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Etkin Y, Woo K, Guidry L. Options for Dialysis and Vascular Access Creation. Surg Clin North Am 2023; 103:673-684. [PMID: 37455031 DOI: 10.1016/j.suc.2023.05.006] [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: 07/18/2023]
Abstract
End-stage kidney disease (ESKD) affects nearly 800,000 patients in the United States. The choice of peritoneal dialysis (PD) versus hemodialysis (HD) should be patient centric. An ESKD Life-Plan is crucial with the goal of creating the right access, for the right patient, at the right time, for the right reason. Complex access should be considered when straightforward access options have been exhausted. Evolving techniques such as percutaneous access for HD and PD should be further investigated. Shared decision-making and palliative care is an essential part of the care of patients with CKD and ESKD..
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Affiliation(s)
- Yana Etkin
- Division of Vascular and Endovascular Surgery, Department of Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Karen Woo
- Division of Vascular Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, 200 UCLA Medical Plaza Suite 526, Los Angeles, CA 90095, USA.
| | - London Guidry
- Division of Vascular and Endovascular Surgery, Department of Surgery, Louisiana State University Health and Science Center, New Orleans, LA, USA
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2
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Feng S, Peden EK, Guo Q, Lee TH, Li Q, Yuan Y, Chen C, Huang F, Cheng J. Downregulation of the endothelial histone demethylase JMJD3 is associated with neointimal hyperplasia of arteriovenous fistulas in kidney failure. J Biol Chem 2022; 298:101816. [PMID: 35278430 PMCID: PMC9052161 DOI: 10.1016/j.jbc.2022.101816] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/27/2022] [Accepted: 02/28/2022] [Indexed: 11/25/2022] Open
Abstract
Jumonji domain-containing protein-3 (JMJD3), a histone H3 lysine 27 (H3K27) demethylase, promotes endothelial regeneration, but its function in neointimal hyperplasia (NIH) of arteriovenous fistulas (AVFs) has not been explored. In this study, we examined the contribution of endothelial JMJD3 to NIH of AVFs and the mechanisms underlying JMJD3 expression during kidney failure. We found that endothelial JMJD3 expression was negatively associated with NIH of AVFs in patients with kidney failure. JMJD3 expression in endothelial cells (ECs) was also downregulated in the vasculature of chronic kidney disease (CKD) mice. In addition, specific knockout of endothelial JMJD3 delayed EC regeneration, enhanced endothelial mesenchymal transition, impaired endothelial barrier function as determined by increased Evans blue staining and inflammatory cell infiltration, and accelerated neointima formation in AVFs created by venous end to arterial side anastomosis in CKD mice. Mechanistically, JMJD3 expression was downregulated via binding of transforming growth factor beta 1-mediated Hes family transcription factor Hes1 to its gene promoter. Knockdown of JMJD3 enhanced H3K27 methylation, thereby inhibiting transcriptional activity at promoters of EC markers and reducing migration and proliferation of ECs. Furthermore, knockdown of endothelial JMJD3 decreased endothelial nitric oxide synthase expression and nitric oxide production, leading to the proliferation of vascular smooth muscle cells. In conclusion, we demonstrate that decreased expression of endothelial JMJD3 impairs EC regeneration and function and accelerates neointima formation in AVFs. We propose increasing the expression of endothelial JMJD3 could represent a new strategy for preventing endothelial dysfunction, attenuating NIH, and improving AVF patency in patients with kidney disease.
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Affiliation(s)
- Shaozhen Feng
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China; Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, USA
| | - Eric K Peden
- Department of Vascular Surgery, DeBakey Heart and Vascular Institute, Houston Methodist Hospital, Houston, USA
| | - Qunying Guo
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, USA
| | - Tae Hoon Lee
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, USA
| | - Qingtian Li
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, USA
| | - Yuhui Yuan
- Department of Surgery, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Changyi Chen
- Department of Surgery, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Fengzhang Huang
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, USA
| | - Jizhong Cheng
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, USA.
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Sharma S, Bera S, Goyal VD, Gupta V, Bisht N. Ulnar-Basilic Arteriovenous Fistula for Hemodialysis Access: Utility as the "Second Procedure" after Radio Cephalic Fistula. Ann Vasc Dis 2021; 14:132-138. [PMID: 34239638 PMCID: PMC8241561 DOI: 10.3400/avd.oa.20-00124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/29/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives: As per standard guidelines, the recommended order of arteriovenous fistula (AVF) creation for hemodialysis (HD) access is radiocephalic (RC), followed by proximal elbow fistulas and arteriovenous graft. Although ulnar-basilic (UB) fistula has been an alternative to RC-AVF, still this procedure searches clear recommendations. We present here our experience on UB-AVF as the preferred “second procedure” instead of proximal fistula after the RC-AVF. Methods: Forty-two UB-AVF were created in nonfeasible and failed RC-AVF cases between 2016 and 2018. They were reviewed retrospectively and outcomes were compared with 480 RC-AVF constructed within the same period. Results: The primary patency at 18 months was 73.8%, 69.6% and mean maturation time was 33.7±6.6 days, 32.1±4.7 days for UB-AVF and RC-AVF respectively (p>0.05). Conclusion: Our altered order of preference enabled us to create all the first-time fistula in the distal forearm, providing all the advantages of distal fistula like RC-AVF and avoiding proximal fistula, improved patient convenience and short-term benefit. In an inference that may be used for references and needs support from a larger sample and longer duration study from other centers, UB-AVF may be considered as the second option after RC-AVF depending on the clinical scenario.
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Affiliation(s)
- Shobhit Sharma
- Department of Surgery, Shri Ram Murti Samarak Institute of Medical Sciences, Bareilly (UP)-243202, India
| | - Sudipta Bera
- Department of Plastic and Reconstructive Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi (UP), India
| | - Vikas Deep Goyal
- Department of Surgery, Shri Ram Murti Samarak Institute of Medical Sciences, Bareilly (UP)-243202, India
| | - Vivek Gupta
- Department of Plastic and Reconstructive Surgery, Sir Gangaram Hospital, New Delhi, India
| | - Navneeta Bisht
- Department of Anesthesia, Shri Ram Murti Samarak Institute of Medical Sciences, Bareilly (UP), India
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Abstract
End-stage kidney disease (ESKD) is a common and morbid disease that affects patients' quality and length of life, representing a large portion of health care expenditure in the United States. These patients commonly have associated diabetes and cardiovascular disease, with high rates of cardiovascular-related death. Management of ESKD requires renal replacement therapy via dialysis or transplantation. While transplantation provides the greatest improvement in survival and quality of life, the vast majority of patients are treated initially with hemodialysis. However, outcomes differ significantly among patient populations. Barriers in access to care have particularly affected at-risk populations, such as Black and Hispanic patients. These patients receive less pre-ESKD nephrology care, are less likely to initiate dialysis with a fistula, and wait longer for transplants-even in pediatric populations. Priorities for ESKD care moving into the future include increasing access to nephrology care in underprivileged populations, providing patient-centered care based on each patient's "life plan," and focusing on team-based approaches to ESKD care. This review explores ESKD from the perspective of epidemiology, costs, vascular access, patient-reported outcomes, racial disparities, and the impact of the COVID-19 crisis.
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Affiliation(s)
- Ryan Gupta
- Division of Vascular Surgery and Endovascular Therapy, University of Colorado, Anschutz School of Medicine, Aurora, CO
| | - Karen Woo
- Division of Vascular Surgery, University of California Los Angeles, David Geffen School of Medicine, 200 UCLA Medical Plaza, Suite 526, Los Angeles, CA 90095.
| | - Jeniann A Yi
- Division of Vascular Surgery and Endovascular Therapy, University of Colorado, Anschutz School of Medicine, Aurora, CO
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Ramakrishnan G, Fontem RF, Sheth SU. Tortuous ulnar artery presenting as left distal forearm mass. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:430-432. [PMID: 32775848 PMCID: PMC7396824 DOI: 10.1016/j.jvscit.2020.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/17/2020] [Indexed: 11/19/2022]
Abstract
Knowledge of anatomic variation in vasculature is critical to safe medical intervention as conduits vary in morphology, architecture, and course. Tortuosity is a common anatomic variant in certain arterial beds; however, its prevalence in ulnar arteries is not well documented in the literature. Here we report two cases of tortuous ulnar arteries in patients being evaluated for upper extremity hemodialysis access.
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Affiliation(s)
| | - Rodrigue F. Fontem
- Department of General Surgery, St. Luke's University Health Network, Bethlehem, Pa
| | - Sharvil U. Sheth
- Department of Vascular Surgery, St. Luke's University Health Network, Bethlehem, Pa
- Correspondence: Sharvil U. Sheth, MD, Department of Vascular Surgery, St. Luke's University Health Network, 3735 Nazareth St, Ste 206, Easton, PA 18045
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Zielinski M, Inston N, Krasinski Z, Gabriel M, Oszkinis G. The forearm basilic vein looped transposition fistula as a tertiary option for upper limb vascular access. J Vasc Access 2018; 19:596-601. [DOI: 10.1177/1129729818764137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: The forearm basilic vein can serve as an option for haemodialysis access but may not be possible in cases where the wrist arteries are unsuitable. In this setting, the forearm basilic vein can be used in a looped transposition with a brachial artery anastomosis. Aims: The aims of this study were to assess the outcome of forearm basilic vein looped transposition as an option for vascular access. Material and methods: Data from January 2007 to December 2010 were prospectively collected and analysed. Outcome measures were operative success, complications, maturation and primary and secondary patency following 5 years of follow-up. Results: From a total of 583 patients receiving autologous vascular access for haemodialysis, 24 (4.1%) underwent a forearm basilic vein looped transposition. The median age was 60 years (range, 27–80 years), with a slight male predominance (13 male:11 female). Mean follow-up was 34 months (1–60 months). Two patients died and other three were transplanted with subsequent fistula closure. All procedures were successful (100%); however, maturation failure occurred in one case (4.2%). No serious perioperative complications were observed. In two cases, we observed late false aneurysm formation requiring intervention. Primary patency at 1, 2, 3 and 5 years was the following: 77%, 62%, 21% and 10%, whereas secondary patency was the following: 81%, 71%, 61% and 32%, respectively. Conclusion: Autologous forearm basilic vein looped transposition is an effective surgical procedure for the creation of access for haemodialysis. This may be a useful option in patients with compromised peripheral arterial diameter or flow and should be considered in patients with a suitable forearm basilic vein.
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Affiliation(s)
- Maciej Zielinski
- Department of General and Vascular Surgery, Poznan University of Medical Sciences, Poznań, Poland
| | - Nicholas Inston
- Department of Renal Surgery, Queen Elizabeth Hospital, University Hospital Birmingham, Birmingham, UK
| | - Zbigniew Krasinski
- Department of General and Vascular Surgery, Poznan University of Medical Sciences, Poznań, Poland
| | - Marcin Gabriel
- Department of General and Vascular Surgery, Poznan University of Medical Sciences, Poznań, Poland
| | - Grzegorz Oszkinis
- Department of General and Vascular Surgery, Poznan University of Medical Sciences, Poznań, Poland
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Zhen Y, Liu P, Ye Z, Zheng X, Ma B, Fan G, Yang Y. Long-Term Results of Ulnar-Basilic Fistula Versus Radiocephalic Fistula for Maintenance Hemodialysis Access. Vasc Endovascular Surg 2017; 51:466-469. [PMID: 28835199 DOI: 10.1177/1538574417718448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this study is to compare the rate of primary patency and secondary patency achieved by ulnar-basilic arteriovenous fistula (UBAVF) and radiocephalic arteriovenous fistula (RCAVF) in the maintenance of hemodialysis access. METHODS This retrospective analysis consists of 365 patients who had a forearm UBAVF or RCAVF between January 2012 and December 2015. Of these patients, 44 patients were treated with UBAVF, while 321 patients were treated with RCAVF. Demographics, primary patency, and secondary patency were documented and compared. RESULTS Primary patency rates at 1 and 2 years were 77.2% and 63.9% in group UBAVF and 88.1% and 71.3% in group RCAVF, respectively. Secondary patency rates at 1 and 2 years were 93.0% and 78.8% in group UBAVF and 98.7% and 80.9% in group RCAVF, respectively. The Kaplan-Meier analysis showed that the primary and secondary patency rates were all without statistical difference between the 2 groups. CONCLUSION Given the similar patency rate between UBAVF and RCAVF, the UBAVF could be considered as a reliable alternative when an RCAVF is not possible.
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Affiliation(s)
- Yanan Zhen
- 1 Vascular Surgery Department, China-Japan Friendship Hospital, Graduate School of Peking Union Medical College, Beijing, China
| | - Peng Liu
- 1 Vascular Surgery Department, China-Japan Friendship Hospital, Graduate School of Peking Union Medical College, Beijing, China
| | - Zhidong Ye
- 1 Vascular Surgery Department, China-Japan Friendship Hospital, Graduate School of Peking Union Medical College, Beijing, China
| | - Xia Zheng
- 1 Vascular Surgery Department, China-Japan Friendship Hospital, Graduate School of Peking Union Medical College, Beijing, China
| | - Bo Ma
- 1 Vascular Surgery Department, China-Japan Friendship Hospital, Graduate School of Peking Union Medical College, Beijing, China
| | - Guohui Fan
- 1 Vascular Surgery Department, China-Japan Friendship Hospital, Graduate School of Peking Union Medical College, Beijing, China
| | - Yuguang Yang
- 1 Vascular Surgery Department, China-Japan Friendship Hospital, Graduate School of Peking Union Medical College, Beijing, China
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Norton de Matos A, Sousa CN, Almeida P, Teles P, Loureiro L, Teixeira G, Rego D, Teixeira S. Radio-cephalic fistula recovered with drainage to forearm basilic vein. Hemodial Int 2017; 21:E63-E65. [PMID: 28074626 DOI: 10.1111/hdi.12536] [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] [Indexed: 12/01/2022]
Abstract
Dysfunction problems with vascular access are a concern to patients and dialysis units. The vascular surgeon should analyse such dysfunction and perform a careful assessment of the vascular network in order to find new fistula layouts. We introduce and discuss the case of creation of a radio-cephalic fistula with outflow into the forearm basilic vein through rotation of the forearm basilic vein toward the cephalic vein in the forearm of an 88-year-old hemodialysis male patient. This technique enables extending fistula patency and improves cost efficiency.
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Affiliation(s)
- António Norton de Matos
- Vascular Access Center (Grupo Estudos Vasculares-GEV), Porto, Portugal.,Angiology and Vascular Surgery Departament, Centro Hospitalar do Porto, Portugal
| | - Clemente Neves Sousa
- Vascular Access Center (Grupo Estudos Vasculares-GEV), Porto, Portugal.,Nursing School of Porto, Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research Faculty of Medicine, Porto University
| | - Paulo Almeida
- Vascular Access Center (Grupo Estudos Vasculares-GEV), Porto, Portugal.,Angiology and Vascular Surgery Departament, Centro Hospitalar do Porto, Portugal
| | - Paulo Teles
- School of Economics and LIAAD-INESC Porto LA, Porto University, Porto, Portugal
| | - Luís Loureiro
- Vascular Access Center (Grupo Estudos Vasculares-GEV), Porto, Portugal.,Angiology and Vascular Surgery Departament, Centro Hospitalar do Porto, Portugal
| | - Gabriela Teixeira
- Vascular Access Center (Grupo Estudos Vasculares-GEV), Porto, Portugal.,Angiology and Vascular Surgery Departament, Centro Hospitalar do Porto, Portugal
| | - Duarte Rego
- Vascular Access Center (Grupo Estudos Vasculares-GEV), Porto, Portugal.,Angiology and Vascular Surgery Departament, Centro Hospitalar do Porto, Portugal
| | - Sérgio Teixeira
- Vascular Access Center (Grupo Estudos Vasculares-GEV), Porto, Portugal.,Angiology and Vascular Surgery Departament, Centro Hospitalar do Porto, Portugal
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