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Cho MS, Javed Z, Patel R, Karim MS, Chan MR, Astor BC, Gardezi AI. Impact of COVID-19 pandemic on hemodialysis access thrombosis. J Vasc Access 2024; 25:467-473. [PMID: 35953895 PMCID: PMC9379590 DOI: 10.1177/11297298221116236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/10/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Delay in care of suspected stenosis or thrombosis can increase the chance of losing a functioning hemodialysis access. Access to care and resources were restricted during the COVID-19 pandemic. To evaluate the impact of the pandemic on arteriovenous fistula (AVF) and arteriovenous graft (AVG) procedures we have assessed the number and success of thrombectomies done before and during the COVID-19 pandemic. METHODS We examined all AVF and AVG angiograms with and without interventions, including thrombectomies, performed at a single center during April 2017-March 2021 (pre-COVID-19 era) and April 2020-March 2021 (COVID-19 era). RESULTS The proportion of procedures that were thrombectomies was higher during the COVID-19 era compared to the pre-COVID-19 era (13.3% vs 8.7%, p = 0.009). The proportion of thrombectomy procedures was higher during COVID-19 for AVF (8.2% vs 3.0%, p < 0.001) but there was no difference for AVG (26.5% vs 27%, p = 0.99). There was a trend toward a higher likelihood of unsuccessful thrombectomy during COVID-19 (33.3% vs 20.4%, p = 0.08). CONCLUSIONS More dialysis access thromboses and unsuccessful thrombectomies were noted during the COVID-19 pandemic. This difference could be due to a delay in patients getting procedures to maintain their dialysis accesses.
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Affiliation(s)
- Min S Cho
- Division of Nephrology, Department of
Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI,
USA
| | - Zain Javed
- Division of Nephrology, Department of
Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI,
USA
| | - Ravi Patel
- Division of Nephrology, Department of
Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI,
USA
| | - Muhammad S Karim
- Division of Nephrology, Department of
Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI,
USA
| | - Micah R Chan
- Division of Nephrology, Department of
Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI,
USA
| | - Brad C Astor
- Division of Nephrology, Department of
Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI,
USA
- Department of Population Health
Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI,
USA
| | - Ali I Gardezi
- Division of Nephrology, Department of
Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI,
USA
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Seet C, Lindsey B, Sivaprakasam R, McCafferty K, Forbes S, Akhtar MR, Khurram M, Mohamed IH. The management of dialysis access thrombosis during the COVID-19 pandemic. J Vasc Access 2023; 24:660-665. [PMID: 34538194 DOI: 10.1177/11297298211045578] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Maintaining patent access is essential for haemodialysis dependent end stage renal failure patients. The COVID-19 pandemic has significantly affected surgical and interventional radiology services worldwide. We aimed to review the impact COVID-19 has caused to the management of acute dialysis access thrombosis. METHODS We conducted a single centre retrospective review of outcomes of patients with arteriovenous fistula and arteriovenous graft thrombosis between March and May 2020, which coincided with the first peak of the COVID-19 pandemic in London, and a similar period in the previous year, March-May 2019. Outcomes in both cohorts of patients were compared, including attempts at salvage, salvage success, 1-month patency rates after salvage and subsequent surgery on the same access. We also analysed the use of tunnelled haemodialysis lines (THL), either due to failed salvage attempts or when salvage was not attempted. RESULTS There was a similar incidence of access thrombosis in both periods (26 cases in 2019, 38 in 2020). There were 601 patients dialysing via an arteriovenous fistula or graft in 2019, and 568 patients in 2020. Access salvage, when attempted, had similar success rates and 1-month patency (salvage success 74% vs 80%, p = 0.39; 1-month patency 55% vs 62%, p = 0.69). The proportion of patients where access salvage was not attempted and a THL inserted was significantly higher in 2020 compared to 2019 (32% vs 4%, p = 0.007). There were more patients who subsequently had surgery to salvage or revise the same access in 2019 compared to 2020 (62% vs 13%, p < 0.001). CONCLUSIONS During the peak of the COVID-19 pandemic, there were fewer attempts at access salvage. This was a conscious decision due to increased pressure on the healthcare system, access to emergency interventional radiology or operative theatres and the perceived risk/benefit ratio of access salvage. The long-term effects of this change in practice remain unknown.
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Affiliation(s)
- Christopher Seet
- Department of Nephrology and Transplantation, The Royal London Hospital, Bart's Health NHS Trust, London, UK
| | - Ben Lindsey
- Department of Nephrology and Transplantation, The Royal London Hospital, Bart's Health NHS Trust, London, UK
| | - Rajesh Sivaprakasam
- Department of Nephrology and Transplantation, The Royal London Hospital, Bart's Health NHS Trust, London, UK
| | - Kieran McCafferty
- Department of Nephrology and Transplantation, The Royal London Hospital, Bart's Health NHS Trust, London, UK
| | - Suzanne Forbes
- Department of Nephrology and Transplantation, The Royal London Hospital, Bart's Health NHS Trust, London, UK
| | - Mohammed Rashid Akhtar
- Department of Interventional Radiology, The Royal London Hospital, Bart's Health NHS Trust, London, UK
| | - Muhammad Khurram
- Department of Nephrology and Transplantation, The Royal London Hospital, Bart's Health NHS Trust, London, UK
| | - Ismail H Mohamed
- Department of Nephrology and Transplantation, The Royal London Hospital, Bart's Health NHS Trust, London, UK
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Jimenez MDA, Méndez A, Furaz K, Botella A, Yetman D, Cazar R, Cabana ML, Handel M, Luz sanchez M, Delgado M, Vasquez MM, Martinez MI, Pereira M, González-Parra E, Sánchez MSP, Garayzabal IS, Rodriguez-Osorio L, Portoles J, Hernán D, Miranda B, Arenas MD, Miranda B, Hernán D, Dapena F, Mendez A, Acuña M, Gaitán D, Guerrero E, Furaz K, de la flor JC, Cordón A, Benavides N, González A, Botella A, Naranjo J, Zalamea F, Manso P, Cabana ML, Beato L, Burgos M, Yetman D, Fernández J, Sobrado J, Carneiro D, Caramés C, Handel M, Terleira M, Sánchez ML, Cerón MD, Herruzo J, Barbeito J, Vasquez MM, SanJuan M, Nieto L, Sainz V, Cazar R, Hernández J, Carrillo JG, Martinez MI, Rossignoli A, Hernández RS, Zamora R, Rodriguez-Osorio L, Ledesma C, Pérez AG, Rubio RE, Garayzábal IS, Iglesias A, Pizarro-Sanchez MS, Piña L, Saíco SEP, Tapia MP, Alexandru S, Picasso ML, Gonzalez-Parra E, Pereira M, Feijoo MCF. Impact of the COVID pandemic on vascular access creation for hemodialysis in 16 Spanish hemodialysis centers. Clin Kidney J 2022; 15:1340-1347. [PMID: 35756749 PMCID: PMC9217639 DOI: 10.1093/ckj/sfac094] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Indexed: 11/22/2022] Open
Abstract
Background The coronavirus disease (COVID) pandemic has resulted in a major disruption in healthcare that has affected several medical and surgical specialties. European and American Vascular Societies have proposed deferring the creation of an elective vascular access (VA) [autologous or prosthetic arteriovenous fistula (AVF) or arteriovenous graft (AVG)] in incident patients on haemodialysis (HD) in the era of the COVID pandemic. The aim of this study is to examine the impact of the COVID pandemic on VA creation and the central venous catheter (CVC)-related hospitalizations and complications in HD patients dialyzed in 16 Spanish HD units of three different regions. Methods We compared retrospectively two periods of time: the pre-COVID (1 January 2019–11 March 2020) and the COVID era (12 March 2020–30 June 2021) in all HD patients (prevalent and incident) dialyzed in our 16 HD centres. The variables analysed were type of VA (CVC, AVF and AVG) created, percentage of CVC in incident and prevalent HD patients, CVC-related hospitalizations and complications (infection, extrusion, disfunction, catheter removal) and percentage of CVC HD sessions that did not reach the goal of Kt (>45) as a marker of HD adequacy. Results A total of 1791 VAs for HD were created and 905 patients started HD during the study period. Patients who underwent vascular access surgery during the COVID period compared with pre-COVID period were significantly younger, with a significant decrease in surgical activity to create AVFs and AVGs in older HD patients (>75 and >85 years of age). There was a significant increase in CVC placement (from 59.7% to 69.5%; P < 0.001) from the pre-COVID to the COVID period. During the COVID pandemic, a significantly higher number of patients started HD through a CVC (80.3% versus 69.1%; P < 0.001). The percentage of CVC in prevalent HD patients has not decreased in the 19 months since the start of the pandemic [414 CVC/1058 prevalent patients (39.4%)]. No significant changes were detected in CVC-related hospitalizations between the pre-COVID and COVID periods. In the COVID period, a significant increase in catheter replacement and the percentage of HD session that did not reach the HD dose objective (Kt > 45) was observed. Conclusions COVID has presented a public health system crisis that has influenced VA for HD, with an increase in CVCs relative to AVFs. A decrease in HD sessions that did not reach the HD dose objective was observed in the COVID period compared with a pre-COVID period.
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Affiliation(s)
| | - Angel Méndez
- Department of nephrology. Los llanos II center, Getafe, Madrid, Spain
| | - Karina Furaz
- Department of nephrology. Los llanos I center, Móstoles, Madrid, Spain
| | - Ana Botella
- Department of nephrology. Los Lauros center, Majadahonda, Madrid, Spain
| | - Delfina Yetman
- Department of nephrology. Os carballos I center; Vigo, Madrid, Spain
| | - Ramiro Cazar
- Department of nephrology. Santa Engracia center, Madrid, Spain
| | - Mara Lisbet Cabana
- Department of nephrology. Os Carballos II center; Porriño, Madrid, Spain
| | - Marc Handel
- Department of nephrology. El Castañar (Béjar) y las Encinas (Ciudad Rodrigo) centers Salamanca, Spain
| | - María Luz sanchez
- Department of nephrology. El Castañar (Béjar) y las Encinas (Ciudad Rodrigo) centers Salamanca, Spain
| | - Margarita Delgado
- Department of nephrology. Los Pinos center, Medina del campo, Valladolid, Spain
| | | | | | - Monica Pereira
- Department of nephrology. Hospital Fundación Jimenez Diaz, Madrid, Spain
| | | | | | | | | | - José Portoles
- Department of nephrology. Hospital Universitario Puerta de Hierro, Madrid, Spain
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Hashmi A, Parikh K, Al-Natour M, Azar N, Sutter C, Ramaiya N, Davidson J, Tavri S. Interventional radiology procedural volume changes during COVID-19 initial phase: A tertiary level Midwest health system experience. Clin Imaging 2021; 72:31-36. [PMID: 33202292 PMCID: PMC7654291 DOI: 10.1016/j.clinimag.2020.10.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/29/2020] [Accepted: 10/17/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND To evaluate Interventional Radiology (IR) procedural volume changes at a large Midwest health system between March 17, 2020 and April 30, 2020 following a state-mandated shutdown of nonessential procedures during the initial phase of COVID-19. METHODS IR procedural volumes were compiled, stratified by location and compared with Diagnostic Radiology (DR) volumes during the same timeframe. Procedure volume was categorized by type, including oncology, dialysis interventions, and drainage procedures with comparisons made using Z-score test for proportions. IR and system-wide surgical procedural volume was compared with baseline values. RESULTS System-wide IR procedural volume decreased by 35%, with a 41% decrease in outpatient and a 25% decrease in inpatient volume during the state-mandated order. DR volume decreased by 45%, with a 57% decrease in outpatient and a 22% decrease in inpatient volume. Total IR procedural volume during the mandate was 1077 versus 1518 during the preceding six weeks. The proportion of Interventional Oncology and dialysis interventions showed no significant change (p > 0.05) while that of drainage procedures increased (p < 0.05). Compared to baseline values, system-wide procedural volumes for IR, Vascular Surgery, Urology, General Surgery, Gastroenterology and Gynecology decreased by 3%, 11%, 25%, 20%, 38% and 31% in March 2020 and 25%, 47%, 68%, 63%, 79% and 73% in April 2020 respectively. CONCLUSION Outpatient IR volumes were less impacted compared to DR during the initial phase of COVID-19. Oncology, dialysis and drainage interventions may be considered essential procedures due to their stability. IR volumes were less affected compared to other procedural specialties.
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Affiliation(s)
- Ahmad Hashmi
- Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, BSH 5056, Cleveland, OH 44106, United States of America
| | - Keval Parikh
- Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, BSH 5056, Cleveland, OH 44106, United States of America
| | - Mohammed Al-Natour
- Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, BSH 5056, Cleveland, OH 44106, United States of America
| | - Nami Azar
- Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, BSH 5056, Cleveland, OH 44106, United States of America
| | - Christopher Sutter
- Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, BSH 5056, Cleveland, OH 44106, United States of America
| | - Nikhil Ramaiya
- Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, BSH 5056, Cleveland, OH 44106, United States of America
| | - Jon Davidson
- Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, BSH 5056, Cleveland, OH 44106, United States of America
| | - Sidhartha Tavri
- Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, BSH 5056, Cleveland, OH 44106, United States of America.
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Bedside Tunneled Hemodialysis Catheter Placement in Patients with COVID-19. Ann Vasc Surg 2021; 73:133-138. [PMID: 33493592 PMCID: PMC7825820 DOI: 10.1016/j.avsg.2021.01.059] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/27/2020] [Accepted: 01/05/2021] [Indexed: 01/08/2023]
Abstract
Background COVID-19, the syndrome caused by the novel SARS-CoV2, is associated with high rates of acute kidney injury requiring renal replacement therapy (RRT). It is well known that despite the ease of bedside insertion, the use of nontunneled dialysis catheters (NTDCs) is associated with increased complications compared to tunneled dialysis catheters (TDCs). Our objective was to develop a strategy for TDC placement at the bedside to provide effective dialysis access, conserve resources and decrease personnel exposure at our medical center in an epicenter of the COVID-19 pandemic. Methods A technique for bedside TDC insertion with ultrasound and plain radiographs in the intensive care unit was developed. Test or clinically COVID-19-positive patients requiring RRT were evaluated for bedside emergent NTDC or nonemergent TDC placement. Patients who underwent NTDC placement were monitored for ongoing RRT needs and were converted to TDC at the bedside after 3–5 days. We prospectively collected patient data focusing on complications and mortality. Results Of the 36 consultations for dialysis access in COVID-positive patients from March 19 through June 5, 2020, a total of 24 bedside TDCs were placed. Only one patient developed a complication, which was pneumothorax and cardiac tamponade during line placement. In-hospital mortality in the cohort was 63.9%. Conclusions Bedside TDC placement has served to conserve resources, prevent complications with transport to and from the operating room, and decrease personnel exposure during the COVID-19 pandemic. This strategy warrants further consideration and could be used in critically ill patients regardless of COVID status.
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