Dialysis patients are operated to have AV Fistula which is a joint junction of an artery and vein in the arm, operated to increase the blood flow through the dialyzer machine. AV- fistula is a type of vascular access which is a path into the body to connect/disconnect devices, but in this case, it is mainly Dialyzer. To reduce the failure rate during maturation period of AV Fistula, doctors recommend squeezing ball exercise as a necessary precaution for AV Fistula failure. Doing Squeezable interaction for about 3-4 times a day is recommended based on patient’s health condition. Hence, the proposed architecture adopts this squeezable exercise by embedding with sensor and measuring the angle at which the sensor is bent. The framework also proposes a new care coordination system having the hardware layer which has key components such as raspberry Pi, sensor which help in recording the pressure values when user presses the ball and software layer which solely focuses on data sync among the applications used by the user. It has been recorded that 53 % of patients having AV-Fistula fail because of negligence and lack of care. The maturation period is so critical and important which made us to build a gamification platform to monitor the exercise and track the activity through android application to keep users motivated and disciplined. In further chapters of the study will focus on different clinical like procedure around AV-Fistula and technical information such as different technologies used and implemented in the proposed system along with sensor circuit. This project goal is to present a way of monitoring patients and to keep track of the compliance whether the patient is active doing exercise daily. This way we are trying to present a care monitoring system for patients to help prevent AV Fistula failure. / Includes bibliography. / Thesis (M.S.)--Florida Atlantic University, 2019. / FAU Electronic Theses and Dissertations Collection

Vascular access (VA) is one of the most important determinants of outcomes in haemodialysis (HD). Poor VA outcomes have a significant adverse impact on patient experience, morbidity and mortality and also result in significant burden on the health economy. An arteriovenous fistula (AVF) is accepted as the best HD vascular access. However AVF prevalence is variable and AVFs are associated with a high early failure rate. A small but significant number of AVFs experience late failure further down the line. The purpose of this project, broadly, was to understand VA outcomes, focusing specifically on AVFs. This project involved a series of clinical studies that were specifically designed by the student researcher to investigate various time points in the life cycle of AVFs – from creation and maturation - to its use and subsequent failure. The MANVAS, OPEN and Coil embolisation studies focus on the early phase of AVF development and maturation, whilst, the VA in Home HD study investigates the impact of intensive self-use in a non-healthcare setting. It is followed by the prospective thrombosed vascular access study focusing on the late phase of VA failure. The MANVAS study, a prospective cohort study, was set up with an aim to follow up patients undergoing AVF formation with a view to defining the natural history and maturation process of AVFs, and determine factors which affect outcomes – demographic, clinical, and biological. The OPEN study was designed to investigate poor maturation due to anastomotic failure by the intervention of the OptiflowTM device. The results suggest high maturation rates that were significantly better than those reported in the literature. The coil embolisation study demonstrated that the intervention of coil embolisation is a safe and effective treatment option for failing AVFs with accessory draining veins. The Vascular Access in Home Haemodialysis (HHD) study demonstrated that VA outcomes are significantly better in HHD patients and unadjusted patient survival in the HHD cohort was associated with incident VA. The thrombosed access study is a prospective longitudinal study designed to assess the effectiveness of endovascular access salvage and investigation of factors that impact longer-term access survival. One of the major aims of the study was to analyse outcomes related to prompt restoration of flow for patients presenting with acute failure of fistulae and grafts. The study showed that timely endovascular salvage is highly effective in restoring immediate patency but long-term outcomes remain poor. It also confirms poor outcomes of grafts as compared to AVFs and demonstrates that progression to thrombosis in AVFs portends poorer prognosis. The endovascular technique of balloon maceration, compared to outcomes reported in the literature, appears to be equally safe and effective with no increased risk of clinically significant pulmonary embolism. The clinical studies in this thesis provide a unique insight into the different aspects of the lifecycle of an AVF, and pave the way for an improvement in our fundamental understanding of the natural history and biology of AVFs.

As fístulas arteriovenosas da região do seio cavernoso constituem as fístulas carotidocavernosas que podem ser diretas ou indiretas. As indiretas são raras, a sua sintomatologia é variada e o tratamento é controverso. Este estudo compreendeu a análise prospectiva de 44 pacientes portadores de fístulas carotidocavernosas indiretas (FCCI) no período de 01 de janeiro de 1994 e 31 de janeiro de 2004, 42 com etiologia espontânea e dois pacientes com etiologia traumática, sendo estes analisados separadamente. Doze (12) pacientes foram submetidos à conduta expectante e orientados a realizar manobras de compressão carótido-jugular. O tratamento endovascular foi realizado por via arterial, venosa ou combinação dos dois, num total de 30 pacientes. Considerando o grupo inteiro, ocorreu trombose espontânea em aproximadamente 24% dos pacientes. Os sintomas e o aspecto angiográfico após o tratamento evoluíram com melhora ou cura em 100% dos casos, com oclusão completa das FCCI em 63,3%, a grande maioria destes submetidos a apenas um procedimento. Além dos acessos venosos tradicionais aos seios cavernosos, vias de acesso alternativas através da veia oftálmica superior foram realizadas por punção percutânea de veia facial, veia supratroclear ou veia frontal. O material embolizante mais utilizado foi o adesivo tissular líquido, \"cola\", isoladamente ou em conjunto com outros materiais. Houve complicações transitórias em 13,3% dos pacientes tratados e nenhuma complicação permanente foi observada, o que demonstrou a baixa morbidade deste procedimento / The arteriovenous fistulas of the cavernous sinus (CS) region constitute the carotid-cavernous fistula, which can be direct or indirect. The indirect type is quite rare, its clinical features is very inespecific and its treatment modalities controversial. Forty-four patients with indirect carotid-cavernous fistulas (ICCF) were studied in a prospective manner between January 1994 to January 2004, 42 with spontaneous etiology and 2 with traumatic etiology, being these analyzed separately. Twelve (12) patients were submitted to a expectant management and instructed to perform carotid-jugular compression. Endovascular treatment was accomplished by arterial approach, vein approach or combination of both, in a total of 30 patients. Considering the entire group, spontaneous thrombosis was observed in approximately 24%. Symptoms and the angiographic features after endovascular treatment improved or disappeared in 100% of the cases, with total obliteration in 63.3%, most of them submitted to just one procedure. Despite the traditional venous routes to the CS, alternative accesses through the superior ophthalmic vein (SOV) were accomplished by percutaneous puncture of the facial, supratrochlear or frontal vein. Liquid adhesive (glue) was the most often embolic material used isolated or with other materials. No permanent complication was observed and only 13,3% of the patients treated cursed with transitory complications, what demonstrated the low morbidity of this procedure

As fístulas arteriovenosas da região do seio cavernoso constituem as fístulas carotidocavernosas que podem ser diretas ou indiretas. As indiretas são raras, a sua sintomatologia é variada e o tratamento é controverso. Este estudo compreendeu a análise prospectiva de 44 pacientes portadores de fístulas carotidocavernosas indiretas (FCCI) no período de 01 de janeiro de 1994 e 31 de janeiro de 2004, 42 com etiologia espontânea e dois pacientes com etiologia traumática, sendo estes analisados separadamente. Doze (12) pacientes foram submetidos à conduta expectante e orientados a realizar manobras de compressão carótido-jugular. O tratamento endovascular foi realizado por via arterial, venosa ou combinação dos dois, num total de 30 pacientes. Considerando o grupo inteiro, ocorreu trombose espontânea em aproximadamente 24% dos pacientes. Os sintomas e o aspecto angiográfico após o tratamento evoluíram com melhora ou cura em 100% dos casos, com oclusão completa das FCCI em 63,3%, a grande maioria destes submetidos a apenas um procedimento. Além dos acessos venosos tradicionais aos seios cavernosos, vias de acesso alternativas através da veia oftálmica superior foram realizadas por punção percutânea de veia facial, veia supratroclear ou veia frontal. O material embolizante mais utilizado foi o adesivo tissular líquido, \"cola\", isoladamente ou em conjunto com outros materiais. Houve complicações transitórias em 13,3% dos pacientes tratados e nenhuma complicação permanente foi observada, o que demonstrou a baixa morbidade deste procedimento / The arteriovenous fistulas of the cavernous sinus (CS) region constitute the carotid-cavernous fistula, which can be direct or indirect. The indirect type is quite rare, its clinical features is very inespecific and its treatment modalities controversial. Forty-four patients with indirect carotid-cavernous fistulas (ICCF) were studied in a prospective manner between January 1994 to January 2004, 42 with spontaneous etiology and 2 with traumatic etiology, being these analyzed separately. Twelve (12) patients were submitted to a expectant management and instructed to perform carotid-jugular compression. Endovascular treatment was accomplished by arterial approach, vein approach or combination of both, in a total of 30 patients. Considering the entire group, spontaneous thrombosis was observed in approximately 24%. Symptoms and the angiographic features after endovascular treatment improved or disappeared in 100% of the cases, with total obliteration in 63.3%, most of them submitted to just one procedure. Despite the traditional venous routes to the CS, alternative accesses through the superior ophthalmic vein (SOV) were accomplished by percutaneous puncture of the facial, supratrochlear or frontal vein. Liquid adhesive (glue) was the most often embolic material used isolated or with other materials. No permanent complication was observed and only 13,3% of the patients treated cursed with transitory complications, what demonstrated the low morbidity of this procedure

Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2016-07-26T13:15:11Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) DISSERTACAO FINAL 29 02 2016 Helen Fuzari.pdf: 2981109 bytes, checksum: 66f689cea951c214857d7d0060de89cd (MD5) / Made available in DSpace on 2016-07-26T13:15:11Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) DISSERTACAO FINAL 29 02 2016 Helen Fuzari.pdf: 2981109 bytes, checksum: 66f689cea951c214857d7d0060de89cd (MD5) Previous issue date: 2016-02-16 / CAPEs / A vibração de corpo inteiro (VCI) é uma forma de treinamento utilizada em diversas populações e tem apresentado diversos benefícios sobre a força muscular e capacidade funcional. No entanto, os efeitos de um treino de VCI em pacientes com doença renal crônica (DRC) ainda não foi desenvolvido. A DRC tem contribuído para a fraqueza musculoesquelética especialmente nos pacientes submetidos à hemodiálise (HD), levando ao sedentarismo e a intolerância ao exercício, contribuindo assim para o quadro de sarcopenia. Programas de exercício físico têm sido propostos para esta população, embora nem sempre com boa adesão, quer pela presença de comorbidades associada ou ainda a sobrecarga que o exercício impõe. Diante desse contexto a presente dissertação teve por objetivo avaliar a eficácia de um programa de treinamento com VCI em DRC sob HD no período interdialítico sobre a força muscular, equilíbrio, qualidade de vida e capacidade funcional através de um ensaio clínico (registro no clinical trials NCT02413073), no artigo original. Artigo 1: Esse estudo foi composto de 2 grupos, um VCI (8 pacientes) e outro Sham (8 pacientes), treinados durante 3 meses, duas vezes por semana em dias alternados a HD, havendo 1 perda. O grupo VCI melhorou a força muscular (VCI 357,72 ± 90,09N; Sham 240,46 ± 68N; p≤ 0,010) e a distância percorrida no teste de caminhada de 6 minutos (TC6min) (VCI 550,75 ± 54,58m; Sham 479,63 ± 68,53m; p≤0,038). O presente estudo constatou melhora da força muscular de extensores de joelho e da distância percorrida após um programa de VCI de 12 semanas para indivíduos com DRC submetidos a HD desenvolvido no período interdialítico. Artigo 2: A revisão sistemática teve como objetivo avaliar a eficácia dos exercícios de membro superior no processo de maturação da fístula arteriovenosa (FAV) (registrada no PROSPERO CRD42015024524). Foram acessadas as bases de dados MEDLINE, CINAHL, Web of Science, Scopus, Lilacs, Scielo, Central e PEDro no período de fevereiro a agosto de 2015, através dos descritores “kidney disease”, “Chronic Renal Insufficiency”, “hemodialysis”, “exercise” and “arteriousvenous fistule”. Foram incluídos estudos com pacientes com DRC no estágio 5, maiores de 18 anos, de ambos os sexos, sob intervenção de exercícios de membro superior homolateral a FAV. Os principais desfechos foram o aumento do diâmetro da veia e taxa de fluxo sanguíneo relacionados à maturação da FAV. Devido as características dos artigos (pequeno número de pacientes envolvidos nos estudos e a ausência de cegamento e alocação), foram incluídos apenas três artigos envolvendo 94 participantes. Para o desfecho diâmetro da veia foi encontrada diferença de média de 0,36 (-0.95 a 1.67) e para o desfecho taxa de fluxo sanguíneo a diferença de média de 107.87 (-3,90 a 219,64). A partir desses resultados, não é possível recomendar os exercícios de membro superior homolateral a FAV, dada a falta de evidência em comprovar a sua eficácia. Conclui-se que outros estudos com maior rigor metodológico possam ser desenvolvidos a fim de verificar a existência de eficácia dos exercícios no processo de maturação da FAV nesses pacientes. / The whole body vibration (WBV) is a form of training used in diverse populations and has brought many benefits on muscle strength and functional capacity. However, the effects of WBV training in patients with chronic kidney disease (CKD) has not yet been developed. The DRC has contributed to the musculoskeletal weakness especially in patients undergoing hemodialysis (HD), leading a sedentary lifestyle and exercise intolerance, thereby contributing to sarcopenia frame. Exercise programs have been proposed for this population, though not always with good adhesion, or by the presence of associated comorbidities or overload that exercise requires. In this context, the present work was to evaluate the effectiveness of a training program with WBV in CKD in HD on interdialytic period on muscle strength, balance, quality of life and functional capacity through a clinical trial (registration in clinical trials NCT02413073) in the original article. This study consisted of 2 groups, one WBV (8 patients) and another Sham (8 patients), trained for 3 months, twice a week on alternate days HD having 1 loss. The WBV group improved muscle strength (WBV 357.72 ± 90,09N; Sham 240.46 ± 68N; p ≤ 0.010) and the distance covered in a 6-minute walk test (6MWT) (WBV 550.75 ± 54, 58m; Sham 479.63 ± 68,53m; p≤0,038). This study found improvement in muscle strength of knee extensors and distance after a 12-week program for individuals with CKD undergoing HD developed in interdialytic period. The systematic review aimed to evaluate the effectiveness of upper limb exercises in the maturation process of arteriovenous fistula (AVF) (recorded in PROSPERO CRD42015024524). Databases were accessed MEDLINE, CINAHL, Web of Science, Scopus, Lilacs, Scielo, Central and PEDro in the period from February to August 2015, using the keywords "kidney disease", "Renal Chronic Insufficiency", "hemodialysis" "exercise" and "arteriousvenous fistule". They included studies of patients with CKD stage 5, 18 years, of both sexes, under intervention upper limb exercises ipsilateral AVF. The main outcome measures were the increase in the diameter of the vein and blood flow rate related to the maturation of the AVF. Because the characteristics of items (small number of patients involved in the studies and the lack of blinding and allocation) were included only three items involving 94 participants. For the outcome of vein diameter was found mean difference of 0.36 (-0.95 to 1.67) and the blood flow rate outcome average difference of 107.87 (219.64 to -3.90). From these results, it is not possible to recommend the upper limb exercises ipsilateral AVF, given the lack of evidence to prove their effectiveness. We conclude that further studies with greater methodological rigor can be developed in order to check for effectiveness of exercise in AVF maturation process in these patients.

Traumatic arteriovenous fistulas of the neck are a relatively uncommon injury, whose ramifications can include immediate or delayed neurological insults, massive bleeding, or death. Angiography and embolization have been increasingly used to manage this complex injury pattern. In this particular case, the patient underwent management of bilateral communicating arteriovenous fistulae using a commercially available plug occlusion device. Epidemiology, with an emphasis on patient management and outcomes, is discussed.

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Darbo tikslas: nustatyti veiksnius, susijusius su arterioveninių jung¬čių (AVJ) dializuojamiems pacientams funkcionavimo trukme bei įvertinti jungčių funkcijos monitoravimo naudą jų funkcionavimo trukmei prail-ginti. Darbo uždaviniai: 1. Įvertinti AVJ funkcijos monitoravimo naudą jos funkcionavimo trukmei prailginti. 2. Nustatyti pirmosios hemodializės procedūros atlikimo būdo ryšį su paciento stacionarizavimo trukme. 3. Nustatyti veiksnius, susijusius su AVJ funkcionavimo trukme. 4. Nustatyti centrinės venos kateterio buvimo ir lokalizacijos reikšmę AVJ funkcionavimo trukmei. 5. Įvertinti AVJ „brandinimo“ trukmės ryšį su AVJ funkcionavimo trukme. 6. Įvertinti priešoperacinio kraujagyslių ultragarsinio ištyrimo reikšmę pirminių jungties disfunkcijų išsivystymui bei AVJ funkcionavimo trukmei. DARBO METODIKA Tyrimas atliktas Lietuvos sveikatos mokslų universiteto Nefrologijos klinikoje, gavus Kauno regioninio tyrimų etikos komiteto leidimą Nr. BE 2-20. Dalis duomenų buvo renkama retrospektyviai, naudojant medicinos dokumentaciją, kita dalis informacijos apie pacientų laboratorinių tyrimų duomenis bei HD procedūros parametrus buvo renkama viso tyrimo ei¬goje. Visos AVJ pagal buvo suskirstytos į tris grupes: 1. Istorinė grupė – monitoravimas taikytas nebuvo (187 pacientai, 260 AVJ); 2. Monitoruota grupė – AVJ buvo monitoruojamos nuo pirmosios per ją atliktos HD (29 pacientai, 31 AVJ); 3. Dalinai monitoruota grupė – AVJ naudojamos HD iki 2008 m. gruo-džio 31 d., o vėliau... [toliau žr. visą tekstą] / Patients to be treated with chronic hemodialysis (HD) must have blood vessel connection. There are three types of blood vessel connections: native arteriovenous fistula (AVF), synthetic prosthesis and permanent central venous catheter. Each connection has its strengths and weaknesses. Primary AVF dysfunction occurs in 7.5% of the whole population of patients receiving HD, and in up to 80% of high risk patients (those with diabetes, elderly patients, and women) [Mann et al 2005]. Compared to other blood vessel connections (permanent central venous catheter or synthetic prosthesis) function of properly formed AVF is the longest, and incurs the lowest incidence of infectious and thrombotic complications. All international guidelines on HD procedures recommend native AVF as the method of choice. Formation of blood vessel junctions and treatment of their complications account for up to 20% of all hospitalizations of patients with end stage renal failure in USA [Allon et al 2002], up to 30% in Canada [Mann et al 2005], and up to 25% in Europe [Pissoni et al 2002]. It should be stated that formation of AVF and treatment of their complications are very expensive, and therefore determining the causes of the development of AVF complications and their timely diagnosis and correction are extremely important. Various methods of monitoring of AVF function are used in many European and USA HD centers; however, the most important criterion of early diagnosis of AVF complications has not... [to full text]