Difficult cannulation of hemodialysis arteriovenous fistula – Role of imaging in access management (DICAF STUDY)

2021 ◽  
pp. 112972982110150
Author(s):  
Manas Ranjan Behera ◽  
Elenjickal Elias John ◽  
Athul Thomas ◽  
Vinoi George David ◽  
Suceena Alexander ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Diagnostic Value ◽  
Central Vein ◽  
Access Management ◽  
Common Causes ◽  
Permanent Loss ◽  
Common Etiology ◽  
Vein Stenosis ◽  
Hemodialysis Arteriovenous Fistula

Background: Difficulty in cannulation of arteriovenous fistula (AVF) can lead to inadequate dialysis, transient to permanent loss of access and increases dependency on bridging catheters. This study aimed to analyze the causes for difficult fistula cannulation, using various imaging modalities. Methodology: This was a retrospective single-center observational study conducted between October 2017 and June 2018. Patients whose fistulae were difficult to cannulate were initially evaluated by physical examination followed by doppler ultrasonography or/and fistulogram as necessary. The patients were divided into two groups that is, primary difficult cannulation (within first three months of creation of fistula) or secondary difficult cannulation (after three months). Results: We encountered difficult cannulation in 43 patients. About 60% were primary difficult cannulations. Most common causes for difficulty in cannulation were cannulation zone (CZ) stenosis (23.3%), immature fistula (20.9%), outflow stenosis (18.6%), inflow stenosis (11.6%), anatomical abnormalities (11.6%), outflow plus CZ stenosis (9.3%) and inflow plus CZ stenosis (4.7%). Among patients with primary difficult cannulation, immature fistula (34.6%) was the most common cause, whereas CZ stenosis (47.1%) was the most common etiology for secondary difficult cannulation. Edema leading to difficult cannulation was found in 12 patients (27.9%), all of which was due to central vein stenosis. Cannulation resulted in hematoma, fistula thrombosis, failure of fistula and pseudoaneurysm in 83.7%, 27.9%, 16.3%, and 2.3% of cases respectively. Bridging temporary dialysis catheter placement was required in 67.4% patients. Ultrasound doppler had lower diagnostic value when compared to fistulogram (71.4% vs 93.9%, p = 0.014). Conclusion: Difficulty in cannulating the arteriovenous fistula is a common problem in hemodialysis patients. We suggest that patients whose fistulae are difficult to cannulate should undergo early radiological evaluation to decrease catheter dependency and access failure.

scholarly journals Clinical Outcomes and Economic Impact of Starting Hemodialysis with a Catheter after Predialysis Arteriovenous Fistula Creation

2019 ◽  
Vol 50 (3) ◽  
pp. 221-227 ◽  
Author(s):  
Alian Al-Balas ◽  
Saad Shariff ◽  
Timmy Lee ◽  
Carlton Young ◽  
Michael Allon
Keyword(s):  
Arteriovenous Fistula ◽  
Economic Impact ◽  
Vascular Access ◽  
Annual Cost ◽  
Central Vein ◽  
Access Management ◽  
Surgical Access ◽  
Clinical Consequences ◽  
Annual Frequency ◽  
Stage Renal Disease

Background: Patients with advanced chronic kidney disease frequently undergo arteriovenous fistula creation prior to reaching end-stage renal disease (ESRD), but some initiate hemodialysis with a central vein catheter, if their fistula is not yet usable. The clinical consequences of the delay in fistula use have not been quantified in such patients. We compared patients with pre-ESRD fistula surgery who initiated dialysis with a catheter versus a fistula in terms of the frequency of post-dialysis vascular access procedures and complications and their economic impact. Methods: We identified 205 patients with predialysis fistula creation from 2006 to 2012 at a large dialysis center who started hemodialysis within the ensuing 2 years. Of these, 91 (44%) initiated dialysis with a catheter and 114 (56%) with a fistula. We compared these 2 groups in terms of their annual frequency of percutaneous vascular access procedures, surgical access procedures, total access procedures, hospitalizations due to catheter-related bacteremia, and overall cost of vascular access management. Results: The 2 groups were similar in demographics, comorbidities, and fistula type. As compared to patients initiating dialysis with a fistula, those initiating with a catheter had a significantly greater annual frequency of percutaneous access procedures (1.29 [1.19–1.40] vs. 0.75 [0.68–0.82]), surgical access procedures (0.69 [0.61–0.76] vs. 0.59 [0.53–0.66]), total access procedures (1.98 [1.86–2.11] vs. 1.34 [1.26–1.44]), and hospitalizations due to catheter-related bacteremia (0.09 [0.07–0.12] vs. 0.02 [0.01–0.03]). Patients initiating dialysis with a catheter incurred a median overall annual cost of access management that was USD 2,669 higher (USD 6,372 [3,121–12,242) vs. USD 3,703 [1,867–6,953], p = 0.0001). Conclusion: Among patients with predialysis fistula creation, those initiating dialysis with a catheter versus a fistula had substantially more frequent percutaneous, surgical, and total vascular access procedures, as well as hospitalizations due to catheter-related bacteremia. The annual cost of access management was substantially higher in those initiating dialysis with a catheter.

Bilateral brachiocephalic vein stenosis in a chronic hemodialysis patient with well-functioning arteriovenous fistula – A rare entity

2020 ◽  
Vol 92 (5) ◽  
pp. 1-5
Author(s):  
MAJ GEN SINGH ◽  
VINOD KUMAR
Keyword(s):  
Arteriovenous Fistula ◽  
Young Female ◽  
Chronic Hemodialysis ◽  
Brachiocephalic Vein ◽  
Central Vein ◽  
Chronic Hemodialysis Patient ◽  
Stage Renal Disease ◽  
End Stage ◽  
Vein Stenosis ◽  
Central Vein Stenosis

<b>Introduction:</b> Central vein stenosis has been reported in patients of end stage renal disease with subclavian vein being more commonly affected than brachiocephalic vein. <br><b>Case report:</b> We present a case of young female with bilateral brachiocephalic vein obstruction following arteriovenous fistula creation for hemodialysis.

scholarly journals Successful treatment of arteriovenous fistula-related venous hypertention: stenting of metal stents at central vein stenosis

2004 ◽  
Vol 37 (7) ◽  
pp. 1535-1540
Author(s):  
Hideaki Kondo ◽  
Katsunori Yoshida ◽  
Akira Kikkawa ◽  
Mitsuhiro Tanbo ◽  
Masaya Takao ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Successful Treatment ◽  
Metal Stents ◽  
Central Vein ◽  
Vein Stenosis ◽  
Central Vein Stenosis

scholarly journals Open and endovascular surgery for stenosis of the peripheral regions of arteriovenous fistula

2019 ◽  
Vol 18 (3) ◽  
pp. 164-174
Author(s):  
Z. B. Kardanakhishvili ◽  
A. B. Zulkarnaev
Keyword(s):  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Clinical Symptoms ◽  
Neointimal Hyperplasia ◽  
Primary Patency ◽  
Central Vein ◽  
Autologous Vein ◽  
Endovascular Interventions ◽  
Increased Risk ◽  
Vein Stenosis

Vascular access is the cornerstone of hemodialysis. With vascular access dysfunction, the results of treatment of patients with stage 5 chronic kidney disease significantly deteriorate. One of the most common causes of vascular access failure is peripheral venous stenosis. Despite the variety of initiating factors, the morphological substrate of stenotic damage to the arteriovenous fistula (or arteriovenous anastomosis) in most cases is neointimal hyperplasia. Stenotic lesions of the arterivenous fistula are strongly associated with an increased risk of thrombosis and loss of vascular access. There are 4 typical localizations of stenosis: arteriovenous or arteriograft anastomosis, stenosis of the juxta-anastomotic segment of the fistula, stenosis of the functional segment of the fistula, and stenosis of the cephalic arc.The most common indication for surgical treatment is vascular access failure; less common indications are clinical symptoms of venous insufficiency.There are various methods of open reconstruction of the stenotic segment of the fistula vein: resection, prosthetics with a synthetic vascular graft, prosthetics or plastic repair of the autologous vein wall, complete or partial drainage of the prestenotic segment of the vein, etc. Currently an alternative method of stenosis repair using endovascular interventions is gaining popularity. In contrast to central vein stenosis, where endovascular interventions are the gold standard, in peripheral vein stenosis it is only an adjuvant method. Complications of endovascular interventions are extremely rare.Despite the fact that endovascular interventions have almost absolute probability of technical success, the primary patency is not high and is about 50% in six months. The use of bare stents is not accompanied by an increase in primary patency. The use of stent-grafts can increase the primary patency, especially in the plastic repair of challenging stenoses of the graft-vein anastomosis or cephalic arch.Many issues related to endovascular interventions remain unresolved, which requires further research. 

Sign in / Sign up

Export Citation Format

Share Document