Medical adjuvant treatment to increase patency of arteriovenous fistulae and grafts

Tanner, Nicola; Silva, Anthony Da

doi:10.1002/14651858.cd002786.pub3

Cited by 61 publications

(59 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Aspirin : Conflicting results were found in RCT investigating the effect of aspirin therapy on access outcomes with two trials showing a marked reduction in thrombosis and one trial reporting an increase in thrombosis compared to placebo . Based on a meta‐analysis of these trials, the summary effect of aspirin on access thrombosis remained uncertain (odds ratio [OR] 0.40, 95% CI 0.07‐2.25, P = .3) . The most recent and largest RCT including 488 patients who received a new AVF, showed no significant reduction in access thrombosis, AVF abandonment or cannulation failure with low dose aspirin (100 mg daily) therapy compared to placebo (RR 1.09, 95% CI 0.72‐1.64)…”

Section: Clinical Trials Of Antiplatelet Agents and Vascular Access Omentioning

confidence: 99%

See 1 more Smart Citation

The pathogenesis of hemodialysis vascular access failure and systemic therapies for its prevention: Optimism unfulfilled

Viecelli

Mori

Roy‐Chaudhury³

et al. 2017

Seminars in Dialysis

View full text Add to dashboard Cite

In patients receiving hemodialysis, the provision of safe and effective vascular access using an arteriovenous fistula or graft is regarded as a critical priority by patients and health professionals. Vascular access failure is associated with morbidity and mortality, such that strategies to prevent these outcomes are essential. Inadequate vascular remodeling and neointimal hyperplasia resulting in stenosis and frequently thrombosis are critical to the pathogenesis of access failure. Systemic medical therapies with pleiotropic effects including antiplatelet agents, omega-3 polyunsaturated fatty acids (fish oils), statins, and inhibitors of the renin-angiotensin-aldosterone system (RAAS) may reduce vascular access failure by promoting vascular access maturation and reducing stenosis and thrombosis through antiproliferative, antiaggregatory, anti-inflammatory and vasodilatory effects. Despite such promise, the results of retrospective analyses and randomized controlled trials of these agents on arteriovenous fistula and graft outcomes have been mixed. This review describes the current understanding of the pathogenesis of arteriovenous fistula and graft failure, the biological effects of antiplatelet agents, fish oil supplementation, RAAS blockers and statins that may be beneficial in improving vascular access survival, results from clinical trials that have investigated the effect of these agents on arteriovenous fistula and graft outcomes, and it explores future therapeutic approaches combining these agents with novel treatment strategies.

show abstract

Section: Clinical Trials Of Antiplatelet Agents and Vascular Access Omentioning

confidence: 99%

“…Ticlopidine : The effect of ticlopidine was studied in three RCT and meta‐analysis of these trial results suggested a reduction in access thrombosis (OR 0.45, 95% CI 0.25‐0.82, p = .009) …”

Section: Clinical Trials Of Antiplatelet Agents and Vascular Access Omentioning

confidence: 99%

The pathogenesis of hemodialysis vascular access failure and systemic therapies for its prevention: Optimism unfulfilled

Viecelli

Mori

Roy‐Chaudhury³

et al. 2017

Seminars in Dialysis

View full text Add to dashboard Cite

show abstract

“…Several studies have investigated the effectiveness of pharmacological therapy to improve patency of AV fistula during the peri-operative period, including antiplatelets, anticoagulants, statins, fish oil, and anti-hypertensive agents. Nonetheless, systemic reviews or meta-analysis showed controversial or no beneficial effects [34,35]. Currently, no pharmacotherapy has been recommended by the guidelines to promote AV fistula maturation [36,37].…”

Section: Discussionmentioning

confidence: 99%

Oral Charcoal Adsorbents Attenuate Neointima Formation of Arteriovenous Fistulas

Shih

Wang

et al. 2020

Toxins

View full text Add to dashboard Cite

Chronic kidney disease (CKD) accelerates the development of neointima formation at the anastomosis site of arteriovenous (AV) fistulas. Accumulation of certain uremic toxins has a deleterious effect on the cardiovascular system. The oral charcoal adsorbent, AST-120, reduces circulating and tissue uremic toxins, but its effect on neointima formation at an AV fistula is unknown. To understand the effect of CKD and AST-120 on neointima formation, we created AV fistulas (common carotid artery to the external jugular vein in an end-to-side anastomosis) in mice with and without CKD. AST-120 was administered in chow before and after AV fistula creation. Administration of AST-120 significantly decreased serum indoxyl sulfate levels in CKD mice. CKD mice had a larger neointima area than non-CKD mice, and administration of AST-120 in CKD mice attenuated neointima formation. Both smooth muscle cell and fibrin components were increased in CKD mice, and AST-120 decreased both. RNA expression of MMP-2, MMP-9, TNFα, and TGFβ was increased in neointima tissue of CKD mice, and AST-120 administration neutralized the expression. Our results provided in vivo evidence to support the role of uremic toxin-binding therapy on the prevention of neointima formation. Peri-operative AST-120 administration deserves further investigation as a potential therapy to improve AV fistula patency.

show abstract

“…Pharmacological interventions using aspirin, dipyridamole, fish oil, clopidogrel, and others have been generally unsuccessful or, when positive, have other studies showing conflicting results . A recent meta‐analysis of studies using fish oil did conclude, however, that omega‐3 polyunsaturated fatty acids supplementation probably protects against primary loss of arteriovenous access patency, with likely low to no effect on dialysis suitability failure, access interventions or access abandonment …”

Section: Arteriovenous Graft Complicationsmentioning

confidence: 99%

How arteriovenous grafts could help to optimize vascular access management

Besarab

Kumbar

2018

Seminars in Dialysis

View full text Add to dashboard Cite

A one-size-fits-all approach to vascular access for dialysis may be prejudicial. Arteriovenous fistulae (AVF) have high primary failure, failure to mature rate, and late-stage complications making them unsuitable choice for many patients. Aging of population with chronic kidney disease (CKD) coupled with venous injury during CKD stages depletes suitable superficial veins for AVF creation. The National Institutes of Health consortium demonstrated the difficulty in attaining a functional AVF in hemodialysis patients. Recognition of flaws in AVF and the quest to reduce catheter use bring to the fore the benefits of arteriovenous grafts (AVG). Advances in catheter technologies, flow, care, and antibiotic locks have resulted in significant improvement in catheter-related infections. However, widespread recognition of catheter-related complications like central vein stenosis, metastatic infections, and exhaustion of venous access sites preclude their being a viable alternative to AVF, furthering the need to explore AVG as a substitute. Placement of "early cannulation" AVG is a catheter sparing option in patients who are likely to have inadequate fistula maturation. Advances in biohybrid technology and tissue-engineered grafts are providing a robust opportunity to develop biocompatible graft materials with minimal tissue reactivity and thrombogenicity. Xenografts (bovine carotid artery grafts) are proving to be comparable and, in many cases, better than conventional polytetrafluoroethylene material. Older age, dialysis dependence, and smaller vein size are related to the appropriateness of AVG creation. An individualized approach in selecting optimal upper extremity vascular access option using patient-specific factors while incorporating the benefits of an AVG would greatly aid in achieving low catheter usage in the dialysis population.

show abstract

Medical adjuvant treatment to increase patency of arteriovenous fistulae and grafts

Abstract: Trusted evidence. Informed decisions. Better health.

Cited by 61 publications

References 38 publications

The pathogenesis of hemodialysis vascular access failure and systemic therapies for its prevention: Optimism unfulfilled

The pathogenesis of hemodialysis vascular access failure and systemic therapies for its prevention: Optimism unfulfilled

Oral Charcoal Adsorbents Attenuate Neointima Formation of Arteriovenous Fistulas

How arteriovenous grafts could help to optimize vascular access management

Contact Info

Product

Resources

About