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Kingsmore D, Edgar B, Stevenson K, Greenlaw N, Aitken E, Jackson A, Thomson P. A practical review of barriers and challenges to a definitive randomised trial of grafts versus fistula. J Vasc Access 2024:11297298241234610. [PMID: 38436199 DOI: 10.1177/11297298241234610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
A definitive randomised controlled trial of arteriovenous fistula (AVF) versus arteriovenous grafts (AVG) has been advocated for more than a decade, but as yet, none has been completed. The aim of this article is to summarise the theoretical barriers, review the difficulties in trial design and practicalities that have thus far prevented this from occurring.
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Affiliation(s)
- David Kingsmore
- Renal Transplant and Vascular Access Surgery, Queen Elizabeth University Hospital, Glasgow, UK
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Department of Vascular Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Ben Edgar
- Renal Transplant and Vascular Access Surgery, Queen Elizabeth University Hospital, Glasgow, UK
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Karen Stevenson
- Renal Transplant and Vascular Access Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Nicola Greenlaw
- Glasgow Clinical Trials Unit, Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Emma Aitken
- Renal Transplant and Vascular Access Surgery, Queen Elizabeth University Hospital, Glasgow, UK
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Andrew Jackson
- Renal Transplant and Vascular Access Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Peter Thomson
- Department of Renal Medicine, Queen Elizabeth University Hospital, Glasgow, UK
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Hoare D, Kingsmore D, Holsgrove M, Russell E, Kirimi MT, Czyzewski J, Mirzai N, Kennedy S, Neale SL, Mercer JR. Realtime monitoring of thrombus formation in vivo using a self-reporting vascular access graft. Commun Med (Lond) 2024; 4:15. [PMID: 38316912 PMCID: PMC10844314 DOI: 10.1038/s43856-024-00436-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 01/10/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) affects 10% of the global population costing over a hundred billion dollars per annum and leading to increased risk of cardiovascular disease. Many patients with CKD require regular haemodialyses. Synthetic arteriovenous grafts (AVG) are increasingly used to provide rapid vascular connection for dialysis. Initially, they have excellent patency rates but are critically limited by neointimal hyperplasia at the venous anastomosis, which drives subsequent thrombosis, graft failure and death. METHODS Here, we describe a system in which electrical impedance spectroscopy sensors are incorporated circumferentially into the wall of a synthetic arteriovenous graft. This is combined with an implantable radiotelemetry system for data transmission outside the patient. The system was tested using monolayers of endothelial and smooth muscle cells as well as swine blood and clots with explanted human carotid artery plaques. Sensor testing was then performed in vitro and the device was implanted in vivo in female swine. RESULTS The device can wirelessly report the accumulation of biological material, both cells and blood. Differences are also detected when comparing controls with pathological atheroma. In swine differences between blockage formation in a graft were remotely obtained and wireless reported. CONCLUSIONS Combining electrical impedance spectroscopy and an implantable radiotelemetry system enables graft surveillance. This has the potential to be used for early detection of venous stenosis and blood clot formation in real-time in vivo. In principle, the concept could apply to other cardiovascular diseases and vascular implantable devices.
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Affiliation(s)
- Daniel Hoare
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK
| | - David Kingsmore
- Queen Elizabeth University Hospital, University of Glasgow, Glasgow, UK
| | - Michael Holsgrove
- Bioelectronics Unit, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Ewan Russell
- Bioelectronics Unit, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Mahmut T Kirimi
- Queen Elizabeth University Hospital, University of Glasgow, Glasgow, UK
| | - Jakub Czyzewski
- Bioelectronics Unit, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Nosrat Mirzai
- Bioelectronics Unit, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Simon Kennedy
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK
| | - Steven L Neale
- Centre for Medical and Industrial Ultrasonics, James Watt School of Engineering, University of Glasgow, Glasgow, UK
| | - John R Mercer
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK.
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Edgar B, Pearson R, Kasthuri R, Gillis K, Geddes C, Rostron M, Brady A, Hussey K, Roditi G, Delles C, McCallum L, Mark P, Kingsmore D. Correction: The impact of renal artery stenting on therapeutic aims. J Hum Hypertens 2024; 38:191. [PMID: 38228762 PMCID: PMC10844090 DOI: 10.1038/s41371-024-00893-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Affiliation(s)
- Ben Edgar
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK.
| | - Robert Pearson
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Ram Kasthuri
- Department of Radiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Keith Gillis
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Colin Geddes
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Maggie Rostron
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Adrian Brady
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK
| | - Keith Hussey
- Department of Vascular Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Giles Roditi
- Department of Radiology, Queen Elizabeth University Hospital, Glasgow, UK
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK
| | - Christian Delles
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK
| | - Linsay McCallum
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK
| | - Patrick Mark
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK
| | - David Kingsmore
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK
- Department of Vascular Surgery, Queen Elizabeth University Hospital, Glasgow, UK
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Meiklem R, Bouamrane MM, Kingsmore D, Stevenson K, Dunlop M, Thomson P. Patient-Centred, Technology-Based Interventions for High Treatment Burden: An Overview of the State of the Art. Stud Health Technol Inform 2024; 310:529-533. [PMID: 38269865 DOI: 10.3233/shti231021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
This study provides an overview of recent efforts to develop technology-based interventions for patients with high treatment burden. Adoption of a technological intervention for high treatment burden will depend on a range of factors, including: the reliability and accessibility of the technology, patient factors including age, socio-economic factors, technology literacy, overall health status and personal priorities - as well as the perceived benefits provided by the technology intervention, from the perspectives of both patients and clinicians.
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Affiliation(s)
- Ramsay Meiklem
- Computer and Information Sciences, University of Strathclyde, Scotland
| | | | | | | | - Mark Dunlop
- Computer and Information Sciences, University of Strathclyde, Scotland
| | - Peter Thomson
- Queen Elizabeth University Hospital, Glasgow, Scotland
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Edgar B, Jones C, Aitken E, Stevenson K, Jackson A, Gaianu L, Thomson P, Kasthuri R, Stove C, Kingsmore D. What are the observed procedural costs of vascular access surgery? Protocol for a systematic review. BMJ Open 2024; 14:e079773. [PMID: 38272545 PMCID: PMC10824010 DOI: 10.1136/bmjopen-2023-079773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/09/2024] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION A central component in the introduction of a novel surgical procedure or technique is an evaluation of its cost efficiency when compared with a benchmark standard of care. Accurate assessment of costs is thus essential in ensuring appropriate allocation of resources within a healthcare system. The treatment of kidney failure requires a significant volume of resources, and vascular access provision is the main modifiable cost. The costs of providing this service are obscured by generic NHS reference costs, which lack adequate granularity to allow meaningful comparisons between treatments. The aim of this systematic review will be to assess the reporting of procedural costs in all published economic analyses of vascular access surgery and perform a comparison of the reported procedural costs involved in arteriovenous fistula (AVF) and arteriovenous graft (AVG) creation. This will provide an estimate as to the accuracy of the NHS reference costs in this field. METHODS AND ANALYSIS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines will be followed. A systematic search will be performed of the MEDLINE, Embase and Cochrane databases to identify full-text economic analyses of vascular access for haemodialysis in which the procedural cost of AVF or AVG creation is reported. Publications in English from 1 January 2000 to 30 August 2023, will be eligible for inclusion. Studies will be selected by title and abstract review, followed by a full-text review using inclusion and exclusion criteria. Studies not reporting the procedural costs of surgery will be excluded. Data collected will pertain to procedural costs of AVF and AVG creation. Costs will be adjusted to a common currency using a gross domestic product (GDP) deflator index and conversion rates based on purchasing power parities for GDP. Comparison with NHS reference costs will indicate their reliability for use in future economic analyses in this field. ETHICS AND DISSEMINATION Ethical approval is not required for this systematic review. Findings will be disseminated through peer-reviewed publications and conference presentations. PROSPERO REGISTRATION NUMBER CRD42023458779.
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Affiliation(s)
- Ben Edgar
- Renal Transplant and Vascular Access Surgery, Queen Elizabeth University Hospital, Glasgow, UK
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Catrin Jones
- Renal Transplant and Vascular Access Surgery, Queen Elizabeth University Hospital, Glasgow, UK
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Emma Aitken
- Renal Transplant and Vascular Access Surgery, Queen Elizabeth University Hospital, Glasgow, UK
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Karen Stevenson
- Renal Transplant and Vascular Access Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Andrew Jackson
- Renal Transplant and Vascular Access Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Lucian Gaianu
- Independent Health Economist, Healthonomics UK Ltd, Reading, UK
| | - Peter Thomson
- Department of Renal Medicine, Queen Elizabeth University Hospital, Glasgow, UK
| | - Ram Kasthuri
- Department of Interventional Radiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Callum Stove
- Department of Interventional Radiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - David Kingsmore
- Renal Transplant and Vascular Access Surgery, Queen Elizabeth University Hospital, Glasgow, UK
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Vascular Surgery, Queen Elizabeth University Hospital, Glasgow, UK
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Pisano U, Stevenson K, Kasthuri R, Kingsmore D. Cephalic arch stenosis: an analysis of outcome by type of first intervention. CVIR Endovasc 2024; 7:13. [PMID: 38240913 PMCID: PMC10798936 DOI: 10.1186/s42155-023-00424-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 12/21/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Cephalic arch stenoses (CAS) occur in near 70% of elbow arteriovenous fistulas. Percutaneous transluminal angioplasty (PTA) remains first-line treatment despite documented stent-grafts (SG) efficacy. The study aim is to report long-term outcomes based on initial treatment of CAS. METHODS Retrospective review of 12-year data in single tertiary centre. Outcomes included technical success, rupture rate, primary patency (PP), dialysis performance; categorical variables assessed via χ2 or Fisher's; nonparametric tests used for skewed data. Kaplan-Meier analysis used for PP and cumulative patency. Cox proportional hazard regression model to assess explanatory variables in PP. RESULTS One hundred one brachio- and radiocephalic fistulas with CAS were included. SG as first intervention had higher success than PTA (85% vs 61%, p = 0.003). Rupture occurred in 9/85 (10.6%) PTA vs 0% in SG (p = 0.046). In a subgroup with poor urea reduction rate (URR), both PTA and SG improved dialysis performance post-intervention (p = 0.002). SG demonstrated better PP than PTA (79,73,60% patency at 3, 6, 9 months; versus 71,51,47%; p = 0.195) and cumulative patency (73,61,61% at 1, 2, 3 years; versus 60,34,26%; p < 0.001). Of the variables analyzed, technical success of PTA was the only discriminating factor (coeff.-1.01; RR 35%, p = 0.035). Accesses that underwent secondary stenting performed better than primarily stented CAS (p = 0.01). CONCLUSIONS SG superiority is confirmed in CAS, particularly when angioplasty is unsuccessful. While PTA has short-lived benefits, it can improve dialysis performance. Other than higher success rate, primary CAS stenting did not have advantages compared to post-PTA stenting in our study. Other factors related to inflow, outflow, conduit characteristics are presumed to be involved in access longevity.
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Affiliation(s)
- Umberto Pisano
- Radiology Department, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, 1345 Govan Road, Glasgow, G51 4TF, UK.
| | - Karen Stevenson
- Renal Transplant Surgery, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - Ram Kasthuri
- Radiology Department, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - David Kingsmore
- Renal Transplant Surgery, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, 1345 Govan Road, Glasgow, G51 4TF, UK
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Kingsmore D, Meiklem R, Stevenson K, Thomson P, Bouamrane M, Dunlop M. A national co-design workshop of a mobile-based application for vascular access as a patient decision aid. J Vasc Access 2024; 25:187-192. [PMID: 35686488 DOI: 10.1177/11297298221091140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Increasing options for vascular access have increased the need for more effective communication to optimize patient engagement and ensure effective consent. An advanced prototype of the mobile application (VA App) was developed over 3 years as a patient decision aid. For the first time, entry to the 2021 UK Kidney Week was opened to all professions and patients and was held online. The VA App was presented in an inter-active session. This report summarizes the findings. METHODS A 30-min interactive session was allocated with the session delivered in four sections: (1) demographic data was collected; (2) an overall opinion was obtained about current patient information sources and satisfaction with these; (3) the participants were asked a series of eight questions regarding the main problem areas previously identified; (4) following a 6-min demonstration video, the participants were then re-asked the same questions to determine if the VA App would improve/worsen these areas. RESULTS Completed data from 30 participants showed great variation in all demographics. The most cited source was verbal and rated the best, whilst all other sources were felt to be poor by 90%. All eight aspects of current information sources rated poorly. There was a unanimous agreement that the VA App could make this better. Interestingly, when the eight aspects were ranked by order of the worst to best, this matched the order of the benefits of the VA App. DISCUSSION This is the first report of an on-line, multi-professional co-design workshop. With a unanimous view that current systems are very limited and that better patient information systems are required, the VA App was found to be a potential solution as a patient decision aid. Interestingly, paper leaflets were widely viewed as the least used and the least effective mechanism for communicating information to patients. Funding for a commercially produced mobile application has been secured and will be further tested in the near future.
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Affiliation(s)
- David Kingsmore
- Department of Vascular Surgery, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
- Renal Transplant Unit, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Ramsay Meiklem
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, Scotland, UK
| | - Karen Stevenson
- Renal Transplant Unit, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
| | - Peter Thomson
- Department of Nephrology, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
| | - Matt Bouamrane
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK
| | - Mark Dunlop
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, Scotland, UK
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8
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De Vriese AS, D'Haeninck A, Mendes A, Ministro A, Krievins D, Kingsmore D, Mestres G, Villanueva G, Rodrigues H, Turek J, Zieliński M, De Letter J, Coelho A, Loureiro LA, Tozzi M, Menegolo M, Alija PF, Theodoridis PG, Gibbs P, Ebrahimi R, Nauwelaers S, Kakkos SK, Matoussevitch V, Moll F, Gargiulo M. Study protocol of a prospective single-arm multicenter clinical study to assess the safety and performance of the aXess hemodialysis graft: The pivotal study. J Vasc Access 2023:11297298231174932. [PMID: 37165650 DOI: 10.1177/11297298231174932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Arteriovenous grafts (AVGs) are used for patients deemed unsuitable for the creation of an autogenous arteriovenous fistula (AVF) or unable to await maturation of the AVF before starting hemodialysis. However, AVGs are prone to infection and thrombosis resulting in low long-term patency rates. The novel aXess Hemodialysis Graft consists of porous polymeric biomaterial allowing the infiltration by cells and the growth of neotissue, while the graft itself is gradually absorbed, ultimately resulting in a fully functional natural blood vessel. The Pivotal Study will examine the long-term effectiveness and safety of the aXess Hemodialysis Graft. METHODS The Pivotal Study is a prospective, single-arm, multicenter study that will be conducted in 110 subjects with end-stage renal disease who are not deemed suitable for the creation of an autogenous vascular access. The primary efficacy endpoint will be the primary patency rate at 6 months. The primary safety endpoint will be the freedom from device-related serious adverse events at 6 months. The secondary endpoints will include the procedural success rate, time to first cannulation, patency rates, the rate of access-related interventions to maintain patency, the freedom from device-related serious adverse events and the rate of access site infections. Patients will be followed for 60 months. An exploratory Health Economic and Outcomes Research sub-study will determine potential additional benefits of the aXess graft to patients, health care institutions, and reimbursement programs. DISCUSSION The Pivotal study will examine the long-term performance and safety of the aXess Hemodialysis Graft and compare the outcome measures with historical data obtained with other graft types and autogenous AVFs. Potential advantages may include superior long-term patency rates and lower infection rates versus currently available AVGs and a shorter time to first cannulation compared to an autologous AVF. As such, the aXess Hemodialysis Graft may fulfill an unmet clinical need in the field of hemodialysis access.
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Affiliation(s)
- An S De Vriese
- Department of Nephrology and Infectious Diseases, AZ-Sint Jan Brugge, Bruges, Belgium
| | | | | | - Augusto Ministro
- Vascular Surgery Department, Hospital Santa Maria, Lisbon, Portugal
| | | | - David Kingsmore
- Department of Vascular Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Gaspar Mestres
- Division of Vascular Surgery, Cardiovascular Institute, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Gonzalo Villanueva
- Department of Angiology and Vascular Surgery, Bellvitge University Hospital, Barcelona, Spain
| | - Hugo Rodrigues
- Centro Hospitalar de Lisboa Central EPE, Lisbon, Portugal
| | - Jakub Turek
- Research and Development Centre, Department of Vascular Surgery, General Hospital, Wroclaw, Poland
| | - Maciej Zieliński
- Research and Development Centre, Department of Vascular Surgery, General Hospital, Wroclaw, Poland
| | - Jan De Letter
- Department of Vascular Surgery, AZ-Sint Jan Brugge, Bruges, Belgium
| | - Andreia Coelho
- Department of Angiology and Vascular Surgery, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | | | - Matteo Tozzi
- Vascular Unit, Department of Medicine and Surgery, Insubria University and Research Center, Varese, Italy
| | - Mirko Menegolo
- Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy
| | - Palma Fariñas Alija
- Division of Angiology and Vascular Surgery, University Hospital of Ribera, Valencia, Spain
| | | | - Paul Gibbs
- Department of Renal and Transplant Surgery, Wessex Kidney Centre at Queen Alexandra Hospital, Portsmouth, UK
| | - Reze Ebrahimi
- Department of Vascular Surgery, Riuniti Hospitals, Ancona, Italy
| | - Sigi Nauwelaers
- Department of Thoracic and Vascular Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Stavros K Kakkos
- Department of Vascular Surgery, University of Patras, Patras, Greece
| | - Vladimir Matoussevitch
- Vascular Access Unit, Department of Vascular and Endovascular Surgery, University Clinic of Cologne, Cologne, Germany
| | - Frans Moll
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mauro Gargiulo
- Department of Experimental, Diagnostic, and Specialty Medicine, Polyclinic SantÓrsola, University of Bologna, Bologna, Italy
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Edgar B, Pearson R, Kasthuri R, Gillis K, Geddes C, Rostron M, Brady A, Hussey K, Roditi G, Delles C, McCallum L, Mark P, Kingsmore D. The impact of renal artery stenting on therapeutic aims. J Hum Hypertens 2023; 37:265-272. [PMID: 36526895 PMCID: PMC10063438 DOI: 10.1038/s41371-022-00785-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/07/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022]
Abstract
Renal artery stenosis manifests as poorly-controlled hypertension, impaired renal function or pulmonary oedema, therefore the success of treatment is dependent on indication. This study aims to determine the outcomes of patients undergoing renal artery stenting (RASt) based on therapeutic aim compared to criteria used in the largest randomised trial. Retrospective case-note review of patients undergoing RASt between 2008-2021 (n = 74). The cohort was stratified by indication for intervention (renal dysfunction, hypertension, pulmonary oedema) and criteria employed in the CORAL trial, with outcomes and adverse consequences reported. Intervention for hypertension achieved significant reduction in systolic blood pressure and antihypertensive agents at 1 year (median 43 mmHg, 1 drug), without detrimental impact on renal function. Intervention for renal dysfunction reduced serum creatinine by a median 124 μmol/L, sustained after 6 months. Intervention for pulmonary oedema was universally successful with significant reduction in SBP and serum creatinine sustained at 1 year. Patients who would have been excluded from the CORAL trial achieved greater reduction in serum creatinine than patients meeting the inclusion criteria, with equivalent blood pressure reduction. There were 2 procedure-related mortalities and 5 procedural complications requiring further intervention. 5 patients had reduction in renal function following intervention and 7 failed to achieve the intended therapeutic benefit. Renal artery stenting is effective in treating the indication for which it has been performed. Previous trials may have underestimated the clinical benefits by analysis of a heterogenous population undergoing a procedure rather than considering the indication, and excluding patients who would maximally benefit.
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Affiliation(s)
- Ben Edgar
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK.
| | - Robert Pearson
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Ram Kasthuri
- Department of Radiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Keith Gillis
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Colin Geddes
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Maggie Rostron
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Adrian Brady
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK
| | - Keith Hussey
- Department of Vascular Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Giles Roditi
- Department of Radiology, Queen Elizabeth University Hospital, Glasgow, UK
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK
| | - Christian Delles
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK
| | - Linsay McCallum
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK
| | - Patrick Mark
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK
| | - David Kingsmore
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK
- Department of Vascular Surgery, Queen Elizabeth University Hospital, Glasgow, UK
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10
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Kingsmore D, White RD, Mestres G, Stephens M, Calder F, Papadakis G, Aitken E, Jackson A, Inston N, Jones RG, Geddes C, Stevenson K, Szabo L, Thomson P, Stove C, Kasthuri R, Edgar B, Tozzi M, Franchin M, Sivaprakasam R, Karydis N. Recruitment into randomised trials of arteriovenous grafts: A systematic review. J Vasc Access 2023:11297298231158413. [PMID: 36905207 DOI: 10.1177/11297298231158413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
Although randomised controlled trials (RCT) are considered the optimal form of evidence, there are relatively few in surgery. Surgical RCT are particularly likely to be discontinued with poor recruitment cited as a leading reason. Surgical RCT present challenges over and above those seen in drug trials as the treatment under study may vary between procedures, between surgeons in one unit, and between units in multi-centred RCT. The most contentious and debated area of vascular access remains the role of arteriovenous grafts, and thus the quality of the data that is used to support opinions, guidelines and recommendations is critical. The aim of this review was to determine the extent of variation in the planning and recruitment in all RCT involving AVG. The findings of this are stark: there have been only 31 RCT performed in 31 years, the vast majority of which exhibited major limitations severe enough to undermine the results. This underlines the need for better quality RCT and data, and further inform the design of future studies. Perhaps most fundamental is the planning for a RCT that accounts for the intended population, the uptake of a RCT and the attrition for the significant co-morbidity in this population.
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Affiliation(s)
- David Kingsmore
- Vascular Surgery, Queen Elizabeth University Hospital, Glasgow, UK.,Renal and Transplant Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Richard D White
- Department of Interventional Radiology, University Hospital of Wales, Cardiff, UK
| | - Gaspar Mestres
- Department of Vascular Surgery, University of Barcelona, Spain
| | - Mike Stephens
- Dialysis Access Team, University Hospital of Wales, Cardiff, UK
| | - Francis Calder
- Renal & Transplant Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Georgios Papadakis
- Renal & Transplant Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Emma Aitken
- Renal and Transplant Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Andrew Jackson
- Renal and Transplant Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Nick Inston
- Renal and Transplant Surgery, University Hospital Birmingham, UK
| | - Rob G Jones
- Interventional Radiology, Queen Elizabeth Hospital Birmingham, UK
| | - Colin Geddes
- Department of Nephrology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Karen Stevenson
- Renal and Transplant Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Laszlo Szabo
- Dialysis Access Team, University Hospital of Wales, Cardiff, UK
| | - Peter Thomson
- Department of Nephrology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Callum Stove
- Department of Interventional Radiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Ram Kasthuri
- Department of Vascular Surgery, University of Insubria, Varesi, Italy
| | - Ben Edgar
- Renal and Transplant Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Matteo Tozzi
- Department of Vascular Surgery, University of Insubria, Varesi, Italy
| | - Marco Franchin
- Department of Vascular Surgery, University of Insubria, Varesi, Italy
| | | | - Nikolaos Karydis
- Department of Renal and Transplant Surgery, University Hospital of Patras, Greece
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11
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Nair M, Kingsmore D, Hennessy M, Hussey K. Stenting the Inferior Mesenteric Artery for Chronic Mesenteric Ischaemia. Eur J Vasc Endovasc Surg 2023; 65:159-160. [PMID: 36216235 DOI: 10.1016/j.ejvs.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 08/23/2022] [Accepted: 10/02/2022] [Indexed: 01/17/2023]
Affiliation(s)
- Manoj Nair
- Department of Vascular Surgery, Queen Elizabeth University Hospital, Glasgow, UK.
| | - David Kingsmore
- Department of Vascular Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Martin Hennessy
- Department of Interventional Radiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Keith Hussey
- Department of Vascular Surgery, Queen Elizabeth University Hospital, Glasgow, UK
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12
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Meiklem R, Stevenson K, Richarz S, Kingsmore D, Bouamrane MM, Dunlop M, Thomson P. Patients' and Clinicians' Perspectives on the Acceptability of Completing Digital Quality of Life Questionnaires During Routine Haemodialysis Clinics: A Mixed-Methods Study. Stud Health Technol Inform 2022; 290:752-756. [PMID: 35673118 DOI: 10.3233/shti220179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Advanced chronic kidney disease is a serious and common medical condition with significant treatment choices incurring varying high treatment burdens. Better understanding on how to best collect quality of life (QoL) in this unique situation may help guide critical decisions. This study investigates the acceptability of digital QoL questionnaires completed during routine haemodialysis sessions. Qualitative data was collected from patient (n=23) and clinical researcher (n=2) interviews alongside analysis of data from questionnaires completed by patients (n=101) during a 6-week validation study. Interviews refined the content and format of digital QoL questionnaires and provided novel insights regarding how patients assessed and completed QoL questions. This study suggests collecting QoL data using digital tablet technology during routine haemodialysis clinics is both feasible and acceptable to patients and has provided novel insights that are not routinely available with traditional methods.
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Affiliation(s)
- Ramsay Meiklem
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, Scotland
| | | | | | | | | | - Mark Dunlop
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, Scotland
| | - Peter Thomson
- Queen Elizabeth University Hospital, Glasgow, Scotland
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13
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Macfarlane AJ, Kearns RJ, Clancy MJ, Kingsmore D, Stevenson K, Jackson A, Mark P, Aitken M, Moonesinghe R, Vindrola-Padros C, Gaianu L, Pettigrew G, Motallebzadeh R, Karydis N, Vesey A, Singh R, Muniraju T, Suttie S, McConnachie A, Wetherall K, El-Boghdadly K, Hogg R, Thomson I, Nangalia V, Aitken E. Anaesthesia Choice for Creation of Arteriovenous Fistula (ACCess) study protocol : a randomised controlled trial comparing primary unassisted patency at 1 year of primary arteriovenous fistulae created under regional compared to local anaesthesia. BMJ Open 2021; 11:e052188. [PMID: 34937718 PMCID: PMC8704953 DOI: 10.1136/bmjopen-2021-052188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 11/18/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Arteriovenous fistulae (AVF) are the 'gold standard' vascular access for haemodialysis. Universal usage is limited, however, by a high early failure rate. Several small, single-centre studies have demonstrated better early patency rates for AVF created under regional anaesthesia (RA) compared with local anaesthesia (LA). The mechanistic hypothesis is that the sympathetic blockade associated with RA causes vasodilatation and increased blood flow through the new AVF. Despite this, considerable variation in practice exists in the UK. A high-quality, adequately powered, multicentre randomised controlled trial (RCT) is required to definitively inform practice. METHODS AND ANALYSIS The Anaesthesia Choice for Creation of Arteriovenous Fistula (ACCess) study is a multicentre, observer-blinded RCT comparing primary radiocephalic/brachiocephalic AVF created under regional versus LA. The primary outcome is primary unassisted AVF patency at 1 year. Access-specific (eg, stenosis/thrombosis), patient-specific (including health-related quality of life) and safety secondary outcomes will be evaluated. Health economic analysis will also be undertaken. ETHICS AND DISSEMINATION The ACCess study has been approved by the West of Scotland Research and ethics committee number 3 (20/WS/0178). Results will be published in open-access peer-reviewed journals within 12 months of completion of the trial. We will also present our findings at key national and international renal and anaesthetic meetings, and support dissemination of trial outcomes via renal patient groups. TRIAL REGISTRATION NUMBER ISRCTN14153938. SPONSOR NHS Greater Glasgow and Clyde GN19RE456, Protocol V.1.3 (8 May 2021), REC/IRAS ID: 290482.
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Affiliation(s)
- Alan Jr Macfarlane
- Department of Anaesthesia, NHS Greater Glasgow and Clyde, Glasgow, UK
- Academic Unit of Anaesthesia, Critical Care and Pain Medicine, University of Glasgow, Glasgow, UK
| | - Rachel J Kearns
- Department of Anaesthesia, NHS Greater Glasgow and Clyde, Glasgow, UK
- Academic Unit of Anaesthesia, Critical Care and Pain Medicine, University of Glasgow, Glasgow, UK
| | - Marc James Clancy
- Department of Renal Surgery, Queen Elizabeth University Hospital, Glasgow, UK
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - David Kingsmore
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Department of Vascular Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Karen Stevenson
- Department of Renal Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Andrew Jackson
- Department of Renal Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Patrick Mark
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Department of Nephrology, Queen Elizabeth University Hospital Campus, Glasgow, UK
| | - Margaret Aitken
- Department of Renal Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Ramani Moonesinghe
- Centre for Perioperative Medicine, University College London, London, UK
- Anaesthesia and Critical Care, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Lucian Gaianu
- Independent Health Economist, Healthonomics UK Ltd, Reading, UK
| | - Gavin Pettigrew
- Department of Surgery, Cambridge University, Cambridge, UK
- Department of Surgery, Addenbrooke's Hospital, Cambridge, UK
| | - Reza Motallebzadeh
- Department of Nephrology and Transplantation, Royal Free London NHS Foundation Trust, London, UK
- Department of Surgery and Interventional Science, University College London, London, UK
| | - Nikolaos Karydis
- Department of Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Alex Vesey
- Department of Vascular Surgery, University Hospital Hairmyres, East Kilbride, UK
| | - Rita Singh
- Department of Anaesthesia, Freeman Hospital, Newcastle upon Tyne, UK
| | - Thalakunte Muniraju
- Department of Nephrology, Dumfries and Galloway Acute Hospitals, Dumfries, UK
| | - Stuart Suttie
- Department of Vascular Surgery, Ninewells Hospital and Medical School, Dundee, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Kirsty Wetherall
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Kariem El-Boghdadly
- Department of Anaesthesia and Perioperative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Centre for Human and Applied Physiological Sciences, King's College London, London, UK
| | - Rosemary Hogg
- Department of Anaesthesia, Belfast Health and Social Care Trust, Belfast, UK
| | - Iain Thomson
- Department of Anaesthesia, Queen Elizabeth University Hospital, Glasgow, UK
| | - Vishal Nangalia
- Department of Anaesthesia, Royal Free London NHS Foundation Trust, London, UK
| | - Emma Aitken
- Department of Renal Surgery, Queen Elizabeth University Hospital, Glasgow, UK
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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14
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Kingsmore D, Jackson A, Stevenson K. A critical review of surgical strategies to minimise venous stenosis in arteriovenous grafts. J Vasc Access 2021; 24:11297298211060944. [PMID: 34847754 DOI: 10.1177/11297298211060944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
It is inevitable that complications arising from surgical procedures are ascribed to surgical technique, and this applies to venous stenosis (VS) in arteriovenous grafts. However, despite a wide range of cellular studies, computer modelling, observational series and clinical trials, there remains uncertainty on whether surgical technique contributes to VS. This article reviews evidence from basic science, fluid dynamics and clinical data to try and rationalise the main surgical options to modify the occurrence of venous stenosis. There is sufficient data from diverse sources to make recommendations on clinical practice (size of target vein, shape of anastomosis, angle of approach, distance from venous needling, trauma to the target vein) whilst at the same time this emphasises the need to carefully report the practical aspects of surgical technique in future clinical trials.
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Affiliation(s)
- David Kingsmore
- Department of Vascular Surgery, Queen Elizabeth University Hospital Trust, Glasgow, UK
- Department of Renal Transplantation, Queen Elizabeth University Hospital Trust, Glasgow, UK
| | - Andrew Jackson
- Department of Renal Transplantation, Queen Elizabeth University Hospital Trust, Glasgow, UK
| | - Karen Stevenson
- Department of Renal Transplantation, Queen Elizabeth University Hospital Trust, Glasgow, UK
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15
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Pearson R, Wubetu J, Jackson A, Kingsmore D. Living donor kidney transplant following nephrectomy for renal artery stenosis with arterial reconstruction and viability assessment using ex vivo normothermic perfusion. BMJ Case Rep 2021; 14:e245273. [PMID: 34789527 PMCID: PMC8601085 DOI: 10.1136/bcr-2021-245273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 11/04/2022] Open
Abstract
Ex vivo normothermic perfusion (EVNP) is increasingly recognised as a viability tool to increase organ utilisation in deceased donor transplantation. We report the use of EVNP to assess graft perfusion quality following indication nephrectomy and back-bench arterial reconstruction in a case of renal artery stenosis, unamenable to endovascular treatment. Once explanted, it was not possible to effectively cold perfuse the graft through the main renal artery or collaterals. An arterial reconstruction was performed with patch angioplasty using the largest collateral creating a single common stem. EVNP was used to assess organ perfusion and, therefore, viability. Excellent global perfusion was evident alongside urine production, demonstrating that the arterial reconstruction was satisfactory. A patient with end-stage renal disease was consented with particular attention to the uncertainty of the underlying donor disease process and long-term outcome of the reconstruction. Primary function was achieved and recipient estimated glomerular filtration rate (eGFR) remains stable at 58 mL/min/1.73 m² at 6 months.
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Affiliation(s)
- Robert Pearson
- Renal Transplantation, Queen Elizabeth University Hospital, Glasgow, UK
| | - Jonathan Wubetu
- Renal Transplantation, Queen Elizabeth University Hospital, Glasgow, UK
| | - Andrew Jackson
- Renal Transplantation, Queen Elizabeth University Hospital, Glasgow, UK
| | - David Kingsmore
- Renal Transplantation, Queen Elizabeth University Hospital, Glasgow, UK
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16
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Gilbert J, Rai J, Kingsmore D, Skousen J, Ptohis N. First Clinical Results of the Merit WRAPSODY™ Cell-Impermeable Endoprosthesis for Treatment of Access Circuit Stenosis in Haemodialysis Patients. Cardiovasc Intervent Radiol 2021; 44:1916-1917. [PMID: 34755199 PMCID: PMC8626388 DOI: 10.1007/s00270-021-03001-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 10/31/2022]
Affiliation(s)
- James Gilbert
- Oxford Transplant Centre, Oxford University Hospitals NHS Foundation Trust, Old Road, Headington, OX3 7LE, Oxford, UK.
| | - Jason Rai
- Oxford Transplant Centre, Oxford University Hospitals NHS Foundation Trust, Old Road, Headington, OX3 7LE, Oxford, UK
| | | | - John Skousen
- Merit Medical Systems, Inc, South Jordan, Utah, USA
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17
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Gilbert J, Rai J, Kingsmore D, Skousen J, Ptohis N. First Clinical Results of the Merit WRAPSODY™ Cell-Impermeable Endoprosthesis for Treatment of Access Circuit Stenosis in Haemodialysis Patients. Cardiovasc Intervent Radiol 2021; 44:1903-1913. [PMID: 34514534 PMCID: PMC8626397 DOI: 10.1007/s00270-021-02953-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 08/20/2021] [Indexed: 11/02/2022]
Abstract
PURPOSE This prospective, observational first in human study evaluated the safety and effectiveness of WRAPSODYTM Cell-impermeable Endoprosthesis (Merit Medical Systems, Inc.) in the treatment of arteriovenous fistula and arteriovenous graft access circuit stenosis. MATERIALS AND METHODS Investigators conducted a prospective analysis of 46 patients with access circuit stenosis from three centres. Treatment sites included the peripheral outflow veins (e.g. cephalic arch, basilic vein swing point; 16 fistula and 10 graft patients); the graft-vein anastomosis (9 patients); and the central veins (up to, but not including the SVC; 11 patients). Primary outcome measures included 30-day freedom from access circuit-related safety events and 30-day target lesion primary patency. Secondary outcome measures included procedural success; device- and procedure-related adverse events; target lesion primary patency; access circuit primary patency; and secondary patency. In-person follow-up was scheduled at 1, 3, 6, and 12 months. An independent data monitoring/clinical event committee adjudicated all reinterventions and device/procedure-relatedness for adverse events. RESULTS All initial procedures were successful. All but one patient was free from safety events through the first 30 days (97.8% (45/46)). This event was not device-related. Over the remainder of the study, one adverse event was adjudicated as possibly device-related. Six- and 12-month target lesion primary patency rates were 97.7% (42/43) and 84.6.% (33/39), respectively. Six- and 12-month access circuit primary patency rates were 84.4% (38/45) and 65.9% (29/44), respectively. CONCLUSION Results suggest that the study device is safe and effective for treatment of stenoses in the peripheral and central veins of arteriovenous access circuits. LEVEL OF EVIDENCE Level 2b, cohort study.
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Affiliation(s)
- James Gilbert
- The Oxford Transplant Centre, Churchill Hospital, Old Road, Headington, Oxford, OX3 7LE, UK.
| | - Jason Rai
- The Oxford Transplant Centre, Churchill Hospital, Old Road, Headington, Oxford, OX3 7LE, UK
| | | | - John Skousen
- Merit Medical Systems, Inc, South Jordan, Utah, USA
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18
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Richarz S, Stevenson K, White B, Thomson P, Jackson A, Isaak A, Kingsmore D. Early-cannulation arteriovenous grafts are safe and effective in avoiding recurrent tunneled central catheter infection. Br J Surg 2021. [DOI: 10.1093/bjs/znab202.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Objective
Tunneled central venous catheter infection (TCVCi) is a common complication that often necessitates removal of the TCVC and a further TCVC. Theoeretically, insertion of an early-cannualtion graft (ecAVG) early after TCVC infection is possible but not widely practiced with concerns over safety and infection in the ecAVG. With 8 years of ecAVG experience, the aim of this study was to compare the outcomes following TCVC infection, comparing replacement with TCVC (TCVCr) versus immediate ecAVG (ecAVGr).
Methods
Retrospective comparison of two cohorts, who underwent replacement of an infected TCVC either by an early cannulation graft (n = 18) or by a further central catheter (n = 39).
Data were abstracted from a prospectively completed electronic patient record and collected on patient demographics, TCVC insertion, duration and infection, including culture proven bacteriaemia and subsequent access interventions.
Results
18/299 patients identified from 2012-2020 had an ecAVG implanted as treatment for a TCVCi. In a one-year time-period (1/1/2015 -31/12/2015) out of 222 TCVC inserted, 39 were as a replacement following a TCVCi. No patient with an ecAVGr developed an immediate infection, nor complication from the procedure. The rate of subsequent vascular access infection was significantly more frequent for those with TCVCr than with an ecAVGr (0.6 vs. 0.1/patient/ 1000 HD days, p < 0.000). The number of further TCVC required was significantly higher in the TCVCr group (7.1 vs. 0.4/patient/ 1000 HD days, p = 0.000).
Conclusion
An ecAVG early following a TCVC infection is safe, reduces the incidence of subsequent infectious complications and reduces the number of TCVC required, with a better functional patency.
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Affiliation(s)
- S Richarz
- Department of Vascular Surgery, University Hospital Basel, Basel, Switzerland
- Department of Renal and Transplant Surgery, Queen Elizabeth University Hospital Glasgow, Glasgow, United Kingdom
| | - K Stevenson
- Department of Renal and Transplant Surgery, Queen Elizabeth University Hospital Glasgow, Glasgow, United Kingdom
| | - B White
- Department of Infectious Diseases and Microbiology, Queen Elizabeth University Hospital Glasgow, Glasgow, United Kingdom
| | - P Thomson
- Department of Nephrology, Queen Elizabeth University Hospital Glasgow, Glasgow, United Kingdom
| | - A Jackson
- Department of Renal and Transplant Surgery, Queen Elizabeth University Hospital Glasgow, Glasgow, United Kingdom
| | - A Isaak
- Department of Vascular Surgery, Cantonal Hospital Aarau, Aarau, Switzerland
| | - D Kingsmore
- Department of Vascular and Endovascular Surgery, Queen Elizabeth University Hospital Glasgow, Glasgow, United Kingdom
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19
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Wlodek E, Kirkpatrick RB, Andrews S, Noble R, Schroyer R, Scott J, Watson CJE, Clatworthy M, Harrison EM, Wigmore SJ, Stevenson K, Kingsmore D, Sheerin NS, Bestard O, Stirnadel-Farrant HA, Abberley L, Busz M, DeWall S, Birchler M, Krull D, Thorneloe KS, Weber A, Devey L. A pilot study evaluating GSK1070806 inhibition of interleukin-18 in renal transplant delayed graft function. PLoS One 2021; 16:e0247972. [PMID: 33684160 PMCID: PMC7939287 DOI: 10.1371/journal.pone.0247972] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 12/11/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Delayed graft function (DGF) following renal transplantation is a manifestation of acute kidney injury (AKI) leading to poor long-term outcome. Current treatments have limited effectiveness in preventing DGF. Interleukin-18 (IL18), a biomarker of AKI, induces interferon-γ expression and immune activation. GSK1070806, an anti-IL18 monoclonal antibody, neutralizes activated (mature) IL18 released from damaged cells following inflammasome activation. This phase IIa, single-arm trial assessed the effect of a single dose of GSK1070806 on DGF occurrence post donation after circulatory death (DCD) kidney transplantation. METHODS The 3 mg/kg intravenous dose was selected based on prior studies and physiologically based pharmacokinetic (PBPK) modeling, indicating the high likelihood of a rapid and high level of IL18 target engagement when administered prior to kidney allograft reperfusion. Utilization of a Bayesian sequential design with a background standard-of-care DGF rate of 50% based on literature, and confirmed via extensive registry data analyses, enabled a statistical efficacy assessment with a minimal sample size. The primary endpoint was DGF frequency, defined as dialysis requirement ≤7 days post transplantation (except for hyperkalemia). Secondary endpoints included safety, pharmacokinetics and pharmacodynamic biomarkers. RESULTS GSK1070806 administration was associated with IL18-GSK1070806 complex detection and increased total serum IL18 levels due to IL18 half-life prolongation induced by GSK1070806 binding. Interferon-γ-induced chemokine levels declined or remained unchanged in most patients. Although the study was concluded prior to the Bayesian-defined stopping point, 4/7 enrolled patients (57%) had DGF, exceeding the 50% standard-of-care rate, and an additional two patients, although not reaching the protocol-defined DGF definition, demonstrated poor graft function. Six of seven patients experienced serious adverse events (SAEs), including two treatment-related SAEs. CONCLUSION Overall, using a Bayesian design and extensive PBPK dose modeling with only a small sample size, it was deemed unlikely that GSK1070806 would be efficacious in preventing DGF in the enrolled DCD transplant population. TRIAL REGISTRATION NCT02723786.
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Affiliation(s)
- E. Wlodek
- GlaxoSmithKline, Clinical Unit Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - R. B. Kirkpatrick
- GlaxoSmithKline, Philadelphia, Pennsylvania, United States of America
| | - S. Andrews
- GlaxoSmithKline, Philadelphia, Pennsylvania, United States of America
| | - R. Noble
- GlaxoSmithKline, Philadelphia, Pennsylvania, United States of America
| | - R. Schroyer
- GlaxoSmithKline, Philadelphia, Pennsylvania, United States of America
| | - J. Scott
- JMS Statistics Ltd, Pinner, United Kingdom
| | - C. J. E. Watson
- University of Cambridge and the NIHR Cambridge Biomedical Research Centre and the NIHR Blood and Transplant Research Unit in Organ Donation and Transplantation at the University of Cambridge, Cambridge, United Kingdom
| | - M. Clatworthy
- University of Cambridge and the NIHR Cambridge Biomedical Research Centre and the NIHR Blood and Transplant Research Unit in Organ Donation and Transplantation at the University of Cambridge, Cambridge, United Kingdom
| | | | - S. J. Wigmore
- Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - K. Stevenson
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - D. Kingsmore
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - N. S. Sheerin
- Newcastle Biomedical Research Centre and the NIHR Blood and Transplant Research Unit in Organ Donation and Transplantation, Newcastle University, Newcastle, United Kingdom
| | - O. Bestard
- L’Hospitalet de Llobregat, Bellvitge University Hospital, Kidney Transplant Unit, Barcelona, Spain
| | | | - L. Abberley
- GlaxoSmithKline, Philadelphia, Pennsylvania, United States of America
| | - M. Busz
- GlaxoSmithKline, Philadelphia, Pennsylvania, United States of America
| | - S. DeWall
- GlaxoSmithKline, Philadelphia, Pennsylvania, United States of America
| | - M. Birchler
- GlaxoSmithKline, Philadelphia, Pennsylvania, United States of America
| | - D. Krull
- GlaxoSmithKline, Philadelphia, Pennsylvania, United States of America
| | - K. S. Thorneloe
- GlaxoSmithKline, Philadelphia, Pennsylvania, United States of America
- * E-mail:
| | - A. Weber
- GlaxoSmithKline, Philadelphia, Pennsylvania, United States of America
| | - L. Devey
- GlaxoSmithKline, Philadelphia, Pennsylvania, United States of America
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20
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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21
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Stoumpos S, Rankin A, Hall Barrientos P, Thomson P, Kasthuri R, Kingsmore D, Roditi G, Mark P. P1322EFFECTS OF HAEMODIALYSIS ARTERIOVENOUS FISTULA CREATION ON CARDIAC STRUCTURE AND FUNCTION. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p1322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background and Aims
Arteriovenous fistula (AVF) is considered the preferred type of access for maintenance haemodialysis. The creation of an AVF may contribute to maladaptive cardiovascular remodelling. We conducted a study to evaluate the effect of AVF creation on cardiac structure and function in patients with end-stage renal disease (ESRD).
Method
In this prospective cohort study, patients with ESRD listed for AVF creation underwent cardiac magnetic resonance imaging at baseline and at 6 weeks. All participants had ultrasound measurements of AVF blood flow at 6 weeks. The primary outcome was the change in left ventricular (LV) mass. Secondary outcomes included changes in LV volumes, left atrial volume, LV ejection fraction, LV global longitudinal strain, cardiac output/index, and septal thickness.
Results
A total of 65 patients were enrolled, of whom 40 had an AVF creation and completed both scans. Patients were divided into 2 groups based on AVF blood flows: 22 in the high flow group (≥ 600mL/min) and 18 in the low flow group (< 600mL/min). On the second cardiac magnetic resonance scan, a mean increase of 7.4 g (95% CI, 1.1–13.7, P=0.02) was observed in LV mass; in the high flow group the mean increase was 15.5 g (95% CI, 7.3–23.8) compared with a small decrease of 2.5 g (95% CI, −10.6 to 5.6) in the low flow group (P=0.003). Significant increases in LV end-diastolic volumes, cardiac output, and cardiac index were also seen after AVF creation (P<0.04). No significant changes were observed in LV ejection fraction (P=0.52), LV end-systolic volumes (P=0.12), and LV global longitudinal strain (P=0.21).
Conclusion
Creation of AVF in adults with ESRD resulted in significant increase of LV myocardial mass early after surgery.
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Affiliation(s)
- Sokratis Stoumpos
- University of Glasgow, Cardiovascular Research Centre, Glasgow, United Kingdom
- Queen Elizabeth University Hospital, Renal and Transplant Unit, Glasgow, United Kingdom
| | - Alastair Rankin
- University of Glasgow, Cardiovascular Research Centre, Glasgow, United Kingdom
| | | | - Peter Thomson
- Queen Elizabeth University Hospital, Renal and Transplant Unit, Glasgow, United Kingdom
| | - Ram Kasthuri
- Queen Elizabeth University Hospital, Radiology, Glasgow, United Kingdom
| | - David Kingsmore
- Queen Elizabeth University Hospital, Renal and Transplant Unit, Glasgow, United Kingdom
| | - Giles Roditi
- Queen Elizabeth University Hospital, Radiology, Glasgow, United Kingdom
| | - Patrick Mark
- University of Glasgow, Cardiovascular Research Centre, Glasgow, United Kingdom
- Queen Elizabeth University Hospital, Renal and Transplant Unit, Glasgow, United Kingdom
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Stoumpos S, Tan A, Hennessy M, Kasthuri R, Radjenovic A, Kingsmore D, Roditi GH, Mark P. FO019FERUMOXYTOL MR ANGIOGRAPHY VS DOPPLER US FOR VASCULAR MAPPING BEFORE HAEMODIALYSIS ARTERIOVENOUS ACCESS CREATION. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz096.fo019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Alfred Tan
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Martin Hennessy
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Ram Kasthuri
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | | | - David Kingsmore
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
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Stoumpos S, Barrientos P, Black D, Stevenson K, Hennessy M, Vesey A, Kasthuri R, Radjenovic A, Kingsmore D, Roditi GH, Mark P. FO039FERUMOXYTOL MR ANGIOGRAPHY VS CT ANGIOGRAPHY FOR THE ASSESSMENT OF POTENTIAL KIDNEY TRANSPLANT RECIPIENTS. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz096.fo039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - Douglas Black
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Karen Stevenson
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Martin Hennessy
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Alex Vesey
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Ram Kasthuri
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | | | - David Kingsmore
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
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Vesey A, Hennessy M, Stoumpos S, Radjenovic A, Kingsmore D, Mark P, Roditi G. LEO 6. Ferumoxytol-Enhanced Magnetic Resonance Angiography—Clinical Feasibility and Optimal Dosing. J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2018.08.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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25
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Isaak A, Takes M, Kingsmore D, Gürke L. Endovascular Retrieval of Intracaval Cement: A Fishing Net Technique. Cardiovasc Intervent Radiol 2018; 41:1958-1961. [PMID: 30128782 DOI: 10.1007/s00270-018-2061-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 08/12/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE To describe a novel endovascular technique for intracaval cement retrieval after spinal surgery. TECHNIQUE We produced a replica of the intracaval cement fragment and a 3D print to plan the endovascular procedure. A woven caval filter was modified with two drawstring sutures to be used as fishing net. We used a 10F sheath in the right internal jugular vein to place the caval filter proximal to the floating fragment, and a 24F sheath in the right femoral vein was the working access. After the deployment of the caval filter, the following steps were performed through the 24F sheath: (A) The drawstring sutures were snared and retrieved to the skin surface in the groin; (B) the fragment was secured with two snare catheters from the femoral access and one through the lumen of the caval filter; (C) the fragment was broken off with a snared guide wire at the base; (D) the smallest fragment was removed directly with the snare; (E) the larger dislodged fragment was controlled within the periprocedural caval filter by tightening the drawstring and removed through the 24F sheath. CONCLUSION Cement fragments located in the inferior vena cava after cement-augmented spinal surgery procedures can be safely removed by the described fishing net technique.
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Affiliation(s)
- Andrej Isaak
- Department of Vascular and Endovascular Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | - Martin Takes
- Department of Interventional Radiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - David Kingsmore
- Department of Vascular and Endovascular Surgery, Queen Elizabeth University Hospital, 1345 Govan Rd, Glasgow, G51 4TF, UK
| | - Lorenz Gürke
- Department of Vascular and Endovascular Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
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26
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Aitken E, McColl G, Kingsmore D. The Role of Qutenza® (Topical Capsaicin 8%) in Treating Neuropathic Pain from Critical Ischemia in Patients with End-Stage Renal Disease: An Observational Cohort Study. Pain Med 2018; 18:330-340. [PMID: 28204726 DOI: 10.1093/pm/pnw139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective Current treatment strategies for painful critical ischemia in patients with end-stage renal disease (ESRD) are suboptimal. A drug that is non-renally excreted has minimal systemic absorption and does not require dose adjustment in renal failure is attractive. The aim of this study was to evaluate the safety and efficacy of Qutenza® (topical capsaicin 8%) for chronic neuropathic pain from critical ischemia in patients with ESRD. Design and Setting A prospective cohort study was conducted in a single-center, university teaching hospital. Patients Twenty patients with ESRD were treated with Qutenza® for neuropathic pain from critical limb ischemia. Methods Patients were followed-up at 1, 6 and 12 weeks post-treatment. The primary end point was the difference in visual analog scale (VAS) between baseline and week 12. Secondary end points were Brief Pain Inventory questionnaire (BPI) scores, quality of life assessment (EQ-5D) and patient global impression of change (PGIC). Safety and tolerability data were also collected. The trial was prospectively registered with clinical trials databases (EudraCT: 2012-001586-32; NCT01704313). Results There was significant reduction in VAS from baseline to week 12 (-20+/-7%; P = 0.02). There was a significant reduction in all seven domains of the BPI. Quality of life also improved at 12 weeks following treatment in two of the EQ-5D domains (mobility and pain). Qutenza® was well tolerated with no significant side effects in this patient cohort, which included 20% diabetics. Conclusions In this small, observational study Qutenza® treatment has been shown to be effective and well-tolerated to treat neuropathic pain from critical ischemia in patients with ESRD.
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Affiliation(s)
- Emma Aitken
- Department of Renal Surgery, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
| | - Gillian McColl
- Department of Renal Surgery, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
| | - David Kingsmore
- Department of Renal Surgery, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
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Stoumpos S, Traynor J, Metcalfe W, Kasthuri R, Stevenson K, Mark P, Kingsmore D, Thomson P. FP562ARTERIOVENOUS FISTULA USE AND PATENCY IN A CONTEMPORARY HAEMODIALYSIS POPULATION: A NATIONAL OBSERVATIONAL STUDY. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.fp562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Sokratis Stoumpos
- Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
- Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Jamie Traynor
- Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Wendy Metcalfe
- Renal Unit, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Ram Kasthuri
- Radiology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Karen Stevenson
- Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Patrick Mark
- Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
- Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - David Kingsmore
- Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Peter Thomson
- Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom
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Stoumpos S, Hennessy M, Vesey A, Radjenovic A, Kasthuri R, Roditi G, Thomson P, Mark P, Kingsmore D. MO050FERUMOXYTOL-ENHANCED MAGNETIC RESONANCE ANGIOGRAPHY FOR THE ASSESSMENT OF PATIENTS WITH COMPLEX ANATOMY DUE FOR VASCULAR ACCESS CREATION. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx122.mo050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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29
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Stoumpos S, Hennessy M, Vesey A, Radjenovic A, Kasthuri R, Kingsmore D, Roditi G, Mark P. MP817FERUMOXYTOL-ENHANCED MAGNETIC RESONANCE ANGIOGRAPHY FOR THE ASSESSMENT OF POTENTIAL KIDNEY TRANSPLANT RECIPIENTS. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx182.mp817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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30
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Aitken E, Thomson P, Bainbridge L, Kasthuri R, Mohr B, Kingsmore D. A randomized controlled trial and cost-effectiveness analysis of early cannulation arteriovenous grafts versus tunneled central venous catheters in patients requiring urgent vascular access for hemodialysis. J Vasc Surg 2017; 65:766-774. [DOI: 10.1016/j.jvs.2016.10.103] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 10/19/2016] [Indexed: 11/16/2022]
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31
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Hennessy M, Roditi G, Stoumpos S, Mark P, Kingsmore D, Radjenovic A, Vesey A. Developing a new imaging service for renal failure patients with ferumoxytol-enhanced magnetic resonance angiography (FeMRA). Clin Radiol 2016. [DOI: 10.1016/j.crad.2016.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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32
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McIlveen E, Jackson A, Bowie J, Stirling C, Downie A, Kingsmore D. A unique case of acute embolus in a renal transplant with salvage by catheter-directed thrombolysis. Scott Med J 2016; 61:106-110. [PMID: 27543329 DOI: 10.1177/0036933016635402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Acute renal transplant emboli can be disastrous and result in loss of the renal transplant. This case was successfully treated with thrombolysis. CASE PRESENTATION A 66-year-old female underwent a right-sided deceased heart-beating donor renal transplant. She had excellent transplant function but presented acutely three years later with pain in the transplanted kidney, an acute rise in serum creatinine and new onset atrial fibrillation. Bedside ultrasound scan demonstrated absent transplant perfusion. Emergency angiogram confirmed acute emboli in the transplant renal artery with some kidney perfusion. Thrombolysis with alteplase and anticoagulation with heparin was commenced. Serial imaging at 24 and 36 h demonstrated significant improvement in transplant perfusion. Following a period of supportive therapy, her transplant function recovered, although not to pre-morbid baseline levels. CONCLUSION Consider acute embolus in a renal transplant patient with acute kidney injury, transplant tenderness and cardiac arrhythmia. Early thrombolysis may salvage renal transplants and good transplant function may be regained.
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Affiliation(s)
- E McIlveen
- LAT Specialty Trainee 3, West of Scotland Deanery, UK
| | - A Jackson
- Specialty Trainee 7, West of Scotland Deanery, UK
| | - J Bowie
- GPST1, West of Scotland Deanery, UK
| | - C Stirling
- Consultant Nephrologist, Western Infirmary, UK
| | - A Downie
- Consultant Radiologist, Western Infirmary, UK
| | - D Kingsmore
- Consultant Vascular and Transplant Surgeon, Western Infirmary, UK
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34
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Aitken E, Jeans E, Aitken M, Kingsmore D. A randomized controlled trial of interrupted versus continuous suturing techniques for radiocephalic fistulas. J Vasc Surg 2015; 62:1575-82. [DOI: 10.1016/j.jvs.2015.07.083] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 07/23/2015] [Indexed: 10/22/2022]
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35
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Sulti ZA, McDonald R, Kingsmore D, Baker A, Coats P. 202 Mitochondrial Dynamics Regulation of Ros and Apoptosis. Heart 2015. [DOI: 10.1136/heartjnl-2015-308066.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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36
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Aitken E, Geddes C, Thomson P, Kasthuri R, Chandramohan M, Berry C, Kingsmore D. Immediate access arteriovenous grafts versus tunnelled central venous catheters: study protocol for a randomised controlled trial. Trials 2015; 16:42. [PMID: 25885054 PMCID: PMC4343055 DOI: 10.1186/s13063-015-0556-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 01/07/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Autologous arteriovenous fistulae (AVF) are the optimal form of vascular access for haemodialysis. AVFs typically require 6 to 8 weeks to "mature" from the time of surgery before they can be cannulated. Patients with end-stage renal disease needing urgent vascular access therefore traditionally require insertion of a tunnelled central venous catheter (TCVC). TCVCs are associated with high infection rates and central venous stenosis. Early cannulation synthetic arteriovenous grafts (ecAVG) provide a novel alternative to TCVCs, permitting rapid access to the bloodstream and immediate needling for haemodialysis. Published rates of infection in small series are low. The aim of this study is to compare whether TCVC ± AVF or ecAVG ± AVF provide a better strategy for managing patients requiring immediate vascular access for haemodialysis. METHODS/DESIGN This is a prospective randomised controlled trial comparing the strategy of TCVC ± AVF to ecAVG ± AVF. Patients requiring urgent vascular access will receive a study information sheet and written consent will be obtained. Patients will be randomised to receive either: (i) TCVC (and native AVF if this is anatomically possible) or (ii) ecAVG (± AVF). 118 patients will be recruited. The primary outcome is systemic bacteraemia at 6 months. Secondary outcomes include culture-proven bacteraemia rates at 1 year and 2 years; primary and secondary patency rates at 3, 6, 12 and 24 months; stenoses; re-intervention rates; re-admission rate; mortality and quality of life. Additionally, treatment delays, impact on service provision and cost-effectiveness will be evaluated. DISCUSSION This is the first randomised controlled trial comparing TCVC to ecAVG for patients requiring urgent vascular access for haemodialysis. The complications of TCVC are considered an unfortunate necessity in patients requiring urgent haemodialysis who do not have autologous vascular access. If this study demonstrates that ecAVGs provide a safe and practical alternative to TCVC, this could instigate a paradigm shift in nephrology thinking and access planning. TRIAL REGISTRATION This study has been approved by the West of Scotland Research Ethics Committee 4 (reference no. 13/WS/0087, 28 August 2013) and is registered with the International Standard Randomised Controlled Trial Number Register (reference no. ISRCTN80588541 , 27 May 2014).
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Affiliation(s)
- Emma Aitken
- Department of Renal Surgery, Western Infirmary, Dumbarton Road, Glasgow, G11 6NT, UK.
- School of Medical, Veterinary and Life Science, University of Glasgow, University Avenue, Glasgow, G12 8TA, UK.
| | - Colin Geddes
- Department of Nephrology, Western Infirmary, Dumbarton Road, Glasgow, G11 6NT, UK.
| | - Pete Thomson
- Department of Nephrology, Western Infirmary, Dumbarton Road, Glasgow, G11 6NT, UK.
| | - Ram Kasthuri
- Department of Radiology, Western Infirmary, Dumbarton Road, Glasgow, G11 6NT, UK.
| | - Mohan Chandramohan
- Department of Radiology, Western Infirmary, Dumbarton Road, Glasgow, G11 6NT, UK.
| | - Colin Berry
- British Heart Foundation Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, University Avenue, Glasgow, G12 8TA, UK.
| | - David Kingsmore
- Department of Renal Surgery, Western Infirmary, Dumbarton Road, Glasgow, G11 6NT, UK.
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Aitken E, Cooper C, Dempster N, McDermott M, Ceresa C, Kingsmore D. Delayed graft function is a syndrome rather than a diagnosis. EXP CLIN TRANSPLANT 2015; 13:19-25. [PMID: 25654410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Delayed graft function is a significant prognostic indicator after renal transplantation. We hypothesized that delayed graft function is not a single entity, and different patterns of delayed graft function reflect various underlying pathological processes. MATERIALS AND METHODS An analysis of 762 renal transplants was performed, showing serum creatinine was charted serially for the first 30 days after transplant. Measurements were obtained: time on hemodialysis; time to peak creatinine; time for creatinine to half; time for creatinine to within 10% of baseline. RESULTS Four patterns of delayed graft function were identified. There was no association between pattern of delayed graft function, and 1-year graft survival or serum creatinine at 1 year. Time for creatinine to > 15 days was associated with a higher creatinine level at 1 year than it was with patients with time for creatinine to half < 5 days (300.6 ± 54.3 vs 211.3 ± 26.0 μmol/L; P < .01). Patients with 1-year creatinine concentrations > 180 μmol/L had longer time on hemodialysis and time for creatinine to half than did those with 1-year creatinine concentrations ≤ 180 μmol/L (9.2 ± 1.3 μmol/L vs 7.0 ± 0.7 μmol/L; P = .03; and 11.6 ± 1.7 μmol/L vs 6.0 ± 0.4 μmol/L; P < .001). Time for creatinine to half of 6.5 days (sensitivity 67.3%; specificity 79.4%; area under the curve, 0.70) was the best predictor of a 1-year creatinine concentration ≤ 180 μmol/L. CONCLUSIONS Delayed graft function is not a single entity; rather; it is the most common presentation of a heterogeneous variety of pathologies. Its rate of resolution of renal function is the best predictor of long-term graft outcome.
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Affiliation(s)
- Emma Aitken
- From the Department of Renal Transplantation, Western Infirmary, Glasgow, Scotland
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38
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Sulti ZA, McDonald R, Kingsmore D, Baker A, Coats P. MITOCHONDRIAL REGULATION OF MICRO RNA SYNTHESIS IN VASCULAR SMOOTH MUSCLE CELL PROLIFERATION. Heart 2014. [DOI: 10.1136/heartjnl-2014-306916.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
BACKGROUND Guidance varies regarding the optimal timing of arteriovenous fistula (AVF) creation. The aim of this study was to evaluate the association between uraemia, haemodialysis and early AVF failure. METHODS Immunoblotting and cell proliferation assays were performed on vascular smooth muscle cells (VSM) cells isolated from long saphenous vein samples to evaluate the cells' ability to proliferate when stimulated with uraemic (post-dialysis) and hyperuraemic (pre-dialysis) serum. Clinical data was collected prospectively for 569 consecutive radiocephalic (RCF) and brachiocephalic (BCF) fistulae. The primary outcome was AVF failure at 6 weeks. Dialysis status (haemodialysis (HD); pre-dialysis (Pre-D)), eGFR and serum urea were evaluated to determine if they affected early AVF failure. RESULTS Human VSM cells demonstrated increased capacity to proliferate when stimulated with hyperuraemic serum. There was no significant difference in early failure rate of either RCF or BCF depending on dialysis status (pre-D RCF 31.4% (n=188); pre-D BCF 22.4% (n=165); HD RCF 29.3% (n=99); HD BCF 25.9% (n=116); p=0.34). There was no difference in mean eGFR between those patients with early AVF failure and those without (11.2+/-0.2 ml/min/1.73 m2 vs. 11.6+/-0.4 ml/min/1.73 m2; p=0.47). Uraemia was associated with early AVF failure (serum urea: 35.0+/-0.7 mg/dl vs. 26.6+/-0.3 mg/dl (p<0.001)). CONCLUSIONS We present the first in vivo evidence of an association between adverse early AVF outcomes and uraemia. This is supported mechanistically by in vitro work demonstrating a pro-mitogenic effect of hyperuraemic serum. We hypothesise that uraemia-driven upregulation of VSM cell proliferation at the site of surgical insult in contributes to higher early AVF failure rates.
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Affiliation(s)
- Emma Aitken
- />Department of Renal Surgery, Western Infirmary, Dumbarton Road, G11 6NY Glasgow, UK
| | - Andrew Jackson
- />Department of Renal Surgery, Western Infirmary, Dumbarton Road, G11 6NY Glasgow, UK
- />Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Chia Kong
- />University of Glasgow Medical School, Glasgow University, Glasgow, UK
| | - Paul Coats
- />Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - David Kingsmore
- />Department of Renal Surgery, Western Infirmary, Dumbarton Road, G11 6NY Glasgow, UK
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Affiliation(s)
- Emma Aitken
- Department of Renal Surgery, Western Infirmary, Glasgow, UK.
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42
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Ceresa C, Aitken E, Dempster N, Kingsmore D. Outcomes of Renal Transplantation in Patients With Major Lower Limb Amputation. Transplant Proc 2014; 46:115-20. [DOI: 10.1016/j.transproceed.2013.07.073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Revised: 07/13/2013] [Accepted: 07/30/2013] [Indexed: 10/25/2022]
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Aitken E, Dempster N, Ceresa C, Daly C, Kingsmore D. The Impact of Socioeconomic Deprivation on Outcomes Following Renal Transplantation in the West of Scotland. Transplant Proc 2013; 45:2176-83. [DOI: 10.1016/j.transproceed.2012.12.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 12/30/2012] [Indexed: 01/20/2023]
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MacAskill M, Wadsworth RM, Kingsmore D, Coats P. Abstract 554: Rabbit Arteriovenous Fistula Model and Identification of a Therapeutic Agent to Increase Fistula Patency. Arterioscler Thromb Vasc Biol 2013. [DOI: 10.1161/atvb.33.suppl_1.a554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
An arteriovenous fistula (AVF) is a vein graft which is created to permit vascular access allowing haemodialysis to be performed in renal failure patients. AVF using native tissues is the preferred surgical option; however AVF are associated with failure rates as high as 50% at 6 months. Failure is principally due to vascular cell proliferation, leading to the development of neointima causing stenosis and impaired blood flow. The aims of this study were to 1) develop a rabbit model of AVF remodelling, 2) investigate the contribution of cannulation injury in AVF remodelling and 3) identify a potential therapeutic which could be delivered topically to reduce AVF stenosis.
The proposed model was an AVF created between the femoral artery and vein of a New Zealand white rabbit. Briefly, the fistula was fashioned by creating a side to side anastomosis, followed by occlusion of the distal vein. Over phase I of the study (days 1-28) maturation of the vein was evident by the presence of a pulsatile flow in the venous branch of the AVF, as well as a significant increase in venous blood velocity from 55.2± 6.0cm/s at day 10 to 68.4± 3.1cm/s by day 28 (p<0.05). A degree of medial/adventitial thickening was also evident at this time point. Rabbits were assigned to 3 groups for phase II of the study (days 29-56). The control group received no intervention, the injury group received cannulation to the AVF every 48-72 hrs, and the injury plus diclofenac group received the same frequency of injury and topical diclofenac (1.16% of
diclofenac
diethylammonium) twice a day, 5 days a week. In the control group, vein wall width increased significantly from 10.5± 0.9μM in the counter lateral vein to 16.6± 1.6μM in the AVF (p<0.05). Cannulation injury caused vein wall thickness to significantly increase to 46.8± 5.7μM (p<0.05). With diclofenac treatment, vein wall width decreased significantly to 15.8± 1.8μM (p<0.05).
These results show for the first time that cannulation injury significantly contributes to AVF remodelling
in vivo
. Topical treatment with diclofenac, which has anti-inflammatory as well as anti-proliferative properties, appears to reduce injury driven remodelling within AVF. Therefore, topical diclofenac could be used as a prophylactic treatment to reduce vascular stenosis in AVF.
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Affiliation(s)
- Mark MacAskill
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Univ of Strathclyde, Glasgow, United Kingdom
| | - Roger M Wadsworth
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Univ of Strathclyde, Glasgow, United Kingdom
| | - David Kingsmore
- Renal Unit, Glasgow Western Infirmary, Glasgow, United Kingdom
| | - Paul Coats
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Univ of Strathclyde, Glasgow, United Kingdom
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Abstract
BACKGROUND Deficiencies in management have been highlighted as contributory factors in the death of many patients with acute kidney injury (AKI). However, there is little evidence addressing the quality of care provided to patients with milder AKI. AIM The aim of this study is to evaluate the quality of care provided to a non-select cohort of patients with AKI and evaluate discrepancies in causation, recognition and management. DESIGN Retrospective inception cohort study. METHODS Demographic data were collected for all 1577 patients admitted to a University Teaching Hospital during a 1-month period. Baseline, admission and peak creatinine were correlated with mortality and length of hospital admission. AKI was classified according to Kidney Disease Improving Global Outcomes criteria. A retrospective case note review of all patients with AKI was carried out to evaluate quality of documentation and clinical management of AKI. Multivariate analysis was undertaken to determine risk factors for AKI. RESULTS Incidence of AKI on admission was 4.6%. A further 10.3% developed AKI while in hospital. All cause mortality was 4-fold higher among patients with AKI compared with those without (19 vs. 3.8%; P < 0.001). Mortality was significantly higher in those patients who developed AKI while an in-patient compared with those with AKI on admission (27.3 vs. 11.8%; P < 0.001). Diabetes, clinician perception of frailty, age and treatment with angiotensin-converting enzyme inhibitor prior to admission were found to be independent risk factors for AKI. AKI was unrecognized in 23.5% of patients, two-thirds of whom were discharged without resolution of renal function. Significant weaknesses in management were poorly kept fluid balance charts (48.2%), failure to withhold nephrotoxic drugs (38.8%) and failure to act upon abnormal biochemistry (41%) in a timely fashion. CONCLUSION AKI is common in hospitalized patients and associated with a significant increase in hospital stay and mortality. AKI is often found in conjunction with other organ failure and in many cases is not preventable. Nevertheless clinicians need to be more vigilant of small creatinine rises to permit early intervention particularly among elderly and frail patients.
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Affiliation(s)
- E Aitken
- Department of Renal Surgery, Western Infirmary, Glasgow G11 6NY, UK.
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46
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Abstract
BACKGROUND Peripheral vascular disease and major extremity amputation are common in patients with established renal failure and are associated with considerable morbidity. Several studies have shown high rates of amputation following simultaneous pancreas-kidney transplantation, but there is minimal literature on the incidence of amputation following renal transplantation. Furthermore, there is little evidence regarding the best method of predicting which patients might be at risk of developing peripheral vascular complications after transplantation. METHODS We undertook a 5 year follow-up on the cohort of patients who were on our renal transplant waiting list 5 years ago (January 2007). At this time, it was standard practice within our unit for all patients to have routine pelvic x-rays to assess for vascular calcification of the iliac vessels at the time of activation onto the transplant waiting list. Any patients with moderate/severe calcification on x-ray, which may complicate transplantation, were referred for computed tomography angiogram (CTA) of their aorto-iliac vessels. Mortality, transplantation outcomes, and amputation rates at 5 years were correlated with the severity of calcification on preoperative imaging. RESULTS One hundred eighty-seven patients were on the waiting list for renal transplantation in January 2007 (92 men; mean age, 58.3 +/- 6.2 years). Ninety-three patients received a transplant during the subsequent 5 years. By January 2012, 82 patients had a functioning transplant, 45 remained on the waiting list (5 suspended), 40 patients had died, and 20 were alive but no longer on the waiting list. Seventy-three (39.5%) had moderate or severe calcification on plain x-ray and went on to have CTA. Of these patients, 16 (21.9%) had extensive calcification affecting all the iliac vessels and were removed from the waiting list as a result. Preoperative imaging was useful in determining the side for surgery in a further 18 patients (24.3%). Twenty-two patients developed vascular complications. Nineteen (86.4%) had moderate-severe vascular calcification on imaging. Four of the patients with vascular complications (18.2%) underwent transplantation (2 had below knee amputation (BKA) prior to transplantation; 1 developed distal ischemia on the same side as the transplantation 2 years postoperatively; 1 had bilateral above knee amputation (AKA) approximately 2 years after transplantation). Eleven (50%) of the patients with vascular complications were dead at 5 years of follow-up. Mortality and amputation rates were higher in patients with moderate-severe calcification than minimal calcification (30.1% vs 16.6%; P = .02 and 10.9% vs 1.8%; P = .003, respectively). There was no difference in rates of delayed graft function (DGF), biopsy-proven acute rejection (BPAR), or creatinine at 1 year between patients who underwent transplantation with moderate-severe calcification and those without, however, intraoperative vascular complications (26.7% vs 3%; P < .001), graft loss (28.1% vs 3.4%; P = .01), and death with a functioning transplant (9.7% vs 1.6%; P = .04) rates were higher in patients with extensive calcification compared with those without. CONCLUSIONS Plain x-ray of the pelvis is a useful screening tool to identify those patients who may require further detailed vascular imaging prior to transplantation. Amputation rates following renal transplantation are low and peripheral vascular disease (PVD) in isolation should not preclude transplantation. Nevertheless, significant vascular calcification is predictive of mortality both with and without transplantation and graft loss in patients with a renal transplant.
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Affiliation(s)
- E Aitken
- Department of Renal Surgery, Western Infirmary, Glasgow, Scotland
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47
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Geddes CC, Jardine AG, Kingsmore D, Murio E, Buist L, Shumeyko V, Padmanabhan N, Daly C, McGregor E, McMillan M, McManus S, Rodger RSC, Clancy M. Five-year outcomes after a change from a cyclosporin-based to a 'low-dose' tacrolimus-based primary immunosuppression regimen for incident kidney transplants--the Glasgow experience. Clin Transpl 2012:95-102. [PMID: 23721012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In January 2007, our centre changed from a cyclosporin (CyA)/azathioprine (Aza)/ prednisolone (Pred) primary immunosuppression regimen (with basiliximab induction and mycophenolate mofetil [MMF] for those at immunologically high risk) to a tacrolimus (Tac) (low dose)/MMF/Pred regimen with basiliximab induction, following presentation of Symphony trial results. This analysis assesses the impact of this change on 5-year outcomes. Three hundred consecutive renal-only transplants were identified: 140 from the 2005-06 era and 160 from the 2007-08 era. The proportions of living donor (37.5 vs. 22.9%; p = 0.04) and donors after circulatory death (11.9 vs. 5.0%; p = 0.03) were higher in the 2007-08 cohort. Five-year actuarial patient survival was higher in the 2007-08 cohort (96.8 vs. 87.1%; p = 0.003), with a trend toward higher 5-year transplant survival (84.7 vs. 76.3%; p = 0.08). Estimated glomerular filtration rate (eGFR) was higher than in the 2005-06 era at 1 (53.5 vs. 44.5 ml/min/1.73m2; p = 0.0006) and 3 years (50.9 vs. 43.4 ml/min/1.73m2; p = 0.02), with a trend toward higher eGFR at 5 years (41.8 vs. 49.6 ml/min/1.73m2; p = 0.09). Differences were consistent when living donor and deceased donor transplants were analysed separately. In a "real world" population, a change from a CyA-based to a Tac (low-dose)/MMF/Pred primary immunosuppression regimen has been associated with better 5-year outcomes.
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Affiliation(s)
- Colin C Geddes
- Glasgow Renal and Transplant Unit, Western Infirmary, Glasgow, United Kingdom.
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McGlynn LM, Stevenson K, Lamb K, Zino S, Brown M, Prina A, Kingsmore D, Shiels PG. Cellular senescence in pretransplant renal biopsies predicts postoperative organ function. Aging Cell 2009; 8:45-51. [PMID: 19067655 DOI: 10.1111/j.1474-9726.2008.00447.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Older and marginal donors have been used to meet the shortfall in available organs for renal transplantation. Post-transplant renal function and outcome from these donors are often poorer than chronologically younger donors. Some organs, however, function adequately for many years. We have hypothesized that such organs are biologically younger than poorer performing counterparts. We have tested this hypothesis in a cohort of preimplantation human renal allograft biopsies ( n = 75) that have been assayed by real-time polymerase chain reaction for the expression of known markers of cellular damage and biological aging, including CDKN2A, CDKN1A, SIRT2 and POT1. These have been investigated for any associations with traditional factors affecting transplant outcome (donor age, cold ischaemic time) and organ function posttransplant (serum creatinine levels). Linear regression analyses indicated a strong association for serum creatinine with pre-transplant CDKN2A levels ( p = 0.001) and donor age ( p = 0.004) at 6 months post-transplant. Both these markers correlated significantly with urinary protein to creatinine ratios ( p = 0.002 and p = 0.005 respectively), an informative marker for subsequent graft dysfunction. POT1 expression also showed a significant association with this parameter ( p = 0.05). Multiple linear regression analyses for CDKN2A and donor age accounted for 24.6% ( p = 0.001) of observed variability in serum creatinine levels at 6 months and 23.7% ( p = 0.001) at 1 year posttransplant. Thus, these data indicate that allograft biological age is an important novel prognostic determinant for renal transplant outcome.
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49
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Easton C, Calder A, Prior F, Dobinson S, I’Anson R, MacGregor R, Mohammad Y, Kingsmore D, Pitsiladis YP. The effects of a novel “fluid loading” strategy on cardiovascular and haematological responses to orthostatic stress. Eur J Appl Physiol 2009; 105:899-908. [DOI: 10.1007/s00421-008-0976-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2008] [Indexed: 11/25/2022]
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50
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Easton C, Calder A, Prior F, Dobinson S, I'Anson R, MacGregor R, Mohammad YAAA, Kingsmore D, Pitsiladis YP. The Effects Of A Novel "Fluid Loading" Strategy On The Cardiovascular And Haematological Responses To Orthostatic Stress. Med Sci Sports Exerc 2008. [DOI: 10.1249/01.mss.0000321773.47112.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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