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Central Line Access for Hemodialysis Adversely Affects Ipsilateral Arteriovenous Graft Outcomes. Ann Vasc Surg 2022; 86:236-241. [DOI: 10.1016/j.avsg.2022.04.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/29/2022] [Accepted: 04/24/2022] [Indexed: 11/19/2022]
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Lim S, Alarhayem AQ, Rowse JW, Caputo FJ, Smolock CJ, Lyden SP, Kirksey L, Hardy DM. Thoracic outlet decompression for subclavian venous stenosis after ipsilateral hemodialysis access creation. J Vasc Surg Venous Lymphat Disord 2021; 9:1473-1478. [PMID: 33676044 DOI: 10.1016/j.jvsv.2021.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/12/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Central venous stenosis is one of the most challenging complications in patients requiring hemodialysis. Venous thoracic outlet syndrome is an underappreciated cause of central venous stenosis in patients requiring dialysis that can result in failed percutaneous intervention and loss of a functioning dialysis access. Limited data exist about the safety and outcomes of first rib resection in patients requiring hemodialysis, and the results have been confounded by the various surgical approaches used. The purpose of the present study was to evaluate the safety, operative outcomes, and patency of the existing dialysis access after transaxillary thoracic outlet decompression. METHODS A retrospective medical record review was performed from January 2008 to December 2019 of patients who had undergone thoracic outlet decompression for subclavian vein stenosis with ipsilateral upper extremity hemodialysis access. The baseline characteristics and comorbidities were reviewed. The operative and postoperative course were evaluated. The survival and patency rates were analyzed using the life-table method and Kaplan-Meier curve. RESULTS A total of 18 extremities in 18 patients were identified. Their mean age was 59 ± 11 years, and 89% were men. A total of 13 fistulas and 5 grafts were included. All patients had undergone repair via a transaxillary approach. First rib resection, anterior scalenectomy, and circumferential venolysis were performed in all 18 patients. The mean operative time was 99 ± 19 minutes, with an estimated blood loss of 78 ± 66 mL. The median length of stay was 2 days. No patient had died at 30 days. The survival rate at 1 year was 83%. The primary, primary-assisted, and secondary patency at 1 year were 42%, 69%, and 93%, respectively. CONCLUSION Thoracic outlet decompression via the transaxillary approach is a technically feasible and safe operation in patients with ipsilateral upper extremity hemodialysis access. Patients with threatened dialysis access due to subclavian vein stenosis should be carefully evaluated for possible extrinsic compression at the costoclavicular junction. These patients might benefit from transaxillary first rib resection, scalenectomy, and venolysis.
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Affiliation(s)
- Sungho Lim
- Department of Vascular Surgery, Sydell and Arnold Miller Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Abdul Q Alarhayem
- Department of Vascular Surgery, Sydell and Arnold Miller Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Jarrad W Rowse
- Department of Vascular Surgery, Sydell and Arnold Miller Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Francis J Caputo
- Department of Vascular Surgery, Sydell and Arnold Miller Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Christopher J Smolock
- Department of Vascular Surgery, Sydell and Arnold Miller Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Sean P Lyden
- Department of Vascular Surgery, Sydell and Arnold Miller Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Lee Kirksey
- Department of Vascular Surgery, Sydell and Arnold Miller Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - David M Hardy
- Department of Vascular Surgery, Sydell and Arnold Miller Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
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Scarritt T, Paragone CM, O'Gorman RB, Kyriazis DK, Maltese C, Rostas JW. Traditional versus Early-access Grafts for Hemodialysis Access: A Single-institution Comparative Study. Am Surg 2020; 80:155-8. [DOI: 10.1177/000313481408000223] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In those patients requiring urgent hemodialysis, the use of early-access grafts may reduce the need for temporary hemodialysis catheters and their resultant complications such as infection and central venous stenosis. We review a consecutive group of patients undergoing placement of a traditional polytetrafluoroethylene (PTFE) graft as compared with a cohort of patients who underwent insertion of a trilaminate PTFE vascular graft (TPVG). During the period from January 2008 to December 2009, 65 sequential patients received a traditional PTFE graft with 78 subsequent patients having a TPVG inserted. Factors examined included use of temporary hemodialysis catheters during the period of graft maturation, incidence of infection, and primary and secondary graft patency. For all patients, incidence was reported as observed during the first year after graft insertion. With the use of the TPVG, need for temporary hemodialysis catheters was reduced from 91 to 32 per cent, and 1-year overall graft patency was improved from 36 to 77 per cent ( P < 0.01). We report that the use of a trilaminate PTFE graft allowed early access, reduced the need for temporary hemodialysis catheters, decreased overall graft complication rates, and significantly improved 1-year patency.
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Affiliation(s)
- Thomas Scarritt
- University of South Alabama College of Medicine, Mobile, Alabama
| | | | - Ronald B. O'Gorman
- Cardiovascular Associates, P.C., Mobile, Alabama
- Department of Surgery, University of South Alabama, Mobile, Alabama
| | - Dimitris K. Kyriazis
- Cardiovascular Associates, P.C., Mobile, Alabama
- Department of Surgery, University of South Alabama, Mobile, Alabama
| | - Carl Maltese
- Cardiovascular Associates, P.C., Mobile, Alabama
- Department of Surgery, University of South Alabama, Mobile, Alabama
| | - Jack W. Rostas
- Department of Surgery, University of South Alabama, Mobile, Alabama
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Costa E, Rocha S, Rocha-Pereira P, Castro E, Reis F, Teixeira F, Miranda V, Faria MDS, Loureiro A, Quintanilha A, Belo L, Santos-Silva A. Cross-Talk between Inflammation, Coagulation/Fibrinolysis and Vascular access in Hemodialysis Patients. J Vasc Access 2018. [DOI: 10.1177/112972980800900405] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This work aimed to study the association between fibrinolytic/endothelial cell function and inflammatory markers in chronic kidney disease (CKD) patients undergoing hemodialysis (HD) and recombinant human erythropoietin (rhEPO) therapies, and its relationship with the type of vascular access (VA) used for the HD procedure. As fibrinolytic/endothelial cell function markers we evaluated plasminogen activator inhibitor type-1 (PAI-1), tissue plasminogen activator (tPA) and D-dimers, and as inflammatory markers; C-reactive protein (CRP), soluble interleukin (IL)-2 receptor (s-IL2R), IL-6 and serum albumin levels. The study was performed in 50 CKD patients undergoing regular HD, 11 with a central venous dialysis catheter (CVC) and 39 with an arteriovenous fistula (AVF), and in 25 healthy controls. Compared to controls, CKD patients presented with significantly higher levels of CRP, s-IL2R, IL-6 and D-dimers, and significantly lower levels of PAI-1. The tPA/PAI-1 ratio was significantly higher in CKD patients. We also found statistical significant correlations in CKD patients between D-dimers levels and inflammatory markers: CRP, albumin, s-IL2R and IL-6. When comparing the two groups of CKD patients, we found that those with a CVC presented statistically significant lower levels of hemoglobin concentration and albumin, and higher levels of CRP, IL-6, D-dimers and tPA. Our results showed an association between fibrinolytic/endothelial cell function and increased inflammatory markers in CKD patients. The increased levels of D-dimer, tPA and inflammatory markers in CKD patients using a CVC, led us to propose a relationship between the type of VA chosen for HD, and the risk of thrombogenesis.
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Affiliation(s)
- E. Costa
- Instituto de Ciências da Saúde da Universidade Católica Portuguesa, Porto - Portugal
- Faculdade Farmácia, Serviço de Bioquímica, Universidade do Porto - Portugal
- Instituto Biologia Molecular e Celular (IBMC), Universidade do Porto - Portugal
| | - S. Rocha
- Faculdade Farmácia, Serviço de Bioquímica, Universidade do Porto - Portugal
- Instituto Biologia Molecular e Celular (IBMC), Universidade do Porto - Portugal
| | - P. Rocha-Pereira
- Instituto Biologia Molecular e Celular (IBMC), Universidade do Porto - Portugal
- Centro Investigação Ciências Saúde, Universidade Beira Interior, Covilhã - Portugal
| | - E. Castro
- Faculdade Farmácia, Serviço de Bioquímica, Universidade do Porto - Portugal
- Instituto Biologia Molecular e Celular (IBMC), Universidade do Porto - Portugal
| | - F. Reis
- Instituto de Farmacologia e Terapêutica Experimental, Faculdade Medicina, Universidade Coimbra - Portugal
| | - F. Teixeira
- Instituto de Farmacologia e Terapêutica Experimental, Faculdade Medicina, Universidade Coimbra - Portugal
| | - V. Miranda
- FMC, Dinefro - Diálises e Nefrologia, SA - Portugal
| | | | - A. Loureiro
- Uninefro – Sociedade Prestadora de cuidados Médicos e de Diálise, SA - Portugal
| | - A. Quintanilha
- Faculdade Farmácia, Serviço de Bioquímica, Universidade do Porto - Portugal
- Instituto Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto - Portugal
| | - L. Belo
- Faculdade Farmácia, Serviço de Bioquímica, Universidade do Porto - Portugal
- Instituto Biologia Molecular e Celular (IBMC), Universidade do Porto - Portugal
| | - A. Santos-Silva
- Faculdade Farmácia, Serviço de Bioquímica, Universidade do Porto - Portugal
- Instituto Biologia Molecular e Celular (IBMC), Universidade do Porto - Portugal
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Henriksson AE, Bergqvist D. Steal Syndrome of the Hemodialysis Vascular Access: Diagnosis and Treatment. J Vasc Access 2018; 5:62-8. [PMID: 16596543 DOI: 10.1177/112972980400500204] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose Steal syndrome is an uncommon but serious condition of arterial insufficiency distal to a permanent hemodialysis fistula. The management of the condition is a great challenge to the surgeon because of the conflicting goals of preserving the fistula and treat the ischemia. In this review the purpose was to analyze the clinical problem and treatment possibilities. Methods Medline and Embase databases were searched for studies relevant to diagnosis and management of steal syndrome of the hemodialysis vascular access. Results The diagnosis of steal syndrome is largely based on clinical features and non-invasive studies. In same cases angiography may be necessary to find out the real causes of the steal syndrome. The cause is usually high fistula flow but other causes as steal phenomenon, inflow, outflow or anastomotic stenosis have to be considered and even combination of causes. The main treatment options are some form of flow reducing procedure or the distal revascularization interval ligation method. In some cases simple distal arterial ligation is the method of choice. Furthermore, in some patients a stenosis has to be treated as the first treatment option. Conclusion For an appropriate treatment of a steal syndrome a careful analysis of the cause is important.
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Affiliation(s)
- A E Henriksson
- Department of Surgery, Sundsvall County Hospital, Sweden.
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Shah A, Smith A, Panchatsharam S. Ultrasound-guided subclavian venous catheterisation - is this the way forward? A narrative review. Int J Clin Pract 2013; 67:726-32. [PMID: 23869675 DOI: 10.1111/ijcp.12146] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 01/30/2013] [Indexed: 12/01/2022] Open
Abstract
Central venous catheterisation is a commonly performed procedure in anaesthesia, critical care, acute and emergency medicine. Traditionally, subclavian venous catheterisation has been performed using the landmark technique and because of the complications associated with this technique, it is not commonly performed in the United Kingdom - where the accepted practice is ultrasound-guided internal jugular vein catheterisation. Subclavian vein catheterisation offers particular advantages over the internal jugular and femoral vein sites such as reduced rates of line-related sepsis, improved patient comfort and swifter access in trauma situations where the internal jugular vein may not be easily accessible. There is a growing body of evidence to suggest a potential emerging role for ultrasound-guided subclavian vein catheterisation. Barriers to this approach include many physicians still believing that the clavicle obscures imaging of the vein. In this article, we review the evidence supporting ultrasound-guided subclavian vein catheterisation and ask the question whether, in view of it potential advantages, it could be the way forward?
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Affiliation(s)
- A Shah
- Imperial School of Anaesthesia, The Hillingdon Hospitals NHS Foundation Trust, London, UK.
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Vascular Access versus the Effect of Statins on Inflammation and Fibrinolysis in Renal Dialysis Patients. J Vasc Access 2013; 14:335-41. [DOI: 10.5301/jva.5000132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2012] [Indexed: 11/20/2022] Open
Abstract
Purpose The aim of this work was to assess the effect of statin therapy on inflammatory and fibrinolytic/endothelial (dys)function markers in end-stage renal disease (ESRD) patients under hemodialysis (HD), according to the type of vascular access. Methods This transversal study includes 191 ESRD patients under regular HD, divided into four groups according to vascular access and statin therapy: 87 patients with arteriovenous fistula (AVF) and no statins (AVF-NS), 61 with AVF and statins (AVF-S), 27 with central venous dialysis catheter (CVC) and no statins (CVC-NS) and 16 with CVC and statins (CVC-S). The basic lipid profile and fibrinolytic/endothelial cell function markers were assessed. Results Patients with CVC presented significantly higher levels of D-dimers compared with AVF groups. CVC-NS patients also presented the highest IL-6 values, which were significantly higher than those presented by CVC-S patients. AVF-S patients presented significantly higher t-PA and PAI-1 values and lower adiponectin levels compared with AVF-NS. Conclusions Our results demonstrate that patients with CVC, particularly those not under statin therapy, present a higher production and turnover of fibrin. We also found that statin therapy decreases inflammation in CVC patients but is associated with a reduction of adiponectin and increased endothelial function marker levels in AVF patients.
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Glass C, Dugan M, Gillespie D, Doyle A, Illig K. Costoclavicular Venous Decompression in Patients With Threatened Arteriovenous Hemodialysis Access. Ann Vasc Surg 2011; 25:640-5. [DOI: 10.1016/j.avsg.2010.12.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Revised: 11/04/2010] [Accepted: 12/06/2010] [Indexed: 11/16/2022]
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Martin MJ, Blair KS, Curry TK, Singh N. Vena Cava Filters: Current Concepts and Controversies for the Surgeon. Curr Probl Surg 2010; 47:524-618. [DOI: 10.1067/j.cpsurg.2010.03.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Chan MR. REDUCING TUNNELED HEMODIALYSIS CATHETER MORBIDITY: Hemodialysis Central Venous Catheter Dysfunction. Semin Dial 2008; 21:516-21. [DOI: 10.1111/j.1525-139x.2008.00495.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Yevzlin AS. REDUCING TUNNELED HEMODIALYSIS CATHETER MORBIDITY: Hemodialysis Catheter-Associated Central Venous Stenosis. Semin Dial 2008; 21:522-7. [DOI: 10.1111/j.1525-139x.2008.00496.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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