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Bae M, Lee CW, Chung SW, Huh U, Kim J, Jeong H, Lee NH. Rejoining Veins for Forced Maturation of Small-Caliber Arteriovenous Fistula. Ann Vasc Surg 2024; 104:268-275. [PMID: 38583760 DOI: 10.1016/j.avsg.2024.01.007] [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: 09/06/2023] [Revised: 01/02/2024] [Accepted: 01/07/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND To evaluate the efficacy of rejoining mainstream and accessory veins for forced maturation of autogenous arteriovenous fistula (AVF). METHODS Twenty-three patients who underwent forced maturation through vein rejoining between January 2018 and September 2022 were included. In cases where AVF maturation failure due to the presence of accessory veins, rejoining was primarily considered when distinguishing the main branch becomes challenging. This difficulty typically occurs when the sizes of the 2 vessels are nearly equal and the combined diameters of these veins exceed 6 mm. RESULTS The mean age and follow-up duration were 57.39 ± 16.22 years and 965.65 ± 573.42 days, respectively. Rejoining of both arterial and venous cannulation sites was performed in 11 patients (47.8%), and rejoining of only the venous cannulation site or only the arterial cannulation site was performed in 11 patients (47.8%) and 1 patient (4.3%), respectively. The mean vein size was 0.35 ± 0.06 cm before rejoining and 0.69 ± 0.07 cm after surgery, indicating a significant increase in size (P < 0.01), whereas the flow did not change significantly following rejoining surgery. Maturation and cannulation success was 100%. The 1-year primary patency rate after surgery was 82.0%. During the follow-up period, 34.8% of the patients required additional percutaneous transluminal angioplasty to maintain patency, and 2 patients (11.8%) had stenosis in the rejoined section. CONCLUSIONS Rejoining surgery is an effective method for achieving AVF maturation in patients with accessory veins when identification of the mainstream vein is difficult, and this method may be considered when achieving maturation by sacrificing 1 vein is expected to be challenging.
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Affiliation(s)
- Miju Bae
- Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine, Yangsan-si, Gyeongsangnam-do, Republic of Korea; Department of Thoracic and Cardiovascular Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Chung Won Lee
- Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine, Yangsan-si, Gyeongsangnam-do, Republic of Korea; Department of Thoracic and Cardiovascular Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
| | - Sung Woon Chung
- Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine, Yangsan-si, Gyeongsangnam-do, Republic of Korea; Department of Thoracic and Cardiovascular Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Up Huh
- Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine, Yangsan-si, Gyeongsangnam-do, Republic of Korea; Department of Thoracic and Cardiovascular Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Jongwon Kim
- Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine, Yangsan-si, Gyeongsangnam-do, Republic of Korea
| | - Hyuncheol Jeong
- Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine, Yangsan-si, Gyeongsangnam-do, Republic of Korea
| | - Na Hyeon Lee
- Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine, Yangsan-si, Gyeongsangnam-do, Republic of Korea
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Lalani K, Rao MS, Sagar MH, R P. A Cost-Effective Approach to Resistant AV Fistula Stenosis: Successful Treatment Using Coronary OPN NC® Balloon in a Low-Income Setting. Semin Dial 2024; 37:269-272. [PMID: 38418259 DOI: 10.1111/sdi.13196] [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: 09/02/2023] [Revised: 01/03/2024] [Accepted: 01/29/2024] [Indexed: 03/01/2024]
Abstract
Stenosis in the anastomotic site or venous limb of an arteriovenous fistula (AVF) is the most frequent cause of AVF failure. Percutaneous angioplasty with a standard or high-pressure balloon is the first-line treatment for AVF stenosis due to its higher technical success rate (90%) and lower complication rate (4%). Almost 20% of stenosis cases are resistant or undilatable by regular-pressure balloon angioplasty due to fibrosis, leading to technical failure or restenosis. Alternative therapies, such as atherectomy devices or cutting balloons, are expensive and difficult to obtain in low-income developing countries. We successfully treated resistant AVF stenosis with a coronary OPN-NC® ultra-high-pressure balloon and produced a good angiographic result with technical success. Coronary hardware is easily available and relatively cheaper compared to dedicated peripheral balloons or devices in our country due to reuse, which can be a boon in such type of cases. According to the standard hospital protocol, Cathlab hardware was reused.
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Affiliation(s)
- Kanhai Lalani
- Department of Cardiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - M Sudhakar Rao
- Department of Cardiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - M Harsha Sagar
- Department of Cardiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Padmakumar R
- Department of Cardiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Pirozzi N, Scrivano J, Andracchio L, Fazzari L, Napoletano A, Pirozzi R. Double guidewire technique (DGT): Optimising endovascular revision of juxta-anastomotic stenosis in AV-fistulae: A retrospective analysis. J Vasc Access 2024; 25:308-312. [PMID: 35822896 DOI: 10.1177/11297298221109663] [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
BACKGROUND Arteriovenous fistula (AVF) is the preferred angioaccess for haemodialysis but suffers from a high stenosis rate, juxta-anastomotic stenosis (JAS) being the most frequent. Percutaneous transluminal angioplasty (PTA) of JAS would have some advantage (such as mini-invasive and vein sparing treatment), but higher recurrence rate is observed as compared to surgery. We report results of juxta anastomotic stenosis PTA using the 'double guide technique' (DGT) as described by Turmel-Rodrigues, in a selected cohort from our Vascular Access Centre. PATIENTS AND METHODS From January to June 2018, 25 consecutive patients were treated by DGT. By means of retrograde access through the outflow vein by a 6 F introducer, two guide wires were navigated: one into proximal radial artery (GW1), the other into distal artery (GW2). GW2 was used to dilate juxta-anastomotic vein and anastomotic area with 6 mm high-pressure balloon, while by GW1 juxta-anastomotic artery was dilated with 4 mm semi-compliant balloon. Mean diameter of balloons were 6.7 and 4.1 mm for venous and arterial tract dilatation. Follow up was carried out up to 12 months. Prospectively collected data were analysed retrospectively. RESULTS One-year primary and secondary patency was 52% and 95% respectively. Recurrence rate was 0.56 procedure/pt/year. Mean access blood flow at 12 months was 830 ml/min. CONCLUSION Double Guidewire Technique is an effective and minimally invasive procedure. By avoiding under dilation of JAS the recurrence rate resulted quite satisfactorily in our population.
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Affiliation(s)
- Nicola Pirozzi
- Nephrology and Dialysis, Interventional Nephrology Unit, Nuova ITOR, Rome, Italy
| | - Jacopo Scrivano
- Nephrology and Dialysis, Interventional Nephrology Unit, Nuova ITOR, Rome, Italy
| | - Ludovica Andracchio
- U.O.C. Nefrologia Dialsi e Trapianto, A.O. S. Camillo Forlanini, INMI L. Spallanzani, Rome, Italy
| | - Loredana Fazzari
- Nephrology and Dialysis, Interventional Nephrology Unit, Nuova ITOR, Rome, Italy
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4
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Xu S, Wang J, Tang L, Cao W, Liang L, Wei K, Wang Z, Kong X. The RADAR technique in reconstruction of failed autologous arteriovenous fistulas due to juxta-anastomotic stenosis is equivalent to that with traditional surgery in maintenance hemodialysis patients. J Vasc Access 2023:11297298231212225. [PMID: 37997036 DOI: 10.1177/11297298231212225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVE Autologous arteriovenous fistula (AVF) is recommended as superior vascular access for hemodialysis but has a high rate of failure, and juxta-anastomotic stenosis (JAS) is one of the predominant causes of fistula failure. The aim of this study was to compare the primary patency in reconstruction of failed AVFs due to JAS between the radial artery deviation and reimplantation (RADAR) technique and traditional surgery (end-vein to side-artery neo-anastomosis) in maintenance hemodialysis (MHD) patients. METHODS A total of 1215 MHD patients with failed AVF were enrolled in this retrospective cohort study, and 614 patients with failed AVF received surgical intervention. Among these surgical interventions, 417 patients experienced AVF failure due to JAS. Finally, 25 patients who received the RADAR technique were enrolled. Controls of 50 patients received traditional surgery were randomly selected matched by age and sex. Clinical data such as age, sex, comorbidities, and blood biochemical indices were collected. Kaplan-Meier survival curves and Cox proportional hazards analyses were used to explore the difference between the RADAR group and the traditional group in reconstruction of failed AVFs. RESULTS The RADAR group and the traditional group shared common baseline characteristics. The primary patencies of the reconstructed AVFs were 88.8%, 79.0%, 72.2%, 57.4%, and 38.3% at 12, 24, 36, 48, and 60 months among the 75 patients, respectively. Kaplan-Meier survival curve analysis demonstrated similar primary patencies in the two groups (log-rank test, p = 0.73). Compared with the traditional group, the RADAR group had no difference in predicting AVF failure after adjusting for potential confounders, with an HR of 0.92 (95% CI, 0.18-4.63). CONCLUSIONS The primary patency of the RADAR technique and the traditional surgery in the reconstruction of failed AVFs due to JAS is almost equal in 5 years.
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Affiliation(s)
- Shuqi Xu
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, PR China
| | - Jie Wang
- Department of Blood Purification Center, Qufu People's Hospital, Qufu, Shandong, PR China
| | - Lijun Tang
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, PR China
- Nephrology Research Institute of Shandong Province, Jinan, Shandong, PR China
| | - Wei Cao
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, PR China
- Nephrology Research Institute of Shandong Province, Jinan, Shandong, PR China
| | - Liming Liang
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, PR China
- Nephrology Research Institute of Shandong Province, Jinan, Shandong, PR China
| | - Kai Wei
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, PR China
- Nephrology Research Institute of Shandong Province, Jinan, Shandong, PR China
| | - Zunsong Wang
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, PR China
- Nephrology Research Institute of Shandong Province, Jinan, Shandong, PR China
| | - Xianglei Kong
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, PR China
- Nephrology Research Institute of Shandong Province, Jinan, Shandong, PR China
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Ratnam L, Karunanithy N, Mailli L, Diamantopoulos A, Morgan RA. Dialysis Access Maintenance: Plain Balloon Angioplasty. Cardiovasc Intervent Radiol 2023; 46:1136-1143. [PMID: 37156943 PMCID: PMC10471649 DOI: 10.1007/s00270-023-03441-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/31/2023] [Indexed: 05/10/2023]
Abstract
Plain balloon angioplasty remains the first-line treatment for dialysis access stenosis. This chapter reviews the outcomes of plain balloon angioplasty from cohort studies and comparative studies. Angioplasty outcomes are more favourable in arteriovenous fistulae (AVF) compared to arteriovenous grafts (AVG) with primary patency at 6 months ranging from 42-63% compared to 27-61%, respectively, and improved for forearm fistulae compared with upper arm fistulae. Higher pressures are required to treat stenoses in AVFs compared to AVGs. Outcomes are worse in more severe stenoses, increased patient age, previous interventions and fistulae that develop early stenoses. Major complication rates following angioplasty in dialysis access are between 3 and 5%. Repeat treatments and the use of adjuncts such as drug-coated balloons and stents can prolong the patency of dialysis access. Level of Evidence No level of evidence (Review paper).
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Affiliation(s)
- Lakshmi Ratnam
- Department of Interventional Radiology, St George's University Hospitals NHS Foundation Trust, London, UK.
- Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK.
| | - Narayan Karunanithy
- Department of Interventional Radiology, Guys and St. Thomas NHS Foundation Trust, London, UK
- School of Biomedical Engineering & Imaging Sciences, Faculty of Life Sciences & Medicine, Kings College London, London, UK
| | - Leto Mailli
- Department of Interventional Radiology, St George's University Hospitals NHS Foundation Trust, London, UK
- Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - Athanasios Diamantopoulos
- Department of Interventional Radiology, Guys and St. Thomas NHS Foundation Trust, London, UK
- School of Biomedical Engineering & Imaging Sciences, Faculty of Life Sciences & Medicine, Kings College London, London, UK
| | - Robert A Morgan
- Department of Interventional Radiology, St George's University Hospitals NHS Foundation Trust, London, UK
- Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK
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Li X, Mantell MD, Trerotola SO. Surgical Referral for Hemodialysis Access Maintenance. Cardiovasc Intervent Radiol 2023; 46:1192-1202. [PMID: 36849837 DOI: 10.1007/s00270-023-03380-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 01/27/2023] [Indexed: 03/01/2023]
Abstract
Hemodialysis access is the lifeline for end-stage renal disease patients. However, dialysis access is associated with a host of complications, including thrombosis, recurrent stenosis, infection, aneurysmal changes and bleeding. Although endovascular therapy remains the first-line treatment owing to its less invasive nature, there are certain situations where surgical referral is recommended or even necessary. Regardless, management of dialysis access complications requires a multidisciplinary approach. Interventional radiologists should be familiar with the appropriate timing for surgical referral to better serve the complex patient population.
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Affiliation(s)
- Xin Li
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street 1 Silverstein, Philadelphia, PA, 19104, USA
| | - Mark D Mantell
- Division of Vascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Scott O Trerotola
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street 1 Silverstein, Philadelphia, PA, 19104, USA.
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Outcome and Risk Factors of Restenosis Post Percutaneous Transluminal Angioplasty at Juxta-Anastomotic of Wrist Autogenous Radial-Cephalic Arteriovenous Fistulas: A Retrospective Cohort Study. Ann Vasc Surg 2023:S0890-5096(23)00026-2. [PMID: 36720303 DOI: 10.1016/j.avsg.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/20/2022] [Accepted: 01/09/2023] [Indexed: 01/31/2023]
Abstract
BACKGROUND This retrospective cohort study was to determine the factors related to restenosis post percutaneous transluminal angioplasty (PTA) at juxta-anastomotic of wrist radial-cephalic arteriovenous fistulas (RC-AVFs). METHODS We conducted a retrospective study of patients who underwent their first PTA for juxta-anastomotic stenosis at RC-AVF from January 1, 2016, to December 31, 2020. Patient and stenotic lesion characteristics and PTA procedure factors were included in the analysis. The primary and assisted primary patency post PTA of RC-AVFs were evaluated using the Kaplan-Meier analysis and log-rank test. A Cox proportional hazard model was used to identify factors associated with restenosis post PTA. The receiver operating characteristic (ROC) curve was employed to evaluate the predictive value of the risk factors for restenosis post PTA. RESULTS A total of 65 patients with a mean age of 59.09 ± 14.94 years were enrolled in the study. The mean RC-AVF age was 9.2 (4.9, 35.05) months, and the median time of intervention for stenosis was 10.8 (4.05, 41.35) months after AVF creation. The primary patency rates following the first PTA at 3, 6, 12, and 24 months were 93.9, 84.6, 63.1, and 55.4%, respectively. The assisted primary patency rates at 3, 6, 12, and 24 months were 95.4, 90.8, 87.7, and 84.6%, respectively. Cox proportional hazard regression analysis revealed the maximum balloon diameter >5 mm had a lower postoperative restenosis rate compared with the maximum balloon diameter ≤5 mm (hazard ratio = 0.422; 95% confidence interval [CI]: 0.201-0.884; P = 0.022). ROC curve analysis showed that the area under the curve of the maximum balloon diameter during PTA was 0.624 (95% CI, 0.486-0.762). The best critical value for the maximum balloon diameter was 6 mm, the sensitivity was 64.5%, and the specificity was 61.8%. CONCLUSIONS For the first PTA at juxta-anastomotic of wrist RC-AVFs without thrombosis and complete occlusion, the use of a balloon with a maximum diameter of ≤5 mm is a risk factor to the occurrence of restenosis within 12 months post PTA. The result may help in tailoring surveillance programs in patients with RC-AVF stenosis.
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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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9
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Anapalli SR, N. HD, Sarma P, Srikanth L, V. SK. Thrombophilic risk factors and ABO blood group profile for arteriovenous access failure in end stage kidney disease patients: a single-center experience. Ren Fail 2022; 44:34-42. [PMID: 35094650 PMCID: PMC8812770 DOI: 10.1080/0886022x.2021.2011746] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 11/11/2021] [Accepted: 11/11/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Thrombosis of fistula occurs most frequently in end-stage kidney disease (ESKD) patients receiving hemodialysis. However, the role of thrombophilia in arteriovenous fistula (AVF) failure has not been well established. Hence, this study was aimed at assessing the roles of hereditary and acquired thrombophilic factors in association with AVF failure among patients with ESKD undergoing hemodialysis. METHODS A cross-sectional study was conducted on 100 ESKD patients, of whom 50 patients with well-functioning AVFs with no fistula failures earlier were enrolled as Group 1, and 50 patients who have had AVF failure were enrolled as Group 2. The hereditary factors as factor V Leiden, factor XIII, prothrombin, and methylene tetrahydrofolate reductase and the acquired factors as lipoprotein (a), fibrinogen, homocysteine, and anticardiolipin antibodies IgG and IgM were studied. RESULTS Among the hereditary factors, no statistically significant difference was observed in relation to factor V Leiden and Prothrombin (p > 0.05). However, for factor XIII and methylene tetrahydrofolate reductase, a statistically significant difference was observed between patients with well-functioning AVFs and patients who have had AVF failure (p < 0.05). We found a statistically significant increase in all the acquired factors in patients who have had AVF failure in comparison with patients with well-functioning AVFs (p < 0.001). Association between ABO blood groups and thrombophilic factors showed significant association between factor V Leiden, anticardiolipin antibody IgG and IgM and ABO blood groups (p < 0.05), whereas none of the other thrombophilic factors showed significant association (p > 0.05). CONCLUSION Thus, our study suggests significant role of acquired factors in causing AVF failure.
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Affiliation(s)
- Sunnesh Reddy Anapalli
- Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati, India
| | - Harini Devi N.
- Department of Biochemistry, Sri Venkateswara Institute of Medical Sciences, Tirupati, India
| | - Pvgk Sarma
- Department of Biotechnology, Sri Venkateswara Institute of Medical Sciences, Tirupati, India
| | - Lokanathan Srikanth
- Department of Biotechnology, Sri Venkateswara Institute of Medical Sciences, Tirupati, India
| | - Siva Kumar V.
- Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati, India
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Ben Romdhane M, Azzabou N, Zribi H, Ghariani MZ, Marghli A. Interest of surgical vascular reconstructions aiming at preserving hemodialysis access. JOURNAL DE MEDECINE VASCULAIRE 2022; 47:242-249. [PMID: 36464419 DOI: 10.1016/j.jdmv.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/19/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Vascular hemodialysis access is a very precious asset for patients with end-stage renal failure. Ideally complications in these accesses should be detected early in order to treat them in time. The aim of this study was to evaluate the effectiveness of vascular reconstructions to preserve the vascular access for hemodialysis and to examine their benefits in terms of conserving the venous network, using hemodialysis catheters, time of cannulation after surgery, patency and postoperative morbi-mortality, by comparing them to those of newly created arterio-venous fistula (AVF). METHODS This was a retrospective, descriptive and comparative study, performed from September 2012 to February 2015. It concerned patients operated for complications of their native AVF. Two groups were compared: reconstructed AVF (group 1) and newly created AVF (group 2). Demographic characteristics, comorbidities, preoperative clinical and paraclinical data, surgical techniques and outcomes were recorded. This data was analyzed and compared between the two groups. RESULTS We collected 151 surgical interventions divided into two groups: 55 surgical reconstructions and 96 new AVF. The average age was 59.9±1.3 years [19.1-88.9], with a male predominance (59.6%). The two groups were comparable in terms of age, gender and comorbidities. Reconstructions were mostly indicated for stenosis (47.3%) and new vascular accesses for venous thrombosis (92.7%). Reconstruction had significantly better successful exploitation rates (95.7%) and time of cannulation (26.6 days) (respectively P=0.025 and P=0.000). Its primary failure rate was null. Its primary patency and primary functional patency were respectively 94.2% and 97.7% at 1 month and 82.2% and 87.1% at 2 years. Morbidity's global rates were comparable between both groups (41.8% vs. 43.8%). The rates of early morbidity and stenosis were significantly higher for reconstructions (respectively P=0.037 and P=0.047), while late morbidity and thrombosis' rates were significantly higher for new AVF (respectively P=0.021 and P=0.023). Mid-term permeabilities were better for reconstructions, but the differences were not statistically significant. CONCLUSION Surgical reconstructions seem to be an effective alternative for the treatment of complicated AVF. Our results appear to be comparable to those of the literature. The benefits of these surgical techniques in terms of conserving venous network, use of hemodialysis catheters, time for cannulation after surgery, patency and postoperative morbi-mortality appear to be undeniable.
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Affiliation(s)
- M Ben Romdhane
- Cardiovascular and Thoracic Department, Abderrahmen Mami Hospital, Tunis, Tunisia.
| | - N Azzabou
- Cardiovascular and Thoracic Department, Abderrahmen Mami Hospital, Tunis, Tunisia
| | - H Zribi
- Cardiovascular and Thoracic Department, Abderrahmen Mami Hospital, Tunis, Tunisia
| | - M Z Ghariani
- Cardiovascular and Thoracic Department, Abderrahmen Mami Hospital, Tunis, Tunisia
| | - A Marghli
- Cardiovascular and Thoracic Department, Abderrahmen Mami Hospital, Tunis, Tunisia
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11
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Gunawardena T, Ridgway D. Swing segment stenosis: An unresolved challenge. Semin Dial 2022; 35:307-316. [PMID: 35475553 DOI: 10.1111/sdi.13086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 03/08/2022] [Accepted: 04/05/2022] [Indexed: 11/29/2022]
Abstract
The native arteriovenous fistula is considered the gold standard among all dialysis access options. Compared with alternatives such as grafts and central venous catheters, their use is associated with a lower risk of infective and thrombotic complications. This leads to better patient outcomes and reduced healthcare-associated costs. Recognizing these advantages, there is a global drive to increase the creation and use of such fistulas in hemodialysis patients. Swing segment stenosis is a common problem encountered with the creation and use of these fistulas that can hurt their maturation and longevity. A "swing segment" in an arteriovenous fistula is defined as a segment of vein that pursues a sharp, curved course. Due to poorly understood reasons, these swing segments tend to develop stenotic lesions that are extremely challenging to treat. This review aims to provide an overview of the pathophysiology, incidence, management, and prevention of these swing segment lesions. We believe that such knowledge will be useful for clinicians who deal with dialysis access creation and maintenance.
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Affiliation(s)
- Thilina Gunawardena
- Fellow in Renal Transplant and Vascular Access Surgery, Royal Liverpool University Hospital, Liverpool, UK
| | - Dan Ridgway
- Consultant Renal Transplant and Vascular Access Surgeon, Royal Liverpool University Hospital, Liverpool, UK
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Noh SY, Goo DE, Kim YJ, Yang SB, Lee JM, Lee WH. Sharp Needle Recanalization Technique for Peripheral Hemodialysis Arteriovenous Fistula Occlusion. Cardiovasc Intervent Radiol 2021; 44:1809-1816. [PMID: 34258680 DOI: 10.1007/s00270-021-02809-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/15/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To determine the efficacy of a percutaneous sharp needle recanalization technique for the treatment of peripheral hemodialysis arteriovenous fistula (AVF) occlusion. MATERIALS AND METHODS This study included 13 patients (14 procedures) between May 2010 and February 2020 with non-thrombotic AVF occlusion wherein guidewire passage through the occluded segment had failed. We successfully passed the guidewire through the occluded segment using a sharp needle recanalization technique with Chiba or Colapinto needles, under ultrasound or fluoroscopic guidance. The type of AVF, site and length of occlusion, technical success, complications, and long-term patency were analyzed. RESULTS Technical success was achieved in 12 (85.7%) out of 14 procedures. The procedure failed in two patients due to the poor angle of approach in the axillary area and diffuse severe stenosis in the draining cephalic vein. In eight procedures, sharp needle recanalization was performed under ultrasound guidance, while the other six procedures were performed under fluoroscopic guidance. Chiba and Colapinto needles were used in five and nine procedures, respectively. The mean length of occlusion was 2.7 cm (range 1.8-4.2 cm). There was one case of mild complication, that is, mild contrast extravasation, which was treated by stent deployment. The post-intervention primary patency rates at 6 months, 1 year, and 2 years were 81.8%, 36.4%, and 18.2%, respectively. CONCLUSION The results of this limited series suggest that the sharp needle recanalization technique is a simple and effective method for the treatment of peripheral non-thrombotic AVF occlusion.
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Affiliation(s)
- Seung Yeon Noh
- Department of Radiology, Kyung Hee University Medical Center, Seoul, Korea
| | - Dong Erk Goo
- Department of Radiology, Soon Chun Hyang University Hospital, 59 Daesagwan-Ro, Yongsan-gu, Seoul, 04401, Korea.
| | - Yong Jae Kim
- Department of Radiology, Soon Chun Hyang University Hospital, 59 Daesagwan-Ro, Yongsan-gu, Seoul, 04401, Korea
| | - Seung Boo Yang
- Department of Radiology, Soon Chun Hyang University Hospital, Gumi, Korea
| | - Jae Myeong Lee
- Department of Radiology, Soon Chun Hyang University Hospital, Bucheon, Korea
| | - Woong Hee Lee
- Department of Radiology, Soon Chun Hyang University Hospital, Cheonan, Korea
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13
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Parker MH, Hashemi H, Grant C, Colpitts DK, Kfoury E, Mukherjee D, Neville R. A novel technique using long segment patch angioplasty maturation to increase the maturation rate of arteriovenous fistulas. J Vasc Surg 2021; 74:230-236. [PMID: 33348009 DOI: 10.1016/j.jvs.2020.12.069] [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: 07/25/2020] [Accepted: 12/05/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Given the superior patency of arteriovenous fistulas (AVFs) and the decreased risk of infection compared with arteriovenous grafts, the Kidney Disease Outcomes Quality Initiative guidelines have recommended the fistula-first approach. However, ∼20% to 60% of all fistulas will fail to mature. We have described our experience with a novel technique using bovine pericardial patch angioplasty to increase the rate of AVF maturation. METHODS We used 2-cm × 9-cm-long or 2.5-cm × 15-cm-long segment pericardial patch angioplasty to assist in the maturation of AVFs. A single-center, retrospective cohort study was conducted of all patients who had undergone patch angioplasty maturation (PAM) for AVFs that had failed to mature. The outcomes of interest were maturation status and patency, censored by the death and last known follow-up dates. RESULTS From March 2007 to October 2019, 139 patients had undergone PAM. Follow-up data were available for 137 of the 139 patients (98.6%), with 126 AVFs (92.0%) progressing to maturation. Of the 126 patients with AVFs that had progressed to maturity, the previous hemodialysis (HD) method was known for 88 patients (69.8%). Of these 88 patients, 70 (79.5%) had previously been receiving HD via an HD catheter. Using a Kaplan-Meier estimator censored for death and loss to follow-up, the assisted primary patency rates at 1, 2, and 3 years were 87.3%, 78.1%, and 68.0%, respectively. Of the 137 patients, 69 (54.8%) had required no additional interventions after patch angioplasty. The complications requiring intervention were stenosis (n = 45; 32.8%), thrombosis (n = 10; 7.3%), infection (n = 3; 2.2%), steal syndrome (n = 3; 2.2%), noninfected wound complications (n = 1; 0.8%), and pseudoaneurysm (n = 1; 0.8%). The average interval to intervention after patch angioplasty was 4.56 months. CONCLUSIONS Long-segment bovine pericardial PAM can be performed safely to treat nonmaturing AVFs, with a 92.0% successful maturation rate and patency rates comparable to those for AVFs. PAM should be a consideration for patients with nonmaturing AVFs.
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Affiliation(s)
- Michael H Parker
- Department of General Surgery, Inova Health System, Falls Church, Va.
| | - Homayoun Hashemi
- Department of General Surgery, Inova Health System, Falls Church, Va
| | - Courtney Grant
- Department of General Surgery, Inova Health System, Falls Church, Va
| | - Dayle K Colpitts
- Department of General Surgery, Inova Health System, Falls Church, Va
| | - Elias Kfoury
- Department of General Surgery, Inova Health System, Falls Church, Va
| | | | - Richard Neville
- Department of General Surgery, Inova Health System, Falls Church, Va
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14
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Results of Prompt Surgical Intervention in Hemodialysis Radiocephalic Fistula Secondary Dysfunction. Int Surg 2020. [DOI: 10.9738/intsurg-d-15-00152.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Radiocephalic fistula (RCF) dysfunction is a common problem due to low maturation and patency rates of these fistulas. The most common procedure in such cases is to place a temporary catheter for the dialysis. Temporary catheter placement and undergoing dialysis with this catheter cause complications, reduce the chance for fistula, and deteriorate the quality of life. The aim of this study was to demonstrate that immediate intervention in RCF dysfunctions can increase fistula success for the patient and can reduce the need for a catheter. Furthermore, the hemodialysis treatment can continue without affecting the quality of life. A total of 295 patients who were admitted for RCF dysfunction and who underwent early surgical intervention without any catheter placement were evaluated for postoperative complications, patency rates, and rates and durations of temporary catheter use over a mean time of 47 months of follow-up (range: 4–79 months). Of the patients, 77.2% (n = 228) underwent new proximal anastomosis (NEO; the radial artery and cephalic vein were reached with an incision created proximal to the previous anastomosis), 14.2% (n = 42) underwent brachiocephalic arteriovenous fistula (AVF), 8.4% (n = 25) underwent side-to-side brachiobasilic AVF + superficialization of the basilic vein. In 88.8% (n = 262) of the patients, successful cannulations were performed within the first 24 to 48 hours without any catheter requirement or complications. Temporary catheter was used for 15.1 ± 10.7 days in 11.2% (n = 33) of the patients. In RCF dysfunctions, early surgical interventions performed in the forearm and elbow provide early cannulation and thus decrease the catheter requirement, also prevent the complications of temporary catheters (infection, decreasing the fistula success, vascular injuries, etc.), increase the autogenous fistula success, and allow for the continuation of dialysis without disturbing the quality of life.
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15
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Gu H, Wan Z, Lai QQ, Zhou Y, Tu B, Hu B, Chen L, Gao XJ. Efficacy of ultrasound-guided percutaneous transluminal angioplasty for arteriovenous fistula stenosis or occlusion at juxta-anastomosis: A 3-year follow-up cohort study. J Vasc Surg 2020; 74:217-224. [PMID: 33340700 DOI: 10.1016/j.jvs.2020.11.041] [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] [Received: 02/01/2020] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Arteriovenous fistula (AVF) is the preferred access for hemodialysis. Percutaneous transluminal angioplasty (PTA) has become a choice for AVF stenosis, and ultrasound has been used in PTA more frequently. METHODS This single-center retrospective cohort study analyzed 129 patients who underwent PTA in the First Affiliated Hospital of Chongqing Medical University from January 2016 to December 2016. Angioplasty was performed using a noncompliant high-pressure balloon. The process was visualized by duplex scan. Our inclusion criteria were as follows: (1) stenoses or occlusions were located at the juxta-anastomosis site: the first 5 cm of the vein distal to the anastomosis; (2) stenosis was confirmed with the following conditions: (a) flow rates are <500 mL/min in the brachial artery and <200 mL/min in the fistula during dialysis, and (b) the stenosis diameter is <1.7 mm. We used the Kaplan-Meier curve to show the postintervention primary and secondary patency rates of patients with stenosis and occlusion. RESULTS Altogether, 129 patients with 76 males were analyzed. Moreover, 104 have AVFs on the left arm, and only one patient had an ulnar-basilic AVF, whereas others had a radial-cephalic AVF. The postintervention primary patency rates are better in occlusion cases (P < .05), whereas secondary patency rates have no difference. The postintervention primary patency rates are better in patients without diabetes mellitus (P < .05), whereas the secondary patency rates had no difference. CONCLUSIONS For juxta-anastomosis site stenosis or occlusion, PTA can be used to obtain satisfactory results.
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Affiliation(s)
- Hui Gu
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ziming Wan
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Qi-Quan Lai
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yu Zhou
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bo Tu
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bo Hu
- Department of Nephrology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Ling Chen
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xue-Jing Gao
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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16
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Noh SY, Kim YJ, Goo DE, Kwon SH. Salvage of a Radiocephalic Arteriovenous Hemodialysis Fistula by Percutaneous Angioplasty to Increase Retrograde Flow from the Palmar Arch in Patients with an Occluded Radial Artery. J Vasc Interv Radiol 2020; 32:92-98. [PMID: 33153864 DOI: 10.1016/j.jvir.2020.09.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 08/18/2020] [Accepted: 09/17/2020] [Indexed: 11/15/2022] Open
Abstract
This brief report presents 12 patients who underwent percutaneous transluminal angioplasty (PTA) to increase the retrograde blood flow from the palmar arch. All the patients had radiocephalic arteriovenous fistulas with occluded feeding arteries. The technical success rate was 100%. Three patients (25.0%) underwent surgical repair for restenosis, 2 patients (16.6%) underwent surgical repair for other reasons, 5 patients (41.8%) underwent repeated PTAs for restenosis, and 2 patients (16.6%) had no further treatment. The target lesion primary patency rates at 6, 12, 36, and 60 months were 90.9%, 54.5%, 36.4%, and 18.2%, respectively.
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Affiliation(s)
- Seung Y Noh
- Department of Radiology, Kyung Hee University Hospital, Seoul, Korea
| | - Yong J Kim
- Department of Radiology, Soon Chun Hyang University Hospital, 59 Daesagwan-Ro, Yongsan-gu, Seoul 04401, Korea.
| | - Dong E Goo
- Department of Radiology, Soon Chun Hyang University Hospital, 59 Daesagwan-Ro, Yongsan-gu, Seoul 04401, Korea
| | - Soon H Kwon
- Department of Internal Medicine, Division of Nephrology, Soon Chun Hyang University Hospital, 59 Daesagwan-Ro, Yongsan-gu, Seoul 04401, Korea
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Manjunath PM, Gurpremjit S, Devender S, Surabhi V, Ramana AP, Sreenivas V, Aggarwal SK. The Effect of Post-Operative Handgrip Exercise on the Maturation of Arteriovenous Fistula: a Randomized Controlled Trial. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02553-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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18
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Lok CE, Huber TS, Lee T, Shenoy S, Yevzlin AS, Abreo K, Allon M, Asif A, Astor BC, Glickman MH, Graham J, Moist LM, Rajan DK, Roberts C, Vachharajani TJ, Valentini RP. KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update. Am J Kidney Dis 2020; 75:S1-S164. [PMID: 32778223 DOI: 10.1053/j.ajkd.2019.12.001] [Citation(s) in RCA: 1001] [Impact Index Per Article: 250.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 12/09/2019] [Indexed: 02/07/2023]
Abstract
The National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (KDOQI) has provided evidence-based guidelines for hemodialysis vascular access since 1996. Since the last update in 2006, there has been a great accumulation of new evidence and sophistication in the guidelines process. The 2019 update to the KDOQI Clinical Practice Guideline for Vascular Access is a comprehensive document intended to assist multidisciplinary practitioners care for chronic kidney disease patients and their vascular access. New topics include the end-stage kidney disease "Life-Plan" and related concepts, guidance on vascular access choice, new targets for arteriovenous access (fistulas and grafts) and central venous catheters, management of specific complications, and renewed approaches to some older topics. Appraisal of the quality of the evidence was independently conducted by using a Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, and interpretation and application followed the GRADE Evidence to Decision frameworks. As applicable, each guideline statement is accompanied by rationale/background information, a detailed justification, monitoring and evaluation guidance, implementation considerations, special discussions, and recommendations for future research.
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19
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Zhu ZR, Zou L, Xing Y, Tan YC, Xu GJ, He ZJ, Cao JQ, Wu JY, Liang XX, Zhang HP, Tan YH, Luo CH. Predictors of primary patency after percutaneous balloon angioplasty for stenosis of Brescia-Cimino hemodialysis arteriovenous fistula. Br J Radiol 2020; 93:20190505. [PMID: 32101462 DOI: 10.1259/bjr.20190505] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Percutaneous transluminal balloon angioplasty (PTA) is recommended as the first choice to treat stenosis of Brescia-Cimino arteriovenous fistulas (B-C AVFs). The ability to predict which B-C AVFs are at risk for recurrent stenosis post-PTA would allow closer monitoring of patients, and possibly result in surgical intervention rather than repeat PTA. The purpose of this study was to identify predictive factors of primary patency after PTA in B-C AVFs. METHODS Patients diagnosed with B-C AVF primary stenosis and treated by PTA between November 2013 and March 2018 were included in the study. Patient and stenotic lesion characteristics and PTA procedure factors were included in the analysis. The Kaplan-Meier method was used to analyze the primary patency rate. Cox proportional hazard regression analysis was used to identify factors predictive of decreased primary patency. RESULTS 74 patients (35 males, 39 females) with a mean age of 61.68 ± 11.44 years (range, 36-84 years) were included in the study. The mean B-C AVF age was 16.34 ± 12.93 months (range, 2-84 months), and the median primary patency time was 7.79 ± 0.48 months. Cox proportional hazard regression analysis revealed stenosis location at the inflow artery [hazard ratio (HR)=3.83, 95% confidence interval (CI): 1.46-10.09] or anastomosis (HR = 1.90, 95% CI: 1.09-3.32), dilation >2 times during PTA (HR = 2.30, 95% CI: 1.22-4.34), and residual stenosis >30% (HR = 2.42, 95% CI: 1.26-4.63) were significantly associated with decreased patency. CONCLUSION In conclusion, the primary patency rate of PTA for B-C AVF dysfunction is reduced by dilation >2 times, residual stenosis >30%, and stenosis located at the inflow artery or anastomosis. These results may help in tailoring surveillance programs, multiple PTA, or a proximal re-anastomosis surgery in patients with AVF dysfunction. ADVANCES IN KNOWLEDGE A number of studies have been conducted to examine the predictors of primary patency after PTA, however, no definitive conclusions have been reached. Our study revealed that stenosis location at the inflow artery or anastomosis, dilation >2 times during PTA, and residual stenosis >30% were the predictors of primary patency after PTA, which may help in tailoring surveillance programs, multiple PTA, or a proximal re-anastomosis surgery in patients with arteriovenous fistulas dysfunction.
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Affiliation(s)
- Zheng-Rong Zhu
- Division of Vascular Surgery, the First People's Hospital of Foshan, Foshan, China
| | - Lan Zou
- Division of Vascular Surgery, the First People's Hospital of Foshan, Foshan, China
| | - Yue Xing
- Division of Vascular Surgery, the First People's Hospital of Foshan, Foshan, China
| | - Yu-Can Tan
- Division of Vascular Surgery, the First People's Hospital of Foshan, Foshan, China
| | - Guo-Jian Xu
- Division of Vascular Surgery, the First People's Hospital of Foshan, Foshan, China
| | - Zhi-Jian He
- Division of Vascular Surgery, the First People's Hospital of Foshan, Foshan, China
| | - Jian-Qiang Cao
- Division of Vascular Surgery, the First People's Hospital of Foshan, Foshan, China
| | - Jia-Yu Wu
- Division of Vascular Surgery, the First People's Hospital of Foshan, Foshan, China
| | - Xiao-Xia Liang
- Division of Vascular Surgery, the First People's Hospital of Foshan, Foshan, China
| | - Hui-Ping Zhang
- Division of Vascular Surgery, the First People's Hospital of Foshan, Foshan, China
| | - Yan-Hong Tan
- Division of Vascular Surgery, the First People's Hospital of Foshan, Foshan, China
| | - Can-Hua Luo
- Division of Vascular Surgery, the First People's Hospital of Foshan, Foshan, China
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Alhaizaey A, Alghamdi M, Azazy A, Omran W, Hamdy M, Alhazmi B, Karmotah A. Durability of percutaneous transluminal angioplasty for failing hemodialysis vascular access, retrospective cohort study. INTERNATIONAL JOURNAL OF SURGERY OPEN 2020. [DOI: 10.1016/j.ijso.2020.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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21
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Kong X, Tang L, Liang L, Cao W, Zhang L, Yong W, Ding N, Li W, Wang Z, Xu D. Clinical outcomes following the surgery of new autologous arteriovenous fistulas proximal to the failed ones in end-stage renal disease patients: a retrospective cohort study. Ren Fail 2019; 41:1036-1044. [PMID: 31814501 PMCID: PMC6913653 DOI: 10.1080/0886022x.2019.1696210] [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] [Indexed: 11/18/2022] Open
Abstract
Background: Most prior studies have explored surgery for the treatment of failed autologous arteriovenous fistulas (AVFs) with limited follow-up times and a lack of end point mortality. Accordingly, we conducted a retrospective cohort study to evaluate the clinical outcomes of the surgery of new AVF proximal to the failed forearm AVF. Methods: In this study, 538 end-stage renal disease patients (group A, 418 with primary AVF; and group B, 120 with failed AVF) were consecutively enrolled between January 2013 and June 2016, with a median follow-up time of 41 months. Primary and secondary patency, all-cause mortality, and risk factors associated with AVF failure were explored by the Kaplan–Meier method or Cox proportional hazards model. Results: In group A (n = 418), the primary and secondary patencies of AVF were 85.6% vs. 96.8%, 79.7% vs. 95.0%, 75.1% vs.93.9%, 73.2% vs. 93.6% and 73.2% vs. 93.6% at 12, 24, 36, 48 and 60 months, respectively. The primary patencies of AVF in group B were 95.0%, 91.7%, 89.2%, 88.3% and 88.3% at 12, 24, 36, 48 and 60 months, respectively. After adjusting for potential confounders, age, angiotensin-converting inhibitors or angiotensin-receptor blockers (anti-RAAS) drugs and D-dimer were independent predictors of AVF failure. However, there were no differences between functional and failed AVF regarding all-cause mortality. Conclusions: The study revealed that the primary and secondary patiencies of the surgery of new AVF proximal to the failed ones were ideal operations to restore failed forearm AVF.
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Affiliation(s)
- Xianglei Kong
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China.,Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Lijun Tang
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China.,Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Liming Liang
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China.,Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Wei Cao
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China.,Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Lei Zhang
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China.,Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Wei Yong
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China.,Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Nannan Ding
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China.,Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Wenbin Li
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China.,Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Zunsong Wang
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China.,Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Dongmei Xu
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China.,Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China.,Shandong Provincial Key Laboratory for Rheumatic Disease and Translational Medicine, Jinan, China.,Nephrology Research Institute of Shandong Province, Jinan, China
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22
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Hong JH. A percutaneous endovascular technique for reducing arteriovenous fistula flow. J Vasc Access 2019; 21:251-255. [DOI: 10.1177/1129729819871433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Reduction of arteriovenous access flow is usually performed by tightening the inflow lumen through an open surgical procedure. A percutaneous endovascular approach can provide a precise and effective reduction of access flow without making a skin incision. After placing a vascular introducer sheath toward the inflow direction of an arteriovenous fistula, a small stent (5 mm diameter × 25 mm length) was deployed in the target area near the anastomosis. A second stent (10 mm × 60 mm) was then deployed inside the first stent, making a corset-shape constraint on the access flow. This newly described endovascular procedure was utilized to reduce the excessive flow of arteriovenous fistula in three patients. Deployment of the constrained stent-graft resulted in reducing the estimated access flow from 1900, 1600, and 1500 mL/min to 1100, 900, and 900 mL/min, respectively. Percutaneous endovascular placement of a constrained stent-graft can narrow the inflow lumen of arteriovenous access to a desired precise diameter of 5 mm and effectively reduce access flow over a long-term period.
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Affiliation(s)
- Joon Ho Hong
- Department of Surgery, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
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23
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Thomas SD, Peden S, Crowe P, Varcoe RL. Interwoven Nitinol Stents to Treat Radiocephalic Anastomotic Arteriovenous Fistula Stenosis. J Endovasc Ther 2019; 26:394-401. [DOI: 10.1177/1526602819842851] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To determine the clinical outcomes in hemodialysis patients after implantation of a Supera stent to treat juxta-anastomotic stenosis in radiocephalic arteriovenous fistulas (AVF). Materials and Methods: A single-center retrospective study was conducted of 42 consecutive patients (mean age 66.7 years, range 40–84; 26 men) who had a failing AVF due to juxta-anastomotic stenosis treated with the interwoven Supera stent between February 2014 and February 2018. A third of the patients had previous juxta-anastomotic intervention (either balloon angioplasty or open surgical revision). Results: The stent was inserted successfully in all patients. Overall mean follow-up was 12.2±8.2 months (range 3.8–38.3). Juxta-anastomotic segment primary patency estimates at 6 and 12 months were 92.5% and 59.8%, respectively, with assisted primary patency rates of 97.5% and 92.9%. Reintervention (elective drug-coated balloon angioplasty) occurred at a rate of 0.31 procedures/year. Two AVFs thrombosed during the 1-year follow-up and were revascularized using balloon angioplasty. Ultrasound measurements of brachial artery flow rates increased significantly from 543.5±96.72 mL/min (range 430–644) before intervention to 919.2±355.9 mL/min (range 200–1600) after intervention (p=0.047). Arterial pressures on hemodialysis improved from −142.3±24.9 mm Hg (range −100 to −180) to −123.4±21.9 mm Hg (range −100 to −184; p=0.051). No AVFs were lost or abandoned during the follow-up period. Conclusion: The interwoven Supera stent is a promising treatment for failing AVFs with juxta-anastomotic stenosis. Encouraging 1-year primary and assisted primary patency was demonstrated, with a low reintervention rate. This treatment facilitates long-term maintenance of AVF vascular accesses.
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Affiliation(s)
- Shannon D. Thomas
- Department of Vascular Surgery, Prince of Wales Hospital, Sydney, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- The Vascular Institute, Prince of Wales Hospital, Sydney, Australia
| | - Samantha Peden
- Department of Vascular Surgery, Prince of Wales Hospital, Sydney, Australia
| | - Phillip Crowe
- Department of Surgery, Prince of Wales Hospital, Sydney, Australia
| | - Ramon L. Varcoe
- Department of Vascular Surgery, Prince of Wales Hospital, Sydney, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- The Vascular Institute, Prince of Wales Hospital, Sydney, Australia
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24
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Dua A, Rothenberg KA, Lavingia K, Oakes DD, Sorial E, Garcia-Toca M. Long-term durability of Oakes salvage procedure to preserve Brescia-Cimino arteriovenous fistula. J Vasc Surg 2019; 70:853-857. [PMID: 30837176 DOI: 10.1016/j.jvs.2018.12.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 12/12/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND In 2002, Oakes et al described a novel procedure designed to salvage the distal cephalic venous outflow of a Brescia-Cimino fistula by placing a prosthetic graft between the brachial artery in the antecubital space and the cephalic vein at the wrist. In this fashion, the more proximal veins were saved for future procedures. Their approach was reported and found to be successful in the short term, but the long-term durability of the Oakes procedure has not been described. This study aimed to determine the long-term primary, primary-assisted, and secondary patency rates of the brachial to distal cephalic vein Oakes procedure. METHODS This is a retrospective review of a prospective database in a large, single institution. All patients who underwent the Oakes procedure from 1998 to 2012 were followed up to 2018. We reviewed the time to intervention, type of intervention, patency rates, and mortality of this patient population. RESULTS Over the 5-year study period, 14 patients were identified who underwent the Oakes procedure, of whom seven (50%) were female. The average age was 55.7 years (range, 38-73 years). All patients had a previously placed Brescia-Cimino that was not suitable for dialysis but was patent. The average number of days to placement of an Oakes brachial to distal cephalic graft was 396 (range, 119-1167) days. A total of 71% (10) of patients underwent an intervention to maintain the graft, of whom 50% (5) underwent an angioplasty and 50% (5) had a thrombectomy/revision procedure. The average number of days to first intervention was 367.3 (range, 21-1048) days from Oakes placement. Of this cohort, 30% (3) of patients had a second intervention, of whom one (33%) underwent an angioplasty and two (66%) had revisions. One patient had a third and a fourth intervention at 39 days and 74 days, respectively, that were both angioplasties. The overall number of days the Oakes procedure remained usable from placement was 843.6 (range, 21-3790) days or 2.3 years. CONCLUSIONS This study concluded that the Oakes procedure may extend the use of the distal dialysis access site by 2.3 years without increasing infection and is hence a durable solution that should be considered in patients requiring dialysis access.
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Affiliation(s)
- Anahita Dua
- Division of Vascular Surgery, Stanford Hospital and Clinics, Stanford, Calif
| | - Kara A Rothenberg
- Division of Vascular Surgery, Stanford Hospital and Clinics, Stanford, Calif; Department of Surgery, University of California San Francisco-East Bay, Oakland, Calif
| | - Kedar Lavingia
- Division of Vascular Surgery, Stanford Hospital and Clinics, Stanford, Calif
| | - David D Oakes
- Division of Vascular Surgery, Stanford Hospital and Clinics, Stanford, Calif; Division of Vascular Surgery, Santa Clara Valley Medical Center, San Jose, Calif
| | - Ehab Sorial
- Division of Vascular Surgery, Stanford Hospital and Clinics, Stanford, Calif; Division of Vascular Surgery, Santa Clara Valley Medical Center, San Jose, Calif
| | - Manuel Garcia-Toca
- Division of Vascular Surgery, Stanford Hospital and Clinics, Stanford, Calif; Division of Vascular Surgery, Santa Clara Valley Medical Center, San Jose, Calif.
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Patanè D, Failla G, Coniglio G, Russo G, Morale W, Seminara G, Calcara G, Bisceglie P, Malfa P. Treatment of juxta-anastomotic stenoses for failing distal radiocephalic arteriovenous fistulas: Drug-coated balloons versus angioplasty. J Vasc Access 2018; 20:209-216. [DOI: 10.1177/1129729818793102] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The aim of our study is to report the results of two types (type A, type B) paclitaxel drug-coated balloon compared with standard percutaneous transluminal angioplasty in the treatment of juxta-anastomotic stenoses of mature but failing distal radiocephalic hemodialysis arteriovenous fistulas. Two groups of 26 and 44 patients treated with two different drug-coated balloon are compared with a control group of 86 treated with standard percutaneous transluminal angioplasty. A color Doppler ultrasound was performed to evaluate stenosis and for treatment planning. We assess primary patency, defined as the absence of dysfunction of the arteriovenous fistulas, patent lesion or residual stenosis < 30% and no need for further reintervention of target lesion. Primary patency and secondary patency are evaluated after 12 months with color Doppler ultrasound for the whole arteriovenous fistulas, defined as absolute (absolute primary patency, absolute secondary patency) and target lesion. Postprocedural technical and clinical success was 100%. After 12 months, absolute primary patency is 81.8% for type A, 84.1% type B, and 54.7% for standard percutaneous transluminal angioplasty; target lesion primary patency is 92% type A, 86.4% type B, and 62.8% standard percutaneous transluminal angioplasty; absolute secondary patency is 95.4% type A, 95.5% type B, and 80.7% standard percutaneous transluminal angioplasty; target lesion secondary patency is 100% type A, 97.7% type B, and 80.7% standard percutaneous transluminal angioplasty. All the patients treated with drug-coated balloon (type A + type B) have an absolute primary patency of 83.3%, a target lesion primary patency of 87.9%, an absolute secondary patency of 95.5%, and a target lesion secondary patency of 98.4%. Our study confirms that the use of drug-coated balloon, indiscriminately among different brands, improves primary patency with statistically significant difference in comparison with standard percutaneous transluminal angioplasty and decreases reintervention of target lesion in juxta-anastomotic stenoses of failing distal arteriovenous fistulas maintaining the radiocephalic fistula as long as possible.
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Affiliation(s)
- Domenico Patanè
- Department of Diagnostic and Interventional Radiology, Azienda Ospedaliera per l’Emergenza Cannizzaro, Catania, Italy
| | - Giovanni Failla
- Department of Diagnostic and Interventional Radiology, Azienda Ospedaliera per l’Emergenza Cannizzaro, Catania, Italy
| | - Giovanni Coniglio
- Department of Diagnostic and Interventional Radiology, Azienda Ospedaliera Papardo, Messina, Italy
| | - Giorgio Russo
- IBFM CNR, Cefalù 90015(PA) and UOS Fisica Sanitaria, Azienda Ospedaliera per l’Emergenza Cannizzaro, Catania, Italy
| | - Walter Morale
- Department of Nefrology e Dialisys, Azienda Ospedaliera per l’Emergenza Cannizzaro, Catania, Italy
| | - Giuseppe Seminara
- Department of Nefrology e Dialisys, Azienda Ospedaliera per l’Emergenza Cannizzaro, Catania, Italy
| | - Giacomo Calcara
- Department of Diagnostic and Interventional Radiology, Azienda Ospedaliera per l’Emergenza Cannizzaro, Catania, Italy
| | - Paola Bisceglie
- Department of Diagnostic and Interventional Radiology, Azienda Ospedaliera per l’Emergenza Cannizzaro, Catania, Italy
| | - Pierantonio Malfa
- Department of Diagnostic and Interventional Radiology, Azienda Ospedaliera per l’Emergenza Cannizzaro, Catania, Italy
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Spanish Clinical Guidelines on Vascular Access for Haemodialysis. Nefrologia 2018; 37 Suppl 1:1-191. [PMID: 29248052 DOI: 10.1016/j.nefro.2017.11.004] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 06/21/2017] [Indexed: 12/26/2022] Open
Abstract
Vascular access for haemodialysis is key in renal patients both due to its associated morbidity and mortality and due to its impact on quality of life. The process, from the creation and maintenance of vascular access to the treatment of its complications, represents a challenge when it comes to decision-making, due to the complexity of the existing disease and the diversity of the specialities involved. With a view to finding a common approach, the Spanish Multidisciplinary Group on Vascular Access (GEMAV), which includes experts from the five scientific societies involved (nephrology [S.E.N.], vascular surgery [SEACV], vascular and interventional radiology [SERAM-SERVEI], infectious diseases [SEIMC] and nephrology nursing [SEDEN]), along with the methodological support of the Cochrane Center, has updated the Guidelines on Vascular Access for Haemodialysis, published in 2005. These guidelines maintain a similar structure, in that they review the evidence without compromising the educational aspects. However, on one hand, they provide an update to methodology development following the guidelines of the GRADE system in order to translate this systematic review of evidence into recommendations that facilitate decision-making in routine clinical practice, and, on the other hand, the guidelines establish quality indicators which make it possible to monitor the quality of healthcare.
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Quaretti P, Leati G, Moramarco LP, Cionfoli N, Corti R, Tinelli C, Fiorina I, Galli F. Percutaneous Transanastomotic Stent Graft Deployment to Salvage Dysfunctional Native Forearm Radiocephalic Fistulae: Feasibility and Primary Patency at 12 Months. J Vasc Interv Radiol 2018; 29:986-992. [DOI: 10.1016/j.jvir.2018.02.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 02/18/2018] [Accepted: 02/25/2018] [Indexed: 10/16/2022] Open
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Schmidli J, Widmer MK, Basile C, de Donato G, Gallieni M, Gibbons CP, Haage P, Hamilton G, Hedin U, Kamper L, Lazarides MK, Lindsey B, Mestres G, Pegoraro M, Roy J, Setacci C, Shemesh D, Tordoir JH, van Loon M, ESVS Guidelines Committee, Kolh P, de Borst GJ, Chakfe N, Debus S, Hinchliffe R, Kakkos S, Koncar I, Lindholt J, Naylor R, Vega de Ceniga M, Vermassen F, Verzini F, ESVS Guidelines Reviewers, Mohaupt M, Ricco JB, Roca-Tey R. Editor's Choice – Vascular Access: 2018 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2018; 55:757-818. [DOI: 10.1016/j.ejvs.2018.02.001] [Citation(s) in RCA: 346] [Impact Index Per Article: 57.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Lee T, Qian J, Thamer M, Allon M. Tradeoffs in Vascular Access Selection in Elderly Patients Initiating Hemodialysis With a Catheter. Am J Kidney Dis 2018; 72:509-518. [PMID: 29784614 DOI: 10.1053/j.ajkd.2018.03.023] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 03/13/2018] [Indexed: 11/11/2022]
Abstract
RATIONALE & OBJECTIVE National vascular access guidelines recommend placement of arteriovenous fistulas (AVFs) over grafts (AVGs) in hemodialysis patients, but have not been comprehensively assessed in the elderly. We evaluated clinically relevant vascular access outcomes in elderly patients receiving an AVF or AVG after hemodialysis therapy initiation. STUDY DESIGN Retrospective cohort study using national administrative data. SETTINGS & PARTCIPANTS Claims data from the US Renal Data System of 9,458 US patients 67 years and older who initiated hemodialysis therapy from July 1, 2010, to June 30, 2011, with a catheter and received an AVF (n=7,433) or AVG (n=2,025) within the ensuing 6 months. PREDICTOR Arteriovenous access subtype, AVF or AVG. OUTCOMES Successful use of vascular access, interventions to make vascular access functional, duration of catheter dependence before successful use of vascular access, frequency of interventions, and abandonment after successful use of vascular access. ANALYTICAL APPROACH Multivariable logistic regression analysis was used to compare the need for intervention before successful use of AVFs and AVGs, and negative bionomial regression was used to calculate the frequency of intervention after successful use of vascular access. RESULTS Unsuccessful use of vascular access within 6 months of creation was higher for AVFs versus AVGs (51% vs 45%; adjusted HR, 1.86; 95% CI, 1.73-1.99). Interventions to make vascular access functional were greater in AVFs versus AVGs (42% vs 23%; OR, 2.66; 95% CI, 2.26-3.12). AVFs had a lower 1-year abandonment rate after successful use compared with AVGs (OR, 0.71; 95% CI, 0.62-0.83) and required one-fourth fewer interventions after successful use (relative risk, 0.75; 95% CI, 0.69-0.81). Patients receiving an AVF had substantially longer catheter dependence before successful use than those receiving an AVG (median time, 3 vs 1 month; P<0.001). LIMITATIONS Residual confounding due to vascular access choice, restriction to an elderly population, and 1-year follow-up period. CONCLUSIONS In elderly hemodialysis patients initiating hemodialysis therapy with a catheter, the optimal vascular access selection depends on tradeoffs between shorter catheter dependence and less frequent interventions to make the vascular access (AVG) functional versus longer access patency and fewer interventions after successful use of the vascular access (AVF).
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Affiliation(s)
- Timmy Lee
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, AL; Veterans Affairs Medical Center, Birmingham, AL.
| | - Joyce Qian
- Medical Technology and Practice Patterns Institute, Bethesda, MD
| | - Mae Thamer
- Medical Technology and Practice Patterns Institute, Bethesda, MD
| | - Michael Allon
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, AL
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A Review of Percutaneous Transluminal Angioplasty in Hemodialysis Fistula. Int J Vasc Med 2018; 2018:1420136. [PMID: 29785307 PMCID: PMC5892221 DOI: 10.1155/2018/1420136] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 02/26/2018] [Indexed: 12/31/2022] Open
Abstract
The number of patients in dialysis increases every year. In this review, we will evaluate the role of percutaneous transluminal angioplasty (PTA) according to patency of arteriovenous fistula and grafts. The main indication of PΤΑ is stenosis > 50% or obstruction of the vascular lumen of an arteriovenous fistula and graft. It is usually performed under local anesthesia. The infection rate is as low as the number of complications. Fistula can be used in dialysis in the same day without the need for a central venous catheter. Primary patency is >50% in the first year while primary assisted patency is 80-90% in the same time period. Repeated PTA is as durable as the primary PTA. An early PTA carries a risk of new interventions. Cutting balloon can be used as a second-line method. Stents and covered stents are kept for the management of complications and central outflow venous stenosis. PTA is the treatment of choice for stenosis or obstruction of dialysis fistulas. Repeated PTA may be needed for better patency. Drug eluting balloon may become the future in PTA of dialysis fistula, but more trials are needed.
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A Dedicated Vascular access Program can Improve Arteriovenous Fistula Rates without Increasing Catheters. J Vasc Access 2018. [DOI: 10.1177/112972980800900406] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose We describe the development and implementation of a comprehensive multidisciplinary vascular access (VA) program and describe its impact on VA distribution rates. Methods A retrospective review of all incident and prevalent patients in our hemodialysis (HD) unit was conducted in September 2001 to determine baseline data including: type of VA along with patient characteristics and comorbidities. Similar data was extracted from the database in 2005 for incident and prevalent patients. Results The VA program had a significant impact on arteriovenous fistulae (AVF) rates in both incident and prevalent HD patients: incident AVF rates increased from 14 to 39% (p=0.04) and prevalent AVF rates from 60 to 64% (p=0.015). Multivariate analysis revealed that male gender (OR 1.79 [CI 0.85–0.98, p=0.006]) and year of dialysis initiation 2005 vs. 2001 (OR 1.65 [CI 1.09–2.5, p=0.017]) were associated with AVF use among prevalent HD patients. Furthermore, age (per 5 years over 70) is associated with a decreased likelihood of having an AVF (OR 0.91 [CI 0.85–0.98, p=0.009]) whereas comorbidities of cardiovascular disease and diabetes had no impact. Conclusion We demonstrate that a structured VA program can increase the number of functioning fistulas without a corresponding increase in catheters in incident and prevalent HD patients.
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Kim SM, Ko HK, Noh M, Ko GY, Kim MJ, Kwon TW, Kim HJ, Cho YP. Factors Affecting Patency following Successful Percutaneous Intervention for Dysfunctional Hemodialysis Vascular Access. Ann Vasc Surg 2017; 47:54-61. [PMID: 28887254 DOI: 10.1016/j.avsg.2017.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 07/24/2017] [Accepted: 08/27/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND This study aimed to investigate the patency following initial successful percutaneous transluminal angioplasty (PTA) for untreated dysfunctional hemodialysis vascular access and to identify predictors of PTA durability. METHODS This retrospective observational study included data of 132 consecutive initial PTA of hemodialysis vascular access in 126 patients who showed immediate technical and clinical success and had at least 1 year of follow-up data. RESULTS The mean duration of primary and secondary patency post-PTA was 16 and 27 months, respectively. On multivariate adjusted Cox regression analysis, dyslipidemia (P < 0.001), use of insulin (P = 0.016), and arteriovenous graft (AVG) (P = 0.016) were significantly associated with shorter primary patency. Dyslipidemia (P < 0.001), use of antiplatelet medication (P = 0.013), and failed vascular access (P = 0.004) were significant predictors of secondary patency loss. Use of statin was the only clinical variable associated with increased primary and secondary patency (P < 0.001). According to a subgroup analysis on the type of vascular access and dysfunction, primary and secondary patency rates were significantly higher in the arteriovenous fistula (AVF) and failing vascular access groups than AVG and failed vascular access groups, respectively. Early dysfunction (within 6 months) was significantly higher in the AVG and failed vascular access groups after initial PTA, but there was no significant difference after multiple PTAs. CONCLUSIONS Post-PTA primary and secondary patency rates were significantly higher with AVF and failing vascular access. The use of statin was associated with increased primary and secondary patency after initial successful PTA in this study.
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Affiliation(s)
- Sung Min Kim
- Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea
| | - Heung Kyu Ko
- Department of Radiology, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea
| | - Minsu Noh
- Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea
| | - Gi-Young Ko
- Department of Radiology, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea
| | - Min-Ju Kim
- Biostatistics Collaboration Unit, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea
| | - Tae-Won Kwon
- Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea
| | - Hee Jin Kim
- Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea
| | - Yong-Pil Cho
- Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea.
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Cho S. The feasibility of surgical salvage of thrombosed arteriovenous fistula by an interventional nephrologist. Kidney Res Clin Pract 2017; 36:175-181. [PMID: 28680825 PMCID: PMC5491164 DOI: 10.23876/j.krcp.2017.36.2.175] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 02/15/2017] [Accepted: 02/17/2017] [Indexed: 12/04/2022] Open
Abstract
Background Salvage of a thrombosed arteriovenous fistula (AVF) by secondary fistula conversion may be more effective than a conventional endovascular procedure for forearm fistula thrombosis. Surgical access procedures are an undeveloped area in interventional nephrology compared to endovascular procedures. Herein, the author report the results of surgical salvage of thrombosed AVFs by interventional nephrologists. Methods The author retrospectively analyzed 52 surgical salvage procedures for AVF thrombosis (radiocephalic fistula = 44 cases, brachiocephalic fistula = 8 cases) that were performed by interventional nephrologist between March 2007 and January 2016. Results Secondary fistula formation using the proximal vein was performed for 46 cases (88.5%); outflow rerouting was performed for two cephalic-arch stenosis cases (3.9%), simple thrombectomy was performed for two cases (3.9%), and a graft interposition was performed for two cases (3.9%). Technical success after the surgical procedures was achieved in 51 cases (98.1%), and 39 AVFs (75.0%) were prepared for immediate puncturing without catheter insertion. The primary and secondary patency rates for AVF at 6, 12, 18, and 24 months were 88.5%, 83.2%, 83.2%, and 83.2% and 96.0%, 96.0%, 93.2%, and 93.2%, respectively. The re-intervention rate was 0.27 ± 0.92/patient/ year. Conclusion Based on these results, the author conclude that surgical salvage of a thrombosed AVF, when performed under local anesthesia by a skilled interventional nephrologist, offers favorable short- and long-term success and should be the preferred treatment.
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Affiliation(s)
- Seong Cho
- Division of Nephrology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
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MacRae JM, Dipchand C, Oliver M, Moist L, Lok C, Clark E, Hiremath S, Kappel J, Kiaii M, Luscombe R, Miller LM. Arteriovenous Access Failure, Stenosis, and Thrombosis. Can J Kidney Health Dis 2016; 3:2054358116669126. [PMID: 28270918 PMCID: PMC5332078 DOI: 10.1177/2054358116669126] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 08/04/2016] [Indexed: 01/29/2023] Open
Abstract
Vascular access–related complications can lead to patient morbidity and reduced patient quality of life. Some of the common arteriovenous access complications include failure to mature, stenosis formation, and thrombosis.
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Affiliation(s)
- Jennifer M MacRae
- Cumming School of Medicine and Department of Cardiac Sciences, University of Calgary, Alberta, Canada
| | | | - Matthew Oliver
- Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Louise Moist
- Department of Medicine, University of Western Ontario, London, Canada
| | - Charmaine Lok
- Faculty of Medicine, University Health Network, University of Toronto, Ontario, Canada
| | - Edward Clark
- Faculty of Medicine, University of Ottawa, Ontario, Canada
| | | | - Joanne Kappel
- Faculty of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Mercedeh Kiaii
- Faculty of Medicine, The University of British Columbia, Vancouver, Canada
| | - Rick Luscombe
- Department of Nursing, Providence Health Care, Vancouver, British Columbia, Canada
| | - Lisa M Miller
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
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Impaired maturation of distal radio-cephalic fistula for haemodialysis: a review of treatment options. J Nephrol 2016; 30:45-51. [DOI: 10.1007/s40620-016-0332-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 06/28/2016] [Indexed: 11/26/2022]
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Muray Cases S, García Medina J, Pérez Abad JM, Andreu Muñoz AJ, Ramos Carrasco F, Pérez Pérez A, Lacasa Pérez N, Cabezuelo Romero JB. Importance of monitoring and treatment of failed maturation in radiocephalic arteriovenous fistula in predialysis: Role of ultrasound. Nefrologia 2016; 36:410-7. [PMID: 26948443 DOI: 10.1016/j.nefro.2015.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 10/05/2015] [Accepted: 10/28/2015] [Indexed: 11/24/2022] Open
Abstract
UNLABELLED The aim of the study was to analyse outcomes of AVF-RC in predialysis stage in which a clinical and radiological follow up of its maturation had been done and primary failure had been treated. MATERIAL AND METHODS We studied 127 RC-AVF in 117 predialysis patients. All cases had a preoperative map. The RC-AVF was considered mature if it had a brachial artery flow ≥500ml/min and a cephalic vein diameter of ≥4mm. Primary failure was treated radiologically or surgically depending on the type of lesion. Fifty-eight patients started dialysis at the time of the study. RESULTS In 106 RC-AVF without thrombosis, 72 (68%) were mature and 34 (32%) were immature. A total of 97% of the immature had at least one lesion, and the most common site was the post-anastomotic vein. Lesions were found in 31% of mature RC-AVF, and 18% of patients required treatment. Radiological treatment was the most frequent for maturation failure. After 6 months, primary and secondary patency were 59% and 78%, while after 12 months they were 48% and 77%, respectively. The 80% of patients started dialysis with a distal AVF (76% RC-AVF and 4% ulnar basilic). None of the patients with treated immature RC-AVF started dialysis with CVC, while 78% of the patients started with said AVF. CONCLUSION Ultrasonography for monitoring maturation provides advantages over clinical monitoring. With our management of RC-AVF in predialysis, 80% of patients start dialysis with an adequate distal AVF.
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Affiliation(s)
- Salomé Muray Cases
- Servicio de Nefrología, Hospital General Universitario Reina Sofía, Murcia, España.
| | - José García Medina
- Servicio de Radiología Vascular, Hospital General Universitario Reina Sofía, Murcia, España
| | | | | | | | - Antonio Pérez Pérez
- Servicio de Nefrología, Hospital General Universitario Reina Sofía, Murcia, España
| | - Noelia Lacasa Pérez
- Servicio de Radiología Vascular, Hospital General Universitario Reina Sofía, Murcia, España
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Fontseré N, Mestres G, Yugueros X, López T, Yuguero A, Bermudez P, Gomez F, Riambau V, Maduell F, Campistol JM. Effect of a postoperative exercise program on arteriovenous fistula maturation: A randomized controlled trial. Hemodial Int 2015; 20:306-14. [DOI: 10.1111/hdi.12376] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Néstor Fontseré
- Department of Nephrology; Vascular Access Unit; Hospital Clinic; University of Barcelona; Barcelona Spain
| | - Gaspar Mestres
- Department of Vascular Surgery; Vascular Access Unit; Hospital Clinic; University of Barcelona; Barcelona Spain
| | - Xavier Yugueros
- Department of Vascular Surgery; Vascular Access Unit; Hospital Clinic; University of Barcelona; Barcelona Spain
| | - Teresa López
- Department of Nephrology; Vascular Access Unit; Hospital Clinic; University of Barcelona; Barcelona Spain
| | - Anna Yuguero
- Department of Nephrology; Vascular Access Unit; Hospital Clinic; University of Barcelona; Barcelona Spain
| | - Patricia Bermudez
- Department of Interventional Radiology; Vascular Access Unit; Hospital Clinic; University of Barcelona; Barcelona Spain
| | - Fernando Gomez
- Department of Interventional Radiology; Vascular Access Unit; Hospital Clinic; University of Barcelona; Barcelona Spain
| | - Vicenç Riambau
- Department of Vascular Surgery; Vascular Access Unit; Hospital Clinic; University of Barcelona; Barcelona Spain
| | - Francisco Maduell
- Department of Nephrology; Vascular Access Unit; Hospital Clinic; University of Barcelona; Barcelona Spain
| | - Josep M. Campistol
- Department of Nephrology; Vascular Access Unit; Hospital Clinic; University of Barcelona; Barcelona Spain
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Surgical Options in the Problematic Arteriovenous Haemodialysis Access. Cardiovasc Intervent Radiol 2015; 38:1405-15. [DOI: 10.1007/s00270-015-1155-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 05/30/2015] [Indexed: 11/27/2022]
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Preemptive Open Surgical vs. Endovascular Repair for Juxta-Anastomotic Stenoses of Autogenous AV Fistulae: A Meta-Analysis. J Vasc Access 2015; 16:454-8. [DOI: 10.5301/jva.5000444] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2015] [Indexed: 11/20/2022] Open
Abstract
Purpose There is controversy about the best mode of preemptive repair of juxta-anastomotic stenoses in radial-cephalic arteriovenous fistula (AVFs). The aim of the present review was to compare the outcome of surgical vs. endovascular repair of those AVF stenoses. Methods A systematic review and meta-analysis was performed for studies comparing the outcome of open surgical vs. endovascular preemptive repair of AVF stenoses located in the juxta-anastomotic region. A search was carried out in April 2015. The analyzed outcome measures were the primary patency at 12 and 18 months and the assisted primary patency at 24 months. In addition, assessment of the methodological quality of the included studies was carried out. Results Four non-randomized cohort studies (297 patients) were analyzed. A random effects model was used to pool the data. The pooled odds ratio (OR and 95% confidence intervals) for the primary patency at 12 and at 18 months was 0.42 (0.25-0.72) and 0.33 (0.2-0.56), respectively, showing statistically significant higher patency of the surgically repaired group. The pooled OR for the assisted primary patency at 24 months was 0.53 (0.28-0.98) also in favor of the surgically repaired group (p<0.04) Conclusions The available evidence, based on non-randomized cohort studies, suggests that surgery is the best way to treat ‘juxta-anastomotic’ stenotic lesions in distal radial-cephalic AVFs, although angioplasty remains a valuable but less durable option in this location of the stenosis.
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One-year patency rate of native arteriovenous fistulas reconstructed by vascular stripping in hemodialysis patients with venous neointimal hyperplasia. J Vasc Surg 2015; 61:192-6. [DOI: 10.1016/j.jvs.2014.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 07/14/2014] [Indexed: 12/12/2022]
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Kwon H, Choi JY, Ko HK, Kim MJ, Kim H, Park H, Han Y, Ko GY, Kwon TW, Cho YP. Comparison of Surgical and Endovascular Salvage Procedures for Juxta-anastomotic Stenosis in Autogenous Wrist Radiocephalic Arteriovenous Fistula. Ann Vasc Surg 2014; 28:1840-6. [DOI: 10.1016/j.avsg.2014.06.060] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 05/25/2014] [Accepted: 06/21/2014] [Indexed: 11/30/2022]
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Kwok TMY, Ramanathan AK. Fistuloplasty techniques for correction of juxta-anastomotic stenosis. Ann R Coll Surg Engl 2014; 96:480-1. [PMID: 25335210 DOI: 10.1308/rcsann.2014.96.6.480a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Which accesses should be abandoned or revised? J Vasc Access 2014; 15 Suppl 7:S76-80. [PMID: 24817460 DOI: 10.5301/jva.5000227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2014] [Indexed: 11/20/2022] Open
Abstract
This review considers the factors in deciding whether to abandon a functioning access. Strong indications for ligation or excision of an access are infection or severe early-onset steal. Access ligation may also be required for central vein occlusion or high-output cardiac failure. In general, a failing or thrombosed access should be restored to function unless it is no longer required. For failing or thrombosed distal arteriovenous fistulas, it may be easiest to abandon it and create a new fistula a few centimetres proximally rather than perform angioplasty, which is likely to require repeating. Other accesses may be abandoned after repeated treatment of the same stenosis over a short period provided other options exist.
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Neuen BL, Gunnarsson R, Webster AC, Baer RA, Golledge J, Mantha ML. Predictors of patency after balloon angioplasty in hemodialysis fistulas: a systematic review. J Vasc Interv Radiol 2014; 25:917-24. [PMID: 24703320 DOI: 10.1016/j.jvir.2014.02.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 02/08/2014] [Accepted: 02/10/2014] [Indexed: 01/05/2023] Open
Abstract
Percutaneous transluminal angioplasty (PTA) is an established treatment for dysfunctional hemodialysis fistulas. This article systematically reviews evidence for predictors of patency after PTA. Outcomes assessed were primary, assisted primary, and secondary patency after intervention, and findings were summarized descriptively. This review included 11 nonrandomized observational studies of 965 fistulas in 939 patients. Follow-up ranged from 0 days to 10 years. Study quality was overall suboptimal. Newer fistulas and longer lesion length may be associated with primary patency loss after PTA. Further studies are needed to confirm these findings, to identify potentially modifiable factors, and to guide the testing of new endovascular devices.
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Affiliation(s)
- Brendon L Neuen
- School of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia.
| | - Ronny Gunnarsson
- School of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia; Research and Development Unit for Primary Health Care and Dental Care, Southern Älvsborg County, Region Västra Götaland, Sweden; Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Angela C Webster
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia; Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Richard A Baer
- Department of Renal Medicine, Cairns Hospital, Cairns, Queensland, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, James Cook University, Townsville, Queensland, Australia; Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Queensland, Australia
| | - Murty L Mantha
- Department of Renal Medicine, Cairns Hospital, Cairns, Queensland, Australia
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Is Repeat PTA of a Failing Hemodialysis Fistula Durable? Int J Vasc Med 2014; 2014:369687. [PMID: 24587906 PMCID: PMC3920629 DOI: 10.1155/2014/369687] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Revised: 11/18/2013] [Accepted: 11/18/2013] [Indexed: 11/18/2022] Open
Abstract
Purpose. Our objective was to evaluate the outcome of percutaneous transluminal angioplasty (PTA) and particularly rePTA in a failing arteriovenous fistula (AV-fistula). Are multiple redilations worthwhile? Patients and Methods. All 159 stenoses of AV fistulas that were treated with PTA, with or without stenting, during 2008 and 2009, were included. Occluded fistulas that were dilated after successful thrombolysis were also included. Median age was 68 (interquartile range 61.5-78.5) years and 75% were male. Results. Seventy-nine (50%) of the primary PTAs required no further reintervention. The primary patency was 61% at 6 months and 42% at 12 months. Eighty (50%) of the stenoses needed at least one reintervention. Primary assisted patency (defined as patency after subsequent reinterventions) was 89% at 6 months and 85% at 12 months. The durability of repeated PTAs was similar to the durability of the primary PTA. However, an early primary PTA carried a higher risk for subsequent reinterventions. Successful dialysis was achieved after 98% of treatments. Nine percent of the stenoses eventually required surgical revision and 13% of the fistulas failed permanently. Conclusion. The present study suggests that most failing AV-fistulas can be salvaged endovascularly. Repeated PTA seems similarly durable as the primary PTA.
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Tessitore N, Bedogna V, Poli A, Lipari G, Pertile P, Baggio E, Contro A, Criscenti P, Mansueto G, Lupo A. Should current criteria for detecting and repairing arteriovenous fistula stenosis be reconsidered? Interim analysis of a randomized controlled trial. Nephrol Dial Transplant 2013; 29:179-87. [PMID: 24166470 DOI: 10.1093/ndt/gft421] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The vascular access guidelines recommend that arteriovenous fistulas (AVFs) with access dysfunction and an access blood flow (Qa) <300-500 mL/min be referred for stenosis imaging and treatment. Significant (>50%) stenosis, however, may be detected in a well-functioning AVF with a Qa > 500 mL/min, too, but whether it is worth correcting or not remains to be seen. METHODS In October 2006, we began an open randomized controlled trial enrolling patients with an AVF with subclinical stenosis and Qa > 500 mL/min, to see how elective stenosis repair [treatment group (TX)] influenced access failure (thrombosis or impending thrombosis requiring access revision), or loss and the related cost compared with stenosis correction according to the guidelines, i.e. after the onset of access dysfunction or a Qa < 400 mL/min [control group (C)]. An interim analysis was performed in July 2012, by which time the trial had enrolled 58 patients (30 C and 28 TX). RESULTS TX led to a relative risk of 0.47 [95% confidence interval (CI): 0.17-1.15] for access failure (P = 0.090), 0.37 [95% CI: 0.12-0.97] for thrombosis (P = 0.033) and 0.36 [95% CI: 0.09-0.99] for access loss (P = 0.041). In the setting of our study (in which all surgery was performed as in patient procedure) no significant differences in costs emerged between the two strategies. The mean incremental cost-effectiveness ratio for TX was €282 or €321 to avoid one episode of thrombosis or access loss, respectively. CONCLUSIONS Our interim analysis showed that elective repair of subclinical stenosis in AVFs with Qa > 500 mL/min cost-effectively reduces the risk of thrombosis and access loss in comparison with the approach of the Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines, raising the question of whether the currently recommended criteria for assessing and treating stenosis should be reconsidered.
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Affiliation(s)
- Nicola Tessitore
- Department of Medicine, Renal Unit, University Hospital, Verona, Italy
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Riella MC, Roy-Chaudhury P. Vascular access in haemodialysis: strengthening the Achilles' heel. Nat Rev Nephrol 2013; 9:348-57. [DOI: 10.1038/nrneph.2013.76] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Stenosis Complicating Vascular access for Hemodialysis: Indications for Treatment. J Vasc Access 2013; 15:76-82. [DOI: 10.5301/jva.5000194] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2013] [Indexed: 11/20/2022] Open
Abstract
The aim of the multidisciplinary team committed to the care of vascular access (VA) for hemodialysis is to prolong as much as possible the functional patency of the access. Stenosis is definitely the most frequent complication of arteriovenous VA. Whereas the best surveillance strategy is still a matter of debate, some evidence is now available about treatment indication and options. The available body of evidence on the best strategy facing this complication of VA is reviewed.
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Mortamais J, Papillard M, Girouin N, Boutier R, Cougnaud L, Martin X, Badet L, Juillard L, Rouvière O. Endovascular Treatment of Juxta-anastomotic Venous Stenoses of Forearm Radiocephalic Fistulas: Long-term Results and Prognostic Factors. J Vasc Interv Radiol 2013; 24:558-64; quiz 565. [DOI: 10.1016/j.jvir.2012.12.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Revised: 12/03/2012] [Accepted: 12/06/2012] [Indexed: 11/30/2022] Open
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Efficacy of percutaneous transluminal angioplasty on dysfunctional fistulae because of inflow stenosis. J Vasc Access 2013; 14:231-8. [PMID: 23334851 DOI: 10.5301/jva.5000129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2012] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Autogenous fistulas are the preferential vascular access for hemodialysis. The aim of this retrospective study was to determine the efficacy of angioplasty for dysfunctional fistulas because of inflow dysfunction.
METHODS We reviewed all the angiographic procedures performed on our institution between April 2007 and April 2009. Procedures performed in dysfunctional fistulas because of inflow stenoses were analyzed. Fistulas with stenoses out of these areas were excluded. The following data were collected: patient age and sex, fistula age at the time of intervention, location of fistula, number and location of stenosis, angiography referral criteria, clinical findings (presence or absence of thrills, bruits and pulsatility) and date of reintervention or failure.
RESULTS During the study period 215 fistulas were submitted to angiography of which, seventy-one presented inflow stenosis (33%). Mean follow-up was 21.72±9.26 months, and average age was 7.03 months. Two groups were considered: 31 fistulas comprising ≤6 months old, and 40 fistulas >6 months old. Primary patency rates±SE for older fistulas at 6, 12, 18 and 24 months, respectively, was 91.3%± 0.04%, 80.7%± 0.07%, 53.8% ±0.10% and 34.2±0.1% versus 91.7±0.08%, 57.1±0.14%, 23±0.14%, 11.4%± 0.1% for younger fistulas (P=0.04). Fistulas ≤6 months old and multiple stenosis were associated with a poorer primary patency rate (P=0.005).
CONCLUSIONS Inflow stenosis is frequently associated with fistula dysfunction. In this study we only analyzed AVF with inflow stenosis and we have shown that angioplasty can have great patency results, particularly for single lesions in matured fistulas.
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