Three Year Patency and Recurrence Rates of Revision Using Distal Inflow with a Venous Interposition Graft for High Flow Brachial Artery Based Arteriovenous Fistula

Gerrickens, Michael W.M.; Vaes, Roel; Govaert, Bastiaan; Loon, Magda van; Tordoir, Jan H.M.; Hoek, F. van; Teijink, Joep A.W.; Scheltinga, Marc R.

doi:10.1016/j.ejvs.2018.03.014

Cited by 12 publications

(23 citation statements)

References 38 publications

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“…[17][18][19] Second, several studies indicated that an HIQ allows for differentiating between patients with and without hand ischemia. 15,16 A recent study demonstrated an inverse correlation between scores of DBI and HIQ in HAIDI patients who received a basilic vein transposition. 19 In the current study, mean HIQ scores were four times higher in patients with severe HAIDI compared with patients with mild ischemia.…”

Section: Discussionmentioning

confidence: 99%

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Severe hemodialysis access-induced distal ischemia may be associated with poor survival

et al. 2020

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Background: Some hemodialysis patients develop hemodialysis access-induced distal ischemia due to insufficient loco-regional perfusion pressure and consequent poor arterial flow. We hypothesized that patients with severe hemodialysis access-induced distal ischemia had worse survival compared with patients with mild or no hemodialysis access-induced distal ischemia. Methods: This single-center retrospective observational cohort study included three groups of prevalent hemodialysis patients with an upper extremity vascular access between 2006 and 2018. Symptomatic patients had signs and symptoms of hemodialysis access-induced distal ischemia and low digital brachial indices (<60%) and were divided into a mild (Grade I–IIa) and a severe hemodialysis access-induced distal ischemia (IIb–IV) group. The control group consisted of hemodialysis patients without signs of hemodialysis access-induced distal ischemia with digital brachial indices ≥60%. Factors potentially related to 4-year survival were analyzed. Results: Mild hemodialysis access-induced distal ischemia-patients displayed higher digital brachial indices ( n = 23, 41%, ±3) compared with severe hemodialysis access-induced distal ischemia-patients ( n = 28, 24%, ±4), whereas controls had the highest values ( n = 48, 80%, ±2; p < .001). A total of 44 patients (44%) died during follow-up. Digital brachial index (hazards ratio 0.989 [0.979–1.000] p = .046) was related to overall mortality following correction for presence of arterial occlusive disease (hazards ratio 2.28 [1.22–4.29], diabetes (hazards ratio 2.00 [1.07–3.72], and increasing age (hazards ratio 1.03 [1.01–1.06] as was digital pressure (hazards ratio 0.990 [0.983–0.998], p = .011). Overall survival was similar in mild hemodialysis access-induced distal ischemia and controls (2-year, 79% ±5; 4-year, 57% ±6, p = .818). In contrast, 4-year survival was >20% lower in patients with severe hemodialysis access-induced distal ischemia (2-year 62%± 10; 4-year 34% ± 10; p = .026). Conclusion: Presence of severe hemodialysis access-induced distal ischemia may be associated with poorer survival in hemodialysis patients. Lower digital brachial index values are associated with higher overall mortality, even following correction for other known risk factors.

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Section: Discussionmentioning

confidence: 99%

“…HIQ scores in HD patients without ischemia are typically <60, while HAIDI patients often score >100 points. 15,16 Various studies indicated that HIQ scores reflect effectiveness of surgical revision for HAIDI. [17][18][19]…”

Section: Hand Ischemic Questionnairementioning

confidence: 99%

Severe hemodialysis access-induced distal ischemia may be associated with poor survival

et al. 2020

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“…Only a limited number of techniques have been described to address this complication. 12,14,[16][17][18][19] Banding, a common and simple technique available for access-flow-reduction, involves constricting the fistula at one or more sites and creating a local drastic reduction in lumen diameter. 18 It is a generally safe technique but is associated with high recurrence rates of HF-AVF (⩾2000 ml/min) which developed in more than half of the banded patients (52%) during an observation period of 12 months, usually within the first 4-6 months.…”

Section: Discussionmentioning

confidence: 99%

Novel external stenting for reconstruction of high flow arteriovenous fistula

2021

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Background: High-flow arteriovenous fistulae (HF-AVF) may lead to adverse cardiac remodeling in hemodialysis patients. We have investigated whether a novel external stent is safe and effective in reducing and stabilizing flow rates during a 1-year follow-up after HF-AVF reconstruction. Methods: All patients with HF-AVF (access flow rate ⩾ 1500 ml/min), who underwent HF-AVF reconstruction with external stenting in two centers between June 2018 and May 2020, were included in this retrospective analysis. During HF-AVF reconstruction, the dilated vein segment was resected, underwent volume reduction, and was externally stabilized using a braided cobalt-chromium external stent. AVF flow rates were assessed preoperatively, intraoperatively, and at follow up visits using duplex ultrasound. Results: Forty-three HF-AVFs in 42 patients were reconstructed and supported with an external stent (mean age 49 years, range 20–86 years; 74% men). Fifty-one percent were forearm AVFs, 49% were upper arm. The mean preoperative flow rate was 2622 ± 893 ml/min (range: 1500–6000 ml/min) and was decreased to 710 ± 221 ml/min (range: 300–1300 ml/min) intra-operatively after HF-AVF reconstruction. At 6 and 12-months follow-up, the mean flow rates were 1132 ± 320 ml/min (range: 470–1700 ml/min) and 1453 ± 888 ml/min (range: 300–3800 ml/min), respectively. Recurrence of high flow (>1500 ml/min) occurred in 16% and 25% of the patients at 6 and 12 months and primary patency rates were 86% and 70%, respectively. Conclusions: This early experience with novel external stenting for HF-AVF reconstruction demonstrates that it is a safe and effective method for reducing and stabilizing flow rates up to 1-year post procedure. Additional studies are required to evaluate the durability of this procedure over the longer term and assess its effect on cardiac remodeling.

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“…Brachial artery-based AVFs have been associated with a greater risk of steal syndrome than radial artery-based AVFs, likely related to the higher flow. 9 , 12 Furthermore, cardiac risks, such as left ventricular hypertrophy and congestive heart failure, have been attributed to the greater flow rate of proximal AVFs. 2 , 12 The data are insufficient to conclude whether the brachioradial artery would have clinical performance more consistent with the typical brachial or radial arteries.…”

Section: Discussionmentioning

confidence: 99%

Staged brachioradial artery to brachioradial vein arteriovenous fistula creation for hemodialysis access in three patients with a high origin of the radial artery

Lawrence

Chivukula

Farlow

et al. 2021

Journal of Vascular Surgery Cases, Innovations and Techniques

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When patients lack suitable superficial veins in the upper extremity to create an arteriovenous fistula, surgeons are faced with a decision between a synthetic graft or autologous fistula using deep veins, such as a brachial artery to brachial vein arteriovenous fistula. In patients with a high radial artery origin (or brachioradial artery) and inadequate superficial veins, arteriovenous fistula creation will be even more challenging. In the present report, we describe a technique used in three such patients who underwent successful staged brachioradial artery to brachioradial vein arteriovenous fistula creation.

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Three Year Patency and Recurrence Rates of Revision Using Distal Inflow with a Venous Interposition Graft for High Flow Brachial Artery Based Arteriovenous Fistula

Abstract: RUDI with GSV interposition for HFA offers acceptable patency rates after 3 years although re-interventions are often required. High immediate post-operative flows and young age are associated with recurrent high flow.

Cited by 12 publications

References 38 publications

Severe hemodialysis access-induced distal ischemia may be associated with poor survival

Severe hemodialysis access-induced distal ischemia may be associated with poor survival

Novel external stenting for reconstruction of high flow arteriovenous fistula

Staged brachioradial artery to brachioradial vein arteriovenous fistula creation for hemodialysis access in three patients with a high origin of the radial artery

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