Fig 4 - uploaded by Patricia Carrilho
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-Doppler mode arterial evaluation: Brachial (left) and ulnar(right) arteries are shown. Both arteries present triphasic waveform flow (note the correctly adjusted sample volume and doppler angle). The * represents vessel calcification (hyperechogenic areas).
Source publication
Chronic kidney disease (CKD) is an emerging global burden with an increasing number of patient's requiring renal replacement therapy (RRT), with hemodialysis being the most prevalent dialysis modality. A functioning vascular access remains the main constrain for an adequate treatment. Clinical and, in some patients, ultrasound evaluation are fundam...
Contexts in source publication
Context 1
... patency and diameter must be evaluated. Markers of arterial disease such as vascular calcification (hyperechogenic contour of the vessel sometimes severe enough that an acoustic shadow is seen), 20 stenotic disease (post-stenotic doubling of peak systolic velocities indicates a >50% diameter reduction) 20 and altered flow pattern must be assessed (Fig. 4). The upper arm arterial circulation is comprised of high resistance flow arteries and this will translate into triphasic flow pattern in the Doppler evaluation 20 (Fig. 4). Alteration of the flow pattern (biphasic/monophasic flow) indicates diseased arteries (although this does not preclude access creation). Radial artery systolic peak ...
Context 2
... shadow is seen), 20 stenotic disease (post-stenotic doubling of peak systolic velocities indicates a >50% diameter reduction) 20 and altered flow pattern must be assessed (Fig. 4). The upper arm arterial circulation is comprised of high resistance flow arteries and this will translate into triphasic flow pattern in the Doppler evaluation 20 (Fig. 4). Alteration of the flow pattern (biphasic/monophasic flow) indicates diseased arteries (although this does not preclude access creation). Radial artery systolic peak velocity (SPV) measurement as well as artery flow rate are also useful, as a value below 50 cm/s and below 50 mL/min respectively, have been associated with higher rates ...
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Purpose
Arteriovenous fistula(AVF) is preferred vascular access for hemodialysis but has primary failure in 20–60%. Studying predictors of AVF failure would help plan appropriate management.We studied AVF outcomes, clinical and vascular factors predicting their failure in patients requiring hemodialysis.
Methods
Retrospective study of patients wit...
Citations
... It provides information on the vascular status and calcification and assists preoperative planning and vascular mapping. 75 )76) CT is more sensitive and objective for VC evaluation than other imaging modalities. Several studies have shown that the quantification of VC by CT has a high sensitivity and specificity and has a good prognostic value for cardiovascular events. ...
Chronic kidney disease (CKD) is associated with a higher prevalence of vascular calcification (VC) and cardiovascular disease. VC in CKD patients showed different pathophysiological features from those of the general population. The pathogenesis of VC in CKD is a highly organized process, and prior studies have suggested that patients with CKD have their own specific contributors to the phenotypic change of vascular smooth muscle cells (VSMCs), including uremic toxins, CKD-mineral and bone disease (CKD-MBD), inflammation, and oxidative stress. For the diagnosis and monitoring of VC in CKD, several imaging modalities, including plain radiography, ultrasound, and computed tomography have been utilized. VC in CKD patients has distinct clinical features and implications. CKD patients revealed a more intense and more prevalent calcification on the intimal and medial layers, whereas intimal calcification is predominantly observed in the general population. While a higher VC score is clearly associated with a higher risk of all-cause mortality and cardiovascular events, a greater VC score in CKD patients does not fully reflect the burden of atherosclerosis, because they have more calcification at equal volumes of atheromatous plaques. The primary goal of VC treatment in CKD is the prevention of VC progression, and the main management is to control the biochemical components of CKD-MBD. Cinacalcet and non-calcium-containing phosphate binders are the mainstay of VC prevention in CKD-MBD management. VC in patients with CKD is an ongoing area of research and is expected to advance soon.
Introduction
Vascular calcification (VC) which is the pathological mineral deposition in the vascular system, predominantly at the intimal and medial layer of the vessel wall, is an important comorbidity in patients with chronic kidney disease (CKD) leading to significant morbidity and mortality while necessitating appropriate treatment. Our review aims to provide an in-depth analysis of the current understanding of VC.
Areas covered
In this review, we first discuss the pathophysiology of VC in CKD patients, then we explain the methods to predict and assess VC. Afterwards, we provide the currently available as well as the potential therapeutic approaches of VC. We finally discuss our understanding regarding the current situation surrounding VC in our expert opinion section.
Expert opinion
Predicting, assessing and treating VC is crucial and the future advances in the field of research surrounding VC will potentially occur in one or more of these three areas of clinical management. There is a current lack of evidence and consensus regarding specific therapeutic options for alleviating VC and this situation may not necessitate VC to be determined, detected, and documented before the available options are implemented. Regardless, the prediction and assessment of VC is still important and requires further improvement together with the developments in therapeutic alternatives. The future has the potential to bring better research which would guide and improve the management of this patient group. A more specialized approach consisting of targeted therapies and more tailored management plans for patients with CKD and VC is on the horizon.
The aim of the current study was to determine the prevalence of anatomic variant in cephalic arch on preoperative mapping venography and evaluate patency rates and predictors of patency in patients with brachiocephalic fistulas. The prevalence of anatomic variant in cephalic arch was retrospectively evaluated in 1004 consecutive patients who underwent bilateral preoperative mapping venography from July 2006 to December 2018 in a single center. The overall prevalence of anatomic variant in cephalic arch was 17.2% (173/1004). For patency analysis, 128 patients with brachiocephalic fistulas were divided into two groups: a standard anatomy (SA) group (n = 97) and a variant anatomy (VA) group (n = 31). There were no significant differences in clinical characteristics between the two groups. The primary patency rate did not differ significantly between the two groups. The secondary patency rate was significantly (p = 0.009) lower in the VA group than in the SA group. Older age (HR 1.03; 95% CI 1.01–1.05; p = 0.007) was a negative predictor of primary patency, and antiplatelet agent (HR 0.53; 95% CI 0.33–0.84; p = 0.007) and large-diameter cephalic vein (HR 0.52; 95% CI 0.31–0.86; p = 0.012) were positive predictors of primary patency. Older age (HR 1.04; 95% CI 1.01–1.07; p = 0.011) and anatomic variant in cephalic arch (HR 2.9; 95% CI 1.19–7.06; p = 0.019) were negative predictors of secondary patency. The current study provides insight into the clinical significance of anatomic variant in cephalic arch. Anatomic variant in cephalic arch should be considered as a potential risk factor for decreased patency of brachiocephalic fistula during preoperative planning.
