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Arteriovenous access

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https://www.readbyqxmd.com/read/28330437/long-term-outcomes-of-fistula-first-initiative-in-an-urban-university-hospital-is-it-still-relevant
#1
Jacques Greenberg, Senthil Jayarajan, Sridhar Reddy, Frank A Schmieder, Andrew B Roberts, Paul S van Bemmelen, Jean Lee, Eric T Choi
PURPOSE: Dialysis access failure is a major cause of morbidity in patients with end-stage renal disease. The Fistula First Breakthrough Initiative (FFBI) dictates arteriovenous fistulae (AVFs) should be preferred over arteriovenous grafts (AVGs) as first line for surgically placed accesses. The purpose of this study was to compare patency rates of surgical dialysis accesses in our mature, urban population after the FFBI. METHODS: Current dialysis patients with accesses placed between 2006 and 2011 were included...
April 2017: Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28326557/analysis-of-blood-flow-characteristics-in-a-model-of-a-mature-side-to-side-arteriovenous-fistula
#2
Ashkan Javadzadegan, Nay Myo Lwin, Muhammad Asyraf, Anne Simmons, Tracie Barber
The creation of an arteriovenous fistula (AVF) is a common surgical procedure in hemodialysis patients suffering from end-stage renal disease (ESRD). However, several complications may occur after surgery, including thrombosis, stenosis, and aneurysm. These complications are attributed to hemodynamics perturbations including pathophysiological wall shear stress (WSS) and flow recirculation zones. In this study, we present a computational hemodynamic analysis in a model of a mature side-to-side AVF, which is then validated by experimental measurements...
March 21, 2017: Artificial Organs
https://www.readbyqxmd.com/read/28301835/fistula-and-survival-outcomes-after-fistula-creation-among-predialysis-chronic-kidney-disease-stage-5-patients
#3
Masahito Miyamoto, Noriaki Kurita, Kotaro Suemitsu, Masaaki Murakami
BACKGROUND: Most guidelines recommend the creation of arteriovenous fistula (AVF) in patients with chronic kidney disease (CKD) stage 4. However, an increasing number of studies suggest that early AVF creation leads to high rates of AVF failure and death before dialysis commencement. Only the Japanese guideline recommends AVF creation at CKD stage 5; however, no data are available regarding access-related outcomes at this stage. METHOD: This was a multicenter cohort study involving Japanese CKD stage 5 patients who underwent preemptive AVF creation from 2009 to 2013...
March 17, 2017: American Journal of Nephrology
https://www.readbyqxmd.com/read/28297070/elbow-avf-configurations-and-indications
#4
Selcuk Baktiroglu, Fatih Yanar, Sercan Yuksel, Burak Celik, Halime G Kilic
INTRODUCTION: Brescia-Cimino radiocephalic arteriovenous fistula (AVF) remains the first-choice vascular access procedure for patients in need of long-term hemodialysis. The average life expectancy of patients receiving hemodialysis has increased in recent years and many patients now live longer and require secondary or tertiary procedures. Elbow fistulas should only rarely be constructed as primary fistulas. The aim of the surgeon must be not only to achieve a functioning fistula, but to avoid possible complications other than failure to mature (FTM), like distal ischemia and cardiac failure and to save the vessels as much as possible for future procedures...
March 6, 2017: Journal of Vascular Access
https://www.readbyqxmd.com/read/28297069/is-early-cannulation-of-an-arteriovenous-fistula-associated-with-early-failure-of-the-fistula
#5
Teun Wilmink, Lee Hollingworth, Tamasin Stevenson, Sarah Powers
OBJECTIVE: To study the effect of early cannulation of arteriovenous fistulas (AVF) on early AVF failure. METHODS: Analysis of two databases of access operations and dialysis sessions from 1/12/2002 till 1/4/2015. Follow-up until 1/4/2016. Functional dialysis use defined as six consecutive cannulations of the AVF with two needles. Early cannulation defined as needling of the AVF within 30 days of creation. Early failure was defined as abandonment for new form of access within 90 days of first cannulation...
March 6, 2017: Journal of Vascular Access
https://www.readbyqxmd.com/read/28297068/drug-eluting-balloons-for-resistant-arteriovenous-dialysis-access-stenosis
#6
Dimitrios Karnabatidis, Panagiotis Kitrou
Vascular access maintenance is vital for hemodialysis patients. Conventional balloon angioplasty is the gold standard of treatment in endovascular therapy according to published guidelines, accompanied by bare metal stents as a bail-out method. Several devices have been used so far with a view to improve patency outcomes, but only covered stents have been proposed as a valid alternative and only for venous juxta-anastomotic stenosis of arteriovenous grafts. Paclitaxel-coated balloons (PCBs) have been extensively investigated in the last few years in pilot studies with small numbers of patients in dialysis access...
March 6, 2017: Journal of Vascular Access
https://www.readbyqxmd.com/read/28297067/optiflow-anastomotic-device-for-hemodialysis-vascular-access-creation
#7
Marc Glickman
The need to have consistent methods and consistent technique to optimize hemodialysis outcomes is behind the concept of the Optiflow™ device. This device was created to allow for consistency in size of the arterial anastomosis and consistency in angle of the vein to the artery at the anastomosis. Early data suggest that allowing these two technical entities can improve outcomes in regards to flow and maturity in arteriovenous fistula creation. This article is a summary of early data that demonstrate the impact the Optiflow device on brachial cephalic fistulas...
March 6, 2017: Journal of Vascular Access
https://www.readbyqxmd.com/read/28297066/cerebral-hyperperfusion-and-other-consequences-of-hemodialysis-central-vein-catheters
#8
Haimanot Wasse
While central venous stenosis is a common consequence of protracted central venous catheter use, intracardiac device transvenous leads, and central venous instrumentation, the majority of patients who develop symptomatic central venous stenosis present with characteristic venous hypertension. However, some patients may develop an abnormal intracranial venous circulation and present with neurologic symptoms. This paper will summarize findings from case reports that describe the neurologic sequelae that can develop as a result of central venous stenosis/occlusion in end-stage renal disease patients with a functional arteriovenous access...
March 6, 2017: Journal of Vascular Access
https://www.readbyqxmd.com/read/28297065/forearm-versus-upper-arm-grafts-for-vascular-access
#9
Shawn M Gage, Jeffrey H Lawson
Forearm and upper arm arteriovenous grafts perform similarly in terms of patency and complications. Primary patency at 1 year for forearm arteriovenous grafts versus upper arm grafts ranges from 22%-50% versus 22%-42%, and secondary patency at 1 year ranges from 78%-89% versus 52%-67%), respectively. Secondary patency at 2 years, ranges from 30%-64% versus 35%-60% for forearm and upper arteriovenous graft, respectively. Ample pre-operative planning is essential to improved clinical success and the decision to place a graft at one location versus the other should be based solely on previous access history, physical exam, appropriate venous imaging, and other factors that make up the clinical picture...
March 6, 2017: Journal of Vascular Access
https://www.readbyqxmd.com/read/28297062/description-and-early-outcomes-of-the-hybrid-graft-for-dialysis
#10
Luis F Gomez, Eric K Peden
INTRODUCTION: Long-term dialysis access has become more challenging as patient survival has improved in end-stage renal disease. The GORE® Hybrid Vascular Graft (GHVG) has been designed to improve dialysis access outcomes and provide additional access options for challenging patients. In this article, we will review the design of the graft, unique properties and reported outcomes. METHODS: We reviewed data available at our institution and performed a Pubmed search on GORE® Hybrid Vascular graft...
March 6, 2017: Journal of Vascular Access
https://www.readbyqxmd.com/read/28297060/drug-eluting-grafts-for-hemodialysis-access
#11
Marc Glickman
The development of new methods for drug elution of graft material, biofiber films and resurfacing of prosthetic graft surfaces offers new opportunities for improvement of graft function in arteriovenous (AV) access. Three areas of research include developing grafts that reduce the development of neointimal hyperplasia, reducing infection and reducing thrombogenicity. The only drug eluting graft presently being used, is the heparin coated expanded polytetrafluoroethylene (ePTFE) graft, which has been shown to decrease the incidence of early thrombosis...
March 6, 2017: Journal of Vascular Access
https://www.readbyqxmd.com/read/28297059/preoperative-ultrasound-still-valuable-for-radio-cephalic-arteriovenous-fistula-creation
#12
Jernej Pajek, Marko Malovrh
Radio-cephalic arteriovenous fistula is a prototype hemodialysis access with small incidences of infection and distal ischemia, it spares proximal veins for future access use and it helps in the maturation of veins that may be used for more proximal access creations. This access type is prone to higher early failure rates compared to more proximal fistulas and there are unsolved uncertainties regarding exact ultrasound parameters predictive of fistula outcome. Evolution of ultrasound use has yielded several functional parameters that can be measured in addition to anatomical lumen sizes, which remain core parameters on which the decision to construct fistula in radio-cephalic forearm position is based...
March 6, 2017: Journal of Vascular Access
https://www.readbyqxmd.com/read/28297058/stent-grafts-for-treatment-of-cannulation-zone-stenosis-and-arteriovenous-graft-venous-anastomosis
#13
David Shemesh, Ilya Goldin, Oded Olsha
Stent grafts (SGs) are widely used for treatment of failing vascular accesses, fistulas and grafts. The mechanical barrier of the covered stent prevents in-stent stenosis and can be used to effectively correct ruptured vein and aneurysms. Treatment of cannulation zone stenosis with SG can be justified when its use is obligatory, in order to prevent total access loss. Although there are worrying complications attendant on SG insertion and cannulation, including jeopardizing future access creation, most studies report no complications of SG in cannulation zone stenosis...
March 6, 2017: Journal of Vascular Access
https://www.readbyqxmd.com/read/28297054/optimal-timing-for-vascular-access-creation
#14
Tamara K Jemcov, Wim Van Biesen
Many guidelines recommend that end-stage renal disease (ESRD) patients should have a permanent vascular access, preferably an autologous arteriovenous fistula (AVF), at the start of renal replacement therapy. Nevertheless, a large proportion of patients still start hemodialysis with a central venous catheter (CVC). On the other hand, there are increasing numbers of patients in whom an AVF has been created, but who never actually end up on dialysis, as well as a substantial number of patients in whom creation of a vascular access has been attempted unsuccessfully...
March 6, 2017: Journal of Vascular Access
https://www.readbyqxmd.com/read/28297053/general-regional-or-local-anesthesia-for-successful-radial-cephalic-arteriovenous-fistula
#15
David Shemesh, Yefim Raikhinstein, Ilya Goldin, Oded Olsha
Autogenous fistulas and in particular radiocephalic fistulas are recommended as the first vascular access for hemodialysis. Unfortunately, the rates of early failure and non-maturation are very high. For more than a decade, brachial plexus block has been proposed as the anesthesia of choice for fistula creation due to its beneficial sympathectomy-like effect, causing vasodilation and attenuation of spasm. Until recently, there was not a single randomized clinical study supporting this proposition. Because performing regional anesthesia is time-consuming and requires expertise, many surgeons prefer local or general anesthesia for vascular access surgery...
March 6, 2017: Journal of Vascular Access
https://www.readbyqxmd.com/read/28297051/endovascular-treatment-to-boost-av-fistula-maturation
#16
Lars Kamper, Patrick Haage
Impaired fistula maturation is associated with puncture-related complications, insufficient dialysis and potential permanent access failure. Non-maturation is frequently initiated by stenotic vascular access vessels comprising the outflow veins, the arteriovenous anastomosis and infrequently the inflow artery. Further findings in maturation protraction are central venous stenoses or accessory outflow veins. Depending on the underlying pathology, several endovascular approaches to boost fistula maturation are possible...
March 6, 2017: Journal of Vascular Access
https://www.readbyqxmd.com/read/28297050/preoperative-computer-simulation-for-planning-of-vascular-access-surgery-in-hemodialysis-patients
#17
Niek Zonnebeld, Wouter Huberts, Magda M van Loon, Tammo Delhaas, Jan H M Tordoir
INTRODUCTION: The arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis patients. Unfortunately, 20-40% of all constructed AVFs fail to mature (FTM), and are therefore not usable for hemodialysis. AVF maturation importantly depends on postoperative blood volume flow. Predicting patient-specific immediate postoperative flow could therefore support surgical planning. A computational model predicting blood volume flow is available, but the effect of blood flow predictions on the clinical endpoint of maturation (at least 500 mL/min blood volume flow, diameter of the venous cannulation segment ≥4 mm) remains undetermined...
March 6, 2017: Journal of Vascular Access
https://www.readbyqxmd.com/read/28297048/upper-arm-hemodialysis-access-in-sweden
#18
Ulf Hedin, Gunilla Welander
AIM: To provide the contemporary use of upper-arm access for hemodialysis in Sweden using data from a unique national registry for hemodialysis access. METHODS: Data were retrieved from a nation-wide registry for dialysis access in Sweden, Dialysis Access Database (DiAD) on the use and function of specific access types with a focus on upper-arm accesses. RESULTS: The data demonstrate an increased use of upper-arm access, likely dependent on a changing patient population, with brachiocephalic arteriovenous fistula (AVF) as the most common access type...
March 6, 2017: Journal of Vascular Access
https://www.readbyqxmd.com/read/28297046/is-shear-stress-the-key-factor-for-avf-maturation
#19
Andrea Remuzzi, Michela Bozzetto, Paolo Brambilla
Autologous arteriovenous fistula (AVF) is the preferred choice for providing vascular access to hemodialysis (HD) patients, but it is still affected by high incidence of non-maturation or early failure. After creation, AVF must undergo vascular remodeling, a process characterized by an increase in blood vessel diameter and wall thickness, to allow efficient and adequate HD. A growing body of evidence indicates that AVF maturation is related to the response of endothelial cells (ECs) to changes in wall shear stress (WSS), and in particular, to changes of its peak value...
March 6, 2017: Journal of Vascular Access
https://www.readbyqxmd.com/read/28297045/surgical-technique-determines-the-outcome-of-the-brescia-cimino-avf
#20
Surendra Shenoy
Over the past 50 years, since Dr. Appel performed the first internal vascular access procedure for hemodialysis, the distal radiocephalic arteriovenous fistula continues to be the access of choice. Over time, failure to maturation has evolved as a major problem associated with this procedure depriving its benefits to many patients with end-stage renal disease. A variable incidence of this problem within similar patients suggests that surgical technique may play an important role in the development of non-maturation...
March 6, 2017: Journal of Vascular Access
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