Vascular access for home haemodialysis

2018 ◽  
Vol 19 (6) ◽  
pp. 593-595 ◽  
Author(s):  
Julien Al Shakarchi ◽  
C Day ◽  
N Inston
Keyword(s):  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Hospital Admissions ◽  
University Hospital ◽  
Arteriovenous Graft ◽  
Dialysis Catheter ◽  
Home Haemodialysis ◽  
Admission Rates ◽  
Arteriovenous Fistulas ◽  
Hospital Access

Introduction: Home haemodialysis has been advocated due to improved quality of life. However, there are very little data on the optimum vascular access for it. Method: A retrospective cohort study was carried on all patients who initiated home haemodialysis between 2011 and 2016 at a large university hospital. Access-related hospital admissions and interventions were used as primary outcome measures. Results: Our cohort consisted of 74 patients. On initiation of home haemodialysis, 62 individuals were using an arteriovenous fistula as vascular access, while the remaining were on a tunnelled dialysis catheter. Of the 12 patients who started on a tunnelled dialysis catheter, 5 were subsequently converted to either an arteriovenous fistula ( n = 4) or an arteriovenous graft ( n = 1). During the period of home haemodialysis use, four arteriovenous fistula failed or thrombosed with patients continuing on home haemodialysis using an arteriovenous graft ( n = 3) or a tunnelled dialysis catheter ( n = 1). To maintain uninterrupted home haemodialysis, interventional rates were 0.32 per arteriovenous fistula/arteriovenous graft access-year and 0.4 per tunnelled dialysis catheter access-year. Hospital admission rates for patients on home haemodialysis were 0.33 per patient-year. Conclusion: Our study has shown that home haemodialysis can be safely and independently performed at home within a closely managed home haemodialysis programme. The authors also advocate the use of arteriovenous fistulas for this cohort of patients due to both low complication and intervention rates.

scholarly journals Patients started on hemodialysis with tunneled dialysis catheter have similar survival after arteriovenous fistula and arteriovenous graft creation

2015 ◽  
Vol 62 (6) ◽  
pp. 1590-1597.e2 ◽  
Author(s):  
Theodore H. Yuo ◽  
Rabih A. Chaer ◽  
Ellen D. Dillavou ◽  
Steven A. Leers ◽  
Michel S. Makaroun
Keyword(s):  
Arteriovenous Fistula ◽  
Arteriovenous Graft ◽  
Dialysis Catheter ◽  
Similar Survival

Catheter-related obstruction of the right brachiocephalic vein following hemodialysis in a patient with lupus nephritis

2020 ◽  
pp. 112972982092608
Author(s):  
Mitsutoshi Shindo ◽  
Kenichi Oguchi ◽  
Chihiro Kimikawa ◽  
Kiyonori Ito ◽  
Jyunki Morino ◽  
...  
Keyword(s):  
Lupus Nephritis ◽  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Brachiocephalic Vein ◽  
Central Vein ◽  
Axillary Vein ◽  
Arteriovenous Graft ◽  
Complete Obstruction ◽  
Hemodialysis Catheter ◽  
The Right

Vascular access is necessary for hemodialysis, and in some cases where it is difficult to establish an arteriovenous fistula or arteriovenous graft, a permanent hemodialysis catheter may be used. However, serious catheter-related complications, such as central vein stenosis or thrombosis, can occur. We herein present a case of complete brachiocephalic vein obstruction in a patient with lupus nephritis receiving hemodialysis using a tunneled hemodialysis catheter. A 64-year-old patient underwent maintenance hemodialysis while taking an anticoagulant, with a tunneled hemodialysis catheter in the right internal jugular vein, because of arteriovenous fistula failure when hemodialysis was introduced. However, the catheter was removed because of a catheter-related bloodstream infection. Following the administration of antibiotics, an arteriovenous graft was implanted between the brachial artery and axillary vein in the right arm. Surprisingly, arteriovenous graft failure and complete obstruction of the right brachiocephalic vein were observed 3 days after arteriovenous graft creation. In conclusion, we report the case of tunneled hemodialysis catheter-related complete obstruction of the right brachiocephalic vein in a lupus nephritis patient undergoing hemodialysis. Clinicians should be aware of this potential complication when tunneled hemodialysis catheters are used and consider the next vascular access type before a tunneled hemodialysis catheter has been indwelled for the long term.

Managing anxiety during arteriovenous fistula or arteriovenous graft needling

2019 ◽  
Vol 4 (4) ◽  
pp. 205-210
Author(s):  
Lynsey Stronach ◽  
Simone Friedl ◽  
Carmen Barton ◽  
Cora Lahart ◽  
Yvie Morley
Keyword(s):  
Young Adults ◽  
Young People ◽  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Arteriovenous Graft ◽  
Children And Young People ◽  
Children And Young Adults

Vascular access is crucial for haemodialysis, but cannulation of an arteriovenous fistula can be anxiety-provoking for patients, particularly children and young people. This article outlines the management and treatment of needle-related anxiety and pain for children and young adults

Aneurysm of Arteriovenous Fistula in Uremic Patients: Is Endograft a Viable Therapeutic Approach?

2002 ◽  
Vol 3 (2) ◽  
pp. 85-88 ◽  
Author(s):  
P.M. Allaria ◽  
E. Costantini ◽  
A. Lucatello ◽  
E. Gandini ◽  
F. Caligara ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Venous Catheter ◽  
Good Alternative ◽  
Central Venous ◽  
Arteriovenous Fistulas ◽  
Risk Of Rupture ◽  
Arterial Aneurysms ◽  
Percutaneous Insertion

One of the complications of arteriovenous fistulas in chronic hemodialyzed patients is the onset of an aneurysm which can be at risk of rupture. Traditional surgical repair is not always feasible and may not be successful in these cases, leading therefore to the loss of a functioning vascular access and requiring in any case the temporary use of a central venous catheter to allow regular hemodialysis sessions. We applied to this kind of aneurysm the same experience developed in the management of major arterial aneurysms and we considered endografting repair a good alternative in this case. In this paper we present the successful treatment of an arteriovenous fistula aneurysm using that technique. A distal radio-cephalic arteriovenous fistula in one of our patients presented an aneurysm with high risk of rupture. The endografting repair with percutaneous insertion of a Wallgraft™ endoprosthesis was well tolerated and the vascular access could be used the day after, without the need for a central venous catheter insertion.

Comparison of Outcomes with Arteriovenous Fistula and Arteriovenous Graft for Vascular Access in Hemodialysis: A Prospective Cohort Study

2016 ◽  
Vol 43 (2) ◽  
pp. 120-128 ◽  
Author(s):  
Hoon Suk Park ◽  
Woo Jeong Kim ◽  
Yong Kyun Kim ◽  
Hyung Wook Kim ◽  
Bum Soon Choi ◽  
...  
Keyword(s):  
Life Expectancy ◽  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Prospective Cohort ◽  
Survival Benefit ◽  
Patient Survival ◽  
The Elderly ◽  
Arteriovenous Graft ◽  
Poor Patient ◽  
Poor Patient Survival

Background: Poor vessel quality and limited life expectancy in the elderly may make arteriovenous fistula (AVF) less ideal than arteriovenous graft (AVG) or catheter for vascular access (VA) in hemodialysis (HD). Methods: A total of 946 adult incident HD patients from clinical research center registry for end-stage renal disease prospective cohort in South Korea were analyzed for outcomes with AVF and AVG. Results: Overall, AVF was associated with better patient survival only in male (p < 0.001) and diabetic (p = 0.004) patients, although it was superior to AVG in access patency, regardless of diabetes mellitus status and gender. AVG (vs. AVF; hazard ratio (HR) 2.282; 95% CI 1.071-4.861; p = 0.032) was associated with poor patient survival. In elderly patients (≥65 years), AVF was associated with survival benefit only in male (p < 0.001) and diabetic (p = 0.04) patients, and with better access patency only in female (p = 0.05) and diabetic (p = 0.04) patients. AVG (vs. AVF; HR 3.158; 95% CI 1.080-9.238; p = 0.036) was associated with poor patient survival. In septuagenarian patients, AVF was associated only with survival benefit (p = 0.01) and there was no advantage in access patency (p = 0.12). However, AVF was superior to AVG in both access patency (p = 0.001) and patient survival (p = 0.03) even with propensity matching. Conclusion: AVF is the more desirable VA and its survival benefits warrant its consideration in septuagenarian patients although a prolonged life expectancy is essential to realize the potential benefits of AVF.

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.

Use of chronically occluded fistula to establish access outflow

2022 ◽  
pp. 112972982110470
Author(s):  
Amal Lagha ◽  
Alexandros Mallios
Keyword(s):  
Arteriovenous Fistula ◽  
Female Patient ◽  
Vascular Access ◽  
Arteriovenous Graft ◽  
Hemodialysis Access

Maintaining a good quality vascular access in the long term can become particularly challenging especially in patients that are on dialysis for many years and present with exhausted venous capital and chronic access related complications. We present a 60-year-old female patient with multiple bilateral previous failed accesses, a previous distal revascularization interval ligation (DRIL) for hemodialysis access induced distal ischemia (HAIDI). Her chronically (more than a month) occluded arteriovenous fistula AVF was used to establish outflow and create a functioning forearm arteriovenous graft (AVG).

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