P1348EFFECT OF CILOSTAZOL ON ARTERIOVENOUS FISTULA IN HEMODIALYSIS PATIENTS

Abstract Background and Aims Permanent vascular access is important in patients requiring hemodialysis. However, among patients requiring hemodialysis, even if arteriovenous fistula surgery is performed, many are unable to undergo hemodialysis with vascular access due to maturation failure. Method Using 194 patients who underwent arteriovenous fistula surgery, a cilostazol group (n = 107) and a control group (n = 87) were compared and analyzed for the occurrence of vascular complications. Results In the cilostazol group, there were less vascular complications (36.4% vs. 52.9%; p = 0.022), especially maturation failure (2.8% vs. 11.5%; p = 0.016). However, there was no significant difference between the cilostazol group and control group regarding percutaneous transluminal angioplasty (PTA) requirement nor frequency and interval to PTA after vascular surgery. The frequency of reoperations due to vascular injury after the start of hemodialysis after maturation was also significantly lower in the cilostazol group. Conclusion These results suggest that vascular access patients may benefit from postoperative cilostazol therapy.

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A Comparative Study on the Effects of Acupressure at SP6 and ST36 Acupoints on the Pain Caused by Fistula Needle Placement in Hemodialysis Patients

Complementary Medicine Journal ◽

10.32598/cmja.10.4.975.1 ◽

2021 ◽

Vol 10 (4) ◽

pp. 354-367

Author(s):

Tahereh Baloochi Beydokhti ◽

Keyword(s):

Arteriovenous Fistula ◽

Hemodialysis Patients ◽

Control Group ◽

Needle Placement ◽

Chi Square ◽

Double Blind ◽

Significant Difference ◽

Chi Square Test ◽

Vas Scores ◽

And Control

Objective: Hemodialysis is one of the most common treatment methods in kidney patients. To do this, repeated insertion of the needle into the vessel is necessary. Patients treated with hemodialysis are exposed to stress and pain caused by perforation of their arteriovenous fistula about 300 times a year. More than 1/5 of hemodialysis patients express this pain as unbearable. This study aims to evaluate the effect of acupressure at SP6 and ST36 acupoints on the pain caused by fistula needle placement in hemodialysis patients. Methods: This study is a double-blind randomized clinical trial conducted in 2016 on 90 hemodialysis patients with arteriovenous fistula in Mashhad, Iran. They were randomly divided into three groups of SP6, ST36, and control. Data were collected after obtaining a written informed consent by a demographic form and the Visual Analog Scale (VAS). Data analysis was performed in SPSS v.16 software by using Kolmogorov-Smirnov test, Kruskal-Wallis test, one-way ANOVA, paired t-test, and Chi-square test. Results: There was a statistically significant difference between VAS scores after the intervention in all three group (P<0.001). The Mean±SD VAS scores before the intervention in SP6, ST36, control groups were 54.47±18.93, 51.5±22.83, 46.6±17.73, respectively which changed to 45.63±20.53, 40.2±20.01, and 51.87±19.05 after the intervention, indicating that acupressure at SP6 and ST36 acupoints reduced pain in patients, while the pain increased in the control group. Conclusion: Acupressure at SP6 and ST36 acupoints is an effective method in relieving pain caused by the insertion of a needle into the arteriovenous fistula in hemodialysis patients.

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Pull-through technique combined with percutaneous angioplasty for treating high-grade arteriovenous fistula stenosis

The Journal of Vascular Access ◽

10.1177/1129729819870633 ◽

2019 ◽

Vol 21 (2) ◽

pp. 223-229 ◽

Cited By ~ 1

Author(s):

Qing He ◽

Bo Yu ◽

Weihao Shi ◽

Jinyun Tan ◽

Lei Zhu ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Percutaneous Transluminal Angioplasty ◽

Transluminal Angioplasty ◽

Control Group ◽

High Grade ◽

Control Groups ◽

Pull Through ◽

Arteriovenous Fistula Stenosis ◽

And Control ◽

Percutaneous Transluminal

Purpose: The aim of this study was to investigate the effectiveness of a new pull-through technique through a brachial artery approach combined with angioplasty for the treatment of arteriovenous fistula. Methods: In this retrospective study, a total of 56 arteriovenous fistula patients with high-grade stenosis induced by arteriovenous fistula, which was divided into pull-through technique through a brachial artery approach (pull-through group, n = 28) and solely through a venous approach (control group, n = 28), were analyzed. Both groups underwent percutaneous transluminal angioplasty treatments simultaneously. Results: The success rate of the pull-through group (89.3%, 25 out of 28) was similar to that of the control group (75.0%, 21 out of 28, p = 0.296). Fistula restenosis occurred with time in both groups but no significant differences in the post-operative fistula patency were found between the pull-through and control groups in follow-ups at 3, 6, and 12 months (71.4% vs 67.9%, 57.1% vs 60.7%, and 20.0% vs 30.0%, respectively, p > 0.05). No significant difference in the post-operative patency rate in patients with diabetes, hypertension, or coronary disease was found between the pull-through and control groups in the follow-ups at 3 and 12 months, respectively. The pull-through group had significantly shorter operation times compared with the control group (45 ± 9 min vs 65 ± 15 min, p < 0.001). No surgical complications were reported in the pull-through group in contrast to three cases (11%, 3 out of 28) with puncture hematoma and acute occlusion in the control group. Conclusion: The pull-through technique combined with percutaneous transluminal angioplasty is an effective, safe and lasting option to treat high-grade arteriovenous fistula stenosis in the upper limb.

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Mechanisms of Intravascular Linear Ablation Induced Restenosis in Rabbit Abdominal Aorta

BioMed Research International ◽

10.1155/2018/7459276 ◽

2018 ◽

Vol 2018 ◽

pp. 1-11

Author(s):

Qiang Chen ◽

Manman Wang ◽

Shuai Shao ◽

Hongze Liu ◽

Xiaodong Xia ◽

...

Keyword(s):

Intimal Hyperplasia ◽

Coronary Intervention ◽

Transluminal Angioplasty ◽

Artery Dissection ◽

Control Group ◽

High Cholesterol Diet ◽

Control Groups ◽

Vsmc Proliferation ◽

Significant Difference ◽

And Control

Objectives. Percutaneous coronary intervention (PCI) is the mainstay treatment for coronary artery disease but complications such as in-stent restenosis and thrombosis remain problematic. Radiofrequency balloon angioplasty (RBA) can improve lumen dimension, fusing intimal tears, and artery dissection but is associated with higher restenosis rate. Methods. After establishing an atherosclerosis model based on endothelial abrasion and high cholesterol diet, forty-five rabbits were randomly divided into three groups: RBA (n=20), percutaneous transluminal angioplasty (PTA) (n=20), and control groups (n=5). The RBA and PTA groups were subdivided according to harvested time posttreatment, respectively (1 hour, 7 days, 14 days, and 28 days). Aorta segments were then isolated for hematoxylin and eosin staining, Masson trichrome staining, immunohistochemistry, and Western blot for TLR-4, NF-κB, MCP-1, and VCAM-1expression. Results. At 28 days, intimal area was significantly lower in the RBA group compared to the PTA and control groups, whilst luminal and medial area were comparable in the RBA and PTA group but higher and lower than the control group, respectively. Expression of TLR-4, NF-κB, MCP-1, and VCAM-1 showed no significant difference between RBA and PTA groups. Conclusions. RBA can depress the intimal hyperplasia and promote dilatation of the artery to greater extents than PTA at 28 days. However, this did not involve TLR-4 signaling pathway, which likely plays a negligible role in mediating restenosis. Reduction of intimal hyperplasia may be due to injury of ablation to the tunica media and inhibition of VSMC proliferation and migration.

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APOPTOSIS INDEX BETWEEN FEMALES AND MALES IN REGULAR HEMODIALYSIS

INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY ◽

10.24293/ijcpml.v19i3.410 ◽

2016 ◽

Vol 19 (3) ◽

pp. 150

Author(s):

Djoko Santoso

Keyword(s):

Age Groups ◽

Microtiter Plate ◽

Hemodialysis Patients ◽

Control Group ◽

Diabetic Patients ◽

Immunochemical Determination ◽

Apoptosis Index ◽

Significant Difference ◽

And Control ◽

Esrd Patients

Many reports have documented apoptosis index in hemodialysis patients, but to date, no single study has directly compared the apoptosis index of males to females. Data on mortality rate among hemodialytic patients in the hemodialysis center at the Department of Internal Medicine Dr Soetomo General Hospital, Surabaya, Indonesia show a high number predominated by female patients. Therefore, to answer the question of whether there is a gender difference in apoptosis index, the researcher studied leukocyte responses in male and female hemodialysis patients. The apoptosis index of the sample was measured by indirect immunoassay method. Cell lyses, followed by immunochemical determination of histone-complexed DNA fragments in a microtiter plate wells. The apoptosis quantization was obtained by determining the amount of colored product spectrophotometrically. One hundred and four non-diabetic subjects who received hemodialysis (HD), and 24 normal controls (NC), were evaluated. The apoptosis index in ESRD patients group and control group showed no significant difference (0.6172 vs 0.4008, p=0.114), neither did it vary in both sexes and age groups. When the sex factor was analyzed (after exclusion from the diabetic ESRD patients), females apoptosis index was significantly higher than that of the males (0.7325 vs 0.55175, p<0.05). In conclusion, apoptosis index in females among non-diabetic patients undergoing hemodialysis is higher than that occur in males and controls.

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Predictive value of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio for primary patency of percutaneous transluminal angioplasty in hemodialysis arteriovenous fistula stenosis

Vascular ◽

10.1177/17085381211039672 ◽

2021 ◽

pp. 170853812110396

Author(s):

Feng Zhu ◽

Yao Yao ◽

Hongbo Ci ◽

Alimujiang Shawuti

Keyword(s):

Arteriovenous Fistula ◽

Percutaneous Transluminal Angioplasty ◽

Transluminal Angioplasty ◽

Primary Patency ◽

Neutrophil To Lymphocyte Ratio ◽

Platelet To Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Significant Difference ◽

Percutaneous Transluminal ◽

Hemodialysis Arteriovenous Fistula

Objective The aim of this study is to investigate the potential association of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) with the primary patency of percutaneous transluminal angioplasty (PTA) in hemodialysis arteriovenous fistula (AVF) stenosis. Methods This study conducted a retrospective review of patients with end-stage renal disease referred for hemodialysis AVF stenosis in one center. The study consisted of 114 patients with significant (significant stenosis was defined as a reduction in the caliber of the fistula vein of > 50% with respect to the non-aneurysmal venous segment). AVF stenosis patients were treated with PTA, with conventional balloon angioplasty. The NLR and PLR were calculated from the pre-interventional blood samples. The patients were classified into two groups: group A, primary patency < 12 months ( n = 35) and group B, and primary patency ≥ 12 months ( n = 79). Comparisons between the groups were performed using the Mann–Whitney U test. Kaplan–Meier analysis was performed to compare the factors, NLR and PLR, for association with primary patency AVFs. A receiver-operating characteristic curve analysis was performed to identify the sensitivity and specificity of the NLR and PLR cut-off values in the prediction of primary patency time. Results There was no difference in gender; age; side of AVF; AVF type; comorbid diseases such as diabetes mellitus and hypertension; or blood parameters such as white cell count, erythrocytes, hemoglobin, neutrophils, lymphocytes, monocytes, eosinophils, basophils, C-reactive protein, NLR, or PLR between the two groups ( p > 0.05). There was also no significant difference in the patency rate between the NLR < 4.13 and NLR ≥ 4.13 groups at 12 months (NLR cut-off point = 4.13, p = 0.273). There were statistically significant differences between the primary patency rates of the PLR < 187.86 and PLR ≥ 187.86 groups at 12 months (PLR cut-off point = 187.86, p = 0.023). The cut-off value for PLR for the determination of primary patency was 187.86, with a sensitivity of 57.0% and specificity of 34.4%. Conclusion An increased level of PLR may be a risk factor for the development of early AVF restenosis after successful PTA. However, more studies are needed to validate this finding.

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Relationship between hemodialysis patients’ educational level and arteriovenous fistula patency

Vascular ◽

10.1177/1708538120918417 ◽

2020 ◽

Vol 28 (5) ◽

pp. 604-608

Author(s):

Atıf Yolgösteren

Keyword(s):

High School ◽

Arteriovenous Fistula ◽

Vascular Access ◽

Educational Level ◽

Hemodialysis Patients ◽

Binary Logistic Regression Analysis ◽

School Graduate ◽

Dialysis Unit ◽

Educational Levels ◽

Significant Difference

Objectives Vascular access is a lifeline for the patients who are in need of long-term hemodialysis. Native arteriovenous fistula is the most intensively preferred vascular access method owing to its longevity and convenience of use. Therefore, in this study, we aimed to determine whether there might be a relationship between hemodialysis patients’ educational levels and arteriovenous fistula patency. Methods A total of 349 patients who were attending in a chronic hemodialysis program between June 2018 and September 2018 at Bursa Uludağ University, Faculty of Medicine Dialysis Unit and in a private dialysis center in İstanbul were included in this study. The patients were grouped into two: those who have had arteriovenous fistula primary failure at least once and those who have never had arteriovenous fistula primary failure. Educational levels of the patients were classified according to Turkish National Education system (illiterate, primary school graduate, secondary school graduate, high school graduate, and university graduate). Mann–Whitney U and Chi-square tests were performed for statistical analyses. Risk factors were determined by applying backward binary logistic regression analysis. Results A total of 349 patients, 161 (46.1%) females and 188 (53.9%) males, were examined retrospectively. The median age of the patients was 64 years (range: 18–90 years). Educational level comparison revealed statistically significant difference in terms of fistula patency ( p = 0.016). In particular, fistula patency was significantly lower in illiterate, primary, secondary, and high school graduates in comparison with university graduates ( p = 0.001, p = 0.015, p = 0.003, and p = 0.018, respectively). When each group of educational level was analyzed separately in terms of fistula patency, it was observed that the higher the educational level was, the lower arteriovenous fistula primary failure rates were. Conclusions In this study, we observed a lower rate of fistula patency in patients with a low level of education. Hence, we are of the opinion that the trainings delivered on arteriovenous fistula care in dialysis centers are required to be shaped in accordance with educational levels of patients.

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A Prospective Clinical Evaluation of the Effects of Intraoperative Systemic Anticoagulation in Patients Undergoing Arteriovenous Fistula Surgery

The American Surgeon ◽

10.1177/000313481007601020 ◽

2010 ◽

Vol 76 (10) ◽

pp. 1112-1114 ◽

Cited By ~ 5

Author(s):

Bonnie R. Wang ◽

Vincent L. Rowe ◽

Sung Wan Ham ◽

Sukgu Han ◽

Kaushal Patel ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Postoperative Bleeding ◽

Bleeding Complications ◽

Controlled Study ◽

Control Group ◽

Heparin Group ◽

Av Fistula ◽

Fistula Surgery ◽

Significant Difference ◽

The Difference

No standard presently exists for the use of systemic heparin during angioaccess surgery to decrease the incidence of postoperative thrombotic complications. Our objective was to study the effects of intraoperatively administered heparin on 30-day patency and postoperative bleeding complications in patients undergoing autogenous arteriovenous (AV) fistula surgery. A prospective, double-blinded, randomized controlled study was performed on 48 patients undergoing AV fistula creation from April 2007 through November 2009. Of the 48 patients, 22 were randomized to the control group and received no heparin. Twenty-six were randomized to receive heparin (75 units/kg intravenously) before clamping of the artery. There was no significant difference in 30-day patency between the heparin and control groups (92% vs 86%, P = 0.65), respectively. Three patients (12%) developed hematomas in the heparin group compared with one (5%) in the control group; however the difference was not statistically significant ( P = 0.61). The results suggest that intraoperative administration of heparin has no statistically significant effect on 30-day patency rates or postoperative bleeding complications. Larger trials with longer term follow-up and assessment of maturation rates are needed to determine the effect of intraoperative anticoagulation on these outcomes of arteriovenous fistula surgery.

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Calcium Channel Antagonists Reduce Restenosis After Percutaneous Transluminal Angioplasty of an Arteriovenous Fistula in Hemodialysis Patients

Therapeutic Apheresis and Dialysis ◽

10.1111/j.1744-9987.2008.00579.x ◽

2008 ◽

Vol 12 (3) ◽

pp. 232-236 ◽

Cited By ~ 5

Author(s):

Shigehiro Doi ◽

Takao Masaki ◽

Kenichiro Shigemoto ◽

Satoru Harada ◽

Noriaki Yorioka

Keyword(s):

Calcium Channel ◽

Arteriovenous Fistula ◽

Percutaneous Transluminal Angioplasty ◽

Hemodialysis Patients ◽

Transluminal Angioplasty ◽

Calcium Channel Antagonists ◽

Percutaneous Transluminal

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Effects of N-acetylcysteine on arterial neo-intimal hyperplasia in rat model of arteriovenous fistula

The Journal of Vascular Access ◽

10.1177/1129729818793368 ◽

2018 ◽

Vol 20 (2) ◽

pp. 190-194

Author(s):

Amirmohsen Jalaeefar ◽

Arash Mohammadi Tofigh ◽

Atoosa Gharib ◽

Mohsen Khandaghy ◽

Mohammad Reza Rahimi

Keyword(s):

Arteriovenous Fistula ◽

Rat Model ◽

Intimal Hyperplasia ◽

Intima Media Thickness ◽

Hemodialysis Patients ◽

Control Group ◽

Clinical Issue ◽

Significant Difference ◽

Hematoxylin And Eosin ◽

The Mean

Introduction: Arteriovenous fistula is the best choice for vascular access in hemodialysis patients. However, arteriovenous fistula dysfunction is a major clinical issue. The most common cause of arteriovenous fistula failure is intimal hyperplasia. In this study, we have investigated the effect of N-acetylcysteine on neo-intimal hyperplasia after arteriovenous fistula creation in rats. Methods: This study was conducted in 24 rats which were randomly divided into two groups: control and N-acetylcysteine groups. An end-to-side anastomosis was made between the femoral artery and vein. The control group received distilled water intraperitoneally while the animals in N-acetylcysteine group received 300 mg/kg/day of N-acetylcysteine via the same route. After 28 days, the thickness of intima and media was measured using hematoxylin and eosin. Results: There was no significant difference between the two groups regarding age ( p = 0.6) and weight ( p = 0.1). The mean intima thickness in N-acetylcysteine group was significantly less than control group (17 ± 20 and 119 ± 46 µm, respectively; p < 0.001). The mean intima/media thickness in the N-acetylcysteine group was significantly less than control group (0.5 ± 0.63 vs 2.05 ± 1.17 µm; p < 0.001). Conclusion: N-acetylcysteine is effective in inhibiting neo-intimal hyperplasia in a rat model of arteriovenous fistula.

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