The Complications of Vascular Access in Hemodialysis

2017 ◽  
Vol 44 (01) ◽  
pp. 057-059 ◽  
Author(s):  
Avais Masud ◽  
Eric Costanzo ◽  
Roman Zuckerman ◽  
Arif Asif
Keyword(s):  
Blood Flow ◽  
Vascular Access ◽  
Great Majority ◽  
Dialysis Access ◽  
Luminal Diameter ◽  
Dialysis Treatment ◽  
Hemodialysis Vascular Access ◽  
Arteriovenous Access ◽  
Risk For Thrombosis

AbstractComplications related to hemodialysis vascular access continue to have a major impact on morbidity and mortality. Vascular access dysfunction is the single most important factor that determines the quality of dialysis treatment. Vascular access stenosis is a common complication that develops in a great majority of patients with an arteriovenous access and leads to access dysfunction. By restricting luminal diameter, this complication leads to a reduction in blood flow and places the access at risk for thrombosis. Similarly, the development of catheter-related fibroepithelial sheath also causes catheter dysfunction with its detrimental effects on blood flow. In this article, we discuss the most common complications associated with dialysis access and provide therapeutic options to manage these problems.

Chronic Ischemic Monomelic Neuropathy after Arteriovenous Fistula Creation: A Unique Presentation of Vascular Steal

2020 ◽  
Vol 3 (2) ◽  
pp. 147-150
Author(s):  
Kaczynski RE ◽  
Asaad Y ◽  
Valentin-Capeles N ◽  
Battista J
Keyword(s):  
Arteriovenous Fistula ◽  
Complete Loss ◽  
Dialysis Access ◽  
Loss Of Function ◽  
Access Site ◽  
Surgical Ligation ◽  
Arteriovenous Access ◽  
Vascular Steal ◽  
Steal Syndrome

We discuss a case of a 58 year old male who presented for left upper extremity steal syndrome including ischemic monomelic neuropathy (IMN) 1.5 months after arteriovenous fistula creation. He presented after three surgical attempts to salvage his fistula with rest pain, complete loss of function with contracture of the 4th and 5th digits, and loss of sensation in the ulnar distribution for more than three weeks. At our institution, he underwent surgical ligation of the distal fistula and creation of a new fistula proximally, resulting in complete resolution of his vascular steal symptoms almost immediately despite the chronicity prior to surgical presentation. Our patient provides a unique perspective regarding dialysis access salvage versus patient quality of life. The patients’ functional status and pain levels should take precedence over salvage of an arteriovenous access site, and early ligation of the access should be completed prior to chronic IMN development. However, if a patient presents late along the IMN course, we recommend strong consideration of access ligation in order to attempt to regain the full neurovascular function of the extremity as we experienced in our patient.

scholarly journals Basilic Vein Transposition Used as a Tertiary Vascular Access for Hemodialysis: 15 Years of Experience

2016 ◽  
Vol 8 ◽  
pp. OJCS.S34837 ◽  
Author(s):  
Róbert Novotný ◽  
Marcela Slavíková ◽  
Jaroslav Hlubocký ◽  
Petr Mitáš ◽  
Jan Hrubý ◽  
...  
Keyword(s):  
Vascular Access ◽  
Infectious Complications ◽  
Primary Patency ◽  
Secondary Patency ◽  
Basilic Vein ◽  
Time Period ◽  
Patient Database ◽  
Arteriovenous Access

Introduction The quality of the life in patients requiring long term hemodialysis is directly proportional to the long-term patency of their vascular access. Basilic vein transposition for vascular access (BAVA) represents a suitable option for creating a tertiary native vascular access for hemodialysis on the upper extremities for patients requiring long term hemodialysis. The purpose of the study is to compare BAVAs with arteriovenous grafts (AVG). Method Data collection was based on selecting all of the patients with BAVA created in the time period in between January 1996 and August 2011. A questionnaire was created and sent to the selected hemodialysis centers. The resulting set of data was statistically analyzed and evaluated. Results In the time period between 1 January 1996 and August 2011, arteriovenous access for hemodialysis was created in 6754 patients (7203 procedures in total). Out of these patients, 175 BAVAs were created. Our patient database of those undergoing the BAVA procedure consisted of 98 females (56%) and 77 males (44%) with an average age of 64.5 years. The prevalence of diabetes mellitus was 60% (105 patients). Primary patency after 12 months was 68.8%, 24 months 59.7%, 36 months 53.8, 48 months 53.8%, and 60 months 50%. Primary assisted patency after 12 months was 89.9%, 24 months 84.6%, 36 months 77.8%, 48 months 77.9%, 60 months 70.8%. Secondary patency after 12 months was 89.4%, 24 months 86.9%, 36 months 81%, 48 months 78.9%, 60 months 75.7%. Twenty-nine BAVAs (16.5%) were obliterated. Conclusion Patients benefit from this type of procedure due to the longer patency of a native arteriovenous access, as well as a lower incidence of infectious complications.

Blood Flow Measurements during Hemodialysis Vascular Access Interventions - Catheter-Based Thermodilution or Doppler Ultrasound?

2011 ◽  
Vol 13 (2) ◽  
pp. 145-151 ◽  
Author(s):  
Søren T. Heerwagen ◽  
Marc A. Hansen ◽  
Torben V. Schroeder ◽  
Søren D. Ladefoged ◽  
Lars Lönn
Keyword(s):  
Blood Flow ◽  
Doppler Ultrasound ◽  
Vascular Access ◽  
Flow Measurements ◽  
Hemodialysis Vascular Access ◽  
Blood Flow Measurements

scholarly journals Blood Loss through AV Fistula: A Case Report and Literature Review

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Fahad Saeed ◽  
Nadia Kousar ◽  
Ramapriya Sinnakirouchenan ◽  
Vijaya S. Ramalingam ◽  
Philip B. Johnson ◽  
...  
Keyword(s):  
Case Report ◽  
Blood Loss ◽  
Vascular Access ◽  
Blood Transfusions ◽  
Dialysis Access ◽  
Dialysis Catheter ◽  
Acute Blood Loss ◽  
Dialysis Patients ◽  
Av Fistula ◽  
Hemodialysis Vascular Access

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.

scholarly journals Hemodialysis arteriovenous access: Detection of stenosis and response to treatment by vascular access blood flow

2001 ◽  
Vol 59 (1) ◽  
pp. 358-362 ◽  
Author(s):  
Steve J. Schwab ◽  
Matthew J. Oliver ◽  
Paul Suhocki ◽  
Richard Mccann
Keyword(s):  
Blood Flow ◽  
Vascular Access ◽  
Response To Treatment ◽  
Arteriovenous Access

P1320ASSESSMENT OF ARTERIOVENOUS FISTULA DYSFUNCTION WITH ACCESS STENOSIS IN HEMODIALYSIS PATIENTS USING SMART-PHONE VIDEOS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Lin-Chun Wang ◽  
Fansan Zhu ◽  
Ohnmar Thwin ◽  
Lela Tisdale ◽  
Xia Tao ◽  
...  
Keyword(s):  
Blood Flow ◽  
Frequency Domain ◽  
Vascular Access ◽  
Flow Patterns ◽  
Massachusetts Institute Of Technology ◽  
Luminal Diameter ◽  
Non Invasive ◽  
Video Recordings ◽  
Blood Flow Patterns ◽  
One Way Anova

Abstract Background and Aims Vascular access dysfunction is one of the leading causes of morbidity and a major contributor to healthcare costs in hemodialysis (HD) patients. Inexpensive, non-invasive tools for routine assessment of vascular access function are needed. Hemodynamically relevant stenoses in arteriovenous fistulas (AVF) lead to a reduction in access flow rate (Qa) and changes in blood flow patterns in the AVF that may be picked up by palpation and auscultation. We hypothesized that these changes in blood flow patterns can not only be felt and heard but also seen, i.e., that they may be detectable in video recordings done with commercially available smartphones after digital motion augmentation. Methods We studied HD patients with AVF dysfunction requiring balloon angioplasty and/or stenting. One-minute video recordings of the skin above the AVF and Qa measurements were conducted before and after the endovascular intervention. Videos were recorded with an iPhone 6S (Apple Inc., Cupertino, CA, USA). Qa was measured by HVT100 endovascular flowmeter (Transonic Systems Inc., Ithaca, NY, USA). Significant access stenosis was defined as a >50% reduction of luminal diameter. Degree of stenosis was assessed by angiography. Frame-to-frame pixel changes in video images were amplified using “Eulerian Video Magnification” (Massachusetts Institute of Technology, MA, USA; http://people.csail.mit.edu/mrub/evm/#code). The time-domain data were then transformed into the frequency-domain signals. Fifty random 10-second segments were sampled per one-minute video, and the frequency with the lowest magnitude (Fmin) was determined in each sample (example shown in Fig. 1). The average Fmin was then assessed for its association with the degree of AVF stenosis. Results Ninety subjects were studied (Table 1). AVF interventions were successful in all patients. Post-intervention Qa (1638 ± 714 ml/min) was on average 1.23-fold higher than pre-intervention Qa (1373 ± 684 ml/min; P<0.01, paired t-test). Subjects were grouped by degree of stenosis, and the number of subjects in each category is shown in Fig. 1B. Higher degrees of stenosis were associated with greater increases in Qa from before to after the intervention (P<0.01, one-way ANOVA; Fig. 1C). Interestingly, the degree of AVF stenosis was also positively related with the change in Fmin from before to after the intervention (P=0.08, one-way ANOVA; Fig. 1D). Conclusion Simple smartphone video recordings of AVF appear to contain frequency-domain information that correlates with hemodynamic changes caused by AVF stenoses. While the Fmin metric employed in our analysis is not ideal, these results should encourage the quest for other parameters that exhibit higher correlations with vascular access dysfunction. If successful, this would allow commercially-available smartphones to be used as ubiquitous tools for quick, non-invasive, ambulatory surveillance of AVF function, thereby allowing timely referrals and avoidance of emergency interventions.

Double Pass Dialysis: A New Method of Renal Replacement in Patients with Malfunctioning Vascular Access

1994 ◽  
Vol 17 (7) ◽  
pp. 379-384 ◽  
Author(s):  
A. Brendolan ◽  
C. Ronco ◽  
C. Crepaldi ◽  
L. Bragantini ◽  
M. Milan ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Blood Flow ◽  
Vascular Access ◽  
Positive Impact ◽  
Clinical Results ◽  
Dialysis Session ◽  
High Flux ◽  
Double Pass ◽  
Dialysis Treatment ◽  
Blood Flows

Several patients undergoing chronic renal replacement therapy present problems related to their vascular access. Low blood flows and high rates of recirculation are common in such patients in which, for this reason, it becomes difficult to apply highly efficient techniques or techniques where diffusion and convection are combined as in hemodiafiltration. In these patients we studied the possibility of partially recirculating the blood in the extracorporeal circuit in order to increase the flow rate per single hollow fiber; we defined our system “double pass dialysis”. We evaluated the system's efficiency in 12 patients during 24 dialysis sessions: 12 high flux dialysis sessions (without reinfusion) and 12 hemodiafiltration sessions (9 liters reinfusion). Different surfaces of polyacrylonitrile dialyzers were utilized (1.3-1.7-2.1 sqm) at 250 and 350 ml/min of blood flow with or without 100 ml/min of recirculation. During each dialysis session blood and dialysate samples were taken in order to calculate BUN, Creatinine, Phosphate and Inuline clearances from both the blood and dialysate side. The clearances of low molecular weight solutes were not really influenced by the artificial increase of the blood flow, but on the other hand, the clearances of higher molecular weight solutes increased from 10 to 30% during both high flux dialysis and hemodiafiltration with recirculation. This increase was evident mostly in hemodiafiltration suggesting that the cleaning effect on the membrane has a positive impact on the permeability. The good clinical results obtained with the double pass dialysis show that the system is safe and reliable and may become a valid support in critical situations in order to reach adequate dialysis treatment.

scholarly journals Arteriovenous Fistula Stenosis: A Case Report

2021 ◽  
Vol 2 (2) ◽  
pp. 34-39
Author(s):  
Seprian Widasmara ◽  
Novi Kurnianingsih ◽  
Sasmojo Widito ◽  
Ardian Rizal
Keyword(s):  
Quality Of Life ◽  
Case Report ◽  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Hemodialysis Access ◽  
Percutaneous Approach ◽  
Hemodialysis Vascular Access ◽  
Anastomosis Site ◽  
Arteriovenous Fistula Stenosis

Background: Arteriovenous fistula (AVF) has better rate of patency and lower rate of complication compared to other vascular access for hemodialysis. One priority to be concerned is access failure for hemodialysis access is common findings and correspond with high healthcare cost, morbidity and mortality. Objective: This case report aimed to elaborate the proper management of patient with arterio fistula stenosis. Case Illustration: A man, 64 years old, stage V CKD with AVF in his left arm for hemodialysis access was admitted to our hospital due to difficulty in cannulation during his last hemodialysis. He had AVF For Hemodialysis access for two years. About 1 month before, he undergone surgery for creation of AVF for hemodialysis access in his right arm, but AVF was failed to reach maturation. Based on vascular doppler ultrasound (DUS) done in AVF of the left arm revealed there was stenosis in the juxta-anastomosis site and cephalic venous stenosis. Angioplasty was done in anastomose AVF and implantation of venous stent in the left cephalic vein. Conclusion: For patients on hemodialysis, vascular access is considered as the lifeline. Complications related to Vascular access is associated with morbidity and reduced quality of life. Surgery often difficult to do as readily as a percutaneous approach. In more than 80% of hemodialysis access underwent percutaneous interventions, flow was successfully restored. Based on this success rate, it has replaced surgical revision as the treatment of stenosis AVF.

scholarly journals Good practices for dialysis education, treatment, and eHealth: A scoping review

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255734
Author(s):  
Anita van Eck van der Sluijs ◽  
Sanne Vonk ◽  
Brigit C. van Jaarsveld ◽  
Anna A. Bonenkamp ◽  
Alferso C. Abrahams
Keyword(s):  
Scoping Review ◽  
Health Care Professionals ◽  
Good Practice ◽  
Cochrane Library ◽  
Local Health ◽  
Dialysis Access ◽  
National Guidelines ◽  
Dialysis Treatment ◽  
Good Practices

Background Recommendations regarding dialysis education and treatment are provided in various (inter)national guidelines, which should ensure that these are applied uniformly in nephrology and dialysis centers. However, there is much practice variation which could be explained by good practices: practices developed by local health care professionals, which are not evidence-based. Because an overview of good practices is lacking, we performed a scoping review to identify and summarize the available good practices for dialysis education, treatment, and eHealth. Methods Embase, Pubmed, the Cochrane Library, CINAHL databases and Web of Science were searched for relevant articles using all synonyms for the words ‘kidney failure’, ‘dialysis’, and ‘good practice’. Relevant articles were structured according to the categories dialysis education, dialysis treatment or eHealth, and assessed for content and results. Results Nineteen articles (12 for dialysis education, 3 for dialysis treatment, 4 for eHealth) are identified. The good practices for education endorse the importance of providing complete and objective predialysis education, assisting peritoneal dialysis (PD) patients in adequately performing PD, educating hemodialysis (HD) patients on self-management, and talking with dialysis patients about their prognosis. The good practices for dialysis treatment focus mainly on dialysis access devices and general quality improvement of dialysis care. Finally, eHealth is useful for HD and PD and affects both quality of care and health-related quality of life. Conclusion Our scoping review identifies 19 articles describing good practices and their results for dialysis education, dialysis treatment, and eHealth. These good practices could be valuable in addition to guidelines for increasing shared-decision making in predialysis education, using patients’ contribution in the implementation of their dialysis treatment, and advanced care planning.

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