Abstract:
BACKGROUND:Almost 80% of patients with end-stage renal disease (ESRD) initiate dialysis via a central venous catheter (CVC). CVCs are associated with multiple complications and a high cost of care. The purpose of our project is to determine the impact of early cannulation arteriovenous grafts (ECAVGs) on quality of care and costs. METHODS:The dialysis access modality, complications, secondary interventions, hospital outcomes, and detailed costs were tracked for 397 sequential patients who underwent access creation between July 2014 and October 2018. Complications were grouped into deep vein thrombosis, line infections, sepsis, pneumothorax, and other. Secondary interventions included angioplasty, angioplasty and stent grafting, thrombectomy, surgical revision, and explantation. Hospital outcomes included length of stay, inpatient mortality, 30-day readmission, and discharge disposition. Costs included supplies, medications, laboratory tests, labor, and other direct costs. All variables were measured at the time of the index procedure, 30 days, 90 days, 180 days, 270 days, 1 year, 18 months, and 2 years. RESULTS:There were 131 patients who underwent arteriovenous fistula (AVF) and 266 who received ECAVG for dialysis access. The total cost of care per patient was $17,523 for AVF and $5,894 for ECAVG at 1 year (P < 0.01). Primary-assisted patency for AVF was 49.3% versus 81.4% for ECAVG (P = 0.027), and secondary-assisted patency for AVF was 63.8% versus 85.4% for ECAVG at 1 year (P = 0.011). There was a survival advantage for ECAVGs at 1 year (78.6% for AVF vs 85.0% for ECAVG, P = 0.034). Patients who received ECAVG had fewer CVC days (2.3% vs 19.1% for AVF, P < 0.001), fewer complications (1.6% vs. 21.5% for AVF, P < 0.001), and fewer secondary interventions (17.0% vs 52.5% for AVF, P < 0.001). CONCLUSIONS:This is the first study on patients with ESRD to report detailed outcomes and cost analysis as it relates to AVF versus ECAVG. ECAVGs have an advantage over AVFs due to lower overall cost and better clinical outcomes at 1 year. Implementation of an urgent start dialysis access program centered around ECAVGs may help achieve the national goal of better health care at a lower cost for patients with ESRD.
journal_name
Ann Vasc Surgjournal_title
Annals of vascular surgeryauthors
Desai SSdoi
10.1016/j.avsg.2019.02.007subject
Has Abstractpub_date
2019-08-01 00:00:00pages
158-166eissn
0890-5096issn
1615-5947pii
S0890-5096(19)30233-Xjournal_volume
59pub_type
杂志文章abstract::A retrospective analysis of 56 patients undergoing ruptured abdominal aortic aneurysm (AAA) repair was performed to find out if cell saver had any impact on postoperative morbidity and mortality. All patients but one were male. The mean age was 68 +/- 8 years (35-85 years). Cell saver was used in 40 patients (CS group...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s10016-001-0123-7
更新日期:2002-07-01 00:00:00
abstract:BACKGROUND:The possibility of predicting severe compartment syndrome using simple biochemical parameters was evaluated in a single-center study of 55 patients who presented with acute femoral embolism and who were treated with open surgical embolectomy. METHODS:Parameters related to tissue damage and oxidative metabol...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2012.12.006
更新日期:2014-01-01 00:00:00
abstract::Renal ischemia remains a vexing issue in the repair of suprarenal abdominal aortic aneurysms (SR-AAAs). Multiple reconstruction methods have been described, including fish-mouth anastomoses, renal artery reimplantation, and aortorenal interposition grafts. We present an alternative method of SR-AAA repair that minimiz...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s10016-005-6602-5
更新日期:2005-09-01 00:00:00
abstract:BACKGROUND:Axillary artery aneurysms are rare conditions, and their causes are various. They can determine severe complications, so the treatment is extremely important. METHODS:We report the case of a young man affected by a saccular axillary artery aneurysm associated with intramuscular arteriovenous malformation, w...
journal_title:Annals of vascular surgery
pub_type:
doi:10.1016/j.avsg.2020.09.053
更新日期:2020-11-04 00:00:00
abstract::We describe the technique using high-volume three-dimensional coils to "augment" an insufficient stent-graft landing zone. This was performed to preserve hypogastric artery perfusion in the case of common iliac artery aneurysm which resides next to the internal iliac artery. ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2017.03.191
更新日期:2017-08-01 00:00:00
abstract::Venous thoracic outlet syndrome (V-TOS) and associated subclavian vein thrombosis (SVT) result in significant patient morbidity and can be difficult to manage. Previous studies have suggested that both mechanical compressive factors and pathological alterations in patient coagulation may contribute to the development ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s10016-006-9106-z
更新日期:2006-09-01 00:00:00
abstract:BACKGROUND:Inferior vena cava filters (IVCFs) are indicated for therapeutic and prophylactic treatment of venous thromboembolism in patients when anticoagulation has failed or is contraindicated. Retrievable IVCFs are not always retrieved despite clinical recommendations. The purpose of this review is to compare result...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,评审
doi:10.1016/j.avsg.2018.02.010
更新日期:2018-08-01 00:00:00
abstract:BACKGROUND:The etiology of postoperative delirium (POD) following vascular surgery is generally unknown. The incidence, however, can be as high as 35%. A possible neuroinflammatory basis for delirium is likely and C-reactive protein (CRP) as a marker for inflammation can possibly play a predictive role. METHODS:Betwee...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2014.07.004
更新日期:2014-11-01 00:00:00
abstract:BACKGROUND:In this single-center study, we assessed the clinical outcomes of fenestrated endovascular aortic repair (f-EVAR) and branched EVAR on morbidity and mortality during total endovascular aortic repair for thoracoabdominal aortic aneurysms (TAAAs). METHODS:Between July 2006 and June 2015, elective f-EVAR and m...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2017.04.025
更新日期:2017-10-01 00:00:00
abstract:BACKGROUND:The D-dimer (DD) level combined with the pretest Wells criteria probability (WCP) score can safely exclude deep venous thrombosis (DVT). The objective of this study was to examine the correlation between DD results alongside WCP score with findings on venous duplex ultrasound (VDU). The hypothesis is that VD...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2017.12.006
更新日期:2018-07-01 00:00:00
abstract:BACKGROUND:Treatment of venous ulcers is demanding for patients, as well as clinicians, and the investigation of underlying venous hypertension is the cornerstone of therapy. We propose that occult iliac vein stenosis should be ruled out by iliac vein interrogation (IVI) in patients with advanced venous stasis. METHOD...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2015.11.036
更新日期:2016-07-01 00:00:00
abstract:BACKGROUND:The treatment for bilateral carotid stenosis (BCS) is challenging, and the optimal treatment strategy is not clear. We report our experience of treating 8 patients with BCS by simultaneous carotid endarterectomy (CEA) and carotid stenting (CAS), thereby providing an alternative for vascular surgeons. METHOD...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2015.11.017
更新日期:2016-05-01 00:00:00
abstract::An inflammatory abdominal aortic aneurysm complicated by primary aortoduodenal fistula was successfully treated by stent grafting. Pharmacotherapy with octreotide after endovascular aneurysm repair was also performed with the expectation of spontaneous and rapid closure of the fistula. Gastrointestinal endoscopy perfo...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2010.12.021
更新日期:2011-05-01 00:00:00
abstract:BACKGROUND:The natural history of penetrating aortic ulcer (PAU) has been variably described and clear guidelines are lacking. We reviewed our experience with PAUs in a tertiary referral center. METHODS:Imaging reports from January 2010 to December 2017 were retrospectively searched for the diagnosis of "penetrating a...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2018.12.062
更新日期:2019-05-01 00:00:00
abstract::Acute spontaneous and isolated dissection of the iliofemoral artery is an extremely rare entity. Conservative, surgical, and endovascular treatment have been used to treat such cases. To the best of our knowledge we report the first case of using hybrid management to successfully treat isolated external iliac artery d...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2013.04.018
更新日期:2014-02-01 00:00:00
abstract::The authors report a case of leiomyosarcoma of the inferior vena cava, responsible for an acute Budd-Chiari syndrome. The diagnosis, suggested by lower limb edema, ascites, and renal failure, was confirmed by sonography, CT scan, and pathological examination. A mesoatrial shunt and right atrial thrombectomy were perfo...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,评审
doi:10.1016/S0890-5096(07)60039-9
更新日期:1989-07-01 00:00:00
abstract:BACKGROUND:The aim of the study was to report early and late outcomes of surgical and endovascular management of subclavian artery atherosclerotic disease (SAAD). METHODS:Data about consecutive patients treated for subclavian artery atherosclerotic occlusive disease between 2001 and 2018 either by open surgical repair...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2019.11.041
更新日期:2020-07-01 00:00:00
abstract::Although retrograde vertebral artery flow was described over 100 years ago, its relationship to symptoms remains unclear. We documented 43 patients who were found by duplex scanning to have reverse flow in the vertebral artery. Of this group, seven patients (16%) were found to have symptoms described as typical for th...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/BF02015293
更新日期:1991-07-01 00:00:00
abstract:BACKGROUND:To describe the prevalence and character of complications associated with revascularization procedures as a result of peripheral arterial disease in octogenarians and nonagenarians and to assess their overall survival depending on baseline characteristics, type of treatment modality, and possible procedure-r...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2010.07.016
更新日期:2011-02-01 00:00:00
abstract:BACKGROUND:The management of hepatic artery aneurysms has evolved largely because of changes in etiology and presentation, and advances in endovascular therapy. Although many case reports have been published on the condition, few have been from developing countries and few have compared patient outcomes after angioembo...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2012.08.018
更新日期:2013-08-01 00:00:00
abstract:BACKGROUND:The aim of this study was to retrospectively evaluate the safety, efficacy, and retrievability of the Aegisy vena cava filter (LifeTech Scientific Co. Ltd, Shenzhen, China). METHODS:Data from all patients who underwent Aegisy vena cava filter placement for pulmonary embolism (PE) prophylaxis during catheter...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2016.02.025
更新日期:2016-10-01 00:00:00
abstract:BACKGROUND:Venous resection during pancreaticoduodenectomy for the excision of pancreatic cancer allows for a more complete resection with negative margins, which increases survival. When the resected vein is greater than 3 cm, reconstruction with an interposition graft is recommended. However, consensus regarding the ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2019.11.008
更新日期:2020-05-01 00:00:00
abstract:BACKGROUND:Iodine contrast medium (ICM) is considered to be gold standard in endovascular procedures, but its nephrotoxicity and hypersensitivity limit the widespread use. Carbon dioxide (CO2) is considered as an alternative for endovascular procedures in patients with contraindication to ICM. However, no studies have ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.avsg.2016.06.028
更新日期:2017-02-01 00:00:00
abstract:BACKGROUND:Carotid body tumors (CBTs) are rare entities for which surgical resection remains the gold standard. Given their hypervascularity, preoperative embolization is often used; however, controversy exists over whether a benefit is associated. Proponents of embolization argue that it minimizes blood loss and compl...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2017.06.149
更新日期:2018-01-01 00:00:00
abstract:BACKGROUND:An aggressive surgical approach to locally advanced malignancy is being increasingly used in the absence of distant metastatic disease. This includes resection and reconstruction of major venous structures. We investigated the results of using a multidisciplinary surgical approach in these instances. METHOD...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2015.01.012
更新日期:2015-07-01 00:00:00
abstract:OBJECTIVES:To analyze the outcome of vascular procedures performed in patients with COVID-19 infection during the 2020 pandemic. METHODS:This is a multicenter, prospective observational cohort study. We analyzed data from 75 patients with COVID-19 infection undergoing vascular surgery procedures in 17 hospitals across...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2021.01.054
更新日期:2021-01-22 00:00:00
abstract::True and false aneurysms of veins are very rare conditions and only few cases have been described in the literature. We present a case of a 56-year-old female with personal history of primary arterial hypertension and connective tissue disease. Ultrasound of the neck showed a saccular, compressible, hypoechoic structu...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2016.09.017
更新日期:2017-05-01 00:00:00
abstract:BACKGROUND:Cancer patients have an increased risk of venous thromboembolic events. Certain chemotherapeutic agents have also been associated with the development of thrombosis. Reported cases of acute arterial ischemic episodes in cancer patients are rare. METHODS:Patients who underwent surgery for acute limb ischemia...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2011.06.002
更新日期:2011-10-01 00:00:00
abstract::Omental artery aneurysms are a unique subset of splanchnic artery aneurysms that are associated with intraperitoneal hemorrhage and high mortality rates. Detecting omental artery aneurysms prior to rupture is especially challenging; as such there are limited data surrounding unruptured aneurysms. Various methods of tr...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2018.05.038
更新日期:2019-01-01 00:00:00
abstract::Radial artery pseudoaneurysms occur infrequently and are most commonly associated with medical interventions such as arterial lines or cardiac catheterization procedures. Animal bites, particularly cat bites, as a cause for radial artery pseudoaneurysms are extremely rare with only 1 previously reported case in the li...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2014.09.016
更新日期:2015-02-01 00:00:00