Surgical Practice to Reduce Dialysis Access Insufficiency

Freeman, Anthony; Gallagher, Martin; Gray-Weale, Anthony C.; Lippey, Eric; Thursby, Peter

doi:10.1111/j.1445-2197.2008.04481.x

Cited by 4 publications

(4 citation statements)

References 22 publications

(37 reference statements)

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“…14,24 A prospective audit was undertaken in three studies. 10,25,26 Wong et al demonstrated an improvement in performance and indication around carotid endarterectomy. 25 In this study, only one report was included concerning volume.…”

Section: Structurementioning

confidence: 99%

“…Most structural measures can only be assessed in observational studies, as was demonstrated in the vascular access studies. 10,23 Furthermore, the outcome of structural measures reflects the result of variables and not for a single variable. Therefore, it is difficult to point out the origin of improvement after structural measures have been implemented.…”

Section: Structure As Indicator Of Quality Of Care In Vascular Surgerymentioning

confidence: 99%

See 1 more Smart Citation

Assessing the Quality of Surgical Care in Vascular Surgery; Moving from Outcome Towards Structural and Process Measures

Ploeg

Flu

Lardenoye

et al. 2010

European Journal of Vascular and Endovascular Surgery

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Section: Structurementioning

confidence: 99%

Section: Structure As Indicator Of Quality Of Care In Vascular Surgerymentioning

confidence: 99%

Assessing the Quality of Surgical Care in Vascular Surgery; Moving from Outcome Towards Structural and Process Measures

Ploeg

Flu

Lardenoye

et al. 2010

European Journal of Vascular and Endovascular Surgery

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“…However, tunneled hemodialysis catheters continue to serve an important role in this patient population and these catheters remain especially prevalent among Canadian hemodialysis patients [3]. Although patients with CVCs have greater morbidity and mortality relative to patients with AV fistulas and grafts [4], CVC access remains beneficial in patients where AV fistulas may be impractical, where short-to intermediate-term bridge access is required until an AV fistula is developed or where vascular anatomy is unsuitable for AV fistula or graft creation [5].…”

Section: Introductionmentioning

confidence: 99%

Chest Radiography and Echocardiography Predictors of Early Hemodialysis Catheter Dysfunction

Burton

O'Brien²,

Rajan³

2012

OJRad

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Purpose: To determine whether radiographic heart morphology and echocardiography findings were associated with early central venous catheter (CVC) failure in hemodialysis patients. Materials & Methods: All hemodialysis catheter insertions between 1996-2007 were captured in a combined nephrology radiology database. Factors were identified that may be associated with early catheter failure. Factors examined included: echocardiography findings, radiographic evidence of flattened heart border, boot-shaped heart and left ventricular hypertrophy as well as patient comorbidities and peri-procedural characteristics. Results: Of the 132 CVC failures in 132 patients, 67 (50.8%) occurred within 30 days of insertion. Early CVC failure was more likely to occur in patients who had insertions from the left side (

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“…Distressingly, we have often been faced with too many patients presenting with florid sepsis when these tunneled dialysis catheters become infected while patients are awaiting maturation of their AVF. 18 Indeed, nationwide data demonstrate an increase in the use of tunneled dialysis catheters. In the United States, the majority of patients starting dialysis do not have a functioning permanent vascular access (autogenous or prosthetic) in place at the time of initiation of dialysis and thus must be dialyzed through a catheter until permanent access is placed and ready to be used.…”

mentioning

confidence: 99%

Duplex Scanning–Derived Access Volume Flow: Novel Predictor of Success Following Endovascular Repair of Failing or Nonmaturing Arteriovenous Fistulae for Hemodialysis

2010

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The objective of this study was to evaluate the feasibility of duplex scanning-derived access volume flow (DAVQ) to predict the success or failure of arteriovenous fistulae (AVF) after interventions. Eighty-eight DAVQ measurements were available for 60 AVF in 59 patients. In 25 cases, physical examination findings or inadequate dialysis suggested failing (11) or nonmaturing (14) AVF. Outflow stenoses (1-4; mean 1.2 +/- 0.8) were confirmed by contrast fistulograms in 23 cases (17 peripheral; 6 central). These 23 cases underwent successful endovascular repair (17 balloon angioplasty; 6 stents) and had pre- and postintervention DAVQ measurements within 2 weeks of the procedure. Each was measured three times in a nontortuous venous segment with laminar flow, and mean values were used for comparison. The overall mean DAVQ for 65 functioning AVF was 1,199 +/- 485 mL/min, whereas it was 652 +/- 438 mL/min (range 150-1,840 mL/min) for the remaining 23 failing or nonmaturing cases (p < .0001). Postintervention, the latter values changed to 867 +/- 517 mL/min (range 257-2,020 mL/min), with a p < .13. Of these, 11 were still nonfunctional after endovascular procedures and had a mean DAVQ of 404 +/- 111 mL/min (range 257-652 mL/min). The remaining 12 cases had a mean DAVQ of 1,280 +/- 382 mL/min (range 762-2,020 mL/min) and were functional and usable for at least 6 months of follow-up (p < .0001). It is interesting to note that none of the AVF cases with postintervention DAVQ < 700 mL/min became functional and usable, whereas all cases with a higher DAVQ underwent successful hemodialysis treatments. This early experience suggests that DAVQ can be used to predict the success or failure of an AVF following endovascular procedures. To our knowledge, this is the first such report.

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Surgical Practice to Reduce Dialysis Access Insufficiency

Cited by 4 publications

References 22 publications

Assessing the Quality of Surgical Care in Vascular Surgery; Moving from Outcome Towards Structural and Process Measures

Assessing the Quality of Surgical Care in Vascular Surgery; Moving from Outcome Towards Structural and Process Measures

Chest Radiography and Echocardiography Predictors of Early Hemodialysis Catheter Dysfunction

Duplex Scanning–Derived Access Volume Flow: Novel Predictor of Success Following Endovascular Repair of Failing or Nonmaturing Arteriovenous Fistulae for Hemodialysis

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