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Biomedical subjects

A F Schild

Publications and source records attributed to A F Schild.

8 recordsLinked to original sources
PubMed2001

The utility of the VCS clip for creation of vascular access for hemodialysis: long-term results and intraoperative benefits.

UNLABELLED: The purpose of this study was to compare the effectiveness of the VCS vascular clip approximating system for the creation of hemodialysis access fistulas. 173 new vascular accesses were created, 92 prosthetic grafts and 81 autologous fistulas over a 40-month period. 50 sutured and 42 clipped fistulas comprised the prosthetic graft series, and 33 sutured and 48 clipped cases the autologous series. Risk factors associated with access patency were correlated and the primary patencies compared in the suture versus clipped group. A significant improvement in primary patency was noted for the clipped prosthetic group at all time points studied, with a positive trend also noted for clipped autologous fistulae. CONCLUSIONS: The vascular clipping system (the VCS system) provides both long-term and immediate advantages for vascular access construction. Clips have been used successfully to treat seven consecutive patients with upper extremity arterial steal syndrome without the technical difficulties associated with traditional methods of repair.

Adult↗
PubMed1999

Preliminary prospective randomized experience with vascular clips in the creation of arteriovenous fistulae for hemodialysis.

BACKGROUND: A new vascular clipping system (VCS) has been introduced for clinical use. This study was developed to determine whether patency rates and treatment outcomes for anastomoses in hemodialysis access surgery can be improved by the application of this new technology. METHODS: During a 10-month period, 96 consecutive patients requiring autologous fistula, synthetic fistula, or graft revisions for hemodialysis were prospectively randomized into two treatment groups. Anastomoses were constructed with the VCS in 46 patients and with polytetrafluoroethylene (PTFE) suturing in 49 patients. The procedures were performed in an outpatient setting, at a large medical center, by one surgeon. Time to construct the anastomosis, amount of bleeding from the anastomotic site, and primary and secondary graft patencies were analyzed. RESULTS: The mean time to construct anastomoses in autologous and synthetic grafts using VCS clips was significantly shorter than with sutures (autologous 14 versus 22 minutes, P = 0.0001; and new grafts 26 versus 30 minutes, P = 0.04). Blood loss was less in anastomoses done with the VCS clip; however, statistical significance was reached only for autologous fistulas (P = 0.0001). At 2-year follow-up, primary and secondary patencies were similar for both the VCS and suture groups with the exception that a statistically significant improvement was found in secondary patency for autologous fistulas when performed with the VCS. CONCLUSIONS: The VCS clip is easy to use and produces a more rapid anastomosis with less bleeding. Primary and secondary patencies using the VCS clip were equivalent or improved when compared with standard suture. In our experience, no complications have been attributed to the use of the clip technique.

Anastomosis, Surgical↗
PubMed1975

Three year experience with bovine graft arteriovenous (A-V) fistulas in 100 patients.

On the basis of the preceding discussion and information, it is our conclusion that: 1. Bovine graft A-V fistuals can be created successfully in 87% of those patients who have had a failure of conventional fistuals. 2. Bovine graft A-V fistuals provide easy needle placement. 3. Bovine graft A-V fistuals give excellent access for effective hemodialysis. 4. Bovine graft A-V fistuals do not cause excessive bleeding at the puncture site. 5. Bovine graft A-V fistuals can be used immediately.

Adolescent↗
PubMedDate not supplied

New graft for low friction tunneling in vascular access surgery.

PURPOSE: Prosthetic accesses of the upper extremity have been in use for more than 25 years. Many different conduits have been employed; investigators have continually searched for a graft with superior properties. METHODS: We describe a prospective randomized study comparing the new Slider Graft (Atrium) with the Hybrid PTFE Graft (Atrium); the latter has been used for a number of years. The Slider Graft is also made of PTFE. For this study, both grafts were 6 mm in diameter and 40 cm in length. The Slider Graft has a low friction polyethylene sheath over its entire length. This sheath expedites the passage of the graft through the tunnel. At one end, the graft and the polyethylene sheath are attached to a metal tip. This tip has male threads, which may be inserted firmly into a Kelly Wyck, Atrium, or any standard non-sheath tunneling system. This alleviates graft separation, turning, and slipping during tunneling. The primary objective of this trial was to determine the safety and efficacy of the Slider Graft as compared to the Hybrid Graft in vascular access surgery. The secondary objective was to evaluate how tunneling effects graft performance. We randomized 60 subjects for this study with two equal arms. During surgery we measured various parameters including ease of tunneling, tunnel bleeding, anastomotic bleeding, graft sweating, and immediate patency. To assess arm edema we measured circumference 7.5 cm and 20 cm above the wrist, prior to surgery and in follow-up visits at 1 week, 1 month, and 3 months. Primary patency was also assessed at these visits and at 6, 9, and 12 months. RESULTS: Our results show tunneling with the Slider Graft is easier to accomplish (p = 0.0001) with reduced tunnel bleeding (p = 0.0047) and anastomotic bleeding (p = 0.042). Further, the Slider Graft virtually eliminated the complication of graft sweating and seroma development (p = 0.0005). This may be due to reduced stretching and graft wetting during insertion. At 180 days the Slider Graft demonstrated improved primary patency, which was statistically significant (p = 0.047). At 360 and 720 days the Slider Graft continued to demonstrate a trend toward improved primary patency (p = 0.160). CONCLUSIONS: This study suggests the Slider Graft has significant advantages when compared to the Hybrid Graft and highlights the importance of tunneling in creating prosthetic accesses.

Journal Article↗
PubMedDate not supplied

Bovine artegraft arteriovenous fistulas for hemodialysis in one-hundred patients after "conventional" arteriovenous fistulas failed.

The use of the Bovine artegraft for creation of arteriovenous fistulas in the hemodialysis patients was first carried out in the midsummer of 1971. Since that time, there has been considerable material reported in the use of this substitute as an access for hemodialysis. In this article information gained from an ongoing study of the first 100 patients in chronic hemodialysis who had Bovine artegraft arteriovenous fistulas was reviewed. The indications for operation, the standard technique, the results, the complications, and the future plans for study of the physiology and hemodynamics of this type of fistula are described. The Bovine artegraft, AV fistula can be created successfully in a high percentage of patients, offers ease of needle placement, and effective dialysis with very little complication.

Adolescent↗