Alexandercreech3009

INTRODUCTION This study evaluates the effect of diabetes on outcomes of autogenous fistulas and prosthetic grafts for hemodialysis access in a large population based cohort of patients. METHODS A retrospective cohort study of all patients who initiated dialysis in the United States Renal Database System (2007-2014). Chi-square, student T-tests, Kaplan-Meier, log-rank tests, multivariable logistic and Cox regression analyses were employed to evaluate maturation, interventions, patency, infection and mortality. RESULTS The study of 381622 patients comprised 303307 (79.5%) autogenous fistulas and 78315 (20.5%) prosthetic grafts placed in 231134 (60.6%) diabetic and 150488 (39.4%) non-diabetic patients. There was decrease in maturation for diabetics compared to non-diabetics who received autogenous fistulas (aHR 0.86; 95%CI 0.83-0.88, P less then 0.001) and prosthetic grafts (aHR 0.88; 95%CI 0.83-0.93, P less then 0.001). Comparing diabetics vs. non-diabetics, primary patency at 5 years was 19.4 vs 23.5% (p less (aHR 1.19; 95%CI 1.17-1.20; P less then 0.001) and 12% increase for prosthetic graft recipients (aHR 1.12; 95%CI 1.10-1.15; P less then 0.001). CONCLUSIONS In this population-based cohort of hemodialysis patients, diabetes mellitus was associated with a decrease in patient survival, access maturation and primary fistula patency. In contrast there was no association between diabetes and prosthetic graft patency and severe prosthetic graft infection warranting excision. INTRODUCTION Acute iliofemoral artery thrombosis (IFAT) can occur in critically ill neonates and infants who require indwelling arterial cannulas for monitoring or as a consequence of cardiac catheterization. Guidelines suggest treatment with anticoagulation but evidence supporting the optimal duration of therapy and the role of surveillance ultrasonography (US) is limited. The objectives of this study were to characterize the kinetics of thrombus resolution and to define an appropriate duration of anticoagulation and interval for surveillance US. METHODS This was a single-center retrospective cohort study of pediatric patients with acute IFAT from 2011 to 2019. Medical records and vascular lab studies were reviewed. Patients with ≥ 1 surveillance US were included. Thrombus resolution was defined as multiphasic flow throughout the index limb without evidence of echogenic intraluminal material by US. Time-to-resolution of thrombus was assessed using Kaplan-Meier (KM) analysis. RESULTS Fifty-four limbs in 50 paof IFAT with anticoagulation resulted in successful short-term outcomes. Based on the observed rate of resolution, management should start with anticoagulation followed by surveillance US at two-week intervals. When treated with anticoagulation, resolution can be expected to occur in one-third of patients every two weeks. OBJECTIVE Isolated internal iliac artery aneurysms (IIIAAs) are rare, life-threatening entities, for which the optimal treatment strategy has not been established. This study aimed to evaluate the outcomes of open and endovascular treatment of IIIAAs. METHODS IIIAA cases between January 2009 and March 2019 at two hospitals were retrospectively reviewed. Demographic, clinical, ancillary testing, treatment, and outcome data were collected and analyzed. RESULTS Forty-two patients (37 men and 5 women) with a mean age of 71 years were included. Twenty-five patients (60%) had a history of hypertension. Twenty-two patients (52%) were asymptomatic, and 16 (38%) presented with abdominal pain (12 with ruptured aneurysms). find more The 42 included patients had 43 treated IIIAAs. The following surgical techniques were used surgical resection (n=6), endovascular coil embolization (n=12), endovascular stent-graft placement across the internal iliac artery origin (n=8 with 9 aneurysms), and combined coil embolization and stent-graft placement (n=16). The immediate technical success rate was 67%, 67%, and 88% for embolization, stent-graft placement, and combined method, respectively. Open surgery was associated with the longest operative time and hospital stay. Overall 30-day mortality was 5% for all patients and 17% for patients with ruptured IIIAAs. Buttock claudication occurred in seven of 40 survived patients (18%). The median follow-up time was 56 months. This combined approach was associated with the lowest rates of endoleak and reintervention among three endovascular methods (6% vs 25% and 29%, 6% vs 17% and 29%). CONCLUSIONS Endovascular coil embolization and stent-graft placement is a feasible, safe, and effective treatment approach for large IIIAAs without adequate aneurysm necks. OBJECTIVE Vascular complications (VCs) occurring in TAVI procedures have frequently been reported in the past. Considering significant technical improvements in delivery systems and vascular closure devices, the goal of this study was to determine the incidence, impact, and prognostic factors of VCs in a recent real-world cohort. METHODS AND RESULTS We report a bicentric prospective analysis of 479 consecutive patients who underwent TAVI between January 2017 and December 2017. Vascular complications were defined according to criteria set out by the Valve Academic Research Consortium Criteria-2 (VARC-2). The incidence of VCs was 26.1% (n = 125 patients), of which 2.9% were major (n = 14) and 23.2% were minor (n = 111) . Vascular complications were related to the primary puncture point in 69% of cases, compared to 31%, at the secondary puncture site. Treatments implemented were medical in 76% of cases and surgical in 24% of cases. The risk factors for VCs were as follows iliac morphology score, sheath-to-iliofemoral artery ratio (SIFAR), and moderate-to-severe iliofemoral calcifications or tortuosity. In the case of major VCs, only SIFAR was a risk factor. Major VCs significantly increased intra-hospital mortality (30.7% vs. 1.1% for minor VCs and 1.3% for no VCs, log rank p less then 0.0001) and 1-year mortality (40.6% vs. 5.6% for minor VCs and 5.6% for no VCs, log rank p less then 0.0001). CONCLUSION Using strictly VARC-2 endpoint definitions, more than one-quarter of TAVI procedures were associated with VCs, primarily minor ones. Secondary puncture points were responsible for one-third of VCs and should, therefore, also be actively monitored. Major VCs significantly impact short and mid-term survival.