arteriovenous access graft infection standards of reporting and implications for comparative data analysis

Abstract There is presently a lack of organization and standardized reporting schema for arteriovenous graft (AVG) infections. The purpose of this paper is to evaluate the various types of treatment modalities for access site infections through an analysis of current publications on AVG. Key proposals are made to support standardization in a data-driven manner to make infection reporting more uniform and thereby facilitate more meaningful comparisons between various dialysis modalities and AVG technologies

A Giant Neurovascular Lower Limb Fillet Flap Can Simultaneously Cover Pelvic and Abdominal Defects

The first description of simultaneous pelvic and abdominal soft-tissue reconstruction with a giant lower limb fillet flap after hip exarticulation and open abdomen is presented. The unfortunate circumstances of a 67-year-old female patient are described leading to soft-tissue necrosis over a periprosthetic femur fracture and open abdomen after emergency implantation of an aortic bifemoral Y-prosthesis because of thrombotic obliteration of the aortic bifurcation. After removal of the hip prosthesis, the neurovascular pedicled myocutaneous fillet flap of the entire left leg was raised and folded proximally at the level of the exarticulated joint of the hip and set into the pelvic and abdominal defect. A giant pedicled neurovascular myocutaneous fillet flap raised over the entire lower extremity is a safe, effective, durable, and sensation-preserving treatment to reconstruct combined pelvic and abdominal soft-tissue defects

Guideline check for vascular access surgery 2021

Fragestellung: Mit dieser Übersichtsarbeit über die aktuellsten Leitlinien zur Shuntchirurgie von Patienten mit chronischer Niereninsuffizienz (NKF-KDOQI, ERBP, GEMAV und ESVS) soll unter anderem geklärt werden, ob es sinnvoll und erforderlich ist, Leitlinien für den deutschsprachigen Raum zu erarbeiten. Material und Methoden: Hierfür wurden diese vier Leitlinien hinsichtlich Methodik, Themenspektrum und Evidenzlage verglichen, um Gemeinsamkeiten, Unterschiede und Besonderheiten aufzuzeigen. Sowohl die fachliche Zusammensetzung der Autorenschaft wie auch die Methodik (PICO-/GRADE-System) der einzelnen Leitlinien sind sich ähnlich. Ergebnisse: Arbeitsgruppen, die viele Nephrologen im Team hatten (NKF-KDOQI, GEMAV), haben das gesamte Spektrum der Kathetereinlage in ihre Leitlinien aufgenommen. Die Leitlinien der ESVS stellen die chirurgischen Aspekte der Shuntchirurgie in den Vordergrund. In den ERBP-Leitlinien, die bei der Themenwahl auch Patientenbedürfnisse einbeziehen, ist die Fistelreifung und Kanülierung ein wichtiges Thema. Die neuen NKF-KDOQI-Leitlinien zeigen Algorithmen, wie ein individualisiertes Dialysekonzept über die Zeit aussehen könnte. Allen Leitlinien ist gemeinsam, dass viele Empfehlungen aufgrund fehlender Evidenz und fehlender aktueller Studien nur auf Expertenmeinungen beruhen. Schlussfolgerungen: Die Evidenzlage muss durch neue randomisierte Studien verbessert werden. Es wäre wünschenswert, wenn mit standardisierten Verfahren und kontinuierlicher Analyse aktualisierte und online abrufbare Empfehlungen zur Verfügung stünden. Um ein solches Projekt zu realisieren, ist eine internationale Kollaboration unabdingbar. Leitlinien für den deutschsprachigen Raum würden sich so erübrigen

A Giant Neurovascular Lower Limb Fillet Flap Can Simultaneously Cover Pelvic and Abdominal Defects

Summary:. The first description of simultaneous pelvic and abdominal soft-tissue reconstruction with a giant lower limb fillet flap after hip exarticulation and open abdomen is presented. The unfortunate circumstances of a 67-year-old female patient are described leading to soft-tissue necrosis over a periprosthetic femur fracture and open abdomen after emergency implantation of an aortic bifemoral Y-prosthesis because of thrombotic obliteration of the aortic bifurcation. After removal of the hip prosthesis, the neurovascular pedicled myocutaneous fillet flap of the entire left leg was raised and folded proximally at the level of the exarticulated joint of the hip and set into the pelvic and abdominal defect. A giant pedicled neurovascular myocutaneous fillet flap raised over the entire lower extremity is a safe, effective, durable, and sensation-preserving treatment to reconstruct combined pelvic and abdominal soft-tissue defects

Open aneurysm repair in patients with concomitant abdominal aortic aneurysm and aorto-iliac occlusive disease is associated with a high mortality and surgical complication rate

AIM OF THE STUDY: To evaluate whether the outcome after open aneurysm repair combined with aorto-femoral bypass in patients with concomitant abdominal aortic aneurysm (AAA) and aorto-iliac occlusive disease (AIOD) is inferior to open aneurysm repair for isolated AAA or aorto-femoral bypass for isolated AIOD. METHODS: We performed a retrospective analysis of 30-day mortality, 1-year mortality and surgical complications of consecutive patients undergoing elective aneurysm repair, aorto-femoral bypass or a combination of these at two vascular surgery departments from 2003 to 2013. Potential risk factors were investigated by multivariable analysis. RESULTS: Overall, 511 patients underwent open repair for isolated AAA, 104 aorto-femoral bypass for isolated AIOD and 46 open AAA repair combined with aorto-femoral bypass for concomitant AAA and AIOD. Surgical complications occurred in 17% of AAA, 23% of AIOD and 37% of combined patients (odds ratio [OR] combined vs AAA 2.76, 95% confidence interval [CI] 1.43–5.34; p = 0.003). Colon ischaemia occurred in 3.7% of AAA, 2.9% of AIOD and 13% of combined patients (incicidence rate ratio [IRR] combined vs AAA 3.27, 95% CI 1.37–7.81; p = 0.01). The 30-day mortality was 3.1% in AAA, 4.8% in AIOD, and 11% in combined patients (IRR combined vs AAA 3.17, 95% CI 1.26–7.96; p = 0.01). One-year mortality was 5.7% in AAA, 5.8% in AIOD and 15% in combined patients (IRR combined vs AAA 2.50, 95% CI 1.17–5.35; p = 0.02). CONCLUSIONS: Combined AAA repair and aorto-femoral bypass has a significantly higher 30-day mortality and postoperative complication rate than isolated AAA repair. Patients with concomitant AAA and AIOD thus represent a high-risk population, which should be considered when deciding on the indication for AAA treatment

Ultrasound-Guided Percutaneous Arteriovenous Fistula Creation Simulation Training in a Lifelike Flow Model

Objectives: To assess the feasibility and training effect of simulation training for ultrasound-guided percutaneous arteriovenous fistula (pAVF) creation in a lifelike flow model. Methods: Twenty vascular trainees and specialists were shown an instructional video on creating a pAVF in a dedicated flow model and then randomized to a study or control group. The procedure was divided into five clearly defined steps. Two observers rated the performance on each step, and the time to perform the exercise was recorded. The study group participants underwent supervised hands-on training on the model before performing a second rated pAVF creation. All participants subsequently completed a feedback questionnaire. Results: After supervised simulation training, the study groups participants increased their mean performance rating from 2.2 ± 0.9 to 3.2 ± 0.7. A mean of 3.8 ± 0.8 procedure steps was accomplished independently (control group 2.1 ± 1.4; p < 0.05). The time taken to perform the procedure was 15.6 ± 3.8 min in the study group (control group 27.2 ± 7.3, p < 0.05). The participants with previous experience in ultrasound-guided vascular procedures (n = 5) achieved higher overall mean scores 3.0 ± 0.8 and accomplished more steps without assistance (2.0 ± 1.0) during the simulation training compared to their inexperienced peers (1.5 ± 0.3 and 0.8 ± 0.4, respectively). The feedback questionnaire revealed that the study group participants strongly agreed (n = 7) or agreed (n = 3) that training on the simulation model improved their skills regarding catheter handling. Conclusions: The study group participants increased their overall performance after training on the simulator. More experienced attendees performed better from the beginning, indicating the model to be lifelike and a potential skill assessment tool. Simulation training for pAVF creation using a lifelike model may be an intermediate step between acquiring ultrasound and theoretical pAVF skills and procedure guidance in theatre. However, this type of training is limited by its reliance on the simulator quality, demonstration devices and costs

Early-cannulation arteriovenous grafts: Multidisciplinary learning is essential to optimize outcomes

Background: It is likely that there will be an increasing role for early-cannulation arteriovenous grafts (ecAVG) with a wider recognition of the need to tailor vascular access to avoid futile procedures and unnecessary TCVC. However, experience of these products is not common and limited to early surgical adopters, with little information on the systemic changes and multi-disciplinary care needed to optimize outcomes. The aim of this study was to report the impact of a multi-disciplinary approach on quantifiable outcomes. Methods: A retrospective analysis of a prospectively maintained database of 295 ecAVG implanted over an 8-year time-period was performed. Indicative outcomes were chosen to reflect nephrology (patient selection), nursing care (cannulation complications of infection and pseudoaneurysm) and radiology (thrombosis) on cumulative impact (functional patency) over three distinct time periods. Results: The incidence of ecAVG increased 10-fold over the three time periods. The use of ecAVG changed significantly from salvage tertiary access to TCVC avoidance and salvage of existing AVF. Nursing complications reduced markedly with significantly fewer over-cannulation episodes and pseudo-aneurysms. With an improved pro-active surveillance programme, the time to first thrombosis doubled and the risk of thrombosis halved. Ultimately this resulted in significantly improved functional patency with a risk of ecAVG loss less than one-third by the last time-period. Conclusions: All aspects of ecAVG use require scrutiny and critical appraisal. Failure or success is not simply achieved by performing good technical surgery with an efficacious product, but by the care taken across a wide range of elements spanning case selection, implantation, use and maintenance