Novel Therapies for Hemodialysis Vascular Access Dysfunction

Terry, Christi M.; Dember, Laura M.

doi:10.2215/cjn.07360713

Cited by 12 publications

(14 citation statements)

References 97 publications

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“…Animal models of AVF have been developed in both rodents (mice and rats) and large animals (pigs, rabbits, and sheep) to characterize the pathobiology of AV access failure and to design new therapeutic strategies aimed to improve durability and survival of these vascular conduits (49). Although large animals, such as pigs, have provided novel insight for device and therapeutic studies and for the initial understanding of the pathobiology of AVF and AVG dysfunction, murine models may have the greatest potential to provide more insight into the pathobiology of AVF failure because of the availability of transgenic mice.…”

Section: Novel Technologies and Strategies To Unravel Vascular Accessmentioning

confidence: 99%

New Insights into Dialysis Vascular Access: Molecular Targets in Arteriovenous Fistula and Arteriovenous Graft Failure and Their Potential to Improve Vascular Access Outcomes

Lee

Misra

2016

CJASN

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Vascular access dysfunction remains a major cause of morbidity and mortality in hemodialysis patients. At present there are few effective therapies for this clinical problem. The poor understanding of the pathobiology that leads to arteriovenous fistula (AVF) and graft (AVG) dysfunction remains a critical barrier to development of novel and effective therapies. However, in recent years we have made substantial progress in our understanding of the mechanisms of vascular access dysfunction. This article presents recent advances and new insights into the pathobiology of AVF and AVG dysfunction and highlights potential therapeutic targets to improve vascular access outcomes.

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Section: Novel Technologies and Strategies To Unravel Vascular Accessmentioning

confidence: 99%

New Insights into Dialysis Vascular Access: Molecular Targets in Arteriovenous Fistula and Arteriovenous Graft Failure and Their Potential to Improve Vascular Access Outcomes

Lee

Misra

2016

CJASN

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“…However, the creation and maintenance of a working access are still major challenges because of poor acceptability among patients and high rates of complications . Vascular access function is an important determinant of patient mortality, morbidity, and quality of life . As such, it is referred to as the “Achilles' Heel” of hemodialysis …”

Section: Introductionmentioning

confidence: 99%

“…2,3 Vascular access function is an important determinant of patient mortality, morbidity, and quality of life. [4][5][6][7] As such, it is referred to as the "Achilles' Heel" of hemodialysis. 3,8 Complications such as thrombosis and infection are common, potentially fatal, and are associated with…”

Section: Introductionmentioning

confidence: 99%

“You know your own fistula, it becomes a part of you”—Patient perspectives on vascular access: A semistructured interview study

Taylor

Hanson

Casey

et al. 2015

Hemodialysis International

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The success of hemodialysis depends on functional vascular access but such an invasive, semipermanent intervention can be confronting for patients. Vascular access complications are potentially life threatening and reduce treatment satisfaction and quality of life. This study aims to describe patient perspectives on vascular access. Face-to-face, semistructured interviews were conducted with 26 adult patients receiving hemodialysis with any form of vascular access at two dialysis units in Australia. The transcripts were analyzed using thematic analysis. We identified five major themes describing patient perspectives on vascular access: developing mental fortitude for access (accepting necessity for survival, self-advocacy, experiential confidence and competency, dependency on others, gaining vascular knowledge), device intrusiveness on the body (restricting normal function, finding compensatory solutions, bodily invasion, confronting appearance), inhibiting pain (aversion to surgery, persisting needle anxieties), exposure to dire health consequences (resigning to inevitable failure, anticipating serious complications, technological skepticism, wary of medical incompetence), and imposing burdens (generating additional expenses, encumbering family members). Patients with a vascular access rely on a precarious lifeline, which is confronting, intrusive, and burdensome. Some develop mental resilience to cope with the pain and invasiveness of vascular access. The results suggest that more attention to address needle anxieties, self-advocacy, lifestyle disruption, fear of complications, and concern for caregiver burden may improve treatment satisfaction and outcomes for patients on hemodialysis.

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“…Therefore, it should be considered only when all other treatment modalities have been exhausted. There are some preliminary reports about possible benefits of using covered stents, drug-eluting or more biocompatible stents as well as brachytherapy to prolong vein patency [ 18 – 20 ]. All the options have some theoretical advantages, but further investigation is needed.…”

Section: Discussionmentioning

confidence: 99%

Brachiocephalic Vein Stenting and Body-Floss Technique as a Treatment of CVD in Dialysis-Dependent Patient – Case Report and Literature Review

Witkiewicz¹

2015

Pol J Radiol

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SummaryBackgroundGiven the increasing number of elderly hemodialysis-dependent patients with concomitant chronic diseases the successful creation and maintenance of reliable vascular access become a real challenge. In current literature central vein disease (CVD) is defined as at least 50% narrowing up to total occlusion of central veins of the thorax including superior vena cava (SVC), brachiocephalic (BCV), subclavian (SCV) and internal jugular vein (IJV). The incidence of CVD has been reported to be as high as 23% in the total dialysis population and 41% in those with access related complains.Case Report61-year-old man has been admitted to the local radiology department with symptoms of the superior vena cava syndrome. The venography revealed occlusion of the right brachiocephalic vein. Due to Tortuosity and lack of stamp of right subclavian vein contributed to the decision to perform recanalization by “body floss” technique. In a further step we have performed PTA of obstructed vein segment using 7×40 mm balloon. Due to the presence of residual stenosis it was decided to implant two self – expanding stents 10×40 mm. After the procedure the patient was discharged in good condition and transferred to dialysis center.ConclusionsMain objective was the salvage of a functioning arteriovenous fistula. Performed endovascular intervention is a safe and effective approach to correct CVD for a short term. To ensure long lasting effects the patient will require enhanced follow-up and inevitable reinterventions. For that matter, prevention of CVD remains critical.

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Novel Therapies for Hemodialysis Vascular Access Dysfunction

Cited by 12 publications

References 97 publications

New Insights into Dialysis Vascular Access: Molecular Targets in Arteriovenous Fistula and Arteriovenous Graft Failure and Their Potential to Improve Vascular Access Outcomes

New Insights into Dialysis Vascular Access: Molecular Targets in Arteriovenous Fistula and Arteriovenous Graft Failure and Their Potential to Improve Vascular Access Outcomes

“You know your own fistula, it becomes a part of you”—Patient perspectives on vascular access: A semistructured interview study

Brachiocephalic Vein Stenting and Body-Floss Technique as a Treatment of CVD in Dialysis-Dependent Patient – Case Report and Literature Review

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