1
|
Attia MI, Atta EM, Elheneidy MA, Sallam EM. Salvage of infected autogenous arteriovenous fistulas, is it possible? J Vasc Access 2023; 24:1275-1283. [PMID: 35196930 DOI: 10.1177/11297298221080080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Infection in autogenous arteriovenous fistulas (AVFs) is a critical situation in patients with end stage renal disease (ESRD) that can lead to life threatening rupture or septicemia. To date, no standard guidelines regarding the surgical repair of the infected AVFs is available. AIM To evaluate the safety and efficacy of the surgical repair in the infected autogenous AVFs. METHODS This prospective study involved 64 ESRD patients who presented with infected autogenous AVFs. Repair of the infected autogenous AVFs was done in 50 cases, while ligation was needed in the other 14 cases. Aneurysmorrhaphy was done in the 26 cases of puncture site infection over venous aneurysms. In 20 cases of AVFs with anastomotic disruption, higher recreation in a proximal clean field (AVF loop anastomosis) was performed, while abscess drainage was done in the remaining four cases presented with non-communicating abscess over the vein. The 14 cases of ligated AVFs included 9 cases of infected ruptured AVFs with active bleeding and 4 cases with non-reconstructable puncture site infection. RESULTS After 1 year of follow up, 41 cases (82%) of the repaired AVFs (n = 50) remained patent and functioning as re-infection occurred in 9 cases. Six tunneled permanent catheters were implanted in the 14 cases with ligated AVFs, while the remaining 8 cases had new AVFs established (7 cases of them retained patent AVFs during the follow up period). CONCLUSION Surgical repair of the infected AVFs is an effective procedure that achieves many goals, such as saving patients' lives, maintaining the patency of the native fistula, and avoidance of creation of new AVFs in another site with exhaustion the available veins.
Collapse
Affiliation(s)
- Mahmoud I Attia
- Vascular Surgery Department, Faculty of Medicine, Kafrelsheikh University, Kafr el-Sheikh, Egypt
| | - Eslam M Atta
- Vascular Surgery Department, Faculty of Medicine, Kafrelsheikh University, Kafr el-Sheikh, Egypt
| | - Mohamed A Elheneidy
- Vascular and Endovascular Surgery Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Emad M Sallam
- Vascular and Endovascular Surgery Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| |
Collapse
|
2
|
Franchin M, Tadiello M, Guzzetti L, Gattuso A, Mauri F, Cervarolo MC, D'Oria MGG, Tozzi M. Acute problems of hemodialysis access: Thrombosis, aneurysms, symptomatic high-flow fistulas, and complications related to central lines. Semin Vasc Surg 2023; 36:300-306. [PMID: 37330242 DOI: 10.1053/j.semvascsurg.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/06/2023] [Accepted: 04/17/2023] [Indexed: 06/19/2023]
Abstract
Hemodynamic complications frequently affect vascular access and are important causes of morbidity and mortality. We present a review of acute complications affecting vascular accesses, focusing on classical and new treatments. Acute complications in hemodialysis vascular access are often underestimated and undertreated, and can present a challenge for both vascular surgeons and anesthesiologists. Accordingly, we considered different anesthesiologic approaches to both hemorrhagic and nonhemorrhagic patients. A strict collaboration among nephrologists, surgeons, and anesthesiologists can potentially improve prevention and management of acute complications and quality of life.
Collapse
Affiliation(s)
- Marco Franchin
- Vascular Surgery Unit, Department of Surgery and Morphological Sciences, Circolo University Teaching Hospital, University of Insubria, ASST Settelaghi, Via Guicciardini, 9, 21100 Varese, Italy.
| | - Marco Tadiello
- Vascular Surgery Unit, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Luca Guzzetti
- Anaesthesiology Unit, Circolo University Teaching Hospital, University of Insubria, ASST Settelaghi, Varese, Italy
| | - Andrea Gattuso
- Vascular Surgery Unit, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Francesca Mauri
- Vascular Surgery Unit, Department of Surgery and Morphological Sciences, Circolo University Teaching Hospital, University of Insubria, ASST Settelaghi, Via Guicciardini, 9, 21100 Varese, Italy
| | - Maria Cristina Cervarolo
- Vascular Surgery Unit, Department of Surgery and Morphological Sciences, Circolo University Teaching Hospital, University of Insubria, ASST Settelaghi, Via Guicciardini, 9, 21100 Varese, Italy
| | | | - Matteo Tozzi
- Vascular Surgery Unit, Department of Surgery and Morphological Sciences, Circolo University Teaching Hospital, University of Insubria, ASST Settelaghi, Via Guicciardini, 9, 21100 Varese, Italy
| |
Collapse
|
3
|
Babici D, Johansen PM, Carranza O, Snelling B. Combined Transradial and Upper Extremity Transvenous Accesses in the Treatment of Carotid-Cavernous Fistulae: Two Case Reports and a Literature Review. Cureus 2022; 14:e24094. [PMID: 35573517 PMCID: PMC9106534 DOI: 10.7759/cureus.24094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/12/2022] [Indexed: 11/05/2022] Open
Abstract
The expansion of indications for neurointerventional procedures, combined with the need to treat a diverse patient population, has driven a need for broader access options. Concurrent arterial and venous access is often necessary for the diagnosis and treatment of various neurovascular diseases. Although complication rates are low, life-threatening severe complications have been reported with these access methods. Moreover, venous access through traditional routes can be challenging in patients with large body habitus. There is a growing trend of utilizing radial artery access for neuroendovascular procedures due to the increased ease of access and similar efficacy. Nevertheless, the use of upper limb veins in neurointerventional procedures is still rare. Upper extremity transvenous access (UETV) has recently emerged as an alternative strategy for neurointerventionalists, but data are limited. This study reports two cases of successful combined upper extremity transvenous access (TVA) and transradial access (TRA) in the treatment of carotid artery-cavernous fistulae. Combined TRA and UETV is a feasible, promising access strategy for patients and may also confer the same safety and patient satisfaction outcomes that have been seen with TRA. Further studies are needed to elucidate the exact impact this strategy has on patient outcomes and satisfaction.
Collapse
|
4
|
Rethinking Resistant Hypertension. J Clin Med 2022; 11:jcm11051455. [PMID: 35268545 PMCID: PMC8911440 DOI: 10.3390/jcm11051455] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/18/2022] [Accepted: 02/25/2022] [Indexed: 02/07/2023] Open
Abstract
Resistant hypertension is common and known to be a risk factor for cardiovascular events, including stroke, myocardial infarction, heart failure, and cardiovascular mortality, as well as adverse renal events, including chronic kidney disease and end-stage kidney disease. This review will discuss the definition of resistant hypertension as well as the most recent evidence regarding its diagnosis, evaluation, and management. The issue of medication non-adherence and its association with apparent treatment-resistant hypertension will be addressed. Non-pharmacological interventions for the treatment of resistant hypertension will be reviewed. Particular emphasis will be placed on pharmacological interventions, highlighting the role of mineralocorticoid receptor antagonists and sodium-glucose cotransporter-2 inhibitors and device therapy, including renal denervation, baroreceptor activation or modulation, and central arteriovenous fistula creation.
Collapse
|
5
|
Fedorova E, Zhang GQ, Shireman PK, Woo K, Hicks CW. Association of preoperative vein mapping with hemodialysis access characteristics and outcomes in the Vascular Quality Initiative. J Vasc Surg 2021; 75:1395-1402.e5. [PMID: 34718099 DOI: 10.1016/j.jvs.2021.10.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 10/13/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Preoperative vein mapping before arteriovenous fistula (AVF) or arteriovenous graft (AVG) placement has been debated as a possible method of improving hemodialysis access outcomes for patients. However, high-quality national studies that have addressed this relationship are lacking. Thus, we assessed the association of preoperative vein mapping with hemodialysis access configuration and outcomes. METHODS In the present cohort study, we analyzed all patients who had undergone AVF or AVG placement with data captured in the Vascular Quality Initiative hemodialysis access dataset from August 2011 to September 2019. The patients were stratified by whether they had undergone preoperative vein mapping. The primary (configuration) outcomes were access type (AVF vs AVG) and location (upper arm vs forearm). The secondary (longitudinal) outcomes were the successful initiation of hemodialysis, maintenance of secondary patency, and the need for reintervention 1 year after the index operation. RESULTS Overall, 85.6% of the 46,010 included patients had undergone preoperative vein mapping. Of the 46,010 patients, 76.1% and 23.9% had undergone AVF and AVG creation, respectively. AVF creation (77.6% vs 67.3%) and forearm location (54.6% vs 47.3%) were more frequent for the patients who had undergone preoperative vein mapping than for those who had not (P < .001). After adjusting for baseline differences between the groups, preoperative vein mapping was associated with increased odds of receiving an AVF vs AVG (adjusted odds ratio, 1.64; 95% confidence interval [CI], 1.55-1.75) and forearm vs upper arm access (adjusted odds ratio, 1.22; 95% CI, 1.16-1.30). The incidence of the loss of secondary patency was lower for patients with preoperative vein mapping (P < .001), and persisted after risk adjustment (adjusted hazard ratio, 0.81; 95% CI, 0.75-0.88). CONCLUSIONS Preoperative vein mapping was associated with favorable hemodialysis access configurations and outcomes in real-world practice. These data suggest that the use of preoperative vein mapping could improve the likelihood of favorable outcomes for patients requiring hemodialysis access.
Collapse
Affiliation(s)
| | - George Q Zhang
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Md
| | - Paula K Shireman
- Department of Surgery, Long School of Medicine, University of Texas Health San Antonio, University Health System, and South Texas Veterans Health Care System, San Antonio, Tex
| | - Karen Woo
- Division of Vascular Surgery, Department of Surgery, University of California, David Geffen School of Medicine, Los Angeles, Los Angeles, Calif
| | - Caitlin W Hicks
- Division of Vascular Surgery and Endovascular Therapy, The Johns Hopkins University School of Medicine, Baltimore, Md; Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Md.
| |
Collapse
|
6
|
Kim K, Anderson EM, Martin AJ, Hu Q, Cort TA, Harland KC, O'Malley KA, Lu G, Berceli SA, Ryan TE, Scali ST. Development of a murine iliac arteriovenous fistula model for examination of hemodialysis access-related limb pathophysiology. JVS Vasc Sci 2021; 2:247-259. [PMID: 34816137 PMCID: PMC8591416 DOI: 10.1016/j.jvssci.2021.09.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/27/2021] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE Hemodialysis access-related hand dysfunction is a common clinical feature of patients with chronic kidney disease (CKD) after arteriovenous fistula (AVF) placement. The heterogeneity in symptoms and the lack of a predictive association with changes in hemodynamic alterations precipitated by the AVF suggest that other factors are involved in the mechanisms responsible for causing hand and limb dysfunction postoperatively. To the best of our knowledge, no suitable animal models have provided a platform for performing preclinical experiments designed to elucidate the biologic drivers of access-related hand dysfunction. Therefore, our objective was to develop a novel murine AVF model that could be used to study dialysis access-related limb dysfunction. METHODS Male 8-week-old C57BL/6J mice (n = 15/group) were exposed to either an adenine-supplemented diet to induce CKD or casein-based chow (control). Four weeks after the diet intervention, the mice were randomly assigned to receive an iliac AVF (n = 10/group) or sham surgery (n = 5/group) on the left hindlimb. The mice were sacrificed 2 weeks after surgery, and AVF specimens and hindlimb skeletal muscles were collected for further analysis. RESULTS Before AVF or sham surgery, the glomerular filtration rates were significantly reduced and the blood urea nitrogen levels were significantly elevated in the CKD groups compared with the controls (P < .05). AVF surgery was associated with an ∼80% patency rate among the survivors (four control and three CKD mice died postoperatively). Patency was verified by changes in hemodynamics using Doppler ultrasound imaging and altered histologic morphology. Compared with sham surgery, AVF surgery reduced ipsilateral hindlimb perfusion to the tibialis anterior muscle (20%-40%) and paw (40%-50%), which remained stable until euthanasia. Analysis of gastrocnemius muscle mitochondrial respiratory function uncovered a significant decrease (40%-50%) in mitochondrial function in the AVF mice. No changes were found in the muscle mass, myofiber cross-sectional area, or centrally nucleated fiber proportion in the extensor digitorum longus and soleus muscles between the sham and AVF mice. CONCLUSIONS The results from the present study have demonstrated that iliac AVF formation is a practical animal model that facilitates examination of hemodialysis access-related limb dysfunction. AVF surgery produced the expected hemodynamic changes, and evaluation of the limb muscle revealed a substantial mitochondrial impairment that was present without changes in muscle size.
Collapse
Affiliation(s)
- Kyoungrae Kim
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Fla
| | - Erik M. Anderson
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla
- Malcolm Randall Veteran Affairs Medical Center, Gainesville, Fla
| | - Andrew J. Martin
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla
- Malcolm Randall Veteran Affairs Medical Center, Gainesville, Fla
| | - Qiongyao Hu
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla
- Malcolm Randall Veteran Affairs Medical Center, Gainesville, Fla
| | - Tomas A. Cort
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Fla
| | - Kenneth C. Harland
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla
- Malcolm Randall Veteran Affairs Medical Center, Gainesville, Fla
| | - Kerri A. O'Malley
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla
- Malcolm Randall Veteran Affairs Medical Center, Gainesville, Fla
| | - Guanyi Lu
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla
| | - Scott A. Berceli
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla
- Malcolm Randall Veteran Affairs Medical Center, Gainesville, Fla
| | - Terence E. Ryan
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Fla
- Center for Exercise Science, University of Florida, Gainesville, Fla
| | - Salvatore T. Scali
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla
- Malcolm Randall Veteran Affairs Medical Center, Gainesville, Fla
| |
Collapse
|
7
|
Affiliation(s)
- Robert S. Brown
- Nephrology Division Department of Medicine Beth Israel Deaconess Medical Center and Harvard Medical School Boston MA USA
| |
Collapse
|
8
|
Atere M, Arora K, Bhavsar U, Ebrahimi F, Nfonoyim JM, Saverimuttu J. Infected Hemodialysis Arteriovenous Fistula with Distant Explosive Pleuritis: A Rare Phenomenon. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e924264. [PMID: 32678807 PMCID: PMC7386552 DOI: 10.12659/ajcr.924264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patient: Male, 36-year-old Final Diagnosis: Explosive pleuritis Symptoms: Abdominal pain Medication:— Clinical Procedure: — Specialty: Critical Care Medicine • Infectious Diseases • General and Internal Medicine • Nephrology • Pulmonology
Collapse
Affiliation(s)
- Muhammed Atere
- Department of Internal Medicine, Richmond University Medical Center, Staten Island, NY, USA
| | - Krisha Arora
- Department of Internal Medicine, Richmond University Medical Center, Staten Island, NY, USA
| | - Urvi Bhavsar
- Department of Internal Medicine, Richmond University Medical Center, Staten Island, NY, USA
| | - Farhang Ebrahimi
- Department of Nephrology/Internal Medicine, Richmond University Medical Center, Staten Island, NY, USA
| | - Jay M Nfonoyim
- Department of Critical Care/Internal Medicine, Richmond University Medical Center, Staten Island, NY, USA
| | - Jessie Saverimuttu
- Department of Infectious Disease/Internal Medicine, Richmond University Medical Center, Staten Island, NY, USA
| |
Collapse
|
9
|
Caputo L, Smeriglio A, Trombetta D, Cornara L, Trevena G, Valussi M, Fratianni F, De Feo V, Nazzaro F. Chemical Composition and Biological Activities of the Essential Oils of Leptospermum petersonii and Eucalyptus gunnii. Front Microbiol 2020; 11:409. [PMID: 32351456 PMCID: PMC7174609 DOI: 10.3389/fmicb.2020.00409] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 02/27/2020] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to characterize the chemical composition and to evaluate the antimicrobial and phytotoxic properties of the essential oils (EOs) obtained from leaves of Leptospermum petersonii chemotype "Variety B" and Eucalyptus gunnii, native to Australia. Geranyl acetate, γ-terpinene, geraniol, terpinolene, α-pinene, p-cimene, and linalool were the main components in L. petersonii EO, confirming also the existence of several chemotypes in such taxa; on the other hand, 1,8-cineole, trans-sabinene hydrate acetate, globulol, longicyclene, terpinolene, and camphene were present in major amounts in the E. gunnii EO. Chemical analysis of L. petersonii revealed that it belongs to the variety "B." E. gunnii EO showed good antibacterial activity, with an MIC of 0.5 and 2 μg/mL against Staphylococcus aureus, and Pectobacterium carotovorum, respectively. The activity of E. gunnii EO was stronger than L. petersonii EO, whose maximum MIC reached 5 μg/mL. E. gunnii and L. petersonii EOs were particularly effective in inhibiting the biofilm formation by S. aureus, already at a concentration of 0.01 μg/mL. The other strains were resistant to both EOs up to a dose of 0.05 μg/mL. The maximum inhibition on biofilm formed by P. carotovorum was recorded for E. gunnii EO, reaching a value of 93.12% at 1.0 μg/mL. This is the first manuscript which studies the biofilm inhibition by EOs and evaluates their effects on biofilm metabolism. Both EOs were more effective against P. carotovorum. In addition, even though L. petersonii EO 0.1 μg/mL was unable to inhibit biofilm formation by Escherichia coli, it decreased the metabolic activity of the biofilm to 78.55% compared to control; furthermore, despite it inducing a relatively low inhibition (66.67%) on biofilm formation, it markedly affected metabolic activity, which decreased to 16.09% with respect to the control. On the contrary, L. petersonii EO 0.5 μg/mL induced a 79.88% inhibition of S. aureus biofilm, maintaining a high metabolic activity (90.89%) compared to the control. Moreover, this EO showed inhibitory activity against radical elongation of Solanum lycopersicum and the germination of radish. On the contrary, E. gunnii EO showed no phytotoxic activity.
Collapse
Affiliation(s)
- Lucia Caputo
- Department of Pharmacy, University of Salerno, Fisciano, Italy
| | - Antonella Smeriglio
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Messina, Italy
| | - Domenico Trombetta
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Messina, Italy
| | - Laura Cornara
- Department for the Earth, Environment and Life Sciences, School of Mathematical, Physical and Natural Sciences, University of Genoa, Genoa, Italy
| | - Greg Trevena
- Essentially Australia, Byron Bay, NSW, Australia
| | - Marco Valussi
- European Herbal and Traditional Medicine Practitioners Association, Norwich, United Kingdom
| | - Florinda Fratianni
- Institute of Food Sciences, CNR-ISA, Italian National Research Council, Avellino, Italy
| | - Vincenzo De Feo
- Department of Pharmacy, University of Salerno, Fisciano, Italy
| | - Filomena Nazzaro
- Institute of Food Sciences, CNR-ISA, Italian National Research Council, Avellino, Italy
| |
Collapse
|
10
|
Lok CE, Huber TS, Lee T, Shenoy S, Yevzlin AS, Abreo K, Allon M, Asif A, Astor BC, Glickman MH, Graham J, Moist LM, Rajan DK, Roberts C, Vachharajani TJ, Valentini RP. KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update. Am J Kidney Dis 2020; 75:S1-S164. [PMID: 32778223 DOI: 10.1053/j.ajkd.2019.12.001] [Citation(s) in RCA: 964] [Impact Index Per Article: 241.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 12/09/2019] [Indexed: 02/07/2023]
Abstract
The National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (KDOQI) has provided evidence-based guidelines for hemodialysis vascular access since 1996. Since the last update in 2006, there has been a great accumulation of new evidence and sophistication in the guidelines process. The 2019 update to the KDOQI Clinical Practice Guideline for Vascular Access is a comprehensive document intended to assist multidisciplinary practitioners care for chronic kidney disease patients and their vascular access. New topics include the end-stage kidney disease "Life-Plan" and related concepts, guidance on vascular access choice, new targets for arteriovenous access (fistulas and grafts) and central venous catheters, management of specific complications, and renewed approaches to some older topics. Appraisal of the quality of the evidence was independently conducted by using a Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, and interpretation and application followed the GRADE Evidence to Decision frameworks. As applicable, each guideline statement is accompanied by rationale/background information, a detailed justification, monitoring and evaluation guidance, implementation considerations, special discussions, and recommendations for future research.
Collapse
|
11
|
Beathard GA, Jennings WC, Wasse H, Shenoy S, Hentschel DM, Abreo K, Urbanes A, Nassar G, Dolmatch B, Davidson I, Asif A. ASDIN white paper: Assessment and management of hemodialysis access-induced distal ischemia by interventional nephrologists. J Vasc Access 2019; 21:543-553. [PMID: 31884872 DOI: 10.1177/1129729819894774] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Although not common, hemodialysis access-induced distal ischemia is a serious condition resulting in significant hemodialysis patient morbidity. Patients with signs and symptoms suggestive of hand ischemia frequently present to the general and interventional nephrologist for evaluation. In order to care for these cases, it is necessary to understand this syndrome and its management. Most cases can be managed conservatively without intervention. Some cases requiring intervention may be treated using techniques within the scope of practice of the interventional nephrologists while other cases require vascular surgery. In order for the interventional nephrologists to evaluate and manage these cases in a timely and appropriate manner, practice guidelines are presented.
Collapse
Affiliation(s)
| | - William C Jennings
- School of Community Medicine, The University of Oklahoma, Tulsa, OK, USA
| | | | - Surendra Shenoy
- Barnes-Jewish Hospital, Washington University, St. Louis, MO, USA
| | | | - Kenneth Abreo
- School of Medicine, LSU Health Shreveport, Shreveport, LA, USA
| | - Aris Urbanes
- Internal Medicine, Wayne State University, Detroit, MI, USA
| | - George Nassar
- Weill Cornell Medicine, New York, NY, USA
- Houston Methodist Hospital, Houston, TX, USA
| | | | - Ingemar Davidson
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Arif Asif
- Hackensack Meridian School of Medicine at Seton Hall University, Nutley, NJ, USA
| |
Collapse
|
12
|
McEwan SJ, Maple H, Gibbs PJ. Good long-term patency: 10-year follow-up using the mid-thigh adductor loop arteriovenous graft. J Vasc Access 2018; 20:313-320. [DOI: 10.1177/1129729818805955] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Definitive access in patients requiring renal replacement therapy is an ever-increasing challenge. For those where autogenous venous access is no longer a viable option, arteriovenous grafts can be considered. This article describes long-term follow-up, complications and patency rates of the mid-thigh ‘adductor loop’ arteriovenous graft. Methods: 50 mid-thigh loop arteriovenous grafts have been inserted into 48 patients in our unit over the past 11 years. A prospective database was collected on patients receiving an arteriovenous graft at our unit by the senior author. All remained under the care of our unit ensuring accurate follow-up data collection and database was updated at regular intervals. Results: Death-only censored primary patency at 1, 3 and 5 years was 76%, 44% and 23%, respectively. Patients receiving transplants were not censored as follow-up of the arteriovenous grafts was possible. Secondary patency at 1, 3 and 5 years was 95%, 63% and 45%. These rates are higher than previous studies looking at lower limb arteriovenous grafts. Graft thrombosis occurred in 14 patients (28%). Six patients were treated for an infection (12%) but only four grafts were excised; much lower than documented in previous studies. Conclusion: Autogenous venous access remains the perceived gold standard for patients requiring dialysis for end stage renal failure, despite some published data reporting poor outcomes. We have shown that adductor loop arteriovenous grafts can be a reliable, safe and long-term alternative in those whom fistula formation is not possible and may have a role earlier in the patient journey than previously thought, as a result of good patency and lower complications.
Collapse
Affiliation(s)
- Samantha J McEwan
- Department of General Surgery, Queen Alexandra Hospital, Portsmouth, UK
| | - Hannah Maple
- Wessex Kidney Centre, Queen Alexandra Hospital, Portsmouth, UK
| | - Paul J Gibbs
- Wessex Kidney Centre, Queen Alexandra Hospital, Portsmouth, UK
| |
Collapse
|
13
|
A Report of Two Cases of Hazards Associated with High Flow Arteriovenous Fistula in ESRD Patients. Case Rep Nephrol 2018; 2018:1686135. [PMID: 29850309 PMCID: PMC5914151 DOI: 10.1155/2018/1686135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 02/24/2018] [Accepted: 02/27/2018] [Indexed: 11/18/2022] Open
Abstract
High flow arteriovenous fistulas are a common clinical entity affecting patients with end-stage renal failure receiving hemodialysis. Given the difficulty in predicting who will develop a high flow arteriovenous fistula the exact prevalence is unclear. We present two cases of patients with high flow arteriovenous fistula that developed clinical cardiac failure at a time point after the fistula was placed with findings of significant cephalic arch stenosis. Both patients required treatment of cephalic arch stenosis with balloon angioplasty with subsequent surgical aneurism resection. Accurate and timely diagnosis of high flow arteriovenous hemodynamics by prospective monitoring of volumetric flow and cardiac function is required to halt this process prior to cardiac compromise.
Collapse
|
14
|
Dumaine C, Kiaii M, Miller L, Moist L, Oliver MJ, Lok CE, Hiremath S, MacRae JM. Vascular Access Practice Patterns in Canada: A National Survey. Can J Kidney Health Dis 2018; 5:2054358118759675. [PMID: 29511569 PMCID: PMC5833215 DOI: 10.1177/2054358118759675] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 10/12/2017] [Indexed: 12/21/2022] Open
Abstract
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. Design: Development and implementation of a survey. Setting: Community and academic VA programs. Participants: Nephrologists, surgeons, and nurses who are involved in VA programs across Canada. Measurements: Practice patterns regarding access creation and maintenance, including indications and contraindications to fistula creation, as well as program-wide facilitators of and barriers to VA. Methods: A small group of CSN VAWG members determined the scope and created several VA questions which were then reviewed by 5 additional VAWG members (4 nephrologists and 1 VA nurse) to ensure that questions were clear and relevant. The survey was then tested by the remaining members of the VAWG and refinements were made. The final survey version was submitted electronically to relevant clinicians (nephrologists, surgeons, and nurses) involved or interested in VA across Canada. Questions centered around 4 major themes: (1) Practice patterns regarding access creation (preoperative assessment and maturation assessment), (2) Practice patterns regarding access maintenance (surveillance and salvage), (3) Indications and contraindications for arteriovenous (AV) access creation, and (4) Facilitators of and barriers to fistula creation and utilization. Results: Eighty-two percent (84 of 102) of invited participants completed the survey; the majority were nurses or VA coordinators (55%) with the remainder consisting of nephrologists (21%) and surgeons (20%). Variation in practice was noted in utility of preoperative Doppler ultrasound, interventions to assist nonmaturing fistulas, and procedures to salvage failing or thrombosed AV-access. Little consensus was seen regarding potential contraindications to AV-access creation (with the exception of limited life expectancy and poor vasculature on preoperative imaging, which had high agreement). Frequent barriers to fistula utilization were primary failure (77% of respondents) and long maturation times (73%). Respondents from centers with low fistula prevalence also cited long surgical wait times as an important barrier to fistula creation, whereas those from centers with high fistula prevalence cited access to multidisciplinary teams and interventional radiology as keys to successful fistula creation and utilization. Conclusions: There is significant variation in VA practice across Canada and little consensus among Canadian clinicians regarding contraindications to fistula creation. Further high-quality studies are needed with regard to appropriate fistula placement to help guide clinical practice.
Collapse
Affiliation(s)
- Chance Dumaine
- Division of Nephrology, Department of Medicine, University of Calgary, Alberta, Canada
| | - Mercedeh Kiaii
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Lisa Miller
- Division of Nephrology, Department of Medicine, University of Manitoba, Winnipeg, Canada
| | - Louise Moist
- Division of Nephrology, Schulich School of Medicine and Dentistry, Department of Medicine, Western University, London, Ontario, Canada
| | | | - Charmaine E Lok
- Faculty of Medicine, University Health Network, University of Toronto, Ontario, Canada
| | - Swapnil Hiremath
- Division of Nephrology, Department of Medicine, University of Ottawa, Ontario, Canada
| | - Jennifer M MacRae
- Division of Nephrology, Department of Medicine, University of Calgary, Alberta, Canada
| |
Collapse
|
15
|
Miller LM, MacRae JM, Kiaii M, Clark E, Dipchand C, Kappel J, Lok C, Luscombe R, Moist L, Oliver M, Pike P, Hiremath S. Hemodialysis Tunneled Catheter Noninfectious Complications. Can J Kidney Health Dis 2017. [PMID: 28270922 DOI: 10.1177/2054358116669130.] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Noninfectious hemodialysis catheter complications include catheter dysfunction, catheter-related thrombus, and central vein stenosis. The definitions, causes, and treatment strategies for catheter dysfunction are reviewed below. Catheter-related thrombus is a less common but serious complication of catheters, requiring catheter removal and systemic anticoagulation. In addition, the risk factors, clinical manifestation, and treatment options for central vein stenosis are outlined.
Collapse
Affiliation(s)
- Lisa M Miller
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Jennifer M MacRae
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Mercedeh Kiaii
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Edward Clark
- Faculty of Medicine, University of Ottawa, Ontario, Canada
| | | | - Joanne Kappel
- Faculty of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Charmaine Lok
- Faculty of Medicine, University Health Network, University of Toronto, Ontario, Canada
| | - Rick Luscombe
- Department of Nursing, Providence Health Care, Vancouver, British Columbia, Canada
| | - Louise Moist
- Department of Medicine, University of Western Ontario, London, Canada
| | - Matthew Oliver
- Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Pamela Pike
- Department of Medicine, Memorial University, Saint John's, Newfoundland and Labrador, Canada
| | | | | |
Collapse
|
16
|
Miller LM, MacRae JM, Kiaii M, Clark E, Dipchand C, Kappel J, Lok C, Luscombe R, Moist L, Oliver M, Pike P, Hiremath S. Hemodialysis Tunneled Catheter Noninfectious Complications. Can J Kidney Health Dis 2016; 3:2054358116669130. [PMID: 28270922 PMCID: PMC5332086 DOI: 10.1177/2054358116669130] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 08/04/2016] [Indexed: 12/19/2022] Open
Abstract
Noninfectious hemodialysis catheter complications include catheter dysfunction, catheter-related thrombus, and central vein stenosis. The definitions, causes, and treatment strategies for catheter dysfunction are reviewed below. Catheter-related thrombus is a less common but serious complication of catheters, requiring catheter removal and systemic anticoagulation. In addition, the risk factors, clinical manifestation, and treatment options for central vein stenosis are outlined.
Collapse
Affiliation(s)
- Lisa M Miller
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Jennifer M MacRae
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Mercedeh Kiaii
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Edward Clark
- Faculty of Medicine, University of Ottawa, Ontario, Canada
| | | | - Joanne Kappel
- Faculty of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Charmaine Lok
- Faculty of Medicine, University Health Network, University of Toronto, Ontario, Canada
| | - Rick Luscombe
- Department of Nursing, Providence Health Care, Vancouver, British Columbia, Canada
| | - Louise Moist
- Department of Medicine, University of Western Ontario, London, Canada
| | - Matthew Oliver
- Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Pamela Pike
- Department of Medicine, Memorial University, Saint John's, Newfoundland and Labrador, Canada
| | | | | |
Collapse
|
17
|
Clark E, Kappel J, MacRae J, Dipchand C, Hiremath S, Kiaii M, Lok C, Moist L, Oliver M, Miller LM. Practical Aspects of Nontunneled and Tunneled Hemodialysis Catheters. Can J Kidney Health Dis 2016; 3:2054358116669128. [PMID: 28270920 PMCID: PMC5332079 DOI: 10.1177/2054358116669128] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 08/04/2016] [Indexed: 12/20/2022] Open
Abstract
Nontunneled hemodialysis catheters (NTHCs) are typically used when vascular access is required for urgent renal replacement therapy. The preferred site for NTHC insertion in acute kidney injury is the right internal jugular vein followed by the femoral vein. When aided by real-time ultrasound, mechanical complications related to NTHC insertion are significantly reduced. The preferred site for tunneled hemodialysis catheters placement is the right internal jugular vein followed by the left internal jugular vein. Ideally, the catheter should be inserted on the opposite side of a maturing or planned fistula/graft. Several dual-lumen, large-diameter catheters are available with multiple catheter tip designs, but no one catheter has shown significant superior performance.
Collapse
Affiliation(s)
- Edward Clark
- Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Joanne Kappel
- Faculty of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Jennifer MacRae
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | | | | | - Mercedeh Kiaii
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Charmaine Lok
- Faculty of Medicine, University Health Network, University of Toronto, Ontario, Canada
| | - Louise Moist
- Department of Medicine, University of Western Ontario, London, Canada
| | - Matthew Oliver
- Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Lisa M Miller
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | | |
Collapse
|
18
|
MacRae JM, Oliver M, Clark E, Dipchand C, Hiremath S, Kappel J, Kiaii M, Lok C, Luscombe R, Miller LM, Moist L. Arteriovenous Vascular Access Selection and Evaluation. Can J Kidney Health Dis 2016; 3:2054358116669125. [PMID: 28270917 PMCID: PMC5332074 DOI: 10.1177/2054358116669125] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 08/04/2016] [Indexed: 12/11/2022] Open
Abstract
When making decisions regarding vascular access creation, the clinician and vascular access team must evaluate each patient individually with consideration of life expectancy, timelines for dialysis start, risks and benefits of access creation, referral wait times, as well as the risk for access complications. The role of the multidisciplinary team in facilitating access choice is reviewed, as well as the clinical evaluation of the patient.
Collapse
Affiliation(s)
- Jennifer M MacRae
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Matthew Oliver
- Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Edward Clark
- Faculty of Medicine, University of Ottawa, Ontario, Canada
| | | | | | - Joanne Kappel
- Faculty of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Mercedeh Kiaii
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Charmaine Lok
- Faculty of Medicine, University Health Network, University of Toronto, Ontario, Canada
| | - Rick Luscombe
- Department of Nursing, Providence Health Care, Vancouver, British Columbia, Canada
| | - Lisa M Miller
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Louise Moist
- Department of Medicine, University of Western Ontario, London, Canada
| | | |
Collapse
|