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1.
Vasc Health Risk Manag ; 16: 419-427, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33116552

RESUMO

Purpose: Central venous lesions (CVLs) can adversely affect hemodialysis access maturation and maintenance, which in turn worsen patient morbidity and access circuit patency. In this study, we assessed several clinical variables, patient characteristics, and clinical consequences of symptomatic central vein stenosis and obstruction in patients who underwent renal replacement therapy in the form of hemodialysis. Patients and Methods: The medical records of all hemodialysis patients with clinically symptomatic CVLs who underwent digital subtraction angiography treatment at King Abdullah University Hospital between January 2017 and December 2019 were retrieved. Patient characteristics and the clinical and anatomical features of CVLs were analyzed retrospectively. Pearson's chi-square tests of association were used to identify and assess relationships between patient characteristics and CVLs. Results: The study cohort comprised 66 patients with end-stage renal disease who developed symptomatic central vein stenosis. Of the 66 patients, 56.1% were men, and their mean age was approximately 52 years. Most (62.1%) of the patients were determined to have a history of central catheter insertion into the jugular vein. Hypertension was the most common comorbidity (78.8%, p<0.001), followed by type 2 diabetes mellitus (47.0 %, p<0.01). The incidence of stenosis was found to be significantly higher in the brachiocephalic vein than in other central veins (43.9%, p<0.001). A repeated central catheter insertion in a patient was predictive of central venous occlusion (p<0.05). Stenotic lesions were found to be associated with a significantly higher success rate than occlusive lesions (91.2%, p<0.01). Conclusion: Multiple central venous catheters (CVCs) are found to be associated with occlusive CVLs and unfavorable recanalization outcomes. Multiple CVC should be avoided by creating a permanent vascular access in a timely fashion for patients with chronic kidney disease and by avoiding the ipsilateral insertion of CVC and AVF.


Assuntos
Derivação Arteriovenosa Cirúrgica/efeitos adversos , Cateterismo Venoso Central/efeitos adversos , Procedimentos Endovasculares , Falência Renal Crônica/terapia , Diálise Renal , Doenças Vasculares/terapia , Veias , Adulto , Idoso , Comorbidade , Constrição Patológica , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Incidência , Jordânia/epidemiologia , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Doenças Vasculares/diagnóstico por imagem , Doenças Vasculares/epidemiologia , Doenças Vasculares/fisiopatologia , Grau de Desobstrução Vascular , Veias/diagnóstico por imagem , Veias/fisiopatologia
2.
Khirurgiia (Mosk) ; (8): 42-48, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32869614

RESUMO

OBJECTIVE: To analyze AVF patency rates after balloon angioplasty and palliative open surgery in patients with native AVF and central vein stenosis. MATERIAL AND METHODS: The study included 39 patients who underwent percutaneous balloon angioplasty (main group) and 41 patients who underwent palliative interventions (comparison group): thrombectomy, proximalization of arteriovenous anastomosis, AVF blood flow reduction. All patients were diagnosed with stenosis of subclavian vein, innominate vein, inferior vena cava or multiple lesions. RESULTS: Primary annual patency rate in the main group was 15.4% [95% CI 6.2; 28.3], in the comparison group - 0% (p=0.0011). Secondary annual patency rate was 66.7% [95% CI 49.6; 79.1] and 19.5% [95% CI 9.2; 32.7], respectively (p<0.0001). In the main group, a strong negative correlation between primary patency rate and stenosis-free period was revealed (r= -0.627 [95%CI -0.787; -0.388], p<0.0001). We did not find such correlation in the comparison group (r=0,049 [95% CI -0.262; 0.351], p=0.7599). Thus, balloon angioplasty is less effective for delayed stenosis. This feature should be considered in planning vascular approach. Different primary and secondary patency rates in the comparison group indicate that AVF blood flow reduction is an effective palliative treatment. CONCLUSION: Balloon angioplasty can significantly increase duration of AVF patency. Effectiveness of this procedure significantly depends on the period of manifestation of central vein stenosis. Balloon angioplasty cannot be considered a radical method in case of significant stenosis. This method only prolongs period for creation of new permanent contralateral vascular approach. Reduction of AVF blood flow can significantly reduce clinical severity of central vein stenosis and slightly extends the period of AVF patency.


Assuntos
Angioplastia com Balão/métodos , Derivação Arteriovenosa Cirúrgica , Constrição Patológica/cirurgia , Insuficiência Venosa/cirurgia , Humanos , Diálise Renal , Estudos Retrospectivos , Resultado do Tratamento
3.
Khirurgiia (Mosk) ; (8): 107-109, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32869623

RESUMO

Aneurysmal transformation of arteriovenous fistula (AVF) is a common complication and associated with increased risk of arrosive bleeding. Ligation of fistulous vein is conventional surgery for bleeding. This is followed by AVF malfunction and need for implantation of central venous catheter. We report reconstructive surgery and maintaining the function of AVF in a patient with aneurysmal transformation of AVF after arrosive bleeding. Reconstructive vascular surgery can significantly extend the period of patent AVF for hemodialysis. This is extremely important in patients with reduced resources of native vessels suitable for AVF formation. The same is true if conversion of the type of renal replacement therapy is associated with significant difficulties.


Assuntos
Aneurisma/cirurgia , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Hemorragia/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Aneurisma/etiologia , Hemorragia/etiologia , Humanos , Ligadura , Diálise Renal , Resultado do Tratamento , Grau de Desobstrução Vascular , Veias/cirurgia
4.
J Bras Nefrol ; 42(2 suppl 1): 41-43, 2020 Aug 26.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32877498

RESUMO

Vascular accesses for hemodialysis are considered the patient's lifeline and their maintenance is essential for treatment continuity. Following the example of institutions in other countries affected by the Covid-19 pandemic, the Brazilian Society of Nephrology developed these guidelines for healthcare services, elaborating on the importance of carrying out procedures for the preparation and preservation of vascular accesses. Creating definitive accesses for hemodialysis, grafts and arteriovenous fistulas are non-elective procedures, as well as the transition from the use of non-tunneled catheters to tunneled catheters, which cause less morbidity. In the case of patients with suspected or confirmed coronavirus infection, one may postpone the procedures for the quarantine period, to avoid spreading the disease.


Assuntos
Derivação Arteriovenosa Cirúrgica/métodos , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Diálise Renal/métodos , Dispositivos de Acesso Vascular , Comitês Consultivos , Derivação Arteriovenosa Cirúrgica/normas , Brasil , Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Cirúrgicos Eletivos/normas , Emergências , Humanos , Nefrologia/normas , Pandemias , Sociedades Médicas
5.
N Engl J Med ; 383(8): 733-742, 2020 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-32813949

RESUMO

BACKGROUND: Standard percutaneous transluminal angioplasty is the current recommended treatment for dysfunctional hemodialysis fistulas, yet long-term outcomes of this treatment are poor. Drug-coated balloons delivering the antirestenotic agent paclitaxel may improve outcomes. METHODS: In this prospective, single-blinded, 1:1 randomized trial, we enrolled 330 participants at 29 international sites. Patients with new or restenotic lesions in native upper-extremity arteriovenous fistulas were eligible for participation. After successful high-pressure percutaneous transluminal angioplasty, participants were randomly assigned to receive treatment with a drug-coated balloon or a standard balloon. The primary effectiveness end point was target-lesion primary patency, defined as freedom from clinically driven target-lesion revascularization or access-circuit thrombosis during the 6 months after the index procedure. The primary safety end point, serious adverse events involving the arteriovenous access circuit within 30 days, was assessed in a noninferiority analysis (margin of noninferiority, 7.5 percentage points). The primary analyses included all participants with available end-point data. Additional sensitivity analyses were performed to assess the effect of missing data. RESULTS: A total of 330 participants underwent randomization; 170 were assigned to receive treatment with a drug-coated balloon, and 160 were assigned to receive treatment with a standard balloon. During the 6 months after the index procedure, target-lesion primary patency was maintained more often in participants who had been treated with a drug-coated balloon than in those who had been treated with a standard balloon (82.2% [125 of 152] vs. 59.5% [88 of 148]; difference in risk, 22.8 percentage points; 95% confidence interval [CI], 12.8 to 32.8; P<0.001). Drug-coated balloons were noninferior to standard balloons with respect to the primary safety end point (4.2% [7 of 166] and 4.4% [7 of 158], respectively; difference in risk, -0.2 percentage points; 95% CI, -5.5 to 5.0; P = 0.002 for noninferiority). Sensitivity analyses confirmed the results of the primary analyses. CONCLUSIONS: Drug-coated balloon angioplasty was superior to standard angioplasty for the treatment of stenotic lesions in dysfunctional hemodialysis arteriovenous fistulas during the 6 months after the procedure and was noninferior with respect to access circuit-related serious adverse events within 30 days. (Funded by Medtronic; IN.PACT AV Access Study ClinicalTrials.gov number, NCT03041467.).


Assuntos
Angioplastia com Balão/métodos , Derivação Arteriovenosa Cirúrgica , Fármacos Cardiovasculares/administração & dosagem , Paclitaxel/administração & dosagem , Dispositivos de Acesso Vascular/efeitos adversos , Grau de Desobstrução Vascular , Idoso , Angioplastia com Balão/instrumentação , Derivação Arteriovenosa Cirúrgica/instrumentação , Fármacos Cardiovasculares/efeitos adversos , Materiais Revestidos Biocompatíveis , Constrição Patológica/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paclitaxel/efeitos adversos , Estudos Prospectivos , Diálise Renal/efeitos adversos , Método Simples-Cego , Extremidade Superior/irrigação sanguínea
7.
Eur J Vasc Endovasc Surg ; 60(4): 568-577, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32807670

RESUMO

OBJECTIVE: Arteriovenous grafts (AVGs) are the second best option for haemodialysis access when native arteriovenous fistulae placement is not possible, because they have a lower patency owing to neointimal hyperplasia at the venous anastomosis. This review aimed to evaluate the effect of geometric graft modification to the graft-vein interface on AVG patency. DATA SOURCES: The MEDLINE and Embase (OvidSP) databases were systematically searched for relevant studies analysing the effect of geometrically modified AVGs on graft patency and stenosis formation (last search July 2019). REVIEW METHODS: Data regarding AVG type, patency, and graft outlet stenosis was extracted for further evaluation. Data were pooled in a random effects model to estimate the relative risk of graft occlusion within one year. Follow up, number of patients, and relevant patient characteristics were extracted for the quality assessment of the included studies using Newcastle-Ottawa Scale and Cochrane Risk of Bias Tool. The quality of the evidence was determined according to the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system. RESULTS: Search strategies produced 2772 hits, of which eight articles met predetermined inclusion criteria. Overall, the included articles had low to moderate risk of bias. In total, 414 expanded polytetrafluoroethylene AVGs (232 geometrically modified and 182 standard) were analysed, comprising two modified AVG types: a prosthetic cuff design (Venaflo®) and grafts with a Tyrell vein patch. Overall, modified grafts did not show a statistically significantly higher one year primary (relative risk [RR] 0.86, 95% confidence interval [CI] 95% 0.64-1.16; GRADE: "low to very low") or secondary patency (RR 0.57, 95% CI 0.32-1.02; GRADE: "low to very low") when compared with standard AVGs. Analysis of prosthetic cuffed grafts (112 patients) separately demonstrated a statistically significantly higher one year primary (RR 0.75, 95% CI 0.61-0.91) and one year secondary patency (RR 0.47, 95% CI 0.30-0.75) compared with standard grafts (92 patients). The results on stenosis formation were inconclusive and inadmissible to quantitative analyses. CONCLUSION: The meta-analysis showed that a prosthetic cuff design significantly improves AVG patency, while a venous cuff does not. Although the heterogeneity and low number of available studies limit the strength of the results, this review shows the potential of grafts with geometric modification to the graft-vein anastomosis and should stimulate further clinical and fundamental research on improving graft geometry to improve graft patency.


Assuntos
Derivação Arteriovenosa Cirúrgica/instrumentação , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Diálise Renal , Grau de Desobstrução Vascular , Idoso , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Implante de Prótese Vascular/efeitos adversos , Feminino , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
9.
AJR Am J Roentgenol ; 215(4): 785-789, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32783553

RESUMO

OBJECTIVE. The purposes of this study were to evaluate the volume of and payments for dialysis arteriovenous fistula and arteriovenous graft maintenance procedures among Medicare beneficiaries from 2010 to 2018 and analyze trends by physician specialty and practice setting after the introduction of bundled Current Procedural Terminology (CPT) codes in 2017. MATERIALS AND METHODS. Claims from the Medicare Part B Physician/Supplier Procedure Summary Master File for the years 2010 through 2018 were extracted by use of the CPT codes for arteriovenous fistula and arteriovenous graft maintenance procedures. Total volumes, payment amounts (professional component), and trends were analyzed by physician specialty and practice setting. RESULTS. From 2010 to 2018, the volume of dialysis circuit maintenance procedures increased 25%, from 308,140 to 385,440 procedures. This increase was driven by increased volumes among nephrologists (30.0%) and surgeons (30.5%) with only a modest increase for interventional radiologists (1.5%). Total physician payments increased 20%, from $333.8 million to $399.5 million. After the introduction of bundled CPT codes in 2017, per-procedure physician payment decreased from $1073 in 2016 to $1025 in 2017 (4.5%). The true decrease in per-procedure payment was underestimated owing to inclusion of higher-cost stenting and embolization procedures in the dialysis-specific codes beginning in 2017. CONCLUSION. The volume of dialysis access maintenance procedures and total physician payments increased from 2010 to 2018 in keeping with the Centers for Medicare & Medicaid Services Fistula First Breakthrough Initiative. Introduction of bundled CPT codes in 2017, designed to reduce redundant payments, correlated with a decrease in average per-procedure physician payment.


Assuntos
Derivação Arteriovenosa Cirúrgica/economia , Reembolso de Seguro de Saúde/economia , Falência Renal Crônica/terapia , Medicare Part B/economia , Pacotes de Assistência ao Paciente/economia , Diálise Renal/economia , Current Procedural Terminology , Cirurgia Geral , Humanos , Falência Renal Crônica/economia , Nefrologia , Radiologia , Estudos Retrospectivos , Estados Unidos
10.
PLoS One ; 15(7): e0234931, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32615582

RESUMO

BACKGROUND: Arteriovenous fistulas (AVF) are a source of various complications. Among previously hemodialyzed kidney transplant recipients (KTxR), the AVF may persist over time. The patients' decisions whether to ligate the functioning AVF may be prompted by many factors. Our knowledge of benefits concerning the procedure as well as patients' attitude towards it is scarce. AIM: Evaluation of the patients' opinion on the persistent AVF ligation after a successful kidney transplantation. MATERIALS AND METHODS: An anonymous survey was carried out among 301 previously hemodialyzed KTxR. The patients were recruited during scheduled visits in the Transplantation Outpatient Unit. All subjects completed an anonymous questionnaire including questions about their attitude towards the matter in question. RESULTS: 69 patients (22.9%) have considered AVF closure. The most common causes for such attitude were esthetic reasons (n = 29) and concerns about heart health (n = 13). Among those 69 subjects, 18 have presented with symptomatic AVF due to multiple symptoms. Symptomatic AVFs were localized on the forearm in 14 out of 18 cases. As many as 116 (38.5%) cases have never wanted to ligate the AVF and 116 (38.5%) subjects did not have a clear opinion. In our study we report 158 (52.5%) cases of non-functioning AVFs. The main reason for the above was spontaneous AVF thrombosis (121 cases). Only 24 subjects reported to rely on the physician-provided information about the AVF management. CONCLUSIONS: One fourth of KTRs have ever considered AVF ligation. There is a distinct need for educating patients on the possibilities of post-transplantation AVF management.


Assuntos
Derivação Arteriovenosa Cirúrgica , Atitude Frente a Saúde , Transplante de Rim , Preferência do Paciente , Transplantados/psicologia , Adulto , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Procedimentos Cirúrgicos Eletivos , Estética , Feminino , Antebraço , Humanos , Falência Renal Crônica/cirurgia , Falência Renal Crônica/terapia , Ligadura , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Diálise Renal , Inquéritos e Questionários , Trombose/etiologia , Trombose/prevenção & controle
11.
Vasc Endovascular Surg ; 54(8): 670-675, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32720863

RESUMO

OBJECTIVES: Surgical thrombectomy for acute arteriovenous fistula (AVF) thrombosis is one of the primary salvage intervention. The independent risk factors affecting the patency of AVF after a successful thrombectomy are yet unknown. Here, the author aimed to report the results of surgically corrected AVFs and the independent risk factors which may cause early failure following the surgical salvage. METHODS: The study cohort comprised 24 patients who had acute AVF thrombosis and underwent successful surgical thrombectomy in the first 24 to 48 hours between January 2016 and April 2020 in our center. The study group was divided into patients with recurrent AVF thrombosis (n = 11, 45.8%) and without recurrent AVF thrombosis (n = 13, 54.1%) following surgical thrombectomy with a follow-up of 22.4 ± 6.8 months. Postthrombectomy primary and secondary patency of AVF were also evaluated. RESULTS: The mean age of the cohort was 58.1 ± 15.2 years. A simple thrombectomy was performed for all cases. Only 2 cases have required a revision at the anastomosis due to severe intimal hyperplasia. Postthrombectomy primary patency rate was 45.5% for 18 months. Receiver operating characteristic analysis was performed with a resulting area under the curve value of 0.81 (95% CI: 0.35-0.94, P = .006) for flow (mL)/d-dimer (ng/mL) <0.63 in predicting recurrent AVF thrombosis following surgical thrombectomy. CONCLUSIONS: Flow (mL)/d-dimer (ng/mL) <0.63 was independent predictor of recurrent thrombosis (RT) of a surgically salvaged AVF. The patients at risk for RT or who may benefit from further intervention should be identified with predictive parameters.


Assuntos
Derivação Arteriovenosa Cirúrgica/efeitos adversos , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Oclusão de Enxerto Vascular/cirurgia , Diálise Renal , Trombectomia , Trombose/cirurgia , Grau de Desobstrução Vascular , Adulto , Idoso , Biomarcadores/sangue , Velocidade do Fluxo Sanguíneo , Feminino , Oclusão de Enxerto Vascular/sangue , Oclusão de Enxerto Vascular/diagnóstico , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Recidiva , Estudos Retrospectivos , Fatores de Risco , Trombectomia/efeitos adversos , Trombose/sangue , Trombose/diagnóstico , Trombose/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
17.
Vascular ; 28(6): 775-783, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32522136

RESUMO

OBJECTIVES: Dialysis fistula aneurysms are common complications which in selective cases require surgical revision. It is recommended to detect and treat outflow stenosis concurrent with a dialysis fistula aneurysm, but usually, the treatment is divided into two stages - the open and endovascular stages are performed separately. We describe the results of hybrid procedures composed of aneurysm resection and endovascular correction for outflow veins performed for a dialysis fistula aneurysm treatment. METHODS: From March 2012, we performed hybrid procedures in 28 patients to correct dialysis fistula aneurysms. Patients, dialysis access, operative data, and the results obtained during a median follow-up of 28.5 months were analyzed. RESULTS: For dialysis fistula aneurysm correction, we performed 27 bypasses and 1 aneurysmorraphy. For outflow vein stenosis correction, we performed standard balloon angioplasty, no stents or stentgraft were used. The average increase in minimal diameter after angioplasty was 135.5% (range 57-275%). The 12- and 24-month primary patency rates of corrected fistulas in the observed group were 92.3% and 80%, respectively. A significant difference in the one-year patency rates between the urgent and planned procedures was observed (81.2% vs. 100%, respectively). No early complications related to endovascular or open procedures were observed. Late complications were observed in seven patients (25%) - mainly thrombosis caused by the recurrence of outflow vein stenosis (six patients, 21.5%), infection, lymphocele, and hematoma (one case of each complication). CONCLUSIONS: A hybrid procedure for the surgical correction of dialysis fistula aneurysms with the simultaneous correction of outflow pathologies enables effective long-term treatment. The obtained data showed the efficiency and good results of this procedure. Procedures performed for urgent indications significantly increase the risk for later complications, especially fistula thrombosis and loss of dialysis access.


Assuntos
Aneurisma/terapia , Angioplastia com Balão , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Implante de Prótese Vascular , Diálise Renal , Veias/cirurgia , Idoso , Aneurisma/diagnóstico por imagem , Aneurisma/etiologia , Aneurisma/fisiopatologia , Angioplastia com Balão/efeitos adversos , Implante de Prótese Vascular/efeitos adversos , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular , Veias/diagnóstico por imagem , Veias/fisiopatologia
18.
Ann Vasc Surg ; 68: 67-75, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32504791

RESUMO

BACKGROUND: Brachiocephalic arteriovenous fistulas (BCFs) are commonly placed in outpatient settings. The impact of general anesthesia (GA), regional anesthesia (RA), or local anesthesia (LA) on perioperative recovery and fistula maturation/patency after outpatient BCF creations is unknown. We evaluated whether outcomes of outpatient BCF creations vary based on anesthesia modality. METHODS: The Vascular Quality Initiative (2011-2018) national database was queried for outpatient BCF creations. Anesthesia modalities included GA, RA, and LA. Perioperative, 3-month, and 1-year outcomes were compared between GA versus RA/LA anesthesia types. RESULTS: Among 3,527 outpatient BCF creations, anesthesia types were GA in 1,043 (29.6%), RA in 1,150 (32.6%), and LA in 1,334 (37.8%). Patients receiving GA were more often younger, obese, Medicaid recipients, without coronary artery disease, and treated in non-office-based settings (P < 0.05 for all). GA compared with RA/LA cohorts were more often admitted postoperatively (5.3% vs. 2.4%, P < 0.001) but had similar rates of thirty-day mortality (0.9 vs. 0.6%, P = 0.39). 3-month access utilization for hemodialysis was lower in GA than in RA/LA cohorts (12.6% vs. 23.6%, P < 0.001). The Kaplan-Meier analysis showed that GA and RA/LA cohorts had similar 1-year primary access occlusion-free survival (43.6% vs. 47.1%, P = 0.24) and endovascular/open reintervention-free survival (57.2% vs. 57.6%, P = 0.98). On multivariable analysis, GA compared with RA/LA use was independently associated with increased postoperative admission (odds ratio [OR]: 1.7, 95% confidence interval [CI]: 1.08-2.67, P = 0.02) and decreased 3-month access utilization (OR: 0.39, 95% CI: 0.25-0.61, P < 0.001) but had similar 1-year access occlusion (hazard ratio [HR]: 1.09, 95% CI: 0.9-1.32, P = 0.36) and reintervention (HR: 1.02, 95% CI: 0.82-1.26, P = 0.88). On subgroup analysis of the RA/LA cohort, RA compared with LA was associated with increased 3-month access utilization (OR: 1.6, 95% CI: 1.01-2.5; P = 0.04) and 1-year access reintervention (HR: 1.46, 95% CI: 1.12-1.89), but had similar 1-year access occlusion (HR: 1.2, 95% CI: 0.95-1.51, P = 0.13). CONCLUSIONS: Compared with RA/LA use, GA use in patients undergoing outpatient BCF creations was associated with increased hospital admissions, decreased access utilization at 3 months, and similar 1-year access occlusion and reintervention. RA/LA is preferable to expedite recovery and access utilization.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Anestesia por Condução , Anestesia Geral , Derivação Arteriovenosa Cirúrgica , Diálise Renal , Extremidade Superior/irrigação sanguínea , Idoso , Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Anestesia por Condução/efeitos adversos , Anestesia Geral/efeitos adversos , Anestesia Local/efeitos adversos , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Canadá , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos , Grau de Desobstrução Vascular
19.
J Vasc Res ; 57(4): 223-235, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32396897

RESUMO

BACKGROUND: There are very few animal models of balloon angioplasty injury in arteriovenous fistula (AVF), hindering insight into the pathophysiologic processes following angioplasty in AVF. The objective of the study was to develop and characterize a rat model of AVF angioplasty injury. METHODS: Balloon angioplasty in 12- to 16-week-old Sprague-Dawley rats was performed at the arteriovenous anastomosis 14 days post-AVF creation with a 2F Fogarty balloon catheter. Morphometry and protein expression of endothelial nitric oxide synthase (eNOS), monocyte-chemoattractant protein-1 (MCP-1), alpha-smooth muscle actin (α-SMA), CD68 (macrophage marker), and collagen expression in AVFs with and without angioplasty were assessed. RESULTS: In AVFs with angioplasty versus without angioplasty: (1) angioplasty increased AVF-vein and artery intimal hyperplasia, (2) angioplasty decreased eNOS protein expression in AVF-vein and artery at 21 days post-AVF creation and remained decreased in the AVF-vein angioplasty group at 35 days, (3) angioplasty increased AVF-vein and artery α-SMA expression within the intimal region at 35 days, (4) angioplasty increased the expression of AVF-vein MCP-1 at 21 days and CD68 at 21 and 35 days, and (5) angioplasty increased AVF-vein and artery collagen expression at 35 days. CONCLUSION: Our findings describe a reproducible rat model to better understand the pathophysiologic mechanisms that ensue following AVF angioplasty.


Assuntos
Angioplastia com Balão , Derivação Arteriovenosa Cirúrgica , Artéria Femoral/lesões , Veia Femoral/lesões , Remodelação Vascular , Lesões do Sistema Vascular/etiologia , Actinas/metabolismo , Animais , Antígenos CD/metabolismo , Antígenos de Diferenciação Mielomonocítica/metabolismo , Quimiocina CCL2/metabolismo , Colágeno/metabolismo , Modelos Animais de Doenças , Artéria Femoral/metabolismo , Artéria Femoral/patologia , Artéria Femoral/cirurgia , Veia Femoral/metabolismo , Veia Femoral/patologia , Veia Femoral/cirurgia , Masculino , Neointima , Óxido Nítrico Sintase Tipo III/metabolismo , Ratos Sprague-Dawley , Fatores de Tempo , Lesões do Sistema Vascular/metabolismo , Lesões do Sistema Vascular/patologia
20.
Vascular ; 28(5): 664-672, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32390561

RESUMO

BACKGROUND: The high rate of clinical failure of prosthetic arteriovenous grafts continues to suggest the need for novel tissue-engineered vascular grafts. We tested the hypothesis that the decellularized rat jugular vein could be successfully used as a conduit and that it would support reendothelialization as well as adaptation to the arterial environment. MATERIALS AND METHODS: Autologous (control) or heterologous decellularized jugular vein (1 cm length, 1 mm diameter) was sewn between the inferior vena cava and aorta as an arteriovenous graft in Wistar rats. Rats were sacrificed on postoperative day 21 for examination. RESULTS: All rats survived, and grafts had 100% patency in both the control and decellularized groups. Both control and decellularized jugular vein grafts showed similar rates of reendothelialization, smooth muscle cell deposition, macrophage infiltration, and cell turnover. The outflow veins distal to the grafts showed similar adaptation to the arteriovenous flow. Both CD34, CD90 and nestin positive cells, as well as M1-type and M2-type macrophages accumulated around the graft. CONCLUSIONS: This model shows that decellularized vein can be successfully used as an arteriovenous graft between the rat aorta and the inferior vena cava. Several types of cells, including progenitor cells and macrophages, are present in the host response to these grafts in this model. This model can be used to test the application of arteriovenous grafts before conducting large animal experiments.


Assuntos
Aorta/cirurgia , Derivação Arteriovenosa Cirúrgica , Veias Jugulares/transplante , Grau de Desobstrução Vascular , Veia Cava Inferior/cirurgia , Animais , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Células Progenitoras Endoteliais/metabolismo , Células Progenitoras Endoteliais/patologia , Células-Tronco Hematopoéticas/metabolismo , Células-Tronco Hematopoéticas/patologia , Veias Jugulares/metabolismo , Veias Jugulares/patologia , Veias Jugulares/fisiopatologia , Macrófagos/metabolismo , Macrófagos/patologia , Masculino , Ratos Wistar , Fatores de Tempo , Remodelação Vascular
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