Hemodialysis access placement with preoperative noninvasive vascular mapping: Comparison between patients with and without diabetes

Sedlacek, Martin; Teodorescu, Victoria; Falk, Abigail; Vassalotti, Joseph A.; Uribarri, Jaime

doi:10.1053/ajkd.2001.26873

Cited by 116 publications

(74 citation statements)

References 10 publications

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“…In selected patients, additional imaging is indicated to exclude the presence of central vein stenosis or thrombosis. A dramatic increase in fistula placement was observed by several centers after implementation of routine preoperative vascular mapping (2,7,9,(25)(26)(27)(28). Among patients who are referred for their initial vascular access surgery, placement of a forearm fistula is feasible in only 40 to 50% (2,3,7,9).…”

Section: Why Should We Increase Fistula Use?mentioning

confidence: 99%

Current Management of Vascular Access

Allon¹

2007

Clinical Journal of the American Society of Nephrology

240

228

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Optimizing vascular access outcomes remains an ongoing challenge for clinical nephrologists. All other things being equal, fistulas are preferred over grafts, and grafts are preferred over catheters. Mature fistulas have better longevity and require fewer interventions, as compared with mature grafts. The major hurdle to increasing fistula use is the high rate of failure to mature of newly created fistulas. There is a desperate need for enhanced understanding of the mechanisms of failure to mature and the optimal type and timing of interventions to promote maturity. Grafts are prone to frequent stenosis and thrombosis. Surveillance for graft stenosis with preemptive angioplasty may reduce graft thrombosis, but recent randomized clinical trials have questioned the efficacy of this approach. Graft stenosis results from aggressive neointimal hyperplasia, and pharmacologic approaches to slowing this process are being investigated in clinical trials. Catheters are prone to frequent thrombosis and infection. The optimal management of catheter-related bacteremia is a subject of ongoing debate. Prophylaxis of catheter-related bacteremia continues to generate important clinical research. Close collaboration among nephrologists, surgeons, radiologists, and the dialysis staff is required to optimize vascular access outcomes and can be expedited by having a dedicated access coordinator to streamline the process. The goal of this review is to provide an update on the current status of vascular access management.

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Section: Why Should We Increase Fistula Use?mentioning

confidence: 99%

Current Management of Vascular Access

Allon¹

2007

Clinical Journal of the American Society of Nephrology

240

228

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“…Patients were followed up for 1 yr, during which primary and secondary AVF patency rates were measured. T he low prevalence of the arteriovenous fistula (AVF) among US hemodialysis (HD) patients (1,2) has initiated nationwide measures to increase AVF creation and prevalence (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Among these are providing educational programs, setting forth guidelines and goals (3,4), implementing multidisciplinary approaches (4 -9), encouraging preoperative venous mapping (14 -19), and asking surgeons to create AVF instead of arteriovenous grafts (AVG) (10 -21).…”

mentioning

confidence: 99%

Endovascular Treatment of the “Failing to Mature” Arteriovenous Fistula

Nassar

Nguyen

Rhee

et al. 2006

Clinical Journal of the American Society of Nephrology

143

100

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In recent literature, surgically created hemodialysis (HD) arteriovenous fistulas (AVF) have high rates of primary failure. Endovascular treatment holds promise to salvage these fistulae. The outcomes of 119 patients who had a "failing to mature" AVF and presented for endovascular management were evaluated prospectively. All patients underwent a fistulogram. Stenotic lesions underwent balloon angioplasty, and accessory veins underwent obliteration. Technical success was determined immediately after the procedure. AVF salvage was determined by successful use during HD. Patients were followed up for 1 yr, during which primary and secondary AVF patency rates were measured. T he low prevalence of the arteriovenous fistula (AVF) among US hemodialysis (HD) patients (1,2) has initiated nationwide measures to increase AVF creation and prevalence (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Among these are providing educational programs, setting forth guidelines and goals (3,4), implementing multidisciplinary approaches (4 -9), encouraging preoperative venous mapping (14 -19), and asking surgeons to create AVF instead of arteriovenous grafts (AVG) (10 -21).Overall, an increase in AVF prevalence is occurring in the United States, albeit at a slow rate (14 -20). One impediment has been high primary failure rates, which in recent series ranged between 23 and 46% (9,(12)(13)(14). The use of ultrasound or other means of preoperative venous mapping is likely to decrease the incidence of primary AVF failures (14 -19). However, the increasing demand to create more fistulas may lead to their creation in borderline vessels, thereby increasing primary failure rates (21-23). Thus, salvage of these primary failures will be essential for increasing AVF prevalence in the United States.In our dedicated endovascular suite, we used percutaneous angioplasty and accessory vein obliteration in attempts to salvage fistulas with primary failure. Because most did not present with thrombosis, we elected to refer to their fistulas as "failing to mature." In this article, we report our initial success rates as well as follow-up on a series of 119 consecutive patients who were referred for salvage of their "failing to mature" AVF. Materials and Methods DefinitionsThe "failing to mature" AVF in our series was defined as an AVF that had been created for at least 8 wk but had not matured enough to allow successful cannulation or use during HD. This includes (1) fistulas that were never cannulated for HD be cause of obvious lack of maturity; (2) fistulas that failed first cannulation attempts and were abandoned; (3) fistulas that were cannulated successfully but could not be used because the blood flow was insufficient to sustain HD; this may have been because of high venous pressure or poor arterial inflow; and (4) fistulas that thrombosed before any attempts at HD. Juxta-arterial anastomosis segment refers to the initial 5 cm of the AVF starting at the arterial anastomosis. Peripheral vein refers to the venous outflow tract of t...

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“…Specifically, sonographic evaluation of the radial artery diameter, arterial flow, arterial resistance, and the artery's ability to respond to an ischemic challenge (fist release after sustained fist clenching) may be helpful in predicting subsequent fistula adequacy for dialysis. 3,6,[11][12][13] The goal of our study was to evaluate the predictive values of preoperative sonographic Doppler radial arterial measurements on subsequent fistula outcomes in a large group of patients undergoing forearm fistula placement after routine preoperative vascular mapping.…”

mentioning

confidence: 99%

Preoperative Sonographic Radial Artery Evaluation and Correlation With Subsequent Radiocephalic Fistula Outcome

Lockhart

Robbin

Allon

2004

Journal of Ultrasound in Medicine

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Objective. Primary failure of forearm radiocephalic dialysis fistulas is common even when preoperative vascular mapping is used. Previous studies have suggested that low peak systolic velocity of the radial artery predicts subsequent fistula failure. The study goal was to evaluate whether preoperative spectral Doppler assessment of radial artery inflow can improve forearm fistula outcome prediction. Methods. Forearm fistulas were placed in 112 patients after preoperative sonographic mapping. Preoperative spectral Doppler sonography measured radial artery peak systolic velocity during tight fist clenching for 3 minutes and after fist relaxation. Vessel diameters and peak systolic velocity were assessed for predictive value based on subsequent fistula adequacy. Fistula flow rates were determined 6 to 12 weeks postoperatively in a subset of patients. Results. Failed and successful fistulas were similar in their preoperative arterial and vein diameters, resistive index, and peak systolic velocity during fist clenching and after fist relaxation. Specifically, there was no difference in fistula success with radial artery peak systolic velocity lower than 50 cm/s versus peak systolic velocity of 50 cm/s or higher. The change in peak systolic velocity after fist relaxation was highly predictive of subsequent fistula outcome among female patients in ad hoc analysis. Fistula adequacy for dialysis in women was 11% when the change in peak systolic velocity was lower than 0 cm/s and 50% when the change was 0 cm/sec or higher (P = .02). The postoperative fistula flow rates were lower when the preoperative change in peak systolic velocity was lower than 0 cm/s than when it was 0 cm/s or higher (316 ± 46 versus 781 ± 150 mL/min; P = .003). Conclusions. There was no difference in the preoperative peak systolic velocity or the resistive index of successful and failed fistulas. Measurement of the radial artery peak systolic velocity change after release of fist clenching was not useful in predicting outcomes in male patients but identified a subset of female patients with a very low likelihood of success. This criterion may merit further investigation in future trials.

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Hemodialysis access placement with preoperative noninvasive vascular mapping: Comparison between patients with and without diabetes

Cited by 116 publications

References 10 publications

Current Management of Vascular Access

Current Management of Vascular Access

Endovascular Treatment of the “Failing to Mature” Arteriovenous Fistula

Preoperative Sonographic Radial Artery Evaluation and Correlation With Subsequent Radiocephalic Fistula Outcome

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