scholarly journals Prospects for Vascular Access Education in Developing Countries: Current Situation in Cambodia

2017 ◽  
Vol 44 (Suppl. 1) ◽  
pp. 52-54
Author(s):  
Toshihide Naganuma ◽  
Yoshiaki Takemoto
Keyword(s):  
Developing Countries ◽  
Vascular Access ◽  
Medical Personnel ◽  
Transluminal Angioplasty ◽  
Dialysis Therapy ◽  
International University ◽  
Development And Management ◽  
Percutaneous Transluminal ◽  
And Training ◽  
Stable Development

We report our activities training doctors on vascular access procedures at International University (IU) Hospital in Cambodia through a program facilitated by Ubiquitous Blood Purification International, a nonprofit organization that provides medical support to developing countries in the field of dialysis medicine. Six doctors from Japan have been involved in the education of medical personnel at IU, and we have collectively visited Cambodia about 15 times from 2010 to 2016. In these visits, we have performed many operations, including 42 for arteriovenous fistula, 1 arteriovenous graft, and 1 percutaneous transluminal angioplasty. Stable development and management of vascular access is increasingly required in Cambodia due to increased use of dialysis therapy, and training of doctors in this technique is urgently required. However, we have encountered several difficulties that need to be addressed, including (1) the situation of personnel receiving this training, (2) problems with facilities, including medical equipment and drugs, (3) financial limitations, and (4) problems with management of vascular access.

scholarly journals Current state of dialysis treatment and vascular access management in Japan

2019 ◽  
Vol 20 (1_suppl) ◽  
pp. 10-14 ◽  
Author(s):  
Takashi Sato ◽  
Hiroshi Sakurai ◽  
Kentaro Okubo ◽  
Risa Kusuta ◽  
Takeshi Onogi ◽  
...  
Keyword(s):  
Vascular Access ◽  
Percutaneous Transluminal Angioplasty ◽  
Japanese Society ◽  
Transluminal Angioplasty ◽  
Access Management ◽  
Dialysis Therapy ◽  
Arteriovenous Fistulae ◽  
First Choice ◽  
Dialysis Outcomes ◽  
Percutaneous Transluminal

According to the data from the Japanese Society for Dialysis Therapy, the number of dialysis patients was about 330,000 at the end of 2016. The mean age of newly initiated patients was 69.4 years and that of maintenance was 68.2 years. And, diabetic nephropathy is the most common primary disease, with an incidence rate of 43.2%. These results mean that the systemic vascular condition is getting worse. In spite of these backgrounds, the patients of 97.3% were treated by hemodialysis; therefore, careful management of vascular access is essential to better maintain the condition of patients. The Dialysis Outcomes and Practice Patterns Study shows that vascular access modalities are an important factor in determining prognoses of patients and that prognosis in Japan is one of the best worldwide. In Japan, the use of arteriovenous fistulae accounts for 95% of vascular access modalities. However, a statistic by Japanese Society for Dialysis Therapy suggests that the use of arteriovenous graft has been increasing. In 2005, Japanese Society for Dialysis Therapy Guidelines recommended percutaneous transluminal angioplasty be the first choice for the treatment of vascular access stenosis. Since then, percutaneous transluminal angioplasty has become an important procedure for long-term maintenance of the morphology and function of vascular access. In Japan, approximately 60% of percutaneous transluminal angioplasty are conducted by nephrologists and urologists; in addition, arteriovenous fistulae creation procedures are also performed by them. According to my private opinion, such conditions above show that even in the absence of standardized training on vascular access management, doctors on site perform their duties in an appropriate manner. However, the problems of how we evaluate the specificity in Japan and pass it down the generations still remain.

Arterial percutaneous angioplasty in hemodialysis access: Endovascular treatment of hand ischemia

2020 ◽  
pp. 112972982094665
Author(s):  
Gabriela Teixeira ◽  
Paulo Almeida ◽  
Luís Loureiro ◽  
Inês Antunes ◽  
Duarte Rego ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Vascular Access ◽  
Percutaneous Transluminal Angioplasty ◽  
Clinical Success ◽  
Invasive Procedure ◽  
Transluminal Angioplasty ◽  
Arterial Stenosis ◽  
Low Flow ◽  
Hemodialysis Access ◽  
Percutaneous Transluminal

Background: Hemodialysis access–induced distal ischemia consists of symptomatic extremity malperfusion after vascular access creation. It is usually caused by discordant vascular resistance, with arteriovenous shunting of a high blood volume from arterial into venous system and subsequent hand hypoperfusion. Less often, hemodialysis access–induced distal ischemia is caused by arterial stenosis. In these cases, access frequently has normal/low flow, radial pulse is usually absent and not recoverable with vascular access digital compression, diabetes is often present, and percutaneous transluminal angioplasty can be critical for access and limb salvage. Methods: Retrospective study conducted between June 2011 and February 2018 of patients with vascular access submitted to arterial percutaneous transluminal angioplasty for limb-threatening ischemia. Results: Twenty-nine patients were referred for arterial angiography after hemodialysis access–induced distal ischemia diagnosis and physical examination or ultrasound findings suggestive of arterial disease. In 11 patients, percutaneous transluminal angioplasty was not technically feasible. Among 18 treated patients, 83.3% had diabetes and 60% had skin ulcerations. Target arteries were radial (11), brachial (7), axillar (2), ulnar (2), and subclavian (1). Clinical success, defined as arteriovenous maintenance and wound healing/pain resolution, was observed in 12 patients (66.7%). Concomitant procedures included adjuvant banding ( n = 2) and finger amputation ( n = 1), and one reintervention was performed. No intra- or postoperative complications were reported. Conclusion: Hemodialysis access–induced distal ischemia is a serious complication of hemodialysis vascular access, with multifactorial etiology. Correct and timely diagnosis is crucial for maintaining access and limb salvage. Percutaneous transluminal angioplasty is a minimally invasive procedure that may be effective and long-lasting in carefully selected patients with ischemic complaints.

Percutaneous transluminal angioplasty (PTA) and venous stenting in hemodialysis patients with vascular access-related venous stenosis or occlusion

Radiography ◽  
2006 ◽  
Vol 12 (2) ◽  
pp. 127-133 ◽  
Author(s):  
Fotini P. Christidou ◽  
Vasilios I. Kalpakidis ◽  
Kostas D. Iatrou ◽  
Ioannis A. Zervidis ◽  
Gerasimos I. Bamichas ◽  
...  
Keyword(s):  
Vascular Access ◽  
Percutaneous Transluminal Angioplasty ◽  
Hemodialysis Patients ◽  
Transluminal Angioplasty ◽  
Venous Stenting ◽  
Venous Stenosis ◽  
Percutaneous Transluminal

Percutaneous Transluminal Angioplasty as Best Treatment in Stenosis of Vascular Access for Hemodialysis

Nephron ◽  
1989 ◽  
Vol 51 (2) ◽  
pp. 192-196 ◽  
Author(s):  
J.C. Rodriguez-Perez ◽  
M. Maynar ◽  
A. Rams ◽  
C. Plaza ◽  
N. Vega ◽  
...  
Keyword(s):  
Vascular Access ◽  
Percutaneous Transluminal Angioplasty ◽  
Transluminal Angioplasty ◽  
Percutaneous Transluminal

The role of stents in hemodialysis vascular access

2021 ◽  
pp. 112972982110150
Author(s):  
Aisha Shaikh ◽  
Alian Albalas ◽  
Brinda Desiraju ◽  
Amy Dwyer ◽  
Nabil Haddad ◽  
...  
Keyword(s):  
Vascular Access ◽  
Neointimal Hyperplasia ◽  
Transluminal Angioplasty ◽  
Hemodialysis Vascular Access ◽  
Clinical Scenarios ◽  
Anatomic Locations ◽  
End Stage ◽  
Percutaneous Transluminal ◽  
Stenotic Lesions

Vascular access is the Achilles’ heel of dialysis therapy among patient with end stage kidney disease. The development of neointimal hyperplasia and subsequent stenosis is common in vascular access and is associated with significant morbidity. Percutaneous transluminal angioplasty using balloon inflation was the standard therapy of these lesions. However, the balloon-based approaches were associated with poor vascular access patency rate necessitating new inventions. It is within this context that different types of stents were developed in order to improve the overall dialysis vascular access functionality. In this article, we review the available literature regarding the use of stents in treating dialysis vascular access stenotic lesions. Further, we review the major clinical trials of stent use in different anatomic locations and in different clinical scenarios.

scholarly journals A case series of favorable vessel dilatation using a nitinol scoring element–equipped helical balloon catheter (AngioSculpt®)

2018 ◽  
Vol 20 (1_suppl) ◽  
pp. 93-96 ◽  
Author(s):  
Ryo Sato ◽  
Tetsuhiko Sato ◽  
Yuichi Shirasawa ◽  
Chika Kondo ◽  
Masao Tadakoshi ◽  
...  
Keyword(s):  
Vascular Access ◽  
Percutaneous Transluminal Angioplasty ◽  
Venous Pressure ◽  
Balloon Catheter ◽  
Case Series ◽  
Hemodialysis Patients ◽  
Transluminal Angioplasty ◽  
Stenosis Rate ◽  
Percutaneous Transluminal ◽  
Vascular Access Stenosis

Objective: Although percutaneous transluminal angioplasty is an effective therapy against vascular access failure in hemodialysis patients, recurrent stenosis imposes enormous burden for hemodialysis patients. A nitinol scoring element–equipped helical balloon catheter (AngioSculpt®) has been altered the landscape for treating several vascular diseases. It is not, however, fully elucidated whether AngioSculpt for advanced vascular access stenosis, difficult to expand by conventional balloons, successfully provides bailout angioplasty. Here, we report our cases whose intradialytic venous pressure significantly improved after percutaneous transluminal angioplasty without any serious adverse complications using AngioSculpt. Patients and Methods: Among patients undergoing hemodialysis in Masuko Memorial Hospital, 16 cases with resistant and recurrent vascular access stenosis underwent AngioSculpt (diameter 6 mm, total length 4 cm) angioplasty. We simultaneously measured the average venous pressures during hemodialysis before and after percutaneous transluminal angioplasty. Results: The average outflow vessel stenosis rate was 73.0 ± 11.3% before AngioSculpt intervention. Fully enlarged vessels were observed by expanding vessels at maximum pressure of 14 atm in all cases without any complications including vascular ruptures. Their intradialytic venous pressures decreased from 181.8 ± 39.2 mmHg to 150.5 ± 39.3 mmHg ( p < 0.0001). Conclusion: AngioSculpt may provide a promising option for treating hemodialysis patients with severely advanced vascular access stenosis, who would otherwise need repeated vascular access surgeries and/or conventional percutaneous transluminal angioplasties.

scholarly journals P1348EFFECT OF CILOSTAZOL ON ARTERIOVENOUS FISTULA IN HEMODIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
JAE WAN JEON ◽  
Young Rok Ham ◽  
Haeri Kim ◽  
Wonjung Choi ◽  
Ki Ryang Na ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Vascular Complications ◽  
Hemodialysis Patients ◽  
Transluminal Angioplasty ◽  
Control Group ◽  
Fistula Surgery ◽  
Significant Difference ◽  
And Control ◽  
Percutaneous Transluminal

Abstract Background and Aims Permanent vascular access is important in patients requiring hemodialysis. However, among patients requiring hemodialysis, even if arteriovenous fistula surgery is performed, many are unable to undergo hemodialysis with vascular access due to maturation failure. Method Using 194 patients who underwent arteriovenous fistula surgery, a cilostazol group (n = 107) and a control group (n = 87) were compared and analyzed for the occurrence of vascular complications. Results In the cilostazol group, there were less vascular complications (36.4% vs. 52.9%; p = 0.022), especially maturation failure (2.8% vs. 11.5%; p = 0.016). However, there was no significant difference between the cilostazol group and control group regarding percutaneous transluminal angioplasty (PTA) requirement nor frequency and interval to PTA after vascular surgery. The frequency of reoperations due to vascular injury after the start of hemodialysis after maturation was also significantly lower in the cilostazol group. Conclusion These results suggest that vascular access patients may benefit from postoperative cilostazol therapy.

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