Objectives: We reviewed a consecutive series of patients who had arteriovenous fistula (AVF) placement in advance of starting hemodialysis and sought to determine what factors were associated with failure of the AVF to be ready for use, which required patients to start dialysis with a tunneled dialysis catheter (TDC).Methods: We analyzed all patients who had an AVF placed at our institution from 2013 to 2018 using data from the Vascular Quality Initiative database and retrospective chart review. The primary study group included patients who had an AVF placed in advance of needing hemodialysis. Patients were categorized as "Success": AVF placement with hemodialysis initiated using the AVF or "Failure": AVF placement with hemodialysis initiated using a TDC.Results: Of the 46 patients reviewed, 26 (56.5%) were classified as "Failure." Preoperative factors associated with failure included: uremia (5% of success group vs 26.9% of failure group; P ¼ .031), uremic males (37.5% of uremic male patients failed vs 0% of uremic females; P ¼ .007), history of coronary artery disease among males (success, 8.33% vs fail, 50%; P ¼ .04), and history of percutaneous coronary intervention among males (fail male, 25% vs fail female, 0%; P ¼ .030).Conclusions: In our series of patients referred for AVF placement prior to starting dialysis, we noted an unexpectedly high rate of hemodialysis initiation with a TDC. This study suggests that patientrelated factors such as uremia and a history of coronary artery disease or intervention may be associated with failure of the AVF to be ready for hemodialysis. Further work building from findings in this study may help with patient selection decisions to minimize the need to initiate hemodialysis with a TDC.
Conclusions: ME resulted in more patients undergoing surgery for a definite indication and decreased rates of postoperative morbidity and mortality. This trend suggests that with ME, healthcare usage and outcomes were improved among nonelderly patients undergoing vascular surgery.
significant associations between the demographic variables, smoking status, and vascular intervention outcomes.Results: The records of 287 patients were reviewed, of whom 105 (36.6%) were current smokers, 140 (48.8%) were former smokers, and 42 (14.5%) were never smokers. Their mean age was 68.1 6 11.4 years. The average pack-year history was 38.7 6 29.1 pack-years, with most former smokers quitting >2 years before their first vascular intervention (n ¼ 97; 70.8%). Overall, the TASC (Trans-Atlantic Inter-Society Consensus Document on Management of Peripheral Arterial Disease) classification was class A for 78 (27.1%), class B for 113 (39.4%), class C for 42 (14.6%), and class D for 54 (18.8%). No significant difference was identified in the likelihood of reintervention for in-stent restenosis (P > .05), total number of reinterventions (P > .05), and interval to stent reocclusion (P > .05) between the three smoking status categories. Additionally, no significant association was identified between the number of pack-years smoked and the interval to stent reocclusion (P > .05). These variables in the three smoking groups were also not statistically significant when stratified by TASC classification (P > .05).Conclusions: Most vascular surgeons will insist on smoking cessation before intervention for peripheral arterial disease. Smoking cessation has many benefits; however, smoking does not seem to affect the reocclusion rates, interval to reintervention, nor the total number of interventions in femoral and popliteal artery stents. Although physicians should actively work with patients to encourage smoking cessation, patient smoking status should not deter nor delay endovascular intervention.
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