Fistula Eligibility: A Work in Progress

Al-Jaishi, Ahmed A.; Moist, Louise

doi:10.1111/sdi.12185

Cited by 9 publications

(6 citation statements)

References 58 publications

(81 reference statements)

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“…Although grafts require more procedures to maintain patency, fistulas require more procedures to establish patency, with the result that overall patency may not differ substantially between the two forms of permanent access [36]. Due to the high primary failure rate and need for multiple procedures to maintain patency with a poor patient quality of life, the eligibility in elderly patients should be carefully determined [37, 38]. However, in skilled hands the endovascular treatment of AVF complications appears to be a valuable approach even in nonagenarians in view of its low invasiveness, low complication rate, and relatively good long-term patency rate [39].…”

Section: Va In Elderly Patients: Recent Findingsmentioning

confidence: 99%

The vascular access in the elderly: a position statement of the Vascular Access Working Group of the Italian Society of Nephrology

et al. 2016

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The incident hemodialysis (HD) population is aging, and the elderly group is the one with the most rapid increase. In this context it is important to define the factors associated with outcomes in elderly patients. The high prevalence of comorbidities, particularly diabetes mellitus, peripheral vascular disease and congestive heart failure, usually make vascular access (VA) creation more difficult. Furthermore, many of these patients may have an insufficient vasculature for fistula maturation. Finally, many fistulas may never be used due to the competing risk of death before dialysis initiation. In these cases, an arteriovenous graft and in some cases a central venous catheter become a valid alternative form of VA. Nephrologists need to know what is the most appropriate VA option in these patients. Age should not be a limiting factor when determining candidacy for arteriovenous fistula creation. The aim of this position statement, prepared by experts of the Vascular Access Working Group of the Italian Society of Nephrology, is to critically review the current evidence on VA in elderly HD patients. To this end, relevant clinical studies and recent guidelines on VA are reviewed and commented. The main advantages and potential drawbacks of the different VA modalities in the elderly patients are discussed.

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Section: Va In Elderly Patients: Recent Findingsmentioning

confidence: 99%

The vascular access in the elderly: a position statement of the Vascular Access Working Group of the Italian Society of Nephrology

et al. 2016

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“…Optimizing VA outcomes requires an appropriate choice of VA type and surgical strategy, on the basis of patient's characteristics and anatomy of vessels [32,33] . Substantial comorbidities, older age and female gender are 118 recognized risk factors of primary fistula failure [11,12,15,18] .…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Vascular Access Care and Surgery Managed by Interventional Nephrologists: A Twelve-Year Experience

Fumagalli

Pietro²,

Migliori³

et al. 2016

Blood Purif

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Background: Optimizing vascular access outcomes is still a challenge, since 30-60% of arteriovenous fistulas fail or do not mature and catheters are widely used in contemporary patients. Methods: This study reports on strategies and outcomes in a single center in which access planning, surgery and maintenance are managed by a team of nephrologists. We retrospectively analyzed 305 fistulas and 61 grafts created in 270 consecutive patients between 2002 and 2013. Results: The percentage of patients receiving a fistula or graft who initiated hemodialysis with a mature access was 68.6%. Among prevalent patients, 71.7% used a fistula, 15.7% a graft and 12.6% a catheter. Rates of primary failure and revision before cannulation were 14.4 and 1.6% for fistulas vs. 4.9 and 3.3% for grafts. After maturation, complications (1.040 vs. 0.188 per patient-year (py)) and interventions (0.743 vs. 0.066 per py) were greater for grafts than for fistulas (p < 0.001). Secondary patency did not significantly differ between grafts and fistulas (median survival 34.8 vs. 57.3 months, p = 0.36), unless primary failures were excluded from Kaplan-Meier analysis (median survival 34.9 vs. 70.9 months, p = 0.03). Conclusions: High fistula prevalence, low access-related morbidity and catheter dependence were achieved using individualized strategies, including mid-forearm or perforating vein fistula creation and selective graft placement in high risk patients. Direct involvement of nephrologists throughout all steps of access care can improve access outcomes, by promoting a patient-centered approach.

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“…Studies have shown that the primary failure rate is two times greater for fistulas (40%) than AVG (19%), with similar cumulative patency, in addition, the number of catheter days before AV access use was more than double in those having a fistula (81 days) compared with AVGs (38 days). However, grafts require more angioplasties (1.4 vs. 3.2 events) and thrombolysis (0.05 vs. 0.98 events) interventions per 1000 patient-days [76,77]. The risk of primary fistula failure is much higher for lower arm fistula (28%) than with upper arm fistula (20%) [75].…”

Section: Vascular Access Choice: Selection Biasmentioning

confidence: 99%

Vascular Access Management for Haemodialysis: A Value-Based Approach from NephroCare Experience

Canaud¹,

Ponce²,

Parisotto³

et al. 2019

Vascular Access Surgery - Tips and Tricks

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A good functioning vascular access (VA) is a prerequisite to obtain a successful dialysis treatment. This chapter reviews VA management in advanced chronic kidney disease (CKD) patients drawn from the experience of a large network dialysis care provider with the following sections: overview on VA management in advanced CKD that follows patient pathway and patient profile, current practice patterns in line with best clinical practices; VA creation addressing crucial themes: when and what type of VA to construct, how to assess patient pre-emptively, how to proceed for the construction and monitoring to prevent early failures and complications; VA management with particular focus on clinical monitoring, surveillance and interventional procedures required to preserve patency and functionality of VA; the often-forgotten patient perspective is VA usage. What information to share, how to proceed for preventing pain, and fears related with VA needling? What should patients know about their VA and how to manage in daily life? Competences, skills and responsibilities of nursing staff when using and managing VA; and future of VA in terms of innovative concept for creating and maintaining VA conduits in dialysis patients.

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Fistula Eligibility: A Work in Progress

Cited by 9 publications

References 58 publications

The vascular access in the elderly: a position statement of the Vascular Access Working Group of the Italian Society of Nephrology

The vascular access in the elderly: a position statement of the Vascular Access Working Group of the Italian Society of Nephrology

Outcomes of Vascular Access Care and Surgery Managed by Interventional Nephrologists: A Twelve-Year Experience

Vascular Access Management for Haemodialysis: A Value-Based Approach from NephroCare Experience

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