Hemodialysis Arteriovenous Fistula Research Articles

Arteriovenous fistula aneurysmorrhaphy is associated with improved patency and decreased vascular access abandonment

BackgroundUpper extremity hemodialysis arteriovenous fistulas (AVFs) can become aneurysmal over time due to repeated cannulation and/or outflow steno-occlusive disease. The optimal surgical management of aneurysmal AVFs (aneurysmorrhaphy vs interposition graft) has remained unclear. MethodsWe performed a retrospective review in which current procedural terminology codes were used to screen for patients who had undergone surgical treatment of aneurysmal AVFs between 2016 and 2021 at a single hospital system. The patients were included after a review of the operative reports. The cases were divided by surgical procedure (aneurysmorrhaphy vs interposition graft placement). The patients who had undergone primary AVF ligation or other types of repair were excluded. The primary outcomes were primary assisted and secondary patency, and the secondary outcome was dialysis access abandonment. Multivariable Cox proportional hazards regression was used to test the association between the type of AVF aneurysm repair and the primary and secondary outcomes. ResultsFrom 2016 to 2021, 6951 patients had undergone 16,190 dialysis access procedures. Of these procedures, 381 (2.4%) were related to surgical treatment of an aneurysmal AVF. We excluded 58 primary AVF ligation cases and 20 cases involving other types of repair, leaving 303 cases for analysis. These were divided into two groups: aneurysmorrhaphy (n = 123; 41%) and interposition graft (n = 180; 59%). No differences were found between the groups in male gender (68% vs 63%), hypertension (98% vs 98%), or central stenosis (14% vs 22%). The patients who had undergone aneurysmorrhaphy were younger (median age, 54 years vs 59 years); had had a lower rate of diabetes (41% vs 59%), coronary artery disease (41% vs 58%), and congestive heart failure (41% vs 55%); and were less likely to have undergone upper arm access (72% vs 92%). The median follow-up was 11.1 months (interquartile range, 3.6-25.2 months). No differences were found in the incidence of 30-day wound complications (1% vs 3%) or surgical site infections (4% vs 6%). On multivariable Cox regression, interposition graft placement was associated with the loss of primary assisted patency (adjusted hazard ratio [aHR], 2.42; 95% confidence interval [CI], 1.18-4.95), loss of secondary patency (aHR, 3.10; 95% CI, 1.21-7.94), and abandonment of dialysis access (aHR, 3.07; 95% CI, 1.61-5.87; P < .05 for all) at 2 years. ConclusionsAVF aneurysmorrhaphy was associated with improved primary assisted and secondary patency and decreased abandonment of dialysis access. We suggest using aneurysmorrhaphy when AVF aneurysms are indicated for repair. However, individual factors such as patient comorbidities, AVF anatomy, remaining dialysis access options, and patient preference should be considered when planning the surgical approach.

Isometric Exercise and Arteriovenous Fistula for Haemodialysis: The Impact on Maturation Process

Isometric Exercise and Arteriovenous Fistula for Haemodialysis: The Impact on Maturation Process

FISTULOPLASTY FORFAILING AVF - AN INSTITUTIONAL EXPERIENCE

Introduction: Failing AVF can be salvaged by open surgical technique, percutaneous encdovascular or hybrid methods. In this study our institutional experience on balloon fistuloplasty is described. The objective is To investigate the effectiveness of endovascular balloon angioplasty to preserve the patency of failing hemodialysis arteriovenous fistulas (AVF). Materials And Method: 1. Period Of Study - 3 YEARS AUG 2019 TO AUG 2022 2. Total No Of Patients – 20 3. Study method – retrospective observational study Results: In a total of 20 patients 16 cases (80%) were successful with immediate restoration of optimal flow rate during dialysis.At the end of 6 months – 8 were successful. 5 had failed fistuloplasty, 3 – expired. Conclusion:Fistuloplasty is a minimally invasive percutaneous procedure with established safety and efficacy to restore the normal function of AVF.Most common site is Cephalic V puncture sites. It is advised to follow Rope Ladder technique to avoid AVF failure.

How does a CIED presence influence chances and safety of haemodialysis access? Conclusions from over 3000 thoracic venografies.

The authors analysed preoperative venogrphies of 3100 patients referred for transvenous lead extraction for a possible chance of safe haemodialysis catheter (HC) implantation or proper AVF function. A chance of safe catheter implantation parallel to existing leads reaches 68.8% ipsilaterally to CIED. Contraindications for implantation have been found in less than 2% of cases contralaterally. Ipsilaterally proper AVF function chance has been found in 50.3% of the cases and almost 98% contralaterally. A bilateral chest electrodes location require the special attention. Abandoned lead, lead burden, bilateral leads, additional lead implantation or abandonment, and implant duration may have a significant influence on HC insertion or proper function of arteriovenous fistula. (1) Obstruction of prominent thoracic veins is a frequent finding in CIED carriers and may impede or disable implantation haemodialysis accesses. (2) Implantation of temporary or permanent HC may be questionable ipsilaterally to the CIED in 31.2% and contralaterally in 2.0% of patients. Proper function of AVF is uncertain in 49.7% ipsilaterally and 2.1% contralaterally to CIED. (3) Pacing history and leads dwell time influence chances of success haemodialysis access even on the free-from CIED chest side. (4) Proper venous flow evaluation seems to be valuable in CIED carriers before an attempt of haemodialysis access formation, even contralaterally.

Patient specific approach to analysis of shear-induced platelet activation in haemodialysis arteriovenous fistula.

Shear-induced platelet activation (SIPAct) is an important mechanism of thrombosis initiation under high blood flow. This mechanism relies on the interaction of platelets with the von Willebrand factor (VWF) capable of unfolding under high shear stress. High shear stress occurs in the arteriovenous fistula (AVF) commonly used for haemodialysis. A novel patient-specific approach for the modelling of SIPAct in the AVF was proposed. This enabled us to estimate the SIPAct level via computational fluid dynamics. The suggested approach was applied for the SIPAct analysis in AVF geometries reconstructed from medical images. The approach facilitates the determination of the SIPAct level dependence on both biomechanical (AVF flow rate) and biochemical factors (VWF multimer size). It was found that the dependence of the SIPAct level on the AVF flow rate can be approximated by a power law. The critical flow rate was a decreasing function of the VWF multimer size. Moreover, the critical AVF flow rate highly depended on patient-specific factors, e.g., the vessel geometry. This indicates that the approach may be adopted to elucidate patient-specific thrombosis risk factors in haemodialysis patients.

Beyond the Tool

After more than a decade in development, including several years of clinical study, hemodialysis arteriovenous fistulae (AVFs) can now be safely created using percutaneous methods. With their technique, Hull et al (1) have gone further and shown that most of their percutaneous arteriovenous fistulae (pAVFs) remained useful for hemodialysis at 5 years. With no need for surgery, angiographic imaging equipment, or iodinated contrast medium, pAVFs can be created using ultrasound guidance in an office, ambulatory surgery center, or hospital.

Arterial diameter ratio as a reliable predictor for upper limb steal syndrome in patients with arteriovenous fistula for hemodialysis.

The aim of this study is to assess the association between the anastomosis diameter enlargement and steal syndrome incidence in patients with upper limb arteriovenous fistula using ratios as reliable predictors. An analytical cross-sectional prospective study was conducted. A total of 49 patients with AVF hemodialysis access were recruited. Twenty-four participants with positive steal syndrome and 25 control were enrolled in the study. Anastomosis diameter, anastomosis diameter ratio, and volume flow ratio were measured ultrasonographically by two expert vascular sonographers. These clinical parameters were recorded and analyzed to assess the difference and association. Patient risk factors and steal syndrome association were emphasized. The study analysis indicates a strong association in the anastomosis diameter and anastomosis diameter ratio between steal and non-steal patients with a p-value ≤0.05. Additionally, there was a significant increase in the volume flow ratio in the patients with steal syndrome compared to the control group (p-value ≤0.05). There was a strong relationship between steal syndrome and the presence of peripheral arterial disease (73.9%, p = 0.001). The ICC index of absolute agreement between the two observers was ICC= 0.99 (95% CI 0.99-0.99, n = 10), indicating excellent agreement between observers. Anastomosis diameter and volume flow ratio strongly suggest that steal syndrome is associated with the increased diameter of anastomosis. Patients with a≥1.05 anastomosis diameter ratio have a greater risk of developing steal syndrome than those with an anastomosis ratio of ≤0.8. In addition, patients with a volume flow ratio ≥0.98 have an increased risk of developing steal syndrome than those with a volume flow ratio of ≤0.75.

Prediction of the anastomosis angle of arteriovenous fistula in hemodialysis to standardize the surgical technique.

Arteriovenous fistula (AVF) is the preferred route of vascular access in hemodialysis. The primary reason of fistula failure is intimal hyperplasia (IH), which leads to stenosis. Wall shear stress (WSS) and disturbed flow are the critical parameters in the formation of IH. The primary goal of this study is to explore the influence of anastomosis angle on WSS and venous outflow rate, as well as to find the ideal angle of anastomosis for AVF to standardize surgical technique. Three-dimensional idealized geometries of end-to-side type AVF for the five various angles of anastomosis are considered in this study. The WSS, blood flow rate at the venous outlet for non-Newtonian, pulsatile blood flow are calculated using a numerical simulation technique. The WSS is higher at 75° compared to other angles and least at 45° for pulsating arterial inflows. The WSS is moderate at 30°, 60° and 90°. On the arterial bed and outer wall of the vein, immediately after the anastomosis, the recirculation zone is observed. At an angle of 45° and 90° anastomosis, the outflow rate is greater at distal venous end. If one believes that high wall shear stress causes IH within the AVF, the results suggest that the AVF should be formed at a 45° angle to avoid IH. However, if one believes that low wall shear stress causes IH within the AVF, the results suggest that AVF should be formed at either 30° or 75° to avoid IH. The findings spotlight the importance of anastomosis angle in determining AVF hemodynamics.

High Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios Are Associated with a Higher Risk of Hemodialysis Vascular Access Failure.

Our aim was to determine the predictive role of the preoperative neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in vascular access malfunctioning in patients who had undergone their first native arterio-venous fistula (AVF) for hemodialysis. Methods: This was a single-center retrospective observational study. All patients who underwent the procedure of the creation of a first native AVF for hemodialysis from January 2019 to December 2020 were considered eligible to be part of this study. Reinterventions for AVF malfunctioning were registered and the population was subdivided into two groups with respect to AVF malfunctioning. ROC curves were obtained to find the appropriate cut-off values for the NLR and PLR. A multivariate analysis was used to identify the independent predictors for an AVF malfunction. Kaplan–Meier curves were used to evaluate the AVF patency rates. A total of 178 patients were enrolled in the study, of them 70% (n = 121) were male. The mean age was 67.5 ± 12 years. Reinterventions for AVF malfunctioning were performed on 102 patients (57.3%). An NLR > 4.21 and a PLR > 208.8 was selected as the cut-off for AVF malfunctioning. The study population was divided into two groups depending on the NLR and PLR values of the individual. For the NLR < 4.21 group, the AVF patency rates were 90.7%, 85.3%, and 84% at the 3-, 6-, and 12-month follow-up, respectively, and 77.5%, 65.8%, and 39.3% at 3, 6, and 12 months for the NLR > 4.21 group, respectively (p < 0.0001). For the PLR < 208.8 group, the patency rates were 85.6%, 76.7%, and 67.7% at the 3-, 6-, and 12-month follow-up. For the PLR > 208.28 group, the patency rates were 80.8%, 71.2%, and 50.7% for the 3-, 6-, and 12-month follow-up, respectively (p = 0.014). The multivariate analysis highlighted that diabetes mellitus, the neutrophil count, the lymphocyte count, and the NLR were independent risk factors for an AVF failure. In our experience, the NLR and PLR are useful markers for the stratification of vascular access failure in hemodialysis patients. The inexpensive nature and ready availability of the values of these biomarkers are two points of strength for everyday clinical practice.

Cost of arterioveinous fistula at the Douala General Hospital: A Cameroon-based cross-sectional study

Background: Cost is a major limiting factor for dialysis in low-income countries. The objective of our study was to determine the economic cost of creating an arteriovenous fistula (AVF) for hemodialysis at the Douala General Hospital (DGH). Material and methods: We conducted a descriptive cross-sectional study including patients undergoing AVF creation at the DGH from January to April 2020. Costs were calculated using a bottom-up approach. The direct cost was composed of the sum of the cost of medical consultation, additional paraclinical tests, drugs, disposables, hotel services, food, transport and medical and nursing care. The indirect cost was calculated as the sum of the costs related to the temporary incapacity to work and the additional expenses of the families. The cost of temporary work incapacity was calculated according to human capital theory. The economic cost was the sum of the direct cost and the indirect cost. The costs were expressed as a mean with standard deviation. The calculated costs were expressed in US Dollars. Statistical significance was considered as p &lt; 0.05. Results: A total of 44 patients were included of which 29/44 (65.9%) were male. The mean age of the study population was 49.1 ± 14.7 years. The median monthly income was $172 and only 6.8% of patients had health insurance. The average direct cost per patient was $327.3 ± $212.7, with hospitalization costs accounting for 59.6% of that cost. The average indirect cost per patient was $64.5 ± $50.3. The largest proportion of these costs was due to lost productivity related to temporary work disability (45.7%). The average economic cost per patient was $391.9 ± $219.5. Direct costs accounted for 83.54% of the economic cost. Re-operation (p = 0.039), age (p &lt; 0.01) and number of hospitalization days (p &lt; 0.01) significantly affected the cost Conclusion: The cost of creating an AVF for hemodialysis was high and represented more than 2 times the median monthly income of patients and was mainly due to hospitalization costs. Therefore, there is a need to implement strategies to reduce the financial burden of arteriovenous fistula creation in our setting.

TH4.2 To do or not to do, Branch ligation of a non-maturing arterio-venous fistula for haemodialysis

Abstract Aim Up to 20% of arterio-venous fistulas (AVFs) may fail to mature to become usable for renal access in patients on Haemodialysis (HD). There is no consensus on benefit of branch ligation. This study aimed to assess the outcomes of branch ligation on maturation of these AVFs. Methods Electronic patient records and Renalware were accessed to obtain data of branch ligation procedures done at secondary care centre from 2016 till 2021. Results With a prevalent dialysis population of over 771 patients and incident dialysis population of 147 in 2021, we as a centre perform 250–300 access procedures annually. A total of 23 ligation procedure were done in the above-mentioned period. Less than 50% of patients had a large branch documented on Duplex scan report to be draining a significant and measurable flow away from the AVF. The other procedures were done based on clinical judgement. All procedures were done under Duplex guidance and under Local or Regional anaesthesia. About two thirds of the fistulas that required branch ligation were Radio-Cephalic AVFs, the rest Brachio-Cephalic AVFs. No complications were reported though one patient needed a fistuloplasty due to vein pinch. In 16 out of the 23(69.5%) patients there was clinical and sonological improvement in flow, and or vein diameter after the branch ligation making them usable for HD. Conclusion Branch ligation of non- maturing fistula in selected cases can help maturation and make these arteriovenous fistulas usable.

Severity and Extent of Lead-Related Venous Obstruction in More Than 3000 Patients Undergoing Transvenous Lead Extraction.

BackgroundLead-related venous stenosis/obstruction (LRVSO) may be a major challenge in patients with cardiac implantable electronic devices (CIED) when device upgrade, insertion of central lines, or creation of an arteriovenous fistula for hemodialysis is indicated. The aim of this study was to evaluate the extent and severity of LRVSO.MethodsWe performed a retrospective analysis of 3002 venograms from patients awaiting transvenous lead extraction (TLE) to assess the occurrence, severity, and extent of LRVSO.ResultsMild LRVSO occurred in 19.9%, moderate in 20.7%, severe in 19.9% and total venous occlusion in 22.5% of the patients. Moderate/severe stenosis or total occlusion of the subclavian and brachiocephalic veins was found in 38.2% and 22.5% of the patients, respectively. LRSVO was not detected in 16.9% of the patients. Moderate and severe superior vena cava (SVC) obstruction and total SVC occlusion were rare (0.4%, 0.3%, and 0.3%, respectively). Lead insertion on the left side of the chest contributed to an increased risk of LRVSO compared to right-sided implantation. Major thoracic veins on the opposite side may be narrowed in varying degrees.ConclusionA total of 60% of the patients with pacemaker or high-voltage leads have an advanced form of LRVSO. Any attempt to insert new pacing leads, central lines, venous ports, or catheters for hemodialysis, or to create dialysis fistula on the same side as the existing lead should be preceded by venography. Furthermore, venography may provide useful information, if it is planned to implant the lead or the catheter on the opposite side of the chest.

Revisiting the Role of Ultrasound Mapping in Arteriovenous Fistula Formation: A Single-Center Experience

Background: The global prevalence of chronic kidney disease (CKD) continues to increase, with the arteriovenous fistula (AVF) as the most preferred vascular access for hemodialysis. Whether routine preoperative ultrasound mapping improves the outcome of AVF formation compared with clinical examination alone remains controversial. Methods: This retrospective study included patients undergoing AVF surgery with and without preoperative ultrasound at our center between September 2017 and August 2020. Outcome measures included AVF early and mid-term outcome. Cox regression analysis was performed to identify independent predictors of favorable AVF outcome. Results: A total of 158 patients received an AVF during the study period. Both groups with (n = 79) and without (n = 79) ultrasound mapping were similar regarding baseline characteristics (age, sex, comorbidities). Patency rates were comparable between the 2 groups at 30 days, 3 months, and 6 months after AVF surgery, although there was a trend toward more favorable outcome for the mapping group ( P = .07). Kaplan-Meier analysis showed that at the end of study, the ultrasound mapping group had a higher mid-term patency rate; however, the improvement was not significant ( P = .07). Cox regression analysis did not reveal age, gender, comorbidities, and ultrasound as predictors of AVF survival. Conclusion: Our study did not find a significant benefit from routine preoperative ultrasound mapping in creating AVFs for hemodialysis. Further well-designed and adequately powered trials are needed to demonstrate the beneficial role of routine preoperative ultrasound mapping for vascular access in CKD coupled with clinical evaluation in short- and long-term AVF outcome.

Accessory Vein Obliteration and Balloon-Assisted Maturation for Immature Arteriovenous Fistulas for Haemodialysis: A Systematic Review and Meta-Analysis.

This study aims to examine outcomes of immature arteriovenous fistula salvage using balloon angioplasty (PTA) without and with accessory vein obliteration (PTA + VO). PubMed and Embase were accessed on 21 September 2020 to retrieve cohort studies on adult patients with end-stage renal failure (ESRF) requiring dialysis. Risk of bias was assessed using Newcastle-Ottawa Scale. Studies were pooled into PTA or PTA + VO arms, with outcomes (technical/clinical success, primary/secondary post-intervention patency until 12months) reported as event rates with 95% confidence intervals. Random-effects model and maximum likelihood meta-regression were used for meta-analysis. Fourteen studies (1030 participants) were included. The between-subgroup difference in outcomes was largely non-significant (p > 0.050). The evidence does not support balloon angioplasty with concomitant accessory vein obliteration for immature fistula salvage.

Clinical outcomes and performance indicators of patients with kidney failure and acute kidney injuries in ASEAN countries.

This review article reports clinical outcomes and performance indicators of patients with kidney failure (KF) and acute kidney injuries (AKI) in Association of South East Asian Nations (ASEAN) countries. Association of South East Asian Nations data, segregated by income status, from national registries and literature were collated, compared and benchmarked against international references. The national incidence and prevalence of treated KF ranged from 172 to 479 per million population (pmp) and 36-2255 pmp, respectively. Brunei (79%), Malaysia (66%) and Singapore (66%) had world-leading proportions of diabetes-related KF. Hemodialysis (HD), Peritoneal Dialysis (PD) and transplant accounted for 68-100%, 0-27% and 0-18% of all KF replacement therapy, respectively. Transplant patient survival was superior with 90%-93% at 5 years and 71%-90% at 10 years, compared to PD (44%-54%) and HD (53-64%) at 5 years. Higher-income countries were able to achieve good anemia control, HD and PD adequacy targets, while usage of arteriovenous fistula in HD varied from 70% to 85%. Acute Kidney Injury rates ranged from 24.2% to 49.2% of high-dependency admissions. Lower incidences of PD peritonitis and HD catheter-related Bloodstream Infections; and PD-favouring quality-of-life were evident in higher-income countries. Association of South East Asian Nations has a challenging burden of kidney disease, with extremely high incidence, prevalence, DM-related KF and AKI rates. The magnitude of the prevailing problem calls for the creation of a regional society under the auspices of ASEAN with a shared perspective of universal, equitable and charitable access to quality renal care; consistent with the founding premises and healthcare initiatives of ASEAN.

Snuff-Box Versus Wrist Radiocephalic Arteriovenous Fistulas for Hemodialysis: Maturation Tend and its Affecting Factors

Thanks to its well proved long-term patency rates, native radiocephalic arteriovenous fistula remains the most commonly used vascular access type. Many articles had approached the criteria leading to a mature fistula. The aims of this work are to evaluate variables that may affect the maturation of distal fistulas and to determine if wrist fistulas have less risk of maturation failure than the snuff-box fistulas. We recorded all distal radiocephalic fistulas that had been created from January 2018 to February 2021. Epidemiological and clinical profile of patients, characteristics of performed fistulas and per and post-operative data were recorded and analyzed. From January 2018 to February 2021, 165 upper limb vascular accesses for hemodialysis had been created including 47 (28.5%) distal radiocephalic fistulas. Among the latter, 39 (83%) fistulas were performed at the wrist and 8 (17%) at snuff-box area. There were 34 men (72.3%). Mean age was 67years (37-87). Both types of fistulas had approximately an identic frequency of primary maturation failure (50% for radiocephalic versus 47.2% for snuff-box fistulas). Secondary maturation had been achieved in 9 fistulas. Patients with medical history of dyslipidemia, peripheral arterial disease (PAD), central catheter placement, and bad quality of vessels tend to develop an immature fistula. No significant differences in maturation tend between snuff-box and wrist fistulas had been demonstrated. Thus, it seems reasonable to privilege the creation of the most distal fistulas allowing preservation of wrist fistulas as a second option in case of snuff-box fistulas maturation failure. However, selection of the most suitable cases for snuff-box fistulas creation, based on clinical and duplex ultrasound data, remains primordial.

Distal Transradial Access for Recanalization of Chronic Occlusions of the Radial Artery

Background. The current state of interventional cardiology is aimed at reducing the number of probable complica-tions of procedures and increasing patient comfort. That is why there was a stage evolution of changing endovascular ap-proaches from transfemoral to transradial. But despite the significant benefits of transradial access, it leaves behind some important complications. One such complication is occlusion of the radial artery. The frequency of this situation ranges from 1 to 30%. That is why the world’s leading interventionists are increasingly using distal transradial access, which is associated with fewer cases of postoperative occlusion of the radial artery.&#x0D; The aim. Occlusion of the radial artery is not an obstacle to changing access to the contralateral artery or more dan-gerous transfemoral access. With distal transradial access it is possible to recanalize artery and provide target procedure.&#x0D; Materials and methods. The study included 318 patients who were scheduled for re-intervention. Among these patients, 12 had a radial artery occlusion, which is 3.7% of the total control group. Successful recanalizations with distal access were performed in 9 patients (75%), and in 3 patients (25%) the attempts were unsuccessful. The technique of recanalization of chronic occlusion included selection of hydrophilic, both non-coronary and coronary wires. At the end of the procedure, hemostasis was performed according to standard procedures using aseptic bandages. Complications of hemostasis were not detected in any patient in the control group. The postoperative period was unremarkable.&#x0D; Conclusions. The study showed the possibility of using distal transradial access to recanalize chronic occlusions of the radial artery, which allows not to waste time on replacement of the contralateral radial artery or life-threatening transfemoral access and perform the necessary amount of the intervention. Besides, this preserves the radial artery for further use in bypass surgery or hemodialysis arteriovenous fistula.

Effectiveness of hydropathic compress of dandelion in ameliorating complications of arteriovenous fistula

Purpose: To investigate the effect of dandelion hydropathic compress on the complications of autologous arteriovenous fistula (AVF).Methods: From January to June 2019, a total of 162 patients treated with arteriovenous fistula for hemodialysis in the blood purification department of Affiliated Hospital of Jining Medical University were enrolled. They were randomly assigned at a ratio of 1:1 to receive either conventional infrared irradiation (control group) or conventional irradiation plus dandelion hydropathic compress (study group). The clinical endpoint was the amelioration of the complications of arteriovenous fistula after 6 months of treatment.Results: Dandelion hydropathic compress combined with conventional infrared irradiation was associated with a significantly higher clinical efficacy (96.30 %) than conventional infrared irradiation alone (77.78 %). The application of dandelion hydropathic compress plus infrared irradiation resulted in significantly reduced pain, a better quality of life, and a lower incidence of complications (p &lt; 0.05).Conclusion: Dandelion hydropathic compress plus routine nursing and infrared irradiation lower the incidence of complications, improve blood flow, relieve pain, and enhance the quality of life of patients. Further clinical trials are needed to confirm the usefulness of this therapeutic strategy.

Recanalization of thrombosed aneurysmal hemodialysis arterovenous fistulas using a hybrid technique based on data from a single center

ObjectiveTo explore the technical specifications and clinical outcomes of thrombosed aneurysmal haemodialysis arteriovenous fistula (AVF) treated with ultrasound-guided percutaneous transluminal angioplasty combined with minimal aneurysmotomy.MethodsThis case series study included 11 patients who had thrombosed aneurysmal AVF and underwent salvage procedures over a 13-month period. All procedures were performed under duplex guidance. Minimal aneurysmotomy was performed, along with manual thrombectomy and thrombolytic agent infusion, followed by angioplasty to macerate the thrombus and sufficiently dilate potential stenoses. A successful procedure was defined as immediate restoration of flow through the AVF.ResultsThe 11 patients (four males and seven females) had a mean age of 49.6 years ± 11.9 years. Six patients (54.5%) had two or more aneurysms. The mean aneurysm maximal diameter was 21.5 mm (standard deviation: ± 5.0 mm), and the mean thrombus length was 12.9 cm (8–22 cm). Ten (83.3%) of the 12 procedures were technically successful. The mean duration of operation was 150.9 minutes (standard deviation: ± 34.2 minutes), and mean postoperative AVF blood flow was 728.6 ml/min (standard deviation: ± 53.7 mi/min). The resumption of hemodialysis was successful in all 11 cases, with a clinical success rate of 100%. The primary patency rates were 90.0% and 75.0% at three and four months over a mean follow-up time of 6.3 months (3–12 months). The secondary patency rates were 90.4% at three and four months.ConclusionA hybrid approach combining ultrasound-guided percutaneous transluminal angioplasty and minimal aneurysmotomy might be a safe and effective method for thrombosed aneurysmal AVF salvage.

MO778: Influence of Therapy on the Duration of First Arteriovenous Fistula in Haemodialysis Patients—A Multicenter Longitudinal Study

Abstract BACKGROUND AND AIMS A 5-year research was conducted on haemodialysis patients with the aim to determine the effect of therapy on the patency of arteriovenous fistula (AVF) for haemodialysis. METHOD The study included 338 haemodialysis patients with the incidence of the creation of AVF in 2014. Patients were divided into two groups, according to the duration time of AVF namely short-term (≤6 months) and long-term (&amp;gt;6 months) patency. Clinical and laboratory parameters were analysed as well as type and frequency of complications, characteristics of AVF and treatment. The data were analysed with a chi-squared test, ANOVA test and an ordinally logistic regression. There was a statistical significance, P &amp;lt;0.05. RESULTS From a total of 338 patients, the average age of 59.06 ± 12.45, 66.6% of patients were men. 80.7% of the patients were in the short-term group. Patients taking anti-platelet drugs make 14.8%, patients taking anticoagulation therapy and double anti-platelets therapy make 1.8%, patients taking statins, angiotensin-converting enzyme inhibitors (ACE)/angiotensin-receptor blockers (ARB) and calcium channel blockers make 47% and 2.6% of patients took no medication. The number of AVF complications was thrombosis in 19.1%, haemorrhage in 1.9%, aneurism and pseudoaneurysm in 0.5%, ‘Steal’ syndrome in 0.3%, infections in 0.3% and other complications in 2.2%. In accordance with the length of anti-platelets therapy (˂30 days, between 30 and 90 days, and ˃90 days) after the creation of AVF, it was concluded that the most influential effect was in the period between 30 and 90 days after creation. Patients with AVF for ˂6 months had significantly more vascular calcifications (P =.0017). The groups did not differ in the length of anti-platelets and anti-coagulation therapy before the creation of AVF (&amp;lt;1 year, &amp;gt;1 year, no therapy), time of maturity of AVF (4–6 weeks, 6–8 weeks, ˃8 weeks), indications for reducing or stopping with anti-platelets or anticoagulation therapy in the moment of AVF creation. Four models of ordinally logistic regression (2015, 2016, 2017, 2018) were created in which the dependent variables were the complications of AVF by years, the factors were the type of treatment and the frequency of each complication for each year, while the covariate was the number of months after the AVF creation (Table). CONCLUSION Patients that started taking anti-platelets drugs from 30 to 90 days of AVF, had AVF for a significantly longer time. The model showed in years states that the frequency of complications decreases over time and that there are more infections and other complications than thrombosis and haemorrhage.