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  • 1
    In: The Journal of Vascular Access, SAGE Publications, Vol. 15, No. 5 ( 2014-09), p. 376-384
    Abstract: To explore the safety and efficacy of PRT-201 applied to the outflow vein of a newly created arteriovenous graft (AVG). Methods Randomized, double-blind, placebo-controlled, single-dose escalation study of PRT-201 (0.01 to 9 mg) applied to the graft-vein anastomosis and adjacent outflow vein immediately after AVG placement. The primary outcome measure was safety. The efficacy measures were intraoperative increases in outflow vein diameter and blood flow rate, primary unassisted patency, and secondary patency by dose groups (placebo, low, medium, high and All PRT-201). Results A total of 89 patients were treated (28 placebo and 61 PRT-201). There were no significant differences in the proportion of placebo and PRT-201 patients reporting adverse events. Intraoperative outflow vein diameter increased 5% (p=0.14) in the placebo group compared with 13% (p=0.01), 15% (p=0.07) and 12% (p 〈 0.001), in the low, medium and high groups, respectively. The comparison between the high and placebo groups was marginally statistically significant (p=0.06). The intraoperative blood flow did not change in the placebo group, and increased in the low, medium and high groups by 19% (p=0.34), 36% (p=0.09) and 46% (p=0.02), respectively. The low group had the longest primary unassisted and secondary patency and the fewest procedures to restore or maintain patency; however, the differences between groups were not statistically significant. Conclusions PRT-201 was well tolerated and increased AVG intraoperative outflow vein diameter and blood flow. Low dose tended to increase secondary patency and decrease the rate of procedures to restore or maintain patency. Larger studies with these doses will be necessary to confirm these results.
    Type of Medium: Online Resource
    ISSN: 1129-7298 , 1724-6032
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2014
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  • 2
    Online Resource
    Online Resource
    SAGE Publications ; 2017
    In:  The Journal of Vascular Access Vol. 18, No. 3 ( 2017-05), p. 232-237
    In: The Journal of Vascular Access, SAGE Publications, Vol. 18, No. 3 ( 2017-05), p. 232-237
    Abstract: For access-challenged patients with bilateral upper extremity central venous stenosis, solutions include the Hemodialysis Reliable Outflow (HeRO) device or an autogenous AV fistula in the lower limb. We evaluated HeRO grafts and transpositions of the femoral vein in maintaining primary and secondary patency. Methods We retrospectively analyzed 40 patients with a HeRO device and 18 patients with superficial femoral artery to transposed femoral vein autogenous arteriovenous fistula (SFA-tFV). All patients had bilateral central venous obstruction. All procedures were outpatient performed by a single surgeon at one center between 2009-2015. Operative details, intraoperative flows, and flows at the first-week postoperative visit were analyzed, as were primary and secondary patency and intervention rates. Complications were compared between groups. Results The one-year cumulative primary patency was 30% for HeRO grafts and 79% for SFA-tFV fistulas (p = 0.0001); secondary patency was 71% for HeRO grafts and 93% for SFA-tFV fistulas (p = 0.03). To maintain patency, HeRO patients required a mean 2.1 interventions per year and thigh fistula patients required a mean 0.4 interventions per year. Thirty-seven percent of thigh fistula patients had a hematoma or seroma versus 5% of HeRO patients and 17% of thigh fistula patients experienced delayed wound healing versus 2.5% of HeRO patients (p 〈 0.05). None of the thigh fistula patients had distal ischemia. Conclusions HeRO patients had lower primary and secondary patency rates versus thigh fistula patients and HeRO grafts required five-fold more interventions to maintain secondary patency. However, patients with thigh fistulas had significantly more wound healing problems. Thus, the SFA-tFV has become our access of choice for patients with bilateral central venous stenosis.
    Type of Medium: Online Resource
    ISSN: 1129-7298 , 1724-6032
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2017
    detail.hit.zdb_id: 2079292-X
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  • 3
    In: Seminars in Dialysis, Wiley, Vol. 25, No. 6 ( 2012-11), p. 689-692
    Type of Medium: Online Resource
    ISSN: 0894-0959
    Language: English
    Publisher: Wiley
    Publication Date: 2012
    detail.hit.zdb_id: 2010756-0
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  • 4
    In: Journal of Vascular Surgery, Elsevier BV, Vol. 60, No. 4 ( 2014-10), p. 1024-1032
    Type of Medium: Online Resource
    ISSN: 0741-5214
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2014
    detail.hit.zdb_id: 1492043-8
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  • 5
    Online Resource
    Online Resource
    Wiley ; 2013
    In:  Seminars in Dialysis Vol. 26, No. 2 ( 2013-03), p. E11-E12
    In: Seminars in Dialysis, Wiley, Vol. 26, No. 2 ( 2013-03), p. E11-E12
    Type of Medium: Online Resource
    ISSN: 0894-0959
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2013
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  • 6
    Online Resource
    Online Resource
    Wiley ; 2015
    In:  Seminars in Dialysis Vol. 28, No. 4 ( 2015-07), p. 450-452
    In: Seminars in Dialysis, Wiley, Vol. 28, No. 4 ( 2015-07), p. 450-452
    Abstract: We present a case in which Minimally Invasive Limited Ligation Endoluminal‐assisted Revision ( MILLER ) banding was complicated by the development of a pseudoaneurysm at the site of attempted banding. A patient with a high‐flow fistula and symptoms of distal arterial hypoperfusion underwent Miller banding. Six weeks post‐Miller banding, the patient's symptoms of hand pain returned gradually and a pseudoaneurysm appeared at the banding site. The remedial surgical procedure revealed a banding suture that had passed through one wall of the vessel and was floating in the pseudoaneurysm cavity. A primary lateral repair of the pseudoaneurysm was performed and the inflow was rebanded over a 4 mm balloon. The patient is now 51 months postpseudoaneurysm repair and the fistula continues to be used for dialysis access. Perforation of the fistula should be suspected when there is more bleeding than usual during the MILLER banding procedure.
    Type of Medium: Online Resource
    ISSN: 0894-0959 , 1525-139X
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2015
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  • 7
    Online Resource
    Online Resource
    SAGE Publications ; 2014
    In:  The Journal of Vascular Access Vol. 15, No. 5 ( 2014-09), p. 358-363
    In: The Journal of Vascular Access, SAGE Publications, Vol. 15, No. 5 ( 2014-09), p. 358-363
    Abstract: Many individuals with end-stage renal disease (ESRD) have adequate arteries and veins for construction of an arteriovenous fistula (AVF) but the fistula may be too deep to cannulate because of overlying adipose tissue. This study evaluated the safety and efficacy of liposuction to superficialize deep AVFs. Methods Between September 2009 and January 2011, 13 patients participated in the study. Mean body mass index (BMI) was 39.1 kg/m 2 . The study was limited to brachiocephalic and radiocephalic fistulas. Mean fistula depth was 8.1 mm. The primary endpoint was the date of the first successful cannulation with two 17-gauge needles. Patients were followed for 12 mo. Results Eleven subjects (85%) underwent successful two-needle cannulation a mean of 33.7 days after the procedure. One patient died of endocarditis and one developed a hematoma and wound necrosis that required surgical elevation to enable cannulation. Projection and palpability of the fistulas tended to increase over time. Mean tissue removed was 243 mL and correlated positively with the number of days to cannulation (r=0.74, p=0.01). Greater BMI correlated positively with more surgical site complications and delays in cannulation. At 12 mo, primary patency after liposuction was 50% and secondary patency was 83%. Conclusions Most subjects had prompt, uncomplicated cannulation but a few had wound necrosis, large hematomas and prolonged time until cannulation. Liposuction is effective in enabling cannulation of deep vein fistulas but because of the substantial risk of serious surgical site complications, it may not be the ideal method.
    Type of Medium: Online Resource
    ISSN: 1129-7298 , 1724-6032
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2014
    detail.hit.zdb_id: 2079292-X
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  • 8
    Online Resource
    Online Resource
    SAGE Publications ; 2016
    In:  The Journal of Vascular Access Vol. 17, No. 4 ( 2016-07), p. 307-312
    In: The Journal of Vascular Access, SAGE Publications, Vol. 17, No. 4 ( 2016-07), p. 307-312
    Abstract: This study was conducted to determine whether volume flow rate at the first postoperative visit could predict early failure of radiocephalic arteriovenous fistulas (RCAVFs). Methods We retrospectively studied the records of 264 patients who received a RCAVF between 2007 and 2013 at our centers. Data collected included patient demographics, medical history, arterial and venous mapping, and volume flow rate intraoperatively after fistula creation but before closing the surgical incision. An intraoperative flow rate 〉 100 mL/minute was targeted. We measured volume flow at the first postoperative visit 1 week after surgery and thereafter as needed. Results Intraoperative flow was not a significant predictor of primary patency (p = 0.44) but flow at the first postoperative visit was a statistically significant predictor of fistula primary patency (p = 0.002). No fistula with a blood flow 〈 200 mL/minute at the 1-week postoperative visit reached maturity without receiving a maturation procedure. The hazard ratio for the first follow-up flow (mL/min) was 0.9973 (95% CI 0.9956, 0.9989), indicating that for every 100 mL increase in blood flow the primary patency increases by 10%. Conclusions Flow rate at the 1-week postoperative visit was the most important predictor of RCAVF patency. Thus, it should be possible to identify patients who would benefit from early intervention or closer follow-up as soon as the first postoperative visit. This should help reduce the use of bridging hemodialysis catheters and minimize the risks of catheter dependency.
    Type of Medium: Online Resource
    ISSN: 1129-7298 , 1724-6032
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2016
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