Arteriovenous Fistula Research Articles

Dural arteriovenous fistula research and management in China (DREAM-INI): initial characterization and patient cohort outcomes

BackgroundIntracranial dural arteriovenous fistulas (DAVFs) are rare lesions, making it challenging to fully understand and improve their management. Globally, only two major large-scale studies have focused on DAVFs. This report...

Successful treatment of rapid onset Foix-Alajouanine syndrome following hyperselective endovascular embolization of thoracic dural arteriovenous fistula: Case report, technical note and literature review.

Foix-Alajouanine syndrome is an extremely rare yet important differential diagnosis for subacute lower limb weakness in middle-aged to elderly adults. Current understanding of the pathophysiology of this disease, along with recent publications on successful endovascular interventions, has shifted the perspective and clinical approach for its management. Nonetheless, neurosurgical pathways for clinical treatment are still preferred over endovascular embolization. Here, we present the case of a 63-year-old male who developed a rapidly progressing thoracic medullary syndrome over a 6-month period, compromising motor function, sphincter control, and sensory function in the lower extremities. The patient was diagnosed with venous congestive myelopathy secondary to a dural arteriovenous fistula and underwent endovascular embolization using hyper-selective catheterization. Over an 8-month period, the patient experienced successful recovery of both motor and sensory functions. This case supports the use of minimally invasive techniques for the treatment of dural arteriovenous fistulae with spinal involvement.

Evaluating post-treatment residual intracranial arteriovenous shunting: a comparison of arterial spin labeling MRI and digital subtraction angiography.

To evaluate the efficacy of arterial spin labeling (ASL) MRI in detecting residual arteriovenous (AV) shunting in treated arteriovenous malformations (AVMs) and fistulas (AVFs). A retrospective institutional review identified 29 patients with DSA-confirmed AV shunt lesions treated via embolization (n = 17), stereotactic radiosurgery (n = 2), surgical resection (n = 8), or combined embolization and surgical resection (n = 4), with corresponding baseline and post-treatment ASL and DSA studies. Two neuroradiologists independently assessed ASL images for residual AV shunting, with inter-rater agreement calculated. Disagreements were jointly reviewed to reach consensus. Sensitivity and specificity for using ASL to detect residual AV shunting were then determined using DSA as the gold standard reference. Seventeen patients with Spetzler-Martin grades II-V AVMs were included: 76.5% with supratentorial nidus, and 52.9% with prior hemorrhage. Twelve AVF patients were included, including eight dural, one vein of Galen, two perimedullary, and one cavernous-carotid fistula. Inter-rater agreement for presence of residual AV shunting was strong (93.5%, κ = 0.87). Two disagreements involved AVM patients after surgical resection. Sensitivity and specificity of ASL for detecting residual was 94% and 93%, respectively. Within the AVM group, both metrics reached 100%, while for AVFs, they both decreased to 83%, with one false positive and one false negative. ASL MRI is highly sensitive and specific for detection of residual AV shunting across a wide spectrum of AV shunt pathologies and treatment modalities. ASL can play an important role as a non-invasive adjunct to DSA, potentially reducing the frequency of DSA during the continuum of post-treatment care.

In Vivo Discrimination of Iodine and Tantalum-Based Liquid Embolics After Intracranial or Spinal Embolization Using Photon-Counting Detector CT.

In vitro differentiation of iodine and tantalum-based liquid embolics post-embolization can be achieved using spectral computed tomography. This study evaluates the in vivo ability of clinical photon-counting computed tomography (PCD-CT) to distinguish these embolic agents in patients undergoing endovascular treatments for cerebrovascular and spinal pathologies. This retrospective study included 25patients treated between April 2021 and March 2024, who underwent PCD-CT imaging post-embolization for intracranial arteriovenous malformations (AVM), dural arteriovenous fistulas (dAVF), spinal tumors, or middle meningeal artery (MMA) embolization for chronic subdural hematomas (cSDH). Imaging analysis involved iterative reconstruction, using conventional images (CI), iodine maps (IM), and virtual non-contrast (VNC) series. Two blinded neuroradiologists assessed the suppression quality of the embolic agents on aLikert scale. Of the 25patients, 22underwent intracranial and 3spinal embolizations. The differentiation between iodine and tantalum-based embolics achieved 92% accuracy for reader 1and 88% for reader2, with aCohen's kappa coefficient of 0.92 indicating high inter-reader agreement. Iodine-based agents were moderately suppressed, whereas tantalum-based agents exhibited superior suppression. Errors arose from mistaking suppressed platinum coils for tantalum-based embolics. Hemorrhage detection accuracy was high, with aCohen's kappa of0.92. PCD-CT effectively differentiates between iodine- and tantalum-based embolics in vivo, demonstrating high diagnostic accuracy and inter-reader reliability. This capability facilitates improved post-procedural assessment and may enhance the management of endovascularly treated patients by reducing imaging artifacts and aiding in hemorrhage detection.

Role of renal vascular coordinator on access flow dysfunction: A quality improvement initiative on improving patency rate.

A renal vascular coordinator (RVC) is a single point-of-contact allied health professional in the early detection and timely intervention of flow dysfunction. In Khoo Teck Puat Hospital (KTPH), RVC performs access ultrasonography assessment and assists in reviewing direct referrals about dysfunctional arteriovenous fistula (AVF)/arteriovenous graft (AVG) from community dialysis centres and plans for appointments with interventional nephrologists and vascular surgeons. We conducted a prospective study from April 2020 to December 2022 to evaluate the appointment-to-intervention time (AIT) and patency rate (PR) of vascular access interventions. Secondary outcome was the percentage of vascular access loss. Ninety-three patients were referred to the RVC and were offered thrombectomy or angioplasty. Twenty-seven patients were excluded from the analysis (did not require intervention (9), admitted without RVC assessment (13), defaulted (4), or bypassed an RVC appointment to their first intervention (1)). The median time from referral to their first RVC visit was 4 (3-6) days. The median AIT for the RVC group was 6 (3-11) days (21.5% within 48 h). The median AIT for the non-RVC group was 6 (2.3-12.8) days (25.5% within 48 h, p = 1.0). The 6-month and 12-month post-intervention PR was 71% and 61.3%, respectively. Fifty-one of the remaining ninety-three patients had previous procedures done to their AVF before April 2020 without RVC involvement. The 6-month and 12-month post-intervention PR was 51% (p < 0.016) and 15.7% (p < 0.00001), respectively. The percentage of vascular access loss was similar in both RVC and non-RVC groups (4.3% vs 2%, p = 0.44). With the addition of RVC, vascular access outcome is improved with longer PR for up to 12 months, with no difference in AIT and number of vascular access losses.

Exploration of pulse wave analysis under reactive hyperemia and close to an arteriovenous fistula: a comparative analysis.

Analyzing novel pulse wave parameters, we aimed to study specific changes in pulse waveform under high flow conditions in three collectives (i.e., healthy individuals and two collectives of patients with kidney disease and different levels of comorbidities): First, under reactive hyperemia in order to assess endothelial function. Second, close to an ateriovenous fistula in order to assess fistula function. Subjects underwent local peripheral tonometric pulse wave analysis with the SphygmoCor® device and duplex sonography to assess flow velocity (peak Vmax and diastolic Vdiast) under physiological conditions. Corresponding measurements were then performed under reactive hyperemia and at fistula arms. The area under the curve and the mean slope between the systolic peak and the end of systole of pulse waves and duplex flow velocities were analysed as parameter differences under high flow and physiological conditions (∆A2 and ∆m2, ∆Vmax and ∆Vdiast). In addition, the augmentation index was evaluated (only) under physiological conditions. The Wilcoxon test was used to assess parameter differences and linear correlation was performed. A total of 108 subjects were evaluated (23 healthy and 85 with fistula in two distinct collectives n = 39/45, measurements under reactive hyperemia in 62 individuals). Significant increments in the novel pulse parameters were observed under reactive hyperemia and near a fistula and were found to correlate with corresponding changes in flow velocity (reactive hyperemia: ∆A2 and ∆m2/Vmax r = 0.347, p = 0.006 and r = 0.374, p = 0.003; fistula: ∆A2/∆Vmax r = 0.315, p = 0.003, no significant correlation for ∆m2/Vmax). Consistent with their different vascular status and endothelial function, changes in pulse wave parameters during reactive hyperemia were significantly different in patients and healthy subjects. Both high flow conditions induced similar changes in the pulse waveform and a delay of the systolic peak in all three collectives. The augmentation index was different in the three collectives and correlated with the increase of the novel parameters and the peak flow velocity under reactive hyperemia: ∆A2 r = 0.445, p < 0.001, ∆m2 r = 0.338, p = 0.007, ∆Vmax r = 0.460. Detection of changes in pulse waveform under high flow conditions is potentially a new clinical application to characterize endothelial function and the functional status of ateriovenous fistulas.

Retraction Note: Comment on "The surgical role of C1 nerve root identification for the disconnection of the spinal dural arteriovenous fistula at the craniocervical junction: a single center restrospective experience".

Retraction Note: Comment on "The surgical role of C1 nerve root identification for the disconnection of the spinal dural arteriovenous fistula at the craniocervical junction: a single center restrospective experience".

Retained foreign body in radial artery: Endovascular retrieval and salvage of a hemodialysis arteriovenous fistula.

A foreign body was inadvertently retained in the patient's radial artery during a previous endovascular procedure, leading to early recurrent thrombosis of his hemodialysis arteriovenous fistula. Through the strategic use of ultrasound, a through-and-through wire, as well as sequential balloon inflation to "push" the foreign body, it was successfully retrieved endovascularly, leading to effective salvage of the patient's hemodialysis access.

A New Approach to Haemodialysis: Nurse-Led Dual Intervention Eases AV-Fistula Puncture Pain and Discomfort

ABSTRACT Background: Chronic kidney disease (CKD) affects approximately 10% of the global population and often progresses to end-stage renal disease, necessitating hemodialysis. Arteriovenous (AV) fistula puncture is a routine yet painful procedure, highlighting the need for effective pain management strategies. Objective: This study aimed to evaluate the effectiveness of a Nurse-Led Dual Intervention, combining cryotherapy and virtual reality, in reducing pain and discomfort during AV fistula puncture among hemodialysis patients. Methods: A randomized controlled trial was conducted with 60 hemodialysis patients assigned to either an experimental or control group. Pain and discomfort were assessed using McGill’s Pain Rating Scale and Borg’s Perceived Discomfort Rating Scale. The intervention involved the simultaneous application of cryotherapy and virtual reality distraction during AV fistula puncture, while the control group received standard care. Results: Post-intervention analysis demonstrated a 43.62% reduction in symptom scores in the experimental group compared to a 2.80% reduction in the control group. Significant decreases in pain intensity and discomfort scores were observed in the experimental group. Additionally, statistical analysis revealed meaningful associations between socio-demographic variables and pain management outcomes. Conclusion: The findings suggest that integrating non-pharmacological interventions, such as cryotherapy and virtual reality, can significantly improve patient comfort and quality of life during hemodialysis. Future research should explore the broader clinical applications of this dual intervention for pain management in various healthcare settings..

Quest for the optimal venous access in a complex skull base dural fistula: Case illustrations and principles.

Treatment of dural arteriovenous fistulae (DAVFs) is dynamic and evolves between diagnostic and therapeutic angiography.A 79-year-old man with a left jugular foramen DAVF presented with new onset cranial nerve XII palsy. The DAVF progressed from Cognard grade I to IIa + b. A transvenous approach was chosen. Attempts to access the left inferior petrosal sinus (IPS) via the left internal jugular vein failed due to occlusion. An alternative route through the left superior ophthalmic vein and left cavernous sinus to the IPS was devised. Successful coil occlusion of the IPS was achieved. Postoperatively, symptoms resolved, and angiography showed no cortical venous reflux.

Angiology in rhythmology: What should Iknow about vascular complications?

Both the performance of electrophysiological examinations and the implantation of cardiac devices (pacemakers, implantable cardioverter-defibrillator [ICDs], and cardiac resynchronization therapy defibrillator [CRT-D] systems) are associated with vascular punctures. This article provides an overview of possible vascular complications and their management from the perspective of angiology. The most common access site for invasive electrophysiological procedures is usually via the femoral veins and/or arteries. Puncture of the brachial vessels is apossible but rarely used alternative. For implantation of transvenous cardiac devices, access via the cephalic vein or axillary vein is used. The electrodes located in the venous vascular system represent aforeign material and increase the risk of thrombus formation in the affected vein. Punctures of the femoral vessels can lead to bleeding, thrombosis and the formation of arteriovenous fistulas or pseudoaneurysms (aneurysma spurium). Venous thromboses can occur postprocedurally. The correct puncture technique is essential to avoid complications. Ultrasound-guided puncture also significantly reduces the rate of vascular complications.

Pericardial Involvement in Hereditary Hemorrhagic Telangiectasia

Hereditary haemorrhagic telangiectasia is a rare disease characterized by cutaneo-mucous and visceral arteriovenous malformations. Cardiac involvement is uncommon and was presented primarily by hyper-output heart failure. Hemorrhagic pericardial effusion, although is extremely rare, can occur during HHT. We report the case of a 48-years-old woman which was hospitalized in 2015 in internal medicine department, Sfax, Tunisia in 2015 for anicteric cholestasis. She noticed a personnel and familial history of recurrent epistaxis. Biologic findings revealed anemia and moderate cholestasis. Viral investigations and immunologic tests were negative. Abdominal tomography showed multiple arterio-venous shunts of the liver. Liver involvement due to Rendu Osler Weber disease was retained. She was treated by ferrous iron, but she was lost to follow up. She was presented in February 2021, with severe anemia (5 g/dL). Physical examination revealed signs of global heart failure. Biological investigations found anemia, inflammatory biological syndrome, cytolysis and cholestasis. Heart ultrasound revealed an abundant pericardial effusion. Only 500cc of hemorrhagic fluid could be aspirated before the needle became blocked. Unfortunately, one week after, re-accumulation of pericardial fluid and worsening occurred. She underwent a partial surgical pericardial excision with pleuropericardial opening. Analysis of the fluid ruled out any infectious cause of this effusion. Histological examination confirmed the vascular dysplasia with signs of hemorrhage and inflammation. The patient was discharged 1 month after surgery with no other bleeding episodes. For her anemia, she received a transfusion of red blood cells. Then, the patient was treated by iron treatment.

Single or dual antiplatelet therapy improves one-year arteriovenous graft patency and overall survival

IntroductionFollowing new dialysis access creation there is no consensus on the optimal use of anti-thrombotic therapy. Recent studies have suggested that single antiplatelet therapy may improve hospital mortality as well as patency. The aim of this study was to assess the role of different antiplatelet and anticoagulation therapies on outcomes following dialysis access creation. Material and MethodsA retrospective study was conducted utilizing patients from the Vascular Quality Initiative who underwent AV fistula (AVF) and AV graft (AVG) creation from 2011-2023. Patients who were antiplatelet and anticoagulation naive were separated into four cohorts: no antiplatelet (No APT), single antiplatelet (SAPT), dual antiplatelet (DAPT), and aspirin with anticoagulation (ASA + AC). Univariate Kaplan-Meier (KM) and multivariable regression analyses were conducted to assess overall survival, primary patency, and secondary patency. Results49,980 patients with AVF creation and 12,688 patients with AVG creation were identified. AVG patients had improved 1-year primary patency with SAPT compared to No APT (48% vs 44%, p = 0.03) on KM analysis. No difference on KM analysis was observed for AVF. Regression analysis showed decreased risk of loss of primary patency for AVF (HR 0.90, CI 0.83-0.97, p = 0.009). AVG with SAPT showed decreased risk of mortality (HR 0.80, CI 0.64 – 1.00, p = 0.05) and decreased risk of loss of primary patency (HR 0.80, CI 0.67-0.94, p = 0.009). DAPT also showed decreased risk of loss of primary patency for AVG (HR 0.64, CI 0.43-0.95, p = 0.028). Survival was worse for both AVF and AVG patients on ASA + AC on KM analysis. ConclusionsSingle antiplatelet therapy following access creation improves primary patency for both AVF and AVG, as well as overall survival for those with AVG. DAPT may further improve primary patency in those with AVG. The use of anticoagulation shows no clear benefit and may be harmful, however is more likely to reflect higher risk patients with other co-morbidities. These results suggest that following an AVF one should consider discharging patients on SAPT, and following an AVG one should consider SAPT or DAPT.

Evaluation of the Learning Experience after Ultrasound-Guided Percutaneous Arteriovenous Fistula Placement Workshop Utilizing the Ellipsys® Vascular Access System.

Excellent ultrasound skills are crucial for planning and creating a percutaneous arteriovenous fistula (AVF). This study presents the findings of a workshop focused on training healthcare professionals in ultrasound-guided puncture techniques for percutaneous AVF placement using the Ellipsys® vascular access system (Medtronic, Minneapolis, MN, USA). Emphasizing the importance of ultrasound guidance in enhancing accuracy and safety, the workshop aimed to equip participants with the necessary skills to perform this procedure effectively. The workshop consisted of didactic lectures, hands-on training sessions, and case-based discussions. Before and immediately after the workshop, the participants completed a paired, anonymous pre- and post-workshop written survey. The workshop was conducted over a one-day period four times over 13 months at a conference center in Bavaria, Germany. Twenty-one healthcare professionals (18 Male and 3 female) from 14 tertiary and 7 secondary hospitals attended the workshop. Participants included vascular surgeons, nephrologists and interventional radiologists. Participants significantly enhanced their knowledge about percutaneous endovascular arteriovenous fistula creation, with average knowledge scores increasing from 4.24 pre- to 2.33 postworkshop (p=0.02). Participants demonstrated significant improvement in confidence of measuring vessels (1.71 to 1.38, p=0.01). Further improvements reported were in ultrasound knowledge (2,10 to 1,90), confidence in identifying arteries (1,29 to 1,24) and veins (1,33 to 1,19), as well as confidence in depicting vessels in both transverse (1,29 to 1,10) and longitudinal (1,43 to 1,24) projections. These changes were not statistically significant. Feedback surveys indicated a high level of satisfaction with the educational content and hands-on training sessions, with scores for various aspects such as the achievement of personal learning goals (1.08), informativeness of teaching materials (1.09), and overall recommendation of the training (1.0). The workshop provided participants with valuable hands-on experience and demonstrated significant improvement in their knowledge about ultrasound-guided AVF creation.

Effect of transarterial embolization of iatrogenic renal artery pseudoaneurysms without or with arteriovenous fistula on renal function at 6-month follow-up

Effect of transarterial embolization of iatrogenic renal artery pseudoaneurysms without or with arteriovenous fistula on renal function at 6-month follow-up

WCN25-4385 A single centre experience of USG guided interventional procedures on AV fistula

WCN25-4385 A single centre experience of USG guided interventional procedures on AV fistula

Optimizing the life of vascular access during follow-up.

Optimizing the longevity of vascular access in hemodialysis patients remains a critical aspect of patient care, given the significant role of arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs) in enabling effective dialysis. Vascular access complications, such as stenosis, thrombosis, and cannulation-related damage, continue to challenge both the functionality and the sustainability of these access points. Recent advancements underscore the importance of a robust follow-up strategy, integrating clinical evaluations with diagnostic tools like color Doppler ultrasound (CDU) and emerging interventional approaches such as drug-coated balloon (DCB) angioplasty. Regular CDU surveillance has shown promise in identifying asymptomatic stenosis, providing an opportunity for early intervention and reducing the risk of thrombotic events. This non-invasive imaging modality allows for detailed evaluation of hemodynamic changes within the vascular access, enabling timely detection and monitoring of stenotic lesions. Furthermore, the use of DCBs - angioplasty balloons coated with antiproliferative agents such as paclitaxel - offers a targeted approach to manage intimal hyperplasia and reduce restenosis rates in vascular access sites. Studies indicate that DCBs can mitigate neointimal proliferation, prolonging patency and enhancing long-term access outcomes. In this paper, we explore the synergistic role of clinical follow-up, ultrasound-based diagnostics, and drug-coated technologies in the preservation of vascular access. By examining the impact of these strategies, we aim to provide a comprehensive approach to vascular access maintenance, emphasizing the need for structured surveillance protocols and interventional techniques to optimize the lifespan of hemodialysis access points.

A novel technique to repair circumflex coronary artery–coronary sinus arteriovenous fistulas

A novel technique to repair circumflex coronary artery–coronary sinus arteriovenous fistulas

WCN25-1787 Risk factors and outcomes of arteriovenous fistula failure – a cross-sectional study from a tertiary care centre in South India

WCN25-1787 Risk factors and outcomes of arteriovenous fistula failure – a cross-sectional study from a tertiary care centre in South India

Percutaneous Transluminal Angioplasty Balloon-Assisted Adjacent Vascular Connection Without Stent Protection: Case Report.

The aneurysmal dilation and excessive blood flow of the cephalic vein caused by the relative stenosis of the cephalic venous arch are important challenges in the maintenance of arteriovenous fistulas, and the use of adjacent vascular connection without stent protection has shown great advantages over traditional open surgery.