Arteriovenous Fistula Formation Research Articles

Endovascular transluminal stent grafting

Iliac vessels are prone to injury during lumbar spine surgery due to their proximity to the lumbar spine. Arterio-venous fistula formation during lumbar spine surgery is an uncommon complication and can present as an asymptomatic incidental finding to rapidly deteriorating hemodynamics leading to cardiopulmonary collapse. We have reported three patients who had symptomatic iliac arterio-venous fistula detected soon after lumbar spine surgery. All these patients were successfully treated by endovascular transluminal stent grafting. © 2013 Wiley Periodicals, Inc.

Arterio-Venous (AV) Fistula: Surgical outcome in College of Medical Sciences Teaching Hospital, Bharatpur, Chitwan

Aims Arteriovenous fistula is considered as reliable form of vascular access for hemodialysis in Chronic Kidney Disease (CKD) patients. We aim to evaluate prospectively, the outcome and primary failure rate of Arteriovenous fistula in 30 Chronic kidney Disease patients with Glomerular Filtration Rate (GFR) <30ml/min. Materials and methods This prospective study was conducted at the department of cardiothoracic and vascular surgery (CTVS), College of Medical Sciences, Bharatpur from May 2011 to May 2012. Thirty patients ranging from age 25 to 76 years with stage IV and V CKD, i.e. GFR below 30ml/min, were included in this study. Detailed physical examination including arterial pulses i.e. axillary, brachial, radial and ulnar and blood pressure in both upper limbs was recorded. Allens test was performed on every patient and left upper limb was used for AV fistula formation. Brachiocephalic fistula was made in 19 (63.33%), while radiocephalic fistula was made in 11 (36.67%) patients. Patients were evaluated post operatively, on outdoor basis, weekly for 6weeks. All patients were evaluated for the presence or absence of complications i.e. infection, hematoma, thrombosis, aneurysms and steal syndrome. Results The complication was primary failure in two patients. One male patient got secondary infection and one female patient got post operative hematoma leading to 6.66% primary failure of fistula. No other complications were noted. Conclusion Arteriovenous fistula is the gold standard for vascular access for hemodialysis in patients with deteriorating renal function and end-stage renal disease. It is designed to improve the effectiveness of dialysis with fewer risks and complications than other vascular accesses. This study gives the higher success rate of 93.33% and concludes that age should not be a limiting factor when determining candidacy for arteriovenous fistula creation and is the safe procedure. Journal of College of Medical Sciences-Nepal, 2012, Vol-8, No-4, 1-6 DOI: http://dx.doi.org/10.3126/jcmsn.v8i4.8693

Creation of an Arteriovenous Fistula Is Associated with Significant Acute Local and Systemic Changes in Microvascular Function

Background: Native arteriovenous fistulae (AVF) are the vascular access of choice for haemodialysis. The consequences of AVF formation on microvascular function, locally or systemically, are unknown. Methods: We recruited 43 predialysis patients undergoing AVF formation. Patients were studied 2 weeks prior to the planned AVF operation and 2 weeks postoperatively. Thirteen patients with failed AVF were subsequently utilised as sham controls. Laser Doppler perfusion imaging was used to measure subcutaneous microvascular blood flow. Microvascular function was assessed as an increase in perfusion in response to iontophoretic administration of vasodilatory stimuli assessing endothelial-dependent (ED) and non-endothelial-dependent (NED) vasodilatation. Results: Patients with successful AVF formation had a significantly reduced ED vasodilatation in the fistula arm (-36 ± 46%, p < 0.001). Only NED vasodilatation was significantly reduced in the non-fistula arm (23 ± 40%, p = 0.01). Patients who had an unsuccessful AVF operation exhibited no recordable changes. Conclusions: Formation of an AVF was associated with local and remote changes in microcirculation. Further assessments are underway to examine the contributions of local shear stress, vasoreactive substances and the autonomic responses. Although the clinical significance of these findings is not yet clear, it is intriguing that AVF formation is associated with such widespread and profound changes in microperfusion.

Surgeons implant bioengineered vein in dialysis patient

There can be no doubt that, for the patient receiving haemodialysis, the importance of how venous access is achieved, managed and maintained is paramount. Despite progress having been made in technique and application, the mainstay of current practice continues to be centred on the formation of arteriovenous fistulae. However, this, and the use of various grafts using synthetic materials, remains beset with problems (Fluck and Kumweda, 2011). These centre on issues to do with infection, clotting (when synthetic substitutes are used) and the inherent challenges in harvesting patient’s own veins, which can be further compromised owing to the patient’s age or other associated pathology, such as diabetes mellitus. On 5 June 2013, surgeons at the Duke University Hospital successfully implanted a bioengineered vein into the arm of a patient suffering from endstage kidney disease, in what is the first stage of a US clinical trial. This may well be seen as one of the most significant steps forward in the ongoing management for this group of patients (Duke Health, 2013). Furthermore, and just as exciting, is the potential for future application in patients with blocked blood vessels (e.g. for use in bypass grafting in cardiac patients) and in the promise it holds out for bioengineering with other organs and tissues. The technology that has enabled this new initiative has been slowly developed over 15 years in collaboration between Laura Niklason and Jeffrey Lawson (Duke Health, 2013). This development can be seen as significant for a number of reasons, as Niklason explained:

Retroperitoneal hematoma: An unexpected complication during intervention on an occluded superficial femoral artery via a retrograde popliteal artery approach

Peripheral arterial disease involvement of the superficial femoral artery (SFA) is common. Different endovascular techniques are used successfully for revascularization of this artery. A retrograde approach to chronic total occlusion (CTO) of the SFA through the ipsilateral popliteal artery has been used occasionally if an antegrade approach is not feasible or has failed. Some of the known complications encountered during this approach are arteriovenous fistula formation at the access site, occlusion of the popliteal artery if closure devices are used, and bleeding. There are no reports of perforation or bleeding of the SFA or the external iliac artery (EIA) during a popliteal approach, probably due to lack of flow in the occluded segment of the SFA. We report a case in which a retroperitoneal hematoma occurred due to retrograde blood flow through the established true channel in the proximal SFA and subsequently to the dissection plane with a wire tip perforation in the EIA, which was treated by stopping retrograde filling with prolonged balloon inflation in the distal SFA before the CTO.

Retroperitoneal hematoma: An unexpected complication during intervention on an occluded superficial femoral artery via a retrograde popliteal artery approach

Peripheral arterial disease involvement of the superficial femoral artery (SFA) is common. Different endovascular techniques are used successfully for revascularization of this artery. A retrograde approach to chronic total occlusion (CTO) of the SFA through the ipsilateral popliteal artery has been used occasionally if an antegrade approach is not feasible or has failed. Some of the known complications encountered during this approach are arteriovenous fistula formation at the access site, occlusion of the popliteal artery if closure devices are used, and bleeding. There are no reports of perforation or bleeding of the SFA or the external iliac artery (EIA) during a popliteal approach, probably due to lack of flow in the occluded segment of the SFA. We report a case in which a retroperitoneal hematoma occurred due to retrograde blood flow through the established true channel in the proximal SFA and subsequently to the dissection plane with a wire tip perforation in the EIA, which was treated by stopping retrograde filling with prolonged balloon inflation in the distal SFA before the CTO.

Correction: Public reporting of surgeons’ performance

Incorrect name of organisation, and further clarification: In “Public reporting of surgeons’ performance” in the 6 May 2013 issue of the Journal (Med J Aust 2013; 198: 399-400), the organisation named as the Australian Vascular Society should have been given as the Australian and New Zealand Society for Vascular Surgery (ANZSVS). The administrator of the Australasian Vascular Audit, a project of the ANZSVS, has requested that it be noted that carotid endarterectomy is one of a number of procedures audited for outcomes. Other procedures audited are open and endovascular aortic surgery, lower-limb bypass graft surgery and arteriovenous fistulae formation for haemodialysis access (see Beiles CB, Bourke B, Thomson I. Results from the Australasian Vascular Surgical Audit: the inaugural year. ANZ J Surg 2012; 82: 105-111).

Nursing observation on traditional Chinese medicine hand soaking massage in the arteriovenous fistula formation

Objective To explore the effect of traditional Chinese herbs hand soaking combined with massage in patients with end-stage renal arteriovenous fistula after angioplasty.Methods 60 cases of arteriovenous fistula after angioplasty with end-stage renal disease were selected as the research object,and randomly divided into control group and treatment group with 30 cases in each group,the control group was given conventional treatment and nursing.Based on the same treatment in control group,the treatment group was added hand soaking with massage bath with traditional Chinese medicine,we compared two groups with fistula maturation in 4 weeks,complications of forming rate within 6 months and postoperative fistula incidence.Results In the treatment group,fistula maturation in 4 weeks and fistula formation rate were significantly higher than those of the control group(P＜0.05),the incidence was significantly less than that in the control group within 6 months of complications,with statistical significant difference(P＜0.05).Conclusion Traditional Chinese Medicine hand soaking combined with massage bath can shorten the maturation time of arteriovenous fistula,reduce the complications,and improve the internal fistula formation rate. Key words: Traditional Chinese Medicine hand soaking; Massage; Arteriovenous fistula; Nursing

Comparison of Efficacy of Side to Side Versus End to Side Arteriovenous Fistulae Formation in Chronic Renal Failure as a Permanent Hemodialysis Access

BackgroundIn candidate patients for permanent hemodialysis or dialysis on a regular basis, an appropriate vascular access has great importance. The best permanent access is AVF (arterio venous fistula). Use of a technique to create AVF with better patency seems to be logical.ObjectivesThe present study aimed to compare the efficacy rate of AVFs using two different anastomosis methods; Side to Side (STS) versus End to Side (ETS) and to determine whether the different approaches render any preferences or complications.Patients and MethodsSixty end stage renal disease (ESRD) patients were included in this clinical trial in two assigned groups of 30 patients. In one group end to side method to create AVF was used while in the other group Side to Side technique was applied for access in surgery. Both groups were followed for duration of 6 months to assess patency. For evaluating the quantitive variables, t-test was used while qualitative variables were measured using the chi-square and Fisher`s exact tests.ResultsIn the 6 months duration, 6 patients (20%) in the STS (side to side) group and 5 patients (16.6%) in the ETS (end to side) group experienced a non-functional AVF. In the ETS group the failure was generally a result of thrombosed access while in the STS group, 4 out of 6 patients with complications, experienced thrombosis while the other 2 patients had venous hypertension. The total failure rate was 18.3% and during the 6 months of follow up no significant difference was detected in the efficacy rate. Nevertheless, in case of longer follow ups, different outcomes could be seen.ConclusionsThis study demonstrated that there was no significant statistical difference between the functional patency rates of fistulae placed by STS or ETS methods.

Iliac vein stenting as a durable option for residual stenosis after catheter-directed thrombolysis and angioplasty of iliofemoral deep vein thrombosis secondary to May–Thurner syndrome

This study aims to evaluate the primary patency and clinical outcomes after stenting for residual iliac venous stenosis during catheter-directed thrombolysis treatment of acute iliofemoral deep vein thrombosis arising from May-Thurner syndome. A retrospective study was done for the all patients who underwent iliac vein stenting after catheter-directed thrombolysis treatment of acute iliofemoral deep vein thrombosis due to May-Thurner syndrome from January 2005 to April 2011 in Inha University Hospital. Patient information was assembled from the electronic medical records, imaging and interview. The patency of iliac vein stent was evaluated with serial computed tomography. Fifty-one patients were enrolled. The median age was 70 years (range 44-86). There were 37 females (72.5%). The duration of symptoms of acute deep vein thrombosis before catheter-directed thrombolysis treatment was 6 days (median, range 1-33). Self-expanding stent was used for iliac vein stenting. Initial technical success rate was 94.1%. There were two complications (3.9%): an arteriovenous fistula formation in left popliteal area and a right inguinal hematoma. Mean follow-up was 15.6 months (range 6 days-80.8 months). Primary patency rate after iliac vein stenting was 95.8% at 6 months, 87.5% at 12 months and 84.3% at 24 months. Four patients had recurrent thrombotic occlusion (7.8%) during the follow-up. Iliac vein stenting showed good primary patency rate with few complications. Iliac vein stenting is a durable option for residual stenosis after catheter-directed thrombolysis treatment of acute deep vein thrombosis in May-Thurner syndrome.

De Novo Dural Arteriovenous Fistula Formation Following Asymptomatic Sinus Thrombosis: A Case Report and Review of the Literature

Cerebral venous sinus thrombosis (CVST) has been suggested to play an important role in the pathogenesis of dural arteriovenous fistular (DAVF) formation but studies supporting a causal relationship are rare. We report a 15-year-old male who developed a brief syncopal episode that was felt to be secondary to dehydration. A non-contrast computerized tomography (CT) scan of the head showed hyperdensities of the posterior superior sagittal and bilateral transverse sinuses. Magnetic resonance venogram confirmed the presence of diffuse CVST without cerebral edema, infarction or hemorrhage. Dural sinuses were partially recanalized after a six-week anticoagulation treatment. At 14 months patient was found with a left sided DAVF that was embolized successfully without complications. The presence of asymptomatic, minimally symptomatic or partially treated CVST may be implicated in the pathogenesis of DAVF. doi: http://dx.doi.org/10.4021/jnr195w

Imaging of Vascular Complications and Their Consequences Following Transplantation in the Abdomen

Transplantation is the surgical treatment of choice for end-stage organ failure. Transplantation procedures performed in the abdomen include liver, renal, pancreas, islet, intestinal, and multivisceral transplantations. Imaging plays a pivotal role in the posttransplantation setting for monitoring the transplant allograft and screening for complications. Knowledge of the surgical techniques employed in abdominal transplantation is essential because it facilitates radiologic understanding and interpretation of the posttransplantation anatomy. This article includes a basic description of the standard surgical techniques performed in the abdomen, with emphasis on the relevant vascular anastomotic reconstructions used. Posttransplantation complications can be broadly classified as vascular or nonvascular in origin. Many of these complications can be accurately depicted and characterized at imaging and dealt with definitively by using interventional radiology techniques, which can be graft- and life-saving and can obviate further complex surgical intervention. The article discusses imaging appearances of vascular complications and their consequences after transplantation in the abdomen. These vascular complications include arterial thrombosis, arterial stenosis, venous thrombosis and stenosis, arteriovenous fistula formation, and pseudoaneurysm formation. The relevant predisposing factors, clinical features, imaging appearances, and potential treatment options for vascular complications of various types of transplantation are presented in a logical and integrated fashion. Knowledge and imaging recognition of the posttransplantation vascular complications discussed in this article will aid radiologists in accurate imaging characterization and thereby facilitate appropriate clinical management and therapy.

Right Axillary Artery Bullet Embolus and the Formation of a Pulmonary Arteriovenous Fistula after a Gunshot Wound to the Back

Right Axillary Artery Bullet Embolus and the Formation of a Pulmonary Arteriovenous Fistula after a Gunshot Wound to the Back

Vascular access and infection prevention and control: a national survey of routine practices in Irish haemodialysis units

BackgroundNational and international guidelines recommend the use of effective vascular access (VA) and infection prevention and control practices within the haemodialysis environment. Establishing an arterio-venous fistula (AVF) and preventing central venous catheter (CVC)-related infections are ongoing challenges for all dialysis settings. We surveyed VA and routine infection prevention and control practices in dialysis units, to provide national data on these practices in Ireland.MethodsA descriptive survey was emailed to nurse managers at all adult (n = 19) and children (n = 1) outpatient haemodialysis units in the Republic of Ireland. Data collected included AVF formation, CVC insertion and maintenance practices, VA use and surveillance of infection and screening protocols. Nineteen of the 20 units responded to the survey.ResultsThe AVF prevalence was 49% for 1370 patients in 17 units who provided these data [mean prevalence per unit: 45.7% (SD 16.2)]; the CVC mean prevalence per unit was 52.5% (SD 16.0). Fourteen dialysis units experienced inadequate access to vascular surgical procedures either due to a lack of dedicated theatre time or hospital beds. Six units administered intravenous prophylactic antimicrobials prior to CVC insertion with only two units using a CVC insertion checklist at the time of catheter insertion.ConclusionIn general, dialysis units in Ireland show a strong adherence to national guidelines. Compared with the 12 countries participating in the Dialysis Outcomes Practice Patterns Study (DOPPS 4), in 2010, AVF prevalence in Irish dialysis units is the second lowest. Recommendations include establishing an AVF national prevalence target rate, discontinuing the administration of intravenous prophylactic antimicrobials prior to CVC insertion and promoting the use of CVC insertion checklists.

A systematic review of preoperative duplex ultrasonography and arteriovenous fistula formation

Arteriovenous fistula (AVF) formation for dialysis access is a common procedure. Fistula maturation is unpredictable. Preoperative duplex mapping may increase procedural success. We undertook a systematic review to assess the effect of preoperative duplex mapping on subsequent AVF patency. The published literature was searched on PubMed and the Cochrane Library using the following keywords: 'arteriovenous fistula,' 'venous mapping,' 'ultrasound,' 'hemodialysis,' 'vascular access,' and 'perioperative vessel mapping.' Conference proceedings were hand searched for otherwise unpublished trials. Only randomized controlled trials in which preoperative duplex mapping was compared with clinical evaluation were eligible. Three trials (402 patients) were identified. More patients who underwent ultrasound successfully started using their fistula for dialysis access, although the difference did not reach statistical significance (174/214 vs 130/188; pooled odds ratio, 1.96; P = .11). Preoperative duplex mapping may improve fistula maturation rates. However, the results do not reach statistical significance and there are no cost-effectiveness data. Further work is required.

Arteriovenous fistula aneurysms in patients with Alport's

Alport's syndrome is a rare but important cause of renal failure. It is characterized by Type IV collagen mutations resulting in connective tissue disorders and renal and cochlear dysfunction. Vascular basement membrane also contains collagen IV and the effect on arteriovenous fistulas (AVFs) is not reported. Anecdotally, we observed a high rate of aneurysm formation in Arteriovenous fistulas (AVF) of patients with Alport's and sought to determine whether this was the case within our population. All patients with a diagnosis of Alport's were identified from a contemporaneously maintained database. AVFs formed in patients with Alport's were identified to define the incidence of aneurysms in this group. A total of 40 patients with a diagnosis of Alport's were identified. Of these, 20 patients had undergone AVF formation, the remainder opting for CAPD as renal replacement or had undergone pre-emptive transplantation. Of the 20 patients identified, 11 had an AVF and of these the rate of aneurysm formation was high (55%). While this finding of high rate of aneurysmal AVF in Alport's patients is a purely observational finding within our population further population study would be extremely interesting and could support enhanced surveillance or alternative dialysis modalities in Alport's syndrome patients.

Ischemic monomelic neuropathy: a rare complication after vascular access formation

Ischemic monomelic neuropathy: a rare complication after vascular access formation

Coronary Subclavian Steal from a Left Internal Thoracic Artery Coronary Bypass Graft due to Ipsilateral Subclavian Artery Stenosis and an Arteriovenous Graft in a Hemodialysis Patient with Left Vertebral Artery Occlusion

Coronary subclavian steal syndrome is an unusual cause of myocardial ischemia, secondary to a reversed blood flow in patients with patent internal thoracic artery coronary bypass grafts. The causes of coronary subclavian steal are either ipsilateral subclavian artery stenosis or upper extremity arteriovenous hemodialysis fistula formation or both. This report involves a 68-year-old woman with left vertebral artery occlusion who developed severe coronary steal in the absence of vertebral subclavian steal due to left subclavian artery stenosis and an arteriovenous hemodialysis graft.

Delayed compartment syndrome following brachiocephalic arteriovenous fistula formation in a hemodialysis patient

Delayed compartment syndrome following the surgical creation of an arteriovenous fistula (AVF) for vascular access is rare. A 71-year-old male patient experienced left anterior forearm compartment syndrome caused by a brachiocephalic AVF. The fistula failed after five days. Immediate radiological de-clotting failed and the thrombosed fistula was de-clotted with the help of a Fogarty balloon. On Day 11, the patient developed symptoms and signs of acute anterior forearm compartment syndrome and underwent immediate surgical decompression of the superficial and deep flexor compartments, which resulted in an excellent outcome. Iatrogenic forearm compartment syndrome is a rare but potential complication after creation of AVF. The critical errors regarding compartment syndrome are failure to recognize or failure to act. This case report illustrates that swift diagnosis and immediate surgical intervention results in an excellent outcome and avoids the morbidity associated with this potentially devastating and debilitating process.

De Novo Dural Arteriovenous Fistula Formation Following Asymptomatic Sinus Thrombosis: A Case Report and Review of the Literature

Cerebral venous sinus thrombosis (CVST) has been suggested to play an important role in the pathogenesis of dural arteriovenous fistular (DAVF) formation but studies supporting a causal relationship are rare. We report a 15-year-old male who developed a brief syncopal episode that was felt to be secondary to dehydration. A non-contrast computerized tomography (CT) scan of the head showed hyperdensities of the posterior superior sagittal and bilateral transverse sinuses. Magnetic resonance venogram confirmed the presence of diffuse CVST without cerebral edema, infarction or hemorrhage. Dural sinuses were partially recanalized after a six-week anticoagulation treatment. At 14 months patient was found with a left sided DAVF that was embolized successfully without complications. The presence of asymptomatic, minimally symptomatic or partially treated CVST may be implicated in the pathogenesis of DAVF. J Neurol Res. 2013;3(2):73-77 doi: https://doi.org/10.4021/jnr195w