Hemodynamic impact of VASQ device in vascular access creation

2020 ◽  
pp. 112972982098315
Author(s):  
Roberto Palumbo ◽  
Sara Dominijanni ◽  
Alessia Centi ◽  
Gabriele D’Urso ◽  
Paola Tatangelo ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Complication Rate ◽  
Neointimal Hyperplasia ◽  
Arterial Flow ◽  
Control Group ◽  
Secondary Patency ◽  
Arteriovenous Fistulae ◽  
The Mean ◽  
The Impact

Background: Native arteriovenous fistula is the preferred vascular access in term of functionality, efficiency and complication rate. Nevertheless, research continues to seek strategies to reduce the risk of neointimal hyperplasia and hemodynamic modification. The aim of the study was to evaluate the impact on hemodynamic of the VasQ device in arteriovenous fistulae creation. Methods: The analysis included patients who underwent to fistula creation with or without implantation of the VasQ device between May and September 2019. The hemodynamic parameters were evaluated pre-operatively and at a follow-up of 1, 3, 6 months. The patency and complication rate were evaluated. Results: Fifteen VasQ devices were implanted during 30 arteriovenous fistula surgery. The baseline patients features were similar between groups (VasQ treated/control). At baseline, preoperative arterial flow was similar; radial artery diameter at surgical site was 3.4 ± 0.8 mm in treated and 2.8 ± 0.5 mm in the control group. The mean arterial flow at 1 month was 480 ± 210 mL/min in treated and 561 ± 27 mL/min in the control group. At 3 months the mean arterial flow in treated was 645 ± 143 mL/min versus 824 ± 211 mL/min ( p = 0.02) in the control group; at 6 months the arterial flow was 714 ± 146 mL/min versus 810 ± 194 mL/min ( p = 0.05) in control group. The cardiac output flow at 6 months in the treated group was 4458 ± 928 mL/min versus 5599 ± 1355 mL/min ( p = 0.05) in the control group. At 6 months the primary patency was 73% and 80% and the secondary patency 80% and 86% in treated compared to the control group, respectively. No VASQ device complications were recorded. Conclusion: The analysis of these data suggested that using VasQ device could be protective against the hemodynamic modification that occur during arteriovenous fistulae creation.

Effect of Hydraulic Expansion on Arteriovenous Fistula of Hemodialysis Patients

2019 ◽  
Author(s):  
Wanjun Ren ◽  
Yuejuan Du ◽  
Huili Jiang ◽  
Dongmei Xu
Keyword(s):  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Stroke Volume ◽  
Arteriovenous Fistula ◽  
Hemodialysis Patients ◽  
Control Group ◽  
Secondary Patency ◽  
Conventional Surgery ◽  
Surgery Group ◽  
The Mean

Background Chronic kidney disease has become a serious public health problem in China. Our study is to explore effect of hydraulic expansion on arteriovenous fistula (AVF) of hemodialysis patients. Methods A total of 190 patients with end-stage renal disease (ESRD) were randomly divided into hydraulic expansion group (n = 117) and conventional surgery group (n = 73). Age, sex, the cause of ESRD, height, weight, body mass index (BMI), blood pressure, and diameter of artery and vein from ultrasonography before surgery from patients were recorded. Doppler ultrasonography of vessel was performed with a 12-MHz scanning probe for vascular measurements. The time of first cannulation was recorded. Primary and secondary patency rates were compared between the two groups. Results The mean arterial pressure for this cohort of patients was around 98.12 mm Hg. The mean diameters of artery and vein ready for anastomoses measured by ultrasonography before surgery were 1.96 and 2.04 mm, respectively. Age, weight, BMI, sex ratio, the cause of renal failure, history of catheter insertion, mean arterial pressure, frequency of hemodialysis, blood flow of hemodialysis, and the mode of anastomoses of AVF in conventional surgery group were similar to hydraulic expansion group. There were no differences in stroke volume of radius arterial and venous pressure before dilation between the two groups. The stroke volume of radius artery increased significantly after hydraulic expansion than before dilation and control group. The primary patency rates of AVF in patients with hydraulic expansion were higher significantly than conventional surgery group. The secondary patency rates in conventional surgery group were not different from hydraulic expansion group. Conclusion Hydraulic expansion showed no difference from conventional surgery in complication after operation, and could decrease the time reliance on catheters and the risk of catheter-related infection, thrombosis, and decrease the related medical care costs.

Adding access blood flow surveillance reduces thrombosis and improves arteriovenous fistula patency: a randomized controlled trial

2017 ◽  
Vol 18 (4) ◽  
pp. 352-358 ◽  
Author(s):  
Inés Aragoncillo ◽  
Soraya Abad ◽  
Silvia Caldés ◽  
Yésika Amézquita ◽  
Almudena Vega ◽  
...  
Keyword(s):  
Blood Flow ◽  
Arteriovenous Fistula ◽  
Doppler Ultrasound ◽  
Vascular Access ◽  
Patency Rate ◽  
Control Group ◽  
Secondary Patency ◽  
Ultrasound Dilution ◽  
Randomized Controlled

Purpose Stenosis is the main cause of arteriovenous fistula (AVF) failure. It is still unclear whether surveillance based on vascular access blood flow (QA) enhances AVF function and longevity. Methods We conducted a three-year follow-up randomized, controlled, multicenter, open-label trial to compare QA-based surveillance and pre-emptive repair of subclinical stenosis with standard monitoring/surveillance techniques in prevalent mature AVFs. AVFs were randomized to either the control group (surveillance based on classic alarm criteria; n = 104) or to the QA group (QA measured quarterly using Doppler ultrasound [ M-Turbo®] and ultrasound dilution [Transonic®] added to classic surveillance; n = 103). The criteria for intervention in the QA group were: 25% reduction in QA, QA<500 mL/min or significant stenosis with hemodynamic repercussion (peak systolic velocity [PSV] more than 400 cm/sc or PSV pre-stenosis/stenosis higher than 3). Results At the end of follow-up we observed a significant reduction in the thrombosis rate in the QA group (0.025 thrombosis/patient/year in the QA group vs. 0.086 thrombosis/patient/year in the control group [p = 0.007]). There was a significant improvement in the thrombosis-free patency rate (HR, 0.30; 95% CI, 0.11-0.82; p = 0.011) and in the secondary patency rate in the QA group (HR, 0.49; 95% CI, 0.26-0.93; p = 0.030), with no differences in the primary patency rate between the groups (HR, 0.98; 95% CI, 0.57-1.61; p = 0.935). There was greater need for a central venous catheter and more hospitalizations associated with vascular access in the control group (p = 0.034/p = 0.029). Total vascular access-related costs were higher in the control group (€227.194 vs. €133.807; p = 0.029). Conclusions QA-based surveillance combining Doppler ultrasound and ultrasound dilution reduces the frequency of thrombosis, is cost effective, and improves thrombosis free and secondary patency in autologous AVF.

scholarly journals P1367THE RELATIONSHIP OF SERUM PHOSPHORUS LEVEL AND ARTERIOVENOUS FISTULA DYSFUNCTION IN MAINTENANCE HEMODIALYSIS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Hyung-Jong Kim ◽  
Mi Jung Lee
Keyword(s):  
Blood Flow ◽  
Risk Factor ◽  
Arteriovenous Fistula ◽  
Flow Rate ◽  
Vascular Access ◽  
Univariate Analysis ◽  
Blood Flow Rate ◽  
Dialysis Unit ◽  
The Mean ◽  
The Impact

Abstract Background and Aims It is known that maintenance of function of arteriovenous fistula (AVF) is very important in the management of hemodialysis (HD) patients. Therefore, identifying a risk factor for decreased vascular access flow has a clinical relevance in real world practice. Although hyperphosphatemia plays a crucial role in the pathogenesis of vascular calcification, there is lack of studies evaluating the effect of hyperphosphatemia on AVF. This study investigated the impact of serum phosphorous (P) on vascular access flow in HD patients. Method Sixty-two maintenance HD patients who visited dialysis unit of Bundang CHA Medical Center from November 2016 to December 2017 were included in this study. Serum P levels were determined every month and time-averaged serum P was calculated. All patients had left arm AVF (side to side anastomosis) and vascular access flow was assessed by Transonic HD 03. Decreased vascular access flow was defined as less than 600 mL/min. Results The mean age was 57.9 ± 12.1 years, 32 patients (51.6%) were men. The mean serum P levels were 5.1 ± 1.1 mg/dL and the vascular access flow was 1,071.4 ± 504.2 mL/min. Decreased vascular access flow was observed in 14 of 62 patients (22.6%). In univariate analysis, higher serum P was significantly associated with decreased vascular access flow (odds ratio [OR]=2.089, 95% confidence interval [CI]=1.159-3.766, P=0.014). But there was no significant association of dialysis blood flow rate, ejection fraction on echocardiography and serum calcium (Ca) levels with vascular access flow. Multivariable analysis indicated that higher serum P was independently associated with greater risk of decreased vascular access flow (OR=4.012, 95% CI=1.651-9.711, P=0.002). Old age, reduced EF, low dialysis blood flow rate and higher serum Ca was not associated with vascular access flow. Conclusion This study demonstrated that higher serum P was the independent risk factor for decreased vascular access flow in maintenance HD patients. Serial monitoring of serum P may be helpful to stratify the risk of vascular access dysfunction in these patients.

Impact of an educative program on dialysis patients’ knowledge and mental health: controlled before and after program

2018 ◽  
Vol 10 (2) ◽  
pp. 20204
Author(s):  
Laetitia Idier ◽  
Aurélie Untas ◽  
Nicole Rascle ◽  
Michèle Koleck ◽  
Maider Aguirrezabal ◽  
...  
Keyword(s):  
Mental Health ◽  
Depressive Symptoms ◽  
Vascular Access ◽  
Educational Program ◽  
Psychological State ◽  
Control Group ◽  
Dialysis Patients ◽  
Emotional Change ◽  
The Impact ◽  
Experimental Group

Introduction:Psychological impact of Therapeutic Patient Education (TPE) for dialysis patients is rarely evaluated since the focus of many studies is on medical variables (i.e., adherence).Objectives:The aims of this study were: 1) to estimate the impact of a TPE program on knowledge, depression and anxiety, 2) to examine change in knowledge as a mediator of the effects of a TPE program on mental health.Method:This study was conducted in three hemodialysis units and comprised two groups: an experimental group with education and a control group with routine care. The program was based of 5 educative sessions. Knowledge, depressive and anxious symptoms were assessed with self-reported outcomes measured before and 3 months after the program.Results:The sample comprised 125 patients. Knowledge about vascular access and nutrition (p < 0.01) and depressive symptoms increased in the experimental group (p < 0.01). Analysis of mediation showed that changes in knowledge about vascular access were a significant mediator of the effects of the program on depressive symptoms (F = 4.90;p = 0.01).Discussion:Knowledge acquired during an educational program could lead to an emotional change. Improving knowledge often leads to an awareness of the risks that can modify the psychological state of patients by reminding them of their vulnerability. This study shows that it is required to be attentive to the way of transmitting knowledge. It’s necessary adapting this transmission to the needs of patients and promoting the acquisition of psychosocial competence too.Conclusion:This study shows that knowledge acquired during an educational program can lead to an emotional change in the short term. A long-term follow-up of the population should be interesting to observe these emotional effects.

scholarly journals The Impact of Game-Based, Modeling, and Collaborative Learning Methods on the Achievements, Motivations, and Visual Mathematical Literacy Perceptions

SAGE Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. 215824402110035
Author(s):  
Aziz İlhan
Keyword(s):  
Collaborative Learning ◽  
Control Group ◽  
Conventional Instruction ◽  
Game Based Learning ◽  
Mathematical Literacy ◽  
Learning Methods ◽  
Learning Groups ◽  
The Mean ◽  
The Impact ◽  
Experimental Group

The present study aimed to investigate the effects of geometry instruction activities conducted in nature based on modeling, game-based, and cooperative learning methods on achievement, mathematical motivation, and visual mathematical literacy perceptions of third-grade elementary school students. The present study is a quantitative study conducted with a pre-test/post-test experimental design with a control group. The study was conducted with 61 students (35 students in the experimental group and 26 students in the control group). Modeling-, game-, and collaborative learning-based activities were conducted with the students in the experimental group. It was determined that the achievements of students who were instructed with modeling-based activities in geometry were high when compared to that of the students instructed with collaborative learning- and game-based methods, and those in the control group where no intervention was applied. This group was followed by the game-based and collaborative learning groups. Based on the variable of motivation, the mean motivation of the students in the modeling group was higher when compared to that of the students in the collaborative learning, game-based, and conventional instruction groups. This group was followed by the collaborative and game-based learning groups. Also, based on the visual mathematical literacy perception variable, the mean visual mathematics literacy perception of the students in the collaborative learning group was higher when compared to that of the students in the groups where the modeling, game-based, and conventional instruction methods were used. This group was followed by the modeling and game-based learning groups.

scholarly journals The impact of vildagliptin on the daily glucose profile and coronary plaque stability in impaired glucose tolerance patients with coronary artery disease: VOGUE—A multicenter randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hiroyuki Yamamoto ◽  
Akihide Konishi ◽  
Toshiro Shinke ◽  
Hiromasa Otake ◽  
Masaru Kuroda ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Controlled Trial ◽  
Control Group ◽  
Randomized Controlled ◽  
Fibrous Cap ◽  
Multicenter Randomized Controlled Trial ◽  
The Mean ◽  
Artery Disease ◽  
Fibrous Cap Thickness ◽  
The Impact

Abstract Background The impact of reduction in glycemic excursion on coronary plaques remains unknown. This study aimed to elucidate whether a dipeptidyl peptidase 4 inhibitor could reduce the glycemic excursion and stabilize the coronary plaques compared with conventional management in coronary artery disease (CAD) patients with impaired glucose tolerance (IGT). Methods This was a multicenter, randomized controlled trial including CAD patients with IGT under lipid-lowering therapy receiving either vildagliptin (50 mg once a day) or no medication (control group) regarding glycemic treatment. The primary endpoint was changes in the minimum fibrous cap thickness and lipid arc in non-significant native coronary plaques detected by optical coherence tomography at 6 months after intervention. Glycemic variability expressed as the mean amplitude of glycemic excursion (MAGE) measured with a continuous glucose monitoring system was evaluated before and 6 months after intervention. Results A total of 20 participants with 47 lesions were allocated to either the vildagliptin group (10 participants, 22 lesions) or the control group (10 participants, 25 lesions). The adjusted difference of mean changes between the groups was − 18.8 mg/dl (95% confidence interval, − 30.8 to − 6.8) (p = 0.0064) for the MAGE (vildagliptin, − 20.1 ± 18.0 mg/dl vs. control, 2.6 ± 12.7 mg/dl), − 22.8° (− 40.6° to − 5.1°) (p = 0.0012) for the mean lipid arc (vildagliptin, − 9.0° ± 25.5° vs. control, 15.8° ± 16.8°), and 42.7 μm (15.3 to 70.1 μm) (p = 0.0022) for the minimum fibrous cap thickness (vildagliptin, 35.7 ± 50.8 μm vs. control, − 15.1 ± 25.2 μm). Conclusions Vildagliptin could reduce the MAGE at 6 months and may be associated with the decreased lipid arc and increased minimum FCT of the coronary plaques in CAD patients with IGT as compared with the control group. These findings may represent its potential stabilization effect on coronary plaques, which are characteristic in this patient subset. Trial registration Registered in the UMIN clinical trial registry (UMIN000008620), Name of the registry: VOGUE trial, Date of registration: Aug 6, 2012, URL: https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000010058

scholarly journals When is a Match Sufficient? A Score-based Balance Metric for the Synthetic Control Method

2020 ◽  
Vol 8 (1) ◽  
pp. 209-228
Author(s):  
Layla Parast ◽  
Priscillia Hunt ◽  
Beth Ann Griffin ◽  
David Powell
Keyword(s):  
Los Angeles ◽  
Control Method ◽  
Control Unit ◽  
Treated Group ◽  
Control Group ◽  
Synthetic Control ◽  
Donor Pool ◽  
Synthetic Control Method ◽  
The Mean ◽  
The Impact

AbstractIn some applications, researchers using the synthetic control method (SCM) to evaluate the effect of a policy may struggle to determine whether they have identified a “good match” between the control group and treated group. In this paper, we demonstrate the utility of the mean and maximum Absolute Standardized Mean Difference (ASMD) as a test of balance between a synthetic control unit and treated unit, and provide guidance on what constitutes a poor fit when using a synthetic control. We explore and compare other potential metrics using a simulation study. We provide an application of our proposed balance metric to the 2013 Los Angeles (LA) Firearm Study [9]. Using Uniform Crime Report data, we apply the SCM to obtain a counterfactual for the LA firearm-related crime rate based on a weighted combination of control units in a donor pool of cities. We use this counterfactual to estimate the effect of the LA Firearm Study intervention and explore the impact of changing the donor pool and pre-intervention duration period on resulting matches and estimated effects. We demonstrate how decision-making about the quality of a synthetic control can be improved by using ASMD. The mean and max ASMD clearly differentiate between poor matches and good matches. Researchers need better guidance on what is a meaningful imbalance between synthetic control and treated groups. In addition to the use of gap plots, the proposed balance metric can provide an objective way of determining fit.

scholarly journals The Impact of Divergent and Convergent Tasks on Iraqi EFL Students Reading Comprehension Success

2021 ◽  
Vol 1 (1) ◽  
pp. 35-39
Author(s):  
Sabeeha Hamza Dehham ◽  
Nadia Majeed Hussein
Keyword(s):  
Reading Skills ◽  
Experimental Approach ◽  
Statistical Significance ◽  
Control Group ◽  
Efl Students ◽  
Preparatory Stage ◽  
The Mean ◽  
And Control ◽  
The Impact ◽  
Experimental Group

This research attempted to explore the effects of divergent and convergent tasks on the successful reading of EFL students at the preparatory stage. To verify the analysis, the null hypothesis was established that states "There are no differences of statistical significance at the level of (0,05) among the mean of scores of the experimental group who study according to divergent and convergent task technique and the mean of the scores of the control group who study according to the regular method".  The experimental approach is used by designing two equivalent experimental groups of 32 students studying the technique proposed, and an 8-week (2019-2020) control group of 32 students, three classes each week using the Google Classroom Platform and Telegram. The present study utilized the platform Google Classroom (GC) and Telegram as an educational platform to assist students during their course learning process. The writing skills test was administered after checking with the experts. The results show that there are statistical differences at level (0,05) between the average of the experimental and control groups' reading skills and those of the experimental group. This difference is because the experimental group uses divergent and convergent tasks.

Resistant Starch Supplementation Improves Bifidobacteria Colonization and Lipid Profile in Adult Obese Subjects Residing in Urban Vadodara

2018 ◽  
Vol 55 (4) ◽  
pp. 432
Author(s):  
Mini Sheth ◽  
Aanchal Johari ◽  
Isha Shah
Keyword(s):  
Lipid Profile ◽  
Resistant Starch ◽  
Age Groups ◽  
Randomised Control Trial ◽  
Control Group ◽  
Obese Adults ◽  
Obese Subjects ◽  
The Mean ◽  
The Impact ◽  
Experimental Group

Obesity continues to be a growing problem globally among all age groups, further associated with life threatening co-morbidities. Resistant Starch (RS) as a dietary component has been recently recognized as a prebiotic with potential role in improving the bacterial ecology of human gut. The present study was undertaken to evaluate the impact of resistant starch supplementation by the obese adults in urban Vadodara on microbial changes in gut flora with respect to Bifidobacteria and Enterobacteria. Using a non randomised control trial study design, 60 obese adults were enrolled from the free living population of urban Vadodara. Baseline information was collected and subjects were classified into control (n=30) and experimental group (n=30). Experimental group was supplemented with 10 g of RS daily for the period of two months (60 days). The control group were not given anything during this period. Blood and stool samples were analysed for lipid profile and the presence of Bifidobacteria and pathogenic Enterobacteria, respectively both at baseline and after the intervention period. Results revealed a significant increase in the mean log counts of Bifidobacteria by 11.7% with no significant reduction in the mean log counts of enteric pathogens and lipid profile of subjects. Hence study concludes that a daily supplementation of 10 grams of RS for 60 days to the obese subjects improved colonization of beneficial gut microbiota in terms of Bifidobacteria, but had little effect on obesity.

Introducing a “no-touch” maneuver to manage challenging anastomoses in arteriovenous fistulae

2020 ◽  
pp. 112972982096839
Author(s):  
Efstratios Georgakarakos ◽  
Kalliopi-Maria Tasopoulou ◽  
George S Georgiadis
Keyword(s):  
Surgical Technique ◽  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Surgical Outcome ◽  
Dialysis Patients ◽  
Synthetic Graft ◽  
Arteriovenous Fistulae ◽  
Feeding Tubes

Native arteriovenous fistula or interposition of a synthetic graft for vascular access is crucial for dialysis patients. Optimal surgical technique, microsurgery instrumentation and preventive hemostasis are considered beneficial for a successful surgical outcome. We describe a simple and novel maneuver using soft-feeding tubes to facilitate the manipulation of veins and perform successful anastomoses without using microsurgery instrumentation or vascular clamps during operations for vascular access.

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