End-to-side versus side-to-side anastomosis with distal vein ligation for arteriovenous fistula creation

Vascular ◽  
2020 ◽  
pp. 170853812097699
Author(s):  
Mohammed ElKassaby ◽  
Nashaat Elsayed ◽  
Ahmed Mosaad ◽  
Mosaad Soliman
Keyword(s):  
Renal Failure ◽  
Surgical Techniques ◽  
Secondary Patency ◽  
Compelling Evidence ◽  
Technical Success ◽  
Arteriovenous Anastomosis ◽  
Arteriovenous Fistulas ◽  
Randomized Controlled ◽  
Randomized Controlled Studies

Introduction There is lack of compelling evidence about the best technique to carry out the anastomosis between the artery and the vein: end to side or side to side. This issue was addressed by very few randomized controlled studies. This topic has recently re-emerged with the advent of the endovascular fistula creation using the side-to-side technique. Objectives: To compare the results of both surgical techniques for the creation of arteriovenous anastomosis. Methods This is a randomized controlled prospective study. All renal failure patients, 18 years and older, referred to our institution requiring creation of a new arm arteriovenous fistulas, including distal radio-cephalic, ulno-basilic, proximal brachio-cephalic or brachio-basilic configurations were included. Results Between February 2018 and October 2018, 378 patients underwent creation of permanent haemodialysis access. A total of 100 patients were randomized equally into the end-to-side and side-to-side groups. Follow-up for the study purpose continued until May 2019 (mean = 9 months, range 1–12). Patients’ age ranged from 19 to 68 years. Sevety-seven arteriovenous fistulas were created at the elbow (37 brachio-basilic and 40 brachio-cephalic). Radio-cephalic fistulae were 23, created at wrist and in the forearm. Primary technical success was 97%, and 35 (70%) and 17 (34%) cases achieved functionally maturation in the end-to-side and side-to-side groups, respectively (P = 0.0001). Primary and secondary patency rates at 12 months were 76% end to side versus 78% STS (P = 0.381) and 84% end to side versus 86% STS (P = 0.225), respectively. Conclusion End-to-side technique should be used in all instances of arteriovenous fistulas creation.

Pharmacology of oral antiplatelet drugs

ESC CardioMed ◽  
2018 ◽  
pp. 195-200
Author(s):  
Tabassome Simon
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Antiplatelet Therapy ◽  
Cardiovascular Events ◽  
Coronary Intervention ◽  
Compelling Evidence ◽  
Coronary Syndrome ◽  
Randomized Controlled ◽  
Randomized Controlled Studies ◽  
Percutaneous Coronary

Compelling evidence from randomized controlled studies have confirmed the efficacy of dual antiplatelet therapy, with aspirin and a P2Y12 inhibitor, in reducing the risk of cardiovascular events particularly among patients with acute coronary syndrome and/or those undergoing percutaneous coronary intervention. They thus represent one of the most frequently prescribed drugs worldwide.

Mid-Term Follow-Up Results of Arteriovenous Fistulas with Basilic Vein Transposition and Prosthetic Grafts in Hemodialysis-Dependent Chronic Renal Failure Patients

2015 ◽  
Vol 24 (1) ◽  
pp. 8-12
Author(s):  
Orkut GÜÇLÜ ◽  
Volkan YÜKSEL ◽  
Serhat HÜSEYİN ◽  
Ümit HALICI ◽  
Şahin İŞCAN ◽  
...  
Keyword(s):  
Renal Failure ◽  
Chronic Renal Failure ◽  
Basilic Vein ◽  
Arteriovenous Fistulas

Ten-year follow-up of subjects who received bronchial thermoplasty (BT) in 3 randomized controlled studies (BT10+)

2019 ◽  
Author(s):  
Rekha Chaudhuri ◽  
Adalberto Rubin ◽  
Jussara Da Costa Fiterman ◽  
Kaharu Sumino ◽  
Jose Roberto Lapa E Silva ◽  
...  
Keyword(s):  
Randomized Controlled ◽  
Bronchial Thermoplasty ◽  
Randomized Controlled Studies

Integrated Approach to Construction and Maintenance of Prosthetic Arteriovenous Access for Hemodialysis

Vascular ◽  
2004 ◽  
Vol 12 (4) ◽  
pp. 243-255 ◽  
Author(s):  
David Shemesh ◽  
Oded Olsha ◽  
Daniel Berelowitz ◽  
Ibrahim Zaghal ◽  
Charles Z. Zigelman ◽  
...  
Keyword(s):  
Surgical Techniques ◽  
Integrated Approach ◽  
Preoperative Imaging ◽  
Secondary Patency ◽  
Dialysis Access ◽  
Expanded Polytetrafluoroethylene ◽  
Number Of Patients ◽  
Arteriovenous Access ◽  
The Creation

Autogenous arteriovenous access is the preferred access for hemodialysis patients with end-stage renal disease but is not feasible in a significant number of patients. The creation of a prosthetic arteriovenous access (PAVA) for hemodialysis using expanded polytetrafluoroethylene is technically simple and the short-term results are usually good, but the PAVA's 1-year patency rate is low (less than 60% in many centers). We have developed an integrated approach for the creation and maintenance of PAVAs, under the direction of a dedicated vascular access surgeon, involving preoperative imaging, anesthetic and surgical techniques, and a postoperative graft surveillance program, to improve patency rates. The design used was a prospective nonrandomized study. Between January 1, 1999, and December 31, 2001, 158 PAVAs were created (36.8% of the 419 fistulae created during this period). High-resolution duplex ultrasonography was added to careful clinical assessment in planning and follow-up of the dialysis access. The preferred method of PAVA creation was the forearm loop using tapered 4 to 7 mm stretch expanded polytetrafluoroethylene. After surgery, patients entered a program of close follow-up and regular graft surveillance and maintenance. Prophylactic surgical revisions and endovascular interventions were performed routinely according to ultrasonography findings to prevent thrombosis. Thrombolysis and thrombectomy were performed without delay when the PAVA thrombosed, minimizing the use of central venous access and salvaging the central veins. No patients were excluded from the study. One-, 2-, and 3-year assisted primary patency rates (including patients without occlusion but who were judged to require prophylactic revision) were 65%, 54.1%, and 48.8%, respectively. With surveillance-directed surgical revisions and endovascular treatment before or after occlusion, the 1-, 2-, and 3-year secondary patency rates (functional patency) were 91.4%, 84.3%, and 78.5%. Of the 158 grafts, 110 never occluded during the study period. There were 155 interventions in 74 PAVAs: 30 surgical revisions, 63 prophylactic endovascular procedures, and 52 instances of thrombolytic therapy combined with percutaneous transluminal angioplasty. The use of prosthetic arteriovenous access for hemodialysis, when autogenous arteriovenous access is not feasible, can still be associated with excellent long-term patency, in spite of previously published poor results, as long as good planning, close follow-up, and aggressive intervention (when indicated) are carried out.

scholarly journals Prospective Single-Arm Trial of Endovascular Mechanical Debulking as Initial Therapy in Patients With Acute and Subacute Lower Limb Ischemia: One-Year Outcomes

2019 ◽  
Vol 26 (3) ◽  
pp. 291-301 ◽  
Author(s):  
Miroslav Bulvas ◽  
Zuzana Sommerová ◽  
Ivan Vaněk ◽  
Jiří Weiss
Keyword(s):  
Limb Ischemia ◽  
Initial Therapy ◽  
Exclusion Criterion ◽  
Secondary Patency ◽  
Primary Therapy ◽  
Technical Success ◽  
Free Survival ◽  
The Mean ◽  
One Year

Purpose: To report the results of a prospective, single-arm study to establish whether the initial treatment of acute or subacute limb ischemia (ALI and SLI, respectively) can be accomplished successfully using endovascular mechanical debulking of the target vessels to avoid the risks associated with thrombolysis and/or open surgery. Materials and Methods: From April 2009 to April 2015, 316 consecutive patients (mean age 70.9±12 years; 184 men) with ALI (202, 63.9%) or SLI (114, 36.1%) were enrolled; the only exclusion criterion was irreversible ischemia. The ALI group included 146 (72.3%) participants with category IIb ischemia and 56 (27.7%) with category IIa. Critical limb ischemia was diagnosed in 74 (64.9%) of the 114 patients with SLI. Target occlusions of thrombotic (n=256) or embolic (n=60) origin were located in the femoropopliteal segment (n=231), prosthetic or venous femoropopliteal bypass grafts (n=75), and the aortoiliac segment (n=35). The mean occlusion length was 22.9±14.8 cm. Results: The overall technical success (residual stenosis ≤30%) was 100% after debulking and adjunctive techniques (aspiration, dilation, stenting) at the level of the target lesions. No open surgical or thrombolytic modalities were necessary to bypass or recanalize the target vessels, and no death occurred in association with target occlusion therapy. Additional infrapopliteal interventions were performed in 195 (61.7%) patients (adjunctive thrombolysis in 29) to treat acute, subacute, and chronic lesions. Minor complications directly related to the debulking procedure occurred in 26 (8.2%) patients. Serious complications occurred in 11 (3.5%) patients, including hemorrhage in 8 (2.5%) patients (associated with infrapopliteal thrombolysis in 5). At 30 days, primary and secondary patency rates were 94.3% and 97.2%, respectively; mortality was 0.3% (1 fatal intracranial hemorrhage after adjunctive thrombolysis). Of 229 patients eligible for 1-year follow-up, amputation-free survival was estimated to be 87.4% in 199 patients with available data. Conclusion: In this all-comers study, mechanical debulking with the Rotarex alone or with adjunctive techniques is feasible as a primary therapy for occluded supratibial vessels in patients with ALI or SLI.

Percutaneous creation of proximal radio-radial arteriovenous hemodialysis fistula before secondary brachial vein elevation

2020 ◽  
pp. 112972982093692
Author(s):  
Alexandros Mallios ◽  
Pierre Bourquelot ◽  
Ghazi Harika ◽  
Benoit Boura ◽  
William C Jennings
Keyword(s):  
Radial Artery ◽  
Secondary Patency ◽  
Inclusion Criteria ◽  
Technical Success ◽  
Second Stage ◽  
Hand Ischemia ◽  
Single Center Study ◽  
Radial Vein ◽  
Brachial Vein

Objective: We evaluate the creation of a percutaneous proximal radial artery–radial vein arteriovenous fistula with Ellipsys® instead of the usual first-stage brachial artery fistula prior to a second-stage brachial vein elevation, in patients with inadequate cephalic and basilic veins. Methods: Single center study of eight patients (six males, mean = 54 years) who underwent a two-stage brachial vein elevation procedure between May 2017 and October 2019. Inclusion criteria were life expectancy > 6 months, patent brachial and proximal radial artery (>2 mm in diameter) absent/inadequate cephalic and basilic veins, existence of a brachial vein >3 mm in diameter, and in continuity with a proximal radial vein > 2 mm in diameter. Results: Technical success was 100%. Four patients required angioplasty of a juxta-anastomotic stenosis, accounting for a 6-month primary and secondary patency rates were 68% and 100%, respectively. Access flow averaged 982 mL/min (range 768–1586) at final follow-up evaluation. There were no significant adverse events related to the procedures. All fistulae were elevated at 4–12 (mean: 8) weeks post creation and were successfully cannulated with two needles after healing was completed (2–4 weeks after elevation). No patients developed hand ischemia or arm edema. Conclusions: Percutaneous creation of a proximal radial artery–radial vein fistula followed by brachial vein elevation is a safe and reliable option for autogenous access creation in patients with inadequate cephalic or basilic veins. Minimally invasive radial artery inflow and longer available length of the targeted brachial vein available for elevation are the main advantages in skilled hands.

BT10+ study design: 10 year follow-up of subjects receiving bronchial thermoplasty (BT) in 3 randomized controlled studies

2017 ◽  
Author(s):  
Rekha Chaudhuri ◽  
Michel Laviolette ◽  
Robert Niven ◽  
Stephen Bicknell ◽  
Michael E Wechsler ◽  
...  
Keyword(s):  
Study Design ◽  
Randomized Controlled ◽  
Bronchial Thermoplasty ◽  
Randomized Controlled Studies

Endovascular Reconstruction for Total Aorto–Iliac Occlusion

2021 ◽  
pp. 152660282110599
Author(s):  
Gabriele Piffaretti ◽  
Aaron Thomas Fargion ◽  
Walter Dorigo ◽  
Raffaele Pulli ◽  
Michelangelo Ferri ◽  
...  
Keyword(s):  
Cox Regression ◽  
Aortic Surgery ◽  
Primary Patency ◽  
Secondary Patency ◽  
Infrarenal Aorta ◽  
Technical Success ◽  
Total Occlusion ◽  
Cox Regression Analysis ◽  
Iliac Bifurcation

Objectives: To analyze outcomes following endovascular treatment of total occlusion of the infrarenal aorta and aorto–iliac bifurcation in a multicenter Italian registry. Methods: It is a multicenter, retrospective, observational cohort study. From January 2015 to December 2018, 1306 endovascular interventions for aorto–iliac occlusive disease were recorded in the vascular registry. For this analysis, only patients treated for total occlusion of the infrarenal aorta and aorto–iliac bifurcation were included. Early (<30 days) primary outcomes of interest were technical success and mortality. Late major outcomes were primary and secondary patency and freedom from conversion to open aortic surgery. Results: A total of 54 (4.1%) patients met the inclusion criteria. Total percutaneous revascularization was possible in 41 (75.9%) patients and hybrid (endo plus open) intervention in 13 (24.1%) patients. The kissing-stent-graft technique was used in 45 (83.3%) cases, covered endovascular reconstruction of the aortic bifurcation (CERAB) in 5 (9.2%), and a unibody endograft deployed in 4 (7.4%). Technical success was 98.1% (n = 53). There were no episodes of intraoperative or perioperative vessel rupture. Conversion to open surgery was not necessary, and there were no in-hospital deaths. The median patient follow-up time was 16 months (interquartrile range [IQR], 6-27). The estimated primary patency rate was 95.8% ± 0.03 (95% confidence interval [CI]: 85.5-98.9) at 1 year, 91.4% ± 0.05 (95% CI: 76.2-97.2) at 2 years, and 85 ± 0.08 (95% CI: 64.5-94.6) at 3 years. Cox regression analysis demonstrated that sex (hazard ratio [HR]: 0.96; 95% CI: 0.15-6.23, p = 0.963), extent of the occlusion (HR: 0.28; 95% CI: 0.05-1.46, p = 0.130), calcium score (HR: 1.88; 95% CI: 0.31-11.27, p = 0.490), or type of endovascular reconstruction (HR: 0.80; 95% CI: 0.13-5.15, p = 0.804) did not affect primary patency. Secondary patency was 95.5% ± 0.04 (95% CI: 78.4-99.2) at 3 years. No patients required late conversion to open surgical bypass. Conclusions: Endovascular reconstruction for total occlusion of the infrarenal aorta and aorto–iliac bifurcation was successful using a combination of percutaneous and hybrid revascularization techniques. Estimated patency rates at 3 years of follow-up are promising and are unaffected by the extent of occlusion or type of revascularization.

To Treat or Not to Treat M2 Occlusions? The Question (and Answer) From a Single Institution

Neurosurgery ◽  
2015 ◽  
Vol 79 (3) ◽  
pp. 428-436 ◽  
Author(s):  
Stephan A. Munich ◽  
Shelby L. Hall ◽  
Marshall C. Cress ◽  
Leonardo Rangel-Castilla ◽  
Kenneth V. Snyder ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Scale Score ◽  
National Institutes Of Health ◽  
Clinical Effects ◽  
Single Institution ◽  
Randomized Controlled ◽  
Randomized Controlled Studies ◽  
Symptomatic Intracranial Hemorrhage ◽  
The Mean

Abstract BACKGROUND: Occlusions of the M2 segment of the middle cerebral artery may cause significant clinical effects, especially when occurring in the dominant cerebral hemisphere, yet endovascular treatment of these lesions remains controversial. OBJECTIVE: To examine the safety and efficacy of endovascular treatment of M2 occlusions at our institution. METHODS: We retrospectively examined radiographic and clinical data of 53 patients presenting with M2 occlusions to our institution. RESULTS: Successful recanalization (Thrombolysis in Cerebral Infarction grade 2b or 3) was achieved in 40 patients (76.9%). No symptomatic intracranial hemorrhage occurred. The mean National Institutes of Health Stroke Scale score at discharge was 6.4 (median, 5.5). In the 38 patients who had follow-up after discharge, the mean follow-up duration was 11.1 months (range, 0.5-36.5 months) and mean National Institutes of Health Stroke Scale score was 3.5 (median, 1). CONCLUSION: The results of our single-institution experience suggest that endovascular therapy for M2 occlusions is safe and effective. Additional evaluation with randomized, controlled studies is warranted.

Efficacy and comparison of elevation transposition and lipectomy for superficialization of cephalic arteriovenous fistula veins

2018 ◽  
Vol 19 (4) ◽  
pp. 350-357 ◽  
Author(s):  
Michele S Wang ◽  
Shouwen Wang
Keyword(s):  
Ambulatory Surgery ◽  
Primary Patency ◽  
Secondary Patency ◽  
Upper Arm ◽  
Arteriovenous Fistulas ◽  
Second Stage ◽  
Ambulatory Surgery Center ◽  
The Mean ◽  
Surgery Center

Objective: Substantial percentages of cephalic arteriovenous fistulas are situated too deep and require superficialization before use for hemodialysis. The superficialization techniques are diverse: tunnel transposition, elevation, elevation transposition, and lipectomy. Since the fistula veins are not mobilized during lipectomy, it is believed that lipectomy produces better outcomes than other techniques. However, no available report directly compares lipectomy with other techniques. The objective of this report is to compare the outcomes of cephalic elevation transposition with lipectomy. Methods: The clinical data of patients who underwent second-stage cephalic elevation transposition or lipectomy at an ambulatory surgery center from 2009 to 2017 were analyzed ( n = 153). Results: Comparing the cephalic elevation transposition group ( n = 125) with the lipectomy group ( n = 28), the mean body mass index was 36.8 ± 7.6 versus 38.1 ± 7.2 ( p = 0.41); the percentage of upper arm fistulas was 84% versus 61% ( p < 0.01); the mean follow-up was 20.1 ± 17.5 versus 38.6 ± 24.4 months ( p < 0.01); the primary patency rates of the whole fistula conduits were 42% versus 50% at 1 year ( p = 0.08); the secondary patency rates were 99% versus 100% at 1 year ( p = 0.22); the primary patency rates of the superficialized vein segments were 73% versus 68% at 1 year ( p = 0.72); and the mean number of percutaneous interventions required for the superficialized vein segments was 0.49 ± 1.10 versus 0.43 ± 0.71 per access-year ( p = 0.74). Conclusion: Cephalic elevation transposition and lipectomy are both reliable techniques for superficialization of cephalic fistula veins and their outcomes are comparable.

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