Haemodialysis

2015 ◽  
Author(s):  
Michael Allon
Keyword(s):  
Vascular Access ◽  
Central Vein ◽  
Close Collaboration ◽  
Cumulative Survival ◽  
Maturation Rate ◽  
Advance Planning ◽  
Medical Disciplines ◽  
Vein Stenosis ◽  
Central Vein Stenosis

Delivery of haemodialysis is dependent on having a vascular access that can reproducibly deliver an adequate blood flow thrice weekly. None of the three types of vascular access is perfect; each has potential advantages and drawbacks. Fistulas are the preferred type of vascular access because they have the longest cumulative survival and require the fewest interventions to maintain their long-term patency, once they achieve suitability for dialysis. However, fistulas have a fairly high non-maturation rate, frequently require revisions to achieve suitability for dialysis, and often are associated with prolonged catheter dependence until they are ready to cannulate. In contrast, grafts have a lower primary failure rate, are usually ready to use within 2–3 weeks of creation, and are therefore associated with a shorter duration of catheter dependence. However, the cumulative survival of grafts is shorter than that of fistulas, and they require more frequent interventions (angioplasty, thrombectomy, or surgical revisions) to maintain their patency for dialysis. The major advantage of dialysis catheters is that they are suitable for use as soon as they are placed. However, catheter use is associated with frequent complications, including catheter-related bacteraemia, dysfunction, and central vein stenosis. Many patients require a tunnelled dialysis catheter as a bridge, until they have a mature fistula or graft. Optimal management of vascular access is extremely challenging, and requires close collaboration among multiple medical disciplines, advance planning, and treatment or prophylaxis of their frequent complications.

Intra-operative central vein angioplasty during arteriovenous access creation

2005 ◽  
Vol 6 (4) ◽  
pp. 187-191 ◽  
Author(s):  
D. Shemesh ◽  
O. Olsha ◽  
D. Berelowitz ◽  
I. Zaghal ◽  
I. Goldin ◽  
...  
Keyword(s):  
Arterial Stenosis ◽  
Long Term Results ◽  
Central Vein ◽  
Flow State ◽  
Arteriovenous Access ◽  
Vein Stenosis ◽  
Integrated Program ◽  
Access Surgery ◽  
Central Vein Stenosis

Central vein stenosis or occlusion due to prior use of central vein hemodialysis catheters may lead to disabling extremity edema or cause early failure after arteriovenous access construction. Our integrated program for arteriovenous access management enables us to identify these stenoses pre-operatively. We carried out intra-operative angiography and angioplasty during arteriovenous access creation in 3 patients with good immediate and long-term results. Intra-operative endovascular therapy is a new application of peripheral vascular surgery techniques for patients with significant central vein stenosis undergoing access surgery, which exploits the high postoperative flow state to maintain patency after angioplasty. It may also be applicable in situations such as proximal arterial stenosis with anticipated steal syndrome and other conditions that may compromise access patency.

scholarly journals Efficacy of Endovascular Treatment of Central Vein Stenosis to Improve Vascular Access Performance in Hemodialysis Patients

2019 ◽  
Vol 58 (6) ◽  
pp. e186-e187
Author(s):  
Raffaella Mauro ◽  
Rodolfo Pini ◽  
Laura Maria Cacioppa ◽  
Mauro Gargiulo ◽  
Gianluca Faggioli ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Vascular Access ◽  
Hemodialysis Patients ◽  
Central Vein ◽  
Vein Stenosis ◽  
Central Vein Stenosis

Tunneled Double-Lumen Silicone Hemodialysis Catheter Placement in Three Patients with Permanent Pacemaker Wires: A Case Study

2005 ◽  
Vol 6 (2) ◽  
pp. 88-91
Author(s):  
K.I. Sombolos ◽  
F.N. Christidou ◽  
G.I. Bamichas ◽  
T.C. Anagnostopoulos ◽  
I.I. Rudenko ◽  
...  
Keyword(s):  
Vascular Access ◽  
Permanent Pacemaker ◽  
Catheter Placement ◽  
Central Vein ◽  
Double Lumen ◽  
Hemodialysis Catheter ◽  
Vein Stenosis ◽  
Central Vein Stenosis

Permanent pacemaker wires have been described as a cause of central vein stenosis. Furthermore, in hemodialysis (HD) patients with transvenous pacemakers, permanent vascular access (VA) created at the ipsilateral arm is not always successful. We report the use of tunneled double-lumen silicone HD catheters, as permanent VA in three HD patients wearing permanent transvenous pacemakers. In one patient, the catheter was inserted ipsilateral to the pacemaker site. Catheter-related infections were the most significant complications.

scholarly journals THREAT ANALYSIS OF REASONS LEADING TO FAILURE OF PERMANENT HEAMODIALYSIS ACCESS

2021 ◽  
Vol 71 (3) ◽  
pp. 861-65
Author(s):  
Falak Siyar ◽  
Muhammad Jamil ◽  
Kishwar Ali ◽  
Humera Latif ◽  
Hafiz Khalid Pervaiz ◽  
...  
Keyword(s):  
Vascular Access ◽  
Venous Hypertension ◽  
Military Hospital ◽  
Central Vein ◽  
True Aneurysm ◽  
Threat Analysis ◽  
Central Venous Stenosis ◽  
Vein Stenosis ◽  
Steal Syndrome ◽  
Central Vein Stenosis

Objective: To analyze the commonest threats which lead to the failure of a permanent vascular haemodialysis access. Study Design: Prospective observational study. Place and Duration of Study: Department of Vascular Surgery, Combined Military Hospital Rawalpindi, from Nov 2018 to Nov 2019. Methodology: All patients who presented with arteriovenous fistula (AVF) or arteriovenous graft (AVG) related complications which can potentially fail an access were included. The frequency, with which these complications occurred, was noted. Results: A total of 158 patients were included, 73 (46.20%) were male and 85 (53.80%) were females. The complications observed in order of frequency were arteriovenous fistulathrombosis (anastomotic or draining vein) in 60 (38%), pseudo aneurysms in 39 (24.68%), stealing veins causing non-maturity of the access in 14 (8.86%), venous hypertension causing extremity edema in 14 (8.86%) (7 due to stealing veins and 7 due to central venous stenosis), AVF anastomotic or draining vein stenosis in 8 (5.06%), wound hematoma in 5 (3.16%), wound infection in 5 (3.16%), true aneurysm of the draining vein in 4 (2.56%), steal syndrome in 3 (1.9%), wound seroma in 3 (1.9%), post op arm edema(not related to central vein stenosis orstealing veins) in 2 (1.26%) and compression neuropathy in 1 (0.6%) of the patients. Conclusion: Complications of vascular access are the potential threats to the life of a permanent vascular access. Early diagnosis and timely intervention can help in fistula salvage.

P1329STENTING VERSUS ISOLATED BALLOON ANGIOPLASTY FOR CENTRAL VEIN STENOSIS IN HEMODIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Aleksei Zulkarnaev ◽  
Zurab Kardanakhishvili ◽  
Boris Baykov
Keyword(s):  
Balloon Angioplasty ◽  
Primary Patency ◽  
Endovascular Intervention ◽  
Time Interval ◽  
Central Vein ◽  
Secondary Patency ◽  
Surgical Interventions ◽  
Endovascular Interventions ◽  
Vein Stenosis ◽  
Central Vein Stenosis

Abstract Background and Aims comparative analysis of the results of isolated balloon angioplasty (BA) and BA with stenting of central veins stenosis in patients on hemodialysis. Method A retrospective study included 62 patients with confirmed stenosis of the central veins: subclavian, brachiocephalic veins, vena cava inferior, or multiple lesions. In 39 patients, stents are not used; isolated balloon angioplasty (BA) was performed. In 23 patients we used bare metal stents. Results Functional primary patency (the time interval between the start of AVF using and the first endovascular intervention) did not differ in the groups – fig. 1A; HR 1.142 [95% CI 0.6875; 1.897], p = 0.5994. The use of stents leads to increase primary patency (the time interval between the first and second endovascular interventions) – fig. 1B; HR 2.064 [95% CI 1.252; 3.404], p = 0.0017. The use of stents allows to increase the functional secondary patency (total duration of use of the AVF) – fig 1C; HR 2.099 [95% CI 1.272; 3.463], p = 0.0016. Secondary patency (the time interval between the first endovascular intervention and the complete cessation of the use of AVF) was higher after BA with stenting: HR 2.03 [95% CI 1.232; 3.347], p = 0.0021; fig 1D. The use of stents allows to increase functional primary assisted patency (non-occlusive period from the start of AVF use) – fig. 1E and primary assisted patency (non-occlusive period from the first surgical intervention) – fig 1F: HR 1.936 [95% CI 1.175; 3.188], p= 0.0053 and HR 2.0 [95% CI 1.213; 3.295], p = 0.0042. The need for open reconstructive interventions after the first BA or BA with stenting was the same 0.374 [95% CI 0.24; 0.556] and 0.45 [95% CI 0.291; 0.664] per 10 patient-months, incidence rate ratio (IRR)= 0.831 [95% CI 0.471; 1.464] р=0.521. The need for endovascular interventions did not differ between isolated BA and BA with stenting 1.137 [95% CI 0.8913; 1.43] and 0.827 [95% CI 0.606; 1.104] per 10 patient-months, IRR=1.374 [95% CI 0.952; 1.999] p=0.09. Total need for surgical interventions (open + endovascular) also did not differ: 1.511 [95% CI 1.225; 1.843] and 1.277 [95% CI 0.997; 1.611] per 10 patient-months, IRR 1.183 [95% CI 0.872; 1.612] p=0.2822. We found a strong negative correlation between functional primary patency and primary patency (r = -0.627; p <0.0001) – fig. 2, as well as a between functional primary patency and secondary patency in patients after isolated BA (= -0.53; p = 0.0005, respectively), but not after stenting (r = -0.351; p = 0.101 and r = -0.304; p = 0.159, respectively). In a case of isolated BA, the success of the first intervention largely determines the secondary patency, which is expressed in a strong, statistically significant positive correlation of primary patency and secondary patency. In a case of BA with stenting, the correlation between these estimates is also statistically significant, but significantly lower. Conclusion 1. The results of balloon angioplasty without stenting are significantly influenced by the duration of the period between the start of AVF use and the manifestation of central vein stenosis. 2. The use of stents can slightly improve the results of endovascular interventions in central vein stenosis, regardless the its time of development. 3. The use of stents leads to a moderate increase in the median patency of AVF and a significant increase in the proportion of patients with functional AVF in the late postoperative period. 4. The use of stents does not reduce the need for surgical interventions

scholarly journals Central vein stenosis masquerading as venous thrombosis

2014 ◽  
Vol 2014 (mar24 1) ◽  
pp. bcr2014203690-bcr2014203690 ◽  
Author(s):  
N. Vellalacheruvu ◽  
N. Monigari ◽  
T. Devasia ◽  
H. Kareem
Keyword(s):  
Venous Thrombosis ◽  
Central Vein ◽  
Vein Stenosis ◽  
Central Vein Stenosis

P1319AMBIGUOUS RESULTS OF CENTRAL VEIN STENOSIS ENDOVASCULAR TREATMENT IN HEMODIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Aleksei Zulkarnaev ◽  
Zurab Kardanakhishvili ◽  
Boris Baykov
Keyword(s):  
Blood Flow ◽  
Median Survival ◽  
Balloon Angioplasty ◽  
Primary Patency ◽  
Main Group ◽  
Control Group ◽  
Time Interval ◽  
Central Vein ◽  
Vein Stenosis ◽  
Central Vein Stenosis

Abstract Background and Aims Balloon angioplasty (BA) without the use of stents has unsatisfactory results, which may cast doubt on its expediency. At the same time, BA is a very expensive treatment method. We conducted a comprehensive comparative analysis of the native arteriovenous fistula (AVF) patency rates in hemodialysis patients with central venous stenosis (CVS) after endovascular BA and «open» palliative surgery. Method A retrospective study included 80 patients with confirmed central vein stenosis: subclavian, brachiocephalic veins, vena cava inferior, or multiple lesions. The main group included 39 patients who underwent percutaneous balloon angioplasty. The control group included 41 patients who did not have balloon angioplasty for various reasons. In this patients we performed only «open» palliative interventions: thrombectomy, proximalization of arteriovenous anastomosis, AVF blood flow reduction. Results Functional primary patency (the time interval between the start of AVF using and the first intervention) did not differ: groups were comparable in time of stenosis manifestation (fig. 1A). Primary patency (the time interval between the first and second interventions) after BA was statistically significantly better than in the main group (fig. 1B), but difference was minimal: median survival in the study group of 8 months [95% CI 6; 10] vs. - 6 months [95% CI 4.9; 7.1]. There was the strong negative correlation between the primary patency and functional primary patency in the main group (r = –0.627 [95%CI –0.787; –0.388], p <0.0001) but not in the control group (r = 0.049 [95%CI –0.262; –0.351], p = 0.7599). Thus, the later manifestation of CVS related with lower effectiveness of BA. The functional secondary patency (total duration of AVF use) in the main group was significantly better: median survival was 47 months [95% CI 40.9; 53.1] vs. 34 months [95% CI 29.8; 38.2] as well as secondary patency (the time interval between the first intervention and the complete cessation of AVF use): median survival was 16 months [95% CI 12.5; 19.5] vs. 7 months [95% CI 4.9; 9.1] (fig. 1 C and D). The occlusion-free period from the moment of starting the AVF use (functional primary assisted patency – fig. 1E) was higher in the main group, but difference was minimal: median survival was 39 months [95% CI 36.5; 41.5] vs. 32 months [95% CI 27.5; 36.5], as well as occlusion-free period from the moment of the first surgical intervention (primary assisted patency – fig. 1F) median survival was 9 months [95% CI 7; 11], in the control group - 7 months [95% CI 5.6; 8.4]. The need for open interventions was lower in the main group: 0.374 [95% CI 0.24; 0.556] and 2.451 [95% CI 1.1963; 3.023] per 10 patient-months, incidence rate ratio (IRR)= 0.153 [95% CI 0.095; 0.237], р<0.0001; as well as overall need for interventions: 1.511 [95% CI 1.225; 1.843] and 2.451 [95% CI 1.963; 3.023] per 10 patient-months, IRR 0.617 [95% CI 0.461; 0.825] p=0.0011. The value of AVF volume blood flow had a strong negative correlation with the primary patency in both groups (r = –0.529, p =0.0027; r = –0.419, p =0.0101). Conclusion 1. Central vein stenosis is inevitably leads to loss of vascular access on the ipsilateral side. 2. Balloon angioplasty allows to extend the period of AVF use but it is not a radical treatment method of CVS. 3. The results of balloon angioplasty are significantly affected by the length of the period from the start of AVF use to the CVS manifestation. 4. Multiple repeated BA are apparently justified in patients for whom the possibility of creating a new vascular access is doubtful. 4. The AVF volume blood flow is an important factor determining the severity of CVS clinical manifestations and the need for repeated surgical interventions.

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