Effectiveness and safety of dialysis vascular access procedures performed by interventional nephrologists

Beathard, Gerald A.; Litchfield, Terry

doi:10.1111/j.1523-1755.2004.00928.x

Cited by 151 publications

(140 citation statements)

References 55 publications

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“…However, the average procedure time of the no-tPA group is comparable with that of other studies of mechanical thrombectomy. In the largest reported series of 4671 thrombectomies, the average procedure time was 52 minutes and average fluoroscopic time was 8.8 minutes (528 seconds) (13). In addition, this average procedure time is also comparable with that of other operators in our center during the same period (average approximately 50 minutes of over 250 cases, unpublished data).…”

Section: Discussionsupporting

confidence: 67%

Thrombectomy of Prosthetic Dialysis Grafts Using Mechanical Plus “No‐Wait Lysis” Approach Requires Less Procedure Time and Radiation Exposure

Almehmi

Broce

Wang

2011

Seminars in Dialysis

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In spite of the existence of various strategies, dialysis graft thrombectomy remains time-consuming and requires substantial radiation exposure. The authors report a new approach for graft thrombectomy, "no-wait lysis", with the objective to examine its effect on procedure time and radiation exposure. Based on the use of tissue plasminogen activator (tPA), the 88 retrospectively reviewed graft thrombectomies were divided into "no-tPA" group (n = 35) and "no-wait lysis" group (n = 53). Fogarty thrombectomy and balloon angioplasty were used similarly in both groups. In the "no-wait lysis" group, small-dose tPA was added directly into the graft during the procedure. Comparing the "no-wait lysis" group with the "no-tPA" group, the procedure time was reduced: 27.2 ± 10.2 vs. 55.5 ± 19.9 minutes (p < 0.0001), and the radiation exposure time was decreased correspondingly: 159.4 ± 61.6 vs. 243.9 ± 101.9 seconds (p < 0.0001). Multivariate regression analysis revealed that the use of "no-wait lysis" approach was the major significant predictor for shorter procedure time and radiation exposure time. In conclusion, our data support that the use of "no-wait lysis" approach for dialysis graft thrombectomy substantially reduces procedure time and radiation exposure, and it may serve as an efficient and economical alternative to other existing approaches.

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Section: Discussionsupporting

confidence: 67%

Thrombectomy of Prosthetic Dialysis Grafts Using Mechanical Plus “No‐Wait Lysis” Approach Requires Less Procedure Time and Radiation Exposure

Almehmi

Broce

Wang

2011

Seminars in Dialysis

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“…Vascular access interventions commonly employed by interventionalist include vascular access education, vascular mapping, percutaneous balloon angioplasty, thrombectomy, intravascular coil and stent insertion, and tunneled hemodialysis catheter-related procedures. Interventional nephrology, a subspecialty of nephrology, may be the ideal specialty to provide interventional services, as nephrologists have an in depth perspective on kidney disease and dialysis access [79–81]. In the last 20 years interventional nephrologists have demonstrated an ability to provide effective, safe, and economical interventional vascular access management care to the dialysis patient population [82].…”

Section: Fistula First Breakthrough Initiative: the Next Stepsmentioning

confidence: 99%

Fistula First Initiative: Historical Impact on Vascular Access Practice Patterns and Influence on Future Vascular Access Care

Lee

2017

Cardiovasc Eng Tech

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The vascular access is the lifeline for the hemodialysis patient. In the United States, the Fistula First Breakthrough Initiative (FFBI) has been influential in improving use of arteriovenous fistulas (AVF) in prevalent hemodialysis patients. Currently, prevalent AVF rates are near the goal of 66% set forth by the original FFBI. However, central venous catheter (CVC) rates remain very high in the United States in patients initiating hemodialysis, nearly exceeding 80%. A new direction of the of the FFBI has focused on strategies to reduce CVC use, and subsequently the FFBI has now been renamed the “Fistula First-Catheter Last Initiative”. However, an AVF may not be the best vascular access in all hemodialysis patients, and arteriovenous grafts (AVG) and central venous catheters (CVC) may be appropriate and the best access for a subset of hemodialysis patients. Unfortunately, there still remains very little emphasis within vascular access initiatives and guidelines directed towards evaluation of the individual patient context, specifically patients with poor long-term prognoses and short life expectancies, patients with multiple comorbidities, patients who are more likely to die than reach end stage renal disease (ESRD), and patients of elderly age with impaired physical and cognitive function. Given the complexity of medical and social issues in advanced CKD and ESRD patients, planning, selection, and placement of the most appropriate vascular access are ideally managed within a multidisciplinary setting and requires consideration of several factors including national vascular access guidelines. Thus, the evolution of the FFBI should underscore the need for multidisciplinary health teams with a major emphasis placed on “the right access for the right patient” and improving the patient’s overall quality of life.

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“…One such indication is the use of stents as treatment for procedure related grade 2 and 3 hematomas 9,10 . It is important to mention that grade 1 hematomas usually respond to balloon tamponade intervention.…”

Section: Indications For Stent Use In Hemodialysis Vascular Access Prmentioning

confidence: 99%

The Role of Endovascular Stents in Dialysis Access Maintenance

Kassem¹,

Alghamdi²,

Vázquez-Padrón³

et al. 2015

Advances in Chronic Kidney Disease

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Vascular stenosis is most often the culprit behind hemodialysis vascular access dysfunction, and while percutaneous transluminal angioplasty (PTA) remains the gold standard treatment for vascular stenosis, over the past decade the use of stents as a treatment option has been on the rise. Aside from the two FDA approved stent-grafts for the treatment of venous graft anastomosis (VGA) stenosis, use of all other stents in vascular access dysfunction is off-label. KDOQI recommends limiting stent use to specific conditions, such as elastic lesions and recurrent stenosis; otherwise, additional adapted indications are in procedure-related complications, such as grade 2 and 3 hematomas. Published reports have shown the potential use of stents in a variety of conditions leading to vascular access dysfunction; such as VGA stenosis, cephalic arch stenosis, central venous stenosis, dialysis access aneurysmal elimination, Cardiac Implantable Electronic Device induced stenosis, and thrombosed arteriovenous grafts (AVG). While further research is needed for many of these conditions, evidence for recommendations has been clear in some; for instance, we know now that stents should be avoided along cannulations sites and should not be used in eliminating dialysis access aneurysms. In this review article, we evaluate the available evidence for the use of stents in each of the aforementioned conditions leading to hemodialysis vascular access dysfunctions.

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Effectiveness and safety of dialysis vascular access procedures performed by interventional nephrologists

Abstract: This study demonstrates that appropriately trained interventional nephrologists can perform these basic procedures in both a safe and effective manner.

Cited by 151 publications

References 55 publications

Thrombectomy of Prosthetic Dialysis Grafts Using Mechanical Plus “No‐Wait Lysis” Approach Requires Less Procedure Time and Radiation Exposure

Thrombectomy of Prosthetic Dialysis Grafts Using Mechanical Plus “No‐Wait Lysis” Approach Requires Less Procedure Time and Radiation Exposure

Fistula First Initiative: Historical Impact on Vascular Access Practice Patterns and Influence on Future Vascular Access Care

The Role of Endovascular Stents in Dialysis Access Maintenance

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