Improved hemodialysis access in children

Applebaum, Harry; Shashikumar, V.L.; Somers, Laurence A.; Baluarte, H. Jorge; Gruskin, Alan B.; Grossman, Michael D.; McGarvey, M.; Weintraub, William H.

doi:10.1016/s0022-3468(80)80279-x

Cited by 21 publications

(4 citation statements)

References 8 publications

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“…AVG is the second step of treatment, following the AVF made with native vessels. 16 In selected cases, an AVG is indicated as the first line of treatment, such as in cases of paucity of autologous material and/or for a short predictable period of hemodialytic treatment (children), 17 or in patients with short obese limbs, where the superficial veins are deep in the subcutaneous tissue, and finally in patients with extreme vascular fragility (thrombocytopenic purpura), where the simple venous puncture produces wounds and serious hematomas. 18 The prosthetic AV access has been the most common access for dialysis in the US.…”

Section: Arteriovenous Graft (Avg)mentioning

confidence: 99%

Vascular access for hemodialysis: current perspectives

Santoro¹,

Benedetto²,

Mondello³

et al. 2014

IJNRD

266

257

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A well-functioning vascular access (VA) is a mainstay to perform an efficient hemodialysis (HD) procedure. There are three main types of access: native arteriovenous fistula (AVF), arteriovenous graft, and central venous catheter (CVC). AVF, described by Brescia and Cimino, remains the first choice for chronic HD. It is the best access for longevity and has the lowest association with morbidity and mortality, and for this reason AVF use is strongly recommended by guidelines from different countries. Once autogenous options have been exhausted, prosthetic fistulae become the second option of maintenance HD access alternatives. CVCs have become an important adjunct in maintaining patients on HD. The preferable locations for insertion are the internal jugular and femoral veins. The subclavian vein is considered the third choice because of the high risk of thrombosis. Complications associated with CVC insertion range from 5% to 19%. Since an increasing number of patients have implanted pacemakers and defibrillators, usually inserted via the subclavian vein and superior vena cava into the right heart, a careful assessment of risk and benefits should be taken. Infection is responsible for the removal of about 30%–60% of HD CVCs, and hospitalization rates are higher among patients with CVCs than among AVF ones. Proper VA maintenance requires integration of different professionals to create a VA team. This team should include a nephrologist, radiologist, vascular surgeon, infectious disease consultant, and members of the dialysis staff. They should provide their experience in order to give the best options to uremic patients and the best care for their VA.

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Section: Arteriovenous Graft (Avg)mentioning

confidence: 99%

Vascular access for hemodialysis: current perspectives

Santoro¹,

Benedetto²,

Mondello³

et al. 2014

IJNRD

266

257

View full text Add to dashboard Cite

show abstract

“…AVGs are justified by some on the basis of the need to prevent use of a central venous catheter in patients presenting late for vascular access 6 and in children who cannot tolerate multiple venipunctures associated with autogenous fistulas. 7 Here, we report an unusual case of lower limb gigantism, chronic lymphedema, and painful varicosities complicating a long-term thigh prosthetic AVG. thigh prosthetic AVG insertion for hemodialysis access 5 years ago.…”

Section: Introductionmentioning

confidence: 91%

“…Lack of suitable vessels is common, particularly in elderly, patients with diabetes, or due to destruction by indiscriminate venipuncture. AVGs are justified by some on the basis of the need to prevent use of a central venous catheter in patients presenting late for vascular access and in children who cannot tolerate multiple venipunctures associated with autogenous fistulas . Here, we report an unusual case of lower limb gigantism, chronic lymphedema, and painful varicosities complicating a long‐term thigh prosthetic AVG.…”

Section: Introductionmentioning

confidence: 95%

Lower limb gigantism, lymphedema, and painful varicosities following a thigh vascular access graft

Thompson

Thiyagarajan

Akoh

2014

Hemodialysis International

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Prosthetic arteriovenous grafts (AVGs) are associated with greater morbidity than autogenous arteriovenous fistulas (AVFs), but their use is indicated when AVF formation is not possible. This report adds to the literature a case of lower limb gigantism, painful varicosities, and lymphedema following long-term use of AVG in the upper thigh. The patient's past medical history included renal transplantation on the same side well before the AVG was inserted and right leg deep vein thrombosis. Suspicion of AVG thrombosis was excluded by Doppler ultrasound, which demonstrated an access flow of 1700 mL/min. A computed tomography (CT) scan of the abdomen and pelvis did not identify the cause of her symptoms. Whereas functional incompetence of the iliac vein valve might be responsible for the varicosities, the extent of hypertrophy in this case raises the suspicion of lymphatic blockage possibly secondary to groin dissection undertaken at the time of graft insertion, in addition to the previous dissection at the time of transplantation. This case highlights the need for minimal groin dissection during AVG insertion, particularly in patients with a history of previous abdominopelvic surgery.

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“…There are, however, a number of children who require acute haemodialysis-those with acute renal failure in whom acute peritoneal dialysis is not feasible and those undergoing long term dialysis in whom there is a failure of established vascular access or peritoneal dialysis. While internal fistulae using polytetrafluoroethylene grafts may be used to provide acute access in these children, such grafts have a high incidence of thrombosis, infection, and pseudoaneurysm formation.4 7 8 For these reasons, vascular access for acute haemodialysis usually requires some form of external device.…”

mentioning

confidence: 99%