Current Topics in Vascular Access: Superficialization of Arteriovenous Fistula

Nanami, Masayoshi; Suemitsu, Kotaro; Nagasawa, Yasuyuki; Hasuike, Yukiko; Kuragano, Takahiro; Nakanishi, Takeshi

doi:10.1159/000496530

Cited by 11 publications

(5 citation statements)

References 20 publications

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“…AVF is deemed as an optimal vascular access for the process of HD, which is also a widely accepted renal replacement therapy for CRF on account of its superior patency, low risk of infection, few complications, and better outcomes [ 23 , 24 ]. Nevertheless, major risk factors including vascular cell proliferation and migration, extracellular matrix remodeling, complicated interactions of growth factors, adhesion molecules, inflammatory mediators, and chemokines may result in AVF maturation failure, which is likely to further improve the morbidity and hospitalization of HD patients [ 25 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

Hirudin Regulates Vascular Function in Chronic Renal Failure through Modulating Macrophage Polarization

Chen¹,

Ding²,

Yang³

2022

BioMed Research International

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Excessive inflammation is responsible for arteriovenous fistula (AVF) failure, which determines the therapeutic effect of chronic renal failure (CRF). Macrophage polarization is of great significance in the inflammatory response. Hirudin (Hiru) has been reported to possess a definite anti-inflammatory effect. This study is to uncover the impacts of Hiru on classically (M1)/alternatively (M2) macrophage polarization in the CRF rat model and rat vascular smooth muscle cells (VSMCs). After the CRF rat model was administrated with different concentrations of Hiru, blood urea nitrogen (BUN) and serum creatinine (Scr) levels were tested. H&E staining was to detect vascular injury, and IHC assay was to analyze inducible nitric oxide synthase (iNOS) and arginase-1 (Arg-1) expressions in vascular tissues. Levels of inflammatory factors were examined by ELISA. Besides, western blot was to estimate the levels of marker proteins related to macrophage, proliferation, and apoptosis. CCK-8 was to measure cell viability. We discovered that Hiru alleviated renal function injury and vascular injury, exacerbated VSMC hyperplasia, and stimulated the differentiation and activation of M1 macrophage towards M2 macrophage in vivo. Moreover, after treatment with lipopolysaccharide (LPS)/IFN-gamma (IFN-γ), the increased M1/M2 ratio and enhanced levels of inflammatory factors were observed. Furthermore, Hiru boosted the proliferation and ameliorated the inflammatory response and apoptosis of rat VSMCs during the process of coincubation of M1-conditioned medium (CM). Collectively, Hiru played a protective role against vascular injury in CRF directly or through its influence on M1 macrophage polarization and inflammation.

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Section: Discussionmentioning

confidence: 99%

Hirudin Regulates Vascular Function in Chronic Renal Failure through Modulating Macrophage Polarization

Chen¹,

Ding²,

Yang³

2022

BioMed Research International

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“…Although strongly advocated in clinical guidelines, timing the formation and development of a functional AVA for haemodialysis is logistically challenging and associated with a high failure rate [ 13 ]. An aging population and the associated prevalence of comorbidities, including obesity, diabetes and peripheral vascular disease, result in less vascular adaptability and higher failure rates [ 14 ]. For pre-emptively placed autogenous fistulas, a recently published US study reported a maturation rate of 79% [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

The arteriovenous access stage (AVAS) classification

Baláž

Hanko

Magowan

et al. 2020

Clinical Kidney Journal

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Background Key anatomical factors mean that individuals needing arteriovenous access are unique and have different possibilities for fistula creation. The aim of this article is to describe a new classification system for all patients needing haemodialysis vascular access in the upper extremity with the purpose to simplify sharing the information about suitability for surgical access creation depending on vascular anatomy. Methods According to the patient’s vascular anatomy in right and left superior extremities, patients were separated into three arteriovenous access stages (AVAS). The AVAS was validated by three blinded observers using a sample of 70 upper limb arteriovenous maps that were performed using ultrasound on patients referred for vascular access assessment. A sample size calculation was performed and calculated that for three observers, a minimum of 67 maps were required to confirm significant agreement at a Kappa value of 0.9 (95% confidence interval 0.75–0.99). Results The Kappa value for inter-rater reliability using Fleiss’ Kappa coefficient was 0.94 and all patients fitted into the AVAS classification system. Conclusion The AVAS classification system is a simplified way to share information about vascular access options based on a patient’s vascular anatomy with high inter-rater reliability.

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“…AVF is considered the gold standard modality of vascular access for maintaining hemodialysis because of its superior patency, provision of high quality of life, and low risk of patient mortality [6]. However, some of complications after AVF operation, including immediate thrombosis, failing to mature, swelling or infection, might occur [7] [8].…”

Section: Discussionmentioning

confidence: 99%

The Medical Care of Multiple Disciplinary Team Reduces the Risks of Complications in Patients after Arteriovenous Fistula Operation

Yang¹,

Deng²,

Zhong³

et al. 2020

OJNeph

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Introduction: Arteriovenous fistula (AVF) operation is recognized a gold standard of hemodialysis for end-stage renal disease. Because various complications may occur during perioperative period, medical care plays an important role in improving the possibility of AVF operation. The objective of the study was to explore the effect of the mode of multiple disciplinary team (MDT) medical care on the patients with end-stage renal disease treated by arteriovenous fistula (AVF) operation. Method: 98 patients with end-stage renal disease under the AVF operation were divided into observation group and control group. The control group was performed with regular medical care and for the observation group was treated under the mode of MDT medical care. Complications after operation, hospitalized time and medical satisfaction were comprehensively compared between the both groups. Results: The overall complications including swelling, bleeding, infection and thrombosis in observation group accounted for 5%, however, 19% of patients suffered different complications in the control group. The total complications significantly decreased in the observation group compared with control group (P < 0.001). The hospitalization time was shortened to 9.8 ± 5.6 days in the observation group, and the average hospitalization in control group was 17.8 ± 8.9 days. The medical satisfaction was increased by 20.83 percent in the observation group compared with the control group (P < 0.001). 75% patients in control group were satisfied with medical care, and 98.53% patients were satisfied for observation group. Conclusion: The mode of MDT medical care was beneficial for patients with end-stage renal disease after AVF operation, which could significantly reduce complications, hospitalized time and improve patients' degree of satisfaction. Thus, it should be recommended in the clinical work.

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Current Topics in Vascular Access: Superficialization of Arteriovenous Fistula

Cited by 11 publications

References 20 publications

Hirudin Regulates Vascular Function in Chronic Renal Failure through Modulating Macrophage Polarization

Hirudin Regulates Vascular Function in Chronic Renal Failure through Modulating Macrophage Polarization

The arteriovenous access stage (AVAS) classification

The Medical Care of Multiple Disciplinary Team Reduces the Risks of Complications in Patients after Arteriovenous Fistula Operation

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