Arterio‐venous fistula for automated red blood cells exchange in patients with sickle cell disease: Complications and outcomes

Abstract

Erythrocytapheresis (ER) can improve outcome in patients with sickle cell disease (SCD). A good vascular access is required but frequently it can be difficult to obtain for sickle cell patients. Arterio-venous fistulas (AVFs) have been suggested for ER in SCD supported by limited evidence. We report the largest cohort of ER performed with AVFs from three French SCD reference centers. Data of SCD patients undergoing ER with AVFs in the French SCD reference center were retrospectively collected. The inclusion criteria were: SS or Sβ-Thalassemia and AVF surgery for ER. SCD-related complications, transfusion history, details about AVF surgical procedure, echocardiographic data before and after AVF, AVF-related surgical and hemodynamical complications were collected. Twenty-six patients (mean age 20.5 years, mean follow-up 68 months [11-279]) were included. Twenty-three patients (88.5%) required central vascular access before AVF. Fifteen AVFs (58%) were created on the forearm and 11 (42%) on the arm. Nineteen patients (73%) had stenotic, thrombotic or infectious AVF complications. A total of 0.36 stenosis per 1,000 AVF days, 0.37 thrombosis per 1,000 AVF days and 0.078 infections per 1.000 AVF days were observed. The mean AVF lifespan was 51 months [13-218]. One patient with severe pulmonary hypertension worsened after AVF creation and died. We report the first series of SCD patients with AVF for ER, demonstrating that AVFs could be considered as a potential vascular access for ER. Patients with increased risk for hemodynamic intolerance of AVFs must be carefully identified, so that alternative vascular accesses can be considered. Am. J. Hematol. 92:136-140, 2017. © 2016 Wiley Periodicals, Inc.

Chronic blood exchange transfusions in the management of pre-capillary pulmonary hypertension complicating sickle cell disease

“…This procedure led to a sudden pulmonary hypertension worsening followed by acute right heart decompensation and death. This case has been previously reported by DELVILLE et al [26].…”

Vascular access practices for therapeutic apheresis: Results of a survey

“…There is a tendency for intimal narrowing to develop, and a percentage of patients will need treatment for this complication. In a study performed by Delville et al on patients undergoing erythrocytapheresis, 19/26 (73%) had stenotic, thrombotic, or infectious AVF complications. A total of 0.36 stenosis per 1000 AVF days, 0.37 thrombosis per 1000 AVF days, and 0.078 infections per 1000 AVF days were observed .…”

Cellular collection by apheresis

“…Arteriovenous fistulae have been used extensively for vascular access in dialysis, and this type of access also has been used successfully in patients undergoing apheresis. 30,31 This is a particularly common type of access for therapeutic plasma exchange among patients who have had arteriovenous fistulae/grafts placed previously to facilitate hemodialysis. Despite the dearth of literature describing their use in cellular collections, they support high flow rates and theoretically could be used in this setting.…”