95 research outputs found
sj-pdf-1-jva-10.1177_11297298231222601 – Supplemental material for International survey of radiocephalic arteriovenous fistula: ISRAF survey
No full textSupplemental material, sj-pdf-1-jva-10.1177_11297298231222601 for International survey of radiocephalic arteriovenous fistula: ISRAF survey by Ali Kordzadeh, ISRAF Collaborators, Vahaj Mohaghegh and Nicholas Inston in The Journal of Vascular Access</p
Rousseau e a radicalidade democrática: um debate com a interpretação de Kevin Inston
No full textRousseau's association to the philosophical sources of democracy is not free of discussion. The author himself preferred the qualification of “republican” instead of “democrat”, and in the Social Contract he pointed out serious difficulties for the existence of democracy as a form of government, even though his theses on popular sovereignty reverberate principles typically linked to democratic constitutions. In view of this, Kevin Inston questioned that contemporary radical democrats have neglected the contribution of the Genevan philosopher, and for this reason he sought to show how much it remains relevant to face the political challenges of our times. However, to what extent are Inston’s efforts to reconcile Rousseau's political theory with contemporary democracy sustainable? Has not the commentator underestimated or ignored crucial elements that make such convergence problematic? The purpose of this paper is to try to provide some answers to such questions.A associação de Rousseau às fontes filosóficas da democracia não constitui algo livre de discussões. O próprio autor preferia a qualificação de “republicano” em vez de “democrata”, e no Contrato Social apontou sérias dificuldades para a existência da democracia como uma forma de governo, ainda que suas teses sobre a soberania popular reverberem princípios tipicamente ligados às constituições democráticas. Diante disso, Kevin Inston questionou que os democratas radicais contemporâneos tenham negligenciado a contribuição do filósofo genebrino, e por isto buscou mostrar o quanto ela continua sendo relevante para enfrentar os desafios políticos da atualidade. Todavia, em que medida se sustentam os esforços de Inston para compatibilizar a teoria política rousseauniana com a democracia contemporânea? Não terá o comentador subestimado ou ignorado elementos cruciais que tornam tal convergência problemática? O objetivo deste artigo é tentar fornecer algumas respostas para tais perguntas
Early cannulation grafts for haemodialysis: An updated systematic review.
No full textPURPOSE
Early cannulation grafts are specifically designed for dialysis, whereas standard expanded polytetrafluoroethylene grafts were not. There is developing collective experience and literature available to allow the assessment of outcomes of these early cannulation grafts. The aim of this review was to review the evidence for both short- and long-term outcomes of early cannulation grafts.
METHODS
Using standardized searches of electronic databases in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses, the primary outcomes for this study were primary and secondary patency rates for early cannulation grafts for dialysis at 12 months and beyond. Secondary outcomes were timing of first cannulation, rates of access thrombosis, steal syndrome, pseudo-aneurysm and infection.
RESULTS
A total of 19 studies were identified and included. These were divided into different graft types. Flixene™, Avflo™, Acuseal™ and Vectra™ grafts all showed that early cannulation within 72 h is possible. Twelve-month pooled primary and secondary patency rates were 43.3% (95% confidence interval: 31.6-55.4) and 73.4% (95% confidence interval: 63-82.7) for the Flixene graft, 58.2% (95% confidence interval: 48-68.1) and 79.2% (95% confidence interval: 68-88.7) for the Avflo graft, 43.6% (95% confidence interval: 30.7-56.9) and 70.5% (95% confidence interval: 49.7-87.8) for the Acuseal graft and 63.7% (95% confidence interval: 53.4-73.4) and 85.8% (95% confidence interval: 82.9-88.4) for the Vectra graft. Data for outcome beyond 12 months were limited to the more recent studies.
CONCLUSION
This review confirms that early cannulation is not detrimental on the early outcome of early cannulation graft patencies. It has also shown that both Vectra and Avflo grafts have adequate long-term patencies. The data do not allow specific graft recommendations, as comparative trials would be required
Training vascular access surgeons: technicians or specialists?
No full textInternationally, vascular access (VA) surgery is delivered in a varied and diverse fashion and subsequently, training in vascular access is poorly defined. Experience of VA during surgical training has implications on future practice. The scope of VA procedures is increasing, yet the focus in vascular training remains largely in the technical aspects of surgery rather than the more comprehensive aspects of surgery applied to dialysis and renal care. To achieve special skills in vascular access surgery may require a change to traditional training with an additional focus on developing an extended portfolio of knowledge and skills. A small number of specialized courses and training facilities are developing to address these issues
Age is just a number: Is frailty being ignored in vascular access planning for dialysis?
No full textCurrent international guidelines advocate fistula creation as first choice for vascular access in haemodialysis patients, however, there have been suggestions that in certain groups of patients, in particular the elderly, a more tailored approach is needed. The prevalence of more senior individuals receiving renal replacement therapy has increased in recent years and therefore including patient age in decision making regarding choice of vascular access for dialysis has gained more relevance. However, it seems that age is being used as a surrogate for overall clinical condition and it can be proposed that frailty may be a better basis to considering when advising and counselling patients with regard to vascular access for dialysis. Frailty is a clinical condition in which the person is in a vulnerable state with reduced functional capacity and has a higher risk of adverse health outcomes when exposed to stress inducing events. Prevalence of frailty increases with age and has been associated with an increased risk of mortality, hospitalisation, disability and falls. Chronic kidney disease is associated with premature ageing and therefore patients with kidney disease are prone to be frailer irrespective of age and the risk increases further with declining kidney function. Limited data exists on the relationship between frailty and vascular access, but it appears that frailty may have an association with poorer outcomes from vascular access. However, further research is warranted. Due to complexity in decision making in dialysis access, frailty assessment could be a key element in providing patient-centred approach in planning and maintaining vascular access for dialysis
Aneurysms and pseudoaneurysms in dialysis access
No full textAneurysms are a common and often difficult complication seen with arteriovenous vascular access for haemodialysis. The purpose of this narrative review is to define and describe the scale of the problem and suggested therapeutic strategies. A narrative review of the published literature illustrated by individual cases is presented with the aim of summarising the relevant literature. The definitions of aneurysm are inconsistent throughout the literature and therefore systematic review is impossible. They vary from qualitative descriptions to quantitative definitions using absolute size, relative size and also size plus characteristics. The incidence and aetiology are also ill defined but separation into true aneurysms and false, or pseudoaneurysms may be helpful in planning treatment, which may be conservative, surgical or radiological. The lack of useful definitions and classification along with the multitude of management strategies proposed make firm evidence based conclusions difficult to draw. Further robust well designed studies are required to define best practice for this common problem
Arteriovenous access ischemic steal (AVAIS) in haemodialysis: a consensus from the Charing Cross Vascular Access Masterclass 2016
No full textArteriovenous access ischaemic steal (AVAIS) is a serious and not infrequent complication of vascular access. Pathophysiology is key to diagnosis, investigation and management. Ischaemia distal to an AV access is due to multiple factors. Clinical steal is not simply blood diversion but pressure changes within the adapted vasculature with distal hypoperfusion and resultant poor perfusion pressures in the distal extremity. Reversal of flow within the artery distal to the AV access may be seen but this is not associated with ischaemia in most cases.Terminology is varied and it is suggested that arteriovenous access ischemic steal (AVAIS) is the preferred term. In all cases AVAIS should be carefully classified on clinical symptoms as these determine management options and allow standardisation for studies.Diabetes and peripheral arterial occlusive disease are risk factors but a 'high risk patient' profile is not clear and definitive vascular access should not be automatically avoided in these patient groups.Multiple treatment modalities have been described and their use should be directed by appropriate assessment, investigation and treatment of the underlying pathophysiology. Comparison of treatment options is difficult as published studies are heavily biased. Whilst no single technique is suitable for all cases of AVAIS there are some that suit particular scenarios and mild AVAIS may benefit from observation whilst more severe steal mandates surgical intervention
Reply to Comments on: Novel use of infrared thermal imaging to predict arteriovenous fistula patency and maturation
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