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.

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.

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.

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.

Using Arteriovenous Fistulae as a Dual Access for Hemodialysis and Total Parenteral Nutrition Administration is Feasible with a Good Outcome: A Case Series

2007 ◽  
Vol 8 (4) ◽  
pp. 305-308 ◽  
Author(s):  
V.C.Y Tang ◽  
M.A Morsy ◽  
E.S. Chemla
Keyword(s):  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Case Series ◽  
Central Line ◽  
Consecutive Series ◽  
Arteriovenous Fistulae ◽  
Central Venous Stenosis ◽  
End Stage ◽  
Line Infection

End stage renal failure patients requiring long term total parenteral nutrition (TPN) often have multiple central line placements due to line infection or occlusion. Sometimes this can cause central venous stenosis or even occlusion. We present three cases in this consecutive series, in which we have successfully used arteriovenous fistulae for both hemodialysis and long term TPN administration as an alternative route without any complications. We therefore think that native AVF and grafts can be used as dual access for hemodialysis and TPN administration provided careful case selection, counselling and follow-up.

Tunneled femoral dialysis catheter: Practical pointers

2021 ◽  
pp. 112972982110396
Author(s):  
Yeshwanter Radhakrishnan ◽  
Jayaprakash Dasari ◽  
Evamaria Anvari ◽  
Tushar J Vachharajani
Keyword(s):  
Upper Extremity ◽  
Vascular Access ◽  
Dialysis Catheter ◽  
End Stage Kidney Disease ◽  
Central Venous ◽  
Femoral Catheter ◽  
Central Venous Stenosis ◽  
Current Review ◽  
End Stage

One of the most challenging aspects of providing end-stage kidney disease care is to achieve adequate long-term access to the bloodstream to support hemodialysis (HD) therapy. Although upper extremity arteriovenous fistula remains the vascular access of choice for patients on HD, complications such as central venous stenosis, access thrombosis, or exhaustion of suitable access sites in the upper extremity, ultimately result in pursuing vascular access creation in the lower extremity. The current review focuses on the indications, contraindications, and clinically relevant practical procedural tips to successfully place a tunneled femoral dialysis catheter. The review highlights some of the prevailing misconceptions regarding femoral catheter placement practices.

scholarly journals Intramuscular ketamine to facilitate pediatric central vascular access

CJEM ◽  
2004 ◽  
Vol 6 (04) ◽  
pp. 259-262 ◽  
Author(s):  
T. Kent Denmark ◽  
Jenny R. Hargrove ◽  
Lance Brown
Keyword(s):  
Vascular Access ◽  
Central Venous Access ◽  
Tertiary Care ◽  
Case Series ◽  
Venous Catheter ◽  
Venous Access ◽  
Central Venous Catheters ◽  
Emergency Physicians ◽  
Central Venous ◽  
Peripheral Venous Access

ABSTRACT Objectives: Obtaining prompt vascular access in young children presenting to the emergency department (ED) is frequently both necessary and technically challenging. The objective of our study was to describe our experience using intramuscular (IM) ketamine to facilitate the placement of central venous catheters in children presenting to our ED needing vascular access in a timely fashion. Methods: We performed a retrospective medical record review of all pediatric patients <18 years of age who presented to our tertiary care pediatric ED between May 1, 1998, and August 7, 2003, and underwent the placement of a central venous catheter facilitated by the use of IM ketamine. Results: Eleven children met our inclusion criteria. Most of the children were young and medically complicated. The children ranged in age from 6 months to 8 years. The only complication identified was vomiting experienced by an 8-year-old boy. Emergency physicians successfully obtained central venous access in all subjects in the case series. Conclusions: The use of IM ketamine to facilitate the placement of central venous catheters in children who do not have peripheral venous access appears to be helpful. Emergency physicians may find it useful to be familiar with this use of IM ketamine.

Spontaneous Bleeding from Collateral Chest Wall Veins Is a Rare Complication of Arteriovenous Fistula with Central Venous Stenosis: A Case Report

2020 ◽  
Vol 25 (1) ◽  
pp. 44-47
Author(s):  
Mohammed Hassan Abdelaty
Keyword(s):  
Arteriovenous Fistula ◽  
Chest Wall ◽  
Rare Complication ◽  
Dialysis Patients ◽  
Central Venous ◽  
Spontaneous Bleeding ◽  
Surgical Ligation ◽  
Central Venous Stenosis ◽  
Venous Stenosis ◽  
Life Threatening

Highlights Dialysis patients with arteriovenous fistula who have central venous stenosis develop collateral veins in the axilla and chest wall. These veins are at risk of spontaneous rupture, and major bleeding may occur. Bleeding should be controlled immediately by using a compression bandage, and patients should be resuscitated with fluids and blood transfusion before surgical ligation of the bleeder. Awareness of this complication and early protection can save the patient from life-threatening hemorrhage.

Central Venous Catheters in Hemodialysis: An Actual Conundrum without Solutions

2002 ◽  
Vol 3 (4) ◽  
pp. 174-176 ◽  
Author(s):  
B. Di Iorio
Keyword(s):  
Renal Disease ◽  
Vascular Access ◽  
End Stage Renal Disease ◽  
Venous Access ◽  
Central Venous Catheters ◽  
Central Venous ◽  
Long Period ◽  
Adequate Care ◽  
Stage Renal Disease ◽  
End Stage

Vascular access maintenance is a major problem for adequate care of End Stage Renal Disease. An ideal access delivers an adequate flow rate for the HD prescription, remains usable for an indefinitely long period of time, and has a low complication rate. The native arteriovenous fistula (AVF) remains the best access, but this option may be impraticable in many conditions. This paper describes why to use CVC, where CVC can be positioned and how CVC infections can be prevented. Also today, vascular access in hemodialysis remains the conundrum without solution, but it is often necessary and remains the only possible venous access in a particular category of patients.

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