Retrospective Review of Arteriovenous Fistula Success Rate in a Multi-ethnic Asian Population

Introduction: Repair of Tetralogy of Fallot up until recent decades involved aggressive resection and annular enlargement through a right ventriculotomy. This resulted in ventricular scarring and pulmonary incompetence, with an increased risk of ventricular tachyarrhythmia and sudden death in young adulthood. Following the NICE guidelines, implantation of ICDs as primary prevention in patients with repaired Tetralogy is ever increasing. This study aims to determine the rate of appropriate and inappropriate discharges, the success rate of ICD therapy and the impact of ICD implantation on the use of anti-arrhythmic medication in this population of patients. Materials and Methods: This is a retrospective review of patients with repaired Tetralogy of Fallot (n = 18) and pulmonary stenosis (n = 2) with implantable cardioverter defibrillators managed at our tertiary centre. Patients were identified from our outpatient database, their notes and charts were examined and details regarding indication for ICD implantation, device specifications and complications following implantation were collected. Data was also collected on the incidence of appropriate and inappropriate therapies and the success rate of ICD therapy along with the impact of implantation on the usage of anti-arrhythmic medication in these patients. Results: Of the 20 patients, 18 had previous repair of Tetralogy of Fallot and 2 had pulmonary valvotomy and infundibular resection for pulmonary stenosis between 1969 and 1989. 70% (n = 14) of these patients required reoperation with 10 patients having pulmonary valve replacements (PVR), 3 having redo infundibular resections and 1 requiring aortic valve replacement. At the time of consideration for ICD implantation 80% had moderate to severe pulmonary incompetence and 60% had more than mild right ventricular dilatation on echocardiography. Indications for ICD implantation were symptomatic ventricular tachycardia requiring cardioversion (n = 8), ventricular tachycardia on 24 hr tape/Reveal or electrophysiological study (n = 8), ventricular fibrillation (VF)/pulseless ventricular tachycardia (VT) (n = 2) and syncope with an abnormal EPS other than VT (n = 2, high grade ventricular ectopics, sinus node dysfunction).The median age at implantation was 22 years (16.4–43 years). All our patients had dual chamber devices implanted with either dual (n = 13) or single coil (n = 6) ventricular leads. GEM3 AT (n = 5), Marquis DR (n = 8) and Maximo DR (n = 7) generators (Medtronic Inc.) were implanted in sub pectoral position and both anti-tachycardia pacing and cardioversion modes were programmed as part of individualised VT and VF protocols. Early post procedural complications included atrial lead displacement (n = 1) and pneumothorax requiring drainage (n = 1).During a median follow up of 1.6 years (0.03– 4.5 years) several episodes of inappropriate therapies were noted in 6 patients (30%) especially early after implantation. This was found to be mainly due to atrial tachyarrhythmia, double counting of T waves or inaccurate interpretation of varying PR intervals as AV dyssynchrony which were effectively dealt with by changes in device programming. There were 33 episodes of inappropriate anti-tachycardia pacing (ATP) in 4 patients and 19 episodes of inappropriate cardioversion in 5 patients. Appropriate ATP was instituted in 4 patients (25%) with successful termination of all 20 episodes (100% success rate) of ventricular tachycardia. One patient required cardioversion with successful termination of VF. One patient (5%) with troublesome tachyarrhythmia died suddenly of unknown cause, 10 months after AICD implantation having had no detections or therapies on his device.Prior to ICD implantation 8 patients were on amiodarone therapy. At the time of last follow up after AICD implantation all patients were established on anti-arrhythmic agents and of these 6 patients were on amiodarone with the others being effectively managed on beta-blockers and/or flecainide.Late complications of ICD implantation included lead failure in 1 patient requiring replacement 3.3 years after implantation and generator replacement in a patient who was pacemaker dependent a year after implantation due to an advisory issued by the manufacturer regarding the risk of sudden battery depletion. Conclusions: In our study we found a rate of 0.6 appropriate and 1.4 inappropriate therapies (0.9 episodes of inappropriate ATP and 0.5 episodes of inappropriate cardioversion) per patient-year of follow up following ICD implantation which is in keeping with published literature. The mortality in our study group was 5% which is acceptable given the high risk population. Implantation of an ICD allowed switching over from amiodarone to less toxic anti arrhythmic therapy in a proportion of patients. Anti-tachycardia pacing was very successful in terminating tachyarrhythmia in our population with 100% success in terminating ventricular tachycardia.

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Endoscopic Sinus Surgery with Middle Turbinate Resection: Results and Complications

Ear Nose & Throat Journal ◽

10.1177/014556139307200510 ◽

1993 ◽

Vol 72 (5) ◽

pp. 351-355 ◽

Cited By ~ 34

Author(s):

John F. Biedlingmaier

Keyword(s):

Success Rate ◽

Retrospective Review ◽

Endoscopic Sinus Surgery ◽

Patency Rate ◽

Middle Turbinate ◽

Partial Resection ◽

Sinus Surgery

Numerous articles have been published on the techniques of endoscopic sinus surgery. Fewer articles are available regarding the effectiveness of these procedures in curing the patient's symptoms. A retrospective review of eighty patients was performed to outline their symptoms and determine the success of the surgery. Partial middle turbinate resection was performed in all patients. The high overall success rate of 93.5% and the high antrostomy patency rate of 94.8% demonstrates the benefits of partial resection.

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Creation and outcome of arteriovenous fistula for hemodialysis: experience in a tertiary care hospital in Saurashtra, Gujarat

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20193137 ◽

2019 ◽

Vol 6 (4) ◽

pp. 1046

Author(s):

Mihir D. Pandya ◽

Archana D. Asher

Keyword(s):

Diabetes Mellitus ◽

Chronic Kidney Disease ◽

Heart Disease ◽

Kidney Disease ◽

Ischemic Heart Disease ◽

Arteriovenous Fistula ◽

Success Rate ◽

Ischemic Heart ◽

Early Failure ◽

Arteriovenous Fistulas

Background: Patients with chronic kidney disease require arteriovenous fistulas for hemodialysis. The aim of our study was to share our experience of creating arteriovenous fistulas for hemodialysis and to analyze the factors affecting the outcome of arteriovenous fistulas.Methods: This is a prospective study carried out in Guru Gobind Singh Government Hospital, Jamnagar from August 2013 to July 2015. All patients with chronic kidney disease in whom arteriovenous fistula was created surgically for hemodialysis were included in this study.Results: Maximum patients (34%) were in the age group of 51-60 years. 76% of the patients were males and 24% were females. Co morbid conditions like diabetes mellitus, hypertension and ischemic heart disease were present in 20%, 26%, and 16% of patients respectively. Success rate of arteriovenous fistulas in patients with diabetes mellitus, hypertension and ischemic heart disease was 30%, 69.2% and 25% respectively. Success rate of arteriovenous fistulas in patients without diabetes mellitus, hypertension and ischemic heart disease was 92.5%, 83.8% and 90.5% respectively. Early failure was present in 20% of the patients. Most common cause of early failure was thrombosis, which occurred in 8% of total patients. Other causes of early failure were wound infection, stenosis and aneurysm, which occurred in 6%, 4% and 2% patients respectively.Conclusions: Presence of diabetes mellitus and ischemic heart disease was associated with a higher risk of arteriovenous fistula failure. The success rate reported in our study was fairly acceptable.

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Success rate of salvage surgical intervention of acutely thrombosed arteriovenous fistula in hemodialysis patients

Suez Canal University Medical Journal ◽

10.21608/scumj.2020.39199.1018 ◽

2020 ◽

Vol 0 (0) ◽

pp. 0-0

Author(s):

mohamed Elyamany ◽

Micheal El Abd ◽

hatem mohamed ◽

sherif Reffat

Keyword(s):

Arteriovenous Fistula ◽

Success Rate ◽

Surgical Intervention ◽

Hemodialysis Patients

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Comparison of surgical and radiological interventions for thrombosed arteriovenous access

The Journal of Vascular Access ◽

10.1177/1129729818762007 ◽

2018 ◽

Vol 19 (6) ◽

pp. 555-560 ◽

Cited By ~ 4

Author(s):

Gary Lambert ◽

Jonathan Freedman ◽

Susan Jaffe ◽

Teun Wilmink

Keyword(s):

Arteriovenous Fistula ◽

Success Rate ◽

Balloon Angioplasty ◽

Primary Patency ◽

Additional Treatment ◽

Surgical Revision ◽

Interventional Treatment ◽

Success Rates ◽

Free Survival ◽

Arteriovenous Access

Introduction: To compare open surgical and radiological interventions for thrombosed arteriovenous access for dialysis. Methods: A retrospective analysis of access procedures and dialysis episodes from 1 December 2002 to 30 November 2015 with follow-up up to 1 August 2016. Hospital records and dialysis database interrogated for further interventions and length of functional use. Results: Some 128 surgical and 27 radiological thrombectomies were compared. Radiological treatment was successful in 24 (89%) cases and surgical interventions in 65 cases (51%; p < 0.001). In all, 82 (64%) of the 128 surgical thrombectomies had no additional treatment, 43 (34%) had a surgical revision and 3 cases (2%) had an on-table balloon angioplasty. All 27 interventional thrombectomies had an additional balloon angioplasty. Success rate was significantly increased after a surgical revision (74%) or balloon angioplasty (87%) compared to no adjuvant procedure (38%; p < 0.001). There was a trend towards higher primary failure rates of arteriovenous fistula thrombectomies in the upper arm (57%) compared to the arteriovenous fistula thrombectomies in forearm (40%) and arteriovenous graft thrombectomies (33%; p = 0.056). Assisted primary patency was better after interventional treatment compared to surgery (p = 0.02) and significantly better after thrombectomy with additional treatment (p = 0.005). Patency after surgical revision or balloon angioplasty of the access was similar (p = 0.15). More procedures were required to maintain the access after balloon angioplasty than after surgical revision, and intervention-free survival was better after surgical revision (p = 0.02). Conclusion: Revision procedures significantly increase success rate of access thrombectomies. Radiological thrombectomies have higher success rates but lower intervention-free survival and need more additional procedures to maintain patency.

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TREATMENT GOALS ACHIEVED AMONG HYPERTENSIVES AT THE B/A REGIONAL HOSPITAL IN SUNYANI, GHANA.

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2020.v13i11.38991 ◽

2020 ◽

pp. 104-108

Author(s):

FRANCIS FORDJOUR ◽

PAUL SODZI ◽

PHILEMON BAAH

Keyword(s):

Blood Pressure ◽

Success Rate ◽

Retrospective Review ◽

Regional Hospital ◽

Treatment Goals ◽

Treatment Optimization ◽

Hypertensive Patients ◽

Clinic Appointment ◽

Hypertension Clinic ◽

Medical Histories

Objective: The objective of the study was to assess the current success rate of hypertensive patients in achieving blood pressure (BP) treatment goals and to investigate the extent of the consistency in the control of BP following initial achievement. Methods: At the hypertension clinic of the B/A Regional Hospital in Sunyani, Ghana, the current BP of 400 sampled patients, aged 35–100 years was measured. In addition, a retrospective review of nine successive BPs previously recorded in patients’ medical histories was done. Results: Of the 400 patients, women constituted 71.75%. Hypertensive aged ≥60 years represented 64.25% with the rest being ˂60 years. In 58% of patients, there were comorbidities. The adherence to clinic appointment was 54.50%. Of the ten clinic visits, 20.30% of patients ˂60 years were adequately controlled of their BPs while those ≥60 years achieved 33.80% control. In all, 29% of the 400 hypertensives met their treatment goals adequately. Consistency in maintaining a controlled BP at all times was achieved by 23.70% of the 400 patients. Regular visits to clinic was associated with adequate BP control (p˂0.001) while comorbidity was not (p=0.122). Conclusion: Treatment goals’ achievement by hypertensives at the Regional Hospital in Sunyani, Ghana, was relatively low. Consistency in maintaining a controlled BP while on medication is poor. The lack of consistency in keeping a controlled BP may contribute to the increased cardiovascular deaths among hypertensives. Intensive mass education and treatment optimization are required to deal with treatment failures among patients.

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A Dedicated Vascular access Program can Improve Arteriovenous Fistula Rates without Increasing Catheters

The Journal of Vascular Access ◽

10.1177/112972980800900406 ◽

2008 ◽

Vol 9 (4) ◽

pp. 254-259 ◽

Cited By ~ 20

Author(s):

M. Kiaii ◽

J.M. MacRAE

Keyword(s):

Cardiovascular Disease ◽

Multivariate Analysis ◽

Arteriovenous Fistula ◽

Vascular Access ◽

Retrospective Review ◽

Patient Characteristics ◽

Male Gender ◽

Similar Data ◽

Arteriovenous Fistulae ◽

Access Program

Purpose We describe the development and implementation of a comprehensive multidisciplinary vascular access (VA) program and describe its impact on VA distribution rates. Methods A retrospective review of all incident and prevalent patients in our hemodialysis (HD) unit was conducted in September 2001 to determine baseline data including: type of VA along with patient characteristics and comorbidities. Similar data was extracted from the database in 2005 for incident and prevalent patients. Results The VA program had a significant impact on arteriovenous fistulae (AVF) rates in both incident and prevalent HD patients: incident AVF rates increased from 14 to 39% (p=0.04) and prevalent AVF rates from 60 to 64% (p=0.015). Multivariate analysis revealed that male gender (OR 1.79 [CI 0.85–0.98, p=0.006]) and year of dialysis initiation 2005 vs. 2001 (OR 1.65 [CI 1.09–2.5, p=0.017]) were associated with AVF use among prevalent HD patients. Furthermore, age (per 5 years over 70) is associated with a decreased likelihood of having an AVF (OR 0.91 [CI 0.85–0.98, p=0.009]) whereas comorbidities of cardiovascular disease and diabetes had no impact. Conclusion We demonstrate that a structured VA program can increase the number of functioning fistulas without a corresponding increase in catheters in incident and prevalent HD patients.

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Outcome after the Treatment of Spinal Dural Arteriovenous Fistulae: A Contemporary Single-institution Series and Meta-analysis

Neurosurgery ◽

10.1227/01.neu.0000126878.95006.0f ◽

2004 ◽

Vol 55 (1) ◽

pp. 77-88 ◽

Cited By ~ 179

Author(s):

Michael P. Steinmetz ◽

Michael M. Chow ◽

Ajit A. Krishnaney ◽

Doreen Andrews-Hinders ◽

Edward C. Benzel ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Retrospective Review ◽

Initial Treatment ◽

Dural Arteriovenous Fistula ◽

Meta Analysis ◽

Type I ◽

Single Institution ◽

Spinal Dural Arteriovenous Fistula ◽

Arteriovenous Fistulae

Abstract OBJECTIVE: Spinal dural arteriovenous fistulae (Type I spinal AVMs) are the most common type of spinal vascular malformations. The optimal treatment strategy has yet to be defined, and endovascular embolization is being offered with increasing frequency. A 7-year single-institution retrospective review of outcome with surgical management of Type I spinal AVMs is presented along with a meta-analysis of existing literature. METHODS: For the institutional analysis, a retrospective review of all patients who underwent treatment at our institution for Type I spinal AVMs was performed. Between 1995 and the present (the time frame during which endovascular treatments were available), 19 consecutive patients were treated. Follow-up was performed by clinical examination or telephone interview, and functional status was measured by use of the Aminoff-Logue score. For the meta-analysis, a MEDLINE search between 1966 and the present was performed for surgical, endovascular, or combined treatment of spinal dural arteriovenous fistula. These series were included in a meta-analysis to evaluate success and failure rates, complications, and functional outcome. Specifically, embolization and microsurgery were compared. RESULTS: For the institutional analysis, 18 of 19 patients were available for long-term follow-up after surgery. There were no surgical failures, but one complication was seen. Patients demonstrated a statistically significant improvement in gait and bladder function after surgery. For the meta-analysis, 98% of those patients treated with microsurgery had their dural arteriovenous fistulae successfully obliterated after the initial treatment, compared with only 46% with embolization, as judged by radiographic or clinical follow-up. 89% percent of patients demonstrated improvement or stabilization in neurological symptoms after surgical treatment. Few complications were demonstrated with either surgery or embolization. CONCLUSION: At this point, surgery seems to be superior to embolization for the management of spinal dural arteriovenous fistula. The fistula is usually obliterated after the initial treatment, with few clinical or radiographic recurrences. The majority of patients either improve or stabilize after treatment. Few worsen, and the morbidity is minimal. It is reasonable to attempt initial embolization, especially at the time of the initial diagnostic spinal angiogram. The treating physicians and patients should be aware of the high chance of recurrence, and patients may ultimately require surgery or repeat embolization. After endovascular therapy, patients are committed to repeat angiography and probably embolization. For these reasons, it is the authors' opinion that surgery should be used as the first-line therapy for spinal dural arteriovenous fistulae.

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Initial 6-month quality review of a percutaneous endovascular arteriovenous fistula program

The Journal of Vascular Access ◽

10.1177/1129729820948692 ◽

2020 ◽

pp. 112972982094869

Author(s):

Sulaiman Sultan ◽

Mark Langsfeld ◽

LeAnn Chavez ◽

Anna Fabre ◽

Robin Osofsky ◽

...

Keyword(s):

Quality Improvement ◽

Arteriovenous Fistula ◽

Success Rate ◽

The United States ◽

Technical Success ◽

Technical Success Rate ◽

Arteriovenous Fistulas ◽

Dialysis Center ◽

Operative Care

Background: Percutaneous arteriovenous fistulas have recently proven successful alternatives to surgical arteriovenous fistulas with encouraging initial results. The Ellipsys Endovascular Arteriovenous Fistula System utilizing ultrasound and thermal energy has recently received approval for use in the United States. At the University of New Mexico, we developed an integrated service between Vascular Surgery, Interventional Radiology, and Interventional Nephrology for percutaneous arteriovenous fistulas utilizing Ellipsys. Methods: We performed a retrospective chart review of the initial 6 months (January 1st 2019 to July 1st 2019) of 18 percutaneous arteriovenous fistula placements to evaluate our initial technical success rate, the number of arteriovenous fistulas meeting maturation characteristics or use in dialysis, and to identify areas for quality improvement. Results: Initial technical success was achieved in 17 out of 18 arteriovenous fistulas (94.4%). Three patients did not report for any follow-up at the end of the initial 6 months. Of the remaining patients, 7 out of 15 were using their arteriovenous fistulas or meeting maturation characteristics at the end of the study (46.7%). Patient loss to follow-up/no-show (16.7%), patient not yet requiring hemodialysis (27.8%), and poor post-surgical maturation and/or need for additional maturation procedures (55.6%) were the predominate reasons for non-use. We identified improved coordination of care, early intervention, and outpatient dialysis center education as the primary areas of focus for quality improvement. Conclusion: Initial technical success rate of percutaneous arteriovenous fistulas placement was comparable to published studies. Early and aggressive secondary angiographic interventions of arteriovenous fistulas failing to meet cannulation requirements, improved coordination of post-operative care, and outpatient dialysis center education appear to be the primary targets for quality improvement.

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Tract dilation to salvage failing buttonholes in arteriovenous dialysis fistulae

The Journal of Vascular Access ◽

10.1177/1129729818804996 ◽

2018 ◽

Vol 20 (3) ◽

pp. 290-300

Author(s):

Eyal Barzel ◽

John W Larkin ◽

Allen Marcus ◽

Marta M Reviriego-Mendoza ◽

Len A Usvyat ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Success Rate ◽

Clinical Success ◽

Clinical Success Rate ◽

Technical Success ◽

Technical Success Rate ◽

Sharp Recanalization ◽

Tract Dilation ◽

Lost To Follow Up

Introduction: Hemodialysis patients with an arteriovenous fistula can use buttonhole techniques for cannulation. Although buttonholes generally work well, patients may report difficult and painful cannulation, and buttonholes may fail over time. We aimed to assess the effectiveness of tract dilation in treatment of failing buttonholes. Methods: We retrospectively analyzed data from patients treated with buttonhole tract dilation at an outpatient vascular access center between January 2013 and August 2015. Results: Data from 23 patients were analyzed. There were 51 tract dilation procedures during 36 encounters for failing arteriovenous fistula buttonhole tract(s). The technical success rate for established tract dilation with “blunt-recanalization” was 90% (n = 46). The five remaining buttonholes had “sharp-recanalization” to create and dilate new tract through the buttonhole. For 46 buttonholes treated with “blunt-recanalization,” there was an 85% clinical success rate at one week (39 buttonholes), and one was lost to follow-up; there was a 70% clinical success rate after one month (32 buttonholes). In the five buttonholes with “sharp-recanalization,” there was only one clinical success with p < 0.05 for difference in success rate compared to “blunt-recanalization” at both one week and one month. There was one complication from “sharp-recanalization” requiring abandonment of the buttonhole tract. Discussion: Buttonhole tract dilation is a useful method to treat difficult cannulation and painful cannulation and has the potential to extend the life of failing buttonholes.

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