Balloon-assisted venous access salvage through a thrombosed arteriovenous graft

Introduction Maintaining vascular access by means of radiological intervention has become the mainstay of management of patients with central venous stenoses and occlusions (CVO), which can be challenging. We present a case of balloon-assisted percutaneous puncture of an occluded left subclavian vein, through a thrombosed arteriovenous graft, for a tunneled dialysis catheter insertion. Methods A thrombosed left arm arteriovenous graft was accessed, and the occluded left subclavian vein was traversed with 0.018 platform. An 8 mm 0.018 low platform balloon was inflated in the left subclavian vein as a target for percutaneous puncture to gain direct access into the occluded segment of the vein. This access was then used for routine placement of a tunneled left subclavian dialysis catheter. Results Successful placement of a tunneled dialysis catheter into an occluded left subclavian vein using a balloon- assisted puncture technique, through a thrombosed left-arm arteriovenous graft. Conclusions Thrombosed arteriovenous grafts are potential access sites into the central veins. Balloon-assisted punctures allow vascular access salvage into otherwise occluded segments of a central vein; in our case, it allowed access into an occluded left subclavian vein for dialysis catheter placement.

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Good long-term patency: 10-year follow-up using the mid-thigh adductor loop arteriovenous graft

The Journal of Vascular Access ◽

10.1177/1129729818805955 ◽

2018 ◽

Vol 20 (3) ◽

pp. 313-320 ◽

Cited By ~ 1

Author(s):

Samantha J McEwan ◽

Hannah Maple ◽

Paul J Gibbs

Keyword(s):

Venous Access ◽

Fistula Formation ◽

Published Data ◽

Arteriovenous Graft ◽

Patient Journey ◽

Graft Thrombosis ◽

Arteriovenous Grafts ◽

Good Patency

Introduction: Definitive access in patients requiring renal replacement therapy is an ever-increasing challenge. For those where autogenous venous access is no longer a viable option, arteriovenous grafts can be considered. This article describes long-term follow-up, complications and patency rates of the mid-thigh ‘adductor loop’ arteriovenous graft. Methods: 50 mid-thigh loop arteriovenous grafts have been inserted into 48 patients in our unit over the past 11 years. A prospective database was collected on patients receiving an arteriovenous graft at our unit by the senior author. All remained under the care of our unit ensuring accurate follow-up data collection and database was updated at regular intervals. Results: Death-only censored primary patency at 1, 3 and 5 years was 76%, 44% and 23%, respectively. Patients receiving transplants were not censored as follow-up of the arteriovenous grafts was possible. Secondary patency at 1, 3 and 5 years was 95%, 63% and 45%. These rates are higher than previous studies looking at lower limb arteriovenous grafts. Graft thrombosis occurred in 14 patients (28%). Six patients were treated for an infection (12%) but only four grafts were excised; much lower than documented in previous studies. Conclusion: Autogenous venous access remains the perceived gold standard for patients requiring dialysis for end stage renal failure, despite some published data reporting poor outcomes. We have shown that adductor loop arteriovenous grafts can be a reliable, safe and long-term alternative in those whom fistula formation is not possible and may have a role earlier in the patient journey than previously thought, as a result of good patency and lower complications.

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Catheter-related obstruction of the right brachiocephalic vein following hemodialysis in a patient with lupus nephritis

The Journal of Vascular Access ◽

10.1177/1129729820926081 ◽

2020 ◽

pp. 112972982092608

Author(s):

Mitsutoshi Shindo ◽

Kenichi Oguchi ◽

Chihiro Kimikawa ◽

Kiyonori Ito ◽

Jyunki Morino ◽

...

Keyword(s):

Lupus Nephritis ◽

Arteriovenous Fistula ◽

Vascular Access ◽

Brachiocephalic Vein ◽

Central Vein ◽

Axillary Vein ◽

Arteriovenous Graft ◽

Complete Obstruction ◽

Hemodialysis Catheter ◽

The Right

Vascular access is necessary for hemodialysis, and in some cases where it is difficult to establish an arteriovenous fistula or arteriovenous graft, a permanent hemodialysis catheter may be used. However, serious catheter-related complications, such as central vein stenosis or thrombosis, can occur. We herein present a case of complete brachiocephalic vein obstruction in a patient with lupus nephritis receiving hemodialysis using a tunneled hemodialysis catheter. A 64-year-old patient underwent maintenance hemodialysis while taking an anticoagulant, with a tunneled hemodialysis catheter in the right internal jugular vein, because of arteriovenous fistula failure when hemodialysis was introduced. However, the catheter was removed because of a catheter-related bloodstream infection. Following the administration of antibiotics, an arteriovenous graft was implanted between the brachial artery and axillary vein in the right arm. Surprisingly, arteriovenous graft failure and complete obstruction of the right brachiocephalic vein were observed 3 days after arteriovenous graft creation. In conclusion, we report the case of tunneled hemodialysis catheter-related complete obstruction of the right brachiocephalic vein in a lupus nephritis patient undergoing hemodialysis. Clinicians should be aware of this potential complication when tunneled hemodialysis catheters are used and consider the next vascular access type before a tunneled hemodialysis catheter has been indwelled for the long term.

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Catheter-related Complications with Totally Implantable Venous Access Devices in Patients with Gynecologic Malignancies

10.21203/rs.3.rs-150258/v1 ◽

2021 ◽

Author(s):

Kristina Ernst ◽

Carolin Bärtels ◽

Nikolaus de Gregorio ◽

Florian Ebner ◽

Fabienne Schochter ◽

...

Keyword(s):

General Anesthesia ◽

Subclavian Vein ◽

Venous Access ◽

Seldinger Technique ◽

Single Shot ◽

Complication Rates ◽

Port Catheter ◽

Port Implantation ◽

Left Subclavian Vein ◽

Catheter Implantation

Abstract Background: The implantation of a subcutaneous implantable venous access device in patients with a gynecological cancer disease could be necessary because of different causes, e.g. application of chemotherapy or parenteral nutrition in case of advanced cancer. 4 years after implementation of the Seldinger-technique in the subclavian vein as standard way of port-catheter-implantation at department of gynecology at the University-Hospital in Ulm a retrospective analysis of complication-rates was performed to define internal standards for this procedure. Methods: Between 01/2014 and 07/2018 we reviewed all patients who received a port implantation at the gynecological department. The standard way of port-implantation used in this cohort was Seldinger-technique. All Data assessed were used anonymously. Patients-characteristics, tumor-entity, surgical and anesthesiological management, morbidity and port catheter associated complications (thrombosis, infections etc.) were analyzed. Results: A total of 638 were included. The implantation was performed in Seldinger-technique. Port catheter implantation was successfully performed in 96.6%. The implantation on the left subclavian vein significantly showed a higher rate of success than in the right subclavian vein (98.2% vs. 95.3%, p=0,036). Significant higher rates of associated thromboses was found in patients with a port implantation on the left side (5.9% vs. 2.0%; p=0.036). Obesity (BMI ≥ 30 kg/ m2) leads to a significant higher rate of venous misplacements (p=0.027). Compared to local anesthesia and analgosedation, general anesthesia leads to a significant lower rate of perioperative complications (20.3% vs. 22.4% vs. 13.1%; p=0.014). Perioperative application of antibiotics seems to reduce postoperative infection rates, even if the results are not significant. Conclusion: Seldinger-Technique is an efficient way for port-implantation. Especially patients with a high potential of complications, like obesity with BMI >30kg/m², or other risk factors, the left subclavian vein should be preferred, as well as general anesthesia. Perioperative application of antibiotics (e.g. single-shot antibiotics) should be considered. Trial registration: retrospectively registered

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Brachio-azygos transthoracic arteriovenous grafts for hemodialysis patients with bilateral central venous obstruction: A small case series

The Journal of Vascular Access ◽

10.1177/11297298211058580 ◽

2021 ◽

pp. 112972982110585

Author(s):

Dan Song ◽

Young Woo Park

Keyword(s):

Lower Extremity ◽

Vascular Access ◽

Median Sternotomy ◽

Case Series ◽

Hemodialysis Patients ◽

Arteriovenous Graft ◽

Venous Obstruction ◽

Central Venous ◽

Arteriovenous Grafts ◽

Central Venous Obstruction

Background: It is difficult to find a reliable outflow vein for vascular access in hemodialysis patients with bilateral central venous obstruction. The lower extremity veins are currently used as the most common alternative veins to make a new vascular access. However, in patients not amenable to make lower extremity access, intrathoracic vein should be considered as an outflow vein, but there are limitations in its use due to postoperative complications. Methods: We introduce a series of cases that underwent arteriovenous graft operation using an intrathoracic vein, the azygos arch, as an outflow vein. Brachio-azygos transthoracic arteriovenous graft is a surgical procedure that anastomoses the azygos arch and the brachial artery with 7 mm ringed polytetrafluoroethylene graft via lateral thoracotomy without median sternotomy. Results: The chest tubes of the patients were removed on the third postoperative day and they discharged within a week. About 1 month later, hemodialysis was initiated through the BATAVG, and it has been used without access dysfunction. Conclusion: Brachio-azygos transthoracic arteriovenous grafts were performed using the azygos arches without major complications. The azygos arch can be a good alternative outflow vein to make a new vascular access for hemodialysis patients with bilateral central venous obstruction.

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Rapid Assessment of Vascular Exit Site and Tunneling Options (RAVESTO): A new decision tool in the management of the complex vascular access patients

The Journal of Vascular Access ◽

10.1177/11297298211034306 ◽

2021 ◽

pp. 112972982110343

Author(s):

Matthew D Ostroff ◽

Nancy Moureau ◽

Mauro Pittiruti

Keyword(s):

Vascular Access ◽

Femoral Vein ◽

Central Venous Access ◽

Rapid Assessment ◽

Venous Access ◽

Central Vein ◽

Exit Site ◽

Central Venous ◽

Venous Catheterization ◽

Subcutaneous Tunneling

In the last decade, different standardized protocols have been developed for a systematic ultrasound venous assessment before central venous catheterization: RaCeVA (Rapid Central Vein Assessment), RaPeVA (Rapid Peripheral Vein Assessment), and RaFeVA (Rapid Femoral Vein Assessment). Such protocols were designed to locate the ideal puncture site to minimize insertion-related complications. Recently, subcutaneous tunneling of non-cuffed central venous access devices at bedside has also grown in acceptance. The main rationale for tunneling is to relocate the exit site based on patient factors and concerns for dislodgement. The tool we describe (RAVESTO—Rapid Assessment of Vascular Exit Site and Tunneling Options) defines the different options of subcutaneous tunneling and their indications in different clinical situations in patients with complex vascular access.

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Vascular access for home haemodialysis

The Journal of Vascular Access ◽

10.1177/1129729818764135 ◽

2018 ◽

Vol 19 (6) ◽

pp. 593-595 ◽

Cited By ~ 1

Author(s):

Julien Al Shakarchi ◽

C Day ◽

N Inston

Keyword(s):

Arteriovenous Fistula ◽

Vascular Access ◽

Hospital Admissions ◽

University Hospital ◽

Arteriovenous Graft ◽

Dialysis Catheter ◽

Home Haemodialysis ◽

Admission Rates ◽

Arteriovenous Fistulas ◽

Hospital Access

Introduction: Home haemodialysis has been advocated due to improved quality of life. However, there are very little data on the optimum vascular access for it. Method: A retrospective cohort study was carried on all patients who initiated home haemodialysis between 2011 and 2016 at a large university hospital. Access-related hospital admissions and interventions were used as primary outcome measures. Results: Our cohort consisted of 74 patients. On initiation of home haemodialysis, 62 individuals were using an arteriovenous fistula as vascular access, while the remaining were on a tunnelled dialysis catheter. Of the 12 patients who started on a tunnelled dialysis catheter, 5 were subsequently converted to either an arteriovenous fistula ( n = 4) or an arteriovenous graft ( n = 1). During the period of home haemodialysis use, four arteriovenous fistula failed or thrombosed with patients continuing on home haemodialysis using an arteriovenous graft ( n = 3) or a tunnelled dialysis catheter ( n = 1). To maintain uninterrupted home haemodialysis, interventional rates were 0.32 per arteriovenous fistula/arteriovenous graft access-year and 0.4 per tunnelled dialysis catheter access-year. Hospital admission rates for patients on home haemodialysis were 0.33 per patient-year. Conclusion: Our study has shown that home haemodialysis can be safely and independently performed at home within a closely managed home haemodialysis programme. The authors also advocate the use of arteriovenous fistulas for this cohort of patients due to both low complication and intervention rates.

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Cannulation practices at haemodialysis initiation via an arteriovenous fistula or arteriovenous graft

The Journal of Vascular Access ◽

10.1177/1129729819869093 ◽

2019 ◽

Vol 21 (5) ◽

pp. 573-581

Author(s):

Kathleen Hill ◽

Rebecca Sharp ◽

Jessie Childs ◽

Adrian Esterman ◽

Richard Le Leu ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Vascular Access ◽

Clinical Decision Making ◽

Central Venous Access ◽

Duplex Ultrasound ◽

Clinical Decision ◽

Venous Access ◽

Time Frame ◽

Arteriovenous Graft

Introduction: A functioning long-term vascular access is required for haemodialysis therapy; however, establishing this can be challenging in the setting of advanced age and vessels damaged by diabetes. Complications include the inability to insert two needles for the treatment resulting in miscannulation trauma and in some cases insertion of a temporary central venous access device. The broad objective of this review is to define the evidence base regarding cannulation practices in the initiation of haemodialysis via an arteriovenous fistula or an arteriovenous graft. Methods: This review uses the framework recommended by the Joanna Briggs Institute and the process by which papers were included or excluded followed the standard Preferred Reporting Items for Systematic Reviews and Meta-Analyses group approach. A total of 20 primary research studies met the inclusion criteria. Results: Cannulation in the 10- to 15-week period rather than delaying past this time frame is associated with the best outcomes. New vascular access given time to mature through single-needle haemodialysis treatments may improve long-term patency. Duplex ultrasound mapping prior to initiation of cannulation supports the clinical decision-making process on timing of and selection of cannulation sites. Conclusion: Cannulation trauma at the initiation of haemodialysis could potentially be reduced with a strategy of incremental haemodialysis using single-needle treatment supported with duplex ultrasonography assessment to ‘map’ the vascular access as a guide for clinicians prior to cannulation initiation.

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Multidisciplinary management of vascular access for haemodialysis: from the preparation of the initial access to the treatment of stenosis and thrombosis

VASA ◽

10.1024/0301-1526/a000093 ◽

2011 ◽

Vol 40 (3) ◽

pp. 188-198 ◽

Cited By ~ 19

Author(s):

Reinhold ◽

Haage ◽

Hollenbeck ◽

Mickley ◽

Ranft

Keyword(s):

Vascular Access ◽

Central Venous ◽

Advantages And Disadvantages ◽

Multidisciplinary Study ◽

First Results ◽

Lower Complication ◽

Lower Complication Rate ◽

Access Problems ◽

Arteriovenous Grafts ◽

The Individual

In February 2008 a multidisciplinary study group was established in Germany to improve the treatment of patients with potential vascular access problems. As one of the first results of their work interdisciplinary recommendations for the management of vascular access were provided, from the creation of the initial access to the treatment of complications. As a rule the wrist arteriovenous fistula (AVF) is the access of choice due to its lower complication rate when compared to other types of access. The AVF should be created 3 months prior to the expected start of haemodialysis to allow for sufficient maturation. Second and third choice accesses are arteriovenous grafts (AVG) and central venous catheters (CVC). Ultrasound is a reliable tool for vessel selection before access creation, and also for the diagnosis of complications in AVF and grafts. Access stenosis and thrombosis can be treated surgically and interventionally. The comparison of both methods reveals advantages and disadvantages for each. The therapeutic decision should be based on the individual patients constitution, and also on the availability and experience of the involved specialists.

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