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Luo K, Cai C, Lai Z, Huang B, Cai J, Liang C, Li J. Measurement of Tremor on Arteriovenous Fistulas with a Flexible Capacitive Sensor. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:7324-7327. [PMID: 34892789 DOI: 10.1109/embc46164.2021.9630463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Arteriovenous fistula (AVF) is a widely used vascular access for hemodialysis in clinical. It is a great challenge to monitoring the status of AVF in daily life due to acute AVF stenosis may occur on unnoticeable occasions, such as sleeping. Inspiring tremor is almost always accompanied by a healthy AVF, which can be adopted as an essential physiological sign for AVF monitoring. Hence, a fistula tremor measurement system based on a flexible capacitive pressure sensor is designed in this study. The sensor consists of polydimethylsiloxane(PDMS) dielectric layers, electrode layers, ground layers, and shielding layers. The PDMS layers are fabricated as cross superposition transverse microstructure film to enhance dielectric constant and sensitivity of the sensor. The isolation shielding layers and ground layers guarantee the sensing chain is noise-free. A microcontroller embedded AD7746 measurement circuit is designed for signal acquisition. We test our prototype on the wrists of healthy volunteers and AVF on dialysis patients separately. The pulse signals and AVF tremor signals are clear and distinguishable. The sensor and measurement system have excellent potential in wearable AVF monitoring.
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Noh SY, Goo DE, Kim YJ, Yang SB, Lee JM, Lee WH. Sharp Needle Recanalization Technique for Peripheral Hemodialysis Arteriovenous Fistula Occlusion. Cardiovasc Intervent Radiol 2021; 44:1809-1816. [PMID: 34258680 DOI: 10.1007/s00270-021-02809-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/15/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To determine the efficacy of a percutaneous sharp needle recanalization technique for the treatment of peripheral hemodialysis arteriovenous fistula (AVF) occlusion. MATERIALS AND METHODS This study included 13 patients (14 procedures) between May 2010 and February 2020 with non-thrombotic AVF occlusion wherein guidewire passage through the occluded segment had failed. We successfully passed the guidewire through the occluded segment using a sharp needle recanalization technique with Chiba or Colapinto needles, under ultrasound or fluoroscopic guidance. The type of AVF, site and length of occlusion, technical success, complications, and long-term patency were analyzed. RESULTS Technical success was achieved in 12 (85.7%) out of 14 procedures. The procedure failed in two patients due to the poor angle of approach in the axillary area and diffuse severe stenosis in the draining cephalic vein. In eight procedures, sharp needle recanalization was performed under ultrasound guidance, while the other six procedures were performed under fluoroscopic guidance. Chiba and Colapinto needles were used in five and nine procedures, respectively. The mean length of occlusion was 2.7 cm (range 1.8-4.2 cm). There was one case of mild complication, that is, mild contrast extravasation, which was treated by stent deployment. The post-intervention primary patency rates at 6 months, 1 year, and 2 years were 81.8%, 36.4%, and 18.2%, respectively. CONCLUSION The results of this limited series suggest that the sharp needle recanalization technique is a simple and effective method for the treatment of peripheral non-thrombotic AVF occlusion.
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Affiliation(s)
- Seung Yeon Noh
- Department of Radiology, Kyung Hee University Medical Center, Seoul, Korea
| | - Dong Erk Goo
- Department of Radiology, Soon Chun Hyang University Hospital, 59 Daesagwan-Ro, Yongsan-gu, Seoul, 04401, Korea.
| | - Yong Jae Kim
- Department of Radiology, Soon Chun Hyang University Hospital, 59 Daesagwan-Ro, Yongsan-gu, Seoul, 04401, Korea
| | - Seung Boo Yang
- Department of Radiology, Soon Chun Hyang University Hospital, Gumi, Korea
| | - Jae Myeong Lee
- Department of Radiology, Soon Chun Hyang University Hospital, Bucheon, Korea
| | - Woong Hee Lee
- Department of Radiology, Soon Chun Hyang University Hospital, Cheonan, Korea
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Agarwal R, Atreyapurapu V, Sharma P, Yerramsetty V, Burli P, Atturu G, Gupta P. Hybrid and percutaneous salvage of a thrombosed native arteriovenous fistula: 1-year outcomes. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2021. [DOI: 10.4103/ijves.ijves_154_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Comparison of pharmacomechanical and surgical interventions for thrombosed native arteriovenous fistulas. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 28:609-614. [PMID: 33403133 PMCID: PMC7759037 DOI: 10.5606/tgkdc.dergisi.2020.19565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 05/27/2020] [Indexed: 11/21/2022]
Abstract
Background
This study aims to compare success and patency rates of pharmacomechanical thrombectomy versus open surgical thrombectomy for thrombosed native arteriovenous fistulas.
Methods
A total of 96 patients (56 males, 40 females; mean age 61±11.7 years; range, 26 to 82 years) with a thrombosed native arteriovenous fistula between January 2016 and December 2018 were retrospectively analyzed. The patients were divided into two groups as pharmacomechanical thrombectomy (n=42) and open surgical thrombectomy (n=54). Primary failure rate and primary patency rate at 6 and 12 months were recorded.
Results
Of 42 patients in the pharmacomechanical thrombectomy group, 41 (98%) had additional interventions, and primary failure occurred in four patients (10%). Primary failure was seen in 15 (28%) patients in the surgical group. The primary patency rates at 6 and 12 months were significantly higher in the pharmacomechanical treatment group than the surgical group (85% vs. 67% and 78% vs. 55%, respectively; p<0.05).
Conclusion
Pharmacomechanical thrombectomy procedure yields higher primary patency rates than open surgical thrombectomy for thrombosed native arteriovenous fistula.
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Gumus F. Patency Rates After Successful Arteriovenous Fistula Thrombectomy: Relevance of the Flow/d-Dimer Ratio in the Decision-Making. Vasc Endovascular Surg 2020; 54:670-675. [PMID: 32720863 DOI: 10.1177/1538574420945064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Surgical thrombectomy for acute arteriovenous fistula (AVF) thrombosis is one of the primary salvage intervention. The independent risk factors affecting the patency of AVF after a successful thrombectomy are yet unknown. Here, the author aimed to report the results of surgically corrected AVFs and the independent risk factors which may cause early failure following the surgical salvage. METHODS The study cohort comprised 24 patients who had acute AVF thrombosis and underwent successful surgical thrombectomy in the first 24 to 48 hours between January 2016 and April 2020 in our center. The study group was divided into patients with recurrent AVF thrombosis (n = 11, 45.8%) and without recurrent AVF thrombosis (n = 13, 54.1%) following surgical thrombectomy with a follow-up of 22.4 ± 6.8 months. Postthrombectomy primary and secondary patency of AVF were also evaluated. RESULTS The mean age of the cohort was 58.1 ± 15.2 years. A simple thrombectomy was performed for all cases. Only 2 cases have required a revision at the anastomosis due to severe intimal hyperplasia. Postthrombectomy primary patency rate was 45.5% for 18 months. Receiver operating characteristic analysis was performed with a resulting area under the curve value of 0.81 (95% CI: 0.35-0.94, P = .006) for flow (mL)/d-dimer (ng/mL) <0.63 in predicting recurrent AVF thrombosis following surgical thrombectomy. CONCLUSIONS Flow (mL)/d-dimer (ng/mL) <0.63 was independent predictor of recurrent thrombosis (RT) of a surgically salvaged AVF. The patients at risk for RT or who may benefit from further intervention should be identified with predictive parameters.
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Affiliation(s)
- Fatih Gumus
- Department of Cardiovascular Surgery, Bartın State Hospital, Turkey
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Wan Z, Xiang R, Wang H, Zhong Q, Tu B. Comparative efficacy and safety of local and peripheral venous thrombolytic therapy with urokinase for thrombosed hemodialysis arteriovenous fistulas. Exp Ther Med 2019; 17:4279-4284. [PMID: 30988800 DOI: 10.3892/etm.2019.7415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 03/06/2019] [Indexed: 01/13/2023] Open
Abstract
Arteriovenous fistula (AVF) thrombosis is a common complication in patients undergoing hemodialysis, and early intervention is required. Urokinase has been used as a thrombolytic agent for declotting the thrombosed access. However, the optimal route for infusing urokinase remains to be determined. In the present retrospective observational study, 49 patients who underwent local venous infusion and 57 patients with peripheral venous infusion of urokinase were included. A urokinase dosage of 300,000 U was administered until successful thrombolysis, which was a maximum of three times. Age, sex, period of dialysis, time of AVF placement, systolic and diastolic blood pressure and thrombus age were similar between the two groups. The efficacy of urokinase infusion via the two routes in resolving thrombosed AVFs, defined as successful fibrinolysis, and the safety, defined as the number of bleeding events, was compared. The cumulative thrombolysis success rate following three sessions of thrombolytic therapy in the local venous thrombolysis group was higher compared with that in the peripheral venous thrombolysis group (85.7 vs. 68.4%; P=0.04). The local thrombolysis group exhibited less ecchymosis (4.1 vs. 14.0%; P=0.07), epistaxis (2.0 vs. 10.5%; P=0.08) and gingival bleeding (4.1 vs. 19.3%; P=0.02) events compared with the peripheral thrombolysis group. Further analyses demonstrated that systolic [odds ratio (OR)=1.10; 95% confidence interval (CI), 1.03-1.17; P<0.01] and diastolic (OR=1.08; 95% CI, 1.02-1.14; P<0.05) blood pressure were protective factors, whereas thrombus age (OR=0.91; 95% CI, 0.84-0.99; P<0.05) was a risk factor for thrombolysis success among patients who underwent local thrombolytic therapy. Overall, the results suggest that local venous infusion of urokinase is superior to peripheral venous infusion for the treatment of patients with thrombosed fistulas.
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Affiliation(s)
- Ziming Wan
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400042, P.R. China
| | - Rui Xiang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400042, P.R. China
| | - Hui Wang
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400042, P.R. China
| | - Qing Zhong
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400042, P.R. China
| | - Bo Tu
- Department of Ultrasonography, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400042, P.R. China
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Takashima T, Matsumoto K, Takeshita C, Nonaka E, Matsushita S, Fukuda M, Miyazono M, Ikeda Y. Restoration of Autologous Arteriovenous Fistula by Removal of the Occluded Short Venous Part and Venovenous End-To-End Anastomosis in a Hemodialysis Patient. Ann Vasc Surg 2018; 52:313.e9-313.e16. [PMID: 29793010 DOI: 10.1016/j.avsg.2018.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 02/13/2018] [Accepted: 03/10/2018] [Indexed: 11/27/2022]
Abstract
Standard salvage procedures for occuluded autologous arteriovenous fistula (AVF) in a hemodialysis patient are endovascular and/or surgical therapy. When endovascular therapy and thrombectomy prove unsuccessful, it is most likely that creating a new AVF or arteriovenous graft will be considered. However, if the occuluded venous part is short, we have adopted an operative technique for repair of AVF by removal of the occluded short venous part and venovenous end-to-end anastomosis. To our knowledge, the efficacy and clinical course of restoration of AVF by the technique have not been reported to date. Here, we describe the technique and report the successful treatment of a hemodialysis patient who developed AVF occlusion.
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Affiliation(s)
- Tsuyoshi Takashima
- Department of Nephrology, National Hospital Organization, Ureshino Medical Center, Ureshino, Saga, Japan.
| | - Keiichiro Matsumoto
- Department of Nephrology, National Hospital Organization, Ureshino Medical Center, Ureshino, Saga, Japan
| | - Chihiro Takeshita
- Department of Nephrology, National Hospital Organization, Ureshino Medical Center, Ureshino, Saga, Japan
| | - Eriko Nonaka
- Department of Nephrology, National Hospital Organization, Ureshino Medical Center, Ureshino, Saga, Japan
| | - Sae Matsushita
- Division of Nephrology, Department of Internal Medicine, Saga University Faculty of Medicine, Saga, Saga, Japan
| | - Makoto Fukuda
- Division of Nephrology, Department of Internal Medicine, Saga University Faculty of Medicine, Saga, Saga, Japan
| | - Motoaki Miyazono
- Division of Nephrology, Department of Internal Medicine, Saga University Faculty of Medicine, Saga, Saga, Japan
| | - Yuji Ikeda
- Division of Nephrology, Department of Internal Medicine, Saga University Faculty of Medicine, Saga, Saga, Japan
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Aurshina A, Ascher E, Hingorani A, Marks N. A novel technique for duplex-guided office-based interventions for patients with acute arteriovenous fistula occlusion. J Vasc Surg 2017; 67:857-859. [PMID: 29017808 DOI: 10.1016/j.jvs.2017.07.135] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 07/27/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The purpose of the study was to aggressively salvage acutely occluded arteriovenous fistulas (AVFs) using duplex imaging as the sole imaging modality for percutaneous transluminal angioplasty of acutely thrombosed AVF. METHODS Over a period of 12 months, 14 patients with acute thrombosis of their AVFs underwent 18 procedures in a single center for AVF salvage. All 14 patients presented with chronic renal failure, and six were diabetic. All patients were treated under duplex guidance alone. Treatment included simple balloon dilation and maceration (group A; n =10 procedures [56%]) for subacute thrombosis or pharmacomechanical thrombectomy (group B; n = 8 procedures [44%]) for more hypoechoic thrombus. A successful procedure was defined as immediate restoration of flow through the AVF. RESULTS Of the 18 procedures, 13 (72%) were successful. Of the 14 patients, thrombus was located at the perianastomotic AVF in 6 (43%), proximal-mid AVF in 6 (43%), mid AVF in 1 (7%), and distal AVF in 1 (7%). From group A, six (60%) were successful. From group B, seven (88%) were successful. Among the unsuccessful procedures, one group B patient was hypercoagulable (polycythemia vera). Of the 18 procedures, 16 (89%) were treated within 2 weeks from when duplex revealed the presence of thrombus. Early rethrombosis (<1-month patency) occurred in three cases (17%), and these patients received new fistulas. Full restoration of the fistula flow was established in 14 cases (78%). Of these 14 patients, 8 (57%) are currently on hemodialysis via fistula, 3 patients (21%) had newly placed fistulas after failed interventions, 2 patients (14%) are not on dialysis yet, and 1 patient (7%) with polycythemia vera disorder is on dialysis via a Tesio catheter (MedComp, Harleysville, Pa). CONCLUSIONS The sole use of duplex ultrasound imaging to salvage acutely occluded AVFs using percutaneous transluminal angioplasty is a safe and effective alternative to traditional treatment of thrombosed failing/maturing AVF.
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Affiliation(s)
- Afsha Aurshina
- Division of Vascular Surgery, Vascular Institute of New York, Brooklyn, NY.
| | - Enrico Ascher
- Division of Vascular Surgery, Vascular Institute of New York, Brooklyn, NY
| | - Anil Hingorani
- Division of Vascular Surgery, Vascular Institute of New York, Brooklyn, NY
| | - Natalie Marks
- Division of Vascular Surgery, Vascular Institute of New York, Brooklyn, NY
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Kim SM, Ko HK, Noh M, Ko GY, Kim MJ, Kwon TW, Kim HJ, Cho YP. Factors Affecting Patency following Successful Percutaneous Intervention for Dysfunctional Hemodialysis Vascular Access. Ann Vasc Surg 2017; 47:54-61. [PMID: 28887254 DOI: 10.1016/j.avsg.2017.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 07/24/2017] [Accepted: 08/27/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND This study aimed to investigate the patency following initial successful percutaneous transluminal angioplasty (PTA) for untreated dysfunctional hemodialysis vascular access and to identify predictors of PTA durability. METHODS This retrospective observational study included data of 132 consecutive initial PTA of hemodialysis vascular access in 126 patients who showed immediate technical and clinical success and had at least 1 year of follow-up data. RESULTS The mean duration of primary and secondary patency post-PTA was 16 and 27 months, respectively. On multivariate adjusted Cox regression analysis, dyslipidemia (P < 0.001), use of insulin (P = 0.016), and arteriovenous graft (AVG) (P = 0.016) were significantly associated with shorter primary patency. Dyslipidemia (P < 0.001), use of antiplatelet medication (P = 0.013), and failed vascular access (P = 0.004) were significant predictors of secondary patency loss. Use of statin was the only clinical variable associated with increased primary and secondary patency (P < 0.001). According to a subgroup analysis on the type of vascular access and dysfunction, primary and secondary patency rates were significantly higher in the arteriovenous fistula (AVF) and failing vascular access groups than AVG and failed vascular access groups, respectively. Early dysfunction (within 6 months) was significantly higher in the AVG and failed vascular access groups after initial PTA, but there was no significant difference after multiple PTAs. CONCLUSIONS Post-PTA primary and secondary patency rates were significantly higher with AVF and failing vascular access. The use of statin was associated with increased primary and secondary patency after initial successful PTA in this study.
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Affiliation(s)
- Sung Min Kim
- Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea
| | - Heung Kyu Ko
- Department of Radiology, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea
| | - Minsu Noh
- Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea
| | - Gi-Young Ko
- Department of Radiology, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea
| | - Min-Ju Kim
- Biostatistics Collaboration Unit, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea
| | - Tae-Won Kwon
- Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea
| | - Hee Jin Kim
- Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea
| | - Yong-Pil Cho
- Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea.
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Preemptive Open Surgical vs. Endovascular Repair for Juxta-Anastomotic Stenoses of Autogenous AV Fistulae: A Meta-Analysis. J Vasc Access 2015; 16:454-8. [DOI: 10.5301/jva.5000444] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2015] [Indexed: 11/20/2022] Open
Abstract
Purpose There is controversy about the best mode of preemptive repair of juxta-anastomotic stenoses in radial-cephalic arteriovenous fistula (AVFs). The aim of the present review was to compare the outcome of surgical vs. endovascular repair of those AVF stenoses. Methods A systematic review and meta-analysis was performed for studies comparing the outcome of open surgical vs. endovascular preemptive repair of AVF stenoses located in the juxta-anastomotic region. A search was carried out in April 2015. The analyzed outcome measures were the primary patency at 12 and 18 months and the assisted primary patency at 24 months. In addition, assessment of the methodological quality of the included studies was carried out. Results Four non-randomized cohort studies (297 patients) were analyzed. A random effects model was used to pool the data. The pooled odds ratio (OR and 95% confidence intervals) for the primary patency at 12 and at 18 months was 0.42 (0.25-0.72) and 0.33 (0.2-0.56), respectively, showing statistically significant higher patency of the surgically repaired group. The pooled OR for the assisted primary patency at 24 months was 0.53 (0.28-0.98) also in favor of the surgically repaired group (p<0.04) Conclusions The available evidence, based on non-randomized cohort studies, suggests that surgery is the best way to treat ‘juxta-anastomotic’ stenotic lesions in distal radial-cephalic AVFs, although angioplasty remains a valuable but less durable option in this location of the stenosis.
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Kwon H, Choi JY, Ko HK, Kim MJ, Kim H, Park H, Han Y, Ko GY, Kwon TW, Cho YP. Comparison of Surgical and Endovascular Salvage Procedures for Juxta-anastomotic Stenosis in Autogenous Wrist Radiocephalic Arteriovenous Fistula. Ann Vasc Surg 2014; 28:1840-6. [DOI: 10.1016/j.avsg.2014.06.060] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 05/25/2014] [Accepted: 06/21/2014] [Indexed: 11/30/2022]
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Klimach SG, Norris JM. Surgical versus endovascular management of thrombosed autogenous arteriovenous fistulae. Int J Surg 2014; 12:237-40. [PMID: 24429061 DOI: 10.1016/j.ijsu.2013.12.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Revised: 12/13/2013] [Accepted: 12/27/2013] [Indexed: 11/17/2022]
Abstract
A best evidence topic in vascular surgery was written according to a structured protocol. The question addressed was: In patients undergoing haemodialysis with thrombosed autogenous arteriovenous fistulae, does surgical management as compared to endovascular management improve clinical outcomes? A total of 130 papers were identified using the search protocol described, of which four represented the best evidence available to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Three of the four studies demonstrated no significant difference between the initial success rates of surgical or endovascular management. However, one study illustrated that hybrid surgery (a combination of endovascular and surgical techniques) significantly improved initial success rates, shortened hospital stays and decreased total monetary costs. Furthermore, three studies showed that subsequent fistula patency rates were significantly higher when surgical management was instigated. Nevertheless, one study suggested that surgery worsened subsequent patency rates and that in fact surgical patients were more likely to require temporary dialysis catheters than endovascular patients. Therefore, the clinical bottom line is that with careful patient and fistula selection, surgery provides a number of benefits over endovascular management of thrombosed autogenous arteriovenous fistulae, particularly in the medium to long term. However, further appropriately powered and randomised Level 1 studies are necessary to clarifying this important issue.
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Affiliation(s)
- Stefan G Klimach
- Brighton and Sussex Medical School, BSMS Teaching Building, University of Sussex, Brighton, East Sussex BN1 9PX, United Kingdom.
| | - Joseph M Norris
- Brighton and Sussex Medical School, BSMS Teaching Building, University of Sussex, Brighton, East Sussex BN1 9PX, United Kingdom.
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Lai CC, Fang HC, Lin CH, Mar GY, Tseng CJ, Liu CP. Distal Radial Artery Pressures Predict Angiographic Result and Short-Term Patency Outcome in Hemodialysis Patients With Juxta-Anastomotic Inflow Stenosis of Radiocephalic Fistula Undergoing Transradial Angioplasty. Ther Apher Dial 2013; 17:311-8. [DOI: 10.1111/1744-9987.12003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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