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or a vascular prosthesis&#44; attempts were made to preserve or perform an autologous VA&#46; Spf of the BV or CV was used as a back-up method and not as a primary alternative to surgery in all cases in which&#44; despite the fact that the vein was permeable and adequately developed&#44; the depth of the vein made it impossible and therefore punctures on a short section were necessary&#44; which in the long run would lead to VA failure&#46; Although this was more frequent in the case of the BV&#44; it did occasionally occur in the CV&#46;</p><p class="elsevierStylePara">The first option was a radiocephalic Arteriovenous Fistula &#40;AVF&#41; and if an AVF at the elbow was required&#44; the surgical technique favoured was mid-humeral AVF&#44; which allowed the development of both veins &#40;BC and CV&#46;&#41; In cases where a brachiobasilic &#40;BB&#41; fistula was performed de novo&#44; since there was no permeable CV&#44; the intervention was carried out in two sessions to allow the vein to develop before Spf &#40;suitable after 4mm&#46;&#41; The following was calculated&#58; survival &#40;SV&#41; of the VA from its creation &#40;counting the period following Spf&#41;&#44; primary survival &#40;SV1&#41; of the Spf &#40;from Spf until some type of intervention is performed aimed at maintaining or re-establishing permeability&#41;&#44; secondary survival &#40;SV2&#41; of Spf &#40;from Spf until its permanent abandon for any reason&#41; and the maturity rate and primary failure rate&#46; The following variables were recorded&#58; age&#44; gender&#44; DM&#59; period of HD when Spf was performed&#59; Body Mass Index &#40;BMI&#41;&#59; number of previous VAs&#59; PC inserted&#59; as well as post-surgical complications &#40;haematoma&#44; oedema of the hand&#44; infection&#41; and interventions &#40;angioplasty and the insertion of stents&#46;&#41; The failure of fistula was considered an event&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">STATISTICAL ANALYSIS</span></p><p class="elsevierStylePara">The Kaplan-Meier method was used to calculate SV1 and SV2&#46; The chi-square test was also used to evaluate the association between the different variables and the existence of thrombosis&#46; The influence of the different variables on the access SV was analysed using the logrank test&#46; P &#60; 0&#46;05 was considered statistically significant&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS</span></p><p class="elsevierStylePara">Spf was performed in 48 patients &#40;43 BV and 5 CV&#41;&#46; The population characteristics are shown in table 1&#46; During the study&#44; nine patients died&#44; three received a transplant and one was transferred to another centre&#46; All had functioning fistulae&#46; The follow-up period was 18&#46;8 months &#40;0&#46;2-75&#46;7&#46;&#41; The indication of Spf was&#58; Spf of the CV due to obesity preventing the vein from being located in 5 patients&#59; Spf of the BV due to complete or partial thrombo-thrombosis of the CV which was used as return in 17 patients&#59; and Spf of the BV due to a BB fistula since there was no permeable CV in 26 patients&#46; Spf was only performed on the first VA in 22&#46;9&#37; of the patients&#46; In 44 patients&#44; Spf was performed once HD had started &#40;mean&#58; 66&#46;1 months &#91;2&#46;75-115&#46;1&#93;&#46;&#41; In four patients this was performed before inclusion in HD&#58; due to development of the BV only in two cases and due to obesity in the other two&#44; which meant that Spf of the CV was required to puncture the vein&#46;</p><p class="elsevierStylePara">The survival of the VA from its creation&#44; counting the period following Spf&#44; was 155&#46;4 &#177; 13&#46;3 months&#46; SV1 following Spf was 65&#46;5 &#177; 4&#46;8 and SV2 was 66&#46;7 &#177; 4&#46;3 months &#40;table 2&#44; figure 1&#46;&#41; The rate of maturity was 97&#46;9&#37; and the primary failure was 2&#46;0&#37;&#46;</p><p class="elsevierStylePara">The mean time elapsed from the VA to Spf was 4&#46;52 months &#40;P25-P75&#58; 1&#46;85-13&#46;76&#41;&#46; Spf was performed at the same time as the fistula in only one patient&#46; The mean time elapsed between Spf and the puncture was 32&#46;3 &#177; 27&#46;9 days&#46;</p><p class="elsevierStylePara">Complications in the immediate post-operative period included four haematomas&#46; No infectious episodes were recorded&#46; In the medium term&#44; oedema of the hand developed in eight patients &#40;16&#46;6&#37;&#41; and stenosis was detected in six of these &#40;five angioplasties and the insertion of a stent&#46;&#41; There was once case of AVF thrombosis following an attempt at revascularization&#46; Four events were detected &#40;loss of functioning VA&#41;&#58; one primary failure during Spf &#40;the only case in which Spf was performed at the same time as the creation of the VA&#41;&#44; three delayed thrombosis complications &#40;5&#46;8&#44; 10&#46;2 and 12&#46;3 months following Spf&#41; and one AVF closure due to steal syndrome and ischaemia of the hand 34&#46;7 months after Spf&#46;</p><p class="elsevierStylePara">None of the variables studied &#40;age&#44; gender&#44; DM&#44; CP&#44; number of previous VAs or obesity &#91;BMI &#62; 30&#93;&#41; were associated with a greater risk of thrombosis&#44; except the presence of oedema of the hand &#40;RR 10&#46;4&#59; CI 95&#37; 1&#46;9-263&#59; p &#60; 0&#46;01&#41;&#44; or had a significant impact on the rate of maturity or SV1 and 2&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara">The present study shows the experience of this hospital in the Spf of autologous VA&#46; Although this is a retrospective observational study&#44; with no control group for comparisons&#44; it serves as a reminder&#44; although not a significantly extensive one&#44; of a surgical technique&#44; which could encourage the performance of autologous VA rather than the insertion of prostheses and PCs&#46;<span class="elsevierStyleSup">5</span></p><p class="elsevierStylePara">The advantage of this alternative is based on data from the literature&#44; which show a 41&#37; increase in the risk of primary failure and 91&#37; more revisions of prostheses than fistulae&#44; with greater possibility of thrombosis and infection&#44; as well as greater mortality and morbidity associated to the use of catheters&#46;<span class="elsevierStyleSup">6&#44;7</span> Several recent studies<span class="elsevierStyleSup">8&#44;9</span> have demonstrated improved SV in Spf of the BV compared with prostheses and a fewer number of interventions and complications&#46; This study does not allow for this type of comparison&#44; given the low proportion of prostheses &#40;0&#46;6-1&#46;6&#37;&#41;&#44; since this was the first option from the beginning&#46; However&#44; it does provide useful data on the survival of this type of VA&#44; which are similar<span class="elsevierStyleSup">10&#44;11</span> or even better<span class="elsevierStyleSup">12</span> than other data published&#46;</p><p class="elsevierStylePara">Most of the patients had PCs inserted with multiple failed fistulae and had been ruled out for autologous VA by other surgeons&#46; This technique facilitated the removal of the PC and preservation of an autologous VA&#46; In a lower percentage&#44; performing this technique in the early stages prevented the use of PCs and extended the life of the AVF&#44;<span class="elsevierStyleSup">13</span> since the BV could be used despite thrombosis of the CV&#46; The problem of using the BV is that is becomes deep very quickly&#44; leaving only a small area accessible for the puncture&#44; therefore requiring repeated punctures in a short section with the danger of recirculation and repeated damage to the neointima&#46; Spf facilitates an extension of the puncture area thus avoiding both problems and provides an &#8220;autologous&#8221; solution to CV failure&#46;</p><p class="elsevierStylePara">One of the disadvantages of Spf is the greater risk of the Spf of the BV failing to mature in comparison with prostheses&#44;<span class="elsevierStyleSup">14</span> given that fibrosis of the scar could prevent adequate dilatation of the vein&#46; In our experience&#44; Spf performed in two sessions&#44; once the vein undergoing superficialization is thick enough&#44; facilitates good results in terms of maturity&#44; up to 97&#37;&#46; Another problem related to this technique is the time required for vascularisation&#44; which is greater than in cases of prostheses or PCs&#46; However&#44; it does allow autologous VA with good survival rates&#46;</p><p class="elsevierStylePara">Complications were similar to those described in any other type of vascular surgery and no infections were detected&#46;</p><p class="elsevierStylePara">None of the factors studied had a significant impact on the maturity rate or survival in the long term&#44; with the exception of oedema of the hand&#46; This was probably due to the fact that it showed the existence of underlying stenosis and the need for revision and subsequent action&#46; In comparison with fistulae&#44; SV2 for Spf is similar&#44; however it has been shown that it requires more revisions&#46;<span class="elsevierStyleSup">15</span> In this study&#44; 12&#46;5&#37; required a subsequent revision via fistulography with the detection of stenosis&#44; requiring an angioplasty in five patients and the insertion of a stent&#46;</p><p class="elsevierStylePara">In conclusion&#44; in our experience&#44; the survival of this type of VA was good&#44; with a low rate of complications and better survival than that described in other studies&#46; It may therefore be considered as an alternative to the insertion of a vascular prosthesis or catheter in those patients that have a VA that may be punctured&#46;</p><p class="elsevierStylePara"><a href="grande&#47;23318078&#95;t1&#95;p68&#46;jpg" class="elsevierStyleCrossRefs"><img src="23318078_t1_p68.jpg" alt="Clinical characteristics of the patients"></img></a></p><p class="elsevierStylePara">Table 1&#46; Clinical characteristics of the patients</p><p class="elsevierStylePara"><a href="grande&#47;23318078&#95;t2&#95;p68&#46;jpg" class="elsevierStyleCrossRefs"><img src="23318078_t2_p68.jpg" alt="Primary and secondary survival of 48 basilic superficializations"></img></a></p><p class="elsevierStylePara">Table 2&#46; Primary and secondary survival of 48 basilic superficializations</p><p class="elsevierStylePara"><a href="grande&#47;23318078&#95;f1&#95;p69&#46;jpg" class="elsevierStyleCrossRefs"><img src="23318078_f1_p69.jpg"></img></a></p><p class="elsevierStylePara">Figure 1&#46; </p>"
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        "resumen" => "<p class="elsevierStylePara">Introducci&#243;n&#58; se analizan los resultados de la Superficializaci&#243;n &#40;Spf&#41; de venas aut&#243;logas para establecer sus posibilidades reales en nuestro medio&#46; M&#233;todos&#58; la Spf se realiz&#243; en 48 pacientes&#46; El tiempo medio de seguimiento fue de 18&#44;8 &#40;0&#44;2-75&#44;7&#41; meses&#46; Se calcul&#243; la tasa de fallo primario&#44; la Supervivencia &#40;SV&#41; primaria y la SV secundaria&#44; y se estudiaron las posibles asociaciones con distintas variables&#46; Resultados&#58; la tasa de maduraci&#243;n fue del 97&#44;9&#37;&#44; y la tasa de fallo primario&#44; del 2&#44;0&#37;&#46; El tiempo medio de SV primaria tras la superficializaci&#243;n fue de 65&#44;5 &#177; 4&#44;8 meses&#44; y el de SV secundaria&#44; de 66&#44;7 &#177; 4&#44;3 meses&#46; Ninguna de las variables preintervenci&#243;n estudiadas &#40;edad&#44; sexo&#44; Diabetes Mellitus &#91;DM&#93;&#44; presencia de cat&#233;ter ipsilateral&#44; n&#250;mero de Acceso Vascular &#40;AV&#41; u obesidad&#41; tuvieron un impacto sobre las mismas&#46; Se detectaron cuatro trombosis&#46; Conclusi&#243;n&#58; la Spf de venas aut&#243;logas puede ser un m&#233;todo alternativo aceptable a la colocaci&#243;n de una pr&#243;tesis vascular o un cat&#233;ter&#46;</p>"
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        "resumen" => "<p class="elsevierStylePara">Introduction&#58; We review our experience with autologous veins Superficialization &#40;Spf&#41;&#44; to establish the actual possibilities of this kind of vascular access in our area&#46; Methods&#58; Between January&#47;2001 and January&#47;2008&#44; Spf was performed in 48 patients&#46; Mean follow-up time was 18&#46;8 &#40;0&#46;2-75&#46;7&#41; months&#46; Primary failure rate was recorded&#59; primary and secondary survival were estimated using the Kaplan&#8211;Meier method&#59; and its possible associations with several variables were analyzed&#46; Results&#58; the maturity rate was 97&#46;9&#37;&#59; and the rate of primary failure 2&#46;0&#37;&#46; After Spf&#44; mean time of primary and secondary survival were 65 months and 67 months&#44; respectively&#46; Four vascular thromboses were observed&#46; None of the presurgery variables analyzed &#40;age&#59; sex&#59; diabetes mellitus&#59; ipsilateral central catheter&#59; the number of previous VA attempts&#59; and obesity&#41; were significantly associated with maturity rate&#44; primary or secondary survivals&#46; Conclusion&#58; the Spf can be a good option alternative to the use of prosthetic grafts or permanent central vascular catheters&#46;</p>"
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Superficialization of autologous vascular access: an alternative to the use of vascular prostheses and permanent catheters
SUPERFICIALIZACIÓN DE ACCESOS VENOSOS AUTÓLOGOS: UNA ALTERNATIVA AL USO DE PRÓTESIS VASCULARES Y CATETERES PERMANENTES.
Matías López- Colladoa, María Dolores Arenasb, María Teresa Gilb, Tamara Malekb, Analía Moledousb, Carlos Nuñezb
a S. Nefrología Hospital Perpetuo Socorro Alicante, Alicante, España,
b S Cirugía Vascular Hospital Perpetuo Socorro Alicante, Alicante, España,
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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">INTRODUCTION</span></p><p class="elsevierStylePara">The use of autologous veins seems to have a more favourable prognosis than prosthetic implants or permanent catheters &#44; which is why initiatives promoting these have been introduced in the US&#44; with renewed interest in superficialization and&#47;or the transposition of autologous VAs&#46;<span class="elsevierStyleSup">2-4</span> The purpose of the present study is to analyse the experience of Spf in this hospital&#44; compared with data in the literature&#44; and evaluate the real possibilities of this type of VA&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">METHOD</span></p><p class="elsevierStylePara">Retrospective observational study&#46; Spf of the Basilic Vein &#40;BV&#41; or Cephalic Vein &#40;CV&#41; was performed in 48 patients between January 2001 and January 2008&#46;</p><p class="elsevierStylePara">Before considering inserting a Permanent Catheter &#40;PC&#41; or a vascular prosthesis&#44; attempts were made to preserve or perform an autologous VA&#46; Spf of the BV or CV was used as a back-up method and not as a primary alternative to surgery in all cases in which&#44; despite the fact that the vein was permeable and adequately developed&#44; the depth of the vein made it impossible and therefore punctures on a short section were necessary&#44; which in the long run would lead to VA failure&#46; Although this was more frequent in the case of the BV&#44; it did occasionally occur in the CV&#46;</p><p class="elsevierStylePara">The first option was a radiocephalic Arteriovenous Fistula &#40;AVF&#41; and if an AVF at the elbow was required&#44; the surgical technique favoured was mid-humeral AVF&#44; which allowed the development of both veins &#40;BC and CV&#46;&#41; In cases where a brachiobasilic &#40;BB&#41; fistula was performed de novo&#44; since there was no permeable CV&#44; the intervention was carried out in two sessions to allow the vein to develop before Spf &#40;suitable after 4mm&#46;&#41; The following was calculated&#58; survival &#40;SV&#41; of the VA from its creation &#40;counting the period following Spf&#41;&#44; primary survival &#40;SV1&#41; of the Spf &#40;from Spf until some type of intervention is performed aimed at maintaining or re-establishing permeability&#41;&#44; secondary survival &#40;SV2&#41; of Spf &#40;from Spf until its permanent abandon for any reason&#41; and the maturity rate and primary failure rate&#46; The following variables were recorded&#58; age&#44; gender&#44; DM&#59; period of HD when Spf was performed&#59; Body Mass Index &#40;BMI&#41;&#59; number of previous VAs&#59; PC inserted&#59; as well as post-surgical complications &#40;haematoma&#44; oedema of the hand&#44; infection&#41; and interventions &#40;angioplasty and the insertion of stents&#46;&#41; The failure of fistula was considered an event&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">STATISTICAL ANALYSIS</span></p><p class="elsevierStylePara">The Kaplan-Meier method was used to calculate SV1 and SV2&#46; The chi-square test was also used to evaluate the association between the different variables and the existence of thrombosis&#46; The influence of the different variables on the access SV was analysed using the logrank test&#46; P &#60; 0&#46;05 was considered statistically significant&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS</span></p><p class="elsevierStylePara">Spf was performed in 48 patients &#40;43 BV and 5 CV&#41;&#46; The population characteristics are shown in table 1&#46; During the study&#44; nine patients died&#44; three received a transplant and one was transferred to another centre&#46; All had functioning fistulae&#46; The follow-up period was 18&#46;8 months &#40;0&#46;2-75&#46;7&#46;&#41; The indication of Spf was&#58; Spf of the CV due to obesity preventing the vein from being located in 5 patients&#59; Spf of the BV due to complete or partial thrombo-thrombosis of the CV which was used as return in 17 patients&#59; and Spf of the BV due to a BB fistula since there was no permeable CV in 26 patients&#46; Spf was only performed on the first VA in 22&#46;9&#37; of the patients&#46; In 44 patients&#44; Spf was performed once HD had started &#40;mean&#58; 66&#46;1 months &#91;2&#46;75-115&#46;1&#93;&#46;&#41; In four patients this was performed before inclusion in HD&#58; due to development of the BV only in two cases and due to obesity in the other two&#44; which meant that Spf of the CV was required to puncture the vein&#46;</p><p class="elsevierStylePara">The survival of the VA from its creation&#44; counting the period following Spf&#44; was 155&#46;4 &#177; 13&#46;3 months&#46; SV1 following Spf was 65&#46;5 &#177; 4&#46;8 and SV2 was 66&#46;7 &#177; 4&#46;3 months &#40;table 2&#44; figure 1&#46;&#41; The rate of maturity was 97&#46;9&#37; and the primary failure was 2&#46;0&#37;&#46;</p><p class="elsevierStylePara">The mean time elapsed from the VA to Spf was 4&#46;52 months &#40;P25-P75&#58; 1&#46;85-13&#46;76&#41;&#46; Spf was performed at the same time as the fistula in only one patient&#46; The mean time elapsed between Spf and the puncture was 32&#46;3 &#177; 27&#46;9 days&#46;</p><p class="elsevierStylePara">Complications in the immediate post-operative period included four haematomas&#46; No infectious episodes were recorded&#46; In the medium term&#44; oedema of the hand developed in eight patients &#40;16&#46;6&#37;&#41; and stenosis was detected in six of these &#40;five angioplasties and the insertion of a stent&#46;&#41; There was once case of AVF thrombosis following an attempt at revascularization&#46; Four events were detected &#40;loss of functioning VA&#41;&#58; one primary failure during Spf &#40;the only case in which Spf was performed at the same time as the creation of the VA&#41;&#44; three delayed thrombosis complications &#40;5&#46;8&#44; 10&#46;2 and 12&#46;3 months following Spf&#41; and one AVF closure due to steal syndrome and ischaemia of the hand 34&#46;7 months after Spf&#46;</p><p class="elsevierStylePara">None of the variables studied &#40;age&#44; gender&#44; DM&#44; CP&#44; number of previous VAs or obesity &#91;BMI &#62; 30&#93;&#41; were associated with a greater risk of thrombosis&#44; except the presence of oedema of the hand &#40;RR 10&#46;4&#59; CI 95&#37; 1&#46;9-263&#59; p &#60; 0&#46;01&#41;&#44; or had a significant impact on the rate of maturity or SV1 and 2&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara">The present study shows the experience of this hospital in the Spf of autologous VA&#46; Although this is a retrospective observational study&#44; with no control group for comparisons&#44; it serves as a reminder&#44; although not a significantly extensive one&#44; of a surgical technique&#44; which could encourage the performance of autologous VA rather than the insertion of prostheses and PCs&#46;<span class="elsevierStyleSup">5</span></p><p class="elsevierStylePara">The advantage of this alternative is based on data from the literature&#44; which show a 41&#37; increase in the risk of primary failure and 91&#37; more revisions of prostheses than fistulae&#44; with greater possibility of thrombosis and infection&#44; as well as greater mortality and morbidity associated to the use of catheters&#46;<span class="elsevierStyleSup">6&#44;7</span> Several recent studies<span class="elsevierStyleSup">8&#44;9</span> have demonstrated improved SV in Spf of the BV compared with prostheses and a fewer number of interventions and complications&#46; This study does not allow for this type of comparison&#44; given the low proportion of prostheses &#40;0&#46;6-1&#46;6&#37;&#41;&#44; since this was the first option from the beginning&#46; However&#44; it does provide useful data on the survival of this type of VA&#44; which are similar<span class="elsevierStyleSup">10&#44;11</span> or even better<span class="elsevierStyleSup">12</span> than other data published&#46;</p><p class="elsevierStylePara">Most of the patients had PCs inserted with multiple failed fistulae and had been ruled out for autologous VA by other surgeons&#46; This technique facilitated the removal of the PC and preservation of an autologous VA&#46; In a lower percentage&#44; performing this technique in the early stages prevented the use of PCs and extended the life of the AVF&#44;<span class="elsevierStyleSup">13</span> since the BV could be used despite thrombosis of the CV&#46; The problem of using the BV is that is becomes deep very quickly&#44; leaving only a small area accessible for the puncture&#44; therefore requiring repeated punctures in a short section with the danger of recirculation and repeated damage to the neointima&#46; Spf facilitates an extension of the puncture area thus avoiding both problems and provides an &#8220;autologous&#8221; solution to CV failure&#46;</p><p class="elsevierStylePara">One of the disadvantages of Spf is the greater risk of the Spf of the BV failing to mature in comparison with prostheses&#44;<span class="elsevierStyleSup">14</span> given that fibrosis of the scar could prevent adequate dilatation of the vein&#46; In our experience&#44; Spf performed in two sessions&#44; once the vein undergoing superficialization is thick enough&#44; facilitates good results in terms of maturity&#44; up to 97&#37;&#46; Another problem related to this technique is the time required for vascularisation&#44; which is greater than in cases of prostheses or PCs&#46; However&#44; it does allow autologous VA with good survival rates&#46;</p><p class="elsevierStylePara">Complications were similar to those described in any other type of vascular surgery and no infections were detected&#46;</p><p class="elsevierStylePara">None of the factors studied had a significant impact on the maturity rate or survival in the long term&#44; with the exception of oedema of the hand&#46; This was probably due to the fact that it showed the existence of underlying stenosis and the need for revision and subsequent action&#46; In comparison with fistulae&#44; SV2 for Spf is similar&#44; however it has been shown that it requires more revisions&#46;<span class="elsevierStyleSup">15</span> In this study&#44; 12&#46;5&#37; required a subsequent revision via fistulography with the detection of stenosis&#44; requiring an angioplasty in five patients and the insertion of a stent&#46;</p><p class="elsevierStylePara">In conclusion&#44; in our experience&#44; the survival of this type of VA was good&#44; with a low rate of complications and better survival than that described in other studies&#46; It may therefore be considered as an alternative to the insertion of a vascular prosthesis or catheter in those patients that have a VA that may be punctured&#46;</p><p class="elsevierStylePara"><a href="grande&#47;23318078&#95;t1&#95;p68&#46;jpg" class="elsevierStyleCrossRefs"><img src="23318078_t1_p68.jpg" alt="Clinical characteristics of the patients"></img></a></p><p class="elsevierStylePara">Table 1&#46; Clinical characteristics of the patients</p><p class="elsevierStylePara"><a href="grande&#47;23318078&#95;t2&#95;p68&#46;jpg" class="elsevierStyleCrossRefs"><img src="23318078_t2_p68.jpg" alt="Primary and secondary survival of 48 basilic superficializations"></img></a></p><p class="elsevierStylePara">Table 2&#46; Primary and secondary survival of 48 basilic superficializations</p><p class="elsevierStylePara"><a href="grande&#47;23318078&#95;f1&#95;p69&#46;jpg" class="elsevierStyleCrossRefs"><img src="23318078_f1_p69.jpg"></img></a></p><p class="elsevierStylePara">Figure 1&#46; </p>"
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        "resumen" => "<p class="elsevierStylePara">Introducci&#243;n&#58; se analizan los resultados de la Superficializaci&#243;n &#40;Spf&#41; de venas aut&#243;logas para establecer sus posibilidades reales en nuestro medio&#46; M&#233;todos&#58; la Spf se realiz&#243; en 48 pacientes&#46; El tiempo medio de seguimiento fue de 18&#44;8 &#40;0&#44;2-75&#44;7&#41; meses&#46; Se calcul&#243; la tasa de fallo primario&#44; la Supervivencia &#40;SV&#41; primaria y la SV secundaria&#44; y se estudiaron las posibles asociaciones con distintas variables&#46; Resultados&#58; la tasa de maduraci&#243;n fue del 97&#44;9&#37;&#44; y la tasa de fallo primario&#44; del 2&#44;0&#37;&#46; El tiempo medio de SV primaria tras la superficializaci&#243;n fue de 65&#44;5 &#177; 4&#44;8 meses&#44; y el de SV secundaria&#44; de 66&#44;7 &#177; 4&#44;3 meses&#46; Ninguna de las variables preintervenci&#243;n estudiadas &#40;edad&#44; sexo&#44; Diabetes Mellitus &#91;DM&#93;&#44; presencia de cat&#233;ter ipsilateral&#44; n&#250;mero de Acceso Vascular &#40;AV&#41; u obesidad&#41; tuvieron un impacto sobre las mismas&#46; Se detectaron cuatro trombosis&#46; Conclusi&#243;n&#58; la Spf de venas aut&#243;logas puede ser un m&#233;todo alternativo aceptable a la colocaci&#243;n de una pr&#243;tesis vascular o un cat&#233;ter&#46;</p>"
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        "resumen" => "<p class="elsevierStylePara">Introduction&#58; We review our experience with autologous veins Superficialization &#40;Spf&#41;&#44; to establish the actual possibilities of this kind of vascular access in our area&#46; Methods&#58; Between January&#47;2001 and January&#47;2008&#44; Spf was performed in 48 patients&#46; Mean follow-up time was 18&#46;8 &#40;0&#46;2-75&#46;7&#41; months&#46; Primary failure rate was recorded&#59; primary and secondary survival were estimated using the Kaplan&#8211;Meier method&#59; and its possible associations with several variables were analyzed&#46; Results&#58; the maturity rate was 97&#46;9&#37;&#59; and the rate of primary failure 2&#46;0&#37;&#46; After Spf&#44; mean time of primary and secondary survival were 65 months and 67 months&#44; respectively&#46; Four vascular thromboses were observed&#46; None of the presurgery variables analyzed &#40;age&#59; sex&#59; diabetes mellitus&#59; ipsilateral central catheter&#59; the number of previous VA attempts&#59; and obesity&#41; were significantly associated with maturity rate&#44; primary or secondary survivals&#46; Conclusion&#58; the Spf can be a good option alternative to the use of prosthetic grafts or permanent central vascular catheters&#46;</p>"
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