Salvage of immature forearm fistulas for haemodialysis by interventional radiology

Turmel-Rodrigues, Luc; Mouton, Albert; Birmelé, Béatrice; Billaux, Luc; Ammar, Naji; Grezard, O.; Hauss, Serge; Pengloan, J

doi:10.1093/ndt/16.12.2365

Cited by 216 publications

(168 citation statements)

References 20 publications

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“…In other words, the majority (over two thirds) of new AVFs matured, despite sonographic evidence for postoperative stenosis and no prophylactic intervention to repair the stenosis. Previous reports have observed a high frequency of juxta-anastomotic or draining vein stenosis in immature AVFs, with angioplasty converting many of them to mature AVFs (17,18). Taken together, these findings suggest that stenosis is necessary but not sufficient for the pathogenesis of AVF nonmaturation.…”

Section: Discussionmentioning

confidence: 58%

Preoperative Venous Intimal Hyperplasia, Postoperative Arteriovenous Fistula Stenosis, and Clinical Fistula Outcomes

Allon

Robbin²,

Young

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Arteriovenous fistulas often fail to mature, and nonmaturation has been attributed to postoperative stenosis caused by aggressive neointimal hyperplasia. Preexisting intimal hyperplasia in the native veins of uremic patients may predispose to postoperative arteriovenous fistula stenosis and arteriovenous fistula nonmaturation.Design, setting, participants, & measurements This work explored the relationship between preexisting venous intimal hyperplasia, postoperative arteriovenous fistula stenosis, and clinical arteriovenous fistula outcomes in 145 patients. Venous specimens obtained during arteriovenous fistula creation were quantified for maximal intimal thickness (median thickness=22.3 mm). Postoperative ultrasounds at 4-6 weeks were evaluated for arteriovenous fistula stenosis. Arteriovenous fistula maturation within 6 months of creation was determined clinically.Results Postoperative arteriovenous fistula stenosis was equally frequent in patients with preexisting venous intimal hyperplasia (thickness.22.3 mm) and patients without hyperplasia (46% versus 53%; P=0.49). Arteriovenous fistula nonmaturation occurred in 30% of patients with postoperative stenosis versus 7% of those patients without stenosis (hazard ratio, 4.33; 95% confidence interval, 1.55 to 12.06; P=0.001). The annual frequency of interventions to maintain arteriovenous fistula patency for dialysis after maturation was higher in patients with postoperative stenosis than patients without stenosis (0.83 [95% confidence interval, 0.58 to 1.14] versus 0.42 [95% confidence interval, 0.28 to 0.62]; P=0.008).Conclusions Preexisting venous intimal hyperplasia does not predispose to postoperative arteriovenous fistula stenosis. Postoperative arteriovenous fistula stenosis is associated with a higher arteriovenous fistula nonmaturation rate. Arteriovenous fistulas with hemodynamically significant stenosis frequently mature without an intervention. Postoperative arteriovenous fistula stenosis is associated with an increased frequency of interventions to maintain long-term arteriovenous fistula patency after maturation.

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Section: Discussionmentioning

confidence: 58%

Preoperative Venous Intimal Hyperplasia, Postoperative Arteriovenous Fistula Stenosis, and Clinical Fistula Outcomes

Allon

Robbin²,

Young

et al. 2013

Clinical Journal of the American Society of Nephrology

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“…However, we strongly believe that endovascular treatment should be attempted before surgery is considered for the following reasons: (1) We and others (22)(23)(24)33) have demonstrated that endovascular treatment is associated with excellent success rates, low complication rates, and promising long-term patency rates (24). Most important, this is done without the introduction and assistance of synthetic polytetrafluroethylene grafts.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Treatment of the “Failing to Mature” Arteriovenous Fistula

Nassar

Nguyen

Rhee

et al. 2006

Clinical Journal of the American Society of Nephrology

143

100

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In recent literature, surgically created hemodialysis (HD) arteriovenous fistulas (AVF) have high rates of primary failure. Endovascular treatment holds promise to salvage these fistulae. The outcomes of 119 patients who had a "failing to mature" AVF and presented for endovascular management were evaluated prospectively. All patients underwent a fistulogram. Stenotic lesions underwent balloon angioplasty, and accessory veins underwent obliteration. Technical success was determined immediately after the procedure. AVF salvage was determined by successful use during HD. Patients were followed up for 1 yr, during which primary and secondary AVF patency rates were measured. T he low prevalence of the arteriovenous fistula (AVF) among US hemodialysis (HD) patients (1,2) has initiated nationwide measures to increase AVF creation and prevalence (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Among these are providing educational programs, setting forth guidelines and goals (3,4), implementing multidisciplinary approaches (4 -9), encouraging preoperative venous mapping (14 -19), and asking surgeons to create AVF instead of arteriovenous grafts (AVG) (10 -21).Overall, an increase in AVF prevalence is occurring in the United States, albeit at a slow rate (14 -20). One impediment has been high primary failure rates, which in recent series ranged between 23 and 46% (9,(12)(13)(14). The use of ultrasound or other means of preoperative venous mapping is likely to decrease the incidence of primary AVF failures (14 -19). However, the increasing demand to create more fistulas may lead to their creation in borderline vessels, thereby increasing primary failure rates (21-23). Thus, salvage of these primary failures will be essential for increasing AVF prevalence in the United States.In our dedicated endovascular suite, we used percutaneous angioplasty and accessory vein obliteration in attempts to salvage fistulas with primary failure. Because most did not present with thrombosis, we elected to refer to their fistulas as "failing to mature." In this article, we report our initial success rates as well as follow-up on a series of 119 consecutive patients who were referred for salvage of their "failing to mature" AVF. Materials and Methods DefinitionsThe "failing to mature" AVF in our series was defined as an AVF that had been created for at least 8 wk but had not matured enough to allow successful cannulation or use during HD. This includes (1) fistulas that were never cannulated for HD be cause of obvious lack of maturity; (2) fistulas that failed first cannulation attempts and were abandoned; (3) fistulas that were cannulated successfully but could not be used because the blood flow was insufficient to sustain HD; this may have been because of high venous pressure or poor arterial inflow; and (4) fistulas that thrombosed before any attempts at HD. Juxta-arterial anastomosis segment refers to the initial 5 cm of the AVF starting at the arterial anastomosis. Peripheral vein refers to the venous outflow tract of t...

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“…In another analysis, Turmel-Rodrigues et al (11) demonstrated the successful application of endovascular techniques to salvage an AVF that had failed to mature.…”

Section: Interventions To Salvage With Early Avf Failurementioning

confidence: 99%

Early Arteriovenous Fistula Failure

Asif

Roy‐Chaudhury²,

Beathard³

2006

Clinical Journal of the American Society of Nephrology

255

213

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A significant number of arteriovenous fistulae (28 to 53%) never mature to support dialysis. Often, renal physicians and surgeons wait for up to 6 months and even longer hoping that the arteriovenous fistula (AVF) will eventually grow to support dialysis before declaring that the AVF has failed. In the interim, if dialysis is needed, then a tunneled catheter is inserted, exposing the patient to the morbidity and mortality associated with the use of this device. In general, a blood flow of 500 ml/min and a diameter of at least 4 mm are needed for an AVF to be adequate to support dialysis therapy. In most successful fistulae, these parameters are met within 4 to 6 wk. Most important, commonly encountered problems (stenosis and accessory veins) that result in early AVF failure can be diagnosed easily with skillful physical examination. Recent studies have indicated that a great majority of fistulae that have failed to mature adequately can be salvaged by percutaneous interventions and become available for dialysis. Early intervention regarding identification and salvage of a nonmaturing AVF is critical for several reasons. First, an AVF is the best available type of access regarding complications, costs, morbidity, and mortality. Second, this approach minimizes catheter use and its associated complications. Finally, access stenosis is a progressive process and eventually culminates in complete occlusion, leading to access thrombosis. In this context, the opportunity to salvage the AVF that fails early may be lost. This report reviews the process of AVF maturation and suggests a strategy for when and how to intervene to identify and salvage AVF with early failure.

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Salvage of immature forearm fistulas for haemodialysis by interventional radiology

Cited by 216 publications

References 20 publications

Preoperative Venous Intimal Hyperplasia, Postoperative Arteriovenous Fistula Stenosis, and Clinical Fistula Outcomes

Preoperative Venous Intimal Hyperplasia, Postoperative Arteriovenous Fistula Stenosis, and Clinical Fistula Outcomes

Endovascular Treatment of the “Failing to Mature” Arteriovenous Fistula

Early Arteriovenous Fistula Failure

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