Precurved non-tunnelled catheters for haemodialysis are comparable in terms of infections and malfunction as compared to tunnelled catheters: A retrospective cohort study

Background: The main limitations of central venous catheters for haemodialysis access are infections and catheter malfunction. Our objective was to assess whether precurved non-tunnelled central venous catheters are comparable to tunnelled central venous catheters in terms of infection and catheter malfunction and to assess whether precurved non-tunnelled catheters are superior to straight catheters. Materials and methods: In this retrospective, observational cohort study, adult patients in whom a central venous catheter for haemodialysis was inserted between 2012 and 2016 were included. The primary endpoint was a combined endpoint consisting of the first occurrence of either an infection or catheter malfunction. The secondary endpoint was a combined endpoint of the removal of the central venous catheter due to either an infection or a catheter malfunction. Using multivariable analysis, cause-specific hazard ratios for endpoints were calculated for tunnelled catheter versus precurved non-tunnelled catheter, tunnelled catheter versus non-tunnelled catheter, and precurved versus straight nontunnelled catheter. Results: A total of 1603 patients were included. No difference in reaching the primary endpoint was seen between tunnelled catheters, compared to precurved non-tunnelled catheters (hazard ratio, 0.91; 95% confidence interval, 0.70– 1.19, p=0.48). Tunnelled catheters were removed less often, compared to precurved non-tunnelled catheters (hazard ratio, 0.65; 9

Surgical and endovascular intervention for dialysis access maturation failure during and after arteriovenous fistula surgery : review of the evidence

Background Maturation failure is the major obstacle to establishing functional arteriovenous fistulae (AVF) for haemodialysis treatment. Various endovascular and surgical techniques have been advocated to enhance fistula maturation and to increase the number of functional AVFs. This narrative review considers the available evidence of interventional techniques for treatment of AVF non-maturation. Results Intra-operative vein dilation and anastomosis modification results in a clinical maturation rate of 74\u201392% and a 6 month cumulative AVF patency of 79\u201393%. Percutaneous transluminal angioplasty (PTA) with or without accessory vein obliteration is successful in 43\u201397% of patients. The long-term primary patency of PTA is rather low and multiple re-interventions are needed to achieve an acceptable cumulative fistula patency. The results of surgical revision exceed the results of endovascular intervention, with a mean primary one year patency of 73% (range 68\u201378%) compared with 49% (range 28\u201372%), respectively. The role of accessory vein obliteration remains unclear. Conclusion Intervention for autologous arteriovenous fistula non-maturation is worthwhile and results in an increased number of functional fistulae. The outcome of surgical revision is better than endovascular and might be preferable in certain patient populations

Pneumomediastinum in late pregnancy: a case report and review of the literature

Background Pneumomediastium is a rare complication of pregnancy or labor. Methods Here, we report our findings in a case report (gravid 5, para 2, gestational age 33 + 4 weeks) and narratively review the current literature on pneumomediastinum in pregnancy or labor. Results Our case is the first case that experienced pneumomediastinum after relatively limited exposure to barotrauma in the current pregnancy. Other reports describe pneumomediastinum after hyperemesis gravidarum or during labor. Treatment is usually conservatively due to the trauma mechanism of barotrauma to the alveoli. Conclusion Physicians should be aware of the possibility of pneumomediastinum in pregnant women with acute thoracic pain in cases of (previous) hyperemesis gravidarum or during labor

What is needed to make cardiovascular models suitable for clinical decision support?: a viewpoint paper

The potential impact of hemodynamic and vascular wall models on the diagnosis, treatment, and well-being of thousands of patients suffering from cardiovascular diseases, is tremendous. Despite the potential impact, it is not straightforward to use these models for individualized diagnosis and intervention planning (model predictive decision support). Major challenges are the adaptation of the models to patient-specific conditions and the necessary uncertainty assessment of the simulated outcome measures.In this manuscript, we will present our view on what is needed to make cardiovascular models suitable for clinical decision support. Hereto, we will first describe how an engineer might support clinical decisions. Secondly, we will give a description of the challenges faced by the engineers. Finally we will introduce an innovative approach in which model personalization is guided by sensitivity analysis, and in which the effect of input uncertainties and model assumptions (acknowledged model errors) on model predictions are considered during model corroboration. The approach is illustrated by two different vascular cases.Hopefully our view will be useful in bringing models from the pre-clinical phase to the clinical phase where they will actually be used for model predictive decision support

Precurved non-tunnelled catheters for haemodialysis are comparable in terms of infections and malfunction as compared to tunnelled catheters:A retrospective cohort study

Clinical epidemiolog