Preemptive Open Surgical vs. Endovascular Repair for Juxta-Anastomotic Stenoses of Autogenous AV Fistulae: A Meta-Analysis

Argyriou, Christos; Schoretsanitis, Nikolaos; Georgakarakos, Efstratios; Georgiadis, George S.; Lazarides, Miltos K.

doi:10.5301/jva.5000444

Cited by 17 publications

(8 citation statements)

References 21 publications

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“…Prior to this initiative, few comprehensive head-to-head comparisons of all possible interventions for the treatment of clinically relevant and/or symptomatic AVF stenoses have been published; most were individual studies comparing one or two interventions in a mix of anatomical locations and population sizes [18,[23][24][25][26][27]. The evidence from clinical trials of newer technologies, such as DCBs, is still growing [5,9,[27][28][29][30][31][32].…”

Section: Discussionmentioning

confidence: 99%

A UK Expert Consensus Approach for Managing Symptomatic Arteriovenous Fistula (AVF) Stenosis in Haemodialysis Patients

Jaffer

Gibbs

Gibson

et al. 2021

Cardiovasc Intervent Radiol

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Purpose Stenoses in mature arteriovenous fistulas (AVFs) are common and can negatively impact on the quality of haemodialysis, the longevity of the AVF and lead to debilitating symptoms. Multiple treatment options exist; however, management can vary between different centres. We aimed to establish multidisciplinary consensus on the optimal stepwise application of interventions based on evidence and consensus. Methods A modified Delphi process was conducted with 13 participants from hospitals across the UK, all of whom have high-volume dialysis access practice. Results The usual intervention to rectify de novo stenoses of mature AVFs is fistuloplasty, although surgery for inflow segment stenoses is also clinically acceptable. Appropriate first-line interventions include plain old balloon angioplasty or high-pressure balloon angioplasty; if these fail during the fistuloplasty, consider upsizing the balloon, prolonged balloon inflation or using alternative interventions, such as cutting or scoring balloons and ultrahigh-pressure balloons. Alternative or subsequent interventions vary by anatomical site and may require additional multidisciplinary team input. For a stenoses recurring between 3 and 12 months, it is appropriate to consider interventions used de novo, but with a lower threshold for using drug-coated balloons (DCBs) in all regions and for using stent grafts in all regions but inflow segment. Recurrence after 12 months should be treated as a de novo lesion, with DCBs considered if they have been used successfully during previous interventions. Conclusions These recommendations aim to provide a practical guide to multidisciplinary teams in order to optimise the use of multiple interventions for rectifying

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Section: Discussionmentioning

confidence: 99%

A UK Expert Consensus Approach for Managing Symptomatic Arteriovenous Fistula (AVF) Stenosis in Haemodialysis Patients

Jaffer

Gibbs

Gibson

et al. 2021

Cardiovasc Intervent Radiol

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“…Clinically, timely surgical correction provides much longer access patency in certain cases, such as the juxta-anastomotic stenosis and cephalic arch stenosis with frequent recurrence [ 12 , 13 ], and reduces unnecessary endovascular procedures, including angioplasty and stent deployment. The NKF-KDOQI guidelines recommended that patients should be re-evaluated for possible construction of a secondary fistula following each episode of access failure [ 14 ], and considered for surgical revision prior to stent deployment unless they have a surgically inaccessible lesion or contraindications for surgery [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Current treatment status and medical costs for hemodialysis vascular access based on analysis of the Korean Health Insurance Database

Lee

Song

et al. 2018

Korean J Intern Med

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Background/AimsThe Republic of Korea is a country where the hemodialysis population is growing rapidly. It is believed that the numbers of treatments related to vascular access-related complications are also increasing. This study investigated the current status of treatment and medical expenses for vascular access in Korean patients on hemodialysis.MethodsThis was a descriptive observational study. We inspected the insurance claims of patients with chronic kidney disease who underwent hemodialysis between January 2008 and December 2016. We calculated descriptive statistics of the frequencies and medical expenses of procedures for vascular access.ResultsThe national medical expenses for access-related treatment were 7.12 billion KRW (equivalent to 6.36 million USD) in 2008, and these expenses increased to 42.12 billion KRW (equivalent to 37.67 million USD) in 2016. The population of hemodialysis patients, the annual frequency of access-related procedures, and the total medical cost for access-related procedures increased by 1.6-, 2.6-, and 5.9-fold, respectively, over the past 9 years. The frequency and costs of access care increased as the number of patients on hemodialysis increased. The increase in vascular access-related costs has largely been driven by increased numbers of percutaneous angioplasty.ConclusionsThe increasing proportion of medical costs for percutaneous angioplasty represents a challenge in the management of end-stage renal disease in Korea. It is essential to identify the clinical and physiological aspects as well as anatomical abnormalities before planning angioplasty. A timely surgical correction could be a viable option to control the rapid growth of access-related medical expenses.

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“…Similar to angioplasty, there are also several subtypes of stents beyond standard bare-metal stents, including drug-eluting and fabric-covered [8]. Although open surgical revision of existing access sites may also be performed, this is becoming less common given the various minimally invasive options [9].…”

Section: Rationalementioning

confidence: 99%

Efficacy and safety of secondary procedures for maintaining arteriovenous hemodialysis access patency: protocol for a systematic review and network meta-analysis

et al. 2020

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Background: Arteriovenous (AV) hemodialysis access creation is recommended by international guidelines as the preferred method of hemodialysis access. However, most AV access sites will require revision to maintain patency. Although several treatment options exist, many have not been directly compared. We intend to compare the relative effectiveness of methods to maintain post-intervention primary patency of failing AV access. Methods: We will search EMBASE, MEDLINE, CENTRAL, trial registries, the grey literature, and ancestry and citation search from January 1977 to present, for randomized controlled trials comparing interventions to maintain primary patency of AV access. Two investigators will independently and blindly review all identified citations and extract data from included studies. The primary outcome is the primary patency 6 months after intervention. Secondary outcomes include immediate technical and functional success, reinterventions, patency, and mortality. Risk of bias, subgroup analyses, and sensitivity analyses are planned. Discussion: There are a number of treatment modalities for the management of failing AV access. However, most modalities have only been directly compared with plain old balloon angioplasty, and currently synthesized evidence focuses on individual pairwise comparisons. In light of the lack of comprehensively synthesized evidence and clinical equipoise, our study intends to synthesize currently available evidence though it is unclear which treatment modality is most effective.

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Preemptive Open Surgical vs. Endovascular Repair for Juxta-Anastomotic Stenoses of Autogenous AV Fistulae: A Meta-Analysis

Abstract: The available evidence, based on non-randomized cohort studies, suggests that surgery is the best way to treat 'juxta-anastomotic' stenotic lesions in distal radial-cephalic AVFs, although angioplasty remains a valuable but less durable option in this location of the stenosis.

Cited by 17 publications

References 21 publications

A UK Expert Consensus Approach for Managing Symptomatic Arteriovenous Fistula (AVF) Stenosis in Haemodialysis Patients

A UK Expert Consensus Approach for Managing Symptomatic Arteriovenous Fistula (AVF) Stenosis in Haemodialysis Patients

Current treatment status and medical costs for hemodialysis vascular access based on analysis of the Korean Health Insurance Database

Efficacy and safety of secondary procedures for maintaining arteriovenous hemodialysis access patency: protocol for a systematic review and network meta-analysis

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