Novel external stenting for reconstruction of high flow arteriovenous fistula

2021 ◽  
pp. 112972982110155
Author(s):  
Vladimir Matoussevitch ◽  
Egan Kalmykov ◽  
Robert Shahverdyan
Keyword(s):  
Flow Rate ◽  
Cardiac Remodeling ◽  
Primary Patency ◽  
High Flow ◽  
Cobalt Chromium ◽  
Mean Flow ◽  
Flow Rates ◽  
Vein Segment ◽  
The Mean

Background: High-flow arteriovenous fistulae (HF-AVF) may lead to adverse cardiac remodeling in hemodialysis patients. We have investigated whether a novel external stent is safe and effective in reducing and stabilizing flow rates during a 1-year follow-up after HF-AVF reconstruction. Methods: All patients with HF-AVF (access flow rate ⩾ 1500 ml/min), who underwent HF-AVF reconstruction with external stenting in two centers between June 2018 and May 2020, were included in this retrospective analysis. During HF-AVF reconstruction, the dilated vein segment was resected, underwent volume reduction, and was externally stabilized using a braided cobalt-chromium external stent. AVF flow rates were assessed preoperatively, intraoperatively, and at follow up visits using duplex ultrasound. Results: Forty-three HF-AVFs in 42 patients were reconstructed and supported with an external stent (mean age 49 years, range 20–86 years; 74% men). Fifty-one percent were forearm AVFs, 49% were upper arm. The mean preoperative flow rate was 2622 ± 893 ml/min (range: 1500–6000 ml/min) and was decreased to 710 ± 221 ml/min (range: 300–1300 ml/min) intra-operatively after HF-AVF reconstruction. At 6 and 12-months follow-up, the mean flow rates were 1132 ± 320 ml/min (range: 470–1700 ml/min) and 1453 ± 888 ml/min (range: 300–3800 ml/min), respectively. Recurrence of high flow (>1500 ml/min) occurred in 16% and 25% of the patients at 6 and 12 months and primary patency rates were 86% and 70%, respectively. Conclusions: This early experience with novel external stenting for HF-AVF reconstruction demonstrates that it is a safe and effective method for reducing and stabilizing flow rates up to 1-year post procedure. Additional studies are required to evaluate the durability of this procedure over the longer term and assess its effect on cardiac remodeling.

Mechanics of machine milking: II. The flow-rate pattern within single pulsation cycles

1966 ◽  
Vol 33 (2) ◽  
pp. 177-191 ◽  
Author(s):  
C. C. Thiel ◽  
P. A. Clough ◽  
D. R. Westgarth ◽  
D. N. Akam
Keyword(s):  
Flow Rate ◽  
Response Rate ◽  
Sphincter Muscle ◽  
Mean Flow ◽  
Considerable Time ◽  
Flow Rates ◽  
Machine Milking ◽  
Closing Force ◽  
The Mean ◽  
Pulsation Cycle

SummaryThe milk flowing during a single pulsation cycle was collected in a circle of contiguous cups which rotated in a chamber at 1 rev/pulsation cycle just below the end of the teatcup liner. The mean flow rate during the time taken for each collecting cup to pass under the milk stream was calculated and the flow-rate curve for the milkflow period of the pulsation cycle plotted. Flow rates were measured at 130, 97, 65, 32 and 16 c/min, and also after the pulsator had been stopped with the liner open for 0·5 min (0 pulsation).It was concluded from the series of flow-rate curves at the different pulsation rates that flow rate from the teat increased in about 0·05 sec to a steady value which continued for 0·5 sec or so, and then declined over a period of about 1·5 sec to a new constant value approximately equal to that shown after milk had flowed continuously from the teat for 0·5 min.These results suggest that once the pressure difference across the streak canal during milking forces the teat sphincter open a considerable time elapses before the muscle control system responds, and that a further much longer period elapses before the full closing force of the sphincter is exerted. Thus, it would appear that at pulsation rates of about 50 c/min and above, the streak canal is closed by pressure exerted on the teat by the closing liner, the sphincter muscle playing no active part because its response rate is slow compared with the pulsation rate. At lower pulsation rates the flow rate declines during each cycle because the sphincter muscle has time to exert a closing force to a greater or lesser extent depending on the duration of the milkflow period.

scholarly journals Role of terminal and anastomotic circulation in the patency of arteries jailed by flow-diverting stents: from hemodynamic changes to ostia surface modifications

2017 ◽  
Vol 126 (5) ◽  
pp. 1702-1713 ◽  
Author(s):  
Christina Iosif ◽  
Philipp Berg ◽  
Sebastien Ponsonnard ◽  
Pierre Carles ◽  
Suzana Saleme ◽  
...  
Keyword(s):  
Flow Rate ◽  
Stent Placement ◽  
Mean Flow ◽  
Hemodynamic Changes ◽  
Flow Rates ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
The Right

OBJECTIVEThe outcome for jailing arterial branches that emerge near intracranial aneurysms during flow-diverting stent (FDS) deployment remains controversial. In this animal study, the authors aimed to elucidate the role of collateral supply with regard to the hemodynamic changes and neointimal modifications that occur from jailing arteries with FDSs. To serve this purpose, the authors sought to quantify 1) the hemodynamic changes that occur at the jailed arterial branches immediately after stent placement and 2) the ostia surface values at 3 months after stenting; both parameters were investigated in the presence or absence of collateral arterial flow.METHODSAfter an a priori power analysis, 2 groups (Group A and Group B) were created according to an animal flow model for terminal and anastomotic arterial circulation; each group contained 7 Large White swine. Group A animals possessed an anastomotic-type arterial configuration to supply the territory of the right ascending pharyngeal artery (APhA), while Group B animals possessed a terminal-type arterial configuration to supply the right APhA territory. Subsequently, all animals underwent FDS placement, thereby jailing the right APhAs. Mean flow rates and velocities inside the jailed branches were quantified using time-resolved 3D phase-contrast MR angiography before and after stenting. Three months after stent placement, the jailed ostia surface values were quantified on scanning electron micrographs. The data were analyzed using descriptive statistics and group comparisons with parametric and nonparametric tests.RESULTSThe endovascular procedures were feasible, and there were no findings of in situ thrombus formation on postprocedural optical coherence tomography or ischemia on postprocedural diffusion-weighted imaging. In Group A, the mean flow rate values at the jailed right APhAs were reduced immediately following stent placement as compared with values obtained before stent placement (p = 0.02, power: 0.8). In contrast, the mean poststenting flow rates for Group B remained similar to those obtained before stent placement. Three months after stent placement, the mean ostia surface values were significantly higher for Group B (527,911 ± 306,229 μm2) than for Group A (89,329 ± 59,762 μm2; p < 0.01, power: 1.00), even though the initial dimensions of the jailed ostia were similar between groups. A statistically significant correlation was found between groups (A or B), mean flow rates after stent placement, and ostia surface values at 3 months.CONCLUSIONSWhen an important collateral supply was present, the jailing of side arteries with flow diverters resulted in an immediate and significant reduction in the flow rate inside these arteries as compared with the prestenting values. In contrast, when competitive flow was absent, jailing did not result in significant flow rate reductions inside the jailed arteries. Ostium surface values at 3 months after stent placement were significantly higher in the terminal group of jailed arteries (Group B) than in the anastomotic group (Group A) and strongly correlated with poststenting reductions in the velocity value.

Bifurcated bypass in severe chronic limb threatening ischaemia

Vascular ◽  
2021 ◽  
pp. 170853812199985
Author(s):  
Daniele Adami ◽  
Michele Marconi ◽  
Alberto Piaggesi ◽  
Davide M Mocellin ◽  
Raffaella N Berchiolli ◽  
...  
Keyword(s):  
Survival Rates ◽  
Primary Patency ◽  
Free Survival ◽  
Mortality And Morbidity ◽  
Bypass Patency ◽  
Stage 4 ◽  
Endovascular Approach ◽  
The Mean ◽  
Clinical Records

Objectives Revascularization according to the angiosome concept is of proven importance for limb salvage in chronic limb threatening ischaemia but it is not always practicable. Bifurcated bypasses could be considered as an option when an endovascular approach is not feasible or has already failed and a single bypass would not allow direct revascularization of the ischaemic area. Bifurcated bypasses are characterized by landing on two different arteries, the main artery (in direct continuity with the foot vessels) and the secondary one (perfusing the angiosome district). The aim of this study is to evaluate the safety and effectiveness of bifurcated bypass in chronic limb threatening ischaemia. Methods Thirty-five patients were consecutively treated with a bifurcated bypass for chronic limb threatening ischaemia from January 2014 to December 2019 in a single vascular surgery centre. Data from clinical records and operative registers were collected prospectively in an electronic database and retrospectively analysed. Primary and primary assisted bypass patency, amputation-free survival, morbidity and mortality rates at 12 and 24 months were analysed. Results Mean follow-up period was 25.1 months (range 2–72 months). Thirty-six bifurcated bypasses were performed on 35 patients (age 75.3 ± 7.2 years; 69.4% were male). According to Wound, Ischemia, foot Infection classification 22.2% belonged to stage 3 and 77.8% to stage 4 and the mean Rutherford’s class was 5.1 ± 0.7. Immediate technical success was 100%. Early mortality and morbidity rates were respectively 5.5%, and 33.3%; foot surgery was performed in 50% of cases with wound healing in all patients. Primary patency and primary assisted bypass patency were 96.7% and 100% at 6 months; 85.2% and 92% at 12 months, 59.9% and 73.4% at 24 months, respectively. Amputation-free survival at 12 and 24 months was, respectively, 95.6% and 78.8%. Overall survival rates at 12 and 24 months were respectively 94.4% and 91.6%. Conclusions Bifurcates bypass can provide good results in patients with chronic limb threatening ischaemia without endovascular option, especially in diabetic ones. Bifurcated bypass is a complex surgical solution, both to be planned and performed, and it is quite invasive for frail patients that should be accurately selected.

Experimental Investigation of Pressure Fluctuations on Inner Wall of a Centrifugal Pump

2019 ◽  
Vol 36 (4) ◽  
pp. 401-410 ◽  
Author(s):  
Xiao-Qi Jia ◽  
Bao-Ling Cui ◽  
Zu-Chao Zhu ◽  
Yu-Liang Zhang
Keyword(s):  
Centrifugal Pump ◽  
Flow Rate ◽  
Pressure Fluctuation ◽  
Pressure Fluctuations ◽  
High Flow ◽  
Low Flow ◽  
Centrifugal Pumps ◽  
Flow Rates ◽  
Pressure Distributions ◽  
Blade Passing Frequency

Abstract Affected by rotor–stator interaction and unstable inner flow, asymmetric pressure distributions and pressure fluctuations cannot be avoided in centrifugal pumps. To study the pressure distributions on volute and front casing walls, dynamic pressure tests are carried out on a centrifugal pump. Frequency spectrum analysis of pressure fluctuation is presented based on Fast Fourier transform and steady pressure distribution is obtained based on time-average method. The results show that amplitudes of pressure fluctuation and blade-passing frequency are sensitive to the flow rate. At low flow rates, high-pressure region and large pressure gradients near the volute tongue are observed, and the main factors contributing to the pressure fluctuation are fluctuations in blade-passing frequency and high-frequency fluctuations. By contrast, at high flow rates, fluctuations of rotating-frequency and low frequencies are the main contributors to pressure fluctuation. Moreover, at low flow rates, pressure near volute tongue increases rapidly at first and thereafter increases slowly, whereas at high flow rates, pressure decreases sharply. Asymmetries are observed in the pressure distributions on both volute and front casing walls. With increasing of flow rate, both asymmetries in the pressure distributions and magnitude of the pressure decrease.

Abstract 1122‐000142: Safety and Efficacy of Surpass Streamline for Intracranial Aneurysms: A Multicenter US Real‐World Experience (SESSIA)

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Juan Vivanco‐Suarez ◽  
Alan Mendez‐Ruiz ◽  
Farooqui Mudassir ◽  
Cynthia B Zevallos ◽  
Milagros Galecio‐Castillo ◽  
...  
Keyword(s):  
Real World ◽  
Intracranial Aneurysms ◽  
The United States ◽  
Chromium Alloy ◽  
Cobalt Chromium ◽  
Anterior Circulation ◽  
Safety And Efficacy ◽  
Post Marketing ◽  
The Mean

Introduction : Flow diversion has established itself as standard treatment of wide complex intracranial aneurysms (IA). Its recognition has been validated with positive occlusion rates and favorable clinical outcomes. The Surpass Streamline (SS) flow diverter (FD) is a braided cobalt/chromium alloy implant with 72 or 96 wires approved by the FDA in 2018. The aim of this study is to determine the safety and efficacy of the SS in a post‐marketing large US cohort. Methods : We performed a multicenter, retrospective study for consecutive patients treated with the SS FD for IA between January 2018 and June 2021 in the United States. Inclusion criteria for participants were: 1. Adults (≥ 18 years) and 2. Treatment with SS FD for IA. Primary safety end point was a major ipsilateral stroke (increase in National Institutes of Health Stroke Scale Score of ≥ 4) or neurological death within 12 months. Primary efficacy was assessed using the 3‐point Raymond‐Roy (RR) occlusion scale on digital subtraction angiography (DSA) at 6‐12‐month follow‐up. Results : A total of 276 patients with 313 aneurysms were enrolled. The median age was 59 years and 199 (72%) were females. The most common comorbidities included hypertension in 156 (57%) subjects followed by hyperlipidemia in 76 (28%) patients. One hundred and twenty‐two (44%) patients were asymptomatic while subarachnoid hemorrhage was present in only 10 (4%) patients. A total of 143 (46%) aneurysms were left‐sided. Aneurysms were located as follows: 274 (88%) were in the anterior circulation with paraophthalmic being the most common in 120 (38%) followed by petrocavernous ICA in 81 (26%); 33 (11%) aneurysms were located in the posterior circulation with basilar trunk being the most common in 14 (5%). The mean maximum aneurysm dome width was 5.77 ± 4.7 mm, neck width 4.22 ± 3.8 mm and dome to neck ratio was 1.63 ± 1.3 mm. The mean number of SS FD implanted per aneurysm was 1.06 (range 1–3) with more than one SS FD implanted in 21 (7%) aneurysms. Modified Rankin Scale (mRS) of 0–2 was present in 206/213 (97%) patients at 6–12 month follow‐up. The complete aneurysm occlusion (RR 1) rate was 145/175 (83%) among subjects who had angiographic follow‐up at 6–12 months. Major stroke and death was encountered in 7 (2%) and 5 (1.8%) of the patients respectively. Conclusions : Our data represent the largest real‐world study using SS FD. These results corroborate its post‐marketing safety and efficacy for the treatment of intracranial aneurysms showing more favorable rates to the initial experience during SCENT trial.

scholarly journals Increased take-off level in automatic milking systems – effects on milk flow, milk yield and milking efficiency at the quarter level

2018 ◽  
Vol 86 (1) ◽  
pp. 85-87 ◽  
Author(s):  
Sabine Ferneborg ◽  
Måns Thulin ◽  
Sigrid Agenäs ◽  
Kerstin Svennersten-Sjaunja ◽  
Peter Krawczel ◽  
...  
Keyword(s):  
Flow Rate ◽  
The Other ◽  
Mean Flow ◽  
Flow Rates ◽  
Decline Phase ◽  
Flow Profiles ◽  
Milk Flow ◽  
Automatic Milking ◽  
Automatic Milking Systems ◽  
Time Required

AbstractThis research communication describes how different detachment levels (0.48, 0.3 and 0.06 kg milk/min) at the quarter-level affect milk flow profiles and overall milking efficiency in automatic milking systems. We hypothesized a higher detachment level would result in greater mean flow rates without affecting the volume of harvested milk per cow during 24 h compared to lower detachment levels. The data suggest milk flow decreased to a rate below the overmilking limit within the 6-s delay time required for termination in all treatments, but the duration of overmilking was shorter for the greatest detachment level compared to the other treatments. We conclude that setting a detachment level at a greater milk flow rate reduces the duration of overmilking without affecting the amount of milk harvested when applied to cows in mid-lactation during quarter-level milking. We also suggest that the steepness of the decline phase of the milk flow curve might have a larger effect than the actual detachment level on the duration of overmilking.

Renal Function in Unanaesthetized River Lampreys (Lampetra FluviatilisL.): Effects of Anaesthesia, Temperature and Environmental Salinity

1983 ◽  
Vol 105 (1) ◽  
pp. 351-362 ◽  
Author(s):  
A. J. MCVICAR ◽  
J. C. RANKIN
Keyword(s):  
Renal Function ◽  
Flow Rate ◽  
Ventilation Rate ◽  
Urine Flow ◽  
The Body ◽  
Urine Flow Rate ◽  
Flow Rates ◽  
Gill Ventilation ◽  
Daily Excretion ◽  
The Mean

1. Improved estimates of urine flow rates of lampreys in various salinities were obtained by the collection of urine for periods of up to 48 h from minimally-stressed, unanaesthetized fish, following catheterization of the urinogenital papilla. 2. The mean urine flow rate of freshwater lampreys was 200.7 ±14.3 ml kg−1 day−1. 3. Urine flow in freshwater lampreys was correlated with spontaneous changes in gill ventilation rate. MS222 anaesthesia reduced both ventilation and urine flow rates, but pronounced effects were only observed at concentrations greater than those needed to induce light anaesthesia (50–55 mg 1−1). Urine flow rate in unanaesthetized fish was extremely sensitive to rapid (6°Ch−1) changes in temperature and Q10 (6–16°C) was approximately 5. 4. Urine flow rate decreased rapidly as the osmotic difference between the body fluids and environment approached zero, and the rate of flow in 30% seawater lampreys was only 7.6% that of freshwater fish. 5. There was no evidence for an effect of environmental calcium concentration on branchial osmotic permeability. 6. Extensive tubular reabsorption of ions occurred in freshwater lampreys. The total daily excretion rate of sodium ions generally decreased in salinities hyperosmotic to the plasma, indicating enhanced reabsorption, but secretion of magnesium and sulphate ions was greatly increased. Urine osmolarity was significantly increased in lampreys in hyperosmotic salinities. 7. Present data compare favourably with data obtained previously from anaesthetized animals, indicating that renal function in lampreys is not significantly impaired by light MS222 anaesthesia.

Fluid Dynamics of Tubes Used in Membrane-Tube Type Glaucoma Shunt Devices

2019 ◽  
Author(s):  
Jong Chul Han ◽  
Young Hoon Hwang ◽  
Byung Heon Ahn
Keyword(s):  
Flow Rate ◽  
Venous Pressure ◽  
Pressure Control ◽  
Full Length ◽  
Internal Diameter ◽  
Minimal Risk ◽  
Flow Rates ◽  
Membrane Tube ◽  
The Mean ◽  
Half Length

Abstract Purpose: To investigate the outflow characteristics of silicone tubes with intraluminal stents used in membrane-tube (MT) type glaucoma shunt devices (MT-device). Methods: The silicone tubes used in MicroMT (internal diameter of 100 µm with 7-0 nylon intraluminal stent) and Finetube MT (internal diameter of 200 µm with 5-0 nylon intraluminal stent) were connected to a syringe-pump that delivered a continuous flow of distilled water at flow rates of 2, 5, 10, and 25 µl/min. The pressures and resistances of tubes were measured at a steady flow rate with full-length, half-length, and absence of intraluminal stents. Results: At flow rates between 2 and 25 µl/min, the mean outflow resistance of tubes ranged from 3.0 ± 1.9 to 3.8 ± 1.7 mmHg/µl/min with a full-length intraluminal stent, 1.8 ± 1.1 to 2.2 ± 1.1 mmHg/µl/min with a half-length intraluminal stent, and 0.1 ± 0 to 0.2 ± 0 mmHg/µl/min without an intraluminal stent. At a physiologic state with a flow rate of 2 µl/min and episcleral venous pressure of 6 mmHg, the mean pressures of tubes were expected to be 13.2 ± 3.0, 10.5 ± 2.4, and 6.4 ± 0.2 mmHg in MicroMT with full-length, half-length, and absence of intraluminal stents, respectively, and 12.5 ± 3.9, 9.6 ± 2.4, and 6.2 ± 0.2 mmHg in Finetube MT with full-length, half-length, and absence of intraluminal stents, respectively. Variance of the pressure decreased according to the intraluminal stent retraction (P < 0.01). Conclusion: The tubes with intraluminal stents used in the MT-device showed safe (with a minimal risk of postoperative ocular hypotony) and effective (sufficient for intraocular pressure control) outflow characteristics.

P4379Pathophysiology of left atrial filling in mitral regurgitation. A new volumetric flow rate index describing disturbed left atrial filling behavior in mitral regurgitation by 3D TTE

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D Frumkin ◽  
K Stangl ◽  
A Muegge ◽  
T Buck ◽  
B Plicht
Keyword(s):  
Mitral Regurgitation ◽  
Left Atrium ◽  
Flow Rate ◽  
Left Atrial ◽  
Volume Overload ◽  
Volumetric Flow Rate ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Mean Flow ◽  
Flow Rates

Abstract Background In chronic mitral regurgitation (MR) the left atrium (LA) is one of the first cardiac structures involved in remodeling by progressive volume overload. Real-time three-dimensional echocardiography is able to monitor volumetric changes of the left atrium during the heart cycle. Purpose We hypothesized that chronic volume overload due to MR leads to detectable changes in the LA filling behavior described by mean and maximum filling flow rates and their relation called volumetric flow rate index. Methods We prospectively analyzed data of 36 patients in different stages of chronic MR and 13 patients without MR. Transthoracic echocardiography was conducted using the Epiq 7G Ultrasound System. Standard 2D- and 3D apical 4-chamber views were recorded and stored for offline analysis. We generated volume-time-curves by 3D volume analysis to derive mean and maximum volumetric flow rates during LA reservoir, conduit and pump phase. Volumetric flow rate index was calculated as the quotient of mean flow rate/maximum flow rate. Results Average MR severity, calculated with the MR Scoring system introduced from Buck et al. and implicated in the ESC Guidelines, was 6.2 points (±2.5) according to Grade I-II. We included 13 patients without MR, 18 with mild MR, 12 patients with moderate MR, 6 patients with severe MR. Left ventricular ejection fraction was similar in the different groups (51,2±12,3%). Maximum and mean flow rate showed no significant correlation with MR severity. Correlation of MR severity with LA dilation (ml/m2 BSA) was r=0.41; p<0.001. Flow rate index showed strong significant correlation with MR severity in left atrial reservoir phase (r=−0.75; p<0.001). There was no statistically relevant difference of volumetric flow rate parameters in left atrial pump and conduit phase. Line chart Conclusions We observed a significant correlation of the volumetric flow rate index to MR severity in the left atrial reservoir phase with stronger correlation than MR severity to left atrial dilation. The results of this work encourage further investigations to establish the presented volumetric flow rate index as a progression marker of MR and to evaluate its prognostic value.

Cerebrospinal fluid formation in rats and cats during treatment with timolol

1982 ◽  
Vol 60 (8) ◽  
pp. 1138-1143 ◽  
Author(s):  
Betty P. Vogh ◽  
David R. Godman
Keyword(s):  
Cerebrospinal Fluid ◽  
Dose Level ◽  
Aqueous Humor ◽  
Flow Rate ◽  
Formation Rate ◽  
Time Study ◽  
Mean Flow ◽  
Dye Dilution ◽  
Fluid Formation ◽  
The Mean

The influence of timolol upon cerebrospinal fluid formation rate has been examined in rats by the measurement of 22Na+ entry into this fluid after 10, 100, or 1000 μg∙kg−1 i.v, and in cats by the dye-dilution measurement of new fluid formation after 30, or 3000 μg∙kg−1 i.v., or 250 μg∙mL−1 in ventricular perfusate. In rats no change from control rates occurred. In the cats there appeared to be no effect of intraventricular timolol; however, a significant decrease of ~ 25% in the mean flow rate was seen after 40 min when drug was given i.v. at either dose level. A time study showed that no further decrease occurred within 5 h and that the observed decrease continued for at least 3 h. These findings are of interest in view of the ability of topical, intraocular, and i.v. timolol to reduce aqueous humor formation rate.

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