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Chen J, Lu J, Fu X, Zhou H. The knowledge, attitudes, and practices of arteriovenous access assessment among hemodialysis nurses: A multicenter cross-sectional survey. Hemodial Int 2024; 28:278-289. [PMID: 38803237 DOI: 10.1111/hdi.13160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 04/02/2024] [Accepted: 05/11/2024] [Indexed: 05/29/2024]
Abstract
INTRODUCTION Hemodialysis nurses' cannulation technique, monitoring, and management methods can affect patients' vascular access longevity. An arteriovenous access assessment comprises a medical history and vascular assessment through physical examination and surveillance. However, further exploration is needed to fully understand hemodialysis nurses' knowledge, attitudes, and practices (KAP) in this area. METHODS Between June and July 2023, we recruited hemodialysis nurses from 21 cities in Guangdong Province using a convenience sampling method. Four questionnaires-the General Data Questionnaire, the KAP Scale of Arteriovenous Access Assessment among Hemodialysis Nurses, the Utrecht Work Engagement Scale, and the NASA Task Load Index-were utilized for data collection through the Questionnaire Star platform. FINDINGS Of the 530 hemodialysis nurses participating in the study, 458 (86.4%) had a valid response. The participants demonstrated moderate knowledge and practice levels regarding arteriovenous access assessment and exhibited positive attitudes. We identified several factors related to arteriovenous access assessment that predict KAP in hemodialysis nurses. These factors included years of experience as a hemodialysis nurse, whether a nurse's knowledge of physical examination was sufficient to meet clinical needs, whether a nurse had received training in performing physical examination, whether a nurse's department regularly checked the quality of physical examination, and nurses' levels of work engagement and mental workload. All factors explained 32.4% of the variance in participants' KAP regarding arteriovenous access assessment. DISCUSSION Improving hemodialysis nurses' assessment of arteriovenous access is crucial to ensure optimal patient care. Dialysis center managers and educators should prioritize understanding hemodialysis nurses' KAP of arteriovenous access assessment and any factors influencing these areas.
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Affiliation(s)
- Jingying Chen
- Department of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, China
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Jinghua Lu
- Department of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, China
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Xia Fu
- Department of Nursing, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Hongzhen Zhou
- Department of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, China
- School of Nursing, Southern Medical University, Guangzhou, China
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2
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Sun M, Wei X, Tang X, Shao X, Guo Y, Zhang Y, Miao J, Wei J, Zhang L. Application of a supporting catheter in surgery for forearm arteriovenous fistula construction. J Vasc Access 2024:11297298241253299. [PMID: 38770677 DOI: 10.1177/11297298241253299] [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: 05/22/2024] Open
Abstract
INTRODUCTION This study explored the feasibility of a supporting catheter combined with modified end-to-side anastomosis in the operation of radio-cephalic arteriovenous fistula (RC-AVF) and evaluated the clinical application value of this technique. METHODS Sixty patients underwent RC-AVF operations in our hospital from January 2022 to June 2022. All the patients were treated with modified end-to-side AVF anastomosis and divided into the control group or the test group depending on whether a supporting catheter was applied. The clinical data of 60 cases were analysed retrospectively. Intraoperative related indices, the first time the fistula was used, the success rate of first puncture, the blood flow of first dialysis, the maturity condition of fistula, the size of anastomosis, the diameter of radial artery and drainage vein, the blood flow of brachial artery 8 weeks after operation and the incidence of complications within 6 months after operation were compared between the two groups. RESULTS Compared with that in the control group, the time spent on the vascular anastomosis in the test group was significantly shortened (p<0.05). The blood flow of the first dialysis, the size of the anastomosis, the diameter of the drainage vein, the blood flow of the brachial artery 8 weeks after the operation and the incidence of complications within 6 months after operation were significantly different between the two groups (p<0.05). CONCLUSION In the RC-AVF operation, using a supporting catheter can not only increase operation efficiency by reducing surgical injury and difficulty of vascular anastomosis, but also improve postoperative prognosis. RC-AVF is worth promoting in clinical practice.
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Affiliation(s)
- Meng Sun
- Department of Nephrology, Lianyungang Clinical College of Nanjing Medical University, Lianyungang, Jiangsu, China
| | - Xiaobao Wei
- Department of Nephrology, The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, China
| | - Xinyu Tang
- Department of Nephrology, The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, China
| | - Xiaojiao Shao
- Department of Nephrology, The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, China
| | - Yibin Guo
- Department of Nephrology, The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, China
| | - Yiwen Zhang
- Department of Nephrology, The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, China
| | - Jiayi Miao
- Department of Nephrology, The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, China
| | - Juanyu Wei
- Department of Nephrology, The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, China
| | - Liyuan Zhang
- Department of Nephrology, Lianyungang Clinical College of Nanjing Medical University, Lianyungang, Jiangsu, China
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Higgins MCSS, Diamond M, Mauro DM, Kapoor BS, Steigner ML, Fidelman N, Aghayev A, Chamarthy MRK, Dedier J, Dillavou ED, Felder M, Lew SQ, Lockhart ME, Siracuse JJ, Dill KE, Hohenwalter EJ. ACR Appropriateness Criteria® Dialysis Fistula Malfunction. J Am Coll Radiol 2023; 20:S382-S412. [PMID: 38040461 DOI: 10.1016/j.jacr.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 12/03/2023]
Abstract
The creation and maintenance of a dialysis access is vital for the reduction of morbidity, mortality, and cost of treatment for end stage renal disease patients. One's longevity on dialysis is directly dependent upon the quality of dialysis. This quality hinges on the integrity and reliability of the access to the patient's vascular system. All methods of dialysis access will eventually result in dialysis dysfunction and failure. Arteriovenous access dysfunction includes 3 distinct classes of events, namely thrombotic flow-related complications or dysfunction, nonthrombotic flow-related complications or dysfunction, and infectious complications. The restoration of any form of arteriovenous access dysfunction may be supported by diagnostic imaging, clinical consultation, percutaneous interventional procedures, surgical management, or a combination of these methods. This document provides a rigorous evaluation of how variants of each form of dysfunction may be appraised and approached systematically. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | - Matthew Diamond
- Research Author, Boston Medical Center, Boston, Massachusetts
| | - David M Mauro
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | | | | | - Nicholas Fidelman
- Panel Vice-Chair, University of California San Francisco, San Francisco, California
| | - Ayaz Aghayev
- Brigham & Women's Hospital, Boston, Massachusetts
| | - Murthy R K Chamarthy
- Vascular Institute of North Texas, Dallas, Texas; Commission on Nuclear Medicine and Molecular Imaging
| | - Julien Dedier
- Boston Medical Center, Boston, Massachusetts, Primary care physician
| | - Ellen D Dillavou
- WakeMed Hospital System, Raleigh, North Carolina; Society for Vascular Surgery
| | - Mila Felder
- Advocate Christ Medical Center, Oak Lawn, Illinois; American College of Emergency Physicians
| | - Susie Q Lew
- George Washington University, Washington, District of Columbia; American Society of Nephrology
| | | | - Jeffrey J Siracuse
- Boston University School of Medicine, Boston, Massachusetts; Society for Vascular Surgery
| | - Karin E Dill
- Specialty Chair, Emory University Hospital, Atlanta, Georgia
| | - Eric J Hohenwalter
- Specialty Chair, Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin
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4
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Bodington R, Hazara AM, Lamplugh A, Syed A, Bhandari S. Reassessing the utility of access recirculation and Kt/V for the prediction of arteriovenous fistula failure using online clearance monitoring: the SHUNT STUDY. J Nephrol 2023; 36:677-686. [PMID: 36445562 DOI: 10.1007/s40620-022-01525-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 11/06/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The arteriovenous fistula (AVF) is prone to thrombosis which can be avoided by use of monitoring and surveillance programmes. Although surveillance imaging techniques have been shown to be more sensitive and specific than clinical monitoring during dialysis, monitoring may have significant advantages in terms of cost and time saving. In this study we evaluate the yield of two monitoring techniques [blood temperature monitoring (BTM) access recirculation (AR) and Kt/V via online-clearance-monitoring (OCM)]. METHODS In this single-centre prospective observational study, 101 patients were followed-up for one year. The primary outcome measure was a composite of AVF failure. OCM-Kt/V and BTM-AR were recorded at every dialysis session. RESULTS Of all baseline characteristics only a prior history of percutaneous transluminal angioplasty (PTA) to the AVF conferred a significant change in AVF survival (failure events/100 pt years with prior PTA vs. without = 64.0 vs. 17.3, log-rank p = 0.0014; unadjusted hazard ratio (HR) 3.74 (95% CI 1.56-8.94) p = 0.003). Participants with baseline AR < 10% vs. > 15% had poorer AVF survival (p = 0.0002) and HR for baseline AR 10-15% group vs. AR > 15% group = 4.5 (95% CI 1.55-13.05). There was no combination of change in (Δ) AR, ΔKt/V or its presence over any number of dialysis sessions that provided an acceptable combination of sensitivity and specificity or discrimination for AVF failure. CONCLUSIONS BTM-AR and OCM-Kt/V are specific but insufficiently sensitive tools for the prediction of AVF failure. BTM-AR and OCM-Kt/V use at every dialysis session appears to add little to the traditional, infrequent use of these evaluations.
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Affiliation(s)
- Richard Bodington
- Sheffield Kidney Institute, Northern General Hospital, Sheffield, S5 7AU, UK.
| | - Adil M Hazara
- Renal Research Department, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Archie Lamplugh
- Renal Research Department, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Ahsan Syed
- Department of Renal Medicine, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Sunil Bhandari
- Renal Research Department, Hull University Teaching Hospitals NHS Trust, Hull, UK
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Sharp recanalization for treatment of central venous occlusive disease in hemodialysis patients. J Vasc Surg Venous Lymphat Disord 2021; 10:306-312. [PMID: 34438087 DOI: 10.1016/j.jvsv.2021.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 08/05/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND The purpose of the present study was to evaluate the technical feasibility and safety of sharp recanalization for central venous occlusive disease (CVOD) in patients requiring hemodialysis. METHODS Patients with CVOD requiring hemodialysis who had undergone endovascular recanalization using sharp devices, including the stiff end of a guidewire, Chiba needle, or RUS-100 to cross occluded segments after conventional techniques had failed were included. The needle was guided toward a target placed at the opposite end of the occlusion. Although the guidewire was passed though the occlusion, subsequent procedures such as percutaneous transluminal angioplasty could be performed. RESULTS A total of 27 sharp recanalization procedures in 25 patients were performed. Two attempts failed, 1 patient had undergone two separate successful procedures, and 23 procedures in 23 patients were successful. The overall technique success was 92.6%. The stiff end of a guidewire was the first choice for all the procedures, and recanalization was achieved in 18 patients (66.7%). A Chiba biopsy needle was used in six procedures (22.2%), with 100% technical success. A RUPS-100 set was used in two procedures (7.4%), with one aborted because of concern for complications. The occlusion was subsequently crossed using a Chiba needle. Four minor adverse events (two of mediastinal hematoma and two of chest pain) had occurred, and two major adverse events (pericardial tamponade and acute pleural effusion in one patient [4%], treated with the guidewire stiff-end technique, who recovered after drainage) had occurred. CONCLUSIONS Sharp recanalization is safe and feasible with high technical success for CVOD in patients requiring hemodialysis who cannot be recanalized using conventional techniques.
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Fila B. Quality indicators of vascular access procedures for hemodialysis. Int Urol Nephrol 2020; 53:497-504. [PMID: 32869172 DOI: 10.1007/s11255-020-02609-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 08/12/2020] [Indexed: 11/29/2022]
Abstract
Improved quality of surgical procedures can minimize complications, the morbidity and mortality of patients, and in addition decrease costs. Quality indicators in angioaccess surgery are, however, not clearly defined. The aim of this review article is therefore to find the most important factors affecting quality in vascular access procedures. Even though autogenous arteriovenous fistula has been recognized as the best vascular access for hemodialysis, the high percentage of unsuccessful attempts associated with it raises the question about quality assessment in angioaccess procedures. Unfortunately, quality indicators in vascular access surgery are difficult to define and measure. Among those that can be obtained are: the time between the presentation of patients to a vascular access surgeon and the construction of a fistula, the percentage of autogenous fistulas, the percentage of functional fistulas in prevalent and incident hemodialysis patients, the percentage of creation of a functional fistula in the first attempt, and durability of an access. Organizational improvement and educational programs are also necessary at institutions with inferior quality indicators of vascular access care, as even small increase in quality may mean the survival of an individual patient. Quality indicators in angioaccess surgery can also serve as a helpful tool in choosing the best vascular access surgeon or vascular access center. The choice can consequently reflect on increased survival and quality of life in patients needing hemodialysis.
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Affiliation(s)
- Branko Fila
- Department of Vascular Surgery, University Hospital Dubrava, Avenija Gojka Šuška 6, 10000, Zagreb, Croatia.
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7
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Eleftheriadis T, Rountas C, Karagiorgas G, Liakopoulos V, Stefanidis I. Unexpected restoration of an arteriovenous graft function: the significance of vascular access surveillance. CEN Case Rep 2020; 9:291-293. [PMID: 32157644 PMCID: PMC7320096 DOI: 10.1007/s13730-020-00460-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 02/27/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- Theodoros Eleftheriadis
- Department of Nephrology, Faculty of Medicine, University of Thessaly, Biopolis, Mezourlo Hill, 41110, Larissa, Greece.
| | - Christos Rountas
- Department of Interventional Radiology, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Georgios Karagiorgas
- Department of Interventional Radiology, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Vassilios Liakopoulos
- Department of Nephrology, Faculty of Medicine, University of Thessaly, Biopolis, Mezourlo Hill, 41110, Larissa, Greece
| | - Ioannis Stefanidis
- Department of Nephrology, Faculty of Medicine, University of Thessaly, Biopolis, Mezourlo Hill, 41110, Larissa, Greece
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Mo YW, Sun CY, Song L, Zhou LF, Zhuang TT, Zhong M, Zheng SQ, Chen YG, Chen YH, Liu SX, Liang XL, Fu X. How to carry out monthly blood flow surveillance of fistula in large-scale hemodialysis units: A cross-sectional study. J Vasc Access 2020; 22:75-80. [PMID: 32476548 DOI: 10.1177/1129729820923939] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The important effect of regular blood flow surveillance on arteriovenous fistula maintenance is emphasized. The ultrasonic dilution technique for blood flow surveillance can be performed during hemodialysis, but there are some limitations. Blood flow is traditionally measured by duplex Doppler ultrasound during the nondialysis period. However, the surveillance workload for arteriovenous fistula has increased with the rapid increase in the hemodialysis population size. Efficient methods for blood flow surveillance during hemodialysis are needed. METHODS Eighty-four hemodialysis patients with a forearm radiocephalic arteriovenous fistula were enrolled in this cross-sectional study. Each received blood flow measurements using ultrasonic dilution technique and duplex Doppler ultrasound during hemodialysis. Duplex Doppler ultrasound measurements included the blood flow of the brachial artery and radial artery. The correlations between these variables were analyzed. RESULTS The correlation coefficients (r) between flow measured by ultrasonic dilution technique and brachial artery flow measured by duplex Doppler ultrasound, between flow measured by ultrasonic dilution technique and radial artery flow measured by duplex Doppler ultrasound, and between brachial artery flow and radial artery flow measured by duplex Doppler ultrasound were 0.724, 0.784, and 0.749, respectively (all p < 0.001). CONCLUSION Blood flow measured by ultrasonic dilution technique was positively correlated with blood flow measured by duplex Doppler ultrasound during hemodialysis, suggesting that duplex Doppler ultrasound can be used to monitor the trends in the blood flow of the brachial artery and radial artery for timely intervention to improve patency during hemodialysis.
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Affiliation(s)
- Ya-Wen Mo
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,School of Nursing, Southern Medical University, Guangzhou, China.,Ya-wen Mo and Chun-yan Sun contributed equally to the article
| | - Chun-Yan Sun
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,School of Nursing, Southern Medical University, Guangzhou, China.,Ya-wen Mo and Chun-yan Sun contributed equally to the article
| | - Li Song
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Li-Fang Zhou
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,School of Nursing, Southern Medical University, Guangzhou, China
| | - Ting-Ting Zhuang
- Department of Rehabilitation Medicine, Guangdong Second Traditional Chinese Medicine Hospital, Guangzhou, China
| | - Mi Zhong
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shu-Qian Zheng
- School of Nursing, Southern Medical University, Guangzhou, China.,Division of Nephrology, Guangzhou Nansha Central Hospital, Guangzhou, China
| | - Ying-Gui Chen
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,School of Nursing, Southern Medical University, Guangzhou, China
| | - Yuan-Han Chen
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shuang-Xin Liu
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xin-Ling Liang
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xia Fu
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,School of Nursing, Southern Medical University, Guangzhou, China
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Kalinin RE, Suchkov IA, Egorov AA, Klimentova EA. [Recirculation syndrome in hemodialysis patients]. Khirurgiia (Mosk) 2019:24-28. [PMID: 31714526 DOI: 10.17116/hirurgia201911124] [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: 11/18/2022]
Abstract
OBJECTIVE To study the causes of recirculation syndrome and optimize surgical correction. MATERIAL AND METHODS There were 2329 procedures of formation and restoration of permanent vascular access in 2109 patients for the period from 1998 to 2018. Recirculation syndrome occurred in 66 (3.1%) patients. Instrumental diagnosis of the causes of recirculation syndrome included Doppler ultrasound of permanent vascular access (100%) and angiography in accordance with indications. All patients were divided into 4 groups. The first group included 39 (59.1%) patients with native arteriovenous fistula. The second group included 12 (18.2%) patients with high arteriovenous fistula (between the brachial artery and the cephalic vein). The third group included 10 (15.1%) patients with major vein transposition. Synthetic prosthesis to create an arteriovenous fistula was used in the fourth group (n=5, 7.6%). RESULTS In the first group, recirculation syndrome was caused by the presence of a large branch in close proximity to the arteriovenous anastomosis, its combination with significant stenosis of the anastomosis, hypoplasia of the outflow pathways of the fistulous vein. In the second group, the reasons were subclavian vein stenosis and dilated tributaries of the saphenous veins. In the third group, the main cause of recirculation syndrome was major vein stenosis in the upper third of the shoulder. In the fourth group, recirculation syndrome was caused by stenosis of the prosthetic-venous anastomosis. CONCLUSION Recirculation syndrome in hemodialysis patients is usually caused by malfunction of permanent vascular access. Ultrasound or angiography may be successfully used to diagnose dysfunction. Effective treatment of this problem implies surgical or endovascular correction of permanent vascular access.
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Affiliation(s)
- R E Kalinin
- Pavlov Ryazan State Medical University of the Ministry of Health of the Russia, Ryazan, Russia
| | - I A Suchkov
- Pavlov Ryazan State Medical University of the Ministry of Health of the Russia, Ryazan, Russia
| | - A A Egorov
- Pavlov Ryazan State Medical University of the Ministry of Health of the Russia, Ryazan, Russia
| | - E A Klimentova
- Pavlov Ryazan State Medical University of the Ministry of Health of the Russia, Ryazan, Russia
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Dolmatch B, Hogan A, Ferko N. An Economic Analysis of Stent Grafts for Treatment of Vascular Access Stenosis: Point-of-Care and Medicare Perspectives in the United States. J Vasc Interv Radiol 2018; 29:765-773.e2. [PMID: 29706343 DOI: 10.1016/j.jvir.2018.01.777] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 01/16/2018] [Accepted: 01/17/2018] [Indexed: 01/31/2023] Open
Abstract
PURPOSE To conduct an economic analysis on the impact of increased stent graft (SG) use for treatment of arteriovenous graft (AVG) anastomotic stenosis or arteriovenous fistula (AVF)/AVG in-stent restenosis (ISR) from United States point-of-care (POC) and Medicare perspectives. MATERIALS AND METHODS The analyses compared initial device and reintervention costs over 2 years between current and projected treatment mixes, including percutaneous transluminal angioplasty (PTA), bare metal stents (BMSs), and SGs. In projected scenarios, the absolute increase in SG use was approximately 3%. Costs included procedure reimbursement rates (Medicare) and device list prices (POC) for index procedures and reinterventions. Reintervention rates and types were informed by the RENOVA and RESCUE randomized trials. Reinterventions were primarily PTA only; however, stent use occurred a proportion of the time. BMS reintervention rates were assumed to be identical to PTA based on observational data. A population size of 1,000 patients was assumed. RESULTS To the POC (n = 1,000), increased SG use was predicted to result in cost savings ranging from $4,106 to $34,420 for AVG anastomotic stenosis. For AVF/AVG ISR, increased SG use was predicted to result in either a cost increase of $17,187 or a cost savings of $13,159. To Medicare (n = 1,000), increased SG use was predicted to save costs for both populations, with savings ranging from $57,401 to $169,544. CONCLUSIONS The use of SG for treatment of AVG anastomotic stenosis and AVF/AVG ISR appears to be economically favorable for POC providers and Medicare. Further data on reintervention rates are required from other SG trials to validate findings.
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Affiliation(s)
- Bart Dolmatch
- Department of Interventional Radiology, The Palo Alto Medical Foundation, Mountain View, California
| | - Andrew Hogan
- Cornerstone Research Group Inc., 3228 S Service Rd, Burlington, ON L7N 3H8, Canada
| | - Nicole Ferko
- Cornerstone Research Group Inc., 3228 S Service Rd, Burlington, ON L7N 3H8, Canada.
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11
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Vega A, Abad S, Aragoncillo I, Galán I, Macías N, Cedeño S, Santos A, García A, Linares T, Martínez-Villaescusa M, López-Gómez JM. Comparison of urea recirculation and thermodilution for monitoring of vascular access in patients undergoing hemodialysis. J Vasc Access 2018. [DOI: 10.1177/1129729817747536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction It is important to monitor vascular access in patients with stage 5 chronic kidney disease receiving hemodialysis. Access recirculation can help to detect a need for intervention. Objectives: To compare urea recirculation with recirculation by thermodilution using blood temperature monitoring to predict a need for intervention of vascular access over a 6-month period. Methods: We analyzed urea recirculation and blood temperature monitoring simultaneously in 61 patients undergoing hemodialysis. During the 6-month follow-up, we recorded all cases of angioplasty or surgery (thrombectomy or reanastomosis). In line with previous studies, we considered a value to be positive when urea recirculation was >10% and blood temperature monitoring >15%. Receiver operating characteristic curves were constructed. Results: Mean urea recirculation was 9.5% ± 6.6% and mean blood temperature monitoring 12.9% ± 4.3% (p = 0.001). Urea recirculation >10% had a sensitivity of 80% and specificity of 78%. Blood temperature monitoring >15% had a sensitivity of 33% and specificity of 85%. During follow-up, 25% of patients developed need for intervention of vascular access. We found an association between vascular access dysfunction and urea recirculation. The Kaplan–Meier analysis confirmed an association between urea recirculation and risk of vascular access dysfunction (log rank = 17.2; p = 0.001). We were unable to confirm this association with blood temperature monitoring (log rank = 0.879; p = 0.656). Conclusion: Urea recirculation is better predictor of vascular access dysfunction than thermodilution.
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Affiliation(s)
- Almudena Vega
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Soraya Abad
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Inés Aragoncillo
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Isabel Galán
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Nicolás Macías
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Santiago Cedeño
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Alba Santos
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ana García
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Tania Linares
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Juan M López-Gómez
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Kim H, Seo HM, Kim JY, Kim M. Prediction of hemodialysis vascular access failure using segmental bioimpedance analysis parameters. Int Urol Nephrol 2018; 50:947-953. [PMID: 29476433 DOI: 10.1007/s11255-018-1827-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 02/13/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE Segmental bioimpedance analysis (BIA) can identify fluid volume changes in the arms of patients on hemodialysis (HD) after vascular access surgery. We investigated whether the difference in fluid volumes between the arms of the patients using segmental BIA is associated with vascular access outcome. METHODS Body composition measurements were taken for 127 patients on HD with segmental, multi-frequency BIA equipment (InBody 1.0, Biospace Co. Ltd, Seoul, Korea). The difference in fluid volume between the arms of the patients was calculated from the fluid volume of the arm with the vascular access minus that of the other. The primary outcome was the loss of vascular access patency within 3 months of BIA measurement. RESULTS The median absolute and relative inter-arm fluid volume differences were 150 ml [interquartile range (IQR) 90-250 ml] and 9.6% (IQR 4.9-14.4%), respectively. Within 3 months of BIA measurement, 38 patients (30.0%) experienced vascular access failure. When the patients were divided into three groups based on the tertiles of relative inter-arm fluid volume differences (lowest tertile: < 6.8%; middle tertile: 6.8-12.7%; highest tertile: > 12.7%), greater difference in relative inter-arm fluid volume differences was associated with higher vascular access failure rates (14 vs. 28 vs. 48%, p value for trend across tertiles = 0.003). CONCLUSIONS We conclude that segmental BIA may be used as a tool that can predict vascular access failure in patients on HD by calculating the relative difference in fluid volume between the arms of the patients with and without vascular access.
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Affiliation(s)
- Hyunwoo Kim
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Jeju National University, Jeju National University Hospital, 15, Aran 13-gil, Jeju City, Jeju, 63241, Republic of Korea.
| | - Hye Mi Seo
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Jeju National University, Jeju National University Hospital, 15, Aran 13-gil, Jeju City, Jeju, 63241, Republic of Korea
| | - Ji Young Kim
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Jeju National University, Jeju National University Hospital, 15, Aran 13-gil, Jeju City, Jeju, 63241, Republic of Korea
| | - Miyeon Kim
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Jeju National University, Jeju National University Hospital, 15, Aran 13-gil, Jeju City, Jeju, 63241, Republic of Korea
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Kamyar MM, Saeed Modaghegh MH, Kazemzadeh G. Limb complaints after autogenous arteriovenous fistula creation in chronic hemodialysis patients. Semin Vasc Surg 2017; 29:172-177. [PMID: 28779783 DOI: 10.1053/j.semvascsurg.2016.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Placement of autogenous arteriovenous fistula (AVF) is one of the basic needs in hemodialysis patients. Although many studies have investigated the complications of AVF placement, the complaints expressed by patients have not been studied in a long-term study. The purpose of this study was to evaluate the incidence of complaints after placement of autogenous AVF in patients undergoing chronic hemodialysis. This cohort study was conducted on patients with end-stage renal disease undergoing AVF placement who were referred to Imam Reza hospital in Mashhad, Iran, from January 2015 to June 2016. The AVFs were placed in all patients and incidence rates of expressed complaints, including pain, paresthesia, and edema, were assessed up to three periods 1 month after surgery and three periods 2 months after starting use of the AVF. Data were analyzed using SPSS software, version 19. The relationship of AVF types with each of the outcomes was analyzed via χ2 test. Three hundred and eighty-eight patients (222 males and 166 females; mean age 54.3 ± 16.0 years) were studied. AVF was established in the cubital site of 230 patients, in snuff box of 103 patients, and distal forearm of 55 patients. Total incidence rate of pain within six follow-up periods and incidence rates of paresthesia and edema were determined as 18.1%, 2.6%, and 5.4%, respectively. A statistically significant relationship was observed between types of AVF and pain and paresthesia (P < .05). According to results from this study, pain and then edema were the most common complaints, followed by AVF placement in the patients. Paresthesia had lower incidence rates compared to other complaints.
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Affiliation(s)
- Mohammad Mahdi Kamyar
- Mashhad Vascular and Endovascular Surgery Research Center, Mashhad University of Medical Sciences, Alavi Hospital, Imam Reza 63 Avenue, Mashhad, Iran
| | - Mohammad Hadi Saeed Modaghegh
- Mashhad Vascular and Endovascular Surgery Research Center, Mashhad University of Medical Sciences, Alavi Hospital, Imam Reza 63 Avenue, Mashhad, Iran
| | - Gholamhossein Kazemzadeh
- Mashhad Vascular and Endovascular Surgery Research Center, Mashhad University of Medical Sciences, Alavi Hospital, Imam Reza 63 Avenue, Mashhad, Iran.
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Martinez L, Esteve V, Yeste M, Artigas V, Llagostera S. Neuromuscular electrostimulation: a new therapeutic option to improve radio-cephalic arteriovenous fistula maturation in end-stage chronic kidney disease patients. Int Urol Nephrol 2017; 49:1645-1652. [DOI: 10.1007/s11255-017-1601-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 04/17/2017] [Indexed: 10/19/2022]
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15
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Effectiveness of beraprost sodium in maintaining vascular access patency in patients on hemodialysis. Int Urol Nephrol 2017; 49:1287-1295. [DOI: 10.1007/s11255-017-1586-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 04/05/2017] [Indexed: 02/06/2023]
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16
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Calcification in arteriovenous fistula blood vessels may predict arteriovenous fistula failure: a 5-year follow-up study. Int Urol Nephrol 2017; 49:881-887. [PMID: 28124305 DOI: 10.1007/s11255-017-1515-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 01/16/2017] [Indexed: 12/20/2022]
Abstract
PURPOSE Arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis. The impact of vascular calcification process on AVF survival remains unclear and results of several studies about this issue are controversial. In the light of the new knowledge about the different susceptibility for calcification process in different blood vessels, the aim of our study was to analyze whether the calcification of AVF-blood vessels may have an impact on AVF longevity. METHODS The study included 90 patients, 49 males and 41 females, all of them Caucasians, with a mean age 62 ± 11 years, on regular hemodialysis for more than 1 year with patent primary AVFs. Vascular calcification in AVF-blood vessels or in the anastomotic region was detected using X-ray examination. RESULTS Calcification in AVF-blood vessels was found in 62% of patients. Binary logistic regression analysis demonstrated that male gender, presence of diabetes mellitus and longer duration of AVF before calcification determination were associated with calcification of AVF-blood vessels. Using a Cox proportional hazard model adjusted for these standardized predicted values revealed that patients with present AVF-blood vessels calcification had increased risk to develop AVF failure with a hazard rate of 3.42 (95% confidence interval 1.00-11.67; P = 0.049). CONCLUSIONS Calcifications of AVF-blood vessels are found frequently among dialysis patients and may jeopardize the survival of native AVF. We suggested the local X-ray as simple and valid method for detection of patients that are at risk for AVFs failure which should be monitored more closely.
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Dariushnia SR, Walker TG, Silberzweig JE, Annamalai G, Krishnamurthy V, Mitchell JW, Swan TL, Wojak JC, Nikolic B, Midia M. Quality Improvement Guidelines for Percutaneous Image-Guided Management of the Thrombosed or Dysfunctional Dialysis Circuit. J Vasc Interv Radiol 2016; 27:1518-30. [DOI: 10.1016/j.jvir.2016.07.015] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 07/12/2016] [Accepted: 07/14/2016] [Indexed: 01/20/2023] Open
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18
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Zhu YL, Ding H, Fan PL, Gu QL, Teng J, Wang WP. Is Brachial Artery Blood Flow Measured by Sonography During Early Postoperative Periods Predictive of Arteriovenous Fistula Failure in Hemodialysis Patients? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1985-1992. [PMID: 27492392 DOI: 10.7863/ultra.15.03058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 12/14/2015] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The aim of our study was to determine a brachial artery blood flow level measured by sonography during early postoperative periods that is predictive of arteriovenous fistula failure in hemodialysis patients. METHODS Doppler sonography was used to estimate the blood flow in the brachial artery of 103 patients at 1 and 14 days after arteriovenous fistula creation. The performance of brachial artery blood flow during early postoperative periods for predicting fistula failure was evaluated, and optimal cutoff values were determined. RESULTS During a 6-month follow-up, 85 fistulas were classified as mature, and 18 were classified as failures. The reproducibility of blood flow measurements in the brachial artery was good (intraclass correlation coefficient, 0.912). The blood flow in the failure group was significantly lower than that in the mature group at both 1 and 14 days after fistula creation (P < .05). During the first 2 postoperative weeks, the blood flow increased by 40.7% in the failure group versus 78.3% in the mature group. The areas under the receiver operating characteristic curves of brachial artery blood flow for predicting failure were 0.77 (95% confidence interval, 0.66-0.87; optimal cutoff value, 310 mL/min)at 1 day and 0.91 (95% confidence interval, 0.83-0.99; 413 mL/min) at 14 days after fistula creation. CONCLUSIONS Brachial artery blood flow measured by sonography during early postoperative periods may be predictive of forearm fistula failure. Blood flow of less than 310 mL/min at 1 day and 413 mL/min at 14 days after fistula creation may indicate a risk of failure to mature.
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Affiliation(s)
- Yu-Li Zhu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hong Ding
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China, Department of Ultrasound, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Pei-Li Fan
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qi-Lan Gu
- Department of Ultrasound, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jie Teng
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wen-Ping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
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Bakhshoude B, Ravari H, Kazemzadeh GH, Rad MP. Diagnostic value of computerized tomography venography in detecting stenosis and occlusion of subclavian vein and superior vena in chronic renal failure patients. Electron Physician 2016; 8:2781-2786. [PMID: 27757189 PMCID: PMC5053460 DOI: 10.19082/2781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 02/22/2016] [Indexed: 11/22/2022] Open
Abstract
Introduction Currently, venography is the standard diagnostic method to examine veins before implementing access, which is invasive in nature. Computerized tomography venography (CTV) can simultaneously indicate deep and superficial venous systems in the upper extremity and their relation to the surrounding anatomical structures; however, its diagnostic value in the detection of central venous disease has yet to be defined. The aim of this study was to determine the diagnostic value of CT venography compared to venography in the diagnosis of stenosis and the occlusion of subclavian veins and the superior vena in renal failure patients. Methods This cross-sectional study was conducted from January to September 2015 on patients with chronic renal failure undergoing upper extremity venography at the Radiology Department of Imam Reza Hospital in Mashhad, Iran. We excluded patients with catheters in their jugular and subclavian vein routes, venous hypertension with reverse-function fistula, or sensitivity to contrast agents. Several factors, including age, gender, catheterization record in jugular and subclavian veins, and fistula record in the upper extremity, as well as clinical symptoms consisting of edema, dermatitis, and ulcers in these organs, were recorded in the corresponding form. Then, the patients consecutively underwent indirect venography and CT venography and traces of stenosis (more than 50%) or complete occlusion in the subclavian vein and superior vena were recorded. The data were analyzed using SPSS software by the chi-squared test, and sensitivity, specificity, and positive and negative predictive values were calculated by means of MedCalc Online, version 16.2. Results The study was conducted on 40 patients (26 males and 14 females) with a mean age of 46.7 ± 10.4 years. In this study, 58 subclavian veins, as well as 32 superior vena cava, were studied. The results showed that the diagnostic value of CTV in the detection of subclavian stenosis had a sensitivity and a specificity of 88.2 and 97.5%, respectively. Moreover, in the superior vena cava, the greatest CTV diagnostic sensitivity and specificity was related to vein stenosis detection (sensitivity = 88.8%; specificity = 100%). Conclusion It seems that the CTV, based on its high sensitivity, specificity, and predictive value, can be used as an efficient tool in the study of stenosis in subclavian veins and superior vena in patients undergoing venography
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Affiliation(s)
- Banafsheh Bakhshoude
- M.D., Resident of Radiology, Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hassan Ravari
- M.D., Associate Professor, Department of Vascular Surgery, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Gholam Hosein Kazemzadeh
- M.D., Associate Professor, Department of Vascular Surgery, Vascular and Endovascular Surgery Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Masoud Pezeshki Rad
- M.D., Associate Professor, Department of Radiology, Vascular and Endovascular Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Zhu YL, Ding H, Fan PL, Gu QL, Teng J, Wang WP. Predicting the maturity of haemodialysis arteriovenous fistulas with colour Doppler ultrasound: a single-centre study from China. Clin Radiol 2016; 71:576-82. [DOI: 10.1016/j.crad.2016.02.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 12/31/2015] [Accepted: 02/29/2016] [Indexed: 10/22/2022]
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