scholarly journals Vascular access cannulation in hemodialysis patients: technical approach

2020 ◽  
Vol 42 (1) ◽  
pp. 38-46
Author(s):  
Manuel Carlos Martins Castro ◽  
Francisca Tokiko Yanagida Carlquist ◽  
Celina de Fátima Silva ◽  
Magdaleni Xagoraris ◽  
Jerônimo Ruiz Centeno ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Vascular Access ◽  
Brachial Artery ◽  
Hemodialysis Patients ◽  
Anatomical Location ◽  
Technical Approach ◽  
Arteriovenous Fistulas ◽  
Cannulation Technique ◽  
Arteriovenous Grafts ◽  
The Mean

ABSTRACT Introduction: The vascular access cannulation technique varies among clinics, and guidelines on vascular access give little importance to cannulation techniques. The objective of this study was to evaluate the cannulation technique and to determine which factors are associated with each detail of the technique. Material and methods: The vascular access cannulation was evaluated in 260 patients undergoing hemodialysis. The type and anatomical location of the vascular access, the cannulation technique, direction, gauge, and distance between needles, besides bevel direction and needle rotation were registered. Results: The arteriovenous fistula was the most frequent vascular access (88%), the most used cannulation technique was area (100%), the needle direction was anterograde in most cases (79.5%), and the mean distance between the tips of needles was 7.57±4.43 cm. For arteriovenous grafts, the proximal anatomical location (brachial artery) and cannulation with 16G needles in anterograde position were more predominant. For arteriovenous fistulas, the distal anatomical location (radial artery) and cannulation through 15G needles were more common. Cannulation of vascular access in retrograde direction was associated with a greater distance between needles (13.2 ± 4.4 vs 6.1 ± 3 cm, p < 0.001). Kt/V was higher when the distance between needles was higher than 5 cm (1.61 ± 0.3 vs. 1.47 ± 0.28, p < 0.01). Conclusions: The vascular access cannulation technique depends on the vascular access characteristics and expertise of cannulators. Clinical trials are required for the formulation of guidelines for vascular access cannulation.

scholarly journals Vascular Access for Hemodialysis: When and how?

2014 ◽  
Vol 12 (2) ◽  
pp. 84-89
Author(s):  
Andreja Figurek ◽  
Evangelos Papachristou ◽  
Dimitrios S. Goumenos
Keyword(s):  
Vascular Access ◽  
Hemodialysis Patients ◽  
Vascular Surgeon ◽  
Proper Actions ◽  
Arteriovenous Fistulas ◽  
Unnecessary Procedures ◽  
Arteriovenous Grafts ◽  
The Right ◽  
Selection Of

AbstractAs chronic kidney disease (CKD) progresses to the terminal stage, proper actions must be taken to prepare the patient for the initiation of the renal replacement therapy (RRT). If hemodialysis is an option for RRT, decisions should be made about the right vascular access for each individual patient. The available options for vascular access include the use of native arteriovenous fistulas (AVF), synthetic arteriovenous grafts (AVG) and double lumen dialysis catheters. With the help of ultrasound mapping, chances for choosing a right access are today very high. For hemodialysis patients the selection of the proper vascular access is of vital issue in regard of preventing complications and unnecessary procedures. Planning, creation and monitoring of the vascular access in dialysis patients should involve not only the nephrologist, but also the vascular surgeon and the interventional radiologist. Thus, multidisciplinary approach should be taken, in order to choose the way that has the most advantages and the least damage for the patient. That is the proper mode for hemodialysis patients to have longer and better quality of life.

Effectiveness and safety of repeated percutaneous intervention in an office-based endovascular center in maintaining hemodialysis access

Vascular ◽  
2021 ◽  
pp. 170853812110043
Author(s):  
Jay Patel ◽  
Stephanie Chang ◽  
Shaan Manawar ◽  
John Munn ◽  
Mark C Rummel ◽  
...  
Keyword(s):  
Percutaneous Intervention ◽  
Dialysis Access ◽  
Arteriovenous Graft ◽  
Hemodialysis Access ◽  
Upper Arm ◽  
Access Site ◽  
Arteriovenous Fistulas ◽  
Arteriovenous Grafts ◽  
The Mean

Objectives Percutaneous dialysis access interventions are routinely used to maintain the patency of dialysis access despite the lack of data regarding their long-term effectiveness. This retrospective study was undertaken to study the effectiveness and safety of percutaneous dialysis access interventions in arm fistulas and bridge grafts in an office-based endovascular center. Methods Patients who had a percutaneous dialysis access intervention in their upper extremity access site, performed at a single office-based endovascular center over a nine-year period (2007–2016) were included in this study. The patients’ demographic factors, patency, and complications were analyzed. Patients were entered in the study after first percutaneous dialysis access intervention. Results A total of 298 limbs in 259 patients had 913 procedures carried out over a nine-year period. There were 190 access arteriovenous fistulas and 108 arteriovenous grafts. The two most common arteriovenous fistulas were the brachiocephalic fistula ( n = 74, 39%) and radio cephalic fistula ( n = 69, 36%). Arteriovenous grafts were most commonly placed in the upper arm ( n = 66, 61%) followed by the forearm ( n = 42, 39%). The mean overall patency for all limbs was 50.86 months. Arteriovenous fistulas had a significantly longer patency than arteriovenous grafts (51.65 vs. 42.09 months; P = 0.01). In addition, patients with two or more percutaneous dialysis access intervention in their arteriovenous fistula had significantly greater patency than those with only one percutaneous dialysis access intervention (58.5 vs. 7.6 months; hazard ratio 0.41; P = 0.0008). This was not true for the arteriovenous graft group. Women represented 49% of the patient group. Their accesses had shorter patency than men (39.8 vs. 60 months; P = 0.0007). Conclusions This data support the use of repeated percutaneous dialysis access intervention to maintain long-term patency of dialysis access sites in an office-based endovascular center. Overall, fistulas have longer patency than grafts and women have poorer outcomes as compared to men

scholarly journals Gender Disparities in Vascular Access Surgical Outcomes in Elderly Hemodialysis Patients

2018 ◽  
Vol 49 (1) ◽  
pp. 11-19 ◽  
Author(s):  
Timmy Lee ◽  
Joyce Qian ◽  
Mae Thamer ◽  
Michael Allon
Keyword(s):  
United States ◽  
Vascular Access ◽  
Surgical Outcomes ◽  
Relative Rate ◽  
Venous Catheter ◽  
The United States ◽  
Hemodialysis Patients ◽  
Elderly Male ◽  
Female Patients ◽  
Arteriovenous Fistulas

Background: Despite national vascular access guidelines promoting the use of arteriovenous fistulas (AVF) over arteriovenous grafts (AVGs) for dialysis, AVF use is substantially lower in females. We assessed clinically relevant AVF and AVG surgical outcomes in elderly male and female patients initiating hemodialysis with a central venous catheter (CVC). Methods: Using the United States Renal Data System standard analytic files linked with Medicare claims, we assessed incident hemodialysis patients in the United States, 9,458 elderly patients (≥67 years; 4,927 males and 4,531 females) initiating hemodialysis from July 2010 to June 2011 with a catheter and had an AVF or AVG placed within 6 months. We evaluated vascular access placement, successful use for dialysis, assisted use (requiring an intervention before successful use), abandonment after successful use, and rate of interventions after successful use. Results: Females were less likely than males to receive an AVF (adjusted likelihood 0.57, 95% CI 0.52–0.63). Among patients receiving an AVF, females had higher adjusted likelihoods of unsuccessful AVF use (hazard ratio [HR] 1.46, 95% CI 1.36–1.56), assisted AVF use (OR 1.34, 95% CI 1.17–1.54), and AVF abandonment (HR 1.28, 95% CI 1.10–1.50), but similar relative rate of AVF interventions after successful use (relative risk [RR] 1.01, 95% CI 0.94–1.08). Among patients receiving an AVG, females had a lower likelihood of unsuccessful AVG use (HR 0.83, 95% CI 0.73–0.94), similar rates of assisted AVG use (OR 1.05, 95% CI 0.78–1.40) and AVG abandonment, and greater relative rate of interventions after successful AVG use (RR 1.16, 95% CI 1.01–1.33). Conclusions: While AVFs should be considered the preferred vascular access in most circumstances, clinical AVF surgical outcomes are uniformly worse in females. Clinicians should also consider AVGs as a viable alternative in elderly female patients initiating hemodialysis with a CVC to avoid extended CVC dependence.

Superficialization of Basilic Vein: Last Chance for a Native Arteriovenous Fistula in Hemodialysis Patients

2003 ◽  
Vol 4 (1) ◽  
pp. 21-24 ◽  
Author(s):  
M. Onaran ◽  
D. Erer ◽  
I. Şen ◽  
E.E. Elnur ◽  
E. Iriz ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Brachial Artery ◽  
Subcutaneous Tissue ◽  
Vascular Grafts ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Basilic Vein ◽  
Number Of Patients

Background Although the best type of vascular access for chronic hemodialysis patients is a native arteriovenous fistula, in an increasing number of patients all the superficial veins have been used and only the placement of vascular grafts or permanent catheters is left. Superficialization of the basilic vein is a possible alternative. Materials and Methods In 49 chronic hemodialysis patients who had no possibilities to have a native arteriovenous fistula created, we performed a basilic vein- brachial artery fistula in the arm. During the same operation the basilic vein was then superficialized for easier access for hemodialysis. Results Mean follow-up was 22.36±15.56 months. Forty-eight patients are still undergoing hemodialysis with their superficialized basilic vein native A-V fistula without any complications. Only one fistula was thrombosed just after the procedure because of poor vessel quality. Conclusion For hemodialysis patients who have no suitable superficial veins at the wrist or elbow, performing a basilic vein - brachial artery fistula and superficializing the vein to the subcutaneous tissue is an acceptable choice before deciding to use more complicated procedures like vascular grafts.

Transjugular percutaneous endovascular treatment of dysfunctional hemodialysis access

2018 ◽  
Vol 20 (5) ◽  
pp. 488-494 ◽  
Author(s):  
Jin Ho Kim ◽  
Sung Bum Cho ◽  
Yun Hwan Kim ◽  
Hwan Hoon Chung ◽  
Seung Hwa Lee ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Internal Jugular Vein ◽  
Patency Rate ◽  
Jugular Vein ◽  
Hemodialysis Access ◽  
Procedure Time ◽  
Arteriovenous Fistulas ◽  
Arteriovenous Grafts ◽  
The Mean ◽  
Vein Stenosis

Purpose: To evaluate the feasibility and the outcomes of transjugular percutaneous endovascular treatment of dysfunctional hemodialysis access in patients with chronic kidney disease. Methods: A total of 50 transjugular treatments in 38 patients with arteriovenous fistulas or arteriovenous grafts from September 2011 to May 2015 were included in this study. Medical records and angiographies were retrospectively reviewed. Success rate, patency rate, procedure time, and complications including internal jugular vein stenosis were evaluated. Results: A total of 50 sessions of transjugular treatments were performed in 38 patients. There were 31 native arteriovenous fistulas including 10 immature cases and 19 arteriovenous grafts. Among the 50 cases, technical success was achieved in 45 and clinical success was achieved in 44; 37 cases (74%) with multiple stenotic sites were treated by the transjugular approach without placement of cross-sheaths. The mean time from puncture of the internal jugular vein to first fistulography was 10 min, and the mean total procedure time was 64 min. The primary patency rate at 6 months was 77%, while the secondary patency rate at 6 months was 97%. Perforation occurred in two cases during conventional percutaneous transluminal angioplasty after failure of the transjugular approach. One dissection occurred during the transjugular approach. There was no newly developed internal jugular vein stenosis during a mean follow-up period of 19.3 months. Conclusion: For the treatment of dysfunctional or immature hemodialysis access, the transjugular approach is a feasible and effective option that avoids injury to the graft or draining vein, especially in immature fistulas.

Dimethylarginine Dimethylaminohydrolase 1 Polymorphisms and Venous Intimal Hyperplasia in Hemodialysis Patients

2019 ◽  
Vol 50 (6) ◽  
pp. 454-464 ◽  
Author(s):  
Chih-Cheng Wu ◽  
Mu-Yang Hsieh ◽  
Chih-Kuo Lee ◽  
Shao-Yuan Chuang ◽  
Ming-Yi Chung ◽  
...  
Keyword(s):  
Vascular Access ◽  
Intimal Hyperplasia ◽  
Nucleotide Polymorphisms ◽  
Dimethylarginine Dimethylaminohydrolase ◽  
Arteriovenous Fistulas ◽  
Plasma Adma ◽  
Observational Cohort ◽  
Arteriovenous Grafts ◽  
Early Restenosis

Background: After angioplasty, veins are more prone to intimal hyperplasia than arteries. Veins tend to produce less nitric oxide (NO), which could lead to endothelial dysfunction. Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of NO synthase and contributes to cardiovascular disease. In humans, dimethylarginine dimethylaminohydrolase 1 (DDAH1) is the major enzyme for ADMA degradation. In this study, we aim to determine whether venous intimal hyperplasia in hemodialysis (HD) vascular access is influenced by common polymorphisms in the DDAH1 genes. Methods: This is a prospective observational cohort study. A total of 473 HD patients referred for the angioplasty of vascular access were enrolled. There were 190 arteriovenous grafts (AVG) and 283 arteriovenous fistulas (AVF). The follow-up lasted for 2 years after the interventions. Seven single nucleotide polymorphisms (SNPs) in DDAH1 were genotyped and ADMA were measured at baseline. The primary outcome was restenosis after angioplasty. Results: Among the 7 SNPs, plasma ADMA levels were significantly different in DDAH1 rs233112 (GA + GG vs. AA, 0.86 ± 0.23 vs. 0.82 ± 0.19 μM, p = 0.03) and rs1498373 (CT + TT vs. CC, 0.87 ± 0.23 vs. 0.82 ± 0.20 μM, p = 0.02) genotypes. The AVF group with GG + GA genotype of rs233112 and CT + TT genotype of rs1498373 had higher risks of early restenosis at 3 months. In the AVG group, only GG + GA genotype of rs233112 was associated with early restenosis. A combined analysis of AVG and AVF groups showed that patients with rs233112 GA + GG genotype and rs1498373 CT + TT genotype had higher risks of early restenosis (both p < 0.001). The multivariate analysis results showed that the association of these genotypes with early restenosis is independent of clinical, access, or biochemical factors. Conclusions: Our findings suggest that certain DDAH1 polymorphisms modulate circulating ADMA levels and are associated with venous intimal hyperplasia.

Liposuction used to treat deep vascular accesses for hemodialysis

2020 ◽  
pp. 112972982092791
Author(s):  
Marius C Florescu ◽  
Troy J Plumb ◽  
Scott Westphal ◽  
Ryan Mullane ◽  
Debra A Reilly
Keyword(s):  
Surgical Complication ◽  
Invasive Technique ◽  
Dialysis Access ◽  
Dialysis Patients ◽  
Hemodialysis Catheter ◽  
Arteriovenous Fistulas ◽  
Post Surgery ◽  
Manual Pressure ◽  
Arteriovenous Grafts ◽  
The Mean

Background: Oftentimes, obese dialysis patients develop a viable dialysis access but the access is too deep for cannulation and needs a superficialization procedure. Methods: We present our 14-patient cohort in whom we performed liposuction to superficialize viable but deep vascular accesses. Out of 14 patients, 12 had arteriovenous fistulas and 2 arteriovenous grafts. The primary end points were the ability to superficialize a completely unusable access and to remove the hemodialysis catheter (3patients), or to significantly extend the useful length of a deep access in which only a very short segment was used and to continue to use the access post-surgery without the need to place a dialysis catheter (11 patients). Results: The study goal was met in 13 out of 14 patients. In two of three patients, the catheters were removed and their access usable length was 14 and 13 cm, respectively. The accesses could be used immediately after liposuction in all patients in which this applied—11 patients. The usable access length increased from a mean of 5 to 12.7 cm. The access mean depth decreased from 10.8 mm pre-surgery to 7 mm post-surgery and 5.3 mm 4 weeks after surgery. The mean volume of fat removed was 43.8 cc. We had only one surgical complication: bleeding that was readily controlled with manual pressure. All patients were discharged to home the same day. Postoperative pain was mild. Conclusion: Liposuction is effective, safe, and seems to be the least invasive technique of superficialization.

scholarly journals Comparison of HemoFoam® and Conventional Gauze Dressing on Hemostasis of Vascular Access Site in Hemodialysis Patients

2019 ◽  
Vol 8 ◽  
pp. 1395
Author(s):  
Davood Bizari ◽  
Hadi Khoshmohabat ◽  
Soheila Salahshour Kordestani ◽  
Rouhollah Zarepur
Keyword(s):  
Vascular Access ◽  
Venous Access ◽  
Hemodialysis Patients ◽  
Dialysis Access ◽  
Access Site ◽  
Puncture Wound ◽  
Arterial Access ◽  
Gauze Dressing ◽  
The Mean ◽  
Venous Access Site

Background: Dialysis access puncture wound bleeding after needle extraction at the end of each hemodialysis session is a very important problem. This study evaluated the effect of HemoFoam® compared to conventional gauze dressing on hemostasis of dialysis access puncture wound bleeding in hemodialysis patients. Materials and Methods: This one-group, before-after, clinical-trial was conducted on 60 hemodialysis patients selected by convenience sampling who underwent hemodialysis through arteriovenous fistula in Shahid Rahnemoon Hospital, Yazd, Iran in 2017. After reviewing the eligibility criteria, the study was performed in two separate sessions. In the first session, only HemoFoam® was used while in the second session; the only conventional dressing was used. Time of hemostasis in each puncture wound was evaluated. Data were analyzed by SPSS 22 (IBM SPSS Statistics for Windows, Armonk, NY: IBM Corp, United States) using paired T-test and Chi-square tests. Results: The mean age of the patients was 55.20±14.25 years. Hemostasis was achieved in 76.6% of cases at the arterial access site in the first two minutes in the HemoFoam® group. The mean homeostasis time in the HemoFoam® group was 2.86±1.87 min at the venous access site and 3.15±1.97 min at the arterial access site (P<0.001). The mean homeostasis time in the conventional dressing group was 10.54±6.65 min at venous access site and 12.74±9.28 min at the arterial access site, which was significantly different between the two groups (P<0.001). Conclusion: HemoFoam® is effective in reducing the time of homeostasis in the vascular access site of hemodialysis patients. Therefore, its use in hemodialysis wards is recommended for hemostasis in the dialysis access puncture wound bleeding. [GMJ.2019;8:e1395]

Brachio-azygos transthoracic arteriovenous grafts for hemodialysis patients with bilateral central venous obstruction: A small case series

2021 ◽  
pp. 112972982110585
Author(s):  
Dan Song ◽  
Young Woo Park
Keyword(s):  
Lower Extremity ◽  
Vascular Access ◽  
Median Sternotomy ◽  
Case Series ◽  
Hemodialysis Patients ◽  
Arteriovenous Graft ◽  
Venous Obstruction ◽  
Central Venous ◽  
Arteriovenous Grafts ◽  
Central Venous Obstruction

Background: It is difficult to find a reliable outflow vein for vascular access in hemodialysis patients with bilateral central venous obstruction. The lower extremity veins are currently used as the most common alternative veins to make a new vascular access. However, in patients not amenable to make lower extremity access, intrathoracic vein should be considered as an outflow vein, but there are limitations in its use due to postoperative complications. Methods: We introduce a series of cases that underwent arteriovenous graft operation using an intrathoracic vein, the azygos arch, as an outflow vein. Brachio-azygos transthoracic arteriovenous graft is a surgical procedure that anastomoses the azygos arch and the brachial artery with 7 mm ringed polytetrafluoroethylene graft via lateral thoracotomy without median sternotomy. Results: The chest tubes of the patients were removed on the third postoperative day and they discharged within a week. About 1 month later, hemodialysis was initiated through the BATAVG, and it has been used without access dysfunction. Conclusion: Brachio-azygos transthoracic arteriovenous grafts were performed using the azygos arches without major complications. The azygos arch can be a good alternative outflow vein to make a new vascular access for hemodialysis patients with bilateral central venous obstruction.

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