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.

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

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.

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.

American Association of Kidney Patients survey of patient preferences for hemodialysis vascular access

2019 ◽  
Vol 21 (2) ◽  
pp. 230-236
Author(s):  
Saravanan Balamuthusamy ◽  
Larry E Miller ◽  
Diana Clynes ◽  
Erin Kahle ◽  
Richard A Knight ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Renal Disease ◽  
Arteriovenous Fistula ◽  
Vascular Access ◽  
End Stage Renal Disease ◽  
American Association ◽  
Venous Catheter ◽  
Central Venous ◽  
Stage Renal Disease ◽  
End Stage

Objectives: To determine the vascular access modalities used for hemodialysis, the reasons for choosing them, and determinants of satisfaction with vascular access among patients with end-stage renal disease. Methods: The American Association of Kidney Patients Center for Patient Research and Education used the American Association of Kidney Patients patient engagement database to identify eligible adult hemodialysis patients. Participants completed an online survey consisting of 34 demographic, medical history, and hemodialysis history questions to determine which vascular access modalities were preferred and the reasons for these preferences. Results: Among 150 respondents (mean age 54 years, 53% females), hemodialysis was most frequently initiated with central venous catheter (64%) while the most common currently used vascular access was arteriovenous fistula (66%). Most (86%) patients previously received an arteriovenous fistula, among whom 77% currently used the arteriovenous fistula for vascular access. Older patients and males were more likely to initiate hemodialysis with an arteriovenous fistula. The factors most frequently reported as important in influencing the selection of vascular access modality included infection risk (87%), physician recommendation (84%), vascular access durability (78%), risk of complications involving surgery (76%), and impact on daily activities (73%); these factors were influenced by patient age, sex, and race. Satisfaction with current vascular access was 90% with arteriovenous fistula, 79% with arteriovenous graft, and 67% with central venous catheter. Conclusion: Most end-stage renal disease patients continue to initiate hemodialysis with central venous catheter despite being associated with the lowest satisfaction rates. While arteriovenous fistula was associated with the highest satisfaction rate, there are significant barriers to adoption that vary based on patient demographics and perception of procedure invasiveness.

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 Clinical aspects and Outcome of Vascular Access Surgery in End stage Renal Disease

2019 ◽  
Vol 6 (9) ◽  
pp. 1-18
Author(s):  
RAVDEEP SINGH SOHAL ◽  
Nagi Gagandeep Singh ◽  
Keishing Chuimei ◽  
Pushkarna Amit ◽  
Singh CP ◽  
...  
Keyword(s):  
Renal Disease ◽  
Vascular Access ◽  
End Stage Renal Disease ◽  
Clinical Aspects ◽  
Vascular Access Surgery ◽  
Stage Renal Disease ◽  
End Stage ◽  
Access Surgery

scholarly journals Arteriovenous fistula as the vascular access contributes to better survival of hemodialysis patients with COVID-19 infection

2021 ◽  
pp. 112972982110212
Author(s):  
Ahmet Murt ◽  
Serap Yadigar ◽  
Serkan Feyyaz Yalin ◽  
Mevlut Tamer Dincer ◽  
Ergun Parmaksiz ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Vascular Access ◽  
High Mortality ◽  
End Stage Renal Disease ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Stage Renal Disease ◽  
End Stage ◽  
Near Future

Background: While COVID-19 in chronic hemodialysis patients has high mortality and the pandemic will not end in the near future, effective follow up strategies should be implemented for these patients. Surgeries have been triaged according to their level of urgencies and arteriovenous fistula (AVF) operations were among elective surgeries. This study aimed to analyze the effect of vascular access on the outcomes of hemodialysis patients who had COVID-19. Methods: One hundred four hemodialysis patients who had COVID-19 were retrospectively analyzed. Seventy-two of them had AVF as the vascular access while 32 of them had tunneled catheters. Inflammatory markers and outcomes of patients with AVFs and catheters were compared. A logistic regression analysis was performed in order to define factors that contribute to better outcomes in hemodialysis patients. Results: COVID-19 had high mortality rate in hemodialysis patients (36.5%). Patients with catheters have higher peak ferritin levels ( p = 0.02) and longer hospital stay ( p = 0.00). Having AVF as the vascular access (OR = 3.36; 95% CI: 1.05–10.72; p = 0.041) and using medium cut-off dialyzers (OR = 7.99; 95% CI: 1.53–41.65; p = 0.014) were related to higher survival of the patients. COVID severity was inversely proportional to the survival ( p = 0.000) Conclusions: AVFs contribute to higher survival of hemodialysis patients with COVID-19. Even in the pandemic era, end stage renal disease patients should be given the opportunity to have their vascular access properly created.

scholarly journals Formation of Abnormal Fistula on Arteriovenous Fistula in a Patient with Buttonhole Cannulation: A Case Report

2015 ◽  
Vol 5 (1) ◽  
pp. 71-76 ◽  
Author(s):  
Wen Cao ◽  
Lin Chen ◽  
Mei Shi ◽  
Li Zhou ◽  
Ping Fu
Keyword(s):  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Maintenance Hemodialysis ◽  
Aneurysmal Dilatation ◽  
Left Wrist ◽  
Cannulation Technique ◽  
Monitoring And Surveillance ◽  
Stage Renal Disease ◽  
End Stage

Buttonhole cannulation has been suggested as a technique that may lead to a reduction in many complications when compared with other techniques such as rope-ladder cannulation. Despite all above, some complications still continue, which may lead to a dysfunction of the arteriovenous fistula (AVF) and inadequate dialysis, having an impact on the quality of life of the patients or eventually making the vascular access unusable. We report a 47-year-old Chinese male with end-stage renal disease who had maintenance hemodialysis three times a week for 5 years. The AVF on the left wrist was operated 5 years ago and proved to be functionally effective with some monitoring and surveillance measures in the fourth year of hemodialysis. Two months later, the buttonhole cannulation technique was applied due to fistula punctuation difficulty by previous aneurysmal dilatation. After 10 times of buttonhole cannulation, the edema on the left forearm of the patient indicated a dysfunction of the AVF. This was further confirmed by the HD02 hemodialysis monitor and a vascular ultrasound, revealing a recirculation of 87%, an abnormal fistula between the AVF and the vein together with thrombus, and aneurysmal dilatation near the anastomosis. The site of cannulation was changed to avoid heavy recirculation (reduced to 25%), and a new AVF on the left wrist was successfully operated. Abnormal fistula on the AVF and vein during buttonhole cannulation is rarely reported, which reminds us that vascular access surveillance should be done regularly before and during the process of construction to find a possible dysfunction of the AVF in patients undergoing buttonhole cannulation.

scholarly journals A three years’ experience of Arteriovenous Fistula (AVF) cases in a tertiary care hospital of East Java, Indonesia: a descriptive observational study

2021 ◽  
Vol 1 (2) ◽  
pp. 24-27
Author(s):  
Rafaela Andira Ledyastatin ◽  
Caesario Tri Prasetyo ◽  
Gold Sunday Palm Tampubolon ◽  
Dhihintia Jiwangga
Keyword(s):  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Tertiary Care Hospital ◽  
Local Population ◽  
Tertiary Care ◽  
Underlying Disease ◽  
Care Hospital ◽  
Arteriovenous Fistulas ◽  
Stage Renal Disease ◽  
End Stage

Introduction: The incidence of end-stage renal disease (ESRD) globally is 700 million people approximately. Patients with ESRD need vascular access for hemodialysis as renal replacement therapy (RRT). Among hemodialysis access, arteriovenous fistula is considered as the most preferred form of vascular access due to its characteristics. This study aimed to to present a descriptive characteristic of arteriovenous fistula creation cases in a tertiary care hospital with a specific view of demographic parameters, fistulas' sites, type of fistulas. Methods: We conducted a descriptive study of single-center in the Department of Thoracic, Cardiac and Vascular Surgery of Dr. Soetomo Academic General Hospital Surabaya, collected data from January 1st, 2017 to December 31st, 2020. All patients who undergo arteriovenous fistula creation considered as a subject in this study. We retrieved the characteristics of the patients, the type of fistula, the site, surgical technique, and underlying disease from patients’ electronic medical data records. Results: A total of 167 patients requiring long-term hemodialysis in our center. Females were dominantly in our study with 56.9% (95). Most of AVFs were created on the left arm. Radiocephalic type of AVF was the most common arteriovenous fistula type found in 111 subjects (66.5%). The highest postoperative successful rate was found in brachiocephalic type in 78.8%, followed by radiocephalic AVF type with 66.7%. The wrist region was favorable in subjects (43.1%). Conclusions: Arteriovenous fistulas for hemodialysis are needed and in our center. Radiocephalic AVFs are the most common type. Further study to learn the different aspects of arteriovenous fistula cases is needed to fulfill queries in the local population.

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

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.

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.

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