Arteriovenous Fistula Research Articles (Page 1)

Teaching NeuroImage: Intracranial Dural Arteriovenous Fistula Presenting as Acute Aphasia.

Background and Purpose: Cavernous dural arteriovenous fistulas (cDAVFs) represent complex neurovascular lesions with potential for devastating complications. Recent reports suggest possible associations with COVID-19 vaccination. We report a case with a detailed analysis of clinical presentation, diagnostic challenges, and neurovascular management implications. Methods: Case report with systematic analysis of clinical timeline, neuroimaging findings, and treatment outcomes in a 66-year-old woman who developed cDAVF following Pfizer-BioNTech COVID-19 vaccination. Results: Patient presented with progressive headaches within days of first vaccination, with symptom escalation following second dose. Despite multiple healthcare encounters over 11 months, diagnosis was delayed due to atypical presentation and initial imaging misinterpretation. Laboratory analysis revealed subtle but significant inflammatory changes when interpreted against individual baseline values. Definitive angiographic diagnosis led to emergency neurosurgical intervention, but resulted in permanent vision loss due to ischemic optic neuropathy. The temporal relationship, absence of alternative risk factors, and biological plausibility support a causal association. Conclusions: This case highlights critical considerations for stroke specialists: (1) recognition of cDAVF as a potential post-vaccination complication, (2) importance of individual baseline interpretation for inflammatory markers, and (3) need for enhanced clinical suspicion in patients presenting with progressive neurological symptoms post-vaccination. Early recognition and intervention are crucial to prevent irreversible neurovascular complications. Keywords: Dural arteriovenous fistula, COVID-19 vaccine, stroke, neurovascular complications, cavernous sinus, diagnostic delay

Arteriovenous fistulas (AVFs) are the preferred vascular access for hemodialysis due to fewer complications, yet many fail to mature. Although clinical predictors have been studied, results remain inconsistent. Recent guidelines recommend considering functional status when selecting access, but evidence is limited. This study evaluated the impact of functional status on fistula maturation. In this retrospective cohort study, we included 315 patients who underwent AVF creation at a university hospital. Data were collected on demographics, comorbidities, and AVF characteristics. Functional status was measured by the Katz Activities of Daily Living (ADL) Index. The primary outcome was overall clinical AVF maturation within 270 days. Secondary outcomes included unassisted maturation and AVF abandonment. Of the 315 patients analyzed, the mean age was 66 years (SD, 13 years) and 43% were women. Clinical AVF maturation rates at 3, 6, and 9 months were 34%, 60%, and 72%, respectively. Patients with severe disability (Katz ADL score 0-2) had lower maturation rates (23%, 43%, and 47% at 3, 6, and 9 months) compared to those with partial or no disability. In univariable analysis, clinical maturation of AVF at 9 months was associated with age, female sex, unmarried status, cardiovascular disease, larger arterial diameter, and severe disability. In multivariable analysis, severe disability was independently associated with maturation failure (OR 2.439, 95% CI 1.028-5.784, p = 0.043). Disability, measured by the Katz ADL Index, independently predicts lower AVF maturation rates. Patients with severe disability may require tailored interventions and closer monitoring.

Arteriovenous fistulas (AVF) and arteriovenous grafts (AVG) are the preferred options for establishing vascular access in adult patients undergoing haemodialysis treatment. Although various official recommendations exist for AVF and AVG cannulation, a comprehensive, personalised approach to cannulation has yet to be proposed. This systematic review highlights existing knowledge gaps and identifies best practices by synthesising quality evidence on all components involved in AVF and AVG cannulation for haemodialysis. A search was conducted across the PubMed, CINAHL, Cochrane, Scopus and Web of Science databases for studies published between January 2016 and January 2023. This review followed the PRISMA statement and was registered with PROSPERO (CRD42024293288). Twenty-four studies met the inclusion criteria and reported outcomes for 11,687 patients and 801 ward staff in 14 countries. Collectively, their results emphasized a person-centred approach, the importance of nurses' and patients' skills, and the need for continuous learning to enhance patient care. While recommendations varied, the implementation of the button-hole technique and innovative nurse-led devices such as plastic cannulas and point-of-care ultrasound guided cannulation were highly recommended. This systematic review highlights the importance of adopting a person-centred approach to managing patients undergoing haemodialysis. It also recommends the systematic assessment of vascular access and the continuous training for nurses and patients. Further research is needed to evaluate the cost-effectiveness of innovative, nurse-led tools in haemodialysis units.

Carotid cavernous fistula (CCF) is a rare complication that can be easily missed after blunt traumatic brain injury. It is defined as an abnormal arteriovenous shunt between the carotid artery or its branches with the cavernous sinus. Most cases are traumatic in origin and although not typically life-threatening, carry a risk of serious complications. One of the most fatal complications is spontaneous intracerebral haemorrhage (ICH), occurring only 0.9-2.6% of cases. We report a rare case of a 27 yo female, who sustained traumatic brain and craniofacial injuries in a motor vehicle accident 25 d earlier. She presented with gradual loss of consciousness following ophthalmic symptoms that began 5 d prior to admission. Imaging confirmed the presence of ICH as a complication of traumatic CCF. This case highlights the diagnostic challenges of traumatic CCF and its potential complications. Diagnosis is challenging due to its rare occurrence with variable time interval for symptoms to develop (ranging from several hours to years after the initial injury), non-specific symptoms that may mimic other conditions, and delays in seeking care. Delayed diagnosis can be fatal, leading to visual loss, cerebral infarction, and haemorrhagic events. Rapid recognition and prompt management of traumatic CCF are crucial for preventing complications and achieving complete resolution with low rates of morbidity and mortality.

Abstract Background Advances in pediatric care have allowed people with intellectual and developmental disabilities (IDD) to live into adulthood, leading to a growing population requiring complex medical support, including renal replacement therapy (RRT) for end-stage kidney disease (ESKD). Although patients with IDD were historically excluded from RRT, recent reports have shown favorable outcomes when appropriate support is provided. This study reports our experience with six patients with IDD receiving RRT. Case presentation We describe two representative cases. The first was a 44-year-old man with renal hypoplasia and severe developmental disability (Yokochi D6) who had long-term pediatric nephrology follow-up at his residential facility. With progression to ESKD, conservative care was initially chosen due to concerns about RRT management. However, when creatinine rose to 8.75 mg/dL, multidisciplinary collaboration enabled arteriovenous shunt creation and initiation of hemodialysis (HD). Despite limited caregiver support, lack of transport, and inability to perform peritoneal dialysis (PD), outpatient HD was successfully maintained. The second case was a 34-year-old woman with renal hypoplasia (Yokochi A6) living with her family who required emergency HD for uremic symptoms. Involuntary movements during HD, transportation difficulties, and inadequate caregiver support hindered continuation. PD was initiated instead, serving as a bridge to planned living-donor kidney transplantation. Owing to cardiac dysfunction, transplantation was deferred, and PD was continued with adaptation of a bathtub-style exit site. Among the remaining four patients, two were managed with HD and two with PD. These cases illustrate the importance of individualized planning and multidisciplinary collaboration when initiating RRT in patients with IDD and complex psychosocial challenges. Conclusions Patients with IDD may undergo RRT successfully when care is individualized and supported by a multidisciplinary team. Treatment decisions should consider functional ability, living environment, and available resources in addition to medical criteria. Our findings highlight the importance of equitable access, person-centered planning, and community collaboration, though conclusions are limited by the small number of cases and heterogeneity of the population. Further work should focus on developing and evaluating tailored decision-making models and addressing systemic barriers to ensure dignity and improve quality of life for patients with IDD.

Background: The arteriovenous fistula (AVF) is a requirement for hemodialysis therapy in end-stage kidney disease (ESKD) patients. A consequence of AVF creation is compensatory cardiovascular hemodynamics, which are subsequently associated with cardiac remodeling. Relatedly, cardiovascular mortality and morbidity are elevated in ESKD patients, which worsens in dialysis patients. Currently, no suitable uremic large animal models exist to investigate the underlying mechanisms of AVF-induced cardiac remodeling. Research Question: This study aims to characterize cardiovascular changes secondary to AVF creation, supported by percutaneous transluminal angioplasty (PTA), in a uremic pig model. Methods: Chronic kidney disease (CKD) was induced via renal embolization, followed by AVF creation 28 days later. The AVF was created by anastomosis of the left common carotid artery to the left external jugular vein. AVF stenosis was alleviated 28 days thereafter via PTA, and cardiac MRI was performed at 14-, 28-, and 42-days post-PTA. Results: Increased end-diastolic volumes were observed in the left and right ventricles at day 42 vs 14 (200.8ml to 249.5ml, p=0.0457, and 204.6ml to 260.0ml, p=0.0268 respectively), while systolic function was preserved. Left ventricle (LV) stroke volume and blood flow through the aorta, pulmonary artery, and vena cava were also increased. In perivascular areas of the free wall of the LV at day 42 vs control, senescence markers showed increased p16 expression (fold change 10.21, p=0.0086) and decreased p21 expression (fold change 0.07, p=0.0357). The LV showed perivascular fibrosis (0.2% to 0.59%, p=0.021), via picrosirius red, reduced collagen-type IV expression (fold change 0.81, p=0.0089), and increased MMP2 levels (fold change 14.33, p=0.0213). Cardiomyocyte cross-sectional area was increased (from 800.9 µm 2 to 1250.0 µm 2 , p=0.0296), without CD4+ or CD68+ cell LV infiltration. Conclusion: In conclusion, AVF creation leads to modified left and right ventricular function and increased peripheral flow, potentially mediated by cellular senescence and fibrosis, resulting in progressive cardiac remodeling. This model of uremic kidney disease can now be used to evaluate mechanisms of AVF induced cardiac disease and test the efficacy of therapeutics like senolytics and anti-fibrotic agents.

Hemodialysis patients have an increased risk of bleeding related to platelet dysfunction and uremia leading to acquired defects in primary hemostasis. Frequently, these patients have multiple medical comorbidities requiring treatment with antiplatelet agents and anticoagulants, further increasing their bleeding risk. This presents added challenges when they present to the emergency department (ED) with arteriovenous fistula or arteriovenous graft (AVF/AVG) bleeding. This retrospective cohort study aims to characterize patient characteristics, mortality outcomes, hemorrhage outcomes, infectious outcomes, repeat ED visits, non-invasive procedures, and invasive procedures associated with ED encounters for AVF/AVG bleeding. This is a retrospective cohort study evaluating ED encounters for patients on hemodialysis with a chief complaint of a bleeding AVF/AVG. Descriptive statistics as well as logistic regression were used to find correlations between patient and encounter factors and the risk of requiring an advanced procedure to prevent further AVF/AVG bleeding. The primary outcome was the need for a formal intervention to revascularize or perform angioplasty on the patient's AVF or AVG. This occurred in 173 (50.7%) encounters. A history of any bleeding event was associated with the primary outcome while a higher initial platelet count or the use of antiplatelets were inversely associated with the primary outcome. This multi-center retrospective cohort study evaluated patient and clinical characteristics in encounters involving AVF/AVG bleeding. Correlating factors between ED encounters involving AVF/AVG bleeding and the need for advanced AVF/AVG interventions are described. Further research with a larger, more diverse patient base is needed to confirm these findings before these characteristics can be considered indications for more rapid interventional radiology or vascular surgery follow up in cases of AVF/AVG bleeding.

Here is a rare and diagnostically challenging case of infective endocarditis (IE) involving the Chiari network in a 47-year-old female with a complex cardiac and social history. She had a history of intravenous drug use (IVDU), prior methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia involving the mitral valve (MV), and methicillin-resistant Staphylococcus aureus (MRSA) endocarditis requiring tricuspid valve (TV) replacement with a CorMatrix bioprosthesis. She presented with a 3-day history of fever, progressive right groin pain and swelling, and worsening dyspnea. On admission, she was afebrile but hypotensive and had tachycardia. On examination, she had a loud holosystolic murmur in the left lower sternal border, a pulsatile right groin mass with a bruit, alongside multiple healed track marks on her lower extremities. Blood work was notable for leukocytosis. Computed tomography of the chest, abdomen, and pelvis revealed multiple pulmonary septic emboli and a right femoral artery pseudoaneurysm with an arteriovenous fistula confirmed on duplex ultrasound. Transthoracic echocardiogram (TTE) showed preserved ejection fraction (60-65%), normal aortic and mitral valves, but poor visualization of the prosthetic tricuspid valve. Blood cultures grew MRSA, and the patient was started on IV vancomycin. Transesophageal echocardiogram (TEE) revealed a large, mobile echogenic mass attached to the Chiari network (CN), positioned in line with the tricuspid regurgitant jet. These new findings, absent on prior imaging, strongly suggested isolated Chiari network endocarditis (CNE) Right-sided infective endocarditis (IE) is a rare clinical entity, accounting for less than 10% of all IE cases. Among these, involvement of the CN- the embryonic remnant of the right valve of the sinus venosus and present in under 2% of the population- is even rarer, with only a few reported cases to date. IVDU remains the leading risk factor for right-sided IE, as seen in our patient. The true incidence of CNE is likely underreported due to the limited sensitivity of TTE, which can make visualizing it challenging. TEE remains the imaging modality of choice for identifying such atypical presentations. Our case reinforced the critical role of TEE in identifying uncommon, non-valvular sources of infection. In the absence of clear treatment guidelines and high surgical risk, the patient was treated conservatively with a 6-week course of antibiotics followed by repeat TEE for monitoring.

Background: Leadless pacemakers offer advantages in immunosuppressed patients or those with limited venous access. This case highlights the novel use of a dual-chamber leadless pacemaker (DC-LP) in a patient with a complex history: orthotopic heart transplant (OHT), kidney transplant (KT), and now end-stage renal disease (ESRD) on intermittent hemodialysis (iHD) via a left arm arteriovenous fistula (AVF). The procedure was complicated by transient atrial non-capture after atrial lead deployment. Description of Case: A 31-year-old male with a history of parvovirus myocarditis status-post OHT and prior KT—complicated by multiple graft rejections, now on iHD for ESRD via a left arm AVF, presented with bradycardia and hypotension during iHD. He denied chest pain or syncope but endorsed exertional fatigue. ECG revealed complete heart block with a junctional escape rhythm and AV dissociation. Two distinct P-wave morphologies suggested dual atrial activity from residual native tissue and donor sinus node. Echocardiogram showed normal LV systolic function (EF 60–65%), mild to moderate RV dilation with mildly reduced function, and elevated RV systolic pressure. Coronary angiography showed no allograft vasculopathy, biopsy revealed mild (1R) rejection. Dopamine transiently improved sinus rate and AV conduction. Due to persistent chronotropic incompetence, a DC-LP was implanted. The decision was driven by his KT history, current iHD, and left arm AVF – factors rendering venous preservation and infection risk reduction critical. Following atrial lead deployment, transient atrial non-capture was noted but resolved spontaneously, likely due to local tissue effects at the implant site. Final programming was AAI70/VVI40. Discussion: This is, to our knowledge, the first reported DC-LP case in a patient with both OHT and KT. His complex profile—including immunosuppression, failed renal graft, left arm AVF, and ESRD—made him ideal for leadless pacing. DC-LP minimizes infection risk, preserves venous access, and avoids lead-related complications. The transient atrial non-capture likely related to local tissue injury, resolved spontaneously, underscoring the modality’s reliability in complex cases. Conclusion: DC-LP is a feasible and beneficial option for transplant recipients. This case demonstrates the successful DC-LP use in a patient with OHT, KT, iHD dependence, and left arm AVF, while emphasizing the importance of recognizing post-implant pacing anomalies that may self-resolve.

Purpose This study aims to provide insights into the rare occurrence of cerebral lipiodol embolism following transcatheter arterial chemoembolization (TACE) in treating hepatocellular carcinoma (HCC). By analyzing a specific case, this research seeks to enhance clinical understanding of the pathogenesis, manifestations, and management strategies for this complication, ultimately improving patient outcomes. Background Cerebral lipiodol embolism is an infrequent yet severe complication of TACE, a standard treatment for unresectable HCC. The embolism occurs when iodized oil, used during the procedure, inadvertently enters the cerebral circulation, often due to arteriovenous shunts associated with liver tumors. Despite TACE’s widespread use, awareness and understanding of this rare complication remain limited, necessitating further investigation to mitigate risks and improve patient safety. Case presentation A 64-year-old man with multiple HCCs and portal vein invasion underwent TACE involving iodized oil and chemotherapy agents. Post-procedure, the patient exhibited neurological deficits, including decreased consciousness and right-sided weakness. Imaging confirmed cerebral lipiodol embolism. Despite gradual neurological improvement, the patient continued to experience significant right-sided weakness, highlighting the long-term impact of this complication. Conclusion Cerebral lipiodol embolism, though rare, poses significant risks during TACE. Early detection through careful imaging and precautionary measures, such as managing Lipiodol injection volumes and speeds, is crucial. Enhanced clinical awareness and intervention strategies can prevent lipiodol from entering the systemic circulation, reducing the incidence of this severe complication.

Improved arteriovenous fistula (AVF) maturation is crucial for reducing the dependency on central venous catheters in patients undergoing hemodialysis (HD). Far-infrared radiation (FIR) is a treatment modality that may enhance maturation and patency. The present trial examined the effect of FIR on newly placed AVFs. The hypothesis was that FIR treatment on the AVF would improve maturation and patency after 12 months compared to a control group. Patients were randomized to receive FIR treatment or no FIR. After AVF placement, the FIR group received FIR on the skin of their AVF for 40 min at every HD treatment for 1 year. The primary outcome was the difference in maturation (time to cannulation), which was expressed as a median and compared with the Mann-Whitney U test. It was furthermore explored as a hazard ratio (HR) determined by Cox regression analysis. Differences in the number of patients with AVF thrombosis and primary patency at 3 months were explored in a Chi-square test. A total of 91 patients were randomized to either FIR (n = 46) or the control group (n = 45). There were no differences in baseline characteristics between groups. No difference in time to cannulation was found (64 days [47; 96] in the FIR group and 69 days [57; 85] in the control group, p = 0.89). The HR for cannulation was 0.82 (95% confidence interval (CI), 0.50-1.34, p = 0.42) in the FIR group compared to the control group. There was no difference in patients with AVF thrombosis (p = 0.32) or primary patency at 3 months (p = 0.17). We did not find that FIR had a beneficial effect on maturation (time to cannulation) or overall patency between treatment groups in newly placed AVFs in patients undergoing HD. (Clinicaltrials.gov: NCT04011072).

To explore the feasibility of establishing arteriovenous fistulas (AVFs) using thrombosed/stenotic cephalic veins in hemodialysis patients. For 27 patients with good vascular conditions but thrombosis and/or stenosis in the cephalic vein, the lesions were relieved by thrombectomy and/or percutaneous transluminal angioplasty (PTA), and radiocephalic AVFs were created. These patients composed the intervention group. A control group (n = 108) of patients with newly created AVFs was obtained via the propensity score matching method. The patients were followed up to observe the maturation and patency rates of AVFs. In the intervention group, 25 patients (92.59%) achieved AVF maturation. The primary patency rates at 3, 6, 9, and 12 months were 95.8%, 87.5%, 83.3%, and 74.5%, respectively. The secondary patency rate remained at 95.8% after 6 months. In the control group, 85 patients (78.70%) achieved AVF maturation. The primary patency rates at 3, 6, 9, and 12 months were 98.8%, 91.3%, 76.1%, and 67.2%, respectively. The secondary patency rates at 12, 24, and 36 months were 92.3%, 89.4%, and 83.0%, respectively. No significant differences were observed in the AVF maturation rates or primary/secondary patency rates between the two groups (p > 0.05). Cox regression analysis also revealed that the decrease in primary or secondary patency did not significantly differ between the two groups (p = 0.60 and p = 0.21, respectively). Thrombosed/stenotic cephalic veins can be used for AVF creation as long as the lesions can be relieved during the perioperative period.

Arteriovenous fistula (AVF) failure is a frequent clinical problem among end stage renal patients seeking durable long term dialysis access. The most common histological in vivo observation of AVF failure is endothelial injury at the juxta-anastomosis area (JAA) followed by thrombus deposition and subsequent neointimal hyperplasia (NH). While hemodynamic factors have been postulated to affect AVF remodeling and failure, the spatial correlations between changes in hemodynamics post AVF creation and in vivo physiologic observations remain poorly understood. In this work, we developed a novel computational fluid dynamics (CFD) model of an AVF using a pre-established aortocaval mouse model and integrated it with agent-based modeling for NH. The CFD simulation was performed using an animal-specific aortocaval fistula geometry derived from in vivo CTA images with prescribed boundary conditions obtained from in vivo ultrasound measurements. CFD results were validated against in vivo ultrasound velocity measurements at the level of the fistula. CFD allowed quantification of turbulence intensities throughout the fluid domain of the AVF. Turbulence was significantly elevated at the JAA and in regions of venous outflow stenosis. Turbulence intensity served as an input parameter for a simple two-rule agent-based model to test the hypothesis that non-homeostatic hemodynamic changes resulting from AVF creation drive spatial gradients in endothelial damage and proliferation of vascular smooth muscle cells (VSMC) leading to an increase in venous thickness or NH. Our findings show that increased velocity and turbulence in the JAA parallels in vivo NH formation, and that further from the JAA (both cranial and caudal) velocity and turbulence decrease incrementally. The results corroborate that perturbed hemodynamics in the JAA are potential triggers for NH and the source of thickness gradients observed in AVFs.

Arteriovenous fistulas (AVFs) are the preferred vascular access for hemodialysis but frequently develop stenosis, requiring repeated endovascular interventions. Cutting balloon angioplasty (CBA) is a potential alternative to conventional percutaneous transluminal angioplasty (cPTA), though supporting evidence remains limited. Single-center randomized controlled trial comparing CBA and cPTA for AVF stenosis. Outcomes included primary and secondary patency at 6 and 12 months, radiological success, and complications. Among 190 patients randomized (CBA: n = 89; cPTA: n = 101), primary patency at 6 and 12 months showed no significant difference (CBA: 78.6%, 56.1%; cPTA: 72.2%, 51.8%; p = 0.53 and p = 0.65). Secondary patency at 12 months was higher in the CBA group (93.9% vs. 78.2%; p = 0.02), with a lower risk of loss by Cox regression (HR = 0.36; 95% CI: 0.14-0.91; p = 0.031). Radiological success favored CBA (84.7% vs. 76.1%; p = 0.025). Access loss due to thrombosis was significantly lower in the CBA group (2.3% vs. 11.1%; p = 0.022), though overall thrombosis rates did not differ. The leading cause of non-salvageability in both groups was an unsatisfactory outcome in the preceding angioplasty (CBA: 2/4; cPTA: 6/11). No significant differences in patency outcomes were observed in subgroup analysis by access type, stenosis location, and excluding patients with prior interventions. Minor complications occurred in 10.3% of procedures, with no major events reported. CBA and cPTA showed similar primary patency, but CBA led to better secondary patency and radiological success. The survival advantage may be associated with better radiological results, leading to fewer resistant stenoses and unsalvageable thrombosis cases. Further prospective trials are warranted to define role of cutting balloons in different clinical scenarios, especially in recurrent or resistant stenoses.

A retrospective single-center study of forearm autogenous arteriovenous fistula creation and 60-month patency

Percutaneous arteriovenous fistulas (pAVFs) are an important technological advancement in dialysis access but often suffer from incomplete maturation and poor cannulation due to split flow. The Real-time Angio Zonal Diversion via Acoustic Navigation (RAZDAN) technique is a minimally invasive, ultrasound-guided ligation method to redirect blood flow and improve cannulation outcomes. This retrospective, multicenter, multispecialty study evaluated 154 patients with immature Ellipsys pAVF using the RAZDAN technique between 2019 and 2024 to assist with maturation and subsequent cannulation. Outcomes included technical success, infection rate, and sustained occlusion at 6 months. Time intervals from access creation to maturation and catheter removal were analyzed. Using the RAZDAN technique, 100% technical success was achieved without hospital-requiring complications. Mean time from access creation to maturation was 49.5 days, and to catheter removal was 95.5 days. Following ligation, maturation occurred at an average of 15.0 days, and catheter removal in 58.0 days. Infection occurred in 1.9% and nerve-related discomfort in 1.2%, all treated or resolved without hospitalization. The RAZDAN technique offers a safe, effective, and reproducible option for enhancing cannulation in pAVFs. It provides a minimally invasive alternative for non-surgical specialists, potentially shortening catheter dependence and improving vascular access outcomes.

Two major groups of perforators connecting, through the deep fascia, the superficial veins (under the superficial fascia) to the radial and ulnar venae comitantes (under the deep fascia). The well-known proximal perforating vein is in the antecubital fossa. In the distal part of the forearm numerous perforators were found, concentrated on the radial side. The purpose of this study is to describe utilization of distal perforating vein (DPV) as an outflow for native arteriovenous fistula in distal part of the forearm. Sixteen patients with chronic kidney disease in stages G4 and G5, aged 56 ± 14.7 years, who underwent AVF utilizing DPV (DPV-AVF), were qualified for the study. All patients underwent vascular mapping using ultrasound to identify DPV. AVF function was assessed after 24 h and during 6-weeks follow-up. Primary, assisted, and secondary fistula survival were evaluated using a life table. All AVFs were patent after discharging. No short time complications were observed. The mean diameter increase of the radial artery, brachial artery, and vein in the antecubital fossa 24 h after surgery was 1 ± 0.8, 0.7 ± 0.4, 1 ± 1.3 mm, respectively. The mean fistula flow rate was 513.7 ± 184.5 ml/min 24 h post-surgery. The first cannulation was uneventful in 29 days post-surgery in 8 (50%) patients. Primary patency rates at 1, 3, and 6 months were 87.5%, 62.5%, and 43.8%, respectively. All 16 fistulas demonstrated adequate functionality, similar to standard radiocephalic fistula (RCAVF). Due to the proximity of the radial artery and the DPV, the wound was much smaller than RCAVF. Using the DPV as a drainage vein preserves other options for creating an AVF in the proximal forearm.

Drug-eluting stents for the treatment of arteriovenous access stenosis: A systematic review and individual patient data (IPD) meta-analysis.

Novel fusion architecture of multi-location blood flow sounds for arteriovenous fistula stenosis diagnosis.