Transradial intervention for native fistula failure

The long-term survival and quality of life of patients on hemodialysis is dependant on the adequacy of dialysis via an appropriately placed vascular access. The native arteriovenous fistula (AV fistula) at the wrist is generally accepted as the vascular access of choice in hemodialysis patients due to its low complication and high patency rates. It has been shown beyond doubt that an optimally functioning AV fistula is a good prognostic factor of patient morbidity and mortality in the dialysis phase. Recent clinical practice guidelines recommend the creation of a vascular access (native fistula or synthetic graft) before the start of chronic hemodialysis therapy to prevent the need for complication-prone dialysis catheters. A multidisciplinary approach, including nephrologists, surgeons, interventional radiologists, and nurses should improve the hemodialysis outcome by promoting the use of native AV fistulae. An important additional component of this program is the Doppler ultrasound for preoperative vascular mapping. This approach may be realized without unsuccessful surgical explorations, with a minimal early failure rate, and a high maturation, even in risk groups such as elderly and diabetic patients. Vascular access care is responsible for a significant proportion of health care costs in the first year of hemodialysis. These results also support clinical practice guidelines that recommend the preferential placement of a native fistula.

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BALLOON ASSISTED SHEATHLESS TRANSRADIAL INTERVENTION IN 5 FRENCH PERCUTANEOUS CORONARY INTERVENTIONS

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(12)60186-7 ◽

2012 ◽

Vol 59 (13) ◽

pp. E185

Author(s):

Justin A. Ratcliffe ◽

Yili Huang ◽

Michael Liou ◽

Samir Pancholy ◽

Tak Kwan

Keyword(s):

Percutaneous Coronary Interventions ◽

Coronary Interventions ◽

Percutaneous Coronary ◽

Transradial Intervention

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TCTAP C-018 Simple Transradial Intervention Becomes Complex

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2014.02.281 ◽

2014 ◽

Vol 63 (12) ◽

pp. S74-S75

Author(s):

Mir Jamal Uddin

Keyword(s):

Transradial Intervention

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Transradial intervention for patients with ST elevation myocardial infarction with or without cardiogenic shock

Catheterization and Cardiovascular Interventions ◽

10.1002/ccd.24896 ◽

2013 ◽

Vol 83 (1) ◽

pp. E1-E7 ◽

Cited By ~ 7

Author(s):

Toshiharu Fujii ◽

Naoki Masuda ◽

Takeshi Ijichi ◽

Yoshinari Kamiyama ◽

Shigemitsu Tanaka ◽

...

Keyword(s):

Myocardial Infarction ◽

Cardiogenic Shock ◽

St Elevation Myocardial Infarction ◽

St Elevation ◽

Transradial Intervention

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Transradial Intervention for Chronic Total Occlusion

The American Journal of Cardiology ◽

10.1016/j.amjcard.2013.01.050 ◽

2013 ◽

Vol 111 (7) ◽

pp. 19B

Author(s):

Tsutomu Murakami ◽

Naoki Masuda ◽

Sho Torii ◽

Makoto Natsumeda ◽

Takeshi Ijichi ◽

...

Keyword(s):

Chronic Total Occlusion ◽

Total Occlusion ◽

Transradial Intervention

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25 Years of Transradial Intervention

JACC Cardiovascular Interventions ◽

10.1016/j.jcin.2017.08.047 ◽

2017 ◽

Vol 10 (22) ◽

pp. 2266-2268 ◽

Cited By ~ 10

Author(s):

Sunil V. Rao ◽

Surya Dharma

Keyword(s):

Transradial Intervention

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P3583Optimal procedural strategy to improve clinical outcome in primary percutaneous coronary intervention

European Heart Journal ◽

10.1093/eurheartj/ehz745.0443 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

Y J Park ◽

J H Lee ◽

B E Park ◽

H N Kim ◽

S Y Jang ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Clinical Outcome ◽

Confidence Interval ◽

Antiplatelet Agents ◽

Coronary Intervention ◽

Thrombus Aspiration ◽

Percutaneous Coronary ◽

Procedural Strategy ◽

Transradial Intervention ◽

Improve Clinical Outcome

Abstract Background Current guideline recommends potent antiplatelet agents and transradial intervention. However, it is uncertain whether routine use of IVUS, thrombus aspiration and glycoprotein IIB-IIIA inhibitor is beneficial for improving clinical outcome in patients with ST-segment elevation myocardial infarction (STEMI). Purpose The aim of this study was to investigate optimal procedural strategy to improve clinical outcome. Methods A total of 6,046 patients who underwent primary percutaneous coronary intervention (PCI) for STEMI were analyzed from the Korean Acute Myocardial Infarction Registry (KAMIR) – National Institute of Health (NIH) database. MACCEs were defined as a composition of all cause death, non-fatal MI, repeat revascularizations including repeated percutaneous coronary intervention and coronary bypass grafting, cerebrovascular accident and rehospitalizations. This research was supported by a fund by Research of Korea Centers for Disease Control and Prevention. Results During the primary PCI, potent antiplatelet agents such as prasugrel and ticagrelor were used in 2342 (38.4%). PCI was performed through transradial approach in 1490 (25.2%). Thrombus aspiration and intravascular ultrasound (IVUS) examination was done in 2204 (36.1%) and 1079 (18.1%), respectively. Glycoprotein IIB-IIIA inhibitor was administered in 1295 (21.7%). Among them, potent antiplatelet agents, transradial intervention, IVUS, and thrombus aspiration significantly reduced MACCEs at 1 year. Glycoprotein IIB-IIIA inhibitor was not effective to improved clinical outcome. In Cox-proportional hazards model, potent antiplatelet agents (hazard ratio 0.82, 95% confidence interval 0.67–0.99; p=0.045) and transradial intervention (hazard ratio 0.61, 95% confidence interval 0.47–0.78; p<0.001) was an independent predictor of MACCEs after adjusting for confounding variables. Combined use of potent antiplatelet agents and transradial intervention (hazard ratio 0.54; 95% confidence interval 0.37–0.80; p=0.002) substantially reduced MACCEs at 1 year. Conclusion Among evidence based procedures during the primary PCI, combined use of potent antiplatelet agents and transradial intervention was optimal procedural strategy to improve clinical outcome.

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Graft for Immediate use as First Stage of a Native Fistula

The Journal of Vascular Access ◽

10.1177/112972980901000312 ◽

2009 ◽

Vol 10 (3) ◽

pp. 203-206 ◽

Cited By ~ 3

Author(s):

Earl Schuman

Keyword(s):

United States ◽

Graft Failure ◽

The United States ◽

Morbidity And Mortality ◽

Dialysis Access ◽

New Paradigm ◽

Novel Approach ◽

Native Fistula ◽

Fistula Maturation

The majority of patients in the United States begin hemodialysis with a catheter. Many have immature or inadequate fistulae. At 90 days 77% of these patients are still using a catheter or a graft. The morbidity and mortality from prolonged catheter use have been well delineated. Although most of us adhere to the DOQI and Fistula First tenets, a fistula at all costs can seem counterproductive. A new paradigm is needed. The techniques described in this paper offer a novel approach to circumvent the problems of increasing catheter use and long fistula maturation times. The graft for immediate use is placed in the forearm and allows the proximal vessels to mature while providing dialysis access without a catheter. When these vessels meet maturation guidelines, or when surveillance indicates impending graft failure, a native fistula can be constructed and used in a 2–3 week period. This approach minimizes or circumvents catheter use altogether.

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