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Li Y, Yang J, Chen Y, Cui W, Wang J, Zhang C, Zhu L, Bian C, Luo T. Prognostic nomogram for the patency of wrist autologous arteriovenous fistula in first year. iScience 2024; 27:110727. [PMID: 39310751 PMCID: PMC11416551 DOI: 10.1016/j.isci.2024.110727] [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] [Academic Contribution Register] [Received: 01/25/2024] [Revised: 05/19/2024] [Accepted: 08/09/2024] [Indexed: 09/25/2024] Open
Abstract
Autologous arteriovenous fistula (AVF) is preferred in hemodialysis patients. Maintaining its patency is a critical problem. This study aimed to create a nomogram model for predicting 1-year primary patency of AVF. Consequently, a total of 414 patients were retrospectively enrolled and randomly allocated to training and validation cohorts. Risk factors were identified by multivariable logistic regression and used to create a nomogram model. Performance of the model was evaluated by receiver operating characteristic (ROC) curve, Hosmer-Lemeshow test, and calibration curve. The results suggested that diameter of cephalic vein, low-density lipoprotein, glycosylated hemoglobin (%), and C-reactive protein were risk factors which could predict the patency of AVF. Area under ROC curves for training and validation cohorts were 0.771 and 0.794, respectively. Calibration ability was satisfactory in both cohorts. Therefore, present nomogram model could predict the 1-year primary patency of AVF.
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Affiliation(s)
- Yu Li
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jinming Yang
- Department of Vascular Intervention, Aerospace Center Hospital, Beijing, China
| | - Yue Chen
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wenhao Cui
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jukun Wang
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chao Zhang
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Linzhong Zhu
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chunjing Bian
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tao Luo
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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Greenstein R, Nawrocki P, Nesbit C. Bottle it up: Prehospital management of an AV fistula bleed using a bottle cap: A case report. Am J Emerg Med 2023; 67:197.e1-197.e2. [PMID: 36933987 DOI: 10.1016/j.ajem.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 03/05/2023] [Accepted: 03/05/2023] [Indexed: 03/11/2023] Open
Abstract
Hemorrhage from arteriovenous fistula sites is a known complication with potentially fatal consequences. The management of AV fistula hemorrhage has historically included direct pressure, tourniquet use, and/or surgical management. We describe a case of a 71-year-old female with hemorrhage from an AV fistula site that was successfully managed in the prehospital setting using a simple bottle cap.
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Affiliation(s)
- Rebecca Greenstein
- Department of Emergency Medicine, Allegheny General Hospital, Pittsburgh, PA, United States of America.
| | - Philip Nawrocki
- Department of Emergency Medicine, Allegheny General Hospital, Pittsburgh, PA, United States of America
| | - Chadd Nesbit
- Department of Emergency Medicine, Allegheny General Hospital, Pittsburgh, PA, United States of America
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Feng R, Wang S, Chang G, Zhang WW, Liu Q, Wang X, Chen W, Wang S. The feasibility of small-caliber veins for autogenous arteriovenous fistula creation: A single-center retrospective study. Front Cardiovasc Med 2023; 10:1070084. [PMID: 36776248 PMCID: PMC9909423 DOI: 10.3389/fcvm.2023.1070084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 10/14/2022] [Accepted: 01/09/2023] [Indexed: 01/28/2023] Open
Abstract
Objective Autogenous arteriovenous fistula (AVF) is recommended as the first choice for hemodialysis vascular access. A small-caliber vein is one of the independent risk factors for AVF maturation and patency. However, the specific threshold is still unclear, making it difficult to accurately determine whether these vessels are suitable for AVF creation. Design This is a single-center retrospective study. Method Patients who underwent AVF creation in our medical center between January 2020 and September 2022 and satisfied the eligibility criteria were included in this retrospective study. Logistic regression analysis was performed to identify risk factors for functional maturation and additional intervention. The optimal cutoff value was determined based on the receiver operating curve (ROC) and the Youden index. Kaplan-Meier analysis was utilized in further patency rate comparisons. Result A total of 125 forearm AVFs were created in 121 patients with end-stage renal disease (ESRD). The mean age was 53.88 ± 15.10 years. Preoperative vascular Doppler ultrasound (DUS) was conducted and recorded in 106 cases (84.80%). The mean targeted artery and vein diameters were 2.17 ± 0.54 and 1.71 ± 0.75 mm, respectively. Small-caliber vein is the risk factor for functional maturation failure (OR = 0.256, 95%CI [0.06-0.75], p = 0.033) and additional intervention (OR = 0.306, 95% CI [0.09-0.78], p = 0.031). The optimal cutoff value is 1.35 mm (augmented) when specificity and sensitivity reach 80 and 63.7%, respectively. The AVFs with a vein diameter of more than 1.35 mm (augmented) showed higher patency rates (p < 0.01). Conclusion After comprehensive DUS evaluation, intraoperative hydrodilation, postoperative active exercise and intensive DUS detection, and application of balloon-assisted maturation, if necessary, using a vein more than 1.35 mm (augmented), could achieve satisfactory functional maturation and postoperative patency in AVF formation.
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Affiliation(s)
- Ruijia Feng
- Department of Vascular Surgery, National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Siwen Wang
- Department of Vascular Surgery, National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Guangqi Chang
- Department of Vascular Surgery, National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wayne W. Zhang
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Washington, Seattle, WA, United States
| | - Qinghua Liu
- Department of Nephrology, The First Affiliated Hospital, NHC Key Laboratory of Nephrology, Guangdong Provincial Key Laboratory of Nephrology, Sun Yat-sen University, Guangzhou, China
| | - Xin Wang
- Department of Nephrology, The First Affiliated Hospital, NHC Key Laboratory of Nephrology, Guangdong Provincial Key Laboratory of Nephrology, Sun Yat-sen University, Guangzhou, China
| | - Wei Chen
- Department of Nephrology, The First Affiliated Hospital, NHC Key Laboratory of Nephrology, Guangdong Provincial Key Laboratory of Nephrology, Sun Yat-sen University, Guangzhou, China,*Correspondence: Wei Chen, ✉
| | - Shenming Wang
- Department of Vascular Surgery, National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China,Shenming Wang, ✉
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Gao M, Wang J. Risk Factors of Arteriovenous Fistula Stenosis of Patients with Maintenance Hemodialysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:2968122. [PMID: 36387371 PMCID: PMC9649314 DOI: 10.1155/2022/2968122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Academic Contribution Register] [Received: 06/03/2022] [Revised: 07/20/2022] [Accepted: 07/26/2022] [Indexed: 07/29/2023]
Abstract
Objective To investigate the risk factors of arteriovenous fistula stenosis in maintenance hemodialysis patients. Methods A total of 80 patients with maintenance hemodialysis in our hospital from January 2017 to January 2022 were included. According to the stenosis degree of the arteriovenous fistula, patients were divided into a stenosis group (n = 35) and an unobstructed group (n = 45). Laboratory examination data, such as the demographic characteristics of patients, past medical history, the use of traditional Chinese medicine (TCM), the TCM for improving blood circulation to promote blood circulation and remove blood stasis, and cellular immune function, were collected. Multivariate Logistic regression analysis was used to analyze the influencing factors. Results There was no significant difference in the age, sexuality, body mass index, proportion of patients with coronary heart disease, cephalic vein diameter, radial artery diameter, albumin, fibrinogen, and blood calcium levels between the two groups (P > 0.05). Compared with the unobstructed group, the stenosis group had higher rates of diabetes and hypertension as well as significantly higher levels of platelets, parathyroid hormone, and D-dimer (P < 0.05). The proportion of TCM application in the stenosis group was 28.6% (10/35), which was significantly lower than that in the unobstructed group 57.8% (26/45). The difference was statistically significant (χ 2 = 6.785, P=0.009). The levels of CD3+ (37.5 ± 5.1% vs. 42.0 ± 4.8%), CD4+ (35.7 ± 3.2% vs. 39.6 ± 3.1%) and CD4+/CD8+ (1.4 ± 0.3 vs. 2.4 ± 1.0) in the stenosis group were significantly lower, while CD8+ level was significantly higher (26.8 ± 5.1% vs. 18.5 ± 6.2%) than that in the unobstructed group (P < 0.001). Logistic regression analysis indicated that the usage of TCM was an independent risk factor for arteriovenous fistula stenosis after adjustment for other factors (odds ratio [OR] 0.302; 95% confidence interval [95% CI] 0.100-0.896; P=0.039). Conclusions Less use of traditional Chinese medicine for activating blood circulation and removing blood stasis and poor cellular immune function are important factors affecting the function of the arteriovenous fistula in patients with maintenance hemodialysis, which is worthy of clinical attention.
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Affiliation(s)
- Meiling Gao
- Blood Purification Center, Changzhou Second People's Hospital, Changzhou 213000, Jiangsu, China
| | - Jing Wang
- Blood Purification Center, Changzhou Second People's Hospital, Changzhou 213000, Jiangsu, China
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Razdan RN, Rosenblatt M, Jiao Y, McLaughlin N, Usvyat LA, Sor M, Larkin JW. Cephalic arch restenosis rates in hemodialysis patients with brachiocephalic fistulae: a retrospective multicenter analysis of 3301 patients. BMC Nephrol 2022; 23:109. [PMID: 35300609 PMCID: PMC8932324 DOI: 10.1186/s12882-022-02728-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 09/15/2021] [Accepted: 03/08/2022] [Indexed: 11/10/2022] Open
Abstract
Background We evaluated restenosis rates at the cephalic arch after percutaneous angioplasty and stenting procedures in patients with brachial artery to cephalic vein arteriovenous fistula (BCAVF) hemodialysis access. Methods We used data from adult hemodialysis patients treated at a national network of 44 outpatient interventional facilities during Oct 2011–2015. We included data from patients with BCAVF who received an exclusive angioplasty, or stent with angioplasty, for treatment of cephalic arch stenosis and had ≥1 subsequent evaluation of the cephalic arch. Median percent restenosis per month at cephalic arch and days between encounters was calculated from the 1st index to 2nd procedure, and for up to 4 subsequent encounters. Analyses were stratified by intervention and device types. Results We identified a cohort of 3301 patients (mean age 62.2 ± 13.9 years, 58.5% male, 33.2% white race) with a BCAVF who had an angioplasty, or stent, at the cephalic arch for an index and ≥ 1 follow-up procedure. Between the 1st index to 2nd procedure, patients who received an angioplasty (n = 2663) or stent (n = 933) showed a median decrease of 18.9 and 16.5% in luminal diameter per month and a median time of 93 and 91 days between encounters, respectively. Restenosis and day rates were similar for standard versus high-pressure angioplasties. Bare metal stents showed 10.1 percentage point higher restenosis rate compared to stent grafts. Restenosis rates and time to restenosis were relatively consistent across subsequent encounters. Conclusions Findings suggest hemodialysis patients with a BCAVF who require an angioplasty or stent to treat a stenosis at the cephalic arch will have stenosis reformed at a rate of 18.9 and 16.5% per month after the first intervention, respectively. Findings suggest patients are at risk of having significant lesions at the cephalic arch within 3 months after the previous intervention. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02728-4.
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Affiliation(s)
| | | | - Yue Jiao
- Fresenius Medical Care, Global Medical Office, Waltham, MA, USA
| | | | - Len A Usvyat
- Fresenius Medical Care, Global Medical Office, Waltham, MA, USA
| | - Murat Sor
- Azura Vascular Care, Malvern, PA, USA.,Georgetown University, Washington, DC, USA
| | - John W Larkin
- Fresenius Medical Care, Global Medical Office, Waltham, MA, USA
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Pang SC, Tan RY, Choke E, Ho J, Tay KH, Gogna A, Irani FG, Zhuang KD, Toh L, Chan S, Krishnan P, Lee KA, Leong S, Lo R, Patel A, Tan BS, Too CW, Chua J, Tng RKA, Tang TY, Chng SP, Chong TT, Tay HT, Yap HY, Wong J, Dharmaraj RB, Ng JJ, Gopinathan A, Loh EK, Ong SJ, Yoong G, Tay JS, Chong KY, Tan CS. SIroliMus coated angioPlasty versus plain balloon angioplasty in the tREatment of dialySis acceSs dysfunctION (IMPRESSION): study protocol for a randomized controlled trial. Trials 2021; 22:945. [PMID: 34930401 PMCID: PMC8687634 DOI: 10.1186/s13063-021-05920-3] [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] [Academic Contribution Register] [Received: 07/23/2021] [Accepted: 12/06/2021] [Indexed: 11/21/2022] Open
Abstract
Background Percutaneous transluminal angioplasty is the current standard treatment for arteriovenous fistula (AVF) stenosis. The mid- and long-term patency with plain balloon angioplasty (PBA) is however far from satisfactory. While paclitaxel-coated balloon angioplasty has been shown to be superior to PBA, concern over its safety profile has recently arisen after a reported possible increased mortality risk with a meta-analysis of large lower limb studies. An angioplasty balloon with a new type of drug coating, the sirolimus-coated balloon (SCB), has been proven to improve patency in the coronary arteries. However, its effect on AV access has yet to be studied. Methods/design This is an investigator-initiated, prospective, multicenter, double-blinded, randomized controlled clinical trial to assess the effectiveness of SCB compared to PBA in improving the patency of AVF after angioplasty. A total of 170 patients with mature AVF that requires PTA due to AVF dysfunction will be randomly assigned to treatment with a SCB or PBA at a 1:1 ratio, stratified by location of AVF and followed up for up to 1 year. The inclusion criteria include [1] adult patient aged 21 to 85 years who requires balloon angioplasty for dysfunctional arteriovenous fistula [2]; matured AVF, defined as being in use for at least 1 month prior to the angioplasty; and [3] successful angioplasty of the underlying stenosis with PBA, defined as less than 30% residual stenosis on digital subtraction angiography (DSA) and restoration of thrill in the AVF on clinical examination. The exclusion criteria include thrombosed or partially thrombosed access circuit at the time of treatment, presence of symptomatic or angiographically significant central vein stenosis that requires treatment with more than 30% residual stenosis post angioplasty, and existing stent placement within the AVF circuit. The primary endpoint of the study is access circuit primary patency at 6 months. The secondary endpoints are target lesion primary patency; access circuit-assisted primary patency; access circuit secondary patency at 3, 6, and 12 months; target lesion restenosis rate at 6 months; total number of interventions; complication rate; and cost-effectiveness. The trial is supported by Concept Medical. Discussion This study will evaluate the clinical efficacy and safety of SCB compared to PBA in the treatment of AVF stenosis in hemodialysis patients. Trial registration ClinicalTrials.govNCT04409912. Registered on 1 June 2020
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Affiliation(s)
- Suh Chien Pang
- Department of Renal Medicine, Singapore General Hospital, Academia, Level 3, 20 College Road, Singapore, 169856, Singapore.
| | - Ru Yu Tan
- Department of Renal Medicine, Singapore General Hospital, Academia, Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Edward Choke
- Vascular and Endovascular Service, Sengkang General Hospital, 110 Sengkang East Way, Singapore, 544886, Singapore
| | - Jackie Ho
- Department of Cardiac, Thoracic & Vascular Surgery, National University Hospital, NUHS Tower Block, Level 9, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Kiang Hiong Tay
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Apoorva Gogna
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Farah G Irani
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Kun Da Zhuang
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Luke Toh
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Shaun Chan
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Pradesh Krishnan
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Kristen A Lee
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Sum Leong
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Richard Lo
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Ankur Patel
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Bien Soo Tan
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Chow Wei Too
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Jasmine Chua
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Ren Kwang Alvin Tng
- Department of Renal Medicine, Singapore General Hospital, Academia, Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Tjun Yip Tang
- Department of Vascular Surgery, Singapore General Hospital, Academia, Level 5, 20 College Road, Singapore, 169856, Singapore
| | - Siew Ping Chng
- Department of Vascular Surgery, Singapore General Hospital, Academia, Level 5, 20 College Road, Singapore, 169856, Singapore
| | - Tze Tec Chong
- Department of Vascular Surgery, Singapore General Hospital, Academia, Level 5, 20 College Road, Singapore, 169856, Singapore
| | - Hsien Ts'ung Tay
- Department of Vascular Surgery, Singapore General Hospital, Academia, Level 5, 20 College Road, Singapore, 169856, Singapore
| | - Hao Yun Yap
- Department of Vascular Surgery, Singapore General Hospital, Academia, Level 5, 20 College Road, Singapore, 169856, Singapore
| | - Julian Wong
- Department of Cardiac, Thoracic & Vascular Surgery, National University Hospital, NUHS Tower Block, Level 9, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Rajesh Babu Dharmaraj
- Department of Cardiac, Thoracic & Vascular Surgery, National University Hospital, NUHS Tower Block, Level 9, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Jun Jie Ng
- Department of Cardiac, Thoracic & Vascular Surgery, National University Hospital, NUHS Tower Block, Level 9, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Anil Gopinathan
- Department of Diagnostic Imaging, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Eu Kuang Loh
- Department of Diagnostic Imaging, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Shao Jin Ong
- Department of Diagnostic Imaging, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Gary Yoong
- Department of Diagnostic Imaging, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Jia Sheng Tay
- Vascular and Endovascular Service, Sengkang General Hospital, 110 Sengkang East Way, Singapore, 544886, Singapore
| | - Kay Yuan Chong
- Division of Medicine, Singapore General Hospital, SingHealth Tower, Level 5, Singapore, Singapore
| | - Chieh Suai Tan
- Department of Renal Medicine, Singapore General Hospital, Academia, Level 3, 20 College Road, Singapore, 169856, Singapore
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Caputo BC, Leong B, Sibona A, Jhajj S, Kohne C, Gabel J, Shih W, Abou Zamzam A, Bianchi C, Teruya T. Arteriovenous fistula maturation: Physical exam versus flow study. Ann Vasc Surg 2021; 77:16-24. [PMID: 34416284 DOI: 10.1016/j.avsg.2021.05.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 11/24/2020] [Revised: 03/30/2021] [Accepted: 05/09/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to determine the utility of routine duplex flow study 4 to 6 weeks after primary AVF creation and to compare physical exam against a duplex flow study in predicting fistula maturation. A surveillance algorithm was established to evaluate the naïve fistula after primary creation. METHODS This was a single institution retrospective review of 155 veterans with primary autogenous AVF creation from 2016 to 2018. All patients received a duplex flow study evaluation after primary creation. A comparison was made between physical exam (PE) and flow study at 4 to 6 weeks post creation. Sensitivities and specificities of physical exam and duplex flow study were compared head-to-head in predicting unassisted fistula maturation. A mature AVF was defined as a fistula that could be repetitively cannulated and provided adequate flow for dialysis. Failure of maturation was defined as an AVF that was never usable for dialysis. An abnormal duplex included thrombosis, stenosis (> 50% on gray scale imaging), inadequate vein diameter (< 4 mm), inadequate vein length or superficialization, or poor flow (< 500 ml/min). Bivariate comparisons were conducted using Pearson's χ², Fishers exact test, and Wilcoxon test depending on distribution. Significance was defined as P < 0.05. RESULTS There were 53 patients with radiocephalic (RC) fistulas, 41 patients with brachiocephalic (BC) fistulas, and 6 patients with brachiobasilic (BB) fistulas. Of patients with a confirmed abnormal duplex ultrasound, 53% had an abnormal PE (sensitivity 53%; PPV 96.3%, P < 0.001). Of the patients with a confirmed normal duplex, 98% had a normal PE (specificity 98%; NPV 68.5%, P < 0.001). An abnormal duplex flow study had a 67% sensitivity for predicting AVF failure or need for reintervention while an abnormal physical examination had a 42% sensitivity in predicting AVF failure or need for reintervention (P < 0.001). In total, 48 fistulas needed reintervention, however only 20 (42%) were associated with an abnormal physical examination. Of those 48 reinterventions, 20 (42%) fistulas exhibited primary assisted maturation (P < 0.001). On duplex flow study alone, 32 patients had hemodynamically significant lesions necessitating reintervention, which went on to afford 9 (28%) primary assisted mature fistulas (P = 0.69). CONCLUSION Abnormal duplex flow studies have a better sensitivity for detecting AVF failure or the need for reintervention compared to physical exam alone. An abnormal duplex correlates more with needing a reintervention to achieve maturation than physical exam. Therefore, we advocate routine use of a postoperative duplex flow study to identify potentially correctable issues and optimize fistula maturation.
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Affiliation(s)
- Ben C Caputo
- Division of Vascular Surgery, Loma Linda University, Veterans Administration Hospital, Loma Linda, CA
| | - Beatriz Leong
- Division of Vascular Surgery, Loma Linda University, Veterans Administration Hospital, Loma Linda, CA
| | - Agustín Sibona
- Division of Vascular Surgery, Loma Linda University, Veterans Administration Hospital, Loma Linda, CA
| | - Sandeep Jhajj
- Division of Vascular Surgery, Loma Linda University, Veterans Administration Hospital, Loma Linda, CA
| | - Courtney Kohne
- Division of Vascular Surgery, Loma Linda University, Veterans Administration Hospital, Loma Linda, CA
| | - Joshua Gabel
- Division of Vascular Surgery, Loma Linda University, Veterans Administration Hospital, Loma Linda, CA
| | - Wendy Shih
- Division of Vascular Surgery, Loma Linda University, Veterans Administration Hospital, Loma Linda, CA
| | - AhmedM Abou Zamzam
- Division of Vascular Surgery, Loma Linda University, Veterans Administration Hospital, Loma Linda, CA
| | - Christian Bianchi
- Division of Vascular Surgery, Loma Linda University, Veterans Administration Hospital, Loma Linda, CA
| | - TheodoreH Teruya
- Division of Vascular Surgery, Loma Linda University, Veterans Administration Hospital, Loma Linda, CA.
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Karmota AG. Paclitaxel coated-balloon (PCB) versus standard plain old balloon (POB) fistuloplasty for failing dialysis access. Ann R Coll Surg Engl 2020; 102:601-605. [PMID: 32538115 DOI: 10.1308/rcsann.2020.0121] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION This study aimed to evaluate the safety and efficacy of paclitaxel-coated balloon compared with conventional plain balloon for the treatment of failing native dialysis access. MATERIALS AND METHODS This prospective study included 60 patients presenting to the Kasr Alainy Hospitals and Aseer Central Hospital in the period from September 2015 to December 2017 with failing native vascular access. Dilatation with a plain balloon was done in 30 patients (group I) and with a paclitaxel-coated balloon in 30 patients (group II) with either stenosis or occlusion. The majority were outflow lesions, with 20 (66.7 %) patients in group I and 21 (70%) patients in group II. Mean balloon diameter was 7.1mm (± 1.5mm) compared with 6.5mm (± 1.2mm) and length 66mm (± 19.1mm) compared with 54.6mm (± 15.7mm), respectively. Safety endpoint was reported as 30 day's freedom from procedure-related major complications and mortality. Procedural technical success was defined as a residual diameter 30% or less for treated lesions. Target lesion primary patency, circuit primary patency and secondary patency were reported at 3, 6 and 12 months. RESULTS There were no 30-day procedure-related major complications or mortality in either group. Procedural technical success of 100% was achieved in both groups. Target lesion primary patency, circuit primary patency and secondary patency in group II were better than in group I, especially at 12 months (90% vs 66.7%, 83.3% vs 60% and 96.7% vs 93.3%, respectively). There was a statistically significant difference in target lesion primary patency (p = 0.029) in patients who were treated with paclitaxel-coated balloon angioplasties. CONCLUSION The paclitaxel-coated balloon proved to be safe and effective, and improved the patency of failing vascular access. Results are comparable with previous studies.
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Affiliation(s)
- A G Karmota
- Faculty of Medicine, Kasr Alainy - Cairo University Hospitals, Cairo, Egypt
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9
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Yazar O, Provoost A, Broughton A, Ghijselings L, Leclef Y, Van Calster K, Reginster F, Fourneau I. Paclitaxel drug-coated balloon angioplasty for the treatment of failing arteriovenous fistulas: a single-center experience. Acta Chir Belg 2020; 120:85-91. [PMID: 30633638 DOI: 10.1080/00015458.2018.1561796] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 12/21/2022]
Abstract
Objectives: To report our experience of angioplasty with Lutonix (Bard Peripheral Vascular, Inc., Tempe, AZ) drug-coated balloon (DCB) for the treatment of failing arteriovenous fistulas (AVF).Materials and methods: Retrospective, single-center analysis consisting of 14 patients treated with Lutonix paclitaxel DCBs in the period from July 2015 through April 2017. We analyzed technical success, clinical success, primary patency of the target lesion, primary patency of the dialysis circuit, and the rate of complications. Regular follow-up of AVF patency was realized by clinical examination and duplex ultrasonography. The Kaplan-Meier survival method was applied to determine the cumulative primary patency of the target lesion and the dialysis circuit.Results: Technical success was 100% and clinical success 92.9%. There were no major or minor complications. Cumulative target lesion primary patency after DCB was 69.2% at 6 months and 31.6% at 12 months. Cumulative vascular circuit primary patency was 61.5% at 6 months and 31.6% at 12 months.Conclusion: Compared to results reported in literature with plain old balloon angioplasty (POBA), Lutonix paclitaxel DCB angioplasty proved a short-term patency benefit in treatment of dialysis AVF stenosis.
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Affiliation(s)
- O. Yazar
- Department of Surgery, Europe Hospitals Brussels, Brussels, Belgium
| | - A. Provoost
- Department of Surgery, Europe Hospitals Brussels, Brussels, Belgium
| | - A. Broughton
- Department of Nephrology, Europe Hospitals Brussels, Brussels, Belgium
| | - L. Ghijselings
- Department of Radiology, Europe Hospitals Brussels, Brussels, Belgium
| | - Y. Leclef
- Department of Surgery, Europe Hospitals Brussels, Brussels, Belgium
| | - K. Van Calster
- Department of Surgery, Europe Hospitals Brussels, Brussels, Belgium
| | - F. Reginster
- Department of Nephrology, Europe Hospitals Brussels, Brussels, Belgium
| | - I. Fourneau
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
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10
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Cao Z, Li J, Zhang T, Zhao K, Zhao J, Yang Y, Jiang C, Zhu R, Li Z, Wu W. Comparative Effectiveness of Drug-Coated Balloon vs Balloon Angioplasty for the Treatment of Arteriovenous Fistula Stenosis: A Meta-analysis. J Endovasc Ther 2020; 27:266-275. [PMID: 32043432 DOI: 10.1177/1526602820902757] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 11/16/2022]
Abstract
Purpose: To compare the effectiveness and safety outcomes of drug-coated balloon angioplasty (DCBA) vs conventional balloon angioplasty (BA) for arteriovenous fistula (AVF) stenosis. Materials and Methods: A systematic review was conducted of PubMed and Embase databases from 1966 to May 2019 to identify English-language articles evaluating DCBA vs BA for the treatment of AVF stenosis. Data extracted from each study were synthesized to evaluate target lesion revascularization (TLR), technical success, and mortality for the 2 approaches. Meta-analyses were performed on these outcomes using random effects models to estimate the odds ratios (ORs) and 95% confidence intervals (CIs). Subgroup and sensitivity analyses were performed. Results: Twelve studies [6 randomized controlled trials (RCTs) and 6 cohort studies] comprising 979 patients were included in this meta-analysis. The pooled results showed that AVFs treated with DCBA had significantly fewer TLRs at 6 months (OR 0.31, 95% CI 0.14 to 0.69, p=0.004) and 12 months (OR 0.45, 95% CI 0.21 to 0.97, p=0.04) than BA. The 2 approaches had similar technical success rates (OR 0.22, 95% CI 0.03 to 1.43, p=0.11). Additionally, the pooled OR of 12-month mortality was 0.71 (95% CI 0.20 to 2.51, p=0.60), indicating no significant difference between DCBA and BA. Subgroup analysis based on study design showed the superiority of DCBA to BA in cohort studies but not RCTs, which had high heterogeneity. Significant publication bias was found in the cohort studies. Conclusion: In de novo or recurrent AVF stenosis, DCBA appears to be an effective procedure associated with lower 6- and 12-month TLR compared with BA. However, larger and randomized controlled studies are warranted to draw definitive conclusions.
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Affiliation(s)
- Zhanjiang Cao
- Department of Vascular Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Jiazheng Li
- Department of Vascular Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Tong Zhang
- Department of Vascular Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Keqiang Zhao
- Department of Vascular Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Junlai Zhao
- Department of Vascular Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yu Yang
- Department of Vascular Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Chao Jiang
- Department of Vascular Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Rongrong Zhu
- Department of Vascular Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Zipeng Li
- Department of Vascular Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Weiwei Wu
- Department of Vascular Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
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11
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Piacentino F, Coppola A, Zaghetto A, Macchi E, De Marchi G, Ossola C, Zorzetto G, Beneventi A, Casamassima N, Tagliaferri C, Tozzi M, Piffaretti G, Fontana F, Genovese EA. Vacuum-assisted mechanical thrombectomy in extensively occlusive thrombosis of dialysis arteriovenous grafts with indigo system. J Vasc Access 2020; 21:673-679. [PMID: 31928304 DOI: 10.1177/1129729819899264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To present a selected series of extensively occlusive thrombosis of arteriovenous graft treated with the Penumbra's Indigo System. MATERIALS AND METHODS Ten patients with acute (within 72 h) extensively occlusive thrombosis of arteriovenous graft (mean extension = 30.1 (range = 15-45) cm) were treated at our institution with the Indigo System. Of the 10 cases, thrombosis was extended to venous outflow in 7 cases and to both arterial inflow and venous outflow in 3 cases. RESULTS Both anatomic and clinical success were achieved in 8 of the 10 procedures (80.0%). In the 2 cases of technical failure, the patients underwent surgical thrombectomy with the finding of arteriovenous graft exhaustion, which was then replaced. The 6-month primary patency, primary-assisted patency, and secondary patency rates were 37.5% (3/8), 50.0% (4/8), and 62.5% (5/8). We reported 2 complications (one minor and one major adverse event). CONCLUSION Percutaneous mechanical thrombectomy aspiration with Indigo System is a relatively safe and effective procedure and can be used even in extensively thrombosed arteriovenous graft.
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Affiliation(s)
- Filippo Piacentino
- Department of Diagnostic and Interventional Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Andrea Coppola
- Department of Diagnostic and Interventional Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Andrea Zaghetto
- Department of Diagnostic and Interventional Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Edoardo Macchi
- Department of Diagnostic and Interventional Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Giuseppe De Marchi
- Department of Diagnostic and Interventional Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Christian Ossola
- Department of Diagnostic and Interventional Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Giada Zorzetto
- Department of Diagnostic and Interventional Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Alessandro Beneventi
- Department of Diagnostic and Interventional Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Nicola Casamassima
- Department of Diagnostic and Interventional Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Chiara Tagliaferri
- Department of Diagnostic and Interventional Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Matteo Tozzi
- Department of Vascular Surgery, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Gabriele Piffaretti
- Department of Vascular Surgery, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Federico Fontana
- Department of Diagnostic and Interventional Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Eugenio Annibale Genovese
- Department of Diagnostic and Interventional Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
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12
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Yousuf M, Gouda Wahdan M, Assem Mohamed H, Elwan S. Percutaneous transluminal angioplasty for failing native hemodialysis arteriovenous fistulas. AL-AZHAR ASSIUT MEDICAL JOURNAL 2020. [DOI: 10.4103/azmj.azmj_65_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 11/04/2022] Open
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13
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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] [Academic Contribution Register] [Indexed: 11/30/2022]
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14
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Haave TR, Manstad-Hulaas F, Brekken R. Treatment of restenosis in radiocephalic arteriovenous hemodialysis fistulas: percutaneous transluminal angioplasty or drug-coated balloon. Acta Radiol 2019; 60:1584-1589. [PMID: 30897933 DOI: 10.1177/0284185119838173] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 12/19/2022]
Affiliation(s)
- Tina R Haave
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Frode Manstad-Hulaas
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim, Norway
- Norwegian National Advisory Unit on Ultrasound and Image-Guided Therapy, St. Olavs Hospital, Trondheim, Norway
| | - Reidar Brekken
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Norwegian National Advisory Unit on Ultrasound and Image-Guided Therapy, St. Olavs Hospital, Trondheim, Norway
- Department of Health Research - Medical Technology, SINTEF, Trondheim, Norway
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15
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ZHANG S, ZHU C, YE Y, LI H. [Percutaneous transluminal angioplasty combined with thrombolysis for acute thrombosis in arterio-venous fistula and graft]. Zhejiang Da Xue Xue Bao Yi Xue Ban 2019; 48:533-539. [PMID: 31901028 PMCID: PMC8800758 DOI: 10.3785/j.issn.1008-9292.2019.10.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To evaluate the efficacy of ultrasound or fluoroscopic-guided percutaneous transluminal angioplasty (PTA) combined with thrombolysis for the treatment of acutely thrombosed arteriovenous fistula (AVF) or grafts (AVG). METHODS One hundred and ninety-two hemodialysed patients, in whom the thrombosed arterio-venous AVF or AVG developed less than 72 h and there were no contraindications for thrombolysis and PTA, underwent PTA combined with thrombolysis therapy in Sir Run Run Shaw Hospital of Zhejiang University from October 2014 to October 2017. Under ultrasound and/or fluoroscopic guidance, balloon catheter was introduced to thrombosis sites along a guide wire. Then the balloon was inflated and normal saline mixed with urokinase and heparin was injected for thrombolysis. After blood flow was restored, angioplasty was performed on vascular stenosed sites. RESULTS A total of 274 endovascular interventional operations were performed for 192 patients. The procedure success rate was 98.2%, clinical success rate was 93.8%and complication rate was 1.46%. The post-intervention primary patency rates for AVF group were 87.4%, 76.7%and 63.9%at 3, 6 and 12 months, respectively; while the post-intervention secondary patency rates were 93.7%, 91.6%and 83.0%, respectively. The post-intervention primary patency rates for AVG group were 60.7%, 51.5%and 43.1%at 3, 6 and 12 months, while the post-intervention secondary patency rates were 82.7%, 77.1%and 70.8%, respectively. CONCLUSIONS PTA combined with thrombolysis is an effective and safe therapeutic option for AVF and AVG thrombosis, which would prolong hemodialysis access and save vascular resources for hemodialyzed patients.
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Affiliation(s)
| | | | | | - Hua LI
- 李华(1962-), 男, 硕士, 主任医师, 主要从事急慢性肾脏病的诊治、终末期肾脏病的一体化治疗、血液透析和腹膜透析通路的建立和维护; E-mail:
;
https://orcid.org/0000-0003-0614-5799
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16
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Ghonemy TA, Farag SE, Soliman SA, Amin EM, Zidan AA. Vascular access complications and risk factors in hemodialysis patients: A single center study. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2015.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Tarek A. Ghonemy
- Internal Medicine Department, Nephrology Unit, Zagazig University Hospital, Egypt
| | - Salama E. Farag
- Internal Medicine Department, Nephrology Unit, Zagazig University Hospital, Egypt
| | - Sameh A. Soliman
- Internal Medicine Department, Nephrology Unit, Zagazig University Hospital, Egypt
| | - Essam M. Amin
- Internal Medicine Department, Nephrology Unit, Zagazig University Hospital, Egypt
| | - Amal A. Zidan
- Clinical Pathology Department, Zagazig University Hospital, Egypt
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17
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Conkbayir I, Celtikci P, Ergun O, Durmaz HA. Value of duplex Doppler ultrasonography for the evaluation of dysfunctional hemodialysis access arteriovenous fistulas prior to endovascular interventions. JOURNAL OF CLINICAL ULTRASOUND : JCU 2018; 46:503-511. [PMID: 29781153 DOI: 10.1002/jcu.22601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Academic Contribution Register] [Received: 12/05/2017] [Revised: 04/01/2018] [Accepted: 04/09/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE To demonstrate accuracy of duplex Doppler ultrasonography (DUS) for the evaluation of native-vein arteriovenous fistula (AVF) dysfunction in end-stage renal disease patients. METHODS This retrospective study included 60 patients with dysfunctioning native-vein AVF evaluated with DUS and digital subtraction angiography (DSA) whose results were compared for detection, identification, and localization of AVF lesions. We calculated sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of DUS and evaluated the agreement between DUS and DSA by the Cohen's kappa coefficient (κ). RESULTS DUS identified correctly 123 of 130 lesions (sensitivity 94.6%, specificity 97.5%, PPV 98.4%, NPV 92%, accuracy of 95.7%). DUS localized correctly 123 of 130 lesions (sensitivity 94.6%, specificity 98.4%, PPV 98.4%, NPV 94.6%, accuracy 96.4%). The κ value was 0.9120 for detection of all lesions (almost perfect agreement). CONCLUSION DUS is a reliable method for the initial evaluation of dysfunctional AVFs, with high sensitivity for detecting and correctly localizing circuit problems.
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Affiliation(s)
- Isik Conkbayir
- Department of Radiology, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Pinar Celtikci
- Department of Radiology, Kars Harakani State Hospital, Kars, Turkey
| | - Onur Ergun
- Department of Radiology, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Hasan Ali Durmaz
- Department of Radiology, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
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18
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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: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution 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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19
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Abstract
Historically, the placement and maintenance of dialysis access has been an integral part of nephrology training. However, in recent years, a big debate has ensued regarding whether this should be limited to trainees' understanding and counseling the patients regarding indications, alternatives, risks and possible complications of these procedures or should it actually involve more of a hands-on experience for the trainees. Some of the barriers in making these procedures a requirement across the board are the lack of standardization of procedural training across various training programs and the absence of consensus on what achieving competency in these procedures looks like. However, in the era of declining interest in nephrology, giving up "ownership" of nephrology procedures and increasing reliance on other sub specialties might be a deterrent in attracting residents to this field; we have to make a concerted effort to increase the exposure and opportunities for the trainees to perform these procedures. Moreover, we need to emphasize the implementation of a curriculum for nephrology fellows to evaluate access properly in order to decrease the burden of access related complications. Lastly, we need to continue working towards a more structured curriculum for a dedicated interventional nephrology fellowship for trainees who want to focus on procedures for their long-term career goals.
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Affiliation(s)
- Sana Waheed
- Division of Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Laura Maursetter
- Division of Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Alexander Yevzlin
- Division of Nephrology, University of Michigan School of Medicine, Ann Arbor, MI, USA
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20
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Calcification in arteriovenous fistula blood vessels may predict arteriovenous fistula failure: a 5-year follow-up study. Int Urol Nephrol 2017; 49:881-887. [PMID: 28124305 DOI: 10.1007/s11255-017-1515-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 11/20/2016] [Accepted: 01/16/2017] [Indexed: 12/20/2022]
Abstract
PURPOSE Arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis. The impact of vascular calcification process on AVF survival remains unclear and results of several studies about this issue are controversial. In the light of the new knowledge about the different susceptibility for calcification process in different blood vessels, the aim of our study was to analyze whether the calcification of AVF-blood vessels may have an impact on AVF longevity. METHODS The study included 90 patients, 49 males and 41 females, all of them Caucasians, with a mean age 62 ± 11 years, on regular hemodialysis for more than 1 year with patent primary AVFs. Vascular calcification in AVF-blood vessels or in the anastomotic region was detected using X-ray examination. RESULTS Calcification in AVF-blood vessels was found in 62% of patients. Binary logistic regression analysis demonstrated that male gender, presence of diabetes mellitus and longer duration of AVF before calcification determination were associated with calcification of AVF-blood vessels. Using a Cox proportional hazard model adjusted for these standardized predicted values revealed that patients with present AVF-blood vessels calcification had increased risk to develop AVF failure with a hazard rate of 3.42 (95% confidence interval 1.00-11.67; P = 0.049). CONCLUSIONS Calcifications of AVF-blood vessels are found frequently among dialysis patients and may jeopardize the survival of native AVF. We suggested the local X-ray as simple and valid method for detection of patients that are at risk for AVFs failure which should be monitored more closely.
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21
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Usefulness of paclitaxel-releasing high-pressure balloon associated with cutting balloon angioplasty for treatment of outflow stenoses of failing hemodialysis arteriovenous shunts. Radiol Med 2016; 122:69-76. [PMID: 27601144 DOI: 10.1007/s11547-016-0680-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 04/06/2016] [Accepted: 08/18/2016] [Indexed: 10/21/2022]
Abstract
AIM To evaluate the technical and clinical success, primary patency (PP) and complications of angioplasty performed with paclitaxel-coated balloon (PCBs) associated with cutting balloon and for the treatment of the outflow stenoses of failing hemodialysis arteriovenous shunt. MATERIAL AND METHODS From September 2014 to September 2015, 50 patients with 66 stenoses were registered. Vascular accesses were autogenous (n = 20) and prosthetic (n = 30). Stenosis were documented during follow-up with routine echo-color Doppler, clinical evaluation and in the remaining incidentally during fistulography. Angioplasty was performed with cutting balloon and afterward with PCB. The mean follow-up time was 8 months (range 6-15 months). Technical success, clinical success, primary patency and complications were registered. RESULTS Technical success was 100 %. Clinical success was 94.7 %. Primary patency rate was 87.7 %; in five patients, a significant re-stenosis (≥50 %) was registered. A residual asymptomatic stenosis (<30 %) was registered in four cases (7 %). No major complications were registered. CONCLUSIONS A short-term patency benefit may be obtained including PCB in angioplasty treatment of failing hemodialysis arteriovenous shunts.
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22
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The primary patency of drug-eluting balloon versus conventional balloon angioplasty in hemodialysis patients with arteriovenous fistula stenoses. Jpn J Radiol 2016; 34:700-704. [DOI: 10.1007/s11604-016-0577-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 02/22/2016] [Accepted: 08/15/2016] [Indexed: 10/21/2022]
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23
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The Relationship Between Neutrophil–Lymphocyte Ratio and Primary Patency of Percutaneous Transluminal Angioplasty in Hemodialysis Arteriovenous Fistula Stenosis When Using Conventional and Drug-Eluting Balloons. Cardiovasc Intervent Radiol 2016; 39:1702-1707. [DOI: 10.1007/s00270-016-1442-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 03/12/2016] [Accepted: 08/01/2016] [Indexed: 10/21/2022]
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24
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Itoga NK, Ullery BW, Tran K, Lee GK, Aalami OO, Bech FR, Zhou W. Use of a proactive duplex ultrasound protocol for hemodialysis access. J Vasc Surg 2016; 64:1042-1049.e1. [PMID: 27183858 DOI: 10.1016/j.jvs.2016.03.442] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 12/12/2015] [Accepted: 03/17/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Arteriovenous fistula (AVF) creation is the preferred approach for hemodialysis access; however, the maturation of AVFs is known to be poor. We established a proactive early duplex ultrasound (DUS) surveillance protocol for evaluating AVFs before attempted access. This study determined the effect of this protocol related to improving AVF maturation. METHODS From 2008 to 2013, 153 patients received new upper extremity AVFs and an early DUS surveillance protocol at a single academic institution. The protocol involved an early DUS evaluation before hemodialysis cannulation of the AVF at 4 to 8 weeks after AVF creation. A positive DUS result was identified as a peak systolic velocity of >375 cm/s or a >50% stenosis on gray scale imaging, along with decreased velocity in the outflow vein. Patients with positive DUS findings underwent prophylactic endovascular or open intervention to assist with AVF maturation. Nature of secondary interventions, as well as AVF patency and maturation, were assessed. Overall clinical outcomes and fistula patency were investigated. RESULTS During the study period, 183 upper extremity AVFs were created in 153 patients, including 82 radiocephalic, 63 brachiocephalic, and 38 brachiobasilic AVFs. A mortality rate of 43% (n = 66) was observed in a median follow-up period of 34.5 months (interquartile range, 19.6-46.9). A total of 164 early DUS were performed at a median of 6 weeks (interquartile range, 3.4-9.6 weeks) after the initial creation. Early DUS showed nine AVFs were occluded and were excluded from further analysis. Hemodynamically significant lesions were found in 62 AVFs (40%); however, only 17 (11%) were associated with an abnormal physical examination. Positive DUS finding prompted a secondary intervention in 81% of the patients. Among those with positive early DUS findings, AVF maturation was 70% in those undergoing a secondary intervention compared with 25% in those not undergoing a prophylactic intervention (P = .011). Primary-assisted patency for AVFs with early positive and negative DUS findings were 83% and 96% at 6 months, 64% and 89% at 1 year, and 52% and 82% at 2 years, respectively (P < .001). CONCLUSIONS Early DUS surveillance of AVFs before initial access is reasonable to identify problematic AVFs that may not be reliably detected on clinical examination. Although DUS criteria for AVFs have yet to be universally accepted, proactive early postoperative DUS interrogation assists in the early detection of dysfunctional AVFs and improvement of fistula maturation. Despite improved patency in those with positive DUS findings who undergo prophylactic secondary intervention, overall patency remains inferior to those without an abnormality detected on early DUS imaging.
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Affiliation(s)
- Nathan K Itoga
- Division of Vascular Surgery, Stanford University, Stanford, Calif
| | - Brant W Ullery
- Division of Vascular Surgery, Stanford University, Stanford, Calif
| | - Ken Tran
- Division of Vascular Surgery, Stanford University, Stanford, Calif
| | - George K Lee
- Division of Vascular Surgery, Stanford University, Stanford, Calif; Division of Vascular Surgery, VA Palo Alto Health Care System, Palo Alto, Calif
| | - Oliver O Aalami
- Division of Vascular Surgery, Stanford University, Stanford, Calif; Division of Vascular Surgery, VA Palo Alto Health Care System, Palo Alto, Calif
| | - Fritz R Bech
- Division of Vascular Surgery, VA Palo Alto Health Care System, Palo Alto, Calif
| | - Wei Zhou
- Division of Vascular Surgery, Stanford University, Stanford, Calif; Division of Vascular Surgery, VA Palo Alto Health Care System, Palo Alto, Calif.
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25
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Su PL, Bao K, Peng HG, Mao W, Wang GS, Yang NZ, Geng WJ, Lin YQ, Jie XN. Effects of Tongmai oral liquid in femoral ateriovenous fistula. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 15:311. [PMID: 26347072 PMCID: PMC4561428 DOI: 10.1186/s12906-015-0844-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Academic Contribution Register] [Received: 01/18/2015] [Accepted: 09/02/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study was conducted to investigate the protective effect of Tongmai oral liquid on arteriovenous fistula function and to provide an effective method to promote fistula maturation. METHODS Fifteen female and fifteen male SPF New Zealand rabbits were randomly allocated into 3 groups including control, Aspirin and Tongmai oral liquid groups. A side-to-side femoral arteriovenous fistula was established in each rabbit and then animals were treated with Aspirin or Tongmai oral liquid for 2 weeks. The concentrations of circulating ET-1 and NO were determined before and after operation (on preoperative day, operative day, post-D1, post-D3, post-D7 and post-D15), respectively. Blood flow of the fistula stoma and contralateral artery and vein was determined on the 15th postoperative day. Last, the fistula stoma was dissected to observe patency, thrombosis and adhesion with surrounding tissues. RESULTS 28 rabbits survived during the surgical process and the following 15-day observational period. Tissue adhesion of arteriovenous fistula with surrounding tissues was improved and fistula thrombosis was reduced by treatment with Tongmai oral liquid. NO concentration decreased to a different extent after vascular surgery. Tongmai oral liquid failed to regulate the equilibrium between NO and ET-1, but it improved blood flow of fistula stoma, as compared to control and Aspirin groups. Blood flow of fistula stoma in the three groups was lower than that of the contralateral femoral artery. CONCLUSIONS Tongmai oral liquid improved the function of femoral ateriovenous fistula in the rabbit model by increasing blood flow and reducing thrombosis, probably not by regulating the dynamic equilibrium between NO and ET-1.
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Affiliation(s)
- Pei-Ling Su
- Department of Nephrology, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), No.111 of Dade Road, Guangzhou, 510120, China.
- Department of Nephrology, The Third Affiliated Hospital, Guangxi University of Chinese Medicine (Liuzhou traditional Chinese Medical Hospital), No.32 of Jiefang Road, Liuzhou, 545001, China.
| | - Kun Bao
- Department of Nephrology, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), No.111 of Dade Road, Guangzhou, 510120, China.
| | - Han-Guo Peng
- Department of Nephrology, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), No.111 of Dade Road, Guangzhou, 510120, China.
- Jiangmen Xinhui District Hospital of Chinese Medicine, No.47 of Huimin Road, Jiangmen, 529100, China.
| | - Wei Mao
- Department of Nephrology, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), No.111 of Dade Road, Guangzhou, 510120, China.
| | - Guan-Su Wang
- Department of Nephrology, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), No.111 of Dade Road, Guangzhou, 510120, China.
| | - Ni-Zhi Yang
- Department of Nephrology, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), No.111 of Dade Road, Guangzhou, 510120, China.
| | - Wen-Jia Geng
- Department of Nephrology, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), No.111 of Dade Road, Guangzhou, 510120, China.
| | - Yi-Qun Lin
- Department of Nephrology, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), No.111 of Dade Road, Guangzhou, 510120, China.
| | - Xi-Na Jie
- Department of Nephrology, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), No.111 of Dade Road, Guangzhou, 510120, China.
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Angiographic mapping of AV fistula related vascular complications in ESRD via multislice CT; adjuvant role in correlation with CDUS. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2015.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 11/24/2022] Open
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Rajabi-Jaghargh E, Banerjee RK. Combined functional and anatomical diagnostic endpoints for assessing arteriovenous fistula dysfunction. World J Nephrol 2015; 4:6-18. [PMID: 25664243 PMCID: PMC4317629 DOI: 10.5527/wjn.v4.i1.6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 07/19/2014] [Revised: 08/26/2014] [Accepted: 11/19/2014] [Indexed: 02/06/2023] Open
Abstract
Failure of arteriovenous fistulas (AVF) to mature and thrombosis in matured fistulas have been the major causes of morbidity and mortality in hemodialysis patients. Stenosis, which occurs due to adverse remodeling in AVFs, is one of the major underlying factors under both scenarios. Early diagnosis of a stenosis in an AVF can provide an opportunity to intervene in a timely manner for either assisting the maturation process or avoiding the thrombosis. The goal of surveillance strategies was to supplement the clinical evaluation (i.e., physical examination) of the AVF for better and earlier diagnosis of a developing stenosis. Surveillance strategies were mainly based on measurement of functional hemodynamic endpoints, including blood flow (Qa) to the vascular access and venous access pressure (VAP). As the changes in arterial pressure (MAP) affects the level of VAP, the ratio of VAP to MAP (VAPR = VAP/MAP) was used for diagnosis. A Qa < 400-500 mL/min or a VAPR > 0.55 is considered sign of significant stenosis, which requires immediate intervention. However, due to the complex nature of AVFs, the surveillance strategies have failed to consistently detect stenosis under different scenarios. VAPR has been primarily developed to detect outflow stenosis in arteriovenous grafts, and it hasn’t been successful in accurate diagnosis of outflow lesions in AVFs. Similarly, AVFs can maintain relatively high blood flow despite the presence of a significant outflow stenosis and thus, Qa has been found to be a better predictor of only inflow lesions. Similar shortcomings have been reported in the detection of functional severity of coronary stenosis using diagnostic endpoints that were based on either flow or pressure. This limitation has been associated with the fact that both pressure and flow change in the presence of a stenosis and thus, hemodynamic diagnostic endpoints that employ only one of these parameters are inherently prone to inaccuracies. Recent attempts have resulted in development of new diagnostic endpoints that can combine the effects of pressure and flow. These new hemodynamic diagnostic endpoints have shown to be better predictors of functional severity of lesions as compared to either flow or pressure based counterparts. In this review article, we discussed the advantages and limitations of current functional and anatomical diagnostic endpoints in AVFs.
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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: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Academic Contribution 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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Features of atherosclerosis in hemodialysis patients. Kidney Res Clin Pract 2013; 32:177-82. [PMID: 26877938 PMCID: PMC4714184 DOI: 10.1016/j.krcp.2013.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 05/25/2013] [Revised: 07/19/2013] [Accepted: 09/24/2013] [Indexed: 11/22/2022] Open
Abstract
Background Cardiovascular disease is the main cause of mortality in dialysis patients. Carotid intima–media thickness (CIMT) is used as a surrogate marker of early atherosclerosis. Atherosclerosis can cause vascular access failure. The purpose of this study was to define the clinical features of atherosclerosis in hemodialysis patients based on CIMT and to define the relationship between CIMT and access failure. Methods In this cross-sectional study, the CIMT of 60 patients on hemodialysis was examined using B-mode Doppler ultrasonography between May 2012 and November 2012. Carotid atherosclerosis was defined as a CIMT≥0.9 mm or the incidence of atherosclerotic plaques. Results The patients’ mean age was 54.5±10.6 years, and 60% of the patients were male. The CIMT was 0.81±0.47 mm (range, 0.35–2.50 mm). The group with atherosclerosis was characterized by older age compared with those without atherosclerosis. Patients with atherosclerosis showed much shorter durations of access patency than their counterparts in the nonatherosclerosis group (hazard ratio, 2.822; 95% confidence interval, 1.113–7.156; P=0.029). Moreover, being overweight was associated with a 2.47-fold (95% confidence interval, 1.101–5.548) increased primary access failure. Conclusion This study shows that atherosclerosis is associated with older age. Patients who are overweight and have atherosclerosis may have shortened access patency.
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Ganie FA, Lone H, Dar AM, Lone GN, Wani ML. Native arterio-venous fistula is the vascular access of choice for hemodialysis in end stage renal disease. Int Cardiovasc Res J 2013; 7:67-70. [PMID: 24757624 PMCID: PMC3987435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 05/13/2013] [Revised: 05/21/2013] [Accepted: 05/27/2013] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES THE AIM OF THE STUDY WAS: Is primary Arterio-venous fistula the vascular access of choice for adequate dialysis and better patient outcome in end stage renal disease. MATERIALS AND METHODS The present study was done in the department of cardiovascular and thoracic surgery at Sher-i-Kashmir institute of medical sciences, Soura, Srinagar Kashmir. Native Arterio-Venous (AV) fistulas were made in the patients with end stage renal disease for performing hemodialysis. They were followed for patency and adequacy of blood flow during hemodialysis. All the patients were operated under local anesthesia. RESULTS The results showed that 77% of the AV fistulas based on radial artery with side-to-side anastomosis and 80% of those with end-to-side anastomosis were functionally patent after one year. After two years, the patency rate in side-to-side and end-to-side anastomosis was 50% and 55%, respectively. In addition, the patency rate was 90% in brachial artery based AV fistula with end-to-side anastomosis, whether done primarily or secondarily, at the end of one year. However, a rapid decline was observed in the patency rate during the third year in both radial artery based and brachial artery based AV fistulas. CONCLUSIONS We concluded that Arterialised arm superficial veins after primary AV fistula was the optimal and rational vascular access for hemodialysis providing adequate blood flow during this process. Besides, failure of primary AV fistula should be replaced by secondary AV fistula preferably based on brachial artery.
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Affiliation(s)
- Farooq Ahmad Ganie
- Department of Cardiovascular and Thoracic Surgery, Soura, Kashmir, India,Corresponding author: Farooq Ahmad Ganie, Cardiovascular and Thoracic Surgery, SKIMS, Soura Srinagar, India. Tel: +94-69064259, E-mail:
| | - Hafeezulla Lone
- Department of Cardiovascular and Thoracic Surgery, Soura, Kashmir, India
| | - Abdul Majeed Dar
- Department of Cardiovascular and Thoracic Surgery, Soura, Kashmir, India
| | - Ghulam Nabi Lone
- Department of Cardiovascular and Thoracic Surgery, Soura, Kashmir, India
| | - Mohd Lateef Wani
- Department of Cardiovascular and Thoracic Surgery, Soura, Kashmir, India
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Five Years of Vascular Access Stenosis Surveillance by Blood Flow Rate Measurements during Hemodialysis Using the Delta-H Method. J Vasc Access 2012; 13:321-8. [DOI: 10.5301/jva.5000053] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Accepted: 12/04/2011] [Indexed: 11/20/2022] Open
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Kim HH, Choi YH, Suh SH, Lee JS, Jung YH, So YH. Arteriovenous Graft Modeling and Hemodynamic Interpretation. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/ojfd.2012.24a040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 11/20/2022]
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Dimopoulou A, Raland H, Wikström B, Magnusson A. MDCT angiography with 3D image reconstructions in the evaluation of failing arteriovenous fistulas and grafts in hemodialysis patients. Acta Radiol 2011; 52:935-42. [PMID: 21969710 DOI: 10.1258/ar.2011.110255] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Arteriovenous fistulas and grafts are the methods of choice for vascular access in renal failure patients in need of hemodialysis. Their major complication, however, is stenosis, which might lead to thrombosis. PURPOSE To demonstrate the usefulness of 16-MDCTA with 3D image reconstructions, in long-term hemodialysis patients with dysfunctional arteriovenous fistulas and grafts (AVF and AVG). MATERIAL AND METHODS During a 17-month period, 31 patients with dysfunctional AVF and AVG (24 AVF and seven AVG) were examined with MDCTA with 3D image postprocessing. Parameters such as comprehension of the anatomy, quality of contrast enhancement, and pathological vascular changes were measured. DSA was then performed in 24 patients. RESULTS MDCTA illustrated the anatomy of the AVF/AVG and the entire vascular tree to the heart, in a detailed and comprehensive manner in 93.5% of the evaluated segments, and depicted pathology of AVF/AVG or pathology of the associated vasculature. MDCTA demonstrated a total of 38 significant stenoses in 25 patients. DSA verified 37 stenoses in 24 patients and demonstrated two additional stenoses. MDCTA had thus a sensitivity of 95%. All 24 patients were treated with percutaneous transluminal angioplasty (PTA) with good technical results. CONCLUSION MDCTA with 3D reconstructions of dysfunctioning AVFs and AVGs in hemodialysis patients is an accurate and reliable diagnostic method helping customize future intervention.
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Affiliation(s)
| | | | - Björn Wikström
- Department of Medical Sciences, Renal Section, University Hospital, Uppsala, Sweden
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Kim WS, Pyun WB, Kang BC. The primary patency of percutaneous transluminal angioplasty in hemodialysis patients with vascular access failure. Korean Circ J 2011; 41:512-7. [PMID: 22022326 PMCID: PMC3193042 DOI: 10.4070/kcj.2011.41.9.512] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 10/26/2010] [Revised: 01/12/2011] [Accepted: 01/17/2011] [Indexed: 11/25/2022] Open
Abstract
Background and Objectives Dysfunction of arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs) contributes significantly to morbidity and hospitalization in the dialysis population. We evaluated the primary patency of AVFs following percutaneous transluminal angioplasty (PTA) in haemodialysis patients. Subjects and Methods We performed 231 interventions in 118 patients with a mean age of 62.1±12.9 years. We performed 122 interventions in 53 AVG patients (44.9%), and 109 interventions in 65 AVF patients (55.1%). If there was thrombosis of the vascular access, urokinase was administered and/or thrombus aspiration was performed. The stent was inserted when balloon dilatation did not expand sufficiently or elastic recoil occurred. Results For the 118 patients, the median patency time was 10.45±10.29 months at 92 months of follow-up. The primary patencies for stenotic AVFs at 6, 12, 24, 36, 48, and 60 months were 63.4%, 41.4%, 17.0%, 9.7%, 7.3%, and 2.4%, respectively. The primary patencies for AVGs at 6, 12, 24, and 36 months were 36.9%, 19.5%, 10.8%, 2.1%, respectively, and were obtained by means of the Kaplan-Meier analysis (log rank=6.42, p<0.05). The median patency time was 11.0 months and 4.45 months in the non-thrombus and thrombus groups, respectively. The complication rate was 1.73% (4/231); two cases of pseudoaneurysms and two cases of extravasation were detected. All therapy failures (5/231) occurred in thrombotic lesions of AVGs and were treated surgically. Conclusion PTA is an efficacious method for the correction of stenosis of AVFs for hemodialysis, thus prolonging the patency of the fistulas.
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Affiliation(s)
- Woo Shin Kim
- Division of Cardiology, Department of Internal Medicine, Mokdong Hospital, School of Medicine, Ewha Womans University, Seoul, Korea
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Saeed F, Kousar N, Sinnakirouchenan R, Ramalingam VS, Johnson PB, Holley JL. Blood Loss through AV Fistula: A Case Report and Literature Review. Int J Nephrol 2011; 2011:350870. [PMID: 21716705 PMCID: PMC3118665 DOI: 10.4061/2011/350870] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 01/03/2011] [Revised: 03/10/2011] [Accepted: 03/24/2011] [Indexed: 11/20/2022] Open
Abstract
Little has been written about acute blood loss from hemodialysis vascular access. We describe a 57-year-old Caucasian male with an approximately 7 gm/dL drop in hemoglobin due to bleeding from a ruptured aneurysm in his right brachiocephalic arteriovenous fistula (AVF). There was no evidence of fistula infection. The patient was successfully managed by blood transfusions and insertion of a tunneled dialysis catheter for dialysis access. Later, the fistula was ligated and a new fistula was constructed in the opposite arm. Aneurysm should be considered in cases of acute vascular access bleeding in chronic dialysis patients.
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Affiliation(s)
- Fahad Saeed
- College of Medicine at Urbana-Champaign, University of Illinois, 611 W Park Street, Urbana, IL 61801, USA
| | - Nadia Kousar
- College of Medicine at Urbana-Champaign, University of Illinois, 611 W Park Street, Urbana, IL 61801, USA
| | - Ramapriya Sinnakirouchenan
- College of Medicine at Urbana-Champaign, University of Illinois, 611 W Park Street, Urbana, IL 61801, USA
| | - Vijaya S. Ramalingam
- College of Medicine at Urbana-Champaign, University of Illinois, 611 W Park Street, Urbana, IL 61801, USA
| | - Philip B. Johnson
- College of Medicine at Urbana-Champaign, University of Illinois, 611 W Park Street, Urbana, IL 61801, USA
| | - Jean L. Holley
- College of Medicine at Urbana-Champaign, University of Illinois, 611 W Park Street, Urbana, IL 61801, USA
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Evaluation of expanded polytetrafluoroethylene-covered stents for the treatment of venous outflow stenosis in hemodialysis access grafts. J Vasc Interv Radiol 2011; 22:647-53. [PMID: 21371910 DOI: 10.1016/j.jvir.2010.12.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 02/22/2010] [Revised: 11/01/2010] [Accepted: 12/13/2010] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To investigate the use of an expanded polytetrafluoroethylene-coated nitinol stent-graft in patients with failing hemodialysis access circuits and compare grafts with and without a heparin-coated surface. MATERIALS AND METHODS A single-institution retrospective review of 16 patients (average age, 55 years; seven men) treated for hemodialysis access circuit stenoses was performed. Patients had a prosthetic arteriovenous (AV) graft (n = 10) or autogenous AV fistula (n = 6), all with clinically relevant access stenoses that were refractory to angioplasty alone; 10 patients also had access circuit thrombosis at the time of treatment. Stents were placed in the basilic (n = 4), brachial (n = 7), cephalic (n = 4), and femoral (n = 1) veins. Study endpoints included primary treatment area patency, primary circuit patency, primary assisted circuit patency, and secondary circuit patency, followed to a maximum of 6 months. RESULTS Primary treatment area patency rates at 30 days and 180 days were 75% and 31%, respectively. Secondary patency rates at the same time points were 88% and 68%, respectively. Mean primary treatment area patency was 93 days. Thrombosis was a major cause of failure, occurring in seven of 11 cases of primary treatment area patency loss. Subgroup analysis demonstrated that the heparin-coated configuration (n = 7) showed a 6-month primary patency rate of 57%, compared with 11% for the stent-grafts without heparin bonding (n = 9; P = .06). CONCLUSIONS Overall, the majority of deployed stent-grafts lost primary patency within 6 months, with thrombosis a major cause of failure. However, the addition of a heparin-coated surface appeared to improve results in these otherwise treatment-refractory access circuits.
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Arteriovenous fistula and graft evaluation in hemodialysis patients using MDCT: a primer. AJR Am J Roentgenol 2010; 194:838-47. [PMID: 20173168 DOI: 10.2214/ajr.09.3357] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Patent arteriovenous fistula (AVF) is related to better prognosis and quality of life for patients on long-term dialysis. When AVF dysfunction is suspected, MDCT is a good noninvasive tool for evaluating the entire AVF structure and determining reversible conditions for treatment. The aim of this article is to introduce the scanning and interpretation techniques and to illustrate the conditions related to early and late fistula failures. CONCLUSION MDCT is a fast, noninvasive, and accurate technique for diagnosing AVF complications. Radiologists familiar with these techniques can help to improve the prognosis and quality of life for hemodialysis patients.
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