Publications by authors named "Massimo Lodi"

19 Publications

  • Page 1 of 1

Narrative review of sentinel lymph node biopsy in breast cancer: a technique in constant evolution with still numerous unresolved questions.

Chin Clin Oncol 2020 12 18. Epub 2020 Dec 18.

Service de chirurgie, Institut de cancérologie Strasbourg Europe (ICANS), Strasbourg Cedex, France; Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), UMR 7104 CNRS, U596 INSERM, ULP. BP 10142, Illkirch Cedex, France.

The aim of this narrative review was to provide an update on the use of sentinel lymph node biopsy (SLNB) for breast carcinoma (BC). Relevant studies published between 01/01/1994 and 15/08/2020 assessing the accuracy and the usefulness of SLNB were reviewed. SLNB was first used in 1977 for penile cancers. However, it took 17 years to enter in clinical practice for BC. The first procedures were based on two methods of non-specific marking of LN vmacrophages using a radioisotope (99mTc) and a blue dye (BD, Isosulfan, Patent or Methylene). To overcome side effects of radioisotopes (radiation exposure) and BD (allergic reactions), innovative tracers such as indocyanine green (ICG), superparamagnetic iron oxide (SPIO), and microbubbles have been explored. The SLN intraoperative examination is no longer performed, due to its low impact on the rate of reoperation and high time and cost of surgery. Likewise, immunohistochemistry, which can lead to an unnecessary ALND in some cases of occult metastases, is no more recommended. Except cases with metastasized LN, all contraindications aim to avoid situations where the risk of false negative would be too high (notably T3-T4 or multicentric tumors). The current indications for invasive BC are T0-T1-T2 N0 or N1 (after an accurate LN evaluation with ultrasound and/or cytology or core biopsy) and for DCIS treated by mastectomy or presenting as a palpable mass. After SLNB, axillary recurrence rates are generally below 2% after a follow up of 8–10 years, comparable to those observed after ALN. Likewise, when the SLN contains less than 2 metastases, axillary recurrence rates remain low even when ALN is omitted. In case of more than 2 metastatic SLN or capsular effraction, ALND is still indicated. For most teams, SLNB can be performed in clinically node-negative patients receiving neoadjuvant systemic therapy. The results of the literature consistently show that SLNB is extremely reliable in selected BC, as long as it is performed with a rigorous technique by teams having undergone multidisciplinary training and having gained the necessary experience.
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http://dx.doi.org/10.21037/cco-20-207DOI Listing
December 2020

Diagnostic Accuracy and Clinical Impact of Sentinel Lymph Node Sampling in Endometrial Cancer at High Risk of Recurrence: A Meta-Analysis.

J Clin Med 2020 Nov 28;9(12). Epub 2020 Nov 28.

Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67200 Strasbourg, France.

Purpose: To assess the value of sentinel lymph node (SLN) sampling in high risk endometrial cancer according to the ESMO-ESGO-ESTRO classification.

Methods: We performed a comprehensive search on PubMed for clinical trials evaluating SLN sampling in patients with high risk endometrial cancer: stage I endometrioid, grade 3, with at least 50% myometrial invasion, regardless of lymphovascular space invasion status; or stage II; or node-negative stage III endometrioid, no residual disease; or non-endometrioid (serous or clear cell or undifferentiated carcinoma, or carcinosarcoma). All patients underwent SLN sampling followed by pelvic with or without para-aortic lymphadenectomy.

Results: We included 17 original studies concerning 1322 women. Mean detection rates were 89% for unilateral and 68% for bilateral. Pooled sensitivity was 88.5% (95%CI: 81.2-93.2%), negative predictive value was 96.0% (95%CI: 93.1-97.7%), and false negative rate was 11.5% (95%CI: 6.8; 18.8%). We noted heterogeneity in SLN techniques between studies, concerning the tracer and its detection, the injection site, the number of injections, and the surgical approach. Finally, we found a correlation between the number of patients included and the SLN sampling performances.

Discussion: This meta-analysis estimated the SLN sampling performances in high risk endometrial cancer patients. Data from the literature show the feasibility, the safety, the limits, and the impact on surgical de-escalation of this technique. In conclusion, our study supports the hypothesis that SLN sampling could be a valuable technique to diagnose lymph node involvement for patients with high risk endometrial cancer in replacement of conventional lymphadenectomy. Consequently, randomized clinical trials are necessary to confirm this hypothesis.
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http://dx.doi.org/10.3390/jcm9123874DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7761304PMC
November 2020

3D-printed simulator for nasopharyngeal swab collection for COVID-19.

Eur Arch Otorhinolaryngol 2020 Nov 6. Epub 2020 Nov 6.

INSERM UMR-S 1121 'Biomaterials and Bioengineering', Strasbourg University, Strasbourg, France.

Introduction: Testing for COVID-19 is a cornerstone of pandemic control. If conducted inappropriately, nasopharyngeal swab collection can be painful and preanalytical sample collection errors may lead to false negative results. Our objective was to develop a realistic and easily available synthetic simulator for nasopharyngeal swab collection.

Materials And Methods: The nasopharyngeal swab collection simulator was designed through different development steps: segmentation, computer-aided design (CAD), and 3D printing. The model was 3D printed using PolyJet technology, which allows multi-material printing using hard and soft materials.

Results: The simulator splits in the parasagittal plane close to the septum to allow better visualization and understanding of nasal cavity landmarks. The model is able to simulate the softness and texture of different structural elements. The simulator allows the user to conduct realistic nasopharyngeal swab collection. A colored pad on the posterior wall of the nasopharynx provides real-time feedback to the user. The simulator also permits incorrect swab insertion, which is of obvious benefit from a training perspective. Comprehensive 3D files for printing and full instructions for manufacturing the simulator is freely available online via an open access link.

Conclusion: In the context of the COVID-19 pandemic, we developed a nasopharyngeal swab collection simulator which can be produced by 3D printing via an open access link, which offers complete operating instructions.
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http://dx.doi.org/10.1007/s00405-020-06454-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7645909PMC
November 2020

Impact of neoadjuvant chemotherapy cycles on survival of patients with advanced ovarian cancer: A French national multicenter study (FRANCOGYN).

Eur J Obstet Gynecol Reprod Biol 2020 Feb 6;245:64-72. Epub 2019 Dec 6.

Department of Gynecologic and Breast Surgery, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France.

Objective: The purpose of this study was to compare two groups of patients presenting advanced ovarian carcinoma benefiting from neoadjuvant chemotherapy (NAC) followed by cytoreductive surgery: after 3-4 cycles (group 1) or ≥ 5 cycles (group 2), regarding overall survival (OS) and progression-free survival (PFS), complications related to surgery as well as the extent of cytoreduction were assessed.

Study Design: We conducted a retrospective, multicenter cohort study in nine referral centers of France, reviewing the charts of all patients who underwent NAC between January 2000 and June 2017. We performed an OS analysis using multivariate Cox regression models adjusted for potential confounders. We also analyzed PFS and surgery-related morbidity.

Results: Of 501 patients included, 236 (47.1 %) benefited from ≤ 4 NAC cycles and 265 (52.9 %) from ≥ 5 NAC cycles. Characteristics data were similar in both groups. The rate of achievement of complete surgery was similar in both groups (p = 0.28). Surgical morbidity and postoperative complications showed no significant differences between both groups. The median OS was 54.2 months, 64 months for group 1 and 49.2 months for group 2. The 5-year survival rate was 45.6 % and 27.6 %. This difference was not statistically significant [HR 1.81 (0.89-3.71), p = 0.09]. Five-year PFS was 19.7 % and 11.7 % respectively (p = 0.31).

Conclusion: In a large series of advanced ovarian cancer, patients receiving late IDS (≥ 5 NAC cycles) seem to show a poorer prognosis than patients operated on earlier. The survival appears to be mainly determined by optimal resection and response to chemotherapy.
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http://dx.doi.org/10.1016/j.ejogrb.2019.12.001DOI Listing
February 2020

A novel machine learning-derived decision tree including uPA/PAI-1 for breast cancer care.

Clin Chem Lab Med 2019 05;57(6):901-910

Unité de Sénologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.

Background uPA and PAI-1 are breast cancer biomarkers that evaluate the benefit of chemotherapy (CT) for HER2-negative, estrogen receptor-positive, low or intermediate grade patients. Our objectives were to observe clinical routine use of uPA/PAI-1 and to build a new therapeutic decision tree integrating uPA/PAI-1. Methods We observed the concordance between CT indications proposed by a canonical decision tree representative of French practices (not including uPA/PAI-1) and actual CT prescriptions decided by a medical board which included uPA/PAI-1. We used a method of machine learning for the analysis of concordant and non-concordant CT prescriptions to generate a novel scheme for CT indications. Results We observed a concordance rate of 71% between indications proposed by the canonical decision tree and actual prescriptions. Discrepancies were due to CT contraindications, high tumor grade and uPA/PAI-1 level. Altogether, uPA/PAI-1 were a decisive factor for the final decision in 17% of cases by avoiding CT prescription in two-thirds of cases and inducing CT in other cases. Remarkably, we noted that in routine practice, elevated uPA/PAI-1 levels seem not to be considered as a sufficient indication for CT for N≤3, Ki 67≤30% tumors, but are considered in association with at least one additional marker such as Ki 67>14%, vascular invasion and ER-H score <150. Conclusions This study highlights that in the routine clinical practice uPA/PAI-1 are never used as the sole indication for CT. Combined with other routinely used biomarkers, uPA/PAI-1 present an added value to orientate the therapeutic choice.
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http://dx.doi.org/10.1515/cclm-2018-1065DOI Listing
May 2019

Why and How Should We Improve Breast Cancer Management in Elderly Women?

Eur J Breast Health 2018 Jul 1;14(3):132-133. Epub 2018 Jul 1.

Unit of Breast, Strasbourg University Hospital, Strasbourg, France.

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http://dx.doi.org/10.5152/ejbh.2018.02070DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6092155PMC
July 2018

Invasive ductal carcinoma limited to the nipple.

Breast J 2018 11 3;24(6):1083. Epub 2018 Aug 3.

Department of Gynecology and Obstetrics, Strasbourg University Hospital, Strasbourg, France.

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http://dx.doi.org/10.1111/tbj.13090DOI Listing
November 2018

[Breast calciphylaxis: An uncommon and difficult pathology].

Presse Med 2018 Mar 9;47(3):288-291. Epub 2018 Mar 9.

CHRU, hôpital de Hautepierre, pôle de gynécologie et obstétrique, unité de sénologie, avenue Molière, 67200 Strasbourg, France; Université de Strasbourg, IGBMC, institut de génétique et biologie moléculaire et cellulaire, CNRS UMR 7104, Inserm U964, 1, rue Laurent-Fries, 67400 Illkirch-Graffenstaden, France; Centre hospitalier de Sarrebourg, rue des Roses, 57400 Sarrebourg, France.

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http://dx.doi.org/10.1016/j.lpm.2018.01.004DOI Listing
March 2018

Author's reply to: Comments on a stripping method to remove stuck catheter and a plea to adopt a large size hemodialysis catheters.

Authors:
Massimo Lodi

J Vasc Access 2018 01;19(1):105

Operative Unit of Nephrology and Dialysis, Ospedale Spirito Santo, Pescara - Italy.

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http://dx.doi.org/10.5301/jva.5000812DOI Listing
January 2018

Relevance of breast MRI in determining the size and focality of invasive breast cancer treated by mastectomy: a prospective study.

World J Surg Oncol 2017 Jul 14;15(1):128. Epub 2017 Jul 14.

MATHELIN Carole MD PhD Unité de sénologie CHRU Hôpitaux universitaires de Strasbourg, Avenue Molière, 67200, Strasbourg, France.

Background: The aim of this study was the evaluation of breast MRI in determining the size and focality of invasive non-metastatic breast cancers.

Methods: The prospective, single-centre study conducted in 2015 compared preoperative MRI with histological analysis of mastectomy.

Results: One hundred one mastectomies from 98 patients were extensively analysed. The rates of false-positive and false-negative MRI were 2 and 4% respectively. The sensitivity of breast MRI was 84.7% for the detection of all invasive foci, 69% for single foci and 65.7% for multiple foci. In the evaluation of tumour size, the Spearman rank correlation coefficient r between the sizes obtained by MRI and histology was 0.62. The MRI-based prediction of a complete response to neoadjuvant chemotherapy was 75%.

Discussion: MRI exhibits high sensitivity in the detection of invasive breast cancers. False positives were linked to the inflammatory nature of the tumour bed. False negatives were associated with small or low-grade tumours and their retro-areolar location. The size of T1 tumours was overestimated by an average of 7%, but MRI was the most efficient procedure. The sensitivity of MRI for the diagnosis of unifocal tumours was higher than that for multifocal sites. Our study confirmed the positive contribution of preoperative MRI for invasive lobular carcinomas and complete response predictions after neoadjuvant chemotherapy.
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http://dx.doi.org/10.1186/s12957-017-1197-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5513043PMC
July 2017

Medical treatment of mammary desmoid-type fibromatosis: which benefit?

World J Surg Oncol 2017 Apr 18;15(1):86. Epub 2017 Apr 18.

Unité de Sénologie, Hôpital Hautepierre, Hôpitaux Universitaires de Strasbourg, CHRU, 1 Avenue Molière, 67200, Strasbourg, France.

Background: Breast fibromatosis is a rare disease characterized by monoclonal fibroblast proliferation. It has no ability to metastasize but has a high local recurrence rate and often infiltrates surrounding tissues. Surgical treatment is the reference, but recently, new targeted therapies have emerged. We report an original case of a patient with breast fibromatosis who received exclusive medical treatment. Our aim was to analyze these treatments based on the clinical and radiological outcome, iatrogenic effects, and pharmacological action.

Case Presentation: We report the case of a 19-year-old woman who developed a desmoid-type fibromatosis of the lower inner quadrant of the right breast, measuring 50 × 25 mm (i.e., a volume of 27.4 cm). Initial surgery was not possible because of potential esthetic and functional prejudice. Thus, she had an exclusive medical treatment including several lines: NSAIDs with tamoxifen and triptorelin, followed by sorafenib, then interferon α2b, and finally sunitinib. With tyrosine-kinase inhibitors (TKIs) (sunitinib), a significant partial response was observed (57% reduction of the maximal tumoral volume). For each treatment, we provided the clinical and radiological outcome in association with known pharmacological action.

Conclusions: TKI had been an interesting alternative option to initial surgery, providing at least a partial response and potentially allowing less mutilating surgery. However, no pharmacological mechanism can unequivocally explain TKI efficacy. In general, breast fibromatosis should be treated along with oncologist and interventional radiologists in a trans-disciplinary modality, thus offering an adapted treatment for this particular desmoid-type fibromatosis localization.
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http://dx.doi.org/10.1186/s12957-017-1148-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5395853PMC
April 2017

Clinical use of computational modeling for surgical planning of arteriovenous fistula for hemodialysis.

BMC Med Inform Decis Mak 2017 03 14;17(1):26. Epub 2017 Mar 14.

Department of Biomedical Engineering, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Bergamo, Italy.

Background: Autogenous arteriovenous fistula (AVF) is the best vascular access (VA) for hemodialysis, but its creation is still a critical procedure. Physical examination, vascular mapping and doppler ultrasound (DUS) evaluation are recommended for AVF planning, but they can not provide direct indication on AVF outcome. We recently developed and validated in a clinical trial a patient-specific computational model to predict pre-operatively the blood flow volume (BFV) in AVF for different surgical configuration on the basis of demographic, clinical and DUS data. In the present investigation we tested power of prediction and usability of the computational model in routine clinical setting.

Methods: We developed a web-based system (AVF.SIM) that integrates the computational model in a single procedure, including data collection and transfer, simulation management and data storage. A usability test on observational data was designed to compare predicted vs. measured BFV and evaluate the acceptance of the system in the clinical setting. Six Italian nephrology units were involved in the evaluation for a 6-month period that included all incident dialysis patients with indication for AVF surgery.

Results: Out of the 74 patients, complete data from 60 patients were included in the final dataset. Predicted brachial BFV at 40 days after surgery showed a good correlation with measured values (in average 787 ± 306 vs. 751 ± 267 mL/min, R = 0.81, p < 0.001). For distal AVFs the mean difference (±SD) between predicted vs. measured BFV was -2.0 ± 20.9%, with 50% of predicted values in the range of 86-121% of measured BFV. Feedbacks provided by clinicians indicate that AVF.SIM is easy to use and well accepted in clinical routine, with limited additional workload.

Conclusions: Clinical use of computational modeling for AVF surgical planning can help the surgeon to select the best surgical strategy, reducing AVF early failures and complications. This approach allows individualization of VA care, with the aim to reduce the costs associated with VA dysfunction, and to improve AVF clinical outcome.
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http://dx.doi.org/10.1186/s12911-017-0420-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5348915PMC
March 2017

The removal of a stuck catheter: an alternative to Hong's technique.

J Vasc Access 2016 Nov 27;17(6):548-551. Epub 2016 Sep 27.

Departmental Organizational Structure for Vascular Surgery and Centre of Vascular Access for the Marche Region, Ancona - Italy.

The use of the tunneled central venous catheter (CVC) is steadily increasing worldwide as a means of vascular access for hemodialysis. The increased use of these devices, which often outlive the patients, and the extended time they are used are associated with more frequent complications. Among these, one of the emerging complications is that of the "embedded" or stuck catheter. This term refers to when the catheter cannot be removed after detaching the retention cuff. In medical literature, experiences with the removal of stuck catheters are described with the use of several different methods. Currently the most commonly used technique also considered the safest is "endoluminal dilation" also known as Hong's Technique, recently modified by Quaretti and Galli. Below, a new technique using a Vollmar ring is described for removing a stuck catheter as an alternative to Hong's technique, or after a failed attempt at using Hong's technique.
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http://dx.doi.org/10.5301/jva.5000557DOI Listing
November 2016

Vascular access scenario in Italy: evolution and comparison by two surveys (1998-2013).

J Vasc Access 2016 Sep 29;17(5):401-4. Epub 2016 Jun 29.

Vascular Access Study Group, Italian Society of Nephrology, Roma - Italy.

Purpose: Dialysis settings have generally improved over the last decades, but the vascular access setting did not see significant advances and experienced a progressive worsening in epidemiology and clinical features. The aim of the study was to describe and compare evolution of vascular access in Italy over time.

Methods: A national survey implemented in Italy last year is presented and compared to a previous survey performed in 1998. Present survey collected data from almost 50% of centers involved in vascular access.

Results: The nephrologist participates in the management of vascular access in 97% of centers. Almost 40% of centers declare more than 40% of central venous catheters (CVCs) at first dialysis with maximum value being 60%. Prevalence of CVCs is greater than 20% in chronic prevalent patients in 38.8% of centers. According to the 2013 survey, CVCs account for 51.6% of procedures, while arteriovenous fistulae (AVF) and prostheses represent 42.4% and 6%, respectively. Nephrologists perform 73% of procedures on CVCs.From 1998 to 2013, a sharp increase in CVC prevalence was seen, in both incident and prevalent dialysis patients. This activity, mostly due to CVC management, is almost completely carried by nephrologists.

Discussion: The variability in CVC utilization among centers suggests the lack of a shared policy in patients and access coupling. Quantitative criteria should be used to reduce inappropriate strategy in vascular access creation. Since this activity in Italy is organized at a local level without a shared organizational model, we should inquire whether a system managed so well in the past should now be rebuilt on the model of organ transplantation.
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http://dx.doi.org/10.5301/jva.5000575DOI Listing
September 2016

The vascular access in the elderly: a position statement of the Vascular Access Working Group of the Italian Society of Nephrology.

J Nephrol 2016 Apr 16;29(2):175-184. Epub 2016 Jan 16.

Unità di Nefrologia IRCCS, Fondazione Salvatore Maugeri, Pavia, Italy.

The incident hemodialysis (HD) population is aging, and the elderly group is the one with the most rapid increase. In this context it is important to define the factors associated with outcomes in elderly patients. The high prevalence of comorbidities, particularly diabetes mellitus, peripheral vascular disease and congestive heart failure, usually make vascular access (VA) creation more difficult. Furthermore, many of these patients may have an insufficient vasculature for fistula maturation. Finally, many fistulas may never be used due to the competing risk of death before dialysis initiation. In these cases, an arteriovenous graft and in some cases a central venous catheter become a valid alternative form of VA. Nephrologists need to know what is the most appropriate VA option in these patients. Age should not be a limiting factor when determining candidacy for arteriovenous fistula creation. The aim of this position statement, prepared by experts of the Vascular Access Working Group of the Italian Society of Nephrology, is to critically review the current evidence on VA in elderly HD patients. To this end, relevant clinical studies and recent guidelines on VA are reviewed and commented. The main advantages and potential drawbacks of the different VA modalities in the elderly patients are discussed.
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http://dx.doi.org/10.1007/s40620-016-0263-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5429362PMC
April 2016

[The Italian Registry of Vascular Access].

G Ital Nefrol 2013 Nov-Dec;30(6)

The Vascular Access Study Group of Italian Society of Nephrology has designed a National Register in order to create an archive that collects the data on vascular accesses more detailed than the mere indication of arteriovenous fistula with native vessels, prosthetic fistula and central venous catheter. The obstacles to such a project are represented by the absence of "uniformity" in the name of the arterovenous fistula, the difficulty in increasing the daily work of dialysis centers with another registry and finally by privacy concerns. In order to standardize the vascular accesses name the Study Group proposal is to eliminate any denomination and adopt a code-descriptive system, indicating the seat of the anastomosis (1/3 distal, middle and proximal forearm, arm or lower limb), the limb (if dominant or non-dominant), the vessels involved, the type of anastomosis and the number of interventions that the pt has undergone including the last one. In this way, uniformity and universality are guaranteed. Every aspect scribed will be a cell of a data base and can used to statistical analysis. The study group has set up a software (Gev@) in order to facilitate data storage. The software is based on a form compiled at the end of each surgical procedure. The form will then be archived in digital format thereby generating automatically the data base. The advantage of this system, is represented by the possibility of turning a routine medical procedure, namely the recording of a surgical procedure, in a data base exportable for the creation of the register. As regards the issue of privacy will be obtained the patient's consent to the processing of data and the register will be stored and managed according to the regulations in terms of privacy. In the coming months, after a time of testing, the software will be available to each italian dialisys center.
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August 2015

Arteriovenous fistula: end-to-end or end-to side anastomosis?

Hemodial Int 2011 Jan 18;15(1):100-3. Epub 2010 Nov 18.

Nephrology and Dialysis Unit, Spirito Santo Hospital, Pescara, Italy.

The purpose of the present study was to compare the end-to-end (ETEa) with the end-to-side (ETSa) anastomosis in patients starting hemodialysis by means of radio-cephalic artero-venous fistulae (AVF). In our experience, we compared the results, as early failure (EF), late thrombosis (LT), stenosis, steal syndrome, and primary patency (PP), in 2 groups of hemodialysis incident patients that had been placed an AVF by means of ETEa or ETSa. The observation period lasted 24 months for each of the 2 types of AVF, starting from October 2005 to September 2007 for ETEa and from October 2007 to September 2009 for ETSa. One hundred forty patients were included in the present study. We have consecutively performed 99 AVF interventions at the wrist or at the third distal of the forearm, in 70 patients by means of ETEa and 82 AVF interventions in the same anatomical places in 70 patients by means of ETSa. The patients with ETEa had a mean age of 64.4 ± 14.6 years, males were 65.8% and the age dialysis at the end of observation was 10.4 ± 5.7 months. Those with ETSa had a mean age of 65.9 ± 15.5 years and the males were 62.9%, the age dialysis at the end of observation was 9.2 ± 5.5 months. The surgical team was composed by the same nephrologists. The statistical study was performed by means of the χ chi-square and Fisher's exact test. We have observed more late thrombosis (10% vs. 4.1%) and stenosis (21.4% vs. 2.7%) in ETEa than in ETSa. The number of early thrombosis was similar in the 2 types of anastomosis. The primary patency 1-year rate was better though not significantly in the ETS (80% vs. 85.7%) In our experience the ETSa provides, overall better results, both regarding the complications and primary survival than ETEa. For the benefits that seem to come from it, we believe, that a broad ETSa in the distal native AVF is preferable to the ETEa.
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http://dx.doi.org/10.1111/j.1542-4758.2010.00503.xDOI Listing
January 2011

Vascular access for hemodialysis: experience of a team of nephrologists.

Hemodial Int 2008 Jul;12(3):328-30

Nephrology and Dialysis Unit, Spirito Santo Hospital, Pescara, Italy.

A survey conducted by Bonucchi et al. underlined the different types of doctors placing arteriovenous fistula (AVF) for hemodialysis in the United States and Europe (in particular Italy). In fact, nephrologists definitely prevail in Italy, where almost 48.8% of nephrologists place an AVF themselves or with the help of a vascular surgeon (26.4%). In Europe, only 35% do so, whereas 89% of AVF are performed by surgeons in the United States. In 98% of the cases occurring at our center, the AVF was placed and reviewed by the nephrologists. This paper reports surgery cases related to the period between January 1983 and September 2006. Over this time, 1386 operations for placing and reviewing vascular access were conducted. Among these, 47 (3.3%) were related to a cuffed central venous catheter (CVC); 1138 (80.2%) related to a distal AVF; 201 (10.6%) related to a proximal AVF; and 51 (3.6%) related to an arteriovenous graft (AVG). In addition, 33 (2.3%) operations performed before January 1983 relating to AV Scribner shunts were included. Arteriovenous fistulas or AVGs were provided to our patients (only 2.6% of them have a CVC), and AVF rescue operations were performed in the shortest possible time with advantages for the patient and his vascular access.
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http://dx.doi.org/10.1111/j.1542-4758.2008.00276.xDOI Listing
July 2008