Liposuction used to treat deep vascular accesses for hemodialysis

Background: Oftentimes, obese dialysis patients develop a viable dialysis access but the access is too deep for cannulation and needs a superficialization procedure. Methods: We present our 14-patient cohort in whom we performed liposuction to superficialize viable but deep vascular accesses. Out of 14 patients, 12 had arteriovenous fistulas and 2 arteriovenous grafts. The primary end points were the ability to superficialize a completely unusable access and to remove the hemodialysis catheter (3patients), or to significantly extend the useful length of a deep access in which only a very short segment was used and to continue to use the access post-surgery without the need to place a dialysis catheter (11 patients). Results: The study goal was met in 13 out of 14 patients. In two of three patients, the catheters were removed and their access usable length was 14 and 13 cm, respectively. The accesses could be used immediately after liposuction in all patients in which this applied—11 patients. The usable access length increased from a mean of 5 to 12.7 cm. The access mean depth decreased from 10.8 mm pre-surgery to 7 mm post-surgery and 5.3 mm 4 weeks after surgery. The mean volume of fat removed was 43.8 cc. We had only one surgical complication: bleeding that was readily controlled with manual pressure. All patients were discharged to home the same day. Postoperative pain was mild. Conclusion: Liposuction is effective, safe, and seems to be the least invasive technique of superficialization.

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Effectiveness and safety of repeated percutaneous intervention in an office-based endovascular center in maintaining hemodialysis access

Vascular ◽

10.1177/17085381211004306 ◽

2021 ◽

pp. 170853812110043

Author(s):

Jay Patel ◽

Stephanie Chang ◽

Shaan Manawar ◽

John Munn ◽

Mark C Rummel ◽

...

Keyword(s):

Percutaneous Intervention ◽

Dialysis Access ◽

Arteriovenous Graft ◽

Hemodialysis Access ◽

Upper Arm ◽

Access Site ◽

Arteriovenous Fistulas ◽

Arteriovenous Grafts ◽

The Mean

Objectives Percutaneous dialysis access interventions are routinely used to maintain the patency of dialysis access despite the lack of data regarding their long-term effectiveness. This retrospective study was undertaken to study the effectiveness and safety of percutaneous dialysis access interventions in arm fistulas and bridge grafts in an office-based endovascular center. Methods Patients who had a percutaneous dialysis access intervention in their upper extremity access site, performed at a single office-based endovascular center over a nine-year period (2007–2016) were included in this study. The patients’ demographic factors, patency, and complications were analyzed. Patients were entered in the study after first percutaneous dialysis access intervention. Results A total of 298 limbs in 259 patients had 913 procedures carried out over a nine-year period. There were 190 access arteriovenous fistulas and 108 arteriovenous grafts. The two most common arteriovenous fistulas were the brachiocephalic fistula ( n = 74, 39%) and radio cephalic fistula ( n = 69, 36%). Arteriovenous grafts were most commonly placed in the upper arm ( n = 66, 61%) followed by the forearm ( n = 42, 39%). The mean overall patency for all limbs was 50.86 months. Arteriovenous fistulas had a significantly longer patency than arteriovenous grafts (51.65 vs. 42.09 months; P = 0.01). In addition, patients with two or more percutaneous dialysis access intervention in their arteriovenous fistula had significantly greater patency than those with only one percutaneous dialysis access intervention (58.5 vs. 7.6 months; hazard ratio 0.41; P = 0.0008). This was not true for the arteriovenous graft group. Women represented 49% of the patient group. Their accesses had shorter patency than men (39.8 vs. 60 months; P = 0.0007). Conclusions This data support the use of repeated percutaneous dialysis access intervention to maintain long-term patency of dialysis access sites in an office-based endovascular center. Overall, fistulas have longer patency than grafts and women have poorer outcomes as compared to men

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The usefulness and feasibility of placing a clinch knot with a guidewire to achieve temporary hemostasis in arteriovenous dialysis access interventions

The Journal of Vascular Access ◽

10.1177/1129729820954742 ◽

2020 ◽

pp. 112972982095474

Author(s):

Sung-Joon Park ◽

Hwan Hoon Chung ◽

Seung Hwa Lee ◽

Sung Beom Cho ◽

Tae-Seok Seo ◽

...

Keyword(s):

Clinical Success ◽

Primary Patency ◽

Interventional Treatment ◽

Secondary Patency ◽

Dialysis Access ◽

Hemodialysis Access ◽

Purse String Suture ◽

Purse String ◽

Arteriovenous Fistulas ◽

Arteriovenous Grafts

Purpose: To evaluate the usefulness and feasibility of using a reversible clinch knot with a guidewire in place rather than eliminating the access route during an arteriovenous hemodialysis access (AV access) intervention using the facing sheath technique. Material and methods: From July 2016 to June 2019, we retrospectively studied 78 sessions performed as interventional treatment for arteriovenous (AV) hemodialysis (HD) access using the “facing-sheath technique.” In all sessions, all antegrade sheaths were removed while a 0.035-inch guidewire remained in place with purse-string suture and the clinch knot. Seventy-two sessions were performed in patients with thrombosed AV accesses (69 arteriovenous grafts [AVGs] and three arteriovenous fistulas [AVFs]), and six sessions were carried out to treat non-thrombosed AV accesses (four AVGs and two AVFs). We evaluated whether proper hemostasis and successful reinsertion of the sheath over the wire into the clinch knot was achieved. Clinical success was defined as achieving prompt restoration of blood flow for AV access, and the postintervention primary and secondary patency were also evaluated. Result: In all 87 clinch knots created in 78 total sessions, proper hemostasis was achieved. All clinch knots that required reversal for additional procedures were successfully reopened (55 clinch knots in 50 sessions). The postintervention primary patency rates at 1, 3, and 6 months, and at 1 year were 77.8%, 68.9%, 55.6%, and 33.3%, respectively. The postintervention secondary patency rates at 1, 3, and 6 months, and also at 1 year were 93.3%, 91.1%, 86.7%, and 86.7%, respectively. Conclusion: Our AV access intervention which used a clinch knot with purse-string suture while the guidewire remained in place was both useful and feasible for maintaining temporary hemostasis.

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Transjugular percutaneous endovascular treatment of dysfunctional hemodialysis access

The Journal of Vascular Access ◽

10.1177/1129729818815327 ◽

2018 ◽

Vol 20 (5) ◽

pp. 488-494 ◽

Cited By ~ 1

Author(s):

Jin Ho Kim ◽

Sung Bum Cho ◽

Yun Hwan Kim ◽

Hwan Hoon Chung ◽

Seung Hwa Lee ◽

...

Keyword(s):

Endovascular Treatment ◽

Internal Jugular Vein ◽

Patency Rate ◽

Jugular Vein ◽

Hemodialysis Access ◽

Procedure Time ◽

Arteriovenous Fistulas ◽

Arteriovenous Grafts ◽

The Mean ◽

Vein Stenosis

Purpose: To evaluate the feasibility and the outcomes of transjugular percutaneous endovascular treatment of dysfunctional hemodialysis access in patients with chronic kidney disease. Methods: A total of 50 transjugular treatments in 38 patients with arteriovenous fistulas or arteriovenous grafts from September 2011 to May 2015 were included in this study. Medical records and angiographies were retrospectively reviewed. Success rate, patency rate, procedure time, and complications including internal jugular vein stenosis were evaluated. Results: A total of 50 sessions of transjugular treatments were performed in 38 patients. There were 31 native arteriovenous fistulas including 10 immature cases and 19 arteriovenous grafts. Among the 50 cases, technical success was achieved in 45 and clinical success was achieved in 44; 37 cases (74%) with multiple stenotic sites were treated by the transjugular approach without placement of cross-sheaths. The mean time from puncture of the internal jugular vein to first fistulography was 10 min, and the mean total procedure time was 64 min. The primary patency rate at 6 months was 77%, while the secondary patency rate at 6 months was 97%. Perforation occurred in two cases during conventional percutaneous transluminal angioplasty after failure of the transjugular approach. One dissection occurred during the transjugular approach. There was no newly developed internal jugular vein stenosis during a mean follow-up period of 19.3 months. Conclusion: For the treatment of dysfunctional or immature hemodialysis access, the transjugular approach is a feasible and effective option that avoids injury to the graft or draining vein, especially in immature fistulas.

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Surgical outcomes of gasless single port retroperitoneal radical nephrectomy for dialysis patients: A comparative analysis with nondialysis patients.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.7_suppl.376 ◽

2011 ◽

Vol 29 (7_suppl) ◽

pp. 376-376 ◽

Cited By ~ 2

Author(s):

Y. Okada ◽

H. Masuda ◽

K. Saito ◽

Y. Iimura ◽

M. Yokoyama ◽

...

Keyword(s):

High Risk ◽

Surgical Outcomes ◽

Surgical Complications ◽

Radical Nephrectomy ◽

Single Port ◽

Oral Feeding ◽

Transfusion Rate ◽

Dialysis Access ◽

Dialysis Patients ◽

The Mean

376 Background: Gasless single port retroperitoneal radical nephrectomy is minimally invasive, curative and cost effective operation which we have developed since 1998 (Eur Urol Suppl 2009; 8: 392), and covered by the Japanese universal insurance system from April, 2008. Patients necessitating dialysis are considered high risk operative candidates because of their multiple comorbidities. We compared surgical outcomes of dialysis patients with non-dialysis patients to evaluate this operation as treatment for high risk group. Methods: We reviewed 304 consecutive patients including 59 (19.4%) dialysis patients who underwent CO2 gasless single port retroperitoneal radical nephrectomy at our institute between 2000 and 2009. Complications within the first 30 days after the surgery were graded retrospectively according to the modified Clavien classification system. Patient demographics, operative outcomes, and complications were compared between dialysis and non-dialysis patients. Results: In all patients, the median patient age and body mass index were 60 years and 23.0 kg/m2. The median length of surgical incision, operative time (OT) and estimated blood loss (EBL) were 6.5 cm, 189 minutes and 214 mL, respectively. The transfusion rate was 3.3%. The intra and postoperative complication rate were 3.9% and 10.1%. Two grade 3a (ureteral obstruction, 1; diverticulitis, 1), three grade 3b (occlusion of peripheral hemodialysis shunt, 3) and two grade 4 (pulmonary embolism, 1; acute heart failure, 1) surgical complications occurred. In dialysis patients, the mean BMI was lower (20.4 vs. 23.3, p<0.0001), the mean OT was shorter (170 vs. 201 minutes, p<0.0001) and the mean EBL was lower (216 vs. 311mL, p<0.0001) than non-dialysis patients. There was no Clavien grade 3 or 4 surgical complications except dialysis access occlusion in dialysis patients. The average time to oral feeding and walking were equivalent, but possible discharge were longer in dialysis patients (4.3 vs. 3.4 days, p<0.0037). Conclusions: Our data supports the safety and feasibility of gasless single port retroperitoneal radical nephrectomy for dialysis patients. No significant financial relationships to disclose.

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Haemodialysis access thrombosis: Outcomes after surgical thrombectomy versus catheter-directed thrombolytic infusion

The Journal of Vascular Access ◽

10.1177/1129729818761277 ◽

2018 ◽

Vol 19 (6) ◽

pp. 535-541 ◽

Cited By ~ 4

Author(s):

Linn Koraen-Smith ◽

Matteus Krasun ◽

Matteo Bottai ◽

Ulf Hedin ◽

Carl M Wahlgren ◽

...

Keyword(s):

Primary Patency ◽

Study Patient ◽

Dialysis Access ◽

Arteriovenous Fistulas ◽

Patient Demographics ◽

Kaplan Meier ◽

First Choice ◽

Surgical Thrombectomy ◽

Arteriovenous Grafts ◽

Healthcare Associated

Introduction: Thrombosis is one of the most common complications of dialysis vascular access and is a significant source of morbidity and healthcare-associated costs. In this retrospective study, outcomes for surgical thrombectomy and thrombolysis after access thrombosis in patients with arteriovenous fistulas or prosthetic grafts (arteriovenous grafts) were analysed. Methods: All patients with a primary episode of dialysis access thrombosis between 2005 and 2013 were included which yielded 131 patients with 149 episodes of access thrombosis (108 arteriovenous grafts; 41 arteriovenous fistulas). In all, 18 patients had two separate accesses during the study. Patient demographics, access anatomy, surgical and radiological procedural data were recorded. Kaplan–Meier estimates and Poisson regression were used for statistical analysis of access patency. Results: In total, 107 underwent surgical thrombectomy and 42 were treated with catheter-directed thrombolytic infusion. Technical success was 60% for surgical thrombectomy and 73% for thrombolysis (p = 0.18). There were no major complications and no deaths within 30 days of the procedure. More patients had adjunctive procedures in the thrombolysis group (65/107 vs 37/42; p = 0.002). There was an increasing risk of rethrombosis or a further access-related event for both arteriovenous fistulas and arteriovenous grafts after open thrombectomy compared with catheter-directed thrombolytic infusion, and arteriovenous fistulas exhibited a lower risk than arteriovenous grafts with an average increase in risk of 23.9% (95% confidence interval: 3.1–49) between each treatment group. Conclusion: Thrombolysis for thrombosis of native and prosthetic dialysis accesses appears to yield better assisted primary patency compared to surgical thrombectomy. Our results suggest that thrombolysis may be considered the first-choice method for treating the thrombosed dialysis access.

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Ultrasound mapping of new cannulation sites for arteriovenous fistulas/grafts at South Tyneside and Sunderland NHS Foundation Trust (STSFT) Renal Unit.

Pakistan Journal of Kidney Diseases ◽

10.53778/pjkd4180 ◽

2021 ◽

Vol 4 (1) ◽

pp. 199-202

Author(s):

Haroon Ayub ◽

Rauri Clark ◽

Shalabh Srivastava ◽

James Andrews ◽

Debra Sweeney ◽

...

Keyword(s):

Smart Phone ◽

Renal Unit ◽

Dialysis Patients ◽

Av Fistula ◽

Small Vessels ◽

Home Haemodialysis ◽

Arteriovenous Fistulas ◽

The Us ◽

Arteriovenous Grafts ◽

Dialysis Nurses

The cannulation of vascular access specially becomes difficult in elderly, diabetic and obese hemodialysis patients. The accessibility of an AV fistula largely relies on the condition of the patient’s veins, which often leads to difficulty in cannulation with the traditional blind method. South Tyneside and Sunderland NHS Foundation Trust (STSFT) Renal unit adopted ultrasound mapping of new cannulation sites for arteriovenous fistulas and arteriovenous grafts. The aim of this study was to evaluate the qualitative impact of this practice on the dialysis patients. This was a qualitative study and was conducted in the Renal Unit at STSFT. Haemodialysis patients with deep or small vessels for cannulation, a vessel with problems and a vessel whose cannulation on the first attempt was vital were included in the study. AVF/AVG were mapped using Doppler ultrasound (US) undertaken by a consultant Interventional Nephrologist (IN). The map of the AVF/AVG and new cannulation sites were captured as an image on the patients’ smart phone to act as record to show the dialysis nurse cannulating the AVF/AVG. It was hoped that this would encourage rope laddering and AVF/AVG preservation. Patients reported no significant improvement in cannulation process even after US mapping of new cannulation sites. Patients did report a better understanding of the AVF/AVG geometry especially amongst the self cannulators on home haemodialysis. According to the patients the successful cannulation was mainly dependent on the skills of dialysis nurses rather than the US mapping of the AVF/AVG being of any assistance.

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Long-term results of endovascular treatment for arteriovenous dialysis access thrombosis in 143 patients: A single center experience

The Journal of Vascular Access ◽

10.1177/1129729819865808 ◽

2019 ◽

Vol 20 (5) ◽

pp. 545-552

Author(s):

Yunus Yilmazsoy ◽

Umut Ozyer

Keyword(s):

Primary Patency ◽

Long Term Results ◽

Secondary Patency ◽

Dialysis Access ◽

Thrombolytic Treatment ◽

Technical Success Rate ◽

Arteriovenous Fistulas ◽

Large Patient ◽

Arteriovenous Grafts

Objective: This study aimed to determine the long-term patency duration and rate of thrombosis of autologous arteriovenous fistulas and synthetic grafts treated with endovascular methods in a large patient population. Methods: A total of 144 arteriovenous accesses (37 radiocephalic, 51 brachiobasilic, 41 brachiocephalic, and 15 femorofemoral) from 143 patients were included in the study. A total of 304 endovascular thrombolytic treatment procedures were performed for 94 (65%) arteriovenous fistula and 50 (35%) arteriovenous graft accesses. Results: The procedural technical success rate was 98.7%. The mean follow-up duration was 32.5 (range, 3–132) months. The primary patency rates for arteriovenous fistulas and arteriovenous grafts were 78% and 78% at 6 months, 66% and 63% at 1 year, and 45% and 0% at 36 months, respectively. The assisted primary patency rates for arteriovenous fistulas and arteriovenous grafts were 82% and 84% at 6 months, 71% and 69% at 1 year, 51% and 29% at 36 months, and 30% and 1% at 60 months, respectively. The secondary patency rates for arteriovenous fistulas and arteriovenous grafts were 94% and 93% at 6 months, 85% and 85% at 1 year, 58% and 59% at 36 months, and 47% and 48% at 60 months, respectively. Conclusion: Although the primary patency durations for arteriovenous fistulas were better after endovascular thrombolytic treatment than those for arteriovenous grafts, the long-term outcomes of assisted primary and secondary patency durations after repeated procedures were similar for both types of arteriovenous accesses.

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Urgent-start peritoneal dialysis results in fewer procedures than hemodialysis

Clinical Kidney Journal ◽

10.1093/ckj/sfz053 ◽

2019 ◽

Vol 13 (2) ◽

pp. 166-171

Author(s):

Delin Wang ◽

Nathan Calabro-Kailukaitis ◽

Mahmoud Mowafy ◽

Eric S Kerns ◽

Khetisuda Suvarnasuddhi ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Retrospective Cohort ◽

Venous Catheter ◽

Dialysis Access ◽

Dialysis Patients ◽

Central Venous ◽

The Usa ◽

The Mean

Abstract Background Peritoneal dialysis (PD) is an underutilized modality for hospitalized patients with an urgent need to start renal replacement therapy in the USA. Most patients begin hemodialysis (HD) with a tunneled central venous catheter (CVC). Methods We examined the long-term burden of dialysis modality-related access procedures with urgent-start PD and urgent-start HD in a retrospective cohort of 73 adults. The number of access-related (mechanical and infection-related) procedures for each modality was compared in the first 30 days and cumulatively through the duration of follow-up. Results Fifty patients underwent CVC placement for HD and 23 patients underwent PD catheter placement for urgent-start dialysis. Patients were followed on average >1 year. The PD group was significantly younger, with less diabetes, with a higher pre-dialysis serum creatinine and more likely to have a planned dialysis access. The mean number of access-related procedures per patient in the two groups was not different at 30 days; however, when compared over the duration of follow-up, the number of access-related procedures was significantly higher in the HD group compared with the PD group (4.6 ± 3.9 versus 0.61 ± 0.84, P < 0.0001). This difference persisted when standardized to procedures per patient-month (0.37 ± 0.57 versus 0.081 ± 0.18, P = 0.019). Infection-related procedures were similar between groups. Findings were the same even after case-matching was performed for age and diabetes mellitus with 18 patients in each group. Conclusions Urgent-start PD results in fewer invasive access procedures compared with urgent-start HD long term, and should be considered for urgent-start dialysis.

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Vascular access cannulation in hemodialysis patients: technical approach

Brazilian Journal of Nephrology ◽

10.1590/2175-8239-jbn-2019-0031 ◽

2020 ◽

Vol 42 (1) ◽

pp. 38-46

Author(s):

Manuel Carlos Martins Castro ◽

Francisca Tokiko Yanagida Carlquist ◽

Celina de Fátima Silva ◽

Magdaleni Xagoraris ◽

Jerônimo Ruiz Centeno ◽

...

Keyword(s):

Clinical Trials ◽

Vascular Access ◽

Brachial Artery ◽

Hemodialysis Patients ◽

Anatomical Location ◽

Technical Approach ◽

Arteriovenous Fistulas ◽

Cannulation Technique ◽

Arteriovenous Grafts ◽

The Mean

ABSTRACT Introduction: The vascular access cannulation technique varies among clinics, and guidelines on vascular access give little importance to cannulation techniques. The objective of this study was to evaluate the cannulation technique and to determine which factors are associated with each detail of the technique. Material and methods: The vascular access cannulation was evaluated in 260 patients undergoing hemodialysis. The type and anatomical location of the vascular access, the cannulation technique, direction, gauge, and distance between needles, besides bevel direction and needle rotation were registered. Results: The arteriovenous fistula was the most frequent vascular access (88%), the most used cannulation technique was area (100%), the needle direction was anterograde in most cases (79.5%), and the mean distance between the tips of needles was 7.57±4.43 cm. For arteriovenous grafts, the proximal anatomical location (brachial artery) and cannulation with 16G needles in anterograde position were more predominant. For arteriovenous fistulas, the distal anatomical location (radial artery) and cannulation through 15G needles were more common. Cannulation of vascular access in retrograde direction was associated with a greater distance between needles (13.2 ± 4.4 vs 6.1 ± 3 cm, p < 0.001). Kt/V was higher when the distance between needles was higher than 5 cm (1.61 ± 0.3 vs. 1.47 ± 0.28, p < 0.01). Conclusions: The vascular access cannulation technique depends on the vascular access characteristics and expertise of cannulators. Clinical trials are required for the formulation of guidelines for vascular access cannulation.

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The Hemostatic Mechanism after Open-Heart Surgery

Thrombosis and Haemostasis ◽

10.1055/s-0038-1646707 ◽

1978 ◽

Vol 39 (02) ◽

pp. 474-487 ◽

Cited By ~ 2

Author(s):

E R Cole ◽

F Bachmann ◽

C A Curry ◽

D Roby

Keyword(s):

Extracorporeal Circulation ◽

Heart Surgery ◽

Polyacrylamide Gel Electrophoresis ◽

Open Heart Surgery ◽

Coagulation System ◽

Open Heart ◽

Time Activity ◽

Post Surgery ◽

Plasma Fractions ◽

The Mean

SummaryA prospective study in 13 patients undergoing open-heart surgery with extracorporeal circulation revealed a marked decrease of the mean one-stage prothrombin time activity from 88% to 54% (p <0.005) but lesser decreases of factors I, II, V, VII and X. This apparent discrepancy was due to the appearance of an inhibitor of the extrinsic coagulation system, termed PEC (Protein after Extracorporeal Circulation). The mean plasma PEC level rose from 0.05 U/ml pre-surgery to 0.65 U/ml post-surgery (p <0.0005), and was accompanied by the appearance of additional proteins as evidenced by disc polyacrylamide gel electrophoresis of plasma fractions (p <0.0005). The observed increases of PEC, appearance of abnormal protein bands and concomitant increases of LDH and SGOT suggest that the release of an inhibitor of the coagulation system (similar or identical to PIVKA) may be due to hypoxic liver damage during extracorporeal circulation.

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