MDCT angiography with 3D image reconstructions in the evaluation of failing arteriovenous fistulas and grafts in hemodialysis patients

2011 ◽  
Vol 52 (9) ◽  
pp. 935-942 ◽  
Author(s):  
Angeliki Dimopoulou ◽  
Hans Raland ◽  
Björn Wikström ◽  
Anders Magnusson
Keyword(s):  
Major Complication ◽  
Hemodialysis Patients ◽  
Transluminal Angioplasty ◽  
3D Image ◽  
Arteriovenous Fistulas ◽  
Image Postprocessing ◽  
Image Reconstructions ◽  
Reliable Diagnostic Method

Background Arteriovenous fistulas and grafts are the methods of choice for vascular access in renal failure patients in need of hemodialysis. Their major complication, however, is stenosis, which might lead to thrombosis. Purpose To demonstrate the usefulness of 16-MDCTA with 3D image reconstructions, in long-term hemodialysis patients with dysfunctional arteriovenous fistulas and grafts (AVF and AVG). Material and Methods During a 17-month period, 31 patients with dysfunctional AVF and AVG (24 AVF and seven AVG) were examined with MDCTA with 3D image postprocessing. Parameters such as comprehension of the anatomy, quality of contrast enhancement, and pathological vascular changes were measured. DSA was then performed in 24 patients. Results MDCTA illustrated the anatomy of the AVF/AVG and the entire vascular tree to the heart, in a detailed and comprehensive manner in 93.5% of the evaluated segments, and depicted pathology of AVF/ AVG or pathology of the associated vasculature. MDCTA demonstrated a total of 38 significant stenoses in 25 patients. DSA verified 37 stenoses in 24 patients and demonstrated two additional stenoses. MDCTA had thus a sensitivity of 95%. All 24 patients were treated with percutaneous transluminal angioplasty (PTA) with good technical results. Conclusion MDCTA with 3D reconstructions of dysfunctioning AVFs and AVGs in hemodialysis patients is an accurate and reliable diagnostic method helping customize future intervention.

scholarly journals Ultrasound guided interventional procedures on arteriovenous fistulae: An Italian experience

2021 ◽  
pp. 112972982097738
Author(s):  
Marcello Napoli ◽  
Giuseppe Bacchini ◽  
Luisa Scarpati ◽  
Giuliana Loizzo ◽  
Anna Zito
Keyword(s):  
Hemodialysis Patients ◽  
Transluminal Angioplasty ◽  
Ultrasound Guided ◽  
New Techniques ◽  
Indwelling Catheters ◽  
Arteriovenous Fistulas ◽  
Italian Experience ◽  
Reduced Costs ◽  
Percutaneous Transluminal

Autogenous (AVF) and prosthetic (AVG) arteriovenous fistulas are the vascular accesses (VA) of choice for hemodialysis thanks to their improved patency, reduced costs, and lower rate of infections relative to catheters. In an effort to maximize the number of primary AVF and AVG, shorten maturation times for AVF, and reduce the number of indwelling catheters, several new techniques have been developed within the context of an overall program designed to optimize access care. This approach includes: (a) Primary Intraoperative Balloon Angioplasty on the vessels selected for AV creation whether small-sized or altered by pre-existing lesions; (b) Percutaneous Transluminal Angioplasty (PTA) on AVF and AVG stenosis, performed under ultrasonographic (UG) or fluoroscopic guide (FG). We report the experience of two Center in performing the above mentioned procedures on even complex VA. The wise adoption of these techniques may avail to meet the stringent demands for reliable VA placement as defined by KDOQI and, thereby, expand the duration and quality of life for hemodialysis patients.

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 Long-term survival of arteriovenous fistulas in home hemodialysis patients

2004 ◽  
Vol 65 (5) ◽  
pp. 1890-1896 ◽  
Author(s):  
Kelvin L. Lynn ◽  
Adrian L. Buttimore ◽  
J. Elisabeth Wells ◽  
Judith A. Inkster ◽  
Justin A. Roake ◽  
...  
Keyword(s):  
Hemodialysis Patients ◽  
Home Hemodialysis ◽  
Term Survival ◽  
Long Term Survival ◽  
Arteriovenous Fistulas

A Prospective, Randomized Trial Comparing a Transparent Dressing and a Dry Gauze on the Exit Site of Long Term Central Venous Catheters of Hemodialysis Patients

2003 ◽  
Vol 4 (2) ◽  
pp. 56-61 ◽  
Author(s):  
I. Le Corre ◽  
M. Delorme ◽  
S. Cournoyer
Keyword(s):  
Quality Of Life ◽  
Hemodialysis Patients ◽  
Exit Site ◽  
Skin Preparation ◽  
Drying Time ◽  
Skin Reactions ◽  
Significant Difference ◽  
The Cost

The objective of this study was to assess the risk of bacteremia, estimate the cost and evaluate the quality of life by using a transparent dressing (TD) versus (vs) a dry gauze (DG) on the exit site of long term central I.V. catheters (LTCC) of hemodialysis patients. This 6-months preliminary study was conducted on 58 patients (pts) randomized to receive DG replaced 3 times/week (29 pts) or TD replaced every 7 days (29 pts). Data on patients, conditions of the exit site, local infection, bacteremia, quality of life and cost related to each type of dressing were collected. Two pts in the DG group experienced bacteremia related to their LTCC vs 1 pt in the group TD. A total of 7 (DG) vs 13 (TD) pts experienced skin condition changes at the catheter exit site. Some skin reactions, erythema and pruritus, did occur initially in the group TD and was due in part to insufficient drying time of the skin preparation solution. The estimated individual, weekly costs for using the DG was $7.60 vs $4.72 Canadian dollars for the TD. The SF-36™ scores did not show a significant difference between the 2 groups during the study (3.8 (PCS), 6.4 (MCS) at study end). Although this study was statistically underpowered, it suggests that the incidence of bacteremia was not increased with the use of a TD. Moreover, the use of a TD allowed fewer dressing changes, lowered total treatment costs, with no observed unfavorable impact on the quality of life and without significant local complications of the exit site. Based on the positive results observed in this pilot study, further study is warranted to examine the cost effectiveness of long-term use of TD dressings on dialysis catheter exit sites.

Effects of long-term aerobic training and detraining on functional capacity and quality of life in hemodialysis patients: A pilot study

2019 ◽  
Vol 43 (6) ◽  
pp. 411-415 ◽  
Author(s):  
Emanuele Poliana Lawall Gravina ◽  
Bruno Valle Pinheiro ◽  
Luciana Angélica da Silva Jesus ◽  
Lilian Pinto da Silva ◽  
Rodolfo Nazareth da Silva ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Functional Capacity ◽  
Aerobic Training ◽  
Training Group ◽  
Hemodialysis Patients ◽  
Significant Difference ◽  
Test Distance ◽  
Training And Detraining

Although previous studies have shown the benefits of exercise training in hemodialysis patients, little is known about the effects of long-term of exercise program on these patients. We investigated the effects and the safety of long-term aerobic training and the effects of detraining on functional capacity and quality of life in hemodialysis patients. Ten patients were allocated to two groups: training and detraining. The training group completed at least 30 months of aerobic training, and the detraining group completed at least 20 months and then discontinued the training for at least 10 months. The outcomes were analyzed at baseline, after 3 months of aerobic training and at the 30-month follow-up. The training and detraining groups performed 37 (5.5) and 24 (3.0) months of aerobic training, respectively. The detraining group discontinued the training for 11.0 (2.0) months. After 3 months of aerobic training, six-minute walking test distance increased significantly in both groups (training group = 569 (287.8) vs 635.5 (277.0) m, p = 0.04; detraining group = 454.5 (72.3) vs 515.0 (91.8) m, p = 0.04). There was no significant difference in the six-minute walking test distance in the training group (576.5 (182.5), p  >  0.05) and a significant decrease (436.2 (89.6) m, p = 0.04) in the detraining group at the follow-up compared to the third month of aerobic training. No significant difference was observed in quality of life during the study. No complications were found during the protocol of the exercise. These results suggest that long-term aerobic training is safe and can maintain functional capacity in hemodialysis patients. In contrast, detraining can result in loss of functional capacity in these patients.

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