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Wongchadakul P, Lohasammakul S, Rattanadecho P. Comparative analysis of RADAR vs. conventional techniques for AVF maturation in patients with blood viscosity and vessel elasticity-related diseases through fluid-structure interaction modeling: Anemia, hypertension, and diabetes. PLoS One 2024; 19:e0296631. [PMID: 38227602 PMCID: PMC10791008 DOI: 10.1371/journal.pone.0296631] [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: 08/08/2023] [Accepted: 12/12/2023] [Indexed: 01/18/2024] Open
Abstract
PURPOSE This study aims to compare two surgical techniques, the standard Vein-to-Artery and the newer Artery-to-Vein (Radial Artery Deviation And Reimplantation; RADAR), for enhancing the success of Arterio-Venous Fistula maturation in end-stage renal disease patients. The impact of diseases like anemia, diabetes, hypertension, and chronic kidney disease were considered. The goals are to advance Arterio-Venous Fistula (AVF) surgery, improve patient outcomes, and contribute to evidence-based surgical guidelines. METHODS Fluid-structure interaction modeling was employed to investigate how hemodynamic and mechanical stresses impact arteriovenous fistula maturation, with a particular focus on the role of wall shear stress in determining maturation outcomes. The critical threshold for vessel injury was identified as wall shear stress values exceeding 35 N/m2, while stenosis formation was projected to occur at levels below 1 N/m2. This work introduced a novel approach by considering disease-related factors, including blood viscosity (anemia), and vessel elasticity (diabetes, hypertension, and chronic kidney diseases), which directly influence hemodynamics and the generation of wall shear stress. Furthermore, the model was designed to incorporate varying thicknesses and elasticities for both the vein and artery, accurately representing authentic vascular anatomy. RESULTS The RADAR technique has demonstrated superior performance compared to the standard technique by providing appropriate wall shear stress in critical regions and minimizing the risk of wall damage. Its use of a thicker vessel also reduces the risk of vessel injury, making it particularly effective for patients with Chronic Kidney Disease (CKD), hypertension, anemia, and diabetes, ensuring optimal blood flow and fewer complications. However, there are minor concerns about stenosis formation in hypertension and anemia cases, which could be mitigated by adjusting the anastomosis angle to be lower than 30°. CONCLUSION Diabetes and hypertension have significant physiological effects that increase the risks associated with arteriovenous fistula maturation. The anemic condition resulting from CKD may help reduce vessel injury but raises concerns about potential stenosis formation. Despite these co-morbidities, the RADAR technique has demonstrated its ability to induce more favorable hemodynamic changes, promoting arteriovenous fistula maturation.
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Affiliation(s)
| | - Suphalerk Lohasammakul
- Department of Anatomy, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Phadungsak Rattanadecho
- Center of Excellence in Electromagnetic Energy Utilization in Engineering (C.E.E.E.), Department of Mechanical Engineering, Faculty of Engineering, Thammasat University (Rangsit Campus), Pathumthani, Thailand
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Pichot O, Diard A, Bosc JY, Abbadie F, Franco G, Mahé G, Sadaghianloo N. Standardized Methodology for Duplex Ultrasound Examination of Arteriovenous Access for Hemodialysis: A Proposal of the French Society of Vascular Medicine and the French-Speaking Society of Vascular Access. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:2213-2220. [PMID: 37544830 DOI: 10.1016/j.ultrasmedbio.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 08/08/2023]
Abstract
Duplex ultrasound (DUS) is an essential tool for characterizing and monitoring arteriovenous (AV) access for hemodialysis. The aim of the work described here, requested by the French Society of Vascular Medicine in collaboration with the French-Speaking Vascular Access Society, is to propose a standardized methodology for performing and documenting DUS, taking into account the variety of AV access techniques and the problems routinely encountered. A steering committee reviewed the literature and selected the relevant references. A draft was prepared, and all items with missing or conflicting data were submitted to a Delphi consensus. The final document was discussed and approved by all participants. The principles of DUS evaluation of AV access consist of examination of the afferent artery, the anastomosis and the entire venous drainage system. DUS uses B-mode ultrasound, color flow, pulsed wave and power Doppler analysis. DUS can be used in a variety of clinical situations, which can directly influence the methodology of the examination and the interpretation of the results. Blood flow should be assessed as it correlates with the risk of thrombosis. The measurement should be adapted to the different anatomical and hemodynamic conditions encountered. Characterization of stenosis should take into account the residual diameter of the drainage vein and its hemodynamic consequences. Other complications can be assessed with a standardized DUS examination. When performed according to a rigorous methodology, DUS of the AV access allows a comprehensive assessment of its functionality and eliminates the need for further invasive diagnostic procedures.
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Affiliation(s)
- Olivier Pichot
- Department of Vascular Medicine, Groupement Hospitalier Mutualiste, Grenoble, France.
| | - Antoine Diard
- Department of Vascular Medicine, Centre Hospitalier Universitaire Bordeaux, France
| | - Jean-Yves Bosc
- Renal Disease Clinics, AIDER Santé, Hôpital Lapeyronie, Montpellier, France
| | - Fabrice Abbadie
- Department of Vascular Medicine, Centre Hospitalier de Vichy, Vichy, France
| | | | - Guillaume Mahé
- Department of Vascular Medicine, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Nirvana Sadaghianloo
- Department of Vascular Surgery, Centre Hospitalier Universitaire de Nice, Nice, France
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3
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Franchin M, Tadiello M, Guzzetti L, Gattuso A, Mauri F, Cervarolo MC, D'Oria MGG, Tozzi M. Acute problems of hemodialysis access: Thrombosis, aneurysms, symptomatic high-flow fistulas, and complications related to central lines. Semin Vasc Surg 2023; 36:300-306. [PMID: 37330242 DOI: 10.1053/j.semvascsurg.2023.04.008] [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: 02/02/2023] [Revised: 04/06/2023] [Accepted: 04/17/2023] [Indexed: 06/19/2023]
Abstract
Hemodynamic complications frequently affect vascular access and are important causes of morbidity and mortality. We present a review of acute complications affecting vascular accesses, focusing on classical and new treatments. Acute complications in hemodialysis vascular access are often underestimated and undertreated, and can present a challenge for both vascular surgeons and anesthesiologists. Accordingly, we considered different anesthesiologic approaches to both hemorrhagic and nonhemorrhagic patients. A strict collaboration among nephrologists, surgeons, and anesthesiologists can potentially improve prevention and management of acute complications and quality of life.
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Affiliation(s)
- Marco Franchin
- Vascular Surgery Unit, Department of Surgery and Morphological Sciences, Circolo University Teaching Hospital, University of Insubria, ASST Settelaghi, Via Guicciardini, 9, 21100 Varese, Italy.
| | - Marco Tadiello
- Vascular Surgery Unit, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Luca Guzzetti
- Anaesthesiology Unit, Circolo University Teaching Hospital, University of Insubria, ASST Settelaghi, Varese, Italy
| | - Andrea Gattuso
- Vascular Surgery Unit, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Francesca Mauri
- Vascular Surgery Unit, Department of Surgery and Morphological Sciences, Circolo University Teaching Hospital, University of Insubria, ASST Settelaghi, Via Guicciardini, 9, 21100 Varese, Italy
| | - Maria Cristina Cervarolo
- Vascular Surgery Unit, Department of Surgery and Morphological Sciences, Circolo University Teaching Hospital, University of Insubria, ASST Settelaghi, Via Guicciardini, 9, 21100 Varese, Italy
| | | | - Matteo Tozzi
- Vascular Surgery Unit, Department of Surgery and Morphological Sciences, Circolo University Teaching Hospital, University of Insubria, ASST Settelaghi, Via Guicciardini, 9, 21100 Varese, Italy
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4
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Recognizing dialysis access steal syndrome with central vein stenosis as arteriovenous fistula complication: A case report. Int J Surg Case Rep 2022; 102:107824. [PMID: 36493710 PMCID: PMC9730160 DOI: 10.1016/j.ijscr.2022.107824] [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: 11/08/2022] [Revised: 11/27/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Ischemic consequences of hemodialysis arteriovenous (AV) access are infrequent, yet they can cause substantial limb impairment or even loss. Ischemia can be caused by many factors, but the most common etiology is reduced blood supply to the distal extremities due to blood flow through the AV fistula (AVF) or AV graft. We reported a case of dialysis access steal syndrome (DASS) in a diabetes mellitus patient. CASE REPORT A 69-year-old diabetic man with left brachiocephalic AVF on his left upper arm has main complaint of left-hand pain, swelling, and coldness. There are also trophic darkening changes in the distal first, third, and fourth fingers. A duplex doppler examination revealed a normal functional AV shunt with bidirectional distal retrograde inflow. There was also significant stenosis at axillary vein. So, a diagnosis of DASS with suspicion of distal anastomosis stenosis at axillary vein was made. The patient underwent digital amputation and surgical plication of the AV shunt. He also underwent percutaneous transluminal angioplasty at the level of axillary. After 10 days of care, he was later discharged. CLINICAL DISCUSSION DASS is life and limb-threatening clinical disorder. Not only does the discomfort make it difficult for the patient to tolerate hemodialysis, but the ischemia can cause tissue necrosis and the eventual loss of fingers and possibly the patient's life. Doppler ultrasonography is a non-invasive technique that provides important information about vascular anatomy and hemodynamics. Aggressive treatment, including limb surgery and intensive blood glucose regulation, will result in favourable results. CONCLUSIONS DASS is a rare condition usually encountered in hemodialysis patients with AVF. Proper diagnosis and management are needed to get an optimal outcome for the patient.
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Wu A, Huang H, Zhang H, Li H. In-plane guided upper arm arteriovenous fistula cannulation with color ultrasound. Hemodial Int 2022; 26:496-502. [PMID: 36068186 DOI: 10.1111/hdi.13043] [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: 03/30/2022] [Revised: 08/08/2022] [Accepted: 08/19/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The blood vessel in the upper extremity arteriovenous fistula (AVF) is deep in the tissue, and cannulation in AVF is frequently associated with blood oozing, hematoma, or aneurysm. This study evaluated the performance of color ultrasound in-plane guided cannulation technique during upper extremity high-AVF cannulation in patients with hemodialysis. METHODS A total of 40 patients with hemodialysis who needed cannulation in upper extremity AVF were recruited in the study, and the patients were randomly divided into observation group and control group. Color Doppler ultrasound was used to guide cannulation in the observation group and in the control group blind cannulation method was applied. The success rate of one-time cannulation, the incidence of subcutaneous hematoma, oozing, and pain caused by incorrect fistula cannulation as well as the satisfaction score of the patients were compared to evaluate the effect and advantages of color ultrasound-guided cannulation. RESULTS The one-time success rate of internal fistula cannulation in the observation group (98.71%) was significantly higher than that in the control group (88.27%). The incidence rates of hematoma, oozing, pain, and total failure events were significantly reduced in the observation group. The average satisfaction degree in the observation group was also significantly higher than that of the control group. CONCLUSION Ultrasonic-guided cannulation effectively enhances the success rate of cannulation in upper extremity AVF, reduces the incidence of cannulation failures, and improves the satisfaction level in the patients.
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Affiliation(s)
- Aichun Wu
- Department of Hemodialysis, WuHan No. 1 Hospital, WuHan, Hubei, China
| | - Hai Huang
- Department of Equipment Section, WuHan No. 1 Hospital, WuHan, Hubei, China
| | - Huang Zhang
- Department of Hemodialysis, WuHan No. 1 Hospital, WuHan, Hubei, China
| | - Hongbing Li
- Department of Hemodialysis, WuHan No. 1 Hospital, WuHan, Hubei, China
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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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7
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Rodriguez S, Pomy BJ, Mangipudi S, Sidawy AN, Ricotta JJ, Nguyen BN, Lala S, Macsata R. Single-Institution Learning Curve for Management of Mega-Fistulae Revision. Ann Vasc Surg 2021; 80:130-135. [PMID: 34748944 DOI: 10.1016/j.avsg.2021.08.047] [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: 06/30/2021] [Revised: 08/24/2021] [Accepted: 08/29/2021] [Indexed: 11/01/2022]
Abstract
Mega-fistulae are generalized aneurysmal dilations of a high flow (1500-4000 mL/min) autogenous arteriovenous (AV) access which may result in hemorrhage and/or high-output cardiac failure. Current treatment options for mega-fistula include ligation with and without prosthetic jump graft, aneurysmorrhaphy, aneurysmectomy with vein transposition, and imbrication. These options may not be suitable for advanced disease; may leave the patient without working AV access, poor cosmetic results, and possible recurrence. We describe our early experience with a technique of complete mega-fistula resection and replacement with an early use prosthetic graft that both maintains existing AV access and eliminates the need for long-term catheter placement; including lessons learned.
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Affiliation(s)
- Stephanie Rodriguez
- George Washington University School of Medicine and Health Sciences, Washington, DC.
| | - Benjamin J Pomy
- George Washington University Hospital, Department of Surgery, Washington, DC
| | - Sowmya Mangipudi
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Anton N Sidawy
- George Washington University Hospital, Department of Surgery, Washington, DC
| | - John J Ricotta
- George Washington University Hospital, Department of Surgery, Washington, DC
| | - Bao-Ngoc Nguyen
- George Washington University Hospital, Department of Surgery, Washington, DC
| | - Salim Lala
- George Washington University Hospital, Department of Surgery, Washington, DC
| | - Robyn Macsata
- George Washington University Hospital, Department of Surgery, Washington, DC
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8
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Gardezi AI, Mawih M, Alrawi EB, Karim MS, Aziz F, Chan MR. Mega Fistulae! A case series. J Vasc Access 2020; 22:1026-1029. [PMID: 33106091 DOI: 10.1177/1129729820968425] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A mega fistula can be defined as generalized aneurysmal dilatation of arteriovenous fistula. Mega fistulae can lead to complications like high output cardiac failure, steal syndrome, skin ulceration and rupture. We describe a series of ten patients who were referred to our interventional nephrology practice for evaluation of mega fistula which had not been in use for a long time. Nine out of ten patients were post-transplant while one was pre dialysis. Five patients had Radiocephalic while four had Brachiocephalic and one had Brachial artery to Median Cubital vein fistula. All except one patient had severe outflow stenosis. The most common site of stenosis in Radiocepahlic and Brachiocepahlic fistula was cephalic vein at the elbow and cephalic arch respectively. Half of the patients had chronic total occlusion of the outflow vein. Successful angioplasty was done in only two patients. Seven patients underwent ligation while one had spontaneous thrombosis of the fistula. None of the patients had regular surveillance of their access for a long time as they were not on dialysis. Unrecognized and uncorrected outflow stenosis over a long time period can lead to creation of mega fistula. Once a mega fistula develops there are not many treatment options other than ligation. This leads to loss of the access which might be needed in future. Continuous access surveillance in patients who are not on dialysis is important to prevent complications like mega fistula.
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Affiliation(s)
- Ali I Gardezi
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Mustafa Mawih
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Ezzideen B Alrawi
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Muhammad S Karim
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Fahad Aziz
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Micah R Chan
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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9
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Tapolyai M, Faludi M, Berta K, Forró M, Zsom L, Pethő ÁG, Rosivall L, Fülöp T. The association of overhydration with megafistulas in hemodialysis patients. Ren Fail 2020; 41:440-445. [PMID: 31162990 PMCID: PMC6566946 DOI: 10.1080/0886022x.2019.1614954] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objectives: Diffuse enlargements of arteriovenous dialysis fistulas customarily attributed to either excessive arterial inflow or central outflow stenosis. The relationship between volume status and clinically enlarged (arteriovenous) fistula (CEF) formation in end-stage renal disease (ESRD) patients is not well understood. Methods: We assessed the pre-dialysis bioimpedance spectroscopy-measured percentage of overhydration (OH%) in 13 prevalent dialysis patients with CEF development and negative angiography and compared the results with those of 52 control dialysis patients (CONTR). All patients were prevalent ESRD patients receiving thrice-weekly maintenance hemodiafiltration at an academic outpatient dialysis unit. Results: 10/13 CEF patients had OH% ≥15% as compared to 20/52 control patients (Chi square p: .02). The degree of OH% was 20.2 ± 7.4% among the CEF vs. 14.4 ± 7.1% in the control group (Student’s t-test p: .01), representing 4.2 ± 3.2 vs. 2.8 ± 1.6 L of excess fluid pre-dialysis (p: .03). Patients with CEF development took an average of 1.7 ± 1.4 vs. 0.8 ± 0.8 (p: .002) antihypertensive medications compared to the CONTR patients, yet their blood pressure was higher: 156/91 vs. 141/78 mmHg (systolic/diastolic p: .03<.0001). We found no difference in fistula vintage, body mass index, age, diabetes status, or diuretic use. The odds ratio of having a CEF in patients with ≥15% OH status was 5.3 (95% CI: 1.3–21.7; p: .01), the Number Needed to Harm with overhydration was 4. Conclusions: There is an association between bioimpedance spectroscopy-measured overhydrated clinical state and the presence of CEF; either as an increased volume capacitance or as a potential cause.
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Affiliation(s)
- Mihály Tapolyai
- a Semmelweis University , Budapest , Hungary.,b Hemodialysis Unit , Fresenius Medical Care , Budapest , Hungary.,c Medical Services , Ralph H. Johnson VA Medical Center , Charleston , SC , USA
| | - Mária Faludi
- a Semmelweis University , Budapest , Hungary.,b Hemodialysis Unit , Fresenius Medical Care , Budapest , Hungary
| | - Klára Berta
- a Semmelweis University , Budapest , Hungary.,b Hemodialysis Unit , Fresenius Medical Care , Budapest , Hungary
| | - Melinda Forró
- d Hemodialysis Unit , Fresenius Medical Care Hungary , Hatvan , Hungary
| | - Lajos Zsom
- e Hemodialysis Unit , Fresenius Medical Care Hungary , Cegléd , Hungary
| | - Ákos G Pethő
- f 1st Department of Internal Medicine, Faculty of Medicine , Semmelweis University , Budapest , Hungary
| | - László Rosivall
- g Department of Pathophysiology, International Nephrology Research and Training Center , Semmelweis University , Budapest , Hungary
| | - Tibor Fülöp
- c Medical Services , Ralph H. Johnson VA Medical Center , Charleston , SC , USA.,h Department of Medicine, Division of Nephrology , Medical University of South Carolina , Charleston , SC , USA
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10
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Turner AD, Chen M, Dahl N, Scoutt L, Dardik A, Ochoa Chaar CI. Intraoperative Ultrasound Guidance for Banding of an Arteriovenous Fistula Causing High Cardiac Output Heart Failure. Ann Vasc Surg 2019; 66:665.e5-665.e8. [PMID: 31863947 DOI: 10.1016/j.avsg.2019.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 11/04/2019] [Accepted: 12/06/2019] [Indexed: 10/25/2022]
Abstract
The creation of an arteriovenous fistula (AVF) is the preferred mode of access for hemodialysis in patients with End-Stage Renal Disease (ESRD). High output cardiac failure is a known but rare complication of AVF resulting from high flow volume. This case report describes the use of intraoperative ultrasound as a guide for the banding of an AVF to decrease flow volume in a patient with high cardiac output failure. The access was preserved, and a gradual decline of cardiac function before and recovery after banding is demonstrated over an 18-year period.
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Affiliation(s)
- Anthony D Turner
- Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT.
| | - Michael Chen
- Department of Internal Medicine, Section of Cardiology, Yale School of Medicine, New Haven, CT
| | - Neera Dahl
- Department of Internal Medicine, Section of Nephrology, Yale School of Medicine, New Haven, CT
| | - Leslie Scoutt
- Department of Radiology & Biomedical Imaging, Yale School of Medicine, New Haven, CT
| | - Alan Dardik
- Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
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11
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Spanish Clinical Guidelines on Vascular Access for Haemodialysis. Nefrologia 2018; 37 Suppl 1:1-191. [PMID: 29248052 DOI: 10.1016/j.nefro.2017.11.004] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 06/21/2017] [Indexed: 12/26/2022] Open
Abstract
Vascular access for haemodialysis is key in renal patients both due to its associated morbidity and mortality and due to its impact on quality of life. The process, from the creation and maintenance of vascular access to the treatment of its complications, represents a challenge when it comes to decision-making, due to the complexity of the existing disease and the diversity of the specialities involved. With a view to finding a common approach, the Spanish Multidisciplinary Group on Vascular Access (GEMAV), which includes experts from the five scientific societies involved (nephrology [S.E.N.], vascular surgery [SEACV], vascular and interventional radiology [SERAM-SERVEI], infectious diseases [SEIMC] and nephrology nursing [SEDEN]), along with the methodological support of the Cochrane Center, has updated the Guidelines on Vascular Access for Haemodialysis, published in 2005. These guidelines maintain a similar structure, in that they review the evidence without compromising the educational aspects. However, on one hand, they provide an update to methodology development following the guidelines of the GRADE system in order to translate this systematic review of evidence into recommendations that facilitate decision-making in routine clinical practice, and, on the other hand, the guidelines establish quality indicators which make it possible to monitor the quality of healthcare.
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12
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A Report of Two Cases of Hazards Associated with High Flow Arteriovenous Fistula in ESRD Patients. Case Rep Nephrol 2018; 2018:1686135. [PMID: 29850309 PMCID: PMC5914151 DOI: 10.1155/2018/1686135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 02/24/2018] [Accepted: 02/27/2018] [Indexed: 11/18/2022] Open
Abstract
High flow arteriovenous fistulas are a common clinical entity affecting patients with end-stage renal failure receiving hemodialysis. Given the difficulty in predicting who will develop a high flow arteriovenous fistula the exact prevalence is unclear. We present two cases of patients with high flow arteriovenous fistula that developed clinical cardiac failure at a time point after the fistula was placed with findings of significant cephalic arch stenosis. Both patients required treatment of cephalic arch stenosis with balloon angioplasty with subsequent surgical aneurism resection. Accurate and timely diagnosis of high flow arteriovenous hemodynamics by prospective monitoring of volumetric flow and cardiac function is required to halt this process prior to cardiac compromise.
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13
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Laranjinha I, Matias P, Azevedo A, Navarro D, Ferreira C, Amaral T, Mendes M, Aires I, Jorge C, Gil C, Ferreira A. Are high flow arteriovenous accesses associated with worse haemodialysis? ACTA ACUST UNITED AC 2018; 40:136-142. [PMID: 29927460 PMCID: PMC6533981 DOI: 10.1590/2175-8239-jbn-3875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 09/13/2017] [Indexed: 01/20/2023]
Abstract
Introduction: An arteriovenous (AV) access flow (Qa) of 400 mL/min is usually sufficient
for an effective hemodialysis (HD), but some accesses continue developing
and become high flow accesses (HFA). Some authors postulated that an HFA
might shift a significant portion of dialyzed blood from the cardiac output,
which could decrease HD efficiency and lead to volume overload. Objective: The aim of our study was to evaluate if HFA is associated with reduced HD
efficiency and/or volume overload in prevalent HD patients. Methods: We performed a 1-year retrospective study and assessed HD efficiency by the
percentage of sessions in which the Kt/V > 1.4 and volume overload by
bioimpedance spectroscopy. Results: The study included 304 prevalent HD patients with a mean age of 67.5 years;
62.5% were males, 36.2% were diabetics, with a median HD vintage of 48
months. Sixteen percent of the patients had a HFA (defined as Qa > 2
L/min). In multivariate analysis, patients with HFA presented higher risk of
volume overload (OR = 2.67, 95%CI = 1.06-6.71) and severe volume overload
(OR = 4.06, 95%CI = 1.01-16.39) and attained dry weight less frequently (OR
= 0.37, 95%CI = 0.14-0.94). However, HFA was not associated with lower
Kt/V. Conclusion: Our results suggest that patients with HFA have higher risk of volume
overload. However, contrarily to what has been postulated, HFA was not
associated with less efficient dialysis, measured by Kt/V. Randomized
controlled trials are needed to clarify these questions.
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Affiliation(s)
| | - Patrícia Matias
- Dialverca - Clínica de diálise, Forte da Casa, Portugal.,Faculdade de Ciências Médicas, Lisbon, Portugal.,Nephrocare - Clínica de diálise, Vila Franca de Xira, Portugal
| | - Ana Azevedo
- Dialverca - Clínica de diálise, Forte da Casa, Portugal
| | - David Navarro
- Nephrocare - Clínica de diálise, Vila Franca de Xira, Portugal
| | - Carina Ferreira
- Universidade Nova de Lisboa, Faculdade de Ciências Médicas, Lisboa, Portugal
| | - Tiago Amaral
- Dialverca - Clínica de diálise, Forte da Casa, Portugal
| | - Marco Mendes
- Dialverca - Clínica de diálise, Forte da Casa, Portugal.,Nephrocare - Clínica de diálise, Vila Franca de Xira, Portugal
| | - Inês Aires
- Dialverca - Clínica de diálise, Forte da Casa, Portugal.,Faculdade de Ciências Médicas, Lisbon, Portugal.,Nephrocare - Clínica de diálise, Vila Franca de Xira, Portugal
| | - Cristina Jorge
- Dialverca - Clínica de diálise, Forte da Casa, Portugal.,Nephrocare - Clínica de diálise, Vila Franca de Xira, Portugal
| | - Célia Gil
- Dialverca - Clínica de diálise, Forte da Casa, Portugal.,Nephrocare - Clínica de diálise, Vila Franca de Xira, Portugal
| | - Anibal Ferreira
- Dialverca - Clínica de diálise, Forte da Casa, Portugal.,Faculdade de Ciências Médicas, Lisbon, Portugal.,Nephrocare - Clínica de diálise, Vila Franca de Xira, Portugal
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14
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Zamboli P, Lucà S, Borrelli S, Garofalo C, Liberti ME, Pacilio M, Lucà S, Palladino G, Punzi M. High-flow arteriovenous fistula and heart failure: could the indexation of blood flow rate and echocardiography have a role in the identification of patients at higher risk? J Nephrol 2018; 31:975-983. [DOI: 10.1007/s40620-018-0472-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 01/08/2018] [Indexed: 11/28/2022]
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15
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Sangeetha B, Chaitanya V, Reddy MH, Kumar ACV, Ram R, Sivakumar V. Mega-fistula. Indian J Nephrol 2016; 26:385-386. [PMID: 27795639 PMCID: PMC5015523 DOI: 10.4103/0971-4065.175979] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- B Sangeetha
- Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - V Chaitanya
- Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - M H Reddy
- Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - A C V Kumar
- Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - R Ram
- Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - V Sivakumar
- Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
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16
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Kagaya Y. Editorial: High-output state due to an arteriovenous fistula for hemodialysis access as a cause of the aggravation of congestive heart failure. J Cardiol Cases 2015; 11:136-138. [PMID: 30534263 PMCID: PMC6279688 DOI: 10.1016/j.jccase.2015.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Indexed: 01/30/2023] Open
Affiliation(s)
- Yutaka Kagaya
- Office of Medical Education, Tohoku University Graduate School of Medicine, Sendai, Japan
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17
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Affiliation(s)
- Adrian Sequeira
- Division of Nephrology and Hypertension; Department of Medicine; Louisiana State University Health Sciences Center; Shreveport Louisiana
| | - Tze-Woei Tan
- Division of Vascular surgery; Department of Surgery; Louisiana State University Health Sciences Center; Shreveport Louisiana
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18
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Hod T, Patibandla BK, Vin Y, Brown RS, Goldfarb-Rumyantzev AS. Arteriovenous fistula placement in the elderly: when is the optimal time? J Am Soc Nephrol 2015; 26:448-56. [PMID: 25168024 PMCID: PMC4310645 DOI: 10.1681/asn.2013070740] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 06/13/2014] [Indexed: 11/03/2022] Open
Abstract
Arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis (HD). However, many AVFs fail before starting dialysis. To assess the optimal time for AVF placement in the elderly, we linked data from the US Renal Data System with Medicare claims data to identify 17,511 patients ≥67 years old on incident HD who started dialysis between January 1, 2005, and December 31, 2008, with an AVF placed as the first predialysis access. AVF success was defined as dialysis initiation using the AVF, with time between AVF placement and dialysis start as our primary variable of interest. The mean age was 76.1±6.0 years, and 58.3% of subjects were men. Overall, 54.9% of subjects initiated dialysis using an AVF, and 45.1% of subjects used a catheter or graft. The success rate increased as time from AVF creation to HD initiation increased from 1-3 months (odds ratio [OR], 0.49; 95% confidence interval [95% CI], 0.44 to 0.53) to 3-6 months (OR, 0.93; 95% CI, 0.85 to 1.02) to 6-9 months (OR, 0.99; 95% CI, 0.88 to 1.11) but stabilized after that time. Furthermore, the number of interventional access procedures increased over time starting at 1-3 months, with a mean of 0.64 procedures/patient for AVFs created 6-9 months predialysis compared with 0.72 for AVFs created >12 months predialysis (P<0.001). Although limited by the observational nature of this study, our results suggest that placing an AVF >6-9 months predialysis in the elderly may not associate with a better AVF success rate.
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Affiliation(s)
- Tammy Hod
- Division of Nephrology, Center for Vascular Biology Research, Department of Medicine, and
| | - Bhanu K Patibandla
- Department of Medicine, St. Vincent Hospital, University of Massachusetts School of Medicine, Worcester, Massachusetts; and
| | - Yael Vin
- Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
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19
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Azevedo PN, Turmel-Rodrigues L. Never Too Old For an Autogenous Dialysis Fistula? Results of Endovascular Interventions in Nonagenarians. Semin Dial 2014; 28:E1-6. [DOI: 10.1111/sdi.12257] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Pedro N. Azevedo
- Radiologie Vasculaire Diagnostique & Interventionnelle; Clinique St-Gatien; Tours France
- Department of Nephrology and Renal Transplantation; Centro Hospitalar Do Porto-Hospital de Santo António (CHP-HSA); Porto Portugal
| | - Luc Turmel-Rodrigues
- Radiologie Vasculaire Diagnostique & Interventionnelle; Clinique St-Gatien; Tours France
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