Patient factors and haemodialysis arteriovenous fistula outcomes

2017 ◽  
Vol 18 (1_suppl) ◽  
pp. S19-S23 ◽  
Author(s):  
Agnes Masengu ◽  
Jennifer Hanko
Keyword(s):  
Life Expectancy ◽  
Central Venous Catheter ◽  
Arteriovenous Fistula ◽  
Venous Catheter ◽  
Optimal Outcome ◽  
Central Venous ◽  
Patient Factors ◽  
Limited Life Expectancy ◽  
Arteriovenous Fistulas ◽  
Limited Life

Arteriovenous fistulas (AVF) improve survival and morbidity for most haemodialysis (HD) patients. Are they better for all patients? In the enthusiastic pursuit of AVFs for all, concerns have been raised regarding high primary AVF failure rates, continued high incident central venous catheter (CVC) use in some countries, and the limited life expectancy of some HD patients. “Fistula first” is changing to “catheter last”. The focus must be on decreasing AVF failure to mature and decreasing incident CVC use. An optimal outcome should be sought for each individual patient, and multiple failed attempts at AVF creation avoided.

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.

Maturing arteriovenous accesses in incident haemodialysis patients and first-year outcomes

2019 ◽  
Vol 21 (3) ◽  
pp. 322-327
Author(s):  
Rita L McGill ◽  
Eduardo K Lacson
Keyword(s):  
Central Venous Catheter ◽  
Arteriovenous Fistula ◽  
Odds Ratio ◽  
Venous Catheter ◽  
The United States ◽  
First Year ◽  
Central Venous ◽  
Arteriovenous Fistulas ◽  
Arteriovenous Access ◽  
One Year

Introduction: Nephrologists have increased arteriovenous access placement in patients with chronic kidney disease. Not yet usable ‘maturing’ arteriovenous fistulas and grafts are nearly as common as mature arteriovenous fistulas or grafts. Little has been reported about patients initiating haemodialysis with unready arteriovenous fistulas or grafts. Methods: The United States Renal Data System records for all adult patients initiating haemodialysis with central venous catheters between July 2010 and December 2011. Patients were categorized by whether a maturing arteriovenous fistula or graft was present. Transition to working arteriovenous fistula or graft was determined from linked Medicare claims. Modality changes and survival were ascertained. A logistic model for one-year survival and a subdistribution hazards model for transition to working arteriovenous fistula or graft, accounting for the competing risk of death, were constructed. Results: Compared to central venous catheter-only, maturing arteriovenous fistula or graft was associated with access conversion (hazard ratio = 2.23 (2.17–2.30) and 3.25 (2.97–3.56), respectively, p < 0.001 for both). Median time to conversion, among those who transitioned, was 95 days (interquartile range = 56–139) for patients with a maturing arteriovenous graft and 135 days (98–198) with a maturing arteriovenous fistula, versus 193 days (138–256) with central venous catheter-only. Pre-dialysis nephrology care, male sex and non-Caucasian race were associated with access conversion. Patients without a maturing arteriovenous fistula or graft had decreased odds of one-year survival (odds ratio = 0.61 (0.58–0.66), p < 0.001), which attenuated with adjustment for access conversion (adjusted odds ratio = 1.06 (0.98–1.13), p = 0.2). Conclusion: Maturing arteriovenous fistulas or grafts were associated with enhanced first-year survival and increased opportunity for working arteriovenous fistulas or grafts, which may reflect pre-dialysis decision-making, quality of care and comorbid diseases. Central venous catheter exposure was substantial, even among patients with maturing access. Contributory factors prolonging conversion to arteriovenous access need to be identified and addressed.

Brachial Arteriovenous Fistula as a Complication of Placement of a Peripherally Inserted Central Venous Catheter: A Case Report and Review of the Literature

2006 ◽  
Vol 72 (9) ◽  
pp. 833-836 ◽  
Author(s):  
Hoang S. Tran ◽  
Brian J. Burrows ◽  
William A. Zang ◽  
David C. Han
Keyword(s):  
Central Venous Catheter ◽  
Arteriovenous Fistula ◽  
Duplex Ultrasound ◽  
Venous Catheter ◽  
Central Venous ◽  
Arterial Tree ◽  
Line Placement ◽  
Term Administration ◽  
History Of ◽  
Picc Line

Peripherally inserted central venous catheter (PICC) lines have become a frequently used method of intravenous access for long-term administration of antibiotics, chemotherapy, and parenteral nutrition. Catheter-related complications involving the arterial tree are rare. We report a case of a 25-year-old woman with a history of difficult PICC line placement that presented with an arteriovenous fistula in the left arm. Duplex ultrasound confirmed the diagnosis of a brachial artery-to-brachial vein arteriovenous fistula (AVF), and the patient underwent surgical repair. To our knowledge, this is the first reported case of an AVF resulting from PICC line placement. Correction of AVF is indicated to alleviate symptoms as well as to prevent future complications.

Point-of-care ultrasound for assessing arteriovenous fistula maturity in outpatient hemodialysis

2020 ◽  
Vol 21 (6) ◽  
pp. 923-930
Author(s):  
George N Coritsidis ◽  
Orlando N Machado ◽  
Farzin Levi-Haim ◽  
Sean Yaphe ◽  
Roshan A Patel ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Arteriovenous Fistula ◽  
Point Of Care ◽  
Demographic Data ◽  
Venous Catheter ◽  
Fisher Exact Test ◽  
Point Of Care Ultrasound ◽  
Central Venous ◽  
Exact Test ◽  
Central Venous Catheter Removal

Background: Point-of-care ultrasound in end-stage renal disease is on the rise. Presently the decision to cannulate an arteriovenous fistula is based on its duration since surgery and physical exam. This study examines the effects of point-of-care ultrasound on decreasing the time to arteriovenous fistula cannulation, time spent with a central venous catheter, and the complications and infections that arise. Methods: Prospective point-of-care ultrasound patients were recruited between January 2015 and January 2018, while retrospective data (non-point-of-care ultrasound) were collected via chart review from patients who had fistula creation between November 2011 and May 2014. Patients had point-of-care ultrasound within 3 weeks after arteriovenous fistula creation and were followed for 1 year. Arteriovenous fistula cannulation was initiated when the following parameters were met: diameter > 6 mm (with no depreciable narrowing of more than 20% throughout), depth < 6 mm, and length > 6 cm. Demographic data, as well as time to cannulation and central venous catheter removal, number of infections, complications, and interventions were compared between point-of-care ultrasound and non-point-of-care ultrasound groups using unpaired t-test, chi-square, and Fisher exact test statistical analysis. Results: A total of 37 patients with new arteriovenous fistulas were followed by point-of-care ultrasound compared to 29 non-point-of-care ultrasound patients. Point-of-care ultrasound patients had earlier cannulations (35.5 vs 63.3 days, p < 0.05), shorter central venous catheter duration (68.2 vs 98.3 days, p < 0.05), and less infections (12 vs 19) without differences in complication compared to the non-point-of-care ultrasound. Conclusion: Point-of-care ultrasound facilitates early and safe arteriovenous fistula cannulation leading to a reduction in central venous catheter time and risk of infection. Point-of-care ultrasound may also aid in earlier identification of complications and difficult cannulations.

scholarly journals A Staged Approach for Repair of Multiple Arteriovenous Fistula Aneurysms Reduces the Need for Temporary Central Venous Catheter for Hemodialysis

2021 ◽  
Vol 233 (5) ◽  
pp. e233
Author(s):  
Jaimie Chang ◽  
Emily E. Hejna ◽  
Ronda Billerbeck ◽  
Samantha L. Terranella ◽  
Matthew Trawczynski ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Arteriovenous Fistula ◽  
Venous Catheter ◽  
Central Venous ◽  
Staged Approach

Vascular access for chronic hemodialysis in children: arteriovenous fistula or central venous catheter?

2014 ◽  
Vol 29 (12) ◽  
pp. 2395-2401 ◽  
Author(s):  
Aicha Merouani ◽  
Michel Lallier ◽  
Julie Paquet ◽  
Johanne Gagnon ◽  
Anne Laure Lapeyraque
Keyword(s):  
Central Venous Catheter ◽  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Venous Catheter ◽  
Chronic Hemodialysis ◽  
Central Venous

American Association of Kidney Patients survey of patient preferences for hemodialysis vascular access

2019 ◽  
Vol 21 (2) ◽  
pp. 230-236
Author(s):  
Saravanan Balamuthusamy ◽  
Larry E Miller ◽  
Diana Clynes ◽  
Erin Kahle ◽  
Richard A Knight ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Renal Disease ◽  
Arteriovenous Fistula ◽  
Vascular Access ◽  
End Stage Renal Disease ◽  
American Association ◽  
Venous Catheter ◽  
Central Venous ◽  
Stage Renal Disease ◽  
End Stage

Objectives: To determine the vascular access modalities used for hemodialysis, the reasons for choosing them, and determinants of satisfaction with vascular access among patients with end-stage renal disease. Methods: The American Association of Kidney Patients Center for Patient Research and Education used the American Association of Kidney Patients patient engagement database to identify eligible adult hemodialysis patients. Participants completed an online survey consisting of 34 demographic, medical history, and hemodialysis history questions to determine which vascular access modalities were preferred and the reasons for these preferences. Results: Among 150 respondents (mean age 54 years, 53% females), hemodialysis was most frequently initiated with central venous catheter (64%) while the most common currently used vascular access was arteriovenous fistula (66%). Most (86%) patients previously received an arteriovenous fistula, among whom 77% currently used the arteriovenous fistula for vascular access. Older patients and males were more likely to initiate hemodialysis with an arteriovenous fistula. The factors most frequently reported as important in influencing the selection of vascular access modality included infection risk (87%), physician recommendation (84%), vascular access durability (78%), risk of complications involving surgery (76%), and impact on daily activities (73%); these factors were influenced by patient age, sex, and race. Satisfaction with current vascular access was 90% with arteriovenous fistula, 79% with arteriovenous graft, and 67% with central venous catheter. Conclusion: Most end-stage renal disease patients continue to initiate hemodialysis with central venous catheter despite being associated with the lowest satisfaction rates. While arteriovenous fistula was associated with the highest satisfaction rate, there are significant barriers to adoption that vary based on patient demographics and perception of procedure invasiveness.

scholarly journals Racial and Sex Disparities in Catheter Use and Dialysis Access in the United States Medicare Population

2020 ◽  
Vol 31 (3) ◽  
pp. 625-636 ◽  
Author(s):  
Shipra Arya ◽  
Taylor A. Melanson ◽  
Elizabeth L. George ◽  
Kara A. Rothenberg ◽  
Manjula Kurella Tamura ◽  
...  
Keyword(s):  
United States ◽  
Central Venous Catheter ◽  
Arteriovenous Fistula ◽  
Venous Catheter ◽  
The United States ◽  
Dialysis Access ◽  
Central Venous ◽  
Observational Cohort ◽  
System Data ◽  
White Patients

BackgroundDespite efforts to increase arteriovenous fistula and graft use, 80% of patients in the United States start hemodialysis on a central venous catheter (CVC).MethodsTo better understand in incident hemodialysis patients how sex and race/ethnicity are associated with time on a central venous catheter and transition to an arteriovenous fistula and graft, our observational cohort study analyzed US Renal Data System data for patients with incident ESKD aged ≥66 years who started hemodialysis on a CVC in July 2010 through 2013.ResultsAt 1 year, 32.7% of 74,194 patients transitioned to an arteriovenous fistula, 10.8% transitioned to an arteriovenous graft, 32.1% stayed on a CVC, and 24.5% died. Women spent a significantly longer time on a CVC than men. Compared with white patients, patients who were black, Hispanic, or of another racial/ethnicity minority spent significantly more days on a CVC. In competing risk regression, women were significantly less likely than men to transition to a fistula and more likely to transition to a graft. Compared with white patients, blacks were significantly less likely to transition to a fistula but more likely to transition to a graft, Hispanics were significantly more likely to transition to a fistula, and other races/ethnicities were significantly more likely to transition to either a fistula or a graft.ConclusionsFemale patients spend a longer time on a CVC and are less likely to transition to permanent access. Compared with white patients, minorities also spend longer time on a CVC, but are more likely to eventually transition to permanent access. Strategies to speed transition to permanent access should target groups that currently lag in this area.

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