In Preparation for a Treatment Guideline for Suitable Vascular Access Repair in Japan

Transjugular percutaneous endovascular treatment of dysfunctional hemodialysis access

PURPOSE

To evaluate the feasibility and the outcomes of transjugular percutaneous endovascular treatment of dysfunctional hemodialysis access in patients with chronic kidney disease.

METHODS

A total of 50 transjugular treatments in 38 patients with arteriovenous fistulas or arteriovenous grafts from September 2011 to May 2015 were included in this study. Medical records and angiographies were retrospectively reviewed. Success rate, patency rate, procedure time, and complications including internal jugular vein stenosis were evaluated.

RESULTS

A total of 50 sessions of transjugular treatments were performed in 38 patients. There were 31 native arteriovenous fistulas including 10 immature cases and 19 arteriovenous grafts. Among the 50 cases, technical success was achieved in 45 and clinical success was achieved in 44; 37 cases (74%) with multiple stenotic sites were treated by the transjugular approach without placement of cross-sheaths. The mean time from puncture of the internal jugular vein to first fistulography was 10 min, and the mean total procedure time was 64 min. The primary patency rate at 6 months was 77%, while the secondary patency rate at 6 months was 97%. Perforation occurred in two cases during conventional percutaneous transluminal angioplasty after failure of the transjugular approach. One dissection occurred during the transjugular approach. There was no newly developed internal jugular vein stenosis during a mean follow-up period of 19.3 months.

CONCLUSION

For the treatment of dysfunctional or immature hemodialysis access, the transjugular approach is a feasible and effective option that avoids injury to the graft or draining vein, especially in immature fistulas.

Evaluation of sterilization using the MEH200® (cotton pack) in vascular access puncture

BACKGROUND

In recent years, chlorhexidine-alcohol has been attracting increasing attention for its role in skin antisepsis. There have been few reports on the infection frequency associated with vascular access and no reports on the infection frequency associated with antiseptics.

AIMS

We investigated skin disinfection during vascular access puncture in patients on chronic hemodialysis (HD).

METHODS

We analyzed patients on chronic HD with arteriovenous fistula (AVF) and arteriovenous graft (AVG) between January 2006 and December 2010.

RESULTS

The MEH200® (cotton pack including alcohol and chlorhexidine gluconate) was used in 97% of patients. A total of 1130 patients were analyzed, including 911 with AVF and 219 with AVG. Of these, seven with AVF had an infection attributed to the insertion site, which represented a rate of 0.008% of patients per year. Twenty patients with AVG had an infection attributed to the insertion site, which represented a rate of 9.1% of patients per year. The frequency was not higher than that previously reported.

CONCLUSIONS

In HD patients, the MEH200® may be effective for the prevention of bacteremia.

Simple Surgical Method for a Native Arteriovenous Fistula of Chronic Hemodialysis Patients and the Patency Rate

Background/Aim

The maintenance and control of vascular access in chronic hemodialysis patients are causing serious problems not only in the quality of life of patients but also in the medical economy. In this regard, we investigated the cumulative patency rate of native arteriovenous fistula (AVF) as a vascular access.

Methods

Simple surgical method for a native AVF is selected. The cumulative patency rate of AVF was compared for each parameter. More particularly, the patency rate in the AVF was investigated by primary disease, age at the time of operation, gender, condition, and site. Furthermore, the influence of factors, including primary disease, gender, age at the time of operation (1 year old), and dialysis period (1 year) on the patency rate, was investigated using Cox's proportional hazard model.

Results

The patency rate of AVF was 85.6, 75.0, 67.5, 52.2% for 12, 36, 60, 120 months, respectively. When the patency rate was investigated by factor, the rate was significantly higher in the males than females. When the influence of risk factors on the patency rate was investigated, the significant and independent risk factors in all the cases were ‘female’ sex.

Conclusions

The AVF is considered as the vascular access with the highest patency rate in the chronic hemodialysis patients. However, the factor influencing this rate is gender. In conclusion, female has a higher risk than male.

Calcium channel antagonists reduce restenosis after percutaneous transluminal angioplasty of an arteriovenous fistula in hemodialysis patients

Percutaneous transluminal angioplasty (PTA) for stenosis of hemodialysis fistulas is associated with a high incidence of restenosis, and improvement of the patency rate after PTA is greatly needed. In addition, angiotensin II receptor blockers (ARB), calcium channel antagonists (CCA) and antiplatelet agents (APA) are commonly administered to most hemodialysis patients. This study retrospectively examined the effect of these medications on the incidence of restenosis after angioplasty for hemodialysis fistulae. The subjects were 92 patients--54 with anastomotic stenosis of an arteriovenous fistula (AVF) and 38 with stenosis of the draining veins of an arteriovenous graft (AVG)--who underwent angioplasty between January 2001 and December 2003. The patency period was defined as the interval from the first to the second angioplasty or surgical reconstruction. We excluded patients who received angioplasty two or more times. The effect of each drug on the patency of the AVF or AVG was assessed by the Kaplan-Meier method with the log-rank test and multiple logistic regression analysis. The group receiving CCA therapy showed a higher patency rate for both an AVF and an AVG. Although multiple logistic regression analysis also showed that a CCA reduces restenosis independently in an AVF, there was no significant correlation between a CCA and patency in an AVG. Treatment with an ARB and an APA was not associated with significantly higher patency rates for either an AVF or AVG. A CCA may reduce the incidence of restenosis after percutaneous intervention for stenosis of an AVF.