SEARCH · PubMed Health

Results for “access”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 37 records · Page 2Linked to original sources

PubMed2003

Vascular access surveillance: evaluation of combining dynamic venous pressure and vascular access blood flow measurements.

BACKGROUND/AIMS: Vascular access thrombosis is one of the most morbid problems encountered by hemodialysis patients. Surveillance protocols utilizing venous pressure (Vp) and vascular access blood flow (VABF) measurements have been employed to preserve vascular access. We undertook a study to evaluate combined dynamic Vp and VABF measurements in the identification of vascular access impairment. We also assessed the effect of preventive repair on thrombosis rates in impaired vascular accesses identified by surveillance. METHODS: Eighty-six chronic hemodialysis patients with a functioning vascular access were enrolled into the surveillance protocol. All vascular accesses with greater than 50% of monthly Vp readings >120 mm Hg or VABF <500 ml/min in arteriovenous fistulas (AVFs) and VABF <650 ml/min in arteriovenous grafts (AVGs), or a decrease in VABF >25% compared to the highest previously measured value, were considered positive. Stenosis >50% on fistulography or a thrombotic event were defined as a 'vascular access impairment episode' while a stenosis <50% or the absence of a thrombotic event was defined as 'no vascular access impairment episode'. Thrombosis rates and intervention rates were calculated per access year at risk. RESULTS: The sensitivity and specificity of the combined surveillance protocol for AVFs were 73.3 and 91%, respectively. In AVGs, they were 68.8 and 87.5%, respectively. The rate of thrombotic events was lower in patients who underwent early repair. The addition of dynamic Vp did not reduce the thrombosis rate any further than surveillance based on VABF alone. CONCLUSION: Combined monitoring for surveillance of AVFs improved sensitivity but had little benefit in AVGs over VABF monitoring alone. Raising VABF cutoff levels might increase and improve identification of vascular access risk for thrombosis, but at the expense of lower specificity.

Arteriovenous Shunt, Surgical↗

PubMedDate not supplied

Detection of access strictures and outlet stenoses in vascular accesses. Which test is best?

The location of stenoses within an access may influence the diagnostic value of access monitoring tests. Whereas decreasing access flow (QACC) should occur with both venous outlet stenoses and strictures within the body of the access, normalized intra-access venous pressure (vPIA/MAP) depends on location of the venous needle relative to the lesion. The authors determined the value of vPIA/MAP and direct measurement of percent access recirculation (AR) and QACC in detecting venous outlet stenoses and strictures. Abnormal access studies were evaluated by Doppler ultrasound and fistulography. Well functioning grafts and arteriovenous fistulas (AVFs) have no AR; QACC averages 1,101 +/- 26 and 1,073 +/- 35 mL/min, and vPIA/MAP ratios are 0.34 and 0.16, respectively. Venous outlet stenoses (n = 36) or strictures (n = 32) were detected before thrombosis or intervention in 172 vascular accesses at risk. QACC in accesses with stricture was significantly lower than in those with venous outlet stenosis (361 +/- 11 vs 526 +/- 43 ml/min), as was less than prescribed blood flow (423 +/- 7 ml/min). AR was not detected in any access with stricture and in only 4 of 36 accesses with outlet stenosis. vPIA/MAP was elevated with venous outlet stenosis but not with strictures. The findings of QACC being less than blood pump flow without AR by dilution methods differentiated strictures from venous outlet stenoses.

Arteriovenous Shunt, Surgical↗

PubMed2002

Are hemodialysis access flow measurements by ultrasound dilution the standard of care for access surveillance?

Maintenance of vascular access function is vital to the delivery of adequate hemodialysis therapy. Failure of function is associated with significant morbidity and cost. Thus, access surveillance programs are suggested. The most common cause for access dysfunction is stenosis formation within the graft fistula. This may lead to reduced blood flow. The measurement of access blood flow has thus been recommended as the preferred method for surveillance. This article reviews blood flow among other methods for the screening of access dysfunction, the techniques used to measure it, the predictability of access flow measurements in determining the presence of access stenosis and allowing successful; intervention and finally the cost-effectiveness of such surveillance. Review of available evidence would suggest that access flow measurements are the best tests currently available to screen for access dysfunction, and as preventative interventions, such as angioplasty and surgery, are successful, they should be regarded as the present standard of care. This would appear to be a cost-effective strategy. Furthermore, the method of choice for access flow measurement is by ultrasound dilution technology.

Arteriovenous Shunt, Surgical↗

PubMed2003

Reducing vascular access morbidity: a comparative trial of two vascular access monitoring strategies.

BACKGROUND: Thrombosis is the primary cause of access failure in polytetrafluoroethylene grafts and arteriovenous fistulas. It can lead to significant patient and access morbidity and mortality, and is difficult to prevent medically. Intervention is largely limited to maximizing access patency by detecting culprit lesions early and intervening with angioplasty or surgical revision. The most efficacious monitoring strategy is undetermined. METHODS: This 3 year prospective study took advantage of a change in monitoring strategy used in a large dialysis centre to compare the efficacy of two methods used to monitor grafts and fistulas in order to prevent access thrombosis. Accesses were monitored using Duplex ultrasonography in year 1, while the saline ultrasound dilution technique (Transonic) became the primary monitoring strategy in year 3 (year 2 was a transition year). Risk factors for thrombosis were determined using multivariate survival analysis, and the performance of Duplex ultrasonography and Transonic monitoring was assessed. RESULTS: A total of 303 656 access days at risk were assessed, with 344, 385 and 425 accesses in years 1, 2 and 3, respectively. The total thrombosis rate was 1.01/1000 access days in year 1 compared with 0.66/1000 access days in year 3. This was accomplished despite a reduction in procedure rates of 55% for angiograms, 13% for angioplasties and 31% for thrombolysis. CONCLUSION: Low flow rates detected using Transonic monitoring were associated with increased thrombosis, while stenosis detected using Duplex ultrasonography was not a strong predictor of incipient thrombosis; however, these different access characteristics were compared using monitoring techniques that may be ideal in different clinical situations.

Adult↗

PubMedDate not supplied

Estimation of hemodialysis access blood flow rates by a urea method is a poor predictor of access outcome.

Blood flow in peripheral arteriovenous fistulae and grafts as used for hemodialysis access can be derived from simultaneous measurements of 1) the amount of access recirculation (AR) induced by reversing the dialysis blood lines, and 2) the dialyzer blood flow rate (Qb). The hemodynamic monitor (HDM) uses magnetic principles to measure AR. The measurement is based on differential conductivity between arterial (A) and venous (V) blood flows in the dialysis blood tubing sets after the injection of hypertonic saline into the V line as a conductivity tracer. Access blood flow rates (Qa) derived from AR measurements by the HDM are predictive of access outcome. The measurement of AR is traditionally done from the comparison of urea levels simultaneously taken from the A and V blood lines and from the systemic circulation. Thus, the urea method can also be used to estimate access blood flow rates. The purpose of this study was to determine whether urea based Qa values are also predictive of outcome. Forty-one patients with arteriovenous fistulae (n = 25) or Gore-Tex grafts (n = 16) were studied by a standard protocol. The protocol involved temporarily reversing the A and V lines, taking three blood samples for urea estimation, performing an HDM recirculation test, and recording Qb as per the machine blood pump setting. The data allowed calculation of Qa by the HDM (Qa [HDM]) and urea (Qa [urea]) methods. Qa (HDM) was 1,177 +/- 887 ml/min (mean +/- standard deviation) and Qa (urea) 964 +/- 793 ml/min, a statistically significant difference (paired t-test p < 0.001). There was a significant linear correlation between the results (r = 0.94, p < 0.0001), but the regression equation also showed that Qa (urea) values were less than Qa (HDM). The influence of the Qa value on access outcome was determined after an 8 month follow-up. Nine of the 41 accesses were lost to clotting. Chi-square and discriminate analyses showed that Qa (HDM) significantly (p = 0.005) predicted access outcome, whereas Qa (urea) did not (p = 0.164). The specificity of a low Qa (HDM) in predicting access clotting was 0.78, compared with 0.62 for Qa (urea). The data show that although Qa can be estimated by the urea method, the finding of a low Qa (urea) is a poor predictor of access outcome and may lead to cost ineffective investigations.

Arteriovenous Shunt, Surgical↗

PubMed1996

Correlates of vascular access and nonvascular access-related hospitalizations in hemodialysis patients.

Four hundred and thirty randomly selected hemodialysis patients, aged 20 years and over, were studied to identify risk factors for vascular access and nonvascular access-related hospitalizations in the immediately preceding 1 year. Risk estimates for hospitalization were assessed using a multinominal logistic analysis model. We measured functional status, utilizing a 14-point Karnofsky scale, and in a separate analysis of covariance, in which Karnofsky score was the outcome, we examined the relationships of age, gender, ethnicity, renal diagnosis, and hospitalization. Individual comparisons were adjusted for multiple comparison bias by Tukey's Honest Difference method. There were a total of 508 hospitalizations of which 322 (63%) lasted > or = 1 week. Two hundred and sixty (60%) patients were hospitalized at least once; 105 (24.4%) for access problems only, 115 (27%) for a nonaccess problem only, and 40 for access and nonaccess-related problems. Access-related problems, accounted for 48% of all hospitalizations. The risk of hemodialysis vascular access morbidity was increased in women (p < 0.028) and white (p < 0.048) hemodialysis patients. Neither diabetic nor elderly hemodialysis patients were at greater risk for access hospitalization than their respective counterparts, though a greater proportion of the access hospitalizations in the elderly (> or = 64 years) lasted > or = 1 week (p < 0.0006). More access-related hospitalizations in blacks (64.5%), lasted for > or = 1 week than in whites (40.6%) (p < 0.001). Hispanics (p < 0.043), whites (p < 0.002), and the older patients (p < 0.054) were at greater risk for nonaccess hospitalization than blacks and younger patients, respectively. Even after adjusting for age, race, and diabetes, each decrease of one unit in the modified Karnofsky score was associated with a 3-4% increased risk for all types of hospitalization (p < 0.001)--poor functional status is associated with increased risk for all hospitalizations. We conclude that the risk for hemodialysis vascular access morbidity is increased in women and white hemodialysis patients. Poor functional status is associated with increased risk for all hospitalizations.

Adult↗

PubMed2005

Design of the Dialysis Access Consortium (DAC) Aggrenox Prevention Of Access Stenosis Trial.

BACKGROUND: Surgically created arteriovenous (AV) grafts are the most common type of hemodialysis vascular access in the United States, but fail frequently due to the development of venous stenosis. The Dialysis Access Consortium (DAC) Aggrenox Prevention of Access Stenosis Trial tests the hypothesis that Aggrenox (containing dipyridamole and aspirin) can prevent stenosis and prolong survival of arteriovenous grafts. METHODS: This is a multicenter, randomized, double-blind, placebo-controlled trial that will enroll 1056 subjects over four years with one-half year follow-up. Subjects undergoing placement of a new AV graft for hemodialysis are randomized to treatment with Aggrenox or placebo immediately following access surgery. The primary outcome is primary unassisted patency defined as the time from access placement until thrombosis or an access procedure carried out to maintain or restore patency. The major secondary outcome is cumulative access patency. Monthly access flow monitoring is incorporated in the study design to enhance detection of a hemodynamically significant access stenosis before it leads to thrombosis. RESULTS: This paper describes the key issues in trial design, broadly including: 1) ethical issues surrounding the study of a clinical procedure that, although common, is no longer the clinical intervention of choice; 2) acceptable risk (bleeding) from the primary intervention; 3) inclusion of subjects already receiving a portion of the study intervention; 4) inclusion of subjects with incident rather than prevalent qualifying clinical conditions; 5) timing of the study intervention to balance safety and efficacy concerns; and 6) the selection of primary and secondary study endpoints. CONCLUSIONS: This is the first, large, multicenter trial evaluating a pharmacologic approach to prevent AV graft stenosis and failure, an important and costly problem in this patient population. Numerous design issues were addressed in implementing the trial and these will form a roadmap for future trials in this area.

Algorithms↗

PubMed2001

Vascular access blood flow monitoring reduces access morbidity and costs.

BACKGROUND: Vascular access morbidity results in suboptimal patient outcomes and costs more than $8000 per patient-year at risk, representing approximately 15% of total Medicare expenditures for ESRD patients annually. In recent years, the rate of access thrombosis has improved following the advent of vascular access blood flow monitoring (VABFM) programs to identify and treat stenosis prior to thrombosis. To define further both the clinical and financial impact of such programs, we used the ultrasound dilution method to study the effects of VABFM on thrombosis-related morbid events and associated costs, compared with both dynamic venous pressure monitoring (DVPM) and no monitoring (NM) in arteriovenous fistulas (AVF) and grafts. METHODS: A total of 132 chronic hemodialysis patients were followed prospectively for three consecutive study phases (I, 11 months of NM; II, 12 months of DVPM; III, 10 months of VABFM). All vascular access-related information (thrombosis rate, hospitalization, angiogram, angioplasty, access surgery, thrombectomy, catheter placement, missed treatments) was collected during the three study periods. RESULTS: During the three study phases, graft thrombosis rate was reduced from 0.71 (phase I), to 0.67 (phase II), to 0.16 (phase III) events per patient-year at risk (P < 0.001 phase III vs. phases I and II). Similarly, hospital days, missed treatments, and catheter use related to thrombotic events were significantly reduced during phase III compared to phases I and II. Hospital days related to vascular access morbidity and adjusted for patient-year at risk were 1.8, 1.6, and 0.4 and missed dialysis treatments were 0.98, 0.86, and 0.26 treatments per patient-year at risk for phases I, II, and III, respectively (P < 0.001 for phase III vs. phases I and II). Catheter use was also significantly reduced during phases II and III, from 0.29 (phase I) to 0.17 and further to 0.07 catheters per patient-year at risk, respectively (P < 0.05 for phase III vs. phase I). Percutaneous angioplasty procedures increased during phases II and III from 0.09 to 0.32 to 0.54 procedures per patient-year at risk for phases I, II, and III, respectively (P < 0.01 for phase III vs. phase I). When the total cost of treatment for thrombosis-related events for grafts was estimated, it was found that during phase III, the adjusted yearly billed amount was reduced by 49% versus phase I and 54% versus phase II to $158,550. Similar trends in reduced thrombosis-related morbid events and cost were observed for AVFs. CONCLUSIONS: VABFM for early detection of vascular access malfunction coupled with preventive intervention reduces thrombosis rates in both polytetrafluoroethylene (PTFE) grafts and native AVFs. While there was a significant increase in the number of angioplasties done during the flow monitoring phase, the comprehensive cost is markedly reduced due to the decreased number of hospitalizations, catheters placed, missed treatments, and surgical interventions. Vascular access blood flow monitoring along with preventive interventions should be the standard of care in chronic hemodialysis patients.

Angioplasty, Balloon↗

PubMedDate not supplied

European guidelines for vascular access: clinical algorithms on vascular access for haemodialysis.

Vascular access remains the Achilles heel of end-stage renal disease patients, receiving haemodialysis. The increase in the number of elderly dialysis patients with additional cardiovascular co-morbidities and diabetes mellitus makes the creation and maintenance of functioning vascular access, more difficult and cumbersome. Therefore, the development of guidelines for vascular access management seems logical. A team of multidisciplinary vascular access experts created a set of algorithms covering the whole spectrum from pre-operative vessel assessment, peri-operative access management and post-operative follow up and surveillance. Additionally, a range of various access complications with their diagnosis and treatment options were included in these algorithms. The new European guidelines for vascular access augment the knowledge of vascular access problems and their management. Additionally, the use of algorithms facilitates the decision-making when treating complications by all physicians dedicated to this field of healthcare.

Aged↗

PubMed2005

Comparison of external catheters with subcutaneous vascular access ports for chronic vascular access in a porcine model.

We sought to compare the outcomes of two chronic vascular access techniques, the externalized catheter and the subcutaneous vascular access port, in pigs. Female farm pigs (n = 30) underwent placement of a chronic vascular access device in the jugular vein for a research protocol: 18 of the animals underwent placement of a tunneled Hickman catheter (THC), and the remaining 12 animals underwent placement of a subcutaneous vascular access port (VAP) without external components. After placement of the devices, animals underwent serial blood sampling. All animals were given identical antibiotic prophylaxis. VAP access required the use of a restraint sling for Huber needle insertion, whereas THC access required no additional equipment. Animals were euthanatized 1 month after placement of the device. In the VAP group, the port was retrieved, cleaned, and steam-autoclaved for reuse. In the THC group, 13 (72%) animals developed infectious complications, and blood and wound cultures were often polymicrobial. One animal was euthanatized secondary to overwhelming sepsis. In addition, three (17%) animals developed thromboembolic complications. In contrast, no thromboembolic complications were noted in the VAP group, and only one animal developed a transient fever which resolved spontaneously; no septic complications or abscesses developed. Blood draws with no anesthesia were successful in both groups. We conclude that subcutaneous vascular access ports are a safe and efficient method for obtaining reliable chronic vascular access for a 1-month period in pigs. The subcutaneous devices were associated with low morbidity. In contrast, externalized catheters can be associated with considerable morbidity.

Animals↗

PubMed2002

Access to quality health services: determinants of access.

Access to health care has been the focus of national health policy in recent years, but little attention has been given to local communities and their access issues. This study offers a conceptual framework and an empirical analysis to identify the independent effect of predisposing, enabling, and medical need factors on access to care in a local community. In addition, access limitations related to the health plan and individual providers are incorporated into the access model. A hierarchical logistic regression is used in which the dichotomous dependent variable-residents' overall satisfaction with access to health care is regressed on five blocks of predictor variables. The most influential variables on access are enabling and health plan variables.

Adolescent↗

PubMed2005

Ultrasonography-guided peripheral intravenous access versus traditional approaches in patients with difficult intravenous access.

STUDY OBJECTIVE: We assess the success rate of emergency physicians in placing peripheral intravenous catheters in difficult-access patients who were unsuccessfully cannulated by emergency nurses. A technique using real-time ultrasonographic guidance by 2 physicians was compared with traditional approaches using palpation and landmark guidance. METHODS: This was a prospective, systematically allocated study of all patients requiring intravenous access who presented to 2 university hospitals between October 2003 and March 2004. Inclusion criterion was the inability of any available nurse to obtain intravenous access after at least 3 attempts on a subgroup of patients who had a history of difficult intravenous access because of obesity, history of intravenous drug abuse, or chronic medical problems. Exclusion criterion was the need for central venous access. Patients presenting on odd days were allocated to the ultrasonographic-guided group, and those presenting on even days were allocated to the traditional-approach group. Endpoints were successful cannulation, number of sticks, time, and patient satisfaction. RESULTS: Sixty patients were enrolled, 39 on odd days and 21 on even days. Success rate was greater for the ultrasonographic group (97%) versus control (33%), difference in proportions of 64% (95% confidence interval [CI] 39% to 71%). The ultrasonographic group required less overall time (13 minutes versus 30 minutes, for a difference of 17 [95% CI 0.8 to 25.6]), less time to successful cannulation from first percutaneous puncture (4 minutes versus 15 minutes, for a difference of 11 [95% CI 8.2 to 19.4]), and fewer percutaneous punctures (1.7 versus 3.7, for a difference of 2.0 [95% CI 1.27 to 2.82]) and had greater patient satisfaction (8.7 versus 5.7, for a difference of 3.0 [95% CI 1.82 to 4.29]) than the traditional landmark approach. CONCLUSION: Ultrasonographic-guided peripheral intravenous access is more successful than traditional "blind" techniques, requires less time, decreases the number of percutaneous punctures, and improves patient satisfaction in the subgroup of patients who have difficult intravenous access.

Adult↗

PubMed2002

Epidemiology of hemodialysis vascular access infections from longitudinal infection surveillance data: predicting the impact of NKF-DOQI clinical practice guidelines for vascular access.

National Kidney Foundation-Dialysis Outcomes Quality Initiative (NKF-DOQI) Vascular Access Guidelines 29 (40% of prevalent patients should have a native fistula) and 30 (<10% use of catheters for chronic hemodialysis) are currently based on opinion, rather than published evidence. The impact of these guidelines on reducing vascular access infection rates is unknown and was tested using data from an outpatient prospective cohort analysis. Patients undergoing hemodialysis from January 1998 through December 2000 at six outpatient facilities in Idaho and Oregon were evaluated prospectively for vascular access infections. There were 111,383 dialysis sessions (DSs) with 471 infections identified (4.2 infections/1,000 DSs). The risk for infection relative to arteriovenous (AV) fistulae was highly dependent on type of access used: 2.2 (P = 0.002) for AV grafts, 13.6 (P < 0.0001) for tunneled catheters, and 32.6 (P < 0.0001) for temporary catheters. Based on incidence infection rates, the number of infections predicted to occur with implementation of guidelines 29 and 30 in this population was calculated, and the percentage of reduction in infection was determined. Following either guideline 29 or 30 alone would have predictably prevented 103 or 97 total infections (22% and 21% reduction) and 40 or 51 bloodstream infections (24% and 30% reduction), respectively. Following both guidelines simultaneously would have prevented 151 total infections (32% reduction) and 64 bloodstream infections (38% reduction). These epidemiological data firmly establish that a major risk for vascular access infections is the type of access used (temporary catheters > tunneled catheters > AV grafts > AV fistulae). Furthermore, they strongly support the role of these NKF-DOQI guidelines in preventing infectious complications attributed to vascular access.

Arteriovenous Shunt, Surgical↗

PubMed2001

Multicenter evaluation of a polyurethaneurea vascular access graft as compared with the expanded polytetrafluoroethylene vascular access graft in hemodialysis applications.

OBJECTIVES: The purpose of this study was to compare in a randomized, prospective, and controlled study, the performance of a multilayered, self-sealing polyurethane vascular access graft (PVAG) and expanded polytetrafluoroethylene (ePTFE) vascular access grafts in hemodialysis applications. Performance measures included graft survival, complications, time to early cannulation, and hemostasis times after cannulation. STUDY DESIGN: A total of 142 patients were randomized equally to receive one of the two grafts after meeting all eligibility requirements. All patients were followed up prospectively to 12 months or to the end of secondary patency. Specifically, this study documented the performance of the PVAG and ePTFE grafts by determining the patencies and complications for both grafts. RESULTS: Patient characteristics between the two groups were similar with respect to risk factors and demographic characteristics (P >.05). Life-table patencies from the date of first dialysis were primary patency: PVAG 55% versus ePTFE 47% (6 months) and PVAG 44% versus ePTFE 36% (12 months) and secondary patency: PVAG 87% versus ePTFE 90% (6 months) and PVAG 78% versus ePTFE 80% (12 months). None of these differences were significant (P >.05). Both primary and secondary patencies were also not significantly different when the date of implantation was the starting point. Adverse events and complications were similar for the two groups, except the PVAG group had a higher incidence of technical complications manifested by graft kinking when compared with the control cohort (P <.05). Additionally, there was no significant difference in complication rates between these two groups with regard to infection and bleeding. When the time to hemostasis after cannulation was compared at 5minutes or less, there were more PVAG cannulation sites that achieved hemostasis compared with ePTFE sites, and this difference was significant (P <.0001). When time to first dialysis access was compared between the two grafts, 53.9% of all PVAG grafts were cannulated before 9 days versus none with the ePTFE grafts (P <.001). However, long-term graft survival was not significantly different when PVAG patients were stratified into early (< 9 days) and the late access (9 >/= days) groups (P =.29). CONCLUSIONS: The PVAG graft allows for early access without compromising long-term performance. Both PVAG and standard ePTFE grafts have similar long-term outcomes, despite early access with the PVAG vascular access grafts.

Biocompatible Materials↗

PubMedDate not supplied

Venous access pressures and the detection of intra-access stenosis.

Venous pressure measured by the dialyzer is an unreliable measure of intra-access venous pressure. During dialysis and zero extracorporeal blood flow, intra-access venous limb pressure (VPd) was measured directly 401 times in 133 subjects using a high flow "in-line" three-way stopcock adjacent to the venous return needle. Subjects with systolic VPd/systolic blood pressure (BP) > or = 0.4, inadequate blood flow, or edema in the access extremity were referred for angiography. Percent diameter lumen reduction by a stenosis (%D) > 50% was considered hemodynamically significant. The authors did 138 angiograms. It was found that VPd/BP increased with %D in both ePTFE bridge grafts and native fistulae. Measurements of venous limb VP/BP taken at the time of dialysis and at the time of angiography did not differ (n = 55). On 80 occasions, accesses had significant stenoses. The overall sensitivity of VPd/BP in ePTFE bridge grafts was 91% and specificity 91%. False negative results occurred in seven of 24 native and eight of 114 ePTFE graft studies; 14 of 15 patients had arm swelling caused by central stenosis. Recirculation > 15% was more sensitive (71%) in detecting stenosis in native accesses than was intra-access pressure. It was concluded that VPd/BP > 0.4 is a useful, sensitive, and specific criteria for detecting synthetic bridge graft accesses at risk for thrombosis.

Angiography↗

PubMed2001

Percutaneous access and closure of femoral artery access sites associated with endoluminal repair of abdominal aortic aneurysms.

PURPOSE: To report longer follow-up and further experience using the Prostar XL Percutaneous Vascular Surgery (PVS) device for access and closure of large bore femoral artery access sites during endovascular repair of abdominal aortic aneurysms (AAAs). METHODS: One hundred forty-four patients (128 men; mean age 72 years, range 56-89) undergoing endovascular AAA repair had percutaneous access and closure of their 16-F femoral artery access sites using a 10-F PVS device. The first 54 patients were enrolled in the phase III trial of the AneuRx stent-graft for AAA treatment. RESULTS: The femoral artery access site was successfully closed in 136 (94.4%) patients, with only 8 patients in whom adequate hemostasis could not be obtained. One-month follow-up was available in 144 patients, 6-month in 100, and 1-year in 59. No groin or lower extremity complications have been observed in any patient who had successful closure of the femoral artery access site. CONCLUSIONS: Large-bore femoral artery access sites can be percutaneously repaired using this device, which minimizes the invasiveness of the endograft procedure.

Aged↗

PubMed2006

Does momentary accessibility influence metacomprehension judgments? The influence of study-judgment lags on accessibility effects.

In two experiments, we investigated momentary accessibility as a basis for metacomprehension judgments. Momentary accessibility has been cited as a major contributor to these judgments, yet the only previous investigation on the topic used judgments that were delayed a day after study, which have not been used in any other studies in the field and may be necessary for demonstrating accessibility-based effects. As expected, Experiment 1 demonstrated that the time between study and judgments moderates accessibility effects, with the relationship between judgments and access measures being substantially greater for delayed than for immediate judgments. Experiment 2 ruled out a plausible artifactual interpretation for accessibility effects on delayed judgments. In the discussion, we explore why study-judgment lags moderate accessibility effects.

Comprehension↗

PubMedDate not supplied

Perceived accessibility versus actual physical accessibility of healthcare facilities.

This study addressed how healthcare clinics perceive themselves in regard to accessibility for persons with spinal cord injuries (SCI). All 40 of the clinics surveyed reported that they were wheelchair accessible; however, there was significant variability in the number of sites that actually met the guidelines of the Americans with Disability Act. In general, a person using a wheelchair could enter the building, the examination room, and the bathroom. The majority of sites did not have an examination table that could be lowered to wheelchair level. Most reported limited experience in working with persons with (SCI), yet they claimed to be able to assist with difficult transfers. Only one site knew about autonomic dysreflexia. Problems of accessibility appeared to be seriously compounded by the clinics' perception of how they met physical accessibility guidelines without consideration of the actual needs of persons with SCI. This study addressed the perception of accessibility as reported by clinic managers versus actual accessibility in healthcare clinics in a Midwestern metropolitan area for persons using wheelchairs.

Architectural Accessibility↗