Vascular access of last resort

Vachharajani, Tushar J.; Agarwal, Anil; Asif, Arif

doi:10.1016/j.kint.2017.10.030

Cited by 26 publications

(21 citation statements)

References 33 publications

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“…The present study demonstrated the percutaneous, endovascular CVA placement technique described enables rightsided placement of CVCs across a range of obstruction types, with more than half of the patients in the SAVE registry having the most severe Type 3 or Type 4 obstruction (1). Options for catheter placement are limited for patients with this degree of venous obstruction, and for hemodialysis patients placements may impact their ability to continue to receive dialysis therapy (14). Catheter placement through a femoral vein is a commonly used alternative in dialysis patients with occluded central veins.…”

Section: Discussionmentioning

confidence: 99%

“…This placement location has been shown to be associated with shorter primary patency than catheters placed through the RIJ and with an increased risk of ipsilateral lower-extremity deep vein thrombosis (6,15). Other catheter placement procedures sometimes used in this patient population include placement through transhepatic and transrenal approaches and placement through a translumbar approach directly into the IVC (14). These procedures are more difficult to perform than conventional catheter placement and pose insertion-related complications specific to the anatomy associated with each procedure (7,8).…”

Section: Discussionmentioning

confidence: 99%

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Multicenter Experience with the Surfacer Inside-Out Access Catheter System in Patients with Thoracic Venous Obstruction: Results from the SAVE Registry

Gallieni

Matoussevitch

Steinke³

et al. 2020

Journal of Vascular and Interventional Radiology

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Purpose: To report the device performance and safety for the Surfacer Inside-Out access catheter system in patients with thoracic central venous obstruction (TCVO) requiring central venous access (CVA).Materials and Methods: Five sites prospectively enrolled 30 patients requiring a tunneled dialysis catheter between February 2017 and September 2018 in the SAVE (Surfacer System to Facilitate Access in Venous Obstructions) registry. Patient demographics, medical history, and type of TCVO were documented at enrollment. Device performance and adverse events were collected during the procedure and upon hospital discharge. Twenty-nine of the 30 patients enrolled required CVA for hemodialysis. Retrospective classification of TCVOs according to SIR reporting standards showed 9 patients (30%) had Type 4 obstructions, 8 (26.7%) had Type 3, 5 (16.7%) had Type 2, and 8 (26.7%) had Type 1 obstruction.Results: Central venous catheters (CVCs) were successfully placed in 29 of 30 patients (96.7%). The procedure was discontinued in 1 patient due to vascular anatomical tortuosity. All 29 patients with successful CVC placement achieved adequate catheter patency and tip positioning. There were no device-related adverse events, catheter malposition, or intra-or postprocedural complications. Mean time from device insertion to removal for the 29 patients who successfully completed the procedure was 24 ± 14.9 (range, 6-70) minutes. Mean fluoroscopy time was 6.8 ± 4.5 (range, 2.2-25.5) minutes. Conclusions:The Surfacer Inside-Out procedure provided an alternative option to restore right-sided CVA in patients with TCVO.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Multicenter Experience with the Surfacer Inside-Out Access Catheter System in Patients with Thoracic Venous Obstruction: Results from the SAVE Registry

Gallieni

Matoussevitch

Steinke³

et al. 2020

Journal of Vascular and Interventional Radiology

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“…3 A hybrid graftcatheter technique, the Hemoaccess Reliable Outflow (HeRO) Vascular Access Device, which is a PTFE AVG coupled to a CVC, has not shown superiority over a standard PTFE AVG as a new access. 69 However, it can be used to salvage an existing AVF/AVG that has proximal stenosis from intimal hyperplasia or central vein occlusion 3,70 as one of a number of vascular access choices available as an HD patient's last resort. 11,27,70…”

Section: Ne W Acce Ss Techni Que Smentioning

confidence: 99%

Barriers to optimal vascular access for hemodialysis

Brown

2020

Seminars in Dialysis

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Vascular access so essential for hemodialysis (HD) has been considered its Achilles heel. 1 Since the description of the Brescia-Cimino radiocephalic arteriovenous fistula (AVF) in 1966, 2 it has been considered the optimal access for HD because it was long-lasting and had generally lower rates of complications and mortality than either arteriovenous grafts (AVGs) or central venous catheters (CVCs). 3,4 This gave rise to the "Fistula First" initiative in 2003 5 that has dominated quality assessment in HD as a central factor in the Centers for Medicare and Medicaid Services (CMS) Five Star ratings and financial reimbursement of HD providers. However, the Fistula First initiative had the unintended consequences of increasing the proportion of CVCs as the percentage of AVG creation markedly decreased from 170 per 1000 patient-years in 2003 to 100 in 2007. 6 Therefore, Fistula First became "Fistula First, Catheter Last" in 2007 7 to modify this effect. But as the end-stage kidney disease (ESKD) population expanded with aging HD patients and those with comorbid conditions, individual assessment of the appropriate access for HD changed the paradigm to "Patient First: ESKD Life-Plan" by the most recent National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines. 3 KDOQI now espouses that "attainment of the 'right access, in the right patient, at the right time, for the right reasons' is a more patient-centered approach to care, where population measures, such as percentage with AVF created or used, or the percentage with hemodialysis CVC, may be unhelpful and counterproductive for patient-centered goals". 3 Attaining a goal of the "right access" has proved elusive mainly because, as depicted by the characteristics desirable for the optimal vascular access shown in Table 1, 3,8,9 the optimal vascular access does not currently exist. Thus, ESKD care providers attempting to offer the right access must weigh the barriers to achieving the most optimal vascular access to suit each of their HD patients individually.

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“…The problem with limited venous access may occur in patients receiving long-term hemodialysis treatment. 1 Implantable cardiac device–related infection can complicate it even more. Patients with end-stage renal disease (ESRD) and cardiac implantable electronic device (CIED) pose very high-risk group when both situations occur simultaneously.…”

Section: Introductionmentioning

confidence: 99%

Simultaneous placement of leadless pacemaker and dialysis catheter in patient with exhausted vasculature

Bednarczyk¹,

Kuliczkowski

Letachowicz³

et al. 2019

J Vasc Access

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The problem with limited venous access may occur in patients receiving long-term hemodialysis treatment with no possibility of arteriovenous access or in patients with cardiac implantable electronic device–related infection leading to the removal of cardiac implantable electronic device. We present a case report where both situations occur simultaneously. Using recent development in cardiac pacing—leadless cardiac pacemaker—we manage to overcome the vascular access problem. The described case emphasizes the necessity of multispecialty collaboration and gains of new pacing technology in patients who need placement of vascular access for hemodialysis and cardiac implantable electronic device where vascular access is scarce.

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Vascular access of last resort

Cited by 26 publications

References 33 publications

Multicenter Experience with the Surfacer Inside-Out Access Catheter System in Patients with Thoracic Venous Obstruction: Results from the SAVE Registry

Multicenter Experience with the Surfacer Inside-Out Access Catheter System in Patients with Thoracic Venous Obstruction: Results from the SAVE Registry

Barriers to optimal vascular access for hemodialysis

Simultaneous placement of leadless pacemaker and dialysis catheter in patient with exhausted vasculature

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