Clinical Surveillance and Monitoring of Arteriovenous Access for Hemodialysis

Gelbfish, Gary A.

doi:10.1053/j.tvir.2008.09.002

Cited by 14 publications

(7 citation statements)

References 22 publications

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“…Furthermore, we observed that the BAT group had relatively good primary and secondary patency rates throughout follow-up. This may be because, in cases with AVG or AVF creation, the major causes of lost patency are stenosis of the graft-vein anastomosis and thrombotic occlusion due to intimal hyperplasia plus impaired remodeling (related to reduced blood ow) at the juxta-anastomotic stenosis [31][32][33][34]. In contrast, the BAT may provide relatively physiological hemodynamics and a lower shear stress (vs. AVF and AVG), which may prolong the patency of the circuit.…”

Section: Discussionmentioning

confidence: 99%

Brachial Artery Transposition Versus Catheters as Tertiary Vascular Access for Maintenance Hemodialysis: A Single-Center Retrospective Study

Shi-ying

Murakami

Nakatani

et al. 2021

Preprint

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Background: Some hemodialysis patients are not suitable for creation of an arteriovenous fistula (AVF) or arteriovenous graft (AVG). They can receive a tunneled cuffed central venous catheter (tcCVC), but this carries risks of infection and mortality. We aimed to evaluate the safety and effectiveness of brachial artery transposition (BAT) versus those of tcCVC.Methods: This retrospective study evaluated hemodialysis patients who underwent BAT or tcCVC placement because of severe heart failure, hand ischemia, central venous stenosis or occlusion, inadequate vessels for creating standard arteriovenous access, or limited life expectancy. The primary outcome was whole access circuit patency.Results: Thirty-eight patients who underwent BAT and 25 who underwent tcCVC placement were included. One-year patency rates for the whole access circuit were 84.6% and 44.9% in the BAT and tcCVC groups, respectively. The BAT group was more likely to maintain patency (unadjusted hazard ratio: 0.17, 95% confidence interval: 0.05-0.60, p=0.006). The two groups did not have significantly different overall survival (log-rank p=0.146), although severe complications were less common in the BAT group (3% vs. 28%, p=0.005).Conclusions: Relative to tcCVC placement, BAT is safe and effective with acceptable patency in hemodialysis patients not suitable for AVF or AVG creation.

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Section: Discussionmentioning

confidence: 99%

Brachial Artery Transposition Versus Catheters as Tertiary Vascular Access for Maintenance Hemodialysis: A Single-Center Retrospective Study

Shi-ying

Murakami

Nakatani

et al. 2021

Preprint

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“…Flow can be assessed by palpation of the thrill along the entire circuit. Similarly, abnormal increase in pressure can be assessed by noting water-hammer pulsatility (21).…”

Section: Basic Physicsmentioning

confidence: 99%

Monitoring Dialysis Arteriovenous Fistulae: It's in our Hands

Coentrão

Turmel-Rodrigues²

2013

J Vasc Access

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Vascular access problems are a daily occurrence in hemodialysis units. Loss of patency of the vascular access limits hemodialysis delivery and may result in underdialysis that leads to increased morbidity and mortality. Despite the known superiority of autogenous fistulae over grafts, autogenous fistulae also suffer from frequent development of stenosis and subsequent thrombosis. International guidelines recommend programmes for detection of stenosis and consequent correction in an attempt to reduce the rate of thrombosis. Physical examination of autogenous fistulae has recently been revisited as an important element in the assessment of stenotic lesions. Prospective observational studies have consistently demonstrated that physical examination performed by trained physicians is an accurate method for the diagnosis of fistula stenosis and, therefore, should be part of all surveillance protocols of the vascular access. However, to optimize hemodialysis access surveillance, hemodialysis practitioners may need to improve their skills in performing physical examination. The purpose of this article is to review the basics and drawbacks of physical examination for dialysis arteriovenous fistulae and to provide the reader with its diagnostic accuracy in the detection of arteriovenous fistula dysfunction, based on current published literature.

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“…The importance of preserving veins for dialysis access cannot be emphasized enough ( Figure 15). As discussed above, patients with CKD undergo frequent blood sampling that damages veins rendering them unsuitable for access creation, and a plan to preserve vessels should be made early on [59,60]. Moreover, following fistula creation, patients and caregivers should be constantly reminded of vascular preservation for future access and inappropriate use of a fistula (Figure 16).…”

Section: Information Provisionmentioning

confidence: 99%