Arteriovenous fistula versus arteriovenous graft as a permanent vascular access for hemodialysis

2009 ◽  
Vol 198 (3) ◽  
pp. 462-463
Author(s):  
Mohammad R. Rasouli ◽  
Shahram Salehirad ◽  
Majid Moini
Keyword(s):  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Arteriovenous Graft

Catheter-related obstruction of the right brachiocephalic vein following hemodialysis in a patient with lupus nephritis

2020 ◽  
pp. 112972982092608
Author(s):  
Mitsutoshi Shindo ◽  
Kenichi Oguchi ◽  
Chihiro Kimikawa ◽  
Kiyonori Ito ◽  
Jyunki Morino ◽  
...  
Keyword(s):  
Lupus Nephritis ◽  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Brachiocephalic Vein ◽  
Central Vein ◽  
Axillary Vein ◽  
Arteriovenous Graft ◽  
Complete Obstruction ◽  
Hemodialysis Catheter ◽  
The Right

Vascular access is necessary for hemodialysis, and in some cases where it is difficult to establish an arteriovenous fistula or arteriovenous graft, a permanent hemodialysis catheter may be used. However, serious catheter-related complications, such as central vein stenosis or thrombosis, can occur. We herein present a case of complete brachiocephalic vein obstruction in a patient with lupus nephritis receiving hemodialysis using a tunneled hemodialysis catheter. A 64-year-old patient underwent maintenance hemodialysis while taking an anticoagulant, with a tunneled hemodialysis catheter in the right internal jugular vein, because of arteriovenous fistula failure when hemodialysis was introduced. However, the catheter was removed because of a catheter-related bloodstream infection. Following the administration of antibiotics, an arteriovenous graft was implanted between the brachial artery and axillary vein in the right arm. Surprisingly, arteriovenous graft failure and complete obstruction of the right brachiocephalic vein were observed 3 days after arteriovenous graft creation. In conclusion, we report the case of tunneled hemodialysis catheter-related complete obstruction of the right brachiocephalic vein in a lupus nephritis patient undergoing hemodialysis. Clinicians should be aware of this potential complication when tunneled hemodialysis catheters are used and consider the next vascular access type before a tunneled hemodialysis catheter has been indwelled for the long term.

Managing anxiety during arteriovenous fistula or arteriovenous graft needling

2019 ◽  
Vol 4 (4) ◽  
pp. 205-210
Author(s):  
Lynsey Stronach ◽  
Simone Friedl ◽  
Carmen Barton ◽  
Cora Lahart ◽  
Yvie Morley
Keyword(s):  
Young Adults ◽  
Young People ◽  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Arteriovenous Graft ◽  
Children And Young People ◽  
Children And Young Adults

Vascular access is crucial for haemodialysis, but cannulation of an arteriovenous fistula can be anxiety-provoking for patients, particularly children and young people. This article outlines the management and treatment of needle-related anxiety and pain for children and young adults

Comparison of Outcomes with Arteriovenous Fistula and Arteriovenous Graft for Vascular Access in Hemodialysis: A Prospective Cohort Study

2016 ◽  
Vol 43 (2) ◽  
pp. 120-128 ◽  
Author(s):  
Hoon Suk Park ◽  
Woo Jeong Kim ◽  
Yong Kyun Kim ◽  
Hyung Wook Kim ◽  
Bum Soon Choi ◽  
...  
Keyword(s):  
Life Expectancy ◽  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Prospective Cohort ◽  
Survival Benefit ◽  
Patient Survival ◽  
The Elderly ◽  
Arteriovenous Graft ◽  
Poor Patient ◽  
Poor Patient Survival

Background: Poor vessel quality and limited life expectancy in the elderly may make arteriovenous fistula (AVF) less ideal than arteriovenous graft (AVG) or catheter for vascular access (VA) in hemodialysis (HD). Methods: A total of 946 adult incident HD patients from clinical research center registry for end-stage renal disease prospective cohort in South Korea were analyzed for outcomes with AVF and AVG. Results: Overall, AVF was associated with better patient survival only in male (p < 0.001) and diabetic (p = 0.004) patients, although it was superior to AVG in access patency, regardless of diabetes mellitus status and gender. AVG (vs. AVF; hazard ratio (HR) 2.282; 95% CI 1.071-4.861; p = 0.032) was associated with poor patient survival. In elderly patients (≥65 years), AVF was associated with survival benefit only in male (p < 0.001) and diabetic (p = 0.04) patients, and with better access patency only in female (p = 0.05) and diabetic (p = 0.04) patients. AVG (vs. AVF; HR 3.158; 95% CI 1.080-9.238; p = 0.036) was associated with poor patient survival. In septuagenarian patients, AVF was associated only with survival benefit (p = 0.01) and there was no advantage in access patency (p = 0.12). However, AVF was superior to AVG in both access patency (p = 0.001) and patient survival (p = 0.03) even with propensity matching. Conclusion: AVF is the more desirable VA and its survival benefits warrant its consideration in septuagenarian patients although a prolonged life expectancy is essential to realize the potential benefits of AVF.

Current state of vascular access in Singapore

2019 ◽  
Vol 21 (5) ◽  
pp. 582-588 ◽  
Author(s):  
Suh Chien Pang ◽  
Ru Yu Tan ◽  
Jia Liang Kwek ◽  
Kian Guan Lee ◽  
Marjorie Wai Yin Foo ◽  
...  
Keyword(s):  
Renal Disease ◽  
Arteriovenous Fistula ◽  
Vascular Access ◽  
End Stage Renal Disease ◽  
Shared Responsibility ◽  
Arteriovenous Graft ◽  
Access Management ◽  
Current State ◽  
Stage Renal Disease ◽  
End Stage

This article described the current state of vascular access management for patients with end-stage renal disease in Singapore. Over the past 10 years, there has been a change in the demographics of end-stage renal disease patients. Aging population and the increase in prevalence of diabetes mellitus has led to the acceleration of chronic kidney disease and increase in incidence and prevalence of end-stage renal disease. Vascular access care has, therefore, been more complicated, with the physical, psychological, and social challenges that occur with increased frequency in elderly patients and patients with multiple co-morbidities. Arteriovenous fistula and arteriovenous graft are created by vascular surgeons, while maintenance of patency of vascular access through endovascular intervention has been a shared responsibility between surgeons, interventional radiologists, and interventional nephrologists. Pre-emptive access creation among end-stage renal disease patients has been low, with up to 80% of new end-stage renal disease patients being commenced on hemodialysis via a dialysis catheter. Access creation is exclusively performed by a dedicated vascular surgeon with arteriovenous fistula success rate up to 78%. The primary and cumulative patency rates of arteriovenous fistula and arteriovenous graft were consistent with the results from many international centers. Vascular access surveillance is not universally practiced in all dialysis centers due to its controversies, in addition to the cost and the limited availability of equipment for surveillance. Timely permanent access placement, with reduced dependence on dialysis catheters, and improved vascular access surveillance are the main areas for potential intervention to improve vascular access management.

Use of chronically occluded fistula to establish access outflow

2022 ◽  
pp. 112972982110470
Author(s):  
Amal Lagha ◽  
Alexandros Mallios
Keyword(s):  
Arteriovenous Fistula ◽  
Female Patient ◽  
Vascular Access ◽  
Arteriovenous Graft ◽  
Hemodialysis Access

Maintaining a good quality vascular access in the long term can become particularly challenging especially in patients that are on dialysis for many years and present with exhausted venous capital and chronic access related complications. We present a 60-year-old female patient with multiple bilateral previous failed accesses, a previous distal revascularization interval ligation (DRIL) for hemodialysis access induced distal ischemia (HAIDI). Her chronically (more than a month) occluded arteriovenous fistula AVF was used to establish outflow and create a functioning forearm arteriovenous graft (AVG).

scholarly journals Comprehensive Comparison of the Performance of Autogenous Brachial-Basilic Transposition Arteriovenous Fistula and Prosthetic Forearm Loop Arteriovenous Graft in a Multiethnic Asian Hemodialysis Population

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Koy Min Chue ◽  
Kyi Zin Thant ◽  
Hai Dong Luo ◽  
Yu Hang Rodney Soh ◽  
Pei Ho
Keyword(s):  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Secondary Patency ◽  
Arteriovenous Graft ◽  
Central Venous ◽  
Maturation Time ◽  
Limited Life Expectancy ◽  
Limited Life ◽  
Comprehensive Comparison

Aim.For patients who have exhausted cephalic vein arteriovenous fistula (AVF) options, controversy exists on whether brachial-basilic AVF with transposition (BBTAVF) or a forearm arteriovenous graft (AVG) should be the next vascular access of choice. This study compared the outcomes of these two modalities.Methods.A retrospective study of 122 Asian multiethnic patients who underwent either a BBTAVF (81) or an AVG (41). Maturation time and intervention rates were analyzed. Functional primary, secondary, and overall patency rates were evaluated.Results.The maturation time for BBTAVFs was significantly longer than AVGs. There was also a longer deliberation time before surgeons abandon a failing BBTAVF compared to an AVG. Both functional primary and secondary patency rates were significantly higher in the BBTAVF group at 1-year follow-up: 73.2% versus 34.1% (p<0.001) and 71.8% versus 54.3% (p=0.022), respectively. AVGs also required more interventions to maintain patency. When maturation rates were considered, the overall patency of AVGs was initially superior in the first 25 weeks after creation and then became inferior afterwards.Conclusion.BBTAVFs had superior primary and functional patency and required less salvage interventions. The forearm AVG might have a role in patients who require early vascular access due to complications from central venous catheters or with limited life expectancy.

The effect of vascular access type on intra-access flow volume during hemodialysis

2019 ◽  
Vol 20 (6) ◽  
pp. 746-751
Author(s):  
Hoon Suk Park ◽  
Woo Jeong Kim ◽  
Joonsung Choi ◽  
Hyung Wook Kim ◽  
Jun Hyun Baik ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Analysis Of Variance ◽  
Vascular Access ◽  
Repeated Measures ◽  
Arteriovenous Graft ◽  
Flow Volume ◽  
Upper Arm ◽  
Repeated Measures Analysis ◽  
The Impact ◽  
Over Time

Introduction: Previous studies have revealed that vascular access resistance is constant during hemodialysis, but differs according to vascular access type. It is possible that intra-access flow volume (Qac) variation during hemodialysis may also differ according to vascular access type. We conducted this study to investigate whether there are differences in Qac according to vascular access type during hemodialysis. Methods: A total of 58 lower-arm arteriovenous fistula, 14 lower-arm arteriovenous graft, 27 upper-arm arteriovenous fistula, and 45 upper-arm arteriovenous graft cases were studied. Three consecutive Qac values (at 30, 120, and 240 min after the start of hemodialysis) were measured in each patient by the ultrasound dilution technique. Variations in Qac over time were analyzed using repeated measures analysis of variance and multivariate regression analyses, to assess the impact of different factors on Qac variation. Results: The repeated measures analysis of variance revealed that a significant interaction exists between time and vascular access type (p < 0.001). This suggests that vascular access type affects Qac change (%) variation over time during hemodialysis. In a multivariate analysis, mean arterial pressure change during hemodialysis (p = 0.009), access type (p < 0.001), and access location (p < 0.001) were independent variables causing Qac change variation. Conclusion: This study showed that there is a significant difference in Qac variation according to vascular access type during hemodialysis and that arteriovenous graft (vs arteriovenous fistula) and the lower-arm location (vs upper arm) were associated with a decrease in Qac during hemodialysis. This suggests that consideration of vascular access type is required to minimize Qac variation during hemodialysis.

scholarly journals A randomized pilot study to evaluate graft versus fistula vascular access strategy in older patients with advanced kidney disease: results of a feasibility study 

2020 ◽  
Author(s):  
Mariana Murea ◽  
Randolph L Geary ◽  
Denise K Houston ◽  
Matthew S Edwards ◽  
Todd W Robinson ◽  
...  
Keyword(s):  
Older Adults ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Arteriovenous Graft ◽  
End Stage Kidney Disease ◽  
Arteriovenous Access ◽  
End Stage

Abstract Background. Although older adults encompass almost half of patients with advanced chronic kidney disease, it remains unclear which long-term hemodialysis vascular access type, arteriovenous fistula or arteriovenous graft, is optimal with respect to effectiveness and patient satisfaction. Clinical outcomes based on the initial AV access type have not been evaluated in randomized controlled trials. This pilot study tested the feasibility of randomizing older adults with advanced kidney disease to initial arteriovenous fistula versus graft vascular access surgery.Methods: Patients 65 years or older with pre-dialysis chronic kidney disease or incident end-stage kidney disease and no prior arteriovenous vascular access intervention were randomized in a 1:1 ratio to undergo surgical placement of a fistula or a graft after providing informed consent. Trial feasibility was evaluated as (i) recruitment of ≥70% of eligible participants, (ii) ≥50% to 70% of participants undergo placement of index arteriovenous access within 90 to 180 days of enrollment, respectively, (iii) ≥80% adherence to study-related assessments, and (iv) ≥70% of participants who underwent index arteriovenous access placement will have a follow-up duration of ≥12 months after index surgery date.Results: Between September 2018 and October 2019, 81% (44/54) of eligible participants consented and were enrolled in the study; 11 had pre-dialysis chronic kidney disease and 33 had incident or prevalent end-stage kidney disease. After randomization, 100% (21/21) assigned to arteriovenous fistula surgery and 78% (18/23) assigned to arteriovenous graft surgery underwent index arteriovenous access placement within a median (1st, 3rd quartile) of 5.0 (1.0, 14.0) days and 13.0 (5.0, 44.3) days, respectively, after referral to vascular surgery. The completion rates for study-specific assessments ranged between 40.0 and 88.6%. At median follow-up of 215.0 days, 5 participants expired, 7 completed 12 months of follow-up, and 29 are actively being followed. Assessments of grip strength, functional independence and vascular access satisfaction were completed by >85% of patients who reached pre-specified post-operative assessment time point.Conclusions: Results from this study reveal it is feasible to enroll and randomize older adults with advanced kidney disease to one of two different arteriovenous vascular access placement surgeries. The study can progress with minor protocol adjustments to a multisite clinical trial.Trial registration: Clinical Trials ID: NCT03545113. Registered June 4, 2018.

Vascular access for home haemodialysis

2018 ◽  
Vol 19 (6) ◽  
pp. 593-595 ◽  
Author(s):  
Julien Al Shakarchi ◽  
C Day ◽  
N Inston
Keyword(s):  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Hospital Admissions ◽  
University Hospital ◽  
Arteriovenous Graft ◽  
Dialysis Catheter ◽  
Home Haemodialysis ◽  
Admission Rates ◽  
Arteriovenous Fistulas ◽  
Hospital Access

Introduction: Home haemodialysis has been advocated due to improved quality of life. However, there are very little data on the optimum vascular access for it. Method: A retrospective cohort study was carried on all patients who initiated home haemodialysis between 2011 and 2016 at a large university hospital. Access-related hospital admissions and interventions were used as primary outcome measures. Results: Our cohort consisted of 74 patients. On initiation of home haemodialysis, 62 individuals were using an arteriovenous fistula as vascular access, while the remaining were on a tunnelled dialysis catheter. Of the 12 patients who started on a tunnelled dialysis catheter, 5 were subsequently converted to either an arteriovenous fistula ( n = 4) or an arteriovenous graft ( n = 1). During the period of home haemodialysis use, four arteriovenous fistula failed or thrombosed with patients continuing on home haemodialysis using an arteriovenous graft ( n = 3) or a tunnelled dialysis catheter ( n = 1). To maintain uninterrupted home haemodialysis, interventional rates were 0.32 per arteriovenous fistula/arteriovenous graft access-year and 0.4 per tunnelled dialysis catheter access-year. Hospital admission rates for patients on home haemodialysis were 0.33 per patient-year. Conclusion: Our study has shown that home haemodialysis can be safely and independently performed at home within a closely managed home haemodialysis programme. The authors also advocate the use of arteriovenous fistulas for this cohort of patients due to both low complication and intervention rates.

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