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Vascular access for hemodialysis

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https://www.readbyqxmd.com/read/28823140/pre-existing-arterial-pathologic-changes-affecting-arteriovenous-fistula-patency-and-cardiovascular-mortality-in-hemodialysis-patients
#1
Ja Young Lee, Young Ok Kim
The radiocephalic arteriovenous fistula (AVF) provides optimal vascular access for hemodialysis; it has a higher long-term patency rate and fewer complications than other vascular access methods. However, the AVF has a high primary failure rate. The presence of small-diameter vessels at anastomosis sites is an important risk factor for AVF failure. However, in a recent study, despite selecting an adequate artery and vein for creating an AVF by routine preoperative vascular mapping, AVF maturation and primary failure occurred...
August 22, 2017: Korean Journal of Internal Medicine
https://www.readbyqxmd.com/read/28822665/the-associations-of-hemodialysis-access-type-and-access-satisfaction-with-health-related-quality-of-life
#2
Natalie Domenick Sridharan, Larry Fish, Lan Yu, Steven Weisbord, Manisha Jhamb, Michel S Makaroun, Theodore H Yuo
OBJECTIVE: In addition to age and comorbidities, health-related quality of life (HRQOL) is known to predict mortality in hemodialysis (HD) patients. Understanding the association of vascular access type with HRQOL can help surgeons to provide patient-centered dialysis access recommendations. We sought to understand the impact of HD access type on HRQOL. METHODS: We conducted a cross-sectional prospective study of community-dwelling prevalent HD patients in Pittsburgh, Pennsylvania...
August 16, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28822660/prospective-randomized-study-of-long-term-hemodialysis-catheter-removal-versus-guidewire-exchange-to-treat-catheter-related-bloodstream-infection
#3
Hossam M Saleh, Mohamed M Tawfik, Hesham Abouellail
BACKGROUND: Long-term (tunneled cuffed) hemodialysis catheters are frequently used vascular access in renal failure patients. Catheter-related bloodstream infection (CRBSI) is a common complication of long-term hemodialysis catheters, with severe morbidities and high risk of mortality. Management of CRBSI by systemic antibiotics while keeping the catheter in place is not effective. Among the different modalities of CRBSI management are catheter removal (CR) and guidewire exchange (GE) of the catheter...
August 16, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28822538/smooth-muscle-nitric-oxide-responsiveness-and-clinical-maturation-of-hemodialysis-arteriovenous-fistulae
#4
Xiaoyong Tong, Xiuyun Hou, Christopher Wason, Tal Kopel, Richard A Cohen, Laura M Dember
The arteriovenous fistula is the preferred type of hemodialysis vascular access for patients with end-stage renal disease, but a high proportion of newly created fistulas fail to mature for use. Stenosis caused by neointimal hyperplasia often is present in fistulas with maturation failure, suggesting that local mechanisms controlling vascular smooth muscle cell (SMC) migration and proliferation are important contributors to maturation failure. SMCs cultured from explants of vein tissue obtained at the time of fistula creation from 19 patients with end-stage renal disease were studied to determine whether smooth muscle responsiveness to nitric oxide is associated with fistula maturation outcomes...
August 16, 2017: American Journal of Pathology
https://www.readbyqxmd.com/read/28819334/cytokine-signature-in-end-stage-renal-disease-patients-on-hemodialysis
#5
Danyelle Romana Alves Rios, Melina Barros Pinheiro, Wander Valadares de Oliveira Junior, Karina Braga Gomes, Andréa Teixeira Carvalho, Olindo Assis Martins-Filho, Ana Cristina Simões E Silva, Luci Maria Sant'Ana Dusse
Hemodialysis is a modality of blood filtration in which accumulated toxins and water are removed from the body. This treatment is indicated for patients at the end stage of renal disease. Vascular access complications are responsible for 20-25% of all hospitalizations in dialyzed patients. The occurrence of thrombosis in the vascular access is a serious problem that may severely compromise or even make the hemodialysis impossible, which is vital for the patient. The aim of this study was to investigate inflammatory profile in patients undergoing hemodialysis as well as the association between these alterations and vascular access thrombosis...
2017: Disease Markers
https://www.readbyqxmd.com/read/28819317/intradialytic-central-venous-oxygen-saturation-is-associated-with-clinical-outcomes-in-hemodialysis-patients
#6
Lili Chan, Hanjie Zhang, Anna Meyring-Wösten, Israel Campos, Doris Fuertinger, Stephan Thijssen, Peter Kotanko
Central venous oxygen saturation (ScvO2) in the superior vena cava is predominantly determined by cardiac output, arterial oxygen content, and oxygen consumption by the upper body. While abnormal ScvO2 levels are associated with morbidity and mortality in non-uremic populations, ScvO2 has received little attention in hemodialysis patients. From 1/2012 to 8/2015, 232 chronic hemodialysis patients with central venous catheters as vascular access had their ScvO2 monitored during a 6-month baseline period and followed for up to 36 months...
August 17, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28805538/effects-of-far-infrared-therapy-on-arteriovenous-fistulas-in-hemodialysis-patients-a-meta-analysis
#7
Qingsong Wan, Shikun Yang, Li Li, Fenfen Chu
BACKGROUND: Far infrared (FIR) therapy may have a beneficial effect on maturity and function of arteriovenous fistulas (AVFs) in hemodialysis (HD) patients. Therefore, we performed this pooled analysis to assess the protective effects of FIR therapy in HD patients. METHODS: The randomized controlled trials (RCTs) and quasi-RCTs of FIR therapy for HD patients were searched from multiple databases. Relevant studies were screened according to the predefined inclusion criteria...
November 2017: Renal Failure
https://www.readbyqxmd.com/read/28804237/aneurysmal-degeneration-of-the-brachial-artery-after-vascular-access-creation-surgical-treatment-results
#8
Sérgio Teixeira, Pedro Sá Pinto, Carlos Veiga, Ivone Silva, Rui Almeida
True peripheral artery aneurysms proximal to a longstanding arteriovenous fistula is a well-recognized complication. Late aneurysmal degeneration is rare. This study analyzed the characteristics, therapeutic options, and outcomes of true donor brachial artery aneurysms (DBAA) after arteriovenous fistula (AVF) for hemodialysis. We retrospectively collected the data of patients with DBAA after AVF creation, surgically repaired between January 2001 and September 2015. We excluded patients with pseudoaneurysms, anastomotic aneurysms, and infected aneurysms...
September 2017: International Journal of Angiology: Official Publication of the International College of Angiology, Inc
https://www.readbyqxmd.com/read/28798220/vascular-access-type-and-clinical-outcomes-among-elderly-patients-on-hemodialysis
#9
Timmy Lee, Mae Thamer, Qian Zhang, Yi Zhang, Michael Allon
BACKGROUND AND OBJECTIVES: The optimal type of initial permanent access for hemodialysis among the elderly is controversial. Duration of central venous catheter dependence, patient comorbidities, and life expectancy are important considerations in whether to place an arteriovenous fistula or graft. We used an observational study design to compare clinical outcomes in elderly patients who initiated hemodialysis with a central venous catheter and subsequently had an arteriovenous fistula or graft placed...
August 10, 2017: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/28794652/stent-tunnel-technique-to-save-thrombosed-native-hemodialysis-fistula-with-extensive-venous-aneurysm
#10
Martin Rabellino, Guillermo J Rosa-Diez, Sergio A Shinzato, Pablo Rodriguez, Oscar A Peralta, Maria S Crucelegui, Rosario Luxardo, Agustina Heredia-Martinez, Mariela I Bedini-Rocca, Ricardo D García-Mónaco
INTRODUCTION AND PURPOSE: The increasing number of patients undergoing hemodialysis and the limited number of access sites have resulted in an increasing number of techniques to maintain vascular access for hemodialysis. Thrombosed arteriovenous (AV) fistulas with large venous aneurysms have poor treatment results, with both endovascular and surgical techniques, leading to a high rate of definitive AV access loss. The purpose of this study was to review the feasibility and initial results of this novel endovascular treatment of thrombosed AV fistulas with large venous aneurysms...
2017: International Journal of Nephrology and Renovascular Disease
https://www.readbyqxmd.com/read/28794293/association-of-pulmonary-hypertension-with-inflammation-and-fluid-overload-in-hemodialysis-patients
#11
Hugo Hyung Bok Yoo, Roberto Dos Reis, Wagner Moneda Telini, Lidiane Rodrigues Telini, João Carlos Hueb, Silmeia Garcia Zanati Bazan, Pasqual Barretti, Luis Cuadrado Martin, Thais Thomaz Queluz
INTRODUCTION: Pulmonary hypertension (PH) has been reported in hemodialysis patients, but data regarding its pathogenesis are scarce. This study aimed to evaluate the role of fluid overload in PH and its interrelationships with the usual biomarkers of micro-inflammatory state in hemodialysis patients. MATERIALS AND METHODS: In is a cross-sectional and prospective study, 119 consecutive hemodialysis patients at a Brazilian referral university hospital were evaluated between March 2007 and February 2013...
July 2017: Iranian Journal of Kidney Diseases
https://www.readbyqxmd.com/read/28779784/drug-coated-balloon-angioplasty-for-dialysis-access-fistula-stenosis
#12
REVIEW
Auréline Boitet, Ziad A Massy, Olivier Goeau-Brissonniere, Isabelle Javerliat, Marc Coggia, Raphaël Coscas
Maintaining vascular access patency represents a tremendous challenge in hemodialysis patients. Although "native" arteriovenous fistula (AVF) is currently recommended as primary vascular access, neointimal hyperplasia stenoses frequently develop, with a risk for AVF thrombosis and vascular access loss. For years, first-line treatment of AVFs stenoses has been percutaneous transluminal angioplasty, generally with high-pressure or cutting uncoated balloons. However, restenosis and reintervention rates remain incredibly high and occur, according to recent studies, in up to 60% and 70% of patients at 6 and 12 months, respectively...
December 2016: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/28779782/future-research-directions-to-improve-fistula-maturation-and-reduce-access-failure
#13
REVIEW
Haidi Hu, Sandeep Patel, Jesse J Hanisch, Jeans M Santana, Takuya Hashimoto, Hualong Bai, Tambudzai Kudze, Trenton R Foster, Jianming Guo, Bogdan Yatsula, Janice Tsui, Alan Dardik
With the increasing prevalence of end-stage renal disease, there is a growing need for hemodialysis. Arteriovenous fistulae (AVF) are the preferred type of vascular access for hemodialysis, but maturation and failure continue to present significant barriers to successful fistula use. AVF maturation integrates outward remodeling with vessel wall thickening in response to drastic hemodynamic changes in the setting of uremia, systemic inflammation, oxidative stress, and pre-existent vascular pathology. AVF can fail due to both failure to mature adequately to support hemodialysis and development of neointimal hyperplasia that narrows the AVF lumen, typically near the fistula anastomosis...
December 2016: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/28779781/vascular-access-should-be-tailored-to-the-patient
#14
REVIEW
Krzysztof Letachowicz, Przemysław Szyber, Tomasz Gołębiowski, Mariusz Kusztal, Waldemar Letachowicz, Wacław Weyde, Jerzy Garcarek, Marian Klinger
A cornerstone of hemodialysis treatment is the creation of a functional and durable dialysis vascular access. Every patient with chronic kidney disease should have a plan of renal replacement therapy and access site protection. Factors having a crucial impact on vascular access selection include age, comorbidity, vessel quality, prognosis, dialysis urgency, and surgeon's preferences. Our medical group have reviewed these factors in our patients and, based on recently published data, developed a clinical decision tree for dialysis access in the chronic kidney disease patient...
December 2016: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/28762638/principles-of-treating-enlarging-pseudoaneurysm-in-a-dialysis-arteriovenous-graft
#15
Daniel V Patel, Tushar J Vachharajani
The arteriovenous graft (AVG) is one of the major types of permanent vascular access used to provide hemodialysis. Complications encountered with AVG use include stenosis, infection, thrombosis, and pseudoaneurysm formation. Venous outflow stenosis along with frequent needle cannulation at the same site can lead to breakdown of the graft material, resulting in pseudoaneurysm formation. In the following case, we illustrate common management principles used to treat pseudoaneurysms. While stent-grafts have been utilized for pseudoaneurysm repair, stent-graft usage is not always optimal...
August 1, 2017: Hemodialysis International
https://www.readbyqxmd.com/read/28753408/contribution-of-monoamine-oxidases-to-vascular-oxidative-stress-in-patients-with-end-stage-renal-disease-requiring-hemodialysis
#16
Diana Utu, Stelian Pantea, Oana M Duicu, Danina M Muntean, Adrian Sturza
Arteriovenous fistula (AVF) is the 'life line' for patients with end-stage renal disease (ESRD) undergoing hemodialysis. AVF maturation failure is a poorly understood process, one of the contributors being endothelial dysfunction due to oxidative stress. Monoamine oxidases (MAOs) A and B were recently identified as novel sources of vascular oxidative stress. The aim of the present study was to assess the contribution of MAOs to the endothelial dysfunction in patients with ESDR with indication of hemodialysis...
July 28, 2017: Canadian Journal of Physiology and Pharmacology
https://www.readbyqxmd.com/read/28752375/biological-and-physical-factors-involved-in-the-maturation-of-arteriovenous-fistula-for-hemodialysis
#17
Andrea Remuzzi, Michela Bozzetto
One of the most important limitations of hemodialysis (HD) treatment is the vascular access (VA) that is used to connect the patient's blood vessels to the extracorporeal circulation. The arteriovenous fistula (AVF) obtained with native vessels is the VA of choice for the low incidence of infections and the long-term patency, but it is affected by high incidence of non-maturation or primary failure. Before use for cannulation, AVF must undergo vascular remodeling, with progressive increase in vessel diameter, to accommodate the increase in blood flow...
July 27, 2017: Cardiovascular Engineering and Technology
https://www.readbyqxmd.com/read/28739575/fda-regulatory-perspectives-for-studies-on-hemodialysis-vascular-access
#18
Frank P Hurst, Robert E Lee, Aliza M Thompson, Brian D Pullin, Douglas M Silverstein
In an effort to foster innovation and new product development, the American Society of Nephrology and the US Food and Drug Administration partnered to form the Kidney Health Initiative in 2012. Part of the Kidney Health Initiative's mission is to foster development of therapies by creating a collaborative environment where the US Food and Drug Administration and the greater nephrology community can interact to optimize product evaluation. This particular Kidney Health Initiative project focused on products related to hemodialysis vascular access, with the goal of clarifying appropriate trial end points that could subsequently inform clinical, regulatory, and coverage decisions...
July 24, 2017: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/28729382/recommended-clinical-trial-end-points-for-dialysis-catheters
#19
Michael Allon, Deborah J Brouwer-Maier, Kenneth Abreo, Kevin M Baskin, Kay Bregel, Deepa H Chand, Andrea M Easom, Leonard Mermel, Michele H Mokrzycki, Priti R Patel, Prabir Roy-Chaudhury, Surendra Shenoy, Rudolph P Valentini, Haimanot Wasse
Central venous catheters are used frequently in patients on hemodialysis as a bridge to a permanent vascular access. They are prone to frequent complications, including catheter-related bloodstream infection, catheter dysfunction, and central vein obstruction. There is a compelling need to develop new drugs or devices to prevent central venous catheter complications. We convened a multidisciplinary panel of experts to propose standardized definitions of catheter end points to guide the design of future clinical trials seeking approval from the Food and Drug Administration...
July 20, 2017: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/28710090/the-clinical-and-economic-effect-of-vascular-access-selection-in-patients-initiating-hemodialysis-with-a-catheter
#20
Alian Al-Balas, Timmy Lee, Carlton J Young, Jeffrey A Kepes, Jill Barker-Finkel, Michael Allon
Patients in the United States frequently initiate hemodialysis with a central venous catheter (CVC) and subsequently undergo placement of a new arteriovenous fistula (AVF) or arteriovenous graft (AVG). Little is known about the clinical and economic effects of initial vascular access choice. We identified 479 patients starting hemodialysis with a CVC at a large medical center (during 2004-2012) who subsequently had an AVF (n=295) or AVG (n=105) placed or no arteriovenous access (CVC group, n=71). Compared with patients receiving an AVG, those receiving an AVF had more frequent surgical access procedures per year (1...
July 14, 2017: Journal of the American Society of Nephrology: JASN
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