Arteriovenous Fistula Thrombosis Research Articles

Association Between Atherosclerotic Cardiovascular Disease (ASCVD) Risk Score and Arteriovenous Fistula Failure in Patients on Maintenance Hemodialysis.

Arteriovenous fistula (AVF) is the vascular access of choice for hemodialysis in end-stage renal disease (ESRD) patients but has a significant failure rate. Atherosclerotic cardiovascular disease (ASCVD) is a major cause of mortality in ESRD patients. Atherosclerosis of the peripheral vessels may contribute to poor maturation of AVF leading to the exploration of the ASCVD score as a prognostic tool for AVF failure. Thisstudy included 110 hemodialysis patients with AVFsand aimed to examine the association between ASCVD score and AVF failure. Participants were categorized into the presence of vascular access failure (N=12) and absence of vascular access failure (N=98), and demographic and clinical data were collected. Results: The study comprised predominantly male patients (63.6%), with a notable prevalence of hypertension anddiabetes. Twelve patients experienced AVF failure, with pseudoaneurysms and thrombosis being the predominant causes. The ASCVD risk group at intermediate and high stages exhibited a statistically significant risk (relative risk (RR)=1.403; 95% CI, 1.041-1.904) of AVF failure in comparison to the low and borderline ASCVD risk groups.There was no association of age, gender (male and female), body mass index (BMI),serum calcium, serum phosphorus, intact parathyroid hormone (iPTH), and serum albumin with AVF failure. The ASCVD score emerges as a potential prognostic tool to identify dialysis patients at high risk of AVF failure, suggesting avenues for targeted interventions and improved patient care. However, limitations of the ASCVD risk estimator and study limitations, such as small sample size and absence of mortality data, warrant cautious interpretation and necessitate further exploration in larger patient populations.

#2885 Thrombosis complicating the first native arteriovenous fistula: what are the risk factors?

Abstract Background and Aims The native arteriovenous fistula is considered the best vascular access for hemodialysis, whose ultimate complication is thrombosis. The risk factors for this complication are multiple. The aim of our work is to determine the risk factors for thrombosis of the first created native AVF. Method This is a retrospective descriptive study of 65 patients over 18 years of age and hemodialyzed in our department who benefited of the confection of a native arteriovenous fistula at the same hospital. Results Arteriovenous fistula thrombosis occurred in 41.53% of patients with an average age of 49.4 years and a sex ratio M/F=3.5. 59.2% of arteriovenous fistulae were distal versus 40.7% proximal, divided into humerocephalic (29.6%) and humerobasilic (11.1%). AVF thrombosis occurred after a mean duration of 3.19 years after its confection [01 months, 13 years]. 25.9% of arteriovenous fistulae had not yet been punctured. 63% of patients were smokers, 55.6% were diabetics, 74.1% were hypertensive and 66.7% were cardiac with predomination of ischemic etiology in 29.6%. 44.4% of patients had obliterative arteriopathy of the lower limbs, 25.9% of whom were amputees. Patients had been on dialysis for an average of 4.4 years [01 months, 13 years], with diabetic nephropathy predominating at 51.9%. All patients were on antiplatelet therapy and 7.4% on anticoagulation. 11.1% had perdialytic hypotension. Multivariate statistical analysis revealed a significant correlation between anemia, diabetes and the occurrence of thrombosis (respectively p = 0.03; p = 0.024). Conclusion Patients with arteriovenous fistula thrombosis have multiple cardiovascular risk factors. Diabetes and anemia remain the main predictive factors for thrombosis.

Outcomes of Surgical and Endovascular Treatment for Cephalic Arch Stenosis in Proximal Arteriovenous Fistula.

The cephalic arch is a significant site of stenosis in proximal arteriovenous fistulas (AVFs) that contributes to access dysfunction and thrombosis. This study aimed to evaluate the outcomes of surgical treatment (ST) and endovascular treatment (ET) for cephalic arch stenosis (CAS). A total of 62 patients with proximal AVF who underwent CAS revision using either ST or ET were enrolled between January 2018 and March 2023. In the ET group, only the initial ET following AVF formation was considered, to mitigate bias. In the ST group, central transposition of the native AVF (transposition group) or interposition of the prosthetic graft into the proximal basilic or axillary vein (interposition group) was performed. We evaluated primary and functional patency based on these groups and calculated the number of patency loss events after CAS treatment. Of the 62 patients, 38 (61%) were male, with a mean age of 66.4 years. ST was performed in 26 (42%) patients, including transposition in 16 and interposition in 10, whereas ET was administered to 36 patients during the study period. Among the ST recipients, 42% had a history of ET for CAS. The incidence of AVF thrombosis was marginally higher in the ST group than in the ET group (39% vs. 19%, P=0.098). The primary patency rates at 6 months, 1 year, and 3 years were 87%, 87%, and 66% in the transposition group; 45%, 23%, and 11% in the interposition group; and 66%, 49%, and 17% in the ET group, respectively. Notably, the primary patency of the transposition group was significantly higher than that of the interposition (P=0.001) and ET groups (P=0.016). The frequency of patency loss events per person-year after the initial revision was 0.40, 0.52, and 1.42 in the transposition, interposition, and ET groups, respectively. Transposition exhibited the most favorable primary patency rate and the lowest number of subsequent patency loss events during follow-up despite the higher rates of AVF thrombosis and previous ET at presentation. Consequently, transposition should be actively considered in eligible patients with CAS.

Elevated Leukocyte Glucose Index Is Associated with Long-Term Arteriovenous Fistula Failure in Dialysis Patients.

(1) Background: Arteriovenous fistula (AVF) is the preferred type of vascular access for dialysis in patients with end-stage kidney disease (ESKD). However, the primary patency of AVF at one year is under 70% due to several risk factors and comorbidities. Leukocyte glucose index (LGI), a new biomarker based on blood leukocytes and glucose values, has been found to be associated with poor outcomes in cardiovascular disease. The aim of this study is to analyze the impact of LGI on the long-term primary patency of AVF following dialysis initiation. (2) Methods: We conducted a retrospective observational study in which we initially enrolled 158 patients with ESKD admitted to the Vascular Surgery Department of the Emergency County Hospital of Targu Mures, Romania, to surgically create an AVF for dialysis between January 2020 and July 2023. The primary endpoint was AVF failure, defined as the impossibility of performing a chronic dialysis session due to severe restenosis or AVF thrombosis. After follow-up, we categorized patients into two groups based on their AVF status: "functional AVF" for those with a permeable AVF and "AVF failure" for those with vascular access dysfunction. (3) Results: Patients with AVF failure had a higher prevalence of atrial fibrillation (p = 0.013) and diabetes (p = 0.028), as well as a higher LGI value (1.12 vs. 0.79, p < 0.001). At ROC analysis, LGI had the strongest association with the outcome, with an AUC of 0.729, and an optimal cut-off value of 0.95 (72.4% sensitivity and 68% specificity). In Kaplan-Meier survival analyses, patients in the highest tertile (T3) of LGI had a significantly higher incidence of AVF failure compared to those in tertile 1 (p = 0.019). Moreover, we found that patients with higher baseline LGI values had a significantly higher risk of AVF failure during follow-up (HR: 1.48, p = 0.003). The association is independent of age and sex (HR: 1.65, p = 0.001), cardiovascular risk factors (HR: 1.63, p = 0.012), and pre-operative vascular mapping determinations (HR: 3.49, p = 0.037). (4) Conclusions: In conclusion, high preoperative values of LGI are positively associated with long-term AVF failure. The prognostic role of the biomarker was independent of age, sex, cardiovascular risk factors, and pre-operative vascular mapping determinations.

Future Directions and Innovations in Venous Sinus Stenting

This review explores the future role of venous sinus stenting (VSS) in the management of idiopathic intracranial hypertension and pulsatile tinnitus. Despite its favorable safety profile and clinical outcomes compared with traditional treatments, VSS is not yet the standard of care for these conditions, lacking high-level evidence data and guidelines for patient selection and indications. Current and recently completed clinical trials are expected to provide data to support the adoption of VSS as a primary treatment option. Additionally, VSS shows potential in treating other conditions, such as dural arteriovenous fistula and cerebral venous sinus thrombosis, and it is likely that the procedure will continue to see an expansion of its approved indications. The current lack of dedicated venous stenting technology is being addressed with promising advancements, which may improve procedural ease and patient outcomes. VSS also offers potential for expansion into modulation of brain electrophysiology via endovascular routes, offering exciting possibilities for neurodiagnostics and treatment of neurodegenerative disorders.

Endovascular Fistula Salvage for Preserving Arteriovenous Fistula Failure in Haemodialysis Patient: Tertiary Referral Hospital, a Single-Centre Experience

Abstract: Efficacy of endovascular intervention for the preservation of failing accesses is very important in hemodialysis patients. This study aimed to determine the efficacy of endovascular balloon angioplasty in preserving the patency of hemodialysis arteriovenous fistula (AVF) failure. This was a retrospective study of hemodialysis patients who received endovascular intervention due to access difficulties. A single-center study was created between January 2022 and June 2022. Fistulography was conducted on patients suspected of having access stenosis, and balloon angioplasty was performed in the same setting if stenosis of 50% was confirmed. Post-operative complications and access restenosis or failure were monitored. The results obtained 69 patients with hemodialysis access failure due to AVF stenosis, occlusion, and thrombosis that were admitted or referred to our hospital. The majority of patients were 40-60 years (50.7%); 88.4% patients were male and 11.6% were female, with a mean age of 56.3±11.6 (range, 18–77). The sites of AVF failure were brachiocephalic (81.1%) and radiocephalic (18.9%). There was no complication recorded. The procedure succes rate was 81.1%. In conclusion, endovascular balloon angioplasty is effective in restoring hemodialysis access patency. Recurrence is common, and interventions must be repeated. Keeping access open can save lives. Percutaneous transluminal angioplasty (PTA) can be used to achieve safely and successfully repair arteriovenous fistulas failure. Keywords: angioplasty; arteriovenous fistula; arteriovenous graft; hemodialysis

Vascular access for hemodialysis in Italy: What a national survey reveals.

Since in Italy there are no official data on vascular access (VA) for hemodialysis the Vascular Access Project Group (VAPG) of the Italian Society of Nephrology (SIN) designed a national survey. A 35-question survey was designed and sent it to the Italian facilities through the SIN website. The basic questions were the prevalence, the location, and the surveillance of VA, the bedside use of ultrasound, the use of fluoroscopy for central venous catheter (CVC) placement, and of buttonhole technique, the role of nephrologist in the access creation. The questionnaire was completed in June 2022 by 161 facilities. The survey registered 15,499 patients, approximately one-third of the Italian dialysis population. The prevalence of arteriovenous fistula (AVF), arteriovenous Graft (AVG), and CVC were 61.8%, 3.7%, and 34.5% respectively. The AVF location was 50% in distal forearm, 20% in meanproximal forearm, 30% in upper arm. For AVF creation, nephrologists were involved in 72% of facilities while for CVC placement in 62%. As regards VA monitoring, 21% of the facilities did not have a surveillance protocol; 60% did not register AVF thrombosis and 53% did not register CVC infections. Most of facilities use the fluoroscope during CVC placement, 37% when needed, and 22% never. Ultrasound-guided puncture of complex AVFs was used by 80% of facilities. Buttonhole puncture was used in 5% of patients. Some considerations emerge from the survey data: (1) The increasing CVC prevalence compared to DOPPS 5 study. (2) The low rate of AVG prevalence. (3) The nephrologist is the operator in many VA procedures. (4) The fluoroscopy for CVC placement and the US-guide puncture of the complex AVF are widely used in most facilities. (5) The practice of the buttonhole is not widespread. (6) When the operator is the nephrologist more distal fistulas are performed.

Antiphospholipid Antibodies Associated with Native Arteriovenous Fistula Complications in Hemodialysis Patients: A Comprehensive Review of the Literature.

Antiphospholipid antibody (aPL)-persistent positivity is frequent in hemodialysis (HD) patients. Native arteriovenous fistula (AVF) complications such as stenosis and thrombosis are among the most important causes of morbidity and mortality in hemodialysis patients. The association between aPL positivity and AVF thrombosis seems to now be well established. However, whether aPL positivity is associated with other AVF complications, such as maturation failure or stenosis, is not well known. Given the significant impact of AVF failure on patient's prognosis, it is of interest to further investigate this particular point in order to improve prevention, surveillance and treatment, and, ultimately, the patient's outcome. This literature review aims to report the recent literature on aPL-associated native AVF complications.

Intracranial dural arteriovenous fistula and deep cerebral venous thrombosis: A case report

Intracranial dural arteriovenous fistula and deep cerebral venous thrombosis: A case report

Plasma level of ADAMTS-13 in maintenance hemodialysis patients and its relation to arteriovenous fistula thrombosis

Background: End-stage renal disease is the final stage of chronic kidney disease in which irreversible deterioration in renal function occur and the body fails to maintain fluid and electrolyte balance, this need regular hemodialysis (HD) a process that removes accumulated solute from a patient with near-total renal function loss. Arteriovenous fistula (AVF) is the vascular access of choice for patients who require hemodialysis. AVF thrombosis is a major issue in hemodialysis patients, which increase their morbidity and lessen HD efficiency.&#x0D; Objective: To assess plasma level of ADAMTS-13 in HD patients and its association with AVF thrombosis, and to correlate the plasma level of ADAMTS-13 with age, duration of dialysis, certain hematological parameters and estimated GFR.&#x0D; Patients and Methods:This Cross_sectional study done on 60 patients with ESRD on regular HD sessions, 20 healthy persons were included as a control . The patients subdivided into two subgroups with and without AVF thrombosis. Plasma samples were freezed until the test for the level of ADAMTS-13 was done.&#x0D; Results: The plasma ADAMTS-13 level was significantly lower in HD patients compared to control group (P &lt; 0.001), and was a significantly lower in patients with a history of AVF thrombosis than HD patients without a history of AVF thrombosis. HD patients with AVF thrombosis had significantly lower eGFR compared to patients without a history of AVF thrombosis. There was a positive correlation of plasma ADAMTS-13 level with the mean of eGFR , platelet count and negative correlation with MPV.&#x0D; Conclusion: Significant differences between HD patients and control regarding eGFR and hematological parameters . Plasma ADAMTS-13 level was significantly lower in patients compared to controls and significantly lower in patients group with AVF thrombosis than HD group without thrombosis.

Plasma level of ADAMTS-13 in maintenance hemodialysis patients and its relation to arteriovenous fistula thrombosis

Background: End-stage renal disease is the final stage of chronic kidney disease in which irreversible deterioration in renal function occur and the body fails to maintain fluid and electrolyte balance, this need regular hemodialysis (HD) a process that removes accumulated solute from a patient with near-total renal function loss. Arteriovenous fistula (AVF) is the vascular access of choice for patients who require hemodialysis. AVF thrombosis is a major issue in hemodialysis patients, which increase their morbidity and lessen HD efficiency. Objective: To assess plasma level of ADAMTS-13 in HD patients and its association with AVF thrombosis, and to correlate the plasma level of ADAMTS-13 with age, duration of dialysis, certain hematological parameters and estimated GFR. Patients and Methods:This Cross_sectional study done on 60 patients with ESRD on regular HD sessions, 20 healthy persons were included as a control . The patients subdivided into two subgroups with and without AVF thrombosis. Plasma samples were freezed until the test for the level of ADAMTS-13 was done. Results: The plasma ADAMTS-13 level was significantly lower in HD patients compared to control group (P &lt; 0.001), and was a significantly lower in patients with a history of AVF thrombosis than HD patients without a history of AVF thrombosis. HD patients with AVF thrombosis had significantly lower eGFR compared to patients without a history of AVF thrombosis. There was a positive correlation of plasma ADAMTS-13 level with the mean of eGFR , platelet count and negative correlation with MPV. Conclusion: Significant differences between HD patients and control regarding eGFR and hematological parameters . Plasma ADAMTS-13 level was significantly lower in patients compared to controls and significantly lower in patients group with AVF thrombosis than HD group without thrombosis. Keywords: ADAMTS-13, Arteriovenous fistula, Hemodialysis, Thrombosis

Recurrent arteriovenous fistula thrombosis: The role of genetic mutations and hyperhomocysteinemia – a clinical case

Thrombophilia denotes an increased predisposition to the formation of blood clots within blood vessels, stemming from genetic or acquired abnormalities in the hemostasis system. The challenge of establishing durable vascular access for hemodialysis in patients is compounded by various detrimental factors affecting the vascular wall, with vascular wall remodeling and hemostasis system disruptions being paramount among them. This clinical case report outlines our findings in a rare instance of recurrent thrombosis in an arteriovenous fistula.&#x0D; The objective of this study is to present a clinical case involving repeated arteriovenous fistula thrombosis in a patient with chronic kidney disease, exacerbated by a confluence of hyperhomocysteinemia and mutations in hemostasis-related genes: F13A1 (103G&gt;T) (heterozygous carrier of blood coagulation factor XIII), FGB-fibrinogen (455G&gt;A) (heterozygous carrier of coagulation factor I), and Serpin1 (PAI-1) (675 5G&gt;4G) (homozygous carrier of tissue plasminogen activator antagonist). Additionally, we aim to illustrate the diagnostic exploration for coagulopathy causes in cases of chronic recurrent thrombosis, emphasizing the importance of utilizing modern genetic tests for diagnosing thrombophilias and urging healthcare professionals to consider these advanced diagnostic possibilities.

Safety and efficacy of the CELT ACD femoral arteriotomy closure device in the office-based laboratory.

Manual compression remains the gold standard for achieving hemostasis for percutaneous common femoral artery access. However, it requires prolonged bedrest and 20 to 30minutes or more of compression for hemostasis. Current arterial closure devices have emerged in recent years, but patients still require prolonged bedrest and time to ambulation and discharge, and these devices are associated with significant access device complications, including hematoma, retroperitoneal bleeding, transfusion requirement, pseudoaneurysm, arteriovenous fistula, and arterial thrombosis. A novel femoral access closure device, the CELT ACD (Vasorum Ltd, Dublin, Ireland), has been previously shown to reduce these complication rates and allow rapid hemostasis, require little or no bedrest, and shortened time to ambulation and discharge. This is especially advantageous in the outpatient setting. We report our initial experience with this device. A prospective single-center single-arm study was performed in an office-based laboratory setting to assess the safety and efficacy of the CELT ACD closure device. Patients underwent diagnostic and therapeutic peripheral arterial procedures from retrograde or antegrade common femoral artery access. Primary endpoints include device deployment success, time to hemostasis, and major or minor complications. Secondary endpoints include time to ambulation and time to discharge. Major complications were defined as bleeding requiring hospitalization or blood transfusion, device embolization, pseudoaneurysm formation, and limb ischemia. Minor complications were defined as bleeding not requiring hospitalization/blood transfusion, device malfunction, and access site infection. A total of 442 patients were enrolled with common femoral access only. Median age was 78years (range, 48-91years), and 64% were male. Heparin was given in all cases, with median heparin dose of 6000 units (range, 3000-10,000 units). Protamine reversal was used in 10 cases due to minor soft tissue bleeding. Average time to hemostasis was 12.1seconds (±13.2seconds), time to ambulation was 17.1minutes (±5.2minutes), and time to discharge was 31.7minutes (±8.9minutes). All devices (100%) were deployed successfully. No major complications occurred (0%). Ten minor complications (2.3%) occurred; all were minor soft tissue bleeding from the access site that resolved with protamine reversal of heparin and manual compression. The CELT ACD closure device is safe and easily deployed with a very low complication rate, and significantly reduces time to hemostasis, ambulation, and discharge in patients undergoing peripheral arterial intervention from a common femoral artery approach in the office-based laboratory setting. This is a promising device that deserves further evaluation.

Effect of endovascular angioplasty in the treatment of early thrombosis of artificial vascular arteriovenous fistula based on medical image detection

Effect of endovascular angioplasty in the treatment of early thrombosis of artificial vascular arteriovenous fistula based on medical image detection

Treatment of arteriovenous access pseudoaneurysms using ultrasound guided balloon assisted thrombin injection: Two cases and systematic review of the literature.

Arteriovenous fistula pseudoaneurysm (AVF-PSA) is a common complication, usually caused during dialysis cannulation, which traditionally has been treated with open and less frequently endovascular techniques. Thrombin injection, although established in the treatment of arterial pseudoaneurysms, has barely been used in the treatment of AVF-PSA, due to concerns for AVF thrombosis or proximal embolization. A systematic review was performed according to the PRISMA 2020 guidelines. PubMed and Cochrane Central databases were reviewed and all clinical reports on AVF-PSA balloon assisted percutaneous thrombin injection through July 2022 were included. The electronic search yielded five case reports. Due to between-study differences and small sample size, the findings were summarized from each report, but the results were not pooled. Additionally, we present our own experience on two patients with AVF-PSA that were treated with balloon assisted percutaneous thrombin injection. A total of five case reports (no of patients: 7, including ours) were included for review. Most of the patients were male (n = 6) and the mean age was 65.9 years. The average size of the PSA was 1.6 cm. In all cases a balloon was inflated to prevent thrombin and thrombotic material intrusion into the fistula lumen, prior to thrombin injection. In one patient n-butyl cyanoacrylate and Lipiodol were used, due to thrombin non availability. Recurrence was reported in only one patient, and average follow-up is 16 months. Thrombin injection with concomitant balloon inflation seems to be a safe and effective treatment for arteriovenous fistula pseudoaneurysms. Future studies should be aimed at evaluating the long-term outcomes of such minimally invasive techniques.

#5737 THE ASSOCIATION OF SERUM IRISIN WITH EARLY PATENCY LOSS OF ARTERIOVENOUS FISTULA

Abstract Background and Aims In patients receiving hemodialysis (HD), arteriovenous fistula (AVF) is the preferred form of vascular access owing to its long-term patency and low risk of infection. Early patency loss of AVF (≤1 year) is associated with higher risk of mortality and morbidity. Irisin is thought to play a protective role in the regulation of endothelial function and vascular calcification. However, the relationship between serum irisin level and early patency loss of AVF is unclear. Method In 73 end-stage kidney disease (ESKD) patients, including pre-dialysis patients who receive AVF placement for the first time (n = 10), HD patients with early patency loss of AVF (n = 24), HD patients that lose AVF function more than 1 year (n = 39), fasting (&amp;gt;8 hours) serum irisin levels and other biochemical parameters (hemoglobin, serum albumin, calcium, phosphate, intact parathyroid hormone, triglyceride, total cholesterol, D-Dimer, fibrinogen, FGF23, C-reactive protein) were measured before receiving access placement or after AVF thrombosis. All patients had radial-cephalic fistula. Results Among 73 patients (median age 58 years, 60.3% male, 31.5% diabetes mellitus (DM)), patients with early patency loss of AVF had significantly higher serum irisin levels, and lower fibrinogen, compared with other two groups. Other characteristics had no significant difference among these three groups (shown in Table 1). Conclusion HD patients with early patency loss of AVF had higher serum irisin levels compared with pre-dialysis patients and HD patients whose AVF patency maintained more than 1 year. The increase of irisin may be related to its putative role in compensatory mechanisms against vascular injury, which is then lost with longer dialysis duration and aggravated vascular damage.

THROMBECTOMY IN PATIENTS WITH THROMBOSIS OF ARTERIO-VENOUS FISTULA: CASE SERIES

Introduction. Thanks to the use of renal replacement therapy at the current stage of medical development, complete medical and social rehabilitation of patients with end-stage chronic renal failure is possible. The key to effective programmed hemodialysis is the formation of adequate permanent vascular access. Ensuring the optimal use and functioning of permanent vascular access is a multidisciplinary challenge. Currently, none of the known options for permanent vascular access is ideal, but a native arteriovenous fistula meets the requirements to a greater extent. Complications from vascular access for hemodialysis remain relevant for their solution today. The most common complication of vascular access is thrombosis of an arteriovenous fistula. For patients with chronic renal failure who are on programmed hemodialysis, thrombosis of vascular access is a great danger, which ultimately can lead to the impossibility of further hemodialysis and is the main reason for hospitalization and high mortality of this contingent of patients and needs an urgent solution.&#x0D; Clinical cases. 17 patients underwent thrombectomy from the subcutaneous "fistula". vein of the upper extremity. The age of the patients was 49.0 (44.0-61.0) years. By gender, the studied patients were distributed as follows: women - 9 (53%), men - 8 (47%). Among 17 (100%) operated patients, 12 (71%) had late thrombosis, 5 (29%) had early thrombosis of arteriovenous fistula,. Of 5 (100%) patients with early thrombosis of arteriovenous fistula, thrombectomy was effective in 2 (40%) patients (p=0.038). On the other hand, in 12 (100%) patients with late thrombosis of arteriovenous fistula, thrombectomy was successful in only 4 (33%) cases.&#x0D; Discussion. The cause of thrombosis of any vascular anastomosis is primarily hyperplasia of the neointima due to the proliferation of smooth muscle cells of the vascular wall. This circumstance leads to the formation of stenosis of the anastomosis, and as soon as the stenosis values become hemodynamically significant (&gt; 50% of the lumen of the vessel), the risk of developing thrombosis increases by more than 50%. Thrombectomy alone is insufficient to restore patency of the permanent vascular access in the long term, as flow-limiting stenosis is present in more than 85% of cases.&#x0D; Conclusions. Neointimal hyperplasia is the main cause of progressive stenosis of arteriovenous fistula and subsequent thrombosis. Thrombectomy is indicated for thrombosis of arteriovenous fistula in the early postoperative period (up to 30 days after arteriovenous fistula formation). Thrombectomy alone is not enough to restore the patency of the permanent vascular access in the long term, and the final treatment requires its reconstruction at an early stage or the creation of a new arteriovenous fistula.

Direct Percutaneous Thrombolysis (DPT): A novel method of salvaging Thrombosed Native Arteriovenous Fistula.

Thrombosed arteriovenous fistulas (AVFs) are either treated by thrombectomy or pharmaco-mechanical thrombolysis with or without percutaneous balloon angioplasty. In this study, we have described an effective and economical technique of salvaging these fistulae using a 20-22-gauge spinal needle and urokinase and have named it direct percutaneous thrombolysis (DPT). This prospective study comprised of 148 patients out of which 120 patients presented with AVF thrombosis and were divided into two groups; those with no obvious stenosis on ultrasound (n = 38) and second with venous stenosis (n = 82). Remaining 28 patients developed thrombosis post angioplasty for venous stenosis. Percutaneous injection of urokinase into the thrombus was done under ultrasound guidance, followed by balloon angioplasty if there was associated stenosis. In 38 patients who didn't have any stenosis, 32 AVFs were successfully thrombolysed by DPT, with technical success of 84.2%. Remaining six patients required angioplasty because of chronic nature of clot. In 82 patients who had venous stenosis, 80 cases were treated successfully by DPT followed by angioplasty with technical success of 97.5%. In third group (n = 28), who developed thrombosis post angioplasty, 100% success rate was noted. The mean length of thrombus was 31.4 ± 4.6 mm and mean diameter of thrombosed vein was 10.5 ± 1.2 mm. There were no major complications encountered during the procedure. Minor complications were seen in 19 patients which included prolonged oozing from puncture site and local hematoma formation. Ultrasound guided DPT with urokinase is a safe and economical option for salvaging thrombosed AVF without vascular stenosis that does not need angioplasty.

Analysis of predictive factors of thrombosis in autogenous arteriovenous fistula.

To investigate the predictors of early diagnosis of thrombus of autogenous arteriovenous fistula (aAVF). The included patients were divided into the thrombus group with aAVF failure or thrombosis and the control group with good internal fistula function. The general data of the patients, including age, sex, diabetes mellitus, were collected. Platelets (PLT), platelet crit (P-LCR), platelet distribution width (PDW), mean platelet volume (MPV), homocysteine (HCY), and other biochemical data were collected. The predictors of thrombus of aAVF were obtained by the t test and logistic regression analysis, and receiver operating characteristic (ROC) curve analysis was used to compare the area under the ROC curve (AUC) between the combined predictors and the original indicators. The optimal critical value was determined when the Youden index reached its maximum value, and the sensitivity, specificity, accuracy, diagnostic index, and so on were calculated. Finally, prediction was performed by substituting each value in individually. PLT, PDW, P-LCR, MPV, and HCY showed significant differences between two groups (p < 0.05). Logistic regression analysis showed that, for PLT (OR = 1.014, 95% CI 1.006-1.022, p = 0.01), PDW (OR = 1.295, 95% CI 1.009-1.661, p = 0.042), P-LCR (OR = 1.230, 95% CI 1.089-1.389, p = 0.001), MPV (OR = 1.696, 95% CI 1.101-2.613, p = 0.017), and HCY (OR = 1.332, 95% CI 1.182-1.502, p = 0.01), the difference was significant; PLT, PDW, P-LCR, MPV, and HCY were positively correlated with thrombogenesis (p < 0.05). By logistic regression, a group of the five predictors of PLT, PDW, P-LCR, MPV, and HCY was obtained, and the combined predictors were 0.014*PLT + 0.258*PDW + 0.207*P-LCR + 0.528*MPV + 0.287*HCY. The area under the curve of the combined predictor was 0.933, the sensitivity was 92.4%, the specificity was 81.2%, the maximum diagnostic index was 0.736, the diagnostic cutoff point was 21.790, and the accuracy rate was 87%. PLT, PDW, P-LCR, MPV, and HCY are predictors of thrombus of aAVF. They can better predict thrombus of aAVF, and the combination of these five indicators is better than a single indicator.

Optimal Flow Volume Measurements in Forearm versus Arm Arteriovenous Fistulas.

Successful haemodialysis is dependent on optimal arteriovenous (AV) access flow. Although 600 mL/min is frequently quoted as the critical level for functional flow volume (Qa) according to the National Kidney Foundation guideline, this may not be applicable for the different configurations of AV fistulas (AVF) or AV grafts (AVG). This study evaluates ultrasound derived Qa measurement in the inflow brachial artery to autologous AVF in the forearm radiocephalic and arm brachiocephalic/basilic configurations in relation to significant flow related AV dysfunction. Five hundred and eleven duplex ultrasound (DUS) scans were analysed in 193 patients. The end points were therapeutic intervention and/or thrombosis of AVF versus no complication within three months of the scan. Receiver operating characteristic (ROC) curves were used to determine the optimal threshold Qa of the brachial artery supplying the AVF. Of the 511 scans, 155 scans were assigned to the intervention group, ie, AVF requiring intervention or thrombosing within 3 months of the DUS. Using ROC curve analysis, the area under the curve (AUC) for all AVF is 0.90 (CI: 0.88-0.93) with an optimal threshold Qa of 686mL/min. In forearm AVF, the threshold Qa is 589mL/min while in arm AVF the threshold Qa is 877mL/min. Forearm Qa is statistically different from arm Qa. Forearm AVF Qa threshold at 589 mL/min is distinct from arm AVF Qa at 877 mL/min and these are predictive of the need for impending intervention or thrombosis due to flow-limiting stenosis. This article is protected by copyright. All rights reserved.