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AVF for hemodialysis

Michael W M Gerrickens, Roel H D Vaes, Bastiaan Govaert, Joep A W Teijink, Marc R Scheltinga
INTRODUCTION: Some hemodialysis patients with a brachial arteriovenous fistula (AVF) have an unsuitable upper arm needle access segment (NAS) necessitating basilic vein transposition (BVT). It was frequently observed that a portion of these patients spontaneously experienced a warmer and less painful dialysis hand after BVT. Aim of this study was to determine whether BVT for an inadequate NAS attenuated hemodialysis access-induced distal ischemia in patients with a brachial AVF. METHODS: Patients with a brachial AVF and an unsuitable NAS also reporting hand ischemia and scheduled to undergo BVT between 2005 and 2016 in a single facility were studied...
March 8, 2018: Hemodialysis International
Kelly A Lara, Rochelle Anne Chua, Trung D Vo
Autogenous arteriovenous fistula (AVF) is the primary recommended access for hemodialysis. Long term use will not uncommonly result in AVF aneurysmal degeneration. Aneurysm associated complications encompass pain, skin ulceration, infection, thrombosis, cannulation difficulties, and life-threatening bleeding. Various methods to repair aneurysmal AVFs have been described. However, there may be circumstances when this is not possible, and require insertion of a temporary hemodialysis catheter (HDC) until a new arteriovenous access is created...
February 23, 2018: Annals of Vascular Surgery
Eric Pillado, Mina Behdad, Russell Williams, Samuel E Wilson
INTRODUCTION: Construction of radiocephalic AV fistula (RC- AVF) results in successful hemodialysis (HD) in approximately 40 percent of ESRD patients. We investigated whether RC-AVF flow measured by ultrasound 30 days postoperative predicted successful HD. METHODS: In this prospective study color Doppler ultrasound (DUS) was used to measure cephalic vein outflow volume at three forearm sites one and three months postoperative. RESULTS: Of 45 consecutive patients screened for feasibility of RC-AVF by physical exam and US arterial and vein mapping, 41 were considered suitable for construction of RC-AVF...
February 22, 2018: Annals of Vascular Surgery
Kelsey Gray, Abraham Korn, Joshua Zane, Gabriel Conzalez, Amy Kaji, Nina Bowens, Christian de Virgilio
INTRODUCTION: Formal preoperative ultrasound (US) mapping of vascular anatomy by radiology is recommended prior to hemodialysis access surgery. We hypothesized that US performed by general surgery residents in place of formal US would decrease the time from initial consult to creation of dialysis access without affecting patient outcomes. METHODS: This is a retrospective review of all patients that underwent dialysis access surgery from November 2014 to July 2016 and received preoperative upper extremity US vein and artery evaluation by either radiology or general surgery residents...
February 22, 2018: Annals of Vascular Surgery
Abraham Korn, Hamid Alipour, Joshua Zane, Ali Shahverdiani, Timothy J Ryan, Amy Kaji, Nina Bowens, Christian de Virgilio
OBJECTIVE: Arteriovenous fistulas (AVF) are the preferred modality for hemodialysis access. Early thrombosis hampers development of a working AVF. We endeavored to determine the incidence of, and identify factors associated with early thrombosis of AVF, and to determine salvage rates following thrombosis, at a high volume hemodialysis access center. METHODS: Retrospective review of autologous AVF created between November 2014 and July 2016 at a single center. Early thrombosis was defined as thrombosis that occurred within 30 days of surgery...
February 22, 2018: Annals of Vascular Surgery
Kelsey Gray, Abraham Korn, Joshua Zane, Hamid Alipour, Amy Kaji, Nina Bowens, Christian de Virgilio
INTRODUCTION: Current guidelines recommend preoperative antibiotics in all vascular surgery cases. However, we hypothesize that patients undergoing arteriovenous fistula (AVF) and arteriovenous graft (AVG) creation have low rates of postoperative surgical site infection (SSI) and that preoperative antibiotic prophylaxis in these patients may not be necessary. METHODS: This is a retrospective review of all patients who underwent AVF and AVG creation from November 2014 through July of 2016 at a single institution...
February 22, 2018: Annals of Vascular Surgery
Kenneth J Woodside, Sarah Bell, Purna Mukhopadhyay, Kaitlyn J Repeck, Ian T Robinson, Ashley R Eckard, Sudipta Dasmunshi, Brett W Plattner, Jeffrey Pearson, Douglas E Schaubel, Ronald L Pisoni, Rajiv Saran
BACKGROUND: Arteriovenous fistulas (AVFs) are the preferred form of hemodialysis vascular access, but maturation failures occur frequently, often resulting in prolonged catheter use. We sought to characterize AVF maturation in a national sample of prevalent hemodialysis patients in the United States. STUDY DESIGN: Nonconcurrent observational cohort study. SETTING & PARTICIPANTS: Prevalent hemodialysis patients having had at least 1 new AVF placed during 2013, as identified using Medicare claims data in the US Renal Data System...
February 8, 2018: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Rui Abreu, Sara Rioja, Joaquin Vallespin, Xavier Vinuesa, Ruben Iglesias, Jose Ibeas
BACKGROUND: Native arteriovenous fistula (AVF) is considered the gold standard of vascular access for hemodialysis due to its longer survival, fewer complications, lower mortality and costs. Patency is important for effective dialysis treatment and this remains a challenge in nephrology. There are no well-defined prognostic factors for early and long-term AVF survival. The aim of this study was to evaluate comorbidity, analytical and ultrasound (US) variables as prognostic factors for early failure and AVF patency...
February 8, 2018: International Angiology: a Journal of the International Union of Angiology
Michael Allon, Peter B Imrey, Alfred K Cheung, Milena Radeva, Charles E Alpers, Gerald J Beck, Laura M Dember, Alik Farber, Tom Greene, Jonathan Himmelfarb, Thomas S Huber, James S Kaufman, John W Kusek, Prabir Roy-Chaudhury, Michelle L Robbin, Miguel A Vazquez, Harold I Feldman
BACKGROUND: Half of surgically created arteriovenous fistulas (AVFs) require additional intervention to effectively support hemodialysis. Postoperative care and complications may affect clinical maturation. STUDY DESIGN: Hemodialysis Fistula Maturation (HFM) Study, a 7-center prospective cohort study. SETTING & PARTICIPANTS: 491 patients with single-stage AVFs who had neither thrombosis nor AVF intervention before a 6-week postoperative ultrasonographic examination and who required maintenance hemodialysis...
February 2, 2018: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Eric Pillado, Abraham Korn, Christian de Virgilio, Nina Bowens
Prolonged use of central venous catheters (CVCs) for hemodialysis (HD) is associated with greater morbidity and mortality when compared with autogenous arteriovenous fistulas (AVF). The objective was to assess compliance with CVC guidelines in adults referred for hemoaccess at a county teaching hospital. Out of 256 patients, 172 (67.2%) were male, with a mean age of 50.0 ± 12.4 years. Overall 62.5 per cent initiated dialysis via CVC. Patients were divided into two groups (those with CVC (62.5%) and those without (37...
October 1, 2017: American Surgeon
Ying Zhang, Xianglei Kong, Lijun Tang, Yong Wei, Dongmei Xu
Arteriovenous fistula is the preferred option for vascular access in hemodialysis patients. The aim of this study was to assess different follow-up methods for hemodialysis patients in our hemodialysis center in China. A cohort of 124 patients with stage 3 chronic kidney disease was recruited and double-blind randomly assigned into two groups. Patients in Group A received phone calls to schedule their next consultation a week in advance. Patients in Group B scheduled their next appointment at the end of each visit...
January 19, 2018: Therapeutic Apheresis and Dialysis
Timmy Lee, Missy Magill, Steven K Burke, Andrew T Blair, Michelle L Robbin, Michael Allon
INTRODUCTION: Arteriovenous fistulas (AVF) frequently fail to mature. Postoperative ultrasounds provide objective measurements to predict unassisted AVF use for hemodialysis (unassisted use) and guide interventions to salvage nonmaturing AVFs. The optimal ultrasound criteria to assess AVF maturation are uncertain. We analyzed data from a multicenter, randomized, controlled, clinical trial to compare 2 published ultrasound maturation criteria used to predict unassisted AVF use for hemodialysis...
December 14, 2017: Journal of Vascular Access
Jeffrey E Hull, William C Jennings, Randy I Cooper, Umar Waheed, Matthew E Schaefer, Rajeev Narayan
PURPOSE: To evaluate safety and efficacy of arteriovenous fistulas (AVFs) created with a thermal resistance anastomosis device. MATERIALS AND METHODS: A prospective single-arm trial at 5 sites enrolled 107 patients. Patients underwent ultrasound (US)-guided anastomosis creation between the proximal radial artery and perforating vein with the Ellipsys Vascular Access System (Avenu Medical, Inc, San Juan Capistrano, California) followed by separate maturation procedures...
December 21, 2017: Journal of Vascular and Interventional Radiology: JVIR
Vasiliki Karava, Pascal Jehanno, Theresa Kwon, Georges Deschênes, Marie-Alice Macher, Pierre Bourquelot
BACKGROUND: This study aimed to describe the efficiency and longevity of arteriovenous fistula (AVF) for hemodialysis (HD) in children weighing ≤20 kg. METHODS: We collected data of all AVFs created using microsurgery techniques between 1988 and 2015. Success was considered as the ability to use the AVF for HD. Primary and secondary patency rates were measured. RESULTS: Forty-eight AVFs (35 forearm, 13 upper arm) were created in 41 children with a median weight of 13...
December 5, 2017: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Ronald L Pisoni, Lindsay Zepel, Richard Fluck, Charmaine E Lok, Hideki Kawanishi, Gültekin Süleymanlar, Haimanot Wasse, Francesca Tentori, Jarcy Zee, Yun Li, Douglas Schaubel, Steven Burke, Bruce Robinson
BACKGROUND: Vascular access practice is strongly associated with clinical outcomes. There is substantial international variation in the use of arteriovenous fistulas (AVFs) and grafts (AVGs), as well as AVF maturation time and location. STUDY DESIGN: Prospective cohort study. SETTING & PARTICIPANTS: Hemodialysis patients participating in the prospective Dialysis Outcomes and Practice Patterns Study (DOPPS) from the United States, Japan, and Europe/ANZ (Belgium, France, Germany, Italy, Spain, Sweden, United Kingdom, Australia, and New Zealand), including 3,850 patients receiving 4,247 new AVFs and 842 patients receiving 1,129 new AVGs in 2009 to 2015...
November 29, 2017: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Bram M Voorzaat, Koen E A van der Bogt, Cynthia J Janmaat, Jan van Schaik, Friedo W Dekker, Joris I Rotmans
OBJECTIVES: Radiocephalic arteriovenous fistulas (RCAVF) are the preferred vascular access (VA) for hemodialysis (HD). Cohort studies from North America revealed that nonmaturation is a significant disadvantage of RCAVFs compared to other VAs. DESIGN: This present retrospective study describes the incidence of nonmaturation of AVFs and functional failure of arteriovenous grafts (AVG) in a multicentre cohort in the Netherlands and attempts to create a prediction model for nonmaturation of RCAVFs...
November 29, 2017: World Journal of Surgery
Yong Zhong, Jiaxi Pu, Xiang Ao, Weisheng Peng, Zhangzhe Peng, Xiaozhao Li, Xiangcheng Xiao, Qiaoling Zhou, Ping Xiao
To investigate the status of vascular access in hemodialysis patients in our center.
 Methods: The general information of hemodialysis patients and types and complications of vascular access at Xiangya Hospital of Central South University from April 2015 to April 2016, were retrospectively analyzed.
 Results: Among 258 prevalent patients, 87.60% of them had arteriovenous fistula (AVF), while 12.40% showed tunneled cuffed catheter. Of the 61 incident patients, 80.33% of them initiated dialysis with a non-tunneled and non-cuffed catheter, 8...
November 28, 2017: Zhong Nan da Xue Xue Bao. Yi Xue Ban, Journal of Central South University. Medical Sciences
Lori Harwood, Barbara Wilson, Maren Goodman
The arteriovenous fistula (AVF) is the recommended access for most people requiring hemodialysis. Success or failure of cannulation of the AVF greatly impacts the patient's experience. Research suggests that skill development in this area is needed. This scoping review was conducted to review current research on cannulation of the AVF to find strategies to improve successful cannulation. Results of this scoping review (n = 36)demonstrated that most studies can be categorized under the technique of cannulation, and concerns and preferences with the AVF as a consequence of cannulation...
September 2017: Nephrology Nursing Journal: Journal of the American Nephrology Nurses' Association
Barbara Wilson, Lori Harwood
There is a lack of consensus in the literature on what constitutes successful arteriovenous fistula (AVF) cannulation outcomes from the patient perspective. The purpose of this study was to describe what successful cannulation means to patients on hemodialysis. A qualitative descriptive approach was used. A purposeful sample of 17 patients dialyzing with an AVF participated in one face-to-face interview. Using content analysis, four themes were identified that impact the patient experience in defining successful cannulation: 1) an emotional response - pain and anxiety, 2) a 'friendly' nurse-patient relationship, 3) nursing interventions/technical skills during cannulation, and 4) the impact of the environment...
September 2017: Nephrology Nursing Journal: Journal of the American Nephrology Nurses' Association
Esther D Wilschut, Joris I Rotmans, Ernst Jan Bos, Daniëlle van Zoest, Daniël Eefting, Jaap F Hamming, Koen E A van der Bogt
BACKGROUND: Failure of maturation occurs in 30%-60% of arteriovenous fistula (AVF) creation for hemodialysis, with highest rates in distal radiocephalic fistulas. This is partly due to initial small blood vessel size with limited blood flow capacity. Forearm exercise has shown potential as stimulus for increasing blood vessel size in patients with end-stage renal disease (ESRD) and may promote maturation of AVFs in the upper limb when applied postoperatively. However, it is unknown if forearm exercise increases blood vessel size pre-operatively, which may contribute to more distal AVF creation and raise success rates of AVF surgery...
November 15, 2017: Journal of Vascular Access
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