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Wright L, Schneider D. Treating hemodialysis access thrombosis with the InThrill Thrombectomy System: Technique and case report. Radiol Case Rep 2024; 19:3141-3145. [PMID: 38779198 PMCID: PMC11109599 DOI: 10.1016/j.radcr.2024.03.007] [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: 02/20/2024] [Revised: 03/01/2024] [Accepted: 03/05/2024] [Indexed: 05/25/2024] Open
Abstract
The purpose of this report is to describe via a case example an efficient mechanical thrombectomy technique for hemodialysis access thrombosis using the InThrill Thrombectomy System (Inari Medical, Irvine, CA). A man in his late 60s with end-stage renal disease and a thrombosed femoral arteriovenous graft (AVG) underwent a thrombectomy procedure to remove all thrombotic material including the arterial plug and restore use of the graft for hemodialysis. The InThrill Thrombectomy System used in this procedure consists of a mechanical thrombectomy catheter with a wall-apposing coring element and a sheath with a retractable funnel and aspiration port. The technique starts with gaining wire and sheath access towards the venous outflow. The InThrill Thrombectomy catheter is deployed proximal to the sheath to sequentially remove small segments of thrombus thus avoiding sheath obstruction. A locking syringe is used for rapid aspiration, reducing or eliminating the need to remove the InThrill sheath with every mechanical thrombectomy pass. Finally, the arterial plug is pulled using a Fogarty balloon sheath (Edwards Lifesciences, Irvine, CA) and extracted using the InThrill catheter, removing what may be the nidus for recurrent AV access thrombosis. The technique described here provided a means to remove all thrombotic material including the arterial plug in a planned, sequential manner, without the need for thrombolytics. Patency was restored to the patient's femoral AVG within 60 minutes, and hemodialysis resumed shortly thereafter. Further studies are needed to support long-term efficacy of this thrombolytic-free treatment option.
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Affiliation(s)
- Luke Wright
- Dignity Health Methodist Hospital of Sacramento, Interventional Radiology, Rancho Cordova, CA, USA
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Prasad R, Vignesh S, Yadav RR, Sharma S, Hasani P, Yadav T, Israrahmed A, Lal H. Direct Percutaneous Thrombolysis (DPT): A novel method of salvaging Thrombosed Native Arteriovenous Fistula. J Vasc Access 2024; 25:1158-1163. [PMID: 36750968 DOI: 10.1177/11297298231153196] [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] [Indexed: 02/09/2023] Open
Abstract
INTRODUCTION Thrombosed arteriovenous fistulas (AVFs) are either treated by thrombectomy or pharmaco-mechanical thrombolysis with or without percutaneous balloon angioplasty. In this study, we have described an effective and economical technique of salvaging these fistulae using a 20-22-gauge spinal needle and urokinase and have named it direct percutaneous thrombolysis (DPT). MATERIALS AND METHOD This prospective study comprised of 148 patients out of which 120 patients presented with AVF thrombosis and were divided into two groups; those with no obvious stenosis on ultrasound (n = 38) and second with venous stenosis (n = 82). Remaining 28 patients developed thrombosis post angioplasty for venous stenosis. Percutaneous injection of urokinase into the thrombus was done under ultrasound guidance, followed by balloon angioplasty if there was associated stenosis. RESULTS In 38 patients who didn't have any stenosis, 32 AVFs were successfully thrombolysed by DPT, with technical success of 84.2%. Remaining six patients required angioplasty because of chronic nature of clot. In 82 patients who had venous stenosis, 80 cases were treated successfully by DPT followed by angioplasty with technical success of 97.5%. In third group (n = 28), who developed thrombosis post angioplasty, 100% success rate was noted. The mean length of thrombus was 31.4 ± 4.6 mm and mean diameter of thrombosed vein was 10.5 ± 1.2 mm. There were no major complications encountered during the procedure. Minor complications were seen in 19 patients which included prolonged oozing from puncture site and local hematoma formation. CONCLUSION Ultrasound guided DPT with urokinase is a safe and economical option for salvaging thrombosed AVF without vascular stenosis that does not need angioplasty.
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Affiliation(s)
- Raghunandan Prasad
- Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Selvamurugan Vignesh
- Department of Imaging Sciences & Interventional Radiology, Meenakshi Mission Hospital & Research Centre, Madurai, Tamil Nadu, India
| | - Rajanikant R Yadav
- Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Srishti Sharma
- Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Prerna Hasani
- Department of Radiology, Bhailal Amin Hospital, Vadodara, Gujarat, India
| | - Tanya Yadav
- Department of Radiodiagnosis, Narayana Super Speciality Hospital, Gurugram, Haryana, India
| | - Amrin Israrahmed
- Division of Intervention Radiology, Medanta Hospital, Lucknow, Uttar Pradesh, India
| | - Hira Lal
- Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Hamano T, Yamaguchi Y, Goto K, Mizokawa S, Ito Y, Dellanna F, Barratt J, Akizawa T. Risk Factors for Thromboembolic Events in Patients With Dialysis-Dependent CKD: Pooled Analysis of Phase 3 Roxadustat Trials in Japan. Adv Ther 2024; 41:1526-1552. [PMID: 38363463 PMCID: PMC10960897 DOI: 10.1007/s12325-023-02727-3] [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: 07/07/2023] [Accepted: 11/01/2023] [Indexed: 02/17/2024]
Abstract
INTRODUCTION Thromboembolic events have occurred in clinical trials of roxadustat. This post hoc analysis explored potential factors related to thromboembolic events in dialysis-dependent patients treated with roxadustat in four phase 3 clinical trials in Japan. METHODS Thromboembolic events with onset before and after week 12 were evaluated. Baseline risk factors for thromboembolic events were investigated by Cox regression analyses. Nested case-control analyses using conditional logistic models with matched pairs of case-control data explored relationships between thromboembolic events and laboratory parameters. RESULTS Of the 444 patients, 56 thromboembolic events were observed in 44 patients during ≤ 52 weeks of treatment. The proportion of venous and arterial thromboembolic events gradually increased after week 12. Baseline risk factors included hemodialysis (vs peritoneal dialysis), advanced age (≥ 65 years), shorter dialysis vintage (< 4 months), and history of thromboembolism. The absence of concomitant intravenous or oral iron therapy (including ferric citrate) was associated with thromboembolic events before week 12 (hazard ratio 11.25; 95% confidence interval [CI] 3.36-37.71; vs presence). Case-control analysis revealed that low average transferrin saturation (< 10%; unadjusted odds ratio [OR] 6.25; 95% CI 1.52-25.62; vs ≥ 20%), high average transferrin level (≥ 2.5 g/L; unadjusted OR 4.36; 95% CI 1.23-15.39; vs < 2.0 g/L), and high average roxadustat dose (≥ 150 mg; unadjusted OR 5.95; 95% CI 1.07-33.16; vs < 50 mg) over the previous 8 weeks before the event onset were associated with thromboembolic events after week 12. However, adjustment for iron status extinguished the significant relationship between roxadustat dose and events. Multivariate case-control analysis showed that increased transferrin from baseline (≥ 1.0 g/L; adjusted OR 7.85; 95% CI 1.82-33.90; vs < 0.5 g/dL) and decreased mean corpuscular volume (< - 2 fL; adjusted OR 5.55; 95% CI 1.73-17.83; vs ≥ 0 fL) were associated with increased risk of thromboembolic events. CONCLUSION In addition to established risk factors, iron deficiency may be related to thromboembolic events. Graphical Abstract available for this article. TRIAL REGISTRATION NCT02780726, NCT02952092, NCT02780141, NCT02779764.
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Affiliation(s)
- Takayuki Hamano
- Department of Nephrology, Nagoya City University Graduate School of Medical Sciences, 1, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8602, Japan.
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4
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Tang QH, Yang H, Chen J, Lin QN, Qin Z, Hu M, Qin X. Comparison between transposed arteriovenous fistulas and arteriovenous graft for the hemodialysis patients: A meta-analysis and systematic review. J Vasc Access 2024; 25:369-389. [PMID: 35708346 DOI: 10.1177/11297298221102875] [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] [Indexed: 11/15/2022] Open
Abstract
It is challenging for a surgeon to determine the appropriate vascular access for hemodialysis patients whose cephalic vein is usually inaccessible. The purpose of the study is to compare the complications and patency rates between transposed arteriovenous fistulas (tAVF) and arteriovenous graft (AVG) for the hemodialysis patients. Studies were recruited from PubMed, Cochrane library, EMBASE, the web of science databases, and reviewing reference lists of related studies from the inception dates to September 2, 2021. Statistical analyses were conducted using the statistical tool Review Manager version5.3 (Cochrane Collaboration, London, UK). I2 > 50% was defined as a high degree of heterogeneity, and then a random-effects model was used. Otherwise, the fixed-effects model was used. Odds ratio with its 95% confidence interval (95% CI) was used. Thirty-three trials (26 retrospective studies, four randomized controlled trials, two prospective trials, and one controlled-comparative study) with 6430 enrolled participants were identified in our analysis. The results showed that tAVF was accompanied with lower thrombosis rate (103/1184 (8.69%) vs 257/1367 (18.80%); I2 = 45%; 95% CI, 0.34 (0.26, 0.45)) and infection rate (43/2031 (2.12%) vs 180/2147 (8.38%); I2 = 0%; 95% CI, 0.20 (0.14, 0.30)) than arteriovenous graft. The significantly better primary patency rates, secondary patency rates, and primary assisted patency rates during follow-up were found in tAVF. However, the failure rate and the prevalence of hematoma were significantly lower in AVG group. No evidence showed the rate of overall mortality, steal syndrome, and aneurysm reduced in tAVF. Our results showed that tAVF is a promising vascular access technique for hemodialysis patients whose cephalic vein is inaccessible. Our data showed that tAVF has less thrombosis, infection risk, and better patency rates when compared with AVG. However, more attentions need to be paid to transposed arteriovenous fistulas maturation and hematoma.
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Affiliation(s)
- Qian-Hui Tang
- Department of Vascular and Endovascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Han Yang
- Department of Vascular and Endovascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Jing Chen
- Department of Vascular and Endovascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Qiu-Ning Lin
- Department of Vascular and Endovascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Zhong Qin
- Department of Vascular and Endovascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Ming Hu
- Department of Vascular and Endovascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xiao Qin
- Department of Vascular and Endovascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
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5
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Cho MS, Javed Z, Patel R, Karim MS, Chan MR, Astor BC, Gardezi AI. Impact of COVID-19 pandemic on hemodialysis access thrombosis. J Vasc Access 2024; 25:467-473. [PMID: 35953895 PMCID: PMC9379590 DOI: 10.1177/11297298221116236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/10/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Delay in care of suspected stenosis or thrombosis can increase the chance of losing a functioning hemodialysis access. Access to care and resources were restricted during the COVID-19 pandemic. To evaluate the impact of the pandemic on arteriovenous fistula (AVF) and arteriovenous graft (AVG) procedures we have assessed the number and success of thrombectomies done before and during the COVID-19 pandemic. METHODS We examined all AVF and AVG angiograms with and without interventions, including thrombectomies, performed at a single center during April 2017-March 2021 (pre-COVID-19 era) and April 2020-March 2021 (COVID-19 era). RESULTS The proportion of procedures that were thrombectomies was higher during the COVID-19 era compared to the pre-COVID-19 era (13.3% vs 8.7%, p = 0.009). The proportion of thrombectomy procedures was higher during COVID-19 for AVF (8.2% vs 3.0%, p < 0.001) but there was no difference for AVG (26.5% vs 27%, p = 0.99). There was a trend toward a higher likelihood of unsuccessful thrombectomy during COVID-19 (33.3% vs 20.4%, p = 0.08). CONCLUSIONS More dialysis access thromboses and unsuccessful thrombectomies were noted during the COVID-19 pandemic. This difference could be due to a delay in patients getting procedures to maintain their dialysis accesses.
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Affiliation(s)
- Min S Cho
- Division of Nephrology, Department of
Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI,
USA
| | - Zain Javed
- Division of Nephrology, Department of
Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI,
USA
| | - Ravi Patel
- Division of Nephrology, Department of
Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI,
USA
| | - Muhammad S Karim
- Division of Nephrology, Department of
Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI,
USA
| | - Micah R Chan
- Division of Nephrology, Department of
Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI,
USA
| | - Brad C Astor
- Division of Nephrology, Department of
Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI,
USA
- Department of Population Health
Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI,
USA
| | - Ali I Gardezi
- Division of Nephrology, Department of
Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI,
USA
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Sharbidre KG, Alexander LF, Varma RK, Al-Balas AA, Sella DM, Caserta MP, Clingan MJ, Zahid M, Aziz MU, Robbin ML. Hemodialysis Access: US for Preprocedural Mapping and Evaluation of Maturity and Access Dysfunction. Radiographics 2024; 44:e230053. [PMID: 38096113 PMCID: PMC10772307 DOI: 10.1148/rg.230053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/07/2023] [Accepted: 07/13/2023] [Indexed: 12/18/2023]
Abstract
Patients with kidney failure require kidney replacement therapy. While renal transplantation remains the treatment of choice for kidney failure, renal replacement therapy with hemodialysis may be required owing to the limited availability and length of time patients may wait for allografts or for patients ineligible for transplant owing to advanced age or comorbidities. The ideal hemodialysis access should provide complication-free dialysis by creating a direct connection between an artery and vein with adequate blood flow that can be reliably and easily accessed percutaneously several times a week. Surgical arteriovenous fistulas and grafts are commonly created for hemodialysis access, with newer techniques that involve the use of minimally invasive endovascular approaches. The emphasis on proactive planning for the placement, protection, and preservation of the next vascular access before the current one fails has increased the use of US for preoperative mapping and monitoring of complications for potential interventions. Preoperative US of the extremity vasculature helps assess anatomic suitability before vascular access creation, increasing the rates of successful maturation. A US mapping protocol ensures reliable measurements and clear communication of anatomic variants that may alter surgical planning. Postoperative imaging helps assess fistula maturation before cannulation for dialysis and evaluates for early and late complications associated with arteriovenous access. Clinical and US findings can suggest developing stenosis that may progress to thrombosis and loss of access function, which can be treated with percutaneous vascular interventions to preserve access patency. Vascular access steal, aneurysms and pseudoaneurysms, and fluid collections are other complications amenable to US evaluation. ©RSNA, 2023 Supplemental material is available for this article. Test Your Knowledge questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Kedar G. Sharbidre
- From the Departments of Radiology (K.G.S., R.K.V., A.A.A.B., M.Z.,
M.U.A., M.L.R.) and Nephrology (A.A.A.B.), University of Alabama at Birmingham,
619 19th St S, Birmingham, AL 35233; and Department of Radiology, Mayo
Clinic, Jacksonville, Fla (L.F.A., D.M.S., M.P.C., M.J.C.)
| | - Lauren F. Alexander
- From the Departments of Radiology (K.G.S., R.K.V., A.A.A.B., M.Z.,
M.U.A., M.L.R.) and Nephrology (A.A.A.B.), University of Alabama at Birmingham,
619 19th St S, Birmingham, AL 35233; and Department of Radiology, Mayo
Clinic, Jacksonville, Fla (L.F.A., D.M.S., M.P.C., M.J.C.)
| | - Rakesh K. Varma
- From the Departments of Radiology (K.G.S., R.K.V., A.A.A.B., M.Z.,
M.U.A., M.L.R.) and Nephrology (A.A.A.B.), University of Alabama at Birmingham,
619 19th St S, Birmingham, AL 35233; and Department of Radiology, Mayo
Clinic, Jacksonville, Fla (L.F.A., D.M.S., M.P.C., M.J.C.)
| | - Alian A. Al-Balas
- From the Departments of Radiology (K.G.S., R.K.V., A.A.A.B., M.Z.,
M.U.A., M.L.R.) and Nephrology (A.A.A.B.), University of Alabama at Birmingham,
619 19th St S, Birmingham, AL 35233; and Department of Radiology, Mayo
Clinic, Jacksonville, Fla (L.F.A., D.M.S., M.P.C., M.J.C.)
| | - David M. Sella
- From the Departments of Radiology (K.G.S., R.K.V., A.A.A.B., M.Z.,
M.U.A., M.L.R.) and Nephrology (A.A.A.B.), University of Alabama at Birmingham,
619 19th St S, Birmingham, AL 35233; and Department of Radiology, Mayo
Clinic, Jacksonville, Fla (L.F.A., D.M.S., M.P.C., M.J.C.)
| | - Melanie P. Caserta
- From the Departments of Radiology (K.G.S., R.K.V., A.A.A.B., M.Z.,
M.U.A., M.L.R.) and Nephrology (A.A.A.B.), University of Alabama at Birmingham,
619 19th St S, Birmingham, AL 35233; and Department of Radiology, Mayo
Clinic, Jacksonville, Fla (L.F.A., D.M.S., M.P.C., M.J.C.)
| | - M. Jennings Clingan
- From the Departments of Radiology (K.G.S., R.K.V., A.A.A.B., M.Z.,
M.U.A., M.L.R.) and Nephrology (A.A.A.B.), University of Alabama at Birmingham,
619 19th St S, Birmingham, AL 35233; and Department of Radiology, Mayo
Clinic, Jacksonville, Fla (L.F.A., D.M.S., M.P.C., M.J.C.)
| | - Mohd Zahid
- From the Departments of Radiology (K.G.S., R.K.V., A.A.A.B., M.Z.,
M.U.A., M.L.R.) and Nephrology (A.A.A.B.), University of Alabama at Birmingham,
619 19th St S, Birmingham, AL 35233; and Department of Radiology, Mayo
Clinic, Jacksonville, Fla (L.F.A., D.M.S., M.P.C., M.J.C.)
| | - Muhammad U. Aziz
- From the Departments of Radiology (K.G.S., R.K.V., A.A.A.B., M.Z.,
M.U.A., M.L.R.) and Nephrology (A.A.A.B.), University of Alabama at Birmingham,
619 19th St S, Birmingham, AL 35233; and Department of Radiology, Mayo
Clinic, Jacksonville, Fla (L.F.A., D.M.S., M.P.C., M.J.C.)
| | - Michelle L. Robbin
- From the Departments of Radiology (K.G.S., R.K.V., A.A.A.B., M.Z.,
M.U.A., M.L.R.) and Nephrology (A.A.A.B.), University of Alabama at Birmingham,
619 19th St S, Birmingham, AL 35233; and Department of Radiology, Mayo
Clinic, Jacksonville, Fla (L.F.A., D.M.S., M.P.C., M.J.C.)
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Lookstein R, Haruguchi H, Suemitsu K, Isogai N, Gallo V, Madassery S, Misra S, Wang H, Roffe PS, Holden A. IN.PACT AV Access Randomized Trial of Drug-Coated Balloons for Dysfunctional Arteriovenous Fistulae: Clinical Outcomes through 36 Months. J Vasc Interv Radiol 2023; 34:2093-2102.e7. [PMID: 37460061 DOI: 10.1016/j.jvir.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/15/2023] [Accepted: 07/09/2023] [Indexed: 09/26/2023] Open
Abstract
PURPOSE To present the 36-month outcomes of the prospective randomized IN.PACT AV Access study of participants with obstructive de novo or restenotic native upper extremity arteriovenous dialysis fistula lesions treated with drug-coated balloon (DCBs) or standard percutaneous transluminal angioplasty (PTA) following successful high-pressure PTA. MATERIALS AND METHODS Participants at 29 international sites were randomized 1:1 to receive an IN.PACT AV DCB (n = 170) or undergo PTA (n = 160). The outcomes through 36 months included target lesion primary patency (TLPP) and access circuit primary patency (ACPP) (composites of clinically driven target lesion or access circuit revascularization and/or access circuit thrombosis), number of reinterventions, and serious adverse events involving the access circuit. RESULTS TLPP was 52.1% in the DCB group compared with 36.7% in the PTA group through 24 months and 43.1% in the DCB group compared with 28.6% in the PTA group through 36 months (both log-rank P < .001). ACPP was 39.4% in the DCB group compared with 25.3% in the PTA group through 24 months and 26.4% in the DCB group compared with 16.6% in the PTA group through 36 months (both log-rank P < .001). Cumulative incidence of access circuit thrombosis through 36 months was 8.2% in the DCB group compared with 18.3% in the PTA group (log-rank P = .040). Cumulative incidence of mortality through 36 months was 26.6% in the DCB group compared with 30.8% in the PTA group (log-rank P = .71). CONCLUSIONS This study demonstrated superior TLPP and ACPP with DCBs compared with PTA, with no difference in mortality through 3 years. Access circuit thrombosis was statistically significantly higher in the PTA group at 3 years.
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Affiliation(s)
- Robert Lookstein
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York.
| | | | | | - Naoko Isogai
- Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Vincent Gallo
- Vascular and Interventional Radiology, Staten Island University Hospital/Northwell Health, New York, New York
| | - Sreekumar Madassery
- Vascular Interventional Services, Rush University Medical Center, Chicago, Illinois
| | - Sanjay Misra
- Department of Radiology, Division of Vascular and Interventional Radiology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Andrew Holden
- Department of Interventional Radiology, Auckland Hospital, Auckland, New Zealand
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Buzzell M, Chen A, Hoffstaetter T, Thompson DA, George SJ, Landis G, Silpe J, Etkin Y. Early Follow-Up after Arteriovenous Fistula Creation is Associated with Improved Access-Related Outcomes. Ann Vasc Surg 2023; 95:203-209. [PMID: 37121342 DOI: 10.1016/j.avsg.2023.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/07/2023] [Accepted: 04/12/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND Up to 60% of arteriovenous fistulas (AVF) require intervention to assist maturation, which prolongs the time until it can be used for hemodialysis (HD). Current guidelines recommend early postoperative AVF examination to detect and address immaturity to decrease time to maturation. This study evaluates how the timing of postoperative follow-up to assess AVF maturity affects patients' outcomes. METHODS All patients who underwent AVF creation between 2017 and 2021 in an academic medical center were retrospectively reviewed, excluding patients lost to follow-up or not on HD. Outcomes were compared between patients that had delayed follow-up to assess AVF maturity, >8 weeks post surgery, versus early follow-up, <8 weeks post-surgery. AVF evaluation for maturity consisted of physical examination and duplex ultrasound. Primary endpoints were time to first cannulation (interval from AVF creation to first successful cannulation) and time to catheter-free dialysis (interval from AVF creation to central venous catheter removal). RESULTS A total of 400 patients were identified: 111 in the delayed follow-up group and 289 in the early follow-up group. The median time to follow-up was 78 days (interquartile range [IQR], 66-125) in the delayed follow-up group versus 39 days (IQR, 36-47) in the early follow-up group, (P < 0.0001). The maturation rate was 87% in the delayed follow-up group versus 81% in the early follow-up group, (P = 0.1) and both groups had similar rates of interventions to assist maturation (66% vs. 57%, P = 0.2). The early follow-up group had a significantly shorter median time to first cannulation (50 vs. 88 days; P < 0.0001) and shorter time to catheter-free HD (75 vs. 118 days; P <0.0001). At 4 months after AVF creation, the incidence of first cannulation was 74% in the early follow-up group versus 63% in the delayed follow-up group (P = 0.001). Similarly, the incidence of catheter-free dialysis was 65% in the early follow-up group versus 50% in the delayed follow-up group at 4 months postoperatively, (P = 0.036). CONCLUSIONS Early postoperative follow-up for evaluation of fistula maturation is associated with reduced time to first successful cannulation of AVF for HD and reduced time to catheter-free dialysis.
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Affiliation(s)
- Mariah Buzzell
- Division of Vascular and Endovascular Surgery, Department of Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Adrian Chen
- Division of Vascular and Endovascular Surgery, Department of Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Tabea Hoffstaetter
- Division of Vascular and Endovascular Surgery, Department of Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Dane A Thompson
- Division of Vascular and Endovascular Surgery, Department of Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Sam J George
- Division of Vascular and Endovascular Surgery, Department of Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Gregg Landis
- Division of Vascular and Endovascular Surgery, Department of Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Jeffrey Silpe
- Division of Vascular and Endovascular Surgery, Department of Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Yana Etkin
- Division of Vascular and Endovascular Surgery, Department of Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY.
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9
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Abstract
Many end-stage kidney failure patients require hemodialysis as a life-sustaining treatment. Hemodialysis access via arteriovenous fistula or graft creation is preferred over long-term dialysis catheters, but intervention to maintain patency and prevent access failure is common. Endovascular and open surgical techniques are both utilized to address the underlying etiology of failure. Endovascular options include balloon angioplasty, angioplasty with stenting, and drug-eluting stents. Open revision is commonly needed for recurrent stenosis, aneurysmal or pseudoaneurysmal change, hemodialysis access-induced distal ischemia, and infection. Treatment plans should be guided by patient's individualized goals of care and require a multidisciplinary approach to the management of this complex disease.
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Affiliation(s)
- John Iguidbashian
- Department of Surgery, University of Colorado Anschutz School of Medicine, 457 South Kingston Cir, Aurora, CO 80012, USA
| | - Rabbia Imran
- University of Colorado Anschutz School of Medicine, 13001 East 17th Place, Aurora, CO 80045, USA
| | - Jeniann A Yi
- Department of Surgery, University of Colorado Anschutz School of Medicine, 457 South Kingston Cir, Aurora, CO 80012, USA.
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Hicks A, Grzeda A, Schucht J, Bond J, Bush C, Dwivedi A, Sigdel A. Comparing Patency Rates of Arteriovenous Dialysis Access following Percutaneous Thrombectomy Using Various Catheter Directed Therapies. Ann Vasc Surg 2023; 92:131-141. [PMID: 36623720 DOI: 10.1016/j.avsg.2022.12.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 12/03/2022] [Accepted: 12/03/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Arteriovenous fistulas often require frequent interventions to maintain patency for hemodialysis. Interventions may include open or percutaneous thrombectomy with additional targeted interventions as indicated. We evaluated the primary and cumulative functional patency rates following three unique approaches to percutaneous thrombectomy of thrombosed dialysis access. METHODS A retrospective review of 236 unique patients who presented with thrombosed hemodialysis access was analyzed over a period of 4 years from 2016 to 2020. We analyzed a total of 413 procedures that utilized 3 separate percutaneous thrombectomy devices to assist with restoring patency. The Indigo System CAT-D Aspiration Thrombectomy Catheter (Penumbra; Alameda, CA), the Arrow-Trerotola Rotational Thrombectomy System (Teleflex; Wayne, PA) and the Angiojet Rheolytic Thrombectomy Catheter (Boston Scientific, Marlborough, MA) devices were compared for primary and cumulative functional patency. Primary patency was defined as time from percutaneous thrombectomy to next intervention (Angioplasty, stenting, and repeat thrombectomy). Cumulative functional patency was defined as time from percutaneous thrombectomy to time of access abandonment. Medical record chart review was utilized to determine patency rates. RESULTS A total of 413 percutaneous thrombectomy procedures were performed. Of the procedures performed, 98 utilized Angiojet, 103 utilized Trerotola, and 212 used Penumbra. The mean primary patency rates in (days) for the devices were as follows: Angiojet (194), Trerotola (204), and Penumbra (107). The mean cumulative functional patency rates (in days) for the devices were as follows: rheolytic thrombectomy (450 days), aspiration thrombectomy (292 days), and rotational thrombectomy (475 days). Angiojet versus Penumbra and Trerotola versus Penumbra both showed diminished patency rates when using the Penumbra catheter that were statistically significant (P < 0.05). CONCLUSIONS All percutaneous thrombectomy approaches do not result in the same primary or cumulative functional patency rates. Approaches with Trerotola and Angiojet resulted in improved primary and cumulative functional patency rates compared to those using Penumbra.
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Affiliation(s)
- Adam Hicks
- University of Louisville, Department of General Surgery, Division of Vascular Surgery, Louisville, KY.
| | - Anthony Grzeda
- University of Louisville, Department of General Surgery, Division of Vascular Surgery, Louisville, KY
| | - Jessica Schucht
- University of Louisville, Department of General Surgery, Division of Vascular Surgery, Louisville, KY
| | - Jordan Bond
- University of Louisville, Department of General Surgery, Division of Vascular Surgery, Louisville, KY
| | - Charles Bush
- University of Louisville, Department of General Surgery, Division of Vascular Surgery, Louisville, KY
| | - Amit Dwivedi
- University of Louisville, Department of General Surgery, Division of Vascular Surgery, Louisville, KY
| | - Abindra Sigdel
- University of Louisville, Department of General Surgery, Division of Vascular Surgery, Louisville, KY
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Chen MCY, Weng MJ, Chao LH. Characterization of hemodialysis fistulas experienced abrupt thrombosis and determination of a proper follow-up protocol: A retrospective cohort study and an interventionist's perspective. PLoS One 2023; 18:e0282891. [PMID: 36913383 PMCID: PMC10010559 DOI: 10.1371/journal.pone.0282891] [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: 01/10/2023] [Accepted: 02/26/2023] [Indexed: 03/14/2023] Open
Abstract
Abrupt thrombosis is a form of thrombosis that occurs unexpectedly and without being preceded by hemodialysis fistula (AVF) dysfunction during dialysis. We found that AVFs with a history of abrupt thrombosis (abtAVF) appeared to have more episodes of thrombosis and required more frequent interventions than those without such history. Therefore, we sought to characterize the abtAVFs and examined our follow-up protocols to determine which one is optimal. We performed a retrospective cohort study using routinely collected data. The thrombosis rate, AVF loss rate, thrombosis-free primary patency, and secondary patency were calculated. Additionally, the restenosis rates of the AVFs under the follow-up protocol/sub-protocols and the abtAVFs were determined. The thrombosis rate, procedure rate, AVF loss rate, thrombosis-free primary patency, and secondary patency of the abtAVFs were 0.237/pt-yr, 2.702/pt-yr, 0.027/pt-yr, 78.3%, and 96.0%, respectively. The restenosis rate for AVFs in the abtAVF group and the angiographic follow-up sub-protocol were similar. However, the abtAVF group had a significantly higher thrombosis rate and AVF loss rate than AVFs without a history of abrupt thrombosis (n-abtAVF). The lowest thrombosis rate was observed for n-abtAVFs, followed up periodically under the outpatient or angiographic sub-protocols. AVFs with a history of abrupt thrombosis had a high restenosis rate, and periodic angiographic follow-up with a mean interval of 3 months was presumed appropriate. For selected populations, such as salvage-challenging AVFs, periodic outpatient or angiographic follow-up was mandatory to extend their usable lives for hemodialysis.
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Affiliation(s)
- Matt Chiung-Yu Chen
- Department of Interventional Radiology, Yuan’s General Hospital, Kaohsiung, Taiwan
- * E-mail:
| | - Mei-Jui Weng
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Lee-Hua Chao
- Department of Interventional Radiology, Yuan’s General Hospital, Kaohsiung, Taiwan
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12
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Neyra NR, Wazir S. The evolving panorama of vascular access in the 21st century. FRONTIERS IN NEPHROLOGY 2022; 2:917265. [PMID: 37675010 PMCID: PMC10479615 DOI: 10.3389/fneph.2022.917265] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/31/2022] [Indexed: 09/08/2023]
Abstract
There are three major types of hemodialysis vascular access: hemodialysis catheters, arteriovenous grafts, and arteriovenous fistulas. Arteriovenous fistulas provide the best access due to their reliability and long-term patency. They are recommended by the current Kidney Disease Outcomes Quality Initiatives (K-DOQI) guidelines; however, not all patients benefit from arteriovenous fistulas due to poor maturation or a lack of adequate vasculature. Currently, hemodialysis is initiated via catheters in the majority of patients. Catheters are associated with high morbidity and mortality due to infection, lower quality of dialysis, and the development of central vein stenosis. The varied responses of patients to the different access types exemplify the need to choose the "right access for the right patient" based on scores that can predict death risk and progression of chronic kidney disease. Additionally, vascular access, often referred to as the "Achilles' heel" of hemodialysis patients, represents a significant percentage of the Medicare budget that continues to increase yearly. The purpose of this paper is to review the current literature on the management of vascular access complications and infection treatment and prevention. The paper also explores emerging research regarding the devices and methods to improve access outcomes such as early cannulation arteriovenous grafts, endovascular arteriovenous fistula creation, and regenerative grafts with resorbable scaffolds, among others. The data were collected through literature searches via PubMed, Athens and web search engines.
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Affiliation(s)
- Nilda Roxana Neyra
- Arizona Kidney Disease and Hypertension Center (AKDHC), Phoenix, AZ, United States
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13
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Salikhova TY, Pushin DM, Nesterenko IV, Biryukova LS, Guria GT. Patient specific approach to analysis of shear-induced platelet activation in haemodialysis arteriovenous fistula. PLoS One 2022; 17:e0272342. [PMID: 36191008 PMCID: PMC9529124 DOI: 10.1371/journal.pone.0272342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 07/19/2022] [Indexed: 11/29/2022] Open
Abstract
Shear-induced platelet activation (SIPAct) is an important mechanism of thrombosis initiation under high blood flow. This mechanism relies on the interaction of platelets with the von Willebrand factor (VWF) capable of unfolding under high shear stress. High shear stress occurs in the arteriovenous fistula (AVF) commonly used for haemodialysis. A novel patient-specific approach for the modelling of SIPAct in the AVF was proposed. This enabled us to estimate the SIPAct level via computational fluid dynamics. The suggested approach was applied for the SIPAct analysis in AVF geometries reconstructed from medical images. The approach facilitates the determination of the SIPAct level dependence on both biomechanical (AVF flow rate) and biochemical factors (VWF multimer size). It was found that the dependence of the SIPAct level on the AVF flow rate can be approximated by a power law. The critical flow rate was a decreasing function of the VWF multimer size. Moreover, the critical AVF flow rate highly depended on patient-specific factors, e.g., the vessel geometry. This indicates that the approach may be adopted to elucidate patient-specific thrombosis risk factors in haemodialysis patients.
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Affiliation(s)
- Tatiana Yu Salikhova
- National Medical Research Center for Hematology, Moscow, Russia
- Moscow Institute of Physics and Technology, Dolgoprudny, Russia
| | - Denis M. Pushin
- National Medical Research Center for Hematology, Moscow, Russia
| | | | | | - Georgy Th Guria
- National Medical Research Center for Hematology, Moscow, Russia
- Moscow Institute of Physics and Technology, Dolgoprudny, Russia
- * E-mail:
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14
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Cunha MD, Ottoni MHF, da Silva NC, Araújo SJT, Duarte RCF, Lucas TC. Hemostatic changes in patients undergoing hemodialysis: differences between central venous catheters and arterio-venous fistulas. Artif Organs 2022; 46:1866-1875. [PMID: 35451088 DOI: 10.1111/aor.14268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/21/2022] [Accepted: 04/11/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Failure to mature the fistula in patients undergoing hemodialysis leads to prolonged use of the central venous catheter (CVC) and can compromise the patency of the catheter and the arteriovenous fistula (AVF) due to thrombus development. OBJECTIVE to evaluate hemostatic changes in patients undergoing hemodialysis with prolonged use of CVC or AVF. METHOD cross-sectional study with a total of 200 adult participants who were divided into the following groups: I:control; II: patients who had 5 to 8 months of CVC insertion; III: patients who had 9 to 36 months of insertion; IV patients who had 5 to 8 months of AVF and V: patients who had 9 to 36 months of AVF. Platelet activation was investigated by expressions of GPIIb/IIIa and p-selectin using flow cytometry. The Elisa-thrombomodulin test was used to compare groups III and V. RESULTS the p-selectin percentage expression of group I was 15.30 (12.30-16.80), II 23.25 (20.75-30.55) and III 54.00 (44.75 -59.29) were significant (p<0.001). Groups I, IV and V were also significant (p<0.001). The median fluorescence for GPIIb/IIIa for groups I, II and III were significant (p<0.0001). As for the Elisa test, an increased absorbance of thrombomodulin was verified in patients who used the CVC 4372 (3951-4733) when compared to those patients who used the AVF 2162 (1932-2485) (p<0.0001). CONCLUSION It can be concluded that CVC patients had a larger platelet expression of GPIIb/IIIa and p-selectin than AVF patients. The high concentration of thrombomodulin in CVC patients may suggest a greater stimulation of the intrinsic than extrinsic coagulation pathways.
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Affiliation(s)
- Mayara Dumont Cunha
- Department of Nursing, Federal University of the Valleys of Jequitinhonha and Mucuri, Diamantina, Brazil
| | | | - Natalia Cristina da Silva
- Department of Medicine, Postgraduate Program in Health Science, Federal University of the Valleys of Jequitinhonha and Mucuri, Diamantina, Brazil
| | | | - Rita Carolina Figueiredo Duarte
- Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Laboratory of Hematology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Thabata Coaglio Lucas
- Department of Nursing, Graduate Program in Health Science, Federal University of the Valleys of Jequitinhonha and Mucuri, Diamantina, Brazil
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15
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Razdan RN, Rosenblatt M, Jiao Y, McLaughlin N, Usvyat LA, Sor M, Larkin JW. Cephalic arch restenosis rates in hemodialysis patients with brachiocephalic fistulae: a retrospective multicenter analysis of 3301 patients. BMC Nephrol 2022; 23:109. [PMID: 35300609 PMCID: PMC8932324 DOI: 10.1186/s12882-022-02728-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 03/08/2022] [Indexed: 11/10/2022] Open
Abstract
Background We evaluated restenosis rates at the cephalic arch after percutaneous angioplasty and stenting procedures in patients with brachial artery to cephalic vein arteriovenous fistula (BCAVF) hemodialysis access. Methods We used data from adult hemodialysis patients treated at a national network of 44 outpatient interventional facilities during Oct 2011–2015. We included data from patients with BCAVF who received an exclusive angioplasty, or stent with angioplasty, for treatment of cephalic arch stenosis and had ≥1 subsequent evaluation of the cephalic arch. Median percent restenosis per month at cephalic arch and days between encounters was calculated from the 1st index to 2nd procedure, and for up to 4 subsequent encounters. Analyses were stratified by intervention and device types. Results We identified a cohort of 3301 patients (mean age 62.2 ± 13.9 years, 58.5% male, 33.2% white race) with a BCAVF who had an angioplasty, or stent, at the cephalic arch for an index and ≥ 1 follow-up procedure. Between the 1st index to 2nd procedure, patients who received an angioplasty (n = 2663) or stent (n = 933) showed a median decrease of 18.9 and 16.5% in luminal diameter per month and a median time of 93 and 91 days between encounters, respectively. Restenosis and day rates were similar for standard versus high-pressure angioplasties. Bare metal stents showed 10.1 percentage point higher restenosis rate compared to stent grafts. Restenosis rates and time to restenosis were relatively consistent across subsequent encounters. Conclusions Findings suggest hemodialysis patients with a BCAVF who require an angioplasty or stent to treat a stenosis at the cephalic arch will have stenosis reformed at a rate of 18.9 and 16.5% per month after the first intervention, respectively. Findings suggest patients are at risk of having significant lesions at the cephalic arch within 3 months after the previous intervention. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02728-4.
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Affiliation(s)
| | | | - Yue Jiao
- Fresenius Medical Care, Global Medical Office, Waltham, MA, USA
| | | | - Len A Usvyat
- Fresenius Medical Care, Global Medical Office, Waltham, MA, USA
| | - Murat Sor
- Azura Vascular Care, Malvern, PA, USA.,Georgetown University, Washington, DC, USA
| | - John W Larkin
- Fresenius Medical Care, Global Medical Office, Waltham, MA, USA
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16
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Hu X, Li B, Mao J, Hu X, Zhang J, Guo H, Wang D, Zhang Y, He J, Zhao N, Zhang H, Pang P. Hemodialysis Arteriovenous Fistula Dysfunction: Retrospective Comparison of Post-thrombotic Percutaneous Endovascular Interventions with Pre-emptive Angioplasty. Ann Vasc Surg 2022; 84:286-297. [PMID: 35247533 DOI: 10.1016/j.avsg.2022.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 12/11/2021] [Accepted: 01/18/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We aimed to compare the clinical outcomes of pre-emptive angioplasty versus post-thrombotic percutaneous endovascular restoration of dysfunctional arteriovenous fistula (AVF). METHODS This retrospective study reviewed data from 80 patients who underwent 114 endovascular interventions for a malfunctioning AVF from July 2016 to August 2019. Stenotic AVFs were treated with pre-emptive angioplasty. Thrombosed AVFs were treated with percutaneous pharmacomechanical fibrinolysis with urokinase used only during the operation or continuously infused. The differences in patency rates were evaluated using Kaplan-Meier method. In addition, univariate and multivariate regression Cox models were used to determine influential factors on the post-intervention primary patency. RESULTS Post-thrombotic interventions and pre-emptive angioplasty yielded statistically similar rates in clinical success (100% vs 100%), anatomic success (94% vs 89%; p = .52), complication (4% vs 11%; p = .29), as well as postintervention primary, assisted primary and secondary patency (p = .80; .57; .57). The use of pre-emptive angioplasty was associated with reduced total cost (¥25108 vs ¥30833, p< .001). The patients who used urokinase only during the operation prolonged both the primary and assisted primary patency (p = .02; .002), while those with continuous infusion of urokinase had worst patency rates and high costs (¥39275 vs ¥25108 vs ¥27140, p< .001). Compared with the other locations, dysfunction in the anastomotic or juxta-anastomotic segment (HR = .41, p = .001) was associated with prolonged postintervention primary patency. CONCLUSIONS No clinical outcome differences was found between the post-thrombotic percutaneous endovascular interventions and pre-emptive angioplasty. However, pre-emptive angioplasty decreased access expenditure.
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Affiliation(s)
- Xinyan Hu
- Department of Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China; Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China; Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China; Institute of Interventional Radiology, Sun Yat-sen University, Zhuhai, 519000 P. R. China
| | - Bing Li
- Department of Ophthalmology, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China
| | - Junjie Mao
- Department of Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China
| | - Xiaojun Hu
- Department of Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China; Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China; Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China; Institute of Interventional Radiology, Sun Yat-sen University, Zhuhai, 519000 P. R. China
| | - Jingjing Zhang
- Department of Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China
| | - Hui Guo
- Department of Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China
| | - Dashuai Wang
- Department of Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China
| | - Yongyu Zhang
- Department of Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China
| | - Jianan He
- Department of Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China
| | - Ni Zhao
- Department of Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China; Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China; Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China; Institute of Interventional Radiology, Sun Yat-sen University, Zhuhai, 519000 P. R. China
| | - Huitao Zhang
- Department of Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China
| | - Pengfei Pang
- Department of Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China; Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China; Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China; Institute of Interventional Radiology, Sun Yat-sen University, Zhuhai, 519000 P. R. China.
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Almehmi A, Sheta M, Abaza M, Almehmi SE, El Khudari H, Shaikh A. Endovascular Management of Thrombosed Dialysis Vascular Circuits. Semin Intervent Radiol 2022; 39:14-22. [PMID: 35210728 PMCID: PMC8856780 DOI: 10.1055/s-0041-1740941] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A functional hemodialysis vascular access is the lifeline for patients with end-stage kidney disease and is considered a major determinant of survival and quality of life in this patient population. Hemodialysis therapy can be performed via arteriovenous fistulas, arteriovenous grafts, and central venous catheters (CVCs). Following dialysis vascular access creation, the interplay between several pathologic mechanisms can lead to vascular luminal obstruction due to neointimal hyperplasia with subsequent stenosis, stasis, and eventually access thrombosis. Restoration of the blood flow in the vascular access circuit via thrombectomy is crucial to avoid the use of CVCs and to prolong the life span of the vascular access conduits. The fundamental principles of thrombectomy center around removing the thrombus from the thrombosed access and treating the underlying culprit vascular stenosis. Several endovascular devices have been utilized to perform mechanical thrombectomy and have shown comparable outcomes. Standard angioplasty balloons remain the cornerstone for the treatment of stenotic vascular lesions. The utility of drug-coated balloons in dialysis vascular access remains unsettled due to conflicting results from randomized clinical trials. Stent grafts are used to treat resistant and recurrent stenotic lesions and to control extravasation from a ruptured vessel that is not controlled by conservative measures. Overall, endovascular thrombectomy is the preferred modality of treatment for the thrombosed dialysis vascular conduits.
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Affiliation(s)
- Ammar Almehmi
- Department of Radiology and Medicine, University of Alabama at Birmingham, Birmingham, Alabama,Address for correspondence Ammar Almehmi, MD Department of Radiology and Medicine, University of Alabama at BirminghamBirmingham, AL 35294
| | - Mohamed Sheta
- Department of Nephrology, University of Texas at Houston, Houston, Texas
| | - Masa Abaza
- Department of Biology, University of Alaska at Anchorage, Anchorage, Alaska
| | - Sloan E. Almehmi
- Department of Biology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Husam El Khudari
- Division of Interventional Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Aisha Shaikh
- Renal Service, Memorial Sloan Kettering Cancer Center, New York, New York
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18
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Shanmugasundaram S, Kubiak A, Dar A, Shrinet A, Chauhan N, Haque H, Kumar A, A Shukla P. High incidence of large bore temporary hemodialysis catheter malfunction in patients with COVID-19 related kidney injury. J Vasc Access 2022; 24:11297298211067332. [PMID: 35000486 DOI: 10.1177/11297298211067332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To evaluate the incidence of large bore hemodialysis catheter malfunction in the setting of COVID-19. MATERIALS AND METHODS A retrospective review was performed of all patients who underwent placement of a temporary hemodialysis catheter after developing kidney injury after COVID-19 infection at our institution. Data collected included demographic information, procedure related information, and incidence of replacement due to lumen thrombosis. Groups were compared using students t-test for continuous variables and Fisher's exact test for nominal variables. RESULTS Sixty-four patients (43M, mean age 63.2 ± 13.3) underwent placement of temporary hemodialysis catheter placement for kidney injury related to COVID 19 infection. Thirty-one (48.4%) of catheters were placed via an internal jugular vein (IJV) access and 33 (52.6%) of catheters were placed via a common femoral vein (CFV) access. Overall, 15 (23.4%) catheters required replacement due to catheter dysfunction. There were no differences in demographics in patients who required replacement to those who did not (p > 0.05). Of the replacements, 5/31 (16%) were placed via an IJV access and 10/33 (30.3%) were placed via a CFV access (p = 0.18). The average time to malfunction/replacement was 7.8 ± 4.8 days for catheters placed via an IJ access versus 3.4 ± 3.3 days for catheters placed via a CFV access (p = 0.055). CONCLUSION A high incidence of temporary dialysis catheter lumen dysfunction was present in patients with COVID-19 infection. Catheters placed via a femoral vein access had more frequent dysfunction with shorter indwelling time.
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Affiliation(s)
- Srinidhi Shanmugasundaram
- Division of Vascular and Interventional Radiology, Department of Radiology, Rutgers - New Jersey Medical School, Newark, NJ, USA
| | - Aleksander Kubiak
- Division of Vascular and Interventional Radiology, Department of Radiology, Rutgers - New Jersey Medical School, Newark, NJ, USA
| | - Aleena Dar
- Division of Vascular and Interventional Radiology, Department of Radiology, Rutgers - New Jersey Medical School, Newark, NJ, USA
| | - Abhishek Shrinet
- Division of Vascular and Interventional Radiology, Department of Radiology, Rutgers - New Jersey Medical School, Newark, NJ, USA
| | - Nirav Chauhan
- Division of Vascular and Interventional Radiology, Department of Radiology, Rutgers - New Jersey Medical School, Newark, NJ, USA
| | - Humza Haque
- Division of Vascular and Interventional Radiology, Department of Radiology, Rutgers - New Jersey Medical School, Newark, NJ, USA
| | - Abhishek Kumar
- Division of Vascular and Interventional Radiology, Department of Radiology, Rutgers - New Jersey Medical School, Newark, NJ, USA
| | - Pratik A Shukla
- Division of Vascular and Interventional Radiology, Department of Radiology, Rutgers - New Jersey Medical School, Newark, NJ, USA
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Moya-Rodríguez A, Xie B, Cook D, Klineberg M, Nathan S, Hammes M, Basu A. Creating patient-specific vein models to characterize wall shear stress in hemodialysis population. Comput Struct Biotechnol J 2022; 20:5729-5739. [PMID: 36382195 PMCID: PMC9619312 DOI: 10.1016/j.csbj.2022.10.010] [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: 07/28/2022] [Revised: 10/04/2022] [Accepted: 10/04/2022] [Indexed: 12/05/2022] Open
Abstract
End-Stage Renal Disease (ESRD) patients require arteriovenous fistulas (AVF) that allow a mature vein to withstand hemodialysis. Unfortunately, venous thrombosis and stenosis in the cephalic vein arch after AVF placement is common and heavily influenced by hemodynamics. To better assess forces and flow behavior in the cephalic arch, we have built patient-specific millifluidic models that allow us to explore the complex interplay between patient-specific vein geometry and fluctuating hemodynamics. These 3D models were created from patient-specific intravascular ultrasound and venogram images obtained three- and twelve-months post AVF creation and fabricated into soft elastomer-based millifluidic devices. Geometric validation of fabricated phantom millifluidic device shows successful replication of original computational 3D model. Millifluidic devices were perfused with a blood-mimicking fluid containing fluorescent tracer beads under steady-state physiologic cephalic vein flow conditions (20 mL/min). Particle image velocimetry was employed to calculate wall shear stress (WSS) across the cephalic arches. Experimental WSS profile evaluation reveals that the physiologic cephalic arch model yields WSS values within physiologic range [76–760 mPa]. Moreover, upon comparing WSS profiles across all models, it is noticeable that WSS values increase as vein diameter decreases, which further supports employed experimental and analysis strategy. The presented millifluidic devices show promise for experimental WSS characterization under pathologic flow conditions to contrast from calculated physiologic hemodynamics and better understand WSS influence on thrombosis and stenosis in hemodialysis patients.
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Ullah K, Bashir M, Ain NU, Sarfraz A, Sarfraz Z, Sarfraz M, Cherrez-Ojeda I. Medical Adjuvant Therapy in Reducing Thrombosis With Arteriovenous Grafts and Fistulae Use: A Meta-Analysis of Randomized Controlled Trials. Clin Appl Thromb Hemost 2021; 27:10760296211063882. [PMID: 34873965 PMCID: PMC8655473 DOI: 10.1177/10760296211063882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Hemodialysis is required for patients with end-stage renal disease (ESRD) that require arteriovenous (AV) grafts or fistulas for vascular access. These access points are prone to thrombosis. To determine the effect of medical adjuvant therapy on AV graft/fistula patency among patients with ESRD on hemodialysis. Adhering to the PRISMA 2020 statement, a systematic search was conducted until August 20, 2021, with keywords including arteriovenous graft, fistula, patency, thrombosis, hemodialysis, adjuvant treatment. The following databases were searched: PubMed, Scopus, Web of Science, CINAHL Plus, and Cochrane. A random-effects model was employed using Review Manager 5.4 for data analysis. The meta-analysis pooled in 1985 participants with 1000 (50.4%) in the medical adjuvant treatment group. At a snapshot, medical adjuvant therapy reduced the risk for graft thrombosis (RR = 0.64, P = .02). Notable medications included aspirin for graft thrombosis (RR = 0.36, P = .006) and ticlopidine for fistula thrombosis (RR = 0.53, P = .01). Certain antiplatelet therapies (aspirin and ticlopidine) reduced the number of patients with AV fistula/graft thrombosis among patients with high heterogeneity among the trials. Other therapies (fish oil, sulfinpyrazone, clopidogrel, and aspirin/dipyridamole) did not demonstrate significant improvement but may be promising once concrete evidence is available. Potential benefits of anti-platelet therapies may be explored to maintain the potency of AV grafts/fistulas through well-designed placebo-controlled trials and long-term follow-up.
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Affiliation(s)
- Kaleem Ullah
- 194774Independent Medical College Faisalabad, Faislabad, Pakistan
| | - Maham Bashir
- 429580Gujranwala Medical College, Gujranwala, Pakistan
| | - Noor Ul Ain
- 194774Independent Medical College Faisalabad, Faislabad, Pakistan
| | | | | | - Muzna Sarfraz
- 66886King Edward Medical University, Lahore, Pakistan
| | - Ivan Cherrez-Ojeda
- 27890Universidad Espíritu Santo, Samborondón, Ecuador.,Respiralab Research Center, Guayaquil, Ecuador
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21
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Jeon JW, Kim HR, Lee E, Lee JI, Ham YR, Na KR, Lee KW, Kim JJ, Choi DE. Effect of cilostazol on arteriovenous fistula in hemodialysis patients. Nefrologia 2021; 41:625-631. [PMID: 36165152 DOI: 10.1016/j.nefroe.2022.01.006] [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: 08/08/2020] [Accepted: 12/02/2020] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND The maturation and patency of permanent vascular access are critical in patients requiring hemodialysis. Although numerus trials have been attempted to achieve permanently patent vascular access, little have been noticeable. Cilostazol, a phosphodiesterase-3 inhibitor, has been shown to be effective in peripheral arterial disease including vascular injury-induced intimal hyperplasia. We therefore aimed to determine the effect of cilostazol on the patency and maturation of permanent vascular access. METHODS This single-center, retrospective study included 194 patients who underwent arteriovenous fistula surgery to compare vascular complications between the cilostazol (n=107) and control (n=87) groups. RESULTS The rate of vascular complications was lower in the cilostazol group than in the control group (36.4% vs. 51.7%; p=0.033), including maturation failure (2.8% vs. 11.5%; p=0.016). The rate of reoperation due to vascular injury after hemodialysis initiation following fistula maturation was also significantly lower in the cilostazol group than in the control group (7.5% vs. 28.7%; p<0.001). However, there were no significant differences in the requirement for percutaneous transluminal angioplasty (PTA), rate of PTA, and the interval from arteriovenous fistula surgery to PTA between the cilostazol and control groups. CONCLUSION Cilostazol might be beneficial for the maturation of permanent vascular access in patients requiring hemodialysis.
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Affiliation(s)
- Jae Wan Jeon
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea; Department of Nephrology, Chungnam National University Sejong Hospital, Sejong, Republic of Korea
| | - Hae Ri Kim
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea; Department of Nephrology, Chungnam National University Sejong Hospital, Sejong, Republic of Korea
| | - Eujin Lee
- Department of Nephrology, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Jong In Lee
- Department of Nephrology, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Young Rok Ham
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea; Department of Nephrology, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Ki Ryang Na
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea; Department of Nephrology, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Kang Wook Lee
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea; Department of Nephrology, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Jwa-Jin Kim
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Dae Eun Choi
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea; Department of Nephrology, Chungnam National University Hospital, Daejeon, Republic of Korea.
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22
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Fedorova E, Zhang GQ, Shireman PK, Woo K, Hicks CW. Association of preoperative vein mapping with hemodialysis access characteristics and outcomes in the Vascular Quality Initiative. J Vasc Surg 2021; 75:1395-1402.e5. [PMID: 34718099 DOI: 10.1016/j.jvs.2021.10.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 10/13/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Preoperative vein mapping before arteriovenous fistula (AVF) or arteriovenous graft (AVG) placement has been debated as a possible method of improving hemodialysis access outcomes for patients. However, high-quality national studies that have addressed this relationship are lacking. Thus, we assessed the association of preoperative vein mapping with hemodialysis access configuration and outcomes. METHODS In the present cohort study, we analyzed all patients who had undergone AVF or AVG placement with data captured in the Vascular Quality Initiative hemodialysis access dataset from August 2011 to September 2019. The patients were stratified by whether they had undergone preoperative vein mapping. The primary (configuration) outcomes were access type (AVF vs AVG) and location (upper arm vs forearm). The secondary (longitudinal) outcomes were the successful initiation of hemodialysis, maintenance of secondary patency, and the need for reintervention 1 year after the index operation. RESULTS Overall, 85.6% of the 46,010 included patients had undergone preoperative vein mapping. Of the 46,010 patients, 76.1% and 23.9% had undergone AVF and AVG creation, respectively. AVF creation (77.6% vs 67.3%) and forearm location (54.6% vs 47.3%) were more frequent for the patients who had undergone preoperative vein mapping than for those who had not (P < .001). After adjusting for baseline differences between the groups, preoperative vein mapping was associated with increased odds of receiving an AVF vs AVG (adjusted odds ratio, 1.64; 95% confidence interval [CI], 1.55-1.75) and forearm vs upper arm access (adjusted odds ratio, 1.22; 95% CI, 1.16-1.30). The incidence of the loss of secondary patency was lower for patients with preoperative vein mapping (P < .001), and persisted after risk adjustment (adjusted hazard ratio, 0.81; 95% CI, 0.75-0.88). CONCLUSIONS Preoperative vein mapping was associated with favorable hemodialysis access configurations and outcomes in real-world practice. These data suggest that the use of preoperative vein mapping could improve the likelihood of favorable outcomes for patients requiring hemodialysis access.
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Affiliation(s)
| | - George Q Zhang
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Md
| | - Paula K Shireman
- Department of Surgery, Long School of Medicine, University of Texas Health San Antonio, University Health System, and South Texas Veterans Health Care System, San Antonio, Tex
| | - Karen Woo
- Division of Vascular Surgery, Department of Surgery, University of California, David Geffen School of Medicine, Los Angeles, Los Angeles, Calif
| | - Caitlin W Hicks
- Division of Vascular Surgery and Endovascular Therapy, The Johns Hopkins University School of Medicine, Baltimore, Md; Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Md.
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23
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Jeon JW, Kim HR, Lee E, Lee JI, Ham YR, Na KR, Lee KW, Kim JJ, Choi DE. Effect of cilostazol on arteriovenous fistula in hemodialysis patients. Nefrologia 2021; 41:S0211-6995(21)00060-6. [PMID: 33985859 DOI: 10.1016/j.nefro.2020.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND The maturation and patency of permanent vascular access are critical in patients requiring hemodialysis. Although numerus trials have been attempted to achieve permanently patent vascular access, little have been noticeable. Cilostazol, a phosphodiesterase-3 inhibitor, has been shown to be effective in peripheral arterial disease including vascular injury-induced intimal hyperplasia. We therefore aimed to determine the effect of cilostazol on the patency and maturation of permanent vascular access. METHODS This single-center, retrospective study included 194 patients who underwent arteriovenous fistula surgery to compare vascular complications between the cilostazol (n=107) and control (n=87) groups. RESULTS The rate of vascular complications was lower in the cilostazol group than in the control group (36.4% vs. 51.7%; p=0.033), including maturation failure (2.8% vs. 11.5%; p=0.016). The rate of reoperation due to vascular injury after hemodialysis initiation following fistula maturation was also significantly lower in the cilostazol group than in the control group (7.5% vs. 28.7%; p<0.001). However, there were no significant differences in the requirement for percutaneous transluminal angioplasty (PTA), rate of PTA, and the interval from arteriovenous fistula surgery to PTA between the cilostazol and control groups. CONCLUSION Cilostazol might be beneficial for the maturation of permanent vascular access in patients requiring hemodialysis.
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Affiliation(s)
- Jae Wan Jeon
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea; Department of Nephrology, Chungnam National University Sejong Hospital, Sejong, Republic of Korea
| | - Hae Ri Kim
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea; Department of Nephrology, Chungnam National University Sejong Hospital, Sejong, Republic of Korea
| | - Eujin Lee
- Department of Nephrology, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Jong In Lee
- Department of Nephrology, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Young Rok Ham
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea; Department of Nephrology, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Ki Ryang Na
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea; Department of Nephrology, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Kang Wook Lee
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea; Department of Nephrology, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Jwa-Jin Kim
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Dae Eun Choi
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea; Department of Nephrology, Chungnam National University Hospital, Daejeon, Republic of Korea.
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24
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Manov JJ, Mohan PP, Vazquez-Padron R. Arteriovenous fistulas for hemodialysis: Brief review and current problems. J Vasc Access 2021; 23:839-846. [PMID: 33818180 DOI: 10.1177/11297298211007720] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The number of people worldwide living with end-stage renal disease is increasing. Arteriovenous fistulas are the preferred method of vascular access in patients who will require hemodialysis. As the number of patients with arteriovenous fistulas grows, the role of physicians who intervene who maintain and salvage these fistulas will grow in importance. This review aims to familiarize practitioners with the rationale for arteriovenous fistula creation, the detection of fistula dysfunction, and the state of the art on fistula maintenance and preservation. Current controversies are briefly reviewed.
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Affiliation(s)
- John J Manov
- Department of Radiology, University of Miami, Miami, FL, USA
| | - Prasoon P Mohan
- Department of Interventional Radiology, University of Miami, Miami, FL, USA
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25
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Kliuk-Ben Bassat O, Schwartz D, Zubkov A, Gal-Oz A, Gorevoy A, Romach I, Grupper A. WoundClot® Hemostatic Gauze Reduces Bleeding Time after Arterial Venous Fistula Decannulation. Blood Purif 2021; 50:952-958. [PMID: 33789264 DOI: 10.1159/000514934] [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: 10/12/2020] [Accepted: 02/01/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Decannulation of the arteriovenous fistula (AVF) after each hemodialysis session requires a precise compression on the needle puncture site. The objective of our study was to evaluate the bleeding time (BT) needed to achieve hemostasis using WoundClot, an innovative hemostatic gauze, and to assess whether its long-term use can improve AVF preservation. METHODS This is a prospective single center study. Initially, the time to hemostasis after AVF decannulation was compared between WoundClot and cotton gauze in 24 prevalent hemodialysis patients. Thereafter, the patients continued to use WoundClot for 12 months and were compared to a control group consisting of 25 patients using regular cotton gauze. Follow-up data included parameters of dialysis adequacy, AVF interventions, and thrombotic events. RESULTS WoundClot use shortened significantly the time needed for hemostasis. Mean venous BT decreased by 3.99 (±4.6) min and mean arterial BT by 6.38 (±4.8) min when using WoundClot compared to cotton gauze (p < 0.001). At the end of the study, dialysis adequacy expressed by spKt/V was higher in the WoundClot group compared to control (1.73 vs. 1.53, respectively, p = 0.047). Although patients in WoundClot group had a higher baseline BT, arterial and venous pressures did not differ between the groups after a median follow up of 10.8 months. AVF thrombosis rate was similar between the groups. CONCLUSIONS WoundClot hemostatic gauze significantly reduced the time required for hemostasis after AVF decannulation and may be associated with better AVF preservation. We suggest using WoundClot for arterial BT longer than 15 min and for venous BT longer than 12.5 min.
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Affiliation(s)
- Orit Kliuk-Ben Bassat
- Department of Nephrology, Tel Aviv Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Doron Schwartz
- Department of Nephrology, Tel Aviv Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Zubkov
- Department of Nephrology, Tel Aviv Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Gal-Oz
- Department of Intensive Care, Tel Aviv Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Gorevoy
- Department of Nephrology, Tel Aviv Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Iris Romach
- Department of Nephrology, Tel Aviv Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ayelet Grupper
- Department of Nephrology, Tel Aviv Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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26
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Noninvasive thrombectomy of graft by nano-magnetic ablating particles. Sci Rep 2021; 11:7004. [PMID: 33772062 PMCID: PMC7998024 DOI: 10.1038/s41598-021-86291-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 03/09/2021] [Indexed: 01/28/2023] Open
Abstract
Artificial vascular treatment is an emerging interdisciplinary subject of medicine. Although the use of artificial vessels has led to many successful advancements, blood clotting remains a major challenge, especially in terms of mural clots created along the vessel wall that do not completely block the vessel. The main objective of this study is to present a method for declotting artificial vessels. This research introduces a novel thrombectomy technique in artificial vessels by employing nano-magnetic particles under a rotating magnetic field to remove mural clots in artificial vessels. A mathematical model describes the relationship between process parameters. In vitro tests confirm the feasibility of nano-magnetic thrombectomy in cleaning and declotting artificial vessels. The results show that the clot fragments are nano-sized, which eliminates the risk of distal emboli as a concern of using current atherectomy techniques. Meanwhile, no damage to the artificial vessels is observed. The results show that the frequency of rotating the magnetic field has the greatest effect on clot removal. The conceptual principles stated in this study also have the potential to be used in other vascular depositions, such as the accumulation of lipids, and calcification atherosclerosis.
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27
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Gubensek J, Avgustin-Rotar N, Premru V. Arteriovenous graft rethrombosis advancing to deep vein thrombosis and pulmonary embolism in the presence of superior vena cava stenosis: A case report. Ther Apher Dial 2021; 25:364-366. [PMID: 33448649 DOI: 10.1111/1744-9987.13579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Jakob Gubensek
- Department of Nephrology, University Medical Center Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Nusa Avgustin-Rotar
- Department of Nephrology, University Medical Center Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Vladimir Premru
- Department of Nephrology, University Medical Center Ljubljana, Ljubljana, Slovenia
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28
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Lee HY, Kim CS, Han KD, Kim MJ. Comparison of the Clinical Outcomes between Angiojet Pharmacomechanical Thrombectomy and Hybrid Surgical Thrombectomy for Thrombotic Occlusion of Hemodialysis Access. Vasc Specialist Int 2020; 36:241-247. [PMID: 33335080 PMCID: PMC7790690 DOI: 10.5758/vsi.200052] [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: 07/31/2020] [Revised: 10/19/2020] [Accepted: 11/19/2020] [Indexed: 11/20/2022] Open
Abstract
Purpose This retrospective study aimed to compare the clinical outcomes between hybrid surgical thrombectomy (ST) and AngioJet pharmacomechanical thrombectomy (PMT) for thrombotic occlusion of arteriovenous graft. Materials and Methods This study enrolled patients who underwent either hybrid ST or AngioJet PMT in Presbyterian Medical Center from July 2018 to December 2018. We primarily compared the technical and clinical success rates between the two groups immediately after the procedures. Subsequently, the postprocedure clinical outcomes, including the primary and secondary patency rates and complications, were also compared. Results The hybrid ST group had a significantly higher bleeding amount than the AngioJet PMT group (P=0.02). The technical and clinical success rates were 96.7% and 93.3% in the AngioJet PMT group and 100% and 100% in the hybrid ST group, respectively. There was no significant difference in complications between the groups. The primary and secondary patencies at 12 months were not statistically different between the groups. Conclusion Comparable clinical outcomes were observed between the AngioJet PMT and hybrid ST groups, highlighting an equivalent efficacy of these two methods. Although the cost is more expensive, AngioJet PMT lowered the bleeding amount. Therefore, it can be considered in selected patients who are at risk of bleeding or reluctant to surgery.
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Affiliation(s)
- Ho Yeong Lee
- Division of Vascular Surgery, Department of Surgery, Presbyterian Medical Center, Jeonju, Korea
| | - Cheol Seung Kim
- Division of Vascular Surgery, Department of Surgery, Presbyterian Medical Center, Jeonju, Korea
| | - Kyu Dam Han
- Division of Vascular Surgery, Department of Surgery, Presbyterian Medical Center, Jeonju, Korea
| | - Mi Jin Kim
- Division of Vascular Surgery, Department of Surgery, Presbyterian Medical Center, Jeonju, Korea
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29
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Tan RY, Pang SC, Tng ARK, Ng HJ, Teh SP, Tan SG, Tang TY, Foo MWY, Gogna A, Chong TT, Tan CS. Effect of short-term low molecular weight heparin on patency following successful salvage of arteriovenous access with recurrent thrombosis. Nephrology (Carlton) 2020; 26:350-357. [PMID: 33207041 DOI: 10.1111/nep.13834] [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: 04/19/2020] [Revised: 11/01/2020] [Accepted: 11/11/2020] [Indexed: 11/26/2022]
Abstract
AIM This study aims to investigate the effect of low molecular weight heparin (LMWH) in maintaining the patency of arteriovenous (AV) access with recurrent thrombosis. METHODS Following successful thrombectomy, 66 patients with recurrent thrombosis were included in the study. The primary, assisted primary and secondary patency rates of patients who received LMWH (n = 24) were compared with those who did not receive anticoagulant (n = 42) using Kaplan-Meier analysis. Cox-regression analysis was performed to investigate potential predictors of patency rates. RESULTS The mean dose of enoxaparin used was 40 ± 13.1 mg or 0.74 ± 0.2 mg/kg daily for a median duration of 14 (IQR 7,28) days. The mean trough anti-Xa concentrations measured after two doses of LMWH was 0.17 ± 0.13 IU/mL. Kaplan-Meier analyses for mean primary, assisted primary and secondary patency rates of LMWH vs no anticoagulation groups were 149 (95% CI: 91 - 207) vs 87 (95% CI: 42-132) days (P < .006), 230 (95% CI: 142-320) vs 107 (95% CI: 62-150) days (P = .01) and 438 (299-579) vs 294 (95% CI: 197-392) days (P = .08) respectively. LMWH remained a significant protective predictor of primary (HR: 0.49; 95% CI: 0.25-0.86; P = .02) and assisted primary patency rates (HR: 0.51; 95% CI: 0.27-0.98; P = .04) after adjusting for patient age, access age, type of AV access, presence of peripheral vascular disease and haemoglobin levels. CONCLUSION LMWH may improve short and mid-term patency rates for AV accesses with recurrent thrombosis.
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Affiliation(s)
- Ru Yu Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Suh Chien Pang
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | | | - Heng Joo Ng
- Department of Haematology, Singapore General Hospital, Singapore
| | - Swee Ping Teh
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Seck Guan Tan
- Department of Vascular Surgery, Singapore General Hospital, Singapore
| | - Tjun Yip Tang
- Department of Vascular Surgery, Singapore General Hospital, Singapore
| | | | - Apoorva Gogna
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - Tze Tec Chong
- Department of Vascular Surgery, Singapore General Hospital, Singapore
| | - Chieh Suai Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore
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30
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Parada G, Yu Y, Riley W, Lojovich S, Tshikudi D, Ling Q, Zhang Y, Wang J, Ling L, Yang Y, Nadkarni S, Nabzdyk C, Zhao X. Ultrathin and Robust Hydrogel Coatings on Cardiovascular Medical Devices to Mitigate Thromboembolic and Infectious Complications. Adv Healthc Mater 2020; 9:e2001116. [PMID: 32940970 DOI: 10.1002/adhm.202001116] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/21/2020] [Indexed: 01/10/2023]
Abstract
Thromboembolic and infectious complications stemming from the use of cardiovascular medical devices are still common and result in significant morbidity and mortality. There is no strategy to date that effectively addresses both challenges at the same time. Various surface modification strategies (e.g., silver, heparin, and liquid-impregnated surfaces) are proposed yet each has several limitations and shortcomings. Here, it is shown that the incorporation of an ultrathin and mechanically robust hydrogel layer reduces bacterial adhesion to medical-grade tubing by 95%. It is additionally demonstrated, through a combination of in vitro and in vivo tests, that the hydrogel layer significantly reduces the formation and adhesion of blood clots to the tubing without affecting the blood's intrinsic clotting ability. The adhesion of clots to the tubing walls is reduced by over 90% (in vitro model), which results in an ≈60% increase in the device occlusion time (time before closure due to clot formation) in an in vivo porcine model. The advantageous properties of this passive coating make it a promising surface material candidate for medical devices interfacing with blood.
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Affiliation(s)
- German Parada
- Chemical Engineering Department Massachusetts Institute of Technology Cambridge MA 02139 USA
- Mechanical Engineering Department Massachusetts Institute of Technology Cambridge MA 02139 USA
| | - Yan Yu
- Mechanical Engineering Department Massachusetts Institute of Technology Cambridge MA 02139 USA
- School of Optical and Electronic Information Huazhong University of Science and Technology Wuhan Hubei 430064 China
| | - William Riley
- Perfusion Services Massachusetts General Hospital Boston MA 02114 USA
| | - Sarah Lojovich
- Perfusion Services Massachusetts General Hospital Boston MA 02114 USA
| | - Diane Tshikudi
- Wellman Center for Photomedicine Massachusetts General Hospital Boston MA 02114 USA
| | - Qing Ling
- Tongji Medical School Huazhong University of Science and Technology Wuhan Hubei 430064 China
| | - Yefang Zhang
- Tongji Medical School Huazhong University of Science and Technology Wuhan Hubei 430064 China
| | - Jiaxin Wang
- Tongji Medical School Huazhong University of Science and Technology Wuhan Hubei 430064 China
| | - Lei Ling
- Tongji Medical School Huazhong University of Science and Technology Wuhan Hubei 430064 China
| | - Yueying Yang
- Mechanical Engineering Department Massachusetts Institute of Technology Cambridge MA 02139 USA
- School of Optical and Electronic Information Huazhong University of Science and Technology Wuhan Hubei 430064 China
| | - Seemantini Nadkarni
- Wellman Center for Photomedicine Massachusetts General Hospital Boston MA 02114 USA
| | - Christoph Nabzdyk
- Department of Anesthesia Critical Care and Pain Medicine Massachusetts General Hospital Boston MA 02114 USA
- Department of Anesthesiology and Perioperative Medicine Mayo Clinic Rochester Rochester MN 55902 USA
| | - Xuanhe Zhao
- Mechanical Engineering Department Massachusetts Institute of Technology Cambridge MA 02139 USA
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31
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A Multicenter Randomized Clinical Trial of Hemodialysis Access Blood Flow Surveillance Compared to Standard of Care: The Hemodialysis Access Surveillance Evaluation (HASE) Study. Kidney Int Rep 2020; 5:1937-1944. [PMID: 33163714 PMCID: PMC7609971 DOI: 10.1016/j.ekir.2020.07.034] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/24/2020] [Accepted: 07/29/2020] [Indexed: 11/20/2022] Open
Abstract
Introduction Arteriovenous (AV) access thrombosis remains 1 of the most troubling AV access–related complications affecting hemodialysis patients. It necessitates an urgent and occasionally complicated thrombectomy procedure and increases the risk of AV access loss. AV access stenosis is found in the majority of thrombosed AV accesses. The routine use of AV access surveillance for the early detection and management of stenosis to reduce the thrombosis rate remains controversial. Methods We have conducted a multicenter, prospective, randomized clinical trial comparing the standard of care coupled with ultrasound dilution technique (UDT) flow measurement monthly surveillance with the standard of care alone. Results We prospectively randomized 436 patients with end-stage renal disease on hemodialysis with arteriovenous fistula (AVF) or arteriovenous graft (AVG) using cluster (shift) randomization to surveillance and control groups. There were no significant differences in the baseline demographic data between the 2 groups, except for ethnicity (P = 0.017). Patients were followed on average for 15.2 months. There were significantly less per-patient thrombotic events (Poisson rate) in the surveillance group (0.12/patient) compared with the control group (0.23/patient) (P = 0.012). There was no statistically significant difference in the total number of procedures between the 2 groups, irrespective of whether thrombectomy procedures were included or excluded, and no statistically significant differences in the rate of or time to the first thrombotic event or the number of catheters placed due to thrombosis. Conclusion The use of UDT flow measurement monthly AV access surveillance in this multicenter randomized controlled trial reduced the per-patient thrombotic events without significantly increasing the total number of angiographic procedures. Even though there is a trend, surveillance did not reduce the first thrombotic event rate.
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deFreitas D, Moss J. Innominate vein stenosis causing raised intracranial pressure and blindness. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:282-284. [PMID: 32548364 PMCID: PMC7283974 DOI: 10.1016/j.jvscit.2018.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 04/11/2018] [Indexed: 11/02/2022]
Abstract
Central venous stenosis causing elevated intracranial pressure is a rare and potentially reversible cause of blindness in patients undergoing hemodialysis. We present the case of a 69-year-old man with progressive vision loss and raised intracranial pressure that was successfully treated with an innominate vein stent.
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Affiliation(s)
- Dorian deFreitas
- Department of Vascular and Endovascular Surgery, UNC Rex Hospital, Raleigh, NC
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Structure-guided design of pure orthosteric inhibitors of αIIbβ3 that prevent thrombosis but preserve hemostasis. Nat Commun 2020; 11:398. [PMID: 31964886 PMCID: PMC6972956 DOI: 10.1038/s41467-019-13928-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 12/06/2019] [Indexed: 02/07/2023] Open
Abstract
A prevailing dogma is that inhibition of vascular thrombosis by antagonizing platelet integrin αIIbβ3 cannot be achieved without compromising hemostasis, thus causing serious bleeding and increased morbidity and mortality. It is speculated that these adverse outcomes result from drug-induced activating conformational changes in αIIbβ3 but direct proof is lacking. Here, we report the structure-guided design of peptide Hr10 and a modified form of the partial agonist drug tirofiban that act as "pure" antagonists of αIIbβ3, i.e., they no longer induce the conformational changes in αIIbβ3. Both agents inhibit human platelet aggregation but preserve clot retraction. Hr10 and modified tirofiban are as effective as partial agonist drugs in inhibiting vascular thrombosis in humanized mice, but neither causes serious bleeding, establishing a causal link between partial agonism and impaired hemostasis. Pure orthosteric inhibitors of αIIbβ3 may thus provide safer alternatives for human therapy, and valuable tools to probe structure-activity relationships in integrins.
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Piacentino F, Coppola A, Zaghetto A, Macchi E, De Marchi G, Ossola C, Zorzetto G, Beneventi A, Casamassima N, Tagliaferri C, Tozzi M, Piffaretti G, Fontana F, Genovese EA. Vacuum-assisted mechanical thrombectomy in extensively occlusive thrombosis of dialysis arteriovenous grafts with indigo system. J Vasc Access 2020; 21:673-679. [PMID: 31928304 DOI: 10.1177/1129729819899264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To present a selected series of extensively occlusive thrombosis of arteriovenous graft treated with the Penumbra's Indigo System. MATERIALS AND METHODS Ten patients with acute (within 72 h) extensively occlusive thrombosis of arteriovenous graft (mean extension = 30.1 (range = 15-45) cm) were treated at our institution with the Indigo System. Of the 10 cases, thrombosis was extended to venous outflow in 7 cases and to both arterial inflow and venous outflow in 3 cases. RESULTS Both anatomic and clinical success were achieved in 8 of the 10 procedures (80.0%). In the 2 cases of technical failure, the patients underwent surgical thrombectomy with the finding of arteriovenous graft exhaustion, which was then replaced. The 6-month primary patency, primary-assisted patency, and secondary patency rates were 37.5% (3/8), 50.0% (4/8), and 62.5% (5/8). We reported 2 complications (one minor and one major adverse event). CONCLUSION Percutaneous mechanical thrombectomy aspiration with Indigo System is a relatively safe and effective procedure and can be used even in extensively thrombosed arteriovenous graft.
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Affiliation(s)
- Filippo Piacentino
- Department of Diagnostic and Interventional Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Andrea Coppola
- Department of Diagnostic and Interventional Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Andrea Zaghetto
- Department of Diagnostic and Interventional Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Edoardo Macchi
- Department of Diagnostic and Interventional Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Giuseppe De Marchi
- Department of Diagnostic and Interventional Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Christian Ossola
- Department of Diagnostic and Interventional Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Giada Zorzetto
- Department of Diagnostic and Interventional Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Alessandro Beneventi
- Department of Diagnostic and Interventional Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Nicola Casamassima
- Department of Diagnostic and Interventional Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Chiara Tagliaferri
- Department of Diagnostic and Interventional Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Matteo Tozzi
- Department of Vascular Surgery, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Gabriele Piffaretti
- Department of Vascular Surgery, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Federico Fontana
- Department of Diagnostic and Interventional Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Eugenio Annibale Genovese
- Department of Diagnostic and Interventional Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
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Chang JT, Li IH, Shih JH, Chien WC, Pan KT, Wu ST, Tsai CS, Kao LT. Health Care Service Utilization After Various Vascular Access Selections. J Surg Res 2019; 244:166-173. [DOI: 10.1016/j.jss.2019.06.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 06/05/2019] [Accepted: 06/11/2019] [Indexed: 12/17/2022]
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Gjorgjievski N, Dzekova-Vidimliski P. Primary antiphospholipid syndrome in a hemodialysis patient with recurrent thrombosis of arteriovenous fistulas. J Bras Nefrol 2019; 42:259-263. [PMID: 31419276 PMCID: PMC7427640 DOI: 10.1590/2175-8239-jbn-2019-0081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 05/27/2019] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The antiphospholipid syndrome is a systemic autoimmune disease defined by recurrent vascular and/or obstetrical morbidity that occurs in patients with persistent antiphospholipid antibodies. CASE PRESENTATION A patient on hemodialysis with a primary antiphospholipid syndrome presented with recurrent vascular access thrombosis, obstetrical complications, and positive lupus anticoagulant. The patient had multiple arteriovenous fistulas that failed due to thrombosis. The obstetrical morbidity was defined by one miscarriage at the 7th week of gestation and a pregnancy complicated by pre-eclampsia with preterm delivery at the 28th week of gestation. A thorough thrombophilia screening confirmed the presence of antiphospholipid antibody. Lupus anticoagulant was present in plasma, measured on two occasions 12 weeks apart. CONCLUSION Thrombophilias are inherited or acquired predispositions to vascular thrombosis and have been associated with thrombosis of the arteriovenous fistula. Patients on hemodialysis with recurrent vascular access thrombosis and presence of thrombophilia should be evaluated about the need for anticoagulant therapy with a vitamin K antagonist.
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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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Ko DS, Choi ST, Lee WS, Chun YS, Park YH, Kang JM. Comparison of Outcomes of Hybrid and Surgical Correction for De Novo Arteriovenous Graft Occlusion. Vasc Specialist Int 2019; 34:88-93. [PMID: 30671417 PMCID: PMC6340696 DOI: 10.5758/vsi.2018.34.4.88] [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: 07/15/2018] [Revised: 08/23/2018] [Accepted: 09/13/2018] [Indexed: 12/03/2022] Open
Abstract
Purpose This study aimed to compare surgical revisions and balloon angioplasty after surgical thrombectomy on thrombosed dialysis access as a first event. Materials and Methods Records of patients undergoing creation of arteriovenous grafts (AVGs) at the Gachon University Gil Medical Center between March 2008 and February 2016 were reviewed. Among them, patients who underwent treatment on first-time thrombotic occlusion after AVG creation were identified. Outcomes were primary, primary-assisted, and secondary patency. The patency was generated using the Kaplan-Meier method, and patency rates were compared by log-rank test. Results A total of 59 de novo interventions (n=26, hybrid interventions; n=33, surgical revisions) for occlusive AVGs were identified. The estimated 1-year primary patency rates were 47% and 30% in the surgery and hybrid groups, respectively. The estimated primary patency rates were not different between the two groups (log-rank test, P=0.73). The Kaplan-Meier estimates of 6 and 12 months for primary-assisted patency rates were 68% and 57% in the surgery group and 56% and 56% in the hybrid group. The Kaplan-Meier estimates of 12 and 24 months secondary patency rates were 90% and 71% in the surgery group and 79% and 62% in the hybrid group. There were no differences in the estimated primary-assisted and secondary patency rates between the two groups. Conclusion Our results showed no significant difference between the two groups in terms of primary patency (P=0.73), primary-assisted patency (P=0.85), and secondary patency (P=0.78). However, percutaneous transluminal angioplasty can give more therapeutic options for both surgeons and patients.
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Affiliation(s)
- Dai Sik Ko
- Division of Vascular Surgery, Department of Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Sang Tae Choi
- Division of Vascular Surgery, Department of Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Won Suk Lee
- Division of Vascular Surgery, Department of Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Yong Soon Chun
- Division of Vascular Surgery, Department of Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Yeon Ho Park
- Division of Vascular Surgery, Department of Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Jin Mo Kang
- Division of Vascular Surgery, Department of Surgery, Gachon University Gil Medical Center, Incheon, Korea
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