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.

scholarly journals Risk of Complications and Survival of Patients Dialyzed with Permanent Catheters

Medicina ◽  
2019 ◽  
Vol 56 (1) ◽  
pp. 2
Author(s):  
Anna Szarnecka-Sojda ◽  
Wojciech Jacheć ◽  
Maciej Polewczyk ◽  
Agnieszka Łętek ◽  
Jarosław Miszczuk ◽  
...  
Keyword(s):  
Vascular Access ◽  
Infectious Complications ◽  
Term Survival ◽  
Long Term Survival ◽  
Dialysis Fistula ◽  
Study Population ◽  
Catheter Implantation ◽  
Stage Renal Disease ◽  
End Stage

Background and Objectives: An increase in the incidence of end-stage renal disease (ESRD) is associated with the need for a wider use of vascular access. Although arteriovenous (A-V) fistula is a preferred form of vascular access, for various reasons, permanent catheters are implanted in many patients. Materials and Methods: A retrospective analysis of clinical data was carried out in 398 patients (204 women) who in 2010–2016 were subjected to permanent dialysis catheters implantation as first vascular access or following A-V fistula dysfunction. The factors influencing the risk of complications related to vascular access and mortality were evaluated and the comparison of the group of patients with permanent catheter implantation after A-V fistula dysfunction with patients with first-time catheter implantation was carried out. Results: The population of 398 people with ESRD with mean age of 68.73 ± 13.26 years had a total of 495 permanent catheters implanted. In 129 (32.6%) patients, catheters were implanted after dysfunction of a previously formed dialysis fistula. An upward trend was recorded in the number of permanent catheters implanted in relation to A-V fistulas. Ninety-two infectious complications (23.1%) occurred in the study population in 65 patients (16.3%). Multivariate analysis showed that permanent catheters were more often used as the first vascular access option in elderly patients and cancer patients. Mortality in the mean 1.38 ± 1.17 years (min 0.0, max 6.70 years) follow-up period amounted to 50%. Older age and atherosclerosis were the main risk factors for mortality. Patients with dialysis fistula formed before the catheter implantation had a longer lifetime compared to the group in which the catheter was the first access. Conclusion: The use of permanent catheters for dialysis therapy is associated with a relatively high incidence of complications and low long-term survival. The main factors determining long-term survival were age and atherosclerosis. Better prognosis was demonstrated in patients after the use of A-V fistula as the first vascular access option.

scholarly journals Long-term survival of arteriovenous fistulas in home hemodialysis patients

2004 ◽  
Vol 65 (5) ◽  
pp. 1890-1896 ◽  
Author(s):  
Kelvin L. Lynn ◽  
Adrian L. Buttimore ◽  
J. Elisabeth Wells ◽  
Judith A. Inkster ◽  
Justin A. Roake ◽  
...  
Keyword(s):  
Hemodialysis Patients ◽  
Home Hemodialysis ◽  
Term Survival ◽  
Long Term Survival ◽  
Arteriovenous Fistulas

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.

Angioplasty to promote arteriovenous fistula maturation and maintenance

2018 ◽  
Vol 19 (4) ◽  
pp. 337-340 ◽  
Author(s):  
Kenneth Abreo ◽  
Mary Buffington ◽  
Bharat Sachdeva
Keyword(s):  
Arteriovenous Fistula ◽  
Term Survival ◽  
Arteriovenous Fistulas ◽  
Methods Of Evaluation ◽  
Drug Eluting ◽  
And Function ◽  
The Impact ◽  
Fistula Maturation

The arteriovenous fistula is currently the best permanent access for the hemodialysis patient. Unfortunately, stenosis impairs maturation, long-term survival, and function of the arteriovenous fistula. Angioplasty currently is the best procedure for the treatment of immature and dysfunctional arteriovenous fistulas. In this review, the authors discuss the optimum time to evaluate arteriovenous fistulas for maturity, methods of evaluation for maturity, and the role of angioplasty in salvaging immature arteriovenous fistulas. The review also discusses the effect of stenosis on dysfunction in mature arteriovenous fistulas and the role of angioplasty to treat this complication. Finally, the impact of cutting balloons and drug-eluting balloons in the treatment of resistant and recurrent stenosis, respectively, is also discussed.

scholarly journals Dialysis therapy: Its past, present, and future? My personal recollection of dialysis therapy

2019 ◽  
Vol 20 (1_suppl) ◽  
pp. 35-37 ◽  
Author(s):  
Seiji Ohira ◽  
Kazutaka Kukita
Keyword(s):  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Physical Factor ◽  
Dialysis Therapy ◽  
Vascular Surgeon ◽  
Term Survival ◽  
Arteriovenous Shunts ◽  
Mental Factor

In Dr Ohira’s era, hemodialysis was done using an external arteriovenous shunt. External arteriovenous shunts surely made repeated hemodialysis possible, but they also brought about serious complications which necessarily produced the arteriovenous fistula. Arteriovenous fistula is definitely the most important contribution to long-term survival of the hemodialysis patient. Hemodialysis therapy soon became very common, so that various kinds of patients appeared for it. Then came the era of arteriovenous grafts, because many patients lost good vessels in order to create the arteriovenous fistula. More grafts are now becoming available, which are made from different materials and in different forms, thus creating greater expectations for the future. Unfortunately, at this time, the revolutionary vascular access surpassing the arteriovenous fistula has yet to appear and we must continue to make proper application of the arteriovenous fistula. Vascular access is surely one of the important factors to assure a smooth dialysis life for patients. So, we must recognize that we play an important role in the dialysis patients’ life. It is interesting to note that in every country, medical care exceeds physical care. This means that the mental factor somewhat compensates for the physical factor. Dr Ohira was a vascular surgeon, but he was also interested in the activities of daily living and quality of life, which must be one of the most delicate fields in medicine.

scholarly journals Comparative analysis of radiocephalic versus brachiocephalic native arteriovenous fistula for hemodialysis in end stage renal disease

2016 ◽  
Vol 5 (1) ◽  
pp. 171
Author(s):  
Aniket Khadatkar ◽  
Chandrashekhar Mahakalkar ◽  
Tanu Pradhan ◽  
Akshay Bora
Keyword(s):  
Arteriovenous Fistula ◽  
Cephalic Vein ◽  
Maturation Time ◽  
Arteriovenous Fistulas ◽  
Before And After ◽  
Arteriovenous Grafts ◽  
Stage Renal Disease ◽  
End Stage ◽  
Work Up

Background: Chronic kidney disease (CKD) is a long term condition caused by damage to both kidneys. The benefits of arteriovenous fistulas over other forms of chronic access are: Arteriovenous fistulas are associated with decreased morbidity and mortality among hemodialysis patients compared with arteriovenous grafts and central venous catheters. Objectives of the study were o choose the proper sites for formation of arteriovenous fistula, to find out the success rate at various sites and to study the complications of arteriovenous fistula.Methods: This prospective study was carried out on total 150 patients over the duration of two years. The fistulae were created using radial artery and cephalic vein side to side (Radiocephalic AVF) and brachial artery and cephalic vein side to side anastomosis (Brachiocephalic AVF). Doppler studies were done before and after every procedure to demonstrate the velocity, volume of blood flow, depth from the skin, diameter of vessels and to access the time of maturation of AVF. Patients were followed up to first dialysis by AVF to assess the overall outcomes and various complications.Results: Brachiocephalic AVF matured earlier than Radiocephalic AVF (mean maturation time Brachiocephalic 38.02 days and Radiocephalic 43.26 days) which was statistically significant. Brachiocephalic AVF matured earlier than Radiocephalic AVF with more flow rate. Complication rate was more at wrist (Radiocephalic AVF with 66.67% of overall complication) than at elbow (Brachiocephalic AVF with 33.33% of overall complication).Conclusions: We concluded that the Brachiocephalic AVF maturation time was significantly less than the maturation time of Radiocephalic AVF and rate of complication was less in Brachiocephalic AVF. The utility of pre-operative colour Doppler to select the vessels for AVF creation was found to be as an essential parameter of pre-operative work up.

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