A Vascular Access Port for Dialysis With a Polyurethane Foam Seal: A Pilot Study

2017 ◽  
Author(s):  
Robert E. Smith ◽  
Nicole C. Docherty ◽  
P. Alex Smith ◽  
Duncan J. Maitland ◽  
Alan C. Glowczwski
Keyword(s):  
Vascular Access ◽  
Prosthetic Graft ◽  
The Body ◽  
Dialysis Access ◽  
Access Port ◽  
Structural Support ◽  
Tissue Integration ◽  
Aneurysmal Dilation ◽  
Stage Renal Disease ◽  
End Stage

End-Stage Renal Disease (ESRD) is a condition wherein the kidneys are incapable of removing toxins from the body. Over 660,000 Americans suffer from ESRD, with millions more in the early stages, known as chronic kidney disease [1]. The only cure for ESRD is a kidney transplant, but the majority of patients receive dialysis every 2–3 days to filter their blood while on the transplant waitlist. Efficient dialysis requires approximately 600 mL/min of flow, which is commonly achieved by directly connecting an artery to a vein in the arm. Such a shunt may be created with an intervening prosthetic graft or by suturing the vein to the artery directly (termed an arteriovenous fistula, or AVF). Though accepted as the gold standard, AVF’s may take >6 weeks to heal and become useable, and 35–50% will never become accessible [1]. Needle trauma to the AVF can weaken the vessel wall and produce aneurysms or hematomas, which leak blood, potentially causing infection or clotting off the AVF [2]. These complications are costly: hemodialysis patients on average cost Medicare over $84,000 per year, and Medicare is the primary payer for more than 80% of nearly 500,000 dialysis patients in the U.S. [1]. An improved dialysis access method is needed to address the clinical shortcomings and high costs associated with AVF’s. A device has been developed to improve clinical outcomes and to reduce the failure rates associated with AVF’s. This device is a type of vascular access port which integrates with the external wall of the venous portion of the AVF, providing structural support to the vessel and preventing the types of trauma which lead to aneurysmal dilation or hematoma formation. The top and bottom sections are implanted independently within the patient’s soft tissue, allowing them to separate gradually as the AVF dilates during maturation. The result is a palpable and easy-to-access port which should improve AVF longevity (Figure 1). Two unique design features were identified as key to the success of this vascular access port: 1. Type of membrane or seal 2. Proper tissue integration into the implant This technical brief examines the selection of the proper membrane or seal on the port.

scholarly journals Cytokine Signature in End-Stage Renal Disease Patients on Hemodialysis

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Danyelle Romana Alves Rios ◽  
Melina Barros Pinheiro ◽  
Wander Valadares de Oliveira Junior ◽  
Karina Braga Gomes ◽  
Andréa Teixeira Carvalho ◽  
...  
Keyword(s):  
Renal Disease ◽  
Vascular Access ◽  
The Body ◽  
T Helper ◽  
T Helper 1 ◽  
Group I ◽  
Group Ii ◽  
Inflammatory Profile ◽  
Stage Renal Disease ◽  
End Stage

Hemodialysis is a modality of blood filtration in which accumulated toxins and water are removed from the body. This treatment is indicated for patients at the end stage of renal disease. Vascular access complications are responsible for 20–25% of all hospitalizations in dialyzed patients. The occurrence of thrombosis in the vascular access is a serious problem that may severely compromise or even make the hemodialysis impossible, which is vital for the patient. The aim of this study was to investigate inflammatory profile in patients undergoing hemodialysis as well as the association between these alterations and vascular access thrombosis. A total of 195 patients undergoing hemodialysis have been evaluated; of which, 149 patients had not experienced vascular access thrombosis (group I) and 46 patients had previously presented this complication (group II). Plasma levels of cytokines including interleukin (IL-) 2, IL-4, IL-5, IL-10, TNF-α, and IFN-γwere measured by cytometric bead array. Our results showed that patients with previous thrombotic events (group II) had higher levels of the IL-2, IL-4, IL-5, and IFN-γwhen compared to those in group I. Furthermore, a different cytokine signature was detected in dialyzed patients according to previous occurrences or not of thrombotic events, suggesting that elevated levels of T-helper 1 and T-helper 2 cytokines might, at least in part, contribute to this complication.

Chronic kidney disease and dialysis

2017 ◽  
Author(s):  
Richard J Haynes ◽  
James A Gilbert
Keyword(s):  
Chronic Kidney Disease ◽  
Peritoneal Dialysis ◽  
Kidney Disease ◽  
Abdominal Cavity ◽  
Kidney Injury ◽  
Well Being ◽  
Prosthetic Graft ◽  
Dialysis Access ◽  
Stage Renal Disease ◽  
End Stage

Chronic kidney disease (CKD) is a common disorder as currently defined. Patients with CKD face two major hazards: cardiovascular disease and—in a minority—progression to end-stage renal disease (ESRD). Advanced CKD also causes numerous metabolic and other complications. The management of CKD involves excluding acute kidney injury, diagnosing the cause of CKD, slowing progression, and detecting and treating complications. If patients do reach ESRD, then renal replacement therapy (RRT) options must be considered. These include haemodialysis, peritoneal dialysis, or transplantation. Haemodialysis requires creation of an arteriovenous fistula or insertion of a prosthetic graft while peritoneal dialysis necessitates the insertion of a catheter into the abdominal cavity. All forms of dialysis access are associated with complications both in the short and long term. However, they remain vital and central to the life and the well-being of the end-stage renal patient on dialysis.

Renal Hemodynamic Response to the Creation of Vascular Access in Patients with End-Stage Renal Disease

Renal Failure ◽  
1995 ◽  
Vol 17 (5) ◽  
pp. 589-593 ◽  
Author(s):  
Susan Crowley ◽  
Richard Morrissey ◽  
Eugene Silverman ◽  
William Yudt ◽  
Przemyslaw Hirszel
Keyword(s):  
Renal Disease ◽  
Vascular Access ◽  
End Stage Renal Disease ◽  
Hemodynamic Response ◽  
Renal Hemodynamic ◽  
The Creation ◽  
Stage Renal Disease ◽  
End Stage

Vascular access types in patients starting hemodialysis after failed kidney transplant: does close nephrology follow-up matter?

2016 ◽  
Vol 18 (1) ◽  
pp. 22-25 ◽  
Author(s):  
Naveed Ul Haq ◽  
Mohamed Said Abdelsalam ◽  
Mohammed Mahdi Althaf ◽  
Abdulrahman Ali Khormi ◽  
Hassan Al Harbi ◽  
...  
Keyword(s):  
Vascular Access ◽  
Clinic Visit ◽  
Study Data ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Early Referral ◽  
Period Data ◽  
Stage Renal Disease ◽  
End Stage

Background Native arteriovenous fistulae (AVFs) are preferred while central venous catheters (CVCs) are least suitable vascular access (VA) in patients requiring hemodialysis (HD). Unfortunately, around 80% of patients start HD with CVCs. Late referral to nephrologist is thought to be a factor responsible for this. We retrospectively analyzed the types of VA at HD initiation in renal transplant recipients followed by nephrologists with failed transplant. If early referral to nephrologist improves AVF use, these patients should have higher prevalence of AVF at HD initiation. Methods All patients who failed their kidney transplants from January 2002 to April 2013 were included in the study. Data regarding planning of VA by nephrologist, documented discussion about renal replacement therapy (RRT), estimated glomerular filtration rate (eGFR) at 6 months and last clinic visit before HD initiation, time of VA referral, and subsequent VA at dialysis initiation were gathered and analyzed. Results Eighty-three patients failed their transplants during study period. Data were inaccessible in six patients. Eleven patients started peritoneal dialysis (PD) while 66 started HD. Thirty-two had previous functioning VA while 34 needed VA. There were 11/34 patients (32%) with eGFR <15 mL/min at six months while 21/34 (61%) had eGFR <15 mL/min at last clinic visit before HD initiation. Only 11/34 (32%) had documented RRT discussion, 8/34 (24%) had VA referral, and 7/34 (21%) had vein mapping. A total of 30/34 (88.3%) started HD with CVC while 4/34 (11.3%) started HD with AVF (p<0.0001). Conclusions Early referral to nephrologist by itself may not improve VA care amongst patient with end-stage renal disease.

scholarly journals Distal Radial Artery Ligation for Dialysis Access Steal Syndrome

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
David Fung ◽  
Yaasin Abdulrehman
Keyword(s):  
Radial Artery ◽  
Surgical Techniques ◽  
Limb Ischemia ◽  
Definitive Treatment ◽  
Dialysis Access ◽  
Artery Ligation ◽  
Stage Renal Disease ◽  
End Stage ◽  
Steal Syndrome ◽  
Distal Radial Artery

Renal replacement therapy is the definitive treatment for end stage renal disease apart from transplant. Steal syndrome, which can lead to distal limb ischemia, is a rare but serious complication in patients who undergo hemodialysis with an arteriovenous fistula. We present a case of a 48-year-old female with limited options for dialysis access who presented with symptoms of steal syndrome. Given the need to keep her current fistula, we opted to treat her with distal radial artery ligation. This case report summarizes the various surgical techniques available for treating dialysis access-associated steal syndrome and why distal radial artery ligation should be considered a viable management strategy, especially in the context of our patient.

La diagnosi precoce di malattia

2019 ◽  
Vol 31 (1) ◽  
pp. 58-60
Author(s):  
Federica Rossi ◽  
Federico Pieruzzi
Keyword(s):  
Wide Spectrum ◽  
Delayed Diagnosis ◽  
Clinical Manifestations ◽  
The Body ◽  
Lysosomal Storage ◽  
Cerebrovascular Complications ◽  
Risk Patients ◽  
Alpha Galactosidase ◽  
Stage Renal Disease ◽  
End Stage

Anderson-Fabry disease is an X-linked, lysosomal, storage disorder characterized by the decreased activity of alpha-Galactosidase A, which results in accumulation of globotriaosylceramide (Gb-3) in cells and tissues throughout the body, leading to a wide spectrum of clinical manifestations. Patients are often misdiagnosed or diagnosed late in their life. This is due to the phenotypic heterogeneity, the poor awareness of this rare disease, and many pitfalls when making a differential diagnosis, in adulthood, as well as in the early stages. Delayed diagnosis has significant clinical implications, because the progression of the disease over time can lead to irreversible end-stage renal disease and life-threatening cardiovascular or cerebrovascular complications. Early diagnosis remains essential in order to start an early treatment and reduce the progression of the disease, thus maximizing the chance to improve patient outcomes. Newborn screening, high-risk patients’ identification, and increasing pediatricians’ and clinicians’ knowledge on this condition, are good strategies to avoid late referrals of Anderson-Fabry patients to reference centers.

Clinical Considerations in Hemodialysis Access Intervention

2018 ◽  
pp. 594-614
Author(s):  
Eric K. Hoffer
Keyword(s):  
Renal Disease ◽  
Arteriovenous Fistula ◽  
End Stage Renal Disease ◽  
Morbidity And Mortality ◽  
Dialysis Access ◽  
Hemodialysis Access ◽  
National Kidney Foundation ◽  
Clinical Considerations ◽  
Stage Renal Disease ◽  
End Stage

Interventional radiologists developed and refined the endovascular approaches to maintenance of the permanent arteriovenous vascular accesses that are integral to the provision of hemodialysis for patients with end stage renal disease. As methods of percutaneous arteriovenous fistula creation expand the scope of IR, this chapter reviews the clinical indications and preferences pertinent to dialysis access creation with respect to National Kidney Foundation Recommendations. Accesses remain imperfect, plagued by the development of flow-limiting intimal hyperplastic stenoses, and require monitoring and maintenance to minimize complications, morbidity and mortality. The measures of dialysis access function used in the surveillance of vascular accesses that indicate potential stenosis, and the utility of pre-occlusion recanalization of these stenoses are discussed. Complications specific to dialysis access interventions are also addressed.

scholarly journals Quality assessment of vascular access procedures for hemodialysis: A position paper of the Vascular Access Society based on the analysis of existing guidelines

2019 ◽  
Vol 21 (2) ◽  
pp. 148-153 ◽  
Author(s):  
Branko Fila ◽  
Ramon Roca-Tey ◽  
Jan Malik ◽  
Marko Malovrh ◽  
Nicola Pirozzi ◽  
...  
Keyword(s):  
Quality Control ◽  
Quality Assessment ◽  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Intermittent Hemodialysis ◽  
Improvement Programs ◽  
Stage Renal Disease ◽  
End Stage ◽  
Quality Improvement Programs ◽  
Access Surgery

Quality assessment in vascular access procedures for hemodialysis is not clearly defined. The aim of this article is to compare various guidelines regarding recommendation on quality control in angioaccess surgery. The overall population of end-stage renal disease patients and patients in need for hemodialysis treatment is growing every year. Chronic intermittent hemodialysis is still the main therapy. The formation of a functional angioaccess is the cornerstone in the management of those patients. Native (autologous) arteriovenous fistula is the best vascular access available. A relatively high percentage of primary failure and fistula abandonment increases the need for quality control in this field of surgery. There are very few recommendations of quality assessment on creation of a vascular access for hemodialysis in the searched guidelines. Some guidelines recommend the proportion of native arteriovenous fistula in incident and prevalent patients as well as the maximum tolerable percentage of central venous catheters and complications. According to some guidelines, surgeon’s experience and expertise have a considerable influence on outcomes. There are no specific recommendations regarding surgeon’s specialty, grade, level of skills, and experience. In conclusion, there is a weak recommendation in the guidelines on quality control in vascular access surgery. Quality assessment criteria should be defined in this field of surgery. According to these criteria, patients and nephrologists could choose the best vascular access center or surgeon. Centers with best results should be referral centers, and centers with poorer results should implement quality improvement programs.

Clinical Outcomes of Arteriovenous Access in Incident Hemodialysis Patients with Medicare Coverage, 2012–2014

2019 ◽  
Vol 49 (2) ◽  
pp. 156-164 ◽  
Author(s):  
Lauren C. Bylsma ◽  
Heidi Reichert ◽  
Shawn M. Gage ◽  
Prabir Roy-Chaudhury ◽  
Robert J. Nordyke ◽  
...  
Keyword(s):  
Vascular Access ◽  
Venous Catheter ◽  
The United States ◽  
Chronic Hemodialysis ◽  
Continuous Coverage ◽  
Sustained Use ◽  
Arteriovenous Access ◽  
Stage Renal Disease ◽  
End Stage ◽  
Primary Payer

Background: Chronic hemodialysis requires a mode of vascular access through an arteriovenous fistula (AVF), a prosthetic arteriovenous graft (AVG), or a central venous catheter (CVC). AVF is recommended over AVG or CVC due to increased patency and decreased intervention rates for those that mature. AVG are preferred over CVC due to decreased infection and mortality risk. The aims of this study were to evaluate the lifespan of AVF and AVG in maturation, sustained access use, and abandonment. Methods: The United States Renal Data System (USRDS), Medicare claims, and CROWNWeb were used to identify access placements. Patients with a first end-stage renal disease (ESRD) service from January 1, 2012 to June 30, 2014 with continuous coverage with Medicare as primary payer and ≥1 AVF or AVG placed after ESRD onset were included. Maturation was defined as the first use of the access for hemodialysis recorded in CROWNWeb. Sustained access use was defined as 3 consecutive months of use without catheter placement or replacement. Accesses that were never used at any time post-placement were considered abandoned. Results: The cohort included 38,035 AVF placements and 12,789 AVG placements. Sixty-nine percent of AVF and 72% of AVG matured. Fifty-two percent of AVF and 51% of AVG achieved sustained access use. One quarter of AVF and 14% of AVG were abandoned without use as recorded in CROWNWeb. Conclusion: Although considered the gold standard for vascular access, only half of AVF and AVG placements achieved sustained access use. The USRDS database has inherent limitations but provides useful clinical insight into maturation, sustained use, and abandonment.

Renal Hemodynamic Response to the Creation of Vascular Access in Patients with End-Stage Renal Disease

Renal Failure ◽  
1995 ◽  
Vol 17 (5) ◽  
pp. 589-593
Author(s):  
Susan T. Crowley ◽  
Richard L. Morrissey ◽  
Eugene D. Silverman ◽  
William M. Yudt ◽  
Przemyslaw Hirszel
Keyword(s):  
Renal Disease ◽  
Vascular Access ◽  
End Stage Renal Disease ◽  
Hemodynamic Response ◽  
Renal Hemodynamic ◽  
The Creation ◽  
Stage Renal Disease ◽  
End Stage
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