The related factors to the re-thrombosis of hemodialysis arteriovenous graft after endovascular salvage.

BACKGROUND: Only a few issues of the related factors to hemodialysis access dysfunction have been evaluated, and the effects of antiplatelets to improve the patency of hemodialysis access remained controversial. Hence, this study aimed to determine the related factors to the re-thrombosis of arteriovenous grafts (AVGs) after endovascular treatment. METHODS: This retrospective study was conducted at a university-affiliated teaching hospital in Southern Thailand. All patients who underwent hemodialysis with thrombosed AVG, who had pharmacomechanical thrombolysis from January 2016 to December 2018, were enrolled. Post-intervention primary patency was analyzed by the Kaplan-Meier method, and the related factors to the re-thrombosis of AVG were evaluated using logistic regression. RESULTS: A total of 157 patients with thrombosed hemodialysis AVG were enrolled. The most common graft location and configuration was a forearm loop graft (65%). Post-intervention primary patency rate at 1, 3, and 6 months were 79.0%, 67.1%, and 54.0%, respectively. Diabetes mellitus (DM) was a significant related factor for re-thrombosis (hazard ratio [HR], 1.89; 95% confidence interval [CI], 1.20-2.98; p = 0.006). A single antiplatelet after the procedure was a protective factor for re-thrombosis (HR, 0.58; 95% CI, 0.38-0.89; p = 0.013). The median post-intervention primary patency was 15.7 months in the group of single antiplatelet usage, which was better than that of the non-antiplatelet group (p = 0.012). CONCLUSION: DM and antiplatelet usage were significant related factors to the re-thrombosis of hemodialysis AVG after endovascular salvage.

Effect of COVID-19 Pandemic-Related Delays in Chemoembolization on the Survival of Patients with Hepatocellular Carcinoma.

Background and Aims: COVID-19 has led to potential delays in liver cancer treatment, which may have undesirable effects on the prognosis of patients. We aimed to quantify the COVID-19 pandemic impact on the survival of patients with hepatocellular carcinoma (HCC) who underwent transarterial chemoembolization (TACE). Methods: A retrospective study was conducted in patients with HCC who underwent TACE at a tertiary care center during the prelockdown (March to July 2019) and lockdown (March to July 2020) periods. Demographic data, tumor characteristics, functional status, and vital status were collected from the hospital medical records. The endpoints were TACE interval, treatment response, and survival after TACE. Cox proportional hazards regression determined the significant preoperative factors influencing survival. Results: Compared to prelockdown, a significant delay occurred during the lockdown in repeated TACE treatments (76.7 vs. 63.5 days, P=0.007). The trend suggested a significant decrease in patients with HCC in the repeated TACE group (-33.3%). After screening, 145 patients were included (prelockdown (n = 87), lockdown (n = 58)). There was no significant difference in the 1-month objective response rate between the prelockdown and lockdown groups (65.5% vs. 64.4%, P=1.00). During follow-up, 56 (64.4%) and 34 (58.6%) deaths occurred in the prelockdown and lockdown groups, respectively (P=0.600). Multivariate analysis revealed no association between the lockdown group and decreased survival (HR 0.88, 95% CI 0.57-1.35, P=0.555). Conclusions: The impact of the COVID-19 pandemic on liver cancer care resulted in significant decreases and delays in repeated TACE treatments in 2020 compared to 2019. However, treatment delays did not seem to significantly impact survival.

Patency of Drug-Coated versus Conventional Balloon Angioplasty for Hemodialysis Access Stenosis.

Purpose: This study aimed to evaluate the post-intervention target primary patency of drug-coated balloon angioplasty (DCBA) compared with conventional balloon angioplasty (CBA) in the treatment of the dysfunctional autogenous arteriovenous fistula (AVF) in a real-world clinical setting. Materials and Methods: This retrospective study included 24 patients with end-stage renal disease, who developed dysfunctional AVF during hemodialysis, and underwent endovascular treatment using CBA and DCBA from January 1, 2014, to June 30, 2021. The demographic data of patients and details regarding their fistula were recorded. Post-intervention target primary patency was analyzed. Results: Sixteen men and 8 women with an average age of 63.9 ± 14.2 years, who underwent 333 endovascular treatments in 57 target lesions of access were enrolled. DCBA was a protective factor for the treatment of a target lesion of dysfunctional access with an adjusted hazard ratio of 0.725 (95% confidence interval [CI]: 0.528-0.996; P = 0.047). According to the Weibull proportional hazards regression model, DCBA showed a longer post-intervention target primary patency than CBA. Conclusion: DCBA has better outcomes in terms of post-intervention target primary patency in the real-world treatment of dysfunctional autogenous AVF.

Decision-Making Scoring System for the Repetition of Conventional Transarterial Chemoembolization in Patients With Inoperable Hepatocellular Carcinoma.

INTRODUCTION: Patients with unresectable hepatocellular carcinoma treated with conventional transarterial chemoembolization (cTACE) have heterogeneous tumor burden and liver function. Therefore, the selection of patients for repeated cTACE is challenging owing to different outcomes. This study aimed to establish a decision-making scoring system for repeated cTACE to guide further treatment. METHODS: All patients with hepatocellular carcinoma who underwent cTACE between 2008 and 2019 were included and randomly assigned into training (n = 324) and validation (n = 162) cohorts. Tumor Size, number of Masses, Albumin-bilirubin score, baseline Alpha-fetoprotein level, and Response to initial cTACE session were selected to generate a "SMAART" score in the training cohort. Patients were stratified according to the SMAART score: low risk, 0-2; medium risk, 3-4; and high risk, 5-8. Prediction error curves based on the integrated Brier score and the Harrell C-index validated the SMAART scores and compared them with the Assessment for Retreatment with Transarterial chemoembolization (ART) score. RESULTS: The low-risk group had the longest median overall survival of 39.0 months, followed by the medium-risk and high-risk groups of 21.2 months and 10.5 months, respectively, with significant differences (P < 0.001). The validation cohort had similar results. The high-risk group had 63.1% TACE refractory cases. The Harrell C-indexes were 0.562 and 0.665 and the integrated Brier scores were 0.176 and 0.154 for ART and SMAART scores, respectively. DISCUSSION: The SMAART score can aid clinicians in selecting appropriate candidates for subsequent cTACE. A SMAART score of ≥5 after the first cTACE session identified patients with poor prognosis who may not benefit from additional cTACE sessions.