Hemodialysis vascular access survival: Upper-arm native arteriovenous fistula

Dixon, Bradley S.; Novak, Lisa; Fangman, Jerry

doi:10.1053/ajkd.2002.29886

Cited by 267 publications

(207 citation statements)

References 24 publications

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“…Only approximately 45% of AVF are functional without intervention after creation (32); the procedure rate is 1.45 (33) to 3.3 procedures per AVF required for maturation or 1.75 procedures per access year (32). Once an AVF is matured, the revision rate ranges from 0.17 to 0.57 (20,21,(73)(74)(75) and is required in approximately 50% of AVF (32,76). This contrasts to fewer interventions for graft maturation, whereas the revisions required for grafts per access year ranges between 0.44 and 1.80 (20,21,73,75,77) (typically three to six rimes greater than for AVF).…”

Section: Impact On the Patient: The Patient Is Firstmentioning

confidence: 99%

“…Once an AVF is matured, the revision rate ranges from 0.17 to 0.57 (20,21,(73)(74)(75) and is required in approximately 50% of AVF (32,76). This contrasts to fewer interventions for graft maturation, whereas the revisions required for grafts per access year ranges between 0.44 and 1.80 (20,21,73,75,77) (typically three to six rimes greater than for AVF). In balance, whereas fistulas require up to three times more interventions for maturation, grafts can require up to six times more interventions for maintenance to achieve similar cumulative survival ( Figure 6).…”

Section: Impact On the Patient: The Patient Is Firstmentioning

confidence: 99%

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Fistula First Initiative

Lok¹

2007

Clinical Journal of the American Society of Nephrology

268

231

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Section: Impact On the Patient: The Patient Is Firstmentioning

confidence: 99%

Section: Impact On the Patient: The Patient Is Firstmentioning

confidence: 99%

Fistula First Initiative

Lok¹

2007

Clinical Journal of the American Society of Nephrology

268

231

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“…arteriovenous fistula; hemodialysis; neointima THE ARTERIOVENOUS (A-V) fistula is the preferred type of vascular access for hemodialysis patients (29). It achieves higher patency rates, has fewer complications than synthetic grafts (12,29,31), and has a lower risk of infections than central venous catheters (17,29). Despite its advantages, A-V fistulae frequently fail to mature or become dysfunctional after successful dialysis sessions, and this occurs primarily due to the development of neointimal hyperplasia (NIH) within the A-V fistula circuit (2, 5, 39).…”

mentioning

confidence: 99%

c-Kit signaling determines neointimal hyperplasia in arteriovenous fistulae

Skartsis

Martinez

Duque

et al. 2014

American Journal of Physiology-Renal Physiology

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Skartsis N, Martinez L, Duque JC, Tabbara M, Velazquez OC, Asif A, Andreopoulos F, Salman LH, Vazquez-Padron RI. c-Kit signaling determines neointimal hyperplasia in arteriovenous fistulae. Am J Physiol Renal Physiol 307: F1095-F1104, 2014. First published September 3, 2014 doi:10.1152/ajprenal.00292.2014.-Stenosis of arteriovenous (A-V) fistulae secondary to neointimal hyperplasia (NIH) compromises dialysis delivery, which worsens patients' quality of life and increases medical costs associated with the maintenance of vascular accesses. In the present study, we evaluated the role of the receptor tyrosine kinase c-Kit in A-V fistula neointima formation. Initially, c-Kit was found in the neointima and adventitia of human brachiobasilic fistulae, whereas it was barely detectable in control veins harvested at the time of access creation. Using the rat A-V fistula model to study venous vascular remodeling, we analyzed the spatial and temporal pattern of c-Kit expression in the fistula wall. Interestingly, c-Kit immunoreactivity increased with time after anastomosis, which concurred with the accumulation of cells in the venous intima. In addition, c-Kit expression in A-V fistulae was positively altered by chronic kidney failure conditions. Both blockade of c-Kit with imatinib mesylate (Gleevec) and inhibition of stem cell factor production with a specific short hairpin RNA prevented NIH in the outflow vein of experimental fistulae. In agreement with these data, impaired c-Kit activity compromised the development of NIH in A-V fistulae created in c-Kit W/Wv mutant mice. These results suggest that targeting of the c-Kit signaling pathway may be an effective approach to prevent postoperative NIH in A-V fistulae. arteriovenous fistula; hemodialysis; neointima THE ARTERIOVENOUS (A-V) fistula is the preferred type of vascular access for hemodialysis patients (29). It achieves higher patency rates, has fewer complications than synthetic grafts (12,29,31), and has a lower risk of infections than central venous catheters (17,29). Despite its advantages, A-V fistulae frequently fail to mature or become dysfunctional after successful dialysis sessions, and this occurs primarily due to the development of neointimal hyperplasia (NIH) within the A-V fistula circuit (2, 5, 39). Stenosed A-V fistulae can sometimes be salvaged through angioplasty or surgical interventions, but these attempts often result in restenosis or additional complications (32). Therefore, there is an unmet medical need for treatments that prevent NIH and improve A-V fistula function. To this end, it is necessary to better define the factors underlying the pathological remodeling of the A-V fistula wall.A-V fistula maturation is a dynamic vascular process with multiple factors contributing to the development of NIH. These include vein configuration (22) In the present study, we investigated the role of c-Kit in the pathological remodeling of A-V fistulae. We show that activation of the c-Kit signaling pathway in adventitial and neointimal cells precedes arteri...

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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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Hemodialysis vascular access survival: Upper-arm native arteriovenous fistula

Cited by 267 publications

References 24 publications

Fistula First Initiative

Fistula First Initiative

c-Kit signaling determines neointimal hyperplasia in arteriovenous fistulae

Endovascular Treatment of the “Failing to Mature” Arteriovenous Fistula

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