Pulmonary Embolism Associated with Dialysis Access Procedure

Beathard, Gerald A.

doi:10.1007/978-1-4614-8803-3_26

Cited by 2 publications

(2 citation statements)

References 138 publications

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“…Native AVF is less thrombogenic than AVG 13–18 . AVF was historically invented by Brescia and Cimino to overcome the thrombogenic nature of Scribner external shunt 19,20 .…”

Section: Discussionmentioning

confidence: 99%

Evaluation of outcomes with permanent vascular access in an elderly Korean population based on the National Health Insurance Service database

Kim

Park

Ban

et al. 2023

Hemodialysis International

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Introduction: As nearly half of patients with end-stage kidney disease (ESKD) who initiate hemodialysis (HD) are over 65 years old (commonly defined as elderly), the fistula first strategy is controversial even in HD patients ≥65 years.Methods: In Korea's National Health Insurance Service database from 2008 to 2019, 41,989 elderly (≥ 65 years) HD patients were retrospectively reviewed to identify their clinical characteristics and outcomes. Vascular access (VA) patencies, risk factors associated with patencies and patient survival between arteriovenous fistula (AVF) and arteriovenous graft (AVG) were compared.Results: Elderly AVF group (n = 28,467) had superior primary, primary assisted, and secondary patencies than elderly AVG group (n = 13,522) (all p values are <0.001). Patient survival was also better in the elderly AVF group than in the elderly AVG (p < 0.001). In multivariate Cox regression analyses for diverse outcomes, AVG (vs. AVF) was identified as a risk factor for allcause mortality (adjusted hazard ratio [HR]: 1.307; 95% confidence interval [CI]: 1.272-1.343; p < 0.001), primary patency (adjusted HR: 1.745; 95% CI: 1.701-1.790; p < 0.001), primary-assisted patency (adjusted HR: 2.163; 95% CI: 2.095-2.233; p < 0.001), and secondary patency (adjusted HR: 3.718; 95% CI: 3.533-3.913; p < 0.001). Conclusion: Our study demonstrated that as a permanent VA for HD, AVF should be strongly considered in elderly (≥ 65 years) ESKD Korean patients. The age limit for AVF creation in ESKD patients should be adjusted more upward.

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“…Native AVF is less thrombogenic than AVG 13–18 . AVF was historically invented by Brescia and Cimino to overcome the thrombogenic nature of Scribner external shunt 19,20 .…”

Section: Discussionmentioning

confidence: 99%

Evaluation of outcomes with permanent vascular access in an elderly Korean population based on the National Health Insurance Service database

Kim

Park

Ban

et al. 2023

Hemodialysis International

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“…The presence of a high-flow hemodialysis fistula is associated with multiple adverse outcomes. These include steal syndrome [25], exotic complications such as hemothorax [26] or pulmonary embolism [27], and the impairment of cardiac function with high-output heart failure resulting from a large proportion a large proportion of the cardiac output recirculated through the enlarged fistulas [22,28,29]. While our working definition of CEF in our study was not harmonized to the diagnosis of ultrasonography-defined megafistula with high overall flow nor did we perform the Nicoladoni-Branham maneuver, our study entertains yet another striking possibility contributing to enlargement of arteriovenous accesses; the one of chronic salt-water overload.…”

Section: Discussionmentioning

confidence: 99%

The association of overhydration with megafistulas in hemodialysis patients

et al. 2019

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Objectives: Diffuse enlargements of arteriovenous dialysis fistulas customarily attributed to either excessive arterial inflow or central outflow stenosis. The relationship between volume status and clinically enlarged (arteriovenous) fistula (CEF) formation in end-stage renal disease (ESRD) patients is not well understood. Methods: We assessed the pre-dialysis bioimpedance spectroscopy-measured percentage of overhydration (OH%) in 13 prevalent dialysis patients with CEF development and negative angiography and compared the results with those of 52 control dialysis patients (CONTR). All patients were prevalent ESRD patients receiving thrice-weekly maintenance hemodiafiltration at an academic outpatient dialysis unit. Results: 10/13 CEF patients had OH% ≥15% as compared to 20/52 control patients (Chi square p : .02). The degree of OH% was 20.2 ± 7.4% among the CEF vs. 14.4 ± 7.1% in the control group (Student’s t -test p : .01), representing 4.2 ± 3.2 vs. 2.8 ± 1.6 L of excess fluid pre-dialysis ( p : .03). Patients with CEF development took an average of 1.7 ± 1.4 vs. 0.8 ± 0.8 ( p : .002) antihypertensive medications compared to the CONTR patients, yet their blood pressure was higher: 156/91 vs. 141/78 mmHg (systolic/diastolic p : .03<.0001). We found no difference in fistula vintage, body mass index, age, diabetes status, or diuretic use. The odds ratio of having a CEF in patients with ≥15% OH status was 5.3 (95% CI: 1.3–21.7; p : .01), the Number Needed to Harm with overhydration was 4. Conclusions: There is an association between bioimpedance spectroscopy-measured overhydrated clinical state and the presence of CEF; either as an increased volume capacitance or as a potential cause.

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Pulmonary Embolism Associated with Dialysis Access Procedure

Cited by 2 publications

References 138 publications

Evaluation of outcomes with permanent vascular access in an elderly Korean population based on the National Health Insurance Service database

Evaluation of outcomes with permanent vascular access in an elderly Korean population based on the National Health Insurance Service database

The association of overhydration with megafistulas in hemodialysis patients

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