Upper Extremity Ischemia and Hemodialysis Vascular Access

Purpose To determine prospectively the clinical value of contrast-enhanced magnetic resonance angiography (CE-MRA) for assessment of the arterial inflow and venous outflow prior to vascular access (VA) creation. Methods Seventy-three patients underwent duplex ultrasonography (DUS) and CE-MRA prior to VA creation for detection of stenoses and occlusions. Two observers read the CE-MRA images for determination of inter-observer agreement. A VA was considered functional if it could be used for successful two-needle hemodialysis therapy within 2 months after creation. Results CE-MRA detected 6 stenosed, 8 occluded arterial vessel segments and 12 stenosed and 41 occluded venous vessel segments in 70 patients. Inter-observer agreement for detection of upper extremity arterial and venous stenoses and occlusions with CE-MRA was substantial to almost perfect (kappa values 0.76–0.96). CE-MRA detected lesions, not detected by DUS, that were associated with VA early failure and non-maturation in 33% of patients (7/21). Accessory veins detected preoperatively were the cause of VA non-maturation in a substantial group of patients (47%: 7/15). Conclusion CE-MRA enables accurate detection of upper extremity arterial and venous stenosis and occlusions prior to VA creation. Preoperative CE-MRA identified arterial and venous stenoses, not detected by DUS that were associated with VA early failure and non-maturation. However, the use of gadolinium containing contrast media is currently contraindicated due the reported incidence of nephrogenic systemic fibrosis.

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Current techniques for assessment of upper extremity vasculature prior to hemodialysis vascular access creation

European Radiology ◽

10.1007/s00330-007-0662-6 ◽

2007 ◽

Vol 17 (11) ◽

pp. 3001-3011 ◽

Cited By ~ 15

Author(s):

R. N. Planken ◽

J. H. M. Tordoir ◽

L. E. M. Duijm ◽

M. W. de Haan ◽

T. Leiner

Keyword(s):

Upper Extremity ◽

Vascular Access ◽

Hemodialysis Vascular Access

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Transposition of Dorsally Lynig Forearm Basilic Vein for Distal Hemodialysis Vascular Access in the Upper Extremity: Surgical Technique and Mid-Term Results

Damar Cerrahi Dergisi ◽

10.9739/uvcd.2011-27703 ◽

2012 ◽

Vol 21 (1) ◽

pp. 1-5

Author(s):

İsmail Oral Hastaoğlu ◽

Can Çağlar Erdem ◽

Fuat Bilgen

Keyword(s):

Surgical Technique ◽

Upper Extremity ◽

Vascular Access ◽

Basilic Vein ◽

Hemodialysis Vascular Access ◽

Mid Term Results

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Rationale and Trial Design of MesEnchymal Stem Cell Trial in Preventing Venous Stenosis of Hemodialysis Vascular Access Arteriovenous Fistula (MEST AVF Trial)

Kidney360 ◽

10.34067/kid.0005182021 ◽

2021 ◽

pp. 10.34067/KID.0005182021

Author(s):

Ameet K. Piryani ◽

Sreenivasulu Kilari ◽

Edwin Takahashi ◽

Randall R. DeMartino ◽

Jay Mandrekar ◽

...

Keyword(s):

Upper Extremity ◽

Vascular Access ◽

Trial Design ◽

Phase 1 ◽

Neointimal Hyperplasia ◽

Ongoing Trial ◽

Arteriovenous Fistulas ◽

Venous Stenosis ◽

Hemodialysis Vascular Access ◽

Fistula Maturation

Background: Hemodialysis arteriovenous fistulas (AVFs) are the preferred vascular access for patients on hemodialysis. In the Hemodialysis Fistula Maturation Study, 43.7% of the patients achieved unassisted maturation of their fistula without needing an intervention. Venous neointimal hyperplasia (VNH) and subsequent venous stenosis (VS) is responsible for lack of maturation. There are no therapies that can prevent VNH/VS formation. The goal of this paper is to present the background, rationale, and trial design of an innovative phase 1 / 2 clinical study that is investigating the safety of autologous adipose derived mesenchymal stem cells (AMSCs) delivered locally to the adventitia of newly created upper extremity radiocephalic (RCF) or brachiocephalic fistula (BCF). Methods: The rationale and pre-clinical studies used to obtain a physician sponsored investigational new drug trial (IND) are discussed. The trial design and endpoints are discussed. Results: This is ongoing trial which will complete this year. Conclusion: This is a phase 1 / 2 single center, randomized trial which will investigate safety and efficacy of autologous AMSCs in promoting maturation in new upper extremity AVFs.

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