Sharp Needle Recanalization: A Salvage Procedure for Failing Arteriovenous Fistula Due to Tight Uncrossable Venous Stenosis

Purpose To determine if large caliber accessory veins are associated with radial-cephalic arteriovenous fistula (RC-AVF) non-maturation. Methods RC-AVFs were created in 15 consecutive patients (radial artery and cephalic vein diameter >2 mm, in the absence of arterial inflow or venous outflow stenoses or occlusions). Contrast-enhanced magnetic resonance angiography (CE-MRA) was performed preoperatively for the determination of vessel diameters, stenoses and occlusions. The location and caliber of accessory veins was determined. Vascular access (VA) function was monitored and all interventions required to obtain a functioning VA were recorded. Non-maturation was defined as a nonfunctional VA at 2 months after creation. The predictive value of accessory vein caliber for prediction of RC-AVF non-maturation was evaluated using receiver operating characteristic (ROC) analysis. Results Non-maturation occurred in 10 (67%) out of 15 RC-AVFs. Large caliber accessory veins (n=4), venous stenosis (n=3) or both (n=2) were associated with RC-AVF non-maturation. The presence of large caliber accessory veins was the only significant predictor for RC-AVF non-maturation (p=0.01). Preoperatively detected accessory veins with a diameter >70% of the cephalic vein diameter, had a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 80, 100, 100 and 91% for prediction of RC-AVF non-maturation on patient level. Accessory vein ligation and dilatation of venous stenosis resulted in an overall salvage success rate of 89% (8/9). Conclusion Large caliber accessory veins are associated with RC-AVF non-maturation. Ligation of large caliber accessory veins is a successful salvage procedure in a substantial group of patients. Furthermore, ligation of these accessory veins during initial RC-AVF creation can potentially reduce non-maturation rates; and therefore, preoperative assessment of accessory veins is recommended.

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Novel technique of percutaneous bypass in a brachiocephalic arteriovenous fistula with cephalic arch occlusion: A case report

The Journal of Vascular Access ◽

10.1177/1129729820949043 ◽

2020 ◽

pp. 112972982094904

Author(s):

Hiang Jin Tan ◽

Lew Pei Shi ◽

Lai Yu Meng ◽

Ho Derek Chunyin ◽

Harsha Pitumpe ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Bypass Graft ◽

Transluminal Angioplasty ◽

Central Vein ◽

Dialysis Access ◽

Salvage Procedure ◽

Arteriovenous Fistulas ◽

Smooth Flow ◽

End Stage

Objective: Arteriovenous fistulas are a principal mainstay of long-term dialysis access for patients with end stage renal failure. However, the patency of arteriovenous fistulas is limited, often requiring percutaneous transluminal angioplasty as a salvage procedure. We report a case of percutaneous method of arteriovenous fistula salvage. Methods: A gentleman with brachiocephalic arteriovenous fistula created in 2015 was admitted under us for dialysis access issue. His fistula history was notable for recurrent and refractory venous outflow stenosis of the cephalic vein and the cephalic arch with multiple previous interventions. Ultrasound showed cephalic arch occlusion with high venous pressures. He underwent left brachicephalic fistula percutaneous bypass. We describe the percutaneous creation of a brachial–subclavian arteriovenous fistula via a bypass graft from a worsening brachial-cephalic fistula with cephalic arch occlusion that is not amendable to angioplasty. Results: Final angiogram showed smooth flow to central vein. He is 2 years post procedure, and his fistula remained patent with no interventions required. Conclusion: Percutaneously created jump bypass grafts can reliably produce sustained long-term patency.

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Post-anastomotic venous stenosis after Optiflow deployment: An unexpected outcome

SAGE Open Medical Case Reports ◽

10.1177/2050313x19851002 ◽

2019 ◽

Vol 7 ◽

pp. 2050313X1985100

Author(s):

Ziad Al Adas ◽

George Haddad ◽

Bhavin C Patel ◽

Lalathaksha Kumbar ◽

Baha Al-Abid ◽

...

Keyword(s):

Arteriovenous Fistula ◽

End Stage Renal Disease ◽

Hypertensive Nephropathy ◽

New Device ◽

The Past ◽

Venous Stenosis ◽

Stage Renal Disease ◽

End Stage ◽

Unexpected Outcome ◽

First Time

Arteriovenous fistula failure represents a major cause of hospitalization and a significant economic burden for end-stage renal disease patients on hemodialysis. The Optiflow (Bioconnect Systems Inc., Ambler, PA) is a new device developed to improve arteriovenous fistula outcomes and decrease failure rates by reducing the risk of stenosis and improving maturation rates. This case report describes a 50-year-old male with hypertensive nephropathy on dialysis who had multiple arteriovenous fistula failures in the past. He was scheduled to undergo brachiocephalic fistula construction using the Optiflow device. After 8 months of use, the new fistula developed a peri-anastomotic venous stenosis, just distal to the Optiflow device. To our knowledge, this is the first time such a complication has been reported.

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Longitudinal Effect of Pressure Drop on the Intima-Media Thickening of the Venous Segment of the Arteriovenous Fistula

Volume 1A: Abdominal Aortic Aneurysms; Active and Reactive Soft Matter; Atherosclerosis; BioFluid Mechanics; Education; Biotransport Phenomena; Bone, Joint and Spine Mechanics; Brain Injury; Cardiac Mechanics; Cardiovascular Devices, Fluids and Imaging; Cartilage and Disc Mechanics; Cell and Tissue Engineering; Cerebral Aneurysms; Computational Biofluid Dynamics; Device Design, Human Dynamics, and Rehabilitation; Drug Delivery and Disease Treatment; Engineered Cellular Environments ◽

10.1115/sbc2013-14478 ◽

2013 ◽

Author(s):

Ehsan Rajabi-Jaghargh ◽

Mahesh K. Krishnamoorthy ◽

Rupak K. Banerjee

Keyword(s):

Pressure Drop ◽

Arteriovenous Fistula ◽

Dialysis Patients ◽

Luminal Diameter ◽

Post Surgery ◽

Opposite Trend ◽

Venous Stenosis ◽

Arteries And Veins ◽

Venous Segment ◽

Over Time

Venous stenosis is one of the primary causes of the arteriovenous fistula (AVF) maturation-failure and is characterized by vasoconstriction and significant intima-media thickening (IMT). Although the hemodynamic endpoints are believed to play a crucial role in the pathogenesis of venous stenosis, the exact mechanism behind this is unclear. Our hypothesis is that the changes in the pressure drop over time (Δp′) can influence the remodeling factors in AVFs: changes in luminal diameter (ΔDh) and IMT. Curved (C-AVF; n = 3) and straight (S-AVF; n = 3) AVFs were created between the femoral arteries and veins of 3 pigs. CT-scan and ultrasound were utilized to numerically evaluate the flow field, and thus pressure drop in AVFs at 2D (D: days), 7D, and 28D post-surgery. For each AVF, IMT was also measured at 4 histological blocks along the vein. For the C-AVF, the pressure drop consistently decreased over time (from 18.32 mmHg at 2D to 4.58 mmHg at 28D), while opposite trend was found for the S-AVF (from 12.91 mmHg at 2D to 24.49 mmHg at 28D). The Δp′ was negative at all the histology blocks for C-AVF which showed the reduction in the resistance over time due to dilation (positive ΔDh) and outward hypertrophy of the venous segment (positive ΔDh/IMT). In contrast, Δp′ was mostly positive for the S-AVF which showed the increase in the resistance due to vasoconstriction (negative ΔDh) and inward hypertrophy (negative ΔDh/IMT). Thus, measuring Δp′ at the successive post-surgery time points can provide important information on the remodeling behavior of AVFs. Also, creating AVFs in a surgical configuration that can result in negative Δp′ and thus favorable remodeling could influence the life expectancy of the dialysis patients.

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Longitudinal Effect of Wall Shear Stress on the Amount of Intimal-Medial Thickening of Venous Wall in Arteriovenous Fistula

ASME 2012 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2012-80806 ◽

2012 ◽

Author(s):

Ehsan Rajabi-Jaghargh ◽

Prabir Roy-Chaudhury ◽

Mahesh K. Krishnamoorthy ◽

Yang Wang ◽

Rupak K. Banerjee

Keyword(s):

Shear Stress ◽

Wall Shear Stress ◽

Arteriovenous Fistula ◽

Hemodynamic Parameters ◽

Temporal Gradient ◽

Post Surgery ◽

Venous Stenosis ◽

Venous Diameter ◽

Consistent Increase ◽

Wall Shear

Arteriovenous fistula (AVF) maturation failure is mainly due to venous stenosis characterized by significant amount of intima-media thickening (IMT). Although hemodynamic endpoints are believed to play a crucial role in pathogenesis of venous stenosis, the exact mechanism behind this is unclear. Our hypothesis is that longitudinal (temporal) changes of hemodynamic parameters, specifically wall shear stress (WSS), influences amount of IMT in maturation process of AVF. AVFs were created in curved (C-AVF) and straight (S-AVF) configurations between femoral artery and vein of 3 pigs. CT-scans and ultrasound were utilized to calculate WSS at 2D (D: days), 7D, and 28D post-surgery. IMT was measured at 4 histological blocks along the vein of AVFs. It was found that C-AVF underwent outward remodeling characterized by consistent increase in venous diameter and larger IMT. This remodeling process was governed by negative temporal gradient of WSS (τ′) [−0.99 ± 0.60 dyn/cm2/day]. In contrast, S-AVF underwent inward remodeling characterized by temporal decrease in venous diameter and relatively smaller IMT. This remodeling process was governed by positive τ′ (0.42 ± 0.6 dyn/cm2/day). In summary, temporal gradient of WSS influences IMT. Temporal decrease of WSS in C-AVF resulted in vasodilation and outward growth of wall (favorable to maturation). However, temporal increase in WSS in S-AVF leaded to vasoconstriction and inward growth of wall (detrimental to maturation). Thus, clinically it can be of great importance to surgeons to create AVF in a configuration that can result in favorable hemodynamic parameters and histological end-points.

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