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Vascular access in the elderly

Ana Verdelho, Sofia Madureira, Manuel Correia, José Manuel Ferro, Mário Rodrigues, Manuel Gonçalves-Pereira, Mafalda Gonçalves, Ana Catarina Santos, Pedro Vilela, Helena Bárrios, Mariana Borges, Helena Santa-Clara
BACKGROUND: Cognitive impairment and cerebrovascular pathology are both frequent with ageing. Cognitive impairment due to vascular pathology of the brain, termed vascular cognitive impairment (VCI), is one of the most frequent causes of cognitive impairment in elderly subjects. Thus far, VCI has no specific pharmacological treatment. Recent observational studies have suggested a protective effect of physical activity in cognition, but adequate randomised controlled trials (RCT) are lacking...
February 11, 2019: Trials
Gang Jee Ko, Yoshitsugu Obi, Tae Ik Chang, Melissa Soohoo, Rieko Eriguchi, Soo Jeong Choi, Daniel L Gillen, Csaba P Kovesdy, Elani Streja, Kamyar Kalantar-Zadeh, Connie M Rhee
OBJECTIVES: Among kidney disease patients ≥80 years progressing to end-stage renal disease, there is growing interest in conservative nondialytic management approaches. However, among those who have initiated hemodialysis, little is known about the impact of withdrawal from dialysis on mortality, nor the patient characteristics associated with withdrawal from dialysis. STUDY DESIGN: Historical cohort study. SETTING AND PARTICIPANTS: We examined 133,162 incident hemodialysis patients receiving care within a large national dialysis organization from 2007 to 2011...
January 25, 2019: Journal of the American Medical Directors Association
Amir Kaki, M Chadi Alraies, Marvin Kajy, Nimrod Blank, James J Glazier, Tamam Mohamad, Mahir Elder, Theodore Schreiber
The field of interventional cardiology has evolved in its ability to carry out complex procedures. Procedures such as transcatheter aortic valve replacement (TAVR), endovascular aneurysm repair (EVAR), and mechanical circulatory support (MCS) devices require large bore access for successful deployment. With the use of large bore-access, comes with it an increased risk for vascular complications, such as thrombosis and limb ischemia. It is paramount for the interventional cardiologist to know how to manage such complications...
January 28, 2019: Catheterization and Cardiovascular Interventions
Isibor J Arhuidese, Michol A Cooper, Muhammad Rizwan, Besma Nejim, Mahmoud B Malas
OBJECTIVE: The objective of this study was to compare the outcomes of arteriovenous fistulas (AVFs) with arteriovenous grafts (AVGs) in a large population-based cohort of elderly patients in the United States. METHODS: A retrospective analysis was performed of all patients ≥75 years old in the prospectively maintained United States Renal Database System who had an AVF or AVG placed for hemodialysis (HD) access between January 2007 and December 2011. Outcomes were mortality, conduit patency, maturation, time to catheter-free dialysis, and infection...
February 2019: Journal of Vascular Surgery
Andrea K Viecelli, Charmaine E Lok
Choosing the optimal hemodialysis vascular access for the elderly patient is best achieved by a patient-centered coordinated multidisciplinary team approach that aligns the patient's end-stage kidney disease Life-Plan, i.e., the individual treatment approach (supportive care, time-limited or long-term kidney replacement therapy, or combination thereof) and selection of dialysis modality (peritoneal dialysis versus hemodialysis) with the most suitable dialysis access. Finding the right balance between the patient's preferences, the likelihood of access function and survival, and potential complications in the context of available resources and limited patient survival can be extremely challenging...
January 2019: Kidney International
Marius J B Keel, Klaus-Arno Siebenrock, Moritz Tannast, Johannes D Bastian
Background: Even 50 years after the introduction of the extrapelvic ilioinguinal approach for open reduction and internal fixation of acetabular fractures involving predominantly the anterior column, this approach is still acknowledged as being the so-called gold standard1 . The pattern of acetabular fractures has changed within the last 10 to 20 years2,3 , with a greater prevalence of quadrilateral plate fractures that is due in part to the increase in elderly trauma. The intrapelvic approach, also called the modified Stoppa approach4-6 , was introduced as a less invasive alternative to the extrapelvic ilioinguinal approach, mostly combined with the first window of the ilioinguinal approach...
September 28, 2018: JBJS Essential Surgical Techniques
Rui Cao, Jun Li, Chenchu Zhang, Zhiyi Zuo, Song Hu
Cerebral small vessel disease has been linked to cognitive, psychiatric and physical disabilities, especially in the elderly. However, the underlying pathophysiology remains incompletely understood, largely due to the limited accessibility of these small vessels in the live brain. Here, we report an intravital imaging and analysis platform for high-resolution, quantitative and comprehensive characterization of pathological alterations in the mouse cerebral microvasculature. By exploiting multi-parametric photoacoustic microscopy (PAM), microvascular structure, blood perfusion, oxygenation and flow were imaged in the awake brain...
December 13, 2018: NeuroImage
Timmy Lee, Joyce Qian, Mae Thamer, Michael Allon
BACKGROUND: Despite national vascular access guidelines promoting the use of arteriovenous fistulas (AVF) over arteriovenous grafts (AVGs) for dialysis, AVF use is substantially lower in females. We assessed clinically relevant AVF and AVG surgical outcomes in elderly male and female patients initiating hemodialysis with a central venous catheter (CVC). METHODS: Using the United States Renal Data System standard analytic files linked with Medicare claims, we assessed incident hemodialysis patients in the United States, 9,458 elderly patients (≥67 years; 4,927 males and 4,531 females) initiating hemodialysis from July 2010 to June 2011 with a catheter and had an AVF or AVG placed within 6 months...
December 13, 2018: American Journal of Nephrology
Arif Asif, Mohamed M Bakr, Michael Levitt, Tushar Vachharajani
BACKGROUND: Conflicting data continue to surround the optimal dialysis access for the elderly. Many propose that catheters are the best option for this population; others emphasize the creation of an arteriovenous fistula. SUMMARY: While an arteriovenous access is the best available access, it has a high early failure rate, particularly in the elderly. However, significant differences exist in forearm (men ≥65 years ~70%; women ≥65 years ~80%) versus upper arm (men ≥65 years ~40%; women ≥65 years ~38%) fistula failure rates in the elderly, with upper arm having much lower failure rates...
December 5, 2018: Blood Purification
Amir Kaki, Nimrod Blank, M Chadi Alraies, Marvin Kajy, Cindy L Grines, Reema Hasan, Wah Wah Htun, James Glazier, Tamam Mohamad, Mahir Elder, Theodore Schreiber
Femoral and radial artery access continue to be the standard of care for percutaneous coronary interventions. Cardiac catheterization has progressed to encompass a wide range of diagnostic and interventional procedures including coronary, peripheral, endovascular, and structural heart disease interventions. Despite advanced technology to make these procedures safe, bleeding, and vascular complications continue to be a substantial source of morbidity, especially in patients undergoing large-bore access procedures...
December 2018: Journal of Interventional Cardiology
Wei You, Xiang-Qi Wu, Fei Ye, Shao-Liang Chen
Background: Balloons cannot pass through severely calcified coronary lesion (SCCL), and sometimes they cannot be opened at a high pressure even if they can pass through the lesion. There are limited data on rotational atherectomy (RA) via transradial access (TRA) in this setting. The aim of this study was to evaluate in-hospital and 1-year outcomes in elderly patients with SCCL who underwent RA via TRA. Methods: Eighty-six consecutive elderly patients with de novo SCCL who underwent RA were enrolled and divided into TRA (n = 45) and transfemoral access (TFA, n = 41) groups in this retrospective analysis from 2008 to 2013...
November 2018: Acta Cardiologica Sinica
Eunjin Bae, Hajeong Lee, Dong Ki Kim, Kook-Hwan Oh, Yon Su Kim, Curie Ahn, Jin Suk Han, Sang-Il Min, Seung-Kee Min, Hyo-Cheol Kim, Kwon Wook Joo
BACKGROUND: The number of elderly patients with end-stage renal disease is increasing rapidly. The higher prevalence of comorbidities and shorter life expectancy in these patients make it difficult to decide on the type of vascular access (VA). We explored the optimal choice for VA in elderly hemodialysis patients. METHODS: We included elderly patients (> 65 years) visiting our VA clinic and divided them into three groups as follows: radiocephalic arteriovenous fistula (AVF), brachiocephalic AVF, and prosthetic arteriovenous graft (AVG)...
November 6, 2018: BMC Nephrology
Takeshi Okamoto, Tsutomu Sakurada, Kenichiro Koitabashi, Yugo Shibagaki
INTRODUCTION: As the number of elderly end-stage renal disease patients lacking suitable vessels for arteriovenous fistula (AVF) is increasing, indications for tunnel cuffed catheters (TCCs) may be expanding. This study aimed to clarify changes over time in the number of patients with TCC and indications for TCCs. METHODS: This single-center retrospective study analyzed 143 catheters for 95 patients who inserted TCCs between July 2005 and July 2017. Patients were divided into two groups (early- and late-phase groups) based on the median observational period...
October 2018: Hemodialysis International
Carlo Lomonte, Carlo Basile, Sandip Mitra, Christian Combe, Adrian Covic, Andrew Davenport, Dimitrios Kirmizis, Daniel Schneditz, Frank van der Sande
Life-sustaining haemodialysis requires a durable vascular access (VA) to the circulatory system. The ideal permanent VA must provide longevity for use with minimal complication rate and supply sufficient blood flow to deliver the prescribed dialysis dosage. Arteriovenous fistulas (AVFs) have been endorsed by many professional societies as the VA of choice. However, the high prevalence of comorbidities, particularly diabetes mellitus, peripheral vascular disease and arterial hypertension in elderly people, usually make VA creation more difficult in the elderly...
October 17, 2018: Nephrology, Dialysis, Transplantation
Hyung Seok Lee, Young Rim Song, Jwa Kyung Kim, Sun Ryoung Choi, Narae Joo, Hyung Jik Kim, Pyoungju Park, Sung Gyun Kim
INTRODUCTION: The number of elderly patients requiring hemodialysis has increased, along with the need for multiple vascular access placements. Thus, the frequency of access creation using the upper arm veins, including transposed basilic arteriovenous fistula, has also increased. The purpose of this study was to identify the prevalence of anatomical variations in the upper arm veins on preoperative mapping venography and to investigate the implications of such variants on access creation...
October 11, 2018: Journal of Vascular Access
Giorgina Barbara Piccoli, Louise Nielsen, Lurilyn Gendrot, Antioco Fois, Emanuela Cataldo, Gianfranca Cabiddu
There is no simple way to prescribe hemodialysis. Changes in the dialysis population, improvements in dialysis techniques, and different attitudes towards the initiation of dialysis have influenced treatment goals and, consequently, dialysis prescription. However, in clinical practice prescription of dialysis still often follows a "one size fits all" rule, and there is no agreed distinction between treatment goals for the younger, lower-risk population, and for older, high comorbidity patients. In the younger dialysis population, efficiency is our main goal, as assessed by the demonstrated close relationship between depuration (tested by kinetic adequacy) and survival...
October 8, 2018: Journal of Clinical Medicine
Joham Choque-Velasquez, Juha Hernesniemi
Background: In this video-abstract, we present one burr-hole craniotomy for the standard suboccipital midline approach developed in Helsinki neurosurgery for the microsurgical management of forth ventricle lesions, distal posterior inferior cerebellar artery aneurysms, and tumoral and vascular lesions of the vermis, cisterna magna region, and posterior brainstem as well. Case Description: We prefer to position the patient in sitting praying position. A midline straight single-layer incision starts on the inion and extends caudally toward the level of C2...
2018: Surgical Neurology International
Murat Tuğcu, Umut Kasapoğlu, Gülizar Şahin, Süheyla Apaydın
Introduction: The number of geriatric patients is increasing in hemodialysis population over the years and mortality is higher in this group of patients. This study evaluated the factors affecting geriatric hemodialysis patient survival. Materials and Methods: This retrospective cohort study enrolled patients discharged from our nephrology clinic from 2009 to 2014. Data collected included demographics, Eastern Cooperative Oncology Group-Performance Status, vascular access type, and metabolic parameters...
2018: International Journal of Nephrology
Amedeo Anselmi, Annamaria Dachille, Vincent Auffret, Majid Harmouche, Antoine Roisne, Marc Bedossa, Hervé Le Breton, Jean-Philippe Verhoye
Minimized length of hospitalization (LoS) and lower risk of hospitalization-related complications are key requirements in the treatment of aortic valve disease, mainly in the elderly candidates. Our objective was to evaluate evolution of LoS after surgical (SAVR) or transcatheter aortic valve implantation (TAVI) and its predictors. We enrolled 1,849 elderly (aged >75) patients receiving SAVR or TAVI from 2009 to 2016. In the surgical cohort (n = 1,006) the mean LoS slightly decreased from 13.81 ± 9.27 days (2009) to 10...
July 20, 2018: American Journal of Cardiology
Gang Jee Ko, Connie M Rhee, Yoshitsugu Obi, Tae Ik Chang, Melissa Soohoo, Tae Woo Kim, Csaba P Kovesdy, Elani Streja, Kamyar Kalantar-Zadeh
Background: Arteriovenous fistulas (AVFs) are the preferred vascular access type in most hemodialysis patients. However, the optimal vascular access type in octogenarians and older (≥80 years) hemodialysis patients remains widely debated given their limited life expectancy and lower AVF maturation rates. Methods: Among incident hemodialysis patients receiving care in a large national dialysis organization during 2007-2011, we examined patterns of vascular access type conversion in 1 year following dialysis initiation in patients <80 versus ≥80 years of age...
August 9, 2018: Nephrology, Dialysis, Transplantation
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