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Munde Y, Agrawal N, Shah J, Lanjewar P, Jawale S. Running out of vascular access in chronic kidney disease patients - A case report on translumbar dialysis catheter. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2021. [DOI: 10.4103/ijves.ijves_173_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kilcoyne MF, Do-Nguyen CC, Moulick A, Madan N, Mahan V, Conley S, Brady PS, Endean ED, Stevens RM. Left innominate vein creation using left internal jugular vein tunneled to right internal jugular vein. J Card Surg 2020; 35:2370-2374. [PMID: 32652646 DOI: 10.1111/jocs.14654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Left innominate vein occlusion is a known complication of pacemaker and central venous catheter placement. For dialysis-dependent patients with an arteriovenous fistula (AVF), this can prevent successful hemodialysis and may require surgical intervention. CASE REPORT An 8-month-old male was diagnosed with hemolytic uremic syndrome and became dialysis-dependent at 11 months of age. After multiple vascular access and peritoneal dialysis complications, the patient had construction of a brachiobasalic AVF in his left arm at 13 years old. While waiting for the AVF to mature, an attempt to remove a previously placed left subclavian vein port-a-cath was unsuccessful and a follow-up imaging revealed that the vessel had become occluded. The fistula remained patent, but due to arm swelling and venous obstruction, his fistula was not accessible. Multiple attempts to percutaneously cross the left innominate vein were unsuccessful and the patient was referred for surgical intervention. At 15 years old, the patient was taken to the operating room for transposition of the left internal jugular vein (LIJ) to the right internal jugular vein (RIJ). The LIJ was transected under the mandible and anastomosed to the RIJ. Subsequently the patient underwent VWING insertion rather than venous transposition for constant site dialysis. Although he has required frequent transcatheter dilation of the LIJ-RIJ anastomosis, the patient was successfully dialyzed using this fistula for 5 years. The patient received a cadaveric renal transplant at 5 years 20 days. CONCLUSIONS In cases of left innominate vein stenosis, transposing the LIJ can create a new left innominate vein that can alleviate venous hypertension and preserve fistula function. This procedure avoids sternotomy and only requires one anastomosis.
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Affiliation(s)
- Maxwell F Kilcoyne
- Doctor of Osteopathic Medicine Program, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Chi Chi Do-Nguyen
- Doctor of Osteopathic Medicine Program, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Achintya Moulick
- Department of Pediatric Cardiovascular and Thoracic Surgery, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania
| | - Nandini Madan
- Department of Pediatric Cardiology, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania
| | - Vicki Mahan
- Department of Pediatric Cardiovascular and Thoracic Surgery, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania
| | - Susan Conley
- Department of Pediatric Nephrology, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania
| | - Paul S Brady
- Department of Cardiovascular and Interventional Radiology, Albert Einstein Healthcare Network, Philadelphia, Pennsylvania
| | - Eric D Endean
- Department of Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Randy M Stevens
- Department of Pediatric Cardiovascular and Thoracic Surgery, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania
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Lazarides MK, Argyriou C, Koutsoumpelis A, Georgakarakos EI, Georgiadis GS. Thigh arteriovenous grafts. Quantitative comparison with alternative options: A meta-analysis. J Vasc Access 2018; 19:430-435. [PMID: 29552941 DOI: 10.1177/1129729818762991] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Thigh arteriovenous grafts are required in a number of patients with exhausted upper extremity veins and comprise 1%-5% of the total access procedures performed. Alternative autogenous lower extremity options are the rarely used sapheno-tibial arteriovenous fistulae, the saphenous vein transpositions, and the femoral vein transpositions. The latter have proven to be the most durable lower limb access procedures, with low infection rates and their primary patency rates ranged from 74% up to 87% at 2 years. Synthetic thigh grafts are suitable for patients who are not good candidates for any upper limb or any autogenous lower limb access and their secondary patency rates ranged from 54% up to 83% at 2 years. Thigh grafts often get infected and their average weighed infection rate in 920 such grafts included in eight large series was 22.9%. A literature search was performed to evaluate thigh grafts compared with alternative options using meta-analysis. Lower limb accesses were found superior compared to HeRO® device regarding 1-year primary failure rate (odds ratio = 0.28, confidence interval = 0.09-0.88, p = 0.03) and additionally autogenous lower limb accesses were found superior compared to thigh grafts regarding the 1-year primary failure rate (odds ratio = 6.54, confidence interval = 2.29-18.72, p = 0.0005).
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Affiliation(s)
- Miltos K Lazarides
- 1 Medical School, University of Cyprus, Nicosia, Cyprus.,2 Department of Vascular Surgery, Democritus University of Thrace, Alexandroupolis, Greece
| | - Christos Argyriou
- 2 Department of Vascular Surgery, Democritus University of Thrace, Alexandroupolis, Greece
| | - Andreas Koutsoumpelis
- 2 Department of Vascular Surgery, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - George S Georgiadis
- 2 Department of Vascular Surgery, Democritus University of Thrace, Alexandroupolis, Greece
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Mansour M, Kamper L, Altenburg A, Haage P. Radiological Central Vein Treatment in Vascular Access. J Vasc Access 2018. [DOI: 10.1177/112972980800900203] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In the last decades, the percutaneous interventional approach for the treatment of central venous obstructions (CVO) has become increasingly popular as the treatment of first choice because of its minimal invasiveness and reported success rates. CVOs are caused by a diverse spectrum of diseases which can be broadly categorized into two principal eliciting genera, either benign or malignant obstructions. The large group of benign venous obstructions includes the increasing number of end-stage renal disease patients with vascular access related complications. Due to the invasiveness and complexity of thoracic surgery for benign CVOs, the less invasive percutaneous interventional therapy can generally be considered the preferred treatment option. Initially, the radiological intervention consisted of balloon angioplasty alone, subsequently additional stent placement was applied. This was advocated as either primary placement or secondary in cases of elastic recoil or residual stenosis after percutaneous transluminal angioplasty (PTA). The efficacy of angioplasty of CVO in patients with vascular accesses, either with or without stenting, has been addressed by various studies. Overall, reports indicate an initial technical and clinical success rate above 95% and satisfactory patency rates. However, systematic follow-up and frequent re-interventions are necessary to maintain vascular patency to achieve long-term success.
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Affiliation(s)
- M. Mansour
- Department of Diagnostic and Interventional Radiology, HELIOS Klinikum Wuppertal, University Hospital Witten/Herdecke, Wuppertal - Germany
| | - L. Kamper
- Department of Diagnostic and Interventional Radiology, HELIOS Klinikum Wuppertal, University Hospital Witten/Herdecke, Wuppertal - Germany
| | - A. Altenburg
- Department of Diagnostic and Interventional Radiology, HELIOS Klinikum Wuppertal, University Hospital Witten/Herdecke, Wuppertal - Germany
| | - P. Haage
- Department of Diagnostic and Interventional Radiology, HELIOS Klinikum Wuppertal, University Hospital Witten/Herdecke, Wuppertal - Germany
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Primary and secondary patencies of transposed femoral vein fistulas are significantly greater than with the HeRO graft. J Vasc Access 2017; 18:232-237. [DOI: 10.5301/jva.5000697] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2017] [Indexed: 11/20/2022] Open
Abstract
Introduction For access-challenged patients with bilateral upper extremity central venous stenosis, solutions include the Hemodialysis Reliable Outflow (HeRO) device or an autogenous AV fistula in the lower limb. We evaluated HeRO grafts and transpositions of the femoral vein in maintaining primary and secondary patency. Methods We retrospectively analyzed 40 patients with a HeRO device and 18 patients with superficial femoral artery to transposed femoral vein autogenous arteriovenous fistula (SFA-tFV). All patients had bilateral central venous obstruction. All procedures were outpatient performed by a single surgeon at one center between 2009-2015. Operative details, intraoperative flows, and flows at the first-week postoperative visit were analyzed, as were primary and secondary patency and intervention rates. Complications were compared between groups. Results The one-year cumulative primary patency was 30% for HeRO grafts and 79% for SFA-tFV fistulas (p = 0.0001); secondary patency was 71% for HeRO grafts and 93% for SFA-tFV fistulas (p = 0.03). To maintain patency, HeRO patients required a mean 2.1 interventions per year and thigh fistula patients required a mean 0.4 interventions per year. Thirty-seven percent of thigh fistula patients had a hematoma or seroma versus 5% of HeRO patients and 17% of thigh fistula patients experienced delayed wound healing versus 2.5% of HeRO patients (p<0.05). None of the thigh fistula patients had distal ischemia. Conclusions HeRO patients had lower primary and secondary patency rates versus thigh fistula patients and HeRO grafts required five-fold more interventions to maintain secondary patency. However, patients with thigh fistulas had significantly more wound healing problems. Thus, the SFA-tFV has become our access of choice for patients with bilateral central venous stenosis.
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Straight configuration saphenous vein transposition to popliteal artery for vascular access. J Vasc Access 2017; 18:e15-e17. [PMID: 27768206 DOI: 10.5301/jva.5000608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2016] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The saphenous vein is commonly used as a vascular graft in peripheral artery surgery but rarely used for vascular access. The literature on straight configuration saphenous vein transposition to the popliteal artery is scarce. Here we present two cases of straight configuration saphenous vein transposition to the popliteal artery for vascular access, the surgical technique and respective follow-up. CASE REPORT Two young men, aged 29 and 36 years, were chosen for lower-limb vascular access for hemodialysis. The first patient was paraplegic since birth. He used his arms to move so upper extremity vascular access was avoided. The second patient presented with an infected upper extremity arteriovenous graft (AVG) and after multiple closed AVFs he had no more available arm veins. Both patients received autologous lower extremity straight configuration saphenous vein transpositions to the popliteal artery under spinal anesthesia in May and October 2012, respectively. Cannulation of the fistula was allowed after one month. There were no early complications. Slight swelling on the leg appeared in one of the patients. Both fistulas were still functional after 36 and 32 months, respectively. CONCLUSIONS The straight configuration saphenous vein transposition to popliteal artery is simple to perform, offers a long and straight segment for cannulation and may be a suitable autologous vascular access in selected patients.
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Hajji M, Harzallah A, Kaaroud H, Jerbi M, Chargui S, Younsi FE, Hamida FB, Abdallah TB. [Exhaustion of vascular capital in patients on hemodialysis: what will be the outcome?]. Pan Afr Med J 2017; 25:237. [PMID: 28293353 PMCID: PMC5337301 DOI: 10.11604/pamj.2016.25.237.10665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 11/02/2016] [Indexed: 11/11/2022] Open
Abstract
Despite advances in the treatment of chronic renal failure, vascular access remains the weakest link in renal replacement therapy (RRT) and the leading cause of morbidity in patients on hemodialysis We report the case of a young female patient with chronic renal insufficiency secondary to vascular nephropathy on periodic hemodialysis and whose vascular capital was early exhausted due to iterative thromboses in arteriovenous fistulas and failure in peritoneal dialysis. Protein C deficiency was objectified. The patient underwent tunneled hemodialysis catheter insertion at the level of the right atrium via a right anterolateral thoracotomy with cannulation of the inferior vena cava, with poor functional outcome after three months of use. Since then she has been dialyzed using puncture of the external jugular veins.
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Affiliation(s)
- Meriam Hajji
- Service de Médecine Interne A, Hôpital Charles Nicolle, Tunis, Tunisie; Laboratoire de Pathologie Rénale LR00SP01, Hôpital Charles Nicolle, Tunis, Tunisie
| | - Amel Harzallah
- Service de Médecine Interne A, Hôpital Charles Nicolle, Tunis, Tunisie; Laboratoire de Pathologie Rénale LR00SP01, Hôpital Charles Nicolle, Tunis, Tunisie
| | - Hayet Kaaroud
- Service de Médecine Interne A, Hôpital Charles Nicolle, Tunis, Tunisie; Laboratoire de Pathologie Rénale LR00SP01, Hôpital Charles Nicolle, Tunis, Tunisie
| | - Mona Jerbi
- Service de Médecine Interne A, Hôpital Charles Nicolle, Tunis, Tunisie; Laboratoire de Pathologie Rénale LR00SP01, Hôpital Charles Nicolle, Tunis, Tunisie
| | - Soumaya Chargui
- Service de Médecine Interne A, Hôpital Charles Nicolle, Tunis, Tunisie; Laboratoire de Pathologie Rénale LR00SP01, Hôpital Charles Nicolle, Tunis, Tunisie
| | - Fethi El Younsi
- Service de Médecine Interne A, Hôpital Charles Nicolle, Tunis, Tunisie; Laboratoire de Pathologie Rénale LR00SP01, Hôpital Charles Nicolle, Tunis, Tunisie
| | - Fethi Ben Hamida
- Laboratoire de Pathologie Rénale LR00SP01, Hôpital Charles Nicolle, Tunis, Tunisie; Faculté de Médecine de Tunis, université Tunis El Manar, Tunis, Tunisie
| | - Taieb Ben Abdallah
- Service de Médecine Interne A, Hôpital Charles Nicolle, Tunis, Tunisie; Laboratoire de Pathologie Rénale LR00SP01, Hôpital Charles Nicolle, Tunis, Tunisie
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Early cannulation graft Flixene™ for conventional and complex hemodialysis access creation. J Vasc Access 2017; 18:109-113. [PMID: 28165572 DOI: 10.5301/jva.5000550] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2016] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The Flixene™ (Atrium™, Hudson, NH) is a trilaminate composite polytetrafluoroethylene (PTFE) graft that allows access within 72 hours. We evaluate our initial experience with this device for conventional and complex hemodialysis access creation. METHODS Retrospective review in end-stage renal disease (ESRD) patients who underwent access creation with Flixene from January 2013 to July 2014. For our analysis, the patients were divided in two groups: those with complex access configurations tunneled in the chest and/or abdominal wall (thoraco-abdominal wall access [TAWA]), and those tunneled in conventional sites (extremity access [EA]). Patient's demographics, indications, complications, reinterventions, patency rates and factors influencing outcomes were evaluated. RESULTS In 19 patients (54% men; mean age 44 years ± 18), 24 grafts were implanted, (13 EA [54%] vs. 11 TAWA), all patent after surgery. Central venous occlusive disease (CVOD) was present in all patients with TAWA and in 7/13 (54%) EA patients (p = 0.016). Early cannulation (within 72 hours) was successful in 12 EA and 5 TAWA grafts (p = 0.044). Complication rates including infection, thrombosis, bleeding and steal syndrome were 8/11 (73%) in TAWA and 5/13 (38%) in EA (p = 0.02). At 12 months, primary patency rates for EA and TAWA were 25% and 41%; secondary patency rates were 55% and 41%, respectively. CONCLUSIONS Early cannulation (EC) grafts are viable alternatives for conventional and complex access creation that allowed early cannulation (<72 hours) in 17 (70%) of our cases. Primary and secondary patency rates at 12 months were equivalent to data reported on ePTFE grafts.
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9
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Gale-Grant O, Chemla ES. Single-center results of a series of prosthetic axillary-axillary arteriovenous access grafts for hemodialysis. J Vasc Surg 2016; 64:1741-1746. [DOI: 10.1016/j.jvs.2016.07.101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 07/17/2016] [Indexed: 10/20/2022]
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10
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MacRae JM, Dipchand C, Oliver M, Moist L, Yilmaz S, Lok C, Leung K, Clark E, Hiremath S, Kappel J, Kiaii M, Luscombe R, Miller LM. Arteriovenous Access: Infection, Neuropathy, and Other Complications. Can J Kidney Health Dis 2016; 3:2054358116669127. [PMID: 28270919 PMCID: PMC5332082 DOI: 10.1177/2054358116669127] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 08/04/2016] [Indexed: 12/16/2022] Open
Abstract
Complications of vascular access lead to morbidity and may reduce quality of life. In this module, we review both infectious and noninfectious arteriovenous access complications including neuropathy, aneurysm, and high-output access. For the challenging patients who have developed many complications and are now nearing their last vascular access, we highlight some potentially novel approaches.
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Affiliation(s)
- Jennifer M MacRae
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | | | - Matthew Oliver
- Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Louise Moist
- Department of Medicine, University of Western Ontario, London, Canada
| | - Serdar Yilmaz
- Department of Surgery, University of Calgary, Alberta, Canada
| | - Charmaine Lok
- Faculty of Medicine, University Health Network, University of Toronto, Ontario, Canada
| | - Kelvin Leung
- Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Edward Clark
- Faculty of Medicine, University of Ottawa, Ontario, Canada
| | | | - Joanne Kappel
- Faculty of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Mercedeh Kiaii
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Rick Luscombe
- Department of Nursing, Providence Health Care, Vancouver, British Columbia, Canada
| | - Lisa M Miller
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
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Surgical Options in the Problematic Arteriovenous Haemodialysis Access. Cardiovasc Intervent Radiol 2015; 38:1405-15. [DOI: 10.1007/s00270-015-1155-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 05/30/2015] [Indexed: 11/27/2022]
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Liu F, Bennett S, Arrigain S, Schold J, Heyka R, McLennan G, Navaneethan SD. Patency and Complications of Translumbar Dialysis Catheters. Semin Dial 2015; 28:E41-7. [PMID: 25800550 PMCID: PMC4836066 DOI: 10.1111/sdi.12358] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Translumbar tunneled dialysis catheter (TLDC) is a temporary dialysis access for patients exhausted traditional access for dialysis. While few small studies reported successes with TLDC, additional studies are warranted to understand the short- and long-term patency and safety of TLDC. We conducted a retrospective analysis of adult patients who received TLDC for hemodialysis access from June 2006 to June 2013. Patient demographics, comorbid conditions, dialysis details, catheter insertion procedures and associated complications, catheter patency, and patient survival data were collected. Catheter patency was studied using Kaplan-Meier curve; catheter functionality was assessed with catheter intervals and catheter-related complications were used to estimate catheter safety. There were 84 TLDCs inserted in 28 patients with 28 primary insertions and 56 exchanges. All TLDC insertions were technically successful with good blood flow during dialysis (>300 ml/minute) and no immediate complications (major bleeding or clotting) were noted. The median number of days in place for initial catheter, secondary catheter, and total catheter were 65, 84, and 244 respectively. The catheter patency rate at 3, 6, and 12 months were 43%, 25%, and 7% respectively. The main complications were poor blood flow (40%) and catheter-related infection (36%), which led to 30.8% and 35.9% catheter removal, respectively. After translumbar catheter, 42.8% of the patients were successfully converted to another vascular access or peritoneal dialysis. This study data suggest that TLDC might serve as a safe, alternate access for dialysis patients in short-term who have exhausted conventional vascular access.
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Affiliation(s)
- Fanna Liu
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
- Department of Nephrology, the First Affiliated Hospital of Jinan University, Guangzhou, China
| | | | - Susana Arrigain
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Jesse Schold
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Robert Heyka
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | | | - Sankar D. Navaneethan
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
- Cleveland Clinic Lerner College of Medicine of CWRU, Cleveland, OH
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Endovascular salvage of a right brachial artery-right atrium hemodialysis graft using a covered endoprosthesis. J Vasc Access 2015; 13:520-3. [PMID: 22522413 DOI: 10.5301/jva.5000072] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2012] [Indexed: 11/20/2022] Open
Abstract
Creation of a functional hemodialysis access in patients with exhausted peripheral access sites and concomitant central venous occlusive disease (CVOD) is a multifaceted challenge; often requiring complex, innovative solutions, not without their own complications. We present a 57-year-old hemodialysis patient with a history of hypercoagulable disorder and multiple failed arteriovenous accesses. Because of inadequate peripheral access sites and chronic occlusions in superior vena cava, brachiocephalic veins and inferior vena cava, in addition to multiple transhepatic catheter related issues; we decided to perform a right brachial artery to right atrium (RA) hemodialysis graft. The access was used without complications for 18 months at which point he had his first episode of thrombosis; open thrombectomy and percutaneous balloon angioplasty (PTA) at the atrial anastomosis were done with success. The following three months, he endured two more thrombectomies and PTAs. During the last intervention we performed an intravascular Ultrasound (IVUS) through the atrial anastomosis, which demonstrated stenosis; and the decision was made to extend the outflow anastomosis with a covered stent into the atrium. Therefore a 10 cm x 10 mm Viabahn stent-graft (W. L. Gore and Associates, Flagstaff, Ariz.) was deployed and post dilated with 8 mm balloon within the graft component. Repeat injection and Intravascular Ultrasound (IVUS) demonstrated significant improvement and free outflow. The brachial-RA hemodialysis graft could be use immediately and at 5 months has remained fully functional and no reinterventions have been necessary.
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Alternative venous outflow by brachial to jugular vein vascular access for hemodialysis in the exhausted upper extremities. J Vasc Access 2015; 16:269-74. [PMID: 25656257 DOI: 10.5301/jva.5000363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2015] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND A shunt is usually created from the distal arm (wrist) to the proximal arm (axillary loop) as long as no central stenosis has occurred. Creating vascular access in a patient with central vein stenosis could induce venous hypertension in the upper extremities. In such patients, an ipsilateral internal jugular vein (IJV) as an arteriovenous (AV) outflow vein should be the last option for using a particular arm. METHODS Thirty-two patients who had AV hemodialysis access via a jugular vein were analyzed retrospectively from 2001 to 2011. All patients had an ipsilateral subclavian or axillary vein stenosis. The preserved IJV and innominate veins were preoperatively confirmed with Doppler echocardiography and contrast venography. RESULTS Mean age of the patients was 57.6 ± 12.3 years, and the mean follow-up period was 43.5 ± 27.4 months. Primary patency was 74%, 54%, 32%, 15% and 5% at 6 months, 1, 2, 3 and 4 years, respectively. Secondary patency was 97%, 93%, 93%, 89%, 79% and 72% at 6 months, 1, 2, 3, 4, and 5 years, respectively. One case of steal syndrome, 2 of seroma, 1 hematoma, 3 swollen arm, 2 infections, 1 pseudoaneurysm, 1 bleeding from puncture site, 8 stenoses and 13 thrombosis cases were noted. CONCLUSIONS A brachial-jugular AV graft showed satisfactory results in terms of patency and complication rate. The IJV could be a good outflow vein for an AV fistula if the IJV is preserved in patients with chronic renal failure who have subclavian or axillary vein stenosis or occlusion.
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Bilateral Central Vein Stenosis: Options for Dialysis Access and Renal Replacement Therapy when all upper Extremity Access Possibilities have been Lost. J Vasc Access 2014; 15:466-73. [DOI: 10.5301/jva.5000268] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2014] [Indexed: 11/20/2022] Open
Abstract
Purpose Patients with bilateral central vein stenosis present a unique challenge: treatment options are limited, largely unproven and associated with reputedly poor outcomes. Our aim was to compare patency rates of different access and renal replacement treatment (RRT) modalities in patients with bilateral central vein stenosis/occlusion. Material and methods Data on all patients presenting to a tertiary referral vascular access centre with end-stage vascular access (defined by bilateral central vein stenosis/occlusion with loss of upper limb access) over a 5-year period were included. 3, 6 and 12-month patencies of translumbar catheters (TLs), tunnelled femoral catheters (Fem), native long saphenous vein loops (SV), prosthetic mid-thigh loop grafts (ThGr), peritoneal dialysis (PD), and expedited donation after cardiac death (DCD) cadaveric renal transplants (Tx) via local allocation policies were compared using log-rank test. Kaplan–Meier survival analysis was used to estimate long-term access survival. Results One hundred forty-six vascular access modalities were attempted in 62 patients (62 Fem, 25 TL, 15 SV, 25 ThGr, 8 PD, 11 Tx). Median follow-up was 876±57 days. Three, 6 and 12-month primary-assisted patencies for each modality were as follows: Fem: 75.4%, 60% and 28%; TL: 88%, 65% and 50%; SV: 87.5%, 60% and 44.6%; ThGr: 64%, 38% and 23.5%; PD: 62.5%, 62.5% and 50%; Tx: 72.7%, 72.7% and 72.7%. SV had better secondary patency at 900 days (76.9%) than ThGr (49.2%) or Fem (35.8%) (p<0.01). No patients died as a result of loss of access. Conclusion Patients with bilateral central vein stenosis often require more than one vascular access modality to achieve a “personal access solution.” Native long saphenous vein loops provided the best long-term patency. Expedited renal transplantation with priority local allocation of DCD organs to patients with precarious vascular access provides a potential solution to this difficult problem.
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Abstract
The most complex patients requiring vascular access are those with bilateral central vein occlusions. Endovascular repair of the central lesions when feasible allow upper extremity use for access. When endovascular repair is not feasible, femoral vein transposition should be the next choice. When lower limb access sites have been exhausted or are contraindicated as in obese patients and in patients with peripheral arterial obstructive disease, a range of extrathoracic "exotic" extra-anatomic access procedures as the necklace cross-chest arteriovenous (AV) grafts, the ipsilateral axillo-axillary loops, the brachial-jugular AV grafts, the axillo-femoral AV grafts or even intra-thoracic ones as the right atrial AV bypasses represent the vascular surgeon's last resort. The selection among those extra-anatomical chest-wall procedures should be based upon each patient's anatomy or patient-specific factors.
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Midterm experience of ipsilateral axillary-axillary arteriovenous loop graft as tertiary access for haemodialysis. J Transplant 2014; 2014:908738. [PMID: 24778864 PMCID: PMC3981058 DOI: 10.1155/2014/908738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 01/21/2014] [Accepted: 02/06/2014] [Indexed: 11/17/2022] Open
Abstract
Objectives. To present a series of ipsilateral axillary artery to axillary vein loop arm grafts as an alternative vascular access procedure for haemodialysis in patients with difficult access. Design. Retrospective case series. Methods. Patients who underwent an axillary loop arteriovenous graft from September 2009 to September 2012 were included. Preoperative venous imaging to exclude central venous stenosis and to image arm/axillary veins was performed. A cuffed PTFE graft was anastomosed to the distal axillary artery and axillary vein and looped on the arm. Results. 25 procedures were performed on 22 patients. Median age was 51 years, with 9 males and 13 females. Median number of previous access procedures was 3 (range 0–7). Median followup was 16.4 months (range 1–35). At 3 months and 1 year, the primary and secondary patency rates were 70% and 72% and 36% and 37%, respectively. There were 11 radiological interventions in 6 grafts including 5 angioplasties and 6 thrombectomies. There were 19 surgical procedures in 10 grafts, including thrombectomy, revision, repair for bleeding, and excision. Conclusions. Our series demonstrates that the axillary loop arm graft yields acceptable early patency rates in a complex group of patients but to maintain graft patency required high rates of surgical and radiological intervention, in particular graft thrombectomy.
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Skupien FJ, Gomes RZ, Shimada EH, Brandao RI, Skupien SV. Transposition of cephalic vein to rescue hemodialysis access arteriovenous fistula and treat symptomatic central venous obstruction. J Vasc Bras 2014. [DOI: 10.1590/jvb.2014.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
It is known that stenosis or central venous obstruction affects 20 to 50% of patients who undergo placement of catheters in central veins. For patients who are given hemodialysis via upper limbs, this problem causes debilitating symptoms and increases the risk of loss of hemodialysis access. We report an atypical case of treatment of a dialysis patient with multiple comorbidities, severe swelling and pain in the right upper limb (RUL), few alternative sites for hemodialysis vascular access, a functioning brachiobasilic fistula in the RUL and severe venous hypertension in the same limb, secondary to central vein occlusion of the internal jugular vein and right brachiocephalic trunk. The alternative surgical treatment chosen was to transpose the RUL cephalic vein, forming a venous necklace at the anterior cervical region, bypassing the site of venous occlusion. In order to achieve this, we dissected the cephalic vein in the right arm to its junction with the axillary vein, devalved the cephalic vein and anastomosed it to the contralateral external jugular vein, providing venous drainage to the RUL, alleviating symptoms of venous hypertension and preserving function of the brachiobasilic fistula.
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Koh KW, Chanyaputhipong J, Tan SG. Killing Two Birds with One Stone: Subclavian Vein Bypass Graft for Relief of Venous Obstruction and Haemodialysis Access. PROCEEDINGS OF SINGAPORE HEALTHCARE 2012. [DOI: 10.1177/201010581202100308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Subclavian and brachio-cephalic vein stenosis or occlusion occurs, most commonly, as an iatrogenic complication of the placement of central venous catheter. This occurrence can cause ipsilateral arm swelling in a newly-created arteriovenous fistula (AVF). Critical central vein stenoses are often successfully managed by endovascular approach; occasionally, complete occlusion with symptomatic severe arm swelling and pain that does not respond to angioplasty requires ligation of the dialysis access. We report successful surgical management of an end-stage-renal-failure (ESRF) patient with symptomatic subclavian vein occlusion refractory to angioplasty in an ipsilateral arm with an existing functional brachio-basilic transposition arteriovenous fistula by performing a basilic to internal jugular vein (IJV) bypass graft, relieving both the arm swelling and salvaging the existing vascular access for future haemodialysis.
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Affiliation(s)
- Kar Wee Koh
- Department of General Surgery, Singapore General Hospital, Singapore
| | | | - Seck Guan Tan
- Department of General Surgery, Singapore General Hospital, Singapore
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20
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Zamani N, Anaya-Ayala JE, Ismail N, Peden EK. Left common iliac artery to inferior vena cava abdominal wall arteriovenous graft for hemodialysis access. J Vasc Surg 2012; 56:489-91. [DOI: 10.1016/j.jvs.2012.01.062] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 01/24/2012] [Accepted: 01/26/2012] [Indexed: 10/28/2022]
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Hossain MA, Chandak P, Anderson L, Morsy M, Chemla ES. Successful early cannulation of a superficial femoral vein transposition angioaccess in a patient without other alternatives. Semin Dial 2012; 25:686-8. [PMID: 22765387 DOI: 10.1111/j.1525-139x.2011.01019.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Early cannulation of a native fistula is defined by Dialysis Outcomes and Practice Patterns Study and Kidney Disease Outcomes and Quality Initiative as between 2 and 12 weeks postoperatively. We present a case of a patient in whom anatomical and hematological barriers prevented early cannulation graft placement, and in whom temporary catheterization was not feasible as a result of central venous occlusion. Successful cannulation at the fifth postoperative day of a native angioaccess was performed and the reasons and challenges faced behind this choice under the circumstances were discussed.
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Affiliation(s)
- Mohammad Ayaz Hossain
- Renal Transplant and Vascular Access Department, St George's Healthcare NHS Trust, Blackshaw Road, London SW17 0 QT, UK
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Oguz E, Ozturk P, Erkul S, Calkavur T. Right intra-atrial catheter placement for hemodialysis in patients with multiple venous failure. Hemodial Int 2012; 16:306-9. [PMID: 22280164 DOI: 10.1111/j.1542-4758.2011.00653.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The purpose of this study is to evaluate the efficacy and safety of direct right atrial catheter insertion for hemodialysis in patients with multiple venous access failure. We retrospectively evaluated the charts of 27 patients with multiple venous access failure who had intra-atrial dialysis catheter placement between October 2005 and October 2010 in our clinic. Permanent right atrial dialysis catheters were placed through a right anterior mini-thoracotomy under intratracheal general anesthesia in all patients. Demographics of the cases, the patency rates of hemodialysis via atrial catheterization, existence of any catheter thrombosis, and catheter-related infections were documented and used in statistical analysis. Seventeen women (63%) and 10 men (37%) with the mean age of 59.0 ± 7.1 years (47-71) were enrolled in this study. Chronic renal failure was diagnosed for the mean of 78.9 ± 24.3 months (33-130). Five patients (18.5%) died. Ventricular fibrillation and myocardial infarction were the causes of death in the early postoperative period in two patients. Two of the remaining three patients died because of cerebrovascular events, and one patient died because of an unknown cause. Ten patients (37%) had been using anticoagulate agents (warfarin) because of concomitant disorders such as deep vein thrombosis, operated valve disease, and arrhythmias. Catheter thrombosis and malfunction was determined in three cases (11.1%). Intra-atrial hemodialysis catheterization is a safe and effective life-saving measure for the patients with multiple venous failure and without any possibility of peritoneal dialysis or renal transplantation.
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Affiliation(s)
- Emrah Oguz
- Department of Cardiovascular Surgery, Ege University Medical School Hospital, Izmir, Turkey.
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Günday M. Aneurysm of the tibial-saphenous fistula in hemodialysis patient: the results of surgical treatment. Vasc Health Risk Manag 2011; 7:657-60. [PMID: 22140315 PMCID: PMC3225347 DOI: 10.2147/vhrm.s23963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Arteriovenous fistulas are widely used for hemodialysis patients with end-stage renal failure. Due to the lack of suitable veins because of the arteriovenous fistulas previously opened in the upper extremity, alternative access routes are being tested. Few complications of long-term alternative arteriovenous fistulas have been reported in the literature. We report the results of surgical repairs of aneurysms that occurred on anterior tibial-saphenous arteriovenous fistulas (along the vein) in patients with end-stage renal disease after 5 years on hemodialysis.
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Affiliation(s)
- Murat Günday
- Thoracic and Cardiovascular Surgery Training and Research Hospital, Cardiovascular Surgery Department, Trabzon, Turkey.
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Carsten CG. Lower extremity arteriovenous hemodialysis access: an important adjunct in select patients. Semin Vasc Surg 2011; 24:102-7. [PMID: 21889098 DOI: 10.1053/j.semvascsurg.2011.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Given the current survival rates of patients receiving hemodialysis, it has become increasingly common for patients to exhaust their upper extremity access options. Likewise, overzealous catheter use can lead to central venous occlusion or stenosis, further limiting the upper extremity access options. In these patients, use of the lower extremities for access is often required. Fortunately, there are a number of options available that have acceptable durability and utility. The purpose of this article is to review the various techniques available for placement of hemodialysis access in the lower extremity and discuss their results.
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Affiliation(s)
- Christopher G Carsten
- Department of Surgery, University of South Carolina School of Medicine, Greenville Hospital System, Greenville, SC 29605, USA.
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Central Venous Stenosis Among Hemodialysis Patients is Often Not Associated With Previous Central Venous Catheters. ASAIO J 2011; 57:439-43. [DOI: 10.1097/mat.0b013e3182246bf8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Vascular Access Flow Reduction for Arteriovenous Fistula Salvage in Symptomatic Patients with Central Venous Occlusion. J Vasc Access 2011; 13:157-62. [DOI: 10.5301/jva.5000020] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2011] [Indexed: 11/20/2022] Open
Abstract
Purpose Vascular access patients with central vein (CV) stenosis or occlusion may have significant symptoms. Treatment is generally by balloon angioplasty, with or without stenting. However, CV lesions may not be correctable and when treated, tend to recur. Surgical bypass of CV obstruction is a major procedure and ligation of the access may leave the patient dependent on catheter dialysis. We review a precision inflow banding procedure to limit vascular access flow and pressure for symptomatic patients with CV obstruction while preserving access functionality. Materials and Methods All individuals with symptomatic CV occlusive disease who underwent an autogenous vascular access inflow restriction procedure by the two senior authors were identified. All had failed attempts to correct CV lesions by angioplasty and stent placement. A precision banding procedure was used for access inflow reduction with the addition of real-time intravascular flow monitoring. Results Twenty-two patients were identified. Ages were 22–72 years (mean=43 years). Nine patients (40.9%) were women, and 8 (36.4%) obese. Mean access flow was 1640 mL/minute before banding decreased to 820 mL/minute after banding (P<.01). All patients had access salvage. Swelling resolved promptly in 20 patients and was markedly improved in two individuals. Three patients underwent aneurysm repair with simultaneous inflow banding and decreased intra-access pressure after flow restriction. Two fistulas failed at eight and 13 months. Mean follow-up was 8 months. Conclusions The symptoms of hemodialysis vascular access patients associated with non-correctable central venous lesions resolved successfully and their access was maintained using a precision inflow banding procedure.
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Combined Femoral Vein Transposition and Iliac Vein to Suprarenal Vena Cava Bypass as a Last Resort Dialysis Access. Ann Vasc Surg 2011; 25:264.e5-8. [DOI: 10.1016/j.avsg.2010.03.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Revised: 03/22/2010] [Accepted: 03/27/2010] [Indexed: 11/20/2022]
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Anaya-Ayala JE, Bellows PH, Ismail N, Cheema ZF, Naoum JJ, Bismuth J, Lumsden AB, Reardon MJ, Davies MG, Peden EK. Surgical Management of Hemodialysis-Related Central Venous Occlusive Disease: A Treatment Algorithm. Ann Vasc Surg 2011; 25:108-19. [DOI: 10.1016/j.avsg.2010.11.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Revised: 11/11/2010] [Accepted: 11/11/2010] [Indexed: 10/18/2022]
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Power A, Singh S, Ashby D, Hamady M, Moser S, Gedroyc W, Taube D, Duncan N, Cairns T. Translumbar central venous catheters for long-term haemodialysis. Nephrol Dial Transplant 2009; 25:1588-95. [PMID: 20023114 DOI: 10.1093/ndt/gfp683] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Vascular access for haemodialysis is achieved by tunnelled central venous catheter (CVC) in at least 23% of prevalent patients in the UK, Canada and the USA. Use of CVCs is associated with an increased incidence of venous stenosis that can progressively limit future vascular access routes. Lack of conventional venous access routes mandates the use of alternative strategies such as the translumbar approach. METHODS We retrospectively analysed patients at our centre requiring translumbar inferior vena caval CVCs (TesioCath) for haemodialysis in the period 1999-2008. Written and electronic records capturing dialysis adequacy and complications, hospital admissions and laboratory data were examined. RESULTS Thirty-nine pairs of translumbar CVCs were inserted in 26 patients with 15 864 catheter days follow-up, mean patient age 61.9 +/- 12.1 years, 31% diabetic, 15% with ischaemic heart disease. All insertions were successful. Insertion of one CVC was associated with a self-limiting retroperitoneal haematoma. No patients died of a catheter-related cause or through lack of vascular access. Cumulative assisted primary catheter site patency was 81% at 6 months and 73% at 1 year (median 18.5 months). Good dialysis adequacy was achieved throughout (mean single-pool Kt/V 1.5 +/- 0.4). The incidence of access-related infection was 2.84/1000 catheter days (exit site infection rate 2.02/1000 catheter days; catheter-related bacteraemia rate 0.82/1000 catheter days). Catheter dysfunction (need for thrombolytic infusion or catheter change) led to 0.88 admissions per 1000 catheter days. CONCLUSION Translumbar inferior vena caval CVCs can offer relatively safe and effective long-term haemodialysis access in patients with no other options.
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Affiliation(s)
- Albert Power
- Imperial College Kidney and Transplant Institute, West London Renal and Transplant Centre, Imperial College Healthcare Trust, Hammersmith Hospital, DuCane Road, London W12 0HS, UK.
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Nortley M, Brett A, Fossati N, Chemla ES. Retroesophageal internal jugular-to-internal jugular vein bypass for venous occlusion in a patient with complex hemodialysis access. J Vasc Surg 2009; 50:1490-2. [DOI: 10.1016/j.jvs.2009.07.073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2009] [Revised: 07/08/2009] [Accepted: 07/08/2009] [Indexed: 10/20/2022]
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31
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Rueda CA, Nehler MR, Kimball TA, Dimond KR, Whitehill TA, Peyton BD. Arteriovenous Fistula Construction Using Femoral Vein in the Thigh and Upper Extremity: Single-Center Experience. Ann Vasc Surg 2008; 22:806-14. [DOI: 10.1016/j.avsg.2008.08.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2008] [Revised: 07/13/2008] [Accepted: 08/05/2008] [Indexed: 11/28/2022]
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32
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Prosthetic axillary-axillary arteriovenous straight access (necklace graft) for difficult hemodialysis patients: A prospective single-center experience. J Vasc Surg 2008; 48:1251-4, 1254.e1. [PMID: 18771891 DOI: 10.1016/j.jvs.2008.06.064] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Revised: 06/30/2008] [Accepted: 06/30/2008] [Indexed: 11/24/2022]
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Yevzlin AS. REDUCING TUNNELED HEMODIALYSIS CATHETER MORBIDITY: Hemodialysis Catheter-Associated Central Venous Stenosis. Semin Dial 2008; 21:522-7. [DOI: 10.1111/j.1525-139x.2008.00496.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Frampton AE, Kessaris N, Hossain M, Morsy M, Chemla ES. Use of the femoral artery route for placement of temporary catheters for emergency haemodialysis when all usual central venous access sites are exhausted. Nephrol Dial Transplant 2008; 24:913-8. [DOI: 10.1093/ndt/gfn582] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Bachleda P, Utikal P, Kalinova L, Drac P, Zadrazil J, Koecher M, Cerna M. OPERATING MANAGEMENT OF CENTRAL VENOUS HYPERTENSION COMPLICATING UPPER EXTREMITY DIALYSIS ACCESS. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2008; 152:155-8. [DOI: 10.5507/bp.2008.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Cleper R, Goldenberg-Cohen N, Kornreich L, Krause I, Davidovits M. Neurologic and ophthalmologic complications of vascular access in a hemodialysis patient. Pediatr Nephrol 2007; 22:1377-82. [PMID: 17487512 DOI: 10.1007/s00467-007-0491-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2007] [Revised: 03/12/2007] [Accepted: 03/16/2007] [Indexed: 11/26/2022]
Abstract
Patients on long-term hemodialysis undergo multiple interventions, including insertion of central catheters and arteriovenous anastomoses for creation of vascular access. The need for high-flow vessels to maintain hemodialysis efficiency leads to wear on the central veins and consequent stenosis and occlusion. In addition to local signs of impaired venous drainage, abnormal venous flow patterns involving the upper chest, face, and central nervous system might develop. We describe the first pediatric case of devastating intracranial hypertension presenting with visual loss in the eye contralateral to a high-flow vascular access in a patient on long-term hemodialysis. The literature on this rare complication of hemodialysis is reviewed.
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Affiliation(s)
- Roxana Cleper
- Department of Pediatric Nephrology, Schneider Children's Medical Center of Israel, Petah Tiqwa 49202, Israel.
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37
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Jaffers GJ, Reiter C, Buckley CJ. Use of the internal mammary vein for access outflow in a hemodialysis fistula. Vascular 2007; 15:172-5. [PMID: 17573025 DOI: 10.2310/6670.2007.00019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A patient with occlusion of multiple central veins from both dialysis and nondialysis catheters required permanent access for hemodialysis. Magnetic resonance imaging showed a patent left innominate vein. He underwent creation of a left axillary artery to internal mammary vein transposition fistula using the basilic vein from his right arm. The fistula has required one revision for outflow stenosis and one for aneurysmal degeneration. It continues to function well 3 years after placement. The internal mammary vein is an option for outflow when permanent hemodialysis access has failed in the presence of a patent innominate vein with occluded or severely stenotic ipsilateral subclavian and jugular veins.
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Affiliation(s)
- Gregory J Jaffers
- Division of Transplantation Surgery, Scott and White Hospital, Temple, TX 76502, USA.
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Venkat A, Kaufmann KR, Venkat K. Care of the end-stage renal disease patient on dialysis in the ED. Am J Emerg Med 2006; 24:847-58. [PMID: 17098110 DOI: 10.1016/j.ajem.2006.05.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2006] [Revised: 05/23/2006] [Accepted: 05/23/2006] [Indexed: 11/22/2022] Open
Abstract
End-stage renal disease is a major public health problem. In the United States, more than 350,000 patients are being treated with either hemodialysis or continuous ambulatory peritoneal dialysis. Given the high burden of comorbidities in these patients, it is imperative that emergency physicians be aware of the complexities of caring for acute illnesses in this population. This article reviews the common medical problems that bring patients with end-stage renal disease to the emergency department, and their evaluation and management.
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Affiliation(s)
- Arvind Venkat
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0769, USA.
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Mickley V. Central vein obstruction in vascular access. Eur J Vasc Endovasc Surg 2006; 32:439-44. [PMID: 16765068 DOI: 10.1016/j.ejvs.2006.04.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2006] [Accepted: 04/26/2006] [Indexed: 10/24/2022]
Abstract
Central venous obstruction has become a major problem because of the frequent need for central venous catheters in haemodialysis patients. This article discusses the epidemiology and clinical features of central venous obstruction and the different surgical and interventional alternatives for its treatment.
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Affiliation(s)
- V Mickley
- Department of Vascular Surgery, Kreiskrankenhaus Rastatt, Engelstrasse 39, D-76437, Germany.
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40
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Chemla ES, Morsy M, Anderson L, Makanjuola D. Asdin Original Investigation: Complex Bypasses and Fistulas for Difficult Hemodialysis Access: A Prospective, Single-Center Experience. Semin Dial 2006; 19:246-50. [PMID: 16689977 DOI: 10.1111/j.1525-139x.2006.00162.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The purpose of this article is to describe several complex vascular access procedures and the outcomes achieved with them in 24 patients (mean age 60 years) undergoing hemodialysis in whom all other accesses had failed and neither peritoneal dialysis nor transplantation was possible. Patients underwent either a necklace bypass (n = 5), axillary loop (n = 1), contralateral internal jugular vein bypass (n = 6), femorofemoral crossover bypass (n = 1), superficial femoral vein transposition (n = 5), axillary artery to popliteal vein bypass (n = 5), or femoral artery to right atrium bypass (n = 1). All grafts implanted were 6 mm, internally reinforced prostheses made of expanded polytetrafluoroethylene (Gore-Tex Intering Vascular Graft). Postoperatively patients had bimonthly clinical examinations in which the thrill, bruit, skin, cannulation sites, and adequacy of dialysis were reviewed. A bimonthly ultrasound dilution assessment that included estimation of the graft inflow rate, recirculation rate, and cardiac output was also performed. There was one serious postoperative complication: rapid-onset severe steal syndrome that required immediate tie off of the fistula. During the median follow-up time of 22 months, three patients died of causes unrelated to their vascular access. Nineteen dilatations and 10 surgical revisions were done. Primary patency rates were 83%, 63.5%, and 63.5%, respectively, at 6 months, 1 year, and 2 years; secondary patency rates were 91%, 77%, and 77%. Complex vascular access procedures can provide patients some additional good-quality time on hemodialysis.
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Affiliation(s)
- Eric S Chemla
- South West London, Surrey and Sussex Renal Transplant Network, London, UK.
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Symington E, Afzali B, MacPhee I, Chemla ES. Compromise of renal transplant blood flow by an arteriovenous graft. Nephrol Dial Transplant 2006; 21:2644-6. [PMID: 16574679 DOI: 10.1093/ndt/gfl130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Emily Symington
- South West Thames Renal Transplant Network, St Helier and St George's Hospitals, London, UK
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