Basilic vein transposition for unsuitable upper arm hemodialysis needle access segment may attenuate concurrent hand ischemia
Bibliographic record
Abstract
Abstract Introduction: Some hemodialysis patients with a brachial arteriovenous fistula (AVF) have an unsuitable upper arm needle access segment (NAS) necessitating basilic vein transposition (BVT). It was frequently observed that a portion of these patients spontaneously experienced a warmer and less painful dialysis hand after BVT. Aim of this study was to determine whether BVT for an inadequate NAS attenuated hemodialysis access‐induced distal ischemia in patients with a brachial AVF. Methods: Patients with a brachial AVF and an unsuitable NAS also reporting hand ischemia and scheduled to undergo BVT between 2005 and 2016 in a single facility were studied. Hand ischemia was graded as proposed in a 2016 consensus meeting. Hand ischemic questionnaire (HIQ‐) scores (0 points, no ischemia—500 points, maximal ischemia), digital brachial index (DBI, ischemia <0.6) and access flow (mL/min) before and after BVT were compared. The cephalic vein and all side branches of the basilic vein were ligated during the BVT. Findings: Ten patients were studied (8 males, 61 [54–75] years). BVT was performed 8 [4–10] months following the initial AVF construction. HIQ‐scores dropped from 220 [71–285] to 9 [0–78] (P = 0.043) postoperatively, whereas DBI increased from 0.51 [0.39–0.67] to 0.85 [0.68–0.97] (P = 0.012). DBI and HIQ‐scores were inversely correlated (R2=71%, P = 0.001). Access flows dropped significantly (Flowpre 1120 mL/min [1100–2300] vs. Flowpost 700 mL/min [600–1760]; P = 0.018). Surgery‐associated complications were absent and dialysis continued uninterruptedly. Eight patients reported total recovery from hand ischemia six weeks postoperatively. Discussion: Basilic vein transposition for an unsuitable upper arm needle access segment may attenuate hand ischemia in patients with a brachial AVF previously reporting hemodialysis access‐induced distal ischemia.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".