Outcomes of operative intervention for ulcers over hemodialysis arteriovenous access
Bibliographic record
Abstract
INTRODUCTION: The native arteriovenous fistula (AVF) is the gold standard for long-term hemodialysis access. When native vein options are exhausted, arteriovenous graft (AVG) becomes the next choice. An ulcer over an AVF or AVG is a serious condition with the potential for life-threatening hemorrhage. OBJECTIVES: This study aims to present our experience with surgical management of ulcers over AVFs or AVGs. MATERIALS AND METHODS: Electronic records of 26 patients who underwent 27 consecutive surgical procedures for ulcers over AVFs or AVGs from December 31, 2016 to December 31, 2021 at the Royal Liverpool University Hospital were retrospectively analyzed. RESULTS: The majority were males (14/26, 53.8%) and the median age was 64.5 years. Operative repair was required for 25 ulcers over 24 AVFs and 2 ulcers over 2 AVGs. Ten patients (37%) presented with bleeding. Seventeen (63%) had impending bleeding suggested by a thin soft tissue covering or a false aneurysm at the site of the ulcer. Previous endovascular intervention for fistula outflow stenosis was a significant predictor for presenting with bleeding (p = 0.031). All ulcers (27/27, 100%) underwent excision and primary skin closure. Fistula wall defects were directly repaired in 18/27 (66.7%). Four/26 (14.8%) fistulas had to be ligated and 2 (7.4%) had end-to-end re-anastomosis after excision of damaged segments. Three/26 (11.53%) fistulas thrombosed immediately after the intervention. The overall fistula salvage rate was 73.08% (19/26). There was 1 (3.7%) patient mortality due to bleeding from wound breakdown after surgery. CONCLUSIONS: An acceptable fistula salvage rate can be expected following surgical repair of ulcers over AVFs and AVGs. A history of previous endovascular interventions for fistula outflow stenosis was a predictor of bleeding from these ulcers.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
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 | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 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".