Revision using distal inflow for high flow hemodialysis access alters arterial flow characteristics in the dialysis arm

Gerrickens, Michael W.M.; Vaes, Roel; Wiersma, Vivi; Kuijk, Sander M. J. van; Snoeijs, Maarten G.; Govaert, Bastiaan; Scheltinga, Marc R.

doi:10.1016/j.jvs.2019.06.197

Cited by 8 publications

(13 citation statements)

References 38 publications

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“…and these individuals should be considered for flow reduction, particularly in patients with symptomatic heart disease. In addition, EHF-AVFs are often associated with steal syndrome or high venous pressure outflow problems such as cephalic arch and central venous stenosis, aneurysm formation, and prolonged post-cannulation bleeding 24,25 .In our practice, all patients with flow over 2lt/min regardless of clinical status and patients with flow over 1,5lt/min and signs of poor tolerance (symptoms of heart failure, high pressure AVF with episodes of bleeding, swelling when a central vein stenosis coexists etc.) Banding is the most common flow reduction strategy.…”

Section: Discussionmentioning

confidence: 99%

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Customizable modification of banding with external stenting for arteriovenous fistula flow reduction

Mallios

Gaudin

Hauguel

et al. 2022

Journal of Vascular Surgery Cases, Innovations and Techniques

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Section: Discussionmentioning

confidence: 99%

“…Flow reduction by revision using distal inflow (RUDI) is a more extensive surgical intervention and requires the use of a prosthetic or saphenous graft 25 . We have recently described an alternative technique using endo-AVF technology and the deep venous system in order to achieve a distalization of inflow 27 .…”

Section: Discussionmentioning

confidence: 99%

Customizable modification of banding with external stenting for arteriovenous fistula flow reduction

Mallios

Gaudin

Hauguel

et al. 2022

Journal of Vascular Surgery Cases, Innovations and Techniques

View full text Add to dashboard Cite

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“…77 In both techniques, the ulnar and radial artery as well as the palmar arch should be intact to preserve distal perfusion. 77,87…”

Section: Discussionmentioning

confidence: 99%

A scoping review on surgical reduction of high flow arteriovenous haemodialysis access

et al. 2022

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Volume flow (Qa) > 1.5–2 l /minQa in arteriovenous accesses may be associated with high flow related systemic or locoregional complications. A variety of surgical techniques are advocated for Qa reduction. Aim of this scoping review is to provide an overview of available evidence regarding the efficacy of this broad spectrum of interventions for Qa reduction in patients with a high flow haemodialysis access. PubMed and Embase were searched according to PRISMA-guidelines. Studies on invasive management of HFA were selected. Inclusion required an English description of surgical techniques in human HFAs including pre- and postoperative access flow-values. Sixty-six studies on 940 patients (mean age 56 years (3–90 years), male 62%, diabetes mellitus 26%, brachial artery-based arteriovenous access 65%) fulfilled inclusion criteria. Performed techniques were banding (58%), revision using distal inflow (12%), plication/anastomoplasty (10%), graft interposition (5%), proximal radial artery ligation (3%), aneurysm repair (4%), or miscellaneous other techniques (8%). Definition of HFA, work-up, indication for surgery and intraoperative monitoring were diverse. All techniques reduced Qa on the short term (mean drop 0.9–1.7 l/min). Secondary access patency rates varied between 70% and 93% (mean follow-up 15 (0–189) months). Definitions of success and recurrence varied widely precluding a comparison of efficacy of techniques. Patient specific factors legitimizing invasive treatment for HFA are discussed. Recommendations on reporting standards when dealing with HFA surgery are provided. In conclusion, the present report on the current management of high flow access does not allow for drawing any definite conclusions due to a lack of standardization in definition, indications for surgical intervention and techniques. Randomized trials comparing different Qa reducing techniques in symptomatic patients are warranted, as are trials comparing a wait-and-see approach versus Qa reduction in asymptomatic patients. As an overview of the variety of techniques was lacking, this scoping review might serve as a map for future researchers.

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“…This is in line with the earlier suggestion that the arterial system in HAIDI patients may be less compliant and stiffer, also likely due to atherosclerosis in the arterial system of the arm. 2,29 Measurements of arterial stiffness and vascular compliance (e.g. using radial applanation tonometry or brachial-ankle pulse wave velocity) 30 may therefore prove useful in predicting and monitoring hand ischemia.…”

Section: Discussionmentioning

confidence: 99%

Severe hemodialysis access-induced distal ischemia may be associated with poor survival

et al. 2020

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Background: Some hemodialysis patients develop hemodialysis access-induced distal ischemia due to insufficient loco-regional perfusion pressure and consequent poor arterial flow. We hypothesized that patients with severe hemodialysis access-induced distal ischemia had worse survival compared with patients with mild or no hemodialysis access-induced distal ischemia. Methods: This single-center retrospective observational cohort study included three groups of prevalent hemodialysis patients with an upper extremity vascular access between 2006 and 2018. Symptomatic patients had signs and symptoms of hemodialysis access-induced distal ischemia and low digital brachial indices (<60%) and were divided into a mild (Grade I–IIa) and a severe hemodialysis access-induced distal ischemia (IIb–IV) group. The control group consisted of hemodialysis patients without signs of hemodialysis access-induced distal ischemia with digital brachial indices ≥60%. Factors potentially related to 4-year survival were analyzed. Results: Mild hemodialysis access-induced distal ischemia-patients displayed higher digital brachial indices ( n = 23, 41%, ±3) compared with severe hemodialysis access-induced distal ischemia-patients ( n = 28, 24%, ±4), whereas controls had the highest values ( n = 48, 80%, ±2; p < .001). A total of 44 patients (44%) died during follow-up. Digital brachial index (hazards ratio 0.989 [0.979–1.000] p = .046) was related to overall mortality following correction for presence of arterial occlusive disease (hazards ratio 2.28 [1.22–4.29], diabetes (hazards ratio 2.00 [1.07–3.72], and increasing age (hazards ratio 1.03 [1.01–1.06] as was digital pressure (hazards ratio 0.990 [0.983–0.998], p = .011). Overall survival was similar in mild hemodialysis access-induced distal ischemia and controls (2-year, 79% ±5; 4-year, 57% ±6, p = .818). In contrast, 4-year survival was >20% lower in patients with severe hemodialysis access-induced distal ischemia (2-year 62%± 10; 4-year 34% ± 10; p = .026). Conclusion: Presence of severe hemodialysis access-induced distal ischemia may be associated with poorer survival in hemodialysis patients. Lower digital brachial index values are associated with higher overall mortality, even following correction for other known risk factors.

show abstract

Revision using distal inflow for high flow hemodialysis access alters arterial flow characteristics in the dialysis arm

Cited by 8 publications

References 38 publications

Customizable modification of banding with external stenting for arteriovenous fistula flow reduction

Customizable modification of banding with external stenting for arteriovenous fistula flow reduction

A scoping review on surgical reduction of high flow arteriovenous haemodialysis access

Severe hemodialysis access-induced distal ischemia may be associated with poor survival

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