-
Journal of Molecular Medicine (Berlin,... Jun 2021Chronic kidney disease is a widespread terminal illness that afflicts millions of people across the world. Hemodialysis is the predominant therapeutic management... (Review)
Review
Chronic kidney disease is a widespread terminal illness that afflicts millions of people across the world. Hemodialysis is the predominant therapeutic management strategy for kidney failure and involves the external filtration of metabolic waste within the circulation. This process requires an arteriovenous fistula (AVF) for vascular access. However, AVF maturation failures are significant obstacles in establishing long-term vascular access for hemodialysis. Appropriate stimulation, activation, and proliferation of smooth muscle cells, proper endothelial cell orientation, adequate structural changes in the ECM, and the release of anti-inflammatory markers are associated with maturation. AVFs often fail to mature due to inadequate tissue repair and remodeling, leading to neointimal hyperplasia lesions. The transdifferentiation of myofibroblasts and sterile inflammation are possibly involved in AVF maturation failures; however, limited data is available in this regard. The present article critically reviews the interplay of various damage-associated molecular patterns (DAMPs) and the downstream sterile inflammatory signaling with a focus on the NLRP3 inflammasome. Improved knowledge concerning AVF maturation pathways can be unveiled by investigating the novel DAMPs and the mediators of sterile inflammation in vascular remodeling that would open improved therapeutic opportunities in the management of AVF maturation failures and its associated complications.
Topics: Alarmins; Animals; Arteriovenous Fistula; Biomarkers; Disease Susceptibility; Humans; Inflammation; Signal Transduction; Toll-Like Receptors
PubMed: 33666676
DOI: 10.1007/s00109-021-02056-4 -
Experimental and Clinical... Jun 2023In patients with end-stage renal disease, arteriovenous fistulas are the standard of care to ensure long-term vascular access. Recent studies suggest some long-term...
OBJECTIVES
In patients with end-stage renal disease, arteriovenous fistulas are the standard of care to ensure long-term vascular access. Recent studies suggest some long-term posttransplant cardiac benefits and quality of life improvements in kidney transplant recipients due to arteriovenous fistula ligation. However, there are no guidelines regarding arteriovenous fistula management after transplant. Our study objective was to evaluate the long-term safety of arteriovenous fistula ligation and the frequency of returning to hemodialysis after ligation.
MATERIALS AND METHODS
Retrospective chart review from February 2014 to December 2020 identified 578 adult patients who underwent successful kidney transplant at our center. Of these patients, 47 underwent subsequent arteriovenous fistula ligation. Both medically driven and patient-driven cases were assessed and approved by a transplant nephrology team with regard to allograft function and ligation suitability.
RESULTS
Our results showed that, of the 47 renal transplant patients, 70.2% chose to undergo arteriovenous fistula ligation due to aneurysmal formation, 44.7% due to pain, and 14.9% due to high-output heart failure. In total, 68.1% of arteriovenous fistula ligations performed were primarily patient driven. There was an average follow-up of 2.9 years after ligation, with 1 unrelated reoperation and no returns to dialysis for all patients who underwent arteriovenous fistula ligation.
CONCLUSIONS
In our study, the long-term risks of surgical complications and allograft impairment after ligation were negligible. As a result of our current findings and known positive cardiovascular benefit, patient-driven arteriovenous fistula ligation after kidney transplant should be routinely considered in patients with stable allograft function.
Topics: Adult; Humans; Kidney Transplantation; Retrospective Studies; Quality of Life; Arteriovenous Shunt, Surgical; Treatment Outcome; Renal Dialysis; Kidney Failure, Chronic; Arteriovenous Fistula; Ligation
PubMed: 37455468
DOI: 10.6002/ect.2023.0024 -
Annals of Neurology Apr 2022
Topics: Arteriovenous Fistula; Arteriovenous Malformations; Capillaries; Humans; Port-Wine Stain; Vascular Malformations
PubMed: 35152468
DOI: 10.1002/ana.26316 -
Renal Failure Dec 2024This study aimed to investigate ultrasound features of arteriovenous fistula stenosis and their relationship with primary patency after percutaneous transluminal...
This study aimed to investigate ultrasound features of arteriovenous fistula stenosis and their relationship with primary patency after percutaneous transluminal angioplasty (post-intervention primary patency) and compare this classification with that using lesion location. Hemodialysis patients who underwent ultrasound-guided percutaneous transluminal angioplasty for arteriovenous fistula stenosis from July 2020 to December 2021 were retrospectively evaluated. Lesions (excluding inflow arteries) were categorized into five groups based on ultrasound features, and the clinical characteristics and risk factors affecting the post-intervention primary patency of the arteriovenous fistula were analyzed. Among 185 patients, 100 (54.05%), 36 (19.46%), 22 (11.89%), 11 (5.95%), and 16 (8.65%) were classified into the intima-dominant, non-intima-dominant, valve obstruction, vascular calcification, and mixed groups, respectively. The dialysis duration and arteriovenous fistula use time were the highest in the vascular calcification group at 86 (interquartile range: 49-140) and 77 (interquartile range: 49-110) months, respectively. Diabetes mellitus was most common in the intima-dominant group (42.0%). In Kaplan-Meier and univariate Cox analysis, type III lesion location (stenosis in the venous confluence site) was associated with the lower post-intervention primary patency. In the multivariate Cox analysis, percutaneous transluminal angioplasty times (the number of times patients were treated with percutaneous transluminal angioplasty for arteriovenous fistula stenosis dysfunction), vascular calcification, calcification at the lesion site requiring percutaneous transluminal angioplasty, and serum parathyroid hormone levels were independent risk factors for post-intervention primary patency. Ultrasound features showed that calcification of the arteriovenous fistula was detrimental to the post-intervention primary patency of arteriovenous fistula.
Topics: Humans; Constriction, Pathologic; Retrospective Studies; Ultrasonography; Vascular Calcification; Arteriovenous Fistula
PubMed: 38186351
DOI: 10.1080/0886022X.2023.2294148 -
European Journal of Vascular and... Sep 2023
Topics: Humans; Arteriovenous Fistula; Arteriovenous Shunt, Surgical; Renal Dialysis; Vascular Patency; Treatment Outcome
PubMed: 37423601
DOI: 10.1016/j.ejvs.2023.07.006 -
Journal of Travel Medicine Jun 2023
Topics: Animals; Humans; Skates, Fish; Arteriovenous Fistula; Renal Dialysis
PubMed: 36006830
DOI: 10.1093/jtm/taac098 -
Cardiovascular and Interventional... Sep 2023Arteriovenous fistula (AVF) stenosis is a common problem leading to dialysis access dysfunction. The conventional balloon (CB) is the most commonly used device during... (Review)
Review
Arteriovenous fistula (AVF) stenosis is a common problem leading to dialysis access dysfunction. The conventional balloon (CB) is the most commonly used device during angioplasty but suffers from poor durability of results due to neointimal hyperplasia-mediated recurrence. The drug-coated balloon (DCB) is an adjunct to balloon angioplasty that reduces neointimal hyperplasia, thereby improving post-angioplasty patency. Despite the heterogeneity of DCB clinical trials to date, the evidence suggests that DCBs of different brands are not necessarily equal, and that patient selection, adequate lesion preparation and proper DCB procedural technique are important to realize the benefit of DCB angioplasty.
Topics: Humans; Vascular Patency; Graft Occlusion, Vascular; Constriction, Pathologic; Hyperplasia; Cardiovascular Agents; Coated Materials, Biocompatible; Time Factors; Treatment Outcome; Arteriovenous Shunt, Surgical; Vascular Access Devices; Renal Dialysis; Angioplasty, Balloon; Arteriovenous Fistula; Paclitaxel
PubMed: 37414842
DOI: 10.1007/s00270-023-03497-9 -
Saudi Medical Journal Jun 2022To identify predictors of recurrent arteriovenous fistula (AVF) stenosis. It also seeks to calculate the average primary patency duration in Saudi patients undergoing...
OBJECTIVES
To identify predictors of recurrent arteriovenous fistula (AVF) stenosis. It also seeks to calculate the average primary patency duration in Saudi patients undergoing hemodialysis.
METHODS
A retrospective case-control study was conducted at a tertiary care hospital in Riyadh. Data from 180 patients who had undergone angioplasty between May 2009 and May 2020 were analyzed. Following the inclusion/exclusion criteria, 99 patients were included. Based on the presence or absence of recurrent AVF stenosis, the patients were divided into cases and controls, respectively. Recurrence was defined as an occurrence of stenosis within <12 months of a previous stenotic event, or patients who had >3 total stenotic events. Clinical, radiological, and laboratory variables were collected and subjected to multivariate binary regression analysis to assess the odds of a recurrence of fistula stenosis.
RESULTS
A total of 29 patients were categorized as cases, while 70 patients were categorized as controls. The median primary patency duration was found to be seven months. Multivariate binary regression analysis revealed higher levels of serum calcium (=0.012) and BMI (=0.007) in patients with recurrent stenosis. A positive association was also observed between the use of antiplatelets (0.039) and recurrent stenosis.
CONCLUSION
Higher levels of corrected calcium, BMI, and the application of antiplatelet therapy were found to be predictors of recurrent AVF stenosis. No other traditional variables were found to be significant.
Topics: Angioplasty, Balloon; Arteriovenous Fistula; Arteriovenous Shunt, Surgical; Calcium; Case-Control Studies; Constriction, Pathologic; Humans; Renal Dialysis; Retrospective Studies; Saudi Arabia; Treatment Outcome; Vascular Patency
PubMed: 35675938
DOI: 10.15537/smj.2022.43.6.20220192 -
Neurosciences (Riyadh, Saudi Arabia) Jan 2023A 65-year-old male patient presented with a rare arterio-venous fistula (AFV). The symptoms included congestion, decreased visual acuity, and proptosis. Further...
A 65-year-old male patient presented with a rare arterio-venous fistula (AFV). The symptoms included congestion, decreased visual acuity, and proptosis. Further investigation revealed a non-traumatic intra orbital AFV with ophthalmic vein thrombosis. The management strategy was craniotomy and the prescription of anticoagulants. The patient recovered 2 months after surgery demonstrating successful resolution of his presenting symptoms and an alternative approach to complicated cases of embolization.
Topics: Male; Humans; Aged; Arteriovenous Fistula; Exophthalmos; Venous Thrombosis; Embolization, Therapeutic
PubMed: 36617457
DOI: 10.17712/nsj.2023.1.20220012 -
World Neurosurgery Oct 2019Fistulas of the filum terminale are rare lesions that result from a fistulous connection between the artery and vein of the filum terminale. These lesions often present... (Review)
Review
BACKGROUND
Fistulas of the filum terminale are rare lesions that result from a fistulous connection between the artery and vein of the filum terminale. These lesions often present as progressive thoracic myelopathy secondary to venous hypertension that is transmitted to the coronal venous plexus of the spinal cord. Frequently, filum fistulas will be associated with lumbar stenosis and likely form as a result of chronic inflammation and compression. However, owing to the relative rarity of filum fistulas and the commonality of lumbar stenosis, the presence of a filum fistula could be overlooked or misdiagnosed.
CASE DESCRIPTION
We have presented the case of a 62-year-old man with severe lumbar stenosis who had presented with progressive thoracic myelopathy. The evaluation, including spinal angiography, identified a low-flow arteriovenous fistula within the filum terminale that was successfully treated with microsurgical obliteration. The patient tolerated the procedure well, with good functional recovery within 1 month.
CONCLUSION
Just as was the case with our patient, these lesions demonstrate a high association with lumbar stenosis and tethered or tight cord syndrome. We reviewed the clinical presentation, imaging findings, surgical management, and possible mechanisms of development for these rarely encountered fistulas.
Topics: Arteriovenous Fistula; Cauda Equina; Humans; Male; Middle Aged; Peripheral Nervous System Diseases; Spinal Cord Diseases; Thoracic Vertebrae
PubMed: 31254689
DOI: 10.1016/j.wneu.2019.06.136