A Retrospective Analysis of Arteriovenous Fistulas as Hemodialysis Access Surgery in the Perspective of KDOQI (Kidney Disease Outcomes Quality Initiative) Guidelines

Chronic kidney disease has been identified as a risk factor for mortality after procedures under general anesthesia (GA). However, a recent study showed that 85 per cent of arteriovenous fistulas in the United States are performed under GA. Our aim was to demonstrate that GA can be avoided in patients with chronic kidney disease and end-stage renal disease by using local anesthesia (LA) with monitored anesthesia care or brachial plexus block (BPB) during hemodialysis access surgery. A retrospective review was performed at a single institution. Outcome measures included need for conversion to GA, major perioperative complications, and 30-day mortality. Four hundred and fourteen access procedures were performed by seven vascular surgeons between 2011 and 2014. Arteriovenous fistulas were placed in 379 (92%), arteriovenous grafts were placed in 31 (7%), and four (1%) received unsuccessful extremity exploration. Anesthetic approach was LA in 344 (83%) and BPB in 64 (15%). GA was initially induced in three (0.7%) and three (0.7%) additional patients required conversion to GA from LA. There were no cardiopulmonary events or perioperative deaths. Of the 32 patients who received an arteriovenous graft, only three (10%) required GA. In conclusion, LA and BPB are safe and conversion to GA is rare. GA should be avoided in hemodialysis access surgery.

Download Full-text

Going beyond the Kidney Disease Outcomes Quality Initiative: Hemodialysis Access Experience at Kaiser Permanente Southern California

Annals of Vascular Surgery ◽

10.1007/s10016-005-9110-8 ◽

2006 ◽

Vol 20 (1) ◽

pp. 75-82 ◽

Cited By ~ 17

Author(s):

Sidney Glazer ◽

Jean Diesto ◽

Peter Crooks ◽

Hock Yeoh ◽

Noel Pascual ◽

...

Keyword(s):

Kidney Disease ◽

Southern California ◽

Hemodialysis Access ◽

Kaiser Permanente ◽

Disease Outcomes

Download Full-text

Autogenous forearm loop arteriovenous fistula creation

The Journal of Vascular Access ◽

10.5301/jva.5000801 ◽

2018 ◽

Vol 19 (2) ◽

pp. 191-194

Author(s):

Weng Jun Tang ◽

Arman Zaharil Mat Saad

Keyword(s):

Kidney Disease ◽

Arteriovenous Fistula ◽

End Stage Kidney Disease ◽

Upper Arm ◽

Arteriovenous Fistulas ◽

Disease Outcomes ◽

Severe Atherosclerosis ◽

End Stage ◽

Distal Artery

Introduction: Arteriovenous fistula is a lifeline for end-stage kidney disease patients on dialysis. The quality of the vein and artery to be used plays a crucial role in attaining a functioning, reliable and long-lasting arteriovenous fistula. The aim of the study is to present an alternative for haemodialysis access to preserve the upper arm vasculature for future use – the forearm loop arteriovenous fistula. Methods: From October 2015 to September 2016, 202 patients with chronic kidney disease (CKD), stages 4 and 5, underwent arteriovenous fistula creation at the Universiti Sains Malaysia Hospital, Malaysia. Nine patients, with severe atherosclerosis of the distal artery, but with satisfactory veins, underwent forearm loop arteriovenous fistula creation. Maturation of the fistula was based on the classification by the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF KDOQI). Results: All nine patients who underwent forearm loop arteriovenous fistula have had diabetes mellitus for more than 10 years. Only one fistula failed to mature within 6 weeks. Two arteriovenous fistulas thrombosed at 3 and 5 months, respectively, after the commencement of haemodialysis. However, the other six matured fistulas are still functioning well after a year of regular usage. Conclusions: Distal forearm arteries in diabetics may be severely atherosclerotic. Forearm loop arteriovenous fistula can be considered as the primary access for cases decided as inconvenient for fistula creation due to severe occlusive atherosclerotic disease of the forearm arteries; in order to preserve upper arm veins for future access procedures.

Download Full-text

Outcomes of Patients Referred for Arteriovenous Fistula Construction: A Systematic Review

International Journal of Medical Students ◽

10.5195/ijms.2019.331 ◽

2019 ◽

Vol 7 (3) ◽

pp. 73-81

Author(s):

Andrew Stanton Kucey ◽

Anish Engineer ◽

Shawn Stefan Albers

Keyword(s):

Kidney Disease ◽

Current Knowledge ◽

Relevant Literature ◽

Venous Catheter ◽

Primary Patency ◽

Arteriovenous Fistulas ◽

Disease Outcomes ◽

The Us ◽

Predictive Outcome ◽

Associated Risk Factors

Chronic Kidney Disease (CKD) affects 10-16% of the US population and its incidence is rising due to increasing prevalence of associated risk factors. Renal replacement therapy is required to treat late stage CKD and hemodialysis is the preferred modality for many patients. Vascular access is required for hemodialysis and arteriovenous fistulas (AVF) are currently the gold standard. This review intended to collate current knowledge on AVF outcomes regarding both the patient and fistula. Scopus and Medline were utilized to identify relevant literature. Inclusion and exclusion criteria were applied to narrow search results. Among CKD patients, 33.5-77.4% require a central venous catheter (CVC) before dialysis through a fistula. Many patients (33-51%) use a CVC regardless of AVF creation due to fistula immaturity or failure. There are large variations in AVF creation policies internationally; 16% of American hemodialysis patients use a fistula compared to 72% of German patients. Primary patency and primary AVFs' failure ranges from 60-70% and 20-26%, respectively. AVFs reduce morbidity and mortality in CKD. At present, too many patients are receiving hemodialysis through a CVC. Inadequate referral times for AVF creation can lead to fistula immaturity or failure in the intervention. Many countries are lagging behind recommended AVF creation rates published by the Kidney Disease Outcomes Quality Initiative. There is a paucity of literature concerning when a patient should be referred for AVF creation. It is paramount to have better predictive outcome measures and more clarity as to when patients will benefit from an AVF.

Download Full-text

Redo Hemodialysis Access In Elderly Patients Has Acceptable Outcomes With Similar Patency Of Arteriovenous Fistulas As Compared To Grafts

Annals of Vascular Surgery ◽

10.1016/j.avsg.2021.01.008 ◽

2021 ◽

Vol 71 ◽

pp. 454-455

Author(s):

M. Libby Weaver ◽

Courtenay M. Holscher ◽

Rebecca A. Sorber ◽

Thomas Reifsnyder

Keyword(s):

Elderly Patients ◽

Hemodialysis Access ◽

Arteriovenous Fistulas

Download Full-text

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

Vascular ◽

10.1177/17085381211004306 ◽

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

Download Full-text

The usefulness and feasibility of placing a clinch knot with a guidewire to achieve temporary hemostasis in arteriovenous dialysis access interventions

The Journal of Vascular Access ◽

10.1177/1129729820954742 ◽

2020 ◽

pp. 112972982095474

Author(s):

Sung-Joon Park ◽

Hwan Hoon Chung ◽

Seung Hwa Lee ◽

Sung Beom Cho ◽

Tae-Seok Seo ◽

...

Keyword(s):

Clinical Success ◽

Primary Patency ◽

Interventional Treatment ◽

Secondary Patency ◽

Dialysis Access ◽

Hemodialysis Access ◽

Purse String Suture ◽

Purse String ◽

Arteriovenous Fistulas ◽

Arteriovenous Grafts

Purpose: To evaluate the usefulness and feasibility of using a reversible clinch knot with a guidewire in place rather than eliminating the access route during an arteriovenous hemodialysis access (AV access) intervention using the facing sheath technique. Material and methods: From July 2016 to June 2019, we retrospectively studied 78 sessions performed as interventional treatment for arteriovenous (AV) hemodialysis (HD) access using the “facing-sheath technique.” In all sessions, all antegrade sheaths were removed while a 0.035-inch guidewire remained in place with purse-string suture and the clinch knot. Seventy-two sessions were performed in patients with thrombosed AV accesses (69 arteriovenous grafts [AVGs] and three arteriovenous fistulas [AVFs]), and six sessions were carried out to treat non-thrombosed AV accesses (four AVGs and two AVFs). We evaluated whether proper hemostasis and successful reinsertion of the sheath over the wire into the clinch knot was achieved. Clinical success was defined as achieving prompt restoration of blood flow for AV access, and the postintervention primary and secondary patency were also evaluated. Result: In all 87 clinch knots created in 78 total sessions, proper hemostasis was achieved. All clinch knots that required reversal for additional procedures were successfully reopened (55 clinch knots in 50 sessions). The postintervention primary patency rates at 1, 3, and 6 months, and at 1 year were 77.8%, 68.9%, 55.6%, and 33.3%, respectively. The postintervention secondary patency rates at 1, 3, and 6 months, and also at 1 year were 93.3%, 91.1%, 86.7%, and 86.7%, respectively. Conclusion: Our AV access intervention which used a clinch knot with purse-string suture while the guidewire remained in place was both useful and feasible for maintaining temporary hemostasis.

Download Full-text