Jennifer Joe, MD

Creating a vascular access in the presence of a cardiovascular implantable electronic device (CIED) in a patient with or approaching end-stage renal disease can be challenging. In this study, we aimed to evaluate the impact of a CIED on the outcomes of vascular access creation in hemodialysis patients and determine their effects on vascular access patency. This is a single-center retrospective review of hemodialysis patients who underwent vascular access creation after CIED placement. Outcomes… Show more

Creating a vascular access in the presence of a cardiovascular implantable electronic device (CIED) in a patient with or approaching end-stage renal disease can be challenging. In this study, we aimed to evaluate the impact of a CIED on the outcomes of vascular access creation in hemodialysis patients and determine their effects on vascular access patency. This is a single-center retrospective review of hemodialysis patients who underwent vascular access creation after CIED placement. Outcomes of vascular access creation and need for endovascular interventions were compared between patients with vascular access created ipsilateral and contralateral to the site of CIED. Comparing patients with arteriovenous (AV) access created ipsilateral to CIED placement (n = 19) versus the contralateral side (n = 17), the primary failure rate was 78.9% versus 35.3% (p = 0.02). For AV accesses that were matured, the median primary patency durations for AV accesses created ipsilateral to the CIED was 11.2 months compared to 7.8 months for AV accesses created contralateral to the CIED (p = 1.00). AV accesses created ipsilateral to a CIED have a higher primary failure rate compared with the contralateral arm and should be avoided as much as possible. Show less

Dialysis vascular access associated coronary-subclavian steal or hypoperfusion syndrome is an uncommon but potentially life threatening condition. Awareness of this syndrome is important in the management of vascular access in hemodialysis patients. We report a case of dialysis vascular access associated coronary-subclavian steal syndrome and review the literature on its pathogenesis and therapeutic implications.

Hemodynamically significant arterial inflow stenosis in dysfunctional fistulae and grafts is poorly understood. No reliable clinical methods exist to detect arterial inflow stenosis. In this study, we assessed the accuracy of a novel screening method to detect arterial inflow stenosis in dysfunctional fistulae and grafts following successful juxta-anastomotic and venous outflow intervention.

A complete guide to every aspect of interventional nephrology—an essential text for students, residents, fellows, and clinicians

There is currently a resurgence of interest in home hemodialysis, which includes ‘short-daily’ or ‘long slow nocturnal-daily’ treatment. A few singlecenter studies have published the benefits of daily home hemodialysis, which include improved cardiovascular risk profiles, mineral metabolism, morbidity and mortality, and, finally, better quality of life. The community has expressed concern about the performance of vascular access in home hemodialysis. This article evaluates the literature… Show more

There is currently a resurgence of interest in home hemodialysis, which includes ‘short-daily’ or ‘long slow nocturnal-daily’ treatment. A few singlecenter studies have published the benefits of daily home hemodialysis, which include improved cardiovascular risk profiles, mineral metabolism, morbidity and mortality, and, finally, better quality of life. The community has expressed concern about the performance of vascular access in home hemodialysis. This article evaluates the literature, suggests that all forms of vascular access in home hemodialysis are safe and reviews the favored buttonhole method of arteriovenous fistula puncture. Show less

Despite the high prevalence of cardiovascular disease documented among the African-American population, there has been little emphasis on the role of dyslipidemia as a prominent risk factor in this large subpopulation. Questions of medication efficacy also have been raised. Together, these factors may have affected awareness, diagnosis, and treatment rates.

This review describes important aspects of racial disparities in cardiovascular disease. The comparisons of this report are confined to the African American and Caucasian subgroups of the US population and to acknowledged contributors to the epidemic of coronary heart disease and cerebrovascular disease. This review emphasizes epidemiologic studies of cardiovascular disease, which have included noninvasive assessments intended to promote better understanding of the early asymptomatic signs in… Show more

This review describes important aspects of racial disparities in cardiovascular disease. The comparisons of this report are confined to the African American and Caucasian subgroups of the US population and to acknowledged contributors to the epidemic of coronary heart disease and cerebrovascular disease. This review emphasizes epidemiologic studies of cardiovascular disease, which have included noninvasive assessments intended to promote better understanding of the early asymptomatic signs in the pathologic cascade that lead to these cardiovascular events. This summary presents evidence of disparities in commonly accepted subclinical markers of cardiovascular disease to include carotid thickening and distensibility, electrocardiogram abnormalities, peripheral vascular disease, and coronary calcification. This review also summarizes the status of disparities in cardiovascular disease, coronary heart disease, and stroke. Show less