Cutaneous necrosis of the arteriovenous fistula puncture site in chronic hemodialysis: A historical complication or an ever‐present threat? A series of 26 cases

Patients with end-stage kidney disease are at increased risk of death from coronavirus disease 2019 (COVID-19). In addition, severe COVID-19 has been associated with an increased risk of arterial and venous thromboses. In this report, we describe the case of a hemodialysis patient who developed an otherwise-unexplained thrombosis of an arteriovenous fistula during a symptomatic COVID-19 infection. Despite prompt treatment with three technically successful thrombectomies along with systemic intravenous heparin and two rounds of catheter-directed thrombolysis with tissue plasminogen activator, the fistula rapidly re-thrombosed each time and he required tunneled dialysis catheter placement. He subsequently required admission for hypoxemia from COVID-19 pneumonia and ultimately developed a catheter-related blood stream infection that likely contributed to his death. As the fistula had been previously well functioning and no angiographic explanation for the thrombosis was found, we speculate in this case the recurrent thromboses were related to the hypercoagulable state characteristic of severe COVID-19. Interventionalists performing hemodialysis access procedures should be aware of the prothrombotic state associated with COVID-19 and should consider it when deliberating how to best plan and approach access interventions in patients with symptomatic COVID-19.

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Superficialization of Basilic Vein: Last Chance for a Native Arteriovenous Fistula in Hemodialysis Patients

The Journal of Vascular Access ◽

10.5301/jva.2008.4872 ◽

2003 ◽

Vol 4 (1) ◽

pp. 21-24 ◽

Cited By ~ 1

Author(s):

M. Onaran ◽

D. Erer ◽

I. Şen ◽

E.E. Elnur ◽

E. Iriz ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Vascular Access ◽

Brachial Artery ◽

Subcutaneous Tissue ◽

Vascular Grafts ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Basilic Vein ◽

Number Of Patients

Background Although the best type of vascular access for chronic hemodialysis patients is a native arteriovenous fistula, in an increasing number of patients all the superficial veins have been used and only the placement of vascular grafts or permanent catheters is left. Superficialization of the basilic vein is a possible alternative. Materials and Methods In 49 chronic hemodialysis patients who had no possibilities to have a native arteriovenous fistula created, we performed a basilic vein- brachial artery fistula in the arm. During the same operation the basilic vein was then superficialized for easier access for hemodialysis. Results Mean follow-up was 22.36±15.56 months. Forty-eight patients are still undergoing hemodialysis with their superficialized basilic vein native A-V fistula without any complications. Only one fistula was thrombosed just after the procedure because of poor vessel quality. Conclusion For hemodialysis patients who have no suitable superficial veins at the wrist or elbow, performing a basilic vein - brachial artery fistula and superficializing the vein to the subcutaneous tissue is an acceptable choice before deciding to use more complicated procedures like vascular grafts.

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The Role of Preoperative Duplex Ultrasound Vessel Mapping in Determining Primary Failure of Pediatric Hemodialysis Arteriovenous Fistula

Journal for Vascular Ultrasound ◽

10.1177/1544316719831508 ◽

2019 ◽

Vol 43 (2) ◽

pp. 63-68

Author(s):

Tam T. T. Huynh ◽

B. N. Garza ◽

J. Geer ◽

K. C. Broadbent ◽

W. A. Martinek ◽

...

Keyword(s):

Children And Adolescents ◽

Arteriovenous Fistula ◽

Pediatric Population ◽

Duplex Ultrasound ◽

The United States ◽

Chronic Hemodialysis ◽

Maturation Time ◽

Pediatric Hemodialysis ◽

Potential Risk Factors

The autogenous arteriovenous fistula (AVF) is the preferred vascular access for pediatric and adult patients on chronic hemodialysis (HD). However, the prevalent rate of AVF use in children remains low in the United States. Duplex ultrasonography (DUS) of arm vessels is an essential step in the planning of AVF creation in adults, but its use in children is not described in much detail. In this retrospective study, we examined the role of preoperative DUS in children and adolescents who underwent AVF creation at a single large pediatric hospital, from 2008 to 2017. In addition, we sought to determine the potential risk factors for primary failure (PF), which was defined as the inability to use the AVF for at least a sustained 6-week period either due to thrombosis or any other reasons. We created 67 AVFs in 57 patients (34 male; 60%). The overall PF was 16% (11/67), and higher in cephalic AVF (10/40, 25%) compared to basilic (1/27, 3.7%), P = .04. The median maturation time was longer for basilic compared to cephalic AVF (105±47 vs. 88±38 days, respectively, P = .006). The size of the juxta-anastomotic vein and artery on preoperative DUS was not significantly different in cephalic versus basilic AVFs. However, the median diameter of the outflow vein was significantly smaller in the cephalic compared to basilic AVF (3.4 mm vs. 4.2 mm, P = .042). In addition, the outflow vein size was the only preoperative factor found to be significant as possible predictor for PF on univariable analysis. The results of this study show that the PF rate and maturation time for AVFs created in children and adolescents are comparable to adults, with the routine use of preoperative DUS. We postulate that vessel selection for AVF in the pediatric population should take into consideration the size of the vein at the outflow (and not just at the anastomosis).

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Bilateral brachiocephalic vein stenosis in a chronic hemodialysis patient with well-functioning arteriovenous fistula – A rare entity

Polish Journal of Surgery ◽

10.5604/01.3001.0014.1734 ◽

2020 ◽

Vol 92 (5) ◽

pp. 1-5

Author(s):

MAJ GEN SINGH ◽

VINOD KUMAR

Keyword(s):

Arteriovenous Fistula ◽

Young Female ◽

Chronic Hemodialysis ◽

Brachiocephalic Vein ◽

Central Vein ◽

Chronic Hemodialysis Patient ◽

Stage Renal Disease ◽

End Stage ◽

Vein Stenosis ◽

Central Vein Stenosis

Introduction: Central vein stenosis has been reported in patients of end stage renal disease with subclavian vein being more commonly affected than brachiocephalic vein. Case report: We present a case of young female with bilateral brachiocephalic vein obstruction following arteriovenous fistula creation for hemodialysis.

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Factors Influencing Arteriovenous Fistula Dysfunction in Japanese Patients on Chronic Hemodialysis

The International Journal of Artificial Organs ◽

10.1177/039139889902200104 ◽

1999 ◽

Vol 22 (1) ◽

pp. 14-17 ◽

Cited By ~ 4

Author(s):

T. Masaki ◽

N. Yorioka ◽

Y. Kyuden ◽

K. Yamashita ◽

Y. Taniguchi ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Japanese Patients ◽

Chronic Hemodialysis ◽

Factors Influencing

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A Case of Saphenofemoral Arteriovenous Fistula for Chronic Hemodialysis with Darier’s Disease

The Journal of Japanese College of Angiology ◽

10.7133/jca.16-00020 ◽

2017 ◽

Vol 57 (2) ◽

pp. 5-7

Author(s):

Kenichiro Sato ◽

Toshiyuki Kobinata ◽

Koichi Tamai ◽

Takehiro Shirasugi

Keyword(s):

Arteriovenous Fistula ◽

Chronic Hemodialysis ◽

Darier’S Disease ◽

Darier's Disease

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Subclavian Vein Stenosis: A Potentially Serious Complication in Chronic Hemodialysis Patients with Permanent Cardiac Pacemakers

The International Journal of Artificial Organs ◽

10.1177/039139889702000604 ◽

1997 ◽

Vol 20 (6) ◽

pp. 316-318 ◽

Cited By ~ 7

Author(s):

F. Cavatorta ◽

S. Campisi ◽

A. Zollo

Keyword(s):

Arteriovenous Fistula ◽

Subclavian Vein ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Brachiocephalic Vein ◽

Hemodialysis Access ◽

Cardiac Pacemakers ◽

Vein Stenosis

We report on two hemodialyzed patients in whom subclavian and brachiocephalic vein stenosis secondary to permanent cardiac pacemakers led to massive congestive edema of the same arm after arteriovenous fistula/grafts were created. Therapeutic solutions regarding hemodialysis access are discussed in these patients with permanent pacemakers requiring hemodialysis.

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The hemostatic efficacy of chitosan-pads in hemodialysis patients with significant bleeding tendency

The Journal of Vascular Access ◽

10.5301/jva.5000707 ◽

2017 ◽

Vol 18 (3) ◽

pp. 220-224 ◽

Cited By ~ 4

Author(s):

Mudi Misgav ◽

Ahron Lubetszki ◽

Tami Brutman-Barazani ◽

Uri Martinowitz ◽

Gili Kenet

Keyword(s):

Crossover Study ◽

Venous Access ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Entire Group ◽

Bleeding Tendency ◽

Extended Time ◽

Puncture Site ◽

Access Points ◽

Hemostatic Efficacy

Background Patients on chronic hemodialysis often have acquired coagulopathy that can aggravate bleeding from puncture site after needle extraction. Chitosan-based pads have been reported to accelerate hemostasis even in the presence of coagulopathy. The aim of this study was to evaluate the hemostatic efficacy of the chitosan pads compared to gauze pads, applied for local hemostasis. Methods A crossover study in a cohort of patients on hemodialysis with extended time to hemostasis after needle extraction. At the end of each dialysis, either gauze or chitosan pad was applied on both access points (arterial and venous). The type of pad was changed in the next dialysis all together 5 times in each patient (10 applications per patient for every pad). Results A total of 288 applications, 144 for each type of pad, were performed in 15 patients. The average time to hemostasis for the entire group was significantly shorter with the chitosan pads compared to the regular gauze pads (“arterial” point 3 vs. 18.5 min, p<0.001 “venous” access 2.8 vs. 13.2 min, p<0.001, respectively). Conclusions Chitosan pads significantly reduce time to hemostasis and should be considered for the treatment of accessible bleeds in patients with coagulopathy.

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