Journal of Vascular Access最新文献

{"title":"Use of vascular access methods for hemodialysis in Serbia: Results from SerbVasc registry.","authors":"Nemanja Stepanovic, Miroslava Popovic, Marijana Bogosavac, Zoran Damnjanovic, David Matejevic, Enes Ljatifi, Radivoje Zoranovic, Tamara Jemcov, Slobodan Tanaskovic, Igor Koncar","doi":"10.1177/11297298241312952","DOIUrl":"https://doi.org/10.1177/11297298241312952","url":null,"abstract":"<p><strong>Introduction: </strong>In many countries, hemodialysis is still the most common method of renal replacement. Significant regional variations exist in creating and maintaining vascular access for hemodialysis. Therefore, analyzing national registries with vascular access data is essential for developing effective national treatment strategies. The Serbian national vascular surgery registry was established as part of the VascuNet collaboration network in 2019. The registry comprehensively records vascular procedures across Serbia, including those related to vascular access for hemodialysis.</p><p><strong>Objectives: </strong>This study aims to evaluate the prevalence of different vascular access methods for hemodialysis in Serbia, focusing on both new and prevalent patients and examining demographic differences and risk factors.</p><p><strong>Patients and methods: </strong>The data were collected from the vascular accesses section of the SerbVasc registry over a 3-year observational period, focusing on the following aspects: number of incident and prevalent patients with types of vascular access, as well as comparison of patients with arteriovenous fistulas (AVF), arteriovenous grafts (AVG), central venous catheters (CVC), and tCVC based on age, gender, smoking, and comorbidities.</p><p><strong>Results: </strong>There were total of 1024 incident hemodialysis patients. AVF was created in 219 patients (21.4%), AVG in 5 patients (0.5%), and tCVC in 150 patients (14.6%), while hemodialysis via CVC was initiated in 650 (63.5%) patients. The total number of permanent vascular accesses for HD was 1402, comprising 686 (48.9%) distal AFVs, 220 (15.7%) proximal AVFs, 91 (6.4%) AVGs, and 405 (28.8%) tCVCs. The prevalence of current smoking was highest in the tCVC (48.3%) and lowest in the dAVF group (18.40%).</p><p><strong>Conclusion: </strong>The percentage of patients starting hemodialysis with AVF remains suboptimal. tCVC is used substantially as first and permanent access, particularly among older patients.</p>","PeriodicalId":56113,"journal":{"name":"Journal of Vascular Access","volume":" ","pages":"11297298241312952"},"PeriodicalIF":1.6,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case of surgical treatment combined with interventional therapy for refractory hemodialysis access with catheter-related right atrial thrombosis.","authors":"Shao-Fen Wang, Zheng-Jin Xu, Tian-Lei Cui","doi":"10.1177/11297298241313005","DOIUrl":"https://doi.org/10.1177/11297298241313005","url":null,"abstract":"<p><p>This case report describes a surgical treatment combined with interventional therapy for a patient with refractory hemodialysis access combined with catheter-related right atrial thrombosis (CRAT). During surgery, an artificial graft was established from the left brachiocephalic vein to the right atrium and the right atrial thrombus was removed. After the operation, the tunneled cuffed catheter (TCC) was replaced with digital subtraction angiography (DSA). The hemodialysis access issue was addressed for this patient, and the access remained functional for normal hemodialysis during the subsequent 10-month follow-up.</p>","PeriodicalId":56113,"journal":{"name":"Journal of Vascular Access","volume":" ","pages":"11297298241313005"},"PeriodicalIF":1.6,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Central venous dialysis catheter related superior cavoatrial junction stenosis.","authors":"Joong Min Park, Tam Vo, Thavenesh Ramachandren","doi":"10.1177/11297298241302886","DOIUrl":"https://doi.org/10.1177/11297298241302886","url":null,"abstract":"","PeriodicalId":56113,"journal":{"name":"Journal of Vascular Access","volume":" ","pages":"11297298241302886"},"PeriodicalIF":1.6,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of the enhanced adult DIVA score in an emergency department: A prospective observational study.","authors":"Domenica Petta, Yari Longobucco, Camilla Elena Magi, Khadija El Aoufy, Carolina Forciniti, Alberto Lucchini, Paolo Iovino, Carla Amato, Pasquale Iozzo, Laura Rasero, Stefano Bambi","doi":"10.1177/11297298241312457","DOIUrl":"https://doi.org/10.1177/11297298241312457","url":null,"abstract":"<p><strong>Background: </strong>Short peripheral catheter (SPC) placement is a routine invasive procedure in clinical settings that is crucial for administering fluids, medications, or blood components. Approximately 11% of adult patients arriving at the Emergency Department (ED) experience difficulties with intravenous access (DIVA), necessitating advanced techniques for successful placement. The Enhanced Adult DIVA (EA-DIVA) score serves as a validated tool to promptly identify patients with DIVA. This study aimed to determine the prevalence of DIVA in the ED by using the EA-DIVA scale, evaluate the time required for venous cannulation in patients with and without DIVA, and establish EA-DIVA score thresholds for the adoption of ultrasound-guided techniques.</p><p><strong>Methods: </strong>This prospective observational study was conducted from May 2023 to January 2024 at the ED of Empoli Hospital, Italy. This study focused on adult patients requiring SPC placement. The nursing staff at the ED performed SPC placements using standard techniques according to clinical protocols.</p><p><strong>Results: </strong>Among 1280 patients, 29.22% required more than one attempt at cannulation independently from their EA-DIVA score, with 12.58% scoring an EA-DIVA of 8 or higher. The time and attempts needed for successful cannulation increased with higher EA-DIVA scores, and ultrasound-guided techniques were more time-consuming but beneficial for these patients. An optimal threshold of 6 on the EA-DIVA scale balanced high sensitivity (96.52%) and specificity (81.37%) for identifying patients who would benefit from ultrasound guidance, minimizing failed attempts and optimizing resource use.</p><p><strong>Conclusion: </strong>The EA-DIVA scale, originally validated in a preoperative setting, was effectively implemented for the first time in the ED. This study established a lower cutoff score for expert intervention utilizing ultrasound guidance compared with previous applications of the EA-DIVA scale. Further validation across diverse clinical settings and among healthcare providers with varying expertise in vascular access is necessary to confirm these findings and broaden their applicability.</p>","PeriodicalId":56113,"journal":{"name":"Journal of Vascular Access","volume":" ","pages":"11297298241312457"},"PeriodicalIF":1.6,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety of bilateral arm pressure measurements in the diagnostic workup of dialysis-associated steal syndrome.","authors":"Bright Benfor, Kihoon Bohle, Eric K Peden","doi":"10.1177/11297298231212226","DOIUrl":"10.1177/11297298231212226","url":null,"abstract":"<p><strong>Objective: </strong>Although bilateral brachial pressure measurement is routinely included in the diagnostic work-up of upper extremity ischemia, it is generally avoided in the presence of hemodialysis access due to fears of inducing access thrombosis. This study evaluated the safety of bilateral brachial pressure measurement in patients with clinical suspicion of dialysis-associated steal syndrome (DASS).</p><p><strong>Methods: </strong>Patients undergoing non-invasive testing for steal syndrome between September 2015 and December 2021 were included in this study. The diagnostic workup was performed by certified vascular sonographers in an outpatient vascular lab and consisted of bilateral brachial pressures, photoplethysmography, and duplex ultrasonography of the access. Interarm differential (IAD) was defined as systolic blood pressure (SBP) in the contralateral arm minus SBP in the access arm. The primary endpoint was immediate access thrombosis.</p><p><strong>Results: </strong>The study sample consisted of 331 subjects with a mean age of 61 ± 13 and a median access age of 9 months (3-31 months) with radiocephalic fistulas present in 29%. Many patients (68%) presented with paresthesia and 4% presented with tissue loss. The mean brachial systolic pressure was 152 ± 37 mmHg on the ipsilateral arm versus 143 ± 34 mmHg on the contralateral (<i>p</i>-value <0.001), with an inter-arm differential (IAD) of -8.4 ± 19 mmHg. A total of 16 subjects (5%) presented a differential ⩾20 mmHg. A positive thrill was noted in all the accesses immediately following blood pressure measurement and no occurrence of access thrombosis was noted at 30 days. Proximal arterial revascularization interventions were performed in 11 cases (3%). Subjects who presented an IAD ⩾20 mmHg had lower ipsilateral digital-brachial index (0.39 ± 0.18 vs 0.68 ± 0.26; <i>p</i> = 0.037), a higher tendency of being referred for angiograms (37.5% vs 10.5%, <i>p</i> = 0.006), and more proximal arterial revascularization procedures (25.0% vs 2.2%, <i>p</i> = 0.001).</p><p><strong>Conclusion: </strong>Bilateral arm pressure measurement in the context of dialysis access-associated steal syndrome (DASS) appears safe and useful for identifying subjects whose symptoms are due to proximal arterial inflow disease. We therefore recommend this test be considered in the diagnostic algorithms of DASS.</p>","PeriodicalId":56113,"journal":{"name":"Journal of Vascular Access","volume":" ","pages":"251-257"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138300751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can the length of a catheter change the time to bubble at the tip performing the \"Bubble Test\"? A bench study.","authors":"Davide Giustivi, Stefano Elli, Chiara Airoldi, Federica Lo Izzo, Michela Rossini, Antonio Gidaro, Alberto Lucchini, Daniele Privitera","doi":"10.1177/11297298231199505","DOIUrl":"10.1177/11297298231199505","url":null,"abstract":"<p><strong>Introduction: </strong>Intraprocedural tip control techniques are critical during central venous catheter placement. According to international guidelines (INS 2021), intracavitary electrocardiography is the first method of choice to verify it; when this technique is not feasible, it is considered acceptable to use a contrast-enhanced ultrasound-based tip location method, commonly known as \"bubble-test\" as an effective alternative.</p><p><strong>Objective: </strong>To assess whether the length of the vascular catheter can alter the time between the injection of the contrast media and its appearance at the catheter tip and the injection duration. Differences between operators stratified according to experience were evaluated as secondary endpoints.</p><p><strong>Methods: </strong>A bench study was conducted using an extracorporeal circuit. For each catheter length (60, 40, and 20 cm), three injections were obtained by each of the five operators with different levels of experience for a total of 45 measurements. Differences among operators were evaluated using ANOVA, and the impact of catheter length and operator expertise on times was assessed using repeated measurement models.</p><p><strong>Results: </strong>Hub-to-tip times of 247.33 ms (SD 168.82), 166 ms (SD 95.46), 138 ms (SD 54.48), and injection duration of 1620 ms (SD 748.58), 1614 ms (SD 570.95), 1566 ms (SD 302.83) were observed for 60, 40, 20 cm catheter length, respectively. A significant time variability between operators was observed. Moreover, moving from 60 to 20 cm, hub-to-tip time was significantly longer for 60 cm devices (<i>p</i> = 0.0124), while little differences were observed for injection duration.</p><p><strong>Conclusions: </strong>Catheter length can change both the time between the injection of the contrast media and its appearance at the catheter tip and the injection duration. Hub-to-tip times obtained with 20 and 40 cm and overall injection duration did not differ significantly; skilled personnel could substantially reduce both values analyzed in this study.</p>","PeriodicalId":56113,"journal":{"name":"Journal of Vascular Access","volume":" ","pages":"109-115"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138453209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-time ultrasound-guided hemostasis using suture-mediated closure device.","authors":"JungWon Kwak, Sung Bum Cho","doi":"10.1177/11297298231215843","DOIUrl":"10.1177/11297298231215843","url":null,"abstract":"<p><strong>Purpose: </strong>Suture-mediated hemostasis device takes a long time to train and have limitations in finding appropriate compression point depending on the tactile sense of the hands. If the appropriate compression point is determined using ultrasound and the instrument is used under ultrasound guidance, it is expected to reduce the technical failure and additional manual compression.</p><p><strong>Materials and methods: </strong>This retrospective study included 104 patients in whom the ProGlide vascular closure device (Abbott Vascular, Redwood City, CA, USA) was deployed to close common femoral artery access between January 2022 and June 2022. Ultrasound-guided hemostasis was performed in 54 patients and 50 conventional hemostasis was performed. We analyzed the medical records (procedure, patient body mass index, coagulation function, visual imaging, ultrasound imaging, time to achieve hemostasis) and post-treatment medical records (progress records, nursing records) to investigate the technical success rate and complications (hematoma, pseudoaneurysm formation, SFA occlusion, access site infection) of the procedure.</p><p><strong>Results: </strong>Technical success rate was 52/54 (Ultrasound guided group) and 47/50 (conventional group), respectively (<i>p</i> > 0.05). Mean hemostasis time was 271 s (US guided group) and 317 s (conventional group), respectively (<i>p</i> > 0.05). Additional manual compression was applied in 7/54 (US guided group) and 15/50 (conventional group) (<i>p</i> < 0.05). In both groups, complications such as hematoma formation, access site infection and SFA occlusion did not occur.</p><p><strong>Conclusion: </strong>Using ultrasound guidance when using the suture mediated closing device reduces the frequency of additional manual compression without increased risk of complication.</p>","PeriodicalId":56113,"journal":{"name":"Journal of Vascular Access","volume":" ","pages":"228-233"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138489232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complete stent graft relining of the hemodialysis access circuit for access salvage.","authors":"Shimon Aronhime, Shmuel Balan, Alexei Cherniavsky, Yaniv Avital","doi":"10.1177/11297298231205006","DOIUrl":"10.1177/11297298231205006","url":null,"abstract":"<p><strong>Background: </strong>Stent grafts (SGs) are widely used in hemodialysis access procedures to maintain function and patency of the access circuit. There are no reports to date describing complete relining of the access circuit with SGs for extreme access salvage.</p><p><strong>Objective: </strong>To report outcomes and experience with complete SG relining of the hemodialysis access circuit.</p><p><strong>Methods: </strong>From April 2020 to May 2023, all hemodialysis salvage procedures that included complete relining of the access circuit with SGs were retrospectively analyzed from a prospectively collected database of 970 hemodialysis access interventions. SGs were placed for various pathologies including residual stenosis, perforation, aneurysm, and thrombosis. Follow up outcomes included primary patency, primary assisted patency, and secondary patency.</p><p><strong>Results: </strong>A total of 16 patients were included in the study. Average stented length was 30 cm. Average follow up was 283 days (range 38-647 days). The primary patency of the entire covered segment was 80% and 68% at 6 and 12 months, respectively. The primary assisted patency of the segment was 88% and 77% at 6 and 12 months, respectively. Secondary patency of the access circuit was 94% at both 6 and 12 months. There were no issues with SG cannulation and zero cases of SG fracture or infection.</p><p><strong>Conclusions: </strong>Salvage of failing hemodialysis access circuits by complete SG relining should be considered for a limited subgroup of patients where the access circuit would otherwise be deemed unsalvageable. Complete SG relining has both good immediate outcomes and 6- and 12-month patency rates.</p>","PeriodicalId":56113,"journal":{"name":"Journal of Vascular Access","volume":" ","pages":"144-148"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138812669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early-cannulation arteriovenous grafts: Multidisciplinary learning is essential to optimize outcomes.","authors":"David B Kingsmore, Karen S Stevenson, Ben Edgar, Emma Aitken, Andrew Jackson, Andrej Isaak, Sabine Richarz, Leigh Bainbridge, Callum Stove, Ram Kasthuri, Peter C Thomson","doi":"10.1177/11297298231212758","DOIUrl":"10.1177/11297298231212758","url":null,"abstract":"<p><strong>Background: </strong>It is likely that there will be an increasing role for early-cannulation arteriovenous grafts (ecAVG) with a wider recognition of the need to tailor vascular access to avoid futile procedures and unnecessary TCVC. However, experience of these products is not common and limited to early surgical adopters, with little information on the systemic changes and multi-disciplinary care needed to optimize outcomes. The aim of this study was to report the impact of a multi-disciplinary approach on quantifiable outcomes.</p><p><strong>Methods: </strong>A retrospective analysis of a prospectively maintained database of 295 ecAVG implanted over an 8-year time-period was performed. Indicative outcomes were chosen to reflect nephrology (patient selection), nursing care (cannulation complications of infection and pseudoaneurysm) and radiology (thrombosis) on cumulative impact (functional patency) over three distinct time periods.</p><p><strong>Results: </strong>The incidence of ecAVG increased 10-fold over the three time periods. The use of ecAVG changed significantly from salvage tertiary access to TCVC avoidance and salvage of existing AVF. Nursing complications reduced markedly with significantly fewer over-cannulation episodes and pseudo-aneurysms. With an improved pro-active surveillance programme, the time to first thrombosis doubled and the risk of thrombosis halved. Ultimately this resulted in significantly improved functional patency with a risk of ecAVG loss less than one-third by the last time-period.</p><p><strong>Conclusions: </strong>All aspects of ecAVG use require scrutiny and critical appraisal. Failure or success is not simply achieved by performing good technical surgery with an efficacious product, but by the care taken across a wide range of elements spanning case selection, implantation, use and maintenance.</p>","PeriodicalId":56113,"journal":{"name":"Journal of Vascular Access","volume":" ","pages":"182-188"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138300747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular tools for vascular access stenosis: Flow-chart proposal.","authors":"Marco Taurisano, Andrea Mancini, Cosma Cortese, Marcello Napoli","doi":"10.1177/11297298241229166","DOIUrl":"10.1177/11297298241229166","url":null,"abstract":"<p><p>Stenosis represents the most relevant arteriovenous fistula (AVF) pathology and can affects the entire conduit forming the fistula, from afferent artery to central venous vessels. Correction of vascular access stenosis significantly affects the survival and quality of life for end stage renal disease patients (ESRD) dependent on hemodialysis. Guidelines consider the procedure of percutaneous transluminal angioplasty (PTA) relevant for the primary treatment of these lesions with excellent results in restoring AVF immediately at the end of the procedure. From first AVF angioplasty in 1981 to now, wide scientific innovation has led to development of new devices, composed by different materials and technologies, specific for the site and the type of stenosis to be treated, able to manage resistant stenotic lesion and to reduce stenosis recurrences. International guidelines do not clearly specify all treatment possibilities in the individual case. In this review the authors want to provide specific information on most used devices for stenosis treatment based on literature evidence, showing when and where to use the various tools available with flow-chart treatment proposal.</p>","PeriodicalId":56113,"journal":{"name":"Journal of Vascular Access","volume":" ","pages":"30-39"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139742822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}