1
|
Ohashi Y, Protack CD, Aoyagi Y, Gonzalez L, Thaxton C, Zhang W, Kano M, Bai H, Yatsula B, Alves R, Hoshina K, Schneider EB, Long X, Perry RJ, Dardik A. Heterogeneous gene expression during early arteriovenous fistula remodeling suggests that downregulation of metabolism predicts adaptive venous remodeling. Sci Rep 2024; 14:13287. [PMID: 38858395 PMCID: PMC11164895 DOI: 10.1038/s41598-024-64075-8] [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: 10/10/2023] [Accepted: 06/05/2024] [Indexed: 06/12/2024] Open
Abstract
Clinical outcomes of arteriovenous fistulae (AVF) for hemodialysis remain inadequate since biological mechanisms of AVF maturation and failure are still poorly understood. Aortocaval fistula creation (AVF group) or a sham operation (sham group) was performed in C57BL/6 mice. Venous limbs were collected on postoperative day 7 and total RNA was extracted for high throughput RNA sequencing and bioinformatic analysis. Genes in metabolic pathways were significantly downregulated in the AVF, whereas significant sex differences were not detected. Since gene expression patterns among the AVF group were heterogenous, the AVF group was divided into a 'normal' AVF (nAVF) group and an 'outliers' (OUT) group. The gene expression patterns of the nAVF and OUT groups were consistent with previously published data showing venous adaptive remodeling, whereas enrichment analyses showed significant upregulation of metabolism, inflammation and coagulation in the OUT group compared to the nAVF group, suggesting the heterogeneity during venous remodeling reflects early gene expression changes that may correlate with AVF maturation or failure. Early detection of these processes may be a translational strategy to predict fistula failure and reduce patient morbidity.
Collapse
Affiliation(s)
- Yuichi Ohashi
- Vascular Biology and Therapeutics Program, Yale School of Medicine, New Haven, CT, USA
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
- Division of Vascular Surgery, Department of Surgery, The University of Tokyo, Tokyo, Japan
| | - Clinton D Protack
- Vascular Biology and Therapeutics Program, Yale School of Medicine, New Haven, CT, USA
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Yukihiko Aoyagi
- Vascular Biology and Therapeutics Program, Yale School of Medicine, New Haven, CT, USA
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Luis Gonzalez
- Vascular Biology and Therapeutics Program, Yale School of Medicine, New Haven, CT, USA
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Carly Thaxton
- Vascular Biology and Therapeutics Program, Yale School of Medicine, New Haven, CT, USA
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Weichang Zhang
- Vascular Biology and Therapeutics Program, Yale School of Medicine, New Haven, CT, USA
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Masaki Kano
- Vascular Biology and Therapeutics Program, Yale School of Medicine, New Haven, CT, USA
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hualong Bai
- Vascular Biology and Therapeutics Program, Yale School of Medicine, New Haven, CT, USA
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Bogdan Yatsula
- Vascular Biology and Therapeutics Program, Yale School of Medicine, New Haven, CT, USA
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Rafael Alves
- Vascular Biology and Therapeutics Program, Yale School of Medicine, New Haven, CT, USA
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Katsuyuki Hoshina
- Division of Vascular Surgery, Department of Surgery, The University of Tokyo, Tokyo, Japan
| | - Eric B Schneider
- Department of Surgery, Center for Health Services and Outcomes Research, Yale School of Medicine, New Haven, CT, USA
| | - Xiaochun Long
- Vascular Biology Center, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Rachel J Perry
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Cellular and Molecular Physiology, Yale School of Medicine, New Haven, CT, USA
| | - Alan Dardik
- Vascular Biology and Therapeutics Program, Yale School of Medicine, New Haven, CT, USA.
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
- Department of Cellular and Molecular Physiology, Yale School of Medicine, New Haven, CT, USA.
- Surgical Service, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.
- Yale School of Medicine, 10 Amistad Street, Room 437, PO Box 208089, New Haven, CT, 06520-8089, USA.
| |
Collapse
|
2
|
Seet C, Lindsey B, Sivaprakasam R, McCafferty K, Forbes S, Akhtar MR, Khurram M, Mohamed IH. The management of dialysis access thrombosis during the COVID-19 pandemic. J Vasc Access 2023; 24:660-665. [PMID: 34538194 DOI: 10.1177/11297298211045578] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Maintaining patent access is essential for haemodialysis dependent end stage renal failure patients. The COVID-19 pandemic has significantly affected surgical and interventional radiology services worldwide. We aimed to review the impact COVID-19 has caused to the management of acute dialysis access thrombosis. METHODS We conducted a single centre retrospective review of outcomes of patients with arteriovenous fistula and arteriovenous graft thrombosis between March and May 2020, which coincided with the first peak of the COVID-19 pandemic in London, and a similar period in the previous year, March-May 2019. Outcomes in both cohorts of patients were compared, including attempts at salvage, salvage success, 1-month patency rates after salvage and subsequent surgery on the same access. We also analysed the use of tunnelled haemodialysis lines (THL), either due to failed salvage attempts or when salvage was not attempted. RESULTS There was a similar incidence of access thrombosis in both periods (26 cases in 2019, 38 in 2020). There were 601 patients dialysing via an arteriovenous fistula or graft in 2019, and 568 patients in 2020. Access salvage, when attempted, had similar success rates and 1-month patency (salvage success 74% vs 80%, p = 0.39; 1-month patency 55% vs 62%, p = 0.69). The proportion of patients where access salvage was not attempted and a THL inserted was significantly higher in 2020 compared to 2019 (32% vs 4%, p = 0.007). There were more patients who subsequently had surgery to salvage or revise the same access in 2019 compared to 2020 (62% vs 13%, p < 0.001). CONCLUSIONS During the peak of the COVID-19 pandemic, there were fewer attempts at access salvage. This was a conscious decision due to increased pressure on the healthcare system, access to emergency interventional radiology or operative theatres and the perceived risk/benefit ratio of access salvage. The long-term effects of this change in practice remain unknown.
Collapse
Affiliation(s)
- Christopher Seet
- Department of Nephrology and Transplantation, The Royal London Hospital, Bart's Health NHS Trust, London, UK
| | - Ben Lindsey
- Department of Nephrology and Transplantation, The Royal London Hospital, Bart's Health NHS Trust, London, UK
| | - Rajesh Sivaprakasam
- Department of Nephrology and Transplantation, The Royal London Hospital, Bart's Health NHS Trust, London, UK
| | - Kieran McCafferty
- Department of Nephrology and Transplantation, The Royal London Hospital, Bart's Health NHS Trust, London, UK
| | - Suzanne Forbes
- Department of Nephrology and Transplantation, The Royal London Hospital, Bart's Health NHS Trust, London, UK
| | - Mohammed Rashid Akhtar
- Department of Interventional Radiology, The Royal London Hospital, Bart's Health NHS Trust, London, UK
| | - Muhammad Khurram
- Department of Nephrology and Transplantation, The Royal London Hospital, Bart's Health NHS Trust, London, UK
| | - Ismail H Mohamed
- Department of Nephrology and Transplantation, The Royal London Hospital, Bart's Health NHS Trust, London, UK
| |
Collapse
|
3
|
Maßmann A, Hammer I, Ketteler M, Latus J. [Acute interventions-dialysis shunt recanalization]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:18-23. [PMID: 36443567 DOI: 10.1007/s00117-022-01089-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/24/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND An arteriovenous fistula is vital for patients who need regular hemodialysis. Continuous patency and sufficient functionality determine quality of life and associated morbidity and mortality of patients. PROBLEM Following successful hemodialysis shunt creation, intimal hyperplasia and consecutive thrombosis or complete occlusion may cause different types of shunt dysfunctionality or even critical failure. OBJECTIVE Immediate shunt recanalization and revision by using an endovascular-first approach is crucial for long-term survival of hemodialysis fistula. There are several mechanisms available for catheter-based thrombus removal to unmask the typically underlying shunt stenosis. METHODS Primary technical recanalization success rates are very similar for clot cleaning. Treatment of intimal hyperplasia is preferably addressed by using drug-coated balloon angioplasty to allow for increased shunt patency compared to plain old balloon angioplasty. Stents and stent grafts are only used for resistant or repeated short-term recurrence of severe stenosis. Finally, surgical revision has a classical role in case of repeated failure of endovascular measures.
Collapse
Affiliation(s)
- Alexander Maßmann
- Diagnostische & Interventionelle Radiologie und Nuklearmedizin, Robert-Bosch-Krankenhaus GmbH am Bosch Health Campus, Auerbachstr. 110, 70376, Stuttgart, Deutschland.
| | - Inga Hammer
- Allgemeine Innere Medizin und Nephrologie, Robert-Bosch-Krankenhaus GmbH am Bosch Health Campus, Stuttgart, Deutschland
| | - Markus Ketteler
- Allgemeine Innere Medizin und Nephrologie, Robert-Bosch-Krankenhaus GmbH am Bosch Health Campus, Stuttgart, Deutschland
- Altersmedizin und Rehabilitation, Robert-Bosch-Krankenhaus GmbH am Bosch Health Campus, Stuttgart, Deutschland
| | - Jörg Latus
- Allgemeine Innere Medizin und Nephrologie, Robert-Bosch-Krankenhaus GmbH am Bosch Health Campus, Stuttgart, Deutschland
| |
Collapse
|
4
|
Chen Q, Liang L, Zhang Z, Du J, Tang L, Cao W, Kong X, Xu D. Pathological analysis of vascularization of the arterialized veins in failed arteriovenous fistulas among uremic patients. J Vasc Interv Radiol 2022; 33:904-912.e1. [PMID: 35605817 DOI: 10.1016/j.jvir.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/29/2022] [Accepted: 05/08/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To assess venous wall vascularization and its correlation with neointimal hyperplasia (NIH) in failed arteriovenous fistulas (AVFs). METHODS A total of 43 uremic patients who received a first AVF creation and 39 patients who received reconstruction of failed fistulas were enrolled in the study. A 5-10 mm vein segment adjacent to future fistula creation or reconstruction site was surgically removed and assessed using histopathological analyses and stained by immunohistochemistry to quantify vasa vasorum density (VVD). RESULTS Both the intimal thickness (70.68 [28.81-99.54] vs. 4.53 [2.69-7.30] μm, P < 0.001) and the intimal thickness/medial thickness ratio (2.20 [0.77-4.36] vs. 0.15 [0.10-0.30], P < 0.001) were higher in failed AVFs than in pre-access veins. CD31 and factor VIII marked VVDs both in the intima (6.31 [1.62-12.53] vs. 0.0 [0.0-0.0], P < 0.001; 7.82 [3.33-11.61] vs. 0.0 [0.0-0.0], P < 0.001) and media (10.0 [7.59-12.95] vs. 3.71 [2.44-4.87], P < 0.001; 8.33 [5.55-13.0] vs. 3.57 [2.53-4.82], P < 0.001), and the intimal VVD/medial VVD ratio (0.67 [0.19-1.08] vs. 0.0 [0.0-0.0], P < 0.001; 0.71 [0.39-1.14] vs. 0.0 [0.0-0.0], P < 0.001) were significantly higher in failed AVFs than in pre-access veins. There was also a positive relationship between the intimal VVD/medial VVD ratio and the intimal thickness/medial thickness ratio (P < 0.001). In addition, compared to pre-access veins, vascular endothelial cell growth factor-A (VEGF-A) expression was higher in failed AVFs. CONCLUSIONS Vascularization of the vessel wall was noticeably more developed in the arterialized veins, especially among the NIH regions in failed AVFs.
Collapse
Affiliation(s)
- Qinlan Chen
- Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, No.44, Wenhua West Road, Jinan, China
| | - Liming Liang
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, No.16766, Jingshi Road, Jinan, 250014, PR China; Nephrology Research Institute of Shandong Province, No.16766, Jingshi Road, Jinan, 250014, PR China
| | - Ziheng Zhang
- Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, No.44, Wenhua West Road, Jinan, China
| | - Jing Du
- Department of Blood Purification Center, Weifang People's Hospital, No.151, Guangwen Street, Kuiwen District, Weifang, China
| | - Lijun Tang
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, No.16766, Jingshi Road, Jinan, 250014, PR China; Nephrology Research Institute of Shandong Province, No.16766, Jingshi Road, Jinan, 250014, PR China
| | - Wei Cao
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, No.16766, Jingshi Road, Jinan, 250014, PR China; Nephrology Research Institute of Shandong Province, No.16766, Jingshi Road, Jinan, 250014, PR China
| | - Xianglei Kong
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, No.16766, Jingshi Road, Jinan, 250014, PR China; Nephrology Research Institute of Shandong Province, No.16766, Jingshi Road, Jinan, 250014, PR China
| | - Dongmei Xu
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, No.16766, Jingshi Road, Jinan, 250014, PR China; Nephrology Research Institute of Shandong Province, No.16766, Jingshi Road, Jinan, 250014, PR China
| |
Collapse
|
5
|
Almehmi A, Sheta M, Abaza M, Almehmi SE, El Khudari H, Shaikh A. Endovascular Management of Thrombosed Dialysis Vascular Circuits. Semin Intervent Radiol 2022; 39:14-22. [PMID: 35210728 PMCID: PMC8856780 DOI: 10.1055/s-0041-1740941] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A functional hemodialysis vascular access is the lifeline for patients with end-stage kidney disease and is considered a major determinant of survival and quality of life in this patient population. Hemodialysis therapy can be performed via arteriovenous fistulas, arteriovenous grafts, and central venous catheters (CVCs). Following dialysis vascular access creation, the interplay between several pathologic mechanisms can lead to vascular luminal obstruction due to neointimal hyperplasia with subsequent stenosis, stasis, and eventually access thrombosis. Restoration of the blood flow in the vascular access circuit via thrombectomy is crucial to avoid the use of CVCs and to prolong the life span of the vascular access conduits. The fundamental principles of thrombectomy center around removing the thrombus from the thrombosed access and treating the underlying culprit vascular stenosis. Several endovascular devices have been utilized to perform mechanical thrombectomy and have shown comparable outcomes. Standard angioplasty balloons remain the cornerstone for the treatment of stenotic vascular lesions. The utility of drug-coated balloons in dialysis vascular access remains unsettled due to conflicting results from randomized clinical trials. Stent grafts are used to treat resistant and recurrent stenotic lesions and to control extravasation from a ruptured vessel that is not controlled by conservative measures. Overall, endovascular thrombectomy is the preferred modality of treatment for the thrombosed dialysis vascular conduits.
Collapse
Affiliation(s)
- Ammar Almehmi
- Department of Radiology and Medicine, University of Alabama at Birmingham, Birmingham, Alabama,Address for correspondence Ammar Almehmi, MD Department of Radiology and Medicine, University of Alabama at BirminghamBirmingham, AL 35294
| | - Mohamed Sheta
- Department of Nephrology, University of Texas at Houston, Houston, Texas
| | - Masa Abaza
- Department of Biology, University of Alaska at Anchorage, Anchorage, Alaska
| | - Sloan E. Almehmi
- Department of Biology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Husam El Khudari
- Division of Interventional Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Aisha Shaikh
- Renal Service, Memorial Sloan Kettering Cancer Center, New York, New York
| |
Collapse
|
6
|
Lundström UH, Welander G, Carrero JJ, Hedin U, Evans M. OUP accepted manuscript. Nephrol Dial Transplant 2022; 37:1742-1750. [PMID: 35138407 PMCID: PMC9395373 DOI: 10.1093/ndt/gfac036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Gunilla Welander
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Juan Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ulf Hedin
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Marie Evans
- Division of Renal medicine, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
7
|
Yeo CB, Yong E, Hong Q, Kwan J, Quek LHH, Pua U, Punamiya S, Chandrasekar S, Tan GWL, Lo ZJ. Outcomes of Catheter-Directed Thrombolysis for Arteriovenous Fistula Thrombosis in Singapore: Is It Still Relevant Today? Ann Vasc Dis 2021; 14:5-10. [PMID: 33786093 PMCID: PMC7991696 DOI: 10.3400/avd.oa.20-00112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Objective: To review the outcomes of catheter-directed thrombolysis (CDT) for salvage of thrombosed arteriovenous fistula (AVF) in a single centre in Southeast Asia. Methods: A retrospective study of CDT in AVF between January 2015 and July 2018 at a tertiary university hospital was carried out. Results: Within the study period, 85 patients underwent CDT for AVF thrombosis. Of these patients, 78% underwent CDT for 24 h and 12% required CDT for 48 h. Moreover, 14% of patients had bleeding during CDT and hence required a decrease in dosing or complete cessation. Incidence of intracranial haemorrhage was 1%, and technical success was 92%. Post CDT, primary patency rates at 12, 24 and 36 months were 87%, 62% and 36%, respectively; assisted primary patency rates at 12, 24 and 36 months were 96%, 82% and 69%, respectively; and secondary patency rates at 12, 24 and 36 months were 99%, 93% and 86%, respectively. Multivariate analysis did not identify any predictive factors for patency post CDT. Conclusion: Within our study population, CDT for AVF salvage conferred good technical results with low rates of complications. There was good primary patency at 12 months, and the results were sustained up to 36 months. It remains a useful modality for fistula salvage, avoiding surgical intervention.
Collapse
Affiliation(s)
- Clarice Biru Yeo
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Enming Yong
- Vascular and Endovascular Surgery, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Qiantai Hong
- Vascular and Endovascular Surgery, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Justin Kwan
- Vascular and Interventional Radiology, Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Lawrence Han Hwee Quek
- Vascular and Interventional Radiology, Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Uei Pua
- Vascular and Interventional Radiology, Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Sundeep Punamiya
- Vascular and Interventional Radiology, Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Sadhana Chandrasekar
- Vascular and Endovascular Surgery, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Glenn Wei Leong Tan
- Vascular and Endovascular Surgery, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Zhiwen Joseph Lo
- Vascular and Endovascular Surgery, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| |
Collapse
|
8
|
Huan KWSJ, Tan CS, Chua D, Yap CJQ, Tan RY, Chong TT, Tang TY. The Cleaner XT™ Device as an Endovascular Adjunct for Pharmacomechanical Thrombolysis of Thrombosed Arteriovenous Fistulas and Grafts. Ann Vasc Dis 2020; 13:390-396. [PMID: 33391556 PMCID: PMC7758596 DOI: 10.3400/avd.oa.20-00046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: This paper documents our experience using the Cleaner XT™ device (Argon Medical Devices, Plano, TX, USA) for pharmacomechanical thrombolysis (PMT) of thrombosed haemodialysis arteriovenous grafts (AVG) and fistulas (AVF). Materials and Methods: This was a retrospective case series (n=17) over six months at Singapore General Hospital. We evaluated demographics, procedural data, technical and procedural success, patency rates and complications. Results: There were 8 (47%) males and the patients' mean age was 66 (± 5.7) years. The mean age of AVF/AVG was 1605 (± 1099) days. All procedures were performed under local anaesthetic. PMT was performed within a mean time of 40 (±34.3) hours from the presentation. Technical, clinical and procedural success was 15/17 (88%). The thrombolysis agents used were tissue plasminogen activator (52.9%) and urokinase (41.2%). Mean primary patency time was 114 (± 116) days, with a 65% 1-month and 47% 3-month primary patency rates. The mean secondary patency time was 155 (±132) days, with 76% one-month and 65% three-month secondary patency rates, respectively. AVF rupture occurred in 3/17 (18%) cases but did not involve loss of the access circuit. Conclusion: The Cleaner XT™ device is a safe, minimally invasive endovascular tool for PMT in thrombosed AVF/AVG, with relatively high success and low complication rates.
Collapse
Affiliation(s)
| | - Chieh Suai Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Deborah Chua
- Department of Vascular Surgery, Singapore General Hospital, Singapore
| | - Charyl Jia Qi Yap
- Department of Vascular Surgery, Singapore General Hospital, Singapore
| | - Ru Yu Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Tze Tec Chong
- Department of Vascular Surgery, Singapore General Hospital, Singapore
| | - Tjun Yip Tang
- Department of Vascular Surgery, Singapore General Hospital, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore
| |
Collapse
|
9
|
Jegatheswaran J, Hundemer GL, Massicotte-Azarniouch D, Sood MM. Anticoagulation in Patients With Advanced Chronic Kidney Disease: Walking the Fine Line Between Benefit and Harm. Can J Cardiol 2019; 35:1241-1255. [PMID: 31472820 DOI: 10.1016/j.cjca.2019.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 07/03/2019] [Accepted: 07/04/2019] [Indexed: 12/23/2022] Open
Abstract
Chronic kidney disease affects more than 3 million Canadians and is highly associated with cardiovascular diseases that require anticoagulation, such as atrial fibrillation and venous thromboembolism. Patients with chronic kidney disease are at a problematic crossroads; they are at high risk of thrombotic conditions requiring anticoagulation and bleeding complications due to anticoagulation. The limited high-quality clinical evidence to guide decision-making in this area further compounds the dilemma. In this review, we discuss the physiology and epidemiology of bleeding and thrombosis in patients with kidney disease. We specifically focus on patients with advanced kidney disease (estimated glomerular filtration rate ≤ 30 mL/min) or who are receiving dialysis and focus on the nephrologist perspective regarding these issues. We summarize the existing evidence for anticoagulation use in the prevention of stroke with atrial fibrillation and provide practical clinical recommendations for considering anticoagulation use in this population. Last, we examine specific scenarios such as the use of a glomerular filtration rate estimating equation and dosing, the use of existing prediction tools for stroke and hemorrhage risk, current patterns of anticoagulation use (including during the dialysis procedure), and vascular calcification with vitamin K antagonist use in patients with chronic kidney disease.
Collapse
Affiliation(s)
| | - Gregory L Hundemer
- Division of Nephrology, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Manish M Sood
- Division of Nephrology, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
| |
Collapse
|
10
|
Gameiro J, Ibeas J. Factors affecting arteriovenous fistula dysfunction: A narrative review. J Vasc Access 2019; 21:134-147. [PMID: 31113281 DOI: 10.1177/1129729819845562] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Vascular access dysfunction is one of the most important causes of morbidity and mortality in haemodialysis patients, contributing to up to one third of hospitalisations and accounting for a significant amount of the health care costs of these patients. In the past decades, significant scientific advances in understanding mechanisms of arteriovenous fistula maturation and failure have contributed to an increase in the amount of research into techniques for creation and strategies for arteriovenous fistula dysfunction prevention and treatment, in order to improve patient care and outcomes. The aim of this review is to describe the pathogenesis of vascular access failure and provide a comprehensive analysis of the associated risk factors and causes of vascular access failure, in order to interpret possible future therapeutic approaches. Arteriovenous fistula failure is a multifactorial process resulting from the combination of upstream and downstream events with consequent venous neo-intimal hyperplasia and/or inadequate outward remodelling. Inflammation appears to be central in the biology of arteriovenous fistula dysfunction but important triggers still need to be revealed. Given the significant association of arteriovenous fistula failure and patient's prognosis, it is therefore imperative to further research in this area in order to improve prevention, surveillance and treatment, and ultimately patient care and outcomes.
Collapse
Affiliation(s)
- Joana Gameiro
- Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Lisboa Norte, EPE, Lisboa, Portugal
| | - Jose Ibeas
- Nephrology Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| |
Collapse
|
11
|
Walsh MT, Moore JE. Editorial: Special Issue on Vascular Access : Towards Improving Vascular Access. Cardiovasc Eng Technol 2018; 8:237-239. [PMID: 28795379 DOI: 10.1007/s13239-017-0326-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Michael T Walsh
- Health Research Institute, Bernal Institute, School of Engineering, University of Limerick, Limerick, Ireland.
| | - James E Moore
- Department of Bioengineering, Imperial College London, London, SW7 2AZ, UK
| |
Collapse
|