Pharmaceutical prevention strategy for arteriovenous fistula and arteriovenous graft failure

Abstract

Vascular access failure (VAF) is a critical problem in patients undergoing hemodialysis (HD). Importantly, VAF impairs the quality of life in patients undergoing HD while imposing high medical costs. A variety of strategies (e.g., endovascular therapy and surgical reconstruction) for treating VAF have been established. However, strategies for preventing VAF are scarce. In this review, we summarized the available literatures regarding the prevention of VAF in patients undergoing HD with a focus on arteriovenous fistulas and arteriovenous grafts. This review proposes the following three aspects for developing strategies for preventing VAF: (i) early identification of risk factors of VAF (e.g., preoperative vascular conditions, age, sex, ethnicity, and clinical backgrounds), (ii) prophylactic drugs to reduce the risk of VAF, and (iii) early VAF detection through monitoring and surveillance of vascular access, particularly at frequent stenotic sites. A few prophylactic drugs may effectively prevent VAF based on the patient's clinical background. A few prophylactic drugs may effectively prevent VAF based on the patient's clinical background; however, currently, there is no strong evidence on the efficacy of these drugs in reducing the incidence of VAF. Thus, additional large, randomized controlled studies are warranted to establish effective strategies for preventing VAF.

Thrombophilic risk factors and ABO blood group profile for arteriovenous access failure in end stage kidney disease patients: a single-center experience

“…The demographic factors including age, sex, and ethnicity; the clinical factors such as heart disease, peripheral arterial disease, diabetes mellitus, obesity, etc. ; the hemodynamic factors consisting of the size and diastolic function of vessels, blood flow, etc., and the technical factors such as the experience of the surgeon and the cannulation techniques employed during dialysis are the common causes for AVF failure [ 6 ]. Early thrombosis of fistula is mostly caused because of an inflow problem due to juxta-anastomosis stenosis or accessory vein, while the late thrombosis tends to be due to outflow stenosis.…”

Factors affecting arteriovenous access patency after percutaneous transluminal angioplasty in chronic haemodialysis patients under vascular access monitoring and surveillance: a single-centre observational study

“…Together, these findings suggest that few prophylactic drugs effectively prevent VA failure for AVF and AVG, and no strong evidence indicates the efficacy of any medications in reducing the incidence of VA failure. 37 Regardless, our study suggests that the use of the prescribed medications alone or in combination may not always have a beneficial effect on vascular patency.…”

The evolving panorama of vascular access in the 21st century

“…Various trials showed that anticoagulation therapy, including the use of heparin or oral anticoagulants, had higher risks of bleeding complications and did not prevent access failure. Likewise antiplatelet aggregation with agents such as dipyridamole and clopidogrel increased the risk of bleeding events and did not prevent AVG thrombosis ( 84 ). Omega 3 polyunsaturated fatty acids (PUFAs) have anti-inflammatory, antiproliferative, anti-platelet aggregation activity and vasodilatory effects, and have been used in different clinical trials to assess their benefits on the prevention of stenosis.…”