scholarly journals Ultrasound mapping of new cannulation sites for arteriovenous fistulas/grafts at South Tyneside and Sunderland NHS Foundation Trust (STSFT) Renal Unit.

2021 ◽  
Vol 4 (1) ◽  
pp. 199-202
Author(s):  
Haroon Ayub ◽  
Rauri Clark ◽  
Shalabh Srivastava ◽  
James Andrews ◽  
Debra Sweeney ◽  
...  
Keyword(s):  
Smart Phone ◽  
Renal Unit ◽  
Dialysis Patients ◽  
Av Fistula ◽  
Small Vessels ◽  
Home Haemodialysis ◽  
Arteriovenous Fistulas ◽  
The Us ◽  
Arteriovenous Grafts ◽  
Dialysis Nurses

 The cannulation  of vascular access specially becomes difficult in elderly, diabetic and obese  hemodialysis patients. The accessibility of an AV fistula largely relies on the condition of the patient’s veins, which often leads to difficulty in cannulation with the traditional blind method. South Tyneside and Sunderland NHS Foundation Trust (STSFT) Renal unit adopted ultrasound mapping of new cannulation sites for arteriovenous fistulas and arteriovenous grafts. The aim of this study was to evaluate the qualitative impact of this practice on the dialysis patients. This was a qualitative study and was conducted in the Renal Unit at STSFT. Haemodialysis patients with deep or small vessels for cannulation, a vessel with problems and a vessel whose cannulation on the first attempt was vital were included in the study. AVF/AVG were mapped using Doppler ultrasound (US) undertaken by a consultant Interventional Nephrologist (IN). The map of the AVF/AVG and new cannulation sites were captured as an image on the patients’ smart phone to act as record to show the dialysis nurse cannulating the AVF/AVG. It was hoped that this would encourage rope laddering and AVF/AVG preservation. Patients reported no significant improvement in cannulation process even after US mapping of new cannulation sites. Patients did report a better understanding of the AVF/AVG geometry especially amongst the self cannulators on home haemodialysis. According to the patients the successful cannulation was mainly dependent on the skills of dialysis nurses rather than the US mapping of the AVF/AVG being of any assistance.

Liposuction used to treat deep vascular accesses for hemodialysis

2020 ◽  
pp. 112972982092791
Author(s):  
Marius C Florescu ◽  
Troy J Plumb ◽  
Scott Westphal ◽  
Ryan Mullane ◽  
Debra A Reilly
Keyword(s):  
Surgical Complication ◽  
Invasive Technique ◽  
Dialysis Access ◽  
Dialysis Patients ◽  
Hemodialysis Catheter ◽  
Arteriovenous Fistulas ◽  
Post Surgery ◽  
Manual Pressure ◽  
Arteriovenous Grafts ◽  
The Mean

Background: Oftentimes, obese dialysis patients develop a viable dialysis access but the access is too deep for cannulation and needs a superficialization procedure. Methods: We present our 14-patient cohort in whom we performed liposuction to superficialize viable but deep vascular accesses. Out of 14 patients, 12 had arteriovenous fistulas and 2 arteriovenous grafts. The primary end points were the ability to superficialize a completely unusable access and to remove the hemodialysis catheter (3patients), or to significantly extend the useful length of a deep access in which only a very short segment was used and to continue to use the access post-surgery without the need to place a dialysis catheter (11 patients). Results: The study goal was met in 13 out of 14 patients. In two of three patients, the catheters were removed and their access usable length was 14 and 13 cm, respectively. The accesses could be used immediately after liposuction in all patients in which this applied—11 patients. The usable access length increased from a mean of 5 to 12.7 cm. The access mean depth decreased from 10.8 mm pre-surgery to 7 mm post-surgery and 5.3 mm 4 weeks after surgery. The mean volume of fat removed was 43.8 cc. We had only one surgical complication: bleeding that was readily controlled with manual pressure. All patients were discharged to home the same day. Postoperative pain was mild. Conclusion: Liposuction is effective, safe, and seems to be the least invasive technique of superficialization.

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

Vascular ◽  
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

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

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.

Percutaneous Superselective Coil-Embolization of Intrarenal Arteriovenous Fistulas

1996 ◽  
Vol 37 (3P2) ◽  
pp. 539-541 ◽  
Author(s):  
H. Husstedt ◽  
A. Chavan ◽  
F. Ghadban ◽  
A. Leppert ◽  
M. Galanski
Keyword(s):  
Coil Embolization ◽  
Av Fistula ◽  
Arteriovenous Fistulas ◽  
Percutaneous Catheter ◽  
Coil Occlusion ◽  
Av Fistulas ◽  
Small Parts

Purpose: To evaluate the role of percutaneous transcatheter coil-occlusion in the management of uncontrollable postoperative hematuria due to iatrogenic arteriovenous (AV) fistula. Material and Methods: In 2 patients, AV fistulas were occluded with percutaneous catheter-guided superselective coil embolization. Results: In both cases, occlusion of the AV fistulas was successful. Only small parts (less than 10%) of the parenchyma had to be sacrificed. No hypertension occurred. Conclusion: Percutaneous coil embolization is a useful alternative to surgery in cases of postoperative AV fistulas. Hematuria can be effectively controlled without resulting hypertension.

Transjugular percutaneous endovascular treatment of dysfunctional hemodialysis access

2018 ◽  
Vol 20 (5) ◽  
pp. 488-494 ◽  
Author(s):  
Jin Ho Kim ◽  
Sung Bum Cho ◽  
Yun Hwan Kim ◽  
Hwan Hoon Chung ◽  
Seung Hwa Lee ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Internal Jugular Vein ◽  
Patency Rate ◽  
Jugular Vein ◽  
Hemodialysis Access ◽  
Procedure Time ◽  
Arteriovenous Fistulas ◽  
Arteriovenous Grafts ◽  
The Mean ◽  
Vein Stenosis

Purpose: To evaluate the feasibility and the outcomes of transjugular percutaneous endovascular treatment of dysfunctional hemodialysis access in patients with chronic kidney disease. Methods: A total of 50 transjugular treatments in 38 patients with arteriovenous fistulas or arteriovenous grafts from September 2011 to May 2015 were included in this study. Medical records and angiographies were retrospectively reviewed. Success rate, patency rate, procedure time, and complications including internal jugular vein stenosis were evaluated. Results: A total of 50 sessions of transjugular treatments were performed in 38 patients. There were 31 native arteriovenous fistulas including 10 immature cases and 19 arteriovenous grafts. Among the 50 cases, technical success was achieved in 45 and clinical success was achieved in 44; 37 cases (74%) with multiple stenotic sites were treated by the transjugular approach without placement of cross-sheaths. The mean time from puncture of the internal jugular vein to first fistulography was 10 min, and the mean total procedure time was 64 min. The primary patency rate at 6 months was 77%, while the secondary patency rate at 6 months was 97%. Perforation occurred in two cases during conventional percutaneous transluminal angioplasty after failure of the transjugular approach. One dissection occurred during the transjugular approach. There was no newly developed internal jugular vein stenosis during a mean follow-up period of 19.3 months. Conclusion: For the treatment of dysfunctional or immature hemodialysis access, the transjugular approach is a feasible and effective option that avoids injury to the graft or draining vein, especially in immature fistulas.

Operative and perioperative management of infected arteriovenous grafts

2016 ◽  
Vol 18 (1) ◽  
pp. 13-21 ◽  
Author(s):  
Ehsan Benrashid ◽  
Linda M. Youngwirth ◽  
Leila Mureebe ◽  
Jeffrey H. Lawson
Keyword(s):  
Risk Factors ◽  
Vascular Graft ◽  
Perioperative Management ◽  
Operative Management ◽  
Dialysis Patients ◽  
Arteriovenous Grafts ◽  
Immunocompromised State

Vascular graft infections are a particularly troublesome complication for dialysis patients, many of whom are in an already immunocompromised state. The objective of this review is to detail the risk factors, etiology, diagnosis, perioperative and operative management of vascular graft infections.

A variant of arteriovenous fistulas within the wall of dural sinuses. Results of combined surgical and endovascular therapy

1991 ◽  
Vol 74 (2) ◽  
pp. 199-204 ◽  
Author(s):  
Stanley L. Barnwell ◽  
Van V. Halbach ◽  
Christopher F. Dowd ◽  
Randall T. Higashida ◽  
Grant B. Hieshima ◽  
...  
Keyword(s):  
Venous Drainage ◽  
Venous Hypertension ◽  
Neurological Dysfunction ◽  
Dural Sinus ◽  
Unique Type ◽  
Content Type ◽  
Av Fistula ◽  
Arteriovenous Fistulas ◽  
Av Fistulas ◽  
Cortical Venous Drainage

✓ Dural arteriovenous (AV) fistulas are thought to be acquired lesions that form in an area of thrombosis within a sinus. If the sinus remains completely thrombosed, venous drainage from these lesions occurs through cortical veins, or, if the sinus is open, venous drainage is usually into the involved sinus. Among 105 patients with dural A V fistulas evaluated over the the past 5 years, seven had a unique type of dural AV fistula in the superior sagittal, transverse, or straight sinus in which only cortical venous drainage occurred despite a patent involved sinus; the fistula was located within the wall of a patent dural sinus, but outflow was not into the involved sinus. This variant of dural AV fistulas puts the patient at serious risk for hemorrhage or neurological dysfunction caused by venous hypertension. Three patients presented with hemorrhage, one with progressive neurological dysfunction, one with seizures, and two with bruit and headaches. A combination of surgical and endovascular techniques was used to close the fistula while preserving flow through the sinus.

scholarly journals Hemodialysis vascular access affects heart function and outcomes: Tips for choosing the right access for the individual patient

2020 ◽  
pp. 112972982096931
Author(s):  
Jan Malik ◽  
Carlo Lomonte ◽  
Joris Rotmans ◽  
Eva Chytilova ◽  
Ramon Roca-Tey ◽  
...  
Keyword(s):  
Heart Failure ◽  
Vascular Access ◽  
Heart Function ◽  
Clinical Status ◽  
Severe Heart Failure ◽  
Dialysis Patients ◽  
Av Fistula ◽  
Hemodialysis Vascular Access ◽  
Cardiovascular Morbidity And Mortality ◽  
The Individual

Chronic kidney disease is associated with increased cardiovascular morbidity and mortality. A well-functioning vascular access is associated with improved survival and among the available types of vascular access the arterio-venous (AV) fistula is the one associated with the best outcomes. However, AV access may affect heart function and, in some patients, could worsen the clinical status. This review article focuses on the specific cardiovascular hemodynamics of dialysis patients and how it is affected by the AV access; the effects of an excessive increase in AV access flow, leading to high-output heart failure; congestive heart failure in CKD patients and the contraindications to AV access; pulmonary hypertension. In severe heart failure, peritoneal dialysis (PD) might be the better choice for cardiac health, but if contraindicated suggestions for vascular access selection are provided based on the individual clinical presentation. Management of the AV access after kidney transplantation is also addressed, considering the cardiovascular benefit of AV access ligation compared to the advantage of having a functioning AVF as backup in case of allograft failure. In PD patients, who need to switch to hemodialysis, vascular access should be created timely. The influence of AV access in patients undergoing cardiac surgery for valvular or ischemic heart disease is also addressed. Cardiovascular implantable electronic devices are increasingly implanted in dialysis patients, but when doing so, the type and location of vascular access should be considered.

scholarly journals Pediatric Thoraco-Lumbar Paraspinal Arteriovenous Fistulas along the Segmental Nerve

2006 ◽  
Vol 12 (1_suppl) ◽  
pp. 158-162
Author(s):  
Y. Niimi ◽  
A. Berenstein ◽  
P.M. Fernandez ◽  
J.L. Brisman ◽  
J.K. Song
Keyword(s):  
Venous Drainage ◽  
Imaging Features ◽  
Av Fistula ◽  
Arteriovenous Fistulas ◽  
Thoracic Level ◽  
Segmental Nerve ◽  
First Choice ◽  
Diagnostic Angiography ◽  
Choice Of Treatment ◽  
Detachable Coils

To characterize the clinical presentation, imaging features and endovascular treatment of paraspinal non-vertebral arteriovenous fistulas along the segmental nerve. Retrospective review was performed on the five patients identified in our database covering 1985 to 2003. All patients presented with an incidentally found continuous murmur over the upper paraspinal or parasternal regions before three years old. In four patients, the AV fistula was in the mid-thoracic level and at L3 in one. All AV fistulas were a high-flow single-hole fistula at the neural foramen with venous drainage into paraspinal and epidural veins without intradural reflux. All fistulas were endovascularly occluded in the same session as the diagnostic angiography. The fistula was occluded with detachable coils in one case and with N-butylcyanoacrylate (NBCA) with flow control in four cases. Complete occlusion of the fistula was obtained in all cases and all patients remained neurologically intact at the last follow up (average six years). Non-vertebral paraspinal arteriovenous fistula along the segmental nerve is a specific disease entity seen in children. Embolization is the first choice of treatment for this disease.

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