Stable incidence and survival of arteriovenous fistulas over 39 years: A long-term national cohort study

Introduction: The age and number of comorbidities in the hemodialysis population has increased over time. This may influence the construction and survival of the arteriovenous fistula (AVF). The present study explored the incidence and survival of AVFs over a period of 39 years. Methods: A retrospective cohort study was conducted based on Danish registries. Incident hemodialysis patients between 1977 and 2015 were included. The incidence of AVF and factors associated with the construction of an AVF were described. Risk factors for AVF survival and repair were explored by Kaplan Meier and Cox proportional hazard analysis. Results: The total number of arteriovenous accesses (AVF and arteriovenous grafts) were 10,187 and there were 4201 central venous catheters (CVC). No significant difference in the proportion of AVFs during the 39 years was seen. Age and renal diagnosis did not influence the proportion of AVFs. Patients with CVCs were found to have a significantly higher prevalence of comorbidities ( p < 0.01). AVF survival remained stable during the 39 years. The first constructed AVF had the best survival, 35% still functioning after 15 years. Factors such as brachiocephalic AVF, female sex, and diabetic nephropathy increased the risk of AVF failure (Odds Ratio (OR): 2.46, 95% Confidence Interval (CI) (2.29–2.65), 1.17 (1.10–1.25), and 1.21 (1.12–1.3)), respectively. Conclusion: Despite an older dialysis population, the proportion and survival of the AVF in the Danish dialysis population has not changed, probably because of increased awareness of AVF as the first choice of vascular access and improved surveillance, surgery, and repair.

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Haemodialysis access thrombosis: Outcomes after surgical thrombectomy versus catheter-directed thrombolytic infusion

The Journal of Vascular Access ◽

10.1177/1129729818761277 ◽

2018 ◽

Vol 19 (6) ◽

pp. 535-541 ◽

Cited By ~ 4

Author(s):

Linn Koraen-Smith ◽

Matteus Krasun ◽

Matteo Bottai ◽

Ulf Hedin ◽

Carl M Wahlgren ◽

...

Keyword(s):

Primary Patency ◽

Study Patient ◽

Dialysis Access ◽

Arteriovenous Fistulas ◽

Patient Demographics ◽

Kaplan Meier ◽

First Choice ◽

Surgical Thrombectomy ◽

Arteriovenous Grafts ◽

Healthcare Associated

Introduction: Thrombosis is one of the most common complications of dialysis vascular access and is a significant source of morbidity and healthcare-associated costs. In this retrospective study, outcomes for surgical thrombectomy and thrombolysis after access thrombosis in patients with arteriovenous fistulas or prosthetic grafts (arteriovenous grafts) were analysed. Methods: All patients with a primary episode of dialysis access thrombosis between 2005 and 2013 were included which yielded 131 patients with 149 episodes of access thrombosis (108 arteriovenous grafts; 41 arteriovenous fistulas). In all, 18 patients had two separate accesses during the study. Patient demographics, access anatomy, surgical and radiological procedural data were recorded. Kaplan–Meier estimates and Poisson regression were used for statistical analysis of access patency. Results: In total, 107 underwent surgical thrombectomy and 42 were treated with catheter-directed thrombolytic infusion. Technical success was 60% for surgical thrombectomy and 73% for thrombolysis (p = 0.18). There were no major complications and no deaths within 30 days of the procedure. More patients had adjunctive procedures in the thrombolysis group (65/107 vs 37/42; p = 0.002). There was an increasing risk of rethrombosis or a further access-related event for both arteriovenous fistulas and arteriovenous grafts after open thrombectomy compared with catheter-directed thrombolytic infusion, and arteriovenous fistulas exhibited a lower risk than arteriovenous grafts with an average increase in risk of 23.9% (95% confidence interval: 3.1–49) between each treatment group. Conclusion: Thrombolysis for thrombosis of native and prosthetic dialysis accesses appears to yield better assisted primary patency compared to surgical thrombectomy. Our results suggest that thrombolysis may be considered the first-choice method for treating the thrombosed dialysis access.

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Effectiveness of Selective Laser Trabeculoplasty Applied to 360° vs. 180° of the Angle

Journal of Ophthalmology ◽

10.1155/2021/8860601 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Abraham Nirappel ◽

Emma Klug ◽

Rebecca Ye ◽

Nathan Hall ◽

Marika Chachanidze ◽

...

Keyword(s):

Proportional Hazard ◽

Selective Laser Trabeculoplasty ◽

Proportional Hazard Model ◽

Laser Trabeculoplasty ◽

Cox Proportional Hazard ◽

Kaplan Meier ◽

Significant Difference ◽

The Mean ◽

Cumulative Probabilities

Purpose. To compare the effectiveness and safety of 360° and 180° of Selective Laser Trabeculoplasty (SLT) for the treatment of elevated intraocular pressure (IOP). Methods. Retrospective cohort study. The main outcome measure was the Kaplan–Meier analysis comparing the cumulative probabilities of survival between the 360° and 180° SLT groups in terms of IOP reduction. Success was defined as ≥20% IOP reduction from baseline with an IOP between 5–18 mmHg and ≤1 glaucoma medication added postoperatively. Additional outcome measures included changes in average IOP, number of glaucoma medications, and the incidence of postoperative IOP spikes. Measurements were obtained at 6 weeks, 1 year, and 2 years postoperatively. Results. Two hundred and fifty-eight eyes of 258 patients were included in the 360° group, and 196 eyes of 196 patients were included in the 180° group. The mean IOP reductions at 2 years were 2.21 ± 2.02 mmHg and 2.43 ± 1.81 mmHg ( p = 0.33 ) in the 180° and 360° groups, respectively. There were no significant differences in the incidence of postoperative IOP spikes between the two groups. There was a significant difference in the survival curves of the two groups ( p = 0.035 ). The Cox proportional-hazard model indicated that 360° of SLT application was a significant predictor of long-term success ( p = 0.030 ). Conclusions. 360° of SLT application seems to provide for greater long-term IOP control than 180° of application without putting patients at an elevated risk for postoperative IOP spikes.

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

Kidney360 ◽

10.34067/kid.0000462020 ◽

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.

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754 Non-conducted premature atrial complexes: a new predictor for atrial fibrillation in cryptogenic stroke patients

European Heart Journal Supplements ◽

10.1093/eurheartj/suab127.004 ◽

2021 ◽

Vol 23 (Supplement_G) ◽

Author(s):

Giampaolo Vetta ◽

Antonio Parlavecchio ◽

Rodolfo Caminiti ◽

Michele Magnocavallo ◽

Carlo Lavalle ◽

...

Keyword(s):

Atrial Fibrillation ◽

Hazard Analysis ◽

Cryptogenic Stroke ◽

Survival Estimate ◽

Electrocardiographic Monitoring ◽

Cox Proportional Hazard ◽

Kaplan Meier ◽

Significant Difference ◽

Electrocardiogram Ecg

Abstract Aims Atrial fibrillation (AF) is the main cardiac cause of stroke, but it frequently remains undetected. In these patient monitoring for AF is recommended using a Holter electrocardiogram (ECG). The aim of the present study is to study non-conducted atrial complexes (ncPAC) recorded on Holter ECG as a new predictor of AF. Methods and results Patients admitted to the Stroke Unit of our hospital for cryptogenic stroke from December 2018 to January 2020 who underwent 24-h electrocardiographic monitoring were prospectively enrolled in the study and were subsequently submitted to 3-month and 6-month follow-up to investigate the occurrence of AF. The study recruited 112 patients. At follow-up visit, AF was diagnosed in 21.4% of the population. The only statistically significant difference between the group with and without a AF diagnosis was the presence of ncPAC (83.3% vs. 16.7%; P < 0.0001). ROC analysis was performed and showed that ncPAC had the best diagnostic accuracy in the AF diagnosis [AUC: 0.798; confidence interval (CI): 0.675–0.921]. The AUC of ncPAC was significantly better than the AUC of premature atrial complexes (PACs) (P < 0.05), CHA2DS2-VASc, HATCH, HAVOC, and C2HEST scores (P < 0.01). Kaplan–Meier curve survival estimate for AF onset by the presence of ncPAC revealed that there was a significant difference in the AF onset between patients with ncPAC and those without (P < 0.0001) and multivariate Cox-proportional hazard analysis revealed that ncPAC presence was an independent predictors of AF onset [hazards ratio (HR): 9.28; CI 95%: 2,66–32,40; P = 0.0001]. Conclusions The presence of ncPAC represents a new predictor of AF that could further guide the investigation of AF in patients with cryptogenic stroke.

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The long‐term outcome of MOGAD: An observational national cohort study of 61 patients

European Journal of Neurology ◽

10.1111/ene.14746 ◽

2021 ◽

Vol 28 (5) ◽

pp. 1659-1664

Author(s):

Romain Deschamps ◽

Julie Pique ◽

Xavier Ayrignac ◽

Nicolas Collongues ◽

Bertrand Audoin ◽

...

Keyword(s):

Cohort Study ◽

Term Outcome ◽

Long Term Outcome ◽

National Cohort

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Forearm brachial artery to brachial vein looped arteriovenous grafts: A single center, single surgeon observational study

The Journal of Vascular Access ◽

10.1177/11297298211015095 ◽

2021 ◽

pp. 112972982110150

Author(s):

Jeremy Liu ◽

Josiah Situmeang ◽

Devin Takahashi ◽

Russell Harada

Keyword(s):

Primary Patency ◽

The Body ◽

Secondary Patency ◽

Close Monitoring ◽

Arteriovenous Graft ◽

Inclusion Criteria ◽

Kaplan Meier ◽

Brachial Vein ◽

Arteriovenous Grafts

Background: Long-term hemodialysis (HD) treatment requires the establishment of a cannulatable vascular access (VA) point. While the arteriovenous fistula (AVF) is considered the gold standard, the arteriovenous graft (AVG) is a viable alternative especially in patients with poor superficial venous anatomy. Few studies have assessed the efficacy of the brachial-brachial arteriovenous graft (BB-AVG) for long-term HD access. By analyzing one surgeon’s experience in creating, surveilling and maintaining BB-AVGs, this retrospective study aims to add to the body of literature in assessing patency outcomes of BB-AVGs. Methods: We identified 57 BB-AVGs that met inclusion criteria and were created between October 6, 2005 and May 1, 2019 by a single surgeon in 54 patients. We analyzed primary failures, patency, complications and interventions. Patency rates were calculated by the Kaplan–Meier method. The incidence of complications and interventions were expressed as number of events per person-year. Results: A total of 54 patients (median age of 65 years) were analyzed. Primary patency rates at 12, 24, and 36 months were 20.4% 7.4%, and 5.0%. Primary assisted patency rates at 12, 24, and 36 months were 46.7%, 33.5%, and 15.1%. The secondary patency rates at 12, 24, and 36 months were 81.8%, 63.8%, and 60.1%, respectively. The incidence of complications and interventions was 2.164 per person-year. Most complications and interventions were due to stenosis (1.202 per person-year) or thrombosis (0.802 per person-year). Conclusion: In patients with poor superficial veins, the brachial vein is a reasonable alternative to use as the venous outflow. However, in order to achieve acceptable patency rates, close monitoring of the VA, as well as aggressive treatment of complications within the brachial vein is necessary. Overall, the BB-AVG should be considered in patients who lack adequate superficial veins and require preservation of the more proximal veins.

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Cohort study of the overall survival of patients with pancreatic cancer in a hospital of specialties of Quito-Ecuador in the period 2007–2017

Innovative Surgical Sciences ◽

10.1515/iss-2020-0030 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Andrés Moreno Roca ◽

Luciana Armijos Acurio ◽

Ruth Jimbo Sotomayor ◽

Carlos Céspedes Rivadeneira ◽

Carlos Rosero Reyes ◽

...

Keyword(s):

Pancreatic Cancer ◽

Cohort Study ◽

Survival Time ◽

Univariate Analysis ◽

Rank Test ◽

Kaplan Meier ◽

Significant Difference ◽

Icd 10 ◽

The Difference ◽

Clinical Records

Abstract Objectives Pancreatic cancers in most patients in Ecuador are diagnosed at an advanced stage of the disease, which is associated with lower survival. To determine the characteristics and global survival of pancreatic cancer patients in a social security hospital in Ecuador between 2007 and 2017. Methods A retrospective cohort study and a survival analysis were performed using all the available data in the electronic clinical records of patients with a diagnosis of pancreatic cancer in a Hospital of Specialties of Quito-Ecuador between 2007 and 2017. The included patients were those coded according to the ICD 10 between C25.0 and C25.9. Our univariate analysis calculated frequencies, measures of central tendency and dispersion. Through the Kaplan-Meier method we estimated the median time of survival and analyzed the difference in survival time among the different categories of our included variables. These differences were shown through the log rank test. Results A total of 357 patients diagnosed with pancreatic cancer between 2007 and 2017 were included in the study. More than two-thirds (69.9%) of the patients were diagnosed in late stages of the disease. The median survival time for all patients was of 4 months (P25: 2, P75: 8). Conclusions The statistically significant difference of survival time between types of treatment is the most relevant finding in this study, when comparing to all other types of treatments.

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

Vascular ◽

10.1177/17085381211004306 ◽

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

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