6 results on '"Clark TWI"'
Search Results
2. Response to Letter to the Editor.
- Author
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Shamimi-Noori S, Mantell MP, Vance AZ, Trerotola SO, and Clark TWI
- Subjects
- Case-Control Studies, Renal Dialysis
- Published
- 2020
- Full Text
- View/download PDF
3. Retrospective Analysis of 77 Hemodialysis Patients Shows No Cases of Steal Syndrome from Graft Taper Reduction.
- Author
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Parikh RS, Bhatt R, Clark TWI, and Trerotola SO
- Subjects
- Adult, Aged, Aged, 80 and over, Arteriovenous Shunt, Surgical adverse effects, Blood Flow Velocity, Blood Vessel Prosthesis Implantation adverse effects, Databases, Factual, Female, Graft Occlusion, Vascular diagnostic imaging, Graft Occlusion, Vascular etiology, Graft Occlusion, Vascular physiopathology, Humans, Ischemia etiology, Ischemia physiopathology, Male, Middle Aged, Prosthesis Design, Retrospective Studies, Risk Factors, Thrombosis diagnostic imaging, Thrombosis etiology, Thrombosis physiopathology, Time Factors, Treatment Outcome, Young Adult, Angioplasty, Balloon adverse effects, Arteriovenous Shunt, Surgical instrumentation, Blood Vessel Prosthesis, Blood Vessel Prosthesis Implantation instrumentation, Graft Occlusion, Vascular therapy, Renal Dialysis, Thrombosis therapy
- Abstract
Purpose: To review the immediate flow response and incidence of steal syndrome after taper reduction of tapered dialysis grafts., Material and Methods: This was a retrospective review of a quality assurance database of all hemodialysis access interventions performed between 2005 and 2017. It identified 77 patients who underwent a taper reduction procedure, involving angioplasty of the arterial limb of the graft and the arterial anastomosis for graft thrombosis/poor flow. A subset of patients underwent 5-, 6-, or 7-mm balloon taper reduction angioplasty coupled with intravascular direct flow measurement (n = 15 with 16 dialysis grafts). A two-tailed Wilcoxon matched-pairs signed-rank test was used to compare pre- and post-taper reduction flows. Mean duration of follow-up was 3.5 years (range, 0-12.5 years)., Results: Mean access survival after taper reduction was 20.2 months (range, 0.10-94.4 months). Pre- and post-taper reduction access flows (mean Qb ± standard deviation) were 574 ± 315 ml/min and 929 ± 352 ml/min, respectively (P < .0001). The mean ratio of post- to pre-taper reduction flows was 1.6 (range, 1.1-10.2). No patients developed steal syndrome within 6 months after taper reduction., Conclusions: Dialysis graft arterial anastomotic taper reduction did not result in the development of steal syndrome within 6 months. In the subset of patients who underwent flow measurements, taper reduction was associated with nearly a 2-fold improvement in access flow, which is a key predictor of access function., (Copyright © 2020 SIR. Published by Elsevier Inc. All rights reserved.)
- Published
- 2020
- Full Text
- View/download PDF
4. Comparison of Clinical Performance of VectorFlow and Palindrome Symmetric-Tip Dialysis Catheters: A Multicenter, Randomized Trial.
- Author
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Nadolski GJ, Redmond J, Shin B, Shamimi-Noori S, Vance A, Hammelman B, Clark TWI, Cohen R, and Rudnick M
- Subjects
- Aged, Biomarkers blood, Catheter Obstruction etiology, Catheterization, Central Venous adverse effects, Device Removal, Equipment Design, Female, Humans, Kidney Failure, Chronic diagnosis, Kidney Failure, Chronic physiopathology, Male, Middle Aged, Philadelphia, Prospective Studies, Renal Dialysis adverse effects, Risk Factors, Time Factors, Treatment Outcome, Urea blood, Catheterization, Central Venous instrumentation, Catheters, Indwelling, Central Venous Catheters, Hemodynamics, Kidney Failure, Chronic therapy, Renal Dialysis instrumentation
- Abstract
Purpose: To compare clinical performance of 2 widely used symmetric-tip hemodialysis catheters., Materials and Methods: Patients with end-stage renal disease initiating or resuming hemodialysis were randomized to receive an Arrow-Clark VectorFlow (n = 50) or Palindrome catheter (n = 50). Primary outcome was 90-d primary unassisted catheter patency. Secondary outcomes were Kt/V ([dialyzer urea clearance × total treatment time]/total volume of urea distribution), urea reduction ratio (URR), and effective blood flow (Q
B )., Results: Primary unassisted patency rates with the VectorFlow catheter at 30, 60, and 90 d were 95.5% ± 3.3, 87.2% ± 7.3, and 80.6% ± 9.8, respectively, compared with 89.1% ± 6.2, 79.4% ± 10.0, and 71.5% ± 12.6 with the Palindrome catheter (P = .20). Patients with VectorFlow catheters had a mean Kt/V of 1.5 at 30-, 60-, and 90-day time points, significantly higher than the mean Kt/V of 1.3 among those with Palindrome catheters (P = .0003). URRs were not significantly different between catheters. Catheter QB rates exceeded National Kidney Foundation-recommended thresholds of 300 mL/min at all time points for both catheters and were similar for both catheters (median, 373 mL/min). Catheter failure, ie, poor flow rate requiring guide-wire exchange or removal, within the 90-day primary outcome occurred in 3 VectorFlow subjects and 5 Palindrome subjects (P = .72). Infection rates were similar, with 0.98 infections per 1,000 catheter days for VectorFlow catheters compared with 2.62 per 1,000 catheter days for Palindrome catheters (P = .44)., Conclusions: The 90-day primary patency rates of Palindrome and VectorFlow catheters were not significantly different, and both achieved sustained high QB through 90 day follow-up. However, dialysis adequacy based on Kt/V was consistently better with the VectorFlow catheter versus the Palindrome., (Copyright © 2020 SIR. Published by Elsevier Inc. All rights reserved.)- Published
- 2020
- Full Text
- View/download PDF
5. Diagnosis and Treatment of Nonmaturing Fistulae for Hemodialysis Access via Transradial Approach: A Case-Control Study.
- Author
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Shamimi-Noori S, Sheng M, Mantell MP, Vance AZ, Cohen R, Trerotola SO, Reddy SN, Nadolski GJ, Stavropoulos SW, and Clark TWI
- Subjects
- Adult, Aged, Aged, 80 and over, Female, Graft Occlusion, Vascular diagnostic imaging, Graft Occlusion, Vascular etiology, Graft Occlusion, Vascular physiopathology, Humans, Male, Middle Aged, Punctures, Retrospective Studies, Risk Factors, Time Factors, Treatment Outcome, Vascular Patency, Arteriovenous Shunt, Surgical adverse effects, Brachial Artery diagnostic imaging, Brachial Artery physiopathology, Catheterization, Peripheral adverse effects, Endovascular Procedures adverse effects, Graft Occlusion, Vascular therapy, Radial Artery diagnostic imaging, Radial Artery physiopathology, Renal Dialysis
- Abstract
Purpose: To compare outcomes of transradial access for endovascular treatment of nonmaturing hemodialysis fistulae compared to brachial arteriography followed by unidirectional or bidirectional fistula access for intervention., Materials and Methods: In this institutional review board-approved, retrospective, case-control study, 56 consecutive patients with nonmaturing arteriovenous fistulae underwent percutaneous intervention between 2015 and 2018. The transradial group (n = 28) underwent radial artery access for diagnostic fistulography and intervention. The control group (n = 28) underwent retrograde brachial artery access for fistulography followed by unidirectional/bidirectional fistula access for intervention. Both groups had similar demographics, fistula characteristics, and stenosis locations., Results: Fewer punctures were required in the transradial group compared to controls (1.2 vs 2.4, P < .0001), and procedure time was shorter (64.9 vs 91.3 minutes, P = .0016). Anatomic, technical, and clinical success rates trended higher in the transradial group compared to controls (93% vs 86%, 96% vs 89%, and 82% vs 64%, respectively). Nonmaturation resulting in fistula abandonment was lower in the transradial group (3.7% vs 25%, P = .025). Primary unassisted patency at 3, 6, and 12 months was 77.1% ± 8.2%, 73.1% ± 8.7%, and 53.3% ± 10.6% in the transradial group, respectively, and 63.0% ± 9.3%, 55.6% ± 9.6%, and 48.1% ± 9.6% in the control group, respectively (P = .76). Primary assisted patency at 12 months was 92.3% ± 5.3% in the transradial group compared to 61.8% ± 9.6% at 12 months in the control group (P = .021). No major complications occurred. Minor complications were lower in the transradial group than in the control group (14% vs 39%, P = .068)., Conclusions: Treatment of nonmaturing fistulae via a transradial approach was safe, improved midterm patency, and was associated with lower rates of fistula abandonment., (Copyright © 2020 SIR. Published by Elsevier Inc. All rights reserved.)
- Published
- 2020
- Full Text
- View/download PDF
6. Outcomes of a Polytetrafluoroethylene Hybrid Vascular Graft with Preloaded Nitinol Stent at the Venous Outflow for Dialysis Vascular Access.
- Author
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Habibollahi P, Mantell MP, Rosenberry T, Leeser DB, and Clark TWI
- Subjects
- Aged, Arteriovenous Shunt, Surgical adverse effects, Axillary Vein diagnostic imaging, Axillary Vein physiopathology, Blood Vessel Prosthesis Implantation adverse effects, Brachial Artery diagnostic imaging, Brachial Artery physiopathology, Female, Graft Occlusion, Vascular etiology, Graft Occlusion, Vascular physiopathology, Graft Occlusion, Vascular therapy, Humans, Male, Middle Aged, Prosthesis Design, Retrospective Studies, Risk Factors, Time Factors, Treatment Outcome, United States, Vascular Patency, Alloys, Arteriovenous Shunt, Surgical instrumentation, Axillary Vein surgery, Blood Vessel Prosthesis, Blood Vessel Prosthesis Implantation instrumentation, Brachial Artery surgery, Polytetrafluoroethylene, Renal Dialysis, Stents
- Abstract
Background: To evaluate outcomes and patency of arteriovenous grafts (AVGs) created using Gore hybrid vascular grafts in hemodialysis patients with limited venous outflow or challenging anatomy., Materials and Methods: A retrospective review was performed in two academic centers of all patients between July 2013 and December 2016 who underwent surgical AVG creation using a Gore hybrid vascular graft in a brachial artery to axillary configuration. Patient characteristics and comorbidities as well as graft patency, function, and subsequent need for percutaneous interventions were recorded., Results: Forty-six patients including 30 females (65.2%) and 16 males (34.8%) with a mean age of 63 ± 13 years were identified. The most common indications for a hybrid vascular graft were limited surgical accessibility and/or revision of existing AVG due to severe stenotic lesions at the venous outflow in 33 patients (72%). One-year primary unassisted and assisted patency rates were 44 ± 8% and 54 ± 8%, respectively, compared with 1-year secondary patency rate of 66 ± 8%. The rate of percutaneous interventions to maintain graft function and patency was approximately one intervention per graft per year., Conclusions: Access created with the hybrid vascular graft in a brachial-axillary (brachial artery to axillary vein) configuration is an acceptable option for patients with limited venous outflow reserve and challenging anatomy. Twelve-month primary and secondary patency rates and need for percutaneous interventions were comparable to traditional AVGs., (Copyright © 2018 Elsevier Inc. All rights reserved.)
- Published
- 2019
- Full Text
- View/download PDF
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