scholarly journals Immature hemodialysis arteriovenous fistulas: What should we aim for?

2021 ◽  
Vol 35 (2) ◽  
Author(s):  
Rui Silva ◽  
◽  
Hugo Diniz ◽  
Miguel Relvas ◽  
José Silvano ◽  
...  
Keyword(s):  
Vascular Access ◽  
Early Identification ◽  
Practical Approach ◽  
Endovascular Techniques ◽  
Arteriovenous Fistulas ◽  
First Choice

Arteriovenous fistulas (AVFs) are the first-choice vascular access for most HD patients. Up to 60% of AVFs do not mature adequately, mostly due to stenosis. Surgical and endovascular techniques can rescue up to 80% of these AVFs from primary failure, allowing them to be safely and effectively used in HD, preserving venous capital, and avoiding placement of CVCs and associated complications. This article reviews and summarizes the existing literature, offering a practical approach on early identification, treatment, and monitoring of immature AVFs.

Which Kind of Vascular Access for Hemodialysis in Pediatric Patients?

2003 ◽  
Vol 4 (2) ◽  
pp. 68-72 ◽  
Author(s):  
O. Manca ◽  
G.F. Pili ◽  
M.G. Murgia ◽  
A. Martorana ◽  
C. Setzu ◽  
...  
Keyword(s):  
Local Anesthesia ◽  
Surgical Procedures ◽  
Vascular Access ◽  
Surgical Procedure ◽  
Pediatric Patients ◽  
Small Diameter ◽  
Clinical Criteria ◽  
Arteriovenous Fistulas ◽  
First Choice

The choice of vascular access in hemodialysis pediatric patients can be challenging, due to the small diameter of vessels. In the last 19 years, 38 arteriovenous fistulas (AVF) for hemodialysis have been created on 21 patients; 25 of them were radio-cephalic AVF. The evaluation of the vessels was, in the majority of cases, done by clinical criteria. A local anesthesia was used in all surgical procedures. The percentage of early AVF failure was 24%. Long-term AVF survival was 97%, 65% and 55% at respectively 1, 3 and 5 years. Our data indicate that even in pediatric patients the radio-cephalic fistula is the first choice surgical procedure.

Arteriovenous Fistula Creation for Hemodialysis: Evaluation of Complications

2021 ◽  
Vol 35 (2) ◽  
pp. 100-105
Author(s):  
Motiur Rahman Sarkar ◽  
Nazmul Hosain ◽  
Moynul Islam ◽  
Saffait Jamil ◽  
Muhammad Mahmudul Hoque
Keyword(s):  
Arteriovenous Fistula ◽  
Upper Limb ◽  
Vascular Access ◽  
Team Work ◽  
Anastomotic Site ◽  
Common Complication ◽  
Arteriovenous Fistulas ◽  
First Choice ◽  
Cannulation Site ◽  
Dialysis Nurses

Background: Vascular access care is a classic example of multidisciplinary team work among nephrologists, vascular surgeons, duplex specialists, dialysis nurses and dialysis staff. The objectives of this study were to determine the complication of arteriovenous fistula (AVF) for hemodialysis (HD) and to find out the role of duplex study for the management of fistula complications. Methods: This was a prospective type of study done on 121 arteriovenous fistulas. All operations were done in different hospitals in Dhaka city. After duplex study of upper limb vessels, the site of fistula creation was determined. All Radio-cephalic, ulnar-basilic and brachiocephalic fistulas were done under local anesthesia. Other fistula of the series was done under brachial block. Immediate postoperative bruit, thrill and distal pulses were monitored. Fistulas were considered mature after at least 6 weeks of fistula creation with good visualization of arterialized vein and good thrill. Patients were advised to report if any complication arises. Results: The most common fistula was Radio-cephalic fistulas (72.73%) and then Brachio-cephalic fistulas (19.84%). The left upper limb was the first choice for fistula creation as a non-dominant limb. Most fistula was created in left upper limb (76.86%). The most common complication was stenosis of arterialized veins (4.13%) and another type of stenosis was found at anastomotic site (2.48%). Second most common complication was cannulation site infections (3.31%). Another common type of infection was found at the site of fistula creation (2.48%). Thrombosis, aneurysm and pseudoaneurysm were identified as the most detrimental complications. Conclusion: Arteriovenous fistula is an important issue for hemodialysis patient as the life line. Dialysis nurses and technician should have knowledge about antisepsis and potential complication of AVFs. Early diagnosis and early treatment prevent loss of vascular access and reduce serious morbidity and mortality. Both the patients and dialysis staffs should give highest care for the AVF to reduce the complications. Bangladesh Heart Journal 2020; 35(2) : 100-105

scholarly journals Age is just a number: Is frailty being ignored in vascular access planning for dialysis?

2021 ◽  
pp. 112972982198990
Author(s):  
Kulli Kuningas ◽  
Nicholas Inston
Keyword(s):  
Decision Making ◽  
Kidney Disease ◽  
Vascular Access ◽  
Clinical Condition ◽  
The Elderly ◽  
Dialysis Access ◽  
Adverse Health Outcomes ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
First Choice

Current international guidelines advocate fistula creation as first choice for vascular access in haemodialysis patients, however, there have been suggestions that in certain groups of patients, in particular the elderly, a more tailored approach is needed. The prevalence of more senior individuals receiving renal replacement therapy has increased in recent years and therefore including patient age in decision making regarding choice of vascular access for dialysis has gained more relevance. However, it seems that age is being used as a surrogate for overall clinical condition and it can be proposed that frailty may be a better basis to considering when advising and counselling patients with regard to vascular access for dialysis. Frailty is a clinical condition in which the person is in a vulnerable state with reduced functional capacity and has a higher risk of adverse health outcomes when exposed to stress inducing events. Prevalence of frailty increases with age and has been associated with an increased risk of mortality, hospitalisation, disability and falls. Chronic kidney disease is associated with premature ageing and therefore patients with kidney disease are prone to be frailer irrespective of age and the risk increases further with declining kidney function. Limited data exists on the relationship between frailty and vascular access, but it appears that frailty may have an association with poorer outcomes from vascular access. However, further research is warranted. Due to complexity in decision making in dialysis access, frailty assessment could be a key element in providing patient-centred approach in planning and maintaining vascular access for dialysis.

scholarly journals P1296CARDIAC COMPLICATIONS OF ARTERIOVENOUS FISTULAS IN PATIENTS WITH END-STAGE RENAL DISEASE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Nessrine Breik ◽  
Hela Jbeli ◽  
Safa Fattoum ◽  
Imen Ouertani ◽  
Badreddine Ben kaab ◽  
...  
Keyword(s):  
Vascular Access ◽  
Interventricular Septum ◽  
Left Ventricular ◽  
Chronic Hemodialysis ◽  
Cardiac Complications ◽  
Arteriovenous Fistulas ◽  
Coronary Syndrome ◽  
Group 2 ◽  
Stage Renal Disease ◽  
Cardiac Status

Abstract Background and Aims Current literature suggests the arteriovenous fistula (AVF) to be the preferred type of vascular access for hemodialysis. However, AVFs have significant and potentially deleterious effects on cardiac functions particularly in the setting of preexisting heart disease. The aim of this study is to compare the clinical and echocardiographic evolution after creation of a proximal AVF and a radial AVF. Method We conducted a retrospective descriptive study including all chronic hemodialysis patients through AVF. Group 1 (G1) included patients with proximal AVF and group 2 (G2) patients with radial AVF. Results Twenty-four patients were collected in G1 and the average age was 55 years. G2 included 13 patients with a mean age of 44 years. Systolic blood pressure decreased after AVF creation in both groups (G1: 62.5%, G2: 45%, NS). A dyspnea was noted in 70% of cases of G1 and 38.4% of cases of G2 (NS). The interventricular septum was thickened in 20.8% of cases of G1 and 38.4% of G2 (NS). Left ventricular (LV) dilatation was observed in both groups with LV diastolic telegram diameter increase of 58% in G1 versus 10% in G2 (p = 0.04). A decrease in LV ejection fraction was found in 62.5% in G1 and 46.1% in G2 (p = 0.066). The major cardiac complications in G1 were acute coronary syndrome in 5 patients and atrial fibrillation in 4 cases after an average of 60 months and 35 months, respectively. No cardiac complications were noted in G2. Conclusion AVFs remain the preferred type of vascular access for chronic hemodialysis therapy because they are associated with better long-term patency and fewer complications compared with synthetic grafts. Its seat will depend on the vascular state and the cardiac status of the dialysis patient.

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.

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

2015 ◽  
Vol 143 (3-4) ◽  
pp. 226-229
Author(s):  
Tamara Jemcov ◽  
Marija Milinkovic ◽  
Igor Koncar ◽  
Ilija Kuzmanovic ◽  
Nenad Jakovljevic ◽  
...  
Keyword(s):  
Vascular Access ◽  
Continuous Process ◽  
Venous Catheter ◽  
Medical Personnel ◽  
High Rate ◽  
Central Venous ◽  
Vascular Surgeon ◽  
Arteriovenous Fistulas ◽  
Clinical Center

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.

scholarly journals Does Static Intra Access Pressure Monitoring of Arteriovenous Fistulas Predicts Intra Access Stenosis?

2021 ◽  
Vol 4 (03) ◽  
Author(s):  
Abaid ur Rehman ◽  
Muhammad Imran Khan ◽  
Omer Sabir ◽  
Muhammad Mohsin Riaz ◽  
Mubashar Dilawar ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Vascular Access ◽  
Doppler Ultrasonography ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Female Ratio ◽  
Arteriovenous Fistulas ◽  
Doppler Us ◽  
Sensitivity Specificity ◽  
Male To Female

The initiation of hemodialysis in patients with chronic kidney disease (CKD) requires vascular access formation. The choice of vascular access for individual patient depends on various factors however arteriovenous fistula (AVF) is conventionally considered to be the vascular access of choice. Once hemodialysis is initiated through a mature AVF, there is an ongoing need for surveillance of the AVF to ensure adequate function and prevent vascular access issues among which flow obstruction (both inflow and outflow) remains the most important. AVF stenosis can potentially lead to inadequate dialysis delivery and thrombosis thus leading to access loss. Physical examination and AVF Doppler ultrasonography (DUS) are useful for evaluation of stenosis in the  arteriovenous connection and the outflow tract. Periodic assessment of the AVF with Static Intra access Pressure (SIAPR) determination may be a reliable means of predicting vascular access stenosis. Material & Methods  A cross sectional study carried out at Department of Nephrology, Fatima Memorial Hospital, Lahore from July 2018 to December 2018. In total 113 patients were included, and all patients underwent SIAPR assessment and Doppler Ultrasound of AVF. Results Mean age of the patients was 56.81±9.38 years, male to female ratio of the patients was 1.8:1. In this study the SIAPR was suggestive of  stenosis in 87(76.99%) patients. The sensitivity, specificity and diagnostic accuracy of SIAPR against Doppler US of the AVF for detection of stenosis was 75.86%, 22.62% & 36.28% respectively Conclusion SIAPR has low specificity and diagnostic accuracy compared to Doppler US for detection of AVF stenosis.

scholarly journals Distal Revascularisation with Interval Ligation (DRIL): An Experience

2009 ◽  
Vol 91 (5) ◽  
pp. 394-398 ◽  
Author(s):  
M Field ◽  
J Blackwell ◽  
A Jaipersad ◽  
M Wall ◽  
MA Silva ◽  
...  
Keyword(s):  
Vascular Access ◽  
International Studies ◽  
Rest Pain ◽  
Basilic Vein ◽  
Central Lines ◽  
Arteriovenous Fistulas ◽  
Number Of Patients ◽  
Digital Pulse ◽  
Global Increase ◽  
Steal Syndrome

INTRODUCTION The global increase of chronic renal failure has resulted in a growing number of patients on haemodialysis using arteriovenous fistulas (AVFs). By virtue of their very function, AVFs at times shunt blood away from regions distally, resulting in an ischaemic steal syndrome. Distal revascularisation with interval ligation (DRIL) has been described as a procedure to treat symptomatic ischaemic steal. We present our experience in the management of this complication. PATIENTS AND METHODS Six patients with severe ischaemic steal were treated using a DRIL procedure between May 2004 and June 2007. There were three males and three females, all with elbow brachiocephalic AVFs. Symptoms ranged from severe rest pain to digital gangrene. Published results from international studies of 135 DRIL procedures were also reviewed. RESULTS Vascular access was maintained along with the elimination of ischaemic symptoms in the six patients using an ipsilateral reversed basilic vein graft. Interval ligation of the distal brachial artery was performed at the same time. All patients showed immediate and sustained clinical improvement of symptoms with a demonstrable increase in digital pulse oximetry. CONCLUSIONS DRIL is a beneficial treatment option that has proven successful at alleviating ischemic steal symptoms and preserving vascular access. This avoids placement of central lines, its associated risks, and the need to create an alternative sited fistula.

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

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.

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.

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