Hemodialysis Catheter-Related Central Venous Thrombosis: Clinical Approach to Evaluation and Management

Gunawansa, Nalaka; Sudusinghe, Dinesha; Wijayaratne, Dilushi

doi:10.1016/j.avsg.2018.02.033

Cited by 49 publications

(60 citation statements)

References 39 publications

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“…During this period, patients utilize alternatives for dialysis such as central vein catheters, that carry higher risks of infections 20 and failure with or without thrombotic events. 21 Thus, shortening the time to maturation has the potential of offering great benefit to patients. In the current study, the median time to first use was found to be 35 days (range: 29-99 days), shorter than that reported previously.…”

Section: Discussionmentioning

confidence: 99%

Patency and functionality of radiocephalic arteriovenous fistulas with an external support device (VasQ™): Real-world single-center experience

2020

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Background: The VasQTM device was designed to improve the outcome of arteriovenous fistulae by optimizing the hemodynamics of the flow in the juxta-anastomotic region of the arteriovenous fistulae through tailored external support. The aim of the study was to evaluate the impact of the VasQ on outcome of radiocephalic arteriovenous fistulae in a real-world setting. Methods: This was a single-center, retrospective analysis of patients with either fistula creation before or after dialysis initiation with implantation of the VasQ device during creation of end-to-side radiocephalic arteriovenous fistulae between June 2018 and May 2019. The flow rate and vein diameter were evaluated intraoperatively, at discharge within 48 h postprocedure and at a follow-up of 1, 3, 6, 9, and 12 months. Results: Thirty-three VasQ devices were implanted during 33 radiocephalic arteriovenous fistula procedures. The study population comprised mostly of men, with an average age of 66 years. Mean intraoperative flow was 428 mL/min (range: 130–945). All patients were discharged with patent arteriovenous fistulae and mean fistula flow of 740 mL/min (range: 230–1300 mL/min). The primary patency was 100% and 79% at 3 and 6 months, respectively. Cumulative/secondary patency was 100% and 90% at 3 and 6 months, respectively. Conclusion: Data presented here suggest that the VasQ device has the potential to provide benefit to the functionality of radiocephalic arteriovenous fistulae.

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Section: Discussionmentioning

confidence: 99%

Patency and functionality of radiocephalic arteriovenous fistulas with an external support device (VasQ™): Real-world single-center experience

2020

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“…chronic complications of venous stenosis or occlusion. [4][5][6][7][8] The incidence of central venous thrombosis following placement of CVCs is as high as 50%, depending on insertion site. [9][10][11] Both subclavian and left-sided access routes are associated with a high incidence of central stenosis and catheter dysfunction.…”

mentioning

confidence: 99%

A Novel Inside-out Access Approach for Hemodialysis Catheter Placement in Patients With Thoracic Central Venous Occlusion

Reindl‐Schwaighofer

Matoussevitch

Winnicki

et al. 2020

American Journal of Kidney Diseases

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“…S. epidermidis, as one of the most commonly isolated etiological agents from CRBSI, is related to persistent multilayered biofilms formation [27,28]. Besides infection, the other major complications of HD catheter are thrombosis [29,30]. The relationship between catheter thrombogenicity and catheter-related infection has been well documented in several studies [31][32][33].…”

Section: Discussionmentioning

confidence: 99%

Eradication of Microorganisms Embedding in Biofilm by a Dose-Dependent Urokinase-Based Catheter Lock Solution in Chronic Hemodialysis Patients

et al. 2020

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Introduction: Catheter-related blood stream infection (CRB-SI), the most common complication of central vein catheter (CVC), was closely associated with high morbidity and mortality in hemodialysis (HD) patients. Conjunction with systemic antibiotic, antibiotic lock (ABL) is an important therapeutic option to salvage the catheter. With extra antimicrobial and biofilm removing properties, urokinase plasminogen activator (uPA)-based ABL could have a potential role in the treatment of CRBSI. Objective: In this study, we aimed to explore effectiveness of uPA-based (ABL) on microorganisms embedded in biofilms in vitro and CVC salvage rate in HD patients with CRBSI. Methods: In vitro, we induced biofilms formation on the surface of HD catheter by mimicking the development of CRBSI. Applying uPA with or without antibiotics on the kinds of microorganism biofilms to explore its antimicrobial and biofilm removing properties. In vivo, 86 HD patients diagnosed as CRBSI were retrospectively enrolled to see effectiveness of uPA-based ABL on catheter salvage rate as compare to heparin-based ABL. Results: uPA was effect to Staphylococcus epidermidis biofilms compared to Staphylococcus aureus, Escherichia coli, and Candida albicans. Less biofilm residues made the regrowth of S. epidermidis also limited. The combination of uPA with antibiotic showed better antimicrobial and antibiofilm activity than uPA alone or heparin-based ABL in vitro and in vivo. Among HD patients, uPA-based ABL did not cause any obvious adverse affects, and it was more effective in treating coagulasenegative Staphylococci related CRBSI than other microorganisms. Conclusions: The combination of uPA and a therapeutic plasma concentration of sensitive antibiotic can work together to effectively remove coagulase-negative S. epidermidis embedded in biofilms in vitro. uPA-based ABL is safe and effective therapeutic intervention for HD patients with CRBSI, especially compared to heparin-based ABL.

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Hemodialysis Catheter-Related Central Venous Thrombosis: Clinical Approach to Evaluation and Management

Cited by 49 publications

References 39 publications

Patency and functionality of radiocephalic arteriovenous fistulas with an external support device (VasQ™): Real-world single-center experience

Patency and functionality of radiocephalic arteriovenous fistulas with an external support device (VasQ™): Real-world single-center experience

A Novel Inside-out Access Approach for Hemodialysis Catheter Placement in Patients With Thoracic Central Venous Occlusion

Eradication of Microorganisms Embedding in Biofilm by a Dose-Dependent Urokinase-Based Catheter Lock Solution in Chronic Hemodialysis Patients

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