Salvage of thrombosed arteriovenous fistulae of patients on hemodialysis: report on the experience of a Brazilian center

ABSTRACT Introduction: Hemodialysis vascular access thrombosis is an acute event that can interrupt the dialytic treatment. A timely management can restore access patency, avoiding the use of central venous catheters and their complications. Objective: To present the experience from a Brazilian Interventional Nephrology Center (INC) in the salvage of arteriovenous fistula (AVF) and grafts for hemodialysis. Methods: A retrospective study was performed to evaluate the primary and secondary patencies of 41 hemodialysis accesses with thrombosis confirmed by ultrasound and submitted to endovascular salvage procedures. We considered clinical success the use of the access for at least 3 subsequent hemodialysis sessions. The procedures were done in an outpatient center by interventional nephrologists. Patients were followed for up to 18 months with Doppler every 3 months. Results: Forty-five salvage procedures were performed in 41 accesses of 40 hemodialysis patients with native AVF or grafts. Of these, 90% were AVF, mostly upper arm, and 10% were grafts. Clinical success rate was 60% (27 procedures). Primary patency at 12 months was 39% and secondary was 52%. Gender of the patient, diabetes, and location of the access did not correlate statistically with outcomes. There were 3 major complications (anastomosis rupture, grade 3 hematoma, and anaphylactic shock). Conclusion: The majority of thrombosed accesses can be successfully treated, maintaining its long-term patency. The need of repeated intervention is frequent.

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Long-term Results with the Palmaz Stent in the Superficial Femoral Artery

Journal of Endovascular Therapy ◽

10.1177/152660289500200207 ◽

1995 ◽

Vol 2 (2) ◽

pp. 161-167 ◽

Cited By ~ 14

Author(s):

Patrice Bergeron ◽

Jean J. Pinot ◽

Vincent Poyen ◽

Huber Benichou ◽

Patrick Khanoyan ◽

...

Keyword(s):

Femoral Artery ◽

Superficial Femoral Artery ◽

Clinical Success ◽

Clinical Success Rate ◽

Primary Patency ◽

Long Term Results ◽

Secondary Patency ◽

Critical Ischemia

Purpose: Femoral stenting has demonstrated inconsistent and often disappointing long-term results. To compare our experience, we retrospectively analyzed a series of patients who had Palmaz balloon-expandable stents placed exclusively for superficial femoral artery (SFA) lesions. Methods: From January 1990 to November 1993, 39 patients were evaluated for claudication (79%) or critical ischemia in 42 limbs. The culprit lesions were confined to the SFA: 24 (57%) occlusions and 18 (43%) stenoses, including 3 restenotic lesions. Stenting was elective in 12 (29%) cases: the 3 restenoses and 9 chronic, calcified occlusions. The remaining stents were applied for postangioplasty residual stenosis or angioscopic findings of thrombogenic luminal irregularities. A total of 55 prostheses were successfully implanted. All patients were maintained on ticlopidine and followed by routine duplex scanning. Follow-up angiography was performed in 28 (72%) patients between 4 and 45 months. Results: In the postprocedural period, two acute thromboses (4.8%) occurred within 48 hours in patients who had long occlusions and poor runoff; no other major complications were encountered, for a clinical success rate of 95%. Follow-up evaluation ranged from 4 months to 4 years with a mean of 25 months. The restenosis rate was 19% (34% in occlusions; 10% in stenotic lesions, p = NS). At 24 months, cumulative primary patency was 77% and secondary patency 89%. Conclusions: Palmaz stents performed well in the SFA, demonstrating a low acute thrombosis rate and good long-term patency. The incidence of restenosis is likely to be greater in occlusions than in stenoses.

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Clinical outcome of endoscopic therapy in patients with symptomatic pancreas divisum: a Dutch cohort study

Endoscopy International Open ◽

10.1055/a-1460-7899 ◽

2021 ◽

Vol 09 (07) ◽

pp. E1164-E1170

Author(s):

David M. de Jong ◽

Pauline M. Stassen ◽

Jan Werner Poley ◽

Paul Fockens ◽

Robin Timmer ◽

...

Keyword(s):

Acute Pancreatitis ◽

Cohort Study ◽

Endoscopic Therapy ◽

Clinical Success ◽

Pancreas Divisum ◽

Univariate Analysis ◽

Clinical Success Rate ◽

Recurrent Acute Pancreatitis ◽

Pancréas Divisum

Abstract Background and study aims Although the majority of patients with pancreas divisum (PDiv) are asymptomatic, a subgroup present with recurrent pancreatitis or pain for which endoscopic therapy may be indicated. The aim of this study was to evaluate success rates and long-term outcomes of endoscopic treatment in patients with symptomatic PDiv. Patients and methods A multicenter, retrospective cohort study was performed. Patients with symptomatic PDiv presenting with recurrent acute pancreatitis (RAP), chronic pancreatitis (CP), or chronic abdominal pancreatic-type pain (CAP) who underwent endoscopic retrograde cholangiopancreatography (ERCP) between January 2000 and December 2019 were included. The primary outcome was clinical success, defined as either no recurrent episode of acute pancreatitis (AP) for RAP patients, no flares for CP patients, or absence of abdominal pain for patients with CAP after technically successful ERCP. Results In 60 of 81 patients (74.1 %) a technically successful papilla minor intervention was performed. Adverse events were reported in 30 patients (37 %), with post-ERCP pancreatitis in 18 patients. The clinical success rate for patients with at least 3 months of follow-up was 42.6 %, with higher rates of success among patients presenting with RAP (44.4 %) as compared to those with CP (33.3 %) or CAP (33.3 %). Long-term sustained response was present in 40.9 % of patients with a technically successful intervention. In patients with RAP who did not completely respond to treatment, the mean number of AP episodes after treatment decreased significantly from 3.5 to 1.1 per year, and subsequently the interval between AP episodes increased from 278 to 690 days (P = 0.0006). A potential predictive factor of failure of clinical success after technically successful ERCP, at univariate analysis, was male sex (OR = 0.25, P = 0.02). Conclusions Endoscopic therapy in patients with symptomatic PDiv is moderately effective, with its highest yield in patients presenting with RAP. Future studies are needed to assess factors predictive for success of endoscopic therapy and potential risk factors for relapse after ERCP.

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Endoscopic Ultrasound-Guided Drainage and Treatment of Symptomatic Pancreatic Fluid Collection following Acute or Acute-on-Chronic Pancreatitis – A Single Center Case Series

Zentralblatt für Chirurgie - Zeitschrift für Allgemeine Viszeral- Thorax- und Gefäßchirurgie ◽

10.1055/a-0638-8505 ◽

2018 ◽

Vol 143 (06) ◽

pp. 577-585

Author(s):

Dominik Kaczmarek ◽

Jacob Nattermann ◽

Christian Strassburg ◽

Tobias Weismüller

Keyword(s):

Success Rate ◽

Endoscopic Ultrasound ◽

Clinical Success ◽

Fluid Collection ◽

Clinical Success Rate ◽

Long Term Results ◽

Pancreatic Fluid Collection ◽

Endoscopic Procedures ◽

Pancreatic Fluid

Abstracts Introduction Pancreatic fluid collection (PFC) is a common complication of acute pancreatitis. Endoscopic ultrasound (EUS)-guided drainage, which is often followed by direct endoscopic necrosectomy (DEN), has become the primary approach to treat PFC, including pancreatic pseudocysts (PP) and walled-off necrosis (WON). We aimed to determine retrospectively the short- and long-term results of patients treated in our endoscopy unit and to identify parameters that are associated with treatment efficacy and outcome. Methods The data of 41 consecutive patients with post-pancreatitic PFC, who underwent endoscopic transmural intervention between 2014 and 2016, were analyzed retrospectively. After an initial EUS-guided puncture, one or more plastic stents were placed and DEN was performed if necrotic tissue remained. Results The mean diameter of the PFC was 74.0 ± 4.8 mm. Of the PFCs, 29.3% were classified as PP and 70.7% as WON. Altogether, 196 transmural endoscopic procedures were performed, including 73 endoscopic necrosectomies in a subgroup of 21 patients (20 WON, 1 PP). Initial technical success was achieved in 97.6% of patients and the short-term clinical success rate was 90.2%. The long-term clinical success rate was 82.9%, since four patients died from septic shock and/or multiple organ failure and three patients developed recurrent PFC some months after the initial discharge from endoscopic treatment. Procedural complications were registered in 9 patients during 10 of 196 endoscopic procedures (5.1%): bleeding (6), cardiorespiratory insufficiency (2), perforation with pneumoperitoneum (1), aspiration with respiratory insufficiency (1), and non-perforating superficial damage of the gastric wall (1). Neither the size of the PFC nor the initial value of C-reactive protein (CRP) or other biochemical markers were correlated with efficacy or outcome of treatment. Only the cumulative number of days with CRP > 50 mg/L significantly correlated with the number of follow-up endoscopic sessions and DEN. Fungal colonization of PFC correlated significantly (p < 0.05) with the risk of mortality (44% vs. 0%), need for intensive care treatment (66.7% vs. 25%), and sepsis (55.6% vs. 12.5%). Conclusions We confirm that EUS-guided drainage followed by DEN in patients with solid necrotic material is an effective and relatively safe therapeutic approach. Prolonged elevation of CRP and fungal colonisation of the PFC are associated with a worse course of the disease.

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One-year results of gastric peroral endoscopic myotomy for refractory gastroparesis: a French multicenter study

Endoscopy ◽

10.1055/a-1205-5686 ◽

2020 ◽

Author(s):

Olivier Ragi ◽

Jérémie Jacques ◽

Julien Branche ◽

Sarah Leblanc ◽

Geoffroy Vanbiervliet ◽

...

Keyword(s):

Success Rate ◽

Multicenter Study ◽

Clinical Success ◽

Clinical Success Rate ◽

Peroral Endoscopic Myotomy ◽

Gastric Retention ◽

Endoscopic Myotomy ◽

Cardinal Symptom

Abstract Background: Data on the long-term outcomes of gastric peroral endoscopic myotomy (G-POEM) for refractory gastroparesis are lacking. We report the results of a large multicenter long-term follow-up study of G-POEM for refractory gastroparesis. Methods: This was a retrospective multicenter study of all G-POEM operations performed in seven expert French centers for refractory gastroparesis with at least 1 year of follow-up. The primary endpoint was the 1-year clinical success rate, defined as at least a 1-point improvement in the Gastroparesis Cardinal Symptom Index (GCSI). Results: 76 patients were included (60.5 % women; age 56 years). The median symptom duration was 48 months. The median gastric retention at 4 hours (H4) before G-POEM was 45 % (interquartile range [IQR] 29 % – 67 %). The median GCSI before G-POEM was 3.6 (IQR 2.8 – 4.0). Clinical success was achieved in 65.8 % of the patients at 1 year, with a median rate of reduction in the GCSI score of 41 %. In logistic regression analysis, only a high preoperative GCSI satiety subscale score was predictive of clinical success (odds ratio [OR] 3.41, 95 % confidence interval [CI] 1.01 – 11.54; P = 0.048), while a high rate of gastric retention at H4 was significantly associated with clinical failure (OR 0.97, 95 %CI 0.95 – 1.00; P = 0.03). Conclusions: The results confirm the efficacy of G-POEM for the treatment of refractory gastroparesis, as evidenced by a 65.8 % clinical success rate at 1 year. Although G-POEM is promising, prospective sham-controlled trials are urgently needed to confirm its efficacy and identify the patient populations who will benefit most from this procedure.

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Long-term follow-up of abandoned transvenous defibrillator leads: a nationwide cohort study

EP Europace ◽

10.1093/europace/euaa086 ◽

2020 ◽

Vol 22 (7) ◽

pp. 1097-1102

Author(s):

Anders Fyhn Elgaard ◽

Jens Brock Johansen ◽

Jens Cosedis Nielsen ◽

Christian Gerdes ◽

Sam Riahi ◽

...

Keyword(s):

Clinical Success ◽

Extraction Procedure ◽

Clinical Success Rate ◽

High Volume ◽

Lead Extraction ◽

Related Data ◽

Major Complications ◽

Long Term Follow Up

Abstract Aims Commonly, a dysfunctional defibrillator lead is abandoned and a new lead is implanted. Long-term follow-up data on abandoned leads are sparse. We aimed to investigate the incidence and reasons for extraction of abandoned defibrillator leads in a nationwide cohort and to describe extraction procedure-related complications. Methods and results All abandoned transvenous defibrillator leads were identified in the Danish Pacemaker and ICD Register from 1991 to 2019. The event-free survival of abandoned defibrillator leads was studied, and medical records of patients with interventions on abandoned defibrillator leads were audited for procedure-related data. We identified 740 abandoned defibrillator leads. Meantime from implantation to abandonment was 7.2 ± 3.8 years with mean patient age at abandonment of 66.5 ± 13.7 years. During a mean follow-up after abandonment of 4.4 ± 3.1 years, 65 (8.8%) abandoned defibrillator leads were extracted. Most frequent reason for extraction was infection (pocket and systemic) in 41 (63%) patients. Procedural outcome after lead extraction was clinical success in 63 (97%) patients. Minor complications occurred in 3 (5%) patients, and major complications in 1 (2%) patient. No patient died from complication to the procedure during 30-day follow-up after extraction. Conclusion More than 90% of abandoned defibrillator leads do not need to be extracted during long-term follow-up. The most common indication for extraction is infection. Abandoned defibrillator leads can be extracted with high clinical success rate and low risk of major complications at high-volume centres.

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Periprocedural and Long-Term Outcomes of Stent Implantation for De Novo Subclavian Artery Disease

Vascular and Endovascular Surgery ◽

10.1177/1538574418824444 ◽

2019 ◽

Vol 53 (4) ◽

pp. 284-291

Author(s):

Hirokazu Onishi ◽

Toru Naganuma ◽

Koji Hozawa ◽

Tomohiko Sato ◽

Hisaaki Ishiguro ◽

...

Keyword(s):

Subclavian Artery ◽

Stent Implantation ◽

De Novo ◽

Clinical Success ◽

Primary Patency ◽

Success Rates ◽

Long Term Outcomes ◽

Procedural Success

Introduction: The purpose of the current study was to investigate the periprocedural and long-term outcomes of stent implantation for de novo subclavian artery (SCA) disease. Material and Methods: We retrospectively investigated consecutive patients with de novo SCA lesions undergoing elective endovascular therapy procedures at our center between April 2004 and September 2015. All patients were included in the analyses of periprocedural outcomes, including procedural and clinical success. Subsequently, patients who completed the clinical follow-up and were assessed with brachial systolic pressure differences between the diseased and the contralateral arms, or angiographic stenosis, after stent implantation with procedural success were included in the analyses of long-term outcomes, including primary patency. Results: There were 62 patients (median 71.0 years, interquartile range 65.3-76.0 years; 45 men) with 62 de novo SCA lesions included in the analyses of periprocedural outcomes. There were 46 stenoses (74.2%) and 16 occlusions (25.8%). Our results indicated high procedural success rates for overall (95.2%), stenotic (97.8%), and occlusive (87.5%) lesions. Similarly, high clinical success rates were observed for overall (91.9%), stenotic (93.5%), and occlusive (87.5%) lesions. The median follow-up time was 6.0 years (interquartile range, 2.6-8.3 years). There were 48 patients with 48 de novo SCA lesions included in the analyses of long-term outcomes. Primary patency estimates were 97.7% (1 year), 97.7% (3 years), 93.1% (5 years), and 87.6% (7 years). Also, we observed a high estimate for freedom from reintervention for the target vessel (93.8%). Conclusion: Stent implantation for de novo SCA disease can be performed successfully and safely with favorable periprocedural and long-term outcomes.

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Effects of different catheter replacement methods on catheter service time and complications in hemodialysis patients: A cohort study

The Journal of Vascular Access ◽

10.1177/1129729819891336 ◽

2019 ◽

Vol 21 (4) ◽

pp. 497-503

Author(s):

Haibo Yu ◽

Qi Xin ◽

Xuewen Wang ◽

Lan Jia ◽

Junming Wang ◽

...

Keyword(s):

Service Time ◽

Patency Rate ◽

Venous Catheter ◽

Primary Patency ◽

Catheter Insertion ◽

Central Venous ◽

Primary Patency Rate ◽

Catheter Replacement

Introduction: Central venous catheter insertion for long-term vascular access is not recommended in clinical practice. However, since arteriovenous fistula creation is difficult to perform in some patients, central venous catheter insertion for long-term vascular access is performed. This study aimed to assess the complications and service time of central venous catheters replaced using different methods and to determine the influencing factors of service time. Methods: Study design: A retrospective observational cohort study. Setting and participants: Patients who underwent tunneled dialysis catheter malfunction (2009–2019) and had to undergo another dialysis catheter insertion were enrolled. Exposures: Ectopic replacement and in situ replacement. Outcomes: Factors such as age, sex, primary patency rate, secondary patency rate, early complications, and late complications were considered. Analytical approach: This study used a Cox proportional hazards regression model. Results: The first and the newly replaced catheter service time were 37.779 ± 24.563 months and 32.468 ± 26.638 (25) months in the ectopic group and 37.075 ± 20.550 months and 26.349 ± 22.672 months in the in situ group, respectively. In the early service time, the newly replaced catheter resulted in significant bleeding from the tunnel. The first catheter had the least complications, most adequate blood flow, and longest service time. Ectopic catheter replacement and the tip shape of the catheter were the independent factors for catheter service time. Catheter service time increased with age. Conclusion: Ectopic catheter replacement can improve the primary patency rate and auxiliary primary patency rate of catheters. Ectopic catheter replacement may require sufficient surgical skills with digital subtraction angiography, resulting in a better prognosis.

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Use of dehydrated human amnion chorion membrane allograft on infected ruptured arteriovenous fistula: revision and closure

Journal of Wound Care ◽

10.12968/jowc.2019.28.sup10.s10 ◽

2019 ◽

Vol 28 (Sup10) ◽

pp. S10-S12

Author(s):

Mutaz Al-Khateeb ◽

Zaki Al-Muzakki ◽

Mohammed Ftyan ◽

Hussam Itani ◽

Niki Istwan ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Vascular Access ◽

Haemodialysis Patient ◽

Primary Patency ◽

Human Amnion ◽

Novel Approach ◽

Hemodialysis Vascular Access ◽

Stage Renal Disease ◽

End Stage

Objective: Over two million individuals worldwide, with end-stage renal disease (ESRD), depend on dialysis therapy or a kidney transplant for survival. Every haemodialysis patient requires vascular access. The arteriovenous fistula (AVF) is preferred for long-term hemodialysis vascular access due to long-term primary patency rates. Given the limited options for haemodialysis access and placement, preservation of existing AVF sites is always a clinical priority. This case report describes a novel approach to wound closure with the application of dehydrated amnion chorion human membrane (dHACM) at an AVF surgical site known to be complicated with issues of scarring and tissue breakdown. The patient was treated successfully with the imperative preservation of his AVF given that he had few other vascular access options.

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Langzeitergebnisse der systemischen Thrombolysetherapie bei aorto-iliakaler Verschlusskrankheit

VASA ◽

10.1024/0301-1526.30.3.212 ◽

2001 ◽

Vol 30 (3) ◽

pp. 212-218

Author(s):

Robert A. Bucek ◽

G. Schnürer ◽

M. Haumer ◽

M. Reiter ◽

A. Ahmadi ◽

...

Keyword(s):

Patency Rate ◽

Clinical Success ◽

Prospective Trial ◽

Transluminal Angioplasty ◽

Primary Patency ◽

Occlusive Disease ◽

Long Term Results ◽

Primary Patency Rate ◽

Lysis Therapy

Background: Long term results of systemic lysis therapy with ultrahigh-dose urokinase (UHUK) in reopening aorto-iliac occlusive disease have not yet been evaluated. This prospective trial investigates the long-term primary patency rate, the rate of complications and assesses the role of different expected influence parameters on the primary patency rate. Patients and methods: 72 patients with aorto-iliac occlusive disease received daily intravenous infusions of UHUK either until reperfusion or – after at least 3 cycles – no progress in recanalization could be stated on two consecutive days by duplex scanning. Results: Systemic lysis therapy was morphological at least partially successful in 44 patients (61.1%). Concomitant percutaneous transluminal angioplasty was performed in 41 patients (56.9%), surgery in 7 patients (9.7%) and both in further 5 patients (6.9%). In patients without surgery hemodynamical success could be achieved in 39 patients (54.2%) and even more important clinical success in 51 patients (70.8%). Compared to baseline results patients improved significantly in ankle/brachial pressure index and in Fontaine stages (p < 0,001), the same results could be seen after a mean follow-up period of 62 months. Thrombolysis was complicated in 4 patients (5.6%) by macroembolizations but no major bleedings or deaths occurred. Primary patency was 76%, 64%, and 43% after 1, 5 and 10 years. Male sex and distal localization were significantly correlated with lower primary clinical patency. Conclusion: Systemic lysis therapy is an alternative to surgical intervention in acute and subacute aorto-iliac occlusive disease, because it offers acceptable long-term results with a low rate of complications.

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Different Activities of Osteoblast and Bacteria on a Nanostructured Titanium Surface for Dental Implant

Advanced Materials Research ◽

10.4028/www.scientific.net/amr.586.39 ◽

2012 ◽

Vol 586 ◽

pp. 39-44 ◽

Cited By ~ 3

Author(s):

Yan Hua Zheng ◽

Jin Bo Li ◽

Xuan Yong Liu ◽

Jiao Sun

Keyword(s):

Dental Implant ◽

Titanium Surface ◽

Clinical Success ◽

Pure Titanium ◽

Clinical Success Rate ◽

Antimicrobial Effect ◽

Antibacterial Activities ◽

Nanostructured Titanium ◽

Good Antibacterial Activity

Insufficience of osteogenesis and antimicrobial effect have been still impacted the long term clinical success rate of dental implants. A nanostructured titanium surface prepared by hydrothermal treatment with H2O2 was evaluated on its osteoblastic viability and antibacterial effect. Samples were divided into 2 groups: untreated pure titanium surface (Ti) and a nanostructured titanium surface (NT). The antibacterial activities against S.mutans and C.albicans were measured by film applicator coating assay, as well as the live/dead bacteria stain. The osteoblastic viability was investigated by SEM and MTT assay. Results showed that the active microbia on NT was reduced at 24h (P<0.05) significantly according to the live/dead bacteria stain and film applicator coating assay, which could also enhance the osteoblast viability. Therefore, a nanostructured titanium surface exhibits good antibacterial activity on S.mutans and C.albicans, and promoting osteoblast viability, which will be a potential kind of dental implant material.

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