Most Important Chronic Complications of Arteriovenous Fistulas for Hemodialysis

Stolić, Radojica

doi:10.1159/000343669

Cited by 147 publications

(137 citation statements)

References 77 publications

(101 reference statements)

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“…Several studies have shown that patients who received treatment in outpatient dialysis facilities were at a high risk of developing infections, probably due to multiple factors such as the need for repeated vascular access through central venous catheters, arteriovenous grafts, or fistulas, and also frequent hospital visits and frequent receipt of antimicrobial drugs [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

A Retrospective Analysis of Dialysis Events over a 3-Year Period in an Outpatient Dialysis Unit in the State of Kuwait

Ramadan

Hebbar

2018

Med Princ Pract

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Objective: To determine the difference in the rates of dialysis events stratified by vascular access type and to describe the microbiological profile and sensitivity patterns of positive blood cultures over a 3-year period. Subjects and Methods: The dialysis event data of 10,751 chronic hemodialysis patients collected from March 2013 to February 2016 at an outpatient dialysis unit in Kuwait were reviewed. The dialysis events studied were: intravenous (IV) antimicrobial use, a positive blood culture, and signs of inflammation at the vascular access site. Dialysis event rates were stratified by the type of vascular access used for the dialysis, i.e., fistula, graft, and tunneled/nontunneled central line. Rates were expressed per 100 patient-months. Results: The overall dialysis event rate was (10.7/100 patient-months). The rate of IV antimicrobial use was higher (12.53/100 patient-months) in patients with tunneled central lines than in all other vascular access types (10.29/100 patient-months). Positive blood culture and inflammation at the vascular access site were highest in patients with nontunneled central lines (1.65 and 1.54/100 patient-months, respectively) when compared to those with other types of vascular access. Gram-negative rod isolates were predominant in patients with central lines (n = 35; 46.67%); however, common skin commensals and gram-negative rods were also identified in patients with fistula or graft (n = 4; 44.45%). Conclusion: Dialysis event rates were higher among patients with tunneled or nontunneled central lines than in patients with fistula or graft. Gram-negative rods were the most commonly isolated microbial group.

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Section: Introductionmentioning

confidence: 99%

A Retrospective Analysis of Dialysis Events over a 3-Year Period in an Outpatient Dialysis Unit in the State of Kuwait

Ramadan

Hebbar

2018

Med Princ Pract

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“…In fact, retrograde flow in the radial artery occurs in more than 70% of patients with AVF, which, however, does not cause ischemia in subjects with normal blood circulation [15] . Ischemic syndrome in physiological conditions results from a fall in blood pressure in the periphery and failure of compensatory vasodilatation [16] . Heart failure in HD patients has a multifactorial character [14,[17][18][19] .…”

Section: Hemodynamic Impact On the Development Of Distal Ischemiamentioning

confidence: 99%

Arteriovenous fistulas and digital hypoperfusion ischemic syndrome in patients on hemodialysis

Stolić¹

2013

WJN

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AIM:To determine survival parameters as well as characteristics of patients with this syndrome. METHODS:The investigation was conducted over a period of eight years, as a prospective, non-randomized, clinical study which included 204 patients, treated by chronic hemodialysis. Most patients received hemodialysis 12 h per week. As vascular access for hemodialysis all subjects had an arteriovenous fistulae. Based on surveys the respondents were divided into groups of patients with and without digital hypoperfusion ischemic syndrome. Gender, demographic and anthropometric characteristics, together with comorbidity and certain habits, were recorded. During this period 34.8% patients died. RESULTS:Patients with digital hypoperfusion ischemic syndrome were older than those without ischemia (P = 0.01). Hemodialysis treatment lasted significantly longer in the patients with digital hypoperfusion ischemic syndrome (P = 0.02). The incidence of cardiovascular disease (P < 0.001) and diabetes mellitus (P = 0.01), as well as blood flow through the arteriovenous fistula (P = 0.036), were higher in patients with digital hypoperfusion ischemic syndrome. Statistically significant differences also existed in relation to oxygen saturation (P = 0.04). Predictive parameters of survival for patients with digital hypoperfusion ischemic syndrome were: adequacy of hemodialysis (B = -3.604, P < 0.001), hypertension (B = -0.920, P = 0.018), smoking (B = -0.901, P = 0.049), diabetes mellitus (B = 1.227, P = 0.005), erythropoietin therapy (B = 1.274, P = 0.002) and hemodiafiltration (B = -1.242, P = 0.033). KaplanMeier survival analysis indicated that subjects with and without digital hypoperfusion ischemic syndrome differed regarding the length of survival (P < 0.001), i.e. , patients with confirmed digital hypoperfusion ischemic syndrome died earlier. CONCLUSION:Survival was significantly longer in the patients without digital hypoperfusion ischemic syndrome.© 2013 Baishideng. All rights reserved.Key words: Digital hypoperfusion ischemic syndrome; Predictive parameters; Survival; Arteriovenous fistula; Hemodialysis Core tip: In order to prevent the occurrence of distal hypoperfusion syndrome, is important identification of risk factors. Problem is the absence of objective indicators of distal ischemia, which is main reason why large proportion our patients have of this symptoms. Our patients with these symptoms were significantly older, which confirms older age as a factor that characterizes BRIEF ARTICLE 26May 6, 2013|Volume 2|Issue 2| WJN|www.wjgnet.com patients with distal hypoperfusion syndrome. We have confirmed greater incidence of diabetes mellitus and smokers among the patients with distal hypoperfusion syndrome. Quality of dialysis, diabetes mellitus, erythropoietin therapy, smokers and hemodiafiltration has predictive value for survival of patients with distal ischemia.Stolic RV, Trajkovic GZ, Miric DJ, Kisic B, Djordjevic Z, Azanjac GL, Stanojevic MS, Stolic DZ. Arteriovenous fistulas and digital hypoperfusion ischemic ...

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“…An AAVF not meeting these criteria has an increased risk of failure and further investigations may be required. 10 Several studies indicate that about 30% of hospitalisations are caused by the constriction and complications of vascular access. 11 Both artery and vein undergo marked changes in haemodynamic forces following creation of an AAVF resulting in vascular remodelling.…”

Section: Discussionmentioning

confidence: 99%

Autogenous Arteriovenous Fistula - A Clinical Study on a New Technique Georgemartha Technique

G¹

2016

jemds

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BACKGROUNDAutologous vascular access for haemodialysis is being performed by surgeons for vascular access, which should be without early failures. The first autogenous vascular access for haemodialysis was the Brescia-Cimino Radio-Cephalic direct wrist access 1966, with a superior patency of 75% at 4 years and a failure rate in the initial phase. A venous hood is formed over the artery at the site of anastomosis. Since then the technique has not changed due to its high success rate and low complications providing vascular access in treating the haemodialysis patients. Many factors play a role in persistence of these fistulae. Development of vascular kink in the cephalic vein is one such factor resulting in reduced blood flow and difficulty in access for haemodialysis. Even though it is under reported and remains elusive in its identification should not be ignored. Here, a new technique is described to refine this technique, which helps to prevent kinking of the draining AV fistula vein.To conceptualise and use a new technique to prevent kink in draining AV fistula vein at the site of anastomosis in Autologous Arteriovenous Fistula (AAVF) and also to study its success in preventing early failures. MATERIALS AND METHODS971 patients were divided into two groups. Group "A" patients were performed conventional AAVF. Group "B" patients were performed a new surgical technique to create AAVF. The new technique consisted of placing heel of the venous hood distally and the toe of the hood proximally. All the patients were followed up for 1 year and assessed clinically and on Doppler study for persistence of fistula and vascular flow. RESULTSGroup A included 223 patients undergoing conventional method of AAVF showed a failure rate of 5.82% at the end of first month and Group B patients undergoing the new technique described in the study showed no failure at the end of first month and both the groups were followed up for 1 year. The study was statistically significant with a p value of 0. CONCLUSIONThis new refined technique named by the author as George-Martha technique was found to be effective in preventing an immediate kink in the draining vein following AAVF for dialysis patients. The procedure is simple and easy to learn and can be adopted by the surgeon.

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Most Important Chronic Complications of Arteriovenous Fistulas for Hemodialysis

Cited by 147 publications

References 77 publications

A Retrospective Analysis of Dialysis Events over a 3-Year Period in an Outpatient Dialysis Unit in the State of Kuwait

A Retrospective Analysis of Dialysis Events over a 3-Year Period in an Outpatient Dialysis Unit in the State of Kuwait

Arteriovenous fistulas and digital hypoperfusion ischemic syndrome in patients on hemodialysis

Autogenous Arteriovenous Fistula - A Clinical Study on a New Technique Georgemartha Technique

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