Journal of Vascular Access最新文献

Introduction: Percutaneous transluminal angioplasty (PTA) is the global standard for treating dysfunctional arteriovenous fistulas (AVF). However, PTA can cause vessel wall damage and intimal hyperplasia, leading to restenosis and the need for reintervention. The drug-coated balloon (DCB) is a novel approach for managing recurrent dysfunction in AVFs. However, there is limited information on the optimal number of DCB treatments required. Specifically, it is uncertain whether a second DCB should be performed in patients in whom the initial treatment with the first DCB was ineffective.

Methods: This single-center, retrospective observational study aimed to evaluate the effectiveness of a second DCB treatment in 40 patients. A second DCB was performed if PTA was required generally within 90 days after the first DCB, indicating failure of the first DCB treatment.

Results: The results showed a significant difference in patency following the second DCB compared to conventional balloon treatment (χ² = 20.46, p < 0.001) and between the first and second DCB treatments (χ² = 11.41, p = 0.0007). Univariate logistic regression analysis indicated that patients with thinner maximum intimal hyperplasia had significantly longer assisted primary patency periods (p = 0.006). Furthermore, receiver operating characteristic curve analysis to assess the sensitivity-specificity profile of the second DCB's effectiveness showed that the optimal threshold for maximum intimal hyperplasia was 1.2 mm (sensitivity/specificity, 0.80/0.58).

Conclusion: Our findings suggest that a second DCB treatment is effective for patients whose first DCB was unsuccessful, particularly in those with maximum intimal hyperplasia thinner than 1.2 mm.

Background: The intracavitary electrocardiogram (IC-ECG) localization technique has been widely used in peripherally inserted central catheter (PICC) placement. However, the accuracy of IC-ECG on PICC tip localization and complications remains controversial. The purpose of this work is to evaluate the clinical efficacy and safety of IC-ECG on PICC placement.

Materials and method: We retrieved randomized control trials from PubMed, Web of Science, Cochrane Library, EMBASE, and CNKI databases published before October 30, 2024. Patients guided by IC-ECG technology or landmark, and then used radiography to confirm the tip position, regardless of age, race, nationality, and region. Interventions other than IC-ECG or landmark were excluded. We used the Cochrane Bias Risk Assessment tools version 2 to evaluate the quality of enrolled trials. The Grading of Recommendations Assessment, Development, and Evaluation Statements online tool was used to determine the certainty of the evidence. The primary outcome was the success rate on the first attempt.

Results: Sixteen studies involving 6707 PICC patients are included. The results of the meta-analysis indicate that the IC-ECG group has a significantly higher success rate on first attempt of PICC placement (RR = 1.23, 95% CI [1.09-1.37], p < 0.00001). Total complications and phlebitis events decreased in the IC-ECG group compared with the landmark group. The mean procedure time, thrombogenesis, infection, and arrhythmia in the IC-ECG group are not statistically significant compared with the landmark group. Trial-sequential analysis (TSA) of the results indicate that sufficient events had been observed in the outcomes in success rate on first attempt, overall successful rate, total complications, phlebitis events, and infection events.

Conclusion: The IC-ECG guided method has a higher success rate on the first attempt and lower total complication for catheter tip localization in PICC placement. IC-ECG may be considered the preferred method for accurate catheter tip placement. (PROSPERO registration number, CRD42023456651).

Background: Medical adhesive-related skin injury (MARSI) is a significant but underreported complication, particularly in cancer patients with peripherally inserted central catheters (PICC). This systematic review and meta-analysis aimed to estimate the prevalence of MARSI and identify key risk factors in this patient population.

Methods: A systematic search of PubMed, Embase, the Cochrane Library, CNKI, Wanfang, and VIP was conducted to identify studies reporting MARSI prevalence and risk factors in cancer patients with PICC. Pooled prevalence estimates and odds ratios (ORs) for risk factors were calculated using a random-effects model. Heterogeneity was assessed using the I² statistic, and subgroup analyses were performed to explore potential sources of heterogeneity. Publication bias was assessed using funnel plots and Egger's test.

Results: A total of 20 studies met the inclusion criteria, encompassing 8411 patients. The pooled prevalence of MARSI was 22% (95% CI: 18-26), with substantial heterogeneity across studies (I² = 96.3%). Subgroup analysis revealed that retrospective studies reported higher prevalence (25%) compared to prospective studies (16%). Key risk factors included advanced age (OR: 2.593, 95% CI: 1.322-5.089), higher BMI (OR: 2.927, 95% CI: 2.029-4.223), pre-existing skin conditions (OR: 2.487, 95% CI: 1.693-3.650), and the use of transparent film dressings (OR: 3.228, 95% CI: 2.086-5.001). Funnel plot and Egger's test showed no significant publication bias.

Conclusions: MARSI is prevalent in cancer patients with PICC. Modifiable risk factors should guide prevention strategies, including careful adhesive selection and regular skin assessments to improve patient outcomes.

Objective: This study aims to evaluate the satisfaction and health-related quality of life (HRQoL) in cancer patients with chest ports and to understand their experiences and challenges.

Methods: A convergent parallel mixed methods study was conducted. We surveyed 618 cancer patients from 17 hospitals using the Quality of Life Assessment, Venous Device-Port questionnaire from October 2022 to October 2023. Concurrently, 14 patients from a tertiary hospital were interviewed in May 2023.

Results: Cancer patients reported a high level of satisfaction with chest port with an average score of 8.25 out of 10. However, over half had concerns such as concerns about port damage, blockage, and infection, and attempted to cover the port with clothing. The most common practical concern was interference with sports or exercise. Thirteen themes emerged from the interviews, divided into sense of benefit (convenience in daily life, high sense of security, reduction in repeated punctures and related pain, and decreased burden of frequent hospital visits), trust issues and emotional reactions at port implantation (trust and passive decision-making, fear and anxiety about surgical procedures, and resistance and passive acceptance), and negative perceptions after port implantation (safety concerns, cosmetic concerns, interference with daily activities, physical discomfort, inconvenience of accessing medical resources, patient uncertainty and need for port care information).

Conclusion: Combining quantitative and qualitative findings provides a deeper understanding of chest port-related HRQoL in cancer patients. Although they reported a high level of satisfaction, they face significant concerns that negatively impact their HRQOL. By addressing their concerns, we can significantly improve their experiences.

Implications for clinical practice: Enhanced patient education, emotional support, and innovative techniques are essential for improving overall satisfaction and quality of life of cancer patients with chest ports.

Background: Exercise management for cancer patients with arm peripherally inserted central catheter-PORT (PICC-PORT) requires standardization to prevent complications and optimize outcomes. However, evidence-based exercise protocols specifically designed for these patients are lacking.

Objective: To develop a comprehensive exercise management protocol for cancer patients with PICC-PORT through systematic investigation and expert consensus.

Methods: A three-phase approach was employed: (1) semi-structured interviews with 22 oncology nurses to identify practical challenges; (2) systematic evidence synthesis from clinical guidelines and databases; and (3) two-round Delphi consultation with 18 intravenous therapy experts.

Results: The final protocol comprises five key dimensions with 25 evidence-based measures, including exercise assessment, exercise components, exercise timing, exercise dosage, and exercise precautions. Expert consensus was achieved with authority coefficients of 0.894 and 0.897 for two rounds, and variation coefficients ranging from 0 to 0.22 in the final round.

Conclusions: This study established a standardized, evidence-based exercise protocol for cancer patients with PICC-PORT. The protocol integrates with established implantation guidelines and provides comprehensive guidance for clinical practice. Future research should evaluate its effectiveness through randomized controlled trials.

The rising global incidence of kidney failure has increased the demand for long-term hemodialysis, which requires reliable vascular access. While arteriovenous fistulas (AVFs) are typically preferred, alternative approaches are needed when autogenous options are exhausted. The use of translocated autologous saphenous vein (SV) conduits has been predominantly documented in developed countries but rarely employed in developing nations, including Vietnam. We presented the case of a 54-year-old patient with dysfunction of all common vascular access sites and central venous catheters. This case represents the first successful use of a translocated autologous great saphenous vein to create arteriovenous access in Vietnam, with a follow-up period of 3 years. The study also highlights the potential of autologous SV conduits as a superior option for vascular access compared to prosthetic grafts. This approach is particularly crucial in developing countries, where economic constraints and the high prevalence of kidney disease often limit access to prosthetic grafts.

The number of the patients treated with maintenance hemodialysis (HD) is increasing due to the increasing incidence of end stage renal disease (ESRD). Autologous arteriovenous fistula (AVF) is the preferable modality for long-term vascular access during HD. AVF stenosis is the main cause of AVF dysfunction in HD patients, but its mechanism has not been fully elucidated. Patients with ESRD often have various related complications due to intestinal microbiota disorders and their metabolites, and the intestinal axis reveals various metabolic disorders in patients with chronic kidney disease. This paper analyzes the correlation between intestinal axis abnormalities and AVF stenosis in patients with CKD through three axes: "gut-liver axis," "gut-brain axis," and "gut-spleen axis," to provide clinical significance for elucidating the mechanism of AVF stenosis and for the prevention and treatment of AVF stenosis.

Purpose: To assess 1-year safety and efficacy of the Gore^® Viabahn^® Endoprosthesis self-expanding (SX) stent graft when used to treat stenosis or thrombosis at the venous anastomosis of synthetic arteriovenous access graft (AVG).

Material and methods: This prospective, multicenter, post-market surveillance study evaluated the SX stent graft when used to treat stenotic or thrombosed vascular access circuits at the venous anastomosis of synthetic AVGs. Safety outcomes of adverse and serious adverse events were assessed. Efficacy outcomes of Kaplan-Meier (KM) estimates of primary patency and secondary patency of both the target lesion and the vascular access circuit, were evaluated through 1 year.

Results: In 103 patients, the stent graft was implanted with placement at the venous anastomosis of stenotic and thrombosed AVGs; 28 patients (27.2%) had elephant trunk placements. In 12 (11.7%) patients, devices were placed across the elbow. Through 1-year, KM estimates of primary patency for the target lesion were 52.7% (95% CI: 41.9, 62.3) and for the vascular access circuit 35.9% (95% CI: 26.2, 45.7). Secondary patency for both the target lesion and the vascular access circuit was 91.5% (95% CI: 83.8, 95.7). Mean cumulative number of reinterventions at 12 months was 0.69 (95% CI: 0.48, 0.90). The rate of device-related adverse events was 36.2%. There were two procedure-related events, and no device defects reported.

Conclusions: This 1-year surveillance study of stent grafting at the venous anastomosis with the GORE^® VIABAHN^® SX stent graft, for treatment of stenotic or thrombosed synthetic AVGs, demonstrated acceptable safety outcomes.

This study aimed to determine the factors affecting arteriovenous fistula (AVF) patency and the relationship between AVF self-care behaviors in hemodialysis (HD) patients. This was a descriptive and correlational study. The data were collected from 195 HD patients between August and December 2023. The mean score of the AVF Assessment Scale (AVF-AS) was significantly higher in diabetic patients and patients with the elbow AVF site. A significant positive correlation was found between the AVF-AS and the total number of AVF operations. AVF-AS was found to be lower in patients with very high levels of AVF self-care behaviors compared to high-level and moderate levels. A statistically significant negative correlation was found between the AVF-AS and the pump speed, Kt/V, URR, and AVF self-care behaviors. This study found that patient-related factors and self-care behaviors effectively maintain AVF patency.

This case report describes a surgical treatment combined with interventional therapy for a patient with refractory hemodialysis access combined with catheter-related right atrial thrombosis (CRAT). During surgery, an artificial graft was established from the left brachiocephalic vein to the right atrium and the right atrial thrombus was removed. After the operation, the tunneled cuffed catheter (TCC) was replaced with digital subtraction angiography (DSA). The hemodialysis access issue was addressed for this patient, and the access remained functional for normal hemodialysis during the subsequent 10-month follow-up.