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The functional profiles of three cases of CAS and a comparative study involving the other cases of stenosis diagnosed in our HD unit are presented here&#46;<span class="elsevierStyleBold"></span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">PATIENTS AND METHOD</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Patients</span></p><p class="elsevierStylePara">We monitored 145 vascular accesses in 131 patients over a period of five years by regularly testing the QA of the vascular access&#46;<span class="elsevierStyleSup">2</span> The average age of the subjects was 62&#46;6 &#177; 13&#46;5 years and they underwent dialysis treatment three times a week in the HD Unit of the Nephroplogy Department at Mollet Hospital Private Foundation with two needles through a native arteriovenous fistula AVF &#40;84&#46;1 &#37;&#41; or a graft AVG &#40;15&#46;9&#37;&#41;&#44; using double needle for their haemodialysis&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Method</span></p><p class="elsevierStylePara">The QAwas determined during HD by the Delta-H method&#44; using the Crit Line III Monitor &#40;ABF-mode&#59; HemaMetrics&#44; United States&#41;&#46; This dilution method&#44; described and validated by Yarar et al&#46;&#44;<span class="elsevierStyleSup">9</span> is a photometric technique based on the inverse relationship that exists between volaemia and haematocrit &#40;Hct&#41;&#46; The QA is determined from changes in Hct after sudden changes in the ultrafiltration rate &#40;from 0&#46;1 to 1&#46;8 l&#47;h&#41; with HD lines in normal and inverted configuration&#46; The changes in Hct are recorded continuously by an optical sensor attached to a blood chamber inserted between the dialyser and the arterial line&#46; The QA was calculated using the following formula&#58;</p><p class="elsevierStylePara">QA&#61; &#40;max UF - min UF&#41; &#183; rev Hct max &#47; &#916; Hct rev - &#916; Hct nor</p><p class="elsevierStylePara">where max UF is the maximum ultrafiltration rate&#44; min UF is the minimum ultrafiltration rate&#44; rev Hct max is the maximum haematocrit measured with reversed lines&#44; &#916; Hct rev is the change in arterial haematocrit with lines in the reverse configuration&#44; and &#916; Hct nor is the change in arterial haematocrit with lines in the normal configuration&#46;</p><p class="elsevierStylePara">The QAwas measured at least every four months during the first hour of the HD session&#44; maintaining a constant blood flow from the HD pump &#40;QB&#41; at 300ml&#47;min&#46; Patients remained in the supine position and resting throughout the examination&#59; patients were not allowed to eat and neither perfusion medication nor saline solution were administered while the QA was being measured&#46; Basal QA was calculated as the average of the first two values of QA obtained during two consecutive HD sessions&#46; All cases with an absolute QA below 700ml&#47;min or a temporary reduction in QA above 20&#37; in relation to the basal value were considered test positive &#91;Test &#40;&#43;&#41;&#93; and were referred them for angiography plus subsequent elective vascular access intervention by angioplasty or revision surgery when vascular luminal stenoses &#62;&#95; 50&#37; were detected&#46; The mean arterial pressure MAP &#40;diastolic arterial pressure &#43; 1&#47;3 pulse pressure&#41; and the Kt&#47;V index &#40;using the second generation Daugirdas formula&#44; the one-compartment model&#41; were established at the same time as QA&#46;<span class="elsevierStyleBold"></span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Statistical analysis</span></p><p class="elsevierStylePara">The data was analysed using the SPSS program version 12&#46;0 for Windows&#46; Values were expressed as percentages or mean &#177; standard deviation&#46; The comparative study of continuous variables among subgroups of patients compared in pairs was performed using a T-test for two independent samples and the Mann-Whitney U test&#46; Values of p &#60; 0&#46;05 were considered to be statistically significant&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS</span></p><p class="elsevierStylePara">During the follow-up period&#44; 54 Test &#40;&#43;&#41; cases&#44; affecting 47 vascular accesses&#44; were identified &#40;seven vascular accesses had a Test &#40;&#43;&#41; twice&#41; due to basal QA below 700 ml&#47;min &#40;n &#61; 27&#41; or a temporary reduction in QA of more than 20&#37; from the basal value &#40;n &#61; 27&#41;&#46; An angiography was carried out in most cases of Test &#40;&#43;&#41; &#40;87&#37;&#44; 47&#47;54&#41; and&#44; of them&#44; 43 cases &#40;91&#46;5&#37;&#44; 43&#47;47&#41; had significant vascular access stenosis &#40;reduction in the vascular lumen of 80&#46;5 &#177; 12&#46;9 &#37;&#41;&#59; 46&#46;5&#37; &#40;20&#47;43&#41; of cases of stenosis were diagnosed on the basis of a temporary reduction in QA&#46;</p><p class="elsevierStylePara">Venous stenosis of the vascular access was detected in 28 cases&#44; involving the arterialized vein of AVF or the venous anastomosis of AVG&#46; This stenosis was isolated &#40;n &#61; 27&#41; or predominant over a simultaneous arterial stenosis &#40;n &#61; 1&#41;&#46; Of them&#44; 17 cases were diagnosed on the basis of a temporary reduction in QA&#46;</p><p class="elsevierStylePara">Arterial stenosis of the vascular access was found in 15 cases&#44; involving the feeding artery of AVF or the arterial anastomosis of AVG&#46; This stenosis was isolated &#40;n &#61; 11&#41; or predominant over a simultaneous venous stenosis &#40;n &#61; 4&#41;&#46; Of them&#44; only three cases were diagnosed on the basis of a temporary reduction in QA&#46;</p><p class="elsevierStylePara">During the study period&#44; three cases of CAS were identified &#40;mean degree 80&#46;0 &#177; 10&#46;0 &#37;&#41; on the basis of a temporary reduction in QA of 52&#46;7 &#177; 2&#46;3 &#37; &#40;figure 1&#41;&#46; The prevalence of CAS was 11&#46;1&#44; 15 and 17&#46;6&#37;&#44; taking into account the cases of vascular access with Test &#40;&#43;&#41; &#40;n &#61;27&#41;&#44; the cases of significant vascular access stenosis &#40;n &#61; 20&#41; and the cases of significant venous stenosis &#40;n &#61; 17&#41;&#44; all based on the temporary reduction in QA&#46; Table 1 shows the characteristics of patients and vascular access presenting this type of stenosis&#46; Table 2 shows the comparative study performed between the cases of CAS &#40;n &#61; 3&#41; and&#58; the remaining cases of stenosis &#40;n &#61; 17&#41;&#44; the cases of arterial stenosis &#40;n &#61; 3&#41; and the remaining cases of venous stenosis &#40;n &#61; 14&#41;&#44; in relation to the temporary reduction in QA&#44; the degree of stenosis and the MAP&#46;</p><p class="elsevierStylePara">As we can see in table 2&#44; CAS shows a different functional behavior in comparison with the rest of cases of stenosis&#58; despite a similar degree of stenosis&#44; the temporary reduction in QA is significantly greater in the cases of CAS&#46; This functional disparity is not secondary to differences in MAP values&#46;<span class="elsevierStyleBold"></span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara">The prevalence of CAS varies according to the different published series&#46; In relation to the total number of dysfunctional AVF&#44; the prevalence of this type of stenosis ranges between 4&#46;25 and 64&#37;&#46;<span class="elsevierStyleSup">4-7&#44;10&#44;11</span> The lowest prevalence &#40;4&#46;25&#37;&#41; was found in a recent study carried out by Nam et al&#46;&#44; involving 1&#44;623 patients with AVF treated using angioplasty&#46;<span class="elsevierStyleSup">7</span> In the retropective study carried out by Rajan et al&#46; &#40;n &#61; 177&#41; and in the prospective study carried out by Jaberi et al&#46; &#40;n &#61; 58&#41; on dysfunctional AVF&#44; the prevalence of CAS was 14&#46;7 and 31&#37;&#44; respectively&#46;<span class="elsevierStyleSup">5&#44;6</span> The highest prevalence of CAS at 64&#37;4 was described in the retrospective study by Hammes et al&#46;&#44; which involved 127 patients who at least underwent one AVF venogram&#46;</p><p class="elsevierStylePara">Although the aetiopathogenesis of CAS is not completely clear&#44; all the investigators agree that the presence of a braquiocephalic AVF is the most important predisposing factor&#46;<span class="elsevierStyleSup">3&#44;5&#44;6</span> In this study&#44; the three patients with CAS were receiving haemodialysis via a braquiocephalic AVF&#46; In the retrospective study by Rajan et al&#46;&#44; involving 177 patients with dysfunctional AVF&#44; the prevalence of CAS was significantly higher for humerocepahlic AVF than for radiocephalic AVF &#40;39 vs&#46; 2&#37;&#41;&#46;<span class="elsevierStyleSup">6</span> In the prospective and observational series by Javeri et al&#46;&#44; involving 58 patients who underwent fistulography&#44; almost all patients with CAS had a braquiocephalic AVF &#40;94&#37;&#41; as compared to the rest of the patients &#40;70&#37;&#41; &#40;p &#61; 0&#46;046&#41;&#46;5</p><p class="elsevierStylePara">Two of the three patients with CAS in this study had diabetic nephropathy and therefore&#44; we cannot confirm the inverse relationship that has been described between this type of stenosis and the presence of diabetes mellitus&#46;<span class="elsevierStyleSup">4&#44;5</span> In the aforementioned study by Javeri et al&#46;&#44; the prevalence of diabetes was significantly lower in patients with CAS &#40;17 vs&#46; 48&#37;&#44; p &#61; 0&#46;03&#41; and in the series by Hammes et al&#46;&#44; the prevalence of CAS was also significant lower in diabetic patients as compared to the rest of the patients&#46;<span class="elsevierStyleSup">4</span></p><p class="elsevierStylePara">The funcional behavior of CAS seems to be different to that of other stenoses&#46; In this study&#44; the temporary drop in QAis significantly higher in cases of CAS in comparison to stenosis at other locations&#44; despite presenting a similar degree of vascular lumen reduction and similar MAP values&#46; An explanation for this functional difference&#44; yet to be confirmed and only speculation at this stage&#44; could be the proximal localisation of this segment of the cephalic vein&#46; This functional disparity&#44; if it is confirmed in further studies&#44; could explain the increase in the prevalence of cases of thrombosis secondary to CAS that some authors have described&#46;<span class="elsevierStyleSup">4</span></p><p class="elsevierStylePara">To sum up&#44; CAS is a unique type of stenosis&#46; If the results of this study are confirmed&#44; then CAS has a functional profile that may be different to that of stenoses at other locations&#46; To date&#44; this is the first functional study on this type of stenosis that has been carried out&#46;<br></br></p><p class="elsevierStylePara"><a href="grande&#47;12518078&#95;f1&#95;352&#46;jpg" class="elsevierStyleCrossRefs"><img src="12518078_f1_352.jpg"></img></a></p><p class="elsevierStylePara">Figure 1&#46; </p><p class="elsevierStylePara"><a href="grande&#47;12518078&#95;t1&#95;352&#46;jpg" class="elsevierStyleCrossRefs"><img src="12518078_t1_352.jpg" alt="Characteristics of the patients and AVF presenting CAS"></img></a></p><p class="elsevierStylePara">Table 1&#46; Characteristics of the patients and AVF presenting CAS</p><p class="elsevierStylePara"><a href="grande&#47;12518078&#95;t2&#95;353&#46;jpg" class="elsevierStyleCrossRefs"><img src="12518078_t2_353.jpg" alt="Comparative study between CAS and the remaining cases of stenosis&#46; The MAP value was obtained&#60;br &#47;&#62;together with the QA value just before the fistulography&#46;"></img></a></p><p class="elsevierStylePara">Table 2&#46; Comparative study between CAS and the remaining cases of stenosis&#46; The MAP value was obtained<br></br>together with the QA value just before the fistulography&#46;</p>"
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Functional profile of cephalic arch stenosis
Perfil funcional de la estenosis del arco de la vena cefálica
Ramon Roca-Teya, Rosa Samona, Omar Ibrika, Isabel Giméneza, Jordi Viladomsa
a Servicio de Nefrologia, Fundación privada Hospital de Mollet, Mollet, Barcelona, España,
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The functional profiles of three cases of CAS and a comparative study involving the other cases of stenosis diagnosed in our HD unit are presented here&#46;<span class="elsevierStyleBold"></span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">PATIENTS AND METHOD</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Patients</span></p><p class="elsevierStylePara">We monitored 145 vascular accesses in 131 patients over a period of five years by regularly testing the QA of the vascular access&#46;<span class="elsevierStyleSup">2</span> The average age of the subjects was 62&#46;6 &#177; 13&#46;5 years and they underwent dialysis treatment three times a week in the HD Unit of the Nephroplogy Department at Mollet Hospital Private Foundation with two needles through a native arteriovenous fistula AVF &#40;84&#46;1 &#37;&#41; or a graft AVG &#40;15&#46;9&#37;&#41;&#44; using double needle for their haemodialysis&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Method</span></p><p class="elsevierStylePara">The QAwas determined during HD by the Delta-H method&#44; using the Crit Line III Monitor &#40;ABF-mode&#59; HemaMetrics&#44; United States&#41;&#46; This dilution method&#44; described and validated by Yarar et al&#46;&#44;<span class="elsevierStyleSup">9</span> is a photometric technique based on the inverse relationship that exists between volaemia and haematocrit &#40;Hct&#41;&#46; The QA is determined from changes in Hct after sudden changes in the ultrafiltration rate &#40;from 0&#46;1 to 1&#46;8 l&#47;h&#41; with HD lines in normal and inverted configuration&#46; The changes in Hct are recorded continuously by an optical sensor attached to a blood chamber inserted between the dialyser and the arterial line&#46; The QA was calculated using the following formula&#58;</p><p class="elsevierStylePara">QA&#61; &#40;max UF - min UF&#41; &#183; rev Hct max &#47; &#916; Hct rev - &#916; Hct nor</p><p class="elsevierStylePara">where max UF is the maximum ultrafiltration rate&#44; min UF is the minimum ultrafiltration rate&#44; rev Hct max is the maximum haematocrit measured with reversed lines&#44; &#916; Hct rev is the change in arterial haematocrit with lines in the reverse configuration&#44; and &#916; Hct nor is the change in arterial haematocrit with lines in the normal configuration&#46;</p><p class="elsevierStylePara">The QAwas measured at least every four months during the first hour of the HD session&#44; maintaining a constant blood flow from the HD pump &#40;QB&#41; at 300ml&#47;min&#46; Patients remained in the supine position and resting throughout the examination&#59; patients were not allowed to eat and neither perfusion medication nor saline solution were administered while the QA was being measured&#46; Basal QA was calculated as the average of the first two values of QA obtained during two consecutive HD sessions&#46; All cases with an absolute QA below 700ml&#47;min or a temporary reduction in QA above 20&#37; in relation to the basal value were considered test positive &#91;Test &#40;&#43;&#41;&#93; and were referred them for angiography plus subsequent elective vascular access intervention by angioplasty or revision surgery when vascular luminal stenoses &#62;&#95; 50&#37; were detected&#46; The mean arterial pressure MAP &#40;diastolic arterial pressure &#43; 1&#47;3 pulse pressure&#41; and the Kt&#47;V index &#40;using the second generation Daugirdas formula&#44; the one-compartment model&#41; were established at the same time as QA&#46;<span class="elsevierStyleBold"></span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Statistical analysis</span></p><p class="elsevierStylePara">The data was analysed using the SPSS program version 12&#46;0 for Windows&#46; Values were expressed as percentages or mean &#177; standard deviation&#46; The comparative study of continuous variables among subgroups of patients compared in pairs was performed using a T-test for two independent samples and the Mann-Whitney U test&#46; Values of p &#60; 0&#46;05 were considered to be statistically significant&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS</span></p><p class="elsevierStylePara">During the follow-up period&#44; 54 Test &#40;&#43;&#41; cases&#44; affecting 47 vascular accesses&#44; were identified &#40;seven vascular accesses had a Test &#40;&#43;&#41; twice&#41; due to basal QA below 700 ml&#47;min &#40;n &#61; 27&#41; or a temporary reduction in QA of more than 20&#37; from the basal value &#40;n &#61; 27&#41;&#46; An angiography was carried out in most cases of Test &#40;&#43;&#41; &#40;87&#37;&#44; 47&#47;54&#41; and&#44; of them&#44; 43 cases &#40;91&#46;5&#37;&#44; 43&#47;47&#41; had significant vascular access stenosis &#40;reduction in the vascular lumen of 80&#46;5 &#177; 12&#46;9 &#37;&#41;&#59; 46&#46;5&#37; &#40;20&#47;43&#41; of cases of stenosis were diagnosed on the basis of a temporary reduction in QA&#46;</p><p class="elsevierStylePara">Venous stenosis of the vascular access was detected in 28 cases&#44; involving the arterialized vein of AVF or the venous anastomosis of AVG&#46; This stenosis was isolated &#40;n &#61; 27&#41; or predominant over a simultaneous arterial stenosis &#40;n &#61; 1&#41;&#46; Of them&#44; 17 cases were diagnosed on the basis of a temporary reduction in QA&#46;</p><p class="elsevierStylePara">Arterial stenosis of the vascular access was found in 15 cases&#44; involving the feeding artery of AVF or the arterial anastomosis of AVG&#46; This stenosis was isolated &#40;n &#61; 11&#41; or predominant over a simultaneous venous stenosis &#40;n &#61; 4&#41;&#46; Of them&#44; only three cases were diagnosed on the basis of a temporary reduction in QA&#46;</p><p class="elsevierStylePara">During the study period&#44; three cases of CAS were identified &#40;mean degree 80&#46;0 &#177; 10&#46;0 &#37;&#41; on the basis of a temporary reduction in QA of 52&#46;7 &#177; 2&#46;3 &#37; &#40;figure 1&#41;&#46; The prevalence of CAS was 11&#46;1&#44; 15 and 17&#46;6&#37;&#44; taking into account the cases of vascular access with Test &#40;&#43;&#41; &#40;n &#61;27&#41;&#44; the cases of significant vascular access stenosis &#40;n &#61; 20&#41; and the cases of significant venous stenosis &#40;n &#61; 17&#41;&#44; all based on the temporary reduction in QA&#46; Table 1 shows the characteristics of patients and vascular access presenting this type of stenosis&#46; Table 2 shows the comparative study performed between the cases of CAS &#40;n &#61; 3&#41; and&#58; the remaining cases of stenosis &#40;n &#61; 17&#41;&#44; the cases of arterial stenosis &#40;n &#61; 3&#41; and the remaining cases of venous stenosis &#40;n &#61; 14&#41;&#44; in relation to the temporary reduction in QA&#44; the degree of stenosis and the MAP&#46;</p><p class="elsevierStylePara">As we can see in table 2&#44; CAS shows a different functional behavior in comparison with the rest of cases of stenosis&#58; despite a similar degree of stenosis&#44; the temporary reduction in QA is significantly greater in the cases of CAS&#46; This functional disparity is not secondary to differences in MAP values&#46;<span class="elsevierStyleBold"></span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara">The prevalence of CAS varies according to the different published series&#46; In relation to the total number of dysfunctional AVF&#44; the prevalence of this type of stenosis ranges between 4&#46;25 and 64&#37;&#46;<span class="elsevierStyleSup">4-7&#44;10&#44;11</span> The lowest prevalence &#40;4&#46;25&#37;&#41; was found in a recent study carried out by Nam et al&#46;&#44; involving 1&#44;623 patients with AVF treated using angioplasty&#46;<span class="elsevierStyleSup">7</span> In the retropective study carried out by Rajan et al&#46; &#40;n &#61; 177&#41; and in the prospective study carried out by Jaberi et al&#46; &#40;n &#61; 58&#41; on dysfunctional AVF&#44; the prevalence of CAS was 14&#46;7 and 31&#37;&#44; respectively&#46;<span class="elsevierStyleSup">5&#44;6</span> The highest prevalence of CAS at 64&#37;4 was described in the retrospective study by Hammes et al&#46;&#44; which involved 127 patients who at least underwent one AVF venogram&#46;</p><p class="elsevierStylePara">Although the aetiopathogenesis of CAS is not completely clear&#44; all the investigators agree that the presence of a braquiocephalic AVF is the most important predisposing factor&#46;<span class="elsevierStyleSup">3&#44;5&#44;6</span> In this study&#44; the three patients with CAS were receiving haemodialysis via a braquiocephalic AVF&#46; In the retrospective study by Rajan et al&#46;&#44; involving 177 patients with dysfunctional AVF&#44; the prevalence of CAS was significantly higher for humerocepahlic AVF than for radiocephalic AVF &#40;39 vs&#46; 2&#37;&#41;&#46;<span class="elsevierStyleSup">6</span> In the prospective and observational series by Javeri et al&#46;&#44; involving 58 patients who underwent fistulography&#44; almost all patients with CAS had a braquiocephalic AVF &#40;94&#37;&#41; as compared to the rest of the patients &#40;70&#37;&#41; &#40;p &#61; 0&#46;046&#41;&#46;5</p><p class="elsevierStylePara">Two of the three patients with CAS in this study had diabetic nephropathy and therefore&#44; we cannot confirm the inverse relationship that has been described between this type of stenosis and the presence of diabetes mellitus&#46;<span class="elsevierStyleSup">4&#44;5</span> In the aforementioned study by Javeri et al&#46;&#44; the prevalence of diabetes was significantly lower in patients with CAS &#40;17 vs&#46; 48&#37;&#44; p &#61; 0&#46;03&#41; and in the series by Hammes et al&#46;&#44; the prevalence of CAS was also significant lower in diabetic patients as compared to the rest of the patients&#46;<span class="elsevierStyleSup">4</span></p><p class="elsevierStylePara">The funcional behavior of CAS seems to be different to that of other stenoses&#46; In this study&#44; the temporary drop in QAis significantly higher in cases of CAS in comparison to stenosis at other locations&#44; despite presenting a similar degree of vascular lumen reduction and similar MAP values&#46; An explanation for this functional difference&#44; yet to be confirmed and only speculation at this stage&#44; could be the proximal localisation of this segment of the cephalic vein&#46; This functional disparity&#44; if it is confirmed in further studies&#44; could explain the increase in the prevalence of cases of thrombosis secondary to CAS that some authors have described&#46;<span class="elsevierStyleSup">4</span></p><p class="elsevierStylePara">To sum up&#44; CAS is a unique type of stenosis&#46; If the results of this study are confirmed&#44; then CAS has a functional profile that may be different to that of stenoses at other locations&#46; To date&#44; this is the first functional study on this type of stenosis that has been carried out&#46;<br></br></p><p class="elsevierStylePara"><a href="grande&#47;12518078&#95;f1&#95;352&#46;jpg" class="elsevierStyleCrossRefs"><img src="12518078_f1_352.jpg"></img></a></p><p class="elsevierStylePara">Figure 1&#46; </p><p class="elsevierStylePara"><a href="grande&#47;12518078&#95;t1&#95;352&#46;jpg" class="elsevierStyleCrossRefs"><img src="12518078_t1_352.jpg" alt="Characteristics of the patients and AVF presenting CAS"></img></a></p><p class="elsevierStylePara">Table 1&#46; Characteristics of the patients and AVF presenting CAS</p><p class="elsevierStylePara"><a href="grande&#47;12518078&#95;t2&#95;353&#46;jpg" class="elsevierStyleCrossRefs"><img src="12518078_t2_353.jpg" alt="Comparative study between CAS and the remaining cases of stenosis&#46; 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        "resumen" => "<p class="elsevierStylePara">La estenosis del cayado o arco de la vena cef&#225;lica &#40;EAC&#41; es un tipo peculiar de estenosis del acceso vascular para hemodi&#225;lisis&#46; Por ejemplo&#44; y a diferencia de los restantes casos de estenosis&#44; la etiopatogenia de la EAC no est&#225; totalmente esclarecida y su prevalencia parece ser inferior en el enfermo diab&#233;tico&#46; Presentamos tres casos de EAC diagnosticados en nuestra Unidad de Hemodi&#225;lisis mediante la aplicaci&#243;n de un programa de monitorizaci&#243;n del flujo sangu&#237;neo del acceso vascular utilizando el m&#233;todo Delta-H&#46; Se revisa la prevalencia&#44; la etiopatogenia&#44; la relaci&#243;n con la diabetes mellitus y el perfil funcional de este tipo de estenosis&#46; Hasta la fecha&#44; es el primer estudio funcional efectuado sobre la EAC&#46;</p>"
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                  "referenciaCompleta" => "National Kidney Foundation. KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for 2006 Updates: Hemodialysis Adequacy, Peritoneal Dialysis Adequacy and Vascular Access. Am J Kidney Dis 48:S1-S322, 2006 (Suppl 1)."
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                  "referenciaCompleta" => "Kian K i Asif A. Cephalic arch stenosis. Seminars in Dialysis 2008; 21: 78-82.  <a href="http://www.ncbi.nlm.nih.gov/pubmed/18034784" target="_blank">[Pubmed]</a>"
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                  "referenciaCompleta" => "Hammes M, Funaki B, Coe FL. Cephalic arch stenosis in patients with fistula access for hemodialysis: relationship to diabetes and thrombosis. Hemodialysis International 2008; 12: 85-89. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18271847" target="_blank">[Pubmed]</a>"
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                  "referenciaCompleta" => "Jaberi A, Schwartz D, Marticorena R i cols. Risk factors for the development of cephalic arch stenosis. J Vasc Access 2007; 8: 287-295.  <a href="http://www.ncbi.nlm.nih.gov/pubmed/18161676" target="_blank">[Pubmed]</a>"
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                  "referenciaCompleta" => "Rajan DK, Clark TWI, Patel NK, Stavropoulos SW, Simons ME. Prevalence and treatment of cephalic arch stenosis in dysfunctional autogenous hemodialysis fistulas. J Vasc Inter Radiol 2003; 14: 567-573."
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                  "referenciaCompleta" => "Nam DH, Kim YK, Goo DE. Percutaneous angioplasty in a cephalic arch stenosis of native arteriovenous fistula. J Vasc Inter Radiol 2008: 19:2 (Supplement) SIR 33rd Annual Scientific Meeting, S36 (Abstract nº 91)."
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                  "referenciaCompleta" => "Kian K, Unger SW, Mishler R, Schon D, Lenz O, Asif A. Role of surgical intervention for cephalic arch stenosis in the ¿Fistula First¿ era. Seminars in Dialysis 2008; 21: 93-96.  <a href="http://www.ncbi.nlm.nih.gov/pubmed/18034783" target="_blank">[Pubmed]</a>"
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Article information
ISSN: 20132514
Original language: English
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Idiomas
Nefrología (English Edition)