Superiority of Autogenous Arteriovenous Hemodialysis Access: Maintenance of Function with Fewer Secondary Interventions

Perera, Ganesha B.; Mueller, Mark; Kubaska, Stephen M.; Wilson, Samuel E.; Lawrence, Peter F.; Fujitani, Roy M.

doi:10.1007/s10016-003-0094-y

Cited by 161 publications

(107 citation statements)

References 10 publications

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“…We observed that autogenous fistulas had a fourfold lower rate of thrombosis than did prosthetic grafts, similar to findings reported in other studies [2,3,5]. The growing proportion of autogenous fistulas in the study population produced a confounding effect in the current study that has been difficult to separate from the effect of an aggressive invasive evaluation.…”

Section: Benefits and Costs Of Autogenous Fistulassupporting

confidence: 88%

“…Patients undergoing hemodialysis rely on large-bore arteriovenous conduits for renal replacement therapy, but hemodialysis accesses have finite patency. Autogenous fistulas fail after a median lifetime of 5 years, and prosthetic arteriovenous grafts fail after a median of 18 months [2,3]. The pathophysiology of late failure of both types of accesses usually involves the formation of a stenosis in the outflow limb triggered by increased venous wall stress, leading to stasis and thrombosis.…”

Section: Introductionmentioning

confidence: 99%

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Economic analysis of angiography and preemptive angioplasty to prevent hemodialysis‐access thrombosis

Bittl

Cohen²,

Seek

et al. 2009

Cathet Cardio Intervent

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Objectives: We sought to determine the economic value of early angiography and prophylactic angioplasty to prevent hemodialysis‐access thrombosis. Background: End stage renal disease consumes more than 6% of the Medicare budget. There is a need to understand the financial impact of each component of care. Methods: We conducted an observational economic analysis of a closed cohort of 818 hemodialysis patients, of whom 560 were referred for 1437 consecutive radiographic procedures during an 8‐year period. Patient‐level, bottom‐up microcosting methods provided supply and personnel costs before and after expansion of an angiographic referral program. Results: The rate of referral for malfunctioning but nonthrombosed hemodialysis accesses increased from 18.8 ± 8.8 to 48.3 ± 11.9 angiographic procedures per 100 patient‐years (P < 0.001), which was associated with a decline in access thrombosis from 27.6 to 22.0 events per 100 patient‐years (P = 0.029) and a net cost of $34,586 per 100 patient‐years. The incremental cost‐effectiveness ratio for invasive surveillance was $6,177 per thrombosis event avoided. The angiographic program expanded at the same time that the proportion of autogenous fistulas increased from 28.3% ± 11.3% to 59.7% ± 10.7% of total referrals (P = 0.0001). On multivariable logistic regression analysis, the expanded angiography program (P = 0.001) and the proportion of autogenous fistulas (P = 0.0001) were both independently associated with the reduction in access thrombosis. Conclusions: Given the incremental costs and the relatively modest benefits in preventing access thrombosis, preemptive angiographic management may represent a less efficient use of healthcare resources than increasing the number of patients with autogenous fistulas. © 2009 Wiley‐Liss, Inc.

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Section: Benefits and Costs Of Autogenous Fistulassupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Economic analysis of angiography and preemptive angioplasty to prevent hemodialysis‐access thrombosis

Bittl

Cohen²,

Seek

et al. 2009

Cathet Cardio Intervent

View full text Add to dashboard Cite

show abstract

“…When primary graft failures (approximately 10%) are also included, secondary graft patency from date of creation is likely to decrease slightly, expecting fistula survival to be superior from 12 mo on (Table 2). Extra follow-up time is required to obtain further insight into long-term AVF patency, but fewer interventions can be expected in fistulas compared with grafts (28).…”

Section: Limitationsmentioning

confidence: 99%

Hemodialysis Arteriovenous Fistula Patency Revisited

Huijbregts

Bots²,

Wittens³

et al. 2008

Clinical Journal of the American Society of Nephrology

327

239

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Background and objectives: Vascular access standards are predominantly based on older, single-center reports; however, the hemodialysis population has changed dramatically and primary arteriovenous fistula failure is a huge problem. This prospective, multicenter study used standardized definitions to analyze patency rates and potential risk factors that affect functional patency and late arteriovenous fistula functionality.Design, setting, participants, & measurements: Eleven centers participated in a guidelines implementation program. All new permanent vascular accesses were included. Patency and functional patency, defined as access survival from creation and from first dialysis use, respectively, were calculated using Kaplan-Meier analysis. Risk factors for primary functional patency loss (intervention-free interval) and secondary failure (abandonment) were determined using regression models.Results: A total of 491 arteriovenous fistulas were placed in 395 patients. Six-, 12-, and 18-mo secondary patency and functional patency were 75 ؎ 2.0, 70 ؎ 2.3, and 67 ؎ 2.7% and 90 ؎ 1.9, 88 ؎ 2.2, and 86 ؎ 2.7%, respectively. Primary failure rate was 40%. Thrombosis rate was 0.14 per patient-year. Diabetes and arteriovenous fistula surveillance were significantly associated with primary functional patency loss. Preoperative duplex was inversely related to secondary failure. The secondary failure rate per hospital varied from 0 to 39%.Conclusions: This study showed a marked difference between patency and functional patency, likely to be explained by high primary failure rates. Hemodialysis patients with diabetes can be expected to have reduced primary functional patency rates, but if treated adequately, then arteriovenous fistula functionality can be maintained as long as in patients without diabetes.

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“…[1][2][3][4][5] They don't rely entirely on their doctors and nurses; they take ownership of their care and control of their lives. They lose their fear of dialysis, of pain, of infiltrations, and of access problems, because they have become empowered and are no longer dependent.…”

Section: Resultsmentioning

confidence: 99%

“…A fistula with a consistent cannulator, i.e. a self-cannulator, will work far longer [1][2][3][4][5] and have fewer problems than one with multiple cannulators. 1-4, 6,7 There is even some evidence that self-cannulation is more comfortable for the patient, i.e., less painful.…”

mentioning

confidence: 99%

A how‐to manual: The art of teaching buttonhole self‐cannulation

Mott¹

2010

Dialysis & Transplantation

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Superiority of Autogenous Arteriovenous Hemodialysis Access: Maintenance of Function with Fewer Secondary Interventions

Cited by 161 publications

References 10 publications

Economic analysis of angiography and preemptive angioplasty to prevent hemodialysis‐access thrombosis

Economic analysis of angiography and preemptive angioplasty to prevent hemodialysis‐access thrombosis

Hemodialysis Arteriovenous Fistula Patency Revisited

A how‐to manual: The art of teaching buttonhole self‐cannulation

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