Detection and treatment of dysfunctional hemodialysis access grafts: effect of a surveillance program on graft patency and the incidence of thrombosis.

Safa, Afshin; Valji, Karim; Roberts, Anne C.; Ziegler, Thomas W.; Hye, Robert J.; Oglevie, Steven B.

doi:10.1148/radiology.199.3.8637982

Cited by 190 publications

(113 citation statements)

References 0 publications

Supporting

Mentioning

103

Contrasting

Unclassified

Order By: Relevance

“…A number of studies have evaluated the positive predictive value of an abnormality of clinical AVG monitoring or surveillance for the presence of hemodynamically significant stenosis. The values were 69%-93% for clinical monitoring (80% for physical examination, 69% for unexplained decrease in Kt/V, and 66% for difficulties encountered during the dialysis session) (3,5,(8)(9)(10), 92% for static dialysis venous pressure (6), 87%-100% for flow monitoring (11,12), and 80% for duplex ultrasound (5).…”

Section: Can One Identify Avgs With Significant Stenosis By Noninvasimentioning

confidence: 99%

“…Such an approach makes sense intuitively. In fact, numerous observational studies have reported that implementation of routine AVG stenosis surveillance, in conjunction with preemptive angioplasty, markedly lowers the frequency of AVG thrombosis in comparison with a historical period without AVG surveillance (6,9,10,(15)(16)(17). More recently, six randomized clinical trials (RCTs) have evaluated this research question (4,5,12,(18)(19)(20) (Figure 2).…”

Section: Does Stenosis Surveillance With Preemptive Angioplasty Prevementioning

confidence: 99%

See 1 more Smart Citation

A Patient with Recurrent Arteriovenous Graft Thrombosis

Allon¹

2015

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

Arteriovenous grafts (AVGs) are prone to frequent thrombosis that is superimposed on underlying hemodynamically significant stenosis, most commonly at the graft-vein anastomosis. There has been great interest in detecting AVG stenosis in a timely fashion and performing preemptive angioplasty, in the belief that this will prevent AVG thrombosis. Three surveillance methods (static dialysis venous pressure, flow monitoring, and duplex ultrasound) can detect AVG stenosis. Whereas observational studies have reported that surveillance with preemptive angioplasty substantially reduces AVG thrombosis, randomized clinical trials have failed to confirm such a benefit. There is a high frequency of early AVG restenosis after angioplasty caused by aggressive neointimal hyperplasia resulting from vascular injury. Stent grafts prevent AVG restenosis better than balloon angioplasty, but they do not prevent AVG thrombosis. Several pharmacologic interventions to prevent AVG failure have been evaluated in randomized clinical trials. Anticoagulation or aspirin plus clopidogrel do not prevent AVG thrombosis, but increase hemorrhagic events. Treatment of hyperhomocysteinemia does not prevent AVG thrombosis. Dipyridamole plus aspirin modestly decreases AVG stenosis or thrombosis. Fish oil substantially decreases the frequency of AVG stenosis and thrombosis. In patients who have exhausted all options for vascular access in the upper extremities, thigh AVGs are a superior option to tunneled internal jugular vein central vein catheters (CVCs). An immediate-use AVG is a reasonable option in patients with recurrent CVC dysfunction or infection. Tunneled femoral CVCs have much worse survival than internal jugular CVCs.Clin J Am Soc Nephrol 10: 2255-2262, 2015. doi: 10.2215/CJN.00190115 Patient PresentationThe following vignette illustrates the numerous challenges in optimizing arteriovenous graft (AVG) patency in hemodialysis patients. A 28-year-old woman initiated peritoneal dialysis when she developed ESRD because of focal glomerular sclerosis. She was hospitalized with an intracerebral bleed caused by a ruptured aneurysm 1.5 years later. A ventricular-peritoneal shunt was placed to treat hydrocephalus, and she was anticoagulated with warfarin to keep the shunt patent. Because of residual left-sided weakness and inadequate family support, she was no longer able to perform peritoneal dialysis. A tunneled central vein catheter (CVC) was placed in the right internal jugular vein, and she was switched to maintenance hemodialysis. A left forearm arteriovenous fistula (AVF) clotted 2 weeks after its creation. A subsequent looped left upper-arm AVG was successfully cannulated 5 weeks after its creation. It clotted four times during the ensuing 6 months and was treated each time by an interventional radiologist or nephrologist, who performed percutaneous thrombectomy, in conjunction with angioplasty of a venous anastomotic stenosis. The patient resumed hemodialysis with an internal jugular CVC when the AVG failed. A right radiocephalic AV...

show abstract

Section: Can One Identify Avgs With Significant Stenosis By Noninvasimentioning

confidence: 99%

Section: Does Stenosis Surveillance With Preemptive Angioplasty Prevementioning

confidence: 99%

A Patient with Recurrent Arteriovenous Graft Thrombosis

Allon¹

2015

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

show abstract

“…Stenosis of the arterial inflow can also be effectively treated via PTA [21]. Several workgroups even observed success rates of 98 % [78]. PTA can be performed without complication if only the afferent artery proximal to the vascular access or the anastomosis is affected but the artery distal to the anastomosis is not stenosed.…”

Section: Insufficient Dialysis Graftmentioning

confidence: 99%

Diagnosis and Treatment of Insufficient Dialysis Vascular Access

Kamper

Faizy²,

Haage³

2015

Fortschr Röntgenstr

View full text Add to dashboard Cite

A wide variety of diagnostic and minimally invasive modalities is currently available to radiologists for providing sufficient medical care for dialysis patients. In addition to clinical examination, ultrasound is the first line imaging method in suspected dialysis vascular access dysfunction. The percutaneous approach is the primarily recommended therapeutic option in many cases. This article reviews the current diagnostic and therapeutic methods in dialysis vascular access insufficiency. Key Points: ??Vascular access dysfunction is often elicited by stenosed vessels, which are regularly associated with concomitant thrombosis. ??Stenoses are commonly observed in the anastomosis, vascular access vein and also in the central venous system. ??Beside the clinical examination, sonography is the diagnostic method of first choice. ??Percutaneous balloon dilatation frequently is the first treatment option. Citation Format: ??Kamper L, Faizy TD, Haage P. Diagnosis and Treatment of Insufficient Dialysis Vascular Access. Fortschr R?ntgenstr 2015; 187: 360???371

show abstract

“…Patients were referred to interventional radiology for a fistulogram when any of the following abnormalities was noted: (1) persistent elevation of dialysis venous pressures (DVP) at a low blood flow during initiation of dialysis, (2) prolonged bleeding from needle puncture sites in the graft, (3) unexplained progressive decrease in Kt/V, or (4) abnormal graft inspection and auscultation (18). We have previously reported that aggressive clinical monitoring of grafts and referral for a fistulogram when any one of these abnormalities was detected decreased the frequency of graft thrombosis by 60% (13).…”

Section: Management Of Dialysis Grafts and Their Complicationsmentioning

confidence: 99%

Comparison of Arteriovenous Grafts in the Thigh and Upper Extremities in Hemodialysis Patients

Miller

Robbin²,

Barker³

et al. 2003

Journal of the American Society of Nephrology

113

View full text Add to dashboard Cite

ABSTRACT. Placement of a thigh graft is an option in hemodialysis patients who have exhausted all upper extremity sites for permanent vascular access. The outcome of thigh grafts has been reported only in retrospective studies. The outcomes of 409 grafts placed at a single institution during a 3.5-yr period were evaluated prospectively, including 63 thigh grafts (15% of the total). Information was recorded on surgical complications, dates of radiologic and surgical interventions, and date of graft failure. The technical failure rate was approximately twice as high for thigh grafts, as compared with upper extremity grafts (12.7 versus 5.8%; P = 0.046). Intervention-free survival was similar for thigh and upper extremity grafts (median, 3.9 versus 3.5 mo; P = 0.55). Thrombosis-free survival was also comparable for thigh and upper extremity grafts (median, 5.7 versus 5.5 mo; P = 0.94). Cumulative survival (time to permanent failure) was similar for thigh and upper extremity grafts (median, 14.8 versus 20.8 mo; P = 0.62). When technical failures were excluded, the median cumulative survival was 27.6 mo for thigh grafts and 22.5 mo for upper extremity grafts (P = 0.72). The frequency of angioplasty (0.28 versus 0.57 per year), thrombectomy (1.58 versus 0.94 per year), surgical revision (0.28 versus 0.18 per year), and total intervention rate (2.15 versus 1.70 per year) was similar between thigh and upper extremity grafts. Access loss as a result of infection tended to be higher for thigh grafts than for upper extremity grafts (11.1 versus 5.2%; P = 0.07). In conclusion, placement of thigh grafts should be considered a viable option among hemodialysis patients who have exhausted all options for a permanent vascular access in both upper extremities. E-mail mdallon@uab.edu

show abstract

Detection and treatment of dysfunctional hemodialysis access grafts: effect of a surveillance program on graft patency and the incidence of thrombosis.

Abstract: The hemodialysis graft surveillance program resulted in a statistically significant reduction in the incidence of graft thrombosis. Although primary patency rates after PTA were low, repeated PTA of detected stenoses allowed good primary assisted patency rates.

Cited by 190 publications

References 0 publications

A Patient with Recurrent Arteriovenous Graft Thrombosis

A Patient with Recurrent Arteriovenous Graft Thrombosis

Diagnosis and Treatment of Insufficient Dialysis Vascular Access

Comparison of Arteriovenous Grafts in the Thigh and Upper Extremities in Hemodialysis Patients

Contact Info

Product

Resources

About