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Böhme T, Noory E, Beschorner U, Jacques B, Bürgelin K, Hirstein S, Zeller T. Combined treatment of dysfunctional dialysis access with cutting balloon and paclitaxel-coated balloon in real world. VASA 2023. [PMID: 36939289 DOI: 10.1024/0301-1526/a001063] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
Background: Dysfunction in arteriovenous (AV) access is a common reason for subsequent intervention. To evaluate the results of endovascular treatment of AV access lesions using cutting balloon (CB) and drug-coated balloon (DCB) angioplasty compared to standard treatment using plain-old balloon angioplasty (POBA). Patients and methods: Patients who retrospectively were selected from a prospectively maintained database. Primary endpoint was primary patency rate at the target lesion up to 12 months after index procedure. Secondary endpoints were the acute treatment success, the "bail out" stent rate, primary patency at 6 months, freedom from target lesion revascularization (TLR), AV access replacement and surgical revision during a follow-up period up to 12 months, and all-cause mortality rate stratified to patients treated with and without DCB. Results: One hundred and eighty-four patients met the inclusion criteria. POBA as stand alone or combined with DCB angioplasty was performed in 71 patients (38.6%), CB in 54 patients (29.3%), and in 59 patients (32.1%), both CB and DCB were used. Primary patency rate at 12 months was 31.6% for the POBA/DCB-group, 52.3% for the CB-group, and 64.8% for the CB/DCB-group, respectively. In total, 80 patients (51.6%) had a TLR including endovascular or surgical revision, or a shunt replacement. All-cause mortality at 12 months was 7.2% in the DCB group and 9.1% in the group of patients treated without a DCB (p=0.747). Conclusions: The use of CB seems to be crucial for a better outcome. The combination of CB and DCB achieves the best patency results at mid-term.
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Affiliation(s)
- Tanja Böhme
- Department of Cardiology and Angiology, Medical Center - University of Freiburg, Germany
| | - Elias Noory
- Department of Cardiology and Angiology, Medical Center - University of Freiburg, Germany
| | - Ulrich Beschorner
- Department of Cardiology and Angiology, Medical Center - University of Freiburg, Germany
| | - Börries Jacques
- Department of Cardiology and Angiology, Medical Center - University of Freiburg, Germany
| | - Karlheinz Bürgelin
- Department of Cardiology and Angiology, Medical Center - University of Freiburg, Germany
| | - Sarah Hirstein
- Department of Cardiology and Angiology, Medical Center - University of Freiburg, Germany
| | - Thomas Zeller
- Department of Cardiology and Angiology, Medical Center - University of Freiburg, Germany
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2
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Deogaonkar G, Thulasidasan N, Phulambrikar R, Diamantopoulos A, Sran K, Ahmed I, Loukopoulos I, Karunanithy N. Endovascular salvage of thrombosed haemodialysis vascular access. VASA 2023; 52:63-70. [PMID: 36464999 DOI: 10.1024/0301-1526/a001043] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: Haemodialysis access thrombosis is associated with significant morbidity and access abandonment rates, for which endovascular salvage is a well described treatment option. This study aimed to evaluate the outcomes of endovascular salvage procedures of thrombosed vascular access circuits and identify factors influencing outcomes. Patients and methods: Retrospective review of 328 consecutive procedures performed over 10 years at our institution between January 2010 and December 2019. Patient demographics, access circuit characteristics, procedure details and outcome data were collected. Kaplan-Meier survival curves were used to estimate patency rates and Cox multivariate regression analysis to identify factors affecting outcomes. Results: Technical and clinical success rates were 87.8% and 75.9% respectively. The primary, primary assisted and secondary patency rates at 6 months were 42.2%, 46.7% and 59.1%; and at 12 months were 23.4%, 28.3% and 41.8% respectively. Median access circuit survival was 9.2 months. Major complication rate was 5.2% including 3 procedure-related deaths. Native AVF, lower time from thrombosis to intervention and pharmacomechanical thrombectomy using AngioJetTM predicted positive outcomes. Previous thrombectomy within 3 months and residual thrombus at completion were associated with poorer outcomes. Age and hypertension predicted higher complication rates. Conclusions: This is one of the largest single center series of endovascular salvage of thrombosed haemodialysis access and demonstrates that endovascular treatment is effective and provides durable access circuit survival. Careful patient screening is essential to optimize outcomes.
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Affiliation(s)
- Ganesh Deogaonkar
- Department of Interventional Radiology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Narayanan Thulasidasan
- Department of Interventional Radiology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Rutuja Phulambrikar
- Department of Interventional Radiology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | | | - Kiran Sran
- Department of Nephrology & Transplantation, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Irfan Ahmed
- Department of Interventional Radiology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Ioannis Loukopoulos
- Department of Nephrology & Transplantation, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Narayan Karunanithy
- Department of Interventional Radiology, Guy's & St Thomas' NHS Foundation Trust, London, UK.,School of Biomedical Engineering & Imaging Sciences, King's College London, UK
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3
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Franco RP, Riella MC, Chula DC, Alcântara MTD, Nascimento MMD. Safety and efficacy of arteriovenous fistula angioplasties performed by nephrologists: report from a Brazilian interventional nephrology center. J Bras Nefrol 2021; 44:196-203. [PMID: 34763352 PMCID: PMC9269175 DOI: 10.1590/2175-8239-jbn-2021-0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 08/22/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: Arteriovenous fistulas (AVF) are the first choice vascular access for hemodialysis. However, they present a high incidence of venous stenosis leading to thrombosis. Although training in interventional nephrology may improve accessibility for treatment of venous stenosis, there is limited data on the safety and efficacy of this approach performed by trained nephrologists in low-income and developing countries. Methods: This study presents the retrospective results of AVF angioplasties performed by trained nephrologists in a Brazilian outpatient interventional nephrology center. The primary outcome was technical success rate (completion of the procedure with angioplasty of all stenoses) and secondary outcomes were complication rates and overall AVF patency. Findings: Two hundred fifty-six angioplasties were performed in 160 AVF. The technical success rate was 88.77% and the main cause of technical failure was venous occlusion (10%). The incidence of complications was 13.67%, with only one patient needing hospitalization and four accesses lost due to the presence of hematomas and/or thrombosis. Grade 1 hematomas were the most frequent complication (8.2%). The overall patency found was 88.2 and 80.9% at 180 and 360 days after the procedure, respectively. Conclusion: Our findings suggest that AVF angioplasty performed by trained nephrologists has acceptable success rates and patency, with a low incidence of major complications as well as a low need for hospitalization.
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Affiliation(s)
- Ricardo P Franco
- Pro-Renal Brasil, Centro de Nefrologia Intervencionista, Curitiba, PR, Brasil
| | - Miguel C Riella
- Pro-Renal Brasil, Centro de Nefrologia Intervencionista, Curitiba, PR, Brasil.,Faculdade Evangélica Mackenzie do Paraná, Curitiba, PR, Brasil
| | - Domingos C Chula
- Pro-Renal Brasil, Centro de Nefrologia Intervencionista, Curitiba, PR, Brasil
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Richard MN, Stroever S, Dowling C, Burton T, Butler A, Plummer D, Dietzek AM. Repeated Endovascular Interventions Are Worthwhile, Even After Thrombosis, to Maintain Long-Term Use of Autogenous Dialysis Fistulas. Vasc Endovascular Surg 2021; 55:823-830. [PMID: 34196244 DOI: 10.1177/15385744211026452] [Citation(s) in RCA: 1] [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
OBJECTIVES Patients often require multiple access re-interventions to improve fistula patency and the overall usable lifespan of autogenous arteriovenous fistula (aAVF). There is no consensus on the appropriate number of re-interventions after which an access should be abandoned and new access placed. We evaluated whether repeated endovascular interventions for failing/failed aAVF are worthwhile or futile. METHODS A retrospective review was performed on aAVFs created between 2009-2014. Fistula function was evaluated until January 2017. Functional fistula patency (FFP) was defined as the total time of functional fistula use for hemodialysis, from time of cannulation to time of measurement or fistula abandonment, including all interventions performed to maintain/reestablish patency. Primary outcomes were FFP duration and number of post-dialysis interventions. RESULTS The study included 163 patients. Mean age was 67 (SD = 15.03). The only variable statistically different between functional fistulas and abandoned fistulas was obesity (p = 0.03). At the end of the study period, 145 (89.0%) patients continued to have functional fistulas, and 73 (44.8%) patients died, but had functional fistulas at time of death. Median FFP for the functional group was 3.18 years (range 0.01-7.01 years) and median number of interventions was 1 (range 0-13). In 18 patients (11%), the fistula was abandoned, most commonly due to thrombosis (47.1%), followed by infection (23.5%). No fistula was abandoned because of an unacceptable rate of reintervention. Median FFP in the abandoned group was 0.91 years (range 0.03-5.30 years), and median number of interventions was 0 (range of 0-5). CONCLUSIONS Through repeated interventions on aAVFs, none of the patients in our study exhausted all hemodialysis access options prior to transplantation, death or loss to follow-up. These results may indicate repeated and/or more frequent revisions do not negatively affect the FFP nor do they increase the overall risk for abandonment of aAVFs.
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Affiliation(s)
| | | | | | | | - Amber Butler
- Department of Research, Danbury Hospital, Danbury, CT, USA
| | - Dahlia Plummer
- Department of Vascular Surgery, Danbury Hospital, Danbury, CT, USA
| | - Alan M Dietzek
- Department of Vascular Surgery, Danbury Hospital, Danbury, CT, USA
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5
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Patel J, Chang S, Manawar S, Munn J, Rummel MC, Johnston D, Jain K. Effectiveness and safety of repeated percutaneous intervention in an office-based endovascular center in maintaining hemodialysis access. Vascular 2021; 30:229-237. [PMID: 33813972 DOI: 10.1177/17085381211004306] [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: 11/15/2022]
Abstract
OBJECTIVES Percutaneous dialysis access interventions are routinely used to maintain the patency of dialysis access despite the lack of data regarding their long-term effectiveness. This retrospective study was undertaken to study the effectiveness and safety of percutaneous dialysis access interventions in arm fistulas and bridge grafts in an office-based endovascular center. METHODS Patients who had a percutaneous dialysis access intervention in their upper extremity access site, performed at a single office-based endovascular center over a nine-year period (2007-2016) were included in this study. The patients' demographic factors, patency, and complications were analyzed. Patients were entered in the study after first percutaneous dialysis access intervention. RESULTS A total of 298 limbs in 259 patients had 913 procedures carried out over a nine-year period. There were 190 access arteriovenous fistulas and 108 arteriovenous grafts. The two most common arteriovenous fistulas were the brachiocephalic fistula (n = 74, 39%) and radio cephalic fistula (n = 69, 36%). Arteriovenous grafts were most commonly placed in the upper arm (n = 66, 61%) followed by the forearm (n = 42, 39%). The mean overall patency for all limbs was 50.86 months. Arteriovenous fistulas had a significantly longer patency than arteriovenous grafts (51.65 vs. 42.09 months; P = 0.01). In addition, patients with two or more percutaneous dialysis access intervention in their arteriovenous fistula had significantly greater patency than those with only one percutaneous dialysis access intervention (58.5 vs. 7.6 months; hazard ratio 0.41; P = 0.0008). This was not true for the arteriovenous graft group. Women represented 49% of the patient group. Their accesses had shorter patency than men (39.8 vs. 60 months; P = 0.0007). CONCLUSIONS This data support the use of repeated percutaneous dialysis access intervention to maintain long-term patency of dialysis access sites in an office-based endovascular center. Overall, fistulas have longer patency than grafts and women have poorer outcomes as compared to men.
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Affiliation(s)
- Jay Patel
- Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
| | - Stephanie Chang
- Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
| | - Shaan Manawar
- Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
| | - John Munn
- Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA.,Advanced Vascular Surgery, Kalamazoo, MI, USA
| | - Mark C Rummel
- Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA.,Advanced Vascular Surgery, Kalamazoo, MI, USA
| | | | - Krishna Jain
- Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA.,Advanced Vascular Surgery, Kalamazoo, MI, USA
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6
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Zheng Q, Xie B, Xie X, Zhang W, Hou J, Feng Z, Tao Y, Yu F, Zhang L, Ye Z. Predictors associated with early and late restenosis of arteriovenous fistulas and grafts after percutaneous transluminal angiography. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:132. [PMID: 33569434 PMCID: PMC7867940 DOI: 10.21037/atm-20-7690] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 01/06/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND The objective of this study was to assess postintervention patency and analyze the predictive factors associated with early and late restenosis after intervention in hemodialysis arteriovenous fistulas (AVF) and arteriovenous grafts (AVG). METHODS This study retrospectively analyzed 284 hemodialysis patients who underwent percutaneous transluminal angioplasty (PTA) due to AVF and AVG stenosis. A total of 350 PTA procedures were performed. Clinical, anatomical, biochemical, and technical variables were analyzed. Using univariate and multivariate analyses, we assessed the postintervention patency of PTA by follow-up, and identified the predictive factors taking into account competing risks. RESULTS Postintervention patency rates at 3, 6, 12, and 24 months were 86.5%, 66.4%, 42.6%, and 29.8%, respectively, with a median patency duration of 11±0.71 months. Kaplan-Meier analysis showed that the patency rate of the AVF group (n=271) was dramatically higher than the AVG group (n=79) at 3, 6, and 12 months after PTA, respectively (88.9% vs. 78.5%, 69.0% vs. 57.4%, 48.8% vs. 20.0%, P<0.01). Cox survival analysis revealed that the factors associated with postintervention patency of AVF included age of fistulas, serum albumin (ALB) levels, location of stenoses, lesion length longer than 2 cm, multiple stenoses, and maximal pressure of dilatation lower than 16 atm. In addition, factors related to postintervention patency of AVG included the presence of diabetes and hypertension, and serum ALB. CONCLUSIONS This study demonstrated that the risk factors associated with postintervention patency of AVF included age of fistulas, lower levels of serum ALB, location of stenoses, lesion length longer than 2 cm, multiple stenoses, and maximal pressure of dilatation lower than 16 atm. In addition, risk factors related to postintervention patency of AVG included the presence of diabetes and lower levels of serum ALB, while the presence of hypertension was found to be a protective factor for reducing patency loss of AVG. Among all these factors, serum ALB and multiple stenoses tended to predict early restenosis, while pressure of dilatation tended to predict late restenosis.
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Affiliation(s)
- Quan Zheng
- Department of Nephrology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
- Department of Nephrology, Shantou University Medical College, Shantou, China
| | - Bingying Xie
- Department of Nephrology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
- Department of Nephrology, Shantou University Medical College, Shantou, China
| | - Xinfu Xie
- Department of Nephrology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
- Department of Nephrology, Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Wenhao Zhang
- Department of Nephrology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
- Department of Nephrology, Shantou University Medical College, Shantou, China
| | - Jihua Hou
- Department of Nephrology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
- Department of Nephrology, Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Zhonglin Feng
- Department of Nephrology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| | - Yiming Tao
- Department of Nephrology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| | - Feng Yu
- Department of Nephrology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| | - Li Zhang
- Department of Nephrology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| | - Zhiming Ye
- Department of Nephrology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
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7
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Yildiz I. The efficacy of percutaneous transluminal angioplasty for the endovascular management of arteriovenous fistula dysfunction: a retrospective analysis in patients with end-stage renal disease. INT ANGIOL 2020; 39:341-348. [DOI: 10.23736/s0392-9590.20.04334-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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8
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Sachdeva B, Abreo K. Drug-Coated Balloon Angioplasty for Hemodialysis Fistula Maintenance. Clin J Am Soc Nephrol 2018; 13:1140-1141. [PMID: 30042226 PMCID: PMC6086701 DOI: 10.2215/cjn.07360618] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Bharat Sachdeva
- Nephrology Section, Department of Medicine, Louisiana State University Medical Center, Shreveport, Louisiana
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9
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Beathard GA, Lok CE, Glickman MH, Al-Jaishi AA, Bednarski D, Cull DL, Lawson JH, Lee TC, Niyyar VD, Syracuse D, Trerotola SO, Roy-Chaudhury P, Shenoy S, Underwood M, Wasse H, Woo K, Yuo TH, Huber TS. Definitions and End Points for Interventional Studies for Arteriovenous Dialysis Access. Clin J Am Soc Nephrol 2018; 13:501-512. [PMID: 28729383 PMCID: PMC5967683 DOI: 10.2215/cjn.11531116] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
This paper is part of the Clinical Trial Endpoints for Dialysis Vascular Access Project of the American Society of Nephrology Kidney Health Initiative. The purpose of this project is to promote research in vascular access by clarifying trial end points which would be best suited to inform decisions in those situations in which supportive clinical data are required. The focus of a portion of the project is directed toward arteriovenous access. There is a potential for interventional studies to be directed toward any of the events that may be associated with an arteriovenous access' evolution throughout its life cycle, which has been divided into five distinct phases. Each one of these has the potential for relatively unique problems. The first three of these correspond to three distinct stages of arteriovenous access development, each one of which has been characterized by objective direct and/or indirect criteria. These are characterized as: stage 1-patent arteriovenous access, stage 2-physiologically mature arteriovenous access, and stage 3-clinically functional arteriovenous access. Once the requirements of a stage 3-clinically functional arteriovenous access have been met, the fourth phase of its life cycle begins. This is the phase of sustained clinical use from which the arteriovenous access may move back and forth between it and the fifth phase, dysfunction. From this phase of its life cycle, the arteriovenous access requires a maintenance procedure to preserve or restore sustained clinical use. Using these definitions, clinical trial end points appropriate to the various phases that characterize the evolution of the arteriovenous access life cycle have been identified. It is anticipated that by using these definitions and potential end points, clinical trials can be designed that more closely correlate with the goals of the intervention and provide appropriate supportive data for clinical, regulatory, and coverage decisions.
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Affiliation(s)
- Gerald A Beathard
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
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Viabahn stent for hemodialysis shunt: efficacy, long segment recanalization and prognostic factors for reintervention. J Vasc Access 2017; 19:76-83. [PMID: 29192725 DOI: 10.5301/jva.5000823] [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: 11/20/2022] Open
Abstract
INTRODUCTION The study evaluated the Heparin Bioactive Surface (HBS) Viabahn Stent (W.L. Gore & Associates, Flagstaff, Arizona) efficacy in the maintenance or re-establishment of hemodialysis. MATERIALS AND METHODS Fifty HBS Viabahn stents deployed in 37 consecutive patients with hemodialysis dysfunction from January 2008 to May 2016 were evaluated in a single-institution retrospective review. Outcomes were stent patency intended as primary circuit patency (PP), assisted primary patency (APP), target lesion primary patency (TLPP) and secondary patency (SP). Moreover, the risk factor analysis for hemodialysis dysfunction that required reintervention was performed. A subgroup analysis was conducted to assess patency of Viabahn stent to treat peripheral venous long segment obstruction (LSO). RESULTS Overall Kaplan-Meyer PPs were 60% at 12 months and 42% at 24 months. Overall TLPP estimated rates were 68% and 49% at 12 and 24 months, respectively. The corresponding SP rates were 85% and 78% at the same period. Estimated PP rates at 12 and 24 months for stent placement after peripheral venous long segment recanalization procedure were 53% and 31%, respectively. Corresponding SP rates were 82% and 68%, respectively. The APP rates were 79% at 12 months and 61% at 24 months. Female sex, access age and thrombosis were associated with reduced primary patency. CONCLUSIONS Considering the high rates of PP, TLPP, APP and SP, Viabahn stents have been proven effective in maintaining or re-establishing the hemodialysis access. Moreover, stent placement after recanalization of LSO of venous out-flow represented a valid approach to rescue a dysfunctional fistula that would otherwise be abandoned.
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11
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Beathard GA, Urbanes A, Litchfield T. Changes in the Profile of Endovascular Procedures Performed in Freestanding Dialysis Access Centers over 15 Years. Clin J Am Soc Nephrol 2017; 12:779-786. [PMID: 28420654 PMCID: PMC5477215 DOI: 10.2215/cjn.09730916] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 02/10/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND OBJECTIVES Marked changes occurred in the vascular access profile of patients receiving hemodialysis in the United States over the 15-year period of 2001-2015. This study was undertaken to evaluate how these changes have affected dialysis access maintenance and salvage procedures performed in freestanding dialysis access centers and to examine the effectiveness, efficiency, and safety of these procedures in this setting. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Data were collected from freestanding, dedicated dialysis access centers operating under a common system of management. Data were available on 689,676 dialysis access procedures. Data relating to case mix, procedure outcome, procedural time, and intraprocedural and immediate postprocedural complications were analyzed. RESULTS The arteriovenous procedure profile changed from one characterized by approximately equal numbers of angioplasties and thrombectomies performed on arteriovenous grafts (AVGs) to one characterized primarily by angioplasties performed on arteriovenous fistulas. The percentage of angioplasties performed throughout the study was significantly greater than thrombectomies, with a mean of 67.9% versus 32.1% (P<0.001). Interventional procedures did not decrease with increasing arteriovenous fistula utilization in prevalent patients receiving dialysis. The incidence roughly paralleled the increasing prevalence of this type of access. A decreasing percentage of AVG utilization resulted in a progressive, roughly parallel, but disproportionately higher, decrease in the percentage of AVG procedures (P<0.001). A progressive improvement in procedure outcomes and a decrease in complication rates and procedure times were observed (P<0.001 for each). A progressive decrease in tunneled dialysis catheter placement was also observed. CONCLUSIONS The procedure profile treated in freestanding, dedicated dialysis access centers changed significantly over 15 years, reflecting the changes that have occurred in the vascular access profile of the dialysis population.
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Affiliation(s)
- Gerald A. Beathard
- Lifeline Vascular Access a division of DaVita Healthcare, Denver, Colorado; and
- Department of Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Aris Urbanes
- Lifeline Vascular Access a division of DaVita Healthcare, Denver, Colorado; and
| | - Terry Litchfield
- Lifeline Vascular Access a division of DaVita Healthcare, Denver, Colorado; and
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13
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Malka KT, Flahive J, Csizinscky A, Aiello F, Simons JP, Schanzer A, Messina LM, Robinson WP. Results of repeated percutaneous interventions on failing arteriovenous fistulas and grafts and factors affecting outcomes. J Vasc Surg 2016; 63:772-7. [DOI: 10.1016/j.jvs.2015.09.031] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 09/15/2015] [Indexed: 10/22/2022]
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14
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Nassar GM, Rhee E, Khan AJ, Nguyen B, Achkar K, Beathard G. Percutaneous Thrombectomy of AVF: Immediate Success and Long-term Patency Rates. Semin Dial 2014; 28:E15-22. [DOI: 10.1111/sdi.12336] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- George M. Nassar
- Dialysis Access Management Centers; Nephrology Dialysis and Transplantation Associates; The Kidney Institute & Houston Methodist Hospital; Weill Cornell University; Houston Texas
| | - Edward Rhee
- Dialysis Access Management Centers; Nephrology Dialysis and Transplantation Associates; The Kidney Institute; Houston Texas
| | - Abdul Jabbar Khan
- Dialysis Access Management Centers; Nephrology Dialysis and Transplantation Associates; The Kidney Institute; Houston Texas
| | - Binh Nguyen
- Dialysis Access Management Centers; Nephrology Dialysis and Transplantation Associates; The Kidney Institute; Houston Texas
| | - Katafan Achkar
- Hamad Medical Corporation and Weill Cornell Medical College; Doha Qatar
| | - Gerald Beathard
- Lifeline Vascular Access; Houston Texas and University of Texas Medical Branch; Galveston Texas
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