Sedoanalgesia with intravenous midazolam and fentanyl for angioplasty of dysfunctional arteriovenous access: A retrospective single-center analysis

2021 ◽  
pp. 112972982110501
Author(s):  
Shih-Ming Huang ◽  
Honda Hsu ◽  
Ing-Heng Hii ◽  
Chien-Hwa Chang
Keyword(s):  
Patency Rate ◽  
Transluminal Angioplasty ◽  
Primary Patency ◽  
Dialysis Access ◽  
Average Pain ◽  
Average Pain Score ◽  
Arteriovenous Access ◽  
One Year

Background: Endovascular therapy, such as percutaneous transluminal angioplasty (PTA), stenting, or embolization, is a well-established form of treatment to prolong the lifespan of arteriovenous access. These procedures, especially PTA, can be accompanied with severe pain. We reviewed and analyzed the efficacy, safety, and outcome of sedoanalgesia using intravenous midazolam and fentanyl, for pain relief during these procedures. Methods: Two hundred and two consecutive patients with dysfunctional dialysis access that had undergone endovascular procedure in our institute between July and November 2017 were included in this study. The dialysis access profile, procedure complication, and 10-point Visual Analog Scale (VAS) were collected. One-year clinical follow-up record was also collected to evaluate arteriovenous access patency and long-term complications. Results: Among the 202 patients, the mean age was (mean ± SD) 67.0 ± 12.08 years. Dialysis access profile of these patients were 119 (58.9%) native arteriovenous fistula and 162 (74.2%) forearm access. The number of lesions treated were 1.63 ± 0.802. Immediate complications included 11 (5.44%) nausea/vomiting, 24 (11.88%) desaturation (SpO2 < 90%, resolved after pillow removal or jaw trust), 16 (7.9%) hypotension (SBP < 90 mmHg, resolved without inotropic agents). There was a low average pain score (1.16 ± 1.594) during the procedure with 136 (67.3%) no pain (VAS 0–1) and 56 (27.7%) mild pain (VAS 2–4). Higher VAS score correlated with overweight patients, longer PTA time and pain after procedure. Six-month primary patency rate was 49.17% and primary assisted patency rate was 93.04%. Conclusions: Sedoanalgesia with intravenous midazolam and fentanyl is an easy, safe, and effective method for surgeons.

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.

Comparison Between Transposed Brachiobasilic Fistula and Arteriovenous Graft for Upper Limb Arteriovenous Access in Patients on Hemodialysis

2020 ◽  
pp. 153857442096925
Author(s):  
Chen-Ting Cheng ◽  
Yuan-Chen Chang ◽  
Ka-Wai Tam ◽  
Yu-Chun Yen ◽  
Yu-Chen Ko
Keyword(s):  
Retrospective Study ◽  
Hemodialysis Patients ◽  
Primary Patency ◽  
Secondary Patency ◽  
Arteriovenous Graft ◽  
Basilic Vein ◽  
Arteriovenous Access ◽  
Secondary Outcomes

Background: Creating and maintaining a functioning arteriovenous access is essential for long-term hemodialysis patients. Transposed brachiobasilic fistula (BBF) or arteriovenous graft (AVG) becomes an option when radiocephalic or brachiocephalic fistula cannot be created or fails. This study compared the patency and complications between BBFs and AVGs among patients on hemodialysis. Methods: A retrospective study was performed in Shuang Ho Hospital, Taiwan, from November 2015 to May 2020. All the operations were done by a single surgeon. Primary outcomes were primary patency, primary-assisted patency, and secondary patency of the BBF and AVG groups. Secondary outcomes were incidence of complications and reinterventions. Results: Of the 144 consecutive patients, 20 and 124 patients underwent BBF and AVG creation, respectively. Median follow-up time was 19.2 months. Primary patency at 1 and 2 years were 67% and 19% in the BBF group and 44% and 16% in the AVG group (P = 0.126). Primary-assisted patency at 1 and 2 years were 82% and 54% in the BBF group and 54% and 30% in the AVG group (P = 0.012). Secondary patency at 1 and 2 years were 100% and 82% in the BBF group and 81% and 67% in the AVG group (P = 0.078). The incidence of complication was significantly higher in the AVG than in the BBF group (1.7 per patient-year vs 0.93, P < 0.001). Conclusion: Compared with the AVG group, BBF group showed better primary-assisted patency, less complication and intervention rates. Therefore, BBF is a reliable option for patients with exhausted cephalic veins if basilic vein is available for reconstruction.

Langzeitergebnisse der systemischen Thrombolysetherapie bei aorto-iliakaler Verschlusskrankheit

VASA ◽  
2001 ◽  
Vol 30 (3) ◽  
pp. 212-218
Author(s):  
Robert A. Bucek ◽  
G. Schnürer ◽  
M. Haumer ◽  
M. Reiter ◽  
A. Ahmadi ◽  
...  
Keyword(s):  
Patency Rate ◽  
Clinical Success ◽  
Prospective Trial ◽  
Transluminal Angioplasty ◽  
Primary Patency ◽  
Occlusive Disease ◽  
Long Term Results ◽  
Primary Patency Rate ◽  
Lysis Therapy

Background: Long term results of systemic lysis therapy with ultrahigh-dose urokinase (UHUK) in reopening aorto-iliac occlusive disease have not yet been evaluated. This prospective trial investigates the long-term primary patency rate, the rate of complications and assesses the role of different expected influence parameters on the primary patency rate. Patients and methods: 72 patients with aorto-iliac occlusive disease received daily intravenous infusions of UHUK either until reperfusion or – after at least 3 cycles – no progress in recanalization could be stated on two consecutive days by duplex scanning. Results: Systemic lysis therapy was morphological at least partially successful in 44 patients (61.1%). Concomitant percutaneous transluminal angioplasty was performed in 41 patients (56.9%), surgery in 7 patients (9.7%) and both in further 5 patients (6.9%). In patients without surgery hemodynamical success could be achieved in 39 patients (54.2%) and even more important clinical success in 51 patients (70.8%). Compared to baseline results patients improved significantly in ankle/brachial pressure index and in Fontaine stages (p < 0,001), the same results could be seen after a mean follow-up period of 62 months. Thrombolysis was complicated in 4 patients (5.6%) by macroembolizations but no major bleedings or deaths occurred. Primary patency was 76%, 64%, and 43% after 1, 5 and 10 years. Male sex and distal localization were significantly correlated with lower primary clinical patency. Conclusion: Systemic lysis therapy is an alternative to surgical intervention in acute and subacute aorto-iliac occlusive disease, because it offers acceptable long-term results with a low rate of complications.

Our Experience with the SL-Plus Cementless Stem: Mid-Term Results

2003 ◽  
Vol 13 (2) ◽  
pp. 101-106
Author(s):  
R. Hart ◽  
P. Buček
Keyword(s):  
Femoral Component ◽  
Long Term Outcomes ◽  
Secondary Osteoarthritis ◽  
Cement Interface ◽  
Average Pain ◽  
Average Pain Score ◽  
Time Of Operation ◽  
Mid Term Results

The authors reviewed the mid-term results of 474 SL-Plus stems performed on 342 patients with primary and secondary osteoarthritis. The average age at the time of operation was 60.5 years (range, 17 to 81 years) and the average duration of follow-up was 60 months (range 25 to 96 months). The average Harris hip rating was 44 points (range, 30 to 58 points) before and 85 points (range, 72 to 94 points) after the operation. Good or excellent outcomes were observed in more than 90 per cent of the hips, with an average pain score of 43 points and average function score of 45 points. Two incomplete intra-operative fractures of the proximal femur were successfully treated by cerclage fixation. Five fractures of the greater trochanter were encountered. Dislocation occurred in five hips, one of which required revision to a captive polyethylene insert. Late infection with loosening of the femoral component occurred in one case. Radiological assessment identified one loose stem, but the patient refused surgical revision. Lower values for metaphyseal and diaphyseal fill observed in 31 cases had no correlation with implant stability and outcome. No progressive subsidence was detected except for one loose femoral component. Seventy-four hips revealed radiolucent lines at the bone cement interface. These were always less than 2mm. These mid-term results seem promising and authors hope that the long-term outcomes will be equally gratifying.

scholarly journals Long-term outcomes of thigh arteriovenous graft stenting

2021 ◽  
Vol 9 (3) ◽  
pp. 71-77
Author(s):  
Masa Abaza BS ◽  
Sloan E Almehmi ◽  
Alian AlBalas ◽  
Ammar Almehmi
Keyword(s):  
Patency Rate ◽  
Primary Patency ◽  
Secondary Patency ◽  
Venous Anastomosis ◽  
Stent Deployment ◽  
Kaplan Meier ◽  
Secondary Patency Rate ◽  
Study Population ◽  
One Year

Background: Stents have been increasingly used for treating venous anastomosis stenosis seen in arteriovenous grafts (AVGs). A major reason for this trend is that stents can potentially confer a better patency rate compared to angioplasty. However, limited data are available about the outcomes of stents that are used to treat thigh AVG dysfunction. This study sought to assess the primary and secondary patency rates of stents used to treat thigh AVGs dysfunction at one year. Methods: This is a retrospective study of dialysis patients who received therapy via thigh grafts (N=50) and underwent stent placement between January 2005 and June 2017 at our center. Data on demographics and baseline characteristics of the study population were collected. The primary and secondary patency rates were defined as the time between stent deployment and the first intervention and second intervention, respectively. Patency and re-intervention rates were estimated using Kaplan-Meier survival analysis. Results: This study included 50 patients with thigh AVGs; mean age was 50.5± 15.5 years; 52% were female; 80% were black; and 90% had hypertension. The main indication for stenting was thrombosis due to venous anastomosis stenosis (74%). The number (mean ± SD) of stents deployed was 1.24 ± 0.8. The primary patency rate at three months and one year was 58.7% and 30.7%. In comparison, the secondary patency rate at three months and one year was 68.2% and 40.7% (p=0.04) Conclusions: Thigh AVG stenting can be successfully used to improve the overall patency rates of failing AVGs.

Endovascular treatment for chronic atherosclerotic occlusive mesenteric disease: Is stenting superior to balloon angioplasty?

VASA ◽  
2010 ◽  
Vol 39 (4) ◽  
pp. 319-324 ◽  
Author(s):  
Daliri ◽  
Grunwald ◽  
Jobst ◽  
Szucs-Farkas ◽  
Diehm ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Patency Rate ◽  
Celiac Artery ◽  
Primary Patency ◽  
Secondary Patency ◽  
Chronic Mesenteric Ischemia ◽  
Primary Patency Rate ◽  
Secondary Patency Rate

Background: Endovascular treatment is an increasingly used therapeutic option in patients with chronic atherosclerotic occlusive mesenteric disease. Purpose of this study was evaluation of patency and mortality in patients treated with visceral artery percutaneous transluminal angioplasty (PTA) or stenting including follow-up. Patients and methods: A retrospective review of 17 consecutive patients (4 women, 13 men) with endovascular treatment for symptomatic chronic mesenteric ischemia from 1998 to 2004 was performed. Mean follow-up period was 42 months. Patient demographics, interventional details, primary and/or secondary patency and mortality were recorded. Cumulative mortality and patency rates were determined using Kaplan-Meier life table analysis. Results: Twenty-six interventions (PTA alone n = 13, PTA and stenting n = 13) were performed in 17 patients. Interventions were performed in the superior mesenteric artery (n = 13) and celiac artery (n = 13). The re-intervention rate was 30 % (6/26). Re-interventions were performed for the superior mesenteric artery (n = 4) and celiac artery (n = 2). Cumulative overall 1-year results were primary patency rate 81 %, secondary patency rate 94 %, and survival rate 82 %. Cumulative 10-year results were primary patency rate 73 %, secondary patency rate 94 %, and survival rate 65 %. The 10-year secondary patency rate was 100 % in patients post initial stenting and 86 % in patients post initial PTA. Conclusions: Long-term follow-up post endovascular treatment for chronic mesenteric ischemia demonstrated a considerable overall secondary patency rate of 94 %. However, the long-term secondary patency rate was higher in patients post initial stenting compared to PTA alone.

No Mortality Signal With Stellarex Low-Dose Paclitaxel DCB: ILLUMENATE Pivotal 4-Year Outcomes

2022 ◽  
pp. 152660282110687
Author(s):  
Sean P. Lyden ◽  
Peter L. Faries ◽  
Khusrow A. K. Niazi ◽  
Ravish Sachar ◽  
Ash Jain ◽  
...  
Keyword(s):  
Low Dose ◽  
Controlled Trial ◽  
Transluminal Angioplasty ◽  
Primary Patency ◽  
Safety And Efficacy ◽  
Kaplan Meier ◽  
Safety Endpoint ◽  
Mortality Difference

Background: Paclitaxel-coated balloons have shown safety and efficacy in the short- to intermediate-term; however, long-term data remain limited. Objectives: To report late safety and efficacy outcomes for a low-dose paclitaxel drug-coated balloon (DCB) compared with percutaneous transluminal angioplasty (PTA) in femoropopliteal lesions from a large randomized controlled trial (RCT). Methods: ILLUMENATE Pivotal is a multicenter, single-blind RCT conducted across 43 US and EU centers to examine the safety and efficacy of the Stellarex DCB for the treatment of femoropopliteal disease. Assessments were recorded for all active patients at 36 and 48 months. Vital status of patients formally exited from the study was also collected. Results: Primary patency through 36 months for patients treated with DCB was significantly higher compared with PTA (p=0.016). The primary safety endpoint through 36 months was 77.4% and 72.4%, respectively (p=0.377). Kaplan-Meier analysis indicated that a higher proportion of DCB subjects were event-free compared with PTA at all study visits. The rate of major adverse event (MAE) through 48 months was 32.9% in the DCB group and 37.9% in the PTA group (p=0.428). No differences in the rate of mortality were evident through 48 months of follow-up with 15.6% in the DCB group and 15.2% in the PTA group (p=0.929). Conclusions: Stellarex DCB was associated with significantly higher patency compared with PTA through 3 years with no mortality difference detected through 4 years. The data from the ILLUMENATE Pivotal RCT support the long-term safety and efficacy of the low-dose Stellarex DCB.

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.

Utility of Basilic Vein Transposition for Dialysis Access

Vascular ◽  
2005 ◽  
Vol 13 (5) ◽  
pp. 268-274 ◽  
Author(s):  
Hosam F. El Sayed ◽  
Bernardo Mendoza ◽  
George H. Meier ◽  
Christopher J. LeSar ◽  
Richard J. DeMasi ◽  
...  
Keyword(s):  
Dialysis Access ◽  
Basilic Vein ◽  
Telephone Interviews ◽  
Secondary Interventions ◽  
Black Patients ◽  
Arteriovenous Access ◽  
Dialysis Outcomes ◽  
Steal Syndrome

Autologous arteriovenous access is the key to long-term success with hemodialysis and is strongly supported by the National Kidney Foundation's Dialysis Outcomes Quality Initiative guidelines. Basilic vein transposition (BVT) fulfills the need for a durable conduit with high patency and maturation rates. This retrospective review examines a single group's experience with this procedure. All patients undergoing BVT for hemodialysis with available follow-up data were reviewed. Telephone interviews were used to supplement clinical data where needed. Functional assisted patency was used as the end point for this procedure, and if the access was never used for dialysis, then the patency was considered zero. Secondary interventions performed while the access remained patent and in use were not considered detrimental to the patency reported. One hundred seventy BVTs in 162 patients were performed between November 1992 and October 2001. There were 87 women (53.7%) and 112 black patients (69.1%); hypertension was present in 138 patients (85.2%) and diabetes in 89 patients (54.9%). Each year, an increasing incidence of BVT was performed in our dialysis population. The BVT was performed as the first access in that extremity in 73 of the procedures (42.9%). Functional patency (primary assisted) was achieved in 40.0% at 2 years and 15.2% at 5 years. The mean assisted patency was 14.6 months. To maintain BVT patency, 40 percutaneous secondary interventions (69.0%) and 18 surgical revisions (31.0%) occurred in 32 patients (19.0%). Ligation for swelling was necessary in 4 patients (2.5%), and steal syndrome occurred in 3 patients (1.9%). BVT is a useful autologous procedure for hemodialysis and the preferred access alternative in patients without an adequate cephalic vein. Although patencies remain poor relative to other conventional arterial vascular procedures, BVT is our most durable hemodialysis access procedure and is often the only available autologous conduit for hemodialysis.

P1362AN EXPERIENCE WITH PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY IN ARTERIO-VENOUS FISTULA DYSFUNCTION SECONDARY TO VASCULAR STENOSIS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Mohammed Shoeb Ahmed Khan ◽  
Faiz Mukthar ◽  
Vinod Kumar K ◽  
Bipi Prasannan ◽  
Rohit P V Nair ◽  
...  
Keyword(s):  
Percutaneous Transluminal Angioplasty ◽  
Transluminal Angioplasty ◽  
Primary Patency ◽  
Central Vein ◽  
Venous Cannulation ◽  
Vascular Stenosis ◽  
One Year ◽  
Venous Fistula ◽  
Percutaneous Transluminal

Abstract Background and Aims Arterio-venous fistula (AVF) is the life line of a hemodialysis patient. Dialysis Outcomes and Practice Study (DOPPS) showed that one year patency for AVF in the USA is 68% and 83% in Europe. The maintenance of the vascular pathways are vital. Vascular stenosis in native AVF at the anastomotic sit, venous cannulation zone, outflow vein or the central vein can lead to loss of AVF. Stenosis necessitate vascular intervention or creation of a “de novo” AVF. The number of possible vascular access sites are limited. Aim : To evaluate the outcome of percutaneous transluminal angioplasty (PTA) in arterio-venous fistula due to vascular stenosis. Method This is a retrospective study of two years (02.05.17 to 02.05.19). Records of patients admitted to our hospital were obtained from hospital archives and images from the hospital radiology archive system. Demographic characteristics, duration of dialysis, stenosis or occlusion level, patency rates of AVF were evaluated. All procedures were performed by interventional radiologists in a hybrid cath lab. Antegrade, retrograde, or both antegrade and retrograde punctures were used, depending on the site of the stenosis as deemed on preoperative ultrasound. A complete angiogram from the proximal arteriovenous anastomosis to the central venous outflow was performed in all cases. A successful percutaneous balloon angioplasty was defined when there was no more than 30% residual stenosis (KDOQI). Primary patency rates were assessed at six months and one year. Results Total number of patients studied were 16. The average age was 66.6 years. All were hypertensive and diabetics comprised 75% of study group. Coronary artery disease was established in 81.25%, and two patients were known to have chronic liver disease. Most common type of AVF was the left brachio-cephalic (62.5%), followed by radio-cephalic (37.5%). Average dialysis vintage of AVF at the time of procedure was one year. Previously failed AVF was present in two patients. There were 18 vascular stenosis in 16 patients. The most common site of stenosis was the venous cannulation zone (62.5%), followed by anastomotic site stenosis (31.5%) and central vein stenosis (18.75%). Successful PTA was done in 12 patients. There were no complications; hemodialysis was resumed within 24 hours after the procedure. The primary patency rate at three months was 100%, six months was 75% and at one year it was 37.5%. Four patients were lost to follow up. Mean follow up was 9.41 ±6.79 months. None underwent a repeat PTA. Conclusion Percutaneous transluminal angioplasty is effective for salvaging arterio-venous fistula in majority of hemodialysis patients.

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