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OBJECTIVE: To describe an alternative arteriovenous fistula (AVF) model involving anastomosis of the common carotid artery (CCA) with the posterior facial vein (PFV). METHODS: Twenty-two male Sprague-Dawley rats (age 6-8 weeks) were used to establish the AVF model involving end-to-side anastomosis of PFV and CCA. The peak velocity of the CCA and the diameter of the outflow vein were recorded at 7, 14, and 42 days after the operation using Doppler ultrasound. Pathological examination of the intimal lesions was performed at 14 and 42 days after operation. RESULTS: One rat died within 24 h after surgery related to anesthesia. The patency rates at days 7, 14, and 42 were 85.7%, 81%, and 81%, respectively. The diameter of the carotid artery in rats is approximately 0.8 mm. The diameter of the outflow vein was increased by 1.7-fold and 2.2-fold at 7 days (1.1 ± 0.118 mm) and 14 days (1.4 ± 0.073 mm). At 42 days (1.96 ± 0.101 mm) after operation, the diameter was 3-fold greater compared to the unoperated control rat. The peak systolic flow velocity of the carotid artery at 7 days (593 ± 17.36 mm/s) and 14 days (767 ± 13.64 mm/s) after surgery was significantly greater compared to the control rat (314 ± 15.13 mm/s). The rate of increase was fastest at 7 days and leveled off from 14 to 42 days (875 ± 26 mm/s) after surgery. At 14 days, the intima area showed a nearly 50-fold increase (230 ± 9.93 µm2 × 103) compared to control (area 5 ± 0.37 µm2 × 103). Comparing 6 weeks with 2 weeks (280 ± 10.54 µm2 × 103) after surgery, the intima area increased 1.2 times. CONCLUSION: The CCA-PFV fistula in rats is a viable alternative AVF model.
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INTRODUCTION: Autogenous arteriovenous fistula (AVF) is the preferred vascular access in patients undergoing maintenance hemodialysis (MHD). However, complications such as thrombosis may occur. This study aimed to construct and validate a machine learning-based risk-prediction model for AVF thrombosis, hypothesizing that such a model can effectively predict occurrences, providing a foundation for early clinical intervention. METHODS: The retrospective longitudinal study included a total of 270 patients who underwent MHD at the Hemodialysis Center of the Second Affiliated Hospital of Harbin Medical University between March 2021 and December 2022. During this study, baseline data and scale information of patients between March 2020 and December 2021 were collected. We recorded outcome indicators between March 2021 and December 2022 for subsequent analyses. Five machine learning models were developed (artificial neural network, logistic regression, ridge classification, random forest, and adaptive boosting). The sensitivity (recall), specificity, accuracy, and precision of each model were evaluated. The effect size of each variable was analyzed and ranked. Models were assessed using the area under the receiver-operating characteristic (AUROC) curve. RESULTS: Among the 270 included patients, 105 had AVF thrombosis (55 male and 50 female patients; age range, 29-79 years; mean age, 56.72 years; standard deviation [SDs], ±13.10 years). Conversely, 165 patients did not have AVF thrombosis (99 male and 66 female patients; age range, 23-79 years; mean age, 53.58 years; SD, ± 13.33 years). During the observation period, approximately 52.6% of patients with AVF experienced long-term complications. The most common complications associated with AVF were thrombosis (105; 38.9%), aneurysm formation (27; 10%), and excessively high output flow (10; 3.7%). Fifty-four (20%) patients with AVF required intervention because of complications associated with vascular access. The AUROC curve of the testing set was between 0.858 and 0.903. CONCLUSION: In this study, we developed five machine learning models to predict the risk of AVF thrombosis, providing a reference for early clinical intervention.
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Autogenous arteriovenous fistula (AVF) is considered the preferred vascular access choice for individuals undergoing maintenance hemodialysis (MHD) and is widely utilized in China, as reported by the Dialysis Outcomes and Practice Patterns Study. Despite its popularity, the significant incidence of poor AVF maturation often leads to the need for central venous catheter insertion, increasing the risk of complications like superior vena cava stenosis and catheter-related infections, which in turn raises the overall mortality risk. With the prevalence of diabetes rising globally among the elderly and diabetic kidney disease being a leading cause of end-stage renal disease necessitating renal replacement therapy, our retrospective review aims to explore the various factors affecting AVF maturation in this specific patient population. While there have been numerous studies examining AVF complications in MHD patients, including issues like failure, patency loss, stenosis, thrombosis, poor maturation, and other influencing factors, there remains a gap in large-scale clinical studies focusing on the incidence and risk factors for immature AVF specifically in elderly diabetic patients. This paper delves into the pathophysiological mechanisms, diagnostic criteria, and unique considerations surrounding AVF maturation in elderly diabetic patients, distinguishing them from the general population. Our literature review reveals that elderly diabetic patients exhibit a higher risk of AVF immaturity compared to the general population. Additionally, there exists a continuing discourse regarding several aspects related to this group, including the choice of dialysis access, timing of AVF surgery, and surgical site selection. Furthermore, we delve into the management strategies for vascular access within this specific group with the goal of providing evidence-based guidance for the establishment and maintenance of functional vascular access in elderly diabetic patients.
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The nursing experience of intimal hyperplasia at buttonhole puncture site in a patient with autogenous arteriovenous fistula was reported.The key points of nursing:to formulate a scientific and reasonable internal fistula puncture plan,to establish and maintain the buttonhole tunnel,to regularly monitor the use of arteriovenous fistula,to replace the traditional internal fistula steel needle(hereinafter referred to as the steel needle)with the hemodialysis trocar needle(hereinafter referred to as the trocar needle)for buttonhole puncture,to treat with far infrared ray during each dialysis,and to guide the patient to apply hirudoid cream on the arm of the fistula side.After careful nursing,the intimal hyperplasia at the buttonhole puncture site disappeared,and there was no recurrence after 6 months of follow-up.
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BACKGROUND: Upper limb exercise has long been considered to be the main means to promote autogenous arteriovenous fistula (AVF) maturation, but in practice exercise intensity and compliance are both typically lacking. Several randomized controlled trials (RCTs) have demonstrated the good effects of functional resistance or pressure exercise in patients with AVF. However, many patients' have difficulty complying with upper limb exercise programs without systematic health education. Therefore, we argue that resistance and pressure exercise supported by health education is actually the most beneficial for AVF patients. METHODS: We randomly divided 114 patients into a control group and an experimental group of 57 patients each. In the control group, conventional care was used, and in the experimental group, online health education based on the IMB (Information-Motivation-Behavior skills) model and functional resistance and pressure upper limb exercises was implemented with the AVF side arm. The failure rate of AVF maturation, clinical maturation time, cephalic venous blood flow, vessel diameter, and vessel skin thickness were compared between the two groups. RESULTS: Fifty-five cases were included for each in the final study. The primary outcome of this study was the failure rate of AVF maturation. Secondary outcomes included clinical maturation time, cephalic vein flow, vessel diameter, and vessel thickness. The failure rate of AVF maturation in the experimental group was significantly lower than that in the control group, and the clinical maturation time in the experimental group was significantly shorter than that in the control group. For the remaining three indicators, there were between-group effects, time effects, and interaction effects in both groups. Comparison between groups showed that there was no statistical difference in the observed indicators of cephalic vein flow, vessel diameter, or vessel thickness between the two groups before the intervention but that there was a statistical difference at the end of the 4th, 8th, and 12th weeks of the intervention. A 2 × 2 comparison also showed that there was a statistical difference between the three indicators at each time point within the two groups. CONCLUSION: IMB model-based online health education combined with functional resistance and pressure exercises can improve AVF maturation status and accelerate AVF maturation within 12 weeks of surgery.
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BACKGROUND: Maintenance hemodialysis (MHD) patients are often admitted to the hospital for severe morbidities. Prolonged intermittent renal replacement therapy (PIRRT) is required during the hospital staying. There are controversial opinions on the use of arteriovenous fistula (AVF) as vascular access for PIRRT in MHD patients. METHODS: Patients with AVF who accepted PIRRT in our center between January 2014 and June 2021 were retrospectively screened. AVF dysfunction and patient mortality were assessed as endpoints. Univariate and multivariate regression models were employed to identify the risk factors of AVF dysfunction. RESULTS: About 162 patients were included in our present study. Twenty-six experienced AVF dysfunction, of whom 53.8%, 19.2%, and 27.0% had percutaneous transluminal balloon angioplasty, surgical revision, and AVF reconstruction, respectively. The accumulated AVF dysfunction rates were 11.8%, 16.2%, and 21.0% in 1, 2, and 3 years, respectively. Multivariate analysis revealed that smoking (HR 2.750, 95% CI 1.181-6.402, p = 0.019), higher platelet (PLT, HR 1.009, 95% CI 1.000-1.017, p = 0.047), higher prothrombin activity (PTA, HR 1.039, 95% CI 1.012-1.066, p = 0.004), and lower diastolic blood pressure (DBP, HR 0.963, 95% CI 0.932-0.996, p = 0.026) were independent risk factors for AVF dysfunction. During the follow-up period, 37 patients died. CONCLUSIONS: Overall, the use of AVF for PIRRT might not dramatically increase the incidence of AVF dysfunction. And, Smoking, lower DBP, higher PLT, and higher PTA were associated with increased AVF dysfunction.
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Fístula Arteriovenosa , Derivación Arteriovenosa Quirúrgica , Terapia de Reemplazo Renal Intermitente , Humanos , Estudios Retrospectivos , Grado de Desobstrucción Vascular/fisiología , Diálisis Renal/efectos adversos , Pronóstico , Derivación Arteriovenosa Quirúrgica/efectos adversosRESUMEN
PURPOSE: To compare the safety and efficacy of X-ray-guided and ultrasound-guided percutaneous transluminal angioplasty in treating arteriovenous fistula dysfunction. MATERIALS AND METHODS: Data for 219 patients with arteriovenous fistula dysfunction between January 2016 and December 2018 were retrospectively analyzed. The primary endpoints were technical success, clinical success, and primary patency rates. The secondary endpoints were complications and secondary patency rates. Procedure outcomes and both endpoints were evaluated by propensity score analysis. RESULTS: After the propensity score matching, 73 matched pairs of cases were created with 34 pairs of autogenous arteriovenous fistula cases and 39 pairs of prosthetic arteriovenous graft cases. There was no significant difference between the X-ray-guided and ultrasound-guided group, respectively, regarding the technical success rate (84.9% vs 87.7%, p = 0.630), clinical success rate (98.6% vs 97.3%, p = 0.999), and complications (10.9% vs 5.5%, p = 0.228). Although the 6- and 12-month secondary patency rates for the dialysis access between the two groups had significant difference (p < 0.05), there was no significant difference in primary and secondary patency curves between the two groups (p > 0.05). CONCLUSION: The overall efficacy of ultrasound-guided versus X-ray-guided percutaneous transluminal angioplasty in treating arteriovenous fistula dysfunction might be comparable.
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Angioplastia de Balón , Fístula Arteriovenosa , Derivación Arteriovenosa Quirúrgica , Humanos , Estudios Retrospectivos , Oclusión de Injerto Vascular/diagnóstico por imagen , Oclusión de Injerto Vascular/etiología , Oclusión de Injerto Vascular/terapia , Grado de Desobstrucción Vascular , Rayos X , Resultado del Tratamiento , Angioplastia/efectos adversos , Angioplastia/métodos , Diálisis Renal/efectos adversos , Derivación Arteriovenosa Quirúrgica/efectos adversos , Ultrasonografía Intervencional/efectos adversos , Angioplastia de Balón/efectos adversos , Angioplastia de Balón/métodosRESUMEN
BACKGROUND: Autogenous arteriovenous fistula (AVF) is the best vascular hemodialysis access for terminal chronic renal failure patients but is prone to thrombosis. Pathogenic mechanisms of AVF thrombus are thus largely explored. As exosomes carry genetic content from cell of origin. We hypothesized that miRNAs in serum exosomes are promising regulators of AVF thrombosis. METHODS: Serum exosomes were isolated from maintenance hemodialysis (MHD) patient, miRNAs profile of the exosomes was obtained by high throughput sequencing, six miRNAs (miR-144-5p, miR-18a-5p, miR-200a-3p, miR-200b-3p, miR-141-3p, and miR-429) were determined as candidates examined by RT-PCR, cells transfected with miR-200b-3p mimics demonstrated significantly increased mRNA levels of VEGF and Ang-II, the relationship between miR-200b-3p and VEGF or Ang-II was performed by adual luciferase reporter assay. RESULTS: There are 43 miRNA down-regulation and 15 miRNA up-regulation between MHD group and MHD+Thrombus group, the expression levels of miR-200b-3p and miR-429 in MHD with thrombus were significantly increased (p < 0.001, p < 0.05). Inhibited miR-200b-3p expression level can increase VEGF mRNA and protein expression levels and decrease Ang-II mRNA and protein expression levels. Furthermore, we also identified that miR-200b-3p targets VEGF and Ang-II. CONCLUSION: Our study indicates that serum exosome-derived miR-200b-3p regulate VEGF and Ang-II to increase intimal hyperplasia to induce AVF thrombosis. Besides miR-200b-3p, miR-200 family may also play a regulatory role in AVF thrombosis.
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MicroARNs , Trombosis , Humanos , Factor A de Crecimiento Endotelial Vascular/genética , MicroARNs/genética , MicroARNs/metabolismo , Diálisis Renal , Trombosis/genética , ARN MensajeroRESUMEN
OBJECTIVE: the objective of this study is to explore the effect of a self-management mode on hemodialysis in autogenous arteriovenous fistula patients, and assess the improvement in their self-care, as well as the management and protection abilities of patients through the self-management mode, so as to improve the quality of dialysis. METHOD: A total of 100 patients undergoing maintenance hemodialysis, who have autogenous fistula and were cared for in the First Affiliated Hospital of Wenzhou Medical University from August 2019 to February 2020 were selected. All patients were divided into either an experimental group (group A, 50 people) or a control group (group B, 50 people), at random. Patients in group A were given self-management education and self-protection behavior education of internal fistulas based on routine nursing, while patients in group B were only given routine nursing. Initially, the general clinical data between the two groups was compared. Then, the patient self-management scale and internal fistula quality assessment were used to evaluate the patients' self-management ability and internal fistula quality. A Philips ClearVue 850 color Doppler ultrasound diagnostic instrument was used to monitor thrombus in patients. RESULTS: we found no significant difference in gender, dialysis frequency (3 times a week), dialysis time and blood biochemical indexes between the two groups (P > 0.05). There were statistically significant differences in the self-management ability, internal fistula quality, time effect, grouping effect and interaction effect between the two groups before and after the experiment (P < 0.001). The result of the ultrasound examination show that 75 patients with arteriovenous fistula results were normal, while 25 patients had complications, including 11 patients with steal phenomenon, 8 patients with stenosis, and 6 patients had thrombosis. CONCLUSION: self-management intervention and ultrasonic thrombus monitoring for hemodialysis patients can improve the quality of autogenous arteriovenous fistulas, and help doctors treat patients according to their individual complications and improve the cure rate of the disease.
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TARGET: To compare the ultrasound characteristics between functional, mature arteriovenous fistulas and functional, non-mature arteriovenous fistulas and to identify the predictors of arteriovenous fistula maturation in the forearm. METHODS: Patients with newly set-up functional arteriovenous fistulas were enrolled in this prospective cohort study. Ultrasound examinations were conducted pre-operatively and post-operatively. The inner vessel diameter, blood flow volume, and resistance index were measured and compared between the maturation group (Group M) and non-maturation group (Group N). Baseline parameters were calculated to determine the predictors of non-maturation of arteriovenous fistulas. RESULTS: All 52 patients with functional arteriovenous fistulas, who were categorized into Group M (25 patients, 48.08%) and Group N (27 patients, 51.92%), finished 24 weeks of follow-up after arteriovenous fistula surgery. The arteriovenous fistulas displayed a significant and rapid increase in the vessel diameter (mean increase of 1.34 times in the arteries and 1.92 times in the veins) and blood flow volume (mean increase of 9.29 times of the arteries and 43.66 times of the veins) and a decrease in the resistance index (mean decrease in 48.00% in the arteries) 8 weeks after surgery. Group N had a lesser increase in the vessel diameters (1.78 times vs 2.06 times, t = -3.136, p = 0.003) and blood flow volume (33.98 times vs 54.11 times, t = -2.383, p = 0.021) of the cephalic vein draining segments (a6) than Group M. The baseline diameter of a6 was the only independent predictor (regression coefficient = 26.229, p = 0.008) of maturation of the functional arteriovenous fistulas after correcting for sex, age, diabetes kidney disease, weight, and height. CONCLUSION: The baseline diameter of the cephalic vein was the only predictor of arteriovenous fistula maturation based on the pre-operative ultrasound measurements in Chinese hemodialysis patients.
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Derivación Arteriovenosa Quirúrgica/efectos adversos , Antebrazo/irrigación sanguínea , Complicaciones Posoperatorias/etiología , Arteria Radial/cirugía , Diálisis Renal , Venas/cirugía , Adulto , Anciano , Velocidad del Flujo Sanguíneo , China , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/fisiopatología , Valor Predictivo de las Pruebas , Estudios Prospectivos , Arteria Radial/diagnóstico por imagen , Arteria Radial/fisiopatología , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Ultrasonografía , Grado de Desobstrucción Vascular , Resistencia Vascular , Venas/diagnóstico por imagen , Venas/fisiopatologíaRESUMEN
INTRODUCTION: The aim of this study is to evaluate the maturation and patency rates after endovascular treatment of non-maturing arteriovenous fistulas with percutaneous transluminal angioplasty, embolization of competitive veins, or a combination of both in a series of consecutive patients. MATERIAL AND METHODS: Retrospective evaluation of patients with non-matured arteriovenous fistulas treated in our hospital was performed. Fistulography and ultrasonography was performed in all patients to evaluate the presence of stenosis and competitive veins. Significant stenoses (> 50%) were treated with balloon angioplasty and competitive veins (accessory and collateral veins) with coil embolization. RESULTS: A total of 78 fistulas were treated. Angioplasty and coil embolization were performed in 73 and 51 patients, respectively. No major complications occurred. In 65 out of 78 arteriovenous fistulas (83%), successful cannulation with two needles was possible after endovascular treatment. Sixty-three arteriovenous fistulas (81%) were used successfully for at least 3 months. Accessory veins were the only lesion present in 14% of the arteriovenous fistulas; coil embolization of these accessory veins resulted in 100% successful maturation. The estimated 3, 6, and 12 months postintervention assisted primary patency rates were, respectively, 73%, 55%, and 45%. The estimated 3, 6, and 12 months postintervention secondary patency rates were, respectively, 81%, 78%, and 73%. CONCLUSION AND DISCUSSION: Angioplasty and coil embolization are successful and safe procedures that can convert a non-mature fistula into a mature one in more than 80% of patients. Accessory vein embolization may be more important than collateral vein embolization in the presence of stenosis.
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Angioplastia de Balón , Derivación Arteriovenosa Quirúrgica/efectos adversos , Embolización Terapéutica , Oclusión de Injerto Vascular/terapia , Diálisis Renal , Extremidad Superior/irrigación sanguínea , Venas/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Angioplastia de Balón/efectos adversos , Angioplastia de Balón/instrumentación , Circulación Colateral , Embolización Terapéutica/efectos adversos , Embolización Terapéutica/instrumentación , Femenino , Oclusión de Injerto Vascular/diagnóstico por imagen , Oclusión de Injerto Vascular/etiología , Oclusión de Injerto Vascular/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Flujo Sanguíneo Regional , Estudios Retrospectivos , Stents , Resultado del Tratamiento , Grado de Desobstrucción Vascular , Venas/diagnóstico por imagen , Venas/fisiopatologíaRESUMEN
Objective The aim of the study was to investigate the early failure of newly created arteriovenous fistula(AVF) in patients on maintenance hemodialysis and the factors responsible for the failure. Methods The clinical data were retrospectively reviewed, preoperative examination and laboratory biochemical indicators of 88 patients with newly created AVF for maintenance hemodialysis in our hospital through Hospital Management Information System and telephone follow-ups. Binary Logistic regression was used to analyze the protective factors for early failure. Results In 88 patients, early failure of the AVF was found in 15 patients. Twenty-three factors, including gender, were involved in statistical analysis. There were statistical differences between the two groups in hypertension (χ2=7.689, P=0.006) and whether they had early referral to nephrologists (χ2=5.334, P=0.021). Further regression analysis showed hypertension ( OR=0.192, 95% CI=0.0538-0.692, P=0.012) was protective factor and without early referral ( OR=3.651, 95% CI=1.068-18.302, P=0.039) was the risk factor of early failure. Conclusion This study shows that no early referral and combined hypertension is an important factor affecting the early failure, emphasizing the clinical work, for the diagnosis of patients with chronic kidney disease, early nephrological referral should be established, and blood pressure monitoring should be done to help reduce the incidence of complications.
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Objective · To observe the vascular structure before autogenous arteriovenous fistula (AVF) construction in patients with end-stage renal disease (ESRD) and analyze the risk factors of the pre-existing venous neointimal hyperplasia. Methods · The 8 vein samples were screened from 20 ESRD patients at their first time of the AVF construction (non-stenosis group), and the other 8 vein samples were screened from 15 ESRD patients at their at least second time of the AVF repair operation (stenosis group). Sections were prepared and stained with hematoxylin & eosin (H-E) or Masson's trichrome for observation. The intimal thickness was measured by the cellSens software, and its correlation with patients' renal function, calcium-phosphorus metabolism, iron metabolism and inflammatory reaction in the non-stenosis group were analyzed. Results · In the non-stenosis group, there were varying degrees of intimal hyperplasia in 5 (62.5%) cases, loss of endothelial cell layer in 3 (37.5%) cases, and vascular wall replacement by collagenous with atrophy or loss of muscle layer in 5 (62.5%) cases. In the stenosis group, almost all vein samples showed general thickening of the wall and 2 (25.0%) totally lost the muscle layer. Avg It of those two groups were statistically significant (P<0.01). In the non-stenosis group, both of average I/M thickness and average I/M area were negatively related to glomerular filtration rate (GFR) (P<0.05) and positively related to serum phosphorus and calcium-phosphorus product (P<0.05). Conclusion · Some apparently normal vein of ESRD patients showed varying degrees of intimal hyperplasia before AVF construction. The intimal hyperplasia had a remarkable correlation with GFR or calcium-phosphorus metabolism. Early intervention of the intimal hyperplasia prior to AVF construction may be a new prevention and control means.
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Objective To discuss the feasibility and clinical value of percutaneous transluminal stenting (PTS) for the treatment of central venous obstruction (CVO) in hemodialysis patients with arteriovenous fistula (AVF).Methods The clinical data of 10 hemodialysis patients with AVF complicated by CVO were retrospectively analyzed.Clinically,all patients presented as swollen hand syndrome.Preoperative or intraoperative digital subtraction angiography (DSA) was performed to determine the obstruction site,and based on the disease condition the appropriate surgical approach was employed.For patients having thrombus formation,catheter-directed thrombolysis (CDT) was carried out first.For patients having severe stenosis or occlusion of veins,pre-expansion with small diameter balloon was employed before PTS.For the remaining patients,PTS was directly performed.All patients were regularly followed up after operation.Results DSA showed that brachiocephalic vein occlusion and/or occlusion or stenosis of subclavian vein,internal jugular vein and superior vena cava were observed in 5 patients who had history of internal jugular vein catheterization,while localized severe stenosis of medial segment of AVF-side subclavian vein was detected in the other 5 patients who had no history of internal jugular vein catheterization.The technical success rate of PTS was 100％ (10/10).A total of 19 stents were implanted in the 10 patients.Seven months after the treatment,one patient developed in-stent re-stenosis,and PTS had to be carried out again.Primary patcncy rates at 6 months and 12 months after the treatment were 100％ (8/8) and 75％ (3/4) respectively.Conclusion In hemodialysis patients with AVF,CVO is mainly characterized by obstructive or severely stenotic lesions.PTS carries higher success rate with satisfactory short-term and mid-term effect,its complications are slight and mild,and the technique is safe and feasible.Therefore,PTS can be used as the preferred treatment method.
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PURPOSE: To retrospectively analyze the technical and clinical outcome of percutaneous rheolytic thrombectomy with the use of the AngioJet device in thrombosed autogenous arteriovenous dialysis fistulas. METHODS: A cohort of 38 consecutive patients (24 men; mean age 70.7 ± 13.8 years) presenting with 59 thrombotic events in 39 autogenous dialysis fistulas were retrospectively analyzed. The AngioJet rheolytic thrombectomy device was used in all cases. Adjunctive therapies, as well as procedure-related complications, were noted. Primary, assisted primary, and secondary patency of the autogenous fistulas was assessed along with factors potentially influencing patency. RESULTS: Initial technical success to recanalize the efferent vein was 100% (n = 59), and a successful postprocedure dialysis session was possible in 97% (n = 57) of cases. Adjunctive procedures included percutaneous thromboaspiration (n = 4, 7%), balloon angioplasty (n = 59, 100%), and stent placement (n = 16, 27%). Complications related to thrombectomy occurred in 3 (5%) procedures (distal arterial embolus). Primary, assisted primary, and secondary patency rates at 12 months were 56.1% (95% CI 42.8% to 75.2%), 61.6% (95% CI 48.6% to 74.7%), and 86.2% (95% CI 74.9% to 97.5%), respectively. Risk factors for early fistula occlusion were greater patient age (p = 0.045), the age of the fistula (p = 0.045), previous stent insertion (p = 0.019), and an upper arm fistula (p = 0.047). CONCLUSION: Percutaneous rheolytic thrombectomy of autogenous dialysis fistulas is effective in restoring patency and allowing subsequent hemodialysis. The complication rate is acceptably low, and the large majority of the fistulas are still used for hemodialysis at 1-year follow-up. Older fistulas and upper arm fistulas are at higher risk for early rethrombosis.
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Angioplastia , Derivación Arteriovenosa Quirúrgica/efectos adversos , Stents , Trombectomía/métodos , Trombosis de la Vena/etiología , Trombosis de la Vena/terapia , Anciano , Anciano de 80 o más Años , Angioplastia/métodos , Angioplastia de Balón/métodos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Diálisis Renal/efectos adversos , Estudios Retrospectivos , Factores de Riesgo , Trombectomía/efectos adversos , Trombectomía/instrumentación , Resultado del Tratamiento , Grado de Desobstrucción Vascular , Trombosis de la Vena/diagnósticoRESUMEN
Objective To evaluate the clinical value of the condition of radial artery for autogenous arteriovenous fistula ostomy by color Doppler ultrasound. Methods The condition of radial artery of 133 end-stage renal disease( ESRD) patients who received autogenous arteri-ovenous fistula ostomy were detected by color Doppler ultrasound,and compared with the postoperative parameters of fistula vascular. Results Among all 133patients,the preoperative radial artery of 95 cases were normal,abnormal in 38 cases. Ostomy surgery performed on 131 cases. Two cases gave up surgery for the poor condition of radial artery,13 cases with fistula failure. The success rate with normal radial artery (95. 8%) was higher than that with the abnormal radial artery(75%). The blood flow parameters of normal radial artery were significantly better than those of the abnormal radial artery,and 4 weeks after operation,the anastomotic blood flow and blood vessel diameter were better than those 1 week before and after surgery. Conclusion Color Doppler ultrasound that can provide preoperative data of radial artery, predict postoperative the state of fistula vascular,and monitor the conditions of postoperative fistula vascular,with better clinical value.
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In South Korea at the end of 2006, the total number of patients that had undergone renal replacement therapy was 46,730 (hemodialysis: 62.1%, peritoneal dialysis: 17.1%, functioning kidney transplantation: 20.8%). There were 9,197 new renal replacement therapy patients in 2006 and the incidence rate per million 185.3. In South Korea, the most common primary cause of end stage renal disease was diabetic nephropathy (42.3%), hypertensive nephrosclerosis (16.9%), and chronic glomerulonephritis (13.0%). The National Kidney Foundation Dialysis Outcomes Quality Initiative (K/DOQI) has recommended placement of autogenous arteriovenous fistulas over alternatives including the use of arteriovenous grafts and central venous catheters to improve the overall outcome of patients undergoing hemodialysis. However, autogenous arteriovenous fistulas, like polytetrafluoroethylene grafts, are also subject to dysfunction and eventual failure. Since first described in 1982, percutaneous transluminal balloon angioplasty has become the mainstay of treatment for accesses failing because of underlying central or peripheral venous stenoses. When angioplasty alone fails, alternative treatment modalities, including stent placement and atherectomy, allow immediate salvage in most cases. Consequently, interventional treatment should be attempted first for dysfunctional and thrombosed autogenous vascular access and should be initiated in all dialysis centers so long as the local radiologists are trained and enthusiastic.