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Arteriovenous Fistula Placement

Alexandros Mallios, William Jennings, Benoit Boura, Alessandro Costanzo, Myriam Combes
Skin necrosis overlying an arteriovenous fistula at the cannulation site is a common and potentially life-threatening problem, often associated with underlying aneurysm formation. Arteriovenous fistula-skin necrosis generally requires resection of surrounding skin margins and the underlying aneurysmal vessel wall, allowing repair with healthy tissue of the arteriovenous fistula in addition to closure of soft tissue and skin. In patients with insufficient fistula length, salvage of these arteriovenous fistulas may result in difficult or insurmountable cannulation issues leading to attempts at one-needle cannulation dialysis or, most often, catheter placement...
March 1, 2018: Journal of Vascular Access
Afsha Aurshina, Anil Hingorani, Ahmad Alsheekh, Pavel Kibrik, Natalie Marks, Enrico Ascher
OBJECTIVE: It has been a widely accepted practice that a previous placed pacemaker, automatic implantable cardioverter defibrillators, or central line can be a contraindication to placing a hemodialysis catheter in the ipsilateral jugular vein. Fear of dislodging pacing wires, tunneling close to the battery site or causing venous obstruction has been a concern for surgeons and interventionalists alike. We suggest that this phobia may be unfounded. METHODS: A retrospective review was conducted of patients in whom hemodialysis catheters were placed over a period of 10 years...
March 1, 2018: Journal of Vascular Access
Katsuhito Ihara, Atsuki Ohashi, Seiji Inoshita
Heparin is commonly used to prevent clotting; however, severe hypersensitivity reactions during vascular access (VA) placement are rarely but occasionally reported. A 49-year-old man experienced a heparin-induced hypersensitivity reaction during VA placement. Severe side effects may occur even while placing the VA; therefore, we reconsidered the routine use of heparin, as the side effects are unpredictable. Physicians should be aware of the risk of heparin-induced hypersensitivity and be ready to effectively manage it during VA placement...
March 9, 2018: Internal Medicine
Jesse D Schold, Stuart M Flechner, Emilio D Poggio, Joshua J Augustine, David A Goldfarb, John R Sedor, Laura D Buccini
BACKGROUND: The effects of underlying noncodified risks are unclear on the prognosis of patients with end-stage renal disease (ESRD). We aimed to evaluate the association of residential area life expectancy with outcomes and processes of care for patients with ESRD in the United States. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: Adult patients with incident ESRD between 2006 and 2013 recorded in the US Renal Data System (n=606,046)...
March 7, 2018: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Chance Dumaine, Mercedeh Kiaii, Lisa Miller, Louise Moist, Matthew J Oliver, Charmaine E Lok, Swapnil Hiremath, Jennifer M MacRae
Background: One of the mandates of the Canadian Society of Nephrology's (CSN) Vascular Access Working Group (VAWG) is to inform the nephrology community of the current status of vascular access (VA) practice within Canada. To better understand VA practice patterns across Canada, the CSN VAWG conducted a national survey. Objectives: (1) To inform on VA practice patterns, including fistula creation and maintenance, within Canada. (2) To determine the degree of consensus among Canadian clinicians regarding patient suitability for fistula creation and to assess barriers to and facilitators of fistula creation in Canada...
2018: Canadian Journal of Kidney Health and Disease
Sushil Mehandru, Attiya Haroon, Avais Masud, Mayurkumar Patel, Elmer Sadiang-Abay, Eric J Costanzo, Tushar J Vachharajani
While an arteriovenous fistula is the best available access, many patients continue to rely on a tunneled hemodialysis catheter for dialysis therapy. Despite the highest risk of catheter-related bacteremia and associated morbidity and mortality, patients often prefer tunneled hemodialysis catheter to avoid pain associated with cannulation of an arteriovenous access. We report three tunneled hemodialysis catheter-dependent end-stage renal disease patients (age: 38, 35, 33 years), who became pregnant. Pregnancy was discovered at 10, 12 and 10 weeks of gestation...
March 1, 2018: Journal of Vascular Access
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
Samuel H Hui, Ryan Folsom, Lois A Killewich, Joel E Michalek, Mark G Davies, Lori L Pounds
BACKGROUND: Duplex ultrasound (DUS) mapping of the veins and arteries of the upper extremity is a well-established practice in arteriovenous fistula creation for long-term hemodialysis access. Previous publications have shown that vein diameters varying from 2 to 3 mm are predictive of success. Regional anesthesia is known to result in vasodilation and thus to increase the diameter of upper extremity veins. This study compares the sizes of veins measured by preoperative DUS mapping with those obtained after regional anesthesia to determine whether intraoperative DUS results in increased vein diameters and thus changes in the operative plan...
February 13, 2018: Journal 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
Christina Rao, Stephanie Fox, Sapan S Desai
Neuromyelitis optica, also known as Devic's disease, is an autoimmune disorder that leads to the inflammation and demyelination of nerves. Devic's disease primarily affects the optic nerve and spinal cord, but can lead to a significant loss of function throughout the body if not treated with steroid therapy or plasmapheresis. We recently saw a 62-year-old patient who received plasmapheresis for Devic's disease through a PTFE arteriovenous graft in her left arm. Her graft clotted without warning, and percutaneous thrombolysis was not successful...
September 2017: Case Reports in Neurology
Premal S Trivedi, Kimberly E Lind, Charles E Ray, Paul J Rochon, Robert K Ryu
PURPOSE: To determine whether utilization and outcomes of dialysis access maintenance interventions vary by patient race or sex. MATERIALS AND METHODS: Data for this retrospective cohort study of first-time arteriovenous (AV) access recipients were drawn from a 5% sample of Medicare beneficiaries, containing claims from all clinical settings (2009-2014) in 2,693 patients who received their first AV fistula/graft in 2009. Maintenance interventions-angiography, angioplasty, thrombolysis, stent placement, and venous embolization-were identified by corresponding Current Procedural Terminology codes...
January 17, 2018: Journal of Vascular and Interventional Radiology: JVIR
Young Erben, Haraldur Bjarnason, Gudrun L Oladottir, Robert D McBane, Peter Gloviczki
OBJECTIVE: The aim of this study was to evaluate outcomes of endovascular recanalization of the inferior vena cava (IVC) and iliac veins with long-standing chronic venous obstruction caused by nonmalignant disease. METHODS: Medical records for 66 patients who underwent endovascular recanalization of the IVC with or without iliac veins from January 2001 to December 2014 at our medical center were retrospectively reviewed. Primary outcomes included morbidity and mortality; secondary outcomes included primary, primary assisted, and secondary patency and resolution of symptoms...
January 11, 2018: Journal of Vascular Surgery. Venous and Lymphatic Disorders
Jennifer St Clair Russell, Shiree Southerland, Edwin D Huff, Maria Thomson, Klemens B Meyer, Janet R Lynch
A patient-centered quality improvement program implemented in one Virginia hemodialysis facility sought to determine if peer-to-peer (P2P) programs can assist patients on in-center hemodialysis with self-management and improve outcomes. Using a single-arm, repeatedmeasurement, quasi-experimental design, 46 patients participated in a four-month P2P intervention. Outcomes include knowledge, self-management behaviors, and psychosocial health indicators: self-efficacy, perceived social support, hemodialysis social support, and healthrelated quality of life (HRQoL)...
November 2017: Nephrology Nursing Journal: Journal of the American Nephrology Nurses' Association
Wen-Yi Li, Yi-Cheng Wang, Shang-Jyh Hwang, Shih-Hua Lin, Kwan-Dun Wu, Yung-Ming Chen
BACKGROUND: The clinical consequences of starting chronic peritoneal dialysis (PD) after emergent dialysis via a temporary hemodialysis (HD) catheter has rarely been evaluated within a full spectrum of treated end-stage renal disease (ESRD). We investigated the longer-term outcomes of patients undergoing emergent-start PD in comparison with that of other practices of PD or HD in a prospective cohort of new-onset ESRD. METHODS: This was a 2-year prospective observational study...
December 11, 2017: BMC Nephrology
Jonathan Misskey, Jason Faulds, Ravi Sidhu, Keith Baxter, Joel Gagnon, York Hsiang
OBJECTIVE: Current Kidney Disease Outcomes Quality Initiative guidelines do not incorporate age in determining autogenous arteriovenous hemodialysis access placement, and the optimal initial configuration in elderly patients remains controversial. We compared patency, maturation, survival, and complications between several age cohorts (<65 years, 65-79 years, >80 years) to determine whether protocols should be modified to account for advanced age. METHODS: All patients at two teaching hospitals undergoing a first autogenous arteriovenous access creation in either arm between 2007 and 2013 were retrospectively analyzed from a prospectively maintained database...
December 7, 2017: Journal of Vascular Surgery
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
Dinesh Bansal, Vijay Kher, Krishan Lal Gupta, Debasish Banerjee, Vivekanand Jha
INTRODUCTION: Despite the growing number of haemodialysis (HD) patients in India, little is known about vascular access practice. We investigated the use and cost of different vascular accesses by Indian nephrologists. METHODS: An online survey was emailed to 920 Indian nephrologists and 388 (42.1%) responded; 98.5% of whom were responsible for managing dialysis patients, 98% in hospitals. RESULTS: Sixty-four percent of patients initiated renal replacement therapy with HD, 7% with peritoneal dialysis, 10% kidney transplantation and 19% conservative care...
November 25, 2017: Journal of Vascular Access
Riccardo Corti, Pietro Quaretti, Franco Galli, Lorenzo Paolo Moramarco, Nicola Cionfoli, Giovanni Leati, Riccardo Corbetta, Matteo Tozzi
A tailored therapy to patient requirements by combining endovascular and surgical steps can be necessary to prolong the life of a vascular access. Stent grafts play a growing role for the therapy of dialytic access complications. Randomized multi-center trials, however, support the on-label use of stent grafts in the treatment of graft venous outflow and in-stent restenosis. The main contraindication to their use is an ongoing infection. We report two cases of new off-label application of Viabahn (Gore, flagstaff, USA) stent graft...
2017: SAGE Open Medical Case Reports
Keagan Werner-Gibbings, Liesl Ischia, William Butcher, Richard Ward-Harvey, Jonathan Stewart, Mark J Jackson
INTRODUCTION: With improved life expectancy and quality of life, elderly patients constitute a progressively larger fraction of consumers utilising renal replacement therapy (RRT). Although substantial data exist for younger cohorts, minimal evidence exists for outcomes of arteriovenous fistula (AVF) and central catheters (CVC) placed in those patients over 80 years. We examined outcomes of primary AVF placement in this cohort to ascertain durability and benefits of AVF in the over 80-year-old population...
November 9, 2017: Journal of Vascular Access
Nosratollah Nezakatgoo, Albert Ndzengue, Manhunath Ramaiah, Elvira O Gosmanova
Peritoneal dialysis (PD) interruption requiring hemodialysis (HD) is not uncommon and its frequently abrupt nature prevents timely creation of permanent HD access and avoidance of central venous catheters (CVC). We retrospectively studied a cohort of 24 end-stage renal disease (ESRD) patients (mean age 50.7 years, 83.3% African-Americans, 58.3% females, time on dialysis interquartile range [IQR] 0 - 65 days) who had simultaneous PD catheter insertion and backup arteriovenous fistula (AVF) creation between January 1, 2012, and December 31, 2013...
November 2017: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
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