Hemodynamic Comparisons Between Different Anastomotic Configurations in Dialysis Access Fistulae

2011 ◽  
Author(s):  
Patrick M. McGah ◽  
Alberto Aliseda ◽  
James J. Riley ◽  
Daniel F. Leotta ◽  
Kirk W. Beach
Keyword(s):  
Peripheral Circulation ◽  
Dialysis Access ◽  
External Influence ◽  
High Failure Rate ◽  
Venous Flow ◽  
Flow Rates ◽  
Capillary Bed ◽  
One Year ◽  
Stage Renal Disease ◽  
End Stage

Arteriovenous fistulae are created surgically to provide an adequate access for dialysis in patients with End-Stage Renal Disease. Producing an autogenous shunt linking an artery and a vein in the peripheral circulation bypasses the high resistance capillary bed in order to provide the necessary flow rates at sites easily accessible for dialysis. In successful fistulae, venous flow rates can easily exceed 1000 mL/min. It has long been recognized that the hemodynamics constitute the primary external influence on the remodeling process [1, 2]; The high flow rate, together with the exposure of the venous tissue to the high arterial pressure, leads to a rapid process of wall remodeling that may end in a mature access or in stenosis and failure. Given the high failure rate of dialysis access (up to 50% require surgical revision within one year [3]), understanding the dynamics of blood flow within the fistula is a necessary step in understanding the remodeling, and ultimately, in improving clinical outcomes.

Incomplete Restoration of Homeostatic Shear Stress Within Arteriovenous Fistulae

2012 ◽  
Author(s):  
Patrick M. McGah ◽  
James J. Riley ◽  
Alberto Aliseda ◽  
Daniel F. Leotta ◽  
Kirk W. Beach
Keyword(s):  
Shear Stress ◽  
Peripheral Circulation ◽  
Shear Stresses ◽  
Dialysis Access ◽  
Venous Flow ◽  
Arteriovenous Fistulae ◽  
Flow Rates ◽  
Stage Renal Disease ◽  
End Stage ◽  
Low Shear

Arteriovenous fistulae are created surgically to provide an adequate access for dialysis in patients with End-Stage Renal Disease (ESRD). Producing an autogenous shunt linking an artery and a vein in the peripheral circulation bypasses the high resistance capillary bed in order to provide the necessary flow rates at sites easily accessible for dialysis. In successful fistulae, venous flow rates can easily exceed 1000 mL/min. It has long been recognized that the hemodynamics constitute the primary external influence on the remodeling process [1]; The high flow rate, together with the exposure of the venous tissue to the high arterial pressure, leads to a rapid process of wall remodeling that may end in a mature access or in failure. Recent hemodynamic simulations [2,3] have computed very high viscous wall shear stresses within fistulae; Stresses > 15Pa have been reported which are much greater than what is typically considered normal (i.e. homeostatic, ≈ 1Pa). Both sustained high shear and sustained low shear have been hypothesized to cause pathological venous remodeling (i.e. intimal hyperplasia) which causes stenoses and threatens fistula patency. The role of high vs. low shear stress in effecting patency remains unclear. Given the high failure rate of dialysis access sites (up to 50% require surgical revision within one year [4]), understanding the dynamics of blood flow within the fistula is a necessary step in understanding the remodeling, and ultimately, in improving clinical outcomes.

Effects of Wall Distensibility on the Numerical Simulation of Arteriovenous Fistulae

2013 ◽  
Author(s):  
Patrick M. McGah ◽  
Alberto Aliseda ◽  
Daniel F. Leotta ◽  
Kirk W. Beach
Keyword(s):  
Vascular Tissue ◽  
Peripheral Circulation ◽  
Shear Stresses ◽  
Dialysis Access ◽  
Arteriovenous Fistulae ◽  
Capillary Bed ◽  
One Year ◽  
Stage Renal Disease ◽  
End Stage ◽  
Hemodynamic Simulations

Arteriovenous fistulae are created surgically to provide an adequate access for dialysis in patients with End-Stage Renal Disease (ESRD). Producing an autogenous shunt linking an artery and a vein in the peripheral circulation bypasses the high resistance capillary bed in order to provide the necessary flow rates at sites easily accessible for dialysis. It has long been recognized that hemodynamics constitute the primary external influence on the remodeling process of anastomosed vascular tissue [1, 2]. The high flow rate, together with the exposure of the venous tissue to the high arterial pressure, leads to a rapid process of wall remodeling that may lead to a mature access or end in failure. Recent hemodynamic simulations [3, 4] have computed very high viscous wall shear stresses within dialysis access fistulae; Stresses >15 Pa have been reported. These are much higher than what is typically considered normal or homeostatic (i.e. ≈ 1–1.5 Pa). The abnormal stresses in the fistulae have been hypothesized to cause pathological venous remodeling (i.e. intimal hyperplasia) which causes stenoses and threatens fistula patency. Given the high failure rate of dialysis access sites (up to 50% require surgical revision within one year), understanding the dynamics of blood flow within the fistula is a necessary step in understanding remodeling, and ultimately, in improving clinical outcomes.

scholarly journals Distal Radial Artery Ligation for Dialysis Access Steal Syndrome

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
David Fung ◽  
Yaasin Abdulrehman
Keyword(s):  
Radial Artery ◽  
Surgical Techniques ◽  
Limb Ischemia ◽  
Definitive Treatment ◽  
Dialysis Access ◽  
Artery Ligation ◽  
Stage Renal Disease ◽  
End Stage ◽  
Steal Syndrome ◽  
Distal Radial Artery

Renal replacement therapy is the definitive treatment for end stage renal disease apart from transplant. Steal syndrome, which can lead to distal limb ischemia, is a rare but serious complication in patients who undergo hemodialysis with an arteriovenous fistula. We present a case of a 48-year-old female with limited options for dialysis access who presented with symptoms of steal syndrome. Given the need to keep her current fistula, we opted to treat her with distal radial artery ligation. This case report summarizes the various surgical techniques available for treating dialysis access-associated steal syndrome and why distal radial artery ligation should be considered a viable management strategy, especially in the context of our patient.

Clinical Considerations in Hemodialysis Access Intervention

2018 ◽  
pp. 594-614
Author(s):  
Eric K. Hoffer
Keyword(s):  
Renal Disease ◽  
Arteriovenous Fistula ◽  
End Stage Renal Disease ◽  
Morbidity And Mortality ◽  
Dialysis Access ◽  
Hemodialysis Access ◽  
National Kidney Foundation ◽  
Clinical Considerations ◽  
Stage Renal Disease ◽  
End Stage

Interventional radiologists developed and refined the endovascular approaches to maintenance of the permanent arteriovenous vascular accesses that are integral to the provision of hemodialysis for patients with end stage renal disease. As methods of percutaneous arteriovenous fistula creation expand the scope of IR, this chapter reviews the clinical indications and preferences pertinent to dialysis access creation with respect to National Kidney Foundation Recommendations. Accesses remain imperfect, plagued by the development of flow-limiting intimal hyperplastic stenoses, and require monitoring and maintenance to minimize complications, morbidity and mortality. The measures of dialysis access function used in the surveillance of vascular accesses that indicate potential stenosis, and the utility of pre-occlusion recanalization of these stenoses are discussed. Complications specific to dialysis access interventions are also addressed.

scholarly journals SO062PREDICTING ONE YEAR MORTALITY IN END-STAGE-RENAL DISEASE PATIENTS STARTING DIALYSIS; MODEL DEVELOPMENT AND VALIDATION

2017 ◽  
Vol 32 (suppl_3) ◽  
pp. iii35-iii35
Author(s):  
Nynke Halbesma ◽  
Eve Miller-Hodges ◽  
Gurbey Ocak ◽  
Sarah Wild ◽  
Friedo Dekker ◽  
...  
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Model Development ◽  
One Year ◽  
Stage Renal Disease ◽  
End Stage ◽  
Development And Validation

Management of the Diabetic Patients with End Stage Renal Disease

1981 ◽  
Vol 2 (1_suppl) ◽  
pp. 6-10 ◽  
Author(s):  
Pablo Amair ◽  
Ramesh Khanna ◽  
Bernard Leibel ◽  
Andreas Pierratos ◽  
Stephen Vas ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Intraperitoneal Administration ◽  
Good Control ◽  
Diabetic Patients ◽  
Serum Triglycerides ◽  
One Year ◽  
Stage Renal Disease ◽  
End Stage

Twenty diabetics with end-stage renal disease who had never previously received dialysis treatment were treated with continuous ambulatory peritoneal dialysis for periods of two to 36 months (average, 14.5). Intraperitoneal administration of insulin achieved good control of blood sugar Even though creatinine clearance decreased significantly (P = 0.001), contro of blood urea nitrogen and serum creatinine was adequate. Hemoglobin and serum albumin levels increased significantly (P = 0.005 and 0.04 respectively). Similarly, there was a significant increase in serum triglycerides and alkaline phosphatase (P = 0.02 and 0.05). Blood pressure became normal without medications in all but one of the patients. Retinopathy, neuropathy, and osteodystrophy remained unchanged. Peritonitis developed once in every 20.6 patient-months a rate similar to that observed in nondiabetics. The calculated survival rate was 92 per cent at one year; the calculated rate of continuation on ambulatory peritoneal dialysis was 87 per cent.

Depression, Perception of Illness and Mortality in Patients with End-Stage Renal Disease

1991 ◽  
Vol 21 (4) ◽  
pp. 343-354 ◽  
Author(s):  
Rolf A. Peterson ◽  
Paul L. Kimmel ◽  
Carol R. Sacks ◽  
Mary Louise Mesquita ◽  
Samuel J. Simmens ◽  
...  
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Early Recognition ◽  
Additional Measure ◽  
Treatment Of Depression ◽  
Severity Scores ◽  
One Year ◽  
Stage Renal Disease ◽  
End Stage

A role of depression in affecting outcome in patients with end stage renal disease (ESRD) has been suggested but few have assessed psychological parameters and medical factors thought to influence survival simultaneously and prospectively. To assess whether depression or perception of illness influences survival in patients treated for ESRD, we prospectively evaluated fifty-seven patients with ESRD treated with hemodialysis (HD, n = 43) or continuous ambulatory peritoneal dialysis (CAPD, n = 14). Patients were interviewed and completed the Beck Depression Inventory (BDI) and the Illness Effects Questionnaire (IEQ). An ESRD severity coefficient was used to measure chronic illness severity. A cognitive item subset of the BDI (CDI) was used as an additional measure of depression. One and two years later, records were examined to determine survival. When initial results of the assessment of survivors and non-survivors were compared, at one year follow-up, there were no differences in mean age, duration of dialysis, severity scores, BDI or IEQ scores. The initial mean CDI scores in the group of non-survivors, however, were significantly greater than the scores in the survivor group. At two year follow-up, CDI scores were significantly different between groups, and were significant in a hazards regression. Disease severity, age and duration of dialysis were also significantly related to mortality at two year follow-up. We conclude cognitive depression is an important, early, indicator of grave prognosis in patients treated for ESRD. Early recognition of and therapeutic efforts directed toward the treatment of depression might modify outcome in ESRD patients.

scholarly journals Bioengineered human acellular vessels for dialysis access in patients with end-stage renal disease: two phase 2 single-arm trials

The Lancet ◽  
2016 ◽  
Vol 387 (10032) ◽  
pp. 2026-2034 ◽  
Author(s):  
Jeffrey H Lawson ◽  
Marc H Glickman ◽  
Marek Ilzecki ◽  
Tomasz Jakimowicz ◽  
Andrzej Jaroszynski ◽  
...  
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Dialysis Access ◽  
Phase 2 ◽  
Two Phase ◽  
Stage Renal Disease ◽  
End Stage

Cost analysis of ongoing care of patients with end-stage renal disease: The impact of dialysis modality and dialysis access

2002 ◽  
Vol 40 (3) ◽  
pp. 611-622 ◽  
Author(s):  
Helen Lee ◽  
Braden Manns ◽  
Ken Taub ◽  
William A. Ghali ◽  
Stafford Dean ◽  
...  
Keyword(s):  
Cost Analysis ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Dialysis Access ◽  
Dialysis Modality ◽  
Ongoing Care ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Impact
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