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Abbadie F, Kosmadakis G, Aguilera D, Piraud A. Duplex ultrasound-guided angioplasty of hemodialysis vascular access. J Vasc Surg 2023; 78:1292-1301.e3. [PMID: 37463647 DOI: 10.1016/j.jvs.2023.07.007] [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: 04/13/2023] [Revised: 06/17/2023] [Accepted: 07/10/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVE Duplex ultrasound-guided angioplasty (DA) for hemodialysis vascular accesses remains questionable regarding its feasibility and safety. Minor complications (requiring no more treatment than nominal therapy) might be over-reported. Our hypothesis is that this procedure has no significant differences between observed rates and the recommended threshold of main outcomes of the procedure defined by the standards of arteriovenous fistulas (AVF) angioplasty. METHODS In a single-center retrospective study, 298 DA performed on 141 patients from 2015 to 2019 were analyzed. Occluded AVF or concomitant use of radiographic guidance were excluded. Duplex ultrasound parameters were collected up to 1 month before, at the end of angioplasty, and on day 30 after the procedure. Complications were registered, and patency rates were studied at 24 months of follow-up. RESULTS Anatomical success was achieved in 142 procedures (47.7%), clinical success in 284 (95.3%), and hemodynamic success in 283 (95.0%). Major complications-requiring at least a specific therapy-were reported in 8 procedures (2.7%) and minor complications-requiring no adjunctive therapy-in 157 (52.7%). At 24 months, overall postintervention primary patency was 34.0%, primary-assisted patency 87.4%, and secondary patency 92.5%. There were no significant differences of patency rates between groups with or without minor complications (P value for primary patency, 0.08; primary-assisted patency, 0.08; secondary patency, 0.23) or 30% residual stenosis (P value for primary patency, 0.82; primary-assisted patency, 0.46; secondary patency: 0.63). Duplex parameters further improved at postoperative day 30 after angioplasty. CONCLUSIONS DA of AVF is feasible, safe-despite over-reported minor complications having no impact on postintervention patency rates-and efficient. A minor complication can be seen as an event without bad or good consequences. Anatomical definition of success does not fit on DA for hemodialysis vascular access. Further studies are required to define the duplex parameter threshold for efficacy.
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Affiliation(s)
- Fabrice Abbadie
- Vascular Medicine Unit, Vichy District Hospital, Vichy, France.
| | | | - Didier Aguilera
- Department of Nephrology, Vichy District Hospital, Vichy, France
| | - Aurélien Piraud
- Department of Clinical Research, Vichy District Hospital, Vichy, France
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2
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Gan Z, Zhou L, Wu X, Gu CF, He X, Guo JH. X-ray-guided and ultrasound-guided percutaneous transluminal angioplasty to treat arteriovenous fistula dysfunction in hemodialysis patients: A retrospective controlled study. J Vasc Access 2023; 24:222-231. [PMID: 34169754 DOI: 10.1177/11297298211023271] [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: 11/16/2022] Open
Abstract
PURPOSE To compare the safety and efficacy of X-ray-guided and ultrasound-guided percutaneous transluminal angioplasty in treating arteriovenous fistula dysfunction. MATERIALS AND METHODS Data for 219 patients with arteriovenous fistula dysfunction between January 2016 and December 2018 were retrospectively analyzed. The primary endpoints were technical success, clinical success, and primary patency rates. The secondary endpoints were complications and secondary patency rates. Procedure outcomes and both endpoints were evaluated by propensity score analysis. RESULTS After the propensity score matching, 73 matched pairs of cases were created with 34 pairs of autogenous arteriovenous fistula cases and 39 pairs of prosthetic arteriovenous graft cases. There was no significant difference between the X-ray-guided and ultrasound-guided group, respectively, regarding the technical success rate (84.9% vs 87.7%, p = 0.630), clinical success rate (98.6% vs 97.3%, p = 0.999), and complications (10.9% vs 5.5%, p = 0.228). Although the 6- and 12-month secondary patency rates for the dialysis access between the two groups had significant difference (p < 0.05), there was no significant difference in primary and secondary patency curves between the two groups (p > 0.05). CONCLUSION The overall efficacy of ultrasound-guided versus X-ray-guided percutaneous transluminal angioplasty in treating arteriovenous fistula dysfunction might be comparable.
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Affiliation(s)
- Zhen Gan
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Liang Zhou
- Department of Interventional Radiology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xian Wu
- Department of Nephrology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chun-Feng Gu
- Department of Nephrology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xu He
- Department of Interventional Radiology, Nanjing First Hospital of Nanjing Medical University, Nanjing, China
| | - Jin-He Guo
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
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Niyyar VD, Agarwal AK, Salman LH. Clinical Aspects of Dialysis Interventions: Physical and Sonographic Findings. Semin Intervent Radiol 2022; 39:9-13. [PMID: 35210727 PMCID: PMC8856772 DOI: 10.1055/s-0041-1740946] [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: 10/19/2022]
Abstract
Physical examination (PE) of arteriovenous access remains of high clinical value and continues to be recommended by leading societies and guidelines. PE is easy to learn and perform. Once learned, examiners can provide a comprehensive arteriovenous (AV) access examination in 20 to 30 seconds. Therefore, we continue to advocate that AV access PE should be part of the training for all dialysis care providers. Similarly, ultrasound can provide important AV access evaluation and provide key information. It is relatively cheap and can be readily available at the bed side. Additionally, it is well accepted by patients, as it is not expected to be associated with pain or discomfort during the examination. We present in this review the key components of PE, signs and symptoms of AV access dysfunction, and the role of ultrasound in AV access evaluation as a complementary tool to PE.
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Affiliation(s)
- Vandana Dua Niyyar
- Division of Nephrology, Emory University School of Medicine, Atlanta, Georgia
| | - Anil K. Agarwal
- Department of Medicine, VA Central California Health Care System, Fresno, California
| | - Loay H. Salman
- Division of Nephrology and Hypertension, Albany Medical College, Albany, New York,Address for correspondence Loay H. Salman, MD, MBA Division of Nephrology and Hypertension, Albany Medical CollegeAlbany, NY 12208
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Xing X, Wang Z, Yang Y, Li J, Xu G, He F. Ultrasound-guided percutaneous transluminal angioplasty for the treatment of cephalic arch stenosis in hemodialysis arteriovenous fistulas. Semin Dial 2021; 35:81-85. [PMID: 34490658 DOI: 10.1111/sdi.13014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 07/21/2021] [Accepted: 07/26/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Cephalic arch stenosis (CAS) is a common cause that leads to the failure of hemodialysis arteriovenous fistulas (AVFs). Patients with CAS are primarily treated with fluoroscopy-guided angioplasty. Here, seven patients with de novo cephalic arch stenosis who underwent office-based UG-PTA were. METHODS Retrospectively analyzed the total of 321 patients with AVF dysfunction in the nephrology departmnet between July 2017 and October 2018. Among them, seven patients with de novo CAS were included in this study and followed up every 2 months for more than a year. RESULTS No significant complications were seen from the operations, and the primary patency rates at 6 and 12 months were found to be 100% and 42.8%, respectively. CONCLUSIONS The office-based UG-PTA is probably safe, effective, and feasible in the management of CAS and can be used as a substitute for fluoroscopy-guided PTA.
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Affiliation(s)
- Xue Xing
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhixiang Wang
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Yang
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jin Li
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gang Xu
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fan He
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Chytilova E, Jemcov T, Malik J, Pajek J, Fila B, Kavan J. Role of Doppler ultrasonography in the evaluation of hemodialysis arteriovenous access maturation and influencing factors. J Vasc Access 2021; 22:42-55. [PMID: 34281411 PMCID: PMC8607314 DOI: 10.1177/1129729820965064] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The goal of vascular access creation is to achieve a functioning arteriovenous
fistula (AVF) or arteriovenous graft (AVG). An autologous fistula has been shown
to be superior to AVG or to central venous catheters (CVCs) with lowest rate of
re-intervention, but vessel obstruction or immaturity accounts for 20 % to 54%
of cases with primary failure of AVF. This review is focused on the factors
influencing maturation; indication and timing of preoperative mapping/creation
of vascular access; ultrasound parameters for creation AVF/AVG; early
postoperative complications following creation of a vascular access; ultrasound
determinants of fistula maturation and endovascular intervention in vascular
access with maturation failure. However, vascular accesses that fail to develop,
have a high incidence of correctable abnormalities, and these need to be
promptly recognized by ultrasonography and managed effectively if a high success
rate is to be expected. We review approaches to promoting fistula maturation and
duplex ultrasonography (DUS) of evaluating vascular access maturation.
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Affiliation(s)
- Eva Chytilova
- Third Department of Internal Medicine, General University Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Tamara Jemcov
- Department of Nephrology, Clinical Hospital Centre Zemun, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jan Malik
- Third Department of Internal Medicine, General University Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jernej Pajek
- Department of Nephrology, Ljubljana University Medical Centre, Slovenia
| | - Branko Fila
- Depatment of Vascular Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Jan Kavan
- Department of Radiology, General University Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic
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Napoli M, Bacchini G, Scarpati L, Loizzo G, Zito A. Ultrasound guided interventional procedures on arteriovenous fistulae. J Vasc Access 2021; 22:91-96. [PMID: 34278873 PMCID: PMC8607312 DOI: 10.1177/1129729820977380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Autogenous (AVF) and prosthetic (AVG) arteriovenous fistulas are the vascular
accesses (VA) of choice for hemodialysis thanks to their improved patency,
reduced costs, and lower rate of infections relative to catheters. In an effort to maximize the number of primary AVF and AVG, shorten maturation
times for AVF, and reduce the number of indwelling catheters, several new
techniques have been developed within the context of an overall program designed
to optimize access care. This approach includes: (a) Primary Intraoperative Balloon Angioplasty on the
vessels selected for AV creation whether small-sized or altered by pre-existing
lesions; (b) Percutaneous Transluminal Angioplasty (PTA) on AVF and AVG
stenosis, performed under ultrasonographic (UG) or fluoroscopic guide (FG). We report the experience of two Center in performing the above mentioned
procedures on even complex VA. The wise adoption of these techniques may avail
to meet the stringent demands for reliable VA placement as defined by KDOQI and,
thereby, expand the duration and quality of life for hemodialysis patients.
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Affiliation(s)
- Marcello Napoli
- UOC Nefrologia, Dialisi e Trapianto, Ospedale Vito Fazzi, Lecce, Puglia, Italy
| | - Giuseppe Bacchini
- UOC Nefrologia, Ospedale Alessandro Manzoni, Lecco, Lombardia, Puglia, Italy
| | - Luisa Scarpati
- UOC Nefrologia, Ospedale Alessandro Manzoni, Lecco, Lombardia, Puglia, Italy
| | - Giuliana Loizzo
- UO Nefrologia e Dialisi, Ospedale della Murgia, Altamura, Puglia, Italy
| | - Anna Zito
- UOC Nefrologia, Dialisi e Trapianto, Ospedale Vito Fazzi, Lecce, Puglia, Italy
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Ghanwat S, Yeramsetti S, Sahu T, Sheorain V, Grover T, Parakh R. A prospective observational study to evaluate utility of USG (ultrasound)-guided arteriovenous fistuloplasty in our institute. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2021. [DOI: 10.4103/ijves.ijves_145_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Gu H, Wan Z, Lai QQ, Zhou Y, Tu B, Hu B, Chen L, Gao XJ. Efficacy of ultrasound-guided percutaneous transluminal angioplasty for arteriovenous fistula stenosis or occlusion at juxta-anastomosis: A 3-year follow-up cohort study. J Vasc Surg 2020; 74:217-224. [PMID: 33340700 DOI: 10.1016/j.jvs.2020.11.041] [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] [Received: 02/01/2020] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Arteriovenous fistula (AVF) is the preferred access for hemodialysis. Percutaneous transluminal angioplasty (PTA) has become a choice for AVF stenosis, and ultrasound has been used in PTA more frequently. METHODS This single-center retrospective cohort study analyzed 129 patients who underwent PTA in the First Affiliated Hospital of Chongqing Medical University from January 2016 to December 2016. Angioplasty was performed using a noncompliant high-pressure balloon. The process was visualized by duplex scan. Our inclusion criteria were as follows: (1) stenoses or occlusions were located at the juxta-anastomosis site: the first 5 cm of the vein distal to the anastomosis; (2) stenosis was confirmed with the following conditions: (a) flow rates are <500 mL/min in the brachial artery and <200 mL/min in the fistula during dialysis, and (b) the stenosis diameter is <1.7 mm. We used the Kaplan-Meier curve to show the postintervention primary and secondary patency rates of patients with stenosis and occlusion. RESULTS Altogether, 129 patients with 76 males were analyzed. Moreover, 104 have AVFs on the left arm, and only one patient had an ulnar-basilic AVF, whereas others had a radial-cephalic AVF. The postintervention primary patency rates are better in occlusion cases (P < .05), whereas secondary patency rates have no difference. The postintervention primary patency rates are better in patients without diabetes mellitus (P < .05), whereas the secondary patency rates had no difference. CONCLUSIONS For juxta-anastomosis site stenosis or occlusion, PTA can be used to obtain satisfactory results.
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Affiliation(s)
- Hui Gu
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ziming Wan
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Qi-Quan Lai
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yu Zhou
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bo Tu
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bo Hu
- Department of Nephrology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Ling Chen
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xue-Jing Gao
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Elkassaby M, Elsaadany N, Mowaphy K, Soliman M. Balloon-assisted maturation of autogenous arteriovenous fistulae: A randomized controlled prospective study. Vascular 2020; 29:776-783. [PMID: 33323057 DOI: 10.1177/1708538120979872] [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: 11/15/2022]
Abstract
BACKGROUND Current guidelines recommend referral of patient with renal failure for access creation 6 months before planned dialysis. There is a growing cohort of patients that require long-term hemodialysis without adequate preparation. Temporary dialysis catheters and rapid access arteriovenous grafts (AVG) are far from being an ideal solution in this scenario. In an effort to expedite maturation of autogenous arteriovenous fistulae (AVF), balloon-assisted maturation (BAM) was advised by some authors. This technique still lacks the support of high-level evidence studies. We investigated the ability of intra-operative BAM to induce early functional maturation of AVFs. METHODS This is a prospective randomized controlled study conducted in a tertiary referral center, with a catchment area of more than 15 million population. Cases were divided into two groups; Group (A), where BAM technique was performed, while in the control group (B), the standard technique was used (NO BAM) for creation of AVFs. RESULTS Between June 2017 and May 2019, 300 cases were recruited from a total of 648 primary AVF creation instances. Patients' age ranged from 19 to 89 (mean 51.17 ±SD 15.5) years. Group A (BAM) included 52.3% (n = 157) AVFs, while Group B included 47.7% (n = 143) AVFs. The average maturation time was 3.7 weeks (SD ± 1.3, 95% CI 3.55-3.95) and 5.91 weeks (SD ± 2.2, 95% CI 5.55-6.26) for both groups, respectively (p = 0.0001). 78.3% of the AVFs that underwent BAM showed early maturation within 2-4 weeks vs 32.2% only in the NO BAM group (p = 0.002). Successful functional maturation was higher among cases of the BAM group (93%), compared to the NO BAM group (77%) (p = 0.001). Complication rates were 9.6% and 4.9% in the two groups, respectively (p = 0.042). CONCLUSION BAM can play a pivotal role in helping the dialysis society meet the goals of the Fistula First Initiative, keeping in mind that this comes with an increased risk of complications. BAM should be considered only when unplanned early access to long-term dialysis is required.
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Affiliation(s)
- Mohammed Elkassaby
- Department of Vascular and Endovascular Surgery, Faculty of Medicine, Mansoura University Hospital, Mansoura, Egypt.,Department of Vascular and Endovascular Surgery, St James's University Hospital, Dublin, Ireland
| | - Nashaat Elsaadany
- Department of Vascular and Endovascular Surgery, Faculty of Medicine, Mansoura University Hospital, Mansoura, Egypt
| | - Khaled Mowaphy
- Department of Vascular and Endovascular Surgery, Faculty of Medicine, Mansoura University Hospital, Mansoura, Egypt
| | - Mosaad Soliman
- Department of Vascular and Endovascular Surgery, Faculty of Medicine, Mansoura University Hospital, Mansoura, Egypt
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Wang B, Rao A, Pappas K, Silpe J, Garlapati A, Talathi S, Mussa F, Landis GS, Etkin Y. Maturation Rates of Arteriovenous Fistulas Using Small Veins in the Era of Endovascular Interventions. Ann Vasc Surg 2020; 71:208-214. [PMID: 32890643 DOI: 10.1016/j.avsg.2020.08.109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Traditional practice suggests the abandonment of veins smaller than 3 mm in diameter for arteriovenous fistula (AVF) creation because of a low rate of maturation. This study aims to show that with balloon-assisted maturation (BAM), undersized veins can be used to create functional AVFs with a high rate of success. METHODS All patients who underwent AVF creation between 2014 and 2018 at a tertiary academic medical center were retrospectively reviewed. The patients without preoperative vein mapping, those who failed to follow-up, and the patients who were not on dialysis were excluded. A fistula was considered to be mature if it was successfully cannulated for dialysis. A total of 596 patients were identified for analysis. The cohort was divided into the small-vein group (SVG, <2.5 mm) and large-vein group (LVG, ≥2.5 mm) based on preoperative vein size. Categorical variables were analyzed with the chi-squared test for their association with maturation status. Continuous variables were analyzed with the Wilcoxon rank sum test. A P-value less than 0.05 was considered significant. RESULTS In the study cohort, 61.9% of the patients were male, with an average age of 62.8 ± 13.7 years, and an average preoperative vein size of 2.9 ± 1.1 mm. With similar demographic distribution, the participants in the SVG (n = 216) had significantly smaller preoperative vein size of 1.9 ± 0.4 mm than the patients in the LVG (n = 380), 3.5 ± 0.8 mm (P = 0.001). There were significantly more radio-cephalic AVFs created in the SVG (77.8% versus 48.7%, P < 0.0001). The overall maturation rate was 83.1% (n = 495), 219 fistulas (36.7%) matured primarily and 276 (46.3%) required interventions. Ninety-one percent of the patients required only 1 or 2 BAMs to achieve maturation. The SVG achieved a maturation rate of 75.9% as compared with 87.1% in the LVG (P = 0.002). A significantly higher number of patients in the SVG required BAM for maturation as compared with the LVG (67.7% versus 49.9%, P = 0.0002); however, there was no difference in the average number of BAMs required for fistula maturation between the groups (1.5 ± 0.8 for the SVG vs. 1.4 ± 0.7 for the LVG). In multivariable logistic regression analysis, vein size ≥2.5 mm (odds ratio (OR) = 2.11, confidence interval (CI): 1.36-3.27, P = 0.0009) and male sex (OR = 2.30, CI: 1.49-3.57, P = 0.0002) were independent predictors of maturation. CONCLUSIONS Small veins can be used for AVF creation with lower but still favorable maturation rates using BAM interventions, especially in male patients. This practice can increase the creation of autogenous dialysis access and potentially reduce complications related to prosthetic dialysis access.
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Affiliation(s)
- Bo Wang
- Division of Vascular and Endovascular Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Amit Rao
- Division of Vascular and Endovascular Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Karalyn Pappas
- The Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY
| | - Jeffrey Silpe
- Division of Vascular and Endovascular Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Avinash Garlapati
- Division of Vascular and Endovascular Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Sonia Talathi
- Division of Vascular and Endovascular Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Firas Mussa
- Division of Vascular and Endovascular Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Gregg S Landis
- Division of Vascular and Endovascular Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Yana Etkin
- Division of Vascular and Endovascular Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY.
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Koratala A, Teodorescu V, Niyyar VD. The Nephrologist as an Ultrasonographer. Adv Chronic Kidney Dis 2020; 27:243-252. [PMID: 32891309 DOI: 10.1053/j.ackd.2020.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 02/17/2020] [Accepted: 03/05/2020] [Indexed: 02/07/2023]
Abstract
Ultrasonography is increasingly being used in the practice of nephrology, whether it is for diagnosis or management of acute or chronic kidney dysfunction, until progression to end-stage kidney disease, including preoperative assessment, access placement, and diagnosis and management of dysfunctional hemodialysis access. Point-of-care ultrasounds are also being used by nephrologists to help manage volume status, especially in patients admitted to the intensive care units, and more recently, for guiding fluid removal in the outpatient dialysis units. Fundamental knowledge of sonography has become invaluable to the nephrologist, and performance and interpretation of ultrasound has now become an essential tool for practicing nephrologists to provide patient-centered care, maximize efficiency, and minimize fragmentation of care. This review will address the growing role of ultrasonography in the management of a patient with CKD from the point of initial contact with the nephrologist throughout the spectrum of kidney disease and its consequences.
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Ultrasound-guided angioplasty of dialysis fistulas in renal transplant patients. Wideochir Inne Tech Maloinwazyjne 2020; 14:532-537. [PMID: 31908699 PMCID: PMC6939217 DOI: 10.5114/wiitm.2019.83316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 02/10/2019] [Indexed: 12/05/2022] Open
Abstract
Introduction Percutaneous endovascular angioplasty has become the treatment of choice for dialysis fistula stenosis. The ultrasound-guided endovascular procedure is used in patients with severe renal impairment and advanced renal transplant failure, when the need for nephrotoxic contrast administration in standard angioplasty may worsen renal function. Aim To evaluate endovascular angioplasty guided by ultrasound for dialysis fistula stenosis in renal transplant patients with severe graft insufficiency. Material and methods We compared ultrasound (US)-guided angioplasty, performed in patients after renal transplantation, with standard contrast angioplasty performed in dialysis patients. We treated 10 kidney allograft recipients (9 kidneys and 1 kidney-pancreas) with significantly compromised renal transplant function and significant stenosis in dialysis fistulas, as detected during US examination. Patients were qualified for percutaneous angioplasty under US guidance. The mean period from transplantation was 32.7 months (5–100 months). Results of their treatment were compared to the control group of 20 end-stage renal disease patients with dialysis fistula stenosis treated by angioplasty under standard contrast visualization. Results The immediate effectiveness of the angioplasty was 100% in both groups. No early complications of angioplasty or problems with the guidewire crossing the stenosis were observed. Twelve months of primary patency was observed in 80% and 45% in the US-guided and control groups, respectively. Conclusions The US-guided endovascular procedure is an effective and safe method of treating dialysis fistula stenosis in patients with impaired renal transplant function.
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Abstract
Sonography is increasingly being used by nephrologists and the field of dialysis access is no exception. Advances in technology have allowed the addition of this universally available, portable, non-invasive tool to the nephrologist's armamentarium, which provides information on both morphology and physiology without the need for contrast or radiation. Ultrasound may be used across the spectrum of dialysis access, including central venous catheter placements, vascular mapping, regional anesthesia, creation, maintenance and assessment of hemodialysis access as well as assessment of the abdominal wall and peritoneal dialysis catheter placements. However, the lack of exposure in most training programs limits incorporation of routine use of ultrasounds in nephrology practice. As our specialty embarks on the ultrasound revolution, a two-pronged approach is essential to provide ample training opportunities while ensuring establishment of basic standards for training and competency.
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Affiliation(s)
- Vandana Dua Niyyar
- Division of Nephrology, Department of Medicine, Emory University, Atlanta, GA, USA
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Kazandjian C, Petit V, Favier C, Terriat B, Steinmetz E. Ultrasound-guided Angioplasty of Arteriovenous Fistulas for Hemodialysis: Benefits and Limitations. Ann Vasc Surg 2018; 58:32-37. [PMID: 30496906 DOI: 10.1016/j.avsg.2018.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/19/2018] [Accepted: 10/02/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Ultrasound-guided percutaneous angioplasty of arteriovenous fistulas (AVFs) makes it possible to avoid contrast agents and X-rays, to optimize the puncture site and to locate some stenoses on the fistulography, but is it really useful? Our objective is to report the results of our experience. METHODS Between November 2012 and November 2017, all the patients treated according to this method in our center were collected retrospectively. The surgical indications were an insufficient maturation of the AVF, an increase in the venous pressure, an inadequate outflow, difficulties in puncture, a prolonged bleeding time, a flow drop, or an aneurysmal evolution. RESULTS During this period, 50 patients had 72 ultrasound-guided angioplasties, 64 on native AVFs (88.9%) and 8 on prosthetic AVFs (11.1%). The technical success rate was 100%. The average preoperative flow of AVFs was 506.8 ± 302.2 vs. 955.9 ± 371.4 mL/min after angioplasty. The mean duration of follow-up was 13.4 ± 12.9 months. The cumulative rates of primary, assisted primary, and secondary patency were 43.5%, 68.8%, 81.5% at 1 year and 31.7%, 63.9%, 76.8% at 2 years, respectively. CONCLUSIONS AVF angioplasty under ultrasound guidance only is feasible, effective, and represents an interesting alternative. A controlled study comparing ultrasound guidance with angioplasties performed under conventional angiographic guidance as the reference technique would better clarify the value of this technique.
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Affiliation(s)
- Caroline Kazandjian
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU François Mitterand, Dijon, France
| | - Vincent Petit
- Service d'Angiologie, CHU François Mitterand, Dijon, France
| | - Claire Favier
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU François Mitterand, Dijon, France
| | | | - Eric Steinmetz
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU François Mitterand, Dijon, France.
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Mestres G, Yugueros X, Fontseré N, Fierro A, Sala X, Derosa TM, Burrel M, Riambau V. Vascular access surgery can be safely performed in an ambulatory setting. J Vasc Access 2018; 20:195-201. [PMID: 30117363 DOI: 10.1177/1129729818794356] [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] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION: Ambulatory surgery is associated with lower costs, but there is lack of evidence of the safety for ambulatory vascular access surgery. The objective of this study is to substantiate the safety and effectiveness of performing vascular access surgery in an ambulatory setting. METHODS: A review of our prospectively maintained database including all vascular access open surgeries (creations and repairs) performed by our Vascular Access Unit between 2013 and 2017 was compiled. Patient comorbidities, surgery details, hospital admission conditions, and 1-week and 1-month follow-up patency and complications (death, infection, bleeding, and readmission/reintervention) were scrutinized. RESULTS: In the last 5 years, 1414 vascular access procedures were performed (67.8% access creations, 32.2% previous access repairs) in 1012 patients. Most surgeries were performed under local anesthesia (59.2%) or axillary plexus block (38.4%) and mainly in an ambulatory setting, without overnight hospital stays (90.9%). During the first postoperative week follow-up, 9 cases (0.6%) needed readmission or reintervention; significant infection materialized in 11 (0.8%) and 10 cases (0.7%) showed noteworthy hematoma or bleeding, only three (0.2%) requiring reintervention. The primary composite endpoint of 24-h death and 1 week readmission, reintervention, infection, or bleeding was 1.9% (27 cases); 1-month access failure was 6.2%. After univariate analysis, ambulatory settings were not related to higher rates of complications or readmissions. CONCLUSION: Arteriovenous access surgery can be safely performed in an ambulatory setting, in spite of complex cases, comorbidities, or the increasing implementation of axillary plexus blocks. Surgical results and patency are good, and complications necessitating readmission remain very low.
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Affiliation(s)
- Gaspar Mestres
- 1 Vascular Access Unit, Vascular Surgery Division, Department of Cardiovascular Surgery, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Xavier Yugueros
- 1 Vascular Access Unit, Vascular Surgery Division, Department of Cardiovascular Surgery, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Nestor Fontseré
- 2 Vascular Access Unit, Department of Nephrology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Alejandro Fierro
- 1 Vascular Access Unit, Vascular Surgery Division, Department of Cardiovascular Surgery, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Xavier Sala
- 3 Vascular Access Unit, Department of Anesthesiology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Teresa Maria Derosa
- 1 Vascular Access Unit, Vascular Surgery Division, Department of Cardiovascular Surgery, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Marta Burrel
- 4 Vascular Access Unit, Department of Angioradiology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Vincent Riambau
- 1 Vascular Access Unit, Vascular Surgery Division, Department of Cardiovascular Surgery, Hospital Clinic, University of Barcelona, Barcelona, Spain
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Schmidli J, Widmer MK, Basile C, de Donato G, Gallieni M, Gibbons CP, Haage P, Hamilton G, Hedin U, Kamper L, Lazarides MK, Lindsey B, Mestres G, Pegoraro M, Roy J, Setacci C, Shemesh D, Tordoir JH, van Loon M, ESVS Guidelines Committee, Kolh P, de Borst GJ, Chakfe N, Debus S, Hinchliffe R, Kakkos S, Koncar I, Lindholt J, Naylor R, Vega de Ceniga M, Vermassen F, Verzini F, ESVS Guidelines Reviewers, Mohaupt M, Ricco JB, Roca-Tey R. Editor's Choice – Vascular Access: 2018 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2018; 55:757-818. [DOI: 10.1016/j.ejvs.2018.02.001] [Citation(s) in RCA: 346] [Impact Index Per Article: 57.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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17
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Niyyar VD, O'Neill WC. Point-of-care ultrasound in the practice of nephrology. Kidney Int 2018; 93:1052-1059. [PMID: 29477241 DOI: 10.1016/j.kint.2017.11.032] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 10/31/2017] [Accepted: 11/13/2017] [Indexed: 12/16/2022]
Abstract
Sonography is increasingly being performed by clinicians and has applications throughout the spectrum of nephrology, including acute and chronic renal failure, urinary obstruction, cystic disease, pain, hematuria, transplantation, kidney biopsy, temporary and permanent vascular access, and assessment of fluid status. The skill is relatively easily acquired, expedites patient care, and enhances the practice of nephrology. However, the lack of exposure in most training programs remains a major obstacle.
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Affiliation(s)
- Vandana Dua Niyyar
- Emory University, Department of Medicine, Renal Division, Atlanta, Georgia, USA
| | - W Charles O'Neill
- Emory University, Department of Medicine, Renal Division, Atlanta, Georgia, USA.
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Tordoir JH, Zonnebeld N, van Loon MM, Gallieni M, Hollenbeck M. Surgical and Endovascular Intervention for Dialysis Access Maturation Failure During and After Arteriovenous Fistula Surgery: Review of the Evidence. Eur J Vasc Endovasc Surg 2018; 55:240-248. [DOI: 10.1016/j.ejvs.2017.12.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 12/03/2017] [Indexed: 01/01/2023]
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Aurshina A, Ascher E, Hingorani A, Marks N. A novel technique for duplex-guided office-based interventions for patients with acute arteriovenous fistula occlusion. J Vasc Surg 2017; 67:857-859. [PMID: 29017808 DOI: 10.1016/j.jvs.2017.07.135] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 07/27/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The purpose of the study was to aggressively salvage acutely occluded arteriovenous fistulas (AVFs) using duplex imaging as the sole imaging modality for percutaneous transluminal angioplasty of acutely thrombosed AVF. METHODS Over a period of 12 months, 14 patients with acute thrombosis of their AVFs underwent 18 procedures in a single center for AVF salvage. All 14 patients presented with chronic renal failure, and six were diabetic. All patients were treated under duplex guidance alone. Treatment included simple balloon dilation and maceration (group A; n =10 procedures [56%]) for subacute thrombosis or pharmacomechanical thrombectomy (group B; n = 8 procedures [44%]) for more hypoechoic thrombus. A successful procedure was defined as immediate restoration of flow through the AVF. RESULTS Of the 18 procedures, 13 (72%) were successful. Of the 14 patients, thrombus was located at the perianastomotic AVF in 6 (43%), proximal-mid AVF in 6 (43%), mid AVF in 1 (7%), and distal AVF in 1 (7%). From group A, six (60%) were successful. From group B, seven (88%) were successful. Among the unsuccessful procedures, one group B patient was hypercoagulable (polycythemia vera). Of the 18 procedures, 16 (89%) were treated within 2 weeks from when duplex revealed the presence of thrombus. Early rethrombosis (<1-month patency) occurred in three cases (17%), and these patients received new fistulas. Full restoration of the fistula flow was established in 14 cases (78%). Of these 14 patients, 8 (57%) are currently on hemodialysis via fistula, 3 patients (21%) had newly placed fistulas after failed interventions, 2 patients (14%) are not on dialysis yet, and 1 patient (7%) with polycythemia vera disorder is on dialysis via a Tesio catheter (MedComp, Harleysville, Pa). CONCLUSIONS The sole use of duplex ultrasound imaging to salvage acutely occluded AVFs using percutaneous transluminal angioplasty is a safe and effective alternative to traditional treatment of thrombosed failing/maturing AVF.
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Affiliation(s)
- Afsha Aurshina
- Division of Vascular Surgery, Vascular Institute of New York, Brooklyn, NY.
| | - Enrico Ascher
- Division of Vascular Surgery, Vascular Institute of New York, Brooklyn, NY
| | - Anil Hingorani
- Division of Vascular Surgery, Vascular Institute of New York, Brooklyn, NY
| | - Natalie Marks
- Division of Vascular Surgery, Vascular Institute of New York, Brooklyn, NY
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Endovascular treatment to boost AV fistula maturation. J Vasc Access 2017; 18:15-18. [DOI: 10.5301/jva.5000678] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2016] [Indexed: 11/20/2022] Open
Abstract
Impaired fistula maturation is associated with puncture-related complications, insufficient dialysis and potential permanent access failure. Non-maturation is frequently initiated by stenotic vascular access vessels comprising the outflow veins, the arteriovenous anastomosis and infrequently the inflow artery. Further findings in maturation protraction are central venous stenoses or accessory outflow veins. Depending on the underlying pathology, several endovascular approaches to boost fistula maturation are possible. To date standard balloon angioplasty remains the primary proven treatment option.
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21
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Cho S, Lee YJ, Kim SR. Clinical experience with ultrasound guided angioplasty for vascular access. Kidney Res Clin Pract 2017; 36:79-85. [PMID: 28393000 PMCID: PMC5331978 DOI: 10.23876/j.krcp.2017.36.1.79] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 10/04/2016] [Accepted: 10/16/2016] [Indexed: 11/23/2022] Open
Abstract
Background The use of ultrasound guided percutaneous transluminal angioplasty (UG-PTA), which use ultrasound as an imaging modality, is an evolving strategy. But, in Korea, this method is rarely used. We report our experiences with UG-PTA with respect to technical success rates and complication rates compared to conventional PTA (C-PTA), performed between 2010 and 2015 at Samsung Changwon Hospital, Korea. Methods In our series, 53 cases of UG-PTA and 90 cases of C-PTA were reviewed, respectively. Cases of central vein stenosis, cephalic arch stenosis, arterial stenosis and thrombosis were excluded. However, cases of juxta-anastomotic stenosis and outflow vein stenosis were included. Results Technical success was achieved in 96.2% (51 of 53) of cases in the UG-PTA group and in 93.3% (84 of 90) of cases in the C-PTA group, respectively (P = 0.710). Technical failure was experienced in a total 8 cases (UG-PTA group: 2/53, 3.8%; C-PTA group: 6/90, 6.7%). No differences were observed in complications. Conclusion Duplex ultrasound-guided angioplasty for dialysis access in the outpatient setting is feasible, safe, and effective for peripheral venous stenotic lesions. It offers many advantages over conventional angiographic procedures, and, in the future, it has great potential to play a significant role in the management of these challenging patients.
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Affiliation(s)
- Seong Cho
- Division of Nephrology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University College of Medicine, Changwon, Korea
| | - Yu-Ji Lee
- Division of Nephrology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University College of Medicine, Changwon, Korea
| | - Sung-Rok Kim
- Division of Nephrology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University College of Medicine, Changwon, Korea
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Huang DY, Yusuf GT, Daneshi M, Husainy MA, Ramnarine R, Sellars MEK, Sidhu PS. Contrast-enhanced US-guided Interventions: Improving Success Rate and Avoiding Complications Using US Contrast Agents. Radiographics 2017; 37:652-664. [PMID: 27860550 DOI: 10.1148/rg.2017160123] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Ultrasonography (US) is an established modality for intervention. The introduction of microbubble US contrast agents (UCAs) has the potential to further improve US imaging for intervention. According to licensing, UCAs are currently approved for clinical use in restricted situations, but many additional indications have become accepted as having clinical value. The use of UCAs has been shown to be safe, and there is no risk of renal toxic effects, unlike with iodinated or gadolinium contrast medium. Broadly speaking, UCAs can be injected into the bloodstream (intravascular use) or instilled into almost any accessible body cavity (endocavitary use), either in isolation or synchronously. In microvascular applications, contrast-enhanced US (CEUS) enhances delineation of necrotic areas and the vascularized target to improve real-time targeting. The ability of CEUS to allow true assessment of vascularity has also been used in follow-up of devascularizing intervention. In macrovascular applications, real-time angiographic images can be obtained with CEUS without nephrotoxic effects or radiation. In endocavitary applications, CEUS can achieve imaging similar to that of iodinated contrast medium-based fluoroscopy; follow-up to intervention (eg, tubography and nephrostography) can be performed at the bedside, which may be advantageous. The use of UCAs is a natural progression in US-guided intervention. The aim of this article is to describe the indications, contraindications, and techniques of using UCAs as an adjunctive tool for US-guided interventional procedures to facilitate effective treatment, improve complication management, and increase the overall success of interventional procedures. Online supplemental material is available for this article. ©RSNA, 2016.
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Affiliation(s)
- Dean Y Huang
- From the Department of Radiology, King's College Hospital, Denmark Hill, London SE5 9RS, England
| | - Gibran T Yusuf
- From the Department of Radiology, King's College Hospital, Denmark Hill, London SE5 9RS, England
| | - Mohammad Daneshi
- From the Department of Radiology, King's College Hospital, Denmark Hill, London SE5 9RS, England
| | - Mohammad Ali Husainy
- From the Department of Radiology, King's College Hospital, Denmark Hill, London SE5 9RS, England
| | - Raymond Ramnarine
- From the Department of Radiology, King's College Hospital, Denmark Hill, London SE5 9RS, England
| | - Maria E K Sellars
- From the Department of Radiology, King's College Hospital, Denmark Hill, London SE5 9RS, England
| | - Paul S Sidhu
- From the Department of Radiology, King's College Hospital, Denmark Hill, London SE5 9RS, England
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Ultrasound-guided angioplasty for treatment of peripheral stenosis of arteriovenous fistula - a single-center experience. J Vasc Access 2017; 18:52-56. [PMID: 27886364 DOI: 10.5301/jva.5000626] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2016] [Indexed: 11/20/2022] Open
Abstract
PURPOSE In patients with end-stage renal disease, arteriovenous fistulas (AVFs) are the access of choice for hemodialysis but are often complicated by stenosis. We present single-center experience of 78 ultrasound-guided angioplasty procedures for treating peripheral stenoses of AVFs. METHODS Between January 2013 and November 2015, 78 angioplasties were performed under ultrasound guidance in 53 patients with end-stage renal disease who were referred from dialysis centers with low flow rate, difficult cannulation, increased cannulation site bleeding, immature or thrombosed AVF. Angioplasties were carried out in the presence of a structural lesion in the AVF resulting in at least 50% reduction in vein diameter with a blood flow of <250 mL/min or a peak systolic velocity >300 cm/s. Clinical success, anatomical success and post-intervention primary and secondary patency rates at 6, 12, 18 and 24 months were studied. RESULTS In 49/53 patients (92.4%), 74 angioplasty procedures were successfully performed, whereas 4/53 patients (7.6%) had primary failure. A total of 35/49 patients (71.4%) underwent single angioplasty procedure whereas 14/49 patients (28.6%) underwent multiple angioplasty procedures. Post-intervention primary patency rates at 6, 12, 18 and 24 months were 78.6%, 60.2%, 53.8% and 48.9%, respectively. Post-intervention secondary patency rates at 6, 12, 18 and 24 months were 100%, 100%, 95.4% and 89%, respectively. Clinical success and anatomical success was 94.8% and 89.7%, respectively. CONCLUSIONS Ultrasound-guided angioplasty is an effective method with good long-term outcomes in selected dialysis patients with peripheral stenosis of AVF.
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Ultrasound-Guided Angioplasty of Dysfunctional Vascular Access for Haemodialysis. The Pros and Cons. Cardiovasc Intervent Radiol 2016; 40:750-754. [DOI: 10.1007/s00270-016-1541-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 12/08/2016] [Indexed: 10/20/2022]
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Multi-slice CT angiography versus duplex ultrasound in detection of stenosis of access arteriovenous fistulas and grafts in dysfunctional hemodialysis. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2016.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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The Clinical Efficacy of Balloon-Assisted Maturation of Autogenous Arteriovenous Fistulae. Ann Vasc Surg 2016; 41:41-45. [PMID: 27903478 DOI: 10.1016/j.avsg.2016.08.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 07/28/2016] [Accepted: 08/02/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Delayed maturation of arteriovenous fistulae (AVF) among patients who require hemodialysis (HD) can lead to catheter sepsis with its resultant morbidity and mortality. Some have proposed that sequential balloon-assisted maturation (BAM) may accelerate the maturation times of these accesses. On the other hand, serial balloon angioplasty of normal vein may result in stenosis and delay maturation. Although the safety of BAM has been shown, direct comparison to nonmatured AVF has not been explored. Therefore, we conducted a retrospective analysis of our prospectively maintained vascular access database to compare the duration of period to AVF maturation between patients who received BAM and those who were not referred for BAM at our institution. METHODS Prospectively collected data over a 3-year period in 194 patients who underwent AVF creation at our institution were retrospectively analyzed. The duration to maturation of the AVF was determined by comparing the period between the creation of the fistula and the first successful cannulation of the fistula. Only patients on HD were included. Patients who underwent BAM or placement of AVF at an outside institution were excluded. Follow-up consisted reviewing of postoperative AVF duplex for patency, hospital and clinic databases, HD center databases, and telephone interviews. RESULTS Of the 194 patients who had AVF placement, 172 patients were on HD within 2 weeks of AVF placement, whereas 22 patients had AVF placed in anticipation of the need for HD. Of the 172 patients on HD within 2 weeks, 54 patients had BAM performed at our institution and 4 patients had BAM at an outside institution, whereas 114 patients were not referred for BAM. Thirty-three of these 114 patients were age and gender matched to compare to the patients who underwent BAM at our institution. At the time of this analysis, of the 54 patients who had BAM, 30 had functional AVF (19 men, 11 women; mean age, 62 years; range, 26-86 [standard deviation, SD ± 18] years). In the BAM group of functioning AVF, n = 30, the total number of procedures was 125 (range, 1-8, average 4). The overall average duration to maturation of the AVF was 119 days (SD ± 84 days) and 146 days (SD ± 157 days) P = 0.73, for BAM and non-BAM, respectively. CONCLUSIONS These preliminary data suggest the role of BAM did not decrease maturation times of AVF and that BAM warrants further scrutiny before further adoption.
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Park SC, Ko SY, Kim JI, Moon IS, Kim SD. Balloon-assisted maturation for arteriovenous fistula maturation failure: an early period experience. Ann Surg Treat Res 2016; 90:272-8. [PMID: 27186572 PMCID: PMC4865705 DOI: 10.4174/astr.2016.90.5.272] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 02/21/2016] [Accepted: 03/12/2016] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Balloon-assisted maturation (BAM) is emerging as a salvage management for arteriovenous fistula maturation failure (AVF MF). However, BAM is a relatively new, yet controversial technique for AVF maturation. Therefore, we evaluated the effectiveness of BAM for AVF MF. METHODS Between January 2012 and December 2014, 249 AVFs were created. The total MF rate was 24.8%. But, only 110 AVFs were enrolled, including 74 brachiocephalic (BC) AVFs and 36 radiocephalic (RC) AVFs. The follow-up period was 12 months. Among those, there were 42 MFs (22 BC AVFs and 20 RC AVFs) and 68 maturation successes (MS) (52 BC AVFs and 16 RC AVFs). BAM was involved in MF group. We compared the clinical characteristics, AVF flows, and AVF flow ratios of MF and MS groups. Also, we evaluated the etiology, management, and result of MF. RESULTS There was no difference in clinical characteristics between MF and MS groups. In MF group, 39 balloon angioplasties (BAs) for 42 AVF MFs were performed. Number of BA was 1.45 ± 0.57 and duration of BA was 21.30 ± 21.24 weeks. BAM rate was 46.2%. For 1 year after AVF creation, AVF flows of MS group were significantly larger than those of MF group (P < 0.05) but there was no difference in AVF flow ratio between MF and MS groups (P > 0.05). CONCLUSION BA for AVF MF is a relatively applicable and effective modality. Although a large volume study is necessary, we suggest BAM is an effective salvage management for AVF MF.
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Affiliation(s)
- Sun Cheol Park
- Division of Vascular and Transplant Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Yeon Ko
- Division of Vascular and Transplant Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Il Kim
- Division of Vascular and Transplant Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In Sung Moon
- Division of Vascular and Transplant Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang Dong Kim
- Division of Vascular and Transplant Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
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The next frontier of office-based inferior vena cava filter placement. J Vasc Surg Venous Lymphat Disord 2016; 4:283-5. [PMID: 27318046 DOI: 10.1016/j.jvsv.2016.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 03/12/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE There is an increasing number of procedures that traditionally were performed in the inpatient setting that are now becoming office-based procedures. These include peripheral endovascular procedures such as angiograms, angioplasties, dialysis access interventions, and treatment for venous insufficiency. We chose to evaluate the feasibility, safety of inferior vena cava (IVC) filter placement in the office-based setting. METHODS All procedures were performed using local anesthesia, and ultrasound guidance for puncture. All venograms were performed with manual injection of iodinated contrast. An IVC filter was placed in the cases (except one failure of placement) using fluoroscopy in the infrarenal position. Patients were observed in a recovery area and then discharged. Follow-up data were obtained through an interview, physical examination, and 24-hour postoperative phone call. RESULTS Over the course of 27 months, 29 Greenfield filters (Boston Scientific, Marlborough, Mass) and three Celect temporary filters (Cook, Bloomington, Ind) were placed in the infrarenal IVC for 18 women and 14 men, with an average age of 75.3 ± 15.6 years (range, 38-97 years). Twenty-four acute, 6 recent (<6 months ago) and three subacute lower extremity deep vein thromboses (DVTs) were identified. The indications for the procedure were patients with: DVT who were to undergo surgery (n = 6), acute large free-floating iliofemoral DVT (deemed high-risk for long-term anticoagulation) (n = 7), new DVT during anticoagulation therapy (n = 6), DVT with gastrointestinal bleeding (n = 4), DVT with hematuria (n = 2), recent DVT (which extended during full dose anticoagulation treatment) while undergoing a long flight (n = 1) (temporary filter placement), DVT with arm hematoma (n = 1), DVT with unsteady gait and history of falls (n = 2), DVT with nose bleeding (n = 1), DVT with dementia and inability to receive anticoagulation treatment (n = 1), DVT and receiving chemotherapy and with thrombocytopenia (n = 1), and DVT and refusal to take anticoagulation medication (n = 1). One patient had a failure to place a filter because of chronic IVC occlusion found on venogram. One patient with history of gastrointestinal bleeding, acute DVT, and atrial fibrillation suffered IVC filter thrombosis 1 month after the procedure. We attempted removal of the temporary filters in the hospital in two patients but failed to retrieve the filter in these two cases. We noted no insertion site DVT, extension of DVT, or pulmonary embolism. CONCLUSIONS Our preliminary experience suggests that placement of IVC filters for treatment of venous thrombotic events in an office-based facility is safe and efficacious with basic endovascular equipment. Long-term outcome cannot be determined at this point.
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Organisation of a Radiological Vascular access Unit. J Vasc Access 2015; 16 Suppl 9:S24-8. [DOI: 10.5301/jva.5000359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2014] [Indexed: 11/20/2022] Open
Abstract
An interventional vascular access unit is usually part of an interdisciplinary centre, including departments of nephrology, vascular surgery, angiology and interventional radiology. We present recommendations on quality control, equipment and diagnostic and interventional techniques for the treatment of vascular access insufficiency.
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Bojakowski K, Góra R, Szewczyk D, Andziak P. Ultrasound-guided angioplasty of dialysis fistula - technique description. Pol J Radiol 2014; 78:56-61. [PMID: 24505224 PMCID: PMC3908508 DOI: 10.12659/pjr.889524] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 08/12/2013] [Indexed: 11/29/2022] Open
Abstract
Endovascular procedures are commonly used for treatment of vascular pathologies. These interventions are routinely performed under angiographic control. Angioplasty is increasingly more often used for correction of dialysis fistula – especially dilatation of stenosis. We describe the technique of dialysis fistula angioplasty under ultrasound control. Benefits of this procedure include lack of nephrotoxic contrast, what is especially important in chronic kidney disease patients in pre-dialysis period. Advantages of ultrasound guidance during dialysis fistula angioplasty lead to cause more and more frequent employment of this technique.
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Affiliation(s)
- Krzysztof Bojakowski
- Department of General, Vascular and Oncological Surgery, CSK MSW, Warsaw, Poland ; Department of Immunology, Biochemistry and Nutrition, Medical University of Warsaw, Warsaw, Poland
| | - Rafał Góra
- Department of General, Vascular and Oncological Surgery, CSK MSW, Warsaw, Poland
| | - Dariusz Szewczyk
- Department of General, Vascular and Oncological Surgery, CSK MSW, Warsaw, Poland ; Department of General and Vascular Surgery, Międzylesie Specialist Hospital, Międzylesie, Poland
| | - Piotr Andziak
- Department of General, Vascular and Oncological Surgery, CSK MSW, Warsaw, Poland ; Medical Research Centre of Polish Academy of Sciences, Warsaw, Poland
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Visciano B, Riccio E, De Falco V, Musumeci A, Capuano I, Memoli A, Di Nuzzi A, Pisani A. Complications of Native Arteriovenous Fistula: The Role of Color Doppler Ultrasonography. Ther Apher Dial 2013; 18:155-61. [DOI: 10.1111/1744-9987.12073] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Bianca Visciano
- Department of Nephrology; Federico II University of Naples; Naples Italy
| | - Eleonora Riccio
- Department of Nephrology; Federico II University of Naples; Naples Italy
| | | | - Antonino Musumeci
- Department of Cardiac Surgery; Federico II University of Naples; Naples Italy
| | - Ivana Capuano
- Department of Nephrology; Federico II University of Naples; Naples Italy
| | - Andrea Memoli
- Department of Nephrology; Federico II University of Naples; Naples Italy
| | - Antonella Di Nuzzi
- Department of Nephrology; Federico II University of Naples; Naples Italy
| | - Antonio Pisani
- Department of Nephrology; Federico II University of Naples; Naples Italy
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García-Medina J. Value of Duplex Ultrasound Assistance for Thromboaspiration and Dilation of Thrombosed Native Arterio-Venous Fistulae. Cardiovasc Intervent Radiol 2013; 36:1658-1663. [DOI: 10.1007/s00270-013-0554-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Accepted: 11/19/2012] [Indexed: 11/29/2022]
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Vardza Raju A, Kyin May K, Htet Zaw M, Capistrano Canlas C, Hannah Seah M, Menil Serrano C, Hartman M, Ho P. Reliability of ultrasound duplex for detection of hemodynamically significant stenosis in hemodialysis access. Ann Vasc Dis 2013; 6:57-61. [PMID: 23641285 DOI: 10.3400/avd.oa.12.00056] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 12/07/2012] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study aims to evaluate the accuracy of AVF and AVG duplex ultrasound (US) compared to angiographic findings in patients with suspected failing dialysis access. MATERIALS AND METHODS From July 2008 to December 2010, US was performed on 35 hemodialysis patients with 51 vascular accesses having clinical feature or dialysis parameter suspicious of access problem. Peak systolic velocity ratio of ≥2 was the criteria for diagnosing stenosis ≥50%. Fistulogram was performed in all these patients. Results of US and fistulogram were compared using Kappa and Receiver Operator Characteristic (ROC) analyses. RESULTS In 51 accesses (35 AVF, 16 AVG), US diagnosed significant stenosis in 45 accesses according to the criteria and angiogram confirmed 44 significant stenoses. In AVF lesions, Kappa was 0.533 with 93.3% sensitivity and 60% specificity for US whereas in AVG lesions, Kappa was 0.636 with 100% sensitivity and 50% specificity. Overall Kappa value of 0.56 meant fair to good agreement. ROC demonstrated area under the curve being 0.79 for all cases and was significant (p = 0.016). Using the ≥50% criteria for stenosis diagnosed by US yielded the best sensitivity (95.5%) and specificity (57.1%). CONCLUSION Duplex ultrasound study, using ≥50% criteria, is a sensitive tool for stenosis detection in patients with suspected failing AVF and AVG.
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Affiliation(s)
- Ashvin Vardza Raju
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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DerDerian T, Hingorani A, Ascher E, Marks N, Jimenez R, Aboian E, Jacob T, Boniscavage P. To BAM or not to BAM?: A closer look at balloon-assisted maturation. Ann Vasc Surg 2012; 27:104-9. [PMID: 23092734 DOI: 10.1016/j.avsg.2012.06.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Revised: 06/03/2012] [Accepted: 06/29/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Balloon assisted maturation (BAM) is a recent, innovative, yet controversial method for developing autogenous arterio-venous fistulae (AVF), with little supportive data. Few retrospective studies have addressed the efficacy of BAM and cofactors affecting successful maturation. We conducted a retrospective analysis of our vascular access database to compare possible factors associated with a successful BAM, as determined by increase in volume flow of the fistulae. METHODS Between 2009 and 2010, data was prospectively collected on patients undergoing BAM of their AVF under ultrasound guidance at our institution. 30 of these patients, consisting of 143 BAMs, were retrospectively analyzed. Data collection included: past medical history, age, number of BAM procedures preformed, volume flow measurement (VFM) in mid-fistulae, size of balloon used, and presence of post procedural wall hematoma. VFM was determined with duplex within one month prior to and subsequent to each BAM performed. RESULTS Of the 30 patients, consisting of 143 BAMs, the average age was 69 years old + 15 (range 38-92) with 20 males and 10 females. The most common risk factors were hypertension (n = 27) and diabetes mellitus (n = 16). The average BAM per patient was 4.8 (range 1-7). Of the 143 BAM procedures, 4 were excluded due to absence of preoperative or postoperative duplex. In 139 BAMs, 74 developed a post procedural hematoma as observed on duplex, and 76 showed an increase in VFM. In all BAMs analyzed, there was no correlation observed between the presence of a hematoma and increase in VFM (P = 0.87). Hematomas occurred most frequently during the second BAM procedure, with 24.3% of all hematomas observed. In 139 BAMs, 8 different balloon sizes were used, 3 mm-10 mm, with the 7mm balloon being the most frequently used (n = 34). No significant difference was noted between increase in VFM in 3 mm to 7 mm balloons. A 8 mm balloon was used in 31 BAMs with 22 developing hematomas. Of the 8mm balloon group, a statistical difference was noted between percent increase in VFM with presence of a hematoma and percent increase in VFM without presence of a hematoma (P = 0.027). CONCLUSIONS These preliminary data, suggest that a more aggressive approach to BAM, with use of larger balloons to create hematoma formation and minimizing excessive dilatation procedures, may have a significant impact on performing a successful maturation in respects to increase in VFM.
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Affiliation(s)
- Trevor DerDerian
- Division of Vascular Surgery, Maimonides Medical Center, Brooklyn, NY 11219, USA.
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Gallagher JJ, Boniscavage P, Ascher E, Hingorani A, Marks N, Shiferson A, Jung D, Jimenez R, Novak D, Jacob T. Clinical Experience With Office-Based Duplex-Guided Balloon-Assisted Maturation of Arteriovenous Fistulas for Hemodialysis. Ann Vasc Surg 2012; 26:982-4. [DOI: 10.1016/j.avsg.2012.01.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 01/06/2012] [Accepted: 01/10/2012] [Indexed: 10/28/2022]
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Fox D, Amador F, Clarke D, Velez M, Cruz J, Labropoulos N, Ryan M, Gelman L. Duplex Guided Dialysis Access Interventions can be Performed Safely in the Office Setting: Techniques and Early Results. Eur J Vasc Endovasc Surg 2011; 42:833-41. [DOI: 10.1016/j.ejvs.2011.04.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Accepted: 04/12/2011] [Indexed: 11/17/2022]
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Salman L, Ladino M, Alex M, Dhamija R, Merrill D, Lenz O, Contreras G, Asif A. Accuracy of Ultrasound in the Detection of Inflow Stenosis of Arteriovenous Fistulae: Results of a Prospective Study. Semin Dial 2010; 23:117-21. [DOI: 10.1111/j.1525-139x.2009.00693.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Kubale R, Walker G, Jung EM, Clevert DA, Bücker A. [Hemodialysis fistulas: possibilities of vascular ultrasound]. Radiologe 2009; 49:1048-57. [PMID: 19851746 DOI: 10.1007/s00117-009-1870-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Vascular ultrasound is an established technique in shunt diagnostics for hemodialysis fistulas that allows non-invasive diagnosis of vascular morphology and hemodynamics. Early detection of shunt stenoses in hemodialysis fistulas or thrombotic occlusions facilitates an interventional decision. High occlusion rates of up to 45% within 1 year in hemodialysis fistulas due to reduced flow volume justify follow up with vascular ultrasound examination. The use of high resolution transducers in vascular ultrasound enables complications, such as stenoses and occlusions to be recognized early therefore allowing preemptive therapy. In the present review the examination technique and strategy, the most important complications and treatment options will be discussed.
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Affiliation(s)
- R Kubale
- Gemeinschaftspraxis für Radiologie und Nuklearmedizin, Pettenkoferstr. 22, 66955, Pirmasens, Deutschland.
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