Hemodialysis Reliable Outflow graft: A valid option in patients with central venous stenosis

2020 ◽  
Vol 21 (6) ◽  
pp. 1023-1028
Author(s):  
Ana Carolina Figueiredo ◽  
Filipe Mira ◽  
Luís Rodrigues ◽  
Emanuel Ferreira ◽  
Nuno Oliveira ◽  
...  
Keyword(s):  
Vascular Access ◽  
Venous Catheter ◽  
Iliac Vein ◽  
Lower Limbs ◽  
Implantation Technique ◽  
Central Venous ◽  
Vein Thrombosis ◽  
Central Venous Stenosis ◽  
Venous Stenosis ◽  
Outflow Graft

Introduction: Central venous stenosis can be the main obstacle to the creation of an autologous vascular access in the upper limbs. The Hemodialysis Reliable Outflow graft was developed to provide an upper limb vascular access option to such patients, avoiding alternative, less advantageous options, such as lower limb vascular accesses or central venous catheters. Its advantages include catheter avoidance and, in case of lower limbs accesses, reduction of the ischemic risk and iliac vein thrombosis, potentially compromising a future kidney transplant. Patients and methods: Revision of the clinical files of the four patients who were placed a Hemodialysis Reliable Outflow device in our Center, including demographic variables, implantation technique characteristics, surgical complications, episodes of infection and thrombosis of the access, and need to place a transitory central venous catheter to undergo hemodialysis treatment. Results: Four Hemodialysis Reliable Outflow grafts were placed, which resulted in a significant improvement in the dialysis efficacy in all patients, with a median raise in the Kt/V of 36.7%. Two cases needed thrombectomy, one of which was unsuccessful. The actual time of patency varies between 3 and 28 months. Conclusion: Our experience with the Hemodialysis Reliable Outflow device showed that it was a safe option for patients with central venous stenosis and was associated with good clinical and analytic outcomes.

Superficialization of dilated radial artery for vascular access: A case report

2021 ◽  
pp. 112972982110470
Author(s):  
Weijing Ge ◽  
Yaxue Shi ◽  
Sijie Liu ◽  
Xuedong Bao ◽  
Min Yu ◽  
...  
Keyword(s):  
Radial Artery ◽  
Vascular Access ◽  
Venous Catheter ◽  
Arterial System ◽  
Arterial Graft ◽  
Central Venous ◽  
Simple Method ◽  
Treatment Need ◽  
Complicated Case ◽  
Central Venous Stenosis

Successful hemodialysis treatment need a well functioning vascular access (VA) allowing two cannulation sites with enough blood flow have minimum adverse events. The expectations, age of the HD population are rising as well as the lack of conventional methods due to central venous exhaustion, we have to choose some complex access, including complex or tertiary vascular access mentioned in 2018 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS) and the option to abandon the venous circuit in instead of arterial system, including arterial-arterial graft and arterial superficialization. This article report a complicated case of AVF dysfunction, central venous stenosis due to central venous catheter and aortic dissection stent as well as lower extremity arteriosclerosis occlusion, using the simple method of superficialization of enlarged radial artery to maintain hemodialysis.

Subcutaneous Implantation of the LifeSite® Hemodialysis Access System in the Femoral Vein

2001 ◽  
Vol 2 (3) ◽  
pp. 91-96 ◽  
Author(s):  
J. Ross
Keyword(s):  
Vascular Access ◽  
Femoral Vein ◽  
Hemodialysis Access ◽  
Central Venous ◽  
Short Term ◽  
Access System ◽  
Central Venous Stenosis ◽  
Venous Stenosis ◽  
Clinical Trails ◽  
Initial Results

Cannulation of the femoral vein is often necessary to provide immediate vascular access for hemodialysis patients in whom a functional permanent access is not available or in patients who have exhausted other access options. Femoral placement of dialysis catheters is typically short term - days, not months - and is associated with high rates of infection, occlusion, recirculation and intervention as well as a high risk of catheter dislodgment. A new, fully subcutaneous vascular access device - the LifeSite®, Hemodialysis Access System (Vasca, Inc., Tewksbury, MA) - has demonstrated better safety and efficacy profiles than a standard tunneled dialysis catheter in clinical trails that evaluated placement within the thoracic veins. The case reported here extends the use of the LifeSite® System to femoral placement in a patient with multiple failed arteriovenous accesses and dialysis catheters subsequent to central venous stenosis. The LifeSite® System was successfully implanted in the patient's left femoral vein and has served the patient for 4 months with no infections or complications requiring intervention, delivering flow rates >400–450 ml/minute for high-flux, dual-needle hemodialysis. These initial results suggest that the LifeSite® Hemodialysis Access System represents a new, safe and effective vascular access option in patients with limited access choices due to failed access in the upper extremities, central venous stenosis, or other vascular inadequacies.

scholarly journals HeRO (Hemodialysis Reliable Outflow) graft alkalmazása tartós hemodialíziskezelés során

2019 ◽  
Vol 160 (31) ◽  
pp. 1231-1234
Author(s):  
Péter Legeza ◽  
Dávid Garbaisz ◽  
Zoltán Szeberin ◽  
Péter Sótonyi
Keyword(s):  
Vascular Access ◽  
Venous Catheter ◽  
Good Alternative ◽  
Venous Occlusion ◽  
Medical Documentation ◽  
Central Venous ◽  
Venous Grafts ◽  
Central Venous Occlusion ◽  
Graft Implantation ◽  
Outflow Graft

Abstract: Creating durable vascular access has become more complicated with the improvement of the management and with the increasing survival of patients with end-stage renal disease. HeRO (Hemodialysis Reliable Outflow) graft allows to maintain vascular access on the upper limb in patients with the presence of bilateral central venous occlusion. Our institute was the first in Hungary to perform a HeRO graft implantation in a patient receiving regular hemodialysis. Our objective was to present our findings with this recent innovation. Case report, medical documentation and imaging studies were reviewed. The patient (73-year-old, female) has been receiving hemodialysis since 12 years with the history of several arteriovenous fistula (AVF) creations, thrombectomies, use of central venous catheter in both sides. Following the occlusion of a left cubital arterio-venous fistula, none of the conventional vascular access types could have been performed due to bilateral subclavian vein occlusion. Successful HeRO graft implantation was performed. The patient underwent graft thrombectomy and endovascular intervention 7 and 12 months after the original procedure. After both reoperations, the graft functioned well for hemodialysis. HeRO graft can be a good alternative to central venous catheters and lower limb arterio-venous grafts in cases of bilateral central venous occlusion. Orv Hetil. 2019; 160(31): 1231–1234.

scholarly journals The novel use of the Haemodialysis reliable outflow graft (HeRo®) in intestinal failure patients with end-stage vascular access

2020 ◽  
pp. 112972982096197
Author(s):  
Fungai Dengu ◽  
James Hunter ◽  
Georgios Vrakas ◽  
James Gilbert
Keyword(s):  
Parenteral Nutrition ◽  
Vascular Access ◽  
Intestinal Failure ◽  
Case Series ◽  
Venous Access ◽  
Central Venous ◽  
Central Venous Stenosis ◽  
Venous Stenosis ◽  
Life Threatening ◽  
End Stage

Intestinal failure (IF) patients are dependent on central venous access to receive parenteral nutrition. Longstanding central venous catheters are associated with life-threatening complications including infections and thromboses resulting in multiple line exchanges and the development ofprogressive central venous stenosis or occlusion. The Haemodialysis Reliable Outflow (HeRO) graft is an arterio-venous device that has been successfully used in haemodialysis patients with ‘end-stage vascular access’. We describe a case series of HeRO graft use in patients with IF and end-stage vascular access. Four HeRO grafts were inserted into IF patients with end-stage vascular access to facilitate or support intestinal transplantation. In all patients the HeRO facilitated immediate vascular access, supporting different combinations of parenteral nutrition, intravenous medications, fluids or renal replacement therapy with no bloodstream infections. In a highly complex group of IF patients with central venous stenosis/occlusion limiting conventional venous access or at risk of life-threatening catheter-related complications, a HeRO® graft can be a feasible alternative.

Paclitaxel-Coated Balloons for the Treatment of Symptomatic Central Venous Stenosis in Vascular Access: Results From a European, Multicenter, Single-Arm Retrospective Analysis

2021 ◽  
pp. 152660282110074
Author(s):  
Panagiotis M. Kitrou ◽  
Tobias Steinke ◽  
Rami El Hage ◽  
Pedro Ponce ◽  
Pierleone Lucatelli ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Outcome Measures ◽  
Vascular Access ◽  
Patient Survival ◽  
Secondary Outcome ◽  
Central Venous ◽  
Central Venous Stenosis ◽  
Major Complications ◽  
Venous Stenosis

Introduction: This was a European, multicenter, investigator-initiated and run, single-arm retrospective analysis to assess the safety and the clinical benefit of the use of paclitaxel-coated balloon (PCB) for the treatment of symptomatic central venous stenosis (CVS). Materials and Methods: Eleven centers from 7 countries across Europe, submitted 86 cases performed during the period between October 2015 and June 2018. Minimum follow-up was 6 months. Patient baseline demographics and procedural details were collected. Mean age was 62.6 years (SD 15.2 years). Median vascular access age was 3.0 years (IQR 1.2–4.8 years). A total of 55 were arteriovenous fistulas (64%) the rest arteriovenous grafts (31/86, 36%). Vessels treated were 43 subclavian veins, 42 brachiocephalic veins and 1 superior vena cava. Median drug-coated balloon diameter was 10 mm (IQR 8–12 mm). Primary outcome measures were clinically assessed intervention-free period (IFP) of the treated segment at 6 months and procedure-related minor and major complications. Secondary outcome measures included access circuit survival, patient survival, and the investigation of independent factors that influence the IFP. Results: IFP was 62.7% at 6 months. Median patient follow-up time was 1.0 year (IQR 0.5–2.2 years). There was 1 minor complication (1/86; 1.2%) and no major complications. Access circuit survival was 87.7% at 6 months. Patient survival was 79.7% at 2 years according to Kaplan-Meier survival analysis. Higher balloon diameters significantly favored IFP [HR 0.71 (0.55–0.92), p=0.006; 5–7 mm group vs 8–12 mm group, p=0.025]. Conclusion: In this analysis, use of PCBs for the treatment of symptomatic CVS was safe. Efficacy was comparable to previous trials. Increased balloon size had a significant effect on patency rates.

Cerebral hyperperfusion and other consequences of hemodialysis central vein catheters

2017 ◽  
Vol 18 (1_suppl) ◽  
pp. S82-S83 ◽  
Author(s):  
Haimanot Wasse
Keyword(s):  
Case Reports ◽  
Venous Catheter ◽  
Venous Hypertension ◽  
Central Vein ◽  
Central Venous ◽  
Venous Circulation ◽  
Central Venous Stenosis ◽  
Cerebral Hyperperfusion ◽  
Venous Stenosis ◽  
Stage Renal Disease

While central venous stenosis is a common consequence of protracted central venous catheter use, intracardiac device transvenous leads, and central venous instrumentation, the majority of patients who develop symptomatic central venous stenosis present with characteristic venous hypertension. However, some patients may develop an abnormal intracranial venous circulation and present with neurologic symptoms. This paper will summarize findings from case reports that describe the neurologic sequelae that can develop as a result of central venous stenosis/occlusion in end-stage renal disease patients with a functional arteriovenous access.

scholarly journals Central Venous Stenosis after Hemodialysis: Case Reports and Relationships to Catheters and Cardiac Implantable Devices

2019 ◽  
Vol 9 (3) ◽  
pp. 135-144 ◽  
Author(s):  
Mario Pacilio ◽  
Silvio Borrelli ◽  
Giuseppe Conte ◽  
Roberto Minutolo ◽  
Antonino Musumeci ◽  
...  
Keyword(s):  
Case Reports ◽  
Superior Vena ◽  
Sinus Node ◽  
Vena Cava ◽  
Venous Catheter ◽  
Transluminal Angioplasty ◽  
Central Venous ◽  
Central Venous Stenosis ◽  
Cardiac Devices ◽  
Venous Stenosis

The appropriate vascular access for hemodialysis in patients with cardiac implantable electronic devices (CIED) is undefined. We describe two cases of end-stage renal disease patients with CIED and tunneled central venous catheter (CVC) who developed venous cava stenosis: (1) a 70-year-old man with sinus node disease and pacemaker in 2013, CVC, and a Brescia-Cimino forearm fistula in 2015; (2) a 75-year-old woman with previous ventricular arrhythmia with implanted defibrillator in 2014 and CVC in 2016. In either case, after about 1 year from CVC insertion, patients developed superior vena cava (SVC) syndrome due to stenosis diagnosed by axial computerized tomography. In case 1, the patient was not treated by angioplasty of SVC and removed CVC with partial resolving of symptoms. In case 2, a percutaneous transluminal angioplasty with placement of a new CVC was required. To analyze these reports in the context of available literature, we systematically reviewed studies that have analyzed the presence of central venous stenosis associated with the simultaneous presence of CIED and CVC. Five studies were found; two indicated an increased incidence of central venous stenosis, while three did not find any association. While more studies are definitely needed, we suggest that these patients may benefit from epicardial cardiac devices and the insertion of devices directly into the ventriculus. If the new devices are unavailable or contraindicated, peritoneal dialysis or intensive conservative treatment in older patients may be proposed as alternative options.

scholarly journals Percutaneous transluminal angioplasty procedure for central venous stenosis inpatient undergoing hemodialysis in Pelni Hospital: case series

2021 ◽  
Vol 1 (1) ◽  
pp. 19-23
Author(s):  
Muhammad Zaini Azwan ◽  
Anak Agung Ngurah Nata Tresnawan Putra
Keyword(s):  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Percutaneous Transluminal Angioplasty ◽  
Transluminal Angioplasty ◽  
Central Venous ◽  
Central Venous Stenosis ◽  
Venous Stenosis ◽  
Kidney Impairment ◽  
Percutaneous Transluminal ◽  
Percutaneous Transluminal Angiography

Introduction: Many causes leads to kidney impairment. This does not rule out the increasing number of patients undergoing hemodialysis.  The common vascular access used during hemodialysis is an arteriovenous fistula (AVF). The arteriovenous fistula was preferred because it lasts longer and has a lower risk of infection for vascular access, meanwhile central venous stenosis or occlusion in the vein that carries the blood from the extremities to the heart often occur. If vascular access is still used during hemodialysis in which central venous stenosis is formed, it needs to make a new vascular access option. Percutaneous transluminal angiography (PTA) main objectives are to dilate the venous lesion that has occlusion more than 50% and extending the lifespan of arteriovenous fistula. In this case, we report six patients hemodialysis with central venous stenosis treated with percutaneous transluminal angiography.  This procedure has benefits that are arteriovenous fistula can be used again to reach hemodialysis adequacy optimally and reduce pain and swelling in the arms. Case description: There six cases who were 45,48,57.58,63 and 66 years old who underwent percutaneous transluminal angioplasty procedures for central venous stenosis. Several past illnesses of the patients underlying the kidney impairment such chronic hypertension, chronic coronary heart complications, and/or diabetes. Several patients felt AVF swollen and/or painful. Minimal residual stenosis after balloon angioplasty was performed. Conclusion: According to our cases, patients that underwent the hemodialysis felt swollen or/and pain due to stenosis ballooning angioplasty help minimize the residual stenosis.

scholarly journals Parathyroidectomy in the presence of central venous stenosis

2013 ◽  
Vol 2013 (may17 1) ◽  
pp. bcr2012008392-bcr2012008392
Author(s):  
M. Megson
Keyword(s):  
Central Venous ◽  
Central Venous Stenosis ◽  
Venous Stenosis
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