Hemodialysis Vascular Access Research Articles

Liposuction for Superficialization of Deep Hemodialysis Vascular Access: A Novel Application.

More than 65% of patients with end-stage renal disease (ESRD) use arteriovenous fistulas (AVFs) for hemodialysis. The increasing incidence of comorbid ESRD and obesity (body mass index, >35 kg/m2) precludes patients from kidney transplantation, resulting in a need for long-term, durable AVF access. Compared with traditional superficialization techniques for overlying adiposity, liposuction is minimally invasive and well-tolerated, allowing for earlier fistula use with lower complications. We present the detailed surgical technique for superficialization of AVFs using liposuction. Fourteen patients with well-matured but difficult-access fistulas due to adiposity were selected. Preoperative ultrasound mapped depth of fistulas. Tumescent liposuction was completed in a cross-hatched manner. Intraoperative ultrasound confirmed cannula positioning and measured fistula depth. A palpable thrill remained throughout superficialization. Cannulation began 4 weeks postoperatively. Mean access depth preoperatively was 10.8 mm (8-15 mm), immediately postoperative was 7 mm (6-9 mm), and at 4 weeks was 5.3 mm (4-8 mm). The average usable access length was 12.7 cm (10-15 cm) after surgery. Thirteen fistulas were successfully accessed after liposuction superficialization. All patients were discharged home the same day. There were no postoperative infections or hemorrhage. Early experience with liposuction for superficialization of deep hemodialysis access is promising. This innovative solution has the possibility to improve outcomes and quality of life for patients living with ESRD and obesity. Our experience shows that this is a safe and effective technique to increase patient eligibility, enable successful and early cannulation, and decrease recovery time.

A randomized controlled trial evaluated the efficacy and safety of apixaban for prevention of recurrent thrombosis after thrombectomy of hemodialysis vascular access.

Dialysis vascular access thrombosis poses a substantial challenge for individuals undergoing hemodialysis. The efficacy and safety of apixaban, a direct oral coagulation factor Xa inhibitor, in preventing recurrent access thrombosis have yet to be explored. Here, a multicenter randomized control study (NCT04489849) enrolled hemodialysis patients to evaluate this who underwent successful endovascular thrombectomy within 48 hours. Participants were assigned to standard care or standard care plus apixaban, 2.5 mg twice daily for three months. The trial design involved open-label administration, with independent adjudication of endpoints. The primary efficacy endpoint was recurrent access thrombosis within three months after thrombectomy. A total of 186 patients with well-balanced baseline characteristics were enrolled, 93 randomized to the apixaban group and 93 to the control group. The apixaban group demonstrated a significantly lower rate of access thrombosis at three months than the control group (24.0% vs. 40.8%; hazard ratio, 0.52 [95% confidence interval 0.31-0.88]), along with a significantly better primary patency failure rate (32.2% vs. 49.5%, 0.57 [0.36-0.91]). Safety outcomes showed comparable death rates and major bleeding incidents but significantly higher incidence of minor bleeding in the apixaban group (22.6% vs. 7.5%). The effect of apixaban did not show interaction in subgroups of different access types, antiplatelet usage, severity of comorbidities, or history of thrombosis. Thus, apixaban effectively reduced the risk of recurrent thrombosis in hemodialysis vascular access post-thrombectomy. Despite a minor increase in bleeding adverse effects, the net clinical benefit favors the use of apixaban in this context.

Personalized decision-making for vascular access creation in hemodialysis.

Selecting the appropriate kidney replacement therapy (KRT) is crucial in order to secure optimal care for chronic kidney disease (CKD) patients with end-stage renal disease (ESRD). Next to renal transplantation, the choice of dialysis modality directly affects patient well-being, treatment effectiveness, and long-term outcomes.1 Therefore, clinical decision-making must take into account a range of factors to tailor decisions to each patient's unique needs. Previously, when the dialysis population was less diverse and resources more limited, straight-forward algorithms could be effectively implemented both for selection of KRT as well as for hemodialysis (HD) vascular access (VA). Recently, the growing ESRD population with more elderly being considered for dialysis care together with improved treatment opportunities have resulted in more challenging decision-making where on-size-fits-all strategies are being replaced by more tailored and personalized strategies aimed to ensure "the right dialysis access - to the right patient - at the right time - for the right reason." In this review, recent trends enforcing a more personalized approach in the selection of VA for HD are summarized and discussed, where these concerns have become especially relevant.

The Potential of Sound Analysis to Reveal Hemodynamic Conditions of Arteriovenous Fistulae for Hemodialysis.

Arteriovenous fistula (AVF), the preferred vascular access for hemodialysis, is associated with high failure rate. The aim of this study was to investigate the potential of AVF sound auscultation in providing quantitative information on AVF hemodynamic conditions. This single-center prospective study involved six patients with native radio-cephalic AVFs who underwent multiple follow-up visits. Doppler Ultrasound blood flow volume (BFV) assessment and electronic stethoscope-based sound recordings were performed during each visit, whereas MRIs were acquired 3days, 3weeks and 1year after surgery. Computational fluid dynamic (CFD) simulations were performed on patient-specific MRI-derived geometrical models. Higher values of median peak amplitudes ratios (high-low peak ratio-HLPR) were found to be associated with complex blood flow and velocity streamlines recirculation at systolic peak, and corresponding extended regions of high oscillatory shear index (OSI). On the contrary, lower values of HLPR were associated with laminar flow pattern and low values of OSI. Significant differences were observed in HLPR between subgroups with extended or limited areas with OSI > 0.1 (0.67 vs 0.31, respectively). Significant relationships were found between AVF sound intensity and brachial BFV (slope = 0.103, p < 0.01) as well as between longitudinal changes in brachial BFV and HLPR (slope = - 0.001, p < 0.01). Our results show that AVF sound can be exploited to extract fundamental information on AVF hemodynamic conditions, providing indication of the presence of complex hemodynamic and adequate BFV to perform hemodialysis. Sound analysis has therefore the potential to improve clinical AVF surveillanceand to ameliorate outcome.

Optimizing venous anastomosis for forearm loop arteriovenous grafts: A comparative analysis of elbow veins and upper arm basilic veins in end-stage kidney disease patients.

Optimizing vascular access for hemodialysis in end-stage kidney disease is crucial. While arteriovenous fistulas (AVFs) are preferred for better patency and fewer complications, many patients require alternatives options like arteriovenous grafts (AVGs) due to anatomical constraints. This study compares outcomes between elbow and upper arm (UA) basilic veins for forearm loop AVGs, highlighting the potential benefits of the UA basilic vein to improve patency and feasibility in patients with poor elbow veins through retrospective analysis. This retrospective study analyzed 59 limbs of patients who underwent forearm loop AVG formation from January 2018 to June 2022. Elbow veins (basilic, median cubital, brachial) and UA basilic veins were evaluated for suitability using duplex ultrasonography. AVG decisions were based on patient age, health, and vein diameter (⩾2.3 mm). Statistical analyses compared baseline characteristics and evaluated primary and secondary patency rates at 12 and 18 months using Pearson's chi-square, Student's t-test, Kaplan-Meier survival analysis, and the Log-rank test. Thirty-six patients had elbow anastomosis, while 23 had UA anastomosis for forearm loop AVG. The elbow group had a higher male proportion (72.7% vs 34.7% in UA, p = 0.005) and larger elbow vein diameters (2.52 ± 0.19 mm vs 2.16 ± 0.21 mm in UA, p < 0.001). Primary patency rates at 12 months were 72.7% for elbow and 56.2% for UA; at 18 months, 59.4% and 25.5%, respectively (p = 0.376). Secondary patency rates at 12 months were 75.7% for elbow and 62.2% for UA; at 18 months, 67.8% and 33.9%, respectively (p = 0.238). The primary and secondary patency rates of forearm loop AVG with UA basilic vein anastomosis were not inferior to those with elbow veins anastomosis. UA basilic vein can be a feasible alternative for creating forearm loop AVG when elbow veins are not suitable.

Outcomes of arteriovenous fistula and role of duplex ultrasound for its assessment in pre-dialysis patients; a single center longitudinal study

Introduction: Arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis; however, it has a primary failure rate of 20%–60%. Analyzing the factors associated with AVF failure is crucial for planning appropriate management strategies. Objectives: We aimed to identify the AVF outcomes and associated factors along with the role of duplex ultrasound (DUS) in preoperative and postoperative AVF assessment at a tertiary care hospital. Patients and Methods: This prospective observational study was conducted on pre-dialysis patients who underwent AVF creation between January 2020 and December 2021.AVF outcomes and associated clinical and vascular factors were analyzed using pre- and post-operative DUS. Results: Of 171 patients, males were predominant (83.6%), and diabetic nephropathy (42.7%) was the predominant cause of chronic kidney disease (CKD). AVF outcomes showed, 109 (63.7%) had unassisted mature AVF and 29 (16.9%) had AVF failure wherein early dialysis suitability failure was predominant (17; 9.94%). Among clinical factors, only a history of smoking correlated with AVF failure (P=0.04). On pre-and post-operative DUS assessment, the absence of distensibility and immediate post-operative vein diameter strongly correlated with AVF failure (P&lt;0.001). A unit increase (1 mm) in outflow vein diameter immediately after surgery emerged as an independent predictor of AVF outcome in both univariate (OR 0.98, 95% CI: 0.35-3.99; P&lt;0.001) and multivariate analysis (OR: 0.313, 95% CI: 0.148-0.663; P&lt;0.001). Conclusion: Most patients in our setting had unassisted AVF fistula. We additionally found that smoking correlated with AVF failure. Predominant factors determining AVF success were cephalic vein diameter, distensibility, and increase in draining vein diameter and flow volume at six weeks. This study highlights using DUS in pre- and post-operative periods, along with conventional examination to improve AVF outcomes.

Treatment with a self-expanding endoprosthesis in patients with stenosis or occlusion at the arteriovenous graft: 6-Month outcomes of a post-marketing surveillance study.

To assess 6-month safety and efficacy of a self-expanding stent graft placement to treat stenotic or thrombosed synthetic arteriovenous access graft at the venous anastomoses. This prospective, multicenter, post-market surveillance study assessed the GORE® VIABAHN® Endoprosthesis (stent graft) in Japanese patients with stenotic or thrombosed vascular access grafts. Key efficacy and safety outcomes were primary patency (PP) and secondary patency (SP) of the target lesion and the vascular access circuit, repeat interventions, technical and clinical success, incidence of adverse and serious adverse events, and device deficiencies through 6 months. The 103 enrolled patients (mean age 71.8 years; 57.3% female) had stent grafts placed in the venous anastomosis of arteriovenous access grafts (on-label). The majority of lesions were stenotic (77.1%) and located in the upper arm (91.4%). Mean lesion length was 42.9 ± 23.6 mm and diameter was 6.7 ± 1.9 mm; 28 patients (27.2%) had elephant trunk placements. Technical and clinical success rates were 100%. At 6 months, Kaplan-Meier estimates of target lesion and circuit PP were 75.1% (95% CI: 65.2, 82.6) and 66.8% (95% CI: 56.4, 75.3), and SP rates were 93.8% (95% CI: 86.7, 97.2) and 93.8% (95% CI: 86.7, 97.2), respectively. Mean cumulative number of reinterventions (0.36; 95% CI: 0.20, 0.51) and incidence of device- or procedure-related adverse events were low (⩽3%). No device deficiencies were reported. The 6-month outcomes of the self-expanding stent graft to treat thrombosed venous anastomoses of synthetic hemodialysis vascular access grafts with stenosis demonstrated safety and effectiveness.

Hemodialysis vascular access in the elderly: Promising results from a tertiary center

BackgroundHemodialysis patients, particularly the elderly, present challenges for vascular access (VA) creation due to age-related vascular changes and comorbidities. This study aimed to characterize outcomes related to VA in elderly patients (≥75 years) and compare them with younger patients, focusing on primary failure, maturation failure, and patency rates. MethodsThis retrospective study included patients evaluated in VA consultations between January 2019 and December 2021; patients were evaluated through physical examination and Color Doppler Ultrasound to determine the suitability of vessels for VA construction. Demographic data, proposed and created VA types were assessed. The primary outcomes were the evaluation and comparison of primary failure and maturation failure of VA in the elderly (O) and younger (Y) groups. Secondary outcomes included the assessment of primary patency and primary assisted patency at 6, 12, and 24 months in both groups. ResultsAmong 167 patients, 36 were elderly. There were no significant differences in proposed and created VA types between the Y and O groups and radial-cephalic AVFs were the most commonly constructed VA in both groups.Primary and maturation failure rates were similar (Y group: 17.3% and 5.6%; O group: 9.7% and 10.7%, respectively). Primary patency and primary assisted patency rates did not significantly differ between groups at 6, 12, and 24 months. ConclusionThe impact of age on the feasibility of VA should not be exaggerated. Preoperative assessment and a tailored approach enable successful autologous access creation in elderly patients, resulting in outcomes comparable to those of younger patients.

Aspirin's Antiplatelet Effects Promote Arteriovenous Fistula Maturation in Hemodialysis Patients: A Systematic Review

Background: Arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis, offering superior long-term patency and lower infection rates compared to other options. However, AVF maturation remains a significant challenge. This systematic review aims to evaluate the efficacy of aspirin in promoting AVF maturation and preventing failure in hemodialysis patients. Methods: A comprehensive search of electronic databases, including ScienceDirect, SpringerLink, PubMed, Cochrane, and ProQuest, was conducted from 2014 to 2024. Studies investigating the impact of aspirin on AVF maturation and failure were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Results: Five studies met the inclusion criteria, encompassing a total of 982 participants. Four studies indicated that aspirin significantly enhanced AVF maturation by increasing flow volume and promoting the development of a robust fistula. However, one study found that aspirin did not significantly reduce the risk of thrombosis or AVF failure. Conclusion: Aspirin appears to be a promising adjunct therapy for promoting AVF maturation in hemodialysis patients. Its antiplatelet effects, primarily through cyclooxygenase inhibition and reduced platelet activation, contribute to improved flow volume and fistula maturation. While the evidence for aspirin's role in preventing AVF failure is mixed, its potential benefits in enhancing maturation warrant further investigation.

Outcomes of Extra-Anatomic Surgical Bypass in Treatment of Central Venous Occlusive Disease in Pediatric Chronic Hemodialysis Patients: One-Year Follow-Up

Abstract Background Maintenance of hemodialysis vascular access patency in pediatric patients remains a key issue. Venous hypertension due to proximal central venous outflow obstruction is a major impediment to long-term arteriovenous access. Prior ipsilateral insertion of central venous catheters is a common risk factor. Management of Central venous occlusive disease (CVOD) in an attempt to avert sacrificing the fistula and improving symptoms of venous hypertension. Surgical bypass has the advantage of being a bale out technique for management of CVOD with maintaining the existing dialysis access and providing prolonged patency and satisfactory outcome specially with the scarce data about the role of endovascular intervention in management of CVOD in pediatric population. Objectives The aim of our prospective, observational study is to evaluate the efficacy and outcome of the surgical management of hemodialysis-related central venous occlusive disease in pediatric patients. Patients and Methods This study was conducted on (15) Pediatric patients with end stage renal disease on regular hemodialysis via upper extremity access who underwent extra-anatomic surgical bypass to treat symptomatic venous hypertension due to central venous occlusive disease. Bypass take-off was from subclavian vein, cephalic vein, or axillary vein of the affected side according to site of obstruction and outflow including contralateral subclavian vein, internal jugular vein or ipsilateral femoral vein. The study period started from June 2021 until May 2022. Patients included in the study were essentially attending the Vascular Outpatient Clinic at Ain Shams University Hospitals and Nasser Institute for Search &amp; Treatment at Cairo. Results Regarding the type of bypass used in the studied patients, the most frequent type used is Lt Axillary to Rt Subclavian bypass and Lt Subclavian to Rt Subclavian bypass 3 (20%) followed by Rt Axillary to Lt Subclavian bypass, Rt Cephalic to Lt Subclavian bypass and Rt Axillary to Rt femoral bypass 2 (13.33%). Technical success was achieved in the 15 (100%) cases while functional success occurred in 13 (86.6%) cases; patients had performed their 4 hours hemodialysis sessions via their preexisting access within 24 h post-procedurally. No in-hospital morbidity or death was recorded. Primary patency rates at 1, 3, 6, and 12 months were 93.3, 86.6, 73.3, and 66.6%, respectively. Secondary patency rates at 1, 3, 6, and 12 months were 100, 93.3, 80, and 73.3%, respectively. Conclusion Extra-anatomic surgical bypass is safe and effective method for management of Central venous occlusive disease and has the advantage of being a bail out technique for maintaining the existing dialysis access and also providing symptomatic relief of venous hypertension, prolonged patency and satisfactory outcome.

Software-Based Surveillance Supplementing Clinical Monitoring for Hemodialysis Vascular Access

Software-Based Surveillance Supplementing Clinical Monitoring for Hemodialysis Vascular Access

Efficacy and Safety of Apixaban for Prevention of Recurrent Thrombosis after Thrombectomy of Hemodialysis Vascular Access: A Randomized Controlled Trial

Efficacy and Safety of Apixaban for Prevention of Recurrent Thrombosis after Thrombectomy of Hemodialysis Vascular Access: A Randomized Controlled Trial

Stent Placement After Percutaneous Recanalization of Superior Vena Cava Stenosis in Maintenance Hemodialysis Patients.

This study aimed to evaluate the efficacy and safety of stent placement after percutaneous recanalization of superior vena cava (SVC) stenosis in maintenance hemodialysis patients. Adult maintenance hemodialysis patients hospitalized at a university-affiliated tertiary hospital due to SVC stenosis from January 2016 to June 2023 were prospectively included. The efficacy and safety of percutaneous blunt/sharp SVC recanalization combined with SVC stent placement were observed. The patients' demographic information and laboratory examination data, stent placement success rate, surgery-related complications, and long-term vascular access patency rate were also recorded and analyzed. The study was approved by the institutional ethics committee (2015-201) and registered at http://www.chictr.org.cn (registry number: ChiCTR-ONN-16007790). A total of 58 patients were included in the study with an average age of 54.79±13.42 years. Percutaneous SVC recanalization was successful in 53 cases, with a success rate of 91.38%, including 37 cases of traditional recanalization and 16 cases of sharp recanalization. Among 53 hemodialysis patients who underwent SVC recanalization, 14 patients successfully received covered stents and 38 patients received bare metal stents, achieving a stent placement success rate of 98.1%. One patient encountered stent displacement into the heart immediately after implantation, causing intra-operative cardiac tamponade, who was successfully rescued by thoracotomy. Fifty-two patients were followed-up for median period of 26 months (cuffed catheter: 25 patients, arteriovenous fistula [AVF]: 27 patients). The overall 2-year vascular access patency rate was 33.2% (cuffed catheter: 22.2%, AVF: 41.7%, p=0.414). There was no statistically significant difference in the 2-year vascular access patency rate between the traditional recanalization group and the sharp recanalization group (34.1% vs 31.1%, p=0.731) and between bare metal stent group and covered stent group (38.1% vs 21.4%, p=0.248). Percutaneous SVC recanalization with stent placement is an effective treatment strategy that can provide viable vascular access for maintenance hemodialysis patients with SVC stenosis. Cautions should be paid to potential life-threatening complications such as stent displacement and cardiac tamponade. Superior vena cava (SVC) stenosis is a common central venous occlusive lesion in maintenance hemodialysis patients. Whether stent should be implanted simultaneously following SVC recanalization is still lacking research. This pilot cohort study suggested that percutaneous SVC recanalization with stent placement was an effective treatment strategy which provides satisfactory vascular access for hemodialysis. We further found that SVC sharp recanalization with subsequent stent implantation was a feasible treatment, with the 2-year vascular access patency comparable to the traditional SVC recanalization group. This study also highlighted endovascular SVC recanalization should be performed with caution, and appropriate balloon sizes should be selected to avoid SVC rupture or stent displacement.

Vascular access in a post-lung transplant patient on maintenance hemodialysis: a case report

BackgroundAn arteriovenous fistula (AVF) is the most common type of vascular access for hemodialysis. As it causes volume overload and sometimes increases pulmonary artery pressure, it is unsuitable for some patients. Herein, we describe a patient with acute kidney disease who required maintenance hemodialysis with vascular access other than an AVF owing to post-lung transplant pulmonary hypertension.Case presentationA 50-year-old man with interstitial pneumonia underwent living-donor lobar lung transplantation at our hospital. Weaning from venoarterial extracorporeal membrane oxygenation was achieved; however, the patient required mechanical ventilation owing to pulmonary hypertension. He developed acute kidney disease and required maintenance hemodialysis with sustainable vascular access. Although echocardiography showed a normal ejection fraction, we expected volume overload after arteriovenous access construction to worsen his pulmonary hypertension because of his inadequate pulmonary vascular bed. Therefore, a tunneled central vein catheter was implanted into the right femoral vein as a bridge, and superficialization of the right brachial artery was performed for long-term vascular access.ConclusionsAs this patient had sustained post-transplant pulmonary hypertension and small grafts, we avoided creating arteriovenous access because of concern over the aggravation of pulmonary hypertension. Evaluation of right heart function and pulmonary hypertension is important before arteriovenous access construction.

Endothelial TGF-β Signaling Regulates Endothelial-Mesenchymal Transition During Arteriovenous Fistula Remodeling in Mice With Chronic Kidney Disease.

Arteriovenous fistulae (AVFs) are the preferred vascular access for hemodialysis in patients with end-stage kidney disease. Chronic kidney disease (CKD) is associated with endothelial injury, impaired AVF maturation, and reduced patency, as well as utilization. Because CKD is characterized by multiple pathophysiological processes that induce endothelial-to-mesenchymal transition (EndMT), we hypothesized that CKD promotes EndMT during venous remodeling and that disruption of endothelial TGF (transforming growth factor)-β signaling inhibits EndMT to prevent AVF failure even in the end-stage kidney disease environment. The mouse 5/6 nephrectomy and aortocaval fistula models were used. CKD was created via 5/6 nephrectomy, with controls of no (0/6) or partial (3/6) nephrectomy in C57BL/6J mice. AVFs were created in mice with knockdown of TGF-βR1/R2 (TGF-β receptors type 1/2) in either smooth muscle cells or endothelial cells. AVF diameters and patency were measured and confirmed by serial ultrasound examination. AVF, both murine and human, were examined using Western blot, histology, and immunofluorescence. Human and mouse endothelial cells were used for in vitro experiments. CKD accelerates TGF-β activation and promotes EndMT that is associated with increased AVF wall thickness and reduced patency in mice. Inhibition of TGF-β signaling in both endothelial cells and smooth muscle cells decreased smooth muscle cell proliferation in the AVF wall, attenuated EndMT, and was associated with reduced wall thickness, increased outward remodeling, and improved AVF patency. Human AVF also showed increased TGF-β signaling and EndMT. CKD promotes EndMT and reduces AVF patency. Inhibition of TGF-β signaling, especially disruption of endothelial cell-specific TGF-β signaling, attenuates EndMT and improves AVF patency in mouse AVF. Inhibition of EndMT may be a therapeutic approach of translational significance to improve AVF patency in human patients with CKD.

Back-up Arteriovenous Fistulas in Peritoneal Dialysis Patients: A Systematic Review and Meta-analysis

Peritoneal dialysis (PD) is a dialysis modality limited by the potential need of transferring to hemodialysis. Optimal hemodialysis vascular access is an arteriovenous fistula. Back-up arteriovenous fistula (bAVF) is a strategy to prevent central venous catheter (CVC) insertion, but its use in the PD population has not been systematically reviewed. Systematic review and meta-analysis. Studies including PD patients with a bAVF and the associated outcomes, including risk of hemodialysis transfer with a CVC and the proportion of bAVFs used. Retrospective or prospective, observational studies, non-randomized or randomized controlled trials. Vascular access at time of hemodialysis transfer (bAVF vs CVC) for patients with and without a bAVF. The data on bAVF outcomes included bAVFs that stopped working, were never used, and the number of patients requiring hemodialysis. Random-effects meta-analysis and meta-proportional analysis were conducted, with risk of bias within studies assessed using the Newcastle-Ottawa Scale. We screened 1,855 studies, 11 of which met the inclusion criteria, comprising 598 (62%) patients with a bAVF and 368 (38%) without. The proportion of bAVFs never used was 69% (95% confidence intervals [CI], 0.58-0.80; I 2=86.2%). Meta-analysis of 8 studies found no difference in hemodialysis transfer between patients with a bAVF and those without (hazard ratio, 1.14; 95% CI, 0.86-1.51). However, the risk of hemodialysis transfer with a CVC was significantly lower in patients with a bAVF (hazard ratio, 0.43; 95% CI, 0.17-0.68). Substantial heterogeneity between the studies and large number of studies with poor quality. bAVF was associated with a high rate of non-utilization but a lower risk of starting hemodialysis via a CVC. Future studies assessing long-term clinical outcomes may provide further insights into the role of bAVF creation in shaping dialysis unit policies.

Risk Factors associated with Central Vein Stenosis Development in Hemodialysis Vascular Access among Patients with Normal Preoperative Venography

We aimed to discover risk factors for central vein stenosis (CVS) in hemodialysis patients with normal preoperative venography. Among the 411 individuals who underwent upper arm venography for hemodialysis access evaluation in 2017, we reviewed venography and medical record data from 349 patients with normal preoperative venography who subsequently underwent arteriovenous fistula creation. We compared the data between patients with and without CVS development. Among the 349 patients, 22 (6.3%) developed CVS during a median 20.9-month follow-up. The development of CVS appeared to be associated with preoperative venography findings (the presence of collateral vessels and cephalic arch stenosis), location of hemodialysis access, and history and duration of ipsilateral hemodialysis catheter placement (p < 0.05). Multivariate analysis identified two or more collateral vessels on venography, left-sided arteriovenous fistula, and a previous history of ipsilateral hemodialysis catheter placement as independent risk factors for CVS development (p < 0.05). Even in patients with normal preoperative venography findings, there is an increased possibility of CVS development after arteriovenous fistula creation if they have more than two collateral vessels on venography, a left-sided arteriovenous fistula, or a history of ipsilateral hemodialysis catheter placement.

A Review of Central Vein Catheter for Hemodialysis: Insertion Sites and Techniques

Chronic kidney disease (CKD) is a global epidemic, being increasingly prevalent in both developed and developing countries, including Indonesia. Hemodialysis (HD) is the primary renal replacement therapy, along with peritoneal dialysis and kidney transplantation. The effectiveness of HD relies on well-functioning vascular access, such as central vein catheters (CVCs). These catheters are classified by their duration of use: short-term, medium-term, and long-term. They are also distinguished by insertion type (central or peripheral), insertion site (jugular, subclavian, femoral), and number of lumens (single, double, triple). The preferred site for insertion is the internal jugular vein, followed by the femoral vein and the subclavian vein. Techniques for CVC insertion include the central approach, the posterior approach, and others. This article reviews the role of CVC for vascular access in HD. Specifically, various CVC insertion sites and techniques will be examined. The authors will also discuss the available research on the application of CVC as vascular access for HD in Indonesia.

Long-term outcomes of lower extremity arteriovenous grafts

Objective: To evaluate the long-term outcomes of lower extremity arteriovenous graft (AVG) in hemodialysis patients. Methods: Hemodialysis patients with lower extremity AVG from August 2015 to July 2023 in the Department of Vascular Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine were enrolled. Therapeutic effects and complications of AVG were retrospectively analyzed. Results: A total of 83 cases aged (58.9±13.3) years were enrolled, including 25 males and 58 females. The success rate of the operation was 100% (83/83), and no perioperative complications occurred. The follow-up time [M (Q1, Q3)] was 38.4 (22.6, 55.3) months, with a follow-up rate of 92.8% (77/83). There were 9 cases (11.7%) of puncture site infection, 5 cases (6.5%) of pseudoaneurysm, 2 cases (2.6%) of seroma, 3 cases (3.9%) of lower limb ischemia, 48 cases (62.3%) of stenosis and 24 cases (31.2%) of thrombosis during the follow-up period. The 6-month, 1-year, 2-year, 3-year and 5-year primary patency rates after surgery were 78.9%, 61.2%, 39.0%, 27.0% and 16.3%, respectively, assisted primary patency rates were 93.5%, 82.5%, 74.9%, 68.0% and 53.0%, respectively, and secondary patency rates were 96.1%, 94.7%, 93.1%, 91.3% and 75.3%, respectively. Conclusion: For patients whose vascular resources of upper limbs are exhausted, lower extremity AVG is a safe and effective hemodialysis vascular access.

"Wire kissing technique" and "externalization and pull-through technique" for treating chronic total occlusion in hemodialysis vascular access: A case report.

The construction and utilization of dependable vascular access are essential for hemodialysis. Despite its importance, complications with vascular access are common, significantly impacting patient morbidity and mortality. This report presents a novel approach to treating chronic total occlusion (CTO) in hemodialysis vascular access using the "wire kissing technique" an "externalization and pull-through technique." An 82-year-old woman on hemodialysis had a thrombotic obstruction in her cephalic vein, which conventional methods failed to address. The wire kissing technique allowed the meeting of antegrade and retrograde wires within the CTO lesion, stabilizing the wire and facilitating balloon passage. The externalization and pull-through technique further enabled the balloon to cross the rigid CTO lesion, successfully completing percutaneous transluminal angioplasty (PTA). Post-procedure ultrasonography showed significant improvements in flow volume and resistance index. These techniques, commonly used in coronary and femoral arteries, have not been previously reported for dialysis vascular access. This case highlights a novel and effective solution for overcoming technical difficulties in crossing CTO lesions, potentially improving outcomes in vascular access for hemodialysis patients.