Showing papers by "Jan H.M. Tordoir published in 2008"
TL;DR: BBAVF is the preferred choice for vascular access if RCAVF or BCAF creation is impossible, or when these types of access have already failed, according to Kidney Disease Outcomes Quality Initiative guidelines.
115 citations
TL;DR: Enrichment of the physician's interest and experience, along with a multidisciplinary approach to outline the optimal strategy of PD-catheter insertion and complication of the treatment, may improve the patients’ survival and decrease the morbidity.
Abstract: Background. This review describes the peritoneal dialysis (PD) catheter implantation techniques for the treatment of PD. The PD catheter-related complications still cause significant morbidity and mortality, resulting in the necessity to switch to haemodialysis (HD) treatment. Methods. Several catheter insertion techniques, using an open surgical approach, laparoscopic and percutaneous techniques have been employed, with their specific early and late complications and failure rates. Results. Despite the similar outcomes of open surgical versus laparoscopic techniques from randomized studies, the laparoscopic insertion has the major advantage of correct catheter positioning in the lower abdomen, with the possibility of adhesiolysis. The minimal invasive percutaneous insertion bears the risk of bowel perforation and catheter malpositioning, and the outcome of this technique is strongly related to the experience of the surgeon. The major complications of these implantation techniques, like bleeding, dialysate leakage and catheter malpositioning, and their management are discussed in our study. Late peritonitis remains the major drawback of PD treatment, with the need of temporary or permanent changeover to the HD treatment in 10% of the patients. Conclusions. Enrichment of the physician's interest and experience, along with a multidisciplinary approach to outline the optimal strategy of PD-catheter insertion and complication of the treatment, may improve the patients' survival and decrease the morbidity.
92 citations
TL;DR: The Rheos System is an implantable device that offers a completely new approach to treating patients with resistant hypertension by electrically activating the carotid baroreflex, and the treatment of resistant hypertension in general is evaluated.
Abstract: Resistant hypertension has a high prevalence and is associated with high morbidity and mortality. The Rheos® Baroreflex Hypertension Therapy™ System is an implantable device that offers a completely new approach to treating patients with resistant hypertension by electrically activating the carotid baroreflex. Preliminary results from current feasibility clinical trials have shown sustained decreases in blood pressure after 1 year. The pivotal trial for US FDA approval and market release is currently ongoing. This article profiles the Rheos System and evaluates the treatment of resistant hypertension in general.
34 citations
TL;DR: Age, history of peripheral arterial reconstruction and radial artery volume flow were significant predictors for the occurrence of ischemia in patients with brachial-basilic and prosthetic forearm AVFs.
32 citations
TL;DR: CE-MRA enables selective imaging ofupper extremity vasculature in patients requiring hemodialysis access and enables a more accurate determination of upper extremity venous diameters, in comparison to DUS.
Abstract: A contrast-enhanced magnetic resonance angiography (CE-MRA) protocol for selective imaging of the entire upper extremity arterial and venous tree in a single exam has been developed. Twenty-five end-stage renal disease (ESRD) patients underwent CE-MRA and duplex ultrasonography (DUS) of the upper extremity prior to hemodialysis vascular access creation. Accuracy of CE-MRA arterial and venous diameter measurements were compared with DUS and intraoperative (IO) diameter measurements, the standard of reference. Upper extremity vasculature depiction was feasible with CE-MRA. CE-MRA forearm and upper arm arterial diameters were 2.94 ± 0.67 mm and 4.05 ± 0.84 mm, respectively. DUS arterial diameters were 2.80 ± 0.48 mm and 4.38 ± 1.24 mm; IO diameters were 3.00 ± 0.35 mm and 3.55 ± 0.51 mm. Forearm arterial diameters were accurately determined with both techniques. Both techniques overestimated upper arm arterial diameters significantly. Venous diameters were accurately determined with CE-MRA but not with DUS (forearm: CE-MRA: 2.64 ± 0.61 mm; DUS: 2.50 ± 0.44 mm, and IO: 3.40 ± 0.22 mm; upper arm: CE-MRA: 4.09 ± 0.71 mm; DUS: 3.02 ± 1.65 mm, and IO: 4.30 ± 0.78 mm). CE-MRA enables selective imaging of upper extremity vasculature in patients requiring hemodialysis access. Forearm arterial diameters can be assessed accurately by CE-MRA. Both CE-MRA and DUS slightly overestimate upper arm arterial diameters. In comparison to DUS, CE-MRA enables a more accurate determination of upper extremity venous diameters.
20 citations
TL;DR: CE-MRA enables accurate detection of upper extremity arterial and venous stenosis and occlusions prior to VA creation, and the use of gadolinium containing contrast media is currently contraindicated due the reported incidence of nephrogenic systemic fibrosis.
Abstract: Purpose: To determine prospectively the clinical value of contrast-enhanced magnetic resonance angio- graphy (CE-MRA) for assessment of the arterial inflow and venous outflow prior to vascular access (VA) creation. Methods: Seventy-three patients underwent duplex ultrasonography (DUS) and CE-MRA prior to VA creation for detection of stenoses and occlusions. Two observers read the CE-MRA images for determination of inter-obser- ver agreement. A VA was considered functional if it could be used for successful two-needle hemodialysis therapy within 2 months after creation. Results: CE-MRA detected 6 stenosed, 8 occluded arterial vessel segments and 12 stenosed and 41 occluded venous vessel segments in 70 patients. Inter-observer agreement for detection of upper extremity arterial and venous ste- noses and occlusions with CE-MRA was substantial to almost perfect (kappa values 0.76-0.96). CE-MRA detected lesions, not detected by DUS, that were associated with VA early failure and non-maturation in 33% of patients (7/21). Accessory veins detected preoperatively were the cause of VA non-maturation in a substantial group of pa- tients (47%: 7/15). Conclusion: CE-MRA enables accurate detection of upper extremity arterial and venous stenosis and occlusions prior to VA creation. Preoperative CE-MRA identified arterial and venous stenoses, not detected by DUS that were associated with VA early failure and non-maturation. However, the use of gadolinium containing contrast media is currently contraindicated due the reported incidence of nephrogenic systemic fibrosis. (J Vasc Access 2008; 9: 269-77)
12 citations
TL;DR: Full retrograde DSA is safe and effective for stenosis detection and stenosis treatment, however, access evaluation by a non-invasive imaging modality such as colour duplex ultrasound will be sufficient in most cases as proximal inflow stenoses are encountered in a minority of patients.
Abstract: Background. The European Best Practice Guidelines on Vascular Access propose magnetic resonance angiography (MRA) of dysfunctional dialysis fistulae and grafts if visualization of the complete arterial inflow and outflow vessels is needed. In a prospective multi-centre study we determined the technical success rate of complete vascular access tree depiction by digital subtraction angiography (DSA) as an alternative to MRA. Instead of a more invasive brachial artery of femoral artery approach, we performed a retrograde catheterization of the venous outflow or graft, and stenoses were treated in connection with DSA. Methods. A catheter was advanced into the central arterial inflow after retrograde puncture of the venous outflow or graft for depiction of the complete inflow, access region and complete outflow. Access DSA through femoral artery puncture was done if the retrograde approach failed to depict the complete vascular access tree. Stenoses with a luminal diameter reduction ≥50% were treated, if possible, in connection with DSA. Results. A total of 116 dysfunctional haemodialysis fistulae and 50 grafts were included. Retrograde DSA depicted the complete vascular tree in 162 patients (97.6%). The arteriovenous anastomosis of four fistulae could not be negotiated by a catheter. DSA demonstrated 247 significant stenoses: 30, 128 and 89 were located in the arterial inflow (12.1%), AV anastomosis and graft region (51.8%) and venous outflow (36.0%), respectively. Ten patients (6.0%) had
12 citations
TL;DR: There is no conclusive evidence that online access flow evaluation has a significant effect on the rate of thrombosis, and future large-scale studies with adequate study design, adequate surveillance and intervention protocols and, possibly, better pre-emptive intervention alternative(s) are necessary.
Abstract: Introduction. Guidelines advocate surveillance of vascular access to reduce incidences of thrombosis. However, the value of online vascular access flow monitoring is still under debate.
Methods. Through a systematic literature search, the effect of online access flow surveillance combined with pre-emptive intervention on thrombosis frequency is reviewed.
Results. Due to methodological differences, adequate comparison of the individual study results is not possible. Moreover, the methodological quality of most of the included studies is not suitable for an adequate statistical analysis of the results.
Conclusion. Until now, there is no conclusive evidence that online access flow evaluation has a significant effect on the rate of thrombosis. Future large-scale studies with adequate study design, adequate surveillance and intervention protocols and, possibly, better pre-emptive intervention alternative(s) are necessary.
3 citations
TL;DR: A patient-specific model is developed to study the effect of anAVF on cardiac function and could be used in surgical planning to choose between different alternatives for an AVF.
3 citations
TL;DR: The position statement provides an excellent, comprehensive frame-work for identifying all vascular access procedure-related complications, however, it does not define the expected complication rates and thresholds.
Abstract: For a valuable quality assessment of health care deliv-ery, relevant data on outcomes must be obtained in astandardized and reproducible fashion to allow com-parison among different centers, between differenttherapies and within a center over time.Complicationdata are an important componentof outcome data.Any classification system used must be clear and con-cise so that reporting standards between the varioussubspecialties may be comparable. Otherwise, whenanalyzing the medical literature meaningful and reli-able comparisons are not possible (1).Today, physicians representing several specialties areperforming vascular access procedures. Unfortu-nately no one specialty uses a comprehensive classifi-cation system that is useful and reproducible for all.The absence of consensus within the surgery, radiol-ogy and nephrology communities on the best way toreport vascular access complications has hamperedproper evaluation of the vascular access work and im-peded progress in this field. The Clinical PracticeCommittee of American Society of Diagnostic and In-terventional Nephrology (ASDIN) has written a posi-tion statement on the “Classification of ComplicationsAssociated with Hemodialysis Access Procedures” inan attempt to rectify this problem by decreasing sub-jectivity in the use of a classification system (2).Vascular access procedure-related complications arecategorized first by the type of event and then by theseverity. Ten vascular access procedure-related com-plications are identified and then graded on a scale ofone through four, in a similar manner described bythe Society of Interventional Radiology (SIR) classifi-cation scheme (3). As opposed to the surgical classi-fication scheme, in which all adverse events occurringwithin thirty days are considered to be post-operativecomplications, the ASDIN classification scheme doesnot include complications which are not directly re-lated to a percutaneous procedure (4).The position statement is well written and very thor-ough. It provides an excellent, comprehensive frame-work for identifying all vascular access procedure-related complications. However, it does not define theexpected complication rates and thresholds. In orderfor any such system to be useful in clinical practice,quality assurance, or clinical research, the ranges andacceptable limits of complications in clinical practicemust be established. This comprehensive classification may be consideredby some to be too cumbersome for practical use andmay not be widely accepted by other specialties per-forming the same procedures. Vascular access proce-dures are only a part of the spectrum of proceduresperformed by vascular surgeons and interventionalradiologists. The Society of Vascular Surgery and theSociety of Interventional Radiology may not find thisclassification scheme applicable to their fields on thewhole.The Vascular Access Society (VAS) and the VascularAccess Society of the Americas (VASA) welcome theproposal of ASDIN to spread knowledge of their po-sition statement on complications of vascular accessprocedures among their members. This documentprovides the basis of cooperation among specialistsdealing with the same daily work, and it will hopefullyallow to better compare data of future publications inthis field. Any classification system must be validated. Accept-ability and reproducibility of any classification systemmust be documented, including centers in the UnitedStates and around the world. It would be necessary tosurvey practitioners involved in vascular access pro-cedures and assess if the criteria for reporting com-