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Shahverdyan R, Lessne ML, Mehta TI. Comparison of Outcomes of Drug-Coated Balloons versus Plain Balloons in Secondary Interventions on Percutaneous Arteriovenous Fistulae. J Vasc Interv Radiol 2024:S1051-0443(24)00318-X. [PMID: 38685469 DOI: 10.1016/j.jvir.2024.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 03/24/2024] [Accepted: 04/21/2024] [Indexed: 05/02/2024] Open
Abstract
PURPOSE To compare patency and reintervention outcomes after either plain old balloon angioplasty (POBA) or drug-coated balloon angioplasty (DCBA) for venous stenoses after percutaneous arteriovenous fistula (pAVF) creation. MATERIALS AND METHODS One-hundred ninety-five pAVFs were successfully created during the study period, 141 using Ellipsys and 54 using Wavelinq. After pAVF creation, 95 patients (48.7%) required secondary percutaneous transluminal angioplasty (PTA) with either POBA (n = 55, 58%) or DCBA (n = 40, 42.1%). The most common site for PTA was the juxta-anastomotic segment (75.5%; 74/98). Univariate and multivariate Cox regression analyses were used to compare target lesion primary patency, access circuit primary patency, secondary patency, and reintervention rates in the POBA and DCBA cohorts. RESULTS Thirty-four of 55 (62%) patients in the POBA cohort and 14 of 40 (35%) patients in the DCBA cohort required reinterventions for pAVF restenosis. Mean number of follow-up days among patients treated with POBA was 1,030.4 (SD ± 342.9) and among those treated with DCBA was 744.4 (SD ± 403.5). The use of POBA compared with DCBA was not associated with target lesion and access circuit primary patency loss in multivariate analysis (hazard ratio [HR], 1.81; 95% CI, 0.93-3.51; P = .080; and HR, 1.77; 95% CI, 0.73-4.28; P = .210, respectively). However, time from fistula creation to the first PTA (days) was statistically significantly associated with both outcomes (HR, 0.997; 95% CI, 0.994-0.999; P = .009; and HR, 0.997; 95% CI, 0.992-0.999; P = .021, respectively). There were no major adverse events. CONCLUSIONS In this retrospective single-center analysis of pAVFs, considerably more patients who underwent PTA with POBA after pAVF creation required reinterventions compared with PTA using DCBA, although the follow-up time of POBA was longer. In multivariate analysis, no differences were noted in the hazard of patency loss between POBA and DCBA.
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Affiliation(s)
| | - Mark L Lessne
- Vascular & Interventional Specialists, Charlotte Radiology, Charlotte, North Carolina; Department of Radiology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Tej Ishaan Mehta
- Department of Radiology, The Johns Hopkins Hospital, Baltimore, Maryland
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2
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Taurisano M, Mancini A, Cortese C, Napoli M. Endovascular tools for vascular access stenosis: Flow-chart proposal. J Vasc Access 2024:11297298241229166. [PMID: 38362739 DOI: 10.1177/11297298241229166] [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: 02/17/2024] Open
Abstract
Stenosis represents the most relevant arteriovenous fistula (AVF) pathology and can affects the entire conduit forming the fistula, from afferent artery to central venous vessels. Correction of vascular access stenosis significantly affects the survival and quality of life for end stage renal disease patients (ESRD) dependent on hemodialysis. Guidelines consider the procedure of percutaneous transluminal angioplasty (PTA) relevant for the primary treatment of these lesions with excellent results in restoring AVF immediately at the end of the procedure. From first AVF angioplasty in 1981 to now, wide scientific innovation has led to development of new devices, composed by different materials and technologies, specific for the site and the type of stenosis to be treated, able to manage resistant stenotic lesion and to reduce stenosis recurrences. International guidelines do not clearly specify all treatment possibilities in the individual case. In this review the authors want to provide specific information on most used devices for stenosis treatment based on literature evidence, showing when and where to use the various tools available with flow-chart treatment proposal.
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Affiliation(s)
- Marco Taurisano
- Department of Nephrology, Hospital "Di Venere," Bari (BA), Apulia, Italy
| | - Andrea Mancini
- Department of Nephrology, Hospital "Di Venere," Bari (BA), Apulia, Italy
| | - Cosma Cortese
- Department of Nephrology, AUOC Policlinico di Bari, Bari (BA), Apulia, Italy
| | - Marcello Napoli
- Department of Nephrology, Hospital "Vito Fazzi," Lecce (LE), Apulia, Italy
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3
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Sharbidre KG, Alexander LF, Varma RK, Al-Balas AA, Sella DM, Caserta MP, Clingan MJ, Zahid M, Aziz MU, Robbin ML. Hemodialysis Access: US for Preprocedural Mapping and Evaluation of Maturity and Access Dysfunction. Radiographics 2024; 44:e230053. [PMID: 38096113 PMCID: PMC10772307 DOI: 10.1148/rg.230053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/07/2023] [Accepted: 07/13/2023] [Indexed: 12/18/2023]
Abstract
Patients with kidney failure require kidney replacement therapy. While renal transplantation remains the treatment of choice for kidney failure, renal replacement therapy with hemodialysis may be required owing to the limited availability and length of time patients may wait for allografts or for patients ineligible for transplant owing to advanced age or comorbidities. The ideal hemodialysis access should provide complication-free dialysis by creating a direct connection between an artery and vein with adequate blood flow that can be reliably and easily accessed percutaneously several times a week. Surgical arteriovenous fistulas and grafts are commonly created for hemodialysis access, with newer techniques that involve the use of minimally invasive endovascular approaches. The emphasis on proactive planning for the placement, protection, and preservation of the next vascular access before the current one fails has increased the use of US for preoperative mapping and monitoring of complications for potential interventions. Preoperative US of the extremity vasculature helps assess anatomic suitability before vascular access creation, increasing the rates of successful maturation. A US mapping protocol ensures reliable measurements and clear communication of anatomic variants that may alter surgical planning. Postoperative imaging helps assess fistula maturation before cannulation for dialysis and evaluates for early and late complications associated with arteriovenous access. Clinical and US findings can suggest developing stenosis that may progress to thrombosis and loss of access function, which can be treated with percutaneous vascular interventions to preserve access patency. Vascular access steal, aneurysms and pseudoaneurysms, and fluid collections are other complications amenable to US evaluation. ©RSNA, 2023 Supplemental material is available for this article. Test Your Knowledge questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Kedar G. Sharbidre
- From the Departments of Radiology (K.G.S., R.K.V., A.A.A.B., M.Z.,
M.U.A., M.L.R.) and Nephrology (A.A.A.B.), University of Alabama at Birmingham,
619 19th St S, Birmingham, AL 35233; and Department of Radiology, Mayo
Clinic, Jacksonville, Fla (L.F.A., D.M.S., M.P.C., M.J.C.)
| | - Lauren F. Alexander
- From the Departments of Radiology (K.G.S., R.K.V., A.A.A.B., M.Z.,
M.U.A., M.L.R.) and Nephrology (A.A.A.B.), University of Alabama at Birmingham,
619 19th St S, Birmingham, AL 35233; and Department of Radiology, Mayo
Clinic, Jacksonville, Fla (L.F.A., D.M.S., M.P.C., M.J.C.)
| | - Rakesh K. Varma
- From the Departments of Radiology (K.G.S., R.K.V., A.A.A.B., M.Z.,
M.U.A., M.L.R.) and Nephrology (A.A.A.B.), University of Alabama at Birmingham,
619 19th St S, Birmingham, AL 35233; and Department of Radiology, Mayo
Clinic, Jacksonville, Fla (L.F.A., D.M.S., M.P.C., M.J.C.)
| | - Alian A. Al-Balas
- From the Departments of Radiology (K.G.S., R.K.V., A.A.A.B., M.Z.,
M.U.A., M.L.R.) and Nephrology (A.A.A.B.), University of Alabama at Birmingham,
619 19th St S, Birmingham, AL 35233; and Department of Radiology, Mayo
Clinic, Jacksonville, Fla (L.F.A., D.M.S., M.P.C., M.J.C.)
| | - David M. Sella
- From the Departments of Radiology (K.G.S., R.K.V., A.A.A.B., M.Z.,
M.U.A., M.L.R.) and Nephrology (A.A.A.B.), University of Alabama at Birmingham,
619 19th St S, Birmingham, AL 35233; and Department of Radiology, Mayo
Clinic, Jacksonville, Fla (L.F.A., D.M.S., M.P.C., M.J.C.)
| | - Melanie P. Caserta
- From the Departments of Radiology (K.G.S., R.K.V., A.A.A.B., M.Z.,
M.U.A., M.L.R.) and Nephrology (A.A.A.B.), University of Alabama at Birmingham,
619 19th St S, Birmingham, AL 35233; and Department of Radiology, Mayo
Clinic, Jacksonville, Fla (L.F.A., D.M.S., M.P.C., M.J.C.)
| | - M. Jennings Clingan
- From the Departments of Radiology (K.G.S., R.K.V., A.A.A.B., M.Z.,
M.U.A., M.L.R.) and Nephrology (A.A.A.B.), University of Alabama at Birmingham,
619 19th St S, Birmingham, AL 35233; and Department of Radiology, Mayo
Clinic, Jacksonville, Fla (L.F.A., D.M.S., M.P.C., M.J.C.)
| | - Mohd Zahid
- From the Departments of Radiology (K.G.S., R.K.V., A.A.A.B., M.Z.,
M.U.A., M.L.R.) and Nephrology (A.A.A.B.), University of Alabama at Birmingham,
619 19th St S, Birmingham, AL 35233; and Department of Radiology, Mayo
Clinic, Jacksonville, Fla (L.F.A., D.M.S., M.P.C., M.J.C.)
| | - Muhammad U. Aziz
- From the Departments of Radiology (K.G.S., R.K.V., A.A.A.B., M.Z.,
M.U.A., M.L.R.) and Nephrology (A.A.A.B.), University of Alabama at Birmingham,
619 19th St S, Birmingham, AL 35233; and Department of Radiology, Mayo
Clinic, Jacksonville, Fla (L.F.A., D.M.S., M.P.C., M.J.C.)
| | - Michelle L. Robbin
- From the Departments of Radiology (K.G.S., R.K.V., A.A.A.B., M.Z.,
M.U.A., M.L.R.) and Nephrology (A.A.A.B.), University of Alabama at Birmingham,
619 19th St S, Birmingham, AL 35233; and Department of Radiology, Mayo
Clinic, Jacksonville, Fla (L.F.A., D.M.S., M.P.C., M.J.C.)
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Rajan DK. Percutaneous Creation of Hemodialysis Fistulas. Cardiovasc Intervent Radiol 2023; 46:1117-1124. [PMID: 36997695 DOI: 10.1007/s00270-023-03418-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/11/2023] [Indexed: 06/19/2023]
Abstract
Non-surgical, percutaneous, or endovascular hemodialysis arteriovenous creation represent an evolution of access creation away from traditional surgical fistulas. These fistulas are additional to surgical alternatives and published studies with the two commercially available devices suggest positive outcomes in terms of technical success, maturation, functionality, and patency. Relevant published studies are presented, and other considerations related to these new devices/procedures are also summarized.
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Affiliation(s)
- Dheeraj K Rajan
- Division of Vascular and Interventional Radiology, University Medical Imaging Toronto-University Health Network/University of Toronto, 585 University Ave, Toronto, ON, Canada, M5G 2N2.
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5
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Habib SG, Jano A, Ali AA, Phillips A, Pinter J, Yuo TH. Early clinical experience and comparison between percutaneous and surgical arteriovenous fistula. J Vasc Surg 2023; 78:766-773. [PMID: 37230183 DOI: 10.1016/j.jvs.2023.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 05/14/2023] [Accepted: 05/17/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Percutaneous arteriovenous fistula (pAVF) has been recently developed as an alternative to surgical AVF (sAVF). We report our experience with pAVF in comparison with a contemporaneous sAVF group. METHODS Charts of all 51 patients with pAVF performed at our institution were analyzed retrospectively, in addition to 51 randomly selected contemporaneous patients with sAVF (2018-2022) with available follow-up. Outcomes of interest were (i) procedural success rate, (ii) number of maturation procedures required, (iii) fistula maturation rates, and (iv) rates of tunneled dialysis catheter (TDC) removal. For patients on hemodialysis (HD), sAVF and pAVF were considered mature when the AVF was used for HD. For patients not on HD, pAVF were considered mature if flow rates of ≥500 mL/min were documented in superficial venous outflow; for sAVF, documentation of maturity based on clinical criteria was required. RESULTS Compared patients with sAVF, patients with pAVF were more likely to be male (78% vs 57%; P = .033) and less likely to have congestive heart failure (10% vs 43%; P < .001) and coronary artery disease (18% vs 43%; P = .009). Procedural success was achieved in 50 patients with pAVF (98%). Fistula angioplasties (60% vs 29%; P = .002) and ligation (24% vs 2%; P = .001) or embolization (22% vs 2%; P = .002) of competing outflow veins were more frequently performed on patients with pAVF. The surgical cohort had more planned transpositions (39% vs 6%; P < .001). When all maturation interventions were combined, pAVF required more maturation procedures, but this was not statistically significant (76% vs 53%; P = .692). When planned second-stage transpositions were excluded, pAVF had a statistically significant higher rate of maturation procedures (74% vs 24%; P < .001). Overall, 36 pAVF (72%) and 29 sAVF (57%) developed mature fistulas. This difference, however, was not statistically significant (P = .112). At the time of AVF creation, 26 patients with pAVF and 40 patients with sAVF were on HD, all through use of a TDC. Catheter removal was recorded in 15 patients with pAVF (58%) and 18 patients with sAVF (45%) (P = .314). The mean time until TDC removal in pAVF group was 146 ± 74 days, compared with 175 ± 99 in the sAVF group (P = .341). CONCLUSIONS Compared with sAVF, rates of maturation after pAVF seem to be similar, but this result may be related to the higher intensity of maturation procedures and patient selection. An analysis of appropriately matched patients will assist in elucidating the possible role of pAVF vis-a-vis sAVF.
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Affiliation(s)
- Salim G Habib
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Antalya Jano
- School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Adham Abou Ali
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Amanda Phillips
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Joshua Pinter
- Division of Interventional Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Theodore H Yuo
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
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Bontinis A, Bontinis V, Koutsoumpelis A, Wilmink T, Giannopoulos A, Rafailidis V, Chorti A, Ktenidis K. A systematic review aggregated data and individual participant data meta-analysis of percutaneous endovascular arteriovenous fistula. J Vasc Surg 2023; 77:1252-1261.e3. [PMID: 36328141 DOI: 10.1016/j.jvs.2022.10.039] [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: 08/15/2022] [Revised: 10/16/2022] [Accepted: 10/25/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess the short-term and mid-term safety and efficacy of percutaneous endovascular arteriovenous fistula (pAVF) creation. METHODS A systematic search was implemented corresponding to the PRISMA 2020 and the PRISMA for individual participant data (IPD) systematic reviews 2015. Aggregated data from the included studies were obtained and meta-analyzed regarding both the overall pAVF efficacy and the comparison of pAVF with surgical AVF (sAVF). We performed a two-stage IPD meta-analysis for studies comparing pAVF and sAVF regarding primary and secondary patency. Primary end points included primary patency, secondary patency, and functional cannulation. RESULTS Eighteen studies with 1863 patients were included. The overall pAVF, primary patency, secondary patency, functional cannulation and abandonment rates were 54.01% (95% confidence interval [CI], 40.69-66.79), 87.27% (95% CI, 81.53-91.42), 79.94% (95% CI, 65.94-89.13), and 15.58% (95% CI, 7.77-28.79), respectively. The overall pAVF, technical success, maturation, reintervention per person-years and mean time to maturation rates were 97.08% (95% CI, 95.66-98.04), 82.13% (95% CI, 71.64-89.32), 0.80 (95% CI, 0.34-1.47), and 58 days (95% CI, 36.64-92.82), respectively. Secondary patency and pAVF abandonment rates where the only end points were WavelinQ and Ellipsys displayed statistically significant differences of 81.36% (95% CI, 76.15-85.65) versus 92.12% (95% CI, 87.94-94.93) and 32.54% (95% CI, 22.23-44.87) versus 11.13% (95% CI, 4.82-23.65). An IPD meta-analysis of hazard ratios for primary and secondary patency between pAVF and sAVF were 1.27 (95% CI, 0.61-2.67) and 1.25 (95% CI, 0.87-1.80), favoring sAVF. Statistically significant difference between pAVF and sAVF were solely depicted for steal syndrome relative risk of 5.91 (95% CI, 1.12-31.12) and wound infections relative risk of 4.19 (95% CI, 1.04-16.88). Plotting of pAVF smoothed hazard estimate displayed an upsurge in the probability of primary patency failure at 1 month after the intervention. CONCLUSIONS Although we failed to identify statistically significant differences between pAVF and sAVF regarding any of the primary end points, pAVF displayed a decreased risk for steal syndrome and wound infection. Although both the Ellipsys and WavelinQ devices displayed satisfactory secondary patency rates, Ellipsys demonstrated a statistically significant improved rate compared with WavelinQ. Additionally, and despite the borderline statistically insignificant inferior reintervention rate displayed by WavelinQ, one in three WavelinQ pAVFs resulted in abandonment. The introduction of pAVF as a treatment modality calls for standardized definition adjustment and improvement.
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Affiliation(s)
- Alkis Bontinis
- Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece
| | - Vangelis Bontinis
- Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece.
| | - Andreas Koutsoumpelis
- Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece
| | - Teun Wilmink
- Department of Vascular Surgery, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Argirios Giannopoulos
- Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece
| | - Vasileios Rafailidis
- Department of Radiology, School of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Angeliki Chorti
- Department of Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Kiriakos Ktenidis
- Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece
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Liebetrau D, Zerwes S, Kerndl H, Schaal J, Hyhlik-Dürr A. Technical aspects of percutaneous endovascular arteriovenous fistula creation with the Ellipsys® Vascular Access System. Preliminary results after 16 patients. Langenbecks Arch Surg 2023; 408:91. [PMID: 36790592 PMCID: PMC9931805 DOI: 10.1007/s00423-023-02812-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 01/17/2023] [Indexed: 02/16/2023]
Abstract
PURPOSE Technical aspects are crucial for planning and performing endovascular arteriovenous fistula (AVF) creation. The Ellipsys® Vascular Access System represents a minimal invasive method for the creation of a proximal forearm fistula. This report summarizes the essential elements for AVF creation with the Ellipsys® Vascular Access System and investigates feasibility, efficacy, and safety procedures conducted on 16 patients. MATERIALS AND METHODS We performed a retrospective analysis of patients who underwent endovascular AVF creation with the Ellipsys® Vascular Access System between May 2020 and March 2022 at a tertiary referral center. RESULTS The median age was 67.5 years (47-86 years). The mean BMI was 31.4 kg/m2. AV fistula was created on 15/16 patients on their left arm. The technical success was 100%. The mean operation time was 24.2 min. There were no complications associated with the procedure. All patients were examined after 30 days (± 5 days). Primary patency after 30 days was 94% (15/16). The mean fistula flow was 681.1 mL/min and the mean AVF diameter was 6.1 mm. Thirteen out of 15 patients met the criteria for potential hemodialysis. CONCLUSION With the Ellipsys Vascular Access System exist an additional possibility of an AV fistula creation. Based on above findings, the Ellipsys® Vascular Access System represents a feasible, safe, and effective method for AVF creation.
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Affiliation(s)
- Dominik Liebetrau
- Vascular Surgery, Medical Faculty, University of Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany.
| | - Sebastian Zerwes
- Vascular Surgery, Medical Faculty, University of Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany
| | - Hagen Kerndl
- Vascular Surgery, Medical Faculty, University of Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany
| | - Jochen Schaal
- Vascular Surgery, Medical Faculty, University of Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany
| | - Alexander Hyhlik-Dürr
- Vascular Surgery, Medical Faculty, University of Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany
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8
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Corr M, Pachchigar A, O'Neill M, Higgins R, O'Neill S, Hanko J, Masengu A. A decade of arteriovenous fistula creations in the ⩾75 years population: Equal opportunity or sub-optimal use of resources. J Vasc Access 2023:11297298221147571. [PMID: 36609176 DOI: 10.1177/11297298221147571] [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: 01/09/2023] Open
Abstract
BACKGROUND The optimal vascular access in the elderly remains contentious in the context of increasingly limited resources and anticipated survival on hemodialysis. Research focus has shifted to include the impact of vascular access on quality of life. This study explored clinical outcomes in individuals aged ⩾75 years who had an arteriovenous fistula (AVF) created in a single center over a 10-year period. MATERIALS AND METHODS Demographic and clinical data concerning AVFs created January 2009-December 2019 were identified from a prospective database for retrospective analysis. Outcome measures were AVF patency and failure to mature rates plus overall patient and vascular access survival. The Vascular Access Specific Quality of life measure (VASQoL) was completed in a contemporary cohort aged ⩾75 years established on HD in October 2021. RESULTS AVF outcomes were available for 272 patients (93%). The failure to mature (FTM) rate was 36% with the significant predictors of AVF FTM being the creation of a radiocephalic AVF (OR 8.13, 95% CI 8.02-8.52, p < 0.01), female gender (OR 4.84, 95% CI 4.70-5.41, p < 0.01), and a history of peripheral vascular disease (OR 5.25, 95% CI 5.22-6.00, p value = 0.02). Functional patency was associated with a median 12-month survival benefit compared to those whose fistula FTM (p < 0.01). The median patency duration for a functionally patent AVF was 3 years. Elderly patients with a fistula reported a lower quality of life in VASQoL scoring than those with central venous catheters. CONCLUSIONS In this cohort, AVF creation in individuals aged ⩾75 years AVFs was associated with comparable AVF patency rates to younger patients. AVF functional patency was associated with superior patient survival compared to those with AVF FTM. A multi-disciplinary surveillance program may help reduce AVF loss. Further work on how vascular access choice impacts quality of life in elderly patients is required.
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Affiliation(s)
- Michael Corr
- Centre of Public Health, Queen's University, Belfast, UK
- Regional Nephrology & Transplant Unit, Belfast Health and Social Care Trust, Belfast, UK
| | | | | | - Rebecca Higgins
- Regional Nephrology & Transplant Unit, Belfast Health and Social Care Trust, Belfast, UK
| | - Stephen O'Neill
- Centre of Public Health, Queen's University, Belfast, UK
- Regional Nephrology & Transplant Unit, Belfast Health and Social Care Trust, Belfast, UK
| | - Jennifer Hanko
- Regional Nephrology & Transplant Unit, Belfast Health and Social Care Trust, Belfast, UK
| | - Agnes Masengu
- Regional Nephrology & Transplant Unit, Belfast Health and Social Care Trust, Belfast, UK
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9
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Isaak A, Wolff T, Zdoroveac A, Taher F, Gürke L, Richarz S, Akifi S. Ultrasound-Guided Percutaneous Arteriovenous Fistula Creation Simulation Training in a Lifelike Flow Model. Bioengineering (Basel) 2022; 9:bioengineering9110659. [PMID: 36354570 PMCID: PMC9687548 DOI: 10.3390/bioengineering9110659] [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: 09/26/2022] [Revised: 10/30/2022] [Accepted: 11/01/2022] [Indexed: 11/09/2022] Open
Abstract
Objectives: To assess the feasibility and training effect of simulation training for ultrasound-guided percutaneous arteriovenous fistula (pAVF) creation in a lifelike flow model. Methods: Twenty vascular trainees and specialists were shown an instructional video on creating a pAVF in a dedicated flow model and then randomized to a study or control group. The procedure was divided into five clearly defined steps. Two observers rated the performance on each step, and the time to perform the exercise was recorded. The study group participants underwent supervised hands-on training on the model before performing a second rated pAVF creation. All participants subsequently completed a feedback questionnaire. Results: After supervised simulation training, the study groups participants increased their mean performance rating from 2.2 ± 0.9 to 3.2 ± 0.7. A mean of 3.8 ± 0.8 procedure steps was accomplished independently (control group 2.1 ± 1.4; p < 0.05). The time taken to perform the procedure was 15.6 ± 3.8 min in the study group (control group 27.2 ± 7.3, p < 0.05). The participants with previous experience in ultrasound-guided vascular procedures (n = 5) achieved higher overall mean scores 3.0 ± 0.8 and accomplished more steps without assistance (2.0 ± 1.0) during the simulation training compared to their inexperienced peers (1.5 ± 0.3 and 0.8 ± 0.4, respectively). The feedback questionnaire revealed that the study group participants strongly agreed (n = 7) or agreed (n = 3) that training on the simulation model improved their skills regarding catheter handling. Conclusions: The study group participants increased their overall performance after training on the simulator. More experienced attendees performed better from the beginning, indicating the model to be lifelike and a potential skill assessment tool. Simulation training for pAVF creation using a lifelike model may be an intermediate step between acquiring ultrasound and theoretical pAVF skills and procedure guidance in theatre. However, this type of training is limited by its reliance on the simulator quality, demonstration devices and costs.
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Affiliation(s)
- Andrej Isaak
- Department of Vascular and Endovascular Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
- Vascular and Endovascular Surgery, Cantonal Hospital Aarau, 5001 Aarau, Switzerland
- Correspondence: ; Tel.: +41-62-838-45-13
| | - Thomas Wolff
- Department of Vascular and Endovascular Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Andrei Zdoroveac
- Vascular and Endovascular Surgery, Cantonal Hospital Aarau, 5001 Aarau, Switzerland
| | - Fadi Taher
- Vascular and Endovascular Surgery, Klinik Ottakring, Montlearstrasse 37, 1160 Wien, Austria
| | - Lorenz Gürke
- Department of Vascular and Endovascular Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
- Vascular and Endovascular Surgery, Cantonal Hospital Aarau, 5001 Aarau, Switzerland
| | - Sabine Richarz
- Department of Vascular and Endovascular Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Shuaib Akifi
- Vascular and Endovascular Surgery, Cantonal Hospital Aarau, 5001 Aarau, Switzerland
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10
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Endovascular Arteriovenous Fistula Creation-Review of Current Experience. Diagnostics (Basel) 2022; 12:diagnostics12102447. [PMID: 36292137 PMCID: PMC9600111 DOI: 10.3390/diagnostics12102447] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/01/2022] [Accepted: 10/02/2022] [Indexed: 11/17/2022] Open
Abstract
Functioning vascular access is an essential element for life-saving hemodialysis therapy. A surgically-created arteriovenous fistula has been considered the best option for many years. Recently, two manufacturers developed systems for percutaneous/endovascular creation of an arteriovenous fistula (WavelinQ and Ellipsys). We provide a review of the available experience with these systems and discuss advantages and disadvantages.
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11
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Sun JB, Liu CC, Shen X, Chen Q, Xu CL, Cui TL. Percutaneous endovascular arteriovenous fistula: A systematic review and meta-analysis. Front Cardiovasc Med 2022; 9:978285. [PMID: 36148078 PMCID: PMC9486211 DOI: 10.3389/fcvm.2022.978285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 08/15/2022] [Indexed: 12/04/2022] Open
Abstract
Objective Currently, percutaneous endovascular creation of arteriovenous fistula (AVF) shows excellent outcomes. However, few systematic research evidence to support clinical decision making on the benefit of endovascular AVF is available. The purpose of this study was to evaluate the efficacy and safety of endovascular AVF (endoAVF) in patients with renal failure. Methods We searched the Medline, Embase, Cochrane Library, and ClinicalTrials.gov databases for studies on endovascular or endovascular versus surgery for the creation of AVF. Two reviewers independently selected studies and extracted data. A systematic review and meta-analysis were performed by Review Manager 5.4 software (Revman, The Cochrane Collaboration, Oxford, United Kingdom) and Stata 15.0 (Stata Corp, College Station, TX, United States). Results A total of 14 case series and 5 cohort studies, with 1,929 patients, were included in this study. The technique success was 98.00% for endoAVF (95% CI, 0.97–0.99; I2 = 16.25%). There was no statistically significant difference in 3 cohort studies between endovascular and surgical AVF for procedural success (OR = 0.69; 95% CI, 0.04–11.98; P = 0.80; I2 = 53%). The maturation rates of endoAVF were 87.00% (95% CI, 0.79–0.93; I2 = 83.96%), and no significant difference was observed in 3 cohort studies between the 2 groups (OR = 0.73; 95% CI, 0.20–2.63; P = 0.63; I2 = 88%). Procedure-related complications for endoAVF was 7% (95% CI, 0.04–0.17; I2 = 78.31%), and it did not show significant difference in 4 cohort studies between the 2 groups (OR = 1.85; 95% CI, 0.37–9.16; P = 0.45; I2 = 59%). Conclusion The endovascular creation of AVF is potentially effective and safe. These important data may provide evidence to support clinicians and patients in making decisions with endovascular AVF. But further research is great necessary due to lack of randomized controlled studies.
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12
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Rajan DK, Ahmed O. Percutaneous Hemodialysis Fistula Creation. J Vasc Interv Radiol 2022; 33:1135-1142.e2. [PMID: 35753616 DOI: 10.1016/j.jvir.2022.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/03/2022] [Accepted: 06/19/2022] [Indexed: 10/17/2022] Open
Abstract
Two devices have been recently introduced to European Union and North American clinical practice that allow for percutaneous creation of autogenous hemodialysis fistulas (pAVF). Although there are similarities between the devices, there are many differences. Adoption of either or both technologies by an interventionalist may be determined by the individual's comfort with the device. Importantly, current and future outcomes will shape acceptance and use of these devices. This review focuses on the similarities and differences of each device, the procedures, published outcomes to date and their interpretation and other clinical considerations towards initiation of a successful pAVF program.
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Affiliation(s)
- Dheeraj K Rajan
- Division of Vascular and Interventional Radiology, Toronto General Hospital-University Health Network/University of Toronto, Toronto, ON, Canada.
| | - Osman Ahmed
- Section of Vascular and Interventional Radiology, 21727University of Chicago Medical Center, Chicago, IL, USA
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13
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Hull JE, Jennings WC, Cooper RI, Narayan R, Mawla N, Decker MD. Long Term Results from The Pivotal Multicenter Trial of Ultrasound Guided Percutaneous Arteriovenous Fistula Creation for Hemodialysis Access. J Vasc Interv Radiol 2022; 33:1143-1150. [PMID: 35659573 DOI: 10.1016/j.jvir.2022.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 04/20/2022] [Accepted: 05/25/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To report the five-year results from the Pivotal Multicenter Trial of Ultrasound Guided Percutaneous Arteriovenous Fistula (pAVF) Creation for Hemodialysis Access. MATERIALS AND METHODS Retrospective review of 107 intent-to-treat (ITT) patients from the pivotal trial provided a long-term follow-up population (LTP) of 85 patients followed a median 50 months (range 12-60). Data evaluated in the LTP group were fistula maturation and use, secondary procedures, and complications. Kaplan-Meier analysis of primary, primary assisted, cumulative patency, and functional patency (time from two-needle to abandonment) were performed for the ITT population. RESULTS In the LTP 99% (84/85) of fistulas were mature with 99% (78/79) of patients requiring hemodialysis using their pAVF. Sustained fistula use (two-needle cannulation at prescribed rate, 2/3 sessions) was achieved in 92% (78/85) of patients, with seven patients never using their pAVF because not on dialysis (n=4), peritoneal dialysis (n=2), and refusing to use fistula (n=1). Fistula maintenance was required in 31.8% (27/85) of patients and included fistula dysfunction (21.2%), thrombosis (5.9%), cannulation injury (12.9%), and arm swelling (4.7%). The number of procedures performed per patient per year (PPPY) to maintain function and patency was 0.32 (91/288) for years 2-5. The cumulative patency was 89.5%, 88.4%, 88.4%, 85.6%, and 82.0% years 1-5, respectively. The functional patency was 91.8% at the end of the study. There were no major complications related to pAVF during long-term follow-up CONCLUSION: Percutaneous fistulae have provided clinically effective and durable access for hemodialysis with low complications. Continued use and evaluation of pAVF is warranted.
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Affiliation(s)
- Jeffrey E Hull
- Richmond Vascular Center, 173 Wadsworth Drive, North Chesterfield, VA 23236
| | - William C Jennings
- Division of Vascular Surgery, Department of Surgery, University of Oklahoma School of Community Medicine, Tulsa, Oklahoma.
| | - Randy I Cooper
- Southwest Vascular Center, 1100 East University Drive Suite 103, Tempe, AZ 85281
| | - Rajeev Narayan
- San Antonio Kidney Disease Center, 26927 Hardy Run, San Antonio, TX 78015
| | - Neghae Mawla
- Dallas Nephrology, 3604 Live Oak, Suite 300, Dallas, TX 75204-6169
| | - Meredith D Decker
- Willes Consulting Group, Inc., 1327 Walnutview Dr., Encinitas, CA 92024
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14
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Mallios A, Gaudin A, Hauguel A, de Blic R, Boura B, Jennings WC. Customizable modification of banding with external stenting for arteriovenous fistula flow reduction. J Vasc Surg Cases Innov Tech 2022; 8:151-157. [PMID: 35330904 PMCID: PMC8938603 DOI: 10.1016/j.jvscit.2022.01.003] [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: 05/24/2021] [Accepted: 01/08/2022] [Indexed: 11/02/2022] Open
Abstract
We performed a single-center retrospective study of prospectively collected data for all patients who had flow reduction surgery with FRAME FR between November 2020 and January 2021. Ten patients had arteriovenous fistula flow reduction surgery with this technique. One patient had a distal fistula, whereas nine were within the cubital fossa. In nine patients the device was applied over the postanastomotic arteriovenous fistula outflow vein and in one in the preanastomotic radial artery. Technical success was achieved in all patients with a median flow reduction from 2150 to 825 mL/min. There were no wound or device-specific complications.
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15
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Malik MH, Mohammed M, Kallmes DF, Misra S. Endovascular Versus Surgical Arteriovenous Fistulas: A Systematic Review and Meta-analysis. Kidney Med 2022; 4:100406. [PMID: 35386608 PMCID: PMC8978111 DOI: 10.1016/j.xkme.2021.100406] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Rationale & Objective To facilitate the process of dialysis for patients with kidney failure, an arteriovenous fistula (AVF) is created using either a surgical or percutaneous approach. We sought to compare the efficacy and procedural outcomes in creating an AVF percutaneously using Ellipsys (Avenu Medical) or WavelinQ (Becton Dickinson Medical) with surgery in all patients with kidney failure requiring a permanent AVF for dialysis. Study Design Systematic review and meta-analysis. Setting & Study Populations All patients requiring a permanent AVF for dialysis. Selection Criteria for Studies We included studies that compared either the Ellipsys device or WavelinQ directly with surgery to create an AVF for long-term dialysis. Data Extraction Two reviewers independently reviewed the studies and extracted the data. Conflicts were resolved with a discussion and approval from the senior author. Analytical Approach Fixed-effects or random-effects models were used to pool the fixed sizes and 95% CIs based on the level of heterogeneity. Results There was no statistically significant difference observed between surgical AVF and endovascular AVF when comparing the primary outcomes of procedural success (OR = 1.44; 95% CI, 0.35, 5.88; P = 0.61; I2 = 0%), complications (OR = 0.28; 95% CI, 0.06, 1.46; P = 0.13; I2 = 69%), and the secondary outcomes of interest that included follow-up time (mean difference [MD] = -17.71; 95% CI, -189.53, 154.12; P = 0.84; I2 = 94%), failure rate (OR = 1.03; 95% CI, 0.21, 5.13; P = 0.97; I2 = 85%), and time to 2-needle cannulation (MD = -5.40; 95% CI, -38.88, 28.08; P = 0.75; I2 = 0%). However, a statistically significant difference was seen among the 2 groups for procedural time (MD = -54.25; 95% CI, -59.78, -48.71; P < 0.001; I2 = 98%), number of interventions needed to maintain patency (OR = 1.73; 95% CI, 1.22, 2.45; P < 0.01; I2 = 94%), and primary patency rate (OR = 0.34; 95% CI, 0.23,0.52; P < 0.001; I2 = 0%). Limitations The total number of studies included in this review was limited, with 3 of the 4 included studies being retrospective and only 1 being prospective. There was a lack of heterogeneity and randomization. Conclusions Percutaneous fistula creation using Ellipsys or WavelinQ is a unique and safe alternative with outcomes comparable to surgery. Future studies are needed, including observational studies in current clinical practice, to evaluate the efficacy and outcomes of endovascular AVF creation in clinical populations.
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Affiliation(s)
| | | | | | - Sanjay Misra
- Vascular and Interventional Radiology, Mayo Clinic, Rochester, MN
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16
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Nelson PR, Mallios A, Randel M, Jennings WC. Percutaneous arteriovenous fistula creation. Semin Vasc Surg 2021; 34:195-204. [PMID: 34911625 DOI: 10.1053/j.semvascsurg.2021.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/09/2021] [Accepted: 10/10/2021] [Indexed: 11/11/2022]
Abstract
The first percutaneous systems used to create an arteriovenous fistula for hemodialysis were approved by the US Food and Drug Administration in 2018 and included the Ellipsys and WavelinQ devices. Early results and longer-term studies of these catheter-based devices suggest that they offer important benefits and potentially improved outcomes in patients with appropriate anatomy. The deep communicating vein in the cubital fossa and its relationship to the proximal radial artery or proximal ulnar artery are key vascular elements of both systems. The devices differ significantly in technical design, energy source, imaging requirements, procedure times, catheters, access vessel sites, and techniques. We review the two approved percutaneous arteriovenous fistula devices, including technical considerations, selecting the appropriate patient, postoperative evaluation, interventions, outcomes, potential complications, and cannulation issues.
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Affiliation(s)
- Peter R Nelson
- Division of Vascular Surgery, Department of Surgery, University of Oklahoma School of Community Medicine, 1919 S. Wheeling Avenue, Suite 600, Tulsa, OK 74104
| | | | - Mark Randel
- Department of Surgery, Eastern Oklahoma Veterans Affairs Health Care System, Tulsa and Muskogee, Oklahoma
| | - William C Jennings
- Division of Vascular Surgery, Department of Surgery, University of Oklahoma School of Community Medicine, 1919 S. Wheeling Avenue, Suite 600, Tulsa, OK 74104; Division of Vascular Surgery, Department of Surgery, University of Oklahoma School of Community Medicine, Tulsa, OK.
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17
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Percutaneous Arteriovenous Fistula Creation with the WavelinQ 4-French EndoAVF System: A Single-Center Retrospective Analysis of 30 Patients. J Vasc Interv Radiol 2021; 33:33-40. [PMID: 34610421 DOI: 10.1016/j.jvir.2021.09.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 09/15/2021] [Accepted: 09/24/2021] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To retrospectively assess the safety and efficacy of percutaneous arteriovenous fistula (pAVF) creation with the WavelinQ 4-F EndoAVF System. MATERIALS AND METHODS From February 2018 to June 2020, 30 pAVFs were created in 30 consecutive patients (men; age, 55.3 years ± 13.6). Of the 30 patients, 21 (70%) were already on hemodialysis using a central venous catheter. The primary outcome measures were technical success, complications, and cannulation rate. The secondary outcome measures included the number of secondary procedures needed for cannulation, maintenance time to cannulation, and pAVF survival. RESULTS Technical success was 100%. The adverse event rate was 6.7% (2/30), including a pseudoaneurysm of the brachial artery that developed immediately after sheath removal and an aneurysm of the anastomosis 17 days after the procedure, which was treated with a covered stent placed in the arterial side. The mean follow-up was 547 days ± 315.7 (range, 14-1,071 days). The cannulation rate was 86.7% (26/30). The mean time to cannulation was 61.3 days ± 32.5 (range, 15-135 days). The mean follow-up after cannulation was 566.2 days ± 252.7 (range, 35-1,041 days). Four pAVFs were thrombosed after cannulation, with 2 of them successfully declotted. Sixteen interventions were needed to achieve cannulation after the index procedure in 15 patients (overall, 0.53 procedures/patient). Seven maintenance endovascular interventions (following cannulation) were performed during the follow-up period in 6 patients (overall, 0.27 procedures/patient, 0.17 procedures/patient-years). For the pAVFs that were cannulated, patency was 96% at 1 year, and 82% at 2 and 3 years, according to the Kaplan-Meier survival analysis. CONCLUSIONS This initial experience suggests that pAVF creation is safe and can be successfully performed with high maturation and long-term patency rates. Larger-scale prospective studies are needed to validate the results.
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18
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Berland T, Clement J, Inston N, Kreienberg P, Ouriel K. Percutaneous Arteriovenous Fistula Creation with the 4 French WavelinQ™ EndoAVF System. J Vasc Surg 2021; 75:1038-1046.e3. [PMID: 34601046 DOI: 10.1016/j.jvs.2021.09.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 09/08/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Percutaneous devices for creation of native arteriovenous fistulae offer an alternative to traditional open surgical techniques. The 4 Fr WavelinQ EndoAVF System was developed as a lower profile alternative to facilitate access through smaller vessels and minimize access site complications; The current report is the original first experience of this device, assessing outcome in 120 patients followed for 6 months. METHODS The use of the 4 Fr WavelinQ system in three studies, EASE (32 patients), EASE-2 (24 patients), and the EU post-market clinical follow-up study (64 patients) was aggregated and analyzed. Patients were followed with duplex ultrasound at discharge and follow-up visits at 1, 3, and 6 months. Primary, assisted primary, and secondary patency rates were evaluated as Kaplan-Meier (KM) estimates and standard errors. Time to maturity and time to successful cannulation were defined as the mean ± SD days from the procedure in patients enrolled on dialysis. RESULTS Procedural success was achieved in 116 patients (96.7%). Primary, assisted-primary, and secondary 6-month patency rates were 71.9%±4.5%, 80.7%±4.1%, and 87.8%±3.3%, respectively. Time to maturity averaged 41±17 days. Time to successful cannulation averaged 68±51 days. Device-related serious adverse events were reported in 3/120 patients (2.5%) and procedure-related serious adverse events occurred in 7/120 patients (5.8%). Arterial or venous access complications were not reported in any of the patients. Access circuit reinterventions were performed in 23 patients (19.2%), split between those performed for EndoAVF maturation (13/120, 10.8%) and maintenance (11/120. 9.2%). CONCLUSIONS Percutaneous creation of native dialysis fistulae with the 4 Fr WavelinQ EndoAVF System is safe and effective, with favorable durability and a low rate of serious complications and reinterventions through 6-month follow-up. Utilization of the 4F device allows for percutaneous fistula creation between the radial artery and radial vein or the ulnar artery and ulnar vein. These findings suggest that the 4 Fr device is a useful percutaneous alternative to open surgical AVF or endovascular AVF with larger-bore devices.
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Affiliation(s)
- Todd Berland
- Division of Vascular Surgery, New York University Medical Center, New York, NY.
| | - Jason Clement
- Department of Radiology, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Nicholas Inston
- Department of Nephrology and Kidney Transplantation, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Paul Kreienberg
- The Vascular Group, The Institute for Vascular Health and Disease, Department of Surgery and Division of Vascular Surgery, Albany Medical College/Albany Medical Center Hospital, Albany, NY
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19
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Analysis of Different Vascular Accesses on Dialysis Quality and Infection Risk Factors of Hemodialysis Patients. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:4554417. [PMID: 34484391 PMCID: PMC8413044 DOI: 10.1155/2021/4554417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 08/18/2021] [Indexed: 12/05/2022]
Abstract
Objective To explore the influence of different vascular accesses on dialysis quality and infection risk factors of hemodialysis patients. Methods A total of 162 patients with end-stage renal disease admitted to our hospital from February 2018 to July 2020 were divided into two groups: cuff tunnel conduit (CTC) group and native arteriovenous fistula (AVF) group. Peripheral blood was collected before and 6 months after dialysis. The incidence of vascular recirculation was measured, and the risk factors of infection were analyzed. Results The levels of HB, Alb, CRP, BUN, Scr, and TP after dialysis in the two groups were lower than those before dialysis (P < 0.05). The Kt/V of patients in both groups did not exceed 1.2, and the URR value exceeded 60%. The results of independent-samples T test analysis documented that the Kt/V level of patients in the AVF group was higher than that of those in the CTC group after dialysis (P < 0.05). The results of the urea method revealed that 22 of 68 patients (32.35%) in the CVC group and 21 of 94 (22.34%) in the AVF group had vascular pathway recirculation. The χ2 test showed that there was no remarkable difference in the incidence of vascular pathway recirculation between both groups (P > 0.05). However, the results of the nonurea method revealed that the incidence of vascular pathway recirculation in the AVF group was lower than that in the CVC group (P < 0.05). Multivariate logistic regression was used to further analyze the factors with statistical significance in the single factor results. It showed that age >60 years, dialysis duration >1 year, dialysis times, diabetes, hypertension, and CTC were all independent risk factors causing vascular access infection. Conclusion If all conditions permit, AVF hemodialysis is a better choice for patients with end-stage renal disease. For the elderly, long-term hemodialysis, and those with diabetes and hypertension, it is necessary to make detailed plans, strengthen the operation proficiency of CTC, and reduce the incidence of infection.
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20
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Mobley D, Kalloo SD, Baskin KM, Koh E, McLennan G, Narayan R, Towbin R, White S, Weintraub JL. Research Priorities for Percutaneous Arteriovenous Fistula Creation in Patients with End-Stage Renal Disease: Proceedings and Recommendations from a Multidisciplinary Research Consensus Panel. J Vasc Interv Radiol 2021; 32:1240.e1-1240.e8. [PMID: 34332723 DOI: 10.1016/j.jvir.2021.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 04/29/2021] [Indexed: 11/19/2022] Open
Abstract
Recently developed endovascular techniques to create percutaneous arteriovenous fistulas are an alternative to surgical arteriovenous fistula creation, although there is currently a lack of high-level evidence regarding their creation, maturation, utilization, and long-term function. Recognizing this, the Society of Interventional Radiology Foundation sponsored a Research Consensus Panel and Summit for the prioritization of a research agenda to identify and address the gaps in current knowledge.
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Affiliation(s)
- David Mobley
- Division of Vascular and Interventional Radiology, Department of Radiology, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, NY.
| | - Sean D Kalloo
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Kevin M Baskin
- Interventional Radiology, Sharon Regional Medical Center, Sharon, PA
| | - Elsie Koh
- American Endovascular Care, New York, NY
| | - Gordon McLennan
- Interventional Radiology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Rajeev Narayan
- Interventional Nephrology, San Antonio Kidney Disease Center, San Antonio, TX
| | - Richard Towbin
- Department of Interventional and Pediatric Radiology, Phoenix Children's Hospital, Phoenix, AZ
| | - Sarah White
- Division of Vascular and Interventional Radiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, WI
| | - Joshua L Weintraub
- Department of Radiology (in Surgery), Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, NY
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21
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Shahverdyan R, Tabbi P, Mestres G. Multicenter European real-world utilization of VasQ anastomotic external support device for arteriovenous fistulae. J Vasc Surg 2021; 75:248-254. [PMID: 34314835 DOI: 10.1016/j.jvs.2021.07.120] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 07/20/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To evaluate the outcomes of arteriovenous fistulae (AVF), created with VasQ external support device under standard clinical practice across three vascular access clinics. METHODS This multinational, retrospective study evaluated prospectively collected clinical outcomes of both forearm and upper arm brachiocephalic AVF (BCAVF) created using the VasQ device. Fifty-one AVF patients were pooled from three different vascular access centers in Germany, Italy, and Spain. Postprocedure outcomes were assessed by flow measurement with ultrasound examination in all centers. Primary failure, usability, patency, and intervention rates during the study period were evaluated. RESULTS Fifty-one VasQ devices were implanted during 37 forearm (36 radiocephalic and 1 ulnar-basilic AVF) and 14 BCAVF procedures. The study population comprised mostly males (73%) and Caucasians (82%), with a mean age of 62.5 years (range, 38-84 years) and mean body mass index of 29.2. One patient died owing to access-unrelated reasons, and one patient was lost to follow-up without AVF assessment after its creation. From the remaining 49, 3 patients had a follow-up of less than 4 weeks and were excluded from maturation, primary failure, and dialysis initiation analysis (because those factors could not be evaluated yet), leaving 46 patients in this evaluation. Maturation was achieved in 91% of patients. The primary failure rate was 9%. A primary patency rate of 77% was observed at 6, 12, and 18 months. The secondary patency rate was 91% at 6 months, and 85% at 12 months and 18 months. Both primary patency and secondary patency did not differ statistically when comparing forearm AVF with BCAVF (P > .25). Successful cannulation was achieved in 86% of patients (32/37) requiring dialysis with a median time from creation to cannulation of 46 days. Of those patients, the functional patency rate was 94%. Five patients underwent seven interventions to maintain or restore patency or functionality, with an overall rate of 0.248 interventions per patient-year. CONCLUSIONS AVFs created with VasQ external support device demonstrated promising patency and functionality outcomes in multicentric real-world setting across the two most commonly used anatomic locations.
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Affiliation(s)
| | - Paola Tabbi
- Department of Vascular Surgery, San Giovanni Hospital, Rome, Italy
| | - Gaspar Mestres
- Department of Angiology and Vascular Surgery, Clinica Sagrada Familia, Barcelona, Spain
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22
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Mordhorst A, Clement J, Kiaii M, Faulds J, Hsiang Y, Misskey J. A Comparison of Outcomes Between Open and Endovascular Arteriovenous Access Creation for Hemodialysis. J Vasc Surg 2021; 75:238-247.e1. [PMID: 34303803 DOI: 10.1016/j.jvs.2021.07.104] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 07/02/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Preliminary outcomes for percutaneous endovascular autogenous access (endoAVF) have shown promising results; however, comparisons with surgical cohorts in dialysis populations are lacking. This study compares autogenous arteriovenous access created with the EverlinQ endoAVF system with accesses created by conventional surgical technique with respect to functional and patency related outcomes. METHODS This is a multicenter, retrospective review of autogenous arteriovenous accesses entered into a prospective database. Patients receiving radiocephalic, brachiocephalic, or endoAVF arteriovenous accesses between 2014 -2019 were included. Autogenous access maturation, primary patency, secondary patency, steal syndrome, and re-interventions were collected and analyzed using standard statistical and survival analyses. RESULTS A total of 369 accesses were created during the study period, including 61 endovascular accesses, 171 radiocephalic accesses, and 137 brachiocephalic accesses (median follow-up 17 months; range 1 - 71 months). Maturation failure at the end of follow-up was 27±6%, 27±5%, and 18±4% for endovascular, radiocephalic, and brachiocephalic accesses, respectively (p =.049 for brachiocephalic vs. endovascular accesses). Primary patencies at 12 and 24 months were 42±5% and 32±7% for endovascular accesses, 43±4% and 24±4% for radiocephalic accesses, and 42±4% and 29±4% for brachiocephalic accesses (p=.906). Secondary patencies at 12 and 24 months were 68±6% and 60±7% for endovascular accesses, 75±3% and 67±4% for radiocephalic accesses, and 91±3% and 81±4% for brachiocephalic accesses (p=.006 for brachiocephalic vs. endovascular accesses). There were no statistically significant differences in ischemic steal syndrome (3.3%, 4.1% and 8.0%; p=.229) or total reinterventions/year (1.0±3.1, 0.9±1.8, and 1.2±1.8; p=.289) for endovascular, radiocephalic, or brachiocephalic arteriovenous accesses, respectively. CONCLUSIONS EndoAVF compare favorably with respect to maturation and patency compared with surgically created accesses in a real-world cohort. Outcomes and reintervention rates are similar to conventional radiocephalic arteriovenous accesses, but are inferior with respect to patency and maturation to brachiocephalic accesses.
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Affiliation(s)
- Alexa Mordhorst
- Division of Vascular Surgery, Department of Surgery, Vancouver General Hospital, Vancouver, BC, Canada.
| | - Jason Clement
- Department of Radiology, St. Paul's Hospital, Vancouver, BC, Canada
| | - Mercedeh Kiaii
- Department of Nephrology, St. Paul's Hospital, Vancouver, BC, Canada
| | - Jason Faulds
- Division of Vascular Surgery, Department of Surgery, Vancouver General Hospital, Vancouver, BC, Canada
| | - York Hsiang
- Division of Vascular Surgery, Department of Surgery, Vancouver General Hospital, Vancouver, BC, Canada
| | - Jonathan Misskey
- Division of Vascular Surgery, Department of Surgery, Vancouver General Hospital, Vancouver, BC, Canada
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Takahashi EA, Kilari S, Misra S. Novel Clinical Therapies and Technologies in Dialysis Vascular Access. KIDNEY360 2021; 2:1373-1379. [PMID: 35369655 PMCID: PMC8676382 DOI: 10.34067/kid.0002962021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/10/2021] [Indexed: 02/08/2023]
Abstract
The hemodialysis population continues to grow. Although procedures for dialysis have existed for >60 years, significant challenges with vascular access to support hemodialysis persist. Failure of arteriovenous fistulas (AVFs) to mature, loss of AVF and graft patency, thrombosis, and infection hinder long-term access, and add extra health care costs and patient morbidity. There have been numerous innovations over the last decade aimed at addressing the issues. In this study, we review the literature and summarize the recent evolution of drug delivery, graft development, minimally invasive AVF creation, and stem-cell therapy for hemodialysis access.
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Affiliation(s)
| | | | - Sanjay Misra
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
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Sandhu B, Hill C, Hossain MA. Endovascular arteriovenous fistulas- are they the answer we haven't been looking for? Expert Rev Med Devices 2021; 18:273-280. [PMID: 33688779 DOI: 10.1080/17434440.2021.1899806] [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: 10/21/2022]
Abstract
INTRODUCTION Surgically created arteriovenous fistulas are the accepted gold standard for the establishment of hemodialysis access in patients requiring dialysis. However, primary and maturation failures may limit their usage. Recent advances in endovascular technology have resulted in the creation of devices for endovascular arteriovenous fistula formation. These devices may offer an additional or alternative approach to fistula formation in patients with end-stage kidney disease. AREAS COVERED This review describes the limitations of surgical arteriovenous fistulas and the endovascular devices currently available. The review covers initial trial data and subsequent studies examining their use. EXPERT OPINION Early results achieved with endovascular fistula formation are encouraging. Current limitations of this technology include anatomic suitability and a high rate of re-interventions required to establish maturity. Greater uptake of the technology will also require a review of long-term outcomes in larger patient cohorts.
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Affiliation(s)
- Bynvant Sandhu
- Department of Renal Transplant and Vascular Access Surgery, Royal Free Hospital, London, UK
| | - Charlie Hill
- Department of Renal Transplant and Vascular Access Surgery, Royal Free Hospital, London, UK
| | - Mohammad Ayaz Hossain
- Department of Renal Transplant and Vascular Access Surgery, Royal Free Hospital, London, UK
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25
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Heindel P, Dieffenbach BV, Sharma G, Belkin M, Ozaki CK, Hentschel DM. Contemporary outcomes of a "snuffbox first" hemodialysis access approach in the United States. J Vasc Surg 2021; 74:947-956. [PMID: 33667611 DOI: 10.1016/j.jvs.2021.01.069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 01/28/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The Society for Vascular Surgery guidelines for permanent hemodialysis (HD) access creation recommend prioritizing the most distal possible autogenous access to minimize complications and preserve more proximal options. The "snuffbox" arteriovenous fistula (AVF) is the most distal radial artery-cephalic vein AVF. Despite the theoretical benefits of the snuffbox approach, recent trends have been toward upper arm access. Our study sought to investigate the feasibility of a snuffbox-first strategy for HD access in all anatomically appropriate candidates. METHODS From January 2016 to August 2019, all patients with end-stage renal disease (ESRD) or pre-ESRD under consideration for HD access were evaluated for a snuffbox-first approach by a team of vascular surgeons and nephrologists at a single, urban academic medical center in the United States. Data were collected prospectively and supplemented by medical record review. A survival analysis was performed to evaluate primary unassisted and secondary patency and clinical and functional maturation. Patients were censored if they had received a kidney transplant or had died. Cox proportional hazards regression was used to determine the risk factors for prolonged clinical maturation and functional maturation. RESULTS A total of 55 snuffbox AVFs were created. The median patient age was 60 years (interquartile range [IQR], 52-70 years), and 52.7% of the patients were men. The median follow-up was 369 days (IQR, 166-509 days). The median survival for primary unassisted patency was 90 days (95% confidence interval [CI], 79-111). Secondary patency at 1 year was 92.3% (95% CI, 85.3%-99.9%). The clinical maturation rate at 1 year was 83.7% (n = 55; 95% CI, 66.8%-91.9%), and the functional maturation rate at 1 year was 85.6% (n = 40; 95% CI, 63.3%-94.4%). Of the patients who were pre-ESRD at AVF creation and had initiated HD during the study period, 87.5% had successfully received incident HD with their snuffbox AVF. Twenty-four patients were receiving HD via a catheter at snuffbox creation. Of those patients, the functional maturation rate at 1 year was 82.5% (95% CI, 44.8%-94.4%). The patients had undergone a median of two interventions (IQR, zero to seven interventions) in the first year. Of these, 46.9% were percutaneous angioplasty and 31.2% were side-branch ligation. Diabetes was associated with slower AVF clinical maturation (multivariate hazard ratio, 0.35; 95% CI, 0.15-0.82; P = .016). A larger artery diameter was associated with earlier AVF clinical maturation (multivariate hazard ratio, 6.64; 95% CI, 2.11-20.9). CONCLUSIONS A snuffbox-first approach to HD access is a viable option for distal access creation in a cohort of patients requiring HD in the United States. Subsequent ancillary interventions to facilitate access maturation were required for most patients.
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Affiliation(s)
- Patrick Heindel
- Division of Vascular and Endovascular Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
| | - Bryan V Dieffenbach
- Division of Vascular and Endovascular Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Gaurav Sharma
- Division of Vascular and Endovascular Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Michael Belkin
- Division of Vascular and Endovascular Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - C Keith Ozaki
- Division of Vascular and Endovascular Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Dirk M Hentschel
- Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
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Abstract
End-stage kidney disease (ESKD) is a common and morbid disease that affects patients' quality and length of life, representing a large portion of health care expenditure in the United States. These patients commonly have associated diabetes and cardiovascular disease, with high rates of cardiovascular-related death. Management of ESKD requires renal replacement therapy via dialysis or transplantation. While transplantation provides the greatest improvement in survival and quality of life, the vast majority of patients are treated initially with hemodialysis. However, outcomes differ significantly among patient populations. Barriers in access to care have particularly affected at-risk populations, such as Black and Hispanic patients. These patients receive less pre-ESKD nephrology care, are less likely to initiate dialysis with a fistula, and wait longer for transplants-even in pediatric populations. Priorities for ESKD care moving into the future include increasing access to nephrology care in underprivileged populations, providing patient-centered care based on each patient's "life plan," and focusing on team-based approaches to ESKD care. This review explores ESKD from the perspective of epidemiology, costs, vascular access, patient-reported outcomes, racial disparities, and the impact of the COVID-19 crisis.
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Affiliation(s)
- Ryan Gupta
- Division of Vascular Surgery and Endovascular Therapy, University of Colorado, Anschutz School of Medicine, Aurora, CO
| | - Karen Woo
- Division of Vascular Surgery, University of California Los Angeles, David Geffen School of Medicine, 200 UCLA Medical Plaza, Suite 526, Los Angeles, CA 90095.
| | - Jeniann A Yi
- Division of Vascular Surgery and Endovascular Therapy, University of Colorado, Anschutz School of Medicine, Aurora, CO
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Harika G, Mallios A, Allouache M, Costanzo A, de Blic R, Boura B, Jennings WC. Comparison of surgical versus percutaneously created arteriovenous hemodialysis fistulas. J Vasc Surg 2021; 74:209-216. [PMID: 33548442 DOI: 10.1016/j.jvs.2020.12.086] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 12/05/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of the present study was to compare the results between percutaneous arteriovenous fistulas (p-AVFs) created with the Ellipsys device (Ellipsys Vascular Access System; Avenu Medical, San Juan Capistrano, Calif) and surgical arteriovenous fistulas (s-AVFs). METHODS A single-center retrospective comparative study of the first 107 patients who had undergone p-AVF creation with the Ellipsys system from May 2017 to May 2018 with an equal number of consecutive patients who had undergone s-AVF creation in our center during the same period. The primary endpoints included the maturation and patency rates. The secondary endpoints were reintervention, risk of infection, and the incidence of steal syndrome and aneurysm formation. RESULTS The demographic, hypertension, and diabetes data were similar for both groups. The only difference between the two groups was that more p-AVF patients had already been receiving hemodialysis (61% vs 47%; P < .05). The p-AVFs showed superior maturation rates at 6 weeks (65% vs 50%; P = .01). The primary patency rates were greater for the s-AVFs at 12 months (86% vs 61%; P < .01). However, primary patency was comparable between the two groups at 24 months (52% vs 55%; P = .48). No significant difference was found in the secondary patency rates at 12 (90% vs 91%) and 24 (88% vs 91%) months. At the 2-year follow-up point, the rate of percutaneous reintervention was similar; however, the s-AVFs had required more frequent surgical revision (36% vs 17%; P = .01). Issues with wound healing and infection were also more frequent with s-AVFs (9% vs 0.9%; P < .01). CONCLUSIONS Fistulas created percutaneously with the Ellipsys system showed superior maturation rates and similar patency with s-AVFs created in an experienced high-volume vascular surgery practice. p-AVFs had a lower risk of wound healing issues, infection, and surgical revision. Larger, prospective, randomized multicenter studies are needed to confirm these findings.
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Affiliation(s)
- Ghazi Harika
- Department of Vascular Surgery, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Alexandros Mallios
- Department of Vascular Surgery, Groupe Hospitalier Paris Saint Joseph, Paris, France.
| | - Mahmoud Allouache
- Department of Vascular Surgery, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Alessandro Costanzo
- Department of Vascular Surgery, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Romain de Blic
- Department of Vascular Surgery, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Benoit Boura
- Department of Vascular Surgery, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - William C Jennings
- Department of Surgery, School of Community Medicine, University of Oklahoma, Tulsa, Okla
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Mallios A, Jennings WC. Percutaneous arteriovenous fistula creation with the Ellipsys Vascular Access System-the state of the art. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 7:506-507. [PMID: 34401611 PMCID: PMC8353338 DOI: 10.1016/j.jvscit.2020.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/16/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Alexandros Mallios
- Department of Vascular Surgery, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - William C Jennings
- Department of Surgery, University of Oklahoma, School of Community Medicine, Tulsa, Okla
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Koo KSH, Monroe EJ, Reis J, Shivaram GM, Munshi R. Initial experience with the Ellipsys Vascular Access System for percutaneous arteriovenous fistula creation in adolescents: A case report. Radiol Case Rep 2020; 16:441-447. [PMID: 33363679 PMCID: PMC7753092 DOI: 10.1016/j.radcr.2020.12.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 12/07/2020] [Accepted: 12/07/2020] [Indexed: 10/24/2022] Open
Abstract
This retrospective, single center, case report describes the first use of the Ellipsys Vascular Access System for percutaneous arteriovenous fistula (pAVF) creation in children. Two adolescent (<20 year of age) patients (18 and 19-year-old females), one of whom was developmentally delayed, were not considered candidates for traditional surgical arteriovenous fistula creation. pAVF creation was successful in both patients using the Ellipsys device and physiologic maturation of the fistula was achieved within 8 weeks of creation with subsequent 2 needle cannulation. No complications or adverse events were encountered. pAVF creation with the Ellipsys device can be safely performed in adolescents. Further studies will be needed to validate the expanded use of these devices in children.
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Affiliation(s)
- Kevin S H Koo
- Department of Radiology, Section of Interventional Radiology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Eric J Monroe
- Department of Radiology, Section of Interventional Radiology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Joseph Reis
- Department of Radiology, Section of Interventional Radiology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Giridhar M Shivaram
- Department of Radiology, Section of Interventional Radiology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Raj Munshi
- Division of Pediatric Nephrology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
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Journal of Vascular Surgery – December 2020 Audiovisual Summary. J Vasc Surg 2020. [DOI: 10.1016/j.jvs.2020.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Shahverdyan R, Konner K, Matoussevitch V. The past and the future of vascular access surgery: Creation of percutaneous arteriovenous fistula using Ellipsys vascular access system in a patient with previous ipsilateral Scribner-shunt. J Vasc Access 2020; 22:1032-1035. [PMID: 33222590 DOI: 10.1177/1129729820969323] [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] Open
Abstract
BACKGROUND Sixty years after the first description of Scribner-shunt, and 54 years after publication of the first radio-cephalic arterio-venous fistula (AVF), endovascular percutaneous AVF (pAVF) was introduced. We report a successful case of Ellipsys-pAVF creation and use for hemodialysis in a patient with a previous ipsilateral Scribner-shunt. CASE A 72-year old female patient with chronic kidney disease (CKD), previous right-sided Scribner-shunt and kidney transplant, underwent a successful creation of right-sided Ellipsys-pAVF. The procedure time was 12 min with intraoperative brachial artery volume flow of 720 ml/min. At 39 days, an ultrasound-guided balloon-angioplasty of the outflow cephalic vein stenosis was performed. Cannulations were started 41 days after the creation of pAVF. No additional interventions were required during the follow-up of 258 days with last follow-up volume flow of 1400 ml/min. CONCLUSIONS This is the first report of the creation of pAVF in a patient with previous "traumatic" ipsilateral placement of a Scribner-shunt. It allows the creation of a small anastomosis in very short time, which can be successfully used for hemodialysis treatment on the same day, if necessary, and reduces the expected risk of high-flow AVF with associated peripheral steal and cardiac outcomes (especially in a patient with cardiomyopathy such this one).
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Affiliation(s)
| | - Klaus Konner
- Vascular Access Unit, Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Vladimir Matoussevitch
- Vascular Access Unit, Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Cologne, Nordrhein-Westfalen, Germany
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Illig KA, Lok C, Rajan DK, Aruny J, Peden E, Nelson P, London MJ, Ross JR. The role of surgery for assisted maturation after endovascular and percutaneous arteriovenous fistula creation. J Vasc Access 2020; 22:822-830. [PMID: 32912041 DOI: 10.1177/1129729820954724] [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: 11/17/2022] Open
Abstract
Even in the best of circumstances, a significant number of patients will require adjunctive endovascular and/or surgical revision prior to achieving functional patency after endovascular or percutaneous AVF creation, at least within the United States. This rate appears to be higher after percutaneous AVF than after endovascular AVF, although because published reports of the former are mostly derived from American experience and those of the latter derived from experience outside the United States, it is unclear whether these differences are due to the technique itself or cultural and/or anatomic differences in dialysis access practices and patient populations. If arterial inflow is poor, this should be corrected first. When flow is adequate (perhaps 900 cc/min) but no single vein is cannulatable, a dominant suitable vein can be superficialized or transposed. If no suitable vein is dominant (most accurately assessed by using an intraoperative flowmeter), the best vein can be used, with or without occlusion of the other veins or reimplantation into the brachial artery. Finally, if the original anastomosis remains the sole supply to the cannulated vein, the original fistula has achieved assisted primary maturation (and assisted primary patency continues), while if a new arteriovenous anastomosis has been constructed, the original fistula has failed. We point out that for this reason as well as to best utilize the upper arm for later access, endovascular and percutaneous AVFs should be constructed and maintained within an atmosphere where both surgeons and non-surgeons work together on the overall access plan.
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Affiliation(s)
- Karl A Illig
- Dialysis Access Institute, The Regional Medical Center, Orangeburg, SC, USA
| | - Charmaine Lok
- Toronto General Hospital Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Dheeraj K Rajan
- Division of Vascular and Interventional Radiology, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - John Aruny
- Dialysis Access Institute, The Regional Medical Center, Orangeburg, SC, USA
| | - Eric Peden
- JC "Rusty" Walter III Centennial Chair, DeBakey Heart and Vascular Center, Department of Cardiovascular Surgery, Houston Methodist Hospital, Weill Cornell Medical College, Houston, TX, USA
| | - Peter Nelson
- Section of Vascular Surgery, Department of Surgery, Mary Louise Todd Chair for Cardiovascular Research, University of Oklahoma College of Medicine, Tulsa, OK, USA
| | - Mark J London
- Dialysis Access Institute, The Regional Medical Center, Orangeburg, SC, USA
| | - John R Ross
- Dialysis Access Institute, The Regional Medical Center, Orangeburg, SC, USA
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Comparison of Outcomes of Percutaneous Arteriovenous Fistulae Creation by Ellipsys and WavelinQ Devices. J Vasc Interv Radiol 2020; 31:1365-1372. [DOI: 10.1016/j.jvir.2020.06.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/11/2020] [Accepted: 06/16/2020] [Indexed: 11/23/2022] Open
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Horst VD, Nelson PR, Mallios A, Kempe K, Pandit V, Kim H, Jennings WC. Avoiding hemodialysis access-induced distal ischemia. J Vasc Access 2020; 22:786-794. [PMID: 32715859 DOI: 10.1177/1129729820943464] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Timely creation and maintenance of a safe and reliable vascular access is essential for hemodialysis patients with end-stage renal disease. Hemodialysis access-induced distal ischemia (HAIDI) is a recognized complication of arteriovenous fistulas and grafts that may result in serious or even devastating consequences. Avoiding such complications is clearly preferred over treatment of HAIDI once established. Proper recognition of patients at increased risk of HAIDI includes careful pre-operative evaluation of the patient's medical and surgical history along with physical examination and imaging to determine a plan for creating a functional permanent access while minimizing the risk of distal ischemia. Our aim is to review identifying characteristics of individuals at risk of HAIDI and provide recommendations regarding pre-operative assessment. Vascular access options and techniques are suggested for establishing a functional vascular access without distal ischemia for such patients.
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Affiliation(s)
- Vernon D Horst
- Division of Vascular Surgery, Department of Surgery, School of Community Medicine, The University of Oklahoma, Tulsa, OK, USA
| | - Peter R Nelson
- Division of Vascular Surgery, Department of Surgery, School of Community Medicine, The University of Oklahoma, Tulsa, OK, USA
| | | | - Kelly Kempe
- Division of Vascular Surgery, Department of Surgery, School of Community Medicine, The University of Oklahoma, Tulsa, OK, USA
| | - Viraj Pandit
- Division of Vascular Surgery, Department of Surgery, School of Community Medicine, The University of Oklahoma, Tulsa, OK, USA
| | - Hyein Kim
- Division of Vascular Surgery, Department of Surgery, School of Community Medicine, The University of Oklahoma, Tulsa, OK, USA
| | - William C Jennings
- Division of Vascular Surgery, Department of Surgery, School of Community Medicine, The University of Oklahoma, Tulsa, OK, USA
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Mallios A, Jennings WC. Percutaneously created sutureless anastomosis. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:498-499. [PMID: 33134629 PMCID: PMC7588750 DOI: 10.1016/j.jvscit.2020.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 05/22/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Alexandros Mallios
- Department of Vascular Surgery, Institut Mutualiste Montsouris, Paris, France
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Isaak A, Mallios A, Gürke L, Wolff T. Teleproctoring in Vascular Surgery to Defy COVID-19 Travel Restrictions. Eur J Vasc Endovasc Surg 2020; 60:623-624. [PMID: 32718826 PMCID: PMC7332910 DOI: 10.1016/j.ejvs.2020.06.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/02/2020] [Accepted: 06/16/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Andrej Isaak
- Vascular and Endovascular Surgery Aarau-Basel, Aarau Cantonal Hospital, Aarau, Switzerland; Vascular and Endovascular Surgery Aarau-Basel, University Hospital Basel, Basel, Switzerland.
| | | | - Lorenz Gürke
- Vascular and Endovascular Surgery Aarau-Basel, Aarau Cantonal Hospital, Aarau, Switzerland; Vascular and Endovascular Surgery Aarau-Basel, University Hospital Basel, Basel, Switzerland
| | - Thomas Wolff
- Vascular and Endovascular Surgery Aarau-Basel, University Hospital Basel, Basel, Switzerland
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Mallios A, Nelson PR, Franco G, Jennings WC. Creating percutaneous radiocephalic arteriovenous fistulas at the wrist. J Vasc Access 2020; 22:299-303. [PMID: 32597355 PMCID: PMC7983340 DOI: 10.1177/1129729820933737] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The first arteriovenous fistulas were created at the wrist more than 60 years ago. Basic surgical construction techniques remain unchanged with mobilization and repositioning of the vessels followed by a sutured anastomosis. We used the Ellipsys device to construct percutaneous radiocephalic-arteriovenous fistulas at the wrist and report the results. METHODS Data were reviewed retrospectively for all patients who had a percutaneous radiocephalic-arteriovenous fistula created during a 6-month period. Each individual underwent ultrasound vessel mapping in addition to physical examination. When a radiocephalic-arteriovenous fistula was feasible and a communicating vein ⩾ 2 mm in diameter was noted in the distal forearm along with a radial artery ⩾ 2 mm, a percutaneous radiocephalic-arteriovenous fistula was considered and reviewed with the patient. RESULTS Four individuals met the criteria to consider a percutaneous radiocephalic-arteriovenous fistula and all elected to have the procedure performed. Ages were 54-85 years. Three were diabetic and one was female. All percutaneous radiocephalic-arteriovenous fistulas were technically successful. Two individuals had not yet started dialysis therapy. Successful and repetitive cannulation for the two individuals with catheters was initiated at 4 and 8 weeks post procedure. The two pre-dialysis patients had physiologic arteriovenous fistula maturation (6 mm vein diameter and >500 mL/min flow) at 4 and 12 weeks. There were no procedural or late complications and none required intervention. Follow-up was 8-23 months (mean 16 months). CONCLUSION The success of these percutaneous radiocephalic-arteriovenous fistulas suggests that use of the Ellipsys device will be applicable at the wrist in selected patients where appropriate vessel sizes and configurations are found.
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Affiliation(s)
| | - Peter R Nelson
- School of Community Medicine, University of Oklahoma, Tulsa, OK, USA
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