Is the Two-Stage Construction Approach Better for Maturation and Long-term Patency of the Transposed Brachiobasilic Arteriovenous Fistulas?

2021 ◽  
pp. 000313482110111
Author(s):  
Joon H. Hong
Keyword(s):  
Flow Dynamics ◽  
Upper Arm ◽  
Two Stage ◽  
Maturation Time ◽  
Arteriovenous Fistulas ◽  
Arteriovenous Access ◽  
Fistula Rate ◽  
The One ◽  
First Time

The transposed brachiobasilic arteriovenous fistula is often constructed by employing a two-stage procedure for better maturation and long-term patency, but its validity on overall outcomes remains controversial. A single-center’s experience is presented herein, comparing one- and two-stage approaches on 229 consecutive first-time arteriovenous access constructed in the upper arm with a loop configuration and an obtuse anastomosis angle that provide favorable flow dynamics. The one- and two-year patency rates were equivalent between the two approaches, but the fistula rate was greater and the maturation time was shorter with the one-stage procedure.

Effectiveness and safety of repeated percutaneous intervention in an office-based endovascular center in maintaining hemodialysis access

Vascular ◽  
2021 ◽  
pp. 170853812110043
Author(s):  
Jay Patel ◽  
Stephanie Chang ◽  
Shaan Manawar ◽  
John Munn ◽  
Mark C Rummel ◽  
...  
Keyword(s):  
Percutaneous Intervention ◽  
Dialysis Access ◽  
Arteriovenous Graft ◽  
Hemodialysis Access ◽  
Upper Arm ◽  
Access Site ◽  
Arteriovenous Fistulas ◽  
Arteriovenous Grafts ◽  
The Mean

Objectives Percutaneous dialysis access interventions are routinely used to maintain the patency of dialysis access despite the lack of data regarding their long-term effectiveness. This retrospective study was undertaken to study the effectiveness and safety of percutaneous dialysis access interventions in arm fistulas and bridge grafts in an office-based endovascular center. Methods Patients who had a percutaneous dialysis access intervention in their upper extremity access site, performed at a single office-based endovascular center over a nine-year period (2007–2016) were included in this study. The patients’ demographic factors, patency, and complications were analyzed. Patients were entered in the study after first percutaneous dialysis access intervention. Results A total of 298 limbs in 259 patients had 913 procedures carried out over a nine-year period. There were 190 access arteriovenous fistulas and 108 arteriovenous grafts. The two most common arteriovenous fistulas were the brachiocephalic fistula ( n = 74, 39%) and radio cephalic fistula ( n = 69, 36%). Arteriovenous grafts were most commonly placed in the upper arm ( n = 66, 61%) followed by the forearm ( n = 42, 39%). The mean overall patency for all limbs was 50.86 months. Arteriovenous fistulas had a significantly longer patency than arteriovenous grafts (51.65 vs. 42.09 months; P = 0.01). In addition, patients with two or more percutaneous dialysis access intervention in their arteriovenous fistula had significantly greater patency than those with only one percutaneous dialysis access intervention (58.5 vs. 7.6 months; hazard ratio 0.41; P = 0.0008). This was not true for the arteriovenous graft group. Women represented 49% of the patient group. Their accesses had shorter patency than men (39.8 vs. 60 months; P = 0.0007). Conclusions This data support the use of repeated percutaneous dialysis access intervention to maintain long-term patency of dialysis access sites in an office-based endovascular center. Overall, fistulas have longer patency than grafts and women have poorer outcomes as compared to men

scholarly journals Ectoparasites of the bats from karst caves of the nature reserve «Ichalkovsky Bor» (Nizhny Novgorod Region)

2018 ◽  
Vol 7 (4) ◽  
pp. 122-126
Author(s):  
Galina Anatolievna Fadeeva ◽  
Elena Evgenievna Boryakova
Keyword(s):  
Natural Habitats ◽  
Karst Caves ◽  
Central Russia ◽  
The Family ◽  
Volga Upland ◽  
The Stability ◽  
The One ◽  
Parasitic Mites ◽  
First Time

The fauna of parasitic mites of bats from the karst caves in the region of the Volga Upland was studied in 2004-2005. Six species of bats such as Daubentons water bat, Brandts bat, whiskered bat, pond bat, northern bat and long-eared bat were examined. 18 species of arthropods were detected, among them there are gamasid mites (10 species) and harvest mites (2 species). Leptotrombidium russicum (Oud., 1902) and Myotrombicula sp. were found for the first time in Central Russia. Spinturnix acuminatus (Koch, 1836), Steatonyssus spinosus (Willmann, 1936), Steatonyssus periblepharus (Kolenati, 1858), Macronyssus flavus (Kolenati, 1856) turned out to be the main group of parasites in this study. As for the insects flies of the family Nycteribiidae and fleas of the family Ischnopsyllidae were found. The cluster analysis of ectoparasite fauna has showed that they are more or less evenly distributed among all members of mixed colonies of bats, while there is no violation of specificity in the choice of hosts. Low values of the Berger-Parker index marked a lack of competition between species, which indicates the stability of parasitic communities formed on bats in mixed colonies and in natural habitats. This fact indicates a complex relationship between the parasites in the community on the one hand, and long-term existence of the community on the other hand. This, in its turn, shows that in long-evolving communities competitive relationships between parasites are obliterated, which gives them stability. Herewith the bat colony is used as an integral whole, although some parasitic species prefer certain types of hosts.

scholarly journals Changing Preference of One- Vs. Two-Stage Implant Placement in Partially Edentulous Individuals: An 18-Year Retrospective Study

2020 ◽  
Vol 10 (20) ◽  
pp. 7060
Author(s):  
Liat Chaushu ◽  
Sarit Naishlos ◽  
Ofir Rosner ◽  
Eran Zenziper ◽  
Ari Glikman ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Bone Loss ◽  
Gingival Index ◽  
Implant Survival ◽  
Two Stage ◽  
One Stage ◽  
Implant Placement ◽  
Crestal Bone Loss ◽  
The One

The purpose of the present long-term retrospective study was to assess the changing preference of one- vs. two-stage implant placement in partially edentulous individuals. The clinical outcome measures were one- vs. two-stage implant placement, implant survival, and gingival index. The radiological outcome measure was crestal bone loss. Other recorded information included gender, age, implant characteristics (brand, type, length, diameter) and implant location (maxilla/mandible). A total of 393 implants in 111 patients were included. The results revealed that there were no significant demographic differences between the one- and two-stage implant placement groups. There was a preference for one-stage surgery when wide diameter implants were used and when the number of implants per patient was ≤3. The mandible was the major implant site in the one-stage surgery group. Crestal bone loss and gingival index were similar for the two groups in both the short and long term. It can be concluded that lack of any long-term differences in implant survival, crestal bone loss and gingival health around implants after one- or two-stage implant placement promoted a significant change over 18 years, increasing to 50% the prevalence of one-stage surgery.

Pantalar Arthrodesis: A Long-term Follow-up

Foot & Ankle ◽  
1981 ◽  
Vol 1 (5) ◽  
pp. 279-283 ◽  
Author(s):  
Gene R. Barrett ◽  
Leslie C. Meyer ◽  
Edward W. Bray ◽  
Richard G. Taylor ◽  
Frank J. Kolb
Keyword(s):  
Spinal Cord ◽  
South Carolina ◽  
Spinal Cord Trauma ◽  
Two Stage ◽  
One Stage ◽  
Ankle Fusion ◽  
Long Term Follow Up ◽  
The One

Eighty-three pantalar arthrodeses in 69 patients performed at the Shriners Hospital for Crippled Children, Greenville, South Carolina, between 1941 and 1977 were evaluated. Follow-up was from 1 to 33 years. Diagnoses included poliomyelitis, myelodysplasia, arthrogryposis, clubfeet, and extremity or spinal cord trauma. Methods of fusion were one-stage pantalar arthrodesis, two-stage triple ankle fusion, one-stage completion of prior tarsal fusion, and one-stage denudation of the talus. Pantalar arthrodesis is successful in the paralytic sensitive foot with a stable knee and there is no greater incidence of nonunion in the one-stage (Hunt-Thompson) procedure than in the two-stage procedure. Complications and failure of fusion are common in the insensitive foot.

Long-term outcomes of lateral tunneled transposed brachiobasilic arteriovenous fistulas in elderly hemodialysis patient

2019 ◽  
Vol 20 (5) ◽  
pp. 557-562 ◽  
Author(s):  
Yen-Chin Lin ◽  
Yu-Ying Huang ◽  
Ming-Yen Lin ◽  
Yi-Wen Chiu ◽  
Lee-Moay Lim ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Medical Center ◽  
Adverse Outcomes ◽  
Long Term Outcomes ◽  
Two Stage ◽  
Vascular Intervention ◽  
Arteriovenous Fistulas ◽  
Significant Difference ◽  
Observation Period

Background: Arteriovenous fistula is recommended for the general dialysis population, but its use remains controversial in the elderly population. We evaluated the long-term outcomes of lateral tunneled transposed brachiobasilic arteriovenous fistulas in older patients who underwent hemodialysis. Methods: In this retrospective cohort study, we included patients who received a two-stage transposed brachiobasilic arteriovenous fistula in a medical center from May 2005 to January 2014. The patients were followed up from the fistula placement date until any intervention, death, failure, January 2015, or the end of the sixth year. Death and arteriovenous fistula failure during the observation period were considered as adverse outcomes, and the cause of death was identified. The cumulative patency rate was calculated using the Kaplan–Meier approach to reveal the long-term outcomes of this procedure. Results: Among the 66 patients who underwent surgery, the average age was 65.8 ± 13.5 years and the majority were females (62.1%). After a median follow-up of 20.6 months, 19 patients died, 12 (18.2%) received vascular intervention, and 3 experienced fistula failure. No significant difference was observed in the 6-year cumulative patency rates between younger and older adults (96.3% vs 80.3%, p = 0.58). None of the deaths during the observation period were related to bloodstream infection. Conclusion: A two-stage lateral tunneled transposed brachiobasilic arteriovenous fistula can be applied to patients undergoing hemodialysis, regardless of age.

scholarly journals Comparative analysis of radiocephalic versus brachiocephalic native arteriovenous fistula for hemodialysis in end stage renal disease

2016 ◽  
Vol 5 (1) ◽  
pp. 171
Author(s):  
Aniket Khadatkar ◽  
Chandrashekhar Mahakalkar ◽  
Tanu Pradhan ◽  
Akshay Bora
Keyword(s):  
Arteriovenous Fistula ◽  
Cephalic Vein ◽  
Maturation Time ◽  
Arteriovenous Fistulas ◽  
Before And After ◽  
Arteriovenous Grafts ◽  
Stage Renal Disease ◽  
End Stage ◽  
Work Up

Background: Chronic kidney disease (CKD) is a long term condition caused by damage to both kidneys. The benefits of arteriovenous fistulas over other forms of chronic access are: Arteriovenous fistulas are associated with decreased morbidity and mortality among hemodialysis patients compared with arteriovenous grafts and central venous catheters. Objectives of the study were o choose the proper sites for formation of arteriovenous fistula, to find out the success rate at various sites and to study the complications of arteriovenous fistula.Methods: This prospective study was carried out on total 150 patients over the duration of two years. The fistulae were created using radial artery and cephalic vein side to side (Radiocephalic AVF) and brachial artery and cephalic vein side to side anastomosis (Brachiocephalic AVF). Doppler studies were done before and after every procedure to demonstrate the velocity, volume of blood flow, depth from the skin, diameter of vessels and to access the time of maturation of AVF. Patients were followed up to first dialysis by AVF to assess the overall outcomes and various complications.Results: Brachiocephalic AVF matured earlier than Radiocephalic AVF (mean maturation time Brachiocephalic 38.02 days and Radiocephalic 43.26 days) which was statistically significant. Brachiocephalic AVF matured earlier than Radiocephalic AVF with more flow rate. Complication rate was more at wrist (Radiocephalic AVF with 66.67% of overall complication) than at elbow (Brachiocephalic AVF with 33.33% of overall complication).Conclusions: We concluded that the Brachiocephalic AVF maturation time was significantly less than the maturation time of Radiocephalic AVF and rate of complication was less in Brachiocephalic AVF. The utility of pre-operative colour Doppler to select the vessels for AVF creation was found to be as an essential parameter of pre-operative work up.

scholarly journals Patency Outcomes of Arteriovenous Fistulas and Grafts for Hemodialysis Access: A Trade-Off between Nonmaturation and Long-Term Complications

Kidney360 ◽  
2020 ◽  
Vol 1 (9) ◽  
pp. 916-924
Author(s):  
Bram M. Voorzaat ◽  
Cynthia J. Janmaat ◽  
Koen E.A. van der Bogt ◽  
Friedo W. Dekker ◽  
Joris I. Rotmans
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort ◽  
Hemodialysis Access ◽  
Short Term ◽  
Upper Arm ◽  
Trade Off ◽  
Arteriovenous Fistulas ◽  
Arteriovenous Grafts

BackgroundArteriovenous fistulas (AVFs) for hemodialysis (HD) are often associated with better outcomes than arteriovenous grafts (AVGs). We aimed to investigate vascular access (VA) outcomes and assessed if AVF nonmaturation outweighs long-term complications of AVGs.MethodsIn this multicenter, retrospective cohort study in The Netherlands, 1- and 3-year primary, primary assisted, secondary, and functional patency rates were calculated, and the incidence of adverse events and procedures was assessed. Functional patency of RCAVFs, upper arm AVFs, and AVGs was compared using Cox analyses.ResultsIn total, 1041 patients who received their first VA were included, of whom 863 had VAs that successfully matured. These patients were analyzed with a median follow-up of 25 months. The 1-year functional patency rates were 67%±2.0% for RCAVFs, 83%±2.0% for upper arm AVFs, and 85%±3.5% for AVGs. Three-year functional patency rates were 62%±2.0% for RCAVFs, 74%±2.0% for upper arm AVFs, and 69%±5% for AVGs. AVGs required more procedures per year (3.3 per year) of functional patency when compared with upper arm AVFs (1.8 per year).ConclusionsThe functional patency of AVFs and AVGs is comparable, although AVGs required more interventions to maintain usability for HD. The choice of VA is a trade-off between short-term advantages, favoring AVGs, and long-term advantages, favoring AVFs. Which VA is most appropriate depends on the patient’s prognosis and preferences.

scholarly journals One-Stage Upper Arm Brachial-Basilic Arteriovenous Fistulas Have Superior Patency to Two-Stage Procedure

2018 ◽  
Vol 67 (2) ◽  
pp. e27-e28 ◽  
Author(s):  
Tze-Woei Tan ◽  
Jeffrey Siracuse ◽  
Karen Woo ◽  
Donald Baril ◽  
Benjamin Brooke ◽  
...  
Keyword(s):  
Upper Arm ◽  
Two Stage ◽  
Arteriovenous Fistulas ◽  
One Stage

Comments on one- versus two-stage procedure for transposed brachio-basilic arteriovenous fistulae

2021 ◽  
pp. 112972982199725
Author(s):  
Joon Ho Hong
Keyword(s):  
Flow Dynamics ◽  
Two Stage ◽  
Arteriovenous Fistulae ◽  
Construction Procedure

The maturation and long-term patency of transposed brachio-basilic arteriovenous fistulae can best be achieved not by adopting a two-stage construction procedure, but by using a loop configuration and an anastomosis angle that allows for the most favorable flow dynamics.

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