Successful Hemodialysis Arteriovenous Fistula Creation in a Patient With Continuous-Flow Left Ventricular Assist Device Support

Chin, Andrew I.; Tong, Kathleen; McVicar, John P.

doi:10.1053/j.ajkd.2016.07.032

Cited by 14 publications

(11 citation statements)

References 11 publications

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“…There have been reports of successful creation, maturation, and use of AVF in patients with CFLVADs. 10,11 Many such cases reporting AVF use have required additional interventions to assist maturation and increased catheter contact days. 12,13 In the published case series of successful AVF creation in patients with CFLVADs, Schaefers and Ertmer 12 required additional procedures such as vein patch plasty and replacement of a stenotic vein segment with a polytetrafluoroethylene graft in two of three patients to maintain patency of the access.…”

Section: Discussionmentioning

confidence: 99%

Considerations for Long-Term Dialysis Access in Patients with Left Ventricular Assist Devices

Safaya

Bhuta

Rajdeo

2021

Annals of Vascular Surgery

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Section: Discussionmentioning

confidence: 99%

Considerations for Long-Term Dialysis Access in Patients with Left Ventricular Assist Devices

Safaya

Bhuta

Rajdeo

2021

Annals of Vascular Surgery

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“…A further two patients are reported by Sasson et al 13 these patients required assisted maturation, although a further case report described unassisted maturation. 14 Chen et al 15 describe successful haemodialysis in a patient with a pulsatile LVAD; however, these are largely obsolete now.…”

Section: Discussionmentioning

confidence: 99%

Arteriovenous fistula creation in a patient without a pulse: Vascular access in patients with left ventricular assist devices

et al. 2019

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Left ventricular assist devices are used in heart failure patients as bridge to transplantation or increasingly as a destination therapy. These patients frequently have renal dysfunction and many reach end-stage renal failure. If haemodialysis is required, minimization of infection risk is essential. Arteriovenous grafts have been recommended for these patients due to hypothetical concerns regarding fistula maturation due to continuous flow. A case is described where a brachiocephalic arteriovenous fistula was successfully formed and used for dialysis without issue. This is one case of a small number in the literature where arteriovenous fistulas have been used in left ventricular assist device patients and it appears that concerns are unfounded and good outcomes have been reported. It would appear from this experience that approaches to vascular access for dialysis in patients with continuous-flow left ventricular assist devices are in accordance with vascular access guidelines and standard practice.

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“…Previous small series or case reports have also demonstrated that maturation is possible. 6,7,13 Within these reports, maturation was recorded and AVF usability was documented for up to 511 days. Long-term data on AVF usability, primary patency, and secondary patency rates are yet to be determined in the VAD population.…”

Section: Discussionmentioning

confidence: 99%

Maturation of arteriovenous fistulas in patients with ventricular assist devices

et al. 2019

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Objective: Postoperative renal dysfunction necessitating hemodialysis after implantation of ventricular assist devices presents a challenge with respect to establishment of hemodialysis access. Lack of pulsatile flow has led to concerns that arteriovenous fistulas will not mature. This study aims to evaluate arteriovenous fistula as a method of hemodialysis. Methods: Consecutive patients who underwent implantation of a ventricular assist device between 1988 and 2016 with a subsequent need for hemodialysis were identified. Retrospective data were collected for patients requiring hemodialysis through an arteriovenous fistula or arteriovenous graft. Access flow rates and duration of patency are reported. Results: Sixty-four patients were identified (10 required long-term hemodialysis, 5 via arteriovenous fistula, 1 via arteriovenous graft). All six patients receiving long-term hemodialysis access were on continuous-flow ventricular assist devices. Brachiocephalic arteriovenous fistulas were performed in all arteriovenous fistula patients, and the average preoperative vein diameter was 4.1 ± 0.9 mm. On 30-day follow-up, the average flow rate was 1262 ± 643 mL/min (880–2220). In arteriovenous fistula patients, one died at 30 days, one arteriovenous fistula required ligation for steal syndrome at 5 months, and one was abandoned after 10.7 months for low flow. Of remaining fistulas, one was converted to an arteriovenous graft at 1.7 years for malfunction (with 5.3 month patency), and one remains open at 4.0 years. Conclusion: Arteriovenous fistulas should be considered in selected patients with ventricular assist devices as a means of long-term hemodialysis access to avoid use of catheters. Maturation and usage of primary arteriovenous fistulas is possible despite lack of pulsatile flow.

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Successful Hemodialysis Arteriovenous Fistula Creation in a Patient With Continuous-Flow Left Ventricular Assist Device Support

Cited by 14 publications

References 11 publications

Considerations for Long-Term Dialysis Access in Patients with Left Ventricular Assist Devices

Considerations for Long-Term Dialysis Access in Patients with Left Ventricular Assist Devices

Arteriovenous fistula creation in a patient without a pulse: Vascular access in patients with left ventricular assist devices

Maturation of arteriovenous fistulas in patients with ventricular assist devices

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