial Occlusive Diseases/therapy , Arterial Occlusive Diseases/etiology
10.
Zhonghua Yi Xue Za Zhi ; 104(32): 3025-3031, 2024 Aug 20.
Article in Chinese | MEDLINE | ID: mdl-39143769

ABSTRACT

Objective: To evaluate the prevalence, intervention methods and effect of arteriovenous graft (AVG) stenosis. Methods: The clinical data of patients who received AVG in the Blood Purification Center, the First Affiliated Hospital of Zhengzhou University from January 2018 to December 2022 were retrospectively analyzed. The patency rate, prevalence and intervention effect of AVG stenosis were analyzed. Results: A total of 475 patients aged (55.5±11.8) years were included, and there were 193 male cases (40.6%) and 282 female cases (59.4%). The patients were followed up for [M (Q1, Q3)] 19 (12, 30) months, and the primary, assisted primary and secondary patency were 14 (5, 27), 27 (13, 55), and 59 (33, 65) months, respectively. There were 799 access events which needed intervention, with a total standardized intervention rate of 0.90 per patient-year. Totally, 431(53.9%, 431/799) stenosis events occurred in 207 AVG. Among 422 AVG stenosis events with complete clinical data, 57.8% (244/422) were multi-site stenosis and 42.2% (178/422) were single-site stenosis. The most common sites of stenosis were graft-vein anastomosis (47.6%, 340/715), venous outflows (22.7%, 162/715), and puncture zone (20.0%, 143/715). In the 414 stenosis with intact follow-up data, 90.8% (376/414) were treated by balloon angioplasty, 8.5% (35/414) received covered stent insertion, and 0.7% (3/414) were intervened by open surgery. Clinical success rate was 98.1% (406/414). The primary patency time after endovascular treatment was 6 (4, 12) months. Covered stent significantly increased post-intervention primary patency time compared withballoon angioplasty [6 (3, 7) months vs 3 (1, 4) months, P=0.020]. Conclusions: Stenosis is the most common complication of AVG, and the most common sites are graft-vein anastomosis, venous outflows, and puncture zone. Intervention of AVG stenosis has a high clinical success rate, and a relatively low post-intervention patency. Covered stent insertion improves the post-intervention patency of AVG, which has a poor effect using balloon expansion.


Subject(s)
Arteriovenous Shunt, Surgical , Graft Occlusion, Vascular , Renal Dialysis , Humans , Male , Female , Middle Aged , Retrospective Studies , Prevalence , Constriction, Pathologic , Vascular Patency , Stents , Aged
11.
Zhonghua Yi Xue Za Zhi ; 104(32): 3032-3036, 2024 Aug 20.
Article in Chinese | MEDLINE | ID: mdl-39143770

ABSTRACT

Objective: To evaluate the long-term outcomes of lower extremity arteriovenous graft (AVG) in hemodialysis patients. Methods: Hemodialysis patients with lower extremity AVG from August 2015 to July 2023 in the Department of Vascular Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine were enrolled. Therapeutic effects and complications of AVG were retrospectively analyzed. Results: A total of 83 cases aged (58.9±13.3) years were enrolled, including 25 males and 58 females. The success rate of the operation was 100% (83/83), and no perioperative complications occurred. The follow-up time [M (Q1, Q3)] was 38.4 (22.6, 55.3) months, with a follow-up rate of 92.8% (77/83). There were 9 cases (11.7%) of puncture site infection, 5 cases (6.5%) of pseudoaneurysm, 2 cases (2.6%) of seroma, 3 cases (3.9%) of lower limb ischemia, 48 cases (62.3%) of stenosis and 24 cases (31.2%) of thrombosis during the follow-up period. The 6-month, 1-year, 2-year, 3-year and 5-year primary patency rates after surgery were 78.9%, 61.2%, 39.0%, 27.0% and 16.3%, respectively, assisted primary patency rates were 93.5%, 82.5%, 74.9%, 68.0% and 53.0%, respectively, and secondary patency rates were 96.1%, 94.7%, 93.1%, 91.3% and 75.3%, respectively. Conclusion: For patients whose vascular resources of upper limbs are exhausted, lower extremity AVG is a safe and effective hemodialysis vascular access.


Subject(s)
Arteriovenous Shunt, Surgical , Lower Extremity , Renal Dialysis , Humans , Male , Female , Middle Aged , Lower Extremity/blood supply , Retrospective Studies , Aged , Treatment Outcome , Vascular Patency
12.
Zhonghua Yi Xue Za Zhi ; 104(32): 3063-3066, 2024 Aug 20.
Article in Chinese | MEDLINE | ID: mdl-39143775

ABSTRACT

Patients who underwent arterio-arterial graft (AAG) surgery at Beijing Haidian Hospital from March 2021 to December 2023 were prospectively included. A total of 13 cases (6 males and 7 females) aged (59±13) years were collected, with a dialysis history of 4.0 (1.8, 10.0) years. Nine cases of "bow"-type AAG and 4 cases of "α"-type AAG were established. The follow-up time was 10 (7, 16) months. The primary patency and secondary patency rates at 3, 6 and 12 months after surgery were 92.3% and 100%, 81.8% and 90.9%, 57.1% and 57.1%, respectively. Stenosis, thrombosis and infection occurred in 2, 5 and 2 cases, respectively. The current study indicates that AAG surgery is simple, minimally invasive, and has a high long-term patency rate. It can be used as a new type of vascular access for patients who fail to establish conventional dialysis access.


Subject(s)
Arteriovenous Shunt, Surgical , Renal Dialysis , Vascular Patency , Humans , Male , Female , Middle Aged , Arteriovenous Shunt, Surgical/methods , Aged , Prospective Studies
13.
Zhonghua Yi Xue Za Zhi ; 104(32): 3037-3041, 2024 Aug 20.
Article in Chinese | MEDLINE | ID: mdl-39143771

ABSTRACT

Objective: To investigate the factors affecting primary patency time in arteriovenous graft (AVG) patients receiving percutaneous transluminal balloon angioplasty (PTA). Methods: Hemodialysis patients who underwent AVG placement at the First Affiliated Hospital of Chongqing Medical University between February 2018 and December 2021 were included. The factors including age, gender, total duration of AVG use, site of stenosis, degree of stenosis, length of stenosis, residual stenosis, and presence of thrombosis were analyzed, and influencing factors of primary patency time in AVG were determined using a multiple linear regression model. Results: A total of 101 patients who underwent 331 PTA treatments were enrolled, including 35 males and 66 females. The median age of patients undergoing PTA for the first time was 61 (51, 68) years, and the primary patency time after PTA was 5 (3, 10) months. The patients were followed up for (38.5±15.3) months. Multivariable linear regression analysis revealed that severe stenosis at the venous anastomosis and reflux veins (ß=-2.773, 95%CI:-5.440--0.105, P=0.042), female (ß=-2.247, 95%CI:-3.853--0.642, P=0.006), and previous multiple PTA treatments (ß=-0.516, 95%CI:-0.978--0.054, P=0.029) were risk factors for a shorter primary patency time after PTA. Conclusion: Severity of stenosis at the venous anastomosis and reflux veins of the AVG, female, and a history of multiple previous PTA treatments are associated with a shorter primary patency time in AVG patients.


Subject(s)
Angioplasty, Balloon , Arteriovenous Shunt, Surgical , Renal Dialysis , Vascular Patency , Humans , Female , Male , Middle Aged , Aged , Graft Occlusion, Vascular , Risk Factors , Constriction, Pathologic
14.
Zhonghua Yi Xue Za Zhi ; 104(32): 3059-3062, 2024 Aug 20.
Article in Chinese | MEDLINE | ID: mdl-39143774

ABSTRACT

A total of 309 (138 males and 171 females) end-stage renal disease patients who underwent implantation of early cannulation arteriovenous grafts (Acuseal) for hemodialysis in Nanfang Hospital, Southern Medical University between December 2016 and May 2021 were retrospectively included. The age of patients was (61.5±10.3) years. There were 244 patients (119 males and 125 females) who received regular follow-up. During the follow-up period, 24 patients died. Perioperative complications included graft infection (4.5%, 11/244), hematoma (4.5%, 11/244) and steal syndrome (4.1%, 10/244). No seroma or anastomotic rupture occurred. The rates of the first postoperative puncture time within 24 h, 48 h and 72 h after implantation were 42.2%(103/244), 32.4% (79/244) and 16.4% (40/244), respectively. The Kaplan-Meier survival analysis showed that the primary patency rates at 6 months and 12 months were 66.5% and 48.4%, respectively, and the secondary patency rates at 6 months and 12 months were 96.7% and 91.8%, respectively. The current study indicates that the Acuseal graft is safe for vascular access in patients requiring hemodialysis, with satisfactory patency and acceptable complication rates at 1-year follow-up.


Subject(s)
Arteriovenous Shunt, Surgical , Kidney Failure, Chronic , Renal Dialysis , Humans , Male , Female , Middle Aged , Retrospective Studies , Kidney Failure, Chronic/therapy , Arteriovenous Shunt, Surgical/methods , Catheterization , Aged , Vascular Patency , Postoperative Complications/etiology , Blood Vessel Prosthesis Implantation/methods , Treatment Outcome , Blood Vessel Prosthesis
15.
Semin Vasc Surg ; 37(2): 133-149, 2024 Jun.
Article in English | MEDLINE | ID: mdl-39151993

ABSTRACT

The growing number of prevalent arteriovenous (AV) accesses has been associated with an increase in the incidence of procedures being performed to maintain patency. To reduce the rate of unnecessary procedures, the 2019 Kidney Disease Outcome Quality Initiative guidelines addended the AV access surveillance recommendations, which includes clinical monitoring and assessment of dialysis adequacy alone. Abnormal clinical findings would necessitate follow-up angiography with or without confirmatory duplex ultrasound. Due to poor patency, increased surveillance schedules have been proposed to identify stenosis early and potentially prevent acute thrombotic events and AV access failure. In this review, we outlined current AV access monitoring and maintenance procedure recommendations, as described by the Centers for Medicare and Medicaid Services and 2019 Kidney Disease Outcome Quality Initiative guidelines. In addition, we highlight the findings of recently published randomized controlled trials that have examined increased surveillance schedules.


Subject(s)
Arteriovenous Shunt, Surgical , Graft Occlusion, Vascular , Practice Guidelines as Topic , Renal Dialysis , Vascular Patency , Humans , Arteriovenous Shunt, Surgical/adverse effects , Arteriovenous Shunt, Surgical/standards , Renal Dialysis/standards , Graft Occlusion, Vascular/diagnostic imaging , Graft Occlusion, Vascular/etiology , Graft Occlusion, Vascular/therapy , Treatment Outcome , Practice Guidelines as Topic/standards , Risk Factors , Predictive Value of Tests , Time Factors
16.
Tech Vasc Interv Radiol ; 27(2): 100963, 2024 Jun.
Article in English | MEDLINE | ID: mdl-39168552

ABSTRACT

Pediatric venous occlusions are a growing cause of morbidity and mortality, especially in hospitalized patients. Catheter-directed recanalization is a safe and effective treatment option in appropriately selected patients. Benefits of catheter directed therapies (CDTs) include the prevention of pulmonary embolism and end organ failure acutely as well as superior vena cava syndrome and post-thrombotic syndrome chronically. Timely diagnosis, recognition of underlying factors for thrombosis, and familiarity with the spectrum of tools and techniques for CDT are essential to optimizing outcomes in the acute setting. Recanalization of chronic venous occlusions can similarly provide symptomatic relief and achieve long term vessel patency. This review will detail the scope, techniques, and outcomes for CDT in the treatment of acquired systemic deep vein occlusions.


Subject(s)
Radiography, Interventional , Venous Thrombosis , Humans , Child , Venous Thrombosis/diagnostic imaging , Venous Thrombosis/therapy , Venous Thrombosis/physiopathology , Treatment Outcome , Child, Preschool , Adolescent , Infant , Phlebography , Vascular Patency , Age Factors , Risk Factors , Infant, Newborn , Male , Female , Endovascular Procedures/instrumentation , Endovascular Procedures/adverse effects , Catheterization, Peripheral/adverse effects , Predictive Value of Tests
17.
Medicine (Baltimore) ; 103(33): e39331, 2024 Aug 16.
Article in English | MEDLINE | ID: mdl-39151525

ABSTRACT

This study aimed to evaluate the long-term clinical outcomes of drug-coated drug (DCB) angioplasty for long femoropopliteal lesions in older patients with chronic limb-threatening ischemia (CLTI). In this multi-center retrospective study, we enrolled 119 patients with CLTI due to Trans-Atlantic Inter-Society Consensus (TASCII) C/D femoropopliteal lesions who underwent DCB angioplasty. A total of 119 patients with 122 limbs (TASCII C = 67, 54.9%; TASCII D = 55, 45.1%) were enrolled. At 36-month follow-up, primary patency, assisted primary patency, secondary patency, and freedom from target lesion revascularization were 47.3%, 49.8%, 59.5%, and 62.7%, respectively, and there was a significant improvement over baseline in Rutherford class (P < .001) and ankle-brachial index measurements (P < .001). Complex target lesions (P = .017) and 1 stenosis-free outflow vessel (P = .001) were risk predictors of freedom from clinically driven target lesion revascularization. Complex target lesions (P = .044), diabetes (P = .007), and 1 stenosis-free outflow vessel (P = .003) were risk predictors of restenosis. At 2 months, the ulcer healing rate was 96.3% (26/27). At 36 months, the limb salvage and survival rates were 85.8% and 83.3%, respectively. DCB angioplasty were safe and effective for older patients with CLTI attributable to femoropopliteal TASCII C/D lesions.


Subject(s)
Angioplasty, Balloon , Femoral Artery , Popliteal Artery , Humans , Male , Female , Retrospective Studies , Aged , Angioplasty, Balloon/methods , Popliteal Artery/diagnostic imaging , Aged, 80 and over , Treatment Outcome , Chronic Limb-Threatening Ischemia/therapy , Peripheral Arterial Disease/therapy , Vascular Patency , Coated Materials, Biocompatible , Middle Aged
18.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 55(4): 1001-1006, 2024 Jul 20.
Article in Chinese | MEDLINE | ID: mdl-39170024

ABSTRACT

Objective: To evaluate the effects of the multiple single cannulation technique (MUST) on the outcomes of arteriovenous graft (AVG). Methods: A retrospective study of AVG created between January 2018 and December 2021 at the First Affiliated Hospital of Zhengzhou University was conducted. The clinical data of patients and their follow-up data for venous access were analyzed. Subjects were divided into the MUST group or the non-MUST group according to whether MUST was used. The cumulative patency rate and complication incidence were compared between the two groups. Logistic regression was applied to analyze the influencing factors of applying MUST in AVG. Results: The MUST group included 115 AVG and the non-MUST group, 122 AVG. The 1-year, 2-year, 3-year, and 4-year cumulative patency rates of the MUST group were 100%, 99.1%, 95.2%, 85.4%, and 73.2%, respectively, while those for the non-MUST group were 97.5%, 92.7%, 77.7%, 69.7%, and 50.0%, respectively, with the 2-year and 3-year patency rates showing significant difference (P=0.022, P=0.004). The standard intervention rate expressed in (median [interquartile range]) in the MUST group was significantly lower than that in the non-MUST group (0.46 [0.00, 0.94] vs. 0.97 [0.60, 1.59], Z=-5.808, P<0.001). A total of 24 (20.9%) AVG in the MUST group and 60 (49.2%) AVG in the non-MUST group had a standard intervention rate >1.0 per patient-year, with significant difference between the two groups. Three (2.6%) AVG in the MUST group and 7 (5.7%) AVG in the non-MUST group were complicated by aneurysm (χ 2=20.737, P<0.001). One (0.9%) AVG in the MUST group and 6 (4.9%) AVG in the non-MUST group had graft infection, with the difference between the groups showing no significance (P=0.121). Multivariate logistic regression showed that dialysis in the alliance facilities (odds ratio [OR]=2.713, 95% confidence interval [CI]: 1.698-4.336, P<0.001], and excellent follow-up [OR=2.189, 95% CI: 1.221-3.927, P=0.009] were the influencing factors of applying MUST in AVG. Conclusion: MUST improves the cumulative patency of AVG and decreases the intervention frequency and the incidence of aneurysm without increasing the risk of graft infection.


Subject(s)
Arteriovenous Shunt, Surgical , Catheterization , Renal Dialysis , Vascular Patency , Humans , Renal Dialysis/methods , Retrospective Studies , Arteriovenous Shunt, Surgical/methods , Catheterization/methods , Male , Female , Middle Aged , Treatment Outcome , Postoperative Complications/prevention & control , Postoperative Complications/etiology , Postoperative Complications/epidemiology
19.
JACC Cardiovasc Interv ; 17(16): 1891-1901, 2024 Aug 26.
Article in English | MEDLINE | ID: mdl-39197987

ABSTRACT

BACKGROUND: The introduction of radial-specific equipment has made transradial (TR) aortoiliac (AI) endovascular therapy (EVT) more convenient. OBJECTIVES: The authors aimed to investigate the perioperative outcomes of the TR approach in patients undergoing AI EVT for symptomatic peripheral artery disease. METHODS: The COMFORT (Contemporary Strategy for Aortoiliac Intervention) registry was a prospective, multicenter, observational study enrolling patients with symptomatic peripheral artery disease undergoing AI EVT between January 2021 and June 2023. The primary outcome was perioperative complications, whereas the secondary outcomes included core laboratory-evaluated residual stenosis >30%, time to hemostasis, time to ambulation, 30-day patency, and 30-day limb symptoms. These outcomes were compared between TR and non-TR AI EVT after propensity score matching. RESULTS: The TR approach was selected for 231 of the 947 patients (24.3%). The TR approach was chosen more in patients with a higher ankle-brachial index, chronic total occlusion, aortic lesion, bare nitinol stent implantation, and plain angioplasty, whereas it was chosen less in patients with dialysis, a history of AI EVT, chronic limb-threatening ischemia, bilateral calcification, and simultaneous infrainguinal EVT (all P < 0.05). After propensity score matching, the incidence of perioperative complications did not differ significantly between the groups (TR group: 6.0% vs non-TR group: 5.1%; P = 0.69). The proportions of residual stenosis, 30-day patency, and 30-day limb symptoms were not significantly different (all P > 0.05); however, the time to hemostasis and the time to ambulation were shorter in the TR group (both P < 0.05). CONCLUSIONS: Non-TR AI EVT and TR AI EVT using radial-specific equipment were associated with a similar risk of perioperative complications. The TR approach helps shorten the time required for hemostasis and ambulation.


Subject(s)
Endovascular Procedures , Iliac Artery , Peripheral Arterial Disease , Radial Artery , Registries , Vascular Patency , Humans , Female , Male , Aged , Endovascular Procedures/adverse effects , Endovascular Procedures/instrumentation , Prospective Studies , Radial Artery/physiopathology , Treatment Outcome , Time Factors , Iliac Artery/diagnostic imaging , Iliac Artery/physiopathology , Iliac Artery/surgery , Middle Aged , Peripheral Arterial Disease/therapy , Peripheral Arterial Disease/physiopathology , Peripheral Arterial Disease/diagnostic imaging , Risk Factors , Risk Assessment , Aged, 80 and over , Catheterization, Peripheral/adverse effects , Stents , Punctures
20.
Medicine (Baltimore) ; 103(31): e39178, 2024 Aug 02.
Article in English | MEDLINE | ID: mdl-39093778

ABSTRACT

This study aimed to examine the influence of diabetes on the left internal mammary artery (LIMA) and saphenous vein (SV) graft failure for 5-year follow-up. We enrolled 202 patients who underwent isolated off-pump coronary artery bypass grafting (CABG) surgery in 2014, angiographic follow-up occurred at 5 years after surgery. Angiographic outcomes in patients with or without diabetes were analyzed. Multivariate logistic regression analysis was used to identify independent predictors of graft dysfunction. A total of 66 (32.7%) patients had diabetes. Five-year rates of LIMA and SV graft failure were similar in patients with and without diabetes. In addition, in diabetics, the proportion of complete graft failure was significantly lower in the LIMA grafts (12/66, 18.2%) than in the SV grafts (57/133, 42.9%) (P = .001). In nondiabetic, the proportion of complete graft failure was also significantly lower in the LIMA grafts (28/136, 20.6%) than in the SV grafts (105/275, 38.2%) (P < .001). Multivariate logistic regression analysis showed that mean graft flow (MGF) was an independent predictor factor for LIMA (odds ratio = 1.186, 95% CI = 1.114-1.263, P < .001) and SV (odds ratio = 1.056, 95% CI = 1.035-1.077, P < .001) graft failure. Diabetes did not influence the patency of LIMA or SV grafts over a 5-year follow-up. LIMA grafts should be maximized in patients undergoing off-pump CABG surgery. Diabetes does not affect the patency of grafts CABG. Using angiography, our study proved that diabetes does not affect the patency of grafted vessels after CABG for 5 years.


Subject(s)
Coronary Angiography , Coronary Artery Bypass, Off-Pump , Mammary Arteries , Vascular Patency , Humans , Coronary Artery Bypass, Off-Pump/methods , Male , Female , Coronary Angiography/methods , Middle Aged , Aged , Mammary Arteries/transplantation , Mammary Arteries/diagnostic imaging , Saphenous Vein/transplantation , Saphenous Vein/diagnostic imaging , Diabetes Mellitus/epidemiology , Graft Occlusion, Vascular/epidemiology , Graft Occlusion, Vascular/diagnostic imaging , Graft Occlusion, Vascular/etiology , Retrospective Studies , Coronary Artery Disease/surgery , Coronary Artery Disease/diagnostic imaging , Follow-Up Studies
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