The first fistula: influence of location on catheter use and the influence of catheter use on maturation

Diskin, Charles J.; Stokes, Thomas J.; Dansby, Linda M.; Radcliff, Lautrec; Carter, Thomas B.; Lazenby, Allen

doi:10.1007/s11255-015-1062-5

Cited by 8 publications

(8 citation statements)

References 24 publications

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“…They found the upper arm was associated with a significantly reduced incidence and prevalence of catheter use and the higher maturation rate of fistula when compared to the forearm as the initial site for fistula creation. The catheter delayed maturation of fistula when placed prior to fistula . In our study, the usage rate of AVFs created before hemodialysis in the two groups is 95.8% and 69.2%, respectively, P = 0.02.…”

Section: Discussionmentioning

confidence: 57%

“…Such as age, smoking history, the presence of cardiovascular disease, hypertension, and diabetes. Diskin confirmed that the location of fistula also play an important role . They found the upper arm was associated with a significantly reduced incidence and prevalence of catheter use and the higher maturation rate of fistula when compared to the forearm as the initial site for fistula creation.…”

Section: Discussionmentioning

confidence: 89%

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Analysis of Follow‐Up Methods of Vascular Access and Patient Outcomes in Hemodialysis at a Tertiary Care Hospital in China

et al. 2018

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Arteriovenous fistula is the preferred option for vascular access in hemodialysis patients. The aim of this study was to assess different follow-up methods for hemodialysis patients in our hemodialysis center in China. A cohort of 124 patients with stage 3 chronic kidney disease was recruited and double-blind randomly assigned into two groups. Patients in Group A received phone calls to schedule their next consultation a week in advance. Patients in Group B scheduled their next appointment at the end of each visit. A total of 116 patients were included in the study and eight dropped out. Twenty-seven patients (46.4%) in Group A and 13 patients (22.4%) in Group B had an AVF prior to hemodialysis (P = 0.006), and 44.8% of patients in Group A and 15.5% of patients in Group B were using AVFs at the initiation of dialysis (P = 0.003). Sixteen patients (27.6%) in Group A and 24 patients (41.3%) in Group B required central venous catheters due to acute on chronic kidney disease and 13 patients (22.4%) in Group A and 21 patients (36.2%) in Group B required central venous catheters due to patient-related delays (P = 0.02). At the end of the study, seven patients in Group A died and 17 patients in Group B died (P = 0.027). The patients who received phone calls to schedule appointments in advance had a higher rate of arteriovenous fistulas prior to dialysis and at hemodialysis initiation had a reduced incidence of acute on chronic kidney disease and patient-related delays, and had an improved prognosis.

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Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 89%

Analysis of Follow‐Up Methods of Vascular Access and Patient Outcomes in Hemodialysis at a Tertiary Care Hospital in China

et al. 2018

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“…The upper extremities are the preferred sites to form a viable hemodialysis access. [1][2][3] However, there are a significant number of patients with preclusion for further use of the arm vessels as viable hemodialysis access due to central venous stenosis/occlusion or exhausted upper extremity veins. Various configurations of the SV to form a fistula have been used since the first description by May et al in 1969.…”

Section: Discussionmentioning

confidence: 99%

“…1 The upper extremity is the most commonly used and preferred area for native fistula creation. 2,3 However, there is not any strong recommendation referring to a secondary site for patients with exhausted upper extremity veins or with thrombotic central venous complications due to multiple catheter access. 1 The shallow course of veins providing easy cannulation and relatively infrequent complications due to blood flow disturbances of the hand are two important motives to create a radiocephalic fistula at the forearm.…”

Section: Introductionmentioning

confidence: 99%

Preliminary balloon dilation of both saphenous fascia and the saphenous vein increases the below-knee fistula patency, but not maturation

et al. 2020

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Objective: There is no reliable secondary site for fistula creation in patients with preclusions for further use of upper extremity vessels as viable hemodialysis access. Below-knee vessels resemble the forearm vascular anatomy and, therefore, methods to improve the outcomes of fistula creation at this level would also help to improve the quality of life for those patients. The aim of the present study was to examine the efforts to improve the functionality of below-knee fistulas in a sample of dialysis patients. Methods: We retrospectively evaluated the results of ankle fistulas created following preliminary balloon dilatation of both the saphenous fascia and the saphenous vein in 11 patients who were considered eligible if they did not have concomitant venous or arterial lower extremity disease. We assessed the changes in fistula flow within 6 months as well as patency and maturation rates. Results: Though the patency rate at 6 months was 63.6% (seven patients), only three fistulas (27.3%) were used for routine dialysis. All mature fistulas were observed in patients with a preoperative posterior tibial artery flow of more than 35 mL/min. Conclusion: Saphenous vein dilation throughout the below-knee promotes fistula patency, but the posterior tibial artery shows inadequate response as an inflow supplier at the ankle level. More proximal connection of saphenous vein after balloon dilation may be used in the future to achieve adequate flow from leg arteries.

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“…They stressed the importance of a careful clinical examination together with an integration of risk assessment in planning for an AVF. In a similar study, Diskin et al found that the upper arm as the initial site for AVF creation was associated with a significantly reduced incidence and prevalence of CVC. These two studies challenge the conventional algorithm of access placement and stress the need for an overall assessment of the patient's condition prior to access surgery.…”

Section: Vascular Anatomymentioning

confidence: 91%

A Patient‐Centered Approach to Hemodialysis Vascular Access in the Era of Fistula First

Kalloo

Blake

Wish

2016

Seminars in Dialysis

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States hemodialysis population. While this endeavor remains steadfast in assuring the continued dominance of this policy for AVF preference, it fails to take into account a subset of the dialysis population who will fail to see the benefits of an AVF. This subset of patients may include the elderly, those with poor vasculature anatomy, those with slowly progressive CKD that are more likely to die than progress to ESRD, and those with an overall poor long-term prognosis and shortened life expectancy. Thus, in an effort to avoid numerous unnecessary surgical and interventional procedures with minimal to no gains in clinical outcomes, an individualized patient approach must be adopted. The CMS instituted quality incentive program (QIP) is designed to reward high AVF prevalence while also penalizing high CVC prevalence. The current model is devoid of case-based adjustment, thus penalties are disbursed to dialysis providers in accordance with a "one-size-fits-all" fistula only approach. The most suitable access for a patient remains the one that takes into account the characteristics unique to the individual patient with a primary focus on patient comfort, satisfaction, quality of life and clinical outcomes.

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The first fistula: influence of location on catheter use and the influence of catheter use on maturation

Cited by 8 publications

References 24 publications

Analysis of Follow‐Up Methods of Vascular Access and Patient Outcomes in Hemodialysis at a Tertiary Care Hospital in China

Analysis of Follow‐Up Methods of Vascular Access and Patient Outcomes in Hemodialysis at a Tertiary Care Hospital in China

Preliminary balloon dilation of both saphenous fascia and the saphenous vein increases the below-knee fistula patency, but not maturation

A Patient‐Centered Approach to Hemodialysis Vascular Access in the Era of Fistula First

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