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1.
J Vasc Access ; 21(6): 963-968, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32372684

RESUMO

BACKGROUND: Many studies suggested that the optimal cephalic vein diameter for wrist radio-cephalic arteriovenous fistula construction should be at least 2 mm to predict successful maturation and primary patency. However, our experience has shown that many patients with smaller cephalic vein diameter (≤2 mm) in the neutral state (without a tourniquet) also have good clinical outcomes. The aim of this study was to identify predictors that affect primary survival of new wrist radio-cephalic arteriovenous fistula in patients with cephalic vein diameter ≤2 mm. METHODS: We performed a retrospective review of 50 patients with preoperative cephalic vein diameters ≤2 mm in the neutral state who underwent wrist radio-cephalic arteriovenous fistula construction between September 2016 and October 2019. Internal diameters of the cephalic vein and radial artery, venous distensibility, peak systolic velocity, and resistance index of the radial artery were determined by ultrasound examination before wrist radio-cephalic arteriovenous fistula placement. Patients were divided into two groups: failure and survival. RESULTS: The radio-cephalic arteriovenous fistula survival rate was 68% from the time of radio-cephalic arteriovenous fistula creation until the end of the study. Univariate analysis showed that larger venous distensibility (p < 0.001), non-diabetic kidney disease (p = 0.009), and slower peak systolic velocity of the radial artery (p = 0.033) were predictive factors for primary radio-cephalic arteriovenous fistula survival. Multivariate regression analysis revealed good venous distensibility (odds ratio = 9.637, 95% confidence interval = 1.893-49.050, p = 0.006) and non-diabetic kidney disease (odds ratio = 0.148, 95% confidence interval = 0.033-0.660, p = 0.012) to be independent predictors for primary radio-cephalic arteriovenous fistula survival. Receiver operating characteristic analysis showed that venous distensibility >0.52 mm (sensitivity: 70.6%, specificity: 68.8%) was the best cut-off value to predict primary radio-cephalic arteriovenous fistula survival. CONCLUSION: When cephalic veins with diameter ≤2 mm are found, venous distensibility should be used to aid in the surgery decision-making process. The outcome of wrist radio-cephalic arteriovenous fistula survival would be significantly improved through the use of cephalic vein with venous distensibility >0.52 mm.


Assuntos
Derivação Arteriovenosa Cirúrgica , Artéria Radial/cirurgia , Grau de Desobstrução Vascular , Veias/cirurgia , Punho/irrigação sanguínea , Adulto , Idoso , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Velocidade do Fluxo Sanguíneo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Artéria Radial/diagnóstico por imagem , Artéria Radial/fisiopatologia , Fluxo Sanguíneo Regional , Diálise Renal , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia Doppler Dupla , Resistência Vascular , Veias/diagnóstico por imagem , Veias/fisiopatologia , Pressão Venosa
2.
J Vasc Interv Radiol ; 31(6): 993-999.e1, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32376177

RESUMO

PURPOSE: To compare outcomes of transradial access for endovascular treatment of nonmaturing hemodialysis fistulae compared to brachial arteriography followed by unidirectional or bidirectional fistula access for intervention. MATERIALS AND METHODS: In this institutional review board-approved, retrospective, case-control study, 56 consecutive patients with nonmaturing arteriovenous fistulae underwent percutaneous intervention between 2015 and 2018. The transradial group (n = 28) underwent radial artery access for diagnostic fistulography and intervention. The control group (n = 28) underwent retrograde brachial artery access for fistulography followed by unidirectional/bidirectional fistula access for intervention. Both groups had similar demographics, fistula characteristics, and stenosis locations. RESULTS: Fewer punctures were required in the transradial group compared to controls (1.2 vs 2.4, P < .0001), and procedure time was shorter (64.9 vs 91.3 minutes, P = .0016). Anatomic, technical, and clinical success rates trended higher in the transradial group compared to controls (93% vs 86%, 96% vs 89%, and 82% vs 64%, respectively). Nonmaturation resulting in fistula abandonment was lower in the transradial group (3.7% vs 25%, P = .025). Primary unassisted patency at 3, 6, and 12 months was 77.1% ± 8.2%, 73.1% ± 8.7%, and 53.3% ± 10.6% in the transradial group, respectively, and 63.0% ± 9.3%, 55.6% ± 9.6%, and 48.1% ± 9.6% in the control group, respectively (P = .76). Primary assisted patency at 12 months was 92.3% ± 5.3% in the transradial group compared to 61.8% ± 9.6% at 12 months in the control group (P = .021). No major complications occurred. Minor complications were lower in the transradial group than in the control group (14% vs 39%, P = .068). CONCLUSIONS: Treatment of nonmaturing fistulae via a transradial approach was safe, improved midterm patency, and was associated with lower rates of fistula abandonment.


Assuntos
Derivação Arteriovenosa Cirúrgica/efeitos adversos , Artéria Braquial , Cateterismo Periférico , Procedimentos Endovasculares , Oclusão de Enxerto Vascular/terapia , Artéria Radial , Diálise Renal , Adulto , Idoso , Idoso de 80 Anos ou mais , Artéria Braquial/diagnóstico por imagem , Artéria Braquial/fisiopatologia , Cateterismo Periférico/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Feminino , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Punções , Artéria Radial/diagnóstico por imagem , Artéria Radial/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
3.
J Vasc Access ; 21(6): 990-996, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32375582

RESUMO

BACKGROUND: The autologous arteriovenous fistula is the primary choice to establish hemodialysis access without high failure rates. Intraoperative ultrasound flow measurements of newly created autologous arteriovenous fistulas represent a possibility of quality control and may therefore be a tool to assess their functionality. The aim of our study was to correlate intraoperative blood flow with access patency. METHODS: Between March 2012 and March 2015, intraoperative transit time flow measurements were collected on 89 patients. Measurements were performed 5-10 min after the creation of a standardized anastomosis using 3-6 mm flow probes. To examine the correlation between intraoperative blood flow and access patency, groups of patients with high (> 200 mL/min) versus low flow (< 200 mL/min) were enrolled. Patients were assessed clinically and with ultrasound every 3 months. Data were analyzed retrospectively. RESULTS: In the current short-term follow-up, including 89 patients (age 62 ± 3 years), 61 (68.5%) of the autologous arteriovenous fistulas were currently being used in an observation period ranging from 3 months to 3 years (mean observation period 546 ± 95 days) postoperatively. The intraoperative blood flow in patients with functioning autologous arteriovenous fistula (78) was significantly higher than that of patients without functioning autologous arteriovenous fistulas (407 ± 25 vs 252 ± 42 mL/min, respectively; p < 0.005) (11). CONCLUSION: The intraoperative measurement of blood flow is a useful tool to predict the outcome of maturation in autologous arteriovenous fistula. With this method, technical problems can be detected and corrected intraoperatively. Routine implementation of intraoperative flow measurements has to be examined by prospective controlled trials.


Assuntos
Derivação Arteriovenosa Cirúrgica , Artéria Radial/cirurgia , Diálise Renal , Extremidade Superior/irrigação sanguínea , Veias/cirurgia , Adulto , Idoso , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Velocidade do Fluxo Sanguíneo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Radial/diagnóstico por imagem , Artéria Radial/fisiopatologia , Fluxo Sanguíneo Regional , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular , Veias/diagnóstico por imagem , Veias/fisiopatologia
4.
J Stroke Cerebrovasc Dis ; 29(7): 104853, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32389556

RESUMO

Giant thrombosed middle cerebral artery (MCA) aneurysms are difficult to treat and sometimes require complex revascularization using allografts. We describe a technical method using revascularization with a natural Y-shaped graft that provides a normal variation for a complex MCA aneurysm. A 65-year-old man with a giant thrombosed MCA aneurysm presented with right hemiparesis and aphasia. The patient had a history of clipping surgery for the ipsilateral side of the MCA aneurysm 25 years before, and a de novo aneurysm developed over the previous 18 years. For the giant thrombosed aneurysm, trapping and revascularization were performed. A natural radial artery Y-graft was used as the graft and anastomosed to both M2 trunks. The symptoms improved after surgery, and the patient was discharged 3 weeks later. This is the first report of a double-barrel bypass using a natural Y-graft. This method attained a normal variation, and the flow of the Y-graft was physiological. For the radical cure of giant thrombosed MCA aneurysms, multiple revascularizations might be required. With this natural Y-graft, complex transpositions could be avoided.


Assuntos
Bioprótese , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Revascularização Cerebral/instrumentação , Aneurisma Intracraniano/cirurgia , Trombose Intracraniana/cirurgia , Artéria Cerebral Média/cirurgia , Artéria Radial/transplante , Idoso , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/fisiopatologia , Trombose Intracraniana/diagnóstico por imagem , Trombose Intracraniana/fisiopatologia , Masculino , Artéria Cerebral Média/diagnóstico por imagem , Artéria Cerebral Média/fisiopatologia , Artéria Radial/diagnóstico por imagem , Artéria Radial/fisiopatologia , Resultado do Tratamento
5.
Vasc Med ; 25(4): 302-308, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32308146

RESUMO

Retinal vein occlusion (RVO) is a common retinal vascular lesion, and a leading cause of visual impairment. Patients with RVO have an increased risk for cardiovascular disease and share multiple common risk factors. In this study, we investigated the endothelial function and arterial stiffness of patients with RVO compared to healthy-control (CL) subjects. We enrolled 40 consecutive patients with RVO and 40 CL subjects. RVO was diagnosed by an ophthalmologist, endothelial function was evaluated by flow mediated dilation (FMD) in the brachial artery, and carotid-femoral pulse wave velocity (PWV) and augmentation index (AIx) of the radial artery were measured to evaluate arterial stiffness and reflected waves, respectively. No significant differences were detected between the studied groups in sex, age, presence of hypertension or dyslipidemia, body mass index, systolic and diastolic blood pressure levels, total cholesterol levels, and smoking habits (p > 0.05 for all). However, patients with RVO had impaired FMD (p = 0.002) and increased PWV (p = 0.004), even after adjustment for several confounders. Both FMD and PWV were also significantly and independently associated with the development of RVO. Furthermore, a significant and positive correlation between PWV and systolic blood pressure existed only in the CL group. Therefore, we have shown that RVO is associated with significant endothelial dysfunction and increased arterial stiffness. Our results strengthen the vascular theory, according to which, systemic endothelial dysfunction and arteriosclerosis play a significant role in the pathogenesis of RVO.


Assuntos
Artéria Braquial/fisiopatologia , Endotélio Vascular/fisiopatologia , Artéria Radial/fisiopatologia , Oclusão da Veia Retiniana/fisiopatologia , Rigidez Vascular , Vasodilatação , Idoso , Artéria Braquial/diagnóstico por imagem , Velocidade da Onda de Pulso Carótido-Femoral , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oclusão da Veia Retiniana/diagnóstico , Ultrassonografia
6.
Ann Vasc Surg ; 68: 451-459, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32278869

RESUMO

BACKGROUND: Hemodynamics has been known to play a major role in the development of intimal hyperplasia leading to arteriovenous fistula failure. The goal of our study is to investigate the influence of different angles of side-to-end radiocephalic anastomosis on the hemodynamic parameters that promote intimal dysfunction and therefore intimal hyperplasia. METHODS: Realistic three-dimensional meshes were reconstructed using ultrasound measurements from distal side-to-end radiocephalic fistulas. The velocity at the proximal and distal radial inflows and at specific locations along the anastomosis and cephalic vein was measured through duplex ultrasound performed by a single examiner. A computational parametric study, virtually changing the inner angle of anastomosis, was performed. For this purpose, we used advanced computational models that include suitable tools to capture the pulsatile and turbulent nature of the blood flow found in arteriovenous fistulas. The results were analyzed in terms of velocity fields, wall shear stress distribution, and oscillatory shear index. RESULTS: Results show that the regions with high oscillatory shear index, which are more prone to the development of hyperplasia, are greater and progressively shift toward the anastomosis area and the proximal vein segment with the decrease of the inner angle of anastomosis. These results are specific to distal radiocephalic fistulas because they are subject to proximal and distal radial inflow. CONCLUSIONS: The results of this study show that inner anastomosis angles approaching 60-70° seem to yield the best hemodynamic conditions for maturation and long-term patency of distal radiocephalic fistulas. Inner angles greater than 90°, representing the smooth loop technique, did not show a clear hemodynamic advantage.


Assuntos
Derivação Arteriovenosa Cirúrgica , Antebraço/irrigação sanguínea , Hemodinâmica , Modelos Cardiovasculares , Modelagem Computacional Específica para o Paciente , Artéria Radial/cirurgia , Veias/cirurgia , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Velocidade do Fluxo Sanguíneo , Humanos , Hiperplasia , Neointima , Artéria Radial/diagnóstico por imagem , Artéria Radial/fisiopatologia , Estresse Mecânico , Resultado do Tratamento , Ultrassonografia Doppler Dupla , Grau de Desobstrução Vascular , Veias/diagnóstico por imagem , Veias/fisiopatologia
7.
BMC Cardiovasc Disord ; 20(1): 148, 2020 03 24.
Artigo em Inglês | MEDLINE | ID: mdl-32204693

RESUMO

BACKGROUND: Where each patient has all three conduits of internal mammary artery (IMA), saphenous vein graft (SVG) and radial artery (RA), most confounders affecting comparison between conduits can be mitigated. Additionally, since SVG progressively fails over time, restricting patient angiography to the late period only can mitigate against early SVG patency that may have occluded in the late period. METHODS: Research protocol driven conventional angiography was performed for patients with at least one of each conduit of IMA, RA and SVG and a minimum of 7 years postoperative. The primary analysis was perfect patency and secondary analysis was overall patency including angiographic evidence of conduit lumen irregularity from conduit atheroma. Multivariable generalized linear mixed model (GLMM) was used. Patency excluded occluded or "string sign" conduits. Perfect patency was present in patent grafts if there was no lumen irregularity. RESULTS: Fifty patients underwent coronary angiography at overall duration postoperative 13.1 ± 2.9, and age 74.3 ± 7.0 years. Of 196 anastomoses, IMA 62, RA 77 and SVG 57. Most IMA were to the left anterior descending territory and most RA and SVG were to the circumflex and right coronary territories. Perfect patency RA 92.2% was not different to IMA 96.8%, P = 0.309; and both were significantly better than SVG 17.5%, P < 0.001. Patency RA 93.5% was also not different to IMA 96.8%, P = 0.169, and both arterial conduits were significantly higher than SVG 82.5%, P = 0.029. Grafting according to coronary territory was not significant for perfect patency, P = 0.997 and patency P = 0.289. Coronary stenosis predicted perfect patency for RA only, P = 0.030 and for patency, RA, P = 0.007, and SVG, P = 0.032. When both arterial conduits were combined, perfect patency, P < 0.001, and patency, P = 0.017, were superior to SVG. CONCLUSIONS: All but one patent internal mammary artery or radial artery grafts had perfect patency and had superior perfect patency and overall patency compared to saphenous vein grafts.


Assuntos
Ponte de Artéria Coronária , Doença da Artéria Coronariana/cirurgia , Artéria Torácica Interna/cirurgia , Artéria Radial/transplante , Veia Safena/transplante , Grau de Desobstrução Vascular , Idoso , Idoso de 80 Anos ou mais , Angiografia Coronária , Ponte de Artéria Coronária/efeitos adversos , Feminino , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Masculino , Artéria Torácica Interna/diagnóstico por imagem , Artéria Torácica Interna/fisiopatologia , Pessoa de Meia-Idade , Estudos Prospectivos , Artéria Radial/diagnóstico por imagem , Artéria Radial/fisiopatologia , Fatores de Risco , Veia Safena/diagnóstico por imagem , Veia Safena/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
8.
BMJ Case Rep ; 13(2)2020 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-32041760

RESUMO

A 50-year-old woman with a history of Crohn's disease treated with adalimumab presented with left hand pain and duskiness. Angiogram showed non-filling of the radial and digital arteries of the hand. Antiphospholipid antibody testing was positive, leading to a diagnosis of antitumour necrosis factor-induced antiphospholipid syndrome. Adalimumab was discontinued, and she was treated with the vitamin K antagonist warfarin and low-dose aspirin. Upon resolution of the antiphospholipid antibodies, she was transitioned to aspirin alone without recurrence of thrombosis.


Assuntos
Adalimumab/efeitos adversos , Anti-Inflamatórios/efeitos adversos , Síndrome Antifosfolipídica/induzido quimicamente , Mãos/irrigação sanguínea , Isquemia/induzido quimicamente , Doenças Vasculares Periféricas/induzido quimicamente , Aspirina/uso terapêutico , Doença de Crohn/tratamento farmacológico , Feminino , Humanos , Pessoa de Meia-Idade , Artéria Radial/diagnóstico por imagem , Artéria Radial/fisiopatologia , Varfarina/uso terapêutico
9.
J Vasc Access ; 21(5): 753-759, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32103699

RESUMO

BACKGROUND: Arteriovenous fistula (AVF) for haemodialysis (HD) induces a volume/pressure overload which impairs bi-ventricular function and increases systolic pulmonary arterial pressure (PAPS) and left ventricular mass (LVM). In the presence of high blood flow (Qa) AVF (> 1.5 L/min/1.73 m2) and cardio-pulmonary recirculation (>20%), high-output congestive heart failure (CHF) may occur and AVF flow reduction is recommended. Proximal Radial Artery Ligation (PRAL) is an effective technique for distal radio-cephalic (RC) AVF flow reduction. METHODS: we evaluated six HD and four transplant patients with high-flow RC AVF and symptoms of CHF who underwent PRAL. We compared echocardiographic (ECHO) findings before (T0) and 1 and 6 months (T1,T6) after PRAL. Preoperative ECHO was performed before (T0b) and after AVF anastomosis manual compression (T0c). RESULTS: At T1 AVF flow reduction rate was 58.4% ± 13% and 80% of patients reported improved CHF symptoms. ECHO data showed an improvement of tricuspid annular plane systolic excursion (TAPSE) at T1 (p = 0.03) and a reduction of PAPS at T6 (p = 0.04). TAPSE improved after AVF anastomosis compression during preoperative ECHO (p = 0.03). Delta of TAPSE at the dynamic manoeuvre at T0 directly correlated with early (1 month after PRAL, p = 0.01) and late (6 months after PRAL, p = 0.04) deltas of TAPSE. CONCLUSIONS: AVF flow reduction after PRAL induces immediate regression of CHF symptoms, early improvement of TAPSE and late improvement of PAPS, suggesting a prevalent right sections involvement in CHF. Preoperative TAPSE modification after AVF anastomosis compression could represent a useful evaluation tool to determine which patients would benefit of PRAL.


Assuntos
Derivação Arteriovenosa Cirúrgica/efeitos adversos , Débito Cardíaco Elevado/cirurgia , Ecocardiografia Doppler em Cores , Antebraço/irrigação sanguínea , Insuficiência Cardíaca/cirurgia , Hemodinâmica , Artéria Radial/cirurgia , Diálise Renal , Idoso , Velocidade do Fluxo Sanguíneo , Débito Cardíaco Elevado/diagnóstico por imagem , Débito Cardíaco Elevado/etiologia , Débito Cardíaco Elevado/fisiopatologia , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Transplante de Rim , Ligadura , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Artéria Radial/diagnóstico por imagem , Artéria Radial/fisiopatologia , Recuperação de Função Fisiológica , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
10.
J Vasc Access ; 21(5): 701-704, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31928135

RESUMO

OBJECTIVE: To investigate the feasibility of percutaneous arteriovenous fistula creation in consecutive patients screened for first access creation. METHODS: Prospective study of ultrasound mapping based on the following minimal anatomic requirements: a patent proximal radial artery and adjacent elbow perforating vein with straight trajectory, each greater than or equal to 2 mm in diameter and within 1.5 mm of each other. In addition, the same population was evaluated for feasibility of a distal radiocephalic fistula established. RESULTS: One hundred consecutive patients were examined between November 2018 and January 2019. Sixty-seven were male (67%) and mean age was 61 years. Sixty-three patients (63%) and a total of 100 limbs (50%) were found to be eligible for a percutaneous fistula creation with Ellipsys®. Thirty-seven percent of patients were ineligible because of the absence of both median cephalic and median cubital veins (15%), absence or inadequate elbow perforating vein and/or smaller than 2 mm proximal radial artery (14%), and/or distance greater than 1.5 mm (8%). We found suitable vessels for a surgical distal fistula creation in 91 extremities (45%), but this percentage dropped to 17% in patients over 70 years old. Among the 100 limbs eligible for percutaneous arteriovenous fistula, only 30 (30%) were eligible for radiocephalic arteriovenous fistula. CONCLUSION: More than 60% of patients were eligible for Ellipsys. The absence of veins at the elbow and a large distance between vessels were the most common limiting factors. Less than one half of the patients were candidates for surgical fistula and this percentage dropped significantly for older individuals.


Assuntos
Derivação Arteriovenosa Cirúrgica/instrumentação , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Artéria Radial/cirurgia , Diálise Renal , Extremidade Superior/irrigação sanguínea , Veias/cirurgia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Implante de Prótese Vascular/efeitos adversos , Estudos de Viabilidade , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Desenho de Prótese , Artéria Radial/diagnóstico por imagem , Artéria Radial/fisiopatologia , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular , Veias/diagnóstico por imagem , Veias/fisiopatologia , Adulto Jovem
11.
J Vasc Access ; 21(5): 694-700, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31920156

RESUMO

OBJECTIVE: To investigate the hemodynamics of percutaneous arteriovenous fistulae (pAVF) created between the proximal radial artery and the deep communicating vein of the elbow. METHODS: Consecutive patients with a percutaneously created proximal radial artery to perforating vein arteriovenous fistulae were evaluated and compared with control patients with clinically well-functioning surgical wrist radiocephalic arteriovenous fistulae (sWRC-AVF). RESULTS: Thirty-one patients with a pAVF (21 males - 68%, mean age: 62 years, range: 53-81), with mean follow-up of 254 days (range: 60-443) and 32 patients with a surgical fistula (20 males - 62%, mean age of 63 years, range: 30-84) were evaluated. Mean access flow and distribution range were similar in the two study groups, with a mean flow of 859 mL/min vs 919 mL/min, respectively. There was no significant difference in the mean radial artery diameter (4 mm vs 4.3 mm, p = 0.2). Statistically significant trends were observed for resistive index (0.57 pAVF vs 0.52 (0.07) and brachial vein cross-sectional area (13 pAVF vs 33 mm2, p = 0.06). The arteriovenous anastomosis area was significantly smaller with pAVFs (13 vs 43 mm2, p = 0.002) and the pressure difference between extremities was less for the pAVF group vs sWRC-AVF (19 vs 27 mm Hg, respectively, p = 0.03). Existence of single cephalic or basilic versus cephalic and basilic outflow did not affect vein maturation or overall flow. CONCLUSIONS: pAVF have a favourable hemodynamic profile with many similarities when compared with surgically created wrist fistulae. Cephalic and/or basilic vein matured with only minor outflow shunted to the deep venous system.


Assuntos
Derivação Arteriovenosa Cirúrgica , Cotovelo/irrigação sanguínea , Artéria Radial/cirurgia , Diálise Renal , Ultrassonografia Doppler , Veias/cirurgia , Punho/irrigação sanguínea , Idoso , Idoso de 80 Anos ou mais , Velocidade do Fluxo Sanguíneo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Artéria Radial/diagnóstico por imagem , Artéria Radial/fisiopatologia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular , Veias/diagnóstico por imagem , Veias/fisiopatologia
12.
Ann Vasc Surg ; 66: 326-333, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31917228

RESUMO

BACKGROUND: The aim of this study was to investigate the predictors of autogenous radiocephalic arteriovenous fistula (RCAVF) maturation. METHODS: This was a retrospective analysis of patients undergoing RCAVF creation from June 2013 to December 2018 at a single medical center. Comparison of the variables between the matured and nonmatured group was performed. RESULTS: A total of 277 patients (men, 173; 62.5%) with a mean age of 56.6 ± 16.9 years underwent primary RCAVF creation during the study period. The mean diameter of the cephalic vein and radial artery were 2.4 ± 0.6 mm (range 1.5 to 4.3 mm) and 2.3 ± 0.5 mm (range 1.5 to 4.0 mm), respectively. Primary functional maturation was achieved in 236 patients (236/277, 85%). There was no statistical significance between the matured and nonmatured group in terms of age (56.4 ± 14.8 vs. 58.1 ± 15.1, respectively; P = 0.498), coronary arterial disease (12% vs. 17%, respectively; P = 0.449), diabetes mellitus (42% vs. 39%, respectively; P = 0.864), smoking (26% vs. 22%, respectively; P = 0.699), or antiplatelet therapy (23% vs. 24%, respectively; P = 0.844). However, female gender (35% vs. 54%, respectively; P = 0.024), peripheral arterial disease (9% vs. 22%, respectively; P = 0.025), and small vein (2.4 ± 0.5 mm vs. 2.0 ± 0.5 mm, respectively; P < 0.01) and artery (2.4 ± 0.5 vs. 2.1 ± 0.4, respectively; P < 0.01) diameter were associated with the failure of maturation. The best cutoff diameter for the cephalic vein and radial artery was 1.85 mm and 2.05 mm, respectively. CONCLUSIONS: In this cohort of patients undergoing RCAVF creation, vein and artery diameter on preoperative ultrasound mapping was the predictor of functional maturation. Female gender and presence of peripheral arterial disease were associated with failure of maturation.


Assuntos
Derivação Arteriovenosa Cirúrgica , Artéria Radial/cirurgia , Diálise Renal , Extremidade Superior/irrigação sanguínea , Grau de Desobstrução Vascular , Veias/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Feminino , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Hong Kong , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Radial/diagnóstico por imagem , Artéria Radial/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Veias/diagnóstico por imagem , Veias/fisiopatologia , Adulto Jovem
13.
J Vasc Access ; 21(5): 646-651, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31894716

RESUMO

PURPOSE: Devices to permit percutaneous endovascular arteriovenous fistula formation have recently been introduced into clinical practice with promising initial evidence. As guidelines support a distal fistula first policy, the question of whether an endovascular arteriovenous fistula should be performed as an initial option is introduced. The aims of this study were to compare a matched cohort of endovascular arteriovenous fistula with surgical radiocephalic arteriovenous fistulas. MATERIALS AND METHODS: Using data from a prospectively collected database over a 3-year period, a matched comparative analysis was performed. RESULTS: WavelinQ arteriovenous fistulas (group W, n = 30) were compared with radiocephalic arteriovenous fistulas (group RC; n = 40). Procedural success was high with 96.7% for group W and 92.6% for group RC. Primary patency at 6 and 12 months was greater in group W (65.5% 6mo and 56.5% 12mo) compared to group RC (53.4% 6mo and 44% 12mo) (p = 0.69 and 0.63). Mean primary patency was significantly lower for RC (235 ± 210 days) vs W (362 ± 240 days) (p < 0.05). Secondary patency for group W was 75.8% and 69.5% at 6 and 12 months, respectively. Secondary patency for RC was lower at 66.7% and 57.6% at 6 and 12 months, respectively. CONCLUSION: Outcomes of WavelinQ arteriovenous fistulas in this series are similar to published results. When compared to a contemporaneously created group of surgical fistulas, WavelinQ demonstrated superior outcomes. These data would support that WavelinQ endovascular arteriovenous fistulas may be considered as a first option in the access pathway particularly if vessels at the wrist are absent or less than ideal.


Assuntos
Derivação Arteriovenosa Cirúrgica/instrumentação , Antebraço/irrigação sanguínea , Artéria Radial/cirurgia , Diálise Renal , Dispositivos de Acesso Vascular , Veias/cirurgia , Adulto , Idoso , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Bases de Dados Factuais , Inglaterra , Feminino , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Radial/diagnóstico por imagem , Artéria Radial/fisiopatologia , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular , Veias/diagnóstico por imagem , Veias/fisiopatologia
14.
J Vasc Access ; 21(2): 237-240, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31464552

RESUMO

PURPOSE: The aim of this article is to retrospectively compare snuff box radial artery access with direct fistula access for radiocephalic fistula intervention. MATERIALS AND METHODS: Review of 68 consecutive radiocephalic interventions between April 2013 and April 2017 was performed. The snuff box radial access was performed under ultrasound guidance with the hand in a neutral position (thumb up). The snuff box radial artery was entered distal to the extensor pollicis longus, over the trapezium bone. Hand held pressure was applied for hemostasis. The procedure times, success, and complications of snuff box radial artery access procedures were reviewed. RESULTS: Snuff box radial artery access was used in 25% (17/68) of radiocephalic fistula interventions. All access procedures were successful. Snuff box radial artery access was only used in cases involving the proximal fistula. Lesions treated from snuff box radial artery access approach included 19% (10/54) of fistula stenosis, 50% (1/2) thrombosis, 63% (5/8) immature fistulae, 100% (1/1) steal syndrome, and none of the (0/5) symptomatic outflow occlusions. The mean procedure times for snuff box radial artery access and direct fistula access were not significant at 29.1 ± 16.3 min (range = 10-81) and 26.8 ± 14.0 min (range = 5-70), respectively (p < 0.57). Minor hematoma occurred in 12% (2/17) snuff box radial artery access and 2% (1/51) direct fistula access. There were no major complications. CONCLUSION: Snuff box radial access was used successfully for radiocephalic fistula intervention with procedure times similar to direct fistula access without major complications.


Assuntos
Derivação Arteriovenosa Cirúrgica , Artéria Radial/cirurgia , Diálise Renal , Extremidade Superior/irrigação sanguínea , Idoso , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Artéria Radial/diagnóstico por imagem , Artéria Radial/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
15.
J Vasc Access ; 21(3): 350-356, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31566061

RESUMO

BACKGROUND AND OBJECTIVES: The recent advent of a device to create a proximal radial artery arteriovenous fistula using an endovascular approach to create the anastomosis represents a significant advance in dialysis access creation. This endovascular arteriovenous fistula offers the beneficial attributes of the proximal radial artery arteriovenous fistula while adding the advantages of avoiding a surgical procedure. The endovascular arteriovenous fistula can be created safely, functions well, has excellent patency, and has a high degree of patient satisfaction. The purpose of this study is to report the 2-year cumulative patency rate for a large multicenter cohort of endovascular arteriovenous fistula cases. DESIGN: An endovascular arteriovenous fistula was created in 105 patients using either local or regional anesthesia and conscious sedation. Patient data were obtained from each program's electronic health record system. Data collection was truncated at 2 years postprocedure and used to calculate cumulative patency. Post-access creation patient satisfaction was assessed. RESULTS: A physiologically mature arteriovenous fistula (blood flow ⩾500 mL/min and a target vein internal diameter ⩾4 mm) was obtained in 98%. A clinically functional arteriovenous fistula (supporting two-needle dialysis according to the patient's dialysis prescription) was demonstrated in 95%. Access failure resulting in the loss of access occurred in eight cases during the study period. The cumulative patency rate at 6, 12, 18, and 24 months was 97.1%, 93.9%, 93.9%, and 92.7%, respectively. The post-procedure patient evaluation emphasized a high level of patient satisfaction. CONCLUSION: The proximal radial artery arteriovenous fistula created using an endovascular approach for the anastomosis is associated with excellent 2-year cumulative patency and is associated with a high level of patient satisfaction.


Assuntos
Derivação Arteriovenosa Cirúrgica/instrumentação , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Procedimentos Endovasculares/instrumentação , Artéria Radial/cirurgia , Extremidade Superior/irrigação sanguínea , Grau de Desobstrução Vascular , Veias/cirurgia , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Implante de Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Feminino , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Desenho de Prótese , Artéria Radial/diagnóstico por imagem , Artéria Radial/fisiopatologia , Diálise Renal , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos , Veias/diagnóstico por imagem , Veias/fisiopatologia
16.
Cardiovasc Revasc Med ; 21(4): 496-500, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31303367

RESUMO

OBJECTIVES: The traditional radial access (TRA) has been used almost routinely in coronary interventions in our clinic. Recently, we have started to use distal radial artery point as distal radial access (DRA) more frequently. The aim of this study is to compare these techniques (DRA and TRA) in terms of their safety, feasibility, and effectiveness. BACKGROUND: Recently, the distal transradial access novel techniques have started to be used in coronary interventions, such as the anatomical snuffbox (AS) and DRA. METHODS: This prospective, randomized study was carried out in a single center. The patients were selected from the catheterization laboratory of Medicana Ankara Hospital, between October 2018 and December 2018. Consecutive patients with TRA (103 patients) and DRA (102 patients) were randomized for coronary intervention. RESULTS: Successful catheterization was achieved in 99 of 103 (96.1%) patients in the TRA group and in 97 patients of 102 (95.1%) patients in the DRA group. The radial artery spasm was observed in 4 cases in TRA group, whereas no radial artery spasm was seen in DRA group (p < 0.0001). The transradial access time in the DRA group (46.85 ±â€¯2.41 s) lasted longer than the TRA (36.66 ±â€¯5.16 s, p = 0.008).In DRA, hemostasis seems quicker than TRA. CONCLUSIONS: DRA is feasible and safe for coronary angiography and interventions like TRA. It can be used as an alternative technique.


Assuntos
Cateterismo Cardíaco , Cateterismo Periférico , Artéria Radial , Idoso , Cateterismo Cardíaco/efeitos adversos , Cateterismo Periférico/efeitos adversos , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/etiologia , Doença Arterial Periférica/fisiopatologia , Estudos Prospectivos , Punções , Artéria Radial/diagnóstico por imagem , Artéria Radial/fisiopatologia , Turquia , Vasoconstrição
17.
J Vasc Surg ; 71(1): 158-172.e1, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31303475

RESUMO

OBJECTIVE: Previous investigations have suggested that a minimum venous outflow diameter (MVOD) and perianastomotic arterial diameter are associated with successful autogenous arteriovenous maturation and patency. The goal of this study was to determine anatomic and clinical variables that may influence access patency to guide optimal autogenous access configuration selection. METHODS: Accesses created from 2010 to 2016 were analyzed from data entered into a prospective database. Preprocedure duplex ultrasound mapping data of artery and tourniquet-derived vein diameters and demographic and clinical variables were collected. Survival-based cut point analysis was used to determine anatomic parameters most predictive of access failure. Kaplan-Meier and Cox proportional hazards analyses were used to assess patencies and maturation and to identify independent predictors of access failure. RESULTS: A total of 356 first-time autogenous accesses were created (median follow-up, 20 months; range, 0-73 months). Of these, 202 (56.7%) were radiocephalic and 154 (43.3%) were brachiocephalic. Maturation failure at end of follow-up for arteriovenous accesses was 26% ± 3% for radiocephalic accesses and 15% ± 3% for brachiocephalic accesses (P < .001). For radiocephalic accesses, MVOD <3.0 mm and radial artery diameter <2.1 mm independently predicted access maturation failure (MVOD <3.0 mm: hazard ratio [HR], 2.62 [95% confidence interval (CI), 1.27-5.39; P = .009]; radial artery diameter <2.1 mm: HR, 2.20 [95% CI, 1.20-4.05; P = .011]) and secondary patency loss (MVOD <3.0 mm: HR, 2.21 [95% CI, 1.24-3.96; P = .007]; radial artery diameter <2.1 mm: HR, 2.11 [95% CI, 1.26-3.63; P = .004]). A combination of radial artery diameter <2.1 mm and MVOD <3.0 mm most strongly predicted maturation failure (HR, 4.24; 95% CI, 1.71-10.49; P = .002) and loss of secondary patency (HR, 4.03; 95% CI, 1.88-8.64; P < .001). Only diabetes mellitus (HR, 2.24; P = .012) predicted secondary patency loss. For brachiocephalic accesses, MVOD <3.4 mm (HR, 2.12; 95% CI, 1.02-4.46; P = .043) was found to independently predict secondary patency loss in addition to previous ipsilateral (HR, 2.37; P = .038) and bilateral (HR, 4.00; P = .015) tunneled hemodialysis catheters. Brachial artery diameter was not associated with either access maturation or patency. CONCLUSIONS: Artery and tourniquet-derived vein diameters independently predict radiocephalic access patency and functional outcomes. A combination of a radial artery diameter <2.1 mm and MVOD <3.0 mm best predicts maturation failure and patency loss for radiocephalic access. MVOD <3.4 mm was associated with increased loss of brachiocephalic access secondary patency, but MVOD was not associated with maturation.


Assuntos
Derivação Arteriovenosa Cirúrgica , Artéria Braquial/cirurgia , Artéria Radial/cirurgia , Diálise Renal , Extremidade Superior/irrigação sanguínea , Grau de Desobstrução Vascular , Veias/cirurgia , Idoso , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Artéria Braquial/diagnóstico por imagem , Artéria Braquial/fisiopatologia , Bases de Dados Factuais , Feminino , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Radial/diagnóstico por imagem , Artéria Radial/fisiopatologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Torniquetes , Resultado do Tratamento , Ultrassonografia Doppler Dupla , Veias/diagnóstico por imagem , Veias/fisiopatologia
18.
J Intensive Care Med ; 35(2): 149-153, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28931367

RESUMO

BACKGROUND: Arterial blood pressure is the most common variable used to assess the response to a fluid challenge in routine clinical practice. The aim of this study was to evaluate the accuracy of the change in the radial artery pulse pressure (rPP) to detect the change in cardiac output after a fluid challenge in patients with septic shock. METHODS: Prospective observational study including 35 patients with septic shock in which rPP and cardiac output were measured before and after a fluid challenge with 400 mL of crystalloid solution. Cardiac output was measured with intermittent thermodilution technique using a pulmonary artery catheter. Patients were divided between responders (increase >15% of cardiac output after fluid challenge) and nonresponders. The area under the receiver operating characteristic curve (AUROC), Pearson correlation coefficient and paired Student t test were used in statistical analysis. RESULTS: Forty-three percent of the patients were fluid responders. The change in rPP could not neither discriminate between responders and nonresponders (AUROC = 0.52; [95% confidence interval: 0.31-0.72] P = .8) nor correlate (r = .21, P = .1) with the change in cardiac output after the fluid challenge. CONCLUSIONS: The change in rPP neither discriminated between fluid responders and nonresponders nor correlated with the change in cardiac output after a fluid challenge. The change in rPP cannot serve as a surrogate of the change in cardiac output to assess the response to a fluid challenge in patients with septic shock.


Assuntos
Pressão Arterial , Hidratação/métodos , Artéria Radial/fisiopatologia , Choque Séptico/fisiopatologia , Termodiluição/estatística & dados numéricos , Adulto , Débito Cardíaco , Cateterismo de Swan-Ganz , Soluções Cristaloides , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROC , Reprodutibilidade dos Testes , Termodiluição/métodos
19.
J Intensive Care Med ; 35(2): 179-186, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29034783

RESUMO

Femoral access in extracorporeal life support (ECLS) has been associated with regional variations in arterial oxygen saturation, potentially predisposing the patient to ischemic tissue damage. Current monitoring techniques, however, are limited to intermittent bedside evaluation of capillary refill among other factors. The aim of this study was to assess whether cerebral and limb regional tissue oxygen saturation (rSO2) values reflect changes in various patient-related parameters during venoarterial ECLS (VA-ECLS). This retrospective observational study included adults assisted by femorofemoral VA-ECLS. Bifrontal cerebral and bilateral limb tissue oximetry was performed for the entire duration of support. Hemodynamic data were analyzed parallel to cerebral and limb rSO2. A total of 23 patients were included with a median ECLS duration of 5 [1-20] days. Cardiac arrhythmias were observed in 12 patients, which was associated with a decreased mean rSO2 from 61%±11% to 51%±10% during atrial fibrillation and 67%±9% to 58%±10% during ventricular fibrillation (P<0.001 for both). A presumably sudden increase in cardiac output due to myocardial recovery (n=8) resulted in a significant decrease in mean cerebral rSO2 from 73%±7% to 54%±6% and from 69%±9% to 53%±8% for the left and right cerebral hemisphere, respectively (P=0.012 for both hemispheres). Also, right radial artery partial gas pressure for oxygen decreased from 15.6±2.8 to 8.3±1.9 kPa (P=0.028). No differences were found in cerebral desaturation episodes between patients with and without neurologic complications. In six patients, limb rSO2 increased from on average 29.3±2.7 to 64.0±5.1 following insertion of a distal cannula in the femoral artery (P=0.027). Likewise, restoration of flow in a clotted distal cannula inserted in the femoral artery was necessary in four cases and resulted in increased limb rSO2 from 31.3±0.8 to 79.5±9.0; P=0.068. Non-invasive tissue oximetry adequately reflects events influencing cerebral and limb perfusion and can aid in monitoring tissue perfusion in patients assisted by ECLS.


Assuntos
Encéfalo/irrigação sanguínea , Oxigenação por Membrana Extracorpórea , Fêmur/irrigação sanguínea , Oximetria/estatística & dados numéricos , Oxigênio/análise , Adulto , Feminino , Artéria Femoral/fisiopatologia , Hemodinâmica , Humanos , Masculino , Oximetria/métodos , Consumo de Oxigênio , Artéria Radial/fisiopatologia , Estudos Retrospectivos
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