scholarly journals Cerebrovascular Accident Secondary to Paradoxical Embolism Following Arteriovenous Graft Thrombectomy

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Jolina Pamela Santos ◽  
Zaher Hamadeh ◽  
Naheed Ansari
Keyword(s):  
Vascular Access ◽  
Parietal Lobe ◽  
Paradoxical Embolism ◽  
Arteriovenous Graft ◽  
Common Procedure ◽  
Left Posterior ◽  
Posterior Parietal ◽  
Stage Renal Disease ◽  
End Stage ◽  
Posterior Parietal Lobe

Thrombectomy is a common procedure performed to declot thrombosed dialysis arteriovenous fistula (AVF) or arteriovenous graft (AVG). Complications associated with access thrombectomy like pulmonary embolism have been reported, but paradoxical embolism is extremely rare. We report a case of a 74-year-old black man with past medical history significant for end-stage renal disease (ESRD), atrial fibrillation on anticoagulation with warfarin, who presented to our hospital with lethargy, aphasia, and right-sided hemiparesis following thrombectomy of a clotted AVG. Computed tomography (CT) scan of brain showed a hypodensity within the left posterior parietal lobe. INR was 2.0 on admission. Echocardiogram revealed a normal sized left atrium with no intracardiac thrombus, and bubble study showed the presence of right-to-left shunting. These findings suggest that the stroke occurred as a result of an embolus originating from the AVG. Paradoxical cerebral embolism is uncommon but can occur after thrombectomy of clotted vascular access in ESRD patients. Clinicians and patients should be aware of this serious and potentially fatal complication of vascular access procedure.

Current state of vascular access in Singapore

2019 ◽  
Vol 21 (5) ◽  
pp. 582-588 ◽  
Author(s):  
Suh Chien Pang ◽  
Ru Yu Tan ◽  
Jia Liang Kwek ◽  
Kian Guan Lee ◽  
Marjorie Wai Yin Foo ◽  
...  
Keyword(s):  
Renal Disease ◽  
Arteriovenous Fistula ◽  
Vascular Access ◽  
End Stage Renal Disease ◽  
Shared Responsibility ◽  
Arteriovenous Graft ◽  
Access Management ◽  
Current State ◽  
Stage Renal Disease ◽  
End Stage

This article described the current state of vascular access management for patients with end-stage renal disease in Singapore. Over the past 10 years, there has been a change in the demographics of end-stage renal disease patients. Aging population and the increase in prevalence of diabetes mellitus has led to the acceleration of chronic kidney disease and increase in incidence and prevalence of end-stage renal disease. Vascular access care has, therefore, been more complicated, with the physical, psychological, and social challenges that occur with increased frequency in elderly patients and patients with multiple co-morbidities. Arteriovenous fistula and arteriovenous graft are created by vascular surgeons, while maintenance of patency of vascular access through endovascular intervention has been a shared responsibility between surgeons, interventional radiologists, and interventional nephrologists. Pre-emptive access creation among end-stage renal disease patients has been low, with up to 80% of new end-stage renal disease patients being commenced on hemodialysis via a dialysis catheter. Access creation is exclusively performed by a dedicated vascular surgeon with arteriovenous fistula success rate up to 78%. The primary and cumulative patency rates of arteriovenous fistula and arteriovenous graft were consistent with the results from many international centers. Vascular access surveillance is not universally practiced in all dialysis centers due to its controversies, in addition to the cost and the limited availability of equipment for surveillance. Timely permanent access placement, with reduced dependence on dialysis catheters, and improved vascular access surveillance are the main areas for potential intervention to improve vascular access management.

Renal Hemodynamic Response to the Creation of Vascular Access in Patients with End-Stage Renal Disease

Renal Failure ◽  
1995 ◽  
Vol 17 (5) ◽  
pp. 589-593 ◽  
Author(s):  
Susan Crowley ◽  
Richard Morrissey ◽  
Eugene Silverman ◽  
William Yudt ◽  
Przemyslaw Hirszel
Keyword(s):  
Renal Disease ◽  
Vascular Access ◽  
End Stage Renal Disease ◽  
Hemodynamic Response ◽  
Renal Hemodynamic ◽  
The Creation ◽  
Stage Renal Disease ◽  
End Stage

Vascular access types in patients starting hemodialysis after failed kidney transplant: does close nephrology follow-up matter?

2016 ◽  
Vol 18 (1) ◽  
pp. 22-25 ◽  
Author(s):  
Naveed Ul Haq ◽  
Mohamed Said Abdelsalam ◽  
Mohammed Mahdi Althaf ◽  
Abdulrahman Ali Khormi ◽  
Hassan Al Harbi ◽  
...  
Keyword(s):  
Vascular Access ◽  
Clinic Visit ◽  
Study Data ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Early Referral ◽  
Period Data ◽  
Stage Renal Disease ◽  
End Stage

Background Native arteriovenous fistulae (AVFs) are preferred while central venous catheters (CVCs) are least suitable vascular access (VA) in patients requiring hemodialysis (HD). Unfortunately, around 80% of patients start HD with CVCs. Late referral to nephrologist is thought to be a factor responsible for this. We retrospectively analyzed the types of VA at HD initiation in renal transplant recipients followed by nephrologists with failed transplant. If early referral to nephrologist improves AVF use, these patients should have higher prevalence of AVF at HD initiation. Methods All patients who failed their kidney transplants from January 2002 to April 2013 were included in the study. Data regarding planning of VA by nephrologist, documented discussion about renal replacement therapy (RRT), estimated glomerular filtration rate (eGFR) at 6 months and last clinic visit before HD initiation, time of VA referral, and subsequent VA at dialysis initiation were gathered and analyzed. Results Eighty-three patients failed their transplants during study period. Data were inaccessible in six patients. Eleven patients started peritoneal dialysis (PD) while 66 started HD. Thirty-two had previous functioning VA while 34 needed VA. There were 11/34 patients (32%) with eGFR <15 mL/min at six months while 21/34 (61%) had eGFR <15 mL/min at last clinic visit before HD initiation. Only 11/34 (32%) had documented RRT discussion, 8/34 (24%) had VA referral, and 7/34 (21%) had vein mapping. A total of 30/34 (88.3%) started HD with CVC while 4/34 (11.3%) started HD with AVF (p<0.0001). Conclusions Early referral to nephrologist by itself may not improve VA care amongst patient with end-stage renal disease.

scholarly journals Quality assessment of vascular access procedures for hemodialysis: A position paper of the Vascular Access Society based on the analysis of existing guidelines

2019 ◽  
Vol 21 (2) ◽  
pp. 148-153 ◽  
Author(s):  
Branko Fila ◽  
Ramon Roca-Tey ◽  
Jan Malik ◽  
Marko Malovrh ◽  
Nicola Pirozzi ◽  
...  
Keyword(s):  
Quality Control ◽  
Quality Assessment ◽  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Intermittent Hemodialysis ◽  
Improvement Programs ◽  
Stage Renal Disease ◽  
End Stage ◽  
Quality Improvement Programs ◽  
Access Surgery

Quality assessment in vascular access procedures for hemodialysis is not clearly defined. The aim of this article is to compare various guidelines regarding recommendation on quality control in angioaccess surgery. The overall population of end-stage renal disease patients and patients in need for hemodialysis treatment is growing every year. Chronic intermittent hemodialysis is still the main therapy. The formation of a functional angioaccess is the cornerstone in the management of those patients. Native (autologous) arteriovenous fistula is the best vascular access available. A relatively high percentage of primary failure and fistula abandonment increases the need for quality control in this field of surgery. There are very few recommendations of quality assessment on creation of a vascular access for hemodialysis in the searched guidelines. Some guidelines recommend the proportion of native arteriovenous fistula in incident and prevalent patients as well as the maximum tolerable percentage of central venous catheters and complications. According to some guidelines, surgeon’s experience and expertise have a considerable influence on outcomes. There are no specific recommendations regarding surgeon’s specialty, grade, level of skills, and experience. In conclusion, there is a weak recommendation in the guidelines on quality control in vascular access surgery. Quality assessment criteria should be defined in this field of surgery. According to these criteria, patients and nephrologists could choose the best vascular access center or surgeon. Centers with best results should be referral centers, and centers with poorer results should implement quality improvement programs.

Clinical Outcomes of Arteriovenous Access in Incident Hemodialysis Patients with Medicare Coverage, 2012–2014

2019 ◽  
Vol 49 (2) ◽  
pp. 156-164 ◽  
Author(s):  
Lauren C. Bylsma ◽  
Heidi Reichert ◽  
Shawn M. Gage ◽  
Prabir Roy-Chaudhury ◽  
Robert J. Nordyke ◽  
...  
Keyword(s):  
Vascular Access ◽  
Venous Catheter ◽  
The United States ◽  
Chronic Hemodialysis ◽  
Continuous Coverage ◽  
Sustained Use ◽  
Arteriovenous Access ◽  
Stage Renal Disease ◽  
End Stage ◽  
Primary Payer

Background: Chronic hemodialysis requires a mode of vascular access through an arteriovenous fistula (AVF), a prosthetic arteriovenous graft (AVG), or a central venous catheter (CVC). AVF is recommended over AVG or CVC due to increased patency and decreased intervention rates for those that mature. AVG are preferred over CVC due to decreased infection and mortality risk. The aims of this study were to evaluate the lifespan of AVF and AVG in maturation, sustained access use, and abandonment. Methods: The United States Renal Data System (USRDS), Medicare claims, and CROWNWeb were used to identify access placements. Patients with a first end-stage renal disease (ESRD) service from January 1, 2012 to June 30, 2014 with continuous coverage with Medicare as primary payer and ≥1 AVF or AVG placed after ESRD onset were included. Maturation was defined as the first use of the access for hemodialysis recorded in CROWNWeb. Sustained access use was defined as 3 consecutive months of use without catheter placement or replacement. Accesses that were never used at any time post-placement were considered abandoned. Results: The cohort included 38,035 AVF placements and 12,789 AVG placements. Sixty-nine percent of AVF and 72% of AVG matured. Fifty-two percent of AVF and 51% of AVG achieved sustained access use. One quarter of AVF and 14% of AVG were abandoned without use as recorded in CROWNWeb. Conclusion: Although considered the gold standard for vascular access, only half of AVF and AVG placements achieved sustained access use. The USRDS database has inherent limitations but provides useful clinical insight into maturation, sustained use, and abandonment.

Renal Hemodynamic Response to the Creation of Vascular Access in Patients with End-Stage Renal Disease

Renal Failure ◽  
1995 ◽  
Vol 17 (5) ◽  
pp. 589-593
Author(s):  
Susan T. Crowley ◽  
Richard L. Morrissey ◽  
Eugene D. Silverman ◽  
William M. Yudt ◽  
Przemyslaw Hirszel
Keyword(s):  
Renal Disease ◽  
Vascular Access ◽  
End Stage Renal Disease ◽  
Hemodynamic Response ◽  
Renal Hemodynamic ◽  
The Creation ◽  
Stage Renal Disease ◽  
End Stage

scholarly journals Risk of Complications and Survival of Patients Dialyzed with Permanent Catheters

Medicina ◽  
2019 ◽  
Vol 56 (1) ◽  
pp. 2
Author(s):  
Anna Szarnecka-Sojda ◽  
Wojciech Jacheć ◽  
Maciej Polewczyk ◽  
Agnieszka Łętek ◽  
Jarosław Miszczuk ◽  
...  
Keyword(s):  
Vascular Access ◽  
Infectious Complications ◽  
Term Survival ◽  
Long Term Survival ◽  
Dialysis Fistula ◽  
Study Population ◽  
Catheter Implantation ◽  
Stage Renal Disease ◽  
End Stage

Background and Objectives: An increase in the incidence of end-stage renal disease (ESRD) is associated with the need for a wider use of vascular access. Although arteriovenous (A-V) fistula is a preferred form of vascular access, for various reasons, permanent catheters are implanted in many patients. Materials and Methods: A retrospective analysis of clinical data was carried out in 398 patients (204 women) who in 2010–2016 were subjected to permanent dialysis catheters implantation as first vascular access or following A-V fistula dysfunction. The factors influencing the risk of complications related to vascular access and mortality were evaluated and the comparison of the group of patients with permanent catheter implantation after A-V fistula dysfunction with patients with first-time catheter implantation was carried out. Results: The population of 398 people with ESRD with mean age of 68.73 ± 13.26 years had a total of 495 permanent catheters implanted. In 129 (32.6%) patients, catheters were implanted after dysfunction of a previously formed dialysis fistula. An upward trend was recorded in the number of permanent catheters implanted in relation to A-V fistulas. Ninety-two infectious complications (23.1%) occurred in the study population in 65 patients (16.3%). Multivariate analysis showed that permanent catheters were more often used as the first vascular access option in elderly patients and cancer patients. Mortality in the mean 1.38 ± 1.17 years (min 0.0, max 6.70 years) follow-up period amounted to 50%. Older age and atherosclerosis were the main risk factors for mortality. Patients with dialysis fistula formed before the catheter implantation had a longer lifetime compared to the group in which the catheter was the first access. Conclusion: The use of permanent catheters for dialysis therapy is associated with a relatively high incidence of complications and low long-term survival. The main factors determining long-term survival were age and atherosclerosis. Better prognosis was demonstrated in patients after the use of A-V fistula as the first vascular access option.

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