Multicentre Study on the Efficacy of Brachial Artery Transposition Among Haemodialysis Patients

Murakami, Masaaki; Mori, Kiyoshi; Hamanoue, Satoshi; Suemitsu, Kotaro; Kajiwara, Kengo; Miyamoto, Masahito; Inoue, Hideki; Sueki, Shina; Nihei, Hiroshi; Mukoyama, Masashi

doi:10.1016/j.ejvs.2021.01.038

Cited by 6 publications

(5 citation statements)

References 22 publications

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“…In contrast, the BAT may provide relatively physiological hemodynamics and a lower shear stress (vs. AVF and AVG), which may prolong the patency of the circuit. In previous reports, primary patency at 1 year of BAT has been as high as over 90% 24 , 37 . In these studies, although about 2–4% of patients developed brachial artery embolism, the majority of patients were asymptomatic, and there were no cases of serious hand ischemia such as upper limb amputation.…”

Section: Discussionmentioning

confidence: 86%

Brachial artery transposition versus catheters as tertiary vascular access for maintenance hemodialysis: a single-center retrospective study

Shi-ying

Murakami

Nakatani

et al. 2022

Sci Rep

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Some hemodialysis patients are not suitable for creation of an arteriovenous fistula (AVF) or arteriovenous graft (AVG). However, they can receive a tunneled cuffed central venous catheter (tcCVC), but this carries risks of infection and mortality. We aimed to evaluate the safety and effectiveness of brachial artery transposition (BAT) versus those of tcCVC. This retrospective study evaluated hemodialysis patients who underwent BAT or tcCVC placement because of severe heart failure, hand ischemia, central venous stenosis or occlusion, inadequate vessels for creating standard arteriovenous access, or limited life expectancy. The primary outcome was whole access circuit patency. Thirty-eight patients who underwent BAT and 25 who underwent tcCVC placement were included. One-year patency rates for the whole access circuit were 84.6% and 44.9% in the BAT and tcCVC groups, respectively. The BAT group was more likely to maintain patency (unadjusted hazard ratio: 0.17, 95% confidence interval: 0.05–0.60, p = 0.006). The two groups did not have significantly different overall survival (log-rank p = 0.146), although severe complications were less common in the BAT group (3% vs. 28%, p = 0.005). Relative to tcCVC placement, BAT is safe and effective with acceptable patency in hemodialysis patients not suitable for AVF or AVG creation.

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Section: Discussionmentioning

confidence: 86%

Brachial artery transposition versus catheters as tertiary vascular access for maintenance hemodialysis: a single-center retrospective study

Shi-ying

Murakami

Nakatani

et al. 2022

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“…In particular, with regard to AS complications, 40 (17%) out of 233 Japanese patients undergoing hemodialysis who newly underwent brachial artery superficialization were reported to have developed complications during a mean follow-up period of 19 months. Impaired wound healing (5.6%) was the most common complication, followed by large aneurysm (2.6%), arterial thrombosis (2.1%), hand ischemia (2.1%), skin infection (2.1%), and arterial stenosis (1.7%) [52] . Sixth, we did not have data concerning the site of AS.…”

Section: Discussionmentioning

confidence: 99%

Association of Four Types of Vascular Access Including Arterial Superficialization with Mortality in Maintenance Hemodialysis Patients: A Nationwide Cohort Study in Japan

Murakami¹,

Fujii²,

Kanda³

et al. 2023

Am J Nephrol

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Introduction: Vascular access usage varies widely across countries. Previous studies have evaluated the association of clinical outcomes with the three types of vascular access, namely arteriovenous fistula (AVF), arteriovenous graft (AVG), and tunneled and cuffed central venous catheter (TC-CVC). However, little is known regarding the association between arterial superficialization (AS) and the mortality of patients. Methods: A nationwide cohort study was conducted using data from the Japanese Society for Dialysis Therapy Renal Data Registry (2006–2007). We included patients aged ≥20 years undergoing hemodialysis with a dialysis vintage ≥6 months. The exposures of interest were the four types of vascular access: AVF, AVG, AS, and TC-CVC. Cox proportional hazards models were used to evaluate the associations of vascular access types with 1-year all-cause and cause-specific mortality. Results: A total of 183,490 maintenance hemodialysis patients were included: 90.7% with AVF, 6.9% with AVG, 2.0% with AS, and 0.4% with TC-CVC. During the 1-year follow-up period, 13,798 patients died. Compared to patients with AVF, those with AVG, AS, and TC-CVC had a significantly higher risk of all-cause mortality after adjustment for confounding factors; adjusted hazard ratios (95% confidence intervals): 1.30 (1.20–1.41), 1.56 (1.39–1.76), and 2.15 (1.77–2.61), respectively. Similar results were obtained for infection-related and cardiovascular mortality. Conclusion: This nationwide cohort study conducted in Japan suggested that AVF usage may have the lowest risk of all-cause mortality. The study also suggested that the usage of AS may be associated with better survival rates compared to those of TC-CVC in patients who are not suitable for AVF or AVG.

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“…Although femoral artery pseudoaneurysm is the most reported complication of intravenous drug addiction, brachial artery involvement is also common 6 . This form of aneurysm presents as an infected, pulsatile, painful, and expanding mass that might or might not affect the peripheral neurovascular system 7 .…”

Section: Introductionmentioning

confidence: 99%

Management of Brachial Artery Pseudoaneurysms in Intravenous Drug Abusers

Sadiq¹,

Nasir²,

Iftikhar³

et al. 2022

PJMHS

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Aim: To assess the outcomes of ligation and excision of brachial artery pseudoaneurysm without revascularization in IV drugs users. Place & duration of study: From Jan 2021 to Jan 2022 at the department of Surgery of Doctors Hospital & Medical Centre Lahore. Methodology: A retrospective observational study was conducted at the surgery department of Doctors Hospital & Medical Centre Lahore for 1 year. Intravenous drug abusers, aged between 18-65 years diagnosed with brachial artery pseudoaneurysm were included in the study whereas pseudoaneurysm was caused due to arteriovenous fistula, hemodialysis, and trauma or in patients who had undergone revascularization were excluded from the study. The data were processed using SPSS 20.0. Results: A total of 15 intravenous drug users were enrolled in the study. The mean age of the participants was 33.4±5.4 years, and the mean period of addiction was 1.9±2.5 years. Majority of patients (65%) presented with an affected right arm. The most common presentations were: bleeding pseudoaneurysm (73.3%), oozing pulsatile mass (20%), and infected pulsatile mass (6.6%). Following the intervention, limb salvage was achieved in all patients. Ischemia was reported in none of the patients. Conclusion: The excision and ligation of the pseudoaneurysm can be an effective treatment option for the pseudoaneurysm of a brachial artery caused due to drug addiction. Keywords: The brachial artery, pseudoaneurysm, intravenous drug users, drug addiction

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Multicentre Study on the Efficacy of Brachial Artery Transposition Among Haemodialysis Patients

Cited by 6 publications

References 22 publications

Brachial artery transposition versus catheters as tertiary vascular access for maintenance hemodialysis: a single-center retrospective study

Brachial artery transposition versus catheters as tertiary vascular access for maintenance hemodialysis: a single-center retrospective study

Association of Four Types of Vascular Access Including Arterial Superficialization with Mortality in Maintenance Hemodialysis Patients: A Nationwide Cohort Study in Japan

Management of Brachial Artery Pseudoaneurysms in Intravenous Drug Abusers

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