Stenosis and thrombosis in haemodialysis fistulae and grafts: the surgeon's point of view

Mickley, V.

doi:10.1093/ndt/gfg504

Cited by 57 publications

(56 citation statements)

References 9 publications

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“…We identified 44 complicated true or false AVA-related aneurysms that required salvage operations, of which 31 arose as sole lesions, while the remaining complicated ones were combined with stenosis of type I (anastomotic venous area in autogenous fistulas or arterial anastomotic area in prosthetic fistulas, N ϭ 6) type II (needling vein segment or mid-graft area, N ϭ 9, or type III (junctional in autogenous fistulas or venous anastomosis in grafts, N ϭ 2) according to the recent proposal by Mickley. 25 A complicated AVA-related aneurysm was defined as any aneurysm with one or more of the following characteristics:…”

Section: Study Populationmentioning

confidence: 99%

Surgical revision of complicated false and true vascular access–related aneurysms

Georgiadis

Lazarides

Panagoutsos

et al. 2008

Journal of Vascular Surgery

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Surgical revision of complicated false and true AVA-related aneurysms reveals acceptable postintervention primary patency rates and therefore is justified. This outcome measure was superior in the following specific groups of corrections: autogenous were better than prosthetic, true aneurysms were better than false aneurysms, patients with one or two previous AVAs in the revised arm were better than those with more than two previous accesses in the revised arm, and finally, forearms were better than those in the upper arm.

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Section: Study Populationmentioning

confidence: 99%

Surgical revision of complicated false and true vascular access–related aneurysms

Georgiadis

Lazarides

Panagoutsos

et al. 2008

Journal of Vascular Surgery

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“…Thrombosis is the leading cause of arteriovenous fistula loss occurring in about 80 % on a silent stenosis (3). Surgical technique of implantation, nurse handling and clinical practice are known to affect survival rate of arteriovenous fistula (4).…”

Section: Introductionmentioning

confidence: 99%

The role of mineral metabolism and inflammation on dialysis vascular access failure

et al. 2006

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Thrombosis of arteriovenous fistula (AVF) is the leading cause of vascular access (VA) loss usually due to silent stenosis. Therefore, assessment of relevant risk factors of VA monitoring may provide insight into potential therapeutic targets for stenosis and thrombosis. The aim of this study was to evaluate the influence of cardiovascular risk factors (including inflammation and mineral metabolism dysfunctions) on the failure of internal AVF in HD patients. 128 HD patients with internal AVF were included in the study and followed up for two years. At baseline, VA morphology and function were followed by Doppler ultrasonography and serum albumin, prealbumine, C-reactive protein, orosomucoid, calcium, phosphorus, parathyroid hormone, bone-type alkaline phosphatase, osteoprotegerin and receptor activator of nuclear factor κB ligand were measured. At baseline, 50 stenoses were detected but none of them required any intervention. Age and biological parameters did not significantly differ between patients with or without VA stenosis. Over the two year- follow up, VA thrombosis occurred in 19 patients. Preexisting stenosis of VA was present in 9/19 patients (47.3% of cases) (chi-square = 3.708, p = 0.0538). Despite the low rate of events, phosphorus [1.75 (0.95–2.77) vs 1.42 (0.47–3.22) mmol/L, p = 0.0416], Calcium x Phosphorus product [4.00 (2.00–5.90) vs 3.40 (1.10–6.80) mmol2/L2, p = 0.0676] and parathyroid hormone [165.00 (1.00–944.00) vs 79.50 (1.00–846.60) ng/L, p = 0.0814) levels were higher in the 19 thrombotic patients whereas all other biological parameters did not significantly differ. These results, which confirm that VA thrombosis occurs more frequently upon preexisting stenosis, also demonstrate that mineral metabolism disorders, compared to inflammation, may contribute to VA dysfunction leading to thrombosis.

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“…Stenosis and thrombosis of the arteriovenous fistulas are the most frequent complications of vascular access 1 accounting for 20% of hospital admissions of dialysis patients. 2 The cost of access procedures and complications has been estimated at $1 billion annually, the single greatest categorical expense for dialysis patient care.…”

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confidence: 99%

Treatment of dialysis access puncture wound bleeding with chitosan dressings

et al. 2006

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Background. Bleeding from coagulopathic hemodialysis puncture sites can contribute to anemia in dialysis patients, and current compressive dressings may contribute to graft thrombosis. We studied the safety and efficacy of a new chitosan-based bandage with an active clotting surface and compared its time to hemostasis and compression strap usage in dialysis access puncture wounds with that of conventional gauze dressings. Methods. Fifty patients received both the chitosan-based and conventional gauze dressings in random order on 2 successive visits. Time to hemostasis and compression strap usage were compared between the visits. Time to hemostasis was analyzed using the binary response variable at 2 and 4 minutes. A compression strap was used if dressing application was unsuccessful at 4 minutes. Covariates included coagulation state as measured by laboratory analysis and anticoagulation therapy. Results. Hemostasis was achieved by 2 minutes in 30% of the chitosan-based and 38% of the conventional dressings (p ¼ 0.608) and by 4 minutes in 86% of the chitosan-based and 72% of the conventional dressings (p ¼ 0.040). Compression strap usage was reduced by 50% in the chitosan-based group compared to the conventional group (7 vs. 14 patients; p ¼ 0.052). No adverse events were reported with either dressing. Conclusions. The chitosan-based bandage from HemCon is a safe and effective hemostatic agent to reduce prolonged posthemodialysis puncture site bleeding and may reduce the use of occlusive compression straps.

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Stenosis and thrombosis in haemodialysis fistulae and grafts: the surgeon's point of view

Cited by 57 publications

References 9 publications

Surgical revision of complicated false and true vascular access–related aneurysms

Surgical revision of complicated false and true vascular access–related aneurysms

The role of mineral metabolism and inflammation on dialysis vascular access failure

Treatment of dialysis access puncture wound bleeding with chitosan dressings

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