Trans-radial percutaneous intervention for thrombosed hemodialysis access: A single-center experience

Background: Traditionally, percutaneous transluminal angioplasty (PTA) is a first-line approach for stenosed dialysis accesses and has been performed through the non-thrombosed vein segment. For thrombosed accesses, thrombectomy (whether open or percutaneous) is a standard approach. The primary objective of our study is to determine the clinical and technical outcomes of the trans-radial approach of PTA among thrombosed dialysis accesses, in terms of safety and feasibility, technical and clinical aspects and factors influencing them, as well as assisted primary patency, secondary patency at 6 and 12 months. Methods: This is a single-center retrospective study that included 150 patients over 3 years. About 123 patients underwent successful percutaneous balloon angioplasty through the radial access. Results: We report an overall technical and clinical success rate of 82%, assisted primary patency rate of about 90.25% at 3 months, 82.93% at 6 months, 73.18% at 1 year, and secondary patency rate of 94% at 1 year. Twenty-seven patients were referred for surgical revisions/creation of a new fistula for reasons like inability to pass wire (6 patients), unfavorable anatomical variations like aneurysms at the proximal segments (5 patients), inability to cross the fistula (5 patients), and persistent fistula dysfunction with no flow after initial balloon dilatation (11 patients). Three patients had hematoma at the radial access site (2.5%) while two patients had the AV fistula segment rupture and were successfully treated conservatively. Conclusion: We conclude that PTA through the trans-radial approach to completely thrombosed hemodialysis accesses is a good alternative to transvenous access and has a very good assisted primary patency and secondary patency at 1 year without major complications.

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Factors associated with infrainguinal bypass graft patency at 1-year; a retrospective analysis of a single centre experience

Perfusion ◽

10.1177/0267659121995760 ◽

2021 ◽

pp. 026765912199576

Author(s):

Pasha Normahani ◽

Ismail Yusuf Anwar ◽

Alona Courtney ◽

Amish Acharya ◽

Viknesh Sounderajah ◽

...

Keyword(s):

Retrospective Analysis ◽

Patency Rate ◽

Bypass Graft ◽

Graft Patency ◽

Primary Patency ◽

Rank Test ◽

Secondary Patency ◽

Factors Associated ◽

Independent Variables ◽

Secondary Patency Rate

Introduction: The aim of this study was to identify factors associated with primary graft patency 1 year following open lower limb revascularisation (LLR) at a tertiary referral vascular service. Methods: A retrospective analysis of patients undergoing infra-inguinal bypass surgery between January 2016 and May 2017 at a tertiary vascular centre (St Mary’s Hospital, London) was performed. Data regarding patient demographics, comorbidities, type of operation and post-operative anti-thrombotic strategy were collected. Quality of run-off score was assessed from pre-operative imaging. Results: Seventy-seven cases were included in the analysis. Overall, the primary patency rate at 1-year was 63.6% ( n = 49/77) and the secondary patency rate was 67.5% ( n = 52/77). Independent variables with statistically significant inferior patency rates at 1-year were (1) bypasses with below knee targets (p = 0.0096), (2) chronic limb threatening ischaemia indication (p = 0.038), (3) previous ipsilateral revascularisation (p < 0.001) and (4) absence of hypertension history (p = 0.041). There was also a trend towards significance for American Society of Anesthesiologists (ASA) grade (p = 0.06). Independent variables with log-rank test p values of <0.1 were included in a Cox proportional hazards model. The only variable with a statistically significant impact on primary patency rates was previous open or endovascular ipsilateral revascularisation (HR 2.44 (1.04–5.7), p = 0.04). Conclusion: At 1-year follow-up, previous ipsilateral revascularisation was the most significant factor in affecting patency rates. Patients in this subgroup should therefore be deemed high-risk, which should be reflected in the informed consent and peri-operative management.

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Zur Auswahl der Prothese für die Hämodialyse

VASA ◽

10.1024/0301-1526.32.4.209 ◽

2003 ◽

Vol 32 (4) ◽

pp. 209-213 ◽

Cited By ~ 3

Author(s):

Senkaya ◽

Aytac ◽

Ercan ◽

Aliosman ◽

Percin

Keyword(s):

Vascular Access ◽

Vein Graft ◽

Patency Rate ◽

Vascular Grafts ◽

Primary Patency ◽

Secondary Patency ◽

Dialysis Treatment ◽

Secondary Patency Rate ◽

First Choice ◽

Av Fistulas

Background: In patients with chronic renal failure, a major concern is to provide safe and reliable long-term vascular access for haemodialysis. The radiocephalic arteriovenous (AV) fistula remains the first choice vascular access procedure, however the grafts are used in order to obtain vascular access in patients with failed native distal and proximal AV fistulas. The aim of this study was to compare the patency rate of different grafts such as standard wall polytetrafluoroethylene (sPTFE), bovine vein graft, Diastat graft, in these patients. Patients and methods: Four hundred and forty-six AV fistulas were surgically created in 361 patients. Eighty-four out of 361 patients undergoing different graft replacements were retrospectively reviewed. We evaluated the primary patency rates, days between the fistula placement and the last dialysis treatment before thrombosis had occurred, and the secondary patency rate, days between the fistula placement and the last dialysis treatment before the graft was considered completely lost. The graft survival was calculated according to the Kaplan-Meier method. Results: There were 58 (69%) women and 26 (31%) men with a mean age of 54,5 years. The sPTFE (Gore- Tex) graft was used in 41 (41.8%), bovine vein graft (ProCol) in 38 (38.7%) and Diastat vascular grafts in 19 (19.5%) patients. Primary and secondary patency rates for sPTFE graft were 37% and 60%, 68% and 85% for bovine graft and 26% and 42% for Diastat vascular grafts, respectively. Conclusions: This study demonstrates that the bovine vein graft provides the longest patency rate compared to the other grafts even in patients with multiple failed accesses.

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Endovascular Management of Aorta-Iliac Stenosis and Occlusive Disease by Kissing-Stent Technique

Stem Cells International ◽

10.1155/2016/4035307 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 6

Author(s):

Meng Liu ◽

Fuxian Zhang

Keyword(s):

Patency Rate ◽

Fold Increase ◽

Primary Patency ◽

Secondary Patency ◽

Covered Stents ◽

Peripheral Ischemia ◽

Secondary Patency Rate ◽

Catheter Directed Thrombolysis ◽

Artery Disease ◽

Kissing Stent

Kissing-stenting treatment has been used to treat patients with peripheral artery disease (PAD). However, the long term efficacy of the stenting therapy is not well defined in Chinese PAD patients. To investigate the question, sixty-three PAD patients (37 males and 26 females), aged66±7.3years, were analysed in the study. They were featured as claudication (n=45, 71.4%), rest pain (n=18, 28.6%), or gangrene (n=8, 12.7%). In total, 161 stents were applied in aorta-iliac lesions with 2.6 stents for each patient, including 55 self-expanding stents, 98 balloon expandable stents, and 8 covered stents. The success rate of implanting Kissing-stents was 100%. Catheter-directed thrombolysis (CDT) with urokinase was performed in 8 cases (12.7%). The severity of peripheral ischemia was significantly improved, as evidenced by 3.3-fold increase of ankle-brachial pressure index (ABI) after the surgery (P=0.008). One, three, five, and seven years after surgery, the primary patency rate was 87.3%, 77.4%, 71.1%, and 65.0%, whereas the secondary patency rate was 95.2%, 92.5%, 89.5%, and 85.0%, respectively. No in-hospital mortality was recorded. In conclusion, Kissing-stenting technique for aorta-iliac lesions is safe and effective with lower complications. It is beneficial for aorta-iliac occlusions that are longer than 60 mm.

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Long-term outcomes of thigh arteriovenous graft stenting

Urology & Nephrology Open Access Journal ◽

10.15406/unoaj.2021.09.00311 ◽

2021 ◽

Vol 9 (3) ◽

pp. 71-77

Author(s):

Masa Abaza BS ◽

Sloan E Almehmi ◽

Alian AlBalas ◽

Ammar Almehmi

Keyword(s):

Patency Rate ◽

Primary Patency ◽

Secondary Patency ◽

Venous Anastomosis ◽

Stent Deployment ◽

Kaplan Meier ◽

Secondary Patency Rate ◽

Study Population ◽

One Year

Background: Stents have been increasingly used for treating venous anastomosis stenosis seen in arteriovenous grafts (AVGs). A major reason for this trend is that stents can potentially confer a better patency rate compared to angioplasty. However, limited data are available about the outcomes of stents that are used to treat thigh AVG dysfunction. This study sought to assess the primary and secondary patency rates of stents used to treat thigh AVGs dysfunction at one year. Methods: This is a retrospective study of dialysis patients who received therapy via thigh grafts (N=50) and underwent stent placement between January 2005 and June 2017 at our center. Data on demographics and baseline characteristics of the study population were collected. The primary and secondary patency rates were defined as the time between stent deployment and the first intervention and second intervention, respectively. Patency and re-intervention rates were estimated using Kaplan-Meier survival analysis. Results: This study included 50 patients with thigh AVGs; mean age was 50.5± 15.5 years; 52% were female; 80% were black; and 90% had hypertension. The main indication for stenting was thrombosis due to venous anastomosis stenosis (74%). The number (mean ± SD) of stents deployed was 1.24 ± 0.8. The primary patency rate at three months and one year was 58.7% and 30.7%. In comparison, the secondary patency rate at three months and one year was 68.2% and 40.7% (p=0.04) Conclusions: Thigh AVG stenting can be successfully used to improve the overall patency rates of failing AVGs.

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Renal artery surgery in the era of endovascular intervention

VASA ◽

10.1024/0301-1526.33.4.226 ◽

2004 ◽

Vol 33 (4) ◽

pp. 226-230 ◽

Cited By ~ 2

Author(s):

Senekowitsch ◽

Assadian ◽

Wlk ◽

Assadian ◽

Ptakovsky ◽

...

Keyword(s):

Renal Artery ◽

Patency Rate ◽

Open Surgery ◽

Primary Patency ◽

Renal Arteries ◽

Secondary Patency ◽

Abdominal Aneurysm ◽

Therapeutic Concept ◽

Secondary Patency Rate ◽

Renal Artery Reconstruction

Background: In the last decade the therapeutic concept of renovascular disease has changed. The numbers of primary surgical revascularisations have fallen substantially due to the invention of percutaneous transluminal angioplasty (PTA). Patients and methods: Retrospective data analysis. From September 1992 to December 2001, 42 patients were operated on 49 renal arteries at our institution. During the same period, 166 PTA of renal arteries alone and 92 PTA with stent were performed. Twenty-five patients and 27 renal arteries were operated encompassing an aortic reconstruction due to atherosclerosis (aortic occlusion 14, aortic aneurysm 11). The median age at operation was 61 years (range 47 years to 76 years). Four patients were operated on because of renal artery aneurysms with a diameter of more than 2.5 cm. The median age of these patients was 68.5 years (range 60 years to 77 years). Seven patients presented with atherosclerotic changes of the renal artery without aorto-iliac involvement. Their median age was 62.8 years at operation (range 39 years to 77 years). Of these, one suffered from rupture of the renal artery during PTA and needed emergency surgery. Six patients and 11 renal arteries with FMD were surgically reconstructed. Results: The primary patency rate of all reconstructed renal arteries of surviving patients after 5 years was 92%, the secondary patency rate after 5 years was 98%. Two patients died perioperatively (4.7%). One patient had presented with a symptomatic thoraco-abdominal aneurysm and died ultimately because of a stroke. The second patient had an infrarenal AAA and died after a myocardial infarction. Twenty (47.7%) of all surgically treated patients had had at least one PTA preoperatively. Conclusion: During the last decade, primary surgical renal artery reconstruction was performed in about half of the cases. The decrease of primary open surgery of the renal arteries was most striking in patients with aorto-iliac occlusive disease. From 1996 on no patient of this group underwent open surgery without having had prior PTA of the renal arteries.

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Endovascular treatment for chronic atherosclerotic occlusive mesenteric disease: Is stenting superior to balloon angioplasty?

VASA ◽

10.1024/0301-1526/a000056 ◽

2010 ◽

Vol 39 (4) ◽

pp. 319-324 ◽

Cited By ~ 9

Author(s):

Daliri ◽

Grunwald ◽

Jobst ◽

Szucs-Farkas ◽

Diehm ◽

...

Keyword(s):

Endovascular Treatment ◽

Patency Rate ◽

Celiac Artery ◽

Primary Patency ◽

Secondary Patency ◽

Chronic Mesenteric Ischemia ◽

Primary Patency Rate ◽

Secondary Patency Rate

Background: Endovascular treatment is an increasingly used therapeutic option in patients with chronic atherosclerotic occlusive mesenteric disease. Purpose of this study was evaluation of patency and mortality in patients treated with visceral artery percutaneous transluminal angioplasty (PTA) or stenting including follow-up. Patients and methods: A retrospective review of 17 consecutive patients (4 women, 13 men) with endovascular treatment for symptomatic chronic mesenteric ischemia from 1998 to 2004 was performed. Mean follow-up period was 42 months. Patient demographics, interventional details, primary and/or secondary patency and mortality were recorded. Cumulative mortality and patency rates were determined using Kaplan-Meier life table analysis. Results: Twenty-six interventions (PTA alone n = 13, PTA and stenting n = 13) were performed in 17 patients. Interventions were performed in the superior mesenteric artery (n = 13) and celiac artery (n = 13). The re-intervention rate was 30 % (6/26). Re-interventions were performed for the superior mesenteric artery (n = 4) and celiac artery (n = 2). Cumulative overall 1-year results were primary patency rate 81 %, secondary patency rate 94 %, and survival rate 82 %. Cumulative 10-year results were primary patency rate 73 %, secondary patency rate 94 %, and survival rate 65 %. The 10-year secondary patency rate was 100 % in patients post initial stenting and 86 % in patients post initial PTA. Conclusions: Long-term follow-up post endovascular treatment for chronic mesenteric ischemia demonstrated a considerable overall secondary patency rate of 94 %. However, the long-term secondary patency rate was higher in patients post initial stenting compared to PTA alone.

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The Sleeve Method for Creation of Radiocephalic Arteriovenous Fistulas in Patients with Calcified Vessels

The Journal of Vascular Access ◽

10.5301/jva.5000761 ◽

2017 ◽

Vol 18 (5) ◽

pp. 384-389 ◽

Cited By ~ 2

Author(s):

Tomasz Gołębiowski ◽

Wacław Weyde ◽

Krzysztof Letachowicz ◽

Mariusz Kusztal ◽

Hanna Augustyniak-Bartosik ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Patency Rate ◽

Treatment Time ◽

Chronic Kidney Disease Stage ◽

Primary Patency ◽

Disease Stage ◽

Secondary Patency ◽

Secondary Patency Rate ◽

The Creation

Introduction Creation of an arteriovenous fistula (AVF) in patients with advanced atherosclerotic changes of the artery is often a challenge for the physician due to difficulties in suturing the vein to the side of the frangible artery. The sleeve technique relies on advancing the end of the artery into the lumen of the vein and protecting the anastomosis by adventitial sutures. Material and Methods The sleeve technique was performed in 23 patients with chronic kidney disease stage IV and V and included hemodialysis patients. Their mean age was 60.8 ± 14.8 years and hemodialysis treatment time 49.8 ± 40.2 months. The most frequent causes of chronic kidney disease are ischemic nephropathy (43%, n = 10) and type l diabetes (21%, n = 5). Only patients with extremely advanced atherosclerotic were recruited and analyzed. Results The primary patency rate was 67%, 59%, 44% and 28% at 6, 12, 24, and 36 months, respectively. The secondary patency rate was 67%, 61%, 50% and 37% at 6, 12, 24, and 36 months, respectively. In three patients the AVF failed directly after the operation. Delayed fistula failure occurred in seven patients. The overall success in the creation of a functioning fistula was achieved in 15 of the 23 patients (65%). No serious complications were observed. Conclusions In patients with calcified atherosclerotic plaques, which constitute a barrier or make it difficult to suture the vein to the side of the artery, the sleeve method may be considered as an alternative before abandoning the creation of a fistula on the forearm. The technique is much simpler than the standard end-to-side or side-to-side anastomosis.

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Comparison of Acuseal and Standard ePTFE Vascular Grafts for Hemodialysis: A Retrospective Case Series

The Open Urology & Nephrology Journal ◽

10.2174/1874303x01912010004 ◽

2019 ◽

Vol 12 (1) ◽

pp. 4-8 ◽

Cited By ~ 1

Author(s):

Louisa M.S. Gerhardt ◽

Andreas Bock ◽

Regula Marti ◽

Stephan Segerer

Keyword(s):

Vascular Graft ◽

Patency Rate ◽

Medical Center ◽

Case Series ◽

Primary Patency ◽

Clinical Impression ◽

Secondary Patency ◽

Retrospective Case ◽

Secondary Patency Rate ◽

Mean Time

Background: Grafts, which allow early cannulation have been increasingly used to avoid starting dialysis via tunneled hemodialysis catheters. As we noted graft failures in patients with early cannulation grafts, we reviewed the outcome of these grafts and compared it to ePTFE grafts. Materials and Methods: We retrospectively analyzed time to first intervention, primary and secondary patency rates as well as the number of interventions needed to maintain patency in patients who received an early cannulation graft (GORE® ACUSEAL, acuseal) or an ePTFE (GORE-TEX®) vascular graft between January 2016 and November 2017 in our medical center. Results: 12 patients who had received an acuseal vascular graft were compared with 13 patients with an ePTFE vascular graft. The mean time to first intervention was similar in both groups. On average 0.33 interventions per graft were needed per month to maintain patency in the acuseal group, and 0.08 in the ePTFE group (p = 0.02). The primary patency rate did not differ significantly between the groups. The secondary patency rate at the end of the observation period was significantly worse in the acuseal group (p = 0.02). Four acuseal grafts were lost after a mean of 202 days, whereas none of the ePTFE grafts was lost. Conclusion: Our data is consistent with our clinical impression of an increased number of interventions and lower longevity of the acuseal vascular graft. These data need conformation in a larger cohort.

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Use of the Viabahn covered stent for the treatment of venous rupture during interventions of dysfunctional or thrombosed hemodialysis vascular access

The Journal of Vascular Access ◽

10.1177/1129729820961955 ◽

2020 ◽

pp. 112972982096195

Author(s):

Chih-Kuo Lee ◽

Ming-Chien Hsieh ◽

Chien-Ming Luo ◽

Min-Tsun Liao ◽

Mu-Yang Hsieh ◽

...

Keyword(s):

Vascular Access ◽

Patency Rate ◽

Clinical Success ◽

Covered Stent ◽

Primary Patency ◽

Secondary Patency ◽

Covered Stents ◽

Secondary Patency Rate ◽

Hemodialysis Vascular Access ◽

Vessel Rupture

Background: Angioplasty-related vessel rupture is a common complication of interventions. The effect of covered stents to treat venous rupture has been evaluated in smaller series, but should be further evaluated. Objective: To report the immediate outcomes and patency rates of a covered stent to rescue angioplasty-related venous rupture of hemodialysis vascular access. Methods: From January 2013 to December 2018, 113 procedures complicated with vessel ruptures were retrospectively analyzed from a prospectively collected database of 8146 hemodialysis access interventions. The strategies to salvage vessel ruptures were based on the discretion of the treating physicians. Follow-up outcomes were obtained via review of the angiographic images, procedural notes, and medical and dialysis records within 12 months after the index procedures. Results: A total of 52 vessel ruptures (21 fistulas, 31 grafts) salvaged by using Viabahn covered stents were enrolled. Vessel ruptures developed in 28 (53.8%) thrombectomy procedures. Device success was achieved in all procedures (100%) and clinical success was achieved in 50 (96.2%). The primary patency of the stent area was 66.0% at 6 months and 50.0% at 12 months. The primary patency of the entire access circuit was 27.4% at 6 months and 16.0% at 12 months. The most common cause of access circuit primary patency loss was thrombotic occlusion for graft accesses and restenosis at stent area for native accesses. Eleven vascular accesses were abandoned within 12 months after vessel ruptures, and the secondary patency rate of the entire access circuit was 78.0% at 12 months. Conclusions: Treatment of angioplasty-induced vessel rupture of hemodialysis vascular accesses by using Viabahn covered stents has good immediate outcomes and patency results at the stent area. Nonetheless, the patency rate of entire access circuit was still below the threshold recommended by guidelines.

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COVID-19 and Singapore: From Early Response to Circuit Breaker

Annals of the Academy of Medicine, Singapore ◽

10.47102/annals-acadmedsg.2020239 ◽

2020 ◽

Vol 49 (8) ◽

pp. 561-572 ◽

Cited By ~ 2

Author(s):

Jacinta I-Pei Chen ◽

Jason Chin-Huat Yap ◽

Li Yang Hsu ◽

Yik Ying Teo

Keyword(s):

Patency Rate ◽

Primary Patency ◽

Clinical Severity ◽

Venous Disease ◽

Secondary Patency ◽

Post Intervention ◽

Stent Patency ◽

Venous Stenting ◽

Secondary Patency Rate ◽

Venous Clinical Severity Score

Introduction: This paper presents our experience with deep venous stenting in a multi-ethnic Asian cohort of patients with symptomatic Non-Thrombotic Iliac Vein Lesions (NIVL) and Post-Thrombotic Syndrome (PTS). Materials and Methods: This was a multicentre retrospective cohort study of patients who had symptomatic deep venous disease. Stent patency rate was evaluated using Duplex ultrasonography immediately post-intervention and at 3, 6 and 12 months. Clinical outcomes were evaluated using the revised Venous Clinical Severity Score (rVCSS) and Visual Analogue Scale (VAS) pain score at baseline and 3 months post-procedure. Results: 87 patients (males = 47/87 (54.0%)); median age = 62 years (IQR 55 – 70)) and 115 limbs were analysed (left = 76/115 (66.1%)). Median follow-up time was 175 (IQR 57 – 257) days. 97/115 (84.3%) had NIVLs and 55/115 (47.8%) had May-Thurner-Syndrome. 43/115 (37.4%) had Clinical, Etiology, Anatomy and Pathophysiology (CEAP) 6 disease. Primary stent patency rates were 98.2% (112/114), 97.9% (93/95), 95.7% (89/93) and 92.8% (64/69) immediately postintervention, 3, 6 and 12 months, respectively. The 6-month secondary patency rate was 99.1% (114/115). Mean rVCSS and VAS improved from 11.52 (±3.54) to 5.77 (±2.36) (P < 0.01) and 6.62 (±1.93) to 2.92 (±1.50) (P < 0.01) respectively, at 3 months. 41/43 (95.3%) venous ulcers healed over a median time of 169 days (IQR 120 – 253). Conclusions: Short term primary patency rates following deep venous stenting are excellent, with few re-interventions. Patients presented with NIVLs rather than PTS. There was excellent clinical improvement at 3 months, with a high and expedient venous ulcer healing rate. Key words: Containment, Coronavirus, Epidemic, Outbreak, Pandemic

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