scholarly journals Gender Disparities in Vascular Access Surgical Outcomes in Elderly Hemodialysis Patients

2018 ◽  
Vol 49 (1) ◽  
pp. 11-19 ◽  
Author(s):  
Timmy Lee ◽  
Joyce Qian ◽  
Mae Thamer ◽  
Michael Allon
Keyword(s):  
United States ◽  
Vascular Access ◽  
Surgical Outcomes ◽  
Relative Rate ◽  
Venous Catheter ◽  
The United States ◽  
Hemodialysis Patients ◽  
Elderly Male ◽  
Female Patients ◽  
Arteriovenous Fistulas

Background: Despite national vascular access guidelines promoting the use of arteriovenous fistulas (AVF) over arteriovenous grafts (AVGs) for dialysis, AVF use is substantially lower in females. We assessed clinically relevant AVF and AVG surgical outcomes in elderly male and female patients initiating hemodialysis with a central venous catheter (CVC). Methods: Using the United States Renal Data System standard analytic files linked with Medicare claims, we assessed incident hemodialysis patients in the United States, 9,458 elderly patients (≥67 years; 4,927 males and 4,531 females) initiating hemodialysis from July 2010 to June 2011 with a catheter and had an AVF or AVG placed within 6 months. We evaluated vascular access placement, successful use for dialysis, assisted use (requiring an intervention before successful use), abandonment after successful use, and rate of interventions after successful use. Results: Females were less likely than males to receive an AVF (adjusted likelihood 0.57, 95% CI 0.52–0.63). Among patients receiving an AVF, females had higher adjusted likelihoods of unsuccessful AVF use (hazard ratio [HR] 1.46, 95% CI 1.36–1.56), assisted AVF use (OR 1.34, 95% CI 1.17–1.54), and AVF abandonment (HR 1.28, 95% CI 1.10–1.50), but similar relative rate of AVF interventions after successful use (relative risk [RR] 1.01, 95% CI 0.94–1.08). Among patients receiving an AVG, females had a lower likelihood of unsuccessful AVG use (HR 0.83, 95% CI 0.73–0.94), similar rates of assisted AVG use (OR 1.05, 95% CI 0.78–1.40) and AVG abandonment, and greater relative rate of interventions after successful AVG use (RR 1.16, 95% CI 1.01–1.33). Conclusions: While AVFs should be considered the preferred vascular access in most circumstances, clinical AVF surgical outcomes are uniformly worse in females. Clinicians should also consider AVGs as a viable alternative in elderly female patients initiating hemodialysis with a CVC to avoid extended CVC dependence.

Gender differences in vascular access in hemodialysis patients in the United States: Developing strategies for improving access outcome

2007 ◽  
Vol 4 (3) ◽  
pp. 193-204 ◽  
Author(s):  
Richard J. Marcus ◽  
Dawn A. Marcus ◽  
Kalathil K. Sureshkumar ◽  
Sabiha M. Hussain ◽  
Rita L. McGill
Keyword(s):  
United States ◽  
Gender Differences ◽  
Vascular Access ◽  
The United States ◽  
Hemodialysis Patients ◽  
Developing Strategies

Arteriovenous Vascular Access–Related Procedural Burden Among Incident Hemodialysis Patients in the United States

2021 ◽  
Author(s):  
Kenneth J. Woodside ◽  
Kaitlyn J. Repeck ◽  
Purna Mukhopadhyay ◽  
Douglas E. Schaubel ◽  
Vahakn B. Shahinian ◽  
...  
Keyword(s):  
United States ◽  
Vascular Access ◽  
The United States ◽  
Hemodialysis Patients

Vascular access survival among incident hemodialysis patients in the United States

1997 ◽  
Vol 30 (1) ◽  
pp. 50-57 ◽  
Author(s):  
John D. Woods ◽  
Marc N. Turenne ◽  
Robert L. Strawderman ◽  
Eric W. Young ◽  
Richard A. Hirth ◽  
...  
Keyword(s):  
United States ◽  
Vascular Access ◽  
The United States ◽  
Hemodialysis Patients

scholarly journals Buttonhole Cannulation of Arteriovenous Fistulas in the United States

Kidney360 ◽  
2020 ◽  
Vol 1 (4) ◽  
pp. 306-313 ◽  
Author(s):  
Tushar J. Vachharajani ◽  
Leslie Wong ◽  
Vandana D. Niyyar ◽  
Kenneth D. Abreo ◽  
Michele H. Mokrzycki
Keyword(s):  
United States ◽  
Vascular Access ◽  
The United States ◽  
Current Evidence ◽  
Maintenance Hemodialysis ◽  
Arteriovenous Fistulas ◽  
Randomized Controlled Studies ◽  
Hemodialysis Vascular Access ◽  
Increased Risk ◽  
Cannulation Technique

The cannulation technique of a hemodialysis vascular access has remained controversial with differing viewpoints. The quality of dialysis, overall patient safety, and individual dialysis experience often dictate the type of cannulation technique used in clinical practice. The three commonly used techniques to access a hemodialysis vascular access are the rope ladder, area, and buttonhole. Although the buttonhole technique has been around since the mid-1970s, the dialysis community remains divided on its suitability for routine use to provide maintenance hemodialysis therapy. The proponents of this technique value the ease of cannulation with less pain and discomfort whereas the opponents highlight the increased risk of infection. The actual clinical evidence from the United States is limited and remains inconclusive. The current review provides an overview of the available experience from the United States, highlighting the correct technique of creating a buttonhole, summarizing the current evidence, and recommending a need for larger randomized controlled studies in both in-center and home hemodialysis populations.

scholarly journals Vascular access placement and mortality in elderly incident hemodialysis patients

2018 ◽  
Vol 35 (3) ◽  
pp. 503-511 ◽  
Author(s):  
Gang Jee Ko ◽  
Connie M Rhee ◽  
Yoshitsugu Obi ◽  
Tae Ik Chang ◽  
Melissa Soohoo ◽  
...  
Keyword(s):  
Vascular Access ◽  
Reference Group ◽  
Venous Catheter ◽  
Hemodialysis Patients ◽  
Survival Models ◽  
First Year ◽  
Type Conversion ◽  
Limited Life Expectancy ◽  
Arteriovenous Fistulas ◽  
Limited Life

Abstract Background Arteriovenous fistulas (AVFs) are the preferred vascular access type in most hemodialysis patients. However, the optimal vascular access type in octogenarians and older (≥80 years) hemodialysis patients remains widely debated given their limited life expectancy and lower AVF maturation rates. Methods Among incident hemodialysis patients receiving care in a large national dialysis organization during 2007–2011, we examined patterns of vascular access type conversion in 1 year following dialysis initiation in patients <80 versus ≥80 years of age. Among a subcohort of patients ≥80 years of age, we examined the association between vascular access type conversion and mortality using multivariable survival models. Results In the overall cohort of 100 804 patients, the prevalence of AVF/arteriovenous graft (AVG) as the primary vascular access type increased during the first year of hemodialysis, but plateaued thereafter. Among 8356 patients ≥80 years of age and treated for >1 year, those with initial AVF/AVG use and placement of AVF from a central venous catheter (CVC) had lower mortality compared with patients with persistent CVC use. When the reference group was changed to patients who had AVF placement from a CVC in the first year of dialysis, those with initial AVF use had similar mortality. A longer duration of CVC use was associated with incrementally worse survival. Conclusions Among incident hemodialysis patients ≥80 years of age, placement of an AVF from a CVC within the first year of dialysis had similar mortality compared with initial AVF use. Our data suggest that initial CVC use with later placement of an AVF may be an acceptable option among elderly hemodialysis patients.

Differences in Initial Hemodialysis Vascular Access Use Among Glomerulonephritis Subtypes in the United States

2016 ◽  
Vol 67 (4) ◽  
pp. 638-647 ◽  
Author(s):  
Michelle M. O’Shaughnessy ◽  
Maria E. Montez-Rath ◽  
Yuanchao Zheng ◽  
Richard A. Lafayette ◽  
Wolfgang C. Winkelmayer
Keyword(s):  
United States ◽  
Vascular Access ◽  
The United States ◽  
Hemodialysis Vascular Access

scholarly journals High rate of native arteriovenous fistulas: How to reach this goal?

2015 ◽  
Vol 143 (3-4) ◽  
pp. 226-229
Author(s):  
Tamara Jemcov ◽  
Marija Milinkovic ◽  
Igor Koncar ◽  
Ilija Kuzmanovic ◽  
Nenad Jakovljevic ◽  
...  
Keyword(s):  
Vascular Access ◽  
Continuous Process ◽  
Venous Catheter ◽  
Medical Personnel ◽  
High Rate ◽  
Central Venous ◽  
Vascular Surgeon ◽  
Arteriovenous Fistulas ◽  
Clinical Center

The types of vascular accesses for hemodialysis (HD) include the native arteriovenous fistula (AVF), arteriovenous graft (AVG) and central venous catheter (CVC). Adequately matured native AVF is the best choice for HD patients and a high percentage of its presence is the goal of every nephrologist and vascular surgeon. This paper analyses the number and type of vascular accesses for HD performed over a 10-year period at the Clinical Center of Serbia, and presents the factors of importance for the creation of such a high number of successful native AVF (over 80%). Such a result is, inter alia, the consequence of the appointment of the Vascular Access Coordinator, whose task was to improve the quality of care of blood vessels in the predialysis period as well as of functional vascular accesses, and to promote the cooperation among different specialists within the field. Vascular access is the ?lifeline? for HD patients. Thus, its successful planning, creation and monitoring of vascular access is a continuous process that requires the collaboration and cooperation of the patient, nephrologist, vascular surgeon, radiologist and medical personnel.

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.

Aneurysm of Arteriovenous Fistula in Uremic Patients: Is Endograft a Viable Therapeutic Approach?

2002 ◽  
Vol 3 (2) ◽  
pp. 85-88 ◽  
Author(s):  
P.M. Allaria ◽  
E. Costantini ◽  
A. Lucatello ◽  
E. Gandini ◽  
F. Caligara ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Venous Catheter ◽  
Good Alternative ◽  
Central Venous ◽  
Arteriovenous Fistulas ◽  
Risk Of Rupture ◽  
Arterial Aneurysms ◽  
Percutaneous Insertion

One of the complications of arteriovenous fistulas in chronic hemodialyzed patients is the onset of an aneurysm which can be at risk of rupture. Traditional surgical repair is not always feasible and may not be successful in these cases, leading therefore to the loss of a functioning vascular access and requiring in any case the temporary use of a central venous catheter to allow regular hemodialysis sessions. We applied to this kind of aneurysm the same experience developed in the management of major arterial aneurysms and we considered endografting repair a good alternative in this case. In this paper we present the successful treatment of an arteriovenous fistula aneurysm using that technique. A distal radio-cephalic arteriovenous fistula in one of our patients presented an aneurysm with high risk of rupture. The endografting repair with percutaneous insertion of a Wallgraft™ endoprosthesis was well tolerated and the vascular access could be used the day after, without the need for a central venous catheter insertion.

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