Arteriovenous Fistula Dysfunction Research Articles

Impact of the Causes of Arteriovenous Fistula Stenosis on the Patency Rate of Arteriovenous Fistula Following Percutaneous Transluminal Angioplasty.

The aim of this study is to investigate the impact of the causes of arteriovenous fistula (AVF) stenosis on the 1-year primary patency rate of AVF following percutaneous transluminal angioplasty (PTA) and to identify the independent risk factors that affect vascular access patency post-PTA. In this investigation, we analyzed the clinical data of 78 patients who underwent successful PTA for dysfunctional autologous AVF in the Nephrology Department of our hospital between January 2020 and September 2022. The primary focus of this study was to observe the postoperative patency rate of AVF in these patients. Subsequently, the patients were categorized based on primary diseases, Charlson comorbidity index (CCI), AVF typing, and causes of AVF stenosis. The postoperative patency rates of AVF were then compared among the respective groups. To further analyze the relevant risk factors influencing vascular access patency following PTA, the Cox proportional hazard model was employed. A total of 78 eligible patients who underwent PTA were included in this study revealing patency rates of 93%, 85%, 80%, and 72% at 3, 6, 9, and 12 months postoperatively, respectively. Analysis using the Kaplan-Meier curve indicated no significant association between the presence of diabetic nephropathy (p = 0.313) and AVF stenosis typing (p = 0.195) with post-PTA patency of AVF. However, the 1-year patency rate demonstrated notable differences, with higher rates observed in the CCI < 7 group compared with the CCI ≥ 7 group and similarly in the simple AVF stenosis group compared with the intimal hyperplasia group (p < 0.001). Furthermore, based on multivariate survival analysis (Cox regression model), the causes of AVF stenosis and CCI index were identified as independent risk factors influencing AVF patency following PTA (p < 0.05). Patients with intimal hyperplasia were found to have a higher likelihood of AVF restenosis compared with those with simple stenosis. Similarly, individuals with a high CCI were more prone to AVF restenosis than those with low CCI. The causes of AVF stenosis and CCI were identified as independent risk factors influencing vascular access patency following PTA.

The Long-Term Patency Rate and Factors Influencing Dysfunction of the Autogenous Arteriovenous Fistula in Hemodialysis Patients: A Retrospective Study.

Autogenous arteriovenous fistula (AV fistula) dysfunction continues to be a widespread clinical challenge, adversely impacting both patients and society as a whole. The aim of this study was to investigate the long-term patency rate of AV fistula, explore the factors that contribute to AV fistula dysfunction, and present the findings in a way that can guide clinical practice. This retrospective cohort study enrolled patients who underwent AV fistula creation and subsequent hemodialysis at a tertiary A-level hospital in Chongqing, China. Demographic, clinical, and laboratory characteristics of the patients, as well as AV fistula dysfunction, were retrospectively reviewed from electronic health records. Cox proportional hazards regression analysis was used to analyze the factors influencing AV fistula dysfunction, and a forest plot was created to visualize the results. Additionally, Kaplan-Meier survival analysis was used to analyze AV fistula survival. This study analyzed 226 patients undergoing hemodialysis, demonstrating cumulative AV fistula patency rates of 82.1% at 12 months, 60.7% at 36 months, 45.4% at 60 months, and 33.5% at 84 months. Univariate Cox proportional hazard regression analysis identified six variables associated with AV fistula dysfunction (p < 0.1): body mass index (BMI), preemptive AV fistula creation, diabetes, total cholesterol, albumin, and uric acid. Subsequent multivariate analysis revealed four independent predictors for dysfunction: elevated BMI (HR: 1.58, p = 0.016), preemptive AV fistula creation (HR: 0.67, p = 0.029), albumin (HR: 2.83, p < 0.001), and uric acid (HR: 1.57, p = 0.020). Our study findings indicated that overweight, hypoalbuminemia, and high concentrations of uric acid were independent risk factors for AV fistula dysfunction. In contrast, preemptive AV fistula creation was an independent protective factor against AV fistula dysfunction. Therefore, early interventions and surveillance for these factors should be performed to improve long-term AV fistula patency rates.

Effectiveness of second drug-coated balloon angioplasty for arteriovenous fistulas following initial treatment failure with first-generation DCBs.

Percutaneous transluminal angioplasty (PTA) is the global standard for treating dysfunctional arteriovenous fistulas (AVF). However, PTA can cause vessel wall damage and intimal hyperplasia, leading to restenosis and the need for reintervention. The drug-coated balloon (DCB) is a novel approach for managing recurrent dysfunction in AVFs. However, there is limited information on the optimal number of DCB treatments required. Specifically, it is uncertain whether a second DCB should be performed in patients in whom the initial treatment with the first DCB was ineffective. This single-center, retrospective observational study aimed to evaluate the effectiveness of a second DCB treatment in 40 patients. A second DCB was performed if PTA was required generally within 90 days after the first DCB, indicating failure of the first DCB treatment. The results showed a significant difference in patency following the second DCB compared to conventional balloon treatment (χ² = 20.46, p < 0.001) and between the first and second DCB treatments (χ² = 11.41, p = 0.0007). Univariate logistic regression analysis indicated that patients with thinner maximum intimal hyperplasia had significantly longer assisted primary patency periods (p = 0.006). Furthermore, receiver operating characteristic curve analysis to assess the sensitivity-specificity profile of the second DCB's effectiveness showed that the optimal threshold for maximum intimal hyperplasia was 1.2 mm (sensitivity/specificity, 0.80/0.58). Our findings suggest that a second DCB treatment is effective for patients whose first DCB was unsuccessful, particularly in those with maximum intimal hyperplasia thinner than 1.2 mm.

Effect of Serum Magnesium Level on Arteriovenous Fistula Dysfunction in Patients on Maintenance Hemodialysis.

To investigate the effect of magnesium level on the arteriovenous fistula (AVF) dysfunction in patients on maintenance hemodialysis (MHD). We selected patients who underwent AVF surgery at The Second Affiliated Hospital of Nantong University from May 2011 to May 2022 and received MHD regularly for over 3 months. Patients were divided into dysfunction and non-dysfunction groups based on their AVF function, with follow-up until 30 November 2022. Retrospective data collection included pre-dialysis general data and clinical laboratory indicators. The magnesium cut-off for AVF dysfunction prediction was determined using the receiver operating characteristic (ROC) curve, and patients were categorized into high and low magnesium groups. AVF survival rates were compared using Kaplan-Meier methods, and the risk of AVF dysfunction and independent risk factors were analyzed with logistic and Cox regressions. In a study of 263 hemodialysis patients with a median age of 61 years, including 164 males (62.4%), 95 developed AVF dysfunction over a median follow-up of 32 months. Two groups of MHD patients were classified based on their AVF function: 95 in the dysfunction group and 168 in the non-dysfunction group. The subjects in the dysfunction group were older than those in the non-dysfunction group. Compared with the non-dysfunction group, the dysfunction group suffered significant reduction in magnesium and creatinine levels (p < 0.05), and significant increase in calcium and hemoglobin levels (p < 0.05). The ROC curve results showed that magnesium = 0.88 mmol/L was the best critical point for predicting AVF dysfunction in MHD patients, with a sensitivity of 68.42% and a specificity of 77.38%. The results of Kaplan-Meier survival analysis showed that the AVF dysfunction in the low magnesium group was significantly higher than that in the high magnesium group (log-rank χ2 = 68.678, p < 0.001). Logistic analysis showed that the low magnesium group was 9.223 times more likely to experience AVF dysfunction than the high magnesium group after adjusting for multiple confounding factors (odds ratio [OR] = 9.223, 95% confidence interval [CI], 4.876-17.445; p < 0.001). After adjusting for multiple confounding factors, multivariate Cox regression analysis suggested that advanced age, low serum magnesium, high serum calcium and high hemoglobin were independent risk factors for AVF failure in MHD patients. The risk in the low serum magnesium group was 4.534 times higher than that in the high serum magnesium group (hazard ratio [HR] = 4.534, 95% CI, 2.633-7.808; p < 0.001). Low serum magnesium is an independent risk factor for AVF dysfunction and can be used as a predictor of AVF dysfunction.

Thrombus stiffness as an independent predictor of endovascular treatment success in hemodialysis fistulas: a study using ultrasound elastography.

This study aimed to evaluate the prognostic value of thrombus stiffness, measured by strain elastography, in independently predicting the success of endovascular treatment for thrombosed hemodialysis fistulas. The study employed a retrospective observational design. Forty-nine patients with chronic kidney disease undergoing hemodialysis and experiencing fistula dysfunction were included. Various factors were evaluated, including patient age, sex, comorbidities, arteriovenous fistula (AVF) type, use of antiplatelet agents, duration of thrombosed AVF dysfunction, thrombus length, thrombus stiffness, and thrombus strain ratio (SR). Thrombus stiffness was measured using strain ultrasound elastography. The presence of comorbidities (P=0.018), duration of AVF dysfunction due to thrombosis (P=0.005), thrombus stiffness (P<0.001), and thrombus SR (P<0.001) were statistically significant predictors of treatment success, while other factors were not. Thrombus stiffness and SR, assessed by two independent radiologists with excellent inter-reader agreement, demonstrated high reliability. The optimal SR cut-off for treatment success was 1.4 (sensitivity, 0.947; specificity, 0.901; area under the curve, 0.935). Multivariable logistic regression analysis revealed that both thrombus SR and thrombus stiffness significantly influenced treatment outcomes (P=0.003 and P=0.007, respectively). A 0.1-unit increase in thrombus SR was associated with 9.37% reduction in the likelihood of treatment success, while a smilar increase in thrombus stiffness exhibited an 8.06% reduction, underscoring their importance as prognostic factors in clinical setting. This study demonstrates the utility of strain ultrasound elastography in assessing thrombus stiffness in thrombosed hemodialysis AVFs and its correlation with treatment success.

Manejo con intervencionismo de un paciente con estenosis múltiple: subclavia, yugular y tronco innominado con disfunción de la fístula arterio-venosa

Introduction: Dysfunction of an arteriovenous fistula in the right upper extremity may be caused by subclavian vein injuries following catheter placement at the start of treatment, potentially leading to chronic stenosis sequelae that affect the development of the primary access. Clinical case: This is a 66-year-old patient with stage 5d chronic kidney disease who is undergoing hemodialysis. He presented with a dysfunctional arteriovenous fistula and significant edema in the right upper extremity, along with collateral circulation. Diagnostic workshop: Interventional treatment revealed chronic stenosis in the right subclavian vein and innominate trunk. Outcome: Interventional treatment using a stent graft and balloon angioplasty significantly improved access flow, reduced edema, and enabled continued hemodialysis sessions without complications. Conclusions: In interventional surgery, stent-grafts offer an effective solution to extend the useful life of vascular accesses, enhancing the quality of life and decreasing the need for repeated interventions in patients with exhausted accesses.

The Efficacy of Ultrasound-Guided Selective Nerve Block in the Endovascular Treatment of Arteriovenous Fistulas

Introduction: Delivering requisite anesthesia for endovascular treatment of dysfunctional arteriovenous fistulas (AVFs) under a targeted nerve block can achieve reasonable analgesia. We evaluated the efficacy and safety of ultrasound-guided selective nerve block (SNB) during percutaneous transluminal angioplasty (PTA) of dysfunctional arteriovenous access. Methods: Two hundred forty-six patients with dysfunctional radiocephalic AVF undergoing PTA were enrolled in this prospective, randomized controlled trial at the Department of Nephrology, Haidian Hospital, Peking University Third Hospital from June 1, 2022, to August 31, 2023. The patients were randomized into either the SNB group (SNB group, n = 123) or the local infiltration anesthesia group (LA group, n = 123). A visual analog scale (VAS) from no pain (= 0) to worst pain possible (= 10) was used to assess the pain intensity. Patient and operator satisfaction were graded from 0 to 2: 0, not satisfied at all; 1, partially satisfied; 2, satisfied. The AVF patency at 1 and 3 months after PTA was also evaluated. Results: Compared with the LA group, the SNB group had significantly lower VAS scores (Z = −7.193, p < 0.001) and required fewer additional anesthetics during the operation (χ2 = −4.847, p = 0.028). Patient and operator satisfaction were significantly higher in the SNB group (p < 0.05). Eight patients in the SNB group encountered grade 3 motor paralysis after the operation, and they all recovered within 60 min. There was no significant difference in primary patency rates of the fistula between the two groups either at 1 month or 3 months after the operation (p > 0.05). Conclusion: Compared with LA, ultrasound-guided SNB has advantages over the LA during endovascular treatment of dysfunctional hemodialysis (HD) fistulas. It can provide safe and efficient analgesia with excellent procedural satisfaction in HD patients.

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.

Exploring the Link Between Renal Failure Risk Factors and Arteriovenous Fistula Functionality in Dialysis Patients

In this study, we aim to investigate the relationship between a comprehensive set of risk factors for renal failure and the function of arteriovenous fistulas (AVFs) in dialysis patients. We will also explore the impact of potential confounders, such as age, sex, and comorbidities, on this relationship. This cross-sectional study was conducted at the dialysis unit of Imam Reza Hospital in Kermanshah, Iran, to examine the relationship between risk factors for renal failure and AVF function in dialysis patients. The study population consisted of patients with end-stage renal disease who required hemodialysis and had undergone AVF surgery. Patients were included if they met the following criteria: being over 18 years old, having undergone AVF surgery at least one year prior, and being willing to participate in the study. Patients with a history of AVF thrombosis, infection, or any other complications requiring surgical intervention during the follow-up period were excluded. A total of 85 patients with kidney failure undergoing hemodialysis were studied. The mean age of these patients was 57.89 ± 15.18 years. Approximately half of the dialysis patients (52.3%) were male. Most of the dialysis patients (95.3%) were in a desirable state. There was no significant relationship between AVF function and gender, indicating that the effectiveness or ineffectiveness of AVF was not related to gender (p=1). There was no significant statistical relationship between patient condition and AVF function (p=0.31). There was no significant statistical relationship between AVF function and diabetes status (p=0.48). There was no significant statistical relationship between AVF function and tobacco use status (p=1). By identifying and addressing factors that contribute to AVF dysfunction, healthcare providers can improve the quality of care for dialysis patients and reduce the need for more invasive procedures, such as central venous catheter placement.

Factors associated with early and late losses of primary patency following drug-coated balloon for dysfunctional arteriovenous fistula.

This study aimed to evaluate the effectiveness of a drug-coated balloon (DCB) for the treatment of dysfunctional arteriovenous fistulas (AVFs) and to identify the risk factors associated with early and late losses of primary patency following DCB in real-world practice. This multicenter, retrospective study included 407 patients (72 ± 11 years, 64.1% males) with dysfunctional AVFs (juxta-anastomotic lesion location in 58.7% of cases, mean size 1.2 mm, mean length 54 mm) who underwent DCB for the first time for the treatment of dysfunctional AVF. The primary outcome measure was the loss of primary patency after DCB. The secondary outcome measures were the factors associated with early (<90 days) and late (⩾90 days) losses of primary patency after DCB. The primary patency rates 6 and 12 months after DCB were 72.5% ± 2.3% and 40.1% ± 2.7%, respectively. The factors associated with the early loss of primary patency were de novo lesions (adjusted hazard ratio [HR], 7.91; [95% confidence interval (CI), 1.90-32.97]; p = 0.005), endovascular treatment (EVT) history within the previous 90 days (adjusted HR, 9.29; [95% CI, 3.09-27.92]; p < 0.001) and juxta-anastomotic stenosis (adjusted HR, 0.30; [95% CI, 0.13-0.70]; p = 0.005). The factors associated with a late loss of primary patency included EVT history within the previous 90 days (adjusted HR, 2.52; [95% CI, 1.89-3.38]; p < 0.001) and pre-dilation balloon size (adjusted HR, 1.99; [95% CI, 1.50-2.64]; p < 0.001). DCB is an effective device to prolong the patency of dysfunctional AVFs in most cases. De novo lesions and their locations were associated with an early loss of primary patency, whereas the vessel preparation balloon size was associated with a late loss of primary patency. EVT history within the previous 90 days was associated with early and late losses of primary patency.

Dysfunctional AV Fistula in End-Stage Renal Disease Patients at Tertiary Care Hospitals of Lahore and Peshawar

Objective: To determine the frequency of dysfunctional arteriovenous fistula utilizing Doppler ultrasound in End stage renal disease patients receiving maintenance hemodialysis.Study Design: Cross-sectional study.Place and Duration of Study: The study was conducted at the Dialysis Unit, Sir Ganga Ram Hospital Lahore, Pakistan, and Department of Nephrology, Lady Reading Hospital Peshawar, Pakistan, from July 2019 to January 2021.Methods: One hundred and seventy-seven (177) people receiving continuous hemodialysis for end-stage renal disease, fulfilling selection criteria, were included in the study. Their medical record was assessed, the clinical examination findings and Doppler ultrasound findings of dysfunctional arteriovenous fistula were recordedResults: In this study, 177 patients who had end-stage renal disease and were on maintenance hemodialysis, fulfilling selection criteria, were included. Among these patients, 124 (70.1%) were male and 53 (29.9%) were females. The patients' average age was 48±13.29 years. In our local population, the frequency of a dysfunctional arteriovenous fistula is 30.5% on physical examination and 44.6% on Doppler ultrasound among patients on thrice weekly maintenance hemodialysis.Conclusion: We concluded that upon physical inspection, 30.5% of individuals receiving thrice-weekly maintenance hemodialysis had dysfunctional arteriovenous fistulas and 44.6% on Doppler ultrasound in our population. Arteriovenous fistula with normal physical examination findings may be dysfunctional on Doppler ultrasonography and Doppler ultrasonography further confirm the findings of physical examination. How to cite this: Kifayat S, Muhammad N, Fawad M, Burki A, Khan MW, Khan MU. Dysfunctional AV Fistula in End-Stage Renal Disease Patients at Tertiary Care Hospitals of Lahore and Peshawar. Life and Science. 2025; 6(1): 51-57. doi: http://doi.org/10.37185/LnS.1.1.689

Efficacy and safety of paclitaxel drug-coated balloon angioplasty for stenosis of hemodialysis vascular access: 6-month results from a brazilian multicenter prospective study.

Stenosis resulting from neointimal hyperplasia remains a significant concern associated with dysfunction of arteriovenous fistulas (AVF). To investigate the safety and efficacy of paclitaxel drug-coated balloon (DCB) angioplasty for treating failing AVFs. Investigators analyzed 58 hemodialysis patients treated with RangerTM DCBs from December 2022 to December 2023 across four centers. Lesions treated were de novo or restenotic and located in the juxta-anastomosis, cannulation zone, and outflow segment. Patients were evaluated through physical examinations and Duplex ultrasound at 1, 3, and 6 months. The primary efficacy endpoint was target lesion primary patency at 1, 3, and 6 months, and the primary safety endpoint was freedom from serious adverse events through 30 days post-procedure. Secondary endpoints were access circuit primary patency and technical and procedural success. Nine patients (16%) had thrombosed access at the initial presentation, and 31 (53%) presented with recurrent stenosis. The target lesion primary patency rate at 6 months was 85.7%, and the access circuit primary patency rate at 6 months was 67.5%. No serious adverse events, either local or systemic, were reported. Sex, age, stenosis location, type of lesion, presence of thrombosis, lesion recurrence, diabetes status, or whether post-ballooning dilation was performed did not significantly affect the 6-month target lesion primary patency. DCB angioplasty was shown to be safe and effective for treating peripheral stenosis in vascular access.

Cephalic to jugular vein bypass surgery of subclavian vein stenosis for arteriovenous fistula salvage in maintenance hemodialysis patients.

Ipsilateral subclavian vein stenosis in a well-functioning upper extremity arteriovenous fistula (AVF) is a significant factor contributing to AVF failure and sometimes swelling of ipsilateral upper extremity. Graft bypass surgery can alleviate outflow tract stenosis in upper extremity AVF, restore function, and efficiently relieve arm swelling. The present study aimed to evaluate patency and postoperative complications after cephalic to jugular graft bypass surgery in patients with upper extremity AVF failure or upper extremity swelling on the same side of the AVF resulting from ipsilateral subclavian vein stenosis. Five patients with upper extremity AVF and ipsilateral subclavian vein stenosis undergoing maintenance hemodialysis were included. Three patients had AVF dysfunction, while two experienced swelling of the arm due to high venous pressure in the AVF. The surgical procedure involved creating a subcutaneous tunnel in the shoulder to connect a 6 mm polytetrafluorethylene (PTFE) graft, from either near the fistula site (n = 3) or at the mid-upper arm cephalic vein (n = 2), to the jugular vein. Graft bypass surgery was successful, and all patients were able to resume hemodialysis postoperatively. Upper extremity edema improved, without any postoperative wound infections, non-healing wounds, steal syndrome, or high-flow AVF leading to heart failure as a complication. Five to 19 months after surgery, the bypass grafts exhibited a primary patency rate of 100%, and vascular access fulfilled the requirements for hemodialysis. Cephalic to jugular vein bypass surgery for upper extremity AVF with ipsilateral subclavian vein stenosis effectively preserved function of the original fistula, and was associated with few postoperative complications.

Mineralocorticoid receptor antagonism attenuates arteriovenous fistula stenosis by modulating the phenotype of vascular smooth muscle cells.

Fistula stenosis is a primary contributor to arteriovenous fistula (AVF) failure in maintenance hemodialysis patients. Emerging data indicated excessive fibrotic remodeling was the primarily contributor to fistula stenosis during AVF remodeling. The mineralocorticoid receptor (MR) has been implicated in vascular remodeling across various cardiovascular pathologies. However, its role in AVF remodeling, particularly concerning fibrotic remodeling, remains elusive. MR expression and the phenotypes of vascular smooth muscle cells (VSMCs) were assessed in dysfunctional AVF. The effects of MR on VSMC phenotypic switching were examined in vitro, and the protective effects of MR antagonists on AVF outcome were evaluated in a rat AVF model. Dysfunctional fistula exhibited significant medial fibrosis and extracellular matrix deposition, alongside markedly increased MR activity. In the dysfunctional fistula vessels, VSMC displayed reduced expression of the contractile marker SMMHC and featured characteristic of a synthetic phenotype, including increased osteopontin expression and heightened proliferation. In vitro studies with cultured VSMC revealed that MR overactivity induced by aldosterone led to phenotypic switching from contractile to synthetic state, concomitant with EGFR-ERK1/2 pathway overactivation. These effects were largely abolished by the MR antagonist fineronone. Knockdown of EGFR expression abrogated ERK1/2 phosphorylation and inhibited the VSMC phenotypic switching. Conversely, ectopic overexpression of EGFR in VSMC diminished the protective effect of finerenone. In rat AVF models, pharmacologic targeting of MR with finerenone significantly improved AVF outcomes, characterized by increased luminal diameters and flow volume, reduced medial fibrosis, and inhibited VSMC phenotypic switching. These beneficial outcomes were likely attributable to a restrained activity of EGFR-ERK1/2 pathway in VSMC and elevated NO production in endothelial cells. Our study demonstrated that therapeutic targeting of MR may improve AVF outcome by modulating VSMC phenotypic switching. These findings offer promising avenues for further clinical investigations aimed at optimizing AVF outcomes in the hemodialysis population.

Factors associated with dysfunction of autogenous arteriovenous fistula in patients with secondary hyperparathyroidism after parathyroidectomy

Background Secondary hyperparathyroidism (SHPT) is a prevalent chronic complication in patients undergoing hemodialysis. Parathyroidectomy (PTX) is crucial for reducing mortality and improving the prognosis in the treatment of refractory hyperparathyroidism. However, it is often associated with a number of postoperative complications such as postoperative hypotension, hyperkalemia, and hungry bone syndrome. A previous study demonstrated that low blood pressure influences the patency of autogenous arteriovenous fistulas (AVF). Few studies have examined AVF dysfunction following PTX. This study aimed to identify and describe the risk variables associated with AVF dysfunction after PTX. Methods Cases of AVF dysfunction after PTX between 2015 and 2021 were studied. Four controls were identified for each patient and were matched for sex and age. Biochemical parameters and blood pressure of the patients before and after PTX were recorded. Risk factors for AVF dysfunction after PTX were identified using conditional logistic regression analysis. Results Sixteen patients and 64 controls were included in this study. Baseline demographic and laboratory data were compared. Patients in the AVF dysfunction group had lower levels of postoperative calcium than the controls. After surgery, calcium levels decreased more in patients with AVF dysfunction than in the control group. The decrease in systolic blood pressure (ΔSBP) after PTX was greater in the AVF dysfunction group than that in the control group. For each 1 mmHg increment in ΔSBP, the risk of AVF dysfunction after surgery increased by 11.6% (OR = 1.116, 95% CI, 1.005–1.239, p = .040). The likelihood of developing AVF dysfunction after surgery was twelvefold higher in diabetic patients than in non-diabetic patients (OR = 12.506, 95% CI, 1.113–140.492, p = .041). Among patients with ΔSBP > 5.8 mmHg after PTX, the AVF failure rate was significantly greater in patients with diabetes than in those without diabetes. Patients with a history of AVF failure had a nine-fold higher risk of developing AVF dysfunction (OR = 9.143, 95% CI, 1.151–72.627, p = .036). Serum albumin, hemoglobin, ΔiPTH, and age were not independent predictors of AVF dysfunction. The cutoff value for SBP was 5.8 mmHg, as determined by the Youden index of the receiver operating characteristic curve. Conclusion Decreased systolic blood pressure (ΔSBP) after PTX, diabetes, and AVF failure history were risk factors for AVF dysfunction following PTX in patients with SHPT. Diabetes patients with ΔSBP > 5.8 mmHg were more prone to AVF dysfunction after PTX.

Response to E.M. Zeltyn-Abramov's comment to the article "Left ventricular ejection fraction: association with risk of death and incidence of arteriovenous fistula dysfunction (mid-term results)"

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Feasibility of an antegrade-retrograde single-sheath inverse technique via vertical puncture in dysfunctional hemodialysis arteriovenous fistula angioplasty

BackgroundStenosis resulting in dysfunctional dialysis access may occur simultaneously on the anastomotic and central venous side. The purpose of this study was to retrospectively evaluate the feasibility of a single sheath inverse technique using the vertical puncture approach to perform bidirectional transvenous percutaneous transluminal angioplasty (PTA) from a single sheath for such dialysis access stenoses.Materials and MethodsTwenty patients (26 cases; 13 males; median age, 74 [range: 50–89] years) who underwent PTA using the sheath inverse technique for dysfunctional arteriovenous fistula stenoses between April 2019 and June 2023 were included. All procedures were performed in an outpatient setting. A 4-cm sheath (4Fr, four cases; 5Fr, 19 cases; 6Fr, three cases) was inserted by vertical puncture through a cutaneous vein in the forearm (20 cases) or upper arm (six cases). After treating one side of the lesion, the sheath was reversed to treat the lesion on the opposite side. The vessel diameter at the sheath insertion site, the success rate of sheath inversion, the number of PTA balloon catheters used, the PTA success rate, adverse events, and primary and secondary patency rates up to one year after PTA were evaluated.ResultsThe median diameter at the sheath indwelling site was 5.2 (range: 3.6–9.5) mm, and sheath inversion was successful in all cases, eliminating the need to place an additional sheath at another site for contralateral stricture treatment. The number of balloon catheters used was one and two in 17 (65%) and eight cases (31%), respectively, and three in one case wherein a drug-coated balloon was used. PTA was successful in all cases and major complications were not observed. However, in one case wherein a sheath had to be placed at the arterial needle puncture site, the skin was hard, leading to difficulty in inversion, and transient venous spasm occurred post-inversion. The primary patency rates at 3, 6 and 12 months after the PTA were 87.5%, 41.7%, and 20.8%, respectively. The secondary patency rates at 6 and 12 months were 100% and 75%, respectively.ConclusionThe single-sheath inverse technique for arteriovenous fistulas was feasible without sheath withdrawal.Graphical

Patency and factors related to patency after percutaneous transluminal angioplasty for inflow arterial stenosis in native arteriovenous fistula dysfunction: a single-center retrospective study

Controversy still exists regarding how much the inflow arterial percutaneous transluminal angioplasty (PTA) contributed to maintaining fistula function for hemodialysis. We aimed to analyze patency and risk factors after inflow arterial PTA. Hemodialysis patients with inflow arterial primary stenosis who were admitted to our institution from January 2017 to December 2022 were examined. One group had arterial-venous fistula with inflow artery stenosis alone (AVF + iAS) and another group had AVF with inflow artery stenosis and any vein stenosis (AVF + iAS + VS). The characteristics of patients, stenotic lesions, and PTA procedures were recorded. Kaplan–Meier analysis was used to compare primary patency, assisted primary patency, and secondary patency in the two groups. Cox proportional hazard analysis was used to identify risk factors associated with patency. We examined 213 patients, 53 in the AVF + iAS group (51 radial arterial stenosis and 2 ulnar arterial stenosis) and 160 in the AVF + iAS + VS group (159 radial arterial stenosis and 1 ulnar arterial stenosis). Kaplan–Meier analysis indicated the AVF + iAS group had better primary patency and assisted primary patency (both P < 0.05), but the groups had similar secondary patency. Cox proportional hazard analysis indicated that none of the analyzed clinical and biochemical indexes had clinically meaningful effects on primary patency, assisted primary patency, or secondary patency in either group. The patency and safety after PTA for inflow arterial stenosis were satisfactory, and none of the examined risk factors had a major clinical impact on patency. We recommend PTA as treatment for inflow stenosis of an AVF.

The impact of depression on platelet activation, cardiocerebral vascular events and arteriovenous fistula dysfunction in patients undergoing haemodialysis

Depression is a common psychiatric disorder among patients undergoing maintenance haemodialysis (MHD). Depression may reportedly contribute to poor prognosis in several ways, including its effects on platelet function. We hypothesised that depression contributes to the occurrence of cardiocerebral vascular events (CCVE) and dysfunction of arteriovenous fistula (DAVF) in patients undergoing MHD through its effects on platelets. In this prospective cohort study, patients undergoing MHD were recruited and divided into depression and non-depression groups according to their Hamilton Depression Scale (HAMD) scores. The 286 enrolled patients had 103 occurrences of depressive symptoms (prevalence = 36.01%). Compared with the non-depression group, depression group had a significantly higher cumulative prevalence of CCVE and DAVF during follow-up. Cox regression analysis indicated that higher HAMD scores and lower plasma platelet distribution width (PDW) were common risk factors for CCVE and DAVF. Furthermore, HAMD scores were significantly negatively correlated with plasma PDW and was the main variable affecting changes in PDW, as indicated by multiple linear regression analysis. Depression may increase the risk of CCVE and DAVF in patients undergoing MHD by activating platelets. Plasma PDW may be a convenient indicator of platelet activation status and may predict the risk of CCVE and DAVF.

Effectiveness of Initial and Repeat Drug-Coated Balloon Angioplasty of Restenotic Arteriovenous Fistulae Compared with That of Plain Angioplasty

Effectiveness of Initial and Repeat Drug-Coated Balloon Angioplasty of Restenotic Arteriovenous Fistulae Compared with That of Plain Angioplasty