The arteriovenous fistula and the history of a forgotten pioneer.

Objective: The radiocephalic arteriovenous fistula (AVF), first introduced by Dr Kenneth Charles Appell, allowed for the provision of hemodialysis for patients with chronic kidney disease (CKD) and remains a reliable method for vascular access today. The purpose of this study is to review the contributions that led to the development of the AVF. We describe the work of Dr Appell, whose procedure bypassed the need for repeated cannulation in achieving vascular access, transforming the management of patients with dialysis-dependent CKD.

Survey of Canadian vascular surgeons and trainees finds work-related musculoskeletal pain and discomfort is common.

Background: Occupational injuries and disability are a source of surgeon morbidity. The purpose of this study was to assess the physical toll of working in operating rooms by Canadian vascular surgeons.

Objective: To assess workplace musculoskeletal (MSK) complaints and challenges faced by Canadian vascular surgeons and trainees and their implications on surgical practice and occupational longevity.

Exploring the Utility of Brain Natriuretic Peptide Measurement in Vascular Surgery.

Background: The Canadian Cardiovascular Society 2016 guidelines recommend pre-operative measurement of brain natriuretic peptide (BNP) to risk-stratify patients for a 30-day composite outcome of death, myocardial infarction, or asymptomatic myocardial injury after noncardiac surgery (MINS). Whether this practice affects outcomes is unclear. The aim of this study was to examine the clinical utility of brain natriuretic peptide and myocardial injury after noncardiac surgery.

A comparison of outcomes between open and endovascular arteriovenous access creation for hemodialysis.

Objective: Preliminary outcomes for percutaneous endovascular autogenous access (endoAVF) have shown promising results; however, comparisons with surgical cohorts in dialysis populations are lacking. This study compares autogenous arteriovenous access created with the EverlinQ endoAVF system with accesses created by conventional surgical technique with respect to functional and patency related outcomes.

Methods: This is a multicenter, retrospective review of autogenous arteriovenous accesses entered into a prospective database.

Deformation mechanics of self-expanding venous stents: Modelling and experiments.

Deformation properties of venous stents based on braided design, chevron design, Z design, and diamond design are compared using in vitro experiments coupled with analytical and finite element modelling. Their suitability for deployment in different clinical contexts is assessed based on their deformation characteristics. Self-expanding stainless steel stents possess superior collapse resistance compared to Nitinol stents.

Wirelessly Heating Stents via Radiofrequency Resonance toward Enabling Endovascular Hyperthermia.

Thermal therapy known as hyperthermia has served as an effective method for cancer treatment. This therapeutic approach has also been attracting attention for treatment of in-stent restenosis, the most common complication of stenting. Mild heating of stents has been shown to be a possible path to addressing this problem.

Wireless Hyperthermia Stent System for Restenosis Treatment and Testing With Swine Model.

This paper reports the first in vivo testing of a resonant-heating stent toward wireless hyperthermia treatment of in-stent restenosis. The stent, made of gold-coated medical-grade stainless steel, is designed to function as an electrical inductor and forms a radiofrequency (RF) resonant circuit with an integrated capacitor microchip. Upon implantation and deployment with the balloon catheter, the stent device serves as a wireless heater as part of the resonant wireless power transfer system, which allows for the device to produce mild heat only when the stent is resonated with a tuned RF electromagnetic field supplied from the external antenna.

Influence of artery and vein diameters on autogenous arteriovenous access patency.

Objective: Previous investigations have suggested that a minimum venous outflow diameter (MVOD) and perianastomotic arterial diameter are associated with successful autogenous arteriovenous maturation and patency. The goal of this study was to determine anatomic and clinical variables that may influence access patency to guide optimal autogenous access configuration selection.

Methods: Accesses created from 2010 to 2016 were analyzed from data entered into a prospective database.

Enabling Angioplasty-Ready "Smart" Stents to Detect In-Stent Restenosis and Occlusion.

Despite the multitude of stents implanted annually worldwide, the most common complication called in-stent restenosis still poses a significant risk to patients. Here, a "smart" stent equipped with microscale sensors and wireless interface is developed to enable continuous monitoring of restenosis through the implanted stent. This electrically active stent functions as a radiofrequency wireless pressure transducer to track local hemodynamic changes upon a renarrowing condition.

An age-based comparison of fistula location, patency, and maturation for elderly renal failure patients.

Objective: Current Kidney Disease Outcomes Quality Initiative guidelines do not incorporate age in determining autogenous arteriovenous hemodialysis access placement, and the optimal initial configuration in elderly patients remains controversial. We compared patency, maturation, survival, and complications between several age cohorts (<65 years, 65-79 years, >80 years) to determine whether protocols should be modified to account for advanced age.

Methods: All patients at two teaching hospitals undergoing a first autogenous arteriovenous access creation in either arm between 2007 and 2013 were retrospectively analyzed from a prospectively maintained database.

Reassessing the normal toe-brachial index in young healthy adults.

Objective: The purpose of this study was to measure the toe-brachial index (TBI) in healthy young adults and to compare it with the accepted reference range.

Methods: Medical students from the undergraduate classes at the University of British Columbia were prospectively recruited. Participants were surveyed on physical parameters (height, weight), lifestyle factors (physical activity and type, smoking status, alcohol consumption), and medical history (current medications, medical conditions, family history).

A comparison of revision using distal inflow and distal revascularization-interval ligation for the management of severe access-related hand ischemia.

Objective: Access-related hand ischemia (ARHI) is a potentially limb-threatening complication of arteriovenous access for dialysis. The distal revascularization-interval ligation (DRIL) and revision using distal inflow (RUDI) procedures both allow treatment of ischemic symptoms while maintaining fistula patency. Although outcomes with the DRIL are well established, experience with the RUDI for ARHI remains preliminary.

Intelligent telemetric stent for wireless monitoring of intravascular pressure and its in vivo testing.

This paper reports a sensor-integrated telemetric stent targeted at wireless detection and monitoring of restenosis, a common vascular complication induced by stent implantation. The developed "smart" stent incorporates the design and fabrication approaches that raise the practicality of the device, being tested in an in vivo study that validates its operating principle. The stent is produced to have a gold-coated helical-like structure that serves as a high-performance inductor/antenna and integrated with a novel capacitive pressure sensor chip, all based on medical-grade stainless steel.

Occlusion of the common and internal iliac arteries for aortoiliac aneurysm repair: experience with the Amplatzer vascular plug.

Background: We sought to evaluate and describe our centre's experience with the Amplatzer vascular plug (AVP) for the occlusion of common and internal iliac arteries (CIA; IIA) during endovascular aortic aneurysm repair (EVAR).

Methods: We performed a retrospective analysis of 20 consecutive patients between October 2006 and December 2007, who underwent occlusion of the CIA or IIA before or during EVAR to prevent endoleak.

Results: Among these 20 patients, 21 occlusion procedures occurred and 20 were successful.

Canadian experience with percutaneous endovascular aneurysm repair: short-term outcomes.

Background: To decrease the morbidity associated with cut-downs during endovascular aneurysm repair, some authors have suggested the totally percutaneous endovascular repair (PEVAR). The goal of this report is to evaluate and describe our centre's experience with the total percutaneous endovascular aneurysm repair (PEVAR) for aortic abdominal aneurysm (AAA).

Methods: We performed a retrospective analysis of 15 consecutive patients with AAA, including 1 with right common iliac artery aneurysm.

Use of short-radius centrifugation to augment ankle-brachial indices.

Background: Peripheral arterial disease is mainly caused by atherosclerosis and is characterized by decreased circulation, lower blood pressure, and insufficient tissue perfusion in the lower extremities. The hemodynamics of standing and altered gravity environments have been well studied relative to arm blood pressures but are less well understood for ankle pressures.

Methods: Because regional blood pressure depends, in part, on the gravitational pressure gradient, we hypothesized that artificial gravity exposure on a short-arm centrifuge with the center of rotation above the head would increase blood pressure in the lower extremities.

Successful ventricular transapical thoracic endovascular graft deployment in a pig model.

Purpose: Aortoiliac occlusive disease may preclude retrograde thoracic endovascular aortic repair. This study evaluated the physiologic and anatomic feasibility of introducing an aortic endograft in an antegrade manner into the descending thoracic aorta of a pig through the left ventricular apex.

Methods: Twelve adult pigs were to undergo antegrade endograft deployment.

Arterialization of a vein graft promotes cell cycle progression through Akt and p38 mitogen-activated protein kinase pathways: impact of the preparation procedure.

Background: Vein arterialization following bypass surgery often leads to graft occlusion, but the underlying cellular mechanisms have been poorly studied.

Objectives: Cell cycle progression and the activation of proliferation signalling were compared in arterialized grafts prepared either according to the conventional procedure or using pharmacological relaxation with the native vein.

Methods: Using the porcine carotid-jugular bilateral interposition graft model on one side, a segment of porcine jugular vein was prepared for grafting using the conventional procedure, with pressure distention at 300 mmHg; the segment grafted on the other side was treated with a combination of pharmacological vasodilators.