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The Journal of Vascular Access Jan 2024The arteriovenous fistula is the main vascular access in hemodialysis. Arteriovenous fistula access is generally evaluated by a vascular surgeon after 2 weeks of its...
BACKGROUND
The arteriovenous fistula is the main vascular access in hemodialysis. Arteriovenous fistula access is generally evaluated by a vascular surgeon after 2 weeks of its surgery, however, exercise programs may begin earlier for improving outcomes. Therefore, we propose this guide with simple, but potentially effective exercises, using low-cost materials that can be safely performed by the patients at home or in the dialysis center. It also provides to the dialysis staff team a starting point for implementing an upper-limb exercise program that may facilitate arteriovenous fistula maturation and maintenance.
METHODS
This exercise routine for arteriovenous fistula maturation can be performed three to four times a day, every day, from 2 to 4 weeks. After its maturation, it can be performed on every non-dialysis day for conventional treatment and every other day, before dialysis, for short daily treatment.
CONCLUSIONS
Based on the available evidence, we have gathered some exercises, in a very easy and understandable language, that may potentially help arteriovenous fistula maturation and maintenance for hemodialysis patients.
Topics: Humans; Treatment Outcome; Arteriovenous Shunt, Surgical; Renal Dialysis; Upper Extremity; Arteriovenous Fistula; Vascular Patency
PubMed: 36120915
DOI: 10.1177/11297298221103797 -
Seminars in Interventional Radiology Jun 2023Dialysis access steal syndrome (DASS) is a phenomenon known to occur following creation of an arteriovenous fistula or arteriovenous graft. The clinical presentation of... (Review)
Review
Dialysis access steal syndrome (DASS) is a phenomenon known to occur following creation of an arteriovenous fistula or arteriovenous graft. The clinical presentation of DASS is characterized by symptoms of limb ischemia due to diversion of arterial flow from the distal extremity. Ischemic monomelic neuropathy (IMN) is a rare subtype of DASS classically described as an acute, isolated presentation of peripheral neuropathy following dialysis access creation. Although the underlying pathophysiology is not entirely understood, the clinical manifestation of IMN is often described as severe distal limb pain that progresses to motor and sensory defects. The onset of IMN may occur immediately following dialysis access creation or intervention. Here, we present a case of IMN following assisted maturation of an endovascular fistula.
PubMed: 37484452
DOI: 10.1055/s-0043-1769765 -
JAMA Network Open Dec 2023The incidence of pregnancy-related acute kidney injury is increasing and is associated with significant maternal morbidity including progression to end-stage kidney...
IMPORTANCE
The incidence of pregnancy-related acute kidney injury is increasing and is associated with significant maternal morbidity including progression to end-stage kidney disease (ESKD). Little is known about characteristics and long-term outcomes of patients who develop pregnancy-related ESKD.
OBJECTIVES
To examine the characteristics and clinical outcomes of patients with pregnancy-related ESKD and to investigate associations between pre-ESKD nephrology care and outcomes.
DESIGN, SETTING, AND PARTICIPANTS
This was a cohort study of 183 640 reproductive-aged women with incident ESKD between January 1, 2000, and November 20, 2020, from the US Renal Data System and maternal data from births captured in the US Centers for Disease Control and Prevention publicly available natality data. Data were analyzed from December 2022 to June 2023.
EXPOSURE
Pregnancy-related primary cause of ESKD, per International Classification of Diseases, Ninth Revision (ICD-9) and ICD-10 codes reported at ESKD onset by the primary nephrologist on Centers for Medicare and Medicaid Services form 2728.
MAIN OUTCOMES MEASURES
Multivariable Cox proportional hazards and competing risk models were constructed to examine time to (1) mortality, (2) access to kidney transplant (joining the waiting list or receiving a live donor transplant), and (3) receipt of transplant after joining the waitlist.
RESULTS
A total of 341 patients with a pregnancy-related primary cause of ESKD were identified (mean [SD] age 30.2 [7.3]). Compared with the general US birthing population, Black patients were overrepresented among those with pregnancy-related ESKD (109 patients [31.9%] vs 585 268 patients [16.2%]). In adjusted analyses, patients with pregnancy-related ESKD had similar or lower hazards of mortality compared with those with glomerulonephritis or cystic kidney disease (adjusted hazard ratio [aHR], 0.96; 95% CI, 0.76-1.19), diabetes or hypertension (aHR, 0.49; 95% CI, 0.39-0.61), or other or unknown primary causes of ESKD (aHR, 0.60; 95% CI, 0.48-0.75). Despite this, patients with pregnancy-related ESKD had significantly lower access to kidney transplant compared with those with other causes of ESKD, including (1) glomerulonephritis or cystic kidney disease (adjusted subhazard ratio [aSHR], 0.51; 95% CI, 0.43-0.66), (2) diabetes or hypertension (aSHR, 0.81; 95% CI, 0.67-0.98), and (3) other or unkown cause (aSHR, 0.82; 95% CI, 0.67-0.99). Those with pregnancy-related ESKD were less likely to have nephrology care or have a graft or arteriovenous fistula placed before ESKD onset (nephrology care: adjusted relative risk [aRR], 0.47; 95% CI, 0.40-0.56; graft or arteriovenous fistula placed: aRR, 0.31; 95% CI, 0.17-0.57).
CONCLUSION AND RELEVANCE
In this study, those with pregnancy-related ESKD had reduced access to transplant and nephrology care, which could exacerbate existing disparities in a disproportionately Black population. Increased access to care could improve quality of life and health outcomes among these young adults with high potential for long-term survival.
Topics: Pregnancy; Young Adult; Humans; Aged; Female; United States; Adult; Cohort Studies; Quality of Life; Medicare; Kidney Failure, Chronic; Glomerulonephritis; Diabetes Mellitus; Hypertension; Kidney Diseases, Cystic; Arteriovenous Fistula
PubMed: 38064217
DOI: 10.1001/jamanetworkopen.2023.46314 -
Journal of Medical Case Reports Oct 2023This paper analyzed the cases of dural arteriovenous fistula (DAVF) with spinal dural arteriovenous fistula (SDAVF) in the diagnosis and treatment process. (Review)
Review
BACKGROUND
This paper analyzed the cases of dural arteriovenous fistula (DAVF) with spinal dural arteriovenous fistula (SDAVF) in the diagnosis and treatment process.
CASE PRESENTATION
One case involving dural arteriovenous fistula (DAVF) with spinal dural arteriovenous fistula (SDAVF) from the 306th Hospital of PLA was retrospectively analyzed. The patient consulted the doctor due to lower limb sensory and motor disorders while exhibiting symptoms of urinary dysfunction. A computed tomographic angiography (CTA) and cerebral angiography confirmed the diagnosis of dural arteriovenous fistula (DAVF), necessitating surgical treatment. The patient was referred to our hospital for an magnetic resonance imaging (MRI) and a spinal angiography to obtain a confirmed diagnosis for spinal arteriovenous fistula, after which they underwent surgical fistula resection. The invasive intracranial dural arteriovenous fistula (DAVF) resection proceeded smoothly but did not ease the patient's symptoms. However, postoperative symptoms were partially relieved by the lumbar open spinal dural arteriovenous fistula adminstration.
CONCLUSIONS
Since not enough is understood about these two diseases, the rate of misdiagnosis is significantly increased. Early diagnosis and treatment of spinal dural arteriovenous fistula (SDAVF) can play a positive role during the recovery from neural function damage.
Topics: Humans; Arteriovenous Fistula; Central Nervous System Vascular Malformations; Cerebral Angiography; Magnetic Resonance Imaging; Retrospective Studies
PubMed: 37872601
DOI: 10.1186/s13256-023-04170-y -
Annals of Vascular Surgery Jul 2023Arteriovenous fistulae mature less frequently in women than in men, leading to inferior patency and decreased fistula utilization in women. We hypothesized that both...
BACKGROUND
Arteriovenous fistulae mature less frequently in women than in men, leading to inferior patency and decreased fistula utilization in women. We hypothesized that both anatomic and physiologic sex differences explain reduced maturation.
METHODS
The electronic medical records of patients who had a primary arteriovenous fistula created from 2016 to 2021 at a single center were reviewed; sample size was determined using a power calculation. Postoperative ultrasound and laboratory tests were obtained at least 4 weeks after fistula creation. Primary unassisted fistula maturation was determined up to 4 years postprocedure.
RESULTS
A total of 28 women and 28 men with a brachial-cephalic fistula were analyzed. The inflow brachial artery diameter was smaller in women than in men, both preoperatively (4.2 ± 0.9 vs. 4.9 ± 1.0 mm, P = 0.008) and postoperatively (4.8 ± 0.8 vs. 5.3 ± 0.9 mm, P = 0.039). Despite similar preoperative brachial artery peak systolic velocity, women had significantly lower postoperative arterial velocity (P = 0.027). Fistula flow was reduced in women, particularly in the midhumerus (747.0 ± 570.4 vs. 1,117.1 ± 471.3 cc/min, P = 0.003). Percentages of neutrophils and lymphocytes were similar among women and men 6 weeks after fistula creation. However, women had reduced monocytes (8.5 ± 2.0 vs. 10.0 ± 2.6%, P = 0.0168). Among 28 men, 24 of 28 (85.7%) achieved unassisted maturation, whereas only 15 of 28 (53.6%) women had fistulae that matured without intervention. Secondary analysis using logistic regression suggested that postoperative arterial diameter was associated with maturation in men, while postoperative monocyte percentage was associated with maturation in women.
CONCLUSIONS
Sex differences during arteriovenous fistula maturation are present in arterial diameter and velocity, suggesting that both anatomic and physiologic differences in arterial inflow contribute to sex differences in fistula maturation. In men, postoperative arterial diameter is correlated with maturation, whereas in women, the significantly lower proportion of circulating monocytes suggests a role for the immune response in fistula maturation.
Topics: Humans; Female; Male; Arteriovenous Shunt, Surgical; Monocytes; Treatment Outcome; Renal Dialysis; Brachial Artery; Arteriovenous Fistula; Vascular Patency; Retrospective Studies
PubMed: 36812979
DOI: 10.1016/j.avsg.2023.01.052 -
The Neuroradiology Journal Dec 2023Cerebellar pial arteriovenous fistula (PAVF) in adults presenting with congestive edema of the brainstem and cervical cord has rarely been reported. Here, we report such...
Cerebellar pial arteriovenous fistula (PAVF) in adults presenting with congestive edema of the brainstem and cervical cord has rarely been reported. Here, we report such a case. A 59-year-old man presented with progressive weakness and numbness of the limbs and hiccups for 6 months. On physical examination, his limbs had grade III muscle strength, and he was unable to stand or walk. He also had occasional incontinence and retention. There was a positive Babinski sign in both lower limbs. Below the neck, he had hypoesthesia of the skin. Magnetic resonance imaging (MRI) showed edema of the brainstem and upper cervical cord. Digital subtraction angiography (DSA) confirmed there was a cerebellar nongalenic-type PAVF lesion; the feeding arteries were the branches of the posterior inferior cerebellar artery (PICA); and the draining vein was a single cortical vein that ultimately entered the venous systems of the brainstem and upper cervical cord. Casting Onyx-18 via the PICA obliterated the PAVF. Postoperatively, the patient recovered gradually. Two and a half months later, he could walk using a crutch and had no incontinence. Six-month follow-up MRI and DSA revealed recession of the edema of the brainstem and cervical cord and no recurrence of this PAVF. One year later, he was nearly normal. In conclusion and extremely rarely, cerebellar nongalenic-type PAVF can present with congestive edema of the brainstem and high cervical cord. This treatment by Onyx-18 embolization can resolve PAVF.
PubMed: 38135276
DOI: 10.1177/19714009231224421 -
Journal of Nephrology Mar 2024Arteriovenous fistula represents the preferred vascular access for patients with kidney failure requiring hemodialysis. Surgeons have traditionally used physical... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Arteriovenous fistula represents the preferred vascular access for patients with kidney failure requiring hemodialysis. Surgeons have traditionally used physical examination to identify the most suitable vessels. This meta-analysis aims to evaluate whether ultrasound mapping should be routinely performed before arteriovenous fistula creation.
METHODS
Medline, Scopus, Web of Science and CENTRAL were systematically searched from inception to November 1, 2022. Randomized controlled trials and cohort studies comparing routine ultrasound mapping to physical examination in terms of arteriovenous fistula patency were included. Meta-analysis was performed by fitting random-effects models. The study protocol has been prospectively registered in PROSPERO (CRD42023402390).
RESULTS
Overall, 18 studies were included, comprising 3655 participants. Routine pre-operative ultrasound mapping was associated with significantly lower rates of primary arteriovenous fistula failure (Risk Ratio-RR: 0.56, 95% confidence intervals-CI: 0.37-0.84, low certainty). A significant outcome was observed by separately pooling randomized controlled trials (RR: 0.37, 95% CI: 0.25-0.54). Routine ultrasound mapping was also associated with significantly higher rates of 1-year primary arteriovenous fistula patency (RR: 1.33, 95% CI: 1.19-1.47, moderate certainty). This effect remained significant in the analysis of randomized controlled trials (RR: 1.26, 95% CI: 1.02-1.56).
CONCLUSIONS
Implementing routine pre-operative ultrasound mapping of vessels is associated with significantly better outcomes in terms of early arteriovenous fistula failure and primary patency rates at 12 months. Further research should confirm the long-term benefits of routine ultrasound examination and evaluate its cost-effectiveness in different populations.
Topics: Humans; Arteriovenous Shunt, Surgical; Renal Dialysis; Ultrasonography; Vascular Patency; Preoperative Care; Kidney Failure, Chronic
PubMed: 38133741
DOI: 10.1007/s40620-023-01814-6 -
Internal Medicine (Tokyo, Japan) Feb 2024We herein report a case of acute neurological symptoms and a fever initially suspected of being encephalitis but later revealed to be dural arteriovenous fistula (dAVF).... (Review)
Review
We herein report a case of acute neurological symptoms and a fever initially suspected of being encephalitis but later revealed to be dural arteriovenous fistula (dAVF). An 84-year-old woman had a fever and cerebral edema and was initially treated for encephalitis. A review of her magnetic resonance imaging findings revealed abnormal blood flow signals. After cerebral angiography, the patient was finally diagnosed with left transverse-sigmoid sinus dAVF. The present case showed that dAVF can also present with an acute onset and a fever, mimicking acute encephalitis. Because the treatments for encephalitis and dAVF differ greatly, the possibility of dAVF should also be considered when diagnosing encephalitis.
Topics: Female; Humans; Aged, 80 and over; Embolization, Therapeutic; Transverse Sinuses; Magnetic Resonance Imaging; Central Nervous System Vascular Malformations; Cerebral Angiography
PubMed: 37258162
DOI: 10.2169/internalmedicine.1819-23 -
Journal of Renal Care Dec 2023Nurses have a great responsibility in the daily care of arteriovenous fistulae, which entails the potential to affect patency. However, good cannulation technique...
BACKGROUND
Nurses have a great responsibility in the daily care of arteriovenous fistulae, which entails the potential to affect patency. However, good cannulation technique involves more than placing a needle in the vessel and relies on different skills to facilitate needling.
OBJECTIVES
To describe the preconditions for cannulation in arteriovenous fistulas.
DESIGN
Descriptive statistics and qualitative content analysis were used in a mixed-methods design.
PARTICIPANTS
Haemodialysis units in Sweden.
MEASUREMENTS
Local guidelines regarding arteriovenous fistula cannulation were analysed in parallel with responses to a questionnaire that contained open-ended and closed-ended questions on cannulation technique.
RESULTS
Preconditions that facilitate cannulation fall into five stages, each with relevant factors in relation to the cannulation, as follows: planning cannulation-maturation and planning the cannulation, patient record, education and experience, and patient information; precannulation-physical examination, hygiene routines, arm position, tourniquet, choosing the cannulation site, and preventing pain; during cannulation-how to needle, type of needle, angle during cannulation, fixation, and adjusting; evaluating cannulation-blood flow rate and arterial and venous pressure; and postcannulation-needle withdrawal and haemostasis. The majority of dialysis units identified implementation of most of these preconditions, but the units handle several practical aspects differently.
CONCLUSIONS
Tracing the chain of cannulation led to identification of necessary preconditions for facilitating good cannulation technique. The findings also show the need for a better understanding of how different preconditions affect arteriovenous fistula and patency.
Topics: Humans; Renal Dialysis; Arteriovenous Shunt, Surgical; Catheterization; Arteriovenous Fistula; Sweden
PubMed: 36394202
DOI: 10.1111/jorc.12448 -
Annals of Vascular Surgery Sep 2023The end-stage kidney disease life-plan aims to individualize hemodialysis (HD) access selection in patients requiring renal replacement therapy. Paucity of data on risk...
BACKGROUND
The end-stage kidney disease life-plan aims to individualize hemodialysis (HD) access selection in patients requiring renal replacement therapy. Paucity of data on risk factors for poor arteriovenous fistula (AVF) outcomes limits the ability of physicians to guide their patients on this decision. This is especially true for female patients, who are known to have worse AVF outcomes when compared to male patients. The goal of this study was to identify risk factors associated with poor AVF maturation outcomes in female patients that will help guide individualized access selection.
METHODS
A retrospective review of 1,077 patients that had AVF creation between 2014 and 2021 at an academic medical center was performed. Maturation outcomes were compared between 596 male and 481 female patients. Separate multivariate logistic regression models were created for the male and female cohorts to identify factors associated with unassisted maturation. AVF was considered mature if it was successfully used for HD for 4-week sessions without need for further interventions. Unassisted fistula was defined as an AVF that matured without any interventions.
RESULTS
The male patients were more likely to receive more distal HD access; 378 (63%) male versus 244 (51%) female patients had radiocephalic AVF, P < 0.001. Maturation outcomes were significantly worse in female patients; 387 (80%) AVFs matured in females and 519 (87%) in male patients, P < 0.001. Similarly, the rate of unassisted maturation was 26% (125) in female patients versus 39% (233) in male patients, P < 0.001. Mean preoperative vein diameters were similar in both groups; 2.8 ± 1.1 mm in male versus 2.7 ± 0.97 mm in female patients, P = 0.17. Multivariate logistic regression analysis of the female patients revealed that Black race (odds ratio [OR]: 0.6, 95% confidence interval [CI]: 0.4-0.9, P = 0.045), radiocephalic AVF (OR: 0.6, 95% CI: 0.4-0.9, P = 0.045), and preoperative vein diameter <2.5 mm (OR: 1.4, 95% CI: 10.33-0.901.1-1.7, P = 0.014) were independent predictors of poor unassisted maturation in this cohort. In male patients, preoperative vein diameter <2.5 mm (OR: 1.4, 95% CI: 1.2-1.7, P < 0.001) and need for HD prior to AVF creation (OR: 0.6, 95% CI: 0.3-0.9, P = 0.018) were independent predictors of poor unassisted maturation.
CONCLUSIONS
Black women with marginal forearm veins may have worse maturation outcomes, and upper arm HD access should be considered when advising patients on their end-stage kidney disease life-plan.
Topics: Humans; Male; Female; Arteriovenous Shunt, Surgical; Treatment Outcome; Vascular Patency; Kidney Failure, Chronic; Renal Dialysis; Retrospective Studies; Arteriovenous Fistula
PubMed: 37270092
DOI: 10.1016/j.avsg.2023.05.032