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Kingsmore D, Stevenson K, Jackson A, Richarz S, Isaak A, White B, Thomson P. Application and implications of a standardised reporting system for arteriovenous access graft infection. J Vasc Access 2021; 23:353-359. [PMID: 33567938 DOI: 10.1177/1129729820987382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION The perception that arteriovenous graft infection (AVGi) is frequent and severe is not based on contemporary data from large units using modern AVG. Furthermore, older reports compounded misperceptions by using non-standardised reporting that prevents easy comparison against the alternative modalities. The aim of this article is to use a recently published reporting scheme to analyse the frequency, management and outcome of AVGi in a large series of sequential early-cannulation AVG with long-term follow-up. METHODS A single-center series analysis was performed of 277 early-cannulation AVG with minimum 1-year follow-up (total 120,082 days). Infections relating to the AVG were classified, root-cause analysed and the outcomes presented. RESULTS Sixteen percent of all AVG implanted (51 episodes) developed infection related to the AVG. Primary AVGi (related to the insertion procedure or within 28 days) occurred in 9 (3%); secondary AVGi (related to AVG in use) occurred 33 times (rate 0.27/1000 haemodialysis days), at a mean of 382 days, and tertiary AVGi (in AVG no longer in use) occurred nine times. Only 1/3 of all AVGi led to bacteraemia, and ½ did not lead to loss of functional access. SUMMARY AVG infection is not common, caused a systemic infection in only one-third, did not lead to metastatic infection, and importantly, was treatable without loss of access in one-half of all cases. Using an objective system that discriminates between aetiology and outcome allows a more complete objective understanding of relative infection risks and outcomes for AVG that can inform discussions with patients requiring vascular access for haemodialysis.
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Affiliation(s)
- David Kingsmore
- Department of Vascular Surgery, Queen Elizabeth University Hospital, Glasgow, UK.,Renal and Transplant Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Karen Stevenson
- Renal and Transplant Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Andrew Jackson
- Renal and Transplant Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Sabine Richarz
- Renal and Transplant Surgery, Queen Elizabeth University Hospital, Glasgow, UK.,Department of Vascular Surgery, University Hospital Basel, Basel, Switzerland
| | - Andrej Isaak
- Renal and Transplant Surgery, Queen Elizabeth University Hospital, Glasgow, UK.,Department of Vascular Surgery, University Hospital Basel, Basel, Switzerland
| | - Beth White
- Department of Infectious Disease and Microbiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Peter Thomson
- Department of Nephrology, Queen Elizabeth University Hospital, Glasgow, UK
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Kingsmore DB, Stevenson KS, Jackson A, Desai SS, Thompson P, Karydis N, Franchin M, White B, Tozzi M, Isaak A. Arteriovenous Access Graft Infection: Standards of Reporting and Implications for Comparative Data Analysis. Ann Vasc Surg 2020; 63:391-398. [DOI: 10.1016/j.avsg.2019.08.081] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/14/2019] [Accepted: 08/14/2019] [Indexed: 11/28/2022]
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Hyder SMS, Iqbal J, Lutfi IA, Shazlee MK, Hamid K, Rashid S. Complications Associated with Permanent Internal Jugular Hemodialysis Catheter: A Retrospective Study. Cureus 2019; 11:e4521. [PMID: 31259130 PMCID: PMC6590860 DOI: 10.7759/cureus.4521] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction A significant increase in patients with end-stage renal disease has been observed currently in our community. Kidney transplantation is the most promising cure but the problem is that large numbers of people are not good candidates for transplantation. Hemodialysis is the next appropriate medication for such patients and for patients with end-stage renal disease, who have no chance for transplantation. Morbidity and mortality are the consequences of vascular access complications. Local data related to the complication rate of permanent hemodialysis catheters is not available. The current study examines the complication rate in people due to permanent intrajugular hemodialysis catheterization. Materials and methods The study has been conducted in Dr Ziauddin University Hospital, Karachi. The dataset consists of 212 patients who had gone through jugular catheterizations for hemodialysis at this hospital from the year 2014 to the year 2015. A descriptive method has been chosen for obtaining appropriate results. Complications have also been categorized as early or late. Results Complications have been detected in around 24% of the patients from the dataset. Among these complications, infection has the highest percentage (around 13%) while 4% percent of patients have a failed puncture. The others have venous thrombosis, catheter thrombosis, hematoma, wrong canulation, and hemothorax and pneumothorax problems. Conclusion The study concludes that the placement of a permanent hemodialysis catheter in the internal jugular vein has a low complication rate. In addition, the method is safe and easy. So, it can be said that the internal jugular vein is a reliable and preferred route for hemodialysis catheterization.
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Affiliation(s)
| | - Junaid Iqbal
- Radiology, Dr Ziauddin University Hospital, Karachi, PAK
| | - Irfan Amjad Lutfi
- Radiology, Shaheed Mohtarma Benazir Bhutto Accident Emergency & Trauma Center, Civil Hospital, Karachi, PAK
| | | | - Kamran Hamid
- Radiology, Dr Ziauddin University Hospital, Karachi, PAK
| | - Sadia Rashid
- Radiology, Dr Ziauddin University Hospital, Karachi, PAK
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Belczak SQ, Abrão SR, Bertoldi V, Cavaquini TJ, Slavo LFM, Sincos IR, Aun R. Alternative grafts for brachioaxillary hemodialysis access: 1-year comparative results. J Vasc Bras 2015. [DOI: 10.1590/1677-5449.0055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND: Many chronic renal patients lack autologous veins in the upper limbs suitable for construction of arteriovenous fistulas for hemodialysis. Alternative fistula options for these patients should be evaluated and compared.OBJECTIVE: To compare different types of grafts used for brachioaxillary access in hemodialysis patients in terms of their patency and complication rates.METHOD: Forty-nine patients free from arterial system abnormalities and with no venous options for creation of arteriovenous fistulae in the arm and/or forearm underwent brachioaxillary bypass with implantation of autologous saphenous vein, polytetrafluoroethylene (PTFE), or PROPATEN(r) grafts. Patients were assessed by Doppler ultrasonography at 3, 6, and 12 months after surgery,.RESULTS: The four first saphenous vein grafts had failed by 3 or 6 months after surgery. The autologous saphenous vein group was discontinued at the beginning of the study because of extreme difficulty in achieving puncture and hematoma formation. Failure rates of PTFE and PROPATEN(r) grafts did not differ after 3 (p = 0.559), 6 (p = 0.920), or 12 months (p = 0.514). A log-rank test applied to cumulative survival of grafts at 1 year (0.69 for PTFE, 0.79 for PROPATEN(r)) detected no significant differences (p = 0.938). There were no differences in complications resulting in graft failure between the two types of prosthetic graft.CONCLUSION: Autologous saphenous vein grafts do not appear to be a good option for brachioaxillary hemodialysis access because of difficulties with achieving puncture. Brachioaxillary fistulae constructed using PTFE or PROPATEN(r) grafts exhibited similar patency and complication rates. Further studies with large samples size are warranted to confirm our findings.
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Affiliation(s)
- Sergio Quilici Belczak
- Instituto Belczak de Cirurgia Vascular e Endovascular, Brazil; Centro Universitário São Camilo, Brazil
| | | | | | | | | | - Igor Rafael Sincos
- Centro Universitário São Camilo, Brazil; Hospital Geral de Carapicuiba, Brazil
| | - Ricardo Aun
- Instituto Israelita de Ensino e Pesquisa Albert Einstein, Brazil
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Niknejad H, Yazdanpanah G, Kakavand M. Extract of fetal membrane would inhibit thrombosis and hemolysis. Med Hypotheses 2015; 85:197-202. [PMID: 25997985 DOI: 10.1016/j.mehy.2015.04.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 04/25/2015] [Indexed: 12/31/2022]
Abstract
The innermost layer of fetal membranes is amnion which has anti-adhesive, anti-inflammation and viscoelastic properties, as well as low immunogenicity. Amniotic membrane has been employed in variety of clinical fields as a natural biomaterial. Amniotic epithelial cells possess stem cell characteristics and capability to differentiate into endothelial cells. The basement membrane of amnion is an extracellular matrix enriched scaffold to support adhesion of endothelial cells. The matrix of amniotic membrane contains two kinds of glycosaminoglycans including perlecan (a heparan sulfate proteoglycan) and hyaluronic acid which both inhibit blood coagulation. Moreover, the other ingredients of amniotic membrane such as pigment-epithelium derived factor (PEDF), IL-10, MMP-9 inhibit platelet aggregation. Based on some biochemical and biomechanical evidences, we hypothesized in this paper that amniotic membrane could prevent thrombosis and hemolysis; therefore, has the capability to be applied in blood contacting devices and implants.
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Affiliation(s)
- Hassan Niknejad
- Department of Tissue Engineering, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Nanomedicine and Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Ghasem Yazdanpanah
- Department of Tissue Engineering, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mona Kakavand
- Department of Tissue Engineering, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Beathard GA. Bacterial Colonization of Thrombosed Dialysis Arteriovenous Grafts. Semin Dial 2015; 28:446-9. [DOI: 10.1111/sdi.12360] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lee SW, Kim SG. Membranes for the Guided Bone Regeneration. Maxillofac Plast Reconstr Surg 2014; 36:239-46. [PMID: 27489841 PMCID: PMC4283533 DOI: 10.14402/jkamprs.2014.36.6.239] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 10/07/2014] [Accepted: 10/17/2014] [Indexed: 11/17/2022] Open
Abstract
Many kinds of membrane have been used for the guided bone regeneration (GBR) technique. However, most membranes do not fulfill all requirements for the ideal membrane for the GBR technique. Among them, collagen membrane has been most widely used. However, its high price and weak tensile strength in wet condition are limitations for wide clinical application. Synthetic polymers have also been used for the GBR technique. Recently, silk based membrane has been considered as a membrane for the GBR technique. Despite many promising preclinical data for use of a silk membrane, clinical data regarding the silk membrane has been limited. However, silk based material has been used clinically as vessel-tie material and an electrospun silk membrane was applied successfully to patients. No adverse effect related to the silk suture has been reported. Considering that silk membrane can be provided to patients at a cheap price, its clinical application should be encouraged.
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Affiliation(s)
- Sang-Woon Lee
- Correspondence to Seong-Gon Kim, Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, 7 Jukheon-gil, Gangneung 210-702, Korea, Tel: 82-33-640-2468, Fax: 82-33-641-2477, E-mail:
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Nakata M, Okada Y, Kobata H, Shigematsu T, Reinach PS, Tomoyose K, Saika S. Diabetes mellitus suppresses hemodialysis-induced increases in tear fluid secretion. BMC Res Notes 2014; 7:78. [PMID: 24490817 PMCID: PMC3922596 DOI: 10.1186/1756-0500-7-78] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 01/31/2014] [Indexed: 01/11/2023] Open
Abstract
Background Hemodialysis is essential for the survival of patients suffering from chronic renal failure. However, in diabetics the incidence of dry eye disease is higher than in non-diabetic individuals. Accordingly, we evaluated if this difference is attributable to different effects of hemodialysis on basal tear fluid secretion. Methods A modified Schirmer´s eye test determined if hemodialysis improved basal tear secretion rates in 36 diabetic and non-diabetic patients undergoing hemodialysis. Results Basal tear secretion was invariant in diabetic patients whereas in non-diabetic individuals this process increased. Conclusion In non-diabetic patients, autonomic neuropathy appears to be less severe and somewhat reversible since only in these individuals hemodialysis improved basal tear fluid secretion. This difference may be a factor contributing to the lower incidence of dry eye disease in non-diabetic patients.
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Affiliation(s)
- Motoko Nakata
- Department of Ophthalmology, Kihoku Bun-in Hospital, Wakayama Medical University School of Medicine, 219 Myouji, Katsuragicho, Wakayama 649-7113, Itogun, Japan.
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Quality of care of vascular access in hemodialysis patients in a hemodialysis center in Iran. JOURNAL OF VASCULAR NURSING 2012; 30:24-8. [PMID: 22321404 DOI: 10.1016/j.jvn.2011.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Revised: 10/07/2011] [Accepted: 10/11/2011] [Indexed: 11/24/2022]
Abstract
Because of the lack of study in the field of vascular access care for hemodialysis patients, an observational study was conducted on 110 patients undergoing chronic hemodialysis in the Isfahan's AliAsghar Hospital. Data were collected using a demographic questionnaire and a checklist related to vascular access care techniques. A total of 63 male and 47 female with an average of 40.02 months of hemodialysis were studied. In addition, 72 patients were under hemodialysis through arteriovenous fistula and 38 patients through subclavian catheters. The overall quality of care for vascular access site was moderate. Selecting an inappropriately high speed for the apparatus at the beginning of dialysis, needling of an aneurysm or needling near the fistula, and incomplete priming of the filter and the tubes were the most frequent inappropriate actions. Reinforcement of the nurses' continuing education programs and development of standard vascular access care protocols are recommended.
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