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.

Novel technique of percutaneous bypass in a brachiocephalic arteriovenous fistula with cephalic arch occlusion: A case report

2020 ◽  
pp. 112972982094904
Author(s):  
Hiang Jin Tan ◽  
Lew Pei Shi ◽  
Lai Yu Meng ◽  
Ho Derek Chunyin ◽  
Harsha Pitumpe ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Bypass Graft ◽  
Transluminal Angioplasty ◽  
Central Vein ◽  
Dialysis Access ◽  
Salvage Procedure ◽  
Arteriovenous Fistulas ◽  
Smooth Flow ◽  
End Stage

Objective: Arteriovenous fistulas are a principal mainstay of long-term dialysis access for patients with end stage renal failure. However, the patency of arteriovenous fistulas is limited, often requiring percutaneous transluminal angioplasty as a salvage procedure. We report a case of percutaneous method of arteriovenous fistula salvage. Methods: A gentleman with brachiocephalic arteriovenous fistula created in 2015 was admitted under us for dialysis access issue. His fistula history was notable for recurrent and refractory venous outflow stenosis of the cephalic vein and the cephalic arch with multiple previous interventions. Ultrasound showed cephalic arch occlusion with high venous pressures. He underwent left brachicephalic fistula percutaneous bypass. We describe the percutaneous creation of a brachial–subclavian arteriovenous fistula via a bypass graft from a worsening brachial-cephalic fistula with cephalic arch occlusion that is not amendable to angioplasty. Results: Final angiogram showed smooth flow to central vein. He is 2 years post procedure, and his fistula remained patent with no interventions required. Conclusion: Percutaneously created jump bypass grafts can reliably produce sustained long-term patency.

scholarly journals P1356PACLITAXEL-COATED BALLOON ANGIOPLASTY FOR STENOSIS OF ARTERIOVENOUS FISTULA IN PATIENTS UNDER HEMODIALYSIS: 18TH MONTH FOLLOW-UP

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
IOANNIS GRIVEAS ◽  
GEORGIOS VOURLIOTAKIS ◽  
IOANNIS KANDOUNAKIS
Keyword(s):  
Clinical Course ◽  
Therapeutic Option ◽  
Minimal Invasive ◽  
Arteriovenous Fistulas ◽  
Day Clinic ◽  
Before And After ◽  
Vascular Stenosis ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background and Aims The recording of the experience of the use of paclitaxel-coated balloons in patients with End Stage Renal Disease under hemodialysis (HD) exhibiting narrowing in arteriovenous fistulas (AVF). Method 20 patients with ultrasonographically confirmed AVF dysfunction were subjected after angiographic screening to prosthesis with a simple angioplasty balloon, and then a balloon drug gradually released the drug paclitaxel. After the damage was restored (one-day clinic), arteriovenous communication was used immediately. The degree of vascular stenosis, blood flow to it and kt / V before and after recovery were assessed by ultrasound. At the same time, the clinical course of the patient and the vestibule of the vessel were monitored for 18 months. Results In the 20 patients of the study, since the damage was recovered, AVF was immediately treated without any problems. After angioplasty the degree of stenosis of the responsible vessel was statistically significantly reduced from 69.85% to 27.38% (p <0.05). Flow volume increased statistically significantly from 690.47 mils / min to 942.67 mils / min (p <0.05). The kt / v of patients improved from 1.25 to 1.6. During the 18th -month follow-up, the clinical course of the patients was stable, no problems related to vascular access appeared. Restenosis occurred to two patients, one of each received another successful angioplasty. Conclusion Drug-releasing balloons can be a useful therapeutic option for patients with AVF stenosis due to accelerated endothelial hyperplasia. The use of paclitaxel-coated balloons helps reduce the risk of restenosis of arteriovenous anastomoses and is a safe, time consuming, minimal invasive and immediate solution to AVF management.

Use of dehydrated human amnion chorion membrane allograft on infected ruptured arteriovenous fistula: revision and closure

2019 ◽  
Vol 28 (Sup10) ◽  
pp. S10-S12
Author(s):  
Mutaz Al-Khateeb ◽  
Zaki Al-Muzakki ◽  
Mohammed Ftyan ◽  
Hussam Itani ◽  
Niki Istwan ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Haemodialysis Patient ◽  
Primary Patency ◽  
Human Amnion ◽  
Novel Approach ◽  
Hemodialysis Vascular Access ◽  
Stage Renal Disease ◽  
End Stage

Objective: Over two million individuals worldwide, with end-stage renal disease (ESRD), depend on dialysis therapy or a kidney transplant for survival. Every haemodialysis patient requires vascular access. The arteriovenous fistula (AVF) is preferred for long-term hemodialysis vascular access due to long-term primary patency rates. Given the limited options for haemodialysis access and placement, preservation of existing AVF sites is always a clinical priority. This case report describes a novel approach to wound closure with the application of dehydrated amnion chorion human membrane (dHACM) at an AVF surgical site known to be complicated with issues of scarring and tissue breakdown. The patient was treated successfully with the imperative preservation of his AVF given that he had few other vascular access options.

scholarly journals Accuracy of Peak Systolic Velocity of Radial Artery as Predictor of Maturation of Radiocephalic Arteriovenous Fistula in Cipto Mangunkusumo Hospital

2019 ◽  
Vol 1 (1) ◽  
pp. 30-33
Author(s):  
Dedy Pratama ◽  
Richard Yehuda Limen ◽  
Akhmadu Muradi
Keyword(s):  
Arteriovenous Fistula ◽  
Radial Artery ◽  
Peak Systolic Velocity ◽  
Cross Sectional ◽  
Arteriovenous Fistulas ◽  
The Mean ◽  
Cross Sectional Design ◽  
Stage Renal Disease ◽  
End Stage ◽  
Relationship Of

Introduction: Hemodialysis is an essential treatment in patients with stage 5 chronic kidney disease (CKD) or End-Stage Renal Disease (ESRD). The maturity of arteriovenous fistulas determines the success of hemodialysis. FAV maturity depends on preoperative preparation. The study aims to examine the preoperative and intraoperative peak systolic velocity (PSV) of the radial artery as a predictor of the successful maturation of the radiocephalic FAV. Method: This study used an analytic cross-sectional design to obtain the relationship of FAV maturation with preoperative and intraoperative PSV. Subjects were those who will undergo radiocephalic FAV surgery with preoperative ultrasound mapping. Shortly after anastomosis, PSV was measured. After 6 weeks, FAV was assessed for its maturity. Results: As many as 71 patients were undergone radiocephalic FAV surgery and followed for six weeks. The mean preoperative PSV of mature fistula was significantly higher than immature (54.6 ± 11.7 cm/s and 26.7 ± 7.7 cm/s; p <0.001). The mean intraoperative PSV of mature fistula was significantly higher than immature (57.9 + 12.6 cm/s and 27.1 + 8.1 cm/s; p <0.001). The mean PSV difference in mature fistulas was significantly higher than immature (3 cm/s and 0 cm/s; p <0.001). Preoperative PSV with a cut-off of 40 cm/s, intraoperative with a cut-off of 42 cm/s, and a difference of PSV with a cut-off of 42 cm/s all had 92.9% accuracy as a predictor of FAV maturation compared to “rule of 6” as a reference standard. Conclusion: Preoperative PSV >40 cm/s and intraoperative PSV >42 cm/s had a good predictor value for radiocephalic FAV maturation. Keywords: peak systolic velocity, maturation, arteriovenous fistula, radial artery

Balloon angioplasty: A promising adjunct to arteriovenous fistula creation compared with hydrostatic dilatation in small-caliber cephalic veins

2021 ◽  
pp. 021849232110415
Author(s):  
Santosh K Tiwari ◽  
Rajendra P Basavanthappa ◽  
Ranjith K Anandasu ◽  
Sanjay C Desai ◽  
Chandrasekhar A Ramswamy ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Balloon Angioplasty ◽  
Duplex Ultrasound ◽  
Primary Patency ◽  
Maturation Time ◽  
Arteriovenous Access ◽  
Dilatation Group ◽  
Stage Renal Disease ◽  
End Stage ◽  
Venous Segment

Background To maintain the patency and longevity of arteriovenous fistula, the availability of a venous segment with adequate diameter is important. In Indian population, many chronic kidney disease patients have poor caliber veins. The study aimed to evaluate the efficacy of hydrostatic dilatation versus Primary balloon angioplasty of small caliber cephalic veins of (≤2.5 mm) preoperatively in terms of patency rate and maturation time of arteriovenous fistula. Methods Patients ( n = 80) with an end-stage renal disease requiring arteriovenous access surgery for hemodialysis with small caliber cephalic veins were randomized into two groups, i.e., hydrostatic dilatation and primary balloon angioplasty, each with 40 patients. All patients underwent a thorough clinical examination as well as duplex ultrasound vein mapping of both upper extremities. Patients were followed up for six months and primary patency, maturation time, and complications were noted. Results Immediate technical success with good palpable thrill was achieved in 97.5% of patients in the primary balloon angioplasty group and 87.5% in the hydrostatic dilatation group. The fistula maturation time in the primary balloon angioplasty group was 34.41 days and 46.18 days in the hydrostatic dilatation group. In the primary balloon angioplasty group, the primary patency of the fistula was 97.5% and 87.5% in the hydrostatic dilatation group, at six months. The arteriovenous fistula functioning rate was 77.5% in the hydrostatic dilatation group as compared to 92.5% in the primary balloon angioplasty group at six months. The incidence of surgical site infection was 5% in the primary balloon angioplasty group as compared to 10% in the hydrostatic dilatation group. Conclusion Primary balloon angioplasty of small caliber cephalic veins (≤2.5 mm) performed prior to arteriovenous fistula creation for hemodialysis is a beneficial procedure.

scholarly journals Subclavian vein angioplasty during arteriovenous fistula surgery: case report and literature review

2012 ◽  
Vol 11 (2) ◽  
pp. 154-157
Author(s):  
Marcus Vinícius Martins Cury ◽  
Marcelo Fernando Matielo ◽  
Ana Carolina Calixtro ◽  
Giuliano de Almeida Sandri ◽  
Marcos Roberto Godoy ◽  
...  
Keyword(s):  
Case Report ◽  
Arteriovenous Fistula ◽  
Subclavian Vein ◽  
Chronic Kidney Disease Stage ◽  
Disease Stage ◽  
Stage Renal Disease ◽  
End Stage ◽  
Vein Stenosis ◽  
Subclavian Stenosis

Patients with chronic kidney disease stage 5 are generally treated by hemodialysis, preferentially performed via an arteriovenous fistula (AVF). We report the case of a 58-year-old male patient with diabetes mellitus, hypertension and end-stage renal disease in whom hemodialysis was conducted via a long-term catheter. His medical record described numerous central venous cannulations and several AVF creations. The patient developed subclinical subclavian stenosis that required creation of a new vascular access route. The purpose of this case report is to describe treatment of subclavian vein stenosis during AVF creation.

scholarly journals Effect of local papaverine on arteriovenous fistula maturation in patients with end-stage renal disease

2019 ◽  
Vol 41 (2) ◽  
pp. 185-192 ◽  
Author(s):  
Reza Manani ◽  
Gholamreza Kazemzadeh ◽  
Ali Saberi ◽  
Fatemeh Sadeghipour ◽  
Asghar Rahmani
Keyword(s):  
Renal Disease ◽  
Arteriovenous Fistula ◽  
End Stage Renal Disease ◽  
Control Group ◽  
Case Group ◽  
Maturation Time ◽  
Stage Renal Disease ◽  
End Stage ◽  
And Control ◽  
Fistula Maturation

Abstract Background: Arteriovenous fistula (AVF) maturation is one of the main concerns in patients with end-stage renal disease (ESRD) and finding a strategy for increasing success rate and accelerating fistula maturation is valuable. The aim of this study was to evaluate the effects of papaverine injection on AVF maturation and success rate. Method: This study was a randomized clinical trial that involved 110 patients with ESRD that were referred for AVF construction. Patients were allocated in papaverine group and control group with block randomization according to age and sex. In the case group, papaverine (0.1 or 0.2 cc) was injected locally within the subadventitia of artery and vein after proximal and distal control during AVF construction and in the control group, AVF construction was done routinely without papaverine injection. Results: Maturation time in case and control groups was 37.94 ± 11.49 and 44.23 ± 9.57 days, respectively (p=0.004). Hematoma was not seen in the case group but occurred in one patient in the control group. One patient of the case group developed venous hypertension. Four functional fistulas, 1 (1.8%) in the case group and 3 (5.5%) in the control group, failed to mature (p=0.618). Maturation rate did not differ between the two groups statistically (p=0.101). Conclusion: Local papaverine injection increased vessel diameter and blood flow, increasing shearing stress in both arterial and venous segment of recently created AVF. In this way, papaverine probably can decrease AVF maturation time without an increase in complications.

Nitinol stent–assisted maturation of the dysfunctional cannulation zone in the immature arteriovenous fistula

2020 ◽  
Vol 21 (6) ◽  
pp. 908-916
Author(s):  
Anoosha Aslam ◽  
Shannon D Thomas ◽  
Vikram Vijayan ◽  
Phillip Crowe ◽  
Ramon L Varcoe ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Bare Metal Stent ◽  
Primary Patency ◽  
Arteriovenous Fistulas ◽  
Vein Segment ◽  
Arterial Inflow ◽  
Median Diameter ◽  
Venous Diameter ◽  
End Stage

Introduction: The native arteriovenous fistula may remain immature despite adequate arterial inflow after formation. This may occur when the puncturable vein segment (cannulation zone) is too small to be reliably punctured, occluded or too deep under the skin for needle access. We performed stenting (stent-assisted maturation) of arteriovenous fistulas with an immature cannulation zone, allowing for a large subcutaneous channel which could then be immediately punctured for dialysis. Methods: We performed a retrospective review of 49 patients (mean age was 58.7 ± 16.09 (12–83) years, mean arteriovenous fistula age of 162.6 ± 27.28 days) with end-stage renal failure who underwent balloon dilatation and bare-metal stent implantation (1.6 ± 0.67 (1–3) stents, median diameter and length of 8 (5–14) mm and 80 (40–150) mm, respectively) through their cannulation zone (forced maturation). Radiocephalic (35 arteriovenous fistulas), brachiocephalic (10 arteriovenous fistulas) and autogenous loop arteriovenous fistulas (4 arteriovenous fistulas) were included with 30 patients (61.2%) having an inadequate cannulation zone venous diameter, 9 patients (18.4%) having an absent cannulation zone and 10 patients (20.4%) having a patent cannulation zone deeper than 1 cm which was not reliably puncturable. The study was conducted over 9 years (January 2008–December 2016) with implantation of the SMART® stent and Absolute Pro® stent in 61.2% and 38.8%, respectively. Long-term outcomes including primary useable segmental and access circuit patency as well as assisted primary access circuit patency, rate of re-intervention, technical success and complications were analysed. Results: At 6 months, 12 months and 4 years, respectively, cannulation zone primary patency was 84.4%, 74.4% and 56.1% and access circuit primary patency was 62.2%, 45.3% and 23.2%; however, assisted primary access circuit patency was 95.6%, 91.1% and 83.8%, achieved with an endovascular re-intervention rate of 0.53 procedures/year with only four thrombosed circuits occurring. Discussion: Forced maturation using nitinol stents allows for long-term haemodialysis access with a low rate of re-intervention.

Arteriovenous fistulas for hemodialysis: Brief review and current problems

2021 ◽  
pp. 112972982110077
Author(s):  
John J Manov ◽  
Prasoon P Mohan ◽  
Roberto Vazquez-Padron
Keyword(s):  
Renal Disease ◽  
Arteriovenous Fistula ◽  
Vascular Access ◽  
End Stage Renal Disease ◽  
State Of The Art ◽  
Arteriovenous Fistulas ◽  
Number Of Patients ◽  
Stage Renal Disease ◽  
End Stage

The number of people worldwide living with end-stage renal disease is increasing. Arteriovenous fistulas are the preferred method of vascular access in patients who will require hemodialysis. As the number of patients with arteriovenous fistulas grows, the role of physicians who intervene who maintain and salvage these fistulas will grow in importance. This review aims to familiarize practitioners with the rationale for arteriovenous fistula creation, the detection of fistula dysfunction, and the state of the art on fistula maintenance and preservation. Current controversies are briefly reviewed.

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