A multicenter study of permanent hemodialysis access patency: beneficial effect of clipped vascular anastomotic technique

Shenoy, Surendra; Miller, Arnold; Petersen, Floyd; Kirsch, Wolff M.; Konkin, Taylor; Kim, Peter; Dickson, Cindy; Schild, A. Frederick; Stewart, Leslie; Reyes, Martha; Anton, L.; Woodward, Robert S.

doi:10.1016/s0741-5214(03)00412-9

Cited by 31 publications

(18 citation statements)

References 21 publications

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“…19,20 For instance, the patency rates for lower extremity bypass grafts are 40% to 78% in 3 yr in the general population, [21][22][23] but the patency rates of bypass grafts in CKD patients is significantly less 24,25 approaching the patency rates of 17% to 34% at 2 yr associated with hemodialysis AV grafts and fistulae. 2 While our animals (stage 3 to 4 CKD) did not have end stage kidney disease, the anastomotic NH lesions in our murine model have the characteristics of the occlusive NH lesions found in human hemodialysis AV fistula. Therefore, the data from our mouse CKD model of AV fistula may provide useful insights into the effect of CKD on anastomotic NH.…”

Section: Discussionmentioning

confidence: 77%

CKD Accelerates Development of Neointimal Hyperplasia in Arteriovenous Fistulas

Kokubo

Ishikawa

Uchida

et al. 2009

Journal of the American Society of Nephrology

108

100

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Arteriovenous (AV) access failure resulting from venous neointimal hyperplasia is a major cause of morbidity in patients with ESRD. To understand the role of chronic kidney disease (CKD) in the development of neointimal hyperplasia, we created AV fistulae (common carotid artery to jugular vein in an end-to-side anastomosis) in mice with or without CKD (renal ablation or sham operation). At 2 and 3 wk after operation, neointimal hyperplasia at the site of the AV anastomosis increased 2-fold in animals with CKD compared with controls, but cellular proliferation in the neointimal hyperplastic lesions did not significantly differ between the groups, suggesting that the enhanced neointimal hyperplasia in the setting of CKD may be secondary to a migratory phenotype of vascular smooth muscle cells (VSMC). In ex vivo migration assays, aortic VSMC harvested from mice with CKD migrated significantly greater than VSMC harvested from control mice. Moreover, animals with CKD had higher serum levels of osteopontin, which stimulates VSMC migration. When we treated animals with bone morphogenic protein-7, which promotes VSMC differentiation, before creation of the AV anastomosis, the effect of CKD on the development of neointimal hyperplasia was eliminated. In summary, CKD accelerates development of neointimal hyperplasia at the anastomotic site of an AV fistula, and administration of bone morphogenic protein-7 neutralizes this effect.

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Section: Discussionmentioning

confidence: 77%

CKD Accelerates Development of Neointimal Hyperplasia in Arteriovenous Fistulas

Kokubo

Ishikawa

Uchida

et al. 2009

Journal of the American Society of Nephrology

108

100

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“…7A) and interrupted placement, it accommodates for pulsatile flow, maintains endothelial integrity and preserves vessel patency. [8][9][10][11] Its unique handpiece (Fig. 7B) consists of a 360-degree rotating shaft and an integral cartridge containing titanium (MRI safe) clips.…”

Section: Discussionmentioning

confidence: 99%

“…Clip design allows accommodation of pulsatile flow, maintenance of endothelial integrity, as well as preserving vessel patency; the very characteristics we aim to preserve if repair of a CAI is attempted. [8][9][10][11] Thus, the aims of this study were to trial the AnastoClip device in a sheep model of carotid artery injury. Both shortterm and long-term outcomes were assessed.…”

mentioning

confidence: 99%

Endoscopic direct vessel closure in carotid artery injury

Padhye

Murphy

Bassiouni

et al. 2014

Int Forum Allergy Rhinol

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“…1 More than 300,000 people with ESRD in the United States are on hemodialysis (HD). 1 An estimated 25.2 billion dollars are spent each year to maintain medical care for this population. Of this, 1-2 billion dollars are spent on maintaining vascular access patency and managing access-related complications.…”

Section: Introductionmentioning

confidence: 99%

“…Our data showed an improvement in primary, secondary, and overall patency for AVG and AVF created with interrupted anastomosis using nonpenetrating clips (AnastoClip™ VCS ® , LeMaitre Vascular, Inc). 1 An increase in patency rates translates into decreased need for secondary procedures to maintain AV access for patients with ESRD. It is desirable to assess the economic impact of patency rates provided by an interrupted anastomotic technique compared with the conventional approach.…”

Section: Introductionmentioning

confidence: 99%

Economic Impact of the Beneficial Effect of Changing Vascular Anastomotic Technique in Hemodialysis Access

Shenoy

Woodward

2005

Vasc Endovascular Surg

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There is an urgent and compelling need to reduce the morbidity and expense of maintaining hemodialysis vascular access patency. We previously reported the beneficial effects of altering anastomotic technique on vascular access patency from a multicenter clinical trial. Interrupted anastomoses created with nonpenetrating clips showed significant improvement in primary, assisted primary, and secondary patencies of native vein fistulae (AVF) and synthetic arteriovenous grafts (AVG). In the current report, we provide an analysis of the economic impact of these procedures. The economic analysis is based on a subgroup of patients who underwent access procedures as outpatients during years 1998-1999 at a university-affiliated hospital that contributed 23% of procedures described in the multicenter clinical trial. Hospital charges and payments received were determined for fistula placement and for commonly performed surgical and endovascular procedures (thrombectomy and angioplasty) that maintain patency. Financial comparisons were based on the hospital's average accumulative charges and actual payments calculated on a daily basis. Cost curves were generated by using charge and payment data. Financial information was extrapolated to the entire study population to estimate the cost savings for the larger group. Both charge and payment calculations indicated financial benefit with the use of clips. When financial estimates were extrapolated to reflect the national volume, clip usage projected significant savings of $20 million for AVF and $30.8 million for AVG for every 1,000 days of access patency. Replacing conventional sutures with clips can reduce the morbidity and cost associated with maintaining permanent hemodialysis vascular accesses. This beneficial effect may be due to the biologic advantages of interrupted, nonpenetrating vascular anastomoses.

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A multicenter study of permanent hemodialysis access patency: beneficial effect of clipped vascular anastomotic technique

Abstract: Replacing conventional suture with clips significantly reduces morbidity associated with maintaining permanent hemodialysis vascular access. This beneficial effect may be due to the biologic superiority of interrupted, nonpenetrating vascular anastomoses.

Cited by 31 publications

References 21 publications

CKD Accelerates Development of Neointimal Hyperplasia in Arteriovenous Fistulas

CKD Accelerates Development of Neointimal Hyperplasia in Arteriovenous Fistulas

Endoscopic direct vessel closure in carotid artery injury

Economic Impact of the Beneficial Effect of Changing Vascular Anastomotic Technique in Hemodialysis Access

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