Management of dialysis fistula thrombosis

Bone, G; Pomajzl, Mary J.

doi:10.1016/0002-9610(79)90319-2

Cited by 55 publications

(14 citation statements)

References 4 publications

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“…Thrombosis is the most common cause of dialysis graft failure and is usually diagnosed clinically by loss o f graft pulse or thrill. Immediate angiographic diagnosis is mandatory since most grafts can be reopened by a surgical approach near the venous end [4]. Peripheral ischemia may develop if excessive flow through the graft or fistula with poor distal arterial flow.…”

Section: Discussionmentioning

confidence: 99%

Digital Intravenous Angiography for the Study of Hemodialysis Vascular Access

Bursztyn¹,

Sharif

Berger³

1986

Nephron

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Section: Discussionmentioning

confidence: 99%

Digital Intravenous Angiography for the Study of Hemodialysis Vascular Access

Bursztyn¹,

Sharif

Berger³

1986

Nephron

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“…But the maintenance of patency using a PTFE graft is difficult, and the reported patency rates at 1 year have varied from 55 to 75% [9][10][11][12][13], The loss of patency is due to the occurrence of stenosis, and it has been reported that stenosis at the graft-vein anasto motic site is the most frequent. However, stenosis may occur anywhere within the native vein proximal to the graft or within the graft itself [12,14,15]. The graftvenous anastomotic site was the second most frequent site in our study also.…”

Section: Discussionmentioning

confidence: 55%

The Treatment of Chronic Hemodialysis Vascular Access by Directional Atherectomy

Mizumoto

Watanabe

Kumon

et al. 1996

Nephron

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Directional atherectomy (DA) was developed as a new therapeutic modality for coronary artery disease. For the past 3 years, we have applied DA intervention to vascular access failure with either poor blood flow rate or high venous pressure. DA intervention was performed on 27 lesions of 16 hemodialyzed patients. A reduction of stenosis to less than 20% of that before treatment was judged a technical success, and the rate of technical success was 84%. All patients showed adequate blood flow rates after DA intervention, indicating initial success. Although restenotic events occurred frequently, repeated DA interventions could be performed successfully. The patency rate at 1 month after DA intervention was 100%, at 3 months 93%, at 6 months 92% and at 12 months 75%. The short-term patency rate of DA was more satisfactory than the results of percutaneous transluminal angioplasty as reported by several investigators. Regarding the site of stenosis, restenotic events were relatively fewer in the lesions occurring at the native vein compared to those at graft-venous anastomotic sites. Eccentric-type stenosis was also associated with fewer restenotic events than circumferential-type stenosis. These results suggest that eccentric-type stenosis at the native vein is the most suitable lesion for the application of DA intervention in terms of long-term patency. As no severe complications occurred after DA intervention, this would appear to be a useful therapeutic modality for the correction of vascular access failure.

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“…The literature on surgical treatment of thrombosed AVFs reports varying results. In 1979, Bone et al [4] reported that simple thrombectomy was ineffective for treatment of thrombosed AVFs, because only 22% of salvaged AVFs functioned at the end of 6 months. In 1985, Palder et al [3] reported a 2‐year patency rate of only 50% for thrombectomies of thrombosed AVFs.…”

Section: Discussionmentioning

confidence: 99%

Surgical Revision and Early Cannulation of the Arteriovenous Fistula in Hemodialysis Patients: An Effective Technique

Kour

2001

Hemodialysis International

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Arteriovenous fistula (AVF) dysfunction is a common problem in hemodialysis patients. After surgical revision for malfunction, we used AVFs early to avoid complications associated with central venous catheters. In this study, we report experience with surgical revisions of native AVFs with suspected arterial dysfunction as the cause of inadequate arterial inflow for dialysis. Exclusion criteria were presence of a central venous catheter as a hemodialysis access, and clinical or radiologic evidence of stenosis or thrombosis of the distal venous segment of the AVF. We prospectively studied 50 patients (mean age 60.2 ± 10.5 years, 25 men and 25 women) with 59 revisions. The patients were followed until change in the modality of dialysis, transplant, or death. The types of AVFs revised were left wrist radiocephalic in 27 patients (54%), left forearm radiocephalic in 10 (20%), right wrist radiocephalic in 6 (12%), left antecubital brachiocephalic in 3 (6%), right antecubital brachiocephalic in 2 (4%), and right forearm radiocephalic in 2 (4%). The causes of inadequate arterial flow were juxta-anastomotic thrombosis in 20 patients (40%), inadequate arterial anastomotic flow in 16 (32%), inadequate anastomosis in 7 (14%), and juxta-anastomotic venous stenosis in 7 (14%). The primary surgical revision techniques were proximal neo-anastomosis using the semiarterialized vein in 43 patients (86%), thrombectomy and re-anastomosis in 5 (10%), and resection and repair in 2 (4%). Technical success, defined as successful cannulation of the revised AVF for hemodialysis and avoidance of central venous catheter, was achieved in 44 of 50 patients (88%). Technical failure occurred 6 cases, the causes being inadequate arterial flow in 3 patients, failure to cannulate the veins in 2 patients, and steal syndrome in 1 patient. After primary revisions failed, 9 re-revisions were done in 6 patients. The 1-year, 2-year, and 3-year primary and overall patency rates were 76.2%, 67.6%, 65.0%, and 85.7%, 75.7%, 65.0%, respectively. In conclusion, surgical salvage of the AVF with inadequate arterial flow is an effective approach that can be performed as an outpatient procedure and allows early cannulation of the semi-arterialized veins, thus avoiding the use of central venous catheters.

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Management of dialysis fistula thrombosis

Cited by 55 publications

References 4 publications

Digital Intravenous Angiography for the Study of Hemodialysis Vascular Access

Digital Intravenous Angiography for the Study of Hemodialysis Vascular Access

The Treatment of Chronic Hemodialysis Vascular Access by Directional Atherectomy

Surgical Revision and Early Cannulation of the Arteriovenous Fistula in Hemodialysis Patients: An Effective Technique

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