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Tseng YH, Lin CC, Wong MY, Kao CC, Lu MS, Lu CH, Huang YK. Pseudomonas aeruginosa Infections Are Associated with Infection Recurrence in Arteriovenous Grafts Treated with Revision. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1294. [PMID: 37512105 PMCID: PMC10384714 DOI: 10.3390/medicina59071294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/30/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: This study was conducted to investigate whether Pseudomonas aeruginosa (PA) infections of arteriovenous grafts (AVGs) recur more frequently than other bacterial infections following treatment with revision. Materials and Methods: Operative procedures, including total excision, subtotal excision, and revision, were performed on 60 patients to treat 65 AVG infections. Final outcomes were classified as no infection recurrence, infection recurrence, and death without prior recurrence. In the competing risk setting, the cumulative incidence was estimated using the cumulative incidence function and Gray's test, and the associations between outcomes and different variables were estimated using a subdistribution hazard (SDH) model. Results: Comparing AVG infections with and without recurrence, PA infection was not associated with a higher risk of infection recurrence (p = 0.13); however, the first operative procedure type was associated with infection recurrence (p = 0.04). AVGs with PA infection were associated with a higher total number of surgical interventions (p < 0.05) than AVGs without PA infection. Regarding the cumulative incidences of outcomes, for AVGs treated with subtotal excision or revision, the cumulative incidence of recurrent infection was 3.3-fold higher for those with PA infection than without one year after the first surgery. However, when AVGs were treated with revision alone, the cumulative incidence was 4.1-fold. After excluding AVGs treated with total excision, the SDH model was applied, obtaining a hazard ratio for infection recurrence of 16.05 (p = 0.02) for AVGs with PA infection compared with AVGs without PA infection. No other variables were significantly associated with infection recurrence. Conclusions: For subtotal resection and revision, AVGs infected with PA had a higher recurrence rate than those infected with other species. However, revision surgery may aggravate the recurrence rate.
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Affiliation(s)
- Yuan-Hsi Tseng
- Division of Thoracic and Cardiovascular Surgery, New Taipei Municipal TuCheng Hospital, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Chien-Chao Lin
- Division of Thoracic and Cardiovascular Surgery, Chiayi Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Min Yi Wong
- Division of Thoracic and Cardiovascular Surgery, Chiayi Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Microbiology Research and Treatment Center, Chiayi Chang Gung Memorial Hospital, Puzi City 613, Taiwan
| | - Chih-Chen Kao
- Division of Thoracic and Cardiovascular Surgery, Chiayi Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Ming-Shian Lu
- Division of Thoracic and Cardiovascular Surgery, Chiayi Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Chu-Hsueh Lu
- Division of Thoracic and Cardiovascular Surgery, Chiayi Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Yao-Kuang Huang
- Division of Thoracic and Cardiovascular Surgery, Chiayi Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
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Feng R, Wang S, Chang G, Zhang WW, Liu Q, Wang X, Chen W, Wang S. The feasibility of small-caliber veins for autogenous arteriovenous fistula creation: A single-center retrospective study. Front Cardiovasc Med 2023; 10:1070084. [PMID: 36776248 PMCID: PMC9909423 DOI: 10.3389/fcvm.2023.1070084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/09/2023] [Indexed: 01/28/2023] Open
Abstract
Objective Autogenous arteriovenous fistula (AVF) is recommended as the first choice for hemodialysis vascular access. A small-caliber vein is one of the independent risk factors for AVF maturation and patency. However, the specific threshold is still unclear, making it difficult to accurately determine whether these vessels are suitable for AVF creation. Design This is a single-center retrospective study. Method Patients who underwent AVF creation in our medical center between January 2020 and September 2022 and satisfied the eligibility criteria were included in this retrospective study. Logistic regression analysis was performed to identify risk factors for functional maturation and additional intervention. The optimal cutoff value was determined based on the receiver operating curve (ROC) and the Youden index. Kaplan-Meier analysis was utilized in further patency rate comparisons. Result A total of 125 forearm AVFs were created in 121 patients with end-stage renal disease (ESRD). The mean age was 53.88 ± 15.10 years. Preoperative vascular Doppler ultrasound (DUS) was conducted and recorded in 106 cases (84.80%). The mean targeted artery and vein diameters were 2.17 ± 0.54 and 1.71 ± 0.75 mm, respectively. Small-caliber vein is the risk factor for functional maturation failure (OR = 0.256, 95%CI [0.06-0.75], p = 0.033) and additional intervention (OR = 0.306, 95% CI [0.09-0.78], p = 0.031). The optimal cutoff value is 1.35 mm (augmented) when specificity and sensitivity reach 80 and 63.7%, respectively. The AVFs with a vein diameter of more than 1.35 mm (augmented) showed higher patency rates (p < 0.01). Conclusion After comprehensive DUS evaluation, intraoperative hydrodilation, postoperative active exercise and intensive DUS detection, and application of balloon-assisted maturation, if necessary, using a vein more than 1.35 mm (augmented), could achieve satisfactory functional maturation and postoperative patency in AVF formation.
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Affiliation(s)
- Ruijia Feng
- Department of Vascular Surgery, National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Siwen Wang
- Department of Vascular Surgery, National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Guangqi Chang
- Department of Vascular Surgery, National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wayne W. Zhang
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Washington, Seattle, WA, United States
| | - Qinghua Liu
- Department of Nephrology, The First Affiliated Hospital, NHC Key Laboratory of Nephrology, Guangdong Provincial Key Laboratory of Nephrology, Sun Yat-sen University, Guangzhou, China
| | - Xin Wang
- Department of Nephrology, The First Affiliated Hospital, NHC Key Laboratory of Nephrology, Guangdong Provincial Key Laboratory of Nephrology, Sun Yat-sen University, Guangzhou, China
| | - Wei Chen
- Department of Nephrology, The First Affiliated Hospital, NHC Key Laboratory of Nephrology, Guangdong Provincial Key Laboratory of Nephrology, Sun Yat-sen University, Guangzhou, China,*Correspondence: Wei Chen, ✉
| | - Shenming Wang
- Department of Vascular Surgery, National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China,Shenming Wang, ✉
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Chang J, Hejna EE, Terranella SL, Trawczynski MH, Hollinger EF, Jensik SC, Olaitan OK, Hertl M, Chan EY. Graft repair of arteriovenous fistula aneurysms is associated with decreased long-term patency. Am J Surg 2022; 224:136-140. [DOI: 10.1016/j.amjsurg.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 02/08/2022] [Accepted: 04/09/2022] [Indexed: 11/01/2022]
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Ullah K, Bashir M, Ain NU, Sarfraz A, Sarfraz Z, Sarfraz M, Cherrez-Ojeda I. Medical Adjuvant Therapy in Reducing Thrombosis With Arteriovenous Grafts and Fistulae Use: A Meta-Analysis of Randomized Controlled Trials. Clin Appl Thromb Hemost 2021; 27:10760296211063882. [PMID: 34873965 PMCID: PMC8655473 DOI: 10.1177/10760296211063882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Hemodialysis is required for patients with end-stage renal disease (ESRD) that require arteriovenous (AV) grafts or fistulas for vascular access. These access points are prone to thrombosis. To determine the effect of medical adjuvant therapy on AV graft/fistula patency among patients with ESRD on hemodialysis. Adhering to the PRISMA 2020 statement, a systematic search was conducted until August 20, 2021, with keywords including arteriovenous graft, fistula, patency, thrombosis, hemodialysis, adjuvant treatment. The following databases were searched: PubMed, Scopus, Web of Science, CINAHL Plus, and Cochrane. A random-effects model was employed using Review Manager 5.4 for data analysis. The meta-analysis pooled in 1985 participants with 1000 (50.4%) in the medical adjuvant treatment group. At a snapshot, medical adjuvant therapy reduced the risk for graft thrombosis (RR = 0.64, P = .02). Notable medications included aspirin for graft thrombosis (RR = 0.36, P = .006) and ticlopidine for fistula thrombosis (RR = 0.53, P = .01). Certain antiplatelet therapies (aspirin and ticlopidine) reduced the number of patients with AV fistula/graft thrombosis among patients with high heterogeneity among the trials. Other therapies (fish oil, sulfinpyrazone, clopidogrel, and aspirin/dipyridamole) did not demonstrate significant improvement but may be promising once concrete evidence is available. Potential benefits of anti-platelet therapies may be explored to maintain the potency of AV grafts/fistulas through well-designed placebo-controlled trials and long-term follow-up.
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Affiliation(s)
- Kaleem Ullah
- 194774Independent Medical College Faisalabad, Faislabad, Pakistan
| | - Maham Bashir
- 429580Gujranwala Medical College, Gujranwala, Pakistan
| | - Noor Ul Ain
- 194774Independent Medical College Faisalabad, Faislabad, Pakistan
| | | | | | - Muzna Sarfraz
- 66886King Edward Medical University, Lahore, Pakistan
| | - Ivan Cherrez-Ojeda
- 27890Universidad Espíritu Santo, Samborondón, Ecuador.,Respiralab Research Center, Guayaquil, Ecuador
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Murea M, Woo K. New Frontiers in Vascular Access Practice: From Standardized to Patient-tailored Care and Shared Decision Making. KIDNEY360 2021; 2:1380-1389. [PMID: 35369664 PMCID: PMC8676387 DOI: 10.34067/kid.0002882021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/07/2021] [Indexed: 02/04/2023]
Abstract
Vascular access planning is critical in the management of patients with advanced kidney disease who elect for hemodialysis for RRT. Policies put in place more than two decades ago attempted to standardize vascular access care around the model of optimal, namely arteriovenous fistula, and least preferred, namely central venous catheter, type of access. This homogenized approach to vascular access care emerged ineffective in the increasingly heterogeneous and complex dialysis population. The most recent vascular access guidelines acknowledge the limitations of standardized care and encourage tailoring vascular access care on the basis of patient and disease characteristics. In this article, we discuss available literature in support of patient-tailored access care on the basis of differences in vascular access outcomes by biologic and social factors-age, sex, and race. Further, we draw attention to the overlooked dimension of patient-reported preferences and shared decision making in the practice of vascular access planning. We discuss milestones to overcome as requisite steps to implement effective shared decision making in vascular access care. Finally, we take into consideration local practice cofactors as major players in vascular access fate. We conclude that a personalized approach to hemodialysis vascular access will require dynamic care specifically relevant to the individual on the basis of biologic factors, fluctuating clinical needs, values, and preferences.
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Affiliation(s)
- Mariana Murea
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Karen Woo
- Department of Surgery, University of California Los Angeles, Los Angeles, California
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Sterile inflammation in the pathogenesis of maturation failure of arteriovenous fistula. J Mol Med (Berl) 2021; 99:729-741. [PMID: 33666676 DOI: 10.1007/s00109-021-02056-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/19/2020] [Accepted: 02/21/2021] [Indexed: 10/22/2022]
Abstract
Chronic kidney disease is a widespread terminal illness that afflicts millions of people across the world. Hemodialysis is the predominant therapeutic management strategy for kidney failure and involves the external filtration of metabolic waste within the circulation. This process requires an arteriovenous fistula (AVF) for vascular access. However, AVF maturation failures are significant obstacles in establishing long-term vascular access for hemodialysis. Appropriate stimulation, activation, and proliferation of smooth muscle cells, proper endothelial cell orientation, adequate structural changes in the ECM, and the release of anti-inflammatory markers are associated with maturation. AVFs often fail to mature due to inadequate tissue repair and remodeling, leading to neointimal hyperplasia lesions. The transdifferentiation of myofibroblasts and sterile inflammation are possibly involved in AVF maturation failures; however, limited data is available in this regard. The present article critically reviews the interplay of various damage-associated molecular patterns (DAMPs) and the downstream sterile inflammatory signaling with a focus on the NLRP3 inflammasome. Improved knowledge concerning AVF maturation pathways can be unveiled by investigating the novel DAMPs and the mediators of sterile inflammation in vascular remodeling that would open improved therapeutic opportunities in the management of AVF maturation failures and its associated complications.
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Cheng CT, Chang YC, Tam KW, Yen YC, Ko YC. Comparison Between Transposed Brachiobasilic Fistula and Arteriovenous Graft for Upper Limb Arteriovenous Access in Patients on Hemodialysis. Vasc Endovascular Surg 2020; 55:164-170. [PMID: 33228455 DOI: 10.1177/1538574420969252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Creating and maintaining a functioning arteriovenous access is essential for long-term hemodialysis patients. Transposed brachiobasilic fistula (BBF) or arteriovenous graft (AVG) becomes an option when radiocephalic or brachiocephalic fistula cannot be created or fails. This study compared the patency and complications between BBFs and AVGs among patients on hemodialysis. METHODS A retrospective study was performed in Shuang Ho Hospital, Taiwan, from November 2015 to May 2020. All the operations were done by a single surgeon. Primary outcomes were primary patency, primary-assisted patency, and secondary patency of the BBF and AVG groups. Secondary outcomes were incidence of complications and reinterventions. RESULTS Of the 144 consecutive patients, 20 and 124 patients underwent BBF and AVG creation, respectively. Median follow-up time was 19.2 months. Primary patency at 1 and 2 years were 67% and 19% in the BBF group and 44% and 16% in the AVG group (P = 0.126). Primary-assisted patency at 1 and 2 years were 82% and 54% in the BBF group and 54% and 30% in the AVG group (P = 0.012). Secondary patency at 1 and 2 years were 100% and 82% in the BBF group and 81% and 67% in the AVG group (P = 0.078). The incidence of complication was significantly higher in the AVG than in the BBF group (1.7 per patient-year vs 0.93, P < 0.001). CONCLUSION Compared with the AVG group, BBF group showed better primary-assisted patency, less complication and intervention rates. Therefore, BBF is a reliable option for patients with exhausted cephalic veins if basilic vein is available for reconstruction.
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Affiliation(s)
- Chen-Ting Cheng
- School of Medicine, College of Medicine, 38032Taipei Medical University, Taipei
| | - Yuan-Chen Chang
- School of Medicine, College of Medicine, 38032Taipei Medical University, Taipei
| | - Ka-Wai Tam
- Division of General Surgery, Department of Surgery, Shuang Ho Hospital, 38032Taipei Medical University, New Taipei City.,Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, 38032Taipei Medical University, Taipei.,Cochrane Taiwan, 38032Taipei Medical University, Taipei
| | - Yu-Chun Yen
- Biostatistics Center, Office of Data Science, 38032Taipei Medical University, Taipei
| | - Yu-Chen Ko
- Division of Cardiovascular Surgery, Department of Surgery, Shuang Ho Hospital, 38032Taipei Medical University, New Taipei City
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Gong M, Zhou Y, Zhao B, Kong J, He X. Efficacy of stent-graft placement to salvage central vein stents with recalcitrant restenosis in patients with arteriovenous fistulas. Semin Dial 2020; 33:382-387. [PMID: 32748477 DOI: 10.1111/sdi.12908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 03/09/2020] [Accepted: 07/14/2020] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to determine the effectiveness and permanency of stent-graft placement to salvage stents with recalcitrant restenosis due to central vein stenosis (CVS). Between May 2014 and February 2016, VIABAHN stent-grafts were deployed in patients with functioning arteriovenous (AV) fistulas who underwent previous bare metal stent (BMS) placement and had recalcitrant stent restenosis that did not respond to percutaneous transluminal angioplasty (PTA). Surveillance was carried out at 3, 6, 12, 18, and 24 months with diagnostic fistulography. Fourteen patients initially underwent 15 BMS placements. In the follow-up period (range, 118-976 days), patients presented with symptomatic venous hypertension; subsequently, a total of 52 unsuccessful repeat PTAs for BMS restenosis were undertaken, and the median primary access survival of PTAs was 66 ± 43 days. For salvage, 14 stent-grafts were placed in segments with recalcitrant restenosis of a CVS stent. Within 1.25 ± 0.72 days after stent-graft placement, patients who initially presented with symptomatic venous hypertension reported complete resolution. The median primary access survival (mean, 1183 ± 312 days) was longer than PTAs alone (P < .01). No major or minor complications were associated with stent-graft deployment or any of the subsequent interventions in the study period. The primary patency rate at 6, 12, and 18 months was 100%, and it was 85.7% at 24 months. The secondary access patency rate was 92.9% at 24 months. In conclusion, stent-graft placement to salvage CVS stents with recalcitrant restenosis in patients with AV fistulas is safe and effective if PTAs fails to maintain luminal patency.
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Affiliation(s)
- Maofeng Gong
- Department of Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, P.R. China
| | - Yangyi Zhou
- Department of Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, P.R. China
| | - Boxiang Zhao
- Department of Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, P.R. China
| | - Jie Kong
- Department of Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, P.R. China
| | - Xu He
- Department of Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, P.R. China
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