Arteriovenous Fistula In Patients Research Articles

Validity and Reliability of the Persian Version of the Scale of the Assessment of Self-Care Behaviors With Arteriovenous Fistula in Patients on Hemodialysis.

Background and Purpose: This methodological study aimed to assess the psychometric properties of the Persian version of the scale for evaluating self-care behaviors with arteriovenous fistula. Methods: This cross-sectional study with a methodological design was planned and conducted in 2022. The Scale of the Assessment of Self-Care Behaviors with Arteriovenous Fistula was translated into Persian. Subsequently, the validity (content and construct) and reliability of this scale were assessed. Results: The exploratory factor analysis revealed a two-factor structure for the scale, accounting for 60.71% of the total variance. Confirmatory factor analysis results indicated that all goodness-of-fit indices supported the model fit (χ2/df = 1.925, Goodness-of-Fit Index = .903, Normed Fit Index = 0.933, Incremental Fit Index = 0.950, Comparative of Fit Index = .950, and Root Mean Square Error of Approximation = .047). Furthermore, this study found that both factors demonstrated satisfactory levels of convergent and divergent validity (construct reliability = .934 and .885 for factors 1 and 2, respectively). After careful evaluation, all coefficients of internal consistency were deemed acceptable (α = .872 and McDonald's omega = 0.879). Conclusions: These significant findings provide compelling evidence that this scale can effectively assess patients' self-care behaviors and facilitate the provision of necessary training in this domain.

The Feasibility of Thrombolysis Followed with Ultrasound-Guided Percutaneous Transluminal Balloon Angioplasty in Acutely and Sub-Acutely Thrombosed Arteriovenous Fistulas.

Prompt resolution of arteriovenous fistula (AVF) thrombosis is essential to minimize the need for temporary dialysis catheters. Identifying the ideal timing for the management of thrombosed arteriovenous fistula (AVF) is an area that has not been thoroughly explored. Herein, we examined a local infusion of urokinase for thrombolysis followed by ultrasound-guided percutaneous transluminal balloon angioplasty (PTA) in acute and subacute AVF thromboses. This retrospective cohort research assessed thrombosed AVF in patients referred to the Second Xiangya Hospital. We included patients who underwent local thrombolysis followed by ultrasound-guided PTA treatment between January 1, 2018, and January 1, 2020. Results. We enrolled the records of 86 patients into the present study, including 44 patients with acute AVF thrombosis (group 1: thrombus age, < 72 hours) and 42 patients with subacute AVF thrombosis (group2: thrombus age, 72 hours to seven days). The thrombolytic success rate was 79.5% in group 1 and 42.9% in group 2 (P < .001). All patients underwent ultrasound-guided PTA to dissolve any residual thrombi regardless of thrombolytic success. Technical success after PTA procedures was achieved in 93.2% of patients in group 1 and 88.1% in group 2 (P = .417). Primary patency at six months was comparable between the two groups (67.5% vs. 64.8%, P = .564). We observed that thrombolytic effect does not affect PTA success rate, and six-month patency rate. Direct local infusion of urokinase to the affected area followed by ultrasound-guided PTA constitutes a minimally invasive and effective method for salvaging thrombosed AVF in contrast to abandoning the occluded fistula.

Factors associated with dysfunction of autogenous arteriovenous fistula in patients with secondary hyperparathyroidism after parathyroidectomy

Background Secondary hyperparathyroidism (SHPT) is a prevalent chronic complication in patients undergoing hemodialysis. Parathyroidectomy (PTX) is crucial for reducing mortality and improving the prognosis in the treatment of refractory hyperparathyroidism. However, it is often associated with a number of postoperative complications such as postoperative hypotension, hyperkalemia, and hungry bone syndrome. A previous study demonstrated that low blood pressure influences the patency of autogenous arteriovenous fistulas (AVF). Few studies have examined AVF dysfunction following PTX. This study aimed to identify and describe the risk variables associated with AVF dysfunction after PTX. Methods Cases of AVF dysfunction after PTX between 2015 and 2021 were studied. Four controls were identified for each patient and were matched for sex and age. Biochemical parameters and blood pressure of the patients before and after PTX were recorded. Risk factors for AVF dysfunction after PTX were identified using conditional logistic regression analysis. Results Sixteen patients and 64 controls were included in this study. Baseline demographic and laboratory data were compared. Patients in the AVF dysfunction group had lower levels of postoperative calcium than the controls. After surgery, calcium levels decreased more in patients with AVF dysfunction than in the control group. The decrease in systolic blood pressure (ΔSBP) after PTX was greater in the AVF dysfunction group than that in the control group. For each 1 mmHg increment in ΔSBP, the risk of AVF dysfunction after surgery increased by 11.6% (OR = 1.116, 95% CI, 1.005–1.239, p = .040). The likelihood of developing AVF dysfunction after surgery was twelvefold higher in diabetic patients than in non-diabetic patients (OR = 12.506, 95% CI, 1.113–140.492, p = .041). Among patients with ΔSBP > 5.8 mmHg after PTX, the AVF failure rate was significantly greater in patients with diabetes than in those without diabetes. Patients with a history of AVF failure had a nine-fold higher risk of developing AVF dysfunction (OR = 9.143, 95% CI, 1.151–72.627, p = .036). Serum albumin, hemoglobin, ΔiPTH, and age were not independent predictors of AVF dysfunction. The cutoff value for SBP was 5.8 mmHg, as determined by the Youden index of the receiver operating characteristic curve. Conclusion Decreased systolic blood pressure (ΔSBP) after PTX, diabetes, and AVF failure history were risk factors for AVF dysfunction following PTX in patients with SHPT. Diabetes patients with ΔSBP > 5.8 mmHg were more prone to AVF dysfunction after PTX.

Possibilities of endovascular treatment of vascular complications in mine–blast trauma

Objective. To optimize approaches to endovascular treatment of posttraumatic false aneurysms and arteriovenous fistulas in patients with complications of mine–blast trauma. Materials and Methods. The results of examination and treatment of 9 patients with complications of mine–blast trauma were analyzed. False aneurysms of various localizations were detected in 5 (55.6%) patients, and arteriovenous fistulas of the same localization were detected in 4 (44.4%) patients. Results. We performed 5 endoprosthetics with the use of stent grafts to exclude lesions from the circulation, as well as 5 selective embolizations with coils. In 1 patient, embolization with endoprosthetics was performed simultaneously. In all 9 patients, the treatment was technically successful, that is, the technical success of the interventions was 100%. None of the patients had any complications. All patients regressed clinical symptoms after the intervention. Conclusions. Endovascular treatment of post–traumatic false aneurysms and arteriovenous fistulas in patients with mine–blast trauma is highly effective. In all 9 patients with arteriovenous fistulas and false aneurysms, endoprosthetics with stent grafts and selective embolization of lesions with complex anatomy were successfully performed. Further study of the long–term results of treatment of these patients is necessary to increase technical and clinical success.

Far Infrared Radiation Does Not Improve Time to Cannulation in Newly Placed Arteriovenous Fistulas in Patients on Hemodialysis

Far Infrared Radiation Does Not Improve Time to Cannulation in Newly Placed Arteriovenous Fistulas in Patients on Hemodialysis

Establishing an autogenous vascular access program in a Guatemalan comprehensive pediatric nephrology center.

The Guatemalan Foundation for Children with Kidney Diseases collaborated with Bridge of Life, a not-for-profit charitable organization, to establish a vascular access program. We reviewed our experience with graded surgical responsibility and structured didactic training, creating arteriovenous fistulas (AVF) for Guatemalan children. Pediatric vascular access missions were completed from 2015 to 2023 and analyzed retrospectively. Follow-up was completed by the Guatemalan pediatric surgeons, nephrologists, and nursing staff. AVF patency and patient survival were evaluated by Kaplan-Meier life-table analysis with univariate and multivariable association between patient demographic variables by Cox proportional hazards models. Among a total of 153 vascular access operations, there were 139 new patient procedures, forming the study group for this review. The mean age was 13.6years, 42.6% were female, and the mean BMI was 17.3. Radial or ulnar artery-based direct AVFs were established in 100 patients (71.9%) and ten of the 25 transposition procedures. Brachial artery inflow was required in 29 direct AVFs (20.9%). Two patients underwent femoral vein transpositions. Access-related distal ischemia was not encountered. Seven of the AVF patients later required access banding for arm edema; all had previous dialysis catheters (mean = 9, range 4-12). Primary and cumulative patency rates were 84% and 86% at 12months and 64% and 81% at 24months, respectively. The median follow-up was 12months. Overall patient survival was 84% and 67% at 12 and 24months, respectively. There were no deaths related to AVF access. Safe and functional AVFs were established in a teaching environment within a Guatemalan comprehensive pediatric nephrology center.

Effects of far infrared therapy in hemodialysis arterio-venous fistula maturation: A meta-analysis.

Hemodialysis patients rely on stable vascular access to perform effective hemodialysis and reach good dialysis quality. However, an obstructed or under-matured arteriovenous fistula (AVF) may increase infection rate and mortality in hemodialysis patients. Far infrared (FIR) therapy might help to promote AVF maturation and reduce obstruction rate. Therefore, this meta-analysis was conducted to evaluate the effect of FIR therapy on AVF obstruction rate and maturation. PubMed, Embase, the Cochrane Library, and other databases which provide publications in randomized controlled trials (RCTs) of FIR to improve AVF in patients with CKD (Chronic Kidney Disease) or HD (hemodialysis) were used to collect articles which published before February 2023. Two authors selected relevant articles independently based on pre-defined inclusion and exclusion criteria, and assessed the quality of the articles by using the Cochrane Handbook before performing a meta-analysis in Review Manager (RevMan) 5.4 software. Four RCTs with 475 patients were included. The results of the meta-analysis showed that the FIR therapy groups had better physiological maturation at 3 months (RR = 1.22; 95% CI = 1.07 to 1.39; p = .002) and clinical maturation at 12 months (RR = 1.35; 95% CI = 1.14 to 1.60; p < .001) than the control groups without FIR therapy. The obstruction rates within 12 months were much lower in the FIR therapy groups than in the control groups (RR = 0.24; 95% CI = 0.08 to 0.68; p = .007), also, there was no statistical heterogeneity. FIR could promote fistula maturation and reduce the incidence of AVF obstruction.

Assessment of Sonographic Parameters for Predicting Primary Patency Rate in Hemodialysis Patients With Venous Valve-Related Stenosis.

Ultrasonography is more frequently used in patients with arteriovenous fistula (AVF) stenosis. The aim of this study is to use sonographic parameters for predicting primary patency in hemodialysis patients with venous valve-related stenosis (VVRS) who are treated by ultrasound-guided percutaneous transluminal angioplasty (PTA). A total of 229 VVRS patients who underwent PTA between January 2017 and December 2021 were enrolled. Clinical characteristics were retrospectively collected. Sonographic parameters were measured both before and after PTA. Univariate and multivariate Cox analyses were performed to identify independent factors associated with primary patency rate. All measured sonographic parameters improved after PTA compared to before PTA. Before PTA, the diameter of VVRS > 1.0 mm, age ≤ 57 years, and body mass index (BMI) > 21.57 kg/m2 were associated with better outcomes. While the diameter of radial artery, proximal radial artery close to the anastomosis, brachial artery, the flow volume of brachial artery, the length and peak velocity (PV) of the VVRS, and the diameter and PV after the VVRS had no association with the primary patency rate. After PTA, only patients with a diameter of VVRS > 4.0 mm had favorable outcome. In addition, patients with a gain of diameter of VVRS > 2.4 mm after PTA had a trend of better outcomes. The diameter of VVRS before and after PTA could be served as markers to predict primary patency rate and second patency rate in AVF patients with VVRS. The gain of diameter of VVRS could also be a potential marker. Using simple markers of sonographic parameters, we could quickly identify patients with a higher risk of restenosis. These patients should be followed more closely in case of restenosis at early. It is also beneficial to the prevention of thrombosis. These measures help to preserve more valuable vascular for a long-term dialysis. Additionally, the physician should pay more attention on the dialysis-related complications in these risky patients, such as hemodialysis-related hypotension.

Clinical Outcomes of Arteriovenous Fistula Treatment Using the Penumbra SMART COIL System: A Subgroup Analysis from the Multicenter SMART Registry

Endovascular embolization procedures are typically the primary treatment modality for arteriovenous fistula (AVF). The objective of this subset analysis was to evaluate the prospective long-term clinical outcomes of AVF patients treated with the SMART COIL System. Patients who had AVFs and underwent endovascular coiling using the Penumbra SMART COIL system were part of a subset analysis within the SMART registry. The SMART registry is a postmarket registry that is prospective, multicenter, and single-arm in design. After the treatment, these patients were monitored for a period of 12±6months. A total of 41 patients were included. No patients (0/41) had a procedural device-related serious adverse event (SAE). Reaccess involving a guidewire due to catheter kickout was unnecessary for 85.4% (35/41) of the patients. Complete occlusion after the procedure was achieved in 87.8% (36/41) of patients. The periprocedural SAE rate was 2.4% (1/41), and no periprocedural deaths occurred (0/41). During the follow-up period, there were instances of retreatment in 3.4% (1/29) of patients. At 1 year, the lesion occlusion was better or stable in 93.3% (28/30) of patients. The rate of SAE from 24hours to 1year (±6months) following the procedure was 26.8% (11/41). The 1-year all-cause mortality rate stood at 2.4% (1/41), and at the 1-year follow-up, 90.9% (20/22) of patients had a modified Rankin Scale score within the range of 0 to2. The coiling procedure for AVFs using the SMART COIL System proved to be safe and effective at the 1-year follow-up.

Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitor Improves the Vascular Function of Arteriovenous Fistula in Rats with Hyperglycemia.

Few evidence-based medications to improve the primary patency of arteriovenous fistulas in patients with diabetes who require hemodialysis are available. We investigated whether proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) could improve arteriovenous fistula function through pleiotropic effects in a rat model of hyperglycemia. Ex vivo effects of PCSK9i on the aorta of Sprague-Dawley (SD) rats were investigated using an organ bath system. For in vivo experiments, an abdominal aortocaval (AC) fistula was generated in SD rats (200-250 g) after inducing hyperglycemia through streptozotocin administration (80 mg/kg, intraperitoneal). Alirocumab (50 mg/kg/week, subcutaneous) was administered on the day of fistula surgery and day 7. Echocardiography, blood flow through the aorta-limb, vasomotor reactivity, and serum biochemistry were examined on D14. Furthermore, enzyme-linked immunosorbent assay and immunoblotting were performed. PCSK9i induced aorta relaxation ex vivo through a potassium channel-associated mechanism. PCSK9i significantly improved blood flow and preserved endothelial function without changes in cardiac function and serum lipid levels in rats with hyperglycemia. The levels of lectin-like oxidized low-density lipoprotein receptor-1, superoxide dismutase, cyclooxygenase-2, caspase-1, and interleukin-1β were significantly reduced in the treatment group. PCSK9i decreased the ratio of phosphorylated to total p38 mitogen-activated protein kinase and extracellular signal-regulated kinase in the aorta of rats with hyperglycemia. Short-term treatment with PCSK9i preserved endothelial function, induced vascular dilatation, and increased blood flow in the AC fistula of rats with hyperglycemia. The pleiotropic mechanisms were associated with the suppression of oxidative stress and tissue inflammation during hyperglycemia.

#1476 Impact of frailty on maturation of native arteriovenous fistula in patients with end-stage kidney disease

Abstract Background and Aims Morbimortality and quality of life in hemodialysis patients is directly related to the reliability and integrity of the vascular access. Current guidelines recommend a shift from a "fistula first" approach to a patient-centered approach due to the aging dialysis population. Frailty, defined as vulnerability to adverse health states due to impaired functional status, comorbidities and psychosocial factors, conditions a worse outcome of patients with end-stage kidney disease (ESKD) undergoing dialysis. Our aim was to assess frailty status before the performance of native arteriovenous fistulas (nAVF) as a predictor of failure to mature. Method Retrospective analysis of ESKD clinic patients who underwent a first nAVF between 2020-2022 and had undergone a frailty assessment before the surgery. The Frail-VIG index, evaluating frailty through deficit accumulation (scored from 0 to 1), vas employed. Patients were categorized as either non-frail (NF-ESKD: Frail-VIG &amp;lt; 0.2) or frail (F-ESKD: Frail-VIG ≥ 0.2). the study evaluated early nAVF and recorded the first ultrasound maturation values 4 weeks after surgery. Results Throughout the study period, 180 patients underwent a first nAVF, 57 (31.6%) having undergone a prior frailty assessment. 27 (47.4%) patients were classified as NF-ESKD, 30 (52.6%) as F-ESKD (23 mild, 6 moderate and 1 severe frailty). In the descriptive analysis, no differences in age, sex, toxic habits, CKD etiology or medical conditions were observed between the two groups (Table 1). Regarding surgical technique, there were no differences in nAVF location and laterality between the two groups (Table 1). F-ESKD patients had a higher primary fistula failure, defined as no flow prior to the first ultrasound evaluation (36.7% vs. 3.8%; p=0.002). In patients with an initial ultrasound evaluation, the F-ESKD group had lower arterial flow (1020.76 ± 589.42 vs. 1455.56 ± 679.78 ml/min; p=0.027) and smaller fistula diameter (4.52 ± 1.51 vs. 6.4 ± 1.61 mm; p=0.018). Maturation was assessed after the first ultrasound evaluation, defined as the presence of an arterial flow greater than 500 ml/min and a diameter greater than 4 mm. A higher proportion of frail patients (88.9% vs. 33.11%; p = 0.004), a lower capacity to perform instrumental activities measured by Lawton Brody index (4.63 ± 2.2 vs. 6.55 ± 2.2; p = 0.034) and a higher percentage of diabetic patients (88.89% vs. 48.48%; p = 0.033) were found in nAVF that had not reached ultrasound-guided maturity (Table 2). In a multivariate analysis adjusted for functional status, type of vascular access and comorbidities, the presence of frailty conferred a higher risk of fistula non-maturation (OR 11.42 95%CI 1.005 - 128.74; p = 0.049). Conclusion The prevalence of frailty is notable among in ESKD patients and contributes to a higher rate of failure in native nAVF. Within this population, adopting an individual approach to the selection of a definitive vascular access may prove both feasible and beneficial in ensuring optimal dialysis access.

Impact of stage-specific limb function exercises guided by a self-management education model on arteriovenous fistula maturation status.

The exercise of limb function is the most economical and safe method to promote the maturation of arteriovenous fistula (AVF). However, due to the lack of a unified exercise standard in China, many patients have insufficient awareness of the importance of AVF, leading to poor effectiveness of limb function exercise. The self-management education model can effectively promote patients to take proactive health-related actions. This study focuses on the characteristics of patients during the peri-AVF period and conducts a phased limb function exercise under the guidance of the self-management education model to observe changes in factors such as the maturity of AVF. To assess the impact of stage-specific limb function exercises, directed by a self-management education model, on the maturation status of AVFs. This study is a randomized controlled trial involving 74 patients with forearm AVFs from the Nephrology Department of a tertiary hospital in Sichuan Province, China. Patients were randomly divided into an observation group and a control group using a random number table method. The observation group underwent tailored stage-specific limb function exercises, informed by a self-management education model which took into account the unique features of AVF at various stages, in conjunction with routine care. Conversely, the control group was given standard limb function exercises along with routine care. The assessment involves the maturity of AVFs post-intervention, postoperative complications, and the self-management level of the fistula in both groups patients. Analyses were conducted using SPSS version 23.0. Count data were represented by frequency and percentage and subjected to chi-square test comparisons. Measurement data adhering to a normal distribution were presented as mean ± SD. The independent samples t-test was utilized for inter-group comparisons, while the paired t-test was used for intra-group comparisons. For measurement data not fitting a normal distribution, the median and interquartile range were presented and analyzed using the Wilcoxon rank sum test. At the 8-wk postoperative mark, the observation group demonstrated significantly higher scores in AVF symptom recognition, symptom prevention, and self-management compared to the control group (P < 0.05). However, the variance in symptom management scores between the observation and control groups lacked statistical significance (P > 0.05). At 4 wk after the operation, the observation group displayed a superior vessel diameter and depth from the skin of the drainage vessels in comparison to the control group (P < 0.05). While the observation group did manifest elevated blood flow rates in the drainage vessels relative to the control group, this distinction was not statistically significant (P > 0.05). By the 8-wk postoperative interval, the observation group outperformed the control group with notable enhancements in blood flow rates, vessel diameter, and depth from the skin of drainage vessels (P < 0.01). Seven days following the procedure, the observation group manifested significantly diminished limb swelling and an overall reduced complication rate in contrast to the control group (P < 0.05). The evaluation of infection, thrombosis, embolism, arterial aneurysm stenosis, and incision bleeding showed no notable differences between the two groups (P > 0.05). By the 4-wk postoperative juncture, complications between the observation and control groups were statistically indistinguishable (P > 0.05). Stage-specific limb function exercises, under the guidance of a self-management education model, amplify the capacity of AVF patients to discern and prevent symptoms. Additionally, they expedite AVF maturation and mitigate postoperative limb edema, underscoring their efficacy as a valuable method for the care and upkeep of AVF in hemodialysis patients.

Arteriovenous fistula for haemodialysis as a predictor of de novo heart failure in kidney transplant recipients.

The haemodynamic effects of a functioning haemodialysis arteriovenous fistula (AVF) can cause or exacerbate heart failure (HF). We investigated whether the presence of an AVF at the time of kidney transplant (KT) is associated with de novo HF. This was an observational cohort study including adult patients who received a KT in the West of Scotland between 2010 and 2020. We evaluated the risk and associations of pretransplant factors with de novo HF, alone and as a composite cardiovascular (CV) outcome (including non-fatal myocardial infarction, non-fatal stroke, de novo HF and CV death). Multivariable proportional hazards regression and sensitivity analyses were used to identify independent correlates of the outcomes. Among 1330 included patients, the incident rate of de novo HF after transplantation was 58/1000 person-years [95% confidence interval (CI) 50-67] in AVF patients (n=716) compared with 33/1000 person-years (95% CI 27-41) in non-AVF patients (n=614). De novo HF was associated with the presence of an AVF [adjusted hazard ratio (aHR) 2.14 (95% CI 1.40-3.26)], duration of dialysis [aHR 1.03/year increase (95% CI 1.01-1.04)], age at transplant [aHR 1.03/year increase (95% CI 1.02-1.05)], female sex [aHR 1.93 (95% CI 1.40-2.65)] and pretransplant diabetes [aHR 2.43 (95% CI 1.48-4.01)]. The presence of an AVF was also associated with the composite CV outcome [aHR 1.91 (95% CI 1.31-2.78)]. The presence of an AVF may be an underrecognized modifiable predictor of de novo HF posttransplantation.

Efficacy of cilostazol in promoting the maturation of newly created arteriovenous fistula in patients with end-stage renal disease: a systematic review and meta-analysis

BACKGROUND Arteriovenous fistula (AVF) is considered the gold standard for vascular access in hemodialysis. However, achieving the successful maturation of AVF remains a challenge. Cilostazol, a phosphodiesterase-3 inhibitor, has shown promise in enhancing AVF maturation. This study aimed to assess the clinical efficacy of cilostazol in promoting AVF maturation. METHODS This meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive systematic literature search was performed using PubMed, ScienceDirect, Cochrane Library, ProQuest, and Google Scholar to identify studies investigating the efficacy of cilostazol on the maturation of newly created AVF in patients with end-stage renal disease and published up to August 2023. The intervention group received perioperative cilostazol therapy, while the control group did not receive cilostazol. The outcomes were the maturation rate of AVF and AVF-related complications. Meta-analysis was conducted using Review Manager software version 5.3. RESULTS 5 studies involving 549 patients were included. The intervention group comprised 228 patients, while the control group comprised 321 patients. In the pooled analysis, patients in the intervention group had a significantly higher rate of AVF maturation (odds ratio [OR] = 2.18, 95% confidence interval [CI]: 1.29–3.68, p = 0.003, I2 = 47%) and a lower rate of AVF-related complications (OR = 0.46, 95% CI: 0.28–0.77, p = 0.003, I2 = 27%) compared to the control. CONCLUSIONS Cilostazol was associated with a higher rate of AVF maturation and a lower rate of AVF-related complications.

Cerebral dural arteriovenous fistulas in patients with PTEN-related hamartoma tumor syndrome.

Central nervous system (CNS) dural arteriovenous fistulas (DAVF) have been reported in PTEN-related hamartoma tumor syndrome (PHTS). However, PHTS-associated DAVF remain an underexplored field of the PHTS clinical landscape. Here, we studied cases with a PTEN pathogenic variant identified between 2007 and 2020 in our laboratory (n = 58), and for whom brain imaging was available. Two patients had DAVF (2/58, 3.4%), both presenting at advanced stages: a 34-year-old man with a left lateral sinus DAVF at immediate risk of hemorrhage, and a 21-year-old woman with acute intracranial hypertension due to a torcular DAVF. Interestingly, not all patients had 3D TOF/MRA, the optimal sequences to detect DAVF. Early diagnosis of DAVF can be lifesaving, and is easier to treat compared to developed, proliferative, or complex lesions. As a result, one should consider brain MRI with 3D TOF/MRA in PHTS patients at genetic diagnosis, with subsequent surveillance on a case-by-case basis.

Delayed Pulsatile Tinnitus by an Ascending Pharyngeal Artery-Internal Jugular Vein Fistula Caused by Blunt Trauma: A Case Report and Review of the Literature.

Head and neck trauma-induced pulsatile tinnitus (PT) should be approached with caution, as it can rarely be attributed to an arteriovenous fistula (AVF). We present a 26-year-old male with a history of blunt trauma who presented delayed PT with direct AVF between the ascending pharyngeal artery (APA) and the internal jugular vein (IJV). The patient underwent occlusion of the fistula with transarterial embolization using coils and PT was completely resolved, confirming successful treatment. The delayed manifestation of PT in the APA-IJV fistula is probably due to the gradual formation of a pseudoaneurysm and subsequent AVF. This case highlights the importance of investigating PT in head trauma patients, as it can be a sign of AVF and possible complications. Overall, this case contributes to understanding delayed PT with AVF and emphasizes the importance of prompt diagnosis and treatment of AVF in patients with head and neck trauma.

Educational video for self-care with arteriovenous fistula in renal patients: randomized clinical trial.

to evaluate the effect of an educational video on the knowledge, attitude, and practice of self-care with arteriovenous fistula in patients undergoing hemodialysis treatment. randomized controlled clinical trial, with two arms and single-blind. The intervention used an educational video on arteriovenous fistula self-care. The Fistula Self-Care Knowledge, Attitude, and Practice Scale was applied to 27 renal patients on hemodialysis in the control group and 28 in the intervention group at baseline, after seven and fourteen days. The data was analyzed using the Statistical Package for the Social Sciences software, using the chi-square test, Student's t-test, Mann-Whitney test, and Friedman's test with post-hoc analysis for multiple comparisons. there were statistically significant differences in the knowledge and practice of self-care with the fistula at 0, 7 and, 14 days in the intervention (p= 0.004 and p<0.001, respectively) and control groups (p<0.001 for knowledge and practice). Attitude showed a significant difference at follow-up (p<0.001), but the post-hoc analysis did not confirm the significance obtained. patients' knowledge and practice showed significant increases at follow-up in the control and intervention groups, while the increase in attitude was not significant in either group. Clinical trial, registration number: U1111-1241-6730.

Is there correlation between flow volume and Kt/V ratio in upper arm arteriovenous fistula in patients end stage renal failure?

Introduction: Chronic kidney disease is irreversible and may result in end-stage renal failure (ESRF). The kidney replacement program is determined by calculating Kt/V ratios, one of the dialysis efficiency indicators in treatment planning in routine dialysis applications in ESRF patients. We aimed to investigate whether there is a correlation between flow rate and Kt/V ratio. Methods: All patients were evaluated by B-mode ultrasonography (US) and color doppler ultrasonography (CDUS). The anastomosis line diameter was measured in the B-mode US. The fistula flow rate was calculated in a spectral examination at the anatomical location where the fistulized flow was best obtained at the anastomosis level. Patients with a fistula flow rate above 300 mL/min in CDUS examinations were considered reasonable flow rates. The fistula flow rate in these patients was compared with the Kt/V ratios. Spearman’s rank correlation coefficient was calculated since the normal distribution condition was not met to determine the relationship between variables. Results: The results of this study showed a high level (r=0.72, P=0.001) of positive and statistically significant correlation between flow rate and Kt/V ratio in upper arm arteriovenous fistula in patients with end stage renal failure. Conclusion: We found a highly positive and statistically significant correlation between fistula flow rate and Kt/V ratio. Low Kt/V ratios have different causes. Low fistula flow should be considered first in low Kt/V values.

Impact of monthly arteriovenous fistula flow surveillance on hemodialysis access thrombosis and loss

Arteriovenous fistula flow dysfunction is the leading cause of vascular access thrombosis and loss in patients undergoing hemodialysis. However, data regarding the influence of access flow rate measurements on the long-term outcomes of access are limited. This study aims to identify accesses at a high risk of thrombosis and loss among patients undergoing hemodialysis by measuring the access flow rate and exploring an optimal threshold value for predicting future access thrombosis. We enrolled 220 patients with arteriovenous fistula undergoing hemodialysis. The primary outcome was the occurrence of access thrombosis. Access flow rates were measured monthly using the ultrasound dilution method and were averaged using all measurements from patients with patent access. In patients experienced access thrombosis, those immediately before the thrombosis were selected. Using these data, we calculated the access flow rate threshold for thrombosis occurrence by analyzing the receiver operating characteristic curve, and the patients were divided into two groups according to whether access flow rates were higher or lower than 400 mL/min. During a median follow-up period of 3.1 years, 4,510 access flows were measured (median measurements per patient, 33 times; interquartile range, 11-54). A total of 65 access thromboses and 19 abandonments were observed. Access thrombosis and loss were higher in the lowflow group than in the high-flow group. This study revealed that low access flow rates are strongly associated with access thrombosis occurrence and subsequent loss of arteriovenous fistulas in patients undergoing hemodialysis.

Standardization of Pre-operative Evaluation to Improve the Outcome of Arteriovenous Fistula for Vascular Access of Hemodialysis: A Review of 700 Cases.

Background With the advent of COVID-19, mortality rates of end-stage kidney disease (ESKD) rose by 37% which makes its treatment an important part of healthcare. Arteriovenous fistula (AVF) is linked to higher patient survival rates. Cimino-Brescia fistula is the most effective vascular access technique, but it has a high rate of primary failure (PF) and a several-week maturation period before it can be used. The current study aims to verify the preoperative evaluation in improving survival among AVF patients. Methodology The current study is a retrospective analysis of the hospital database from Jan 2022 to July 2023, with patients of a mean age of 60.2 years. The sample size was around 700, including the patients indicated for long-term hemodialysis (HD) with an estimated GFR of less than 20 mm/min/1.73m². Following AVF surgery, post-operative outcomes, PF, and maturation time were considered. Results Among the 757 AVF procedures, 588 (82%) were new cases, and 112 (16%) had prior AVF history on the same side. PF was observed in 126 (18%) AVFs, while 574 (84%) achieved maturation. Age at surgery did not correlate with PF. Male sex and brachiocephalic AVF (BCAVF) had lower PF rates, while female gender, non-BCAVF, and vascular chronic kidney disease (CKD) were independent predictors. Proximal fistulas had a higher failure risk (32%). During surgery, the PF occurred six times more frequently in patients with veins and arteries under 2 mm and without a bruit. Conclusion AVF maturation aims to achieve a functional AVF for easy dialysis, requiring meticulous vein selection, doppler vascular mapping, and a standardized process to reduce PF rates. Factors determining PF include thrill and bruit, flow rates, and comorbidities. These findings can help clinicians make informed decisions and improve outcomes for patients undergoing fistula surgery.