SS14. Brachial Vein Transposition Arteriovenous Fistulas for Hemodialysis Access

Objectives Percutaneous dialysis access interventions are routinely used to maintain the patency of dialysis access despite the lack of data regarding their long-term effectiveness. This retrospective study was undertaken to study the effectiveness and safety of percutaneous dialysis access interventions in arm fistulas and bridge grafts in an office-based endovascular center. Methods Patients who had a percutaneous dialysis access intervention in their upper extremity access site, performed at a single office-based endovascular center over a nine-year period (2007–2016) were included in this study. The patients’ demographic factors, patency, and complications were analyzed. Patients were entered in the study after first percutaneous dialysis access intervention. Results A total of 298 limbs in 259 patients had 913 procedures carried out over a nine-year period. There were 190 access arteriovenous fistulas and 108 arteriovenous grafts. The two most common arteriovenous fistulas were the brachiocephalic fistula ( n = 74, 39%) and radio cephalic fistula ( n = 69, 36%). Arteriovenous grafts were most commonly placed in the upper arm ( n = 66, 61%) followed by the forearm ( n = 42, 39%). The mean overall patency for all limbs was 50.86 months. Arteriovenous fistulas had a significantly longer patency than arteriovenous grafts (51.65 vs. 42.09 months; P = 0.01). In addition, patients with two or more percutaneous dialysis access intervention in their arteriovenous fistula had significantly greater patency than those with only one percutaneous dialysis access intervention (58.5 vs. 7.6 months; hazard ratio 0.41; P = 0.0008). This was not true for the arteriovenous graft group. Women represented 49% of the patient group. Their accesses had shorter patency than men (39.8 vs. 60 months; P = 0.0007). Conclusions This data support the use of repeated percutaneous dialysis access intervention to maintain long-term patency of dialysis access sites in an office-based endovascular center. Overall, fistulas have longer patency than grafts and women have poorer outcomes as compared to men

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The usefulness and feasibility of placing a clinch knot with a guidewire to achieve temporary hemostasis in arteriovenous dialysis access interventions

The Journal of Vascular Access ◽

10.1177/1129729820954742 ◽

2020 ◽

pp. 112972982095474

Author(s):

Sung-Joon Park ◽

Hwan Hoon Chung ◽

Seung Hwa Lee ◽

Sung Beom Cho ◽

Tae-Seok Seo ◽

...

Keyword(s):

Clinical Success ◽

Primary Patency ◽

Interventional Treatment ◽

Secondary Patency ◽

Dialysis Access ◽

Hemodialysis Access ◽

Purse String Suture ◽

Purse String ◽

Arteriovenous Fistulas ◽

Arteriovenous Grafts

Purpose: To evaluate the usefulness and feasibility of using a reversible clinch knot with a guidewire in place rather than eliminating the access route during an arteriovenous hemodialysis access (AV access) intervention using the facing sheath technique. Material and methods: From July 2016 to June 2019, we retrospectively studied 78 sessions performed as interventional treatment for arteriovenous (AV) hemodialysis (HD) access using the “facing-sheath technique.” In all sessions, all antegrade sheaths were removed while a 0.035-inch guidewire remained in place with purse-string suture and the clinch knot. Seventy-two sessions were performed in patients with thrombosed AV accesses (69 arteriovenous grafts [AVGs] and three arteriovenous fistulas [AVFs]), and six sessions were carried out to treat non-thrombosed AV accesses (four AVGs and two AVFs). We evaluated whether proper hemostasis and successful reinsertion of the sheath over the wire into the clinch knot was achieved. Clinical success was defined as achieving prompt restoration of blood flow for AV access, and the postintervention primary and secondary patency were also evaluated. Result: In all 87 clinch knots created in 78 total sessions, proper hemostasis was achieved. All clinch knots that required reversal for additional procedures were successfully reopened (55 clinch knots in 50 sessions). The postintervention primary patency rates at 1, 3, and 6 months, and at 1 year were 77.8%, 68.9%, 55.6%, and 33.3%, respectively. The postintervention secondary patency rates at 1, 3, and 6 months, and also at 1 year were 93.3%, 91.1%, 86.7%, and 86.7%, respectively. Conclusion: Our AV access intervention which used a clinch knot with purse-string suture while the guidewire remained in place was both useful and feasible for maintaining temporary hemostasis.

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Transjugular percutaneous endovascular treatment of dysfunctional hemodialysis access

The Journal of Vascular Access ◽

10.1177/1129729818815327 ◽

2018 ◽

Vol 20 (5) ◽

pp. 488-494 ◽

Cited By ~ 1

Author(s):

Jin Ho Kim ◽

Sung Bum Cho ◽

Yun Hwan Kim ◽

Hwan Hoon Chung ◽

Seung Hwa Lee ◽

...

Keyword(s):

Endovascular Treatment ◽

Internal Jugular Vein ◽

Patency Rate ◽

Jugular Vein ◽

Hemodialysis Access ◽

Procedure Time ◽

Arteriovenous Fistulas ◽

Arteriovenous Grafts ◽

The Mean ◽

Vein Stenosis

Purpose: To evaluate the feasibility and the outcomes of transjugular percutaneous endovascular treatment of dysfunctional hemodialysis access in patients with chronic kidney disease. Methods: A total of 50 transjugular treatments in 38 patients with arteriovenous fistulas or arteriovenous grafts from September 2011 to May 2015 were included in this study. Medical records and angiographies were retrospectively reviewed. Success rate, patency rate, procedure time, and complications including internal jugular vein stenosis were evaluated. Results: A total of 50 sessions of transjugular treatments were performed in 38 patients. There were 31 native arteriovenous fistulas including 10 immature cases and 19 arteriovenous grafts. Among the 50 cases, technical success was achieved in 45 and clinical success was achieved in 44; 37 cases (74%) with multiple stenotic sites were treated by the transjugular approach without placement of cross-sheaths. The mean time from puncture of the internal jugular vein to first fistulography was 10 min, and the mean total procedure time was 64 min. The primary patency rate at 6 months was 77%, while the secondary patency rate at 6 months was 97%. Perforation occurred in two cases during conventional percutaneous transluminal angioplasty after failure of the transjugular approach. One dissection occurred during the transjugular approach. There was no newly developed internal jugular vein stenosis during a mean follow-up period of 19.3 months. Conclusion: For the treatment of dysfunctional or immature hemodialysis access, the transjugular approach is a feasible and effective option that avoids injury to the graft or draining vein, especially in immature fistulas.

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Brachial Vein Transposition Arteriovenous Fistula for Hemodialysis Access

The Japanese Journal of Phlebology ◽

10.7134/phlebol.23.59 ◽

2012 ◽

Vol 23 (2) ◽

pp. 59-64

Author(s):

Harunobu Matsumoto ◽

Eisuke Yamamoto ◽

Chiaki Kamiya ◽

Emi Miura ◽

Tadashi Kitaoka ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Hemodialysis Access ◽

Brachial Vein

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A systematic review of the brachial vein arteriovenous fistulas as a viable option for haemodialysis access

The Journal of Vascular Access ◽

10.1177/1129729820983178 ◽

2020 ◽

pp. 112972982098317

Author(s):

Paschalis Gavriilidis ◽

Vassilios Papalois

Keyword(s):

Systematic Review ◽

Patency Rate ◽

Secondary Patency ◽

Viable Option ◽

Arteriovenous Fistulas ◽

Secondary Patency Rate ◽

Pseudo Aneurysm ◽

Brachial Vein ◽

Secondary Outcomes ◽

Steal Syndrome

Objectives: International guidelines recommend the use of autogenous vascular access. Where suitable superficial veins are unavailable deeper veins may be used as an option. In most cases, basilic veins are used when cephalic veins are unavailable; arteriovenous fistulas using the brachial vein from the deep venous network are rare. Therefore, the purpose of the present study was to conduct a systematic review of the available literature evaluating the use of the brachial vein in arteriovenous fistulas. Methods: Systematic literature search of electronic databases in accordance with PRISMA was conducted. The primary outcomes of this study were primary and secondary patency rates for brachial vein arteriovenous fistulas; the secondary outcomes were the rates of access thrombosis, steal syndrome, pseudo-aneurysm and infection. Results: The 1-year primary, assisted, and secondary patency was recorded at (24%–77%), (45%–85%) and (45%–96%), respectively. The 2-year primary, assisted and secondary patency rate was recorded at (12%–46%), (19%–75%) and (19%–92%), respectively. However, the consistency regarding the reports and definitions used were highly variable. The incidence rate of infection, thrombosis and steal syndrome was 5% (0%–12%), 15.9% (9.5%–35%) and 3% (2%–6%), respectively. Conclusion: Available studies support the use of brachial veins as a reliable access option in patients with non-accessible superficial veins where an autologous option is required.

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A Comparison of Brachial Artery-Brachial Vein Arteriovenous Fistulas With AV Grafts in Patients With Poor Superficial Venous Anatomy

Journal of Vascular Surgery ◽

10.1016/j.jvs.2015.06.033 ◽

2015 ◽

Vol 62 (2) ◽

pp. 535

Author(s):

Jerry J. Kim ◽

Ezinne J. Ihenachor ◽

Aaron B. Parrish ◽

Jenny D. Bleck ◽

Matthew C. Koopmann ◽

...

Keyword(s):

Brachial Artery ◽

Venous Anatomy ◽

Arteriovenous Fistulas ◽

Brachial Vein

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Analysis of 855 Upper Extremity Fistulas Created Using a Standard Protocol: The Role of Graft Extension to Achieve Functional Status

The American Surgeon ◽

10.1177/000313481307900625 ◽

2013 ◽

Vol 79 (6) ◽

pp. 625-629

Author(s):

Bassan J. Allan ◽

Enrique R. Perez ◽

Marwan Tabbara

Keyword(s):

Upper Extremity ◽

Chronic Hemodialysis ◽

Standard Protocol ◽

Hemodialysis Access ◽

Arteriovenous Fistulas ◽

Excellent Method ◽

The Creation ◽

National Programs ◽

Current Guidelines

The Fistula First Breakthrough Initiative (FFBI) has been one of the most important national programs to help achieve considerable improvements in the care of patients on chronic hemodialysis. FFBI has helped place guidelines to push practitioners to reduce the use of tunneled central venous catheters and to increase the rate of arteriovenous fistula use in patients requiring chronic hemodialysis access. However, despite current guidelines, no specific protocols exist for the creation and management of autogenous arteriovenous fistulas and outcomes at most centers are below national benchmarks. In this study, we examine the effectiveness of a standard protocol used at our institution for the creation of autogenous upper extremity fistulas for hemodialysis access in achieving early cannulation and early removal of tunneled dialysis catheters. Our review encompasses 855 consecutive autogenous fistulas created over a 10-year period. Our findings suggest that the use of a standard protocol for creation and management of autogenous fistulas can help increase the rate of functional accesses over national benchmarks. Additionally, extension/conversion of malfunctioning fistulas to grafts appears to be an excellent method to expedite removal of a tunneled dialysis catheter with concomitant preservation of a fistula.

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