USE of IMplanting the Biotronik PassEo-18 Lux drug coated balloon to treat failing haemodialysis arteRiovenous FIstulas and grafts (SEMPER FI Study).

BACKGROUND: Plain old balloon angioplasty has been the mainstay of treatment for arteriovenous fistula (AVF) stenoses. Recent studies suggest that drug coated balloons (DCB) may significantly reduce re-intervention rates on native and recurrent lesions. The Passeo-18 Lux DCB (Biotronik AG, Buelach, Switzerland) is packaged with a 3.0 µg/mm2 dose of paclitaxel. The hypothesis is that its use provides better target lesion primary patency (TLPP), primary assisted patency (PP), secondary patency (SP) rates and reduces the number of visits for re-intervention in a cohort of patients with stenotic AVF and arteriovenous grafts (AVGs). METHODS: The USE of IMplanting the Biotronik PassEo-18 Lux DCB to treat failing haemodialysis arteRiovenous FIstulas and grafts trial (SEMPER FI) was a prospective double-centre, multi-investigator, non-consecutive, non-blinded single-arm study investigating the efficacy and safety of the Passeo-18 Lux DCB in patients with stenotic AVF/AVG lesions between January 2021 and January 2022. Patient demographics, clinical characteristics, vascular access history, operative indications, details and outcomes were collected prospectively. TLPP, circuit access primary patency (CAP), PP, SP and deaths 6- and 12-months post-intervention were studied. RESULTS: Ninety-one patients with 110 lesions were recruited across the two centres. 62.6% (n = 57) were male with a median age of 63.5 years (SD = 10.5). 62.6% (n = 57) were taking anti-platelets. Eighty-five AVFs and six AVGs were treated. 60% (n = 54) of AVFs intervened were radiocephalic. 52.7% (n = 58) of targeted lesions were juxta-anastomotic stenosis (JAS) and one-third (n = 33) at the AVF/AVG outflow. 70.9% (n = 78) of lesions were recurrent. Median time from last intervention was 219 days. 78% of target lesions (n = 85) and circuits (n = 70) were patent at 6-months, of which 96.7% (n = 87) of those requiring assisted intervention were patent. CONCLUSION: This study shows that the Passeo-18 Lux DCB can be an effective and safe tool in the treatment of failing haemodialysis AVFs/AVGs.

Diverticular Disease of the Appendix Is Associated with Complicated Appendicitis.

INTRODUCTION: Diverticular disease of the vermiform appendix (DDA) has an incidence of 0.004 to 2.1% in appendicectomy specimens. DDA is variably associated with perforation and malignancy. We report a single-center experience of DDA. The primary aim is to validate the association of DDA with complicated appendicitis or malignancy, and the secondary aim is to validate systemic inflammatory response syndrome (SIRS) criteria and quick Sepsis-related Organ Failure Assessment (qSOFA) scores. METHODS: The histopathology reports of 2,305 appendicectomy specimens from January 2011 to December 2015 were reviewed. Acute appendicitis was found in 2,164 (93.9%) specimens. Histology of the remaining 141 (6.1%) patients revealed: normal appendix (n = 110), DDA (n = 22), endometriosis of appendix (n = 6), and an absent appendix (n = 3). Patient demographics, clinical profile, operative data, and perioperative outcomes of DDA patients are studied. Modified Alvarado score, Andersson score, SIRS criteria, and qSOFA scores were retrospectively calculated. RESULTS: The incidence of DDA was 0.95%. Ten patients (45.5%) had diverticulitis. The mean age of DDA patients was 39.5 years (range 23-87), with male preponderance (n = 12, 54.5%). The median Modified Alvarado score was 8 (range 4-9), and the median Andersson score was 5 (range 2-8). Fourteen patients (63.6%) had SIRS, and none had a high qSOFA score. Eight patients (36.4%) had complicated appendicitis (perforation [n = 2] or abscess [n = 6]). Eleven (50%) patients underwent laparoscopic appendicectomy. There were three 30-day readmissions and no mortality. CONCLUSION: DDA is a distinct clinical pathology associated with complicated appendicitis.

INTRODUÇÃO: A doença diverticular do apêndice vermiforme (DDA) tem uma incidência de 0,004 a 2,1% em peças de apendicectomia. DDA está de forma variável associada a perfuração e malignidade. Reportamos uma experiência unicêntrica de DDA. O objectivo primário é validar a associação de DDA com apendicite complicada ou malignidade, e o objectivo secundário é validar os critérios de Systemic Inflammatory Response Syndrome (SIRS) e o score de quick Sepsis-related Organ Failure Assessment (qSOFA). MÉTODOS: Os relatórios histopatológicos de 2,305 peças de apendicectomia de Janeiro 2011 a Dezembro de 2015 foram revistos. Apendicite aguda foi verificada em 2,164 (93,9%) peças. A histologia das restantes 141 (6,1%) revelou: apêndice normal (n = 110), DDA (n = 22), endometriose do apêndice (n = 6) e apêndice ausente (n = 3). As características demográficas dos doentes, perfil clínico, dados cirúrgicos e perioperatórios dos doentes com DDA foram avaliados. Modified Alvarado score, Andersson score, SIRS criteria, e o qSOFA scores foram calculados retrospectivamente. RESULTADOS: A incidência de DDA foi de 0,95%. Dez doentes (45,5%) tinham diverticulite. A idade média dos doentes com DDA foi de 39,5 anos (âmbito 23­87) com predominância masculina (n = 12, 54,5%). A mediana do Modified Alvarado score foi de 8 (âmbito 4­9), e a mediana do Andersson score foi de 5 (âmbito 2­8). Quatorze doentes (63,6%) tinham SIRS e nenhum tinha um qSOFA score alto. Oito doentes (36,4%) tinham apendicite complicada (perfuração n = 2; abcesso n = 6). Onze (50%) doentes foram submetidos a apendicectomia laparoscópica. Verificaram-se 3 readmissões aos 30 dias e nenhuma morte. CONCLUSÃO: DDA é uma entidade clínica e patológica distinta e está associada a apendicite complicada.