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

Contribution of inflow artery to observed flow in a vascular access: A computational fluid dynamic modeling study of an arteriovenous fistula circuit

2020 ◽  
pp. 112972982094406
Author(s):  
Jeffrey Krampf ◽  
Ramesh Agarwal ◽  
Surendra Shenoy
Keyword(s):  
Linear Relationship ◽  
Arteriovenous Fistula ◽  
Dynamic Modeling ◽  
Vascular Access ◽  
Computational Fluid Dynamic ◽  
Fluid Dynamic ◽  
Function Evaluation ◽  
Anastomotic Site ◽  
Flow Volume ◽  
Computational Fluid Dynamic Modeling

Introduction: The volume of blood flowing through the vascular access is an important parameter necessary to provide adequate dialysis for a functional arteriovenous fistula. Higher blood flows are seen in arteriovenous access that receive inflow from larger arteries such as brachial or axillary compared to those based on medium-caliber radial or ulnar arteries. We hypothesized that an anatomic difference in the length and the diameter of the artery is an important determinant of the flow volume in arteriovenous fistula created at different anatomic locations. Methods: Using computational fluid dynamics, we evaluated the contribution of the length and diameter of inflow artery on simulations performed with geometric models constructed to represent arteriovenous fistula circuits. Lengths and diameters of the inflow artery were altered to mimic arteriovenous fistula created at various locations of the upper extremity with standard and variant anatomy. Results: Models of arteriovenous fistula created with variable lengths and diameters of the inflow artery suggest that the length of the vessel has an inverse linear relationship and the diameter has a direct linear relationship to flow volume. Conclusion: Computational fluid dynamic modeling of arteriovenous fistula can be used to understand the physiologic basis of clinical observations of function. Evaluation of the effect of inflow artery length and diameter helps explain the higher flows seen in arteriovenous fistula created using large caliber arteries for inflow. Computational fluid dynamic modeling helps operators understand the contributions of inflow artery in access function and can guide anastomotic site selection.

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 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 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.

Impact of preoperative exercise in not initially candidates to native arteriovenous fistulas

2021 ◽  
pp. 112972982110455
Author(s):  
Javier Carbayo ◽  
Alejandra Muñoz de Morales ◽  
Inés Aragoncillo ◽  
Soraya Abad ◽  
David Arroyo ◽  
...  
Keyword(s):  
Observational Study ◽  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Complication Rate ◽  
Isometric Exercise ◽  
High Rate ◽  
Similar Increase ◽  
Arteriovenous Fistulas ◽  
Preoperative Exercise

Background: Native autologous arteriovenous fistula (AVFn) is the preferred vascular access for hemodialysis due to its long term patency and low complication rate. A challenging limitation is the anatomical inability to perform AVFn and failure of maturation. Preoperative isometric exercise (PIE) can increase vascular calibers and improve the rate of distal AVF. However, it is unknown whether PIE might enhance the performance of AVFn in patients who are not initially candidates. Methods: A retrospective observational study was conducted over a population of 45 patients evaluated in vascular access clinic, 23 were not initially candidates for radiocephalic (NRC-AVF) and 22 were not candidates for autologous fistula at all (NA-AVF). They were assigned to perform PIE with handgrip device and revaluated. Results: After 4–8 weeks of PIE, a AVFn was performed in 16 patients from NA-AVF group and a radiocephalic AVFn was performed in 21 patients from NRC-AVF group. Both groups experienced a significant and similar increase in venous caliber 0.91 ± 0.43 mm in NA-AVF versus 0.76 ± 0.47 mm in NRC-AVF ( p = 0.336) and arterial caliber 0.18 ± 0.24 mm versus 0.18 ± 0.21 mm ( p = 0.928), respectively. Nevertheless, primary failure rate was significantly higher in NA-AVF ( n = 8, 50%) than in NRC-AVF group ( n = 3, 14.3%) ( p = 0.030). After 6 months, the fistula usability for dialysis was only 50% in NA-AVF, while 86.7% were dialyzed by fistula in NRC-AVF group ( p = 0.038). Conclusions: PIE allowed the allocation of an AVFn in patients not initially candidates, but entailed a high rate of maturation failure. Patients not candidates to radiocephalic AVF benefited from PIE and preserved a long term usability of AVF for dialysis.

Resection of puncture site necrosis over an arteriovenous fistula: Endoclamp use for preservation of cannulation sites

2018 ◽  
Vol 19 (3) ◽  
pp. 316-318 ◽  
Author(s):  
Alexandros Mallios ◽  
William Jennings ◽  
Benoit Boura ◽  
Alessandro Costanzo ◽  
Myriam Combes
Keyword(s):  
Arteriovenous Fistula ◽  
Skin Necrosis ◽  
Vascular Control ◽  
Puncture Site ◽  
Arteriovenous Fistulas ◽  
Angioplasty Balloon ◽  
Cannulation Site ◽  
Extensive Calcification ◽  
Life Threatening ◽  
Surrounding Skin

Skin necrosis overlying an arteriovenous fistula at the cannulation site is a common and potentially life-threatening problem, often associated with underlying aneurysm formation. Arteriovenous fistula-skin necrosis generally requires resection of surrounding skin margins and the underlying aneurysmal vessel wall, allowing repair with healthy tissue of the arteriovenous fistula in addition to closure of soft tissue and skin. In patients with insufficient fistula length, salvage of these arteriovenous fistulas may result in difficult or insurmountable cannulation issues leading to attempts at one-needle cannulation dialysis or, most often, catheter placement. Pre-existing stents or extensive calcification may add to the technical challenge of gaining proximal and/or distal control. We describe our technique for dealing with such arteriovenous fistula-skin necrosis lesions utilizing endo-occlusion with an angioplasty balloon for vascular control, allowing a limited incision and tissue resection with preservation of arteriovenous fistula cannulation length.

scholarly journals Does Regular Surveillance Improve the Long-Term Survival of Arteriovenous Fistulas?

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Ashwin Shetty ◽  
William L. Whittier
Keyword(s):  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Major Complication ◽  
Limited Data ◽  
Term Survival ◽  
Long Term Survival ◽  
Arteriovenous Fistulas ◽  
Arteriovenous Grafts ◽  
Available Information

The rate of arteriovenous fistula (AVF) placement continues to rise and AVF failure is a major complication. The main cause of AVF failure is stenosis leading to thrombosis. Although the detection of early stenosis with preemptive correction prior to thrombosis seems to be a plausible option to prevent access failure, there is much debate, on the basis of studies of surveillance with arteriovenous grafts, as to whether early surveillance actually improves the longevity of AVFs. Evaluating the available information for surveillance, specifically the data for AVF stenosis and survival, is necessary to determine if surveillance is warranted. These trials have shown that vascular access flow (Qa) surveillance is beneficial in revealing subclinical stenosis. Preemptive angioplasty and surgical revision have shown to decrease thrombosis rates. However, at the present time, there is only limited data on whether preemptive treatment equates to improved long-term AVF survival.

A prospective cohort study of predictors of upper extremity arteriovenous fistula maturation

2020 ◽  
Vol 21 (5) ◽  
pp. 746-752
Author(s):  
Aiza Waheed ◽  
Agnes Masengu ◽  
Tomas Skala ◽  
Guiyun Li ◽  
Jacek Jastrzebski ◽  
...  
Keyword(s):  
Cohort Study ◽  
Arteriovenous Fistula ◽  
Prospective Cohort Study ◽  
Vascular Access ◽  
Prospective Cohort ◽  
Care Center ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Nursing Assessment ◽  
Arteriovenous Fistulas

Background: A substantial proportion of arteriovenous fistulas fail to function adequately for hemodialysis. Existing studies on arteriovenous fistula failure prediction assess patency rather than the more clinically relevant outcome of arteriovenous fistula function. We hypothesized that preoperative demographic and ultrasound characteristics, and postoperative assessment by an experienced vascular access nurse would predict which arteriovenous fistulas will not function adequately for hemodialysis. Methods: Prospective cohort study of chronic kidney disease patients at a tertiary care center in Vancouver, Canada, with arteriovenous fistula creation between 2009 and 2013. Pre and postoperative clinical assessment and ultrasound blood vessel mapping were performed by an experienced vascular access nurse. The primary outcome was failure to achieve a fistula used successfully for hemodialysis (FUSH). Results: Outcomes were assessed in 200 patients; 123 (61.5%) arteriovenous fistulas were radiocephalic. Overall, 26.5% of arteriovenous fistulas had FUSH failure (34.1% of lower arm vs 14.3% of upper arm, p = 0.002). Univariate predictors of FUSH failure included older age (p = 0.03), female sex (p = 0.05), smaller arterial diameter (p ⩽ 0.001), lower artery volume flow (p = 0.04), and smaller vein diameter (p = 0.01). In multivariable analysis, artery diameter (odds ratio: 0.44, 95% confidence interval: 0.28–0.68) most significantly predicted FUSH failure. Vascular access nurse assessment 6 weeks postoperatively correctly predicted outcome in 83.8% of FUSH and 65.0% of FUSH failure. Conclusion: Smaller artery diameter most strongly predicted FUSH failure. Early postoperative nursing assessment was more useful to predict FUSH than FUSH failure, and as such was insufficient in determining which arteriovenous fistulas should be abandoned as many predicted to fail could be salvaged with further intervention.

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