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The Cochrane Database of Systematic... Sep 2015Haemodialysis treatment requires reliable vascular access. Optimal access is provided via functional arteriovenous fistula (fistula), which compared with other forms of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Haemodialysis treatment requires reliable vascular access. Optimal access is provided via functional arteriovenous fistula (fistula), which compared with other forms of vascular access, provides superior long-term patency, requires few interventions, has low thrombosis and infection rates and cost. However, it has been estimated that between 20% and 60% of fistulas never mature sufficiently to enable haemodialysis treatment. Mapping blood vessels using imaging technologies before surgery may identify vessels that are most suitable for fistula creation.
OBJECTIVES
We compared the effect of conducting routine radiological imaging evaluation for vascular access creation preoperatively with standard care without routine preoperative vessel imaging on fistula creation and use.
SEARCH METHODS
We searched Cochrane Kidney and Transplant's Specialised Register to 14 April 2015 through contact with the Trials' Search Co-ordinator using search terms relevant to this review.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) that enrolled adult participants (aged ≥ 18 years) with chronic or end-stage kidney disease (ESKD) who needed fistulas (both before dialysis and after dialysis initiation) that compared fistula maturation rates relating to use of imaging technologies to map blood vessels before fistula surgery with standard care (no imaging).
DATA COLLECTION AND ANALYSIS
Two authors assessed study quality and extracted data. Dichotomous outcomes, including fistula creation, maturation and need for catheters at dialysis initiation, were expressed as risk ratios (RR) with 95% confidence intervals (CI). Continuous outcomes, such as numbers of interventions required to maintain patency, were expressed as mean differences (MD). We used the random-effects model to measure mean effects.
MAIN RESULTS
Four studies enrolling 450 participants met our inclusion criteria. Overall risk of bias was judged to be low in one study, unclear in two, and high in one.There was no significant differences in the number of fistulas that were successfully created (4 studies, 433 patients: RR 1.06, 95% CI 0.95 to 1.28; I² = 76%); the number of fistulas that matured at six months (3 studies, 356 participants: RR 1.11, 95% CI 0.98 to 1.25; I² = 0%); number of fistulas that were used successfully for dialysis (2 studies, 286 participants: RR 1.12, 95% CI 0.99 to 1.28; I² = 0%); the number of patients initiating dialysis with a catheter (1 study, 214 patients: RR 0.66, 95% CI 0.42 to 1.04); and in the rate of interventions required to maintain patency (1 study, 70 patients: MD 14.70 interventions/1000 patient-days, 95% CI -7.51 to 36.91) between the use of preoperative imaging technologies compared with standard care (no imaging).
AUTHORS' CONCLUSIONS
Based on four small studies, preoperative vessel imaging did not improve fistula outcomes compared with standard care. Adequately powered prospective studies are required to fully answer this question.
Topics: Adult; Aged; Arteriovenous Shunt, Surgical; Blood Vessels; Humans; Middle Aged; Preoperative Care; Randomized Controlled Trials as Topic; Renal Dialysis; Ultrasonography, Doppler, Color; Vascular Patency
PubMed: 26418347
DOI: 10.1002/14651858.CD007013.pub2 -
Child's Nervous System : ChNS :... Jun 2024Pediatric non-galenic pial arteriovenous fistulas (pAVFs) are rare vascular malformations that are characterized by a pial arterial-venous connection without an... (Review)
Review
INTRODUCTION
Pediatric non-galenic pial arteriovenous fistulas (pAVFs) are rare vascular malformations that are characterized by a pial arterial-venous connection without an intervening capillary bed. Outcomes and treatment strategies for pAVFs are highly individualized, owing to the rarity of the disease and lack of large-scale data guiding optimal treatment approaches.
METHODS
We performed a systematic review of pediatric patients (< 18 years at diagnosis) diagnosed with a pAVF by digital subtraction angiogram (DSA). The demographics, treatment modalities, and outcomes were documented for each patient and clinical outcome data was collected. Descriptive information stratified by outcome scores were classified as follows: 1 = excellent (no deficit and full premorbid activity), 2 = good (mild deficit and full premorbid activity), 3 = fair (moderate deficit and impaired activity), 4 = poor (severe deficit and dependent on others), 5 = death.
RESULTS
A total of 87 studies involving 231 patients were identified. Median age at diagnosis was 3 years (neonates to 18 years). There was slight male preponderance (55.4%), and 150 subjects (81.1%*) experienced excellent outcomes after treatment. Of the 189 patients treated using endovascular approaches, 80.3% experienced excellent outcomes and of the 15 patients surgically treated subjects 75% had an excellent outcome. The highest rate of excellent outcomes was achieved in patients treated with Onyx (95.2%) and other forms of EvOH (100%). High output heart failure and comorbid vascular lesions tended to result in worse outcomes, with only 54.2% and 68% of subjects experiencing an excellent outcome, respectively. *Outcomes were reported in only 185 patients.
CONCLUSION
pAVFs are rare lesions, necessitating aggregation of patient data to inform natural history and optimal treatment strategies. This review summarizes the current literature on pAVF in children, where children presenting with heart failure as a result of high flow through the lesion were less likely to experience an excellent outcome. Prospective, large-scale studies would further characterize pediatric pAVFs and enable quantitative analysis of outcomes to inform best treatment practices.
Topics: Humans; Child; Arteriovenous Fistula; Pia Mater; Child, Preschool; Adolescent; Infant; Female; Infant, Newborn; Treatment Outcome; Male; Intracranial Arteriovenous Malformations
PubMed: 38506930
DOI: 10.1007/s00381-024-06352-5 -
Journal of Vascular Surgery Jul 2018Long-term patency of arteriovenous fistulas (AVFs) is critical for hemodialysis vascular access. We compared the efficacy of a one-stage vs two-stage approach to... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Long-term patency of arteriovenous fistulas (AVFs) is critical for hemodialysis vascular access. We compared the efficacy of a one-stage vs two-stage approach to brachiobasilic AVF creation by primarily investigating primary and secondary patency rates. We hypothesize that the two-stage is superior to the one-stage procedure in terms of efficacy and safety.
METHODS
This review was performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Searches were performed on MEDLINE, EMBASE, Google Scholar, and Cochrane Database. Risk of bias and quality assessment scores were both performed based on previously validated tool.
RESULTS
The systematic search revealed a total of 242 publications for possible inclusion. On the basis of title and abstract review, two randomized controlled trials and nine case-cohort series fit our inclusion criteria. There were no statistically significant differences in failure rates (pooled risk ratio [RR], 1.10; 95% confidence interval [CI], 0.79-1.55; P = .25), 1-year primary patency rates (RR, 1.31; 95% CI, 0.83-2.06; P = .24), 1-year secondary patency rates (RR, 0.97; 95% CI, 0.54-1.77) and 2-year secondary patency rates (RR, 1.19; 95% CI, 0.54-2.63; P = .67) between both groups. However, the two-stage procedure had significantly improved 2-year primary patency rates (RR, 2.50; 95% CI, 1.66-3.74; P < .00001). There were no differences in steal syndrome, hematoma, infection, pseudoaneuryms, or stenosis, although there was a trend toward an increased incidence of postoperative thrombosis (RR, 1.81; 95% CI, 0.95-3.45; P = .07) in one-stage procedures.
CONCLUSIONS
With improved 2-year primary patency rates and the absence of significant differences in complications, this study suggests potential benefit of a two-stage over a one-stage procedure for brachiobasilic AVF creation. However, rather than being a definitive answer, our results merely highlight the continuing need for an adequately powered, well-designed, randomized controlled trial to interrogate this question further.
Topics: Adult; Aged; Arteriovenous Shunt, Surgical; Brachial Artery; Chi-Square Distribution; Female; Graft Occlusion, Vascular; Humans; Male; Middle Aged; Odds Ratio; Renal Dialysis; Risk Factors; Time Factors; Treatment Outcome; Upper Extremity; Vascular Patency; Veins
PubMed: 29937034
DOI: 10.1016/j.jvs.2018.03.428 -
Journal of Neurosurgical Sciences Aug 2018The appropriate interpretation of natural history of brain arteriovenous malformations (bAVMs) and of factors that negatively affect the risk of future hemorrhage are... (Review)
Review
INTRODUCTION
The appropriate interpretation of natural history of brain arteriovenous malformations (bAVMs) and of factors that negatively affect the risk of future hemorrhage are important when recommending management pathways. With the present systematic review, we aim to provide an overview of the available evidence on natural history of brain arteriovenous malformations (bAVMs), focusing on hemorrhage rates and risk factors for future hemorrhage.
EVIDENCE ACQUISITION
We performed a systematic literature analysis using the Ovid Medline database, encompassing English language studies (published between 1980 and 2018) reporting the natural history of untreated bAVMs. Annual hemorrhage rates in both unruptured and previously ruptured bAVMs, as well as risk factors for future hemorrhage were extracted for analysis.
EVIDENCE SYNTHESIS
Eighteen studies with a total of 8418 bAVM-cases could be extracted from the literature. Seventeen studies reported annual hemorrhage rates and ten studies reported risk factors for future hemorrhage. The average annualized hemorrhage rate was 2.2% for unruptured bAVMs and 4.3%, for bAVMs that presented with hemorrhage. Prior hemorrhage and deep AVM location could be identified as most consistently reported risk factors for future hemorrhage.
CONCLUSIONS
Previously ruptured bAVMs have a higher annual hemorrhage rate than unruptured bAVMs. Deep bAVM location and prior hemorrhage may increase the risk for subsequent hemorrhage.
Topics: Arteriovenous Fistula; Humans; Intracranial Arteriovenous Malformations; Intracranial Hemorrhages; Risk Factors
PubMed: 29595047
DOI: 10.23736/S0390-5616.18.04452-1 -
Archives of Academic Emergency Medicine 2023This systematic review and meta-analysis aimed to summarize the evidence regarding the impact of needle direction and distance of arteriovenous fistula (AVF) cannulation... (Review)
Review
INTRODUCTION
This systematic review and meta-analysis aimed to summarize the evidence regarding the impact of needle direction and distance of arteriovenous fistula (AVF) cannulation on KT/V (where k is the dialyzer urea clearance, t, the duration of dialysis, and V, the volume of distribution of urea) and access recirculation (AR) as hemodialysis (HD) adequacy criteria.
METHODS
A comprehensive systematic search was performed on international and domestic electronic databases from the earliest to June 4, 2022 using keywords. Analysis was performed in STATA software v.14.
RESULTS
Three randomized control trials (RCTs) and four non-RCT articles were included in the final review. Six studies reported the effects of direction, while four mentioned the effects of distances of AVF cannulation on outcomes of HD adequacy based on KT/V or AR. Results of three non-RCT studies showed that retrograde direction decreased KT/V more than antegrade direction (ES: 0.44, 95% CI: -0.38 to 1.27). Two non-RCT studies showed that antegrade decreased AR compared to the retrograde direction (ES: -0.64, 95%CI: -1.94 to 0.67). However, the results of two RCTs indicated uncertainty about this issue. Two of the four studies suggested that a distance of 5 cm or more in arterial and venous needles had greater adequacy than a distance of less than 5 cm. However, other studies did not confirm this finding.
CONCLUSION
Overall comparison of the results qualitatively and quantitatively indicated uncertainty about the effects of direction and distance of AVF cannulation on HD adequacy outcomes. More studies with high-quality designs, such as RCTs, are required to better understand and adjudicate the effects of needle direction and distance of AVF cannulation on HD adequacy outcomes.
PubMed: 37609532
DOI: 10.22037/aaem.v11i1.1943 -
European Journal of Vascular and... Apr 2020Aneurysms arising from arteriovenous fistulae are a common finding among dialysed patients and pose a risk of acute bleeding. The aim of this study was to perform a... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Aneurysms arising from arteriovenous fistulae are a common finding among dialysed patients and pose a risk of acute bleeding. The aim of this study was to perform a systematic review and meta-analysis evaluating the surgical options for the treatment of aneurysmal arteriovenous fistulae.
METHODS
A systematic review and meta-analysis of articles published between January 1973 and March 2019 describing the surgical treatment of arteriovenous fistulae aneurysms.
RESULTS
A total of 794 records were identified. After duplicate and low quality studies were removed, 72 full text articles were reviewed and from these 13 were included in the meta-analysis. The total number of patients was 597. Aneurysms were located in the upper arm in 289 (59%) cases and the smallest diameter of a treated aneurysm was 15 mm. The most frequent indication for treatment was bleeding prevention in 513 (86%) cases. Aneurysmorrhaphy was the surgical method of choice in all 13 studies. The pooled primary patency at 12 months was 82% (95% CI 69%-90%, 12 studies, I = 84%, p < .01). The 12 month primary patency rates were similar for aneurysmorrhaphy with external prosthetic reinforcement (85%, 95% CI 71%-93%, two studies, I = 0%, p = .33) and aneurysmorrhaphy performed using a stapler (74%, 95% CI 61%-83%, four studies, I = 0%, p = .48) and without a stapler (82%, 95% CI 60%-94%, six studies, I = 92%, p < .01).
CONCLUSION
Aneurysmorraphy of arteriovenous fistulae is a procedure with acceptable short and long term results, with a low complication and aneurysm recurrence rate.
Topics: Aneurysm; Arteriovenous Shunt, Surgical; Humans; Renal Dialysis; Time; Upper Extremity; Vascular Patency
PubMed: 31879147
DOI: 10.1016/j.ejvs.2019.07.033 -
International Journal of Medical... 2016The middle meningeal artery (MMA) is a very important artery in neurosurgery. Many diseases, including dural arteriovenous fistula (DAVF), pseudoaneurysm, true aneurysm,... (Review)
Review
The middle meningeal artery (MMA) is a very important artery in neurosurgery. Many diseases, including dural arteriovenous fistula (DAVF), pseudoaneurysm, true aneurysm, traumatic arteriovenous fistula (AVF), moyamoya disease (MMD), recurrent chronic subdural hematoma (CSDH), migraine and meningioma, can involve the MMA. In these diseases, the lesions occur in either the MMA itself and treatment is necessary, or the MMA is used as the pathway to treat the lesions; therefore, the MMA is very important to the development and treatment of a variety of neurosurgical diseases. However, no systematic review describing the importance of MMA has been published. In this study, we used the PUBMED database to perform a review of the literature on the MMA to increase our understanding of its role in neurosurgery. After performing this review, we found that the MMA was commonly used to access DAVFs and meningiomas. Pseudoaneurysms and true aneurysms in the MMA can be effectively treated via endovascular or surgical removal. In MMD, the MMA plays a very important role in the development of collateral circulation and indirect revascularization. For recurrent CDSHs, after burr hole irrigation and drainage have failed, MMA embolization may be attempted. The MMA can also contribute to the occurrence and treatment of migraines. Because the ophthalmic artery can ectopically originate from the MMA, caution must be taken to avoid causing damage to the MMA during operations.
Topics: Aneurysm; Central Nervous System Vascular Malformations; Collateral Circulation; Embolization, Therapeutic; Hematoma, Subdural, Chronic; Humans; Meningeal Arteries; Meningioma; Migraine Disorders; Moyamoya Disease; Neurosurgical Procedures
PubMed: 27766029
DOI: 10.7150/ijms.16489 -
European Journal of Vascular and... May 2017Arteriovenous fistula (AVF) formation is the most common vascular access procedure for patients requiring haemodialysis. However, it is associated with high failure... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Arteriovenous fistula (AVF) formation is the most common vascular access procedure for patients requiring haemodialysis. However, it is associated with high failure rates, influenced by vessel diameter and arterial inflow. Mode of anaesthesia may affect these factors, and subsequently AVF maturation rates.
OBJECTIVE
To perform a systematic review and meta-analysis to assess the effect of anaesthesia type for autologous primary radiocephalic or brachiocephalic AVF creation on subsequent fistula failure rates.
METHODS
The online databases of Medline, EMBASE, CINAHL, The Cochrane Database of Systematic Reviews, ClinicalTrials.gov, and Google Scholar as well as vascular and anaesthesiology conference abstracts were searched on August 1, 2016. Randomised control trials (RCTs) that reported the effect of anaesthesia type on subsequent failure rates during autologous AVF creation were included. Two independent reviewers performed methodological assessment and data extraction. Random effects models were used to calculate pooled effect size estimates. A sensitivity analysis was also carried out.
RESULTS
Four RCTs (286 patients) were identified with 286 autologous AVFs. There were 48 fistula failures. Most of the studies suffered from significant methodological flaws. There was a significantly lower failure rate among patients undergoing regional (12/143) compared with local (36/143) anaesthesia (OR 0.28, 95% CI 0.14-0.57). On sensitivity analysis, having excluded the most heavily weighted study, the results remained significant (OR 0.20, 95% CI 0.05-0.75).
CONCLUSIONS
The use of regional anaesthesia is associated with lower AVF failure rates when compared with local anaesthesia in patients undergoing primary forearm AVF formation for haemodialysis.
Topics: Adolescent; Adult; Aged; Anesthesia, Conduction; Anesthesia, Local; Arteriovenous Shunt, Surgical; Chi-Square Distribution; Female; Forearm; Humans; Male; Middle Aged; Odds Ratio; Renal Dialysis; Risk Factors; Treatment Outcome; Young Adult
PubMed: 28285956
DOI: 10.1016/j.ejvs.2017.01.025 -
Journal of Craniovertebral Junction &... 2020Perimedullary arteriovenous fistulas (PMAVFs) are uncommon vascular malformations, and they rarely occur at the level of the craniovertebral junction (CVJ). The... (Review)
Review
Perimedullary arteriovenous fistulas (PMAVFs) are uncommon vascular malformations, and they rarely occur at the level of the craniovertebral junction (CVJ). The therapeutic management is challenging and can include observation alone, endovascular occlusion, or surgical exclusion, depending on both patient and malformation characteristics. A systematic literature search was conducted using MEDLINE, Scopus, and Google Scholar databases, searching for the following combined MeSH terms: . We also present an emblematic case of PMAVF at the level of the craniovertebral junction associated to a venous pseudoaneurysm. A total of 31 published studies were identified; 10 were rejected from our review because they did not match our inclusion criteria. Our case was not included in the systematic review. We selected 21 studies for this systematic review with a total of 58 patients, including 20 females (34.5%) and 38 males (65.5%), with a female/male ratio of 1:1.9. Thirty-nine out of 58 patients underwent surgical treatment (67.2%), 15 out of 58 patients were treated with endovascular approach (25.8%), 3 out of 58 patients underwent combined treatment (5.2%), and only 1 patient was managed conservatively (1.7%). An improved outcome was reported in 94.8% of cases (55 out of 58 patients), whereas 3 out of 58 patients (5.2%) were moderately disabled after surgery and endovascular treatment. In literature, hemorrhagic presentation is reported as the most common onset (subarachnoid hemorrhage in 63% and intramedullary hemorrhage in 10%), frequently caused either by venous dilation, due to an ascending drainage pathway into an intracranial vein, or by the higher venous flow rates that can be associated with intracranial drainage. Hiramatsu and Sato stated that arterial feeders from the anterior spinal artery (ASA) and aneurysmal dilations are associated with hemorrhagic presentation. In agreement with the classification by Hiramatsu, we defined the PMAVF of the CVJ as a vascular lesion fed by the radiculomeningeal arteries from the vertebral artery and the spinal pial arteries from the ASA and/or lateral spinal artery. Considering the anatomical characteristics, we referred to our patient as affected by PMAVF, even if it was difficult to precisely localize the arteriovenous shunts because of the complex angioarchitecture of the fine feeding arteries and draining veins, but we presumed that the shunt was located in the point of major difference in vessel size between the feeding arteries and draining veins. PMAVFs of CVJ are rare pathologies of challenging management. The best diagnostic workup and treatment are still controversial: more studies are needed to compare different therapeutic strategies concerning both long-term occlusion rates and outcomes.
PubMed: 33100763
DOI: 10.4103/jcvjs.JCVJS_106_20 -
Clinical Cardiology Aug 2023Drug-coated balloons (DCBs) have been used in dialysis patients with arteriovenous fistula (AVF) stenosis, but whether DCBs have advantages over ordinary balloons is... (Meta-Analysis)
Meta-Analysis Review
Drug-coated balloons (DCBs) have been used in dialysis patients with arteriovenous fistula (AVF) stenosis, but whether DCBs have advantages over ordinary balloons is still controversial. A meta-analysis was designed to investigate the safety and efficacy of DCBs and common balloons (CBs) in the treatment of AVF stenosis. We searched the PubMed, EMBASE, and China National Knowledge Internet (CNKI) databases for randomized controlled trials that evaluated the comparison of DCB angioplasty versus CB angioplasty for AVF stenosis in dialysis patients and reported at least one outcome of interest. The results showed that the DCB group had a higher first-stage patency rate of the target lesion 6 months [odds ratio, OR = 2.31, 95% confidence interval, CI: (1.69, 3.15), p < .01] and 12 months [OR = 2.09, 95% CI: (1.50, 2.91), p < .01] after surgery. There was no statistically significant difference in all-cause mortality between the two groups at 6 months [OR = 0.85, 95% CI: (0.47, 1.52), p = .58] and 12 months [OR = 0.99, 95% CI: (0.60, 1.64), p = .97]. Compared with CB, DCBs as a new endovascular treatment for AVF stenosis have a higher primary patency rate of target lesions and can delay the occurrence of restenosis. There is no evidence that DCB can increase the mortality of patients.
Topics: Humans; Vascular Patency; Graft Occlusion, Vascular; Constriction, Pathologic; Treatment Outcome; Coated Materials, Biocompatible; Time Factors; Angioplasty, Balloon; Arteriovenous Fistula; Paclitaxel
PubMed: 37417371
DOI: 10.1002/clc.24078