Arteriovenous access in hemodialysis: A multidisciplinary perspective for future solutions

In hemodialysis, vascular access is a key issue. The preferred access is an arteriovenous fistula on the non-dominant lower arm. If the natural vessels are insufficient for such access, the insertion of a synthetic vascular graft between artery and vein is an option to construct an arteriovenous shunt for punctures. In emergency situations and especially in elderly with narrow and atherosclerotic vessels, a cuffed double-lumen catheter is placed in a larger vein for chronic use. The latter option constitutes a greater risk for infections while arteriovenous fistula and arteriovenous shunt can fail due to stenosis, thrombosis, or infections. This review will recapitulate the vast and interdisciplinary scenario that characterizes hemodialysis vascular access creation and function, since adequate access management must be based on knowledge of the state of the art and on future perspectives. We also discuss recent developments to improve arteriovenous fistula creation and patency, the blood compatibility of arteriovenous shunt, needs to avoid infections, and potential development of tissue engineering applications in hemodialysis vascular access. The ultimate goal is to spread more knowledge in a critical area of medicine that is importantly affecting medical costs of renal replacement therapies and patients’ quality of life.

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Use of dehydrated human amnion chorion membrane allograft on infected ruptured arteriovenous fistula: revision and closure

Journal of Wound Care ◽

10.12968/jowc.2019.28.sup10.s10 ◽

2019 ◽

Vol 28 (Sup10) ◽

pp. S10-S12

Author(s):

Mutaz Al-Khateeb ◽

Zaki Al-Muzakki ◽

Mohammed Ftyan ◽

Hussam Itani ◽

Niki Istwan ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Vascular Access ◽

Haemodialysis Patient ◽

Primary Patency ◽

Human Amnion ◽

Novel Approach ◽

Hemodialysis Vascular Access ◽

Stage Renal Disease ◽

End Stage

Objective: Over two million individuals worldwide, with end-stage renal disease (ESRD), depend on dialysis therapy or a kidney transplant for survival. Every haemodialysis patient requires vascular access. The arteriovenous fistula (AVF) is preferred for long-term hemodialysis vascular access due to long-term primary patency rates. Given the limited options for haemodialysis access and placement, preservation of existing AVF sites is always a clinical priority. This case report describes a novel approach to wound closure with the application of dehydrated amnion chorion human membrane (dHACM) at an AVF surgical site known to be complicated with issues of scarring and tissue breakdown. The patient was treated successfully with the imperative preservation of his AVF given that he had few other vascular access options.

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Optiflow anastomotic device for hemodialysis vascular access creation

The Journal of Vascular Access ◽

10.5301/jva.5000664 ◽

2017 ◽

Vol 18 (1_suppl) ◽

pp. S84-S87 ◽

Cited By ~ 3

Author(s):

Marc Glickman

Keyword(s):

Arteriovenous Fistula ◽

Vascular Access ◽

Early Data ◽

Hemodialysis Vascular Access ◽

Arterial Anastomosis ◽

The Impact

The need to have consistent methods and consistent technique to optimize hemodialysis outcomes is behind the concept of the Optiflow™ device. This device was created to allow for consistency in size of the arterial anastomosis and consistency in angle of the vein to the artery at the anastomosis. Early data suggest that allowing these two technical entities can improve outcomes in regards to flow and maturity in arteriovenous fistula creation. This article is a summary of early data that demonstrate the impact the Optiflow device on brachial cephalic fistulas.

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Superficialization of the wrist native arteriovenous fistula for effective hemodialysis vascular access construction

Kidney International ◽

10.1046/j.1523-1755.2002.00202.x ◽

2002 ◽

Vol 61 (3) ◽

pp. 1170-1173 ◽

Cited By ~ 18

Author(s):

Wacław Weyde ◽

Magdalena Krajewska ◽

Waldemar Letachowicz ◽

Marian Klinger

Keyword(s):

Arteriovenous Fistula ◽

Vascular Access ◽

Hemodialysis Vascular Access

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Hemodialysis Vascular Access: Rising Costs As A Surrogate Marker For Patency and Function of Arteriovenous Fistulas

Annals of Vascular Surgery ◽

10.1016/j.avsg.2016.05.047 ◽

2016 ◽

Vol 34 ◽

pp. 27

Author(s):

Zachary M. Feldman ◽

Lisa B. Liu ◽

Stephen D. Abramowitz ◽

Peter L. Faries ◽

Michael L. Marin ◽

...

Keyword(s):

Vascular Access ◽

Surrogate Marker ◽

Arteriovenous Fistulas ◽

Hemodialysis Vascular Access ◽

And Function

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Proximal radial artery arteriovenous fistula for hemodialysis vascular access

Journal of Vascular Surgery ◽

10.1016/j.jvs.2017.06.114 ◽

2018 ◽

Vol 67 (1) ◽

pp. 244-253 ◽

Cited By ~ 24

Author(s):

William C. Jennings ◽

Alexandros Mallios ◽

Nasir Mushtaq

Keyword(s):

Arteriovenous Fistula ◽

Radial Artery ◽

Vascular Access ◽

Hemodialysis Vascular Access

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Hemodialysis vascular access survival: Upper-arm native arteriovenous fistula

American Journal of Kidney Diseases ◽

10.1053/ajkd.2002.29886 ◽

2002 ◽

Vol 39 (1) ◽

pp. 92-101 ◽

Cited By ~ 204

Author(s):

Bradley S. Dixon ◽

Lisa Novak ◽

Jerry Fangman

Keyword(s):

Arteriovenous Fistula ◽

Vascular Access ◽

Upper Arm ◽

Hemodialysis Vascular Access

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Multicenter Investigation of the Initial Hemodialysis Vascular Access and Its Related Factors in Hangzhou of China

BioMed Research International ◽

10.1155/2021/6628139 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Qisu Ying ◽

Yong Mao ◽

Xiangcheng Xie ◽

Ping Wu ◽

Jilin Ma ◽

...

Keyword(s):

Risk Factors ◽

Arteriovenous Fistula ◽

Vascular Access ◽

End Stage Renal Disease ◽

Venous Catheter ◽

Chronic Glomerulonephritis ◽

Central Venous ◽

Hemodialysis Vascular Access ◽

Stage Renal Disease ◽

End Stage

Objective. To investigate the initial hemodialysis vascular access in Hangzhou and provide evidence for improving the use of autologous arteriovenous fistula by identifying factors associated with the choice of initial vascular access. Methods. We retrospectively studied the initial hemodialysis vascular access of 257 patients in five hemodialysis units in Hangzhou of China during a 21-month period (January 2018 to September 2019). A logistic regression was used to identify the risk factors of failing to use an arteriovenous fistula at the initiation of hemodialysis. Results. (1) 257 participants with mean age 67.65 ± 13.43 years old were reviewed, including 165 males (64.2%) and 92 females (35.8%). The etiologies of end-stage renal disease included diabetic nephropathy (37.35%), chronic glomerulonephritis (31.13%), hypertensive nephropathy (14.01%), and other diseases (17.51%). Only 51 patients (19.84%) received arteriovenous fistula, whereas the remaining 206 patients (80.16%) initiated dialysis with a central venous catheter. (2) Logistic regression analysis revealed that the independent risk factors for central venous catheter at the initial hemodialysis were age >70 years old ( OR = 4.827 , p < 0.01 versus ≤70 years old), chronic glomerulonephritis as the primary etiology ( OR = 2.565 , p < 0.05 versus nonchronic glomerulonephritis) and eGFR <8.5 mL/min/1.73m2 ( OR = 2.283 , p < 0.05 versus eGFR ≥8.5 mL/min/1.73m2). Conclusion. The proportion of patients using arteriovenous fistula as the initial hemodialysis vascular access in Hangzhou was still low. The choice of vascular access for the first hemodialysis was related to age, eGFR, and the primary etiology of end-stage renal disease. Increasing the proportion of planned vascular access and arteriovenous fistula at the initiation of hemodialysis is still our current goal.

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Arteriovenous Fistula Stenosis: A Case Report

Heart Science Journal ◽

10.21776/ub.hsj.2021.002.02.8 ◽

2021 ◽

Vol 2 (2) ◽

pp. 34-39

Author(s):

Seprian Widasmara ◽

Novi Kurnianingsih ◽

Sasmojo Widito ◽

Ardian Rizal

Keyword(s):

Quality Of Life ◽

Case Report ◽

Arteriovenous Fistula ◽

Vascular Access ◽

Hemodialysis Access ◽

Percutaneous Approach ◽

Hemodialysis Vascular Access ◽

Anastomosis Site ◽

Arteriovenous Fistula Stenosis

Background: Arteriovenous fistula (AVF) has better rate of patency and lower rate of complication compared to other vascular access for hemodialysis. One priority to be concerned is access failure for hemodialysis access is common findings and correspond with high healthcare cost, morbidity and mortality. Objective: This case report aimed to elaborate the proper management of patient with arterio fistula stenosis. Case Illustration: A man, 64 years old, stage V CKD with AVF in his left arm for hemodialysis access was admitted to our hospital due to difficulty in cannulation during his last hemodialysis. He had AVF For Hemodialysis access for two years. About 1 month before, he undergone surgery for creation of AVF for hemodialysis access in his right arm, but AVF was failed to reach maturation. Based on vascular doppler ultrasound (DUS) done in AVF of the left arm revealed there was stenosis in the juxta-anastomosis site and cephalic venous stenosis. Angioplasty was done in anastomose AVF and implantation of venous stent in the left cephalic vein. Conclusion: For patients on hemodialysis, vascular access is considered as the lifeline. Complications related to Vascular access is associated with morbidity and reduced quality of life. Surgery often difficult to do as readily as a percutaneous approach. In more than 80% of hemodialysis access underwent percutaneous interventions, flow was successfully restored. Based on this success rate, it has replaced surgical revision as the treatment of stenosis AVF.

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