High rate of native arteriovenous fistulas: How to reach this goal?

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.

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Aneurysm of Arteriovenous Fistula in Uremic Patients: Is Endograft a Viable Therapeutic Approach?

The Journal of Vascular Access ◽

10.1177/112972980200300207 ◽

2002 ◽

Vol 3 (2) ◽

pp. 85-88 ◽

Cited By ~ 16

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.

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Temporary central venous catheter at hemodialysis initiation and reasons for use: a cross-sectional study

Renal Replacement Therapy ◽

10.1186/s41100-021-00318-y ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Izaya Nakaya ◽

Taijiro Goto ◽

Yuki Nakamura ◽

Kazuhiro Yoshikawa ◽

Junji Oyama ◽

...

Keyword(s):

Healthcare Providers ◽

Venous Catheter ◽

Japanese Patients ◽

Cross Sectional Study ◽

High Rate ◽

Sectional Study ◽

Central Venous ◽

Cross Sectional ◽

Arteriovenous Fistulas ◽

Stage Renal Disease

Abstract Background Creating permanent vascular access (VA) is recommended before hemodialysis initiation in patients with end-stage renal disease (ESRD). Although many patients are still introduced to hemodialysis with temporary central venous catheters (CVCs), the reasons for their use remain unclear. We aimed to clarify the characteristics of Japanese patients introduced to hemodialysis using temporary CVCs, the reasons for their use, and whether this rate can be reduced in the future. Methods We conducted this cross-sectional study in an acute care general hospital in Japan. We enrolled 393 patients aged ≥ 18 years who received a permanent VA creation for initiating hemodialysis. We classified participants into the temporary CVC group or the permanent VA group according to the VA type at hemodialysis initiation and compared their backgrounds. We identified why permanent VA could not be used at hemodialysis initiation for patients in the temporary CVC group. Results Of the 393 patients, 137 (35%) initiated hemodialysis with a temporary CVC, and arteriovenous fistulas (AVFs) were created as the first VA in all patients during hospitalization following hemodialysis initiation. The remaining 256 patients (65%) initiated hemodialysis via AVF cannulation. The duration of predialysis nephrology care was significantly shorter in the temporary CVC group than that in the permanent VA group. The median time from AVF creation to the first successful cannulation was also shorter in the temporary CVC group (8 vs. 66 days, P < 0.001), but the estimated glomerular filtration rate values at hemodialysis initiation did not differ. Reasons for temporary CVC use were varied and complex. Problems on the part of healthcare providers, patient behavioral issues, and characteristics of causative kidney disease itself were underlying reasons. Delayed referral to a nephrologist was less frequent than expected (16%) and the most commonly reported reason (20%) was that a nephrologist was unable to predict the timing of hemodialysis initiation. Conclusions Patients with ESRD should be referred to a nephrologist earlier for AVF creation. However, given the already relatively high rate of hemodialysis initiation with permanent VA in Japan, we considered it surprisingly difficult to further reduce the temporary CVC usage rate in Japan.

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P1317THE PREVALENCE OF CENTRAL VENOUS CATHETERS AND LOWER ARM ARTERIOVENOUS FISTULAS DEPENDS ON DIFFERENT VASCULAR ACCESS MANAGEMENT POLICIES: A MULTICENTER ITALIAN STUDY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa143.p1317 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Pietro Finocchiaro ◽

Antonino Alberti ◽

Rocco Tripepi ◽

Maria Carmela Versace ◽

Maurizio Garozzo ◽

...

Keyword(s):

Vascular Access ◽

Central Venous Catheters ◽

The South ◽

Central Venous ◽

Vascular Surgeon ◽

Arteriovenous Fistulas ◽

Italian Regions ◽

Dialysis Vintage ◽

Significant Difference ◽

Management Policies

Abstract Background and Aims According to local resources, different vascular access (VA) procedures are employed in every country. In Italy, high variability exists in VA management among different dialysis units. In 2018, the DOPPS 5 study showed a declining prevalence of lower arm arteriovenous fistulas (AVF) in Europe with an increasing tendency of making upper arm AVFs and placing central venous catheters (CVCs). Accordingly, an Italian Survey in 2013 confirmed an increasing trend in CVCs use among different Italian regions. Hence, we made an epidemiologic, multicenter study to evaluate a possible relation between this trend and the variability of local VA management policies. Method VA data from 236 patients of prevalent patients were collected from five dialysis centers in the South of Italy. The prevalence of the various types of VAs was analyzed in relation to the following different VA surgery policies adopted in the participant centers: Results Age of patients was comparable among all centers while dialysis vintage was higher in center A (P<0.001). The prevalence of lower arm AVFs was significantly reduced In Center A (50.6%) and the prevalence of CVCs (25.8%) was significantly increased as compared to the Centers D-E. On the contrary the Centers D-E had the highest prevalence of lower arm AVF (70.8%) and the lowest of CVCs (12.3%), with a statistically significant difference as compared to Center A (Table 1 ). Conversely, no differences were noticed when comparing data from Centers B-C vs. Center A and vs. Centers D-E, although the prevalence of lower arm AVFs was slightly higher, but the difference was not significant, and that of CVCs was slightly lower as compared to Center A ,fully supported by the vascular surgeon (Figure 1 ). Conclusion The reduced tendency of lower arm fistulas and the increasing prevalence of CVCs showed by the DOPPS 5 study might not be applicable to all Italian regions. In our study of 5 dialysis units in the South of Italy, the stability of the nephrologist’s surgical activity probably played a crucial role in explaining the observed decreased use of CVCs with a steadily high prevalence (over 70%) of the lower arm fistulas, regardless of aging.

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Vascular Access for Hemodialysis: When and how?

BANTAO Journal ◽

10.2478/bj-2014-0017 ◽

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.

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

10.26678/abcm.cobem2021.cob2021-1388 ◽

2021 ◽

Author(s):

Saulo Gonçalves ◽

Mário Silva ◽

Matheus Costa ◽

Thabata Lucas ◽

Rudolf Huebner

Keyword(s):

Central Venous Catheter ◽

Vascular Access ◽

Venous Catheter ◽

Central Venous

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Gender Disparities in Vascular Access Surgical Outcomes in Elderly Hemodialysis Patients

American Journal of Nephrology ◽

10.1159/000495261 ◽

2018 ◽

Vol 49 (1) ◽

pp. 11-19 ◽

Cited By ~ 10

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.

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

The Journal of Vascular Access ◽

10.1177/1129729819838132 ◽

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.

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Hemodialysis Reliable Outflow graft: A valid option in patients with central venous stenosis

The Journal of Vascular Access ◽

10.1177/1129729820917255 ◽

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.

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Relevance of a skilled vascular surgeon and optimized facility practices in the long-term patency of arteriovenous fistulas: a prospective study

Brazilian Journal of Nephrology ◽

10.1590/2175-8239-jbn-2018-0125 ◽

2019 ◽

Vol 41 (3) ◽

pp. 330-335

Author(s):

Esteban Lucas Siga ◽

Noemi Ibalo ◽

Maria R. Benegas ◽

Farias Laura ◽

Carlos Luna ◽

...

Keyword(s):

Vascular Access ◽

Patency Rate ◽

Primary Patency ◽

Vascular Surgeon ◽

Term Outcome ◽

Long Term Outcome ◽

Arteriovenous Fistulas ◽

The North ◽

Almost All

Abstract Introduction: Arteriovenous fistulas (AVF) are the best hemodialysis vascular accesses, but their failure rate remains high. Few studies have addressed the role of the vascular surgeon's skills and the facility's practices. We aimed to study these factors, with the hypothesis that the surgeon's skills and facility practices would have an important role in primary failure and patency rates at 12 months, respectively. Methods: This was a single-center, prospective cohort study carried out from March 2005 to March 2017. Only incident patients were included. A single surgeon made all AVFs, either in the forearm (lower) or the elbow (upper). Vascular access definitions were in accordance with the North American Vascular Access Consortium. Results: We studied 113 AVFs (65% lower) from 106 patients (39% diabetics, 58% started with catheter). Time to first connection was 21.5 days (IR: 14 - 31). Only 14 AVFs (12.4%) underwent primary failure and 18 failed during the first year. Functional primary patency rate was 80.9% (SE 4.1) whereas primary unassisted patency rate, which included PF, was 70.6% (4.4). Logistic regression showed that diabetes (OR = 3.3, 95%CI 1.38 - 7.88, p = .007) and forearm location (OR = 3.03, 95CI% 1.05 - 8.76, p = 0.04) were predictors of AVF failure. Patency of lower and upper AVFs was similar in non-diabetics, while patency in diabetics with lower AVFs was under 50%. (p = 0.003). Conclusions: Results suggest that a long-lasting, suitable AVF is feasible in almost all patients. The surgeon's skills and facility practices can have an important role in the long term outcome of AVF.

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P1366THE ROLE OF A NEPHROLOGIST IN THE CREATION OF VASCULAR ACCESS FOR HEMODIALYSIS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1366 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Gennadii Fomenko

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Vascular Access ◽

Kidney Diseases ◽

Kidney Injury ◽

Venous Catheter ◽

Vascular Surgeon ◽

Dialysis Unit ◽

The Creation ◽

Set Up

Abstract Background and Aims The creation of vascular access: has it anything to do with a nephrologist ? At first glance, the concept of vascular access is the responsibility of surgical specialists. However, a nephrologist has started executing some of the common intensive treatment methods, using the equipment and techniques, specific to the field of dialysis. In this case, a nephrology specialist sets up different kinds of vascular access, namely the AV (arteriovenous) fistula, the AV graft, and the venous catheter; he/she is, therefore, responsible for its assessment and congruent correction. Method the usage of statistical data, gathered by the medical specialists of the dialysis unit of the Regional Chernihiv Hospital; the analysis of the possible nephrologist’s contribution to the creation of vascular access in patients with kidney diseases. Results During 2017-2019, 332 catheterizations were performed, during each of them vascular access was established: Conclusion 1. A nephrologist, in collaboration with a vascular surgeon, is particularly interested in the creation of vascular access in a patient with chronic kidney disease at the pre-dialysis stage; 2. In most cases, a nephrologist can set up temporary or permanent vascular access in patients with chronic kidney disease or acute kidney injury, which improves the quality of hemodialysis by making him an active participant of the treatment process.

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