-
Canadian Family Physician Medecin de... Aug 2022To provide family physicians with an evidence-based overview on the various methods of vascular access for hemodialysis (HD) and to provide a framework for the clinical... (Review)
Review
OBJECTIVE
To provide family physicians with an evidence-based overview on the various methods of vascular access for hemodialysis (HD) and to provide a framework for the clinical assessment of HD access.
SOURCES OF INFORMATION
A MEDLINE literature search was conducted using the MeSH terms , , , and (or ), including all relevant English-language articles published between January 1995 and September 2021.
MAIN MESSAGE
The main types of permanent vascular access for HD are arteriovenous fistulas, arteriovenous grafts, and central venous catheters. A pragmatic, patient-centred approach is required when choosing the type of access for an individual. Common complications of vascular access creation include thrombosis, central venous stenosis, dialysis access steal syndrome, and arteriovenous fistula aneurysms.
CONCLUSION
Family physicians play an important role in the clinical assessment and monitoring of HD vascular access. A thorough clinical assessment can detect a failing arteriovenous fistula and any associated complications, which can allow for prompt investigation and intervention to restore functionality, maintain access longevity, and improve patient quality of life.
Topics: Arteriovenous Fistula; Arteriovenous Shunt, Surgical; Central Venous Catheters; Humans; Quality of Life; Renal Dialysis; Treatment Outcome
PubMed: 35961720
DOI: 10.46747/cfp.6808577 -
Journal of the American Society of... Sep 2020
Topics: Arteriovenous Fistula; Arteriovenous Shunt, Surgical; Humans; Renal Dialysis
PubMed: 32639939
DOI: 10.1681/ASN.2020060854 -
Techniques in Vascular and... Dec 2022The vascular lab (VL) provides vital information for dialysis access to guide management. This article discusses the indication, protocol, and diagnostic criteria for...
The vascular lab (VL) provides vital information for dialysis access to guide management. This article discusses the indication, protocol, and diagnostic criteria for the evaluation of arteriovenous fistulas and grafts. An arteriovenous (AV) dialysis access is made by creating a connection between an artery and vein (AV fistula [AVF]) or by interposing a conduit between an artery and a vein (AV graft [AVG]) to provide high flow circuit for hemodialysis. A normal mature AV dialysis access has a thrill or vibration from turbulent flow in the graft or vein. The nomenclatures at our institution for an AVF and AVG are in the Figure 1 A and B diagrams.
Topics: Humans; Arteriovenous Shunt, Surgical; Renal Dialysis; Arteriovenous Fistula; Veins; Arteries
PubMed: 36404066
DOI: 10.1016/j.tvir.2022.100864 -
CNS Neuroscience & Therapeutics Oct 2019Patients with brain arteriovenous malformation (bAVM) are at risk of intracranial hemorrhage (ICH). Overall, bAVM accounts for 25% of hemorrhagic strokes in adults... (Review)
Review
Patients with brain arteriovenous malformation (bAVM) are at risk of intracranial hemorrhage (ICH). Overall, bAVM accounts for 25% of hemorrhagic strokes in adults <50 years of age. The treatment of unruptured bAVMs has become controversial, because the natural history of these patients may be less morbid than invasive therapies. Available treatments include observation, surgical resection, endovascular embolization, stereotactic radiosurgery, or combination thereof. Knowing the risk factors for bAVM hemorrhage is crucial for selecting appropriate therapeutic strategies. In this review, we discussed several biological risk factors, which may contribute to bAVM hemorrhage.
Topics: Arteriovenous Fistula; Blood-Brain Barrier; Embolization, Therapeutic; Humans; Intracranial Arteriovenous Malformations; Intracranial Hemorrhages; Radiosurgery; Risk Factors; Vascular Endothelial Growth Factor A
PubMed: 31359618
DOI: 10.1111/cns.13200 -
Fertility and Sterility Oct 2021To quantify the efficacy of medical management of uterine arteriovenous malformation (AVM) and compare efficacy between different classes of medication. In addition, we... (Comparative Study)
Comparative Study Meta-Analysis
OBJECTIVE
To quantify the efficacy of medical management of uterine arteriovenous malformation (AVM) and compare efficacy between different classes of medication. In addition, we evaluated for factors associated with treatment success and pregnancy outcomes after medical management.
DESIGN
Systematic review and meta-analysis.
SETTING
Not applicable.
PATIENT(S)
Thirty-two studies representing 121 premenopausal women with medically-treated uterine AVM were identified via database searches of MEDLINE, Embase, Web of Science, and cited references.
INTERVENTION(S)
Medical treatment with progestins, gonadotropin-releasing hormone agonists (GnRH-a), methotrexate, combined hormonal contraception , uterotonics, danazol, or combination of the above.
MAIN OUTCOME MEASURE(S)
Primary outcome of treatment success was defined as AVM resolution without subsequent procedural interventions. Secondary outcome was treatment complication (readmission or transfusion).
RESULT(S)
The overall success rate of medical management was 88% (106/121). After adjusting for clustering effects, success rates for progestin (82.5%; 95% confidence interval [CI], 70.1%-90.4%), GnRH-a (89.3%; 99% CI, 71.4%-96.5%) and methotrexate (90.0%; 99% CI, 55.8%-98.8%) were significantly different from the null hypothesis of 50% success. The agents with the lowest adjusted proportion of complications were progestins (10.0%; 99% CI, 3.3%-26.8%) and GnRH-a (10.7%; 99% CI, 3.5%-28.4%). No clinical factors were found to predict treatment success. Twenty-six subsequent pregnancies are described, with no reported recurrences of AVM.
CONCLUSION(S)
Medical management for uterine AVM is a reasonable approach in a well selected patient. These data should be interpreted in the context of significant publication bias.
Topics: Arteriovenous Fistula; Blood Transfusion; Clinical Decision-Making; Female; Humans; Patient Readmission; Patient Selection; Pregnancy; Pregnancy Rate; Risk Assessment; Risk Factors; Treatment Outcome; Uterine Artery; Uterus
PubMed: 34130801
DOI: 10.1016/j.fertnstert.2021.05.095 -
Kidney360 Jan 2021
Topics: Arteriovenous Fistula; Arteriovenous Shunt, Surgical; Humans; Kidney Diseases; Renal Dialysis
PubMed: 35368825
DOI: 10.34067/KID.0006262020 -
Journal of Vascular Surgery Nov 2019
Topics: Arteriovenous Fistula; Data Systems; Humans; Kidney Transplantation; United States
PubMed: 31653392
DOI: 10.1016/j.jvs.2019.07.066 -
Annals of Vascular Surgery Sep 2022Intimal hyperplasia (IH), a crucial histopathological injury, forms the basis of vascular stenosis and thrombogenesis. In addition, it is common in maladies such as... (Review)
Review
Intimal hyperplasia (IH), a crucial histopathological injury, forms the basis of vascular stenosis and thrombogenesis. In addition, it is common in maladies such as stenosis at the anastomosis of arteriovenous fistula and restenosis after angioplasty. Various cellular and noncellular components play critical parts in the advancement of IH. This article reviews the distinctive components of IH, such as endothelial dysfunction, multiplication, and movement of vascular smooth muscle cells. Finally, in addition to synthesis of large amounts of extracellular matrix and inflammatory responses, which have frequently been studied in recent years, we offer a premise for clinical treatment with vascular smooth muscle cells.
Topics: Arteriovenous Fistula; Constriction, Pathologic; Humans; Hyperplasia; Treatment Outcome; Tunica Intima
PubMed: 35472499
DOI: 10.1016/j.avsg.2022.04.030 -
Journal of the American Society of... Nov 2019
Topics: Arteriovenous Fistula; Arteriovenous Shunt, Surgical; Cohort Studies; Humans; Renal Dialysis; Retrospective Studies
PubMed: 31611241
DOI: 10.1681/ASN.2019090952 -
Journal of Vascular Surgery. Venous and... Mar 2024
Topics: Humans; Arteriovenous Fistula; Pulmonary Veins; Pulmonary Artery
PubMed: 37972756
DOI: 10.1016/j.jvsv.2023.101717