Results of repeated percutaneous interventions on failing arteriovenous fistulas and grafts and factors affecting outcomes

Malka, Kimberly T.; Flahive, Julie; Csizinscky, Alex; Aiello, Francesco; Simons, Jessica P.; Schanzer, Andres; Messina, Louis M.; Robinson, William P.

doi:10.1016/j.jvs.2015.09.031

Cited by 42 publications

(33 citation statements)

References 10 publications

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“…AVG is thought to be at higher risk of stenosis and thrombosis compared to AVF due to unendothelialized foreign material that attracts macrophages and accelerates neointimal hyperplasia from the release of pro‐inflammatory cytokines 19 . Our multivariate analysis however showed that the type of AV access was not a significant predictor of patency (Table 4), which is consistent with previous study where the purported patency advantage of AVF over AVG was not seen when repeated interventions were required 20 …”

Section: Discussionsupporting

confidence: 90%

Effect of short‐term low molecular weight heparin on patency following successful salvage of arteriovenous access with recurrent thrombosis

et al. 2020

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Aim This study aims to investigate the effect of low molecular weight heparin (LMWH) in maintaining the patency of arteriovenous (AV) access with recurrent thrombosis. Methods Following successful thrombectomy, 66 patients with recurrent thrombosis were included in the study. The primary, assisted primary and secondary patency rates of patients who received LMWH (n = 24) were compared with those who did not receive anticoagulant (n = 42) using Kaplan‐Meier analysis. Cox‐regression analysis was performed to investigate potential predictors of patency rates. Results The mean dose of enoxaparin used was 40 ± 13.1 mg or 0.74 ± 0.2 mg/kg daily for a median duration of 14 (IQR 7,28) days. The mean trough anti‐Xa concentrations measured after two doses of LMWH was 0.17 ± 0.13 IU/mL. Kaplan‐Meier analyses for mean primary, assisted primary and secondary patency rates of LMWH vs no anticoagulation groups were 149 (95% CI: 91 ‐ 207) vs 87 (95% CI: 42‐132) days (P < .006), 230 (95% CI: 142‐320) vs 107 (95% CI: 62‐150) days (P = .01) and 438 (299‐579) vs 294 (95% CI: 197‐392) days (P = .08) respectively. LMWH remained a significant protective predictor of primary (HR: 0.49; 95% CI: 0.25‐0.86; P = .02) and assisted primary patency rates (HR: 0.51; 95% CI: 0.27‐0.98; P = .04) after adjusting for patient age, access age, type of AV access, presence of peripheral vascular disease and haemoglobin levels. Conclusion LMWH may improve short and mid‐term patency rates for AV accesses with recurrent thrombosis.

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Section: Discussionsupporting

confidence: 90%

Effect of short‐term low molecular weight heparin on patency following successful salvage of arteriovenous access with recurrent thrombosis

et al. 2020

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“…12 Considering that this might be a marker of poor vascular quality, some authors defend that placement of an AVG may be a better choice in certain patients with high risk of AVF failure. 12,122 Moreover, Malka et al 123 reported that second endovascular interventions on AVFs are associated with poor primary patency and that pharmacomechanical thrombectomy predicted the need for additional interventions to maintain patency. This explains the need to stratify which stenosis should undergo angioplasty.…”

Section: Vessel Injurymentioning

confidence: 99%

Factors affecting arteriovenous fistula dysfunction: A narrative review

Gameiro

Ibeas

2019

J Vasc Access

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Vascular access dysfunction is one of the most important causes of morbidity and mortality in haemodialysis patients, contributing to up to one third of hospitalisations and accounting for a significant amount of the health care costs of these patients. In the past decades, significant scientific advances in understanding mechanisms of arteriovenous fistula maturation and failure have contributed to an increase in the amount of research into techniques for creation and strategies for arteriovenous fistula dysfunction prevention and treatment, in order to improve patient care and outcomes. The aim of this review is to describe the pathogenesis of vascular access failure and provide a comprehensive analysis of the associated risk factors and causes of vascular access failure, in order to interpret possible future therapeutic approaches. Arteriovenous fistula failure is a multifactorial process resulting from the combination of upstream and downstream events with consequent venous neo-intimal hyperplasia and/or inadequate outward remodelling. Inflammation appears to be central in the biology of arteriovenous fistula dysfunction but important triggers still need to be revealed. Given the significant association of arteriovenous fistula failure and patient’s prognosis, it is therefore imperative to further research in this area in order to improve prevention, surveillance and treatment, and ultimately patient care and outcomes.

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“…Technical success was defined as a restoration of HD access flow and resolution of stenosis (<30% residual stenosis) without residual thrombus after the procedure. 13 We verified both the HD access survival rate and the re-intervention survival rate. The HD access survival period was defined as the duration from intervention to HD access loss, and if HD access survived, it was defined as the duration from intervention to death or the last follow-up.…”

Section: Discussionmentioning

confidence: 83%

Efficacy of the transjugular approach in endovascular intervention for hemodialysis access comparing with conventional approach

et al. 2020

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Purpose: Compared with the conventional approach, the benefits of the transjugular approach in endovascular intervention for hemodialysis access avoids complications due to direct puncture and reduces direct radiation exposure to the hands of operator. The aim of this non-inferiority study was to evaluate the efficacy of the transjugular approach in endovascular intervention for hemodialysis access comparing with conventional approach. Methods: We retrospectively assessed endovascular intervention for hemodialysis access performed in our hospital from 2012 to 2016, divided into the conventional approach group and the transjugular approach group. The hemodialysis access survival rate, re-intervention survival rate, and lesion characteristics were comparatively evaluated. Results: We included 223 cases in 118 patients (146 cases with conventional approaches and 77 cases with transjugular approaches). There was a higher incidence of thrombosis with the conventional approach (p < 0.001), however, no significant difference in the hemodialysis access type or main lesion location. The transjugular approach showed either a better hemodialysis access survival rate (p = 0.017) and a trend toward improved re-intervention survival rate (p = 0.098) than the conventional approach. Following classification according to the presence of thrombus, there was no significant difference in either the hemodialysis access survival rate or the re-intervention survival rate between the approaches with or without thrombus. Conclusion: The transjugular approach could be performed in most cases and was similar to the conventional approach in terms of outcomes. The transjugular approach should be considered as an alternative to either replace or use in combination with the conventional approach in endovascular intervention for hemodialysis access.

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Results of repeated percutaneous interventions on failing arteriovenous fistulas and grafts and factors affecting outcomes

Cited by 42 publications

References 10 publications

Effect of short‐term low molecular weight heparin on patency following successful salvage of arteriovenous access with recurrent thrombosis

Effect of short‐term low molecular weight heparin on patency following successful salvage of arteriovenous access with recurrent thrombosis

Factors affecting arteriovenous fistula dysfunction: A narrative review

Efficacy of the transjugular approach in endovascular intervention for hemodialysis access comparing with conventional approach

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