Longitudinal comparison of dialysis access methods: Risk factors for failure

Hodges, Timothy; Fillinger, Mark F.; Zwolak, Robert M.; Walsh, Daniel B.; Bech, Fritz; Cronenwett, Jack L.

doi:10.1016/s0741-5214(97)70014-4

Cited by 256 publications

(146 citation statements)

References 28 publications

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“…The thigh graft thrombosis rate of 1.58 per patient-year compares favorably to that reported for tunneled dialysis catheters (3.0 to 3.2 per patient-year, or 8.1 to 8.8 per 1000 patient-days) (28,33). The cumulative thigh graft survival rate at 1 yr (62%) is substantially higher than the corresponding 9% rate reported for tunneled dialysis catheters (34). Finally, the median dialysis blood flow delivered by grafts is substantially higher than that obtained with catheters, thereby enhancing dialysis adequacy (6).…”

Section: Discussionmentioning

confidence: 51%

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

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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

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Section: Discussionmentioning

confidence: 51%

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

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“…However, fistulas fail to mature at a higher rate than do grafts (2)(3)(4)(5). Therefore, when one includes failures to mature in calculating vascular access outcomes, the cumulative survival of fistulas and grafts is similar ( Figure 1A) (2)(3)(4)(5)(6)(7)(8)(9)(10). However, once they are successfully used for dialysis, grafts require far more interventions than do fistulas to maintain long-term patency for dialysis.…”

Section: Why Should We Increase Fistula Use?mentioning

confidence: 99%

Current Management of Vascular Access

Allon¹

2007

Clinical Journal of the American Society of Nephrology

254

231

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Optimizing vascular access outcomes remains an ongoing challenge for clinical nephrologists. All other things being equal, fistulas are preferred over grafts, and grafts are preferred over catheters. Mature fistulas have better longevity and require fewer interventions, as compared with mature grafts. The major hurdle to increasing fistula use is the high rate of failure to mature of newly created fistulas. There is a desperate need for enhanced understanding of the mechanisms of failure to mature and the optimal type and timing of interventions to promote maturity. Grafts are prone to frequent stenosis and thrombosis. Surveillance for graft stenosis with preemptive angioplasty may reduce graft thrombosis, but recent randomized clinical trials have questioned the efficacy of this approach. Graft stenosis results from aggressive neointimal hyperplasia, and pharmacologic approaches to slowing this process are being investigated in clinical trials. Catheters are prone to frequent thrombosis and infection. The optimal management of catheter-related bacteremia is a subject of ongoing debate. Prophylaxis of catheter-related bacteremia continues to generate important clinical research. Close collaboration among nephrologists, surgeons, radiologists, and the dialysis staff is required to optimize vascular access outcomes and can be expedited by having a dedicated access coordinator to streamline the process. The goal of this review is to provide an update on the current status of vascular access management.

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“…(3) Puncture of dialysis grafts and fistulae could cause platelet thrombi and cytokine release (27). (4) Figure 6. From pathogenesis to pathology to novel therapies.…”

Section: Pathogenesis Of Avf and Ptfe Graft Failurementioning

confidence: 99%

“…Primary nonfunction or rates of failure to mature up to 50% have been reported by some centers, particularly when an aggressive fistula placement policy is enforced (5). Therefore, primary patency rates as low as 43% (6) and 56% (7) have been reported for AVF in some instances. In addition, Miller et al (5) showed a higher primary nonfunction rate in forearm fistulae as compared with upper arm fistulae (59 versus 34%).…”

Section: Introduction and Types Of Hemodialysis Vascular Accessmentioning

confidence: 99%

Hemodialysis Vascular Access Dysfunction

Roy‐Chaudhury

Sukhatme

Cheung³

2006

Journal of the American Society of Nephrology

505

283

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Hemodialysis vascular access dysfunction is a major cause of morbidity and hospitalization in the hemodialysis population. The major cause of hemodialysis vascular access dysfunction is venous stenosis as a result of neointimal hyperplasia. Despite the magnitude of the clinical problem, however, there has been a paucity of novel therapeutic interventions in this field. This is in marked contrast to a recent plethora of targeted interventions for the treatment of arterial neointimal hyperplasia after coronary angioplasty. The reasons for this are two-fold. First there has been a relative lack of cellular and molecular research that focuses on venous neointimal hyperplasia in the specific setting of hemodialysis vascular access. Second, there have been inadequate efforts by the nephrology community to translate the recent advances in molecular and interventional cardiology into therapies for hemodialysis vascular access. This review therefore (1) briefly examines the different forms of hemodialysis vascular access that are available, (2) describes the pathology and pathogenesis of hemodialysis vascular access dysfunction in both polytetrafluoroethylene grafts and native arteriovenous fistulae, (3) reviews recent concepts about the pathogenesis of vascular stenosis that could potentially be applied in the setting of hemodialysis vascular access dysfunction, (4) summarizes novel experimental and clinical therapies that could potentially be used in the setting of hemodialysis vascular access dysfunction, and, finally, (5) offers some broad guidelines for future innovative translational and clinical research in this area that hopefully will reduce the huge clinical morbidity and economic costs that are associated with this condition.

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Longitudinal comparison of dialysis access methods: Risk factors for failure

Cited by 256 publications

References 28 publications

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

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

Current Management of Vascular Access

Hemodialysis Vascular Access Dysfunction

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