Arteriovenous Fistula Toxicity

Abstract

The arteriovenous fistula (AVF) has been a mainstay of hemodialysis treatments and the preferred access route since its inception in the 1960s, due to its longevity and resistance to infection. However, the AVF is not benign. There is significant primary failure, as well as cardiac, vascular, and other, less well recognized, complications. Together, they represent toxicity, to which considerable morbidity and mortality can be attached. Official policy, based on guidelines where AVF toxicity is given short shrift, drives an increase in use of these devices, and may have undesired consequences.

Reversible pulmonary hypertension in post -renaltransp lantation patient with longst anding arteriovenous fistula

“…Компьютерная томография органов грудной клетки: а, б -при поступлении; в, г -после лигирования АВФ. Сердце обозначено как «Cor», звездочкой обозначен гидроторакс, белые стрелки -проявления кардиогенного отека легких в течение года после успешной трансплантации, поскольку имеются данные, свидетельствующие о формировании сердечной недостаточности и росте сердечнососудистой заболеваемости и смертнос ти у пациентов с функционирующей АВФ, с одной стороны [23], и о достаточно высокой частоте тром бозов неиспользуемого сосудистого доступа -с другой [11]. Авторы солидарны с мнением O. Mancaetal [11], что только персонализированный подход к пациенту может помочь принять оптимальное решение о за крытии или сохранении АФВ после успешной ТП.…”

New Hemodialysis Access System

“…Several papers describe the cardiovascular effects of AVF associated with structural anomalies of the heart which correlate with high mortality [4,5,6,7]. Amerling et al [8] reviewed patient outcomes with AVF as currently constructed in the US and stated obvious problems with AVF have not been addressed or studied. A recent paper describes underreported fatal AVF hemorrhages [9].…”

The Arteriovenous Fistula: Lesser Evil or God’s Blessing?

“…We read the review by Amerling et al [1] with great surprise. Its main message is that arteriovenous fistula (AVF) 'undoubtedly contributes to excess cardiovascular (CV) mortality in hemodialysis (HD) patients and shortens life spans' [1] .…”

“…The right answer is obviously the second one. We are disappointed by the review by Amerling et al [1] which denies the life-saving benefit of Brescia-Cimino's basic idea of AVF for millions of human beings. The key word in the case of vascular access (VA) choice is 'eligibility' [8] .…”

“…diet and genetic factors) may play a role [4] . (3) Central venous catheters (CVC) 'have been demonized mostly by associative data' [1] . This is true.…”