Reinforced Aneurysmorrhaphy for True Aneurysmal Haemodialysis Vascular Access

Rokošný, Slavomír; Baláž, Peter; Wohlfahrt, Peter; Palouš, D.; Janoušek, L

doi:10.1016/j.ejvs.2014.01.010

Cited by 24 publications

(27 citation statements)

References 19 publications

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“…The advantages of aneurysmorrhaphy compared with ligation are the preservation of vascular access and an excellent long-term patency with minimal periprocedural complications. 10 In previously published studies, AVF closure has been shown to decrease left ventricular diameter and mass. 7,15,16 However, results of the present study show that the effect of AVF reduction on heart remodeling is not present in all patients and is dependent on cardiac index before operation but does not depend on increased AVF flow.…”

Section: Discussionmentioning

confidence: 97%

Cardiac remodeling after reduction of high-flow arteriovenous fistulas in end-stage renal disease

et al. 2016

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In patients with end-stage renal disease, excessive blood flow through an arteriovenous fistula (AVF) may lead to volume overload-induced cardiac remodeling and heart failure. It is unclear which patients with hyperfunctional AVF may benefit from AVF reduction or ligation. The indication for the procedure is often based on AVF flow. Because cardiac remodeling is driven by increased venous return, which is equivalent to cardiac output, we hypothesized that an elevated cardiac index (CI) might better identify subjects with reverse remodeling after AVF reduction. Thirty patients (age 52±12 years, 73% male) with AVF flow ⩾1.5 l min(-1) underwent comprehensive echocardiographic evaluations before and after AVF reduction. At baseline, 16 patients had a normal CI (2.5-3.8 l min(-1) m(-2)) and 14 had a high CI (4.0-6.0 l min(-1) m(-2)). A left ventricular end-diastolic diameter decrease after operation was predicted by elevated baseline CI (P<0.01), but not elevated AVF flow (P=0.07). There was a significant decrease in CI, left ventricular mass, left atrial and right ventricular diameter and pulmonary systolic pressure in the high CI group but not in the normal CI group. After AVF reduction, systemic vascular resistance decreased in the normal CI group, whereas it did not change in the high CI group. In conclusion, reduction of high-flow AVF leads to reverse cardiac remodeling but only in patients with elevated CI. The variability of the response of systemic vascular resistance to AVF flow may explain this observation. Increased CI but not increased AVF flow may better determine candidates for AVF reduction.

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Section: Discussionmentioning

confidence: 97%

Cardiac remodeling after reduction of high-flow arteriovenous fistulas in end-stage renal disease

et al. 2016

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“…This novel approach is feasible to treat multiple extensive AVFAs but since cannulation of the repaired fi stulae has to be delayed for 4-6 weeks of recovery a temporary tunnelled dialysis catheter is needed. The 1-year primary patency results of remodelling techniques with and without support appear similar (86% [42] vs. 80-93% [19,43]). Primary patency rates of 88%, 84%, and 69% at 1, 2 and 3 years, respectively have also been reported using stapled aneurysmorrhaphy [18].…”

Section: Remodelling Techniquesmentioning

confidence: 87%

“…While several studies have reported on the treatment of high fl ow vascular access, only a few of them assess high fl ow vascular access in the presence of an aneurysm. Aneurysmorrhaphy with external mesh can signifi cantly reduce fl ow rates [35,43] and precipitate reverse cardiac remodelling with fl ow rates ≥ 1.5 L/min in patients with elevated cardiac index (≥ 3.9 L/min/m 2 ) [35]. However, aneurysmorrhaphy has proven unsuccessful with fl ow rates >2.5 L/min [19].…”

Section: Surgical Techniques For High Fl Ow Avfamentioning

confidence: 99%

Contemporary management of arteriovenous hemodialysis fistula aneurysms

2018

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SOUHRNÚvod: Aneurysma arteriovenózní fi stuly vzniká až u 60 % hemodialyzovaných pacientů. Často jde o asymptomatickou komplikaci, avšak s možným rizikem rozvoje závažných komplikací. Existuje řada chirurgických a endovaskulárních technik léčby, ale jasná klinická doporučení, kdy a jak intervenovat, chybějí. Autoři popisují klinický obraz, indikace k léčbě a současné možnosti léčby aneurysmatu arteriovenózní fi stuly. Metodika: Nesystematický přehled publikované literatury uvedených databází: MEDLINE, ScienceDirect, Scopus a Cochrane Database of Systematic Reviews. Do hodnocení byly zahrnuty publikace týkající se aneurysmatu arteriovenózní fi stuly a terapeutických možností od ledna 1973 do června 2016. Z hodnocení byly vyřazeny práce týkající se aneurysmatu a pseudoaneurysmatu protetických graftů. Výsledky: Aneurysma arteriovenózní fi stuly je defi nováno jako dilatace všech tří vrstev cévní stěny a průměrem větším než 18 mm. Indikace k léčbě jsou: bolestivost, riziko krvácení a neadekvátní průtok (nízký/vysoký). Samotný průměr aneurysmatu, stejně jako kosmetické důvody, by neměly být indikací k léčbě. Nejčastěji využívané terapeutické modality léčby aneurysma arteriovenózní fi stuly jsou: resekce s interpozicí, remodelační techniky a implantace stentgraftu. I když bylo publikováno několik léčebných metod, v současné době neexistuje publikace srovnávající jednotlivé léčebné techniky. Závěr: Asymptomatické aneurysma arteriovenózní fi stuly má být léčeno konzervativně s pravidelným sledováním. Vzhledem k absenci dostatečných důkazů neexistuje jasná strategie léčby pro aneurysma arteriovenózní fi stuly vyžadující intervenci. U symptomatického aneurysmatu, zejména s vysokým rizikem krvácení, by měla být co nejdříve indikována terapie.ABSTRACT Introduction: Aneurysms develop in up to 60% of patients with an arteriovenous fi stula. Frequently arteriovenous fi stula aneurysms are asymptomatic with the presence of symptoms potentially heralding the development a signifi cant complication. A range of surgical and endovascular techniques are available to manage arteriovenous fi stula aneurysms but clinical guidelines regarding the appropriate application of each approach are lacking. This review will examine the presentation, indications for treatment and management options for arteriovenous fi stula aneurysms. Methods: A non-systematic review of published literature in the following databases was performed: MEDLINE, ScienceDirect, Scopus and the Cochrane Database of Systematic Reviews. Publications relating to arteriovenous fi stula aneurysms and treatment options between January 1973 and June 2016 were considered for inclusion. Articles pertaining to aneurysms and pseudoaneurysms of prosthetic arteriovenous access sites were excluded. The literature search was supplemented by a review of the author's experience. Results: Arteriovenous fi stula aneurysms are defi ned by an expansion of the intimal, medial and adventitial layers of the vessel wall to a diameter of more than 18 mm. Treatment of arteriovenous fi stula aneur...

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“…19 ) With conventional methods, the dilated anastomosis is retained, and the mean blood pressure is higher than before surgery at the anastomosis site, which may cause the recurrence of high flow or aneurysm formation at the anastomosis site. 20 ) Moreover, even though various methods have been introduced for improving banding, 18 , 21 – 24 ) the period during which the access functions effectively after surgery is not very long that recurrence within 1 year after surgery was more than half. 13 , 16 )…”

Section: Discussionmentioning

confidence: 99%

Graft Inclusion Technique: A New Flow Reduction Procedure for High Flow Arteriovenous Fistulae

Nojima

Motomiya²

2018

Annals of Vascular Diseases

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Objective: Flow reduction is required to preserve vascular access in cases with high flow access (HFA). We report a new flow reduction procedure, the graft inclusion technique (GIT).Methods: The GIT procedure developed by us involves the intraluminal placement and suturing of a 4-mm polytetrafluoroethylene graft to the anastomosis and outflow tract to plicate the enlarged anastomosis and maintain lower flow volumes. Flow reduction for HFA was retrospectively assessed in a series of 25 patients (age 65±12 years; 17 males and 8 females) to evaluate flow volume and patency rate, wherein 10 patients underwent conventional methods of flow reduction and 15 underwent GIT.Results: Compared with preprocedure values, mean flow volume (MFV) was significantly lower after the procedure with both the conventional methods (1,817 vs. 586 ml/min; P<0.05) and the GIT (2,262 vs. 890 ml/min; P<0.05). An increase in MFV occurred during follow-up after conventional flow reduction (586 vs. 1,036 ml/min), while GIT could maintain lower MFV (890 vs. 791 ml/min), suggesting that GIT can significantly lower MFV levels (2,262 vs. 791 ml/min; P<0.05) and maintain these lower MFV levels during follow-up. Secondary patency rate for the GIT was 100% at 1 year and 83% at 3 years.Conclusion: The GIT may be used as an access-preserving, reliable, long-term, and stable flow-reducing procedure that does not require flow adjustment during surgery.

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Reinforced Aneurysmorrhaphy for True Aneurysmal Haemodialysis Vascular Access

Abstract: Reinforced aneurysmorrhaphy with an external mesh prosthesis is an effective method for treating true aneurysmal haemodialysis AV access, with excellent long-term patency and minimal complications due to infection.

Cited by 24 publications

References 19 publications

Cardiac remodeling after reduction of high-flow arteriovenous fistulas in end-stage renal disease

Cardiac remodeling after reduction of high-flow arteriovenous fistulas in end-stage renal disease

Contemporary management of arteriovenous hemodialysis fistula aneurysms

Graft Inclusion Technique: A New Flow Reduction Procedure for High Flow Arteriovenous Fistulae

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