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1.
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
3.
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
4.
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
6.
J Vasc Access ; 21(4): 536-538, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32390495

RESUMO

The recommendations recently proposed by the European and American Vascular Societies in this new 'Covid-19' era regarding the triage of various vascular operations into urgent, emergent and programmed based on the nature of their pathology aim at reserving health care expenses and hospital staff towards managing the current unexpected worldwide pandemic to the highest possible degree. The suggestion for implementation of these changes into real-world practice, however, does not come without a cost. In particular, the recommendation for deferral of access creation in pre-dialysis patients, ethical, socio-economic and medico-legal issues arise which should be seriously taken into consideration. At the end of the day, vascular access creation is the lifeline of haemodialysis patients and the indication for surgery warrants patient-specific clinical judgement rather than 'group labelling'.


Assuntos
Derivação Arteriovenosa Cirúrgica , Betacoronavirus/patogenicidade , Cateterismo Venoso Central , Infecções por Coronavirus/prevenção & controle , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Nefropatias/terapia , Exposição Ocupacional/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Diálise Renal , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Cateterismo Venoso Central/efeitos adversos , Tomada de Decisão Clínica , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Humanos , Nefropatias/diagnóstico , Exposição Ocupacional/efeitos adversos , Saúde do Trabalhador , Segurança do Paciente , Seleção de Pacientes , Pneumonia Viral/diagnóstico , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Diálise Renal/efeitos adversos , Medição de Risco , Fatores de Risco , Tempo para o Tratamento , Virulência
7.
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
8.
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
9.
Ann Biol Clin (Paris) ; 78(2): 206-209, 2020 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-32319951

RESUMO

Factor V deficiency is a rare hemostatic disorder. It may present with a diverse spectrum of symptoms due to a variety of mechanisms including development of autoantibodies associated with a number of conditions. We report a first case of factor V deficiency in Tunisian hemodialysis patient due to an autoantibody most likely secondary to antibiotic exposure responsible for an arteriovenous shunt thrombosis rather than bleeding. We discuss here the clinical and biological features of acquired factor V inhibitor and provide a short review of the current literature.


Assuntos
Derivação Arteriovenosa Cirúrgica/efeitos adversos , Autoanticorpos/sangue , Transtornos da Coagulação Sanguínea/etiologia , Fator V/imunologia , Diálise Renal , Trombose/etiologia , Idoso , Transtornos da Coagulação Sanguínea/sangue , Transtornos da Coagulação Sanguínea/diagnóstico , Fator V/antagonistas & inibidores , Humanos , Masculino , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/diagnóstico , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/terapia , Trombose/sangue , Trombose/diagnóstico , Tunísia
11.
J Vasc Access ; 21(5): 746-752, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32340534

RESUMO

BACKGROUND: A substantial proportion of arteriovenous fistulas fail to function adequately for hemodialysis. Existing studies on arteriovenous fistula failure prediction assess patency rather than the more clinically relevant outcome of arteriovenous fistula function. We hypothesized that preoperative demographic and ultrasound characteristics, and postoperative assessment by an experienced vascular access nurse would predict which arteriovenous fistulas will not function adequately for hemodialysis. METHODS: Prospective cohort study of chronic kidney disease patients at a tertiary care center in Vancouver, Canada, with arteriovenous fistula creation between 2009 and 2013. Pre and postoperative clinical assessment and ultrasound blood vessel mapping were performed by an experienced vascular access nurse. The primary outcome was failure to achieve a fistula used successfully for hemodialysis (FUSH). RESULTS: Outcomes were assessed in 200 patients; 123 (61.5%) arteriovenous fistulas were radiocephalic. Overall, 26.5% of arteriovenous fistulas had FUSH failure (34.1% of lower arm vs 14.3% of upper arm, p = 0.002). Univariate predictors of FUSH failure included older age (p = 0.03), female sex (p = 0.05), smaller arterial diameter (p ⩽ 0.001), lower artery volume flow (p = 0.04), and smaller vein diameter (p = 0.01). In multivariable analysis, artery diameter (odds ratio: 0.44, 95% confidence interval: 0.28-0.68) most significantly predicted FUSH failure. Vascular access nurse assessment 6 weeks postoperatively correctly predicted outcome in 83.8% of FUSH and 65.0% of FUSH failure. CONCLUSION: Smaller artery diameter most strongly predicted FUSH failure. Early postoperative nursing assessment was more useful to predict FUSH than FUSH failure, and as such was insufficient in determining which arteriovenous fistulas should be abandoned as many predicted to fail could be salvaged with further intervention.


Assuntos
Derivação Arteriovenosa Cirúrgica/enfermagem , Recursos Humanos de Enfermagem no Hospital , Diálise Renal/enfermagem , Ultrassonografia/enfermagem , Extremidade Superior/irrigação sanguínea , Idoso , Idoso de 80 Anos ou mais , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Colúmbia Britânica , Competência Clínica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Risco , Centros de Atenção Terciária , Fatores de Tempo , Falha de Tratamento , Grau de Desobstrução Vascular
12.
Vascular ; 28(5): 604-608, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32295495

RESUMO

OBJECTIVES: Vascular access is a lifeline for the patients who are in need of long-term hemodialysis. Native arteriovenous fistula is the most intensively preferred vascular access method owing to its longevity and convenience of use. Therefore, in this study, we aimed to determine whether there might be a relationship between hemodialysis patients' educational levels and arteriovenous fistula patency. METHODS: A total of 349 patients who were attending in a chronic hemodialysis program between June 2018 and September 2018 at Bursa Uludag University, Faculty of Medicine Dialysis Unit and in a private dialysis center in Istanbul were included in this study. The patients were grouped into two: those who have had arteriovenous fistula primary failure at least once and those who have never had arteriovenous fistula primary failure. Educational levels of the patients were classified according to Turkish National Education system (illiterate, primary school graduate, secondary school graduate, high school graduate, and university graduate). Mann-Whitney U and Chi-square tests were performed for statistical analyses. Risk factors were determined by applying backward binary logistic regression analysis. RESULTS: A total of 349 patients, 161 (46.1%) females and 188 (53.9%) males, were examined retrospectively. The median age of the patients was 64 years (range: 18-90 years). Educational level comparison revealed statistically significant difference in terms of fistula patency (p = 0.016). In particular, fistula patency was significantly lower in illiterate, primary, secondary, and high school graduates in comparison with university graduates (p = 0.001, p = 0.015, p = 0.003, and p = 0.018, respectively). When each group of educational level was analyzed separately in terms of fistula patency, it was observed that the higher the educational level was, the lower arteriovenous fistula primary failure rates were. CONCLUSIONS: In this study, we observed a lower rate of fistula patency in patients with a low level of education. Hence, we are of the opinion that the trainings delivered on arteriovenous fistula care in dialysis centers are required to be shaped in accordance with educational levels of patients.


Assuntos
Derivação Arteriovenosa Cirúrgica/efeitos adversos , Escolaridade , Oclusão de Enxerto Vascular/etiologia , Nefropatias/terapia , Diálise Renal , Grau de Desobstrução Vascular , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Nefropatias/diagnóstico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
14.
Ann Vasc Surg ; 67: 448.e1-448.e10, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32209414

RESUMO

BACKGROUND: Brachio-basilic/brachial transposition arteriovenous fistula has emerged as one of the autologous arteriovenous fistula options. However, there have not been many reports on the outcomes of basilic or brachial elevation of arteriovenous fistula compared with those of conventional transposition. We evaluated the efficacy of modified brachio-basilic and brachio-brachial arteriovenous fistula creation with short-segment elevation preserving the axillary area. METHODS: From March 2016 to August 2018, medical records of the patients who underwent short-segment elevation of brachio-basilic or brachio-brachial arteriovenous fistula in the upper arm (sBAE or sBRE) were reviewed retrospectively. RESULTS: Of the 51 patients, 37 underwent sBAE and 14 underwent sBRE. Maturation failure occurred in two patients (3.92%), who underwent sBAE. Stenosis was the most common complication, which developed in 13 patients (25.5%), and there was no significant difference between the sBAE and the sBRE. In the 51 patients, cumulative primary patency rates at 6 and 12 months were 88.3% and 69.1%, respectively. Assisted primary patency rates at 6 and 12 months were 97.8% and 90.7%, respectively. Secondary patency rates at 6 and 12 months were both 100%. There were no significant differences between the sBAE and the sBRE in 1-year primary patency (79.1% vs. 46.7%; P = 0.20), assisted primary patency (91.6% vs. 88.1%; P = 0.36), and secondary patency rates (100% vs. 100%). CONCLUSIONS: Brachio-basilic/brachial arteriovenous fistula with short-segment elevation preserving the axilla showed excellent 1-year patency rate, easier cannulation, and other future advantages, and therefore, is a logical modification of conventional transposition of arteriovenous fistula.


Assuntos
Derivação Arteriovenosa Cirúrgica/métodos , Axila/irrigação sanguínea , Artéria Braquial/cirurgia , Diálise Renal , Extremidade Superior/irrigação sanguínea , Veias/cirurgia , Idoso , Idoso de 80 Anos ou mais , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Artéria Braquial/diagnóstico por imagem , Artéria Braquial/fisiopatologia , Feminino , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular , Veias/diagnóstico por imagem , Veias/fisiopatologia
15.
Complement Ther Med ; 49: 102326, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32147063

RESUMO

BACKGROUND AND PURPOSE: Patients undergoing continuous hemodialysis experience the arteriovenous fistula puncture-related pain approximately 300 times per year. Pain management is important priorities in painful procedures. Therefore, this systematic review and meta-analysis study was conducted to determine the effect of cryotherapy on arteriovenous fistula puncture-related pain in hemodialysis patients. METHODS: This systematic review and meta-analysis study was conducted by searching the related article with using the keywords including Cryotherapy, Ice, Punctures, Catheterization, Pain, and Fistula (using AND & OR operators) through Iranian (including SID, and Magiran) and international databases (including Embase, Web of Science, Medline via PubMed, Scopus, and ProQuest). Interventional studies in English or Persian languages were included in the study without time limitation. Finally, after excluding duplicates, screening based on inclusion and exclusion criteria, and quality assessment (based on the JADAD standard checklist), 8 studies entered the systematic review process (Qualitative Synthesis) and 6 studies entered the meta-analysis process (Quantitative Synthesis). RESULTS: Based on the results of the review, the included studies were conducted between 2008-2017. The total number of participants in all studies obtained through systematic review (8 studies) was 422 with an age of 16 years old and above. The review of studies showed a positive effect of cryotherapy on reducing the arteriovenous fistula puncture-related pain in hemodialysis patients. CONCLUSION: Regarding the positive effect of cryotherapy on arteriovenous fistula puncture-related pain, cryotherapy as a low-risk and uncomplicated procedure seems to be effective and useful in reducing pain and ultimately reducing its unpleasant psychological and physical side effects.


Assuntos
Derivação Arteriovenosa Cirúrgica/efeitos adversos , Crioterapia , Manejo da Dor/métodos , Dor/prevenção & controle , Punções/efeitos adversos , Diálise Renal , Humanos
16.
J Vasc Interv Radiol ; 31(4): 630-634, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32127320

RESUMO

PURPOSE: To retrospectively evaluate the safety and effectiveness of the Covera stent graft (SG) for the treatment of dysfunctional or thrombosed arteriovenous grafts (AVGs). MATERIALS AND METHODS: Within 29 months (February 2016-August 2018), 79 patients underwent Covera SG placement in the authors' department for the treatment of dysfunctional AVGs. Data were available for 64 patients who underwent 64 procedures, using 64 devices. Minimum follow-up was 6 months, unless reintervention occurred. Mean follow-up was 277 days (6-923 days). Treatment characteristics were 51 cases with venous-graft anastomosis (VGA) stenosis (79.7%), 13 cases of puncture zone stenosis (20.3%), 14 cases of in SG stenosis (21.9%), 8 cases of pseudoaneurysm treatment (12.5%) (1 treatment area might have had more than 1 characteristic). Thirty-six patients presented with thrombosis (56.2%), and 31 of 64 case were de novo treatment areas (48.4%). Primary outcome measurements were technical success and post-intervention primary patency (PIPP) at 6 months, whereas secondary outcome measurements included factors influencing primary outcome. RESULTS: Technical success was 100%. Median PIPP was 336 days, and 73.6% of treatment areas were patent at 6 months. There were no significant differences in terms of PIPP when de novo treatment areas were compared with restenotic areas (519 vs. 320 days, respectively; P = .1); patients who presented with versus those who presented without thrombosis (320 vs. 583 days, respectively; P = .07); puncture zone stenosis or elsewhere (329 vs. 686 days, respectively; P = .52); and VGA stenosis or elsewhere (336 vs. 335 days, respectively; P = .9). CONCLUSIONS: Use of the Covera SG for AVG treatment was safe and effective in every type of treatment area presented in this retrospective analysis.


Assuntos
Derivação Arteriovenosa Cirúrgica/efeitos adversos , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Procedimentos Endovasculares/instrumentação , Oclusão de Enxerto Vascular/cirurgia , Stents , Trombose/cirurgia , Idoso , Implante de Prótese Vascular/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 , Desenho de Prótese , Estudos Retrospectivos , Trombose/diagnóstico por imagem , Trombose/etiologia , Trombose/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
17.
Enferm. nefrol ; 23(1): 34-43, ene.-mar. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-193372

RESUMO

INTRODUCCIÓN: El dolor a la punción de la fístula arteriovenosa es una constante en todos los pacientes en hemodiálisis. OBJETIVO: El propósito del estudio fue explorar la percepción del dolor a la punción en los pacientes en hemodiálisis, analizando tanto emociones como ideas sobre su calidad de vida. MATERIAL Y MÉTODO: Se realizó un estudio cualitativo, de carácter fenomenológico, en el Hospital Universitario Reina Sofía de Córdoba, en la Unidad de Nefrología y en el Servicio de Consultas Externas "El Perpetuo Socorro" (que también pertenece al mismo hospital). Se realizaron entrevistas semiestructuradas a diez pacientes, hombres y mujeres, que sufrían de Insuficiencia Renal Crónica bajo tratamiento de hemodiálisis. RESULTADOS: Se llevó a cabo un análisis de contenido del que emergieron tres categorías principales asociadas a distintas subcategorías: 1) Doler, duele ¿eh? Pero… (Mejora con el tiempo; Cuando duele lo hace de verdad; ¿Duele? Ni te enteras); 2) Ansiedad y miedos relacionados con la intervención (Cuestión de mentalizarse; Ansiedad anticipatoria; Desesperación e inseguridad ante complicaciones y desinformación; ¡Por Dios, que no se rompa la fístula!; Las manos de la enfermera); 3) Una calidad de vida comprometida (Muchas limitaciones; Pero no tiene tanto impacto; ¿Catéter o fístula?). CONCLUSIONES: El estudio permitió describir las percepciones de los pacientes en hemodiálisis en torno a la punción, su contexto y consecuencias, posibilitando, primero, una mayor comprensión y empatía en los profesionales de la salud y, después, una base para otras aproximaciones indagatorias al fenómeno en cuestión


INTRODUCTION: Pain during puncture of the arteriovenous fistula is a constant in all hemodialysis patients. OBJECTIVE: The purpose of the study was to explore the perception of pain during puncture in hemodialysis patients, analyzing both emotions and ideas about their quality of life. MATERIAL AND METHOD: A qualitative study with a phenomenological approach was carried out at the Reina Sofía University Hospital in Córdoba, at the Nephrology Unit and at the External Consultation Service "El Perpetuo Socorro" (which also belongs to the same hospital). Semi-structured interviews were conducted with ten patients, men and women suffering from chronic renal failure on hemodialysis. RESULTS: A content analysis was carried out from which three main categories associated with different subcategories emerged: 1) It hurts, it hurts, huh? But... (Improves over time; When it hurts, it does; Does it hurt? You don't even know); 2) Anxiety and fears related to the intervention (Question of make aware; Anticipatory anxiety; Despair and insecurity in the face of complications and misinformation; For God's sake, do not break the fistula!; The nurse's hands); 3) A compromised quality of life (Many limitations; But it doesn't have that much impact; catheter or fistula?). CONCLUSIONS: The study allowed describing the perceptions of hemodialysis patients regarding puncture, context and consequences, allowing, first, a greater understanding and empathy in health professionals and, later, a basis for other approaches to the phenomenon


Assuntos
Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Diálise Renal/efeitos adversos , Diálise Renal/psicologia , Punções/efeitos adversos , Punções/psicologia , Dor/etiologia , Dor/psicologia , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Qualidade de Vida , 25783
18.
PLoS One ; 15(3): e0230358, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32208424

RESUMO

Endothelial dysfunction is a critical event in vascular inflammation characterized, in part, by elevated surface expression of adhesion molecules such as intercellular adhesion molecule-1 (ICAM-1). ICAM-1 is heavily N-glycosylated, and like other surface proteins, it is largely presumed that fully processed, complex N-glycoforms are dominant. However, our recent studies suggest that hypoglycosylated or high mannose (HM)-ICAM-1 N-glycoforms are also expressed on the cell surface during endothelial dysfunction, and have higher affinity for monocyte adhesion and regulate outside-in endothelial signaling by different mechanisms. Whether different ICAM-1 N-glycoforms are expressed in vivo during disease is unknown. In this study, using the proximity ligation assay, we assessed the relative formation of high mannose, hybrid and complex α-2,6-sialyated N-glycoforms of ICAM-1 in human and mouse models of atherosclerosis, as well as in arteriovenous fistulas (AVF) of patients on hemodialysis. Our data demonstrates that ICAM-1 harboring HM or hybrid epitopes as well as ICAM-1 bearing α-2,6-sialylated epitopes are present in human and mouse atherosclerotic lesions. Further, HM-ICAM-1 positively associated with increased macrophage burden in lesions as assessed by CD68 staining, whereas α-2,6-sialylated ICAM-1 did not. Finally, both HM and α-2,6-sialylated ICAM-1 N-glycoforms were present in hemodialysis patients who had AVF maturation failure compared to successful AVF maturation. Collectively, these data provide evidence that HM- ICAM-1 N-glycoforms are present in vivo, and at levels similar to complex α-2,6-sialylated ICAM-1 underscoring the need to better understand their roles in modulating vascular inflammation.


Assuntos
Aterosclerose/patologia , Endotélio Vascular/patologia , Inflamação/patologia , Molécula 1 de Adesão Intercelular/imunologia , Isoformas de Proteínas/análise , Adulto , Idoso , Animais , Artérias/citologia , Artérias/patologia , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Aterosclerose/imunologia , Modelos Animais de Doenças , Endotélio Vascular/citologia , Endotélio Vascular/imunologia , Epitopos/análise , Epitopos/imunologia , Epitopos/metabolismo , Feminino , Glicosilação , Células Endoteliais da Veia Umbilical Humana , Humanos , Inflamação/imunologia , Molécula 1 de Adesão Intercelular/análise , Molécula 1 de Adesão Intercelular/metabolismo , Macrófagos/imunologia , Masculino , Manose/metabolismo , Camundongos , Camundongos Knockout para ApoE , Pessoa de Meia-Idade , Ácido N-Acetilneuramínico/metabolismo , Isoformas de Proteínas/metabolismo , Adulto Jovem
19.
PLoS One ; 15(3): e0230372, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32210455

RESUMO

Arteriovenous fistula puncture pain is a serious problem for patients undergoing dialysis and a good indication for topical anesthetics. No previous study has compared lidocaine/prilocaine cream (EMLA) with lidocaine tape for pain relief during arteriovenous fistula puncture in patients undergoing maintenance hemodialysis. To this end, we conducted a multicenter randomized crossover study including 66 patients (mean age, 65.8 years; males, 57.6%) undergoing maintenance hemodialysis thrice/week. Subjects were assigned to Sequence EL (EMLA administration followed by lidocaine, with 1-week wash-out) or Sequence LE (reverse administration, first lidocaine then EMLA). All subjects completed the study. At each puncture site, 1 g EMLA (25 mg lidocaine + 25 mg prilocaine) or one sheet of lidocaine tape (18 mg lidocaine) was applied 1 h or 30 min prior to arteriovenous fistula puncture, respectively. The primary endpoint was puncture pain relief, which was measured using a 100-mm visual analog scale. The secondary endpoints included quality of life, which was measured by SF-36, and safety. EMLA produced a 10.1-mm greater visual analog scale improvement than lidocaine tape (P = 0.00001). However, there was no statistically significant difference in the quality of life between the two groups, and no significant carryover/period effect was observed in any analysis. Further, no drug-related adverse events were observed. Taken together, these results suggest that EMLA cream is superior to lidocaine tape for the relief of arteriovenous fistula puncture pain in patients undergoing maintenance hemodialysis. Trial registration: University Hospital Medical Information Network Clinical Trials Registry (UMIN000027885).


Assuntos
Anestésicos Locais/administração & dosagem , Combinação Lidocaína e Prilocaína/administração & dosagem , Dor Processual/prevenção & controle , Punções/efeitos adversos , Creme para a Pele/administração & dosagem , Idoso , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Estudos Cross-Over , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Humanos , Japão , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Processual/diagnóstico , Dor Processual/etiologia , Diálise Renal/efeitos adversos , Diálise Renal/métodos
20.
J Endovasc Ther ; 27(2): 266-275, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32043432

RESUMO

Purpose: To compare the effectiveness and safety outcomes of drug-coated balloon angioplasty (DCBA) vs conventional balloon angioplasty (BA) for arteriovenous fistula (AVF) stenosis. Materials and Methods: A systematic review was conducted of PubMed and Embase databases from 1966 to May 2019 to identify English-language articles evaluating DCBA vs BA for the treatment of AVF stenosis. Data extracted from each study were synthesized to evaluate target lesion revascularization (TLR), technical success, and mortality for the 2 approaches. Meta-analyses were performed on these outcomes using random effects models to estimate the odds ratios (ORs) and 95% confidence intervals (CIs). Subgroup and sensitivity analyses were performed. Results: Twelve studies [6 randomized controlled trials (RCTs) and 6 cohort studies] comprising 979 patients were included in this meta-analysis. The pooled results showed that AVFs treated with DCBA had significantly fewer TLRs at 6 months (OR 0.31, 95% CI 0.14 to 0.69, p=0.004) and 12 months (OR 0.45, 95% CI 0.21 to 0.97, p=0.04) than BA. The 2 approaches had similar technical success rates (OR 0.22, 95% CI 0.03 to 1.43, p=0.11). Additionally, the pooled OR of 12-month mortality was 0.71 (95% CI 0.20 to 2.51, p=0.60), indicating no significant difference between DCBA and BA. Subgroup analysis based on study design showed the superiority of DCBA to BA in cohort studies but not RCTs, which had high heterogeneity. Significant publication bias was found in the cohort studies. Conclusion: In de novo or recurrent AVF stenosis, DCBA appears to be an effective procedure associated with lower 6- and 12-month TLR compared with BA. However, larger and randomized controlled studies are warranted to draw definitive conclusions.


Assuntos
Angioplastia com Balão/instrumentação , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Fármacos Cardiovasculares/administração & dosagem , Materiais Revestidos Biocompatíveis , Oclusão de Enxerto Vascular/terapia , Diálise Renal , Dispositivos de Acesso Vascular , Idoso , Idoso de 80 Anos ou mais , Angioplastia com Balão/efeitos adversos , Fármacos Cardiovasculares/efeitos adversos , Pesquisa Comparativa da Efetividade , Desenho de Equipamento , Feminino , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Resultado do Tratamento , Grau de Desobstrução Vascular
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