scholarly journals Our experience of arteriovenous fistula creation as vascular access for hemodialysis

2020 ◽  
Vol 7 (7) ◽  
pp. 2321
Author(s):  
Pradeep K. Sharma ◽  
Rupesh Nagori ◽  
Shekhar Baweja ◽  
Vikas Aggarwal ◽  
Pawan Katti ◽  
...  
Keyword(s):  
Physical Examination ◽  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Color Doppler ◽  
Postoperative Outcome ◽  
Arterial System ◽  
Dominant Hand ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Background: End stage renal disease (ESRD) patients depend on lifelong renal replacement therapy. The arteriovenous fistula (AVF) is the preferred hemodialysis access. Cimino fistulas are currently accepted as the best mode of vascular access for hemodialysis (HD). The present study was planned to study for presence of on table bruit and thrill and to know postoperative outcome and patency.Methods: This single center, prospective study was carried out in department of Urology at SNMC, Jodhpur from November 2018 to May 2019.  Dominance of hand was examined, and preference was given to non-dominant hand. Physical examination of the arterial system along with physical examination of the venous system was done.  Preoperative color Doppler of upper limb veins and arteries was done in selected patients. End to side anastomosis was done between cephalic vein and radial artery.Results: In this study of 70 cases of AVFs, there were 53 (75.71%) successful cases and 17 (24.2%) were failures.  End (vein) to side (artery) anastomosis was done in 70 (100%) cases.  On table bruit was present in 63 (90%) and thrill in 58 (82.8%) cases. All patients with failed post-operative fistula were not doing ball exercise.Conclusions: Presence of on table thrill and bruit are indicators of successful AVF. Post-operative ball exercise should be done for better results.

scholarly journals Vascular Access Calcification and Arteriovenous Fistula Maturation

2014 ◽  
Vol 7 (1) ◽  
pp. 22-25
Author(s):  
Timmy Lee
Keyword(s):  
Arteriovenous Fistula ◽  
Vascular Calcification ◽  
Vascular Access ◽  
Hemodialysis Vascular Access ◽  
Pathophysiological Role ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients ◽  
Fistula Maturation ◽  
Arteriovenous Fistula Maturation

The vascular access serves as the “lifeline” for the hemodialysis patient, but in recent years has become the “Achilles Heel” of the hemodialysis procedure. The vascular health of the vessels used to create arteriovenous accesses is paramount to vascular access maturation and successful outcomes. Vascular calcification is widely present in the vessels of chronic kidney disease (CKD) and end stage renal disease (ESRD) patients, and may also potentially impact the vascular access remodeling process. Few studies have been published to date evaluating vascular calcification as it relates to vascular access outcomes. However, an improved understanding of how vascular calcification plays a pathophysiological role in hemodialysis vascular access dysfunction may improve therapies to treat arteriovenous fistula (AVF) non-maturation and the health of the vessels prior to vascular access creation.

scholarly journals The influence of propofol-based total intravenous anesthesia on postoperative outcomes in end-stage renal disease patients: A retrospective observation study

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254014
Author(s):  
Ho Bum Cho ◽  
Mun Gyu Kim ◽  
Sun Young Park ◽  
Sanghoon Song ◽  
Youn Sil Jang ◽  
...  
Keyword(s):  
Chloride Concentration ◽  
Postoperative Outcome ◽  
Total Intravenous Anesthesia ◽  
Cardiac Events ◽  
Observation Study ◽  
Intravenous Anesthesia ◽  
Volatile Anesthesia ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Background To determine whether the anesthetic method of propofol total intravenous anesthesia (TIVA) is associated with postoperative outcome in ESRD patients, we evaluated the incidence of postoperative major adverse cardiac events (MACE), comparing propofol TIVA versus anesthesia with volatile anesthesia in ESRD patients. Methods Retrospectively, we identified cases with ESRD patients who underwent surgery under general anesthesia. Patients were divided into those who received only volatile anesthesia (volatile group) and those who received only propofol TIVA (TIVA group). The incidence of MACE and potential confounding variables were compared separately in a univariate logistic model and subsequently by multivariate logistic regression. Results Among the 2576 cases in ESRD patients, 1374 were in the TIVA group and 1202 were in the volatile group. The multivariate analysis included 12 factors, including the anesthesia method, of which five factors were significant. Factors that were associated with a significantly lower MACE risk included preoperative chloride concentration (OR: 0.96; 95% CI, 0.92–0.99), baseline SBP (OR: 0.98; 95% CI, 0.98–0.99), and propofol TIVA (OR: 0.37; 95% CI, 0.22–0.60). Conclusions We inferred that the anesthetic method associated with the postoperative outcome in patients with ESRD.

scholarly journals Quality assessment of vascular access procedures for hemodialysis: A position paper of the Vascular Access Society based on the analysis of existing guidelines

2019 ◽  
Vol 21 (2) ◽  
pp. 148-153 ◽  
Author(s):  
Branko Fila ◽  
Ramon Roca-Tey ◽  
Jan Malik ◽  
Marko Malovrh ◽  
Nicola Pirozzi ◽  
...  
Keyword(s):  
Quality Control ◽  
Quality Assessment ◽  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Intermittent Hemodialysis ◽  
Improvement Programs ◽  
Stage Renal Disease ◽  
End Stage ◽  
Quality Improvement Programs ◽  
Access Surgery

Quality assessment in vascular access procedures for hemodialysis is not clearly defined. The aim of this article is to compare various guidelines regarding recommendation on quality control in angioaccess surgery. The overall population of end-stage renal disease patients and patients in need for hemodialysis treatment is growing every year. Chronic intermittent hemodialysis is still the main therapy. The formation of a functional angioaccess is the cornerstone in the management of those patients. Native (autologous) arteriovenous fistula is the best vascular access available. A relatively high percentage of primary failure and fistula abandonment increases the need for quality control in this field of surgery. There are very few recommendations of quality assessment on creation of a vascular access for hemodialysis in the searched guidelines. Some guidelines recommend the proportion of native arteriovenous fistula in incident and prevalent patients as well as the maximum tolerable percentage of central venous catheters and complications. According to some guidelines, surgeon’s experience and expertise have a considerable influence on outcomes. There are no specific recommendations regarding surgeon’s specialty, grade, level of skills, and experience. In conclusion, there is a weak recommendation in the guidelines on quality control in vascular access surgery. Quality assessment criteria should be defined in this field of surgery. According to these criteria, patients and nephrologists could choose the best vascular access center or surgeon. Centers with best results should be referral centers, and centers with poorer results should implement quality improvement programs.

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.

Current state of vascular access in Singapore

2019 ◽  
Vol 21 (5) ◽  
pp. 582-588 ◽  
Author(s):  
Suh Chien Pang ◽  
Ru Yu Tan ◽  
Jia Liang Kwek ◽  
Kian Guan Lee ◽  
Marjorie Wai Yin Foo ◽  
...  
Keyword(s):  
Renal Disease ◽  
Arteriovenous Fistula ◽  
Vascular Access ◽  
End Stage Renal Disease ◽  
Shared Responsibility ◽  
Arteriovenous Graft ◽  
Access Management ◽  
Current State ◽  
Stage Renal Disease ◽  
End Stage

This article described the current state of vascular access management for patients with end-stage renal disease in Singapore. Over the past 10 years, there has been a change in the demographics of end-stage renal disease patients. Aging population and the increase in prevalence of diabetes mellitus has led to the acceleration of chronic kidney disease and increase in incidence and prevalence of end-stage renal disease. Vascular access care has, therefore, been more complicated, with the physical, psychological, and social challenges that occur with increased frequency in elderly patients and patients with multiple co-morbidities. Arteriovenous fistula and arteriovenous graft are created by vascular surgeons, while maintenance of patency of vascular access through endovascular intervention has been a shared responsibility between surgeons, interventional radiologists, and interventional nephrologists. Pre-emptive access creation among end-stage renal disease patients has been low, with up to 80% of new end-stage renal disease patients being commenced on hemodialysis via a dialysis catheter. Access creation is exclusively performed by a dedicated vascular surgeon with arteriovenous fistula success rate up to 78%. The primary and cumulative patency rates of arteriovenous fistula and arteriovenous graft were consistent with the results from many international centers. Vascular access surveillance is not universally practiced in all dialysis centers due to its controversies, in addition to the cost and the limited availability of equipment for surveillance. Timely permanent access placement, with reduced dependence on dialysis catheters, and improved vascular access surveillance are the main areas for potential intervention to improve vascular access management.

The Predictive Factors of Arteriovenous Fistula Maturation in Patients with End-Stage Renal Disease

2020 ◽  
Vol 25 (1) ◽  
pp. 28-34
Author(s):  
Supomo Supomo ◽  
Satya Septia Wahyunigrum ◽  
Aditya Agam Nugraha
Keyword(s):  
Renal Disease ◽  
Arteriovenous Fistula ◽  
Predictive Factors ◽  
End Stage Renal Disease ◽  
Arterial Diameter ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients ◽  
Fistula Maturation ◽  
Arteriovenous Fistula Maturation

Highlights Arterial diameter above 2 mm had an almost 5 times better AVF maturation outcome. Average age of ESRD patients who underwent the AVF procedure was above 50 years. Percentage of AVF maturation was higher in men. Hypertension was the most common comorbid factor in ESRD patients.

Physical examination of the hemodialysis arteriovenous fistula to detect early dysfunction

2018 ◽  
Vol 20 (1) ◽  
pp. 7-11 ◽  
Author(s):  
Kenneth Abreo ◽  
Bakhtiar M Amin ◽  
Adrian P Abreo
Keyword(s):  
Physical Examination ◽  
Arteriovenous Fistula ◽  
Nurse Practitioners ◽  
Physical Exam ◽  
Limited Experience ◽  
Stage Renal Disease ◽  
End Stage ◽  
Key Terms ◽  
Training Physicians ◽  
Hemodialysis Arteriovenous Fistula

The maintenance of vascular access patency for end-stage renal disease patients on hemodialysis is necessary for survival. Many nephrologists, nurse practitioners, and nurses have limited experience with the physical examination of the arteriovenous fistula. In this review, we define key terms used in the assessment of an arteriovenous fistula. We discuss the arteriovenous fistula physical exam, including details of inspection, palpation, and auscultation. Using these concepts, we review the abnormal findings that can assist practitioners in determining the location of a stenosis. We review the existing literature that validates physical exam findings with gold standard tests such as ultrasound and angiography. Finally, we review data supporting the value of training physicians and nurses in arteriovenous fistula physical examination.

American Association of Kidney Patients survey of patient preferences for hemodialysis vascular access

2019 ◽  
Vol 21 (2) ◽  
pp. 230-236
Author(s):  
Saravanan Balamuthusamy ◽  
Larry E Miller ◽  
Diana Clynes ◽  
Erin Kahle ◽  
Richard A Knight ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Renal Disease ◽  
Arteriovenous Fistula ◽  
Vascular Access ◽  
End Stage Renal Disease ◽  
American Association ◽  
Venous Catheter ◽  
Central Venous ◽  
Stage Renal Disease ◽  
End Stage

Objectives: To determine the vascular access modalities used for hemodialysis, the reasons for choosing them, and determinants of satisfaction with vascular access among patients with end-stage renal disease. Methods: The American Association of Kidney Patients Center for Patient Research and Education used the American Association of Kidney Patients patient engagement database to identify eligible adult hemodialysis patients. Participants completed an online survey consisting of 34 demographic, medical history, and hemodialysis history questions to determine which vascular access modalities were preferred and the reasons for these preferences. Results: Among 150 respondents (mean age 54 years, 53% females), hemodialysis was most frequently initiated with central venous catheter (64%) while the most common currently used vascular access was arteriovenous fistula (66%). Most (86%) patients previously received an arteriovenous fistula, among whom 77% currently used the arteriovenous fistula for vascular access. Older patients and males were more likely to initiate hemodialysis with an arteriovenous fistula. The factors most frequently reported as important in influencing the selection of vascular access modality included infection risk (87%), physician recommendation (84%), vascular access durability (78%), risk of complications involving surgery (76%), and impact on daily activities (73%); these factors were influenced by patient age, sex, and race. Satisfaction with current vascular access was 90% with arteriovenous fistula, 79% with arteriovenous graft, and 67% with central venous catheter. Conclusion: Most end-stage renal disease patients continue to initiate hemodialysis with central venous catheter despite being associated with the lowest satisfaction rates. While arteriovenous fistula was associated with the highest satisfaction rate, there are significant barriers to adoption that vary based on patient demographics and perception of procedure invasiveness.

Arteriovenous fistulas for hemodialysis: Brief review and current problems

2021 ◽  
pp. 112972982110077
Author(s):  
John J Manov ◽  
Prasoon P Mohan ◽  
Roberto Vazquez-Padron
Keyword(s):  
Renal Disease ◽  
Arteriovenous Fistula ◽  
Vascular Access ◽  
End Stage Renal Disease ◽  
State Of The Art ◽  
Arteriovenous Fistulas ◽  
Number Of Patients ◽  
Stage Renal Disease ◽  
End Stage

The number of people worldwide living with end-stage renal disease is increasing. Arteriovenous fistulas are the preferred method of vascular access in patients who will require hemodialysis. As the number of patients with arteriovenous fistulas grows, the role of physicians who intervene who maintain and salvage these fistulas will grow in importance. This review aims to familiarize practitioners with the rationale for arteriovenous fistula creation, the detection of fistula dysfunction, and the state of the art on fistula maintenance and preservation. Current controversies are briefly reviewed.

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