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.

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.

Hemodynamics Alterations Induced by Central Venous Catheter in Vascular Access for Hemodialysis

2021 ◽  
Author(s):  
Saulo Gonçalves ◽  
Mário Silva ◽  
Matheus Costa ◽  
Thabata Lucas ◽  
Rudolf Huebner
Keyword(s):  
Central Venous Catheter ◽  
Vascular Access ◽  
Venous Catheter ◽  
Central Venous

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.

Timing of referral for vascular access for hemodialysis: Analysis of the current status and the barriers to timely referral

2019 ◽  
Vol 20 (6) ◽  
pp. 659-665
Author(s):  
Suh Min Kim ◽  
Ahram Han ◽  
Sanghyun Ahn ◽  
Sang-il Min ◽  
Jongwon Ha ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Vascular Access ◽  
Venous Catheter ◽  
Current Status ◽  
Rapid Progression ◽  
Central Venous ◽  
Progression Of Kidney Disease ◽  
Current Guidelines ◽  
Timely Referral ◽  
Late Referral

Introduction: Current guidelines recommend the placement of vascular access 6 months before the anticipated start of hemodialysis therapy; however, many patients start hemodialysis using a central venous catheter. We investigated the timing of referral for vascular access, the vascular access type at hemodialysis initiation, and the barriers to a timely referral. Methods: The study involved a retrospective review of 237 patients for whom the first vascular access for hemodialysis was created between January and November 2017. Results: Among the 237 patients, 58.2% were referred before hemodialysis initiation, while 41.8% were referred after hemodialysis initiation. Among the 138 patients, 55, 59, and 24 patients were referred more than 6 months, between 2 and 6 months, and within 2 months before hemodialysis initiation, respectively. Within these subgroups, 3.6%, 10.2%, and 75.0% patients underwent hemodialysis initiation with a central venous catheter, respectively. Among the 99 patients referred after hemodialysis initiation, the reasons for late referral were as follows: unexpected rapid progression of kidney disease (n = 23), noncompliance (n = 21), late visit to the nephrologist (initial visit within 2 months of hemodialysis initiation; n = 14), change of treatment strategy from peritoneal dialysis or transplants (n = 9), and unknown reasons (n = 32). Conclusion: Only 23% of patients were referred for vascular access 6 months before the anticipated hemodialysis therapy. In addition, 53% of patients initiated hemodialysis with a central venous catheter. Avoidance of catheter insertion was mostly successful in patients referred 2 months before hemodialysis initiation. The most common modifiable barrier to the timely referral was noncompliance.

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.

Clinical Performance of a New Transparent Chlorhexidine Gluconate Central Venous Catheter Dressing

2008 ◽  
Vol 13 (1) ◽  
pp. 13-19 ◽  
Author(s):  
Carol Olson ◽  
James M. Heilman
Keyword(s):  
Health Care ◽  
Central Venous Catheter ◽  
Vascular Access ◽  
New Technologies ◽  
Insertion Site ◽  
Venous Catheter ◽  
Chlorhexidine Gluconate ◽  
Ease Of Use ◽  
Central Venous ◽  
Or Education

Abstract As the sciences of vascular access and infection prevention rapidly advance healthcare professionals are often faced with new technologies designed to help, but which are often so complicated to use that they cause unforeseen problems. As a vascular access team at a major mid-western hospital, we evaluated the ease-of-use and the performance characteristics of a new transparent catheter dressing, 3M Tegaderm CHG IV Securement Dressing® (3M Health Care™, St. Paul, MN) containing the antimicrobial chlorhexidine gluconate (CHG), with a variety of central venous catheters insertion sites in comparison to a standard non-antimicrobial dressing Tegaderm® (3M Health Care™, St. Paul, MN). Following IRB approval, sixty-three consenting patients were enrolled and randomized; 33 in the CHG antimicrobial dressing group and 30 in the standard dressing group. Thirty six patients had peripherally inserted central catheters (PICCs), 20 had intrajugular insertions (IJ), and 7 had subclavian insertions. The new 3M Tegaderm CHG IV Securement Dressing® (3M Health Care™, St. Paul, MN) was evaluated for its ability to permit visualization of the insertion site, ease of use, ease of using correctly, ability to secure the catheter and absorb exudates and remain transparent. The new 3M Tegaderm CHG IV Securement Dressing® (3M Health Care™, St. Paul, MN) was found to be as easy to use in central venous catheter care clinical practice as the standard of care non-antimicrobial transparent adhesive dressing. No additional training or education was required to properly use it. This dressing was applied and removed like standard transparent adhesive dressings, but offered many advantages over standard dressings. Advantages include that it is antimicrobial, handles moderate bleeding, remains transparent and appears to offer greater catheter securement than the Tegaderm® (3M Health Care™, St. Paul, MN) standard dressing. The CHG gel pad also conformed well to the catheter.

scholarly journals Vascular Access, Complications and Survival in Incident Hemodialysis Patients

2021 ◽  
Vol 1 (2) ◽  
pp. 88-99
Author(s):  
Massimo Torreggiani ◽  
Lucia Bernasconi ◽  
Marco Colucci ◽  
Simone Accarino ◽  
Ettore Pasquinucci ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Central Venous Catheter ◽  
Vascular Access ◽  
Hospital Admissions ◽  
Patient Survival ◽  
Venous Catheter ◽  
Hemodialysis Patients ◽  
Central Venous ◽  
Risk Of Death ◽  
Access Complications

The arteriovenous fistula (AVF) has long been considered the optimal vascular access. However, the evolving characteristics of the ageing dialysis population limit the creation of an AVF in all patients. Thus, more patients start hemodialysis (HD) with a central venous catheter (CVC) rather than an AVF, and the supremacy of the AVF has recently been questioned. The aim of this study was to analyze the incidence and rate of access complications in 100 patients between 2010 and 2015. A total of 63 patients started HD with an AVF, while 37 began HD with a CVC. We found no differences in patient survival according to the vascular access in use at the beginning of dialysis, but patients were more likely to die while undergoing dialysis by means of a CVC than an AVF. Patients started on dialysis with a CVC had more cardiovascular disease, while patients who began dialysis with an AVF presented more hypertension. Fistulas presented a longer survival time despite more hospital admissions, but CVCs bore a higher risk of infections. Our results suggest that starting dialysis with a CVC does not confer a greater risk of death.

Central Venous Catheter Tip Placement: Determination of Posterior Malposition—A Case Study

2006 ◽  
Vol 11 (2) ◽  
pp. 85-89
Author(s):  
Mary B. Markovich
Keyword(s):  
Central Venous Catheter ◽  
Chest Radiograph ◽  
Vascular Access ◽  
Accurate Determination ◽  
Venous Catheter ◽  
Central Venous ◽  
Single View ◽  
Catheter Tip

Abstract Methods for determining central venous catheter (CVC) tip placement vary among facilities. In most institutions, a single-view, anterior chest radiograph is used to visualize and evaluate the CVC catheter for malposition and/or position of the catheter tip. However, this method does not identify the posterior malposition of the catheter tip, which, on the anterior view, may appear correctly placed. In this article, the author (a) identifies the need for double-view chest radiographs for accurate determination of CVC tip placement and (b) emphasizes the importance of expertise of vascular access practitioners in the determination of catheter-tip placement and the identification of malposition and complication of CVC placement.

Vascular Access and Clinical Outcomes in Underserved Hemodialysis Patients in Mexico

2021 ◽  
pp. 1-8
Author(s):  
Pablo Maggiani-Aguilera ◽  
Jochen G. Raimann ◽  
Jonathan S. Chávez-Iñiguez ◽  
Guillermo Navarro-Blackaller ◽  
Peter Kotanko ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Vascular Access ◽  
Mortality Risk ◽  
Proportional Hazards ◽  
Venous Catheter ◽  
Cox Proportional Hazards ◽  
Adverse Outcomes ◽  
Central Venous ◽  
Conversion Rates ◽  
The Usa

<b><i>Introduction:</i></b> Central venous catheter (CVC) as vascular access in hemodialysis (HD) associates with adverse outcomes. Early CVC to fistula or graft conversion improves these outcomes. While socioeconomic disparities between the USA and Mexico exist, little is known about CVC prevalence and conversion rates in uninsured Mexican HD patients. We examined vascular access practice patterns and their effects on survival and hospitalization rates among uninsured Mexican HD patients, in comparison with HD patients who initiated treatment in the USA. <b><i>Methods:</i></b> In this retrospective study of incident HD patients at Hospital Civil (HC; Guadalajara, MX) and the Renal Research Institute (RRI; USA), we categorized patients by the vascular access at the first month of HD and after the following 6 months. Factors associated with continued CVC use were identified by a logistic regression model. We developed multivariate Cox proportional hazards models to investigate the effects of access and conversion on mortality and hospitalization over an 18-month follow-up period. <b><i>Results:</i></b> In 1,632 patients from RRI, the CVC prevalence at month 1 was 64% and 97% among 174 HC patients. The conversion rate was 31.7% in RRI and 10.6% in HC. CVC to non-central venous catheter (NON-CVC) conversion reduced the risk of hospitalization in both HC (aHR 0.38 [95% CI: 0.21–0.68], <i>p</i> = 0.001) and RRI (aHR 0.84 [95% CI: 0.73–0.93], <i>p</i> = 0.001). NON-CVC patients had a lower mortality risk in both populations. <b><i>Discussion/Conclusion:</i></b> CVC prevalence and conversion rates of CVC to NON-CVC differed between the US and Mexican patients. An association exists between vascular access type and hospitalization and mortality risk. Prospective studies are needed to evaluate if accelerated and systematic catheter use reduction would improve outcomes in these populations.

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