Effect of Central Venous Angioplasty on Hemodialysis Access Circuit Flow: Prospective Study of 25 Symptomatic Patients

Yan, Yan; Sudheendra, Deepak; Dagli, Mandeep; Stavropoulos, S. William; Clark, Timothy W.I.; Soulen, Michael C.; Mondschein, Jeffrey I.; Shlansky-Goldberg, Richard D.; Trerotola, Scott O.

doi:10.1016/j.jvir.2015.03.005

Cited by 11 publications

(11 citation statements)

References 27 publications

(50 reference statements)

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“…As has been previously reported by some 14 but not all 13 investigators, PTA of central vein stenosis lesions had no significant effect on AVF Qa in our patients in whom the clinical indication was ipsilateral extremity edema ( Figure 3(d)). We attribute this finding to the development of alternative draining collateral veins in association with highgrade central venous stenosis.…”

Section: Discussionsupporting

confidence: 87%

“…Thus, a decision for intervention should be made based upon the interventionalist's clinical judgment of the relevance of the anatomical derangement to the presenting clinical signs and symptoms. In order to do this, the interventionalist needs to have insight into which stenosis may be a flow-limiting lesion, 3,5,6,9,14 and what changes in Qa would be expected from an intervention on such a stenosis. To assist the interventionalist in these endeavors, we used our findings to develop GLMs that can be used to best predict the change in Qa following PTA on any given stenosis.…”

Section: Discussionmentioning

confidence: 99%

“…The latter subgroup was evaluated separately despite its small size because central venous stenoses have unique physiologic and clinical implications. [12][13][14] AVFs with a cannulation zone stenosis constituted an additional subgroup that was not analyzed separately because of its small sample size; however, it was included in the Total Peripheral subgroup. When judged necessary, the data derived from the Total Peripheral subgroup was also analyzed by the three AVF types: radiocephalic, brachiocephalic, and brachial-basilic transposition.…”

Section: Methodsmentioning

confidence: 99%

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The effect of angioplasty of single arteriovenous fistula–associated stenosis on arteriovenous fistula blood flow rate

et al. 2020

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Introduction: Percutaneous balloon angioplasty of arteriovenous fistula–associated stenosis is performed for a variety of indications. Successful percutaneous transluminal angioplasty (PTA) is expected to increase in arteriovenous fistula blood flow rate (Qa). A validated approach to predicting changes in Qa based upon stenosis characteristics is not available. Methods: Three baseline parameters were determined in a group of patients with a single arteriovenous fistula–associated stenosis undergoing PTA. These were percent estimated stenosis, stenosis minimum luminal diameter, and baseline Qa. The relationship between these parameters and changes in Qa following PTA was analyzed using Spearman’s rank correlation and linear regression. Results: 113 patients (total group) were studied. Of these,106 had peripheral stenosis (total peripheral subgroup) and 7 had central stenosis. For the total group and total peripheral subgroup, a highly significant inverse correlation was seen between changes in Qa and baseline Qa. A weaker correlation was seen between changes in Qa and minimum luminal diameter, but no correlation was seen with percent estimated stenosis. A minimum luminal diameter ⩽2.0 mm was predictive of ⩾300-mL/min increases in Qa, whereas a minimum luminal diameter >4.5 mm was associated with <300-mL/min increases in Qa. PTA of Central vein stenosis was not associated with significant changes in Qa. Conclusion: Baseline Qa is the best predictor for change in Qa following PTA. Stenosis minimum luminal diameter cutoffs of ⩽2.0 and >4.5 mm are useful in predicting the magnitude of changes in Qa. Percent estimated stenosis is not predictive of change in Qa. PTA of central veins does not seem to change Qa.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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The effect of angioplasty of single arteriovenous fistula–associated stenosis on arteriovenous fistula blood flow rate

et al. 2020

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“…However, balloon dilation should be performed only if there is a clinical indication such as arm or face swelling. Several studies have reported that balloon dilation for a narrowed lesion found incidentally on angiogram and without symptoms accelerates lesion growth [15–17].…”

Section: Treatmentmentioning

confidence: 99%

Central venous disease in hemodialysis patients

Park

Choi

Baik

2019

Kidney Res Clin Pract.

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Central venous disease (CVD) is difficult to treat and often resistant to treatment. In CVD, hemodialysis vascular access should sometimes be abandoned, or in serious cases, the patient's life may be threatened. Therefore, prevention is ideal. However, as the prevalence of chronic kidney disease (CKD) has increased steadily with population aging, CKD patients with a peripherally inserted central catheter (PICC) are encountered frequently. PICCs can cause CVD, and the basilic vein, which is regarded as the important last option for native arteriovenous fistula (AVF) creation in end-stage renal disease (ESRD) patients, is destroyed frequently after its use as the entry site of PICC. The most well-established risk factors for CVD are a history of central venous catheter (CVC) insertion and its duration of use. Therefore, to reduce the incidence of CVD, catheterization in the central vein (CV) should be minimized, along with its duration of use. In this review, we will first explain the basic territories of the CV and introduce its pathophysiology, clinical features, and advanced treatment options. Finally, we will emphasize prevention of CVD.

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“…As a result, ultrasound has emerged as a noninvasive, inexpensive, and important imaging alternative, particularly in those patients in whom an abnormality is not certain, and to evaluate the etiology of perigraft masses. It should be noted that if no stenosis is found by ultrasound in a patient with a high suspicion of stenosis, magnetic resonance venography (MRV), or diagnostic fistulogram may be useful, particularly to exclude a central stenosis .…”

Section: Arteriovenous Graftsmentioning

confidence: 99%

Sonography of Arteriovenous Fistulas and Grafts

Pietryga

Little

Robbin

2017

Seminars in Dialysis

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Arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs) are the vascular accesses of choice for long-term hemodialysis. Strategies to establish and maintain functioning AVFs and AVGs are essential. In addition to clinical evaluation, ultrasound plays a critical role in the evaluation and maintenance of AVFs and AVGs. AVFs have a high rate of failure to mature which can be reliably diagnosed with ultrasound. Treatable etiologies of the failure to mature can often be diagnosed with ultrasound. Causes of secondary AVG failure can also be diagnosed with ultrasound and treated. AVGs have a relatively short functional life expectancy due to a high rate of AVG thrombosis. Ultrasound is a safe, noninvasive way to diagnose vascular stenosis in both AVFs and AVGs prior to thrombosis, potentially saving the access. Routine surveillance ultrasound of asymptomatic AVFs and AVGs is controversial with conflicting studies on its benefit. Routine surveillance ultrasound of AVFs and AVGs is not common practice.

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Effect of Central Venous Angioplasty on Hemodialysis Access Circuit Flow: Prospective Study of 25 Symptomatic Patients

Cited by 11 publications

References 27 publications

The effect of angioplasty of single arteriovenous fistula–associated stenosis on arteriovenous fistula blood flow rate

The effect of angioplasty of single arteriovenous fistula–associated stenosis on arteriovenous fistula blood flow rate

Central venous disease in hemodialysis patients

Sonography of Arteriovenous Fistulas and Grafts

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