Aggressive treatment of early fistula failure

Beathard, Gerald A.; Arnold, Perry; Jackson, Jerry W.; Litchfield, Terry; Lifeline, Physician Operators Forum of RMS

doi:10.1046/j.1523-1755.2003.00210.x

Cited by 421 publications

(302 citation statements)

References 37 publications

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“…Fortunately, recurrent stenoses respond very well to repeat angioplasty, which frequently provides an opportunity to perform the necessary dilation with a larger size angioplasty balloon because the AVF then is generally more developed. It is interesting that our data as well as those of Beathard et al (24) show that once these "failing to mature" fistulas undergo salvage treatment and become usable during HD, they demonstrate comparable patency to other studies that have followed fistulas that did not require intervention for initial use (12,13,22,30 -32).…”

Section: Discussionsupporting

confidence: 64%

“…Our success rates are comparable but modestly lower than those reported by Beathard et al (24) in their series on early AVF failure. However, this difference may relate to disease severity.…”

Section: Discussioncontrasting

confidence: 53%

“…The most common lesion in our series is stenosis of the juxta-arterial anastomosis segment. Very frequently, this lesion is associated with narrowing of the arterial anastomosis or with downstream venous stenosis (Tables 3 and 4) (24). The juxta-arterial anastomosis lesion significantly restricts the flow to the AVF, prevents the maturation process, and may progress to complete occlusion if untreated.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Endovascular Treatment of the “Failing to Mature” Arteriovenous Fistula

Nassar

Nguyen

Rhee

et al. 2006

Clinical Journal of the American Society of Nephrology

148

100

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In recent literature, surgically created hemodialysis (HD) arteriovenous fistulas (AVF) have high rates of primary failure. Endovascular treatment holds promise to salvage these fistulae. The outcomes of 119 patients who had a "failing to mature" AVF and presented for endovascular management were evaluated prospectively. All patients underwent a fistulogram. Stenotic lesions underwent balloon angioplasty, and accessory veins underwent obliteration. Technical success was determined immediately after the procedure. AVF salvage was determined by successful use during HD. Patients were followed up for 1 yr, during which primary and secondary AVF patency rates were measured. T he low prevalence of the arteriovenous fistula (AVF) among US hemodialysis (HD) patients (1,2) has initiated nationwide measures to increase AVF creation and prevalence (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Among these are providing educational programs, setting forth guidelines and goals (3,4), implementing multidisciplinary approaches (4 -9), encouraging preoperative venous mapping (14 -19), and asking surgeons to create AVF instead of arteriovenous grafts (AVG) (10 -21).Overall, an increase in AVF prevalence is occurring in the United States, albeit at a slow rate (14 -20). One impediment has been high primary failure rates, which in recent series ranged between 23 and 46% (9,(12)(13)(14). The use of ultrasound or other means of preoperative venous mapping is likely to decrease the incidence of primary AVF failures (14 -19). However, the increasing demand to create more fistulas may lead to their creation in borderline vessels, thereby increasing primary failure rates (21-23). Thus, salvage of these primary failures will be essential for increasing AVF prevalence in the United States.In our dedicated endovascular suite, we used percutaneous angioplasty and accessory vein obliteration in attempts to salvage fistulas with primary failure. Because most did not present with thrombosis, we elected to refer to their fistulas as "failing to mature." In this article, we report our initial success rates as well as follow-up on a series of 119 consecutive patients who were referred for salvage of their "failing to mature" AVF. Materials and Methods DefinitionsThe "failing to mature" AVF in our series was defined as an AVF that had been created for at least 8 wk but had not matured enough to allow successful cannulation or use during HD. This includes (1) fistulas that were never cannulated for HD be cause of obvious lack of maturity; (2) fistulas that failed first cannulation attempts and were abandoned; (3) fistulas that were cannulated successfully but could not be used because the blood flow was insufficient to sustain HD; this may have been because of high venous pressure or poor arterial inflow; and (4) fistulas that thrombosed before any attempts at HD. Juxta-arterial anastomosis segment refers to the initial 5 cm of the AVF starting at the arterial anastomosis. Peripheral vein refers to the venous outflow tract of t...

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Section: Discussionsupporting

confidence: 64%

Section: Discussioncontrasting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Endovascular Treatment of the “Failing to Mature” Arteriovenous Fistula

Nassar

Nguyen

Rhee

et al. 2006

Clinical Journal of the American Society of Nephrology

148

100

View full text Add to dashboard Cite

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“…When AVF primary failure occurs, the costs are more than doubled (40,62) (costs of CVC complications not included). However, AVF intervention is effective (approximately 80%) (34,63) and necessary in approximately one third of patients to achieve FFI objectives. An AVF that can be created and then functions without intervention is the most cost-effective (US$4862/yr) (40), but such a scenario occurs in only 40% (32) of AVF.…”

Section: Impact On the Health Care Systemmentioning

confidence: 99%

Fistula First Initiative

Lok¹

2007

Clinical Journal of the American Society of Nephrology

279

231

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“…1-3 However, AVFs are prone to early failure because of poor maturation and subsequent thrombosis resulting from several factors, including inadequate inflow or limited venous outflow. 4 The Fistula First project was initiated by the Centers for Medicare & Medicaid Services with the goal of AVF rates of 50% in incident and 40% in prevalent hemodialysis patients. 5 With this increasing trend toward predialysis fistula placement and imminent increase in problems, early identification of lesions associated with this preferred type of vascular access becomes a necessity.…”

Section: Introductionmentioning

confidence: 99%