causes significant morbidity & mortality in patients on hemodialysis
⚡️Most AV access associated complications are due to vascular stenosis👇🏽
2/
💥 Role of Stents in Dialysis Vascular Access - Tweetorial
⚡️Indications for Stent Use
⚡️Recent Clinical Trials of Stents in Dialysis Vascular Access
⚡️Complications associated with Stent Use
1/
@ASDINNews
#VascularAccessPearls
causes significant morbidity & mortality in patients on hemodialysis
⚡️Most AV access associated complications are due to vascular stenosis👇🏽
2/
-Scribner’s Shunt in 1960 ➡️
-Brescia-Cimino AVF in 1966 ➡️
-1st Balloon Angioplasty in 1981 ➡️
-1st Bare Metal Stent in 1988 ➡️
-1st Covered Stent in 1996 ➡️
-DCB use in 2012
3/
-Percutaneous Balloon Angioplasty (PTA) remains the 1st line therapy for stenosis but it is NOT very effective
-AVF patency after PTA is only 50% at 6-months & it is worse for AVGs👇🏽
4/
-Hemodynamic stress
-Surgical trauma
-Cannulation needle trauma
-AVG
‼️But balloon angioplasty, the treatment for stenosis, can itself induce NIH & cause restenosis👇🏽
5/
⚡️What are Endovascular Stents?
They are scaffolds that provide mechanical endoluminal support to the vessel wall to maintain patency
6/
-1st generation stents were Bare-Metal Stents made of stainless steel
-Next generation of metal stents were Nitinol Stents made of nickel-titanium alloy
- Covered-Stents (Stent-Grafts) are Nitinol stents covered w/ ePTFE or Dacron
7/
⚡️Covered Stents (Stent-Grafts) theoretically form a barrier, & prevent tissue in-growth through the stent & cause less restenosis👇🏽
8/
⚡️But before we get to the trials, let’s discuss the basic indications for Stent use:
☄️Rupture of the vessel
☄️Recoil (Residual stenosis)
☄️Restenosis
9/
⚡️In most cases, extravasation can be controlled w/ manual compression or balloon tamponade but if bleeding persists then stents can be used to control the bleeding👇🏽
10/
⚡️Recoil is defined as residual stenosis of > 30% following angioplasty & is thought to occur due to elastic recoil of the vessel wall
⚡️Recoil is associated w/ poor AV access survival👇🏽
11/
⚡️AVG patency post-angioplasty is very poor👇🏽
⚡️Most common site for AVG stenosis is at the graft-vein anastomosis, therefore recent clinical trials have tested the Stent-grafts at this site👇🏽
12/
☄️Flair PIVOTAL Trial: Flair SG vs. PTA for AVG
☄️REVISE Trial: Viabahn SG vs PTA for AVG
⚡️Both trials showed better 6-month patency with SG use compared to PTA for graft-vein anastomosis stenosis👇🏽
13/
☄️RESCUE Trial: Fluency SG vs PTA for In-stent restenosis in both AVF & AVG
⚡️RESCUE Trial showed better 6-month patency with SG compared to PTA👇🏽
14/
☄️Recurrent graft-vein anastomosis stenosis in AVG
☄️In-stent restenosis in AVF & AVG👇🏽
16/
17/
☄️Stent Migration
☄️Stent Fracture
☄️Stent Strut Protrusion
☄️Jailing of the veins
☄️Infection
18/
⚡️Stent fracture & protrusion can occur due to repeated cannulation thru the stent👇🏽
⚡️Stent fracture can occur if stent is placed across a joint👇🏽
19/
⚡️Hence, the operator must be very careful during stent deployment in order to avoid this complication👇🏽
20/
⚡️Stent associated AV access infections are more common when the stents are placed in the Pseudo-aneurysms 👇🏽
21/
More from Health
Before we get too far into 2021, I thought I’d write a thread recapping some of the research that came out of my lab in 2020. Most of this work was led by my talented team of graduate students, Kerrianne Morrison, @kmdebrabander, and @DesiRJones.
Back in January, a news story was published about Kerrianne’s study showing improved social interaction outcomes for autistic adults when paired with another autistic partner.
A detailed thread about the study and a link to the paper can be found here (feel free to DM me your email address if you’d like a copy of the full paper for this study or any of our studies):
Another paper published early in 2020 (it appeared a few months earlier online) showed that traditional standalone tasks of social cognition are less predictive of functional and social skills among autistic adults than commonly assumed in autism research.
Next, @kmdebrabander led and published an innovative study about how well autistic and non-autistic adults can predict their own cognitive and social cognitive performance.
Back in January, a news story was published about Kerrianne’s study showing improved social interaction outcomes for autistic adults when paired with another autistic partner.
A detailed thread about the study and a link to the paper can be found here (feel free to DM me your email address if you’d like a copy of the full paper for this study or any of our studies):
In our new paper out today, autistic adults held a \u201cget to know you\u201d conversation with an unfamiliar autistic or typically-developing (TD) person. We were curious: would social interaction outcomes differ when their partner was also autistic? THREAD https://t.co/4koqUKV9G1
— Noah Sasson (@Noahsasson) December 11, 2019
Another paper published early in 2020 (it appeared a few months earlier online) showed that traditional standalone tasks of social cognition are less predictive of functional and social skills among autistic adults than commonly assumed in autism research.
How well does social cognition predict functional and social skills in autism? Our new paper attempts to answer this question. This thread summarizes why we conducted the study, what we found, and why I think it\u2019s important. https://t.co/KB1nIpK0M2
— Noah Sasson (@Noahsasson) August 16, 2019
Next, @kmdebrabander led and published an innovative study about how well autistic and non-autistic adults can predict their own cognitive and social cognitive performance.
New by @kmdebrabander and our lab: Autistic adults don\u2019t differ from non-autistic adults in the accuracy of their self-assessment on general cognitive tasks but are less accurate on social cognitive tasks. This however was unrelated to social functioning https://t.co/0MrqMKKO0r
— Noah Sasson (@Noahsasson) September 20, 2020
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I’m torn on how to approach the idea of luck. I’m the first to admit that I am one of the luckiest people on the planet. To be born into a prosperous American family in 1960 with smart parents is to start life on third base. The odds against my very existence are astronomical.
I’ve always felt that the luckiest people I know had a talent for recognizing circumstances, not of their own making, that were conducive to a favorable outcome and their ability to quickly take advantage of them.
In other words, dumb luck was just that, it required no awareness on the person’s part, whereas “smart” luck involved awareness followed by action before the circumstances changed.
So, was I “lucky” to be born when I was—nothing I had any control over—and that I came of age just as huge databases and computers were advancing to the point where I could use those tools to write “What Works on Wall Street?” Absolutely.
Was I lucky to start my stock market investments near the peak of interest rates which allowed me to spend the majority of my adult life in a falling rate environment? Yup.
Ironies of Luck https://t.co/5BPWGbAxFi
— Morgan Housel (@morganhousel) March 14, 2018
"Luck is the flip side of risk. They are mirrored cousins, driven by the same thing: You are one person in a 7 billion player game, and the accidental impact of other people\u2019s actions can be more consequential than your own."
I’ve always felt that the luckiest people I know had a talent for recognizing circumstances, not of their own making, that were conducive to a favorable outcome and their ability to quickly take advantage of them.
In other words, dumb luck was just that, it required no awareness on the person’s part, whereas “smart” luck involved awareness followed by action before the circumstances changed.
So, was I “lucky” to be born when I was—nothing I had any control over—and that I came of age just as huge databases and computers were advancing to the point where I could use those tools to write “What Works on Wall Street?” Absolutely.
Was I lucky to start my stock market investments near the peak of interest rates which allowed me to spend the majority of my adult life in a falling rate environment? Yup.
1/12
RT-PCR corona (test) scam
Symptomatic people are tested for one and only one respiratory virus. This means that other acute respiratory infections are reclassified as
2/12
It is tested exquisitely with a hypersensitive non-specific RT-PCR test / Ct >35 (>30 is nonsense, >35 is madness), without considering Ct and clinical context. This means that more acute respiratory infections are reclassified as
3/12
The Drosten RT-PCR test is fabricated in a way that each country and laboratory perform it differently at too high Ct and that the high rate of false positives increases massively due to cross-reaction with other (corona) viruses in the "flu
4/12
Even asymptomatic, previously called healthy, people are tested (en masse) in this way, although there is no epidemiologically relevant asymptomatic transmission. This means that even healthy people are declared as COVID
5/12
Deaths within 28 days after a positive RT-PCR test from whatever cause are designated as deaths WITH COVID. This means that other causes of death are reclassified as
RT-PCR corona (test) scam
Symptomatic people are tested for one and only one respiratory virus. This means that other acute respiratory infections are reclassified as
4/10
— Dr. Thomas Binder, MD (@Thomas_Binder) October 22, 2020
...indication, first of all that testing for a (single) respiratory virus is done outside of surveillance systems or need for specific therapy, but even so the lack of consideration of Ct, symptoms and clinical findings when interpreting its result. https://t.co/gHH6kwRdZG
2/12
It is tested exquisitely with a hypersensitive non-specific RT-PCR test / Ct >35 (>30 is nonsense, >35 is madness), without considering Ct and clinical context. This means that more acute respiratory infections are reclassified as
6/10
— Dr. Thomas Binder, MD (@Thomas_Binder) October 22, 2020
The neither validated nor standardised hypersensitive RT-PCR test / Ct 35-45 for SARS-CoV-2 is abused to mislabel (also) other diseases, especially influenza, as COVID-19.https://t.co/AkFIfTCTkS
3/12
The Drosten RT-PCR test is fabricated in a way that each country and laboratory perform it differently at too high Ct and that the high rate of false positives increases massively due to cross-reaction with other (corona) viruses in the "flu
External peer review of the RTPCR test to detect SARS-CoV-2 reveals 10 major scientific flaws at the molecular and methodological level: consequences for false positive results.https://t.co/mbNY8bdw1p pic.twitter.com/OQBD4grMth
— Dr. Thomas Binder, MD (@Thomas_Binder) November 29, 2020
4/12
Even asymptomatic, previously called healthy, people are tested (en masse) in this way, although there is no epidemiologically relevant asymptomatic transmission. This means that even healthy people are declared as COVID
Thread web\u2b06\ufe0f\u2b07\ufe0f
— Dr. Thomas Binder, MD (@Thomas_Binder) December 16, 2020
The fabrication of the "asymptomatic (super) spreader" is the coronation of the total nons(ci)ense in the belief system of #CoronasWitnesses.
Asymptomatic transmission 0.7%; 95% CI 0%-4.9% - could well be 0%!https://t.co/VeZTzxXfvT
5/12
Deaths within 28 days after a positive RT-PCR test from whatever cause are designated as deaths WITH COVID. This means that other causes of death are reclassified as
8/8
— Dr. Thomas Binder, MD (@Thomas_Binder) March 24, 2020
By the way, who the f*** created this obviously (almost) worldwide definition of #CoronaDeath?
This is not only medical malpractice, this is utterly insane!https://t.co/FFsTx4L2mw
fascinated by this man, mario cortellucci, and his outsized influence on ontario and GTA politics. cortellucci, who lives in vaughan and ran as a far-right candidate for the italian senate back in 2018 - is a major ford donor...
his name might sound familiar because the new cortellucci vaughan hospital at mackenzie health, the one doug ford has been touting lately as a covid-centric facility, is named after him and his family
but his name also pops up in a LOT of other ford projects. for instance - he controls the long term lease on big parts of toronto's portlands... where doug ford once proposed building an nfl stadium and monorail... https://t.co/weOMJ51bVF
cortellucci, who is a developer, also owns a large chunk of the greenbelt. doug ford's desire to develop the greenbelt has been
and late last year he rolled back the mandate of conservation authorities there, prompting the resignations of several members of the greenbelt advisory
his name might sound familiar because the new cortellucci vaughan hospital at mackenzie health, the one doug ford has been touting lately as a covid-centric facility, is named after him and his family
but his name also pops up in a LOT of other ford projects. for instance - he controls the long term lease on big parts of toronto's portlands... where doug ford once proposed building an nfl stadium and monorail... https://t.co/weOMJ51bVF
cortellucci, who is a developer, also owns a large chunk of the greenbelt. doug ford's desire to develop the greenbelt has been
and late last year he rolled back the mandate of conservation authorities there, prompting the resignations of several members of the greenbelt advisory
