External dilator-assisted banding for high-flow hemodialysis arteriovenous fistula

Letachowicz, Krzysztof; Kusztal, Mariusz; Gołębiowski, Tomasz; Letachowicz, Waldemar; Weyde, Wacław; Klinger, Marian

doi:10.1080/0886022x.2016.1184936

Cited by 11 publications

(18 citation statements)

References 16 publications

(22 reference statements)

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“…An alternative approach for access ligation is flow reduction. The banding procedure can be performed precisely using real-time flow ultrasound monitoring by means of a dowel, dilators, or balloons at various sizes [28][29][30]. Such procedures were shown to reduce effectively the symptoms of AVF-associated HF [28].…”

Section: Discussionmentioning

confidence: 99%

The impact of location and patency of the arteriovenous fistula on quality of life of kidney transplant recipients

et al. 2021

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Section: Discussionmentioning

confidence: 99%

The impact of location and patency of the arteriovenous fistula on quality of life of kidney transplant recipients

et al. 2021

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“…Despite the modification of the cardiovascular risk through an intervention on AVF seems to be a promising intervention in KTx recipients, the patients were not convinced to a routine VA ligation (8). An alternative option could be a precision flow reduction by banding with a real-time access flow assessment or banding with the use of a sizing dowel (33)(34)(35). Using the data from the United States Renal Data Systems, it was found that AV access ligation was uncommon and performed in 4.6% of patients.…”

Section: Discussionmentioning

confidence: 99%

Vascular Access Perspectives in Patients After Kidney Transplantation

et al. 2021

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Introduction: More attention has been paid to the influence of arteriovenous fistula (AVF) on the cardiovascular system. In renal transplant recipients, some beneficial effect of an elective vascular access (VA) ligation was observed in patients with a high AVF flow. However, this strategy is not widely accepted and is in contradiction to the rule of vasculature preservation for possible future access. The aim of our study is to elucidate the vascular access function and VA perspective in the kidney transplantation (KTx) population.Materials and Methods: KTx patients with a stable graft function were recruited to participate in this single center observational study (NCT04478968). The measurement of VA flow and vessel mapping for future vascular access was performed by a color Doppler ultrasound. The study group included 99 (63%) males and 58 (37%) females; the median age was 57 (IQR 48–64) years. The median time from the transplantation to the baseline visit was 94 (IQR 61–149) months. Median serum creatinine concentration was 1.36 (IQR 1.13–1.67) mg/dl.Results: Functioning VA was found in 83 out of 157 (52.9%) patients. The sites were as follows: snuffbox in six (7.2%), wrist in 41 (49.4%), distal forearm in 18 (21.7%), middle or proximal forearm in eight (9.6%), upper-arm AV graft in one (1.2%), and upper-arm AVFs in nine (10.8%) patients, respectively. Blood flow ranged from 248 to 7,830 ml/min; the median was 1,134 ml/min. From the transplantation to the study visit, 66 (44.6%) patients experienced access loss. Spontaneous thrombosis was the most common, and it occurred in 60 (90.9%) patients. The surgical closure of VA was performed only in six (4%) patients of the study group with a functioning VA at the time of transplantation. Access loss occurred within the 1st year after KTx in 33 (50%) patients. Majority (50 out of 83, 60.2%) of the patients with an active VA had options to create a snuffbox or wrist AVF on the contralateral extremity. In a group of 74 patients without a functioning VA, the creation of a snuffbox or wrist AVF on the non-dominant and dominant extremity was possible in seven (9.2%) and 40 (52.6%) patients, respectively. In 10 (13.1%) patients, the possibilities were limited only to the upper-arm or proximal forearm VA on both sides. Access ligation was considered by 15 out of 83 (18.1%) patients with a patent VA.Conclusions: In the majority of the patients, vascular access blood flow was below the threshold of the negative cardiovascular effect of vascular access. Creation of a distal AVF is a protective measure to avoid a high flow and preserve the vessels for future access. The approach to VA should be individualized and adjusted to the patient's profile.

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“…The presence of a high-flow hemodialysis fistula is associated with multiple adverse outcomes. These include steal syndrome [25], exotic complications such as hemothorax [26] or pulmonary embolism [27], and the impairment of cardiac function with high-output heart failure resulting from a large proportion a large proportion of the cardiac output recirculated through the enlarged fistulas [22,28,29]. While our working definition of CEF in our study was not harmonized to the diagnosis of ultrasonography-defined megafistula with high overall flow nor did we perform the Nicoladoni-Branham maneuver, our study entertains yet another striking possibility contributing to enlargement of arteriovenous accesses; the one of chronic salt-water overload.…”

Section: Discussionmentioning

confidence: 99%

The association of overhydration with megafistulas in hemodialysis patients

et al. 2019

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Objectives: Diffuse enlargements of arteriovenous dialysis fistulas customarily attributed to either excessive arterial inflow or central outflow stenosis. The relationship between volume status and clinically enlarged (arteriovenous) fistula (CEF) formation in end-stage renal disease (ESRD) patients is not well understood. Methods: We assessed the pre-dialysis bioimpedance spectroscopy-measured percentage of overhydration (OH%) in 13 prevalent dialysis patients with CEF development and negative angiography and compared the results with those of 52 control dialysis patients (CONTR). All patients were prevalent ESRD patients receiving thrice-weekly maintenance hemodiafiltration at an academic outpatient dialysis unit. Results: 10/13 CEF patients had OH% ≥15% as compared to 20/52 control patients (Chi square p : .02). The degree of OH% was 20.2 ± 7.4% among the CEF vs. 14.4 ± 7.1% in the control group (Student’s t -test p : .01), representing 4.2 ± 3.2 vs. 2.8 ± 1.6 L of excess fluid pre-dialysis ( p : .03). Patients with CEF development took an average of 1.7 ± 1.4 vs. 0.8 ± 0.8 ( p : .002) antihypertensive medications compared to the CONTR patients, yet their blood pressure was higher: 156/91 vs. 141/78 mmHg (systolic/diastolic p : .03<.0001). We found no difference in fistula vintage, body mass index, age, diabetes status, or diuretic use. The odds ratio of having a CEF in patients with ≥15% OH status was 5.3 (95% CI: 1.3–21.7; p : .01), the Number Needed to Harm with overhydration was 4. Conclusions: There is an association between bioimpedance spectroscopy-measured overhydrated clinical state and the presence of CEF; either as an increased volume capacitance or as a potential cause.

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External dilator-assisted banding for high-flow hemodialysis arteriovenous fistula

Cited by 11 publications

References 16 publications

The impact of location and patency of the arteriovenous fistula on quality of life of kidney transplant recipients

The impact of location and patency of the arteriovenous fistula on quality of life of kidney transplant recipients

Vascular Access Perspectives in Patients After Kidney Transplantation

The association of overhydration with megafistulas in hemodialysis patients

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