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Wang Y, Huang XM, Zhang Y, Li J, Li J, Ye Z, Peng Y, Zhang XJ, Tang N, Qiu WW, Xu L. Comparison of ultrasound features and lesion sites in dysfunctional arteriovenous fistula. Ren Fail 2024; 46:2294148. [PMID: 38186351 PMCID: PMC10776081 DOI: 10.1080/0886022x.2023.2294148] [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: 04/17/2023] [Accepted: 12/06/2023] [Indexed: 01/09/2024] Open
Abstract
This study aimed to investigate ultrasound features of arteriovenous fistula stenosis and their relationship with primary patency after percutaneous transluminal angioplasty (post-intervention primary patency) and compare this classification with that using lesion location. Hemodialysis patients who underwent ultrasound-guided percutaneous transluminal angioplasty for arteriovenous fistula stenosis from July 2020 to December 2021 were retrospectively evaluated. Lesions (excluding inflow arteries) were categorized into five groups based on ultrasound features, and the clinical characteristics and risk factors affecting the post-intervention primary patency of the arteriovenous fistula were analyzed. Among 185 patients, 100 (54.05%), 36 (19.46%), 22 (11.89%), 11 (5.95%), and 16 (8.65%) were classified into the intima-dominant, non-intima-dominant, valve obstruction, vascular calcification, and mixed groups, respectively. The dialysis duration and arteriovenous fistula use time were the highest in the vascular calcification group at 86 (interquartile range: 49-140) and 77 (interquartile range: 49-110) months, respectively. Diabetes mellitus was most common in the intima-dominant group (42.0%). In Kaplan-Meier and univariate Cox analysis, type III lesion location (stenosis in the venous confluence site) was associated with the lower post-intervention primary patency. In the multivariate Cox analysis, percutaneous transluminal angioplasty times (the number of times patients were treated with percutaneous transluminal angioplasty for arteriovenous fistula stenosis dysfunction), vascular calcification, calcification at the lesion site requiring percutaneous transluminal angioplasty, and serum parathyroid hormone levels were independent risk factors for post-intervention primary patency. Ultrasound features showed that calcification of the arteriovenous fistula was detrimental to the post-intervention primary patency of arteriovenous fistula.
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Affiliation(s)
- Yin Wang
- Department of Nephrology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao-mei Huang
- Department of Nephrology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Zhang
- Department of Ultrasound, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jingjing Li
- Department of Ultrasound, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Li
- Department of Nephrology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zheng Ye
- Department of Nephrology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Peng
- Department of Nephrology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xian-jin Zhang
- Department of Nephrology, Hubei Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Wuhan, China
| | - Na Tang
- Department of Nephrology, Union Jiangbei Hospital of Huazhong University of Science and Technology, Wuhan Caidian District People’s Hospital, Wuhan, China
| | - Wen-wen Qiu
- Department of Nephrology, Wuhan Huangpi District People’s Hospital, Wuhan, China
| | - Li Xu
- Department of Nephrology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Wu CK, Lin CH. Integrating vascular access surveillance with clinical monitoring for stenosis prediction. J Nephrol 2024; 37:461-470. [PMID: 37980698 DOI: 10.1007/s40620-023-01799-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/27/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Arteriovenous fistula and arteriovenous graft are the most common types of vascular access for dialysis; stenosis and thrombosis are major complications leading to access failure and to an incresed risk of mortality. The aim of the present study was to assess the results of integrating strict vascular access blood flow surveillance with routine clinical monitoring for predicting vascular access stenosis in chronic hemodialysis patients. METHODS In this retrospective study, chronic dialysis patients with arteriovenous fistula or arteriovenous graft were included from a setting in which all patients underwent quarterly blood flow surveillance in 2017. The results of blood flow surveillance were confirmed by thorough physical examination. Predictive performance of blood flow surveillance models in detecting stenosis in patients with arteriovenous fistula or arteriovenous graft was evaluated. The predictive performance of the quarterly blood flow surveillance model was described by confusion matrix. Differences in accuracy, positive predictive value (PPV), and negative predictive value (NPV) between blood flow surveillance models with distinct blood flow thresholds were evaluated. RESULTS Of 397 included patients, 336 had an arteriovenous fistula and 61 had an arteriovenous graft. In 2017, 106 percutaneous transluminal angioplasty procedures were performed in patients with an arteriovenous fistula, and 63 in patients with an arteriovenous graft. The results revealed similar predictive performance of surveillance models using an absolute blood flow threshold of < 500 or < 400 mL/min in predicting stenosis in patients with arteriovenous fistula. Blood flow surveillance models for patients with an arteriovenous fistula had significantly higher accuracy than those for patients with an arteriovenous graft. Furthermore, the use of a relative threshold, defined as blood flow < 1000 mL/min and a 25% decline in blood flow, did not affect the predictive performance of blood flow surveillance models. CONCLUSION Blood flow surveillance models using thresholds of < 400 and < 600 mL/min, followed by thorough physical examination, showed an accuracy of 91.54% and 72.15% in predicting stenosis in patients with arteriovenous fistula and arteriovenous graft, respectively. These two blood flow surveillance models may be integrated with routine clinical monitoring to improve early detection and treatment of stenosis in hemodialysis patients.
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Affiliation(s)
- Chung-Kuan Wu
- Division of Nephrology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- School of Medicine, Fu-Jen Catholic University, New Taipei, Taipei, Taiwan
| | - Chia-Hsun Lin
- School of Medicine, Fu-Jen Catholic University, New Taipei, Taipei, Taiwan.
- Division of Cardiovascular Surgery, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, No. 95, Wenchang Rd., Shilin Dist., Taipei, 111045, Taiwan.
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3
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Kambayashi Y, Iseri K, Morikawa T, Yao A, Yokochi A, Honda H. Risk factors for blood vessel rupture during vascular access intervention therapy for hemodialysis patients. PLoS One 2023; 18:e0283844. [PMID: 37000893 PMCID: PMC10065258 DOI: 10.1371/journal.pone.0283844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/19/2023] [Indexed: 04/03/2023] Open
Abstract
Blood vessel rupture is a major complication associated with vascular access intervention therapy (VAIVT). However, information regarding the risk factors for ruptures related to VAIVT is limited. The purpose of this study was to investigate the risk factors for rupture during VAIVT. This was a single-center, retrospective observational study. Demographic, clinical, anatomical, and VAIVT procedure variables were reviewed and analyzed using multivariate logistic regression. The 211 patients included in the study underwent 628 VAIVT procedures from November 2019 to December 2021, and 20 blood vessel ruptures occurred. Patients with ruptures had significantly lower BMI (p = 0.043), shorter access vintage(p = 0.017), underwent VAIVT for the first time (p = 0.006), and had lower blood flow quantity (p = 0.005), lower brachial artery flow volume (p = 0.018), and higher resistance index (p = 0.011). The multivariate logistic regression revealed that receiving VAIVT for the first time (OR 5.95, 95%CI 1.01-34.84; p = 0.048) and high resistance index (OR 1.86, 95%CI 1.01-3.16; p = 0.02) were significantly associated with a high risk for rupture. Furthermore, receiver operating characteristic curve analysis to assess the sensitivity-specificity profiles of the resistance index for ruptures showed that the optimal threshold was 0.70 (sensitivity/specificity, 0.69/0.70). Heightened surveillance during vascular access intervention therapy is warranted, especially in patients undergoing VAIVT for the first time or patients with a high resistance index (> 0.70).
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Affiliation(s)
- Yui Kambayashi
- Department of Nephrology, Kanto Rosai Hospital, Kawasaki City, Kanagawa, Japan
- * E-mail:
| | - Ken Iseri
- Department of Nephrology, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan
| | - Tomoki Morikawa
- Department of Nephrology, Kanto Rosai Hospital, Kawasaki City, Kanagawa, Japan
| | - Atushi Yao
- Department of Nephrology, Kanto Rosai Hospital, Kawasaki City, Kanagawa, Japan
| | - Akio Yokochi
- Department of Nephrology, Kanto Rosai Hospital, Kawasaki City, Kanagawa, Japan
| | - Hirokazu Honda
- Department of Nephrology, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan
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Luo Q, Liu H, Yang Q. Analysis of Factors Influencing Restenosis after Percutaneous Transluminal Angioplasty. Blood Purif 2022; 51:1031-1038. [PMID: 35504252 DOI: 10.1159/000524159] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/21/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This study aimed to analyse the influencing factors of arteriovenous fistula (AVF) ultrasound-guided restenosis after percutaneous transluminal angioplasty (PTA). METHODS This was a retrospective trial. The clinical data and ultrasound examination data of patients in maintenance haemodialysis who received ultrasound-guided PTA for AVF stenosis at our hospital from January 2018 to December 2020 were retrospectively analysed. The fistula patency and the relationship between age, dialysis age, fistula service age, combined hypertension, diabetes, hypoproteinaemia, stenosis type, fistula location, and patency rate after the operation were evaluated. RESULTS A total of 128 participants were evaluated. The results showed that being over 65 years old, with complications from hypertension, diabetes, and hypoproteinaemia, are all risk factors affecting the patency of postoperative internal fistulas. Compared with lumen stenosis, the patency rate of hyperplastic endothelial stenosis (p = 0.014) and thrombotic stenosis (p = 0.017) was lower, and the difference was statistically significant. The patency rate of the mixed site (p = 0.010), the anastomotic site (p = 0.041), and the cephalic vein near the anastomotic site (p = 0.018) was lower than the forearm cephalic vein, and the difference was statistically significant. CONCLUSION Age, hypertension complications, diabetes complications, hypoproteinaemia, and the type and location of the AVF stenosis were essential for vascular patency of internal fistulas after PTA. Other risk factors of restenosis after PTA still need further research.
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Affiliation(s)
- Qian Luo
- Department of Ultrasonography, Yongchuan Hospital of Chongqing Medical University, Chongqing, China.,Leshan Hospital of Traditional Chinese Medicinel, Leshan, China
| | - Hong Liu
- Department of Radiology, Leshan Hospital of Traditional Chinese Medicine, Leshan, China
| | - Quan Yang
- Department of Radiology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
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Kim DH, Han D, Kim J, Park HC, Lee YK, Shin DG, Kang MK, Cho JR, Choi S, Lee N. Vasodilator agents improve hemodialysis vascular access patency: A population-based study from Korea. Medicine (Baltimore) 2021; 100:e27439. [PMID: 34622859 PMCID: PMC8500602 DOI: 10.1097/md.0000000000027439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 09/17/2021] [Indexed: 01/05/2023] Open
Abstract
Vascular access (VA) failure is an important problem for patients undergoing hemodialysis, and maintaining VA patency is challenging. In this study, we used a nationwide database to investigate the effects of nitrate, as a vasodilator, on VA failure in hemodialysis patients.We investigated the Korean insurance claims data of hemodialysis patients who underwent angioplasty for VA failure between January 2012 and December 2017. The patients were divided into 2 groups: those not receiving vasodilator therapy (controls) and those receiving any vasodilator administration (vasodilator treatment, VDT). The primary endpoint was VA primary patency, defined as the time between arteriovenous dialysis access creation and the first percutaneous transluminal angioplasty (PTA).During the study period, a total of 6350 patients were recruited, 409 (6.4%) patients assigned to the VDT group and 5941 (93.6%) controls. PTA was performed in 998 patients (15.7%), including 8 in the VDT group and 990 controls. The VA site PTA rate was significantly lower in the VDT group (2.0%) than in the control group (16.7%, P < .001). In the subgroup analysis, the patency rates associated with the different vasodilators were similar (P = .736). All vasodilators, except molsidomine, improved the patency rate by approximately 20%.In this large national database study, vasodilator administration was associated with higher VA primary patency, compared with controls, in hemodialysis patients. VDT may have a beneficial effect on maintaining VA patency in patients undergoing hemodialysis.
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Affiliation(s)
- Do Hyoung Kim
- Division of Nephrology, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Donghoon Han
- Division of Cardiology, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jaehwan Kim
- Data Science Team, Hanmi Pharm. Co., Ltd., Seoul, Korea
| | - Hayne Cho Park
- Division of Nephrology, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Young-Ki Lee
- Division of Nephrology, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Dong Geum Shin
- Division of Cardiology, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Min-Kyung Kang
- Division of Cardiology, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jung Rae Cho
- Division of Cardiology, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Seonghoon Choi
- Division of Cardiology, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Namho Lee
- Division of Cardiology, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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Mathematical Models for Blood Flow Quantification in Dialysis Access Using Angiography: A Comparative Study. Diagnostics (Basel) 2021; 11:diagnostics11101771. [PMID: 34679469 PMCID: PMC8534972 DOI: 10.3390/diagnostics11101771] [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: 08/16/2021] [Revised: 09/10/2021] [Accepted: 09/17/2021] [Indexed: 11/26/2022] Open
Abstract
Blood flow rate in dialysis (vascular) access is the key parameter to examine patency and to evaluate the outcomes of various endovascular interve7ntions. While angiography is extensively used for dialysis access–salvage procedures, to date, there is no image-based blood flow measurement application commercially available in the angiography suite. We aim to calculate the blood flow rate in the dialysis access based on cine-angiographic and fluoroscopic image sequences. In this study, we discuss image-based methods to quantify access blood flow in a flow phantom model. Digital subtraction angiography (DSA) and fluoroscopy were used to acquire images at various sampling rates (DSA—3 and 6 frames/s, fluoroscopy—4 and 10 pulses/s). Flow rates were computed based on two bolus tracking algorithms, peak-to-peak and cross-correlation, and modeled with three curve-fitting functions, gamma variate, lagged normal, and polynomial, to correct errors with transit time measurement. Dye propagation distance and the cross-sectional area were calculated by analyzing the contrast enhancement in the vessel. The calculated flow rates were correlated versus an in-line flow sensor measurement. The cross-correlation algorithm with gamma-variate curve fitting had the best accuracy and least variability in both imaging modes. The absolute percent error (mean ± SEM) of flow quantification in the DSA mode at 6 frames/s was 21.4 ± 1.9%, and in the fluoroscopic mode at 10 pulses/s was 37.4 ± 3.6%. The radiation dose varied linearly with the sampling rate in both imaging modes and was substantially low to invoke any tissue reactions or stochastic effects. The cross-correlation algorithm and gamma-variate curve fitting for DSA acquisition at 6 frames/s had the best correlation with the flow sensor measurements. These findings will be helpful to develop a software-based vascular access flow measurement tool for the angiography suite and to optimize the imaging protocol amenable for computational flow applications.
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7
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Smith TA, Gage D, Quencer KB. Narrative review of vascular iatrogenic trauma and endovascular treatment. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1199. [PMID: 34430640 PMCID: PMC8350708 DOI: 10.21037/atm-20-4332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/12/2020] [Indexed: 11/29/2022]
Abstract
Iatrogenic injury is unfortunately a leading cause of morbidity and mortality for patients worldwide. The etiology of iatrogenic injury is broad, and can be seen with both diagnostic and therapeutic interventions. While steps can be taken to reduce the occurrence of iatrogenic injury, it is often not completely avoidable. Once iatrogenic injury has occurred, prompt recognition and appropriate management can help reduce further harm. The objective of this narrative review it to help reader better understand the risk factors associated with, and treatment options for a broad range of potential iatrogenic injuries by presenting a series of iatrogenic injury cases. This review also discusses rates, risk factors, as well as imaging and clinical signs of iatrogenic injury with an emphasis on endovascular and minimally invasive treatments. While iatrogenic vascular injury once required surgical intervention, now minimally invasive endovascular treatment is a potential option for certain patients. Further research is needed to help identify patients that are at the highest risk for iatrogenic injury, allowing patients and providers to reconsider or avoid interventions where the risk of iatrogenic injury may outweigh the benefit. Further research is also needed to better define outcomes for patients with iatrogenic vascular injury treated with minimally invasive endovascular techniques verses conservative management or surgical intervention.
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Affiliation(s)
- Tyler Andrew Smith
- Department of Interventional Radiology, University of Utah, Salt Lake City, UT, USA
| | - David Gage
- Department of Medicine, Intermountain Healthcare, Murray, UT, USA
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Zheng Y, Thelen BJ, Rajaram N, Krishnamurthy VN, Hamilton J, Funes-Lora MA, Morgan T, Yessayan L, Bishop B, Osborne N, Henke P, Shih AJ, Weitzel WF. Angioplasty Induced Changes in Dialysis Vascular Access Compliance. Ann Biomed Eng 2021; 49:2635-2645. [PMID: 34382112 DOI: 10.1007/s10439-021-02844-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/29/2021] [Indexed: 11/24/2022]
Abstract
Dialysis vascular access remains vitally important to maintain life and functional capacity with end stage renal disease. Angioplasty is an integral part of maintaining dialysis access function and patency. To understand the effect of angioplasty balloon dilation on vascular wall mechanics, we conducted a clinical study to evaluate the elastic modulus of the anastomosis in five subjects with anastomosis stenoses, before and after six angioplasty procedures, using B-mode ultrasound DICOM data. A novel and open source vascular ultrasound high-resolution speckle tracking software tool was used. The median lumen diameter increased from 3.4 to 5.5 mm after angioplasty. Meanwhile, the median elastic modulus of the 18 measurements at the anastomosis increased by 52.2%, from 2.24 × 103 to 3.41 × 103 mmHg. The results support our hypothesis that the structural changes induced in the vessel wall by balloon dilation lead to reduced vascular compliance and a higher elastic modulus of the vessel wall.
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Affiliation(s)
- Yihao Zheng
- Department of Mechanical Engineering, Worcester Polytechnic Institute, 100 Institute Rd, Worcester, MA, 01609, USA. .,VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
| | - Brian J Thelen
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Statistics, University of Michigan, Ann Arbor, MI, USA.,Michigan Tech Research Institute, Michigan Technological University, Ann Arbor, MI, USA
| | - Nirmala Rajaram
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Venkataramu N Krishnamurthy
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Departments of Radiology and Surgery, University of Michigan, Ann Arbor, MI, USA
| | - James Hamilton
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Emerge Now Inc., Los Angeles, CA, USA
| | | | | | - Lenar Yessayan
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Nickolas Osborne
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Peter Henke
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Albert J Shih
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - William F Weitzel
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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9
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Jaffer O, Gibbs P, Gibson M, Gilbert J, Hanko J, Jeevaratnam P, Jones R, Nicholas J, Ramnarine R, Sivaprakasam R, Steiner K, Tippett R, Wilkins J. A UK Expert Consensus Approach for Managing Symptomatic Arteriovenous Fistula (AVF) Stenosis in Haemodialysis Patients. Cardiovasc Intervent Radiol 2021; 44:1736-1746. [PMID: 34231014 DOI: 10.1007/s00270-021-02875-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 05/17/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Stenoses in mature arteriovenous fistulas (AVFs) are common and can negatively impact on the quality of haemodialysis, the longevity of the AVF and lead to debilitating symptoms. Multiple treatment options exist; however, management can vary between different centres. We aimed to establish multidisciplinary consensus on the optimal stepwise application of interventions based on evidence and consensus. METHODS A modified Delphi process was conducted with 13 participants from hospitals across the UK, all of whom have high-volume dialysis access practice. RESULTS The usual intervention to rectify de novo stenoses of mature AVFs is fistuloplasty, although surgery for inflow segment stenoses is also clinically acceptable. Appropriate first-line interventions include plain old balloon angioplasty or high-pressure balloon angioplasty; if these fail during the fistuloplasty, consider upsizing the balloon, prolonged balloon inflation or using alternative interventions, such as cutting or scoring balloons and ultra-high-pressure balloons. Alternative or subsequent interventions vary by anatomical site and may require additional multidisciplinary team input. For a stenoses recurring between 3 and 12 months, it is appropriate to consider interventions used de novo, but with a lower threshold for using drug-coated balloons (DCBs) in all regions and for using stent grafts in all regions but inflow segment. Recurrence after 12 months should be treated as a de novo lesion, with DCBs considered if they have been used successfully during previous interventions. CONCLUSIONS These recommendations aim to provide a practical guide to multidisciplinary teams in order to optimise the use of multiple interventions for rectifying AVF stenoses and provide unified evidence-based practice guidelines.
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Affiliation(s)
- Ounali Jaffer
- Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, Whitechapel, London, E1 1BB, UK.
| | - Paul Gibbs
- Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Matthew Gibson
- Royal Berkshire Hospital, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - James Gilbert
- Oxford Transplant Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jennifer Hanko
- Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | | | - Robert Jones
- University Hospital Birmingham, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Johann Nicholas
- Royal Shrewsbury Hospital, Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
| | - Raymond Ramnarine
- Gloucestershire Royal Hospital, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - Rajesh Sivaprakasam
- Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, Whitechapel, London, E1 1BB, UK
| | - Kate Steiner
- Lister Hospital, East and North Herts NHS Trust, Stevenage, UK
| | - Richard Tippett
- Dorset County Hospital, Dorset County Hospital NHS Foundation Trust, Dorchester, UK
| | - Jason Wilkins
- King's College Hospital NHS Foundation Trust, London, UK
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10
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Double Mesh Nitinol Stent Versus Self-expanding Stent-graft in Recurrent/Resistant Cephalic Vein Arch Stenoses in Dialysis Fistulae: A Comparative Study. Cardiovasc Intervent Radiol 2020; 44:230-236. [PMID: 33156388 DOI: 10.1007/s00270-020-02699-9] [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: 04/17/2020] [Accepted: 10/24/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To compare the double mesh nitinol stent (DNS) versus the self-expanding stent-graft (SES) in recurrent/resistant cephalic vein arch stenosis in dialysis fistulae. MATERIALS AND METHODS 17 cases with recurrent/resistant stenosis of the cephalic vein arch treated with a DNS were compared retrospectively with 18 cases treated with an SES. Stenting was performed either for significant recoil post-angioplasty with high-pressure balloons or in recurrent stenoses. Patients were followed up with Doppler ultrasound in our vascular access surveillance programme. Primary and assisted primary patency rates at 3, 6 and 12 months were estimated by Kaplan-Meier analysis. RESULTS Both stents showed 100% technical success immediately post-stenting, defined as residual stenosis < 30%. 3, 6 and 12 month primary patency of the DNS was 82.4%, 69.7% and 28.1% versus 88.9%, 77.8% and 72.2% for the SES. The DNS had a mean primary patency of 242.4 days compared to 896.3 days for the SES (p = 0.021). 12 month assisted primary patency was 88.2% (DNS) and 100% (SES). The DNS had a mean assisted primary patency of 812 days compared to 1390.3 days for the SES, though this did not reach statistical significance. No stent fractures were identified at 2 years in either group. CONCLUSION Both stents had 100% technical success with no stent fractures. SES showed statistically significant higher primary patency. Assisted primary patency was also higher, though this did not reach statistical significance.
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11
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Experimental murine arteriovenous fistula model to study restenosis after transluminal angioplasty. Lab Anim (NY) 2020; 49:320-334. [PMID: 33082594 DOI: 10.1038/s41684-020-00659-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 09/03/2020] [Indexed: 12/29/2022]
Abstract
Percutaneous transluminal angioplasty (PTA) is a very common interventional treatment for treating stenosis in arteriovenous fistula (AVF) used for hemodialysis vascular access. Restenosis occurs after PTA, resulting in vascular lumen loss and a decrease in blood flow. Experimental animal models have been developed to study the pathogenesis of stenosis, but there is no restenosis model after PTA of stenotic AVF in mice. Here, we describe the creation of a murine model of restenosis after angioplasty of a stenosis in an AVF. The murine restenosis model has several advantages, including the rapid development of restenotic lesions in the vessel after angioplasty and the potential to evaluate endovascular and perivascular therapeutics for treating restenosis. The protocol includes a detailed description of the partial nephrectomy procedure to induce chronic kidney disease, the AVF procedure for development of de novo stenosis and the angioplasty treatment associated with progression of restenosis. We monitored the angioplasty-treated vessel for vascular patency and hemodynamic changes for a period of 28 d using ultrasound. Vessels were collected at different time points and processed for histological analysis and immunostaining. This angioplasty model, which can be performed with basic microvascular surgery skills, could be used to identify potential endovascular and perivascular therapies to reduce restenosis after angioplasty procedures.
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DeVita MV, Khine SK, Shivarov H. Novel Approaches to Arteriovenous Access Creation, Maturation, Suitability, and Durability for Dialysis. Kidney Int Rep 2020; 5:769-778. [PMID: 32518859 PMCID: PMC7270716 DOI: 10.1016/j.ekir.2020.02.1024] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/06/2020] [Accepted: 02/10/2020] [Indexed: 12/26/2022] Open
Abstract
Since the arteriovenous fistula (AVF) was first conceived over 50 years ago, the goal to create a vascular conduit with predictable and reproducible maturation and durability continues to elude caregivers. Recently, however, advances in the understanding of vascular biology and new technologies now provides us with some optimism; we are moving toward a viable solution. A quickly maturing, sustainable, and durable arteriovenous access may soon be attainable. This review will discuss these advances. There are novel approaches to AVF creation and devices to enhance maturation, advances in arteriovenous graft material(s), and devices to safely prolong the use of tunneled dialysis catheters. Although hemodialysis (HD) access remains a complex problem, these innovations may lead the way to optimizing the care and the quality of life of those patients who have no choice but to proceed with HD.
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Affiliation(s)
- Maria V. DeVita
- Division of Nephrology, Lenox Hill Hospital, Northwell Health, Zucker School of Medicine, New York, New York, USA
| | - San Kyaw Khine
- Division of Nephrology, Lenox Hill Hospital, Northwell Health, Zucker School of Medicine, New York, New York, USA
| | - Hristo Shivarov
- Division of Nephrology, Lenox Hill Hospital, Northwell Health, Zucker School of Medicine, New York, New York, USA
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Han YM, Kim KY, Chung BH, Yu HC, Kim KH, Hwang HP. Rupture, Breakdown, and Pulmonary Artery Embolism of a Balloon Catheter Tip during Percutaneous Transluminal Angioplasty of Arteriovenous Fistula. Vasc Specialist Int 2020; 35:245-250. [PMID: 31915671 PMCID: PMC6941773 DOI: 10.5758/vsi.2019.35.4.245] [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: 07/18/2019] [Revised: 10/13/2019] [Accepted: 10/15/2019] [Indexed: 11/20/2022] Open
Abstract
Percutaneous transluminal angioplasty is a well-known treatment for arteriovenous fistula stenosis. Balloon rupture during endovascular procedures is a rare but possible complication. The bursting balloon itself does not cause a serious problem, but it can occasionally cause entrapment, especially in case of breakdown of the balloon catheter tip. Here, we present four cases of balloon rupture during angioplasty in the hemodialysis circuit. In three cases, the ruptured balloon catheter was removed by cutdown of access conduit, while in one case, tip of ruptured balloon catheter was migrated into the pulmonary artery and was removed surgically. The operator must attempt to reduce the risk of balloon rupture by gradually expanding the balloons under bursting pressure. If the balloon bursts, it should not be removed excessively and attempt should be made to remove it using endovascular techniques. Surgical removal is considered after careful evaluation of the condition of the balloon and vessel.
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Affiliation(s)
- Young Min Han
- Department of Radiology, Research Institute for Clinical Medicine, Biomedical Research Institute, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea
| | - Kun Yung Kim
- Department of Radiology, Research Institute for Clinical Medicine, Biomedical Research Institute, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea
| | - Byeoung Hoon Chung
- Department of Surgery, Research Institute for Clinical Medicine, Biomedical Research Institute, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea
| | - Hee Chul Yu
- Department of Surgery, Research Institute for Clinical Medicine, Biomedical Research Institute, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea
| | - Kyung Hwa Kim
- Department of Thoracic and Cardiovascular Surgery, Research Institute for Clinical Medicine, Biomedical Research Institute, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea
| | - Hong Pil Hwang
- Department of Surgery, Research Institute for Clinical Medicine, Biomedical Research Institute, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea
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The Efficacy of Paclitaxel Drug-Eluting Balloon Angioplasty Versus Standard Balloon Angioplasty in Stenosis of Native Hemodialysis Arteriovenous Fistulas: An Analysis of Clinical Success, Primary Patency and Risk Factors for Recurrent Dysfunction. Cardiovasc Intervent Radiol 2019; 42:685-692. [DOI: 10.1007/s00270-019-02171-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 01/25/2019] [Indexed: 11/26/2022]
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