Impact of preoperative exercise in not initially candidates to native arteriovenous fistulas

2021 ◽  
pp. 112972982110455
Author(s):  
Javier Carbayo ◽  
Alejandra Muñoz de Morales ◽  
Inés Aragoncillo ◽  
Soraya Abad ◽  
David Arroyo ◽  
...  
Keyword(s):  
Observational Study ◽  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Complication Rate ◽  
Isometric Exercise ◽  
High Rate ◽  
Similar Increase ◽  
Arteriovenous Fistulas ◽  
Preoperative Exercise

Background: Native autologous arteriovenous fistula (AVFn) is the preferred vascular access for hemodialysis due to its long term patency and low complication rate. A challenging limitation is the anatomical inability to perform AVFn and failure of maturation. Preoperative isometric exercise (PIE) can increase vascular calibers and improve the rate of distal AVF. However, it is unknown whether PIE might enhance the performance of AVFn in patients who are not initially candidates. Methods: A retrospective observational study was conducted over a population of 45 patients evaluated in vascular access clinic, 23 were not initially candidates for radiocephalic (NRC-AVF) and 22 were not candidates for autologous fistula at all (NA-AVF). They were assigned to perform PIE with handgrip device and revaluated. Results: After 4–8 weeks of PIE, a AVFn was performed in 16 patients from NA-AVF group and a radiocephalic AVFn was performed in 21 patients from NRC-AVF group. Both groups experienced a significant and similar increase in venous caliber 0.91 ± 0.43 mm in NA-AVF versus 0.76 ± 0.47 mm in NRC-AVF ( p = 0.336) and arterial caliber 0.18 ± 0.24 mm versus 0.18 ± 0.21 mm ( p = 0.928), respectively. Nevertheless, primary failure rate was significantly higher in NA-AVF ( n = 8, 50%) than in NRC-AVF group ( n = 3, 14.3%) ( p = 0.030). After 6 months, the fistula usability for dialysis was only 50% in NA-AVF, while 86.7% were dialyzed by fistula in NRC-AVF group ( p = 0.038). Conclusions: PIE allowed the allocation of an AVFn in patients not initially candidates, but entailed a high rate of maturation failure. Patients not candidates to radiocephalic AVF benefited from PIE and preserved a long term usability of AVF for dialysis.

scholarly journals Does Regular Surveillance Improve the Long-Term Survival of Arteriovenous Fistulas?

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Ashwin Shetty ◽  
William L. Whittier
Keyword(s):  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Major Complication ◽  
Limited Data ◽  
Term Survival ◽  
Long Term Survival ◽  
Arteriovenous Fistulas ◽  
Arteriovenous Grafts ◽  
Available Information

The rate of arteriovenous fistula (AVF) placement continues to rise and AVF failure is a major complication. The main cause of AVF failure is stenosis leading to thrombosis. Although the detection of early stenosis with preemptive correction prior to thrombosis seems to be a plausible option to prevent access failure, there is much debate, on the basis of studies of surveillance with arteriovenous grafts, as to whether early surveillance actually improves the longevity of AVFs. Evaluating the available information for surveillance, specifically the data for AVF stenosis and survival, is necessary to determine if surveillance is warranted. These trials have shown that vascular access flow (Qa) surveillance is beneficial in revealing subclinical stenosis. Preemptive angioplasty and surgical revision have shown to decrease thrombosis rates. However, at the present time, there is only limited data on whether preemptive treatment equates to improved long-term AVF survival.

scholarly journals High rate of native arteriovenous fistulas: How to reach this goal?

2015 ◽  
Vol 143 (3-4) ◽  
pp. 226-229
Author(s):  
Tamara Jemcov ◽  
Marija Milinkovic ◽  
Igor Koncar ◽  
Ilija Kuzmanovic ◽  
Nenad Jakovljevic ◽  
...  
Keyword(s):  
Vascular Access ◽  
Continuous Process ◽  
Venous Catheter ◽  
Medical Personnel ◽  
High Rate ◽  
Central Venous ◽  
Vascular Surgeon ◽  
Arteriovenous Fistulas ◽  
Clinical Center

The types of vascular accesses for hemodialysis (HD) include the native arteriovenous fistula (AVF), arteriovenous graft (AVG) and central venous catheter (CVC). Adequately matured native AVF is the best choice for HD patients and a high percentage of its presence is the goal of every nephrologist and vascular surgeon. This paper analyses the number and type of vascular accesses for HD performed over a 10-year period at the Clinical Center of Serbia, and presents the factors of importance for the creation of such a high number of successful native AVF (over 80%). Such a result is, inter alia, the consequence of the appointment of the Vascular Access Coordinator, whose task was to improve the quality of care of blood vessels in the predialysis period as well as of functional vascular accesses, and to promote the cooperation among different specialists within the field. Vascular access is the ?lifeline? for HD patients. Thus, its successful planning, creation and monitoring of vascular access is a continuous process that requires the collaboration and cooperation of the patient, nephrologist, vascular surgeon, radiologist and medical personnel.

Novel technique of percutaneous bypass in a brachiocephalic arteriovenous fistula with cephalic arch occlusion: A case report

2020 ◽  
pp. 112972982094904
Author(s):  
Hiang Jin Tan ◽  
Lew Pei Shi ◽  
Lai Yu Meng ◽  
Ho Derek Chunyin ◽  
Harsha Pitumpe ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Bypass Graft ◽  
Transluminal Angioplasty ◽  
Central Vein ◽  
Dialysis Access ◽  
Salvage Procedure ◽  
Arteriovenous Fistulas ◽  
Smooth Flow ◽  
End Stage

Objective: Arteriovenous fistulas are a principal mainstay of long-term dialysis access for patients with end stage renal failure. However, the patency of arteriovenous fistulas is limited, often requiring percutaneous transluminal angioplasty as a salvage procedure. We report a case of percutaneous method of arteriovenous fistula salvage. Methods: A gentleman with brachiocephalic arteriovenous fistula created in 2015 was admitted under us for dialysis access issue. His fistula history was notable for recurrent and refractory venous outflow stenosis of the cephalic vein and the cephalic arch with multiple previous interventions. Ultrasound showed cephalic arch occlusion with high venous pressures. He underwent left brachicephalic fistula percutaneous bypass. We describe the percutaneous creation of a brachial–subclavian arteriovenous fistula via a bypass graft from a worsening brachial-cephalic fistula with cephalic arch occlusion that is not amendable to angioplasty. Results: Final angiogram showed smooth flow to central vein. He is 2 years post procedure, and his fistula remained patent with no interventions required. Conclusion: Percutaneously created jump bypass grafts can reliably produce sustained long-term patency.

scholarly journals Relevance of a skilled vascular surgeon and optimized facility practices in the long-term patency of arteriovenous fistulas: a prospective study

2019 ◽  
Vol 41 (3) ◽  
pp. 330-335
Author(s):  
Esteban Lucas Siga ◽  
Noemi Ibalo ◽  
Maria R. Benegas ◽  
Farias Laura ◽  
Carlos Luna ◽  
...  
Keyword(s):  
Vascular Access ◽  
Patency Rate ◽  
Primary Patency ◽  
Vascular Surgeon ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Arteriovenous Fistulas ◽  
The North ◽  
Almost All

Abstract Introduction: Arteriovenous fistulas (AVF) are the best hemodialysis vascular accesses, but their failure rate remains high. Few studies have addressed the role of the vascular surgeon's skills and the facility's practices. We aimed to study these factors, with the hypothesis that the surgeon's skills and facility practices would have an important role in primary failure and patency rates at 12 months, respectively. Methods: This was a single-center, prospective cohort study carried out from March 2005 to March 2017. Only incident patients were included. A single surgeon made all AVFs, either in the forearm (lower) or the elbow (upper). Vascular access definitions were in accordance with the North American Vascular Access Consortium. Results: We studied 113 AVFs (65% lower) from 106 patients (39% diabetics, 58% started with catheter). Time to first connection was 21.5 days (IR: 14 - 31). Only 14 AVFs (12.4%) underwent primary failure and 18 failed during the first year. Functional primary patency rate was 80.9% (SE 4.1) whereas primary unassisted patency rate, which included PF, was 70.6% (4.4). Logistic regression showed that diabetes (OR = 3.3, 95%CI 1.38 - 7.88, p = .007) and forearm location (OR = 3.03, 95CI% 1.05 - 8.76, p = 0.04) were predictors of AVF failure. Patency of lower and upper AVFs was similar in non-diabetics, while patency in diabetics with lower AVFs was under 50%. (p = 0.003). Conclusions: Results suggest that a long-lasting, suitable AVF is feasible in almost all patients. The surgeon's skills and facility practices can have an important role in the long term outcome of AVF.

Aneurysm of Arteriovenous Fistula in Uremic Patients: Is Endograft a Viable Therapeutic Approach?

2002 ◽  
Vol 3 (2) ◽  
pp. 85-88 ◽  
Author(s):  
P.M. Allaria ◽  
E. Costantini ◽  
A. Lucatello ◽  
E. Gandini ◽  
F. Caligara ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Venous Catheter ◽  
Good Alternative ◽  
Central Venous ◽  
Arteriovenous Fistulas ◽  
Risk Of Rupture ◽  
Arterial Aneurysms ◽  
Percutaneous Insertion

One of the complications of arteriovenous fistulas in chronic hemodialyzed patients is the onset of an aneurysm which can be at risk of rupture. Traditional surgical repair is not always feasible and may not be successful in these cases, leading therefore to the loss of a functioning vascular access and requiring in any case the temporary use of a central venous catheter to allow regular hemodialysis sessions. We applied to this kind of aneurysm the same experience developed in the management of major arterial aneurysms and we considered endografting repair a good alternative in this case. In this paper we present the successful treatment of an arteriovenous fistula aneurysm using that technique. A distal radio-cephalic arteriovenous fistula in one of our patients presented an aneurysm with high risk of rupture. The endografting repair with percutaneous insertion of a Wallgraft™ endoprosthesis was well tolerated and the vascular access could be used the day after, without the need for a central venous catheter insertion.

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.

scholarly journals Novel Clinical Therapies and Technologies in Dialysis Vascular Access

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0002962021
Author(s):  
Edwin Takahashi ◽  
Sreenivasulu Kilari ◽  
Sanjay Misra
Keyword(s):  
Drug Delivery ◽  
Health Care ◽  
Stem Cell ◽  
Vascular Access ◽  
Graft Patency ◽  
Hemodialysis Access ◽  
Arteriovenous Fistulas ◽  
Patient Morbidity ◽  
Care Costs

The hemodialysis population continues to grow. Although procedures for dialysis have existed for over 60 years, significant challenges with vascular access to support hemodialysis persist. Failure of arteriovenous fistulas (AVFs) to mature, loss of AVF and graft patency, thrombosis and infection hinder long-term access and add extra health care costs as well as patient morbidity. There have been numerous innovations over the last decade aimed at addressing the issues. Herein, we review the literature and summarize the recent evolution of drug delivery, graft development, minimally invasive AVF creation, and stem cell therapy for hemodialysis access.

scholarly journals Extracranial Dural Arteriovenous Fistula as a Cause of Mastoid Mass: A Case Report

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Md Moshiur Rahman
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
External Jugular Vein ◽  
Middle Income ◽  
Arteriovenous Fistulas ◽  
Middle Income Countries ◽  
Dural Arteriovenous Fistulas ◽  
Superior Longitudinal Sinus ◽  
Transvenous Approach

Introduction: Dural arteriovenous fistulas account for 10 to 15% of intracranial arteriovenous malformations. They are defined as malformations to short-circuits between dural and extracranial arteries with dural venous sinuses. Its presentation is in frequent and its management is a challenge in low- and middle-income countries where there are difficulties in accessing high quality technological tools. Case: We present the case of an unusual dural arteriovenous fistula involving the mastoid region and draining into the external jugular vein and through emissary veins into the superior longitudinal sinus, which was treated transarterially. Conclusion: Endovascular management of intracranial dural arteriovenous fistulas can be a challenge. Endovascular treatment includes a transarterial or transvenous approach from the femoral artery or vein. There is little evidence on this subject, so it is necessary to carry out more studies to determine risk factors, intervention effects and medium- and long-term outcomes.

Use of chronically occluded fistula to establish access outflow

2022 ◽  
pp. 112972982110470
Author(s):  
Amal Lagha ◽  
Alexandros Mallios
Keyword(s):  
Arteriovenous Fistula ◽  
Female Patient ◽  
Vascular Access ◽  
Arteriovenous Graft ◽  
Hemodialysis Access

Maintaining a good quality vascular access in the long term can become particularly challenging especially in patients that are on dialysis for many years and present with exhausted venous capital and chronic access related complications. We present a 60-year-old female patient with multiple bilateral previous failed accesses, a previous distal revascularization interval ligation (DRIL) for hemodialysis access induced distal ischemia (HAIDI). Her chronically (more than a month) occluded arteriovenous fistula AVF was used to establish outflow and create a functioning forearm arteriovenous graft (AVG).

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