A systematic follow-up protocol achieving a low hemodialysis graft thrombosis rate

2019 ◽  
Vol 20 (6) ◽  
pp. 683-690
Author(s):  
Pilar Caro Acevedo ◽  
Rosa Marchante ◽  
Israel J Thuissard ◽  
David Sanz-Rosa ◽  
Raquel Amann ◽  
...  
Keyword(s):  
Early Diagnosis ◽  
Vascular Access ◽  
Venous Pressure ◽  
Graft Patency ◽  
Secondary Patency ◽  
Graft Thrombosis ◽  
Significant Stenosis ◽  
Monitoring And Surveillance ◽  
Thrombosis Rate

Introduction: Graft is an alternative to native arteriovenous fistula to ensure permanent vascular access in hemodialysis patients. The most common complication is significant stenosis, which frequently causes thrombosis and graft loss. Periodic monitoring and surveillance with elective correction of stenotic lesions can prolong graft survival. Objective: To describe the effect of early diagnosis of significant stenosis on the rate of thrombosis and graft patency. Methods: Retrospective, observational study of a cohort of 86 prevalent patients undergoing hemodialysis with a graft as their vascular access. We applied a systematic follow-up protocol of 115 grafts based on various screening methods of monitoring (clinical monitoring, pre-pump arterial pressure, dynamic venous pressure, percentage of recirculation, and dose of dialysis) in conjunction with surveillance (normalized intra-access venous pressure and access flow). The annual rates of thrombosis, and primary, primary-assisted, and secondary patency were assessed. Results: The incidence of significant stenosis and thrombosis was 57.4% (65/115) and 39.0% (45/115), respectively. Of all screening procedures, normalized intra-access venous pressure was the best predictor of significant stenosis (hazards ratio, 7.71; 95% confidence interval, 3.06–19.46). The annual rate of thrombosis fluctuated from 0 to 0.26 thromboses/patient/year, with an average rate of 0.14 thromboses/patient/year. Primary, primary-assisted, and secondary patency were 74%/79%/82%, 50%/60%/66%, and 23%/35%/37% at 1, 2, and 5 years, respectively. Conclusion: The implementation of a systematic graft follow-up protocol combined with monitoring and surveillance enabled early diagnosis and elective correction of significant stenosis, prolonged graft patency, and a low thrombosis rate.

MILLER Banding Procedure for Treatment of Dialysis Access–Related Steal Syndrome, Pulmonary Hypertension, and Heart Failure

2021 ◽  
pp. 000313482110562
Author(s):  
Ahmad Alqassieh ◽  
Patrick B. Dennis ◽  
Veena Mehta ◽  
June Shi ◽  
Angello Lin ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Vascular Access ◽  
Primary Patency ◽  
Secondary Patency ◽  
Dialysis Access ◽  
Long Term Follow Up ◽  
Steal Syndrome

A Minimally Invasive Limited Ligation Endoluminal-assisted Revision (MILLER) banding procedure has been used for treating patients with dialysis access–related steal syndrome (DASS) and high-flow vascular access–related pulmonary hypertension (PHT) and heart failure (HF). We performed a retrospective analysis of patients undergoing the MILLER procedure performed for DASS, HF, and PHT from our Vascular Access Database from September 2017 to October 2019. Outcomes included primary patency of banding, primary assisted patency, and secondary patency, using time-to-event analyses with Kaplan-Meier curves and life tables to estimate 6- and 12-month rates. A total of 13 patients (6 men and 7 women, mean age 60 ± 14 years) underwent the MILLER procedure, 6 patients for DASS and 7 patients for pulmonary hypertension and heart failure (PHT/HF). Technical success was achieved in all patients. The longest duration of follow-up was 28 months (median 12 months [IQR 7, 19]). One patient died at 1 month after the intervention due to stroke. One patient developed access thrombosis of the graft 3 days after the procedure. Repeat banding was required in 1 patient 8 months after the first procedure. The 6-month primary patency rate of banding following this procedure was 83% while the 12-month rate was 66%. The 6- and 12-month secondary patency rates were 87% and 75%, respectively. The MILLER procedure can be performed for DASS and PHT/HF with improvement of symptoms and good long-term patency rates. Additional interventions to maintain patency and efficacy are required on long-term follow-up.

P1339ARTERIOVENOUS FISTULA AND BASILIC VEIN TRANSPOSITION IN ELDERLY PATIENTS ON HEMODIALYSIS: AN OBSERVATIONAL STUDY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Vinant Bhargava ◽  
Priti Meena ◽  
Ambrish Satwik ◽  
Apurv Srivastava ◽  
A K Bhalla ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Vascular Access ◽  
Elderly Population ◽  
The Elderly ◽  
Primary Patency ◽  
New Delhi ◽  
Secondary Patency ◽  
Basilic Vein ◽  
The Mean

Abstract Background and Aims With the increase in the line expectancy of chronic kidney disease in the older population (>60 years), the numbers requiring haemodialysis is progressively rising. The elderly population may be different from the younger in terms of non-suitable vessels for access creation, non-maturation, and vascular calcifications, and this may alter the outcomes of use of arteriovenous fistula (AVF). This study was conducted to analyse the outcomes of AVF in elderly patients (>60 years). Method Retrospective study was conducted in the Department of Nephrology at Sir Ganga Ram Hospital, New Delhi. Patients of more than 60 years of age in whom AVF was created from 1st January 2012 to 31st December 2016 were included in the study. Follow-up data of 3.5 years was analysed. The primary endpoint was to assess primary and secondary patency rates. Results A total of 300 patients were included in the study. The mean age was 63.8 years. Radiocephalic AVF (RCAVF) was the most common site of [69.8% (n = 210)], followed by brachiocephalic (BCAVF) in 25.2% (n = 75) and basilic vein transposition (BVT) in 5% (n = 15). At 12 months, overall survival of the AVF was 66.8%. At 42 months, the primary patency rate of RCAVF, BCAVF, and BVT was 50.6%, 52.6%, and 50.4% respectively. The commonest cause of access failure was thrombosis (20.4%) followed by non-maturation (9%). Vascular access abandonment was found least in BCAVF. Conclusion AVF remains the preferred vascular access for haemodialysis in the elderly population. Brachiocephalic AVF has higher primary and secondary patency rates. Thrombosis and failure of maturation are major concerns in the elderly AVF.

P1358THE MONITORING OF FIRST LEVEL IN DIAGNOSIS OF COMPLICATION OF VASCULAR ACCESS: MULTICENTRIC STUDY ON 900 HEMODIALIZED PATIENTS WITH FOLLOW UP TO 5 YEARS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Ersilia Satta ◽  
Carmine Romano ◽  
Carmelo Alfarone ◽  
Sandro Gentile ◽  
Domenico Russo
Keyword(s):  
Vascular Access ◽  
Health Care Professionals ◽  
Venous Pressure ◽  
Duplex Ultrasound ◽  
Patient Characteristics ◽  
Multicentric Study ◽  
Flow Monitoring ◽  
The Status

Abstract Background and Aims Vascular Access (VA) is the lifeline of hemodialysis patient. The universal goal of access monitoring is to identify access stenosis and enable intervention prior to thrombosis; thereby, maximizing access longevity and minimizing morbidity. The advent and use of techniques including dynamic and static venous pressure monitoring, physical examination, access flow measurement, imagining and combined imaging and flow monitoring by duplex ultrasound demonstrate that it is possible to predict which accesses are at high risk for future thrombosis. Currently arteriovenous fistula (AVF) and arteriovenous graft (AVF) have been recognized as the permanent access. This study takes advantage of the opportunity to utilize data from 19 associated Dialysis Clinics to examine trends in VA use, trends in patient characteristics and practice associated with VA. Determine the status quo of the overall information related to the VA to start a five years follow up study with the aims to reduce VA complications 8stenosis and thrombosis) and related hospitalization days to improve patient’s quality of life. Method VA data were collected for each patient at study entry. Practice pattern data from the facility medical director, nurse manager and VA surgeon were also analyzed. We have developed a mask on the management database to implement the first level monitoring of access and collected data at each treatment (Fig.1) Results Average age of 801 patients enrolled was 73,5 years. Native AVF was used by 79%, AVG by 2% and CVC by 19%. As the age increase as well as he use of CVC move from 6% (15-39(years) to 50,5% in patients with more than 85 years. Most frequent complications were: Thrombosis 16,5 %, Infectios 5,5%. Related VA hospitalization days are 28,7 % of total days. Average dialysis goals achieved were: QB 290 ml/Min; blood processed 69,7 L; KT/V:1,35. Conclusion By interpreting collecting data for specific performance measures using accurate reports allow health care professionals to highlight the VA performance/inefficiences and provide correct information to the clinical staff to support them in their daily clinical practice and decision making.

scholarly journals Standardized Protocol for Hemodialysis Vascular Access Assessment: The Role of Ultrasound and ColorDoppler

2018 ◽  
Vol 45 (1-3) ◽  
pp. 260-269 ◽  
Author(s):  
Federico Nalesso ◽  
Francesco Garzotto ◽  
Ilaria Petrucci ◽  
Sara Samoni ◽  
Grazia Maria Virzì ◽  
...  
Keyword(s):  
Early Diagnosis ◽  
Vascular Access ◽  
Hemodynamic Parameters ◽  
Non Invasive ◽  
Standardized Protocol ◽  
Hemodialysis Vascular Access ◽  
Simple Step ◽  
Artery Flow

Introduction: Ultrasound and colorDoppler technique, which is relatively inexpensive, rapid, non-invasive and repeatable is a powerful tool used for early diagnosis of vascular access (VA) complications in hemodialysis patients. To date a standard and widely comprehensible echocolorDoppler (ECD) protocol is not available. Materials and Methods: A simple step-by-step protocol based on anatomical and hemodynamic parameters of VA has been developed during a 3-years VA ECD follow-up. It consists of an ECD study scheme. The algorithm created involves the calculation of brachial artery flow, description of artero-venous and/or graft-vascular anastomosis and efferent vessel and/or graft. Results: The algorithm allows to formulate a medical report that takes into account both anatomic and hemodynamic parameters of the VA. Reduction of complications and the prevention of chronic complications as well as the early detection of acute problems were achieved. Discussion and Conclusion: The creation of a step-by-step protocol may simplify the multidisciplinary management of VA, its monitoring and the early diagnosis of its complications.

Endovascular bypass for salvage of vascular access in hemodialysis catheter-consigned patients

2018 ◽  
Vol 19 (6) ◽  
pp. 585-592 ◽  
Author(s):  
Matt Chiung-Yu Chen ◽  
Mei-Jui Weng ◽  
Huei-Lung Liang
Keyword(s):  
Vascular Access ◽  
Clinical Success ◽  
Primary Patency ◽  
Secondary Patency ◽  
Success Rates ◽  
Access Site ◽  
Hemodialysis Catheter ◽  
Kaplan Meier ◽  
The Mean

Purpose: This study was performed to retrospectively assess the efficacy of percutaneous creation of an intervascular bypass with or without stent graft deployment (endovascular bypass) for salvage of abandoned vascular access sites in hemodialysis catheter-consigned patients. Methods: Salvage of abandoned vascular access sites was attempted in 16 patients with hemodialysis catheters. These vascular access sites were salvaged using endovascular bypass techniques to redirect the access flow to a nonarterialized vein as a new outflow conduit or cannulation segment. The postintervention primary, assisted primary, and secondary patency rates of the access site and bypass were calculated using the Kaplan–Meier method. Results: The procedural and clinical success rates were both 100%. The postintervention primary patency rate of the bypass and access site at 360 days was 75.7 ± 12.5% and 56.8 ± 14.9%, respectively. The mean follow-up period was 461.9 days (range: 121–900 days). No major complications were observed. One bare bypass tunnel rupture and one pseudoaneurysm were noted during the procedure. Conclusion: Salvage of abandoned vascular access sites for hemodialysis catheter-consigned patients can be technically feasible and clinically successful using endovascular bypass techniques in selected patients when surgical revision is not considered or is not possible.

scholarly journals Hemodialysis vascular access in children – A retrospective study in a pediatric dialysis unit

2021 ◽  
Vol 35 (3) ◽  
Author(s):  
Gabriela Teixeira ◽  
◽  
Paulo Almeida ◽  
Norton Matos ◽  
Maria Faria ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Vascular Access ◽  
Failure Time ◽  
Venous Catheter ◽  
Maintenance Hemodialysis ◽  
Secondary Patency ◽  
Central Venous ◽  
Dialysis Unit

Objective: Permanent access in the form of a fistula is the preferred form of vascular access for most pediatric patients on maintenance hemodialysis (HD) therapy; however, the technical aspects of the procedure that are unique to the pediatric population, the expectation of a short waiting time for kidney transplantation and the need to cannulate every other day (with the pain and fear associated with it) limit its use. Our objective was to analyze the long-term outcomes of pediatric arteriovenous fistulas in our institution. Methods: A retrospective review was performed of all arteriovenous fistula (AVF) created in a HD population aged 0 to 18 years at a single institution from 2007 to 2019. Data abstracted included age, weight, etiology of renal failure, time on dialysis, central venous catheter history and transplantation history. Data were analyzed to determine the primary and secondary patency. Results: During the study period, 19 AVFs were performed in 16 patients, of whom 9 patients (56.3%) were male. Mean patient age was 12.3 years (range 5-17 years), and mean weight was 38.3kg (range 12-83kg). At the time of AVF creation, 9 patients were on dialysis and 7 patients had a central venous catheter (CVC), with a median length of CVC dependence of 10 months. Procedures performed included 4 radiocephalic fistulas, 11 brachiocephalic fistulas and 4 brachiobasilic. Five accesses failed to mature (26.3%). Mean follow-up was 6 years. The 2-year primary and secondary patency rates were 92.3% and 100%, respectively. The 4-year primary and secondary patency rates were 76.9% and 100%, respectively. No thrombosis was documented during follow-up. During the postoperative period, 10 patients (62.5%) received a kidney transplant, in a mean time of 23 months. Conclusions: AVFs demonstrate excellent long-term patency in pediatric HD patients. No significant complications were reported and no thrombosis occurred.

Determinants of haemodialysis access survival

VASA ◽  
2010 ◽  
Vol 39 (2) ◽  
pp. 133-139 ◽  
Author(s):  
Diehm ◽  
van den Berg ◽  
Schnyder ◽  
Bühler ◽  
Willenberg ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Vascular Access ◽  
Female Gender ◽  
Secondary Patency ◽  
Patients With Diabetes ◽  
Potential Risk Factors ◽  
Surgical Data ◽  
Male Patients ◽  
Repeated Revascularization

Background: Vascular access patency is of vital importance for patients requiring haemodialysis. This analysis validates potential risk factors and benefits in patients undergoing vascular access procedures. Patients and methods: Vascular access procedures performed over a two-year period were retrospectively analysed. Clinical data and concomitant medication were retrieved from files as were surgical data following a standardized data capture sheet. Outcome parameters were primary (PP) and secondary patency (SP) as well as freedom from repeated revascularization. Minimal follow-up with functioning access was 679 days. Results: During the observation period, 244 patients (mean age 62.2 ± 0.9 years, 60.7 % male patients, 36.1 % pre-emptive, 31.1 % late referral) underwent vascular accesses procedures. PP and SP were 35.6 % and 45.6 %, respectively, at 540 days. Presence of diabetes mellitus was associated with decreased PP (OR: 0.6, 95 %-CI: 0.3 - 1.0) and SP (OR: 0.4, 95 %-CI: 0.2 - 0.7), whereas female gender was associated with lower SP (OR: 0.6, 95 %-CI: 0.3 - 0.9) and freedom from repeated revascularization rates (OR: 0.6, 95 %-CI: 0.3 - 1.0). In contrast, presence of hyperparathyreoidism was associated with higher SP (OR: 1.7, 95 %-CI: 1.0 - 3.0) and freedom from repeated revascularization (OR: 1.7, 95 %-CI: 1.0 - 3.0) rates. Conclusions: Haemodialysis access performs worst in patients with diabetes mellitus and in women. The benefit of hyperparathyroidism should be interpreted as hypothesis generating.

scholarly journals Comprehensive Comparison of the Performance of Autogenous Brachial-Basilic Transposition Arteriovenous Fistula and Prosthetic Forearm Loop Arteriovenous Graft in a Multiethnic Asian Hemodialysis Population

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Koy Min Chue ◽  
Kyi Zin Thant ◽  
Hai Dong Luo ◽  
Yu Hang Rodney Soh ◽  
Pei Ho
Keyword(s):  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Secondary Patency ◽  
Arteriovenous Graft ◽  
Central Venous ◽  
Maturation Time ◽  
Limited Life Expectancy ◽  
Limited Life ◽  
Comprehensive Comparison

Aim.For patients who have exhausted cephalic vein arteriovenous fistula (AVF) options, controversy exists on whether brachial-basilic AVF with transposition (BBTAVF) or a forearm arteriovenous graft (AVG) should be the next vascular access of choice. This study compared the outcomes of these two modalities.Methods.A retrospective study of 122 Asian multiethnic patients who underwent either a BBTAVF (81) or an AVG (41). Maturation time and intervention rates were analyzed. Functional primary, secondary, and overall patency rates were evaluated.Results.The maturation time for BBTAVFs was significantly longer than AVGs. There was also a longer deliberation time before surgeons abandon a failing BBTAVF compared to an AVG. Both functional primary and secondary patency rates were significantly higher in the BBTAVF group at 1-year follow-up: 73.2% versus 34.1% (p<0.001) and 71.8% versus 54.3% (p=0.022), respectively. AVGs also required more interventions to maintain patency. When maturation rates were considered, the overall patency of AVGs was initially superior in the first 25 weeks after creation and then became inferior afterwards.Conclusion.BBTAVFs had superior primary and functional patency and required less salvage interventions. The forearm AVG might have a role in patients who require early vascular access due to complications from central venous catheters or with limited life expectancy.

Dialysis arteriovenous access monitoring and surveillance according to the 2017 Spanish Guidelines

2018 ◽  
Vol 19 (5) ◽  
pp. 422-429 ◽  
Author(s):  
Ramon Roca-Tey ◽  
José Ibeas ◽  
Teresa Moreno ◽  
Enrique Gruss ◽  
José Luis Merino ◽  
...  
Keyword(s):  
Vascular Access ◽  
Current Evidence ◽  
Screening Methods ◽  
Significant Stenosis ◽  
Arteriovenous Fistulas ◽  
Arteriovenous Access ◽  
Monitoring And Surveillance ◽  
Multidisciplinary Group ◽  
Reduced Risk

The Spanish Multidisciplinary Group on Vascular Access (GEMAV), which includes experts from the five scientific societies involved (nephrology (S.E.N.), vascular surgery (SEACV), interventional radiology (SERAM-SERVEI), infectious diseases (SEIMC), and nephrology nursing (SEDEN)), along with the methodological support of the Iberoamerican Cochrane Centre, has developed the Spanish Clinical Guidelines on Vascular Access for Hemodialysis. This article summarizes the main issues from the guideline’s chapter entitled “Monitoring and surveillance of arteriovenous access.” We will analyze the current evidence on conflicting topics such as the value of the flow-based screening methods for the arteriovenous access surveillance or the role of Doppler ultrasound as the imaging exploration to confirm suspected stenosis. In addition, the concept of significant stenosis and the criteria to perform the elective intervention for stenosis were reviewed. The adoption of these guidelines will hopefully translate into a reduced risk of thrombosis and increased patency rates for both arteriovenous fistulas and grafts.

scholarly journals Plasma Total Homocysteine and Hemodialysis Access Thrombosis

1999 ◽  
Vol 10 (5) ◽  
pp. 1095-1099
Author(s):  
DOUGLAS SHEMIN ◽  
KATE L. LAPANE ◽  
LINDA BAUSSERMAN ◽  
ELIAS KANAAN ◽  
SEWELL KAHN ◽  
...  
Keyword(s):  
Vascular Access ◽  
Proportional Hazards ◽  
Controlled Trial ◽  
Hemodialysis Access ◽  
Graft Thrombosis ◽  
Thcy Level ◽  
Increased Risk ◽  
Total Homocysteine ◽  
Plasma Total Homocysteine

Abstract. Mild hyperhomocysteinemia, a putative risk factor for atherothrombotic cardiovascular disease morbidity and mortality, may contribute to the excess incidence of atherothrombotic outcomes in the dialysis-dependent end-stage renal disease population. Hemodialysis access (fistula or graft) thrombosis is an unfortunately common and costly morbidity in this patient population. In this study, using a prospective design, the potential relationship between baseline nonfasting, predialysis plasma total homocysteine (tHcy) levels and vascular access-related morbidity was examined in a cohort of 84 hemodialysis patients with a fistula or prosthetic graft as their primary hemodialysis access. Vascular access thrombotic episodes were recorded over a subsequent 18-mo follow-up period. Forty-seven patients (56% of the total) had at least one access thrombosis during the 18-mo follow-up period (median follow-up, 13 mo; rate, 0.6 events per patient-year of follow-up). Proportional hazards modeling revealed that each 1 μM/L increase in the tHcy level was associated with a 4.0% increase in the risk of access thrombosis (95% confidence interval, 1.0 to 6.0%, P = 0.008). This association persisted after adjustment for type of access (fistula versus graft), age, gender, time on dialysis, diabetes, smoking, hypertension, nutritional status, urea reduction ratio, dyslipidemia, and the presence of previous vascular disease. Elevated tHcy levels appear to confer a graded, independent increased risk for hemodialysis access thrombosis. A randomized, controlled trial examining the effect of tHcy-lowering intervention on hemodialysis access thrombosis appears to be justified.

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