Vascular Access Creation and Care—Perspective From India

Sampathkumar, Krishnaswamy; Lobo, Valentine; Balasubramaniam, J; Mahaldar, Amol Ramesh; Yevzlin, Alexander S.; Kumbar, Lalathaksha

doi:10.1053/j.ackd.2015.09.001

Cited by 5 publications

(3 citation statements)

References 13 publications

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“…2 Over the years, some nephrologists from around the world, particularly from Europe (Italy and Germany), India and now United States, have started creating the AVF. [3][4][5][6][7][8][9] Reported outcomes of AVFs created by nephrologists are similar to that of the surgeons. 9 A survey done in Italy showed that about 50% of nephrologists in the country perform AVF surgery.…”

Section: Introductionmentioning

confidence: 77%

Functional Outcomes of Arteriovenous Fistulas Created by Nephrologist

Shrestha¹,

Soni²,

Vachharajani

2020

Kathmandu Univ. Med. J.

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Background Nephrologists worldwide, after undergoing surgical training, have reported creating arteriovenous fistulas (AVFs). Objective To demonstrate the functional outcome of arteriovenous fistulas created by a trained Nepalese nephrologist. Method This was a cross sectional study. A convenient sampling method was used and all consecutive AVFs created by a single nephrologist from January 2016 to December 2018 were included to assess their functional status within 3 months of creation. Patients with incomplete data and no follow up for up to 3 months post surgery were excluded. Result One hundred sixty six (166) arteriovenous fistulas were created during the study period; mean age of the patients was 52 ± 14 years, 121 (75%) male and 65 (39%) were diabetic. The most common site of arteriovenous fistula creation was left radiocephalic (Lt RC) 69(41.5%), followed by left brachiocephalic (Lt BC) 66(39.7%). Other sites were left brachiobasilic (Lt BB) 10(6%), right brachiocephalic (Rt BC) 10(6%), right radiocephalic (Rt RC) 9(5.4%) and right brachiobasilic (Rt BB) 2(1.2%). 139 arteriovenous fistulas (83.7%) were functional within 3 months post creation. Functional outcomes of radiocephalic, brachiocephalic and brachiobasilic arteriovenous fistulas were 75.6%, 90.7% and 100% respectively at 3 months post creation. Lymphoceles developed in three Lt BC arteriovenous fistulas, thrombosis in two Lt BC arteriovenous fistulas and infection in two Lt BC arteriovenous fistulas with pseudoaneurysm formation. Conclusion The functional outcome of arteriovenous fistulas created by a trained Nepalese nephrologist is similar to that reported in the literature.

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Section: Introductionmentioning

confidence: 77%

Functional Outcomes of Arteriovenous Fistulas Created by Nephrologist

Shrestha¹,

Soni²,

Vachharajani

2020

Kathmandu Univ. Med. J.

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“…In addition to insurance costs, high equipment costs, including the balloon, sheath, guidewire, and the fluoroscopic machine, must also be considered. Consequently, surgical thrombectomies are more prevalent in low-income countries [12]. …”

Section: Discussionmentioning

confidence: 99%

“…Interventional nephrology has emerged as a subspecialty worldwide, but surgical activity is still limited to a few individual areas [12,22,23]. These studies, however, have reported high success rates of access creation and management.…”

Section: Discussionmentioning

confidence: 99%

The feasibility of surgical salvage of thrombosed arteriovenous fistula by an interventional nephrologist

Cho

2017

Kidney Res Clin Pract.

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BackgroundSalvage of a thrombosed arteriovenous fistula (AVF) by secondary fistula conversion may be more effective than a conventional endovascular procedure for forearm fistula thrombosis. Surgical access procedures are an undeveloped area in interventional nephrology compared to endovascular procedures. Herein, the author report the results of surgical salvage of thrombosed AVFs by interventional nephrologists.MethodsThe author retrospectively analyzed 52 surgical salvage procedures for AVF thrombosis (radiocephalic fistula = 44 cases, brachiocephalic fistula = 8 cases) that were performed by interventional nephrologist between March 2007 and January 2016.ResultsSecondary fistula formation using the proximal vein was performed for 46 cases (88.5%); outflow rerouting was performed for two cephalic-arch stenosis cases (3.9%), simple thrombectomy was performed for two cases (3.9%), and a graft interposition was performed for two cases (3.9%). Technical success after the surgical procedures was achieved in 51 cases (98.1%), and 39 AVFs (75.0%) were prepared for immediate puncturing without catheter insertion. The primary and secondary patency rates for AVF at 6, 12, 18, and 24 months were 88.5%, 83.2%, 83.2%, and 83.2% and 96.0%, 96.0%, 93.2%, and 93.2%, respectively. The re-intervention rate was 0.27 ± 0.92/patient/ year.ConclusionBased on these results, the author conclude that surgical salvage of a thrombosed AVF, when performed under local anesthesia by a skilled interventional nephrologist, offers favorable short- and long-term success and should be the preferred treatment.

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Comparison of Dialysis Catheter Insertion and Complications Under Ultrasound Guidance with or without Fluoroscopic Assistance: A Randomized Study

Konnepati,

Sethi,

Lal

et al. 2024

IJN

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Background: Fluoroscopy is considered to be the gold standard and an essential requirement for catheter insertion. However, there is a paucity of data regarding the outcomes in ultrasound (USG)-guided insertion with and without fluoroscopy. We compared the complications of USG-guided tunneled dialysis catheter (TDC) insertion with and without fluoroscopy assistance. Materials and Methods: This was a single-center randomized controlled trial (RCT) done in a tertiary hospital in North India. After screening 153 patients, 149 were enrolled: 87 were randomized into USG-guided insertion without fluoroscopy (group A) and 62 were randomized into USG-guided insertion with fluoroscopy (group B). All insertions were done in a dedicated procedure room by trained nephrologists. Outcomes were analyzed at baseline and at 1-month follow-up. Mechanical complications as well as infective and thrombotic complications were compared between both the groups. Results: TDC insertion was successful (100%) in all the study participants (N = 149). One hundred twenty-nine catheters (86.5%) were inserted in the first attempt, 19 (12.5%) in the second attempt, and one catheter insertion required three attempts for insertion. The mean age of study participants was 43 years (±16.5), and males constituted 63% of the study cohort. Baseline laboratory characteristics of the two groups were comparable. The mean time of catheter insertion was 41.26 min (standard deviation [SD] 11.8) in group A and 47.74 min (SD 17.2) in group B (P = 0.007). The mean score of ease of catheter insertion, exit site bleed, infective and mechanical complications were not different between the two groups. Conclusion: Our study concluded that fluoroscopy has no additional advantage in reducing mechanical, infective, or thrombotic complications. In experienced hands, USG-guided TDC insertion without fluoroscopy assistance is as good as the insertion done with fluoroscopy assistance, with a shorter procedure time.

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Vascular Access Creation and Care—Perspective From India

Cited by 5 publications

References 13 publications

Functional Outcomes of Arteriovenous Fistulas Created by Nephrologist

Functional Outcomes of Arteriovenous Fistulas Created by Nephrologist

The feasibility of surgical salvage of thrombosed arteriovenous fistula by an interventional nephrologist

Comparison of Dialysis Catheter Insertion and Complications Under Ultrasound Guidance with or without Fluoroscopic Assistance: A Randomized Study

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