The journal of vascular access (J Vasc Access)

Publisher: Wichtig Editore

Current impact factor: 0.85

Impact Factor Rankings

2016 Impact Factor Available summer 2017
2014 / 2015 Impact Factor 0.846
2013 Impact Factor 1.017
2012 Impact Factor 0.97
2011 Impact Factor 1.091
2010 Impact Factor 0.764
2009 Impact Factor 1.065

Impact factor over time

Impact factor
Year

Additional details

5-year impact 0.98
Cited half-life 4.10
Immediacy index 0.14
Eigenfactor 0.00
Article influence 0.25
Website Journal of Vascular Access, The website
Other titles The journal of vascular access (Online)
ISSN 1724-6032
OCLC 60648733
Material type Document, Periodical, Internet resource
Document type Internet Resource, Computer File, Journal / Magazine / Newspaper

Publisher details

Wichtig Editore

  • Pre-print
    • Archiving status unclear
  • Post-print
    • Author cannot archive a post-print version
  • Restrictions
    • 6 to 12 months depending on journal
  • Conditions
    • On author's personal websiteor departmental web page or institutional repository or PubMed Central
    • Publisher's version/PDF cannot be used
    • Author version accepted for publication after peer-review
  • Classification
    white

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: We describe a technique for rescue surgery of autologous arterovenous fistula (AVF), using bovine mesenteric vein (BMV), which may be used in patients with autologous AVF malfunction caused by steno-occlusion on the arterial side or by fibrosis of the first portion of the vein. To preserve the autologous AVF, we replaced the diseased portion of the artery, or the first centimeters of the vein, by a segment of BMV, with the aim of saving the patency and functionality of the access. We used this technique in 16 cases. All patients underwent hemodialysis treatment immediately after the procedure. Infection or aneurismal dilatation of the graft in implanted BMV was never observed.
    No preview · Article · Feb 2019 · The journal of vascular access
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    ABSTRACT: Purpose: Central venous obstruction Occlusion (CVO) has been considered a contraindication for creating a vascular access due to fear of developing a swollen extremity. However, many of these individuals developed large collateral veins and are asymptomatic. We report our experience constructing arteriovenous fistulas (AVFs) in these challenging patients. Methods: Patients with a new AVF constructed in the presence of known CVO were identified. Venous imaging confirmed proximal obstruction and extensive collateral venous return. The AVF was constructed in the extremity with the most favorable ultrasound vessel mapping and collateral central venous outflow. Arterial inflow via the radial artery was utilized when feasible. Results: AVFs associated with known CVO were constructed in 19 patients during an eight-year time period. The mean age was 53 years, 63% were female, and 58% diabetic. Arterial inflow was from the radial artery in 15 patients and the brachial or axillary artery in 5 individuals. Post-operative AVF flow volumes were 415-910 mL/min (mean = 640 mL/min). Eight patients (42%) developed some degree of arm edema. Two resolved without intervention. The others required inflow banding (n = 2), outflow branch coiling (n = 1), and/or recanalization with angioplasty (n = 4) of the CVO to resolve swelling. Mean follow-up was 14 months. Two AVFs failed at 8 and 16 months. Primary and cumulative patency rates were 49% and 100% at 12 months and 39% and 80% at 24 months, respectively. Conclusions: CVO need not preclude the creation of a successful AVF. Extensive venous collaterals and avoiding high-flow AVFs are important elements for success. Cumulative patency was 80% at 24 months.
    No preview · Article · Feb 2016 · The journal of vascular access
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    ABSTRACT: Background: Native or prosthetic arteriovenous (AV) fistulas are preferred for permanent haemodialysis (HD) access. These are marked with circuit steno-occlusive disease leading to dysfunction or even failure. Late failure rates have been reported as high as 50%. Standard angioplasty balloons are an established percutaneous intervention for HD access stenosis. Reported restenosis rates remain high and practice guidelines recommend a wide 6-month primary patency (PP) of at least 50% for any intervention. Neointimal hyperplasia is one of the main causes for access circuit stenosis. Drug eluting balloon (DeB) angioplasty has been proposed as an alternative intervention to reduce restenosis by local drug delivery and possible inhibition of this process. Purpose: To systematically assess the reported efficacy and safety of DeB angioplasty in percutaneous management of prosthetic and autologous HD access stenosis. Methods: Protocol for the review was developed following the PRISMA-P 2015 statement. An electronic database (Medline, EMBASE, Clinical Trials.gov and Cochrane CENTRAL) search was conducted to identify articles reporting on the use of DeB intervention in HD AV access. Backward and forward citation search as well as grey literature search was performed. The MOOSE statement and PRISMA 2009 statement were followed for the reporting of results. Data from the included studies comparing DeBs with non-DeBs were pooled using a random effects meta-analysis model and reported separately on randomised and non-randomised studies. Results: Six studies reported on 254 interventions in 162 participants (mean 27 ± 10 SD). The pooled mean and median duration of follow-up was 12 and 13 months (range 6-24 months). These comprised two randomised control trials (RCTs) and four cohort studies. Participant's mean age was 64 ± 5 years and 61% were male. Target lesions (TLs) ranged from under 2 mm to 5.9 mm and 51 were reported as de novo stenosis. Device failure described as wasting of the DeB was reported in two studies (55% and 92.8%). At 6 months TL PP was reported between 70% to 97% for DeBs in the RCTs and cohort studies, and 0% to 26% for non-DeBs. TLs treated with DeBs were associated with a higher primary patency at 6 months as compared to non-DeB balloons (RCTs: odds ratio [OR] 0.25, 95% CI 0.08 to 0.77 and I2 = 19%, cohort studies: OR 0.10, 95% CI 0.03 to 0.31 and an I2 = 20%). No procedure-related major or minor complications were reported. Conclusions: Current literature reports DeBs as being safe and may convey some benefit in terms of improved rate of restenosis when used to treat AV access disease. However, this body of evidence is small and clinically heterogeneous. A large multicentre RCT may help to clarify the role of DeBs in the percutaneous treatment of AV HD access stenosis.
    No preview · Article · Feb 2016 · The journal of vascular access
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    ABSTRACT: Objective: We investigated which arm and vein led to the most successful outcomes during non-fluoroscopic peripherallyinserted central catheter (PICC) insertion. Methods: A total of 743 cases from July 2012 to March 2014 were retrospectively reviewed. We also analyzed the following: 1) accessed arm (right or left), 2) accessed vein (cephalic, basilic, or brachial), 3) primary and secondary success rates, 4) causes of failure (location of obstacles), and 5) problemsolving methods for catheter repositioning. Results: The primary success rate was 46.3% (344/743) with 49.4% (123/249) on the right arm and 44.7% (273/494) on the left arm. The secondary success rate was 53.7% (399/743) with 50.6% (126/249) on the right arm and 55.3% (273/494) on the left arm. The causes of failure were 100% (43/43) for the left cephalic vein, 61.5% (8/13) for the right cephalic vein, 50.6% (43/85) for the left brachial vein, and 51.1% (23/45) for the right brachial vein, 51.1% (187/366) for the left basilic vein, and 49.7% (95/191) for the right basilic vein. The failure rate through the left cephalic vein was significantly higher than that for other veins. The most common locations of obstacles were the subclavian vein (28.8%, 115/399), axillary vein (24.3%, 97/399), and brachiocephalic vein (19.3%, 77/399). The most common problem-solving methods were with guidewire assistance (74.7%, 298/399), venographic guidance (13.8%, 55/399), and fluoroscopic guidance (11.5%, 46/399). Conclusions: Right-arm access through the basilic or brachial vein may be more appropriate for successful nonfluoroscopic PICC insertion compared with the access through the left arm and the cephalic vein.
    No preview · Article · Feb 2016 · The journal of vascular access
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    ABSTRACT: Purpose: Totally implantable venous access systems (ports) are commonly placed and have a low complication rate. The most common complication is infection, which can have very negative effects on patients resulting in hospitalization and/or treatment delay in the setting of neoplasm. While a number of variables have been studied in relation to diminishing infectious rates, one remaining question is the effect of accessing the port on day of placement, which is the aim of this retrospective study. Materials and methods: After internal review board approval the electronic medical records of 2,006 patients who underwent port placement between 10/1/2008 and 9/30/2013 were reviewed. Of these patients 628 were excluded as they did not have complete placement and removal data available, leaving 1378 patients in our cohort. Results: There was a significantly longer number of infection-free catheter days in the out-patient cohort as compared to the in-patient cohort (p = 0.027). In-patients mean day after placement when the port was first accessed (DAP) (0.5) was statistically earlier (closer to placement) than the out-patients DAP (7.2) (p<0.0001). However, the increased likelihood of infection could not be explained by DAP (p = 0.2029) even when controlling for in-patient and out-patient status (p = 0.97). Conclusions: Accessing the port on the day of placement does not significantly contribute to an increased likelihood of infection. This study seems to indicate that placing a port on the first day of outpatient therapy likely optimally balances respect for patient time with infection control.
    No preview · Article · Feb 2016 · The journal of vascular access
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    ABSTRACT: Purpose: We developed the new technique of the axillary vein catheterization, which is connected with the determination of only two anatomical points of reference for puncture site identification. The primary outcome of this study was to determine the rate of successful catheterizations and the assessment of procedure success rate, depending on cannulation side as well as physician experience. The secondary objective was to evaluate the early complication rate and to determine whether this method can be used in clinical practice. Methods: The methodology of this prospective, cohort study included catheterization of the axillary vein via the infraclavicular approach. All procedures were performed by the first two authors, each of whom had different levels of experience with the technique. The choice of the cannulation side was based on clinical factors, and the technique was identical on the right and left sides. Results: The cannulation success rate reached 85.6% (N = 153). The correlation between physician experience and the procedure success rate as well as between cannulation side and procedure success rate were not significant. A common early complication was a puncture of axillary artery (14.4%) with the following proper cannulation in the majority of patients (77.3%, p<0.01, exact test). Conclusions: The procedure success rate, 85.6% (95% CI [80.0, 91.2%]), is comparable to other landmark-based techniques of the central vein cannulation. The moderately high percentage of axillary artery puncture points out that the approach should be used only as an alternative method to the central vein catheterization.
    No preview · Article · Feb 2016 · The journal of vascular access
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    ABSTRACT: Purpose: Haemodialysis (HD) is a lifeline therapy for patients with end-stage renal disease (ESRD). A critical factor in the survival of renal dialysis patients is the surgical creation of vascular access, and international guidelines recommend arteriovenous fistulas (AVF) as the gold standard of vascular access for haemodialysis. Despite this, AVFs have been associated with high failure rates. Although risk factors for AVF failure have been identified, their utility for predicting AVF failure through predictive models remains unclear. The objectives of this review are to systematically and critically assess the methodology and reporting of studies developing prognostic predictive models for AVF outcomes and assess them for suitability in clinical practice. Methods: Electronic databases were searched for studies reporting prognostic predictive models for AVF outcomes. Dual review was conducted to identify studies that reported on the development or validation of a model constructed to predict AVF outcome following creation. Data were extracted on study characteristics, risk predictors, statistical methodology, model type, as well as validation process. Results: We included four different studies reporting five different predictive models. Parameters identified that were common to all scoring system were age and cardiovascular disease. Conclusions: This review has found a small number of predictive models in vascular access. The disparity between each study limits the development of a unified predictive model.
    No preview · Article · Feb 2016 · The journal of vascular access
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    ABSTRACT: Purpose: Catheter locking solutions such as recombinant tissue plasminogen activator (rt-PA) are used to treat and prevent clotting of hemodialysis (HD) catheters during HD treatments and the interdialytic period. However, evidence to guide the use of rt-PA for catheter dysfunction is limited. Methods: We evaluated outcomes using two catheter dysfunction protocols in a cohort of consecutive prevalent dialysis patients (Jan 2013 to Sep 2014) undergoing HD with a tunneled catheter. In the intensive protocol, rt-PA was administered to all catheters based on blood flow and/or line reversal. In the standard protocol, rt-PA administration was based only on blood flow. The primary outcome was the rate of rt-PA use for catheter malfunction (rt-PA treatment days/1000 total line days; [TLD]). Secondary outcomes included the cost of rt-PA/TLD and the rate of catheter-related bacteremia. Results: There were 26 and 35 patients managed by the intensive and standard protocols, respectively. The rate of rt-PA use was 52/1000 TLD (intensive) versus 39/1000 TLD (standard) (rate ratio 1.30, 95% CI 1.12-1.52 CI, p<0.001). The rate of bacteremia was 0.43 and 0.22/1000 TLD for the intensive and standard protocols, respectively (p = 0.491). The cost of rt-PA was CDN $5.58 and CDN $6.15 per TLD for the intensive protocol and standard protocol groups (p<0.001). Conclusions: Managing catheter dysfunction based on line reversal and blood flow as opposed to only blood flow was associated with a higher rate of rt-PA use, but at a reduced overall cost.
    No preview · Article · Feb 2016 · The journal of vascular access
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    ABSTRACT: Purpose: Venous port catheters, also known as "totally implantable venous access devices" (TIVADs), are now the standard of care in patients requiring long-term intermittent intravenous drug administration. We describe a modification of the implantation technique that we use in our department in order to improve the cosmetic result of a TIVAD. Methods: After ultrasound-guided venous access in the internal jugular vein (IJV) or another appropriate vein has been obtained, we create a port pocket in the deltopectoral groove, in the upper-lateral chest wall, in a "far-lateral-oblique" orientation, respecting the individual patient's relaxed skin tension lines. Then we create a subcutaneous tunnel using a straight metal tunneler in two steps: first tunneling cranially and perpendicular to the port incision for a small distance, and then, after turning the tunneler at a right angle continuing in a straight line until we exit at the venous access site. Results: This configuration not only prevents catheter kinking, to ensure uninhibited flow, but also allows us to place the port pocket in a more discreet position, in order to offer a better cosmetic result to our patients. Conclusions: Adoption of a "far-lateral-oblique" port implantation site along with the "L-shaped tunneling technique" will offer doctors who are implanting TIVADs a useful alternative for a better cosmetic result.
    No preview · Article · Jan 2016 · The journal of vascular access

  • No preview · Article · Jan 2016 · The journal of vascular access
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    ABSTRACT: Introduction: We present a case of peripherally inserted central catheter (PICC) port placement where the catheter had been malpositioned to the persistent left superior vena cava. Methods: Despite the obvious elevation of the P-wave signaling proximity of the catheter tip to the sinus node, the catheter was not in the desired location within the superior vena cava or the right atrium, because of the presence of a persistent left superior vena cava. Computed tomography was used in order to locate the catheter. Results: The catheter was located in the persistent left superior vena cava. Conclusions: Malpositioning of the catheter in the persistent left superior vena cava occurs in 0.3%-0.5% of patients. The catheter was subsequently removed.
    No preview · Article · Jan 2016 · The journal of vascular access
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    ABSTRACT: Objectives: Hemodialysis (HD) patients with superior vena cava (SVC) occlusion have limited access options. Femoral access is commonly employed but is associated with high complication rates. Hemodialysis Reliable Outflow (HeRO) catheters can be used in tunneled catheter-dependent (TCD) patients who have exhausted other access options. The HeRO graft bypasses occlusion and traverses stenosis with outflow directly into the central venous circulation. At our institution we have used the inside-out central venous access technique (IOCVA) to traverse an occluded vena cava for HeRO graft placement. We review our experience with this technique. Methods: A retrospective chart review was conducted of patients with HeRO graft placement at our institution. All were dependent on a tunneled femoral dialysis catheter due to central venous occlusion (CVO). The IOCVA technique was used in each case. This technique was used as last resort for patients who had no other dialysis access option. Demographics, patency rates, complications, and mortality were recorded. Results: A total of 11 HeRO grafts were placed in 11 patients from January 2012 to June 2013, with 100% technical success rate. Three grafts were ligated due to steal syndrome. Two grafts were lost due to thrombosis. Five of 11 patients experienced a 30-day complication. Three patients died within the follow-up period; however, none were directly related to the graft placement. Follow up range was 65-573 days; 5 of 11 grafts were used for dialysis at the end of the follow-up period. The 12-month patency rate was 30%. Conclusions: HeRO grafts are one option for dialysis patients with CVO. There is, however, a high incidence of steal syndrome and other complications. These grafts should be offered as a final potential alternative to catheter dependence.
    No preview · Article · Jan 2016 · The journal of vascular access
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    ABSTRACT: Background: Native vein arteriovenous fistulas (AVFs) are the recommended first-line vascular access in hemodialysis patients. Despite this, AVFs are plagued with unfavorable maturation rates. We conducted a retrospective cohort study to assess the AVF success rate and to identify any significant associating factors. Methodology: Demographic and clinical data of all AVFs created from January 2011 to June 2013 at a single center with a multi-ethnic Asian population, were reviewed. The primary outcome was AVF successfully used for hemodialysis (FUSH) at 6 months. Secondary endpoints were the overall FUSH and actual maturation time of the AVFs. Univariate and multivariate analyses were performed to identify factors associated with AVF success. Results: A total of 375 fistulas were created during the study period (110 radiocephalic, 176 brachiocephalic, 89 brachiobasilic). The mean age was 59.4 ± 12.6 years and 42.9% were females. Seventy-one percent of patients had diabetes, 32.5% had ischemic heart disease and 10.7% had peripheral vascular disease. 246/375 (65.6%) AVFs FUSH by 6 months, and the average AVF maturation time was 16.1 ± 10.7 weeks. Of the 246 AVFs, 11% required secondary procedure to assist their success. Univariate analysis showed that gender (p = 0.035), age (p = 0.018), vein size on pre-operative vein mapping (p = 0.004) and operating surgeon (p = 0.021) were significant factors associated with AVF success. On multivariate analysis, age, pre-operative vein size and operating surgeon were significantly associated with fistula success. Conclusions: Reasonable FUSH rates can be achieved in the study patients. Patient age, pre-operative vein mapping size and operating surgeon were shown to influence AVF success rate.
    No preview · Article · Jan 2016 · The journal of vascular access
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    ABSTRACT: Purpose: To evaluate the extent of normal variation in implantable port devices between supine fluoroscopy and upright chest x-ray in relation to body mass index (BMI) based on three different measurement methods. Methods: Retrospectively, 80 patients with implanted central venous access port systems from 2012-01-01 until 2013-12-31 were analyzed. Three parameters (two quantitative and one semi-quantitative) were determined to assess port positions: projection of port capsule to anterior ribs (PCP) and intercostal spaces, ratio of extra- and intravascular catheter portions (EX/IV), normalized distance of catheter tip to carina (nCTCD). Changes were analyzed for males and females and normal-weight and overweight patients using analysis of variance with Bonferroni-corrected pairwise comparison. Results: PCP revealed significantly greater changes in chest x-rays in overweight women than in the other groups (p<0.001, F-test). EX/IV showed a significantly higher increase in overweight women than normal-weight women and men and overweight men (p<0.001). nCTCD showed a significantly greater increase in overweight women than overweight men (p = 0.0130). There were no significant differences between the other groups. Inter- and intra-observer reproducibility was high (Cronbach alpha of 0.923-1.0) and best for EX/IV. Conclusions: Central venous port systems show wide normal variations in the projection of catheter tip and port capsule. In overweight women apparent catheter migration is significantly greater compared with normal-weight women and with men. The measurement of EX/IV and PCP are straightforward methods, quick to perform, and show higher reproducibility than measurement of catheter tip-to-carina distance.
    No preview · Article · Dec 2015 · The journal of vascular access

  • No preview · Article · Dec 2015 · The journal of vascular access
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    ABSTRACT: Purpose: Prior studies have reported infection rates of converting non-tunneled dialysis catheters (NTDCs) to tunneled dialysis catheters (TDCs) versus de novo placement of TDCs using povidone-iodine. Chlorhexidine, per the Center of Disease Control guidelines, has been exclusively used in our institution since 2005. Therefore, our study aims to determine whether there is a difference in infection rates between conversion and de novo placement when utilizing chlorhexidine. Materials and methods: A retrospective analysis from 1/1/2009 to 8/10/2012 was performed of patients who underwent placement of NTDCs, which were subsequently converted to TDCs and those who underwent de novo TDC placement. To assess the rate of infection, the following data points were collected: date of procedure(s), indication, outcomes, site of catheter insertion, pre- and post-procedure laboratory values, complications, infection rates within the life of the initially placed catheter, catheter days, and survival. Results: The conversion cohort was composed of 205 patients, 135 of whom were lost to follow-up, leaving 70 patients. The de novo cohort included 70 randomly selected patients. Of the 70 patients who underwent conversion, 23 developed a catheter-related infection, with an infection rate of 0.26 events per 100 catheter days. Of the 70 de novo catheters, 20 developed infection with an infection rate of 0.25 events per 100 catheters days. Conclusion: In this series, there is no difference in infection rates between conversion and de novo TDC placement when utilizing chlorhexidine as the sterilization agent. However, these infection rates are superior to those reported when using povidone-iodine.
    No preview · Article · Dec 2015 · The journal of vascular access