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Liu W, Wu M, Wang X, Huang XK, Cai WJ, Ding TY, Duan LL, Qiao R, Wu YG. Recanalization of thrombosed aneurysmal hemodialysis arterovenous fistulas using a hybrid technique based on data from a single center. BMC Nephrol 2022; 23:185. [PMID: 35568810 PMCID: PMC9107707 DOI: 10.1186/s12882-022-02820-9] [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: 02/05/2022] [Accepted: 05/10/2022] [Indexed: 11/19/2022] Open
Abstract
Objective To explore the technical specifications and clinical outcomes of thrombosed aneurysmal haemodialysis arteriovenous fistula (AVF) treated with ultrasound-guided percutaneous transluminal angioplasty combined with minimal aneurysmotomy. Methods This case series study included 11 patients who had thrombosed aneurysmal AVF and underwent salvage procedures over a 13-month period. All procedures were performed under duplex guidance. Minimal aneurysmotomy was performed, along with manual thrombectomy and thrombolytic agent infusion, followed by angioplasty to macerate the thrombus and sufficiently dilate potential stenoses. A successful procedure was defined as immediate restoration of flow through the AVF. Results The 11 patients (four males and seven females) had a mean age of 49.6 years ± 11.9 years. Six patients (54.5%) had two or more aneurysms. The mean aneurysm maximal diameter was 21.5 mm (standard deviation: ± 5.0 mm), and the mean thrombus length was 12.9 cm (8–22 cm). Ten (83.3%) of the 12 procedures were technically successful. The mean duration of operation was 150.9 minutes (standard deviation: ± 34.2 minutes), and mean postoperative AVF blood flow was 728.6 ml/min (standard deviation: ± 53.7 mi/min). The resumption of hemodialysis was successful in all 11 cases, with a clinical success rate of 100%. The primary patency rates were 90.0% and 75.0% at three and four months over a mean follow-up time of 6.3 months (3–12 months). The secondary patency rates were 90.4% at three and four months. Conclusion A hybrid approach combining ultrasound-guided percutaneous transluminal angioplasty and minimal aneurysmotomy might be a safe and effective method for thrombosed aneurysmal AVF salvage.
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Affiliation(s)
- Wei Liu
- Department of Nephropathy, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, P.R. China.,Department of Nephropathy, Anqing Municipal Hospital, Anqing, Anhui, 246000, P.R. China
| | - Meng Wu
- Department of Nephropathy, Anqing Municipal Hospital, Anqing, Anhui, 246000, P.R. China
| | - Xu Wang
- Department of Nephropathy, Anqing Municipal Hospital, Anqing, Anhui, 246000, P.R. China
| | - Xiao-Kang Huang
- Department of Nephropathy, Anqing Municipal Hospital, Anqing, Anhui, 246000, P.R. China
| | - Wen-Jiao Cai
- Department of Nephropathy, Anqing Municipal Hospital, Anqing, Anhui, 246000, P.R. China
| | - Teng-Yun Ding
- Department of Ultrasonography, Anqing Municipal Hospital, Anqing, Anhui, 246000, P.R. China
| | - Liang-Liang Duan
- Department of Nephropathy, Anqing Municipal Hospital, Anqing, Anhui, 246000, P.R. China
| | - Rui Qiao
- Department of Cardiology, Anqing Municipal Hospital, Anqing, Anhui, 246000, P.R. China
| | - Yong-Gui Wu
- Department of Nephropathy, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, P.R. China. .,Center for Scientific Research, Anhui Medical University, Hefei, Anhui, 230022, P.R. China.
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Stegmayr B, Willems C, Groth T, Martins A, Neves NM, Mottaghy K, Remuzzi A, Walpoth B. Arteriovenous access in hemodialysis: A multidisciplinary perspective for future solutions. Int J Artif Organs 2020; 44:3-16. [PMID: 32438852 PMCID: PMC7780365 DOI: 10.1177/0391398820922231] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In hemodialysis, vascular access is a key issue. The preferred access is an arteriovenous fistula on the non-dominant lower arm. If the natural vessels are insufficient for such access, the insertion of a synthetic vascular graft between artery and vein is an option to construct an arteriovenous shunt for punctures. In emergency situations and especially in elderly with narrow and atherosclerotic vessels, a cuffed double-lumen catheter is placed in a larger vein for chronic use. The latter option constitutes a greater risk for infections while arteriovenous fistula and arteriovenous shunt can fail due to stenosis, thrombosis, or infections. This review will recapitulate the vast and interdisciplinary scenario that characterizes hemodialysis vascular access creation and function, since adequate access management must be based on knowledge of the state of the art and on future perspectives. We also discuss recent developments to improve arteriovenous fistula creation and patency, the blood compatibility of arteriovenous shunt, needs to avoid infections, and potential development of tissue engineering applications in hemodialysis vascular access. The ultimate goal is to spread more knowledge in a critical area of medicine that is importantly affecting medical costs of renal replacement therapies and patients’ quality of life.
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Affiliation(s)
- Bernd Stegmayr
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Christian Willems
- Department of Biomedical Materials, Institute of Pharmacy, Martin Luther University of Halle-Wittenberg, Halle, Germany
| | - Thomas Groth
- Department of Biomedical Materials, Institute of Pharmacy, Martin Luther University of Halle-Wittenberg, Halle, Germany.,Interdisciplinary Center of Material Research, Martin Luther University of Halle-Wittenberg, Halle, Germany
| | - Albino Martins
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics of University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark-Parque de Ciência e Tecnologia, Barco, Portugal
| | - Nuno M Neves
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics of University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark-Parque de Ciência e Tecnologia, Barco, Portugal
| | - Khosrow Mottaghy
- Department of Physiology, RWTH Aachen University, Aachen, Germany
| | | | - Beat Walpoth
- Department of Cardiovascular Surgery (Emeritus), University of Geneva, Geneva, Switzerland
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