Journal of Vascular Access最新文献

{"title":"The impact of enhancing vascular access care quality through monitoring and training: A multicentre observational study.","authors":"Sonia Casanova-Vivas, Pablo García-Molina, Pablo López-Guardiola, María José Gil-Carbonell, Enrique Bernardo Hevilla-Cucarella, Vicenta Solaz-Martínez, Beatriz Valdelvira-Gimeno, Alicia Fernández-Martínez, José Vicente Visconti-Gijón, M Luisa Ballestar-Tarín","doi":"10.1177/11297298241296163","DOIUrl":"10.1177/11297298241296163","url":null,"abstract":"<p><strong>Aim: </strong>This study evaluates the impact of monitoring a primary quality indicator and the effect of training on improving the care and maintenance of vascular access devices.</p><p><strong>Design: </strong>A prospective, quasi-experimental, multicentre study with 10 periodical cross-sections from 2017 and 2020.</p><p><strong>Participants: </strong>Adult patients hospitalised over 24 h, with or without vascular access device, excluding those in emergency, psychiatry, outpatients or minor surgery units.</p><p><strong>Methods: </strong>The study included 10 cross-sections between 2017 and 2020 in all participating hospitals, using the INCATIV^® (Quality Indicators in Intravenous Therapy and Vascular Access) questionnaire. Training sessions for nursing staff were conducted between cross-sections, involving face-to-face sessions in open classrooms and clinical sessions in the units, based on the study Care bundle.</p><p><strong>Results: </strong>53,991 vascular accesses were analysed, with an average INCATIV Index score of 8.95 (SD: 1.32), showing improvement from 8.09 in the first cross-section to 9.21 in the last. Significant variability was observed between hospitals, with secondary hospitals scoring lower on the INCATIV^® Index. Training interventions 1 and 2 showed significant improvement across all hospital categories, whereas intervention 5 did not show significant effects. Compliance with main recommendations was studied, with a notable decrease in phlebitis rates from 4.45% in the first cross-section to 1.23% in the tenth.</p><p><strong>Conclusion: </strong>The study developed a single indicator to assess and quantify vascular access care quality. It demonstrated that implementing a care bundle through serial training interventions and continuous assessment by nursing staff, supported by process indicators and data availability on the study platform, significantly reduces complications and enhances the quality and safety of vascular access care.</p>","PeriodicalId":56113,"journal":{"name":"Journal of Vascular Access","volume":" ","pages":"1661-1672"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12397542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The trans-radial approach for endovascular intervention of the problem arterio-venous fistula: A single-centre case series and systematic review.","authors":"Asanka Rohan Wijetunga, Yunyi Wang, Conan Wai Hang Chan, James Elhindi, James Colbourne","doi":"10.1177/11297298241299904","DOIUrl":"10.1177/11297298241299904","url":null,"abstract":"<p><strong>Introduction: </strong>The arteriovenous fistula (AVF) is the gold standard access modality for haemodialysis, but due to patient and technical factors, it is prone to stenosis and thrombosis. The trans-radial approach offers multiple unique benefits, but its safety, efficiency and efficacy have not been rigorously studied in the context of the AVF. This study provides a case series of trans-radial AVF procedures, and a systematic review and meta-analysis of existing literature to solidify the role of the trans-radial approach in endovascular AVF surgery.</p><p><strong>Methods: </strong>Surgical records were interrogated to identify all trans-radial AVF interventions between 2019 and 2021. The primary endpoints were procedure time and complication rates. The secondary endpoints were primary assisted patency and increase in pre- and post-operative brachial artery blood flow. The systematic review was performed by searching MEDLINE, Embase and CENTRAL from 2000 to 2023.</p><p><strong>Results: </strong>The case series identified 76 consecutive procedures performed on 49 patients. Mean procedure time was 64 min, and only one complication, a puncture site haematoma, was identified. Mean postoperative AVF flow increase was 342 mL/min (<i>p</i> < 0.001). Primary-assisted patency at 6 and 12 months was 91% and 82% respectively. The systematic review included 16 studies totalling 1163 procedures with a mean MINORS score of 69%. Mean procedure time was 44 min. Complications were rare: procedural failure (1.2%), haematoma (0.90%), radial artery occlusion (0.74%) and pseudoaneurysm (0.12%). Post-procedural flow increased by an average of 274 mL/min. Pooled primary-assisted patency rates at 6 and 12 months were 88% and 77% respectively.</p><p><strong>Conclusion: </strong>The trans-radial approach allows for expedient, safe and durable AVF endovascular surgery, however this technique would benefit from prospective evaluation.</p>","PeriodicalId":56113,"journal":{"name":"Journal of Vascular Access","volume":" ","pages":"1681-1692"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711247","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":"Acute lower limb ischemia caused by repeat deployment of vascular closure device.","authors":"Ahmet Can Topcu, Mesut Buz, Fatih Dogu Geyik","doi":"10.1177/11297298241287807","DOIUrl":"10.1177/11297298241287807","url":null,"abstract":"<p><p>Vascular closure devices are used to facilitate faster hemostasis and earlier ambulation, improve patient comfort, and reduce length of hospital stay after percutaneous endovascular procedures. However, their use may rarely be associated with limb ischemia due to endothelial damage and arterial thrombosis. This report illustrates the case of a patient who experienced acute lower limb ischemia due to superficial femoral artery occlusion caused by repeat closure with Angio-Seal vascular closure device within 30 days in a small-caliber superficial femoral artery. The patient was surgically treated by vascular repair with a synthetic graft, and remains symptom-free in 3-year follow-up. Repeat deployment of vascular closure devices in the same access site within a period of 30 days may cause acute limb ischemia due to arterial thrombosis, especially in patients with small-caliber arteries, even in the absence of evident risk factors.</p>","PeriodicalId":56113,"journal":{"name":"Journal of Vascular Access","volume":" ","pages":"1770-1773"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333099","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":"Transcutaneous parallel suture plication to fixate a difficult-to-cannulate brachiobasilic fistula: A case presentation.","authors":"Koen Ea Van der Bogt, Joris I Rotmans","doi":"10.1177/11297298241273572","DOIUrl":"10.1177/11297298241273572","url":null,"abstract":"<p><p>We describe a patient with a matured transposed brachiobasilic fistula that was difficult to cannulate due to \"rolling\" and the inability to fixate. After placing multiple parallel transcutaneous sutures close to the fistula, there were no difficulties with needling. Even after removing the sutures, cannulation went uneventful.</p>","PeriodicalId":56113,"journal":{"name":"Journal of Vascular Access","volume":" ","pages":"1746-1747"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12397541/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sharp recanalization of superior vena cava occlusion with stent migration in a hemodialysis patient: Rescue strategy for life-threatening hemothorax.","authors":"Dan Wu, Xin Du, Lizhu Jin, Tianlei Cui","doi":"10.1177/11297298251372340","DOIUrl":"https://doi.org/10.1177/11297298251372340","url":null,"abstract":"<p><p>Superior vena cava (SVC) occlusion in hemodialysis patients presents significant therapeutic challenges, particularly when complicated by stent migration. Sharp recanalization may serve as a salvage intervention for refractory cases though high-risk. Here, we present a 72-year-old male with stent migration-induced recurrent SVC syndrome. After failed conventional guidewire recanalization, sharp recanalization was performed with a dual-snare snare-assisted approach. We innovatively performed vertical penetration through the migrated stent. A stent was then vertically deployed within the expanded fenestration. Although SVC patency was successfully restored, the procedure was complicated by massive hemothorax secondary to venous wall laceration. Immediate hemostasis was achieved through emergency deployment of overlapping covered stents. The patient maintained preserved vascular access patency without recurrent symptoms during 6-month follow-up. This case presents an innovative approach of vertical puncture and stent migration to address SVC occlusion, which not only demonstrates the feasibility of sharp recanalization for complex SVC occlusion, but also highlights the critical role of timely endovascular salvage techniques in preventing life-threatening hemorrhagic complications.</p>","PeriodicalId":56113,"journal":{"name":"Journal of Vascular Access","volume":" ","pages":"11297298251372340"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980034","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":"Port malposition in the anterior mediastinum resulting in chemotherapy extravasation into the pleural cavity: A case report and literature review.","authors":"Jiaobo He","doi":"10.1177/11297298241303202","DOIUrl":"10.1177/11297298241303202","url":null,"abstract":"<p><p>We present a rare case of port malposition into the anterior mediastinum resulting in chemotherapy extravasation into the pleural cavity. While management of extravasation into soft tissues has been established, the data on treatment of mediastinal and intrapleural extravasation is limited. This case underscores how utilizing state-of-the-art technology like real-time intracavitary electrocardiography(IC-ECG) or transthoracic/subxiphoid ultrasound with the \"bubble test\", rather than reliance on postoperative chest radiography, can help eliminate catheter malposition and its potential catastrophic consequences.</p>","PeriodicalId":56113,"journal":{"name":"Journal of Vascular Access","volume":" ","pages":"1782-1787"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787793","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":"Effectiveness and sustainability of a multidisciplinary care model for patients with hemodialysis access dysfunction.","authors":"Chye Chung Gan, Suh Chien Pang, Ru Yu Tan, Alvin Ren Kwang Tng, Chee Wooi Tan, Lydia Wei Wei Lim, Hsien Ts'ung Tay, Kun Da Zhuang, Li Choo Ng, Kiang Hiong Tay, Tze Tec Chong, Chieh Suai Tan","doi":"10.1177/11297298241293826","DOIUrl":"10.1177/11297298241293826","url":null,"abstract":"<p><strong>Background: </strong>A multidisciplinary care model involving the interventional radiologist, vascular surgeon, interventional nephrologist, renal advanced nurse practitioner, and renal coordinators was implemented to improve the care for the patient admitted with dysfunctional hemodialysis access. This study aims to evaluate the effectiveness and sustainability of this multidisciplinary care model.</p><p><strong>Method: </strong>A dedicated interventional nephrology suite was established to perform endovascular procedures for patients admitted with hemodialysis access dysfunction via the emergency department of the hospital. We retrospectively collected data from electronic medical records 1-year before and after the implementation (April 2015). Outcome measures include waiting time for intervention, length of stays (LOS), number of dialysis catheter insertions before the intervention, number of inpatient dialysis required, and success rates of the interventions. The waiting time for intervention and LOS was tracked over the next 3 years to determine the sustainability of the care model.</p><p><strong>Results: </strong>Eight hundred eighty-one endovascular interventions (314 angioplasties, 567 thrombolysis) were performed on 554 patients. Post-implementation, a greater proportion of intervention was performed within 24 h (238 (50.2%) vs 70 (17.2%), <i>p</i> < 0.001) with lesser proportion of patients requiring bridging hemodialysis via temporary catheter, 156 (32.9%) versus 215 (52.8%), <i>p</i> < 0.001. A shorter median LOS and days-to-intervention were reported, 3 (IQR 2-6) versus 5 days (IQR 3-8), <i>p</i> < 0.001 and 1 (IQR 1-2) versus 3 days (IQR 2-4), <i>p</i> < 0.001 respectively. Less hemodialysis session/patient required, 2 (IQR 1-3) versus 3 (IQR 2-4), <i>p</i> < 0.001. The procedural success rate was greater, 440 (92.8%) versus 355 (87.2%), <i>p</i> = 0.020. Three years following implementation, the proportion of patients who received intervention within 24 h and were discharged within 48 h was reported to be persistently greater, 43% versus 13%, <i>p</i> < 0.001, and 27% versus 6%, <i>p</i> < 0.001 respectively.</p><p><strong>Discussion: </strong>This multi-disciplinary collaboration demonstrated a sustainable care model in improving the delivery of healthcare services for patients with dysfunctional hemodialysis access.</p>","PeriodicalId":56113,"journal":{"name":"Journal of Vascular Access","volume":" ","pages":"1604-1609"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565428","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":"Comparing results of midline catheter and peripherally inserted central catheter in cancer patients under chemotherapy.","authors":"Beatrice Faccini, Federico Aula, Vincenzo Fontana, Alessandra Rosa, Damiano Consoli, Filippo Bondielli, Sergio Bertoglio","doi":"10.1177/11297298241289326","DOIUrl":"10.1177/11297298241289326","url":null,"abstract":"<p><strong>Background and objectives: </strong>Peripherally inserted central catheters (PICC), and peripherally inserted midlines (MC) represent a possible less invasive alternative option to totally implantable vascular access devices (TIVAD) in cancer patients. This study aims to investigate the outcomes of PICC, and MC devices in patients undergoing chemotherapy.</p><p><strong>Methods: </strong>A prospective non-concurrent observational study was conducted at the IRCCS Ospedale Policlinico San Martino, Genova (Italy) on 559 cancer patients candidate to chemotherapy bearing PICC, and MC during the period 2019-2022. The primary endpoint was the comparative analysis for failure of the different types of peripheral insertion accesses requiring removal. Secondary outcome measures were age at diagnosis, gender, period of diagnosis, cancer site and type of chemotherapy. The negative binomial regression analysis was applied to estimate catheter removal rate ratios (RR), along with 95% confidence limits (95% CL), in each category of the risk factors.</p><p><strong>Results: </strong>The median follow-up time was 2.6 months (IQR = 1.4-4.6; min-max = 0.03-12.7), and at the end of the study period, a total of 45 catheter failures were detected. A risk reduction of approximately 75% (RR = 0.24; 95% CL = 0.11-0.51) was emphasized for patients with PICC when compared with those with MLC. Type of chemotherapy and cancer site appeared to be important predictive factors for catheter removal risk.</p><p><strong>Conclusions: </strong>For cancer patients undergoing chemotherapy by a non TIVAD, PICC must be preferred to MC because of higher safety and efficacy.</p>","PeriodicalId":56113,"journal":{"name":"Journal of Vascular Access","volume":" ","pages":"1645-1650"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12397530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What are the reported procedural costs of vascular access surgery?","authors":"Ben Edgar, Catrin Jones, Emma Aitken, Karen Stevenson, Andrew Jackson, Lucian Gaianu, Peter Thomson, Ram Kasthuri, Callum Stove, David B Kingsmore","doi":"10.1177/11297298241284737","DOIUrl":"10.1177/11297298241284737","url":null,"abstract":"<p><strong>Introduction: </strong>Since the inception of arteriovenous grafts (AVG) as a novel technique, there has been greater emphasis on the assessment of outcomes rather than costs. Gross-costing methods over-simplify vascular access surgery and do not reflect the true costs of the service, preventing accurate cost-effectiveness analysis. The aim of this study is to assess the reporting of procedural costs of arteriovenous access creation in economic analyses of vascular access surgery, and to compare the reported costs of the two most performed procedures - arteriovenous fistula (AVF) and arteriovenous graft (AVG).</p><p><strong>Methods: </strong>This systematic review included studies reporting a per-procedure cost for AVF or AVG creation. Costs were adjusted from original to target price year using a Gross Domestic Product (GDP) deflator index and converted to 2021 US Dollars using conversion rates based on purchasing power parities.</p><p><strong>Results: </strong>The results demonstrate wide discrepancy in the reported procedural costs of arteriovenous access creation. Most of the data represents retrospectively observed costs rather than prospective data collected on an intention-to-treat basis. Charges are frequently presented in lieu of costs, and aggregated gross-costing methodology predominates rather than more accurate micro-costing.</p><p><strong>Conclusion: </strong>Future micro-costing studies of vascular access surgery are essential to allow a greater understanding of cost-drivers and allow accurate cost-effectiveness analysis.</p>","PeriodicalId":56113,"journal":{"name":"Journal of Vascular Access","volume":" ","pages":"1510-1519"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333117","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":"Optimizing venous anastomosis for forearm loop arteriovenous grafts: A comparative analysis of elbow veins and upper arm basilic veins in end-stage kidney disease patients.","authors":"Young Ju Oh, Hyo Kee Kim, Jee Hyun Park, Cheol Woong Jung, Heungman Jun","doi":"10.1177/11297298241291695","DOIUrl":"10.1177/11297298241291695","url":null,"abstract":"<p><strong>Introduction: </strong>Optimizing vascular access for hemodialysis in end-stage kidney disease is crucial. While arteriovenous fistulas (AVFs) are preferred for better patency and fewer complications, many patients require alternatives options like arteriovenous grafts (AVGs) due to anatomical constraints. This study compares outcomes between elbow and upper arm (UA) basilic veins for forearm loop AVGs, highlighting the potential benefits of the UA basilic vein to improve patency and feasibility in patients with poor elbow veins through retrospective analysis.</p><p><strong>Methods: </strong>This retrospective study analyzed 59 limbs of patients who underwent forearm loop AVG formation from January 2018 to June 2022. Elbow veins (basilic, median cubital, brachial) and UA basilic veins were evaluated for suitability using duplex ultrasonography. AVG decisions were based on patient age, health, and vein diameter (⩾2.3 mm). Statistical analyses compared baseline characteristics and evaluated primary and secondary patency rates at 12 and 18 months using Pearson's chi-square, Student's <i>t</i>-test, Kaplan-Meier survival analysis, and the Log-rank test.</p><p><strong>Results: </strong>Thirty-six patients had elbow anastomosis, while 23 had UA anastomosis for forearm loop AVG. The elbow group had a higher male proportion (72.7% vs 34.7% in UA, <i>p</i> = 0.005) and larger elbow vein diameters (2.52 ± 0.19 mm vs 2.16 ± 0.21 mm in UA, <i>p</i> < 0.001). Primary patency rates at 12 months were 72.7% for elbow and 56.2% for UA; at 18 months, 59.4% and 25.5%, respectively (<i>p</i> = 0.376). Secondary patency rates at 12 months were 75.7% for elbow and 62.2% for UA; at 18 months, 67.8% and 33.9%, respectively (<i>p</i> = 0.238).</p><p><strong>Conclusion: </strong>The primary and secondary patency rates of forearm loop AVG with UA basilic vein anastomosis were not inferior to those with elbow veins anastomosis. UA basilic vein can be a feasible alternative for creating forearm loop AVG when elbow veins are not suitable.</p>","PeriodicalId":56113,"journal":{"name":"Journal of Vascular Access","volume":" ","pages":"1577-1581"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513624","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}