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1.
Clin Ter ; 170(6): e454-e459, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31696909

RESUMO

AIMS: The radio-cephalic arteriovenous fistula (RCAVF) is the first choice treatment in end-stage renal disease patients. In the last few years, the hemodialysis population has shown a high percentage of elderly patients (> 65 year old) with comorbidities, mainly vascular diseases, which may adversely affect their vascular access success. The aim of this study was to evaluate the effectiveness of a loup-assisted technique to create RCAVFs in over 65 patients. PATIENTS AND METHODS: 98 consecutive patients with renal failure were prospectively observed. The patient were divided in relation to their age (> 65 year old; < 65 year old). In both groups, a microsurgical distal RCAVF was created. Statistics included the prevalence of distal RCAVF created, the incidence of immediate failure, the primary and secondary patency rate at one year. RESULTS: Distal RCAVF was created in 82.60% of patients younger than 65 years and in 73.07% of patients older than 65 years, with no statistically significant difference. The incidence of immediate failure, the primary and secondary patency at one year were not statistically significant between the two groups. CONCLUSIONS: Distal RCAVF should be the first choice vascular access even in ESRD elderly patients. The loup-assisted microsurgical fistula creation, allows to perform distal RCAVF with success, even in patients older than 65 years old, achieving similar results to younger patients.


Assuntos
Derivação Arteriovenosa Cirúrgica/métodos , Idoso , Idoso de 80 Anos ou mais , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Feminino , Humanos , Falência Renal Crônica/cirurgia , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Diálise Renal , Resultado do Tratamento
2.
Rev Port Cir Cardiotorac Vasc ; 26(3): 229-233, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31734978

RESUMO

Creating and maintaining a functional vascular access (VA) is a critical factor in the survival of a dialysis patient. It implies a creative attitude either to maintain its functionality or to build a new one wherever possible, being it autologous or synthetic. We describe the VA history of a 59 years-old male patient, with extreme obesity, which started in 2012 with failed attempts of VA construction in both forearms until a functional brachiocephalic arteriovenous fistula (AVF) in the right upper limb was achieved. However, it required ligation due to severe venous hypertension secondary to central venous disease related to previous CVC use. As he had no good superficial conduit in the left arm we decided to harvest the arterialized right cephalic vein and implant it in the left arm, creating an autologous arteriovenous shunt between the brachial artery and axillary vein (AV). Despite initial patency, it failed irreversibly approximately one year after creation. As no more superficial veins were available in the upper limbs, a prosthetic access was the next step. We decided for a hybrid graft (HG) between the left brachial artery and the AV because of the patient's biotype and scarred axilla that impeded a safe re-intervention on the AV. This graft was used between 2015 and 2017 with multiple interventions to maintain patency. In 2017 a significant diffuse prosthesis deterioration and reduced AVF flow were noticed with no possible segmental reconstruction. We were then forced to proceed with subtotal graft substitution preserving the outflow stented segment of the HG, using an early cannulation graft to prevent CVC use. After this successful reconstruction, the patient started hemodialysis on the following day with no intercurrences registered.


Assuntos
Derivação Arteriovenosa Cirúrgica/métodos , Oclusão de Enxerto Vascular/cirurgia , Falência Renal Crônica/terapia , Falha de Prótese/efeitos adversos , Diálise Renal , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Oclusão de Enxerto Vascular/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
3.
Khirurgiia (Mosk) ; (11): 24-28, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31714526

RESUMO

OBJECTIVE: To study the causes of recirculation syndrome and optimize surgical correction. MATERIAL AND METHODS: There were 2329 procedures of formation and restoration of permanent vascular access in 2109 patients for the period from 1998 to 2018. Recirculation syndrome occurred in 66 (3.1%) patients. Instrumental diagnosis of the causes of recirculation syndrome included Doppler ultrasound of permanent vascular access (100%) and angiography in accordance with indications. All patients were divided into 4 groups. The first group included 39 (59.1%) patients with native arteriovenous fistula. The second group included 12 (18.2%) patients with high arteriovenous fistula (between the brachial artery and the cephalic vein). The third group included 10 (15.1%) patients with major vein transposition. Synthetic prosthesis to create an arteriovenous fistula was used in the fourth group (n=5, 7.6%). RESULTS: In the first group, recirculation syndrome was caused by the presence of a large branch in close proximity to the arteriovenous anastomosis, its combination with significant stenosis of the anastomosis, hypoplasia of the outflow pathways of the fistulous vein. In the second group, the reasons were subclavian vein stenosis and dilated tributaries of the saphenous veins. In the third group, the main cause of recirculation syndrome was major vein stenosis in the upper third of the shoulder. In the fourth group, recirculation syndrome was caused by stenosis of the prosthetic-venous anastomosis. CONCLUSION: Recirculation syndrome in hemodialysis patients is usually caused by malfunction of permanent vascular access. Ultrasound or angiography may be successfully used to diagnose dysfunction. Effective treatment of this problem implies surgical or endovascular correction of permanent vascular access.


Assuntos
Derivação Arteriovenosa Cirúrgica/efeitos adversos , Constrição Patológica/complicações , Falência Renal Crônica/terapia , Diálise Renal , Derivação Arteriovenosa Cirúrgica/métodos , Humanos , Fluxo Sanguíneo Regional , Síndrome , Resultado do Tratamento , Grau de Desobstrução Vascular , Veias/patologia
4.
Medicine (Baltimore) ; 98(48): e18216, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770282

RESUMO

This study compared clinical outcomes of patient survival and arteriovenous fistula (AVF) patency between incident hemodialysis patients with and without type 2 diabetes mellitus (T2DM).Between January 2011 and December 2013, 384 consecutive incident hemodialysis patients with confirmed first upper-extremity AVF placement were divided into a T2DM group (n = 180, 46.9%) and a non-DM group (n = 204, 53.1%) and analyzed retrospectively. The primary outcome was all-cause mortality, and secondary outcome was AVF patency.Patients in the T2DM group had a higher prevalence of hypertension (P = .02), smoking (P < .01), cardiovascular disease (P < .01), history of cerebrovascular accident (CVA) (P < .01), and peripheral arterial occlusive disease (P < .01) than those in the non-DM group. On Kaplan-Meier survival analysis, the overall survival and AVF patency rates were significantly higher in the non-DM group relative to the T2DM group (both P < .01). In the adjusted model, older age (hazard ratio [HR], 1.04; 95% confidence interval [CI], 1.02-1.06; P < .01), T2DM (HR, 1.76; 95% CI, 1.12-2.77; P = .014), and history of CVA (HR, 1.76; 95% CI, 1.04-2.98; P = .04) were significantly associated with an increased risk of mortality. Older age and T2DM were independently associated with decreased primary (HR, 1.03; 95% CI, 1.02-1.04; P < .01, HR, 1.69; 95% CI, 1.22-2.33; P < .01, respectively) and secondary (HR, 1.03; 95% CI, 1.01-1.04; P < .01, HR, 2.07; 95% CI, 1.42-3.00; P < .01, respectively) AVF patency during follow-up.Compared with patients in the non-DM group, patients in the T2DM group had a higher mortality rate and worse AVF patency rates.


Assuntos
Derivação Arteriovenosa Cirúrgica , Diabetes Mellitus Tipo 2 , Falência Renal Crônica , Diálise Renal , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Derivação Arteriovenosa Cirúrgica/métodos , Comorbidade , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Humanos , Estimativa de Kaplan-Meier , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Diálise Renal/efeitos adversos , Diálise Renal/métodos , Diálise Renal/mortalidade , Estudos Retrospectivos , Medição de Risco , Grau de Desobstrução Vascular
5.
Medicine (Baltimore) ; 98(40): e17238, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577715

RESUMO

INTRODUCTION: Arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis due to its higher patency and lower infection rate. However, its suboptimal maturation rate is a major weakness. Although substantial risk factors for AVF maturation failure have been disclosed, modifiable risk factors remain unknown. During the AVF maturation process, an elevated luminal pressure is required for outward remodeling; however, excessively high luminal pressure may also be detrimental to AVF maturation, which remains to be defined. We hypothesized that higher AVF luminal pressure is harmful to its maturation, and investigate its potential as a modifiable factor to improve AVF maturation. METHODS AND ANALYSIS: This prospective study includes patients undergoing surgical creation for a native AVF. The exclusion criteria were as follows: age <20 years, inability to sign an informed consent, and failure to create a native AVF due to technical difficulties. Demographic and laboratory profiles will be collected before AVF surgery. Vascular sonography will be performed within 1 week of AVF creation to measure the diameters, flow rates, and flow volumes of AVF and its branched veins. The pressure gradient within AVF will be estimated from the blood flow rates using the modified Bernoulli equation. The primary outcome is spontaneous AVF maturation defined as provision of sufficient blood flow for hemodialysis within 2 months of its creation without any interventional procedures. The secondary outcome is assisted AVF maturation, which is defined as AVF maturation within 2 months from its creation aided by any interventional procedure before the successful use of AVF. DISCUSSION: While contemporary theory for AVF maturation failure focuses on disturbed wall shear stress, complicate assumptions and measurement preclude its clinical applicability. AVF luminal pressure, which may be manipulated pharmaceutically and surgically, may be a target to improve the outcome of AVF maturation. TRIAL REGISTRATION: This study has been registered at the protocol registration and results system. The Protocol ID: NCT04017806.


Assuntos
Derivação Arteriovenosa Cirúrgica/métodos , Diálise Renal/métodos , Grau de Desobstrução Vascular/fisiologia , Remodelação Vascular/fisiologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Fumar Cigarros/epidemiologia , Comorbidade , Feminino , Hemodinâmica/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Insuficiência Renal/etiologia , Insuficiência Renal/terapia , Projetos de Pesquisa , Fatores de Risco , Fatores Sexuais , Taiwan , Fatores de Tempo , Adulto Jovem
6.
Clin Nephrol ; 92(5): 233-236, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31496512

RESUMO

OBJECTIVE: To compare the functions and complications of forearm basilic vein transposition-arteriovenous fistula (BVT-AVF) created using the no-touch technique with that of conventional radiocephalic arteriovenous fistula (RC-AVF). MATERIALS AND METHODS: The no-touch technique was used to created basilic vein transposition-radial artery fistula in 22 patients. Another 30 patients received surgeries for RC-AVF. The fistula functions and complications were compared between these two groups. RESULTS: The two groups did not differ significantly in the incidence of postoperative bleeding, limb swelling, infection, steal syndrome, fistula thrombosis, fistula aneurysm, fistula flow, fistula maturation time, Kt/v, and fistula median survival. CONCLUSION: Forearm BVT-AVF created by the no-touch technique is a good alternative access for patients in whom the standard arteriovenous fistula cannot be established.


Assuntos
Derivação Arteriovenosa Cirúrgica , Antebraço/irrigação sanguínea , Artéria Radial/cirurgia , Veias/cirurgia , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Derivação Arteriovenosa Cirúrgica/métodos , Derivação Arteriovenosa Cirúrgica/estatística & dados numéricos , Humanos , Hemorragia Pós-Operatória/epidemiologia
7.
Nephrol Nurs J ; 46(4): 407-411, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31490050

RESUMO

The arteriovenous fistula (AVF) is the recommended hemodialysis access for pediatric patients who weight more than 20 kg and who are not expected to receive a kidney transplant for one year or longer. Whereas buttonhole cannulation of the AVF has been discouraged in adults because of the associated risk of infection, the published pediatric experience with this technique is extremely limited. A retrospective chart review of all buttonhole cannulated AVFs in a single pediatric hemodialysis unit was performed. Approximately 5,600 cannulations were performed over 215.5 patient months with no infections of the AVF or adjacent skin in 13 of 14 (93%) patients. Results from this experience provide evidence that the buttonhole cannulation technique can be successfully performed in pediatric patients on hemodialysis without an associated increased risk of infection.


Assuntos
Derivação Arteriovenosa Cirúrgica/métodos , Cateterismo/métodos , Diálise Renal , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Infecções Relacionadas a Cateter/epidemiologia , Cateterismo/efeitos adversos , Criança , Humanos , Estudos Retrospectivos , Medição de Risco , Resultado do Tratamento
8.
Ann Saudi Med ; 39(4): 258-264, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31381376

RESUMO

BACKGROUND: Bloodstream infections (BSI) are a major complication of hemodialysis. The risk of infection among hemodialysis patients is usually associated with the dialysis procedure itself, specifically the means of vascular access. OBJECTIVES: Estimate the rate of BSI and assess factors possibly associated with BSI. DESIGN: Analytical retrospective medical record review. SETTING: Hemodialysis unit in a tertiary care center. PATIENTS AND METHODS: Adult patients (18-60 years old) who had hemodialysis as first renal replacement therapy in the 20-month period from January 2014 to August 2016 were included in this study. Demographic and clinical characteristics were used in a multivariate logistic regression to assess factors that might be associated with BSI. MAIN OUTCOME MEASURES: The rate of BSI and associated factors among chronic hemodialysis outpatients. SAMPLE SIZE AND CHARACTERISTICS: 160 outpatients on hemodialysis, median (IQR) age 47.7 (37.0-56.0) years, males (60.6%). RESULTS: The rate of BSI was 0.4 per 100 patient-months. Multivariate logistic regression revealed that patients who had central venous catheters had the highest risk for BSI (odds ratio: 10.088; 95% CI= 2.595-39.215; P=.001) compared with arteriovenous fistulas. Gram-negative bacteria were isolated in 54.6% of cases, with coagulase-negative Staphylococcus the most frequent isolate (18.2%), followed by Klebsiella pneumoniae and Enterobacteriaceae (15.2%, each). CONCLUSIONS: The type of vascular access type is the main risk factor associated with BSI in hemodialysis patients. The arteriovenous fistula, which has a lower infection rate compared to the catheter, is the best available option for hemodialysis patients. LIMITATIONS: Retrospective, single center and relatively small sample size. CONFLICT OF INTEREST: None.


Assuntos
Bacteriemia/epidemiologia , Infecções Relacionadas a Cateter/epidemiologia , Diálise Renal/efeitos adversos , Adulto , Assistência Ambulatorial , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Derivação Arteriovenosa Cirúrgica/métodos , Bacteriemia/microbiologia , Infecções Relacionadas a Cateter/microbiologia , Cateteres Venosos Centrais/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Diálise Renal/métodos , Estudos Retrospectivos , Fatores de Risco , Centros de Atenção Terciária , Adulto Jovem
9.
Khirurgiia (Mosk) ; (7): 42-44, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31355813

RESUMO

OBJECTIVE: To present anexperience of arteriovenous fistula formation for hemodialysis in patients with multiple previous formations of vascular access. MATERIAL AND METHODS: Original technique of permanent vascular access was applied in 33 patients. Surgical procedure implies transposition of great saphenous vein from lower leg to thigh and formation of 2 fistulous veins for hemodialysis. RESULTS: Patients are under observation for 8-12 months after surgery. There were no cases of thrombosis within this period.


Assuntos
Derivação Arteriovenosa Cirúrgica/métodos , Diálise Renal , Veia Safena/transplante , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Humanos , Resultado do Tratamento
10.
Pol Przegl Chir ; 91(3): 6-9, 2019 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-31243166

RESUMO

INTRODUCTION: The hemodialysis treatment requires an outflow vein from an arterio-venous fistula which is easily accessible and suitable for multiple venepunctures. The growing number of elderly patients, overweight ones and such with diabetes mellitus has been leading to increased relative share of the primary cubital anastomoses. MATERIAL AND METHODS: The data set comprises of 442 arterio-venous anastomoses performed within a 5-year period (from 1st July 2011 until 30th June 2016) in the Clinic of Nephrology and Dialysis at Medical University, Pleven, Bulgaria. The primary cubital fistulas are 311 (70 %) of all cases. Consecutive superficialization of the outflow vein is performed in 18 cases (6 %). RESULTS: Not a single case of complications has been recorded - neither during the intervention, nor during the usage of the fistula afterwards. One-year patency of the fistula is observed in 17 patients (94 %). The surgery has been successful (comfortable access for puncture area) in 17 cases (94 %). CONCLUSION: Our experience demonstrates that the planned superficialization of the outflow vein(s) is beneficial and highly advisable. The latter improves the hospital treatment quality of the hemodialysis patients.


Assuntos
Derivação Arteriovenosa Cirúrgica/métodos , Diabetes Mellitus/fisiopatologia , Antebraço/irrigação sanguínea , Falência Renal Crônica/terapia , Idoso , Feminino , Antebraço/cirurgia , Humanos , Masculino , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/métodos
11.
Ann Vasc Surg ; 60: 211-220, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31200038

RESUMO

BACKGROUND: The purpose of the study was to compare the access patency rates of forearm loop arteriovenous grafts (AVGs) using deep veins and superficial veins for venous outflow. METHODS: The medical records of patients on dialysis were retrospectively reviewed to identify the individual risk factors and the outcomes of forearm loop AVGs according to their outflow types. RESULTS: Overall, 170 cases were enrolled in this study. Of these, 103 cases (60.6%) used deep veins for outflow. Most patients using deep vein outflow had their venous anastomosis above the elbow (P = 0.000). Patients with venous anastomosis above the elbow were more likely to be female (P = 0.049) and have a lower albumin level (P = 0.025). The primary patency rates for superficial vein outflow and deep view outflow were 35.5% and 29.4% at 12 months and 18.9% and 4.9% at 24 months, respectively. There was a statistically significant difference between the two groups (P = 0.013). The assisted primary patency rates for superficial venous outflow and deep vein outflow were 85.5% and 79.5% at 12 months and 73.2% and 59.6% at 24 months, respectively (P = 0.139). Primary and assisted primary patency rates did not differ according to the crossing of the elbow. CONCLUSIONS: The primary patency rate of AVGs using deep veins for outflow was inferior to AVGs using superficial veins. But the assisted primary patency rate showed no difference. The use of a deep vein for outflow in the forearm loop AVG is a safe strategy for patients with exhausted superficial veins.


Assuntos
Derivação Arteriovenosa Cirúrgica/métodos , Antebraço/irrigação sanguínea , Veias/cirurgia , Idoso , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Feminino , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/fisiopatologia , Oclusão de Enxerto Vascular/terapia , Humanos , Masculino , Diálise Renal , Retratamento , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular , Veias/diagnóstico por imagem , Veias/fisiopatologia
12.
J Orthop Surg Res ; 14(1): 143, 2019 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-31118080

RESUMO

BACKGROUND: We evaluated the effects on arteriovenous fistula (AVF) function and clinical outcomes in patients given cast fixation, external skeletal fixation [ESF], or volar locking plate fixation [VLPF] for an ipsilateral distal radial fracture (DRF). METHODS: Thirteen patients were assigned to the surgery group or the cast group; follow-up was ≥12 months. One-year clinical outcomes and serial AVF function and radiographic outcomes were recorded and analyzed. RESULTS: All fractures were union and all AVFs were preserved with continuous hemodialysis. The surgery group had better immediately (radial inclination and articular step-off) and 1-year post-index procedure radiographic findings (radial height, radial inclination, volar tilting, ulnar variance, and articular step-off) and better 1-year functional outcomes (Mayo and QuickDASH score) than did the cast group. The VLPF subgroup had better QuickDASH scores and radiographic outcomes (radial inclination and ulnar variance) than did the ESF subgroup. CONCLUSIONS: One year after the index procedure, none of the treatment affected shunt function in DRFs ipsilateral to AVFs. ESF and VLPF yielded better functional and radiographic outcomes than did cast fixation in patients with ipsilateral DRFs and AVFs. LEVEL OF EVIDENCE: III.


Assuntos
Derivação Arteriovenosa Cirúrgica/métodos , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/cirurgia , Diálise Renal/métodos , Adulto , Idoso , Derivação Arteriovenosa Cirúrgica/tendências , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Diálise Renal/instrumentação , Diálise Renal/tendências , Estudos Retrospectivos , Resultado do Tratamento
13.
Expert Rev Cardiovasc Ther ; 17(5): 369-376, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31056981

RESUMO

Introduction: With high rates of arteriovenous fistula (AVF) failure, there is a continued need to predict other factors and mechanisms associated with maturation deficits. Given the central association of inflammation with AVF failure, with neointimal hyperplasia (NIH) as one such mechanism, inflammation must be considered in two endogenous ways, either pro-inflammatory or pro-resolving, resulting in inward or outward vascular remodeling. Areas covered: This review summarizes and critically evaluates the preclinical and interventional data underlying AVF failure in attempts to elucidate the necessary balance between inflammation and its resolution. Expert opinion: Understanding the pro-inflammatory and pro-resolving mechanisms underlying inward and outward vascular remodeling and NIH prevention with AVF maturation is a necessary effort to develop key diagnostic and therapeutic interventions towards the ongoing issue of long-term AVF patency. The ability for clinical application has progressed but is limited to the identification of key targets and pathways with little understanding of how they are related synergistically or antagonistically. Likewise, the balance between acute inflammation and pro-resolution requires pertinent temporal considerations necessary for timely therapeutic application and predictive measurement.


Assuntos
Derivação Arteriovenosa Cirúrgica/métodos , Hiperplasia/patologia , Inflamação/patologia , Humanos , Neointima/patologia , Grau de Desobstrução Vascular
14.
Biomed Res Int ; 2019: 8952414, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31080833

RESUMO

Introduction: Hyperglycemia is a major factor in influencing the patency rate of arteriovenous shunts, potentially associated with the RhoA/Rho-associated protein kinase (ROCK) pathway. Besides, galectin-3 mediates thrombotic mechanisms in venous thrombosis and peripheral artery disease. We hypothesized that high ROCK activity and galectin-3 levels are associated with arteriovenous shunt dysfunction. Methods: We prospectively enrolled 38 patients diagnosed with arteriovenous shunt dysfunction. 29 patients received a complete follow-up and each provided two blood samples, which were collected at the first visit for occluded status of arteriovenous shunts and 1 month later for patent status. A Western blot assay for a myosin phosphatase target subunit (MYPT) was performed to examine Rho-kinase activity. A Western blot assay for platelet galectin-3 and enzyme-linked immunosorbent assay (ELISA) for circulating galectin-3 were completed. Results: Higher platelet MYPT ratios and galectin-3 levels were identified at occluded arteriovenous shunts (MYPT ratio: 0.5 [0.3-1.4] vs. 0.4 [0.3-0.6], p = 0.01; galectin-3: 1.2 [0.4-1.6] vs. 0.7 [0.1-1.2], p = 0.0004). The plasma galectin-3 binding protein ELISA was also higher at occluded arteriovenous shunts (8.4 [6.0-9.7] µg/mL vs. 7.1 [4.5-9.1] µg/mL, p = 0.009). Biomarker ratios (occluded/patent status) trended high in patients with poorly controlled diabetes (MYPT ratio: 1.7 [1.0-3.0] vs. 1.1 [0.7-1.3], p = 0.06; galectin-3: 1.6 [1.3-3.4] vs. 1.1 [0.8-1.9], p = 0.05). Conclusion: High platelet ROCK activity and galectin-3 levels are associated with increased risk in arteriovenous shunt dysfunction, especially in patients with poorly controlled diabetes.


Assuntos
Fístula Arteriovenosa/metabolismo , Plaquetas/metabolismo , Diabetes Mellitus/metabolismo , Galectina 3/metabolismo , Quinases Associadas a rho/metabolismo , Idoso , Derivação Arteriovenosa Cirúrgica/métodos , Feminino , Humanos , Masculino , Cadeias Leves de Miosina/metabolismo , Fosfatase de Miosina-de-Cadeia-Leve/metabolismo , Fosforilação/fisiologia , Estudos Prospectivos , Diálise Renal/métodos , Transdução de Sinais/fisiologia , Proteína rhoA de Ligação ao GTP/metabolismo
16.
Contrib Nephrol ; 198: 1-11, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30991410

RESUMO

BACKGROUND: An arteriovenous fistula (AVF) is considered the gold standard modality of vascular access (VA) for maintenance hemodialysis (HD) because of its superior patency, few complications, provision of high quality of life, and low risk of patient mortality. The rapid growth of the aging population and the high prevalence of comorbidities, particularly diabetes mellitus and peripheral vascular disease, in patients requiring HD inevitably deteriorate the ability to construct and maintain a conventional AVF because of these patients' insufficient vascular adaptability. Furthermore, a substantial proportion of patients undergoing HD encounter non-maturation AVF failure and mis-cannulation-related complications, resulting in the need for a temporary VA procedure. Superficialization of the AVF is an alternative form of VA that facilitates the construction of an autologous fistula by maximizing the availability of a deeply located vein. Superficialization is also utilized in VA revision to improve the cannulability of an arterialized vein. SUMMARY: Superficialization involves various approaches, including tunnel transposition, elevation, lipectomy, and liposuction. Tunnel transposition and elevation are prerequisites for construction of an alternative autologous AVF, especially a one- or two-stage transposed brachial-basilic AVF, which is widely recognized as preferential to an arteriovenous graft in patients who cannot undergo conventional AVF installation. Elevation, lipectomy, and liposuction are also employed as revisional interventions for approximating the depth of the arterialized vein and ensuring a sufficient cannulable segment in the forearm and upper arm area. More recently, modified minimally invasive techniques for each superficialization procedure have been introduced to avoid postoperative complications. Amid the growing methodological diversity of superficialization, increasingly more studies have been performed in an attempt to clarify its feasibility and outcomes. On the whole, most superficialization procedures have acceptable patency and safety profiles. However, the preferable superficialization approach varies in accordance with both the influence of the anatomic location and the inherent advantages and limitations of each procedure. Key Messages: Both careful assessment of a patient's vascular adaptability and adequate comprehension of the various superficialization modalities that are available will enable optimal establishment of an autologous AVF in individual patients. This could lead to better outcomes and more successful management of HD.


Assuntos
Fístula Arteriovenosa/cirurgia , Derivação Arteriovenosa Cirúrgica/métodos , Diálise Renal/métodos , Humanos , Resultado do Tratamento , Dispositivos de Acesso Vascular/tendências
17.
Plast Reconstr Surg ; 143(5): 1522-1529, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31033835

RESUMO

BACKGROUND: The Gustilo classification serves as a proxy for injury severity, but recent data suggest rising complications with decreasing arterial runoff. This study aims to compare different microsurgical anastomosis options based on the number of patent vessels in the lower extremity. METHODS: A single-center retrospective review of 806 lower extremity free flaps performed from 1976 to 2016 was performed. Patients with Gustilo type IIIB injuries were grouped based on the number of patent vessels in the leg (three, two, or one). Patients were compared based on the type of anastomosis performed, evaluating for perioperative complications and flap failures. RESULTS: Perioperative complications occurred in 111 flaps (27 percent): 71 take-backs (17 percent), 45 partial losses (11 percent), and 37 complete losses (9 percent). Among patients with three-vessel runoff (61.8 percent), there was no difference in take-backs or flap loss between those with end-to-end versus end-to-side anastomoses. In 68 patients (18.7 percent) with two-vessel runoff, no difference between take-backs or flap loss was noted when comparing any anastomosis (i.e., end-to-end into an injured vessel, end-to-end into an uninjured vessel, or end-to-side into an uninjured vessel), although vein grafts were required more often in the end-to-side groups (p < 0.01). Finally, in 39 patients (10.7 percent) with single-vessel runoff, no difference was seen between end-to-end anastomosis into an injured vessel or end-to-side anastomosis into an uninjured vessel in terms of take-backs or flap loss. CONCLUSION: Higher rates of flap failure correlated with decreasing numbers of patent vessels in the leg, but neither type of microvascular anastomosis nor vessel selection demonstrated any impact on reconstructive outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Artérias/lesões , Fraturas Expostas/cirurgia , Retalhos de Tecido Biológico/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Lesões do Sistema Vascular/cirurgia , Acidentes de Trânsito , Adulto , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Artérias/cirurgia , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Derivação Arteriovenosa Cirúrgica/métodos , Feminino , Fíbula/lesões , Fíbula/cirurgia , Fraturas Expostas/complicações , Retalhos de Tecido Biológico/transplante , Rejeição de Enxerto/epidemiologia , Rejeição de Enxerto/etiologia , Humanos , Masculino , Procedimentos Ortopédicos/efeitos adversos , Procedimentos Ortopédicos/métodos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Estudos Retrospectivos , Fraturas da Tíbia/etiologia , Fraturas da Tíbia/cirurgia , Resultado do Tratamento , Lesões do Sistema Vascular/etiologia
18.
J Vasc Surg ; 70(2): 554-561, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30837175

RESUMO

OBJECTIVE: Radial artery-based wrist arteriovenous fistulas (AVFs) are commonly created as an initial upper extremity arteriovenous access. A more distal access site, such as the anatomic snuffbox AVF, can also be created. Although much has been written about wrist AVFs, outcomes of snuffbox AVFs are unclear. Our goal was to compare perioperative and midterm outcomes between these two types of distal access. METHODS: The Vascular Quality Initiative database was queried for all patients undergoing snuffbox AVFs and wrist AVFs from 2011 to 2017. Unmatched and matched analyses were performed for baseline characteristics and outcomes at 6 months for ischemic steal, wound infection, and arm swelling. Multivariable analysis was performed for unmatched and matched analyses for primary patency, surgical or endovascular repair, and patient survival. Kaplan-Meier matched analysis was performed for primary patency, freedom from surgical or endovascular intervention, and survival. RESULTS: We identified 4525 distal forearm fistulas: 179 (4%) snuffbox AVFs and 4346 (96%) wrist AVFs. The average age was 59 ± 14.7 years, and 72.3% of patients were male. There were no significant differences in baseline demographics or comorbidities of patients with snuffbox AVFs and wrist AVFs except that patients with snuffbox AVFs had fewer tunneled lines at access creation (70.2% vs 65.2%; P = .046) and had a lower American Society of Anesthesiologists class. There were no significant differences in unmatched outcomes at 6 months for ischemic steal (0.8% vs 1.9%; P = .336), wound infection (0% vs 0.2%; P = .649), and arm swelling (0.8% vs 1.3%; P = .592). Matched analysis showed no significant differences in baseline characteristics and outcomes at 6 months for ischemic steal (0% vs 1.8%; P = .146), wound infection (0% vs 0%), and arm swelling (0.9% vs 1.2%; P = .789). Kaplan-Meier matched analysis showed no significant differences between snuffbox AVFs and wrist AVFs at 6 months for primary patency (51% vs 48%; P = .61), freedom from endovascular intervention (84.5% vs 82.5%; P = .98), freedom from surgical intervention (90% vs 86%; P = .08), and survival (92% vs 96%; P = .1). In multivariable analysis of unmatched data, snuffbox AVFs and wrist AVFs had similar primary patency (hazard ratio [HR], 0.97; 95% confidence interval [CI], 0.75-1.26; P = .83), likelihood of surgical intervention (HR, 0.61; 95% CI, 0.35-1.05; P = .074) and endovascular intervention (HR, 0.96; 95% CI, 0.65-1.42; P = .83), and survival (HR, 1.47; 95% CI, 0.9-2.4; P = .128). CONCLUSIONS: Snuffbox AVFs have midterm results similar to those of wrist AVFs.


Assuntos
Derivação Arteriovenosa Cirúrgica/métodos , Antebraço/irrigação sanguínea , Diálise Renal , Grau de Desobstrução Vascular , Punho/irrigação sanguínea , Adulto , Idoso , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Bases de Dados Factuais , Feminino , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Oclusão de Enxerto Vascular/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Intervalo Livre de Progressão , Reoperação , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Estados Unidos
19.
Cardiovasc Intervent Radiol ; 42(6): 835-840, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30927031

RESUMO

PURPOSE: To evaluate long-term primary and secondary patency results of drug-eluting balloon angioplasty for the treatment of juxta-anastomotic stenoses in distal radiocephalic arteriovenous fistulas. MATERIALS AND METHODS: Thirty-eight patients with juxta-anastomotic stenotic distal radiocephalic arteriovenous fistulas who underwent endovascular treatment with drug-eluting balloons between January 2014 and August 2016 in our interventional radiology department were included in this retrospective study. Color Doppler examination for follow-up was performed 15 days, 6 months, 12 months, 18 months, 24 months, 36 months, and 48 months after the procedure. Kaplan-Meier analysis was used to estimate primary and secondary patency rates. RESULTS: Totally, 42 angioplasty with drug-eluting balloons was performed in 38 patients (20 men and 18 women; mean age 66.42 ± 12.01). Technical and clinical success rate was 100% (42/42). The mean follow-up period was 27.71 months ± 12.98 (range, 1-54 months). The estimated primary patency rates at 6 months were 94.7% (95% CI, 80.9%-99.0%), at 12 months were 81.2% (95% CI, 64.6%-91.4%), at 24 months were 60.7% (95% CI, 43.6%-75.7%), and at 48 months were 53.1% (95% CI, 36.5%-69.1%). The estimated secondary patency rates at 6 months were 97.3% (95% CI, 84.5%-99.8%), at 12 months were 86.5% (95% CI, 70.7%-94.8%), at 24 months were 69.0% (95% CI, 51.8%-82.4%), and at 48 months were 61.7% (95% CI, 44.6%-76.5%). CONCLUSION: Drug-eluting balloon angioplasty is a useful, effective technique in dysfunctional radiocephalic fistulas due to juxta-anastomotic stenoses. We demonstrated remarkably high primary patency rates at 6, 12, 24, and 48 months.


Assuntos
Angioplastia com Balão/métodos , Fístula Arteriovenosa/terapia , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Oclusão de Enxerto Vascular/terapia , Diálise Renal/efeitos adversos , Idoso , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/etiologia , Derivação Arteriovenosa Cirúrgica/métodos , Constrição Patológica , Feminino , Seguimentos , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/etiologia , Humanos , Estimativa de Kaplan-Meier , Masculino , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Ultrassonografia Doppler em Cores , Grau de Desobstrução Vascular
20.
Enferm. nefrol ; 22(1): 10-17, ene.-mar. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-183589

RESUMO

Objetivo: Valorar la posible asociación entre la forma de punción de la fístula arteriovenosa y el dolor que siente el paciente por la inserción de la aguja. Metodología: Se ha seguido la declaración PRISMA para revisiones sistemáticas. Se han consultado 6 bases de datos; Medline, Scopus, Cuiden, CINAHL, SciELO, y Cochrane PLUS. Además, se realizó una búsqueda secundaría manual para detectar literatura gris no encontrada en las bases de datos o mediantes las estrategias definidas. Criterios de inclusión; estudios de nivel de evidencia 1 en la escala Scottish Intercollegiate Guidelines Network, publicados en los últimos 10 años, idiomas español/inglés, y temática relacionada con las técnicas utilizadas en hemodiálisis para el abordaje de la fistula. Los artículos se evaluaron de forma crítica para detectar cualquier riesgo de sesgo mediante el instrumento CASPe y el manual Cochrane para Revisiones Sistemáticas de Intervenciones. Resultados: Se identificaron un total de 150 resultados, seleccionándose finalmente 9 estudios. Los resultados han sido muy heterogéneas, encontrándose resultados para el dolor, tasas de infección, número de intentos de canalización, flujo sanguíneo, presión venosa, tiempo de hemostasia, seguridad, dilataciones aneurismáticas, estética del brazo portador de la fístula y calidad de vida del paciente. Conclusiones: La evidencia no respalda el uso preferencial de la técnica del ojal sobre la canalización tradicional. Por tanto, se necesita mejorar el rigor metodológico y un mayor tamaño muestral para dilucidar que técnica da mejores prestaciones respecto al dolor, permitiendo por tanto mejorar la calidad de vida de los pacientes de hemodiálisis


Aims: To assess the possible association between the manner of arteriovenous fistula cannulation and the patient pain related to the insertion of the needle for the hemodialysis session. Methodology: The PRISMA statement for systematic reviews has been followed. Six databases have been consulted: Medline, Scopus, Cuiden, CINAHL, SciELO, and Cochrane PLUS. In addition, a secondary manual search was performed to detect grey literature not found in databases or through defined strategies. Inclusion criteria: studies of level of evidence 1 on the Scottish Intercollegiate Guidelines Network scale, published in the last 10 years, Spanish/English languages, and topics related to the techniques used to canalize the hemodialysis fistula. The articles were critically evaluated to detect any risk of bias using the CASPe instrument and the Cochrane Handbook for Systematic Reviews of Interventions. Results: A total of 150 results were identified, 9 of which were finally selected. The results have been very heterogeneous, finding results for pain, infection rates number of attempts of channalization, blood flow, venous pressure, time of hemostasis, safety, aneurysmal dilations, esthetics of the fistula-carrying arm and quality of life of the patient. Conclusions: The evidence does not support the preferential use of the buttonhole technique over traditional channeling. Therefore, it is necessary to improve the methodological quality and a larger sample size to elucidate which technique gives better benefits with respect to pain, thus allowing to improve the quality of life of hemodialysis patients


Assuntos
Humanos , Punções/métodos , Derivação Arteriovenosa Cirúrgica/métodos , Dor Aguda/diagnóstico , Medição da Dor/métodos , Diálise Renal/métodos , Percepção da Dor/classificação , Derivação Arteriovenosa Cirúrgica/estatística & dados numéricos , Insuficiência Renal Crônica/terapia
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