Patient attitudes towards the arteriovenous fistula: a qualitative study on vascular access decision making.

Background: The use of arteriovenous fistulas (AVFs) among hemodialysis (HD) patients has been consistently associated with lower rates of morbidity and mortality; however, up to 30% of eligible patients refuse the creation or cannulation of an AVF. We aimed to understand the attitudes, beliefs, preferences and values of patients who refused creation or use of an AVF.

Methods: With qualitative methodology, we conducted semi-structured interviews with 13 HD patients (Canada, 2009), who previously refused creation or use of an AVF.

Economic evaluation of open vs endovascular repair of blunt traumatic thoracic aortic injuries.

Objectives: During the last decade, endovascular repair (EV) has replaced open surgical repair (OSR) as the preferred method of treatment of blunt traumatic thoracic aortic injuries (BTAIs) at many trauma centers. This has resulted in reductions in mortality, length of stay, and major complications, including paraplegia, with the added expense of the initial endograft, subsequent surveillance, and reinterventions. The purpose of this study was to conduct an economic evaluation comparing these two methods of repair.

Who should be referred for a fistula? A survey of nephrologists.

Background: There is marked variation in the use of the arteriovenous fistula (AVF) across programmes, regions and countries not explained by differences in patient demographics or comorbidities. The lack of clear criteria of who should or should not get a fistula may contribute to this, as well as barriers to creating AVFs.

Methods: We conducted a survey of Canadian and American nephrologists to assess the patient variables considered to determine the timing and type of access requested.

The use of 3D epiaortic scanning to enhance evaluation of atherosclerotic plaque in the ascending aorta: a case series.

Transesophageal echocardiography (TEE) is becoming the standard of practice for cardiopulmonary bypass (CPB) surgery. Unfortunately, large sections of the ascending aorta are not visible on TEE, and epiaortic scanning has proven superior to TEE and aortic palpation in determining the extent of plaque in the ascending aorta. The recently introduced x4 3-dimensional (3D) ultrasound probe allows both real time 3D imaging and gated acquisition sequences.

Is more frequent hemodialysis beneficial and what is the evidence?

Purpose Of Review: The HEMO study results have shown that increasing dialysis dose in conventional thrice weekly hemodialysis does not improve patient outcomes. Interest has therefore turned to more frequent (daily) hemodialysis treatments. This review covers the rationale for such an approach together with a current review of the published study data.

Hemodynamic and volume changes during hemodialysis.

Background: Volume overload is a factor in the hypertension of hemodialysis (HD) patients. Fluid removal is therefore integral to the hemodialysis treatment. Fluid removal by hemodialysis ultrafiltration (UF) may cause intradialytic hypotension and leg cramps.