scholarly journals Preservation of vascular access.

1993 ◽  
Vol 4 (4) ◽  
pp. 997-1003
Author(s):  
J L Porile ◽  
M Richter
Keyword(s):  
Vascular Access ◽  
Venous Pressure ◽  
Graft Loss ◽  
Laboratory Evaluation ◽  
Dialysis Access ◽  
New Techniques ◽  
Lower Complication ◽  
Lower Complication Rate ◽  
Access Problems

Preservation of vascular access is critical in the long-term successful management of hemodialysis patients. Dialysis access abnormalities are the most common cause of hospitalization in this patient group, and access problems can increase the morbidity and cost involved in the care of these patients. Native fistulas are preferable to synthetic grafts because of longer survival and a lower complication rate. Venous outflow stenosis is the most common site of obstruction in a failing graft. The pathophysiology of access failure is poorly understood, but it seems to be related to intimal hyperplasia in the native vessel downstream from the anastomosis. The stimulation of local growth factors by needle puncture may also play a role. An assessment of access adequacy includes careful physical examination, laboratory evaluation, and ultimately, angiography. Measurements of recirculation and venous pressure are commonly used to screen for access dysfunction, and their appropriate use will lower the incidence of graft loss in dialysis units. Treatment is usually either angioplasty or surgery, with some centers having success with thrombolytic therapy. New techniques such as atherectomy and stent placement may prove to be beneficial, but this requires further study.

Multidisciplinary management of vascular access for haemodialysis: from the preparation of the initial access to the treatment of stenosis and thrombosis

VASA ◽  
2011 ◽  
Vol 40 (3) ◽  
pp. 188-198 ◽  
Author(s):  
Reinhold ◽  
Haage ◽  
Hollenbeck ◽  
Mickley ◽  
Ranft
Keyword(s):  
Vascular Access ◽  
Central Venous ◽  
Advantages And Disadvantages ◽  
Multidisciplinary Study ◽  
First Results ◽  
Lower Complication ◽  
Lower Complication Rate ◽  
Access Problems ◽  
Arteriovenous Grafts ◽  
The Individual

In February 2008 a multidisciplinary study group was established in Germany to improve the treatment of patients with potential vascular access problems. As one of the first results of their work interdisciplinary recommendations for the management of vascular access were provided, from the creation of the initial access to the treatment of complications. As a rule the wrist arteriovenous fistula (AVF) is the access of choice due to its lower complication rate when compared to other types of access. The AVF should be created 3 months prior to the expected start of haemodialysis to allow for sufficient maturation. Second and third choice accesses are arteriovenous grafts (AVG) and central venous catheters (CVC). Ultrasound is a reliable tool for vessel selection before access creation, and also for the diagnosis of complications in AVF and grafts. Access stenosis and thrombosis can be treated surgically and interventionally. The comparison of both methods reveals advantages and disadvantages for each. The therapeutic decision should be based on the individual patients’ constitution, and also on the availability and experience of the involved specialists.

Therapeutic Plasma Exchange Application in Children Requires Individual Decision

2020 ◽  
Author(s):  
Gürkan Atay ◽  
Demet Demirkol
Keyword(s):  
Plasma Exchange ◽  
Vascular Access ◽  
Pediatric Patients ◽  
Demyelinating Disease ◽  
Pediatric Intensive Care ◽  
Therapeutic Plasma Exchange ◽  
Transplantation Rejection ◽  
Access Problems ◽  
Uremic Syndrome

AbstractTherapeutic plasma exchange (TPE) is a treatment administered with the aim of removing a pathogenic material or compound causing morbidity in a variety of neurologic, hematologic, renal, and autoimmune diseases. In this study, we aimed to assess the indications, efficacy, reliability, complications, and treatment response of pediatric patients for TPE. This retrospective study analyzed data from 39 patients aged from 0 to 18 years who underwent a total of 172 TPE sessions from January 2015 to April 2018 in a tertiary pediatric intensive care unit. Indications for TPE were, in order of frequency, macrophage activation syndrome (28.2%, n = 11), renal transplantation rejection (15.4%, n = 6), liver failure (15.4%, n = 6), Guillain–Barre's syndrome (15%, n = 6), hemolytic uremic syndrome (7.7%, n = 3), acute demyelinating disease (7.7%, n = 3), septic shock (5.1%, n = 2), and intoxication (5.1%, n = 2). No patient had any adverse event related to the TPE during the procedure. The TPE session was ended prematurely in one patient due to insufficient vascular access and lack of blood flow (2.6%). In the long term, thrombosis due to the indwelling central catheter occurred (5.1%, n = 2). TPE appears to be an effective first-stage or supplementary treatment in a variety of diseases, may be safely used in pediatric patients, and there are significant findings that its area of use will increase. In experienced hands and when assessed carefully, it appears that the rate of adverse reactions and vascular access problems may be low enough to be negligible.

MILLER Banding Procedure for Treatment of Dialysis Access–Related Steal Syndrome, Pulmonary Hypertension, and Heart Failure

2021 ◽  
pp. 000313482110562
Author(s):  
Ahmad Alqassieh ◽  
Patrick B. Dennis ◽  
Veena Mehta ◽  
June Shi ◽  
Angello Lin ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Vascular Access ◽  
Primary Patency ◽  
Secondary Patency ◽  
Dialysis Access ◽  
Long Term Follow Up ◽  
Steal Syndrome

A Minimally Invasive Limited Ligation Endoluminal-assisted Revision (MILLER) banding procedure has been used for treating patients with dialysis access–related steal syndrome (DASS) and high-flow vascular access–related pulmonary hypertension (PHT) and heart failure (HF). We performed a retrospective analysis of patients undergoing the MILLER procedure performed for DASS, HF, and PHT from our Vascular Access Database from September 2017 to October 2019. Outcomes included primary patency of banding, primary assisted patency, and secondary patency, using time-to-event analyses with Kaplan-Meier curves and life tables to estimate 6- and 12-month rates. A total of 13 patients (6 men and 7 women, mean age 60 ± 14 years) underwent the MILLER procedure, 6 patients for DASS and 7 patients for pulmonary hypertension and heart failure (PHT/HF). Technical success was achieved in all patients. The longest duration of follow-up was 28 months (median 12 months [IQR 7, 19]). One patient died at 1 month after the intervention due to stroke. One patient developed access thrombosis of the graft 3 days after the procedure. Repeat banding was required in 1 patient 8 months after the first procedure. The 6-month primary patency rate of banding following this procedure was 83% while the 12-month rate was 66%. The 6- and 12-month secondary patency rates were 87% and 75%, respectively. The MILLER procedure can be performed for DASS and PHT/HF with improvement of symptoms and good long-term patency rates. Additional interventions to maintain patency and efficacy are required on long-term follow-up.

Native Arterio-Venous Fistula for Hemodialysis: What to Expect Early after Creation?

2003 ◽  
Vol 4 (2) ◽  
pp. 39-44 ◽  
Author(s):  
M. Leblanc ◽  
E. Saint-Sauveur ◽  
V. Pichette
Keyword(s):  
Blood Flow ◽  
Vascular Access ◽  
Complication Rates ◽  
Ultrasound Dilution ◽  
Flow Monitoring ◽  
Significant Difference ◽  
Lower Complication ◽  
Vascular Mapping ◽  
Venous Fistula

Native arterio-venous fistulas (AVFs) are preferred for hemodialysis vascular access over synthetic grafts and long-term catheters. However, prevalence rates of native AVFs are variable around the world and have increased only slightly in United States since the DOQI guidelines. To increase rates of native AVFs, pre-operative vascular mapping by ultrasound has been found of major help for appropriate selection of the vessels. The minimal desirable lumen diameter of the artery should be > 2 mm and > 2.5 to 3 mm for the vein at the anatomosis. Early failure can be reduced to less than 10% when the feeding artery is > 2 mm, even in diabetics. If sizes of the vessels are smaller than those targets at the wrist, moving to the upper arm should be considered. The interval between creation and first cannulation varies from 2 weeks to 4 months. There might not be much advantage to wait for more than 4 weeks; however, in large dialysis units, observing a delay of 4 to 6 weeks may be worthwhile to avoid initial problems such as infiltrations and lacerations. Access flow monitoring is essential since it is a reliable predictor of vascular access dysfunction, reducing associated morbidity and costs. Early monitoring of recently created native AVFs has shown that the increase in intra-access blood flow occurs very soon after construction and becomes maximal after a few weeks. A recent prospective study involving all new native AVFs monitored by ultrasound-dilution between weeks 6 and 10 after creation, and every 3 to 6 weeks over 4 months, showed no statistically significant difference in access blood flow between the initial and final measurements (respective values of 1132 ± 681 and 1097 ± 644 ml/min). Access flow was higher in males, and in brachio-cephalic compared to radio-cephalic AVFs. Over the long-term, AVFs are associated with longer patency and lower complication rates, and efforts should be directed at further increasing their prevalence.

scholarly journals Improvement of the Safety Profile of Canaloplasty and Phacocanaloplasty: A Review of Complications and Their Management

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Joanna Konopińska ◽  
Zofia Mariak ◽  
Marek Rękas
Keyword(s):  
Intraocular Pressure ◽  
Mitomycin C ◽  
Safety Profile ◽  
Schlemm’S Canal ◽  
New Techniques ◽  
Schlemm's Canal ◽  
Lower Complication ◽  
Lower Complication Rate ◽  
Microsurgical Techniques ◽  
Early Indication

Research on the methods used to achieve persistent and safe control of intraocular pressure resulted in the implementation of novel surgical procedures, such as canaloplasty and phacocanaloplasty. Herein, we review the literature focused on the safety profile of canaloplasty and phacocanaloplasty and the management of related complications. The aim of canaloplasty is to restore the natural aqueous outflow. This goal is achieved via a surgical procedure that involves viscocanalostomy with catheterisation of Schlemm’s canal (360°) and placement of a circumferential suture that tensions the canal walls. This improves Schlemm’s canal drainage, choroidoscleral flow, and subconjunctival filtration. The efficacy of canaloplasty for reducing the intraocular pressure is similar to those of trabeculectomy with mitomycin C and deep sclerectomy augmented with an implant and mitomycin C. However, canaloplasty is associated with a lower complication rate than those conventional techniques. Novel microsurgical techniques for the treatment of glaucoma are unlikely to replace the conventional methods. However, these new techniques offer alternatives, especially for patients who have an early indication for surgical intervention. Nevertheless, canaloplasty is associated with the expectations of efficient, safe, and modern surgical treatment.

scholarly journals Thrombolysis versus surgery for the treatment of thrombosed dialysis access grafts.

1995 ◽  
Vol 6 (6) ◽  
pp. 1619-1624
Author(s):  
G A Beathard
Keyword(s):  
Surgical Therapy ◽  
Vascular Access ◽  
Complication Rate ◽  
Initial Treatment ◽  
Surgical Revision ◽  
Dialysis Access ◽  
Graft Replacement ◽  
Surgical Thrombectomy ◽  
Treatment Surgery

Thrombolysis offers several advantages over surgery in the treatment of thrombosed dialysis access grafts. This study was undertaken to compare the results obtained when thrombolysis was used as the preferred treatment (Thrombolysis Period) for this problem in comparison with the results that had been obtained when surgical therapy had been the preferred treatment (Surgery Period). Each period of study lasted 12 months and the two periods ran consecutively. All data were collected prospectively. No significant problems were encountered when thrombolysis was substituted for surgical therapy as the preferred treatment of thrombosed dialysis access grafts. During the Surgical Period there were 580 thrombotic episodes, a rate of 0.86 per patient. During the Thrombolysis Period there were 568 episodes, a rate of 0.76. These differences were not statistically significant. During the Thrombolysis Period, thrombolysis was found to be as effective as surgery had been during the Surgical Period in the initial treatment of thrombosed grafts. The rate of surgical revision was decreased by two-thirds during the Thrombolysis Period, but the rate of graft replacement was not altered. Long-term patency after therapy by thrombolysis during the Thrombolysis Period was superior to that for surgical thrombectomy performed during the Surgical Period, and was equal to that for revision and graft replacement. The complication rate for thrombolysis was low and complications were managed easily without sequelae. It is concluded that thrombolysis is safe and, when used as the preferred treatment for thrombosed dialysis access grafts, is as effective as surgical therapy. Since it preserves potential vascular access sites and yields long-term patency rates superior to those for surgical thrombectomy, it should be regarded as the treatment of choice for this problem.

Advanced Glaucoma Surgery with a Focus on Schlemm’s Canal

2009 ◽  
Vol 03 (02) ◽  
pp. 40 ◽  
Author(s):  
Matthias C Grieshaber ◽  
Keyword(s):  
Open Angle Glaucoma ◽  
Venous Pressure ◽  
Glaucoma Surgery ◽  
Schlemm’S Canal ◽  
Schlemm's Canal ◽  
Lower Complication ◽  
Lower Complication Rate ◽  
Advanced Glaucoma ◽  
Randomised Controlled ◽  
Near Future

New surgical strategies for open-angle glaucoma aim to re-establish the physiological aqueous outflow by directly targeting the site of maximal resistance, i.e. the juxtacanalicular meshwork and inner wall of Schlemm’s canal. Canaloplasty uses anab externoapproach, whereas Trabectome (trabeculotomy) and trabecular micro-bypass (iStent) use anab internoapproach. They all work independently of a filtering bleb and have an inherently lower complication rate than trabeculectomy. Preliminary data suggest that they lower intraocular pressure (IOP) to the mid-teens and are more efficient in combination with phacoemulsification. However, their ability to lower IOP is limited by the level of the episcleral venous pressure. Its good safety profile means that Schlemm’s canal surgery may become more popular in the near future, but the outcome of these procedures still needs to be validated in long-term randomised, controlled studies.

scholarly journals Midline Mandibulotomy Approach for Oral Cavity and Oropharynx Tumors: Long-Term Experience in a Single Institution

2022 ◽  
Author(s):  
José M López-Arcas ◽  
Juan Manuel Vadillo ◽  
José L Del Castillo ◽  
Patricia A Lara ◽  
José L. Cebrián ◽  
...  
Keyword(s):  
Oral Cavity ◽  
Head And Neck Oncology ◽  
Robotic Technology ◽  
Single Institution ◽  
Modern Times ◽  
Lower Complication ◽  
Lower Complication Rate ◽  
Long Term Experience

Abstract Purpose: To describe our clinical experience with the use of the midline mandibulotomy approach for oral cavity and oropharynx tumors.Methods: Charts were reviewed retrospectively for 67 consecutive patients who underwent mandibulotomies over a 15-year period (2002-2017) as part of their treatment for oral and oropharyngeal malignancies, with an average follow-up of 57.7 months.Results: Sixty-seven patients underwent a mandibulotomy. There were 59 males (88%) with a mean age of 56.9 years and eight females (12%) with a mean age 56.5 years. The approach was a midline mandibulotomy in 50 patients (74.6%), a paramedian mandibulotomy in 10 patients (14.9%), and a posterior mandibulotomy in seven (10.44%: angle 1 (1.5%), body 5 (7.5%), and ramus 1 (1.5%).In the group of patients undergoing median or paramedian mandibulotomies, adequate exposure of the lesion was achieved in all cases with a significant lower rate of complications (13,4%) (p<0.005) compared to the posterior mandibulotomy group (37,5%) .Conclusions: The results of the study confirm that the anterior mandibulotomy approach provides excellent exposure for oral and oropharyngeal tumors, with a significant lower complication rate compared to the posterior mandibulotomy approach.Until minimally invasive Robotic technology is not widespread, conventional techniques such as midline mandibulotomy approaches, with “modern-times” refinements still have their place in head and neck oncology surgery

Long-term outcomes of basilic vein transposition fistula for hemodialysis

VASA ◽  
2007 ◽  
Vol 36 (1) ◽  
pp. 29-32 ◽  
Author(s):  
Yilmaz ◽  
Senkaya ◽  
Saba ◽  
Bicer
Keyword(s):  
Vascular Access ◽  
Prosthetic Graft ◽  
Primary Patency ◽  
Dialysis Access ◽  
Superficial Vein ◽  
Basilic Vein ◽  
Term Survival ◽  
Maturation Rate

Background: There has been a dramatic increase in both the availability of hemodialysis and long-term survival of patients with chronic renal failure. Patients who require long-term hemodialysis need long-term vascular access. The transposed autologous basilic vein to brachial artery arteriovenous fistula provides vascular access in the absence of adequate superficial vein. Patients and methods: We follow an aggressive "all-autogenous" policy with regard to dialysis access and recommend prosthetic graft when autogenous options are exhausted. A retrospective analysis was performed of consecutive patients who underwent basilic vein transposition for hemodialysis access between January 2000 and March 2004. Mean follow-up was 21 months (range, 4 to 32 months). Results: A retrospective review of 42 patients undergoing basilic vein transposition was performed. 18 of the patients were men and 24 patients were women. The mean age was 34.6 ± 12.9 (mean ± SD) years. Most of the patients were already receiving hemodialysis (92%), with a mean of 2.2 (range, 1 to 4) previous access attempts. Maturation rate was 85.7%. Primary patency rates were 71.4%, 54.7% and secondary (overall) patency rates were 88.0%, 64.2% at the end of the first and second years, respectively. Complications developed in 23 (54.7%) cases, and included arm edema, thrombosis, hematoma, infection, steal syndrome, poor flow and aneurysm formation. Conclusion: Transposed brachial-basilic fistula have a good long-term patency rate and should be considered early, before prosthetic grafting, in the absence of a suitable superficial vein.

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