Endovascular Arteriovenous Dialysis Fistula Intervention: Outcomes and Factors Contributing to Fistula Failure

In recent years, new emerging technology has allowed the endovascular creation of dialysis fistulas in the proximal forearm without the need for open surgery. Two such systems currently exist, and evidence to date has demonstrated high rates of technical success in fistula creation, high rates of dialysis functionality, and low rates of re-intervention using both systems. Whilst early trial data has demonstrated lower rates of re-intervention to maintain patency compared to surgical fistulas, endovascular re-interventions are still required to maintain functionality. The endovascular fistula (endoAVF) typically exhibits a shared drainage pattern and is morphologically distinct from the surgical fistula and patterns of failure observed often differ to what has been traditionally encountered. A fresh approach and understanding is therefore required and here we share our observations and experience of endovascular re-intervention in endoAVF created with the Wavelinq system.

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High-output cardiac failure secondary to high-output arteriovenous fistula: investigations, management and definitive treatment

BMJ Case Reports ◽

10.1136/bcr-2019-233669 ◽

2020 ◽

Vol 13 (2) ◽

pp. e233669 ◽

Cited By ~ 1

Author(s):

James Leon Hartley ◽

Asheesh Sharma ◽

Lamis Taha ◽

Thomas Hestletine

Keyword(s):

Pulmonary Hypertension ◽

Arteriovenous Fistula ◽

Cardiac Failure ◽

Rare Complication ◽

Definitive Treatment ◽

Progressive Dyspnoea ◽

Dialysis Fistula ◽

End Stage ◽

Haemodialysis Treatment ◽

High Output

A 32 year-old woman was admitted to our institution with progressive dyspnoea. Her medical history was notable for end-stage renal failure secondary to chronic pyelonephritis, and she had undergone a cadaveric renal transplant in 2010. This had been preceded by haemodialysis treatment via a radiocephalic arteriovenous fistula. Her diagnostic evaluation was remarkable for pulmonary hypertension. A subsequent doppler ultrasound of her arteriovenous fistula revealed a blood flow of 3 L/min. This is consistent with a high output fistula. Echocardiography demonstrated an improvement in pulmonary artery pressure with occlusion of the fistula. After multidisciplinary discussion, a decision was made to surgically tie off her fistula. The patient experienced immediate improvement in her shortness of breath along with resolution of pulmonary hypertension on echocardiography. This case highlights the rare complication of high output cardiac failure from a dialysis fistula and its successful surgical management.

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MON-131 MODELS FOR TRAINING IN DIALYSIS FISTULA ANGIOPLASTY TECHNIQUES

Kidney International Reports ◽

10.1016/j.ekir.2019.05.922 ◽

2019 ◽

Vol 4 (7) ◽

pp. S357

Author(s):

L.L. MYAT ◽

S. May

Keyword(s):

Dialysis Fistula

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Hybrid procedures in the dialysis fistula aneurysm treatment

Vascular ◽

10.1177/1708538120931626 ◽

2020 ◽

Vol 28 (6) ◽

pp. 775-783

Author(s):

Rafał Góra ◽

Krzysztof Bojakowski ◽

Bartosz Foroncewicz ◽

Stanisław Kaźmierczak ◽

Piotr Andziak

Keyword(s):

Term Treatment ◽

Late Complications ◽

Primary Patency ◽

Dialysis Access ◽

Hybrid Procedures ◽

Aneurysm Treatment ◽

Long Term Treatment ◽

Significant Difference ◽

Dialysis Fistula ◽

Vein Stenosis

Objectives Dialysis fistula aneurysms are common complications which in selective cases require surgical revision. It is recommended to detect and treat outflow stenosis concurrent with a dialysis fistula aneurysm, but usually, the treatment is divided into two stages – the open and endovascular stages are performed separately. We describe the results of hybrid procedures composed of aneurysm resection and endovascular correction for outflow veins performed for a dialysis fistula aneurysm treatment. Methods From March 2012, we performed hybrid procedures in 28 patients to correct dialysis fistula aneurysms. Patients, dialysis access, operative data, and the results obtained during a median follow-up of 28.5 months were analyzed. Results For dialysis fistula aneurysm correction, we performed 27 bypasses and 1 aneurysmorraphy. For outflow vein stenosis correction, we performed standard balloon angioplasty, no stents or stentgraft were used. The average increase in minimal diameter after angioplasty was 135.5% (range 57–275%). The 12- and 24-month primary patency rates of corrected fistulas in the observed group were 92.3% and 80%, respectively. A significant difference in the one-year patency rates between the urgent and planned procedures was observed (81.2% vs. 100%, respectively). No early complications related to endovascular or open procedures were observed. Late complications were observed in seven patients (25%) – mainly thrombosis caused by the recurrence of outflow vein stenosis (six patients, 21.5%), infection, lymphocele, and hematoma (one case of each complication). Conclusions A hybrid procedure for the surgical correction of dialysis fistula aneurysms with the simultaneous correction of outflow pathologies enables effective long-term treatment. The obtained data showed the efficiency and good results of this procedure. Procedures performed for urgent indications significantly increase the risk for later complications, especially fistula thrombosis and loss of dialysis access.

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Risk of Complications and Survival of Patients Dialyzed with Permanent Catheters

Medicina ◽

10.3390/medicina56010002 ◽

2019 ◽

Vol 56 (1) ◽

pp. 2

Author(s):

Anna Szarnecka-Sojda ◽

Wojciech Jacheć ◽

Maciej Polewczyk ◽

Agnieszka Łętek ◽

Jarosław Miszczuk ◽

...

Keyword(s):

Vascular Access ◽

Infectious Complications ◽

Term Survival ◽

Long Term Survival ◽

Dialysis Fistula ◽

Study Population ◽

Catheter Implantation ◽

Stage Renal Disease ◽

End Stage

Background and Objectives: An increase in the incidence of end-stage renal disease (ESRD) is associated with the need for a wider use of vascular access. Although arteriovenous (A-V) fistula is a preferred form of vascular access, for various reasons, permanent catheters are implanted in many patients. Materials and Methods: A retrospective analysis of clinical data was carried out in 398 patients (204 women) who in 2010–2016 were subjected to permanent dialysis catheters implantation as first vascular access or following A-V fistula dysfunction. The factors influencing the risk of complications related to vascular access and mortality were evaluated and the comparison of the group of patients with permanent catheter implantation after A-V fistula dysfunction with patients with first-time catheter implantation was carried out. Results: The population of 398 people with ESRD with mean age of 68.73 ± 13.26 years had a total of 495 permanent catheters implanted. In 129 (32.6%) patients, catheters were implanted after dysfunction of a previously formed dialysis fistula. An upward trend was recorded in the number of permanent catheters implanted in relation to A-V fistulas. Ninety-two infectious complications (23.1%) occurred in the study population in 65 patients (16.3%). Multivariate analysis showed that permanent catheters were more often used as the first vascular access option in elderly patients and cancer patients. Mortality in the mean 1.38 ± 1.17 years (min 0.0, max 6.70 years) follow-up period amounted to 50%. Older age and atherosclerosis were the main risk factors for mortality. Patients with dialysis fistula formed before the catheter implantation had a longer lifetime compared to the group in which the catheter was the first access. Conclusion: The use of permanent catheters for dialysis therapy is associated with a relatively high incidence of complications and low long-term survival. The main factors determining long-term survival were age and atherosclerosis. Better prognosis was demonstrated in patients after the use of A-V fistula as the first vascular access option.

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Multicentre, randomised, blinded, control trial of drug-eluting balloon vs Sham in recurrent native dialysis fistula stenoses

The Journal of Vascular Access ◽

10.1177/1129729818801556 ◽

2018 ◽

Vol 20 (3) ◽

pp. 260-269 ◽

Cited By ~ 17

Author(s):

Jan “John” Swinnen ◽

Kerry Hitos ◽

Lukas Kairaitis ◽

Simon Gruenewald ◽

George Larcos ◽

...

Keyword(s):

Endovascular Treatment ◽

Late Lumen Loss ◽

Significant Difference ◽

Dialysis Fistula ◽

Secondary Endpoints ◽

Drug Eluting ◽

The Difference ◽

Drug Eluting Balloon ◽

Randomised Controlled ◽

Haemodialysis Fistula

Background: Endovascular treatment of autogenous arteriovenous haemodialysis fistula stenosis has high reintervention rates. We investigate the effect of drug-eluting balloons in the treatment of recurrent haemodialysis fistula stenosis. Methods: This is a randomised, controlled, investigator-initiated and run, prospective, blinded, multicentre trial. Patients with recurrent autogenous arteriovenous haemodialysis fistula stenosis received standard endovascular treatment plus drug-eluting balloon or standard endovascular treatment plus uncoated balloon (Sham). Primary endpoint was late lumen loss in trial area on ultrasound at 6 weeks, 3, 6 and 12 months. Secondary endpoints were freedom from reintervention to the Index Trial Area and decline in fistula flow (Qa). Interim analysis was performed at 6 months (unblinded due to timeliness). Results: Patients with 132 recurrent stenoses (48% in bare Nitinol stents) were randomised with 70 receiving drug-eluting balloon and 62 Sham. At 6 months, decline in late lumen loss was 0.23 ± 0.03 mm/month for Sham and 0.045 ± 0.03 mm/month for drug-eluting balloon arm, a significant difference (0.18 mm, p = 0.0002). At 12 months, this difference persisted at 0.12 mm (p = 0.0003). At 6 months, significant difference in late lumen loss for instent restenoses (p = 0.0004) was observed, with non-significant difference for unstented restenoses (p = 0.065). Mean time for freedom from reintervention was 10.14 months for Sham versus 42.39 months for drug-eluting balloon (p = 0.001). The same was shown for instent (p = 0.014) and unstented (p = 0.029) restenoses. Qa decline rate at 6 months was 36.89 mL/min/month (Sham) and 0.41 mL/min (drug-eluting balloon). The difference was significant (36.48 mL/min; p = 0.02) and persisted to 12 months (p = 0.44). Conclusion: Paclitaxel drug-eluting balloon significantly delays restenosis after angioplasty for recurrent autogenous arteriovenous haemodialysis fistula stenosis, persisting to 12 months. Drug-eluting balloon significantly increases freedom from reintervention at 12 months with these effects true in stented and unstented fistulas.

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