Correlation of pre-existing radial artery macrocalcifications with late patency of primary radiocephalic fistulas in diabetic hemodialysis patients

Georgiadis, George S.; Georgakarakos, Efstratios; Antoniou, George Α.; Panagoutsos, Stelios; Argyriou, Christos; Mourvati, Efthimia; Passadakis, Ploumis; Lazarides, Miltos K.

doi:10.1016/j.jvs.2014.02.042

Cited by 48 publications

(54 citation statements)

References 29 publications

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“…Moreover, preexisting arterial micro-calcification was not associated with a higher frequency of juxta-anastomotic stenosis in the early postoperative ultrasound, nor was it associated with a shorter unassisted AVF patency after maturation. Of interest, a recent publication using radiography to assess arterial macro-calcification in diabetic hemodialysis patients observed shorter primary patency of radiocephalic fistulas in those patients with preoperative arterial macro-calcification 26 . In view of the low sensitivity of radiography for arterial micro-calcification 27 , it may be that only extreme degrees of arterial micro-calcification are likely to impair AVF outcomes.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Arterial Microcalcification and Clinical Outcomes of Arteriovenous Fistulas for Hemodialysis

Allon

Robbin

Umphrey

et al. 2015

American Journal of Kidney Diseases

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Background Arteriovenous fistulas (AVFs) often fail to mature, but the mechanism of AVF non-maturation is poorly understood. Arterial micro-calcification is common in patients with chronic kidney disease (CKD), and may limit vascular dilatation, thereby contributing to early postoperative juxta-anastomotic AVF stenosis and impaired AVF maturation. This study evaluated whether preexisting arterial micro-calcification adversely affects AVF outcomes. Study Design Prospective study. Setting & Participants 127 patients with CKD undergoing AVF surgery at a large academic medical center. Predictors Preexisting arterial micro-calcification (≥1% of media area) assessed independently by von Kossa stains of arterial specimens obtained during AVF surgery and by preoperative ultrasound. Outcomes Juxta-anastomotic AVF stenosis (ascertained by ultrasound obtained 4-6 weeks postoperatively); AVF non-maturation (inability to cannulate with 2 needles with dialysis blood flow ≥300 ml/min for ≥6 sessions in 1 month within 6 months of AVF creation); and duration of primary unassisted AVF survival after successful use (time to first intervention). Results Arterial micro-calcification was present by histology in 40% of patients undergoing AVF surgery. The frequency of a postoperative juxta-anastomotic AVF stenosis was similar in patients with or without preexisting arterial micro-calcification (32% vs 42%; OR, 0.65; 95% CI, 0.28-1.52; p=0.3). AVF non-maturation was observed in 29%, 33%, 33%, and 33% of patients with <1%, 1%-4.9%, 5%-9.9%, and ≥10% arterial micro-calcification, respectively (p=0.9). Sonographic arterial micro-calcification was found in 39% of patients and was associated with histologic calcification (p=0.001), but did not predict AVF non-maturation. Finally, among AVFs that matured, the unassisted AVF maturation (time to first intervention) was similar for patients with and without preexisting arterial micro-calcification (HR, 0.64; 95% CI, 0.35-1.21; p=0.2). Limitations Single center study. Conclusions Arterial micro-calcification is common in patients with advanced CKD, but does not explain postoperative AVF stenosis, AVF non-maturation, or AVF failure after successful cannulation.

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Section: Discussionmentioning

confidence: 99%

Preoperative Arterial Microcalcification and Clinical Outcomes of Arteriovenous Fistulas for Hemodialysis

Allon

Robbin

Umphrey

et al. 2015

American Journal of Kidney Diseases

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“…[12][13][14]19 In this study, a mean diabetic duration >10 years yielded a survival detriment for subgroups I and II vs a similar subcontrol group, suggesting the pivotal role of long standing diabetes as a cofactor for increased mortality in patients with upper extremity Vc.…”

Section: Discussionmentioning

confidence: 53%

“…These diabetic patients were picked up for further evaluation because they partly represent a cohort of a previous pilot study. 14 Imaging. Soft-tissue X-ray imaging with medial linear calcifications outlining the vessel wall and without patchy intimal calcifications were considered positive and subject to further independent analysis by two physicians experienced in vascular access imaging and surveillance.…”

Section: Methodsmentioning

confidence: 99%

“…1,[11][12][13] A recent study reported a tendency toward higher all-cause mortality rates in diabetic patients with ESRD presenting with AMC of radial arteries at the time of autogenous radial-cephalic fistula (RCF) construction compared with a similar cohort with healthy distal arm vessels. 14 AMC occurs in arteries of any size, but its histologic prevalence in radial arteries was 45-fold greater in patients with chronic kidney disease compared with those without chronic kidney disease. 15 Medial sclerotic lesions in the radial arteries, visible on plain radiographic images of the hand as medial wall linear macrocalcifications, are expected in 37% of prevalent patients treated with hemodialysis.…”

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confidence: 92%

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Upper limb vascular calcification score as a predictor of mortality in diabetic hemodialysis patients

Georgiadis

Argyriou

Antoniou

et al. 2015

Journal of Vascular Surgery

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“…Traditionally, the treatment of diabetic foot consists primarily of medical pharmacotherapy or surgical reconstruction of blood flow; however, for patients with diabetic foot caused by arterial occlusion, medication cannot fundamentally solve the underlying cause of the condition. In addition, the lesions in the lower extremities of such patients are typically segmental and involve the arteries of the leg; due to the absence of the distal artery flow tract, such patients may not be able to undergo an artery bypass or vascular interventional treatment (5).…”

Section: Introductionmentioning

confidence: 99%

Clinical observation of the application of autologous peripheral blood stem cell transplantation for the treatment of diabetic foot gangrene

Shu

Liang²

2015

Experimental and Therapeutic Medicine

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Abstract. The aim of the present study was to investigate the optimal mobilization plan in autologous peripheral blood stem cell transplantation for the treatment of diabetic foot and to observe its clinical curative effect. A total of 127 patients with diabetic foot were treated with different doses of granulocyte colony stimulating factor (G-CSF) to mobilize their hematopoietic stem cells. Subsequently, the extracted stem cell suspension was injected into the ischemic lower extremities along the blood vessels in the areas presenting with pathological changes. Following the treatment, the intermittent claudication distance, skin temperature, ankle brachial index and pain scores of the patients were evaluated. In addition, the associations among the mobilization time, doses and peripheral blood CD34 + level were analyzed. The collection efficiency of the stem cells was associated with the dose of G-CSF and the mobilization time. Following the injection of the autologous peripheral blood stem cell suspension, the ischemic area of the patients was improved significantly. In conclusion, autologous peripheral blood stem cell transplantation can promote the establishment of collateral circulation in patients with diabetic foot, and the optimal time for gathering stem cells is closely correlated with the peripheral blood CD34 + level.

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Correlation of pre-existing radial artery macrocalcifications with late patency of primary radiocephalic fistulas in diabetic hemodialysis patients

Cited by 48 publications

References 29 publications

Preoperative Arterial Microcalcification and Clinical Outcomes of Arteriovenous Fistulas for Hemodialysis

Preoperative Arterial Microcalcification and Clinical Outcomes of Arteriovenous Fistulas for Hemodialysis

Upper limb vascular calcification score as a predictor of mortality in diabetic hemodialysis patients

Clinical observation of the application of autologous peripheral blood stem cell transplantation for the treatment of diabetic foot gangrene

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