scholarly journals Cardiac Arrest Secondary to Bilateral Pulmonary Emboli following Arteriovenous Fistula Thrombectomy: A Case Report with Review of the Literature

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Avni Shah ◽  
Naheed Ansari ◽  
Zaher Hamadeh
Keyword(s):  
Cardiac Arrest ◽  
Arteriovenous Fistula ◽  
Pulmonary Emboli ◽  
Hemodialysis Access ◽  
Number Of Patients ◽  
Life Threatening ◽  
Timely Fashion ◽  
Pulmonary Embolization ◽  
Stage Renal Disease ◽  
End Stage

Number of patients with End Stage Renal Disease (ESRD) is growing worldwide. Hemodialysis remains the main modality of renal replacement therapy for ESRD patients. A patent hemodialysis access (arteriovenous fistula or arteriovenous graft) plays a key role in successful delivery of hemodialysis. Common vascular access issues encountered by patients and nephrologists are thrombosis and infection. The thrombosed access is declotted by various percutaneous techniques these days by multiple outpatient access centers in a timely fashion. Thrombolysis can give rise to various complications, a few of which can be life threatening. A young hemodialysis patient underwent percutaneous thrombolysis of his clotted arteriovenous fistula. Outpatient access thrombectomy was complicated immediately afterwards with cardiac arrest requiring cardiac resuscitation in the recovery room. The patient was admitted to intensive care unit after life sustaining care. Work up revealed multiple pulmonary emboli to both lung fields on CT scan of the chest. Patient was anticoagulated and discharged from the hospital. Thrombolysis of clotted hemodialysis access is associated commonly with occurrences of pulmonary embolic which are usually asymptomatic. Massive pulmonary embolization due to access thrombolysis is rare. Nephrologists and radiologists should be aware of this dangerous complication particularly in patients with preexisting cardiopulmonary disease.

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.

Arteriovenous fistulas for hemodialysis: Brief review and current problems

2021 ◽  
pp. 112972982110077
Author(s):  
John J Manov ◽  
Prasoon P Mohan ◽  
Roberto Vazquez-Padron
Keyword(s):  
Renal Disease ◽  
Arteriovenous Fistula ◽  
Vascular Access ◽  
End Stage Renal Disease ◽  
State Of The Art ◽  
Arteriovenous Fistulas ◽  
Number Of Patients ◽  
Stage Renal Disease ◽  
End Stage

The number of people worldwide living with end-stage renal disease is increasing. Arteriovenous fistulas are the preferred method of vascular access in patients who will require hemodialysis. As the number of patients with arteriovenous fistulas grows, the role of physicians who intervene who maintain and salvage these fistulas will grow in importance. This review aims to familiarize practitioners with the rationale for arteriovenous fistula creation, the detection of fistula dysfunction, and the state of the art on fistula maintenance and preservation. Current controversies are briefly reviewed.

scholarly journals Case report of a near-fatal case of Mycobacterium massiliense sepsis after de-clotting of an arteriovenous fistula

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Haroon Nawaz ◽  
Ayesha A. Choudhry ◽  
William Morse
Keyword(s):  
Arteriovenous Fistula ◽  
Early Recognition ◽  
Fatal Case ◽  
Mycobacterium Abscessus ◽  
Rapid Improvement ◽  
Separate Species ◽  
Mycobacterium Massiliense ◽  
Life Threatening ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background Mycobacterium massiliense is a rapidly growing a non-tuberculous mycobacterium that has been validated as a separate species from the Mycobacterium abscessus group. Only few antibiotics have demonstrated germicidal activity against Mycobacterium massiliense, and some of those include amikacin, clarithromycin, and cefoxitin. Case presentation We present the first reported case of near-fatal septic shock caused by disseminated Mycobacterium massiliense after de-clotting of an infected arteriovenous fistula, in a patient with end-stage renal disease with concomitant human immunodeficiency virus infection. Early recognition of the culprit organism and treatment with a combination therapy of clarithromycin and amikacin led to rapid improvement. Conclusion This unique case can highlight the importance of taking into consideration Mycobacterium massiliense infection as a cause of arteriovenous fistula thrombosis and highlights the risk of disseminated infection leading to life threatening sepsis upon de-clotting of the fistula.

scholarly journals Comparative Study of Autologous Radiocephalic and Brachiocephalic Arteriovenous Fistula in Patients with End Stage Renal Disease

2020 ◽  
Vol 18 (1) ◽  
pp. 78-81
Author(s):  
Deepak Thapa Magar ◽  
Kiran Shrestha ◽  
Dinesh Chapagain ◽  
Kumar Shrestha ◽  
Sara Thapa
Keyword(s):  
Renal Disease ◽  
Arteriovenous Fistula ◽  
Failure Rate ◽  
Vascular Access ◽  
End Stage Renal Disease ◽  
Patency Rate ◽  
Av Fistula ◽  
Number Of Patients ◽  
Stage Renal Disease ◽  
End Stage

Introduction: End-stage renal disease requires treatment with dialysis or renal transplantation. For the dialysis, autologous radiocephalic (RC) or brachiocephalic (BC) arteriovenous fistula (AVF) is the better option for vascular access for hemodialysis. Aims: The aim of this study is to find out the outcome between RC AVF and BC AVF. Methods: This is the retrospective study, conducted for the period of 24 months from September 2017 to September 2019 in the department of Cardiothoracic and Vascular Surgery of Bir Hospital, Nepal. RC and BC AVF were created for the assess of hemodialysis. Outcome and different complications were taken into consideration.  Results: The total number of patients included in this study was 400. The overall failure rate of autologous AV fistula was 12.75%. Out of these, the failure rate was more in RC AV fistula group, 34 (17%) than in BC AV fistula group, 17 (8.5%). The most common complication was bleeding in both groups having an overall rate of 39 (9.75%). The limb edema was more common in BC AV fistula group 16 (8.0%) then in RC AV fistula group 7(3.5%). The overall infection rate was 4.5%. Overall patency rate was 87.25%. Conclusion: Autologous RC AVF and BC AVF are the choices for vascular access for hemodialysis in patients with end-stage renal disease. BC AVF has a better patency rate than RC AVF but with the slight higher risk of complications.

scholarly journals ARTERIOVENOUS FISTULA CARE

2018 ◽  
Vol 25 (09) ◽  
pp. 1426-1431
Author(s):  
Qura Tul Ain Iqbal ◽  
Amna Shareef ◽  
Aurangzeb Afzal ◽  
Sania Ashraf
Keyword(s):  
Arteriovenous Fistula ◽  
Weight Lifting ◽  
Av Fistula ◽  
Number Of Patients ◽  
Study Population ◽  
Precautionary Measures ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients ◽  
Knowledge Attitude And Practice

Objectives: To determine knowledge, attitude and practice regarding AV fistulacare in patients of end stage renal disease on hemodialysis. Study Design: Cross sectionalstudy. Setting: ESRD patients in Nephrology Department of Lahore General Hospital by usingself-designed questionnaire. Period: Six months from Jan 2017 to June 2017. Method: Thestudy included about 141(consecutive sampling) patients of chronic kidney disease using AVfistula for hemodialysis. Data was collected using self designed questionnaire. Data analysiswas done using SPSS version 22. Result: The most well- known precautionary measures to betaken for arteriovenous fistula care are to avoid taking blood pressure and intravenous line on thearm bearing AV fistula and to avoid trauma and weight lifting with that limb. The knowledge wasseen to be particularly deficient about the measures to be taken in case of swelling. The attitudetowards AV fistula care was observed to be positive, majority of our study population claimed tofollow maximum precautionary measures most of the time, but percentage of practicing doesnot coincide with that (85.1% vs.74.7% respectively). The least practiced measure is elevationof limb in case of swelling, observed by only 36.9% of our study population. Conclusion:Knowledge regarding fistula care was adequate about most of the precautionary measures,most of the participants showed positive attitude towards practicing precautionary measures forfistula care, but number of patients actually practicing these precautions is less than the numberof patients that have knowledge about them.

scholarly journals Nuances of Arteriovenous Fistula Creation for Vascular Access in Hemodialysis

2021 ◽  
Author(s):  
Parag Sahasrabudhe ◽  
Ameya Bindu
Keyword(s):  
Life Expectancy ◽  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Comprehensive Overview ◽  
Standardized Protocol ◽  
Number Of Patients ◽  
Rising Incidence ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background With rising incidence and increased life expectancy of patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD), the number of patients requiring hemodialysis has increased substantially. Vascular access is the lifeline for a patient on hemodialysis (HD), and an arteriovenous fistula (AVF) is the undisputed gold standard for HD access. An effective and long-lasting fistula serves to increase the life expectancy of ESRD patients and improves their quality of life. Learning Objectives This paper aims to give a comprehensive overview of AVF creation, including the various techniques, patient selection, troubleshooting with decision-making, and common complications. Authors share their experience from previous publications and over 2000 AVF surgeries. They have not only described a new modification of the technique of proximal fistula but have also established a direct correlation between bruit and thrill on operation table and success of fistula surgery. Conclusion A standardized, protocol-driven multidisciplinary approach with careful patient and site selection, guided by outcome predictors, is vital in AVF surgery. Knowledge about the potential complications of AVFs contributes to their timely detection and allows measures to be taken that might prevent deleterious consequences that range from loss of vascular access to serious morbidity and mortality.

scholarly journals Ifosfamide May Be Safely Used in Patients with End Stage Renal Disease on Hemodialysis

Sarcoma ◽  
2009 ◽  
Vol 2009 ◽  
pp. 1-5 ◽  
Author(s):  
Sheron Latcha ◽  
Robert G. Maki ◽  
Gary K. Schwartz ◽  
Carlos D. Flombaum
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Response To Therapy ◽  
Common Side Effect ◽  
Pharmacokinetic Data ◽  
Life Threatening ◽  
Stage Renal Disease ◽  
End Stage ◽  
Metastatic Sarcoma ◽  
Radiographic Improvement

Background. Pharmacokinetic data on clearance of ifosfamide in hemodialysis patients are limited. Consequently, these patients are excluded from therapy with this agent. We review the outcomes for patients at our institution with end stage renal disease on dialysis who received ifosfamide for metastatic sarcoma.Patients and Methods. We treated three patients with end stage renal disease on hemodialysis with escalating doses of ifosfamide. Data on radiographic response to therapy, WBC and platelet counts, signs or symptoms of infection, neuropathy and bladder toxicity are reported. Starting doses of ifosfamide were based on review of the literature available with subsequent modifications based on each patient's prior exposure to myelosuppressive agents and on symptoms of neurotoxicity and the degree of myelosuppression following each cycle of chemotherapy.Results. Myelosuppression was the most common side effect from therapy, but no patient developed a life threatening infection, neurotoxicity, or hematuria. One patient developed epistaxis in the setting of thrombocytopenia while on warfarin therapy. All patients had clinical evidence for therapeutic response and two had documented radiographic improvement following ifosfamide administration.Conclusion. Ifosfamide can be used safely in combination with hemodialysis in patients with end stage renal disease.

scholarly journals Sustainability of the Peritoneal Dialysis-First Policy in Hong Kong

2015 ◽  
Vol 40 (4) ◽  
pp. 320-325 ◽  
Author(s):  
Agnes Shin-Man Choy ◽  
Philip Kam-Tao Li
Keyword(s):  
Hong Kong ◽  
Peritoneal Dialysis ◽  
Financial Burden ◽  
Training Programme ◽  
Number Of Patients ◽  
Ultrafiltration Failure ◽  
Average Annual Cost ◽  
The Government ◽  
Stage Renal Disease ◽  
End Stage

In Hong Kong, the average annual cost of haemodialysis (HD) per patient is more than double of that of peritoneal dialysis (PD). As the number of patients with end-stage renal disease (ESRD) has surged, it has posed a great financial burden to the government and society. A PD-first policy has been implemented in Hong Kong for three decades based on its cost-effectiveness, and has achieved successful outcomes throughout the years. A successful PD-first policy requires medical expertise in PD, the support of dedicated staff and a well-designed patient training programme. Addressing patients' PD problems is the key to sustainability of the PD-first policy. In this article, we highlight three important groups of patients: those with frequent peritonitis, ultrafiltration failure or inadequate dialysis. Potential strategies to improve the outcomes of these groups will be discussed. Moreover, enhancing HD as back-up support and promoting organ transplantation are needed in order to maintain sustainability of the PD-first policy.

scholarly journals Assessment of left ventricular mass changes after arteriovenous fistula surgical banding in end-stage renal disease

2018 ◽  
Vol 29 (6) ◽  
pp. 1280
Author(s):  
JuanC Duque ◽  
Camilo Cortesi ◽  
Sedki Mai ◽  
Laisel Martinez ◽  
Adriana Dejman ◽  
...  
Keyword(s):  
Renal Disease ◽  
Arteriovenous Fistula ◽  
Left Ventricular Mass ◽  
End Stage Renal Disease ◽  
Left Ventricular ◽  
Ventricular Mass ◽  
Stage Renal Disease ◽  
End Stage
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