scholarly journals Endovasal laser obliteration of arteriovenous fistulas in patients on chronic hemodialy

2021 ◽  
Vol 18 (1) ◽  
pp. 129-134
Author(s):  
B. A. Veselov ◽  
E. P. Burleva
Keyword(s):  
Renal Failure ◽  
Blood Flow ◽  
Chronic Renal Failure ◽  
Energy Density ◽  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Venous Hypertension ◽  
Vascular Compression ◽  
Arteriovenous Fistulas ◽  
Access Complications

Introduction. Vascular access complications are associated with about 30% of patient hospitalizations, and annual costs of vascular access maintenance account for 14–20% of total healthcare costs for dialysis patients. At the same time, current international clinical guidelines emphasize the need to implement a patient-centered approach with planning of possible vascular access complications and selection of optimal surgical interventions (risk/benefit balance) for correction of compromised access.Aim. To present the first experience of endovasal laser obliteration of arteriovenous fistulas for correction of venous hypertension syndrome.Materials and methods. The first experience of complicated arteriovenous fistulas liquidation using endovasal laser obliteration in 6 patients receiving hemodialysis replacement therapy for stage 5 chronic kidney disease (National kidney Foundation (NkF) classification) is presented. In 5 patients due to the presence of venous hypertension of the upper extremity, where the arteriovenous fistula functioned, open intervention was unacceptable because of the high risk of bleeding. In one patient the arteriovenous fistula was closed due to its aneurysmatic transformation. we performed endovasal laser obliteration of four Cimino-type radial artery-cephalic arteriovenous fistulas, one brachial-basilar arteriovenous fistula, and one brachial-cubital arteriovenous fistula. Endovasal laser obliteration was performed with an endovascular light guide under ultrasound navigation using tumescent anesthesia. we used a laser device with a wavelength of 1.56 µm and power of 15 w, working in continuous mode (time 2–4 min, energy density 500 to 1,000 J/cm). The average diameter (Me) of the fistula vein was 8 mm.Results. The course of the early postoperative period in all patients was uncomplicated. The follow-up period was 30 days. Symptoms of venous hypertension were eliminated in all patients, the pain syndrome disappeared completely, there were slight feelings of heaviness and fullness of the limb.Discussion. Experience has shown that standard modes used for varicose vein obliteration for elimination of arteriovenous fistulas in chronic renal failure are ineffective: under conditions of blood flow in the area of arteriovenous anastomosis the energy density is almost 10 times higher. Therefore, other modes were used in our study: energy density from 500 to 1,000 J/cm. This was due to the lack of coagulation of the fistula vein when using standard parameters due to high blood flow rate, despite the use of proximal and distal vascular compression. In all cases we obtained positive results (obliteration of arteriovenous fistulas) without complications along with the correction of venous hypertension within 1 month after the intervention.Conclusion. The advantages of this method are technical simplicity and minimal blood loss, which is especially important for this cohort of patients with initial anemia against chronic renal failure.

scholarly journals Differences in Arteriovenous Fistula Maturation between Diabetes Mellitus and Non-Diabetes Mellitus in Chronic Renal Failure Patients in Padang

2021 ◽  
Vol 6 (1) ◽  
pp. 1287-1291
Author(s):  
Richard Santosa ◽  
Raflis Rustam ◽  
Vendry Rivaldy
Keyword(s):  
Diabetes Mellitus ◽  
Renal Failure ◽  
Chronic Renal Failure ◽  
Arteriovenous Fistula ◽  
Kidney Failure ◽  
Chronic Kidney Failure ◽  
Fistula Surgery ◽  
Arteriovenous Fistulas ◽  
Significant Difference ◽  
Patients With Diabetes

Background: Arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis (HD). Several factors can affect AVF maturity, such as diabetes. This study aims to determine the differences in the maturation of arteriovenous fistulas between diabetes mellitus and non-diabetes mellitus in patients with chronic kidney failure in Padang. Methods: This was a comparative cross-sectional study of patients with chronic kidney failure who underwent arteriovenous fistula surgery in Padang. The sampling technique in this study was consecutive sampling. The analysis was carried out using statistical analysis according to the existing data scale and using SPSS software. Results: This study involved 46 patients with chronic kidney failure who underwent arteriovenous fistula surgery in Padang, of which 23 patients with diabetes mellitus and 23 patients with non-diabetes mellitus. The diameter of the arteriovenous fistula between diabetes mellitus and non-diabetes mellitus in patients with chronic renal failure had a significant difference (p<0.05). There was no significant difference in flow, depth, and maturation of arteriovenous fistulas in patients with diabetes mellitus and non-diabetes mellitus with chronic renal failure. Conclusion: There is no difference in the maturation of arteriovenous fistula between patients with diabetes mellitus and non-diabetes mellitus

Calcium phosphate product level as a predictor for arteriovenous fistula re-operations in patients with chronic renal failure

Vascular ◽  
2018 ◽  
Vol 27 (3) ◽  
pp. 284-290 ◽  
Author(s):  
Mehmet Erin Tüysüz ◽  
Mehmet Dedemoğlu
Keyword(s):  
Renal Failure ◽  
Chronic Renal Failure ◽  
Calcium Phosphate ◽  
Arteriovenous Fistula ◽  
Product Level ◽  
Increased Risk ◽  
High Calcium ◽  
Phosphate Product ◽  
Group 2 ◽  
Group 1

Objectives There is an increased calcium phosphate product level causing the formation of calcification in the arterial wall and thus decreased quality of fistula in patients with chronic renal failure. The purpose of our study is to verify the relationship between arteriovenous fistula re-operation and high calcium phosphate product level. Methods Seventy-nine consecutive patients with chronic renal failure between April 2016 and February 2018 were included in the study. Patients having calcium phosphate product level ≥50 mg2/dl2 were defined as group 1, whereas those having <50 mg2/dl2 were defined as group 2. Primary outcome of interest was the need for re-operation during the follow-up and to determine the risk factors for re-operation. To determine independent predictors for re-operation, multivariate logistic regression model was used. Results The rates of redo and tredo operation were significantly higher in group 1 compared to group 2 ( p = 0.01 and 0.04). In multivariate analysis, phosphate (OR: 1.84, 95% CI: 1.00–3.40, p = 0.05) and triglyceride (OR: 1.01, 95% CI: 1.00–1.02, p = 0.04) levels for redo operation and calcium phosphate product level (OR: 1.11, 95% CI: 1.01–1.22, p = 0.03) for tredo operation were found to be independent predictors. Conclusions High calcium phosphate product level leads to increased risk of arteriovenous fistula re-operation by causing arterial stiffness in this patient group. Additionally, these re-operations place additional burden on morbidity and cost efficacy. Thus, we recommend keeping the calcium phosphate product level at the optimal level in these patients to avoid both the risk of arteriovenous fistula re-operation and the other cardiovascular problems.

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.

scholarly journals Surgical repair of aneurysm of arteriovenous fistula in patients with chronic renal failure

2014 ◽  
Vol 1 ◽  
pp. 17-20 ◽  
Author(s):  
Faruk Cingoz ◽  
Celalettin Gunay ◽  
Adem Guler ◽  
Mehmet Ali Sahin ◽  
Bilgehan Savas Oz ◽  
...  
Keyword(s):  
Renal Failure ◽  
Chronic Renal Failure ◽  
Arteriovenous Fistula ◽  
Surgical Repair

Intraoperative use of transit time flow measurement improves patency of newly created radiocephalic arteriovenous fistulas in patients requiring hemodialysis

2020 ◽  
Vol 21 (6) ◽  
pp. 990-996
Author(s):  
Anna E Cyrek ◽  
Johannes Bernheim ◽  
Benjamin Juntermanns ◽  
Peri Husen ◽  
Arkadius Pacha ◽  
...  
Keyword(s):  
Blood Flow ◽  
Arteriovenous Fistula ◽  
Transit Time ◽  
Intraoperative Ultrasound ◽  
Low Flow ◽  
Flow Measurements ◽  
Technical Problems ◽  
Arteriovenous Fistulas ◽  
Time Flow ◽  
Observation Period

Background: The autologous arteriovenous fistula is the primary choice to establish hemodialysis access without high failure rates. Intraoperative ultrasound flow measurements of newly created autologous arteriovenous fistulas represent a possibility of quality control and may therefore be a tool to assess their functionality. The aim of our study was to correlate intraoperative blood flow with access patency. Methods: Between March 2012 and March 2015, intraoperative transit time flow measurements were collected on 89 patients. Measurements were performed 5–10 min after the creation of a standardized anastomosis using 3–6 mm flow probes. To examine the correlation between intraoperative blood flow and access patency, groups of patients with high (> 200 mL/min) versus low flow (< 200 mL/min) were enrolled. Patients were assessed clinically and with ultrasound every 3 months. Data were analyzed retrospectively. Results: In the current short-term follow-up, including 89 patients (age 62 ± 3 years), 61 (68.5%) of the autologous arteriovenous fistulas were currently being used in an observation period ranging from 3 months to 3 years (mean observation period 546 ± 95 days) postoperatively. The intraoperative blood flow in patients with functioning autologous arteriovenous fistula (78) was significantly higher than that of patients without functioning autologous arteriovenous fistulas (407 ± 25 vs 252 ± 42 mL/min, respectively; p < 0.005) (11). Conclusion: The intraoperative measurement of blood flow is a useful tool to predict the outcome of maturation in autologous arteriovenous fistula. With this method, technical problems can be detected and corrected intraoperatively. Routine implementation of intraoperative flow measurements has to be examined by prospective controlled trials.

scholarly journals The management of vascular access in hemodialysis patients during the coronavirus disease 2019 epidemic: A multicenter cross-sectional study

2020 ◽  
pp. 112972982093748
Author(s):  
Jia Shi ◽  
Jian-Jun Yan ◽  
Jian Chen ◽  
Qing-Hong Zhang ◽  
Yi Yang ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Cross Sectional Study ◽  
Hemodialysis Patients ◽  
Sectional Study ◽  
Epidemic Disease ◽  
Cross Sectional ◽  
Flow Reduction ◽  
Arteriovenous Access ◽  
Access Complications

Background: Coronavirus disease 2019 is an epidemic disease throughout the world. The management of vascular access during the epidemic is currently unknown. Methods: In this multicenter cross-sectional study, we collected vascular access data from hemodialysis patients treated at 44 hospitals in Hubei from 22 January to 10 March 2020. We estimated the management of vascular access during the coronavirus disease 2019 outbreak. Results: Of the 9231 hemodialysis patients included, 5387 patients (58.4%) were men and 2959 patients (32.1%) were older than 65 years. Arteriovenous fistula was the predominant type of vascular access, accounting for 76.5%; 496 patients (5.4%) developed vascular access complications; catheter flow reduction was the most common vascular access complication, and stenosis was the predominant complication among those with arteriovenous access. Overall, 280 vascular access sites were placed in patients newly diagnosed with uremia, of whom 260 (92.8%) underwent catheter insertion; 149 rescue procedures were carried out to treat the vascular access complications, which consisted of 132 catheters, 7 percutaneous transluminal angioplasties, 6 arteriovenous fistula repairs, and 4 arteriovenous fistulas. Occlusion of the arteriovenous access had the highest rescue rate (92.7%), while many other vascular access complications remained untreated; 69 and 142 patients were diagnosed with confirmed and suspected coronavirus disease 2019, respectively. A total of 146 patients died, of whom 29 patients (19.9%) died due to vascular access complications. Conclusion: Catheter flow reduction and stenosis of arteriovenous access were the major vascular access complications. Most of the vascular access sites established were catheters, and many of the vascular access complications remained untreated.

Complications of Subclavian Catheter Hemodialysis: A 5 Year Prospective Study in 257 Consecutive Patients

1982 ◽  
Vol 5 (5) ◽  
pp. 297-303 ◽  
Author(s):  
R. Vanholder ◽  
N. Lameire ◽  
J. Verbanck ◽  
R. Van Rattinghe ◽  
M. Kunnen ◽  
...  
Keyword(s):  
Renal Failure ◽  
Chronic Renal Failure ◽  
Vascular Access ◽  
Vena Cava ◽  
Seldinger Technique ◽  
Access Method ◽  
Valuable Alternative ◽  
Patient Tolerance ◽  
Vena Cava Thrombosis ◽  
Subclavian Catheter

The complications related to the use of subclavian catheters for hemodialysis were prospectively studied in 257 consecutive acute and chronic renal failure patients. Using 394 catheters, 3006 single needle dialyses were performed. Indications for starting catheter dialysis were mainly the absence or disappearance of an adequate vascular access. Most hazardous complications were sepsis (9), malposition (6), hemothorax (3), bleeding (2), vena cava thrombosis (2) and pneumothorax (2). A number of mechanical problems occurred, where the obstructed catheter could easily be replaced by a modified Seldinger technique. No mortal complications occurred. Patient tolerance was excellent. It is concluded that single needle subclavian hemodialysis is a valuable alternative vascular access method in acute situations. It enables the continuation of hemodialysis on an ambulatory basis.

Doppler Sonographic Evaluation of Cerebral Blood Flow in Anemia Resulting From Chronic Renal Failure

2005 ◽  
Vol 24 (7) ◽  
pp. 947-952 ◽  
Author(s):  
Alpay Haktanir ◽  
Serap Demir ◽  
Murat Acar ◽  
Kagan Ucok ◽  
Ramazan Albayrak ◽  
...  
Keyword(s):  
Renal Failure ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Chronic Renal Failure ◽  
Sonographic Evaluation
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