Arteriovenous Access Failure, Stenosis, and Thrombosis

MacRae, Jennifer M.; Dipchand, Christine; Oliver, Matthew J.; Moist, Louise; Lok, Charmaine E.; Clark, Edward G.; Kappel, Joanne; Kiaii, Mercedeh; Luscombe, Rick; Miller, Lisa

doi:10.1177/2054358116669126

Cited by 92 publications

(100 citation statements)

References 102 publications

(106 reference statements)

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“…Thrombosis occurs rarely as an unexpected event but usually follows and/ or complicates an underlying stenosis of the distal or proximal vein or proximal artery [56]. This well-established fact reinforces the need for regular VA monitoring to correct pre-emptively this causal factor.…”

Section: Complications In Established Vamentioning

confidence: 88%

Vascular Access Management for Haemodialysis: A Value-Based Approach from NephroCare Experience

Canaud¹,

Ponce²,

Parisotto³

et al. 2019

Vascular Access Surgery - Tips and Tricks

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A good functioning vascular access (VA) is a prerequisite to obtain a successful dialysis treatment. This chapter reviews VA management in advanced chronic kidney disease (CKD) patients drawn from the experience of a large network dialysis care provider with the following sections: overview on VA management in advanced CKD that follows patient pathway and patient profile, current practice patterns in line with best clinical practices; VA creation addressing crucial themes: when and what type of VA to construct, how to assess patient pre-emptively, how to proceed for the construction and monitoring to prevent early failures and complications; VA management with particular focus on clinical monitoring, surveillance and interventional procedures required to preserve patency and functionality of VA; the often-forgotten patient perspective is VA usage. What information to share, how to proceed for preventing pain, and fears related with VA needling? What should patients know about their VA and how to manage in daily life? Competences, skills and responsibilities of nursing staff when using and managing VA; and future of VA in terms of innovative concept for creating and maintaining VA conduits in dialysis patients.

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Section: Complications In Established Vamentioning

confidence: 88%

Vascular Access Management for Haemodialysis: A Value-Based Approach from NephroCare Experience

Canaud¹,

Ponce²,

Parisotto³

et al. 2019

Vascular Access Surgery - Tips and Tricks

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“…Thrombosis is a common complication of AVF and arteriovenous grafts. Compared with thrombosed grafts, AVF thrombosis has a higher risk and requires treatment within 48 h; otherwise, thrombi may adhere to the vessel wall, making it difficult to remove then (3,14). In the present study, only thrombosed AVFs were included.…”

Section: Discussionmentioning

confidence: 99%

“…AVF thrombosis accounts for 65-85% of permanent access loss (2). Following the creation of AVFs, early-onset thrombosis is due to inadequate blood inflow and late-onset thrombosis is associated with stenotic lesions (1,3,4). AVF thrombosis is also a major cause of permanent access loss (3), resulting in missed hemodialysis, hospitalization and increased medical costs (1).…”

Section: Introductionmentioning

confidence: 99%

“…Following the creation of AVFs, early-onset thrombosis is due to inadequate blood inflow and late-onset thrombosis is associated with stenotic lesions (1,3,4). AVF thrombosis is also a major cause of permanent access loss (3), resulting in missed hemodialysis, hospitalization and increased medical costs (1). Taking into consideration that vascular injury, platelet abnormalities and hypercoagulability may contribute to fistula thrombosis, fish oil, anti-platelet agents and oral anti-coagulants have been tested in clinical trials for preventing thrombosed access.…”

Section: Introductionmentioning

confidence: 99%

“…Only a limited number of methods have been developed to treat access thrombosis, including pharmacological thrombolytic therapy, surgical thrombectomy and percutaneous declotting procedures (3). Urokinase has been successfully used as a thrombolytic agent for resolving thrombosed vascular access (6,7).…”

Section: Introductionmentioning

confidence: 99%

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Comparative efficacy and safety of local and peripheral venous thrombolytic therapy with urokinase for thrombosed hemodialysis arteriovenous fistulas

et al. 2019

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Arteriovenous fistula (AVF) thrombosis is a common complication in patients undergoing hemodialysis, and early intervention is required. Urokinase has been used as a thrombolytic agent for declotting the thrombosed access. However, the optimal route for infusing urokinase remains to be determined. In the present retrospective observational study, 49 patients who underwent local venous infusion and 57 patients with peripheral venous infusion of urokinase were included. A urokinase dosage of 300,000 U was administered until successful thrombolysis, which was a maximum of three times. Age, sex, period of dialysis, time of AVF placement, systolic and diastolic blood pressure and thrombus age were similar between the two groups. The efficacy of urokinase infusion via the two routes in resolving thrombosed AVFs, defined as successful fibrinolysis, and the safety, defined as the number of bleeding events, was compared. The cumulative thrombolysis success rate following three sessions of thrombolytic therapy in the local venous thrombolysis group was higher compared with that in the peripheral venous thrombolysis group (85.7 vs. 68.4%; P=0.04). The local thrombolysis group exhibited less ecchymosis (4.1 vs. 14.0%; P=0.07), epistaxis (2.0 vs. 10.5%; P=0.08) and gingival bleeding (4.1 vs. 19.3%; P=0.02) events compared with the peripheral thrombolysis group. Further analyses demonstrated that systolic [odds ratio (OR)=1.10; 95% confidence interval (CI), 1.03-1.17; P<0.01] and diastolic (OR=1.08; 95% CI, 1.02-1.14; P<0.05) blood pressure were protective factors, whereas thrombus age (OR=0.91; 95% CI, 0.84-0.99; P<0.05) was a risk factor for thrombolysis success among patients who underwent local thrombolytic therapy. Overall, the results suggest that local venous infusion of urokinase is superior to peripheral venous infusion for the treatment of patients with thrombosed fistulas.

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Omega-3 fatty acids for dialysis vascular access outcomes in patients with chronic kidney disease

Tam

Siddiqui

et al. 2018

Cochrane Database of Systematic Reviews

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Arteriovenous Access Failure, Stenosis, and Thrombosis

Abstract: Vascular access–related complications can lead to patient morbidity and reduced patient quality of life. Some of the common arteriovenous access complications include failure to mature, stenosis formation, and thrombosis.

Cited by 92 publications

References 102 publications

Vascular Access Management for Haemodialysis: A Value-Based Approach from NephroCare Experience

Vascular Access Management for Haemodialysis: A Value-Based Approach from NephroCare Experience

Comparative efficacy and safety of local and peripheral venous thrombolytic therapy with urokinase for thrombosed hemodialysis arteriovenous fistulas

Omega-3 fatty acids for dialysis vascular access outcomes in patients with chronic kidney disease

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