We Refuse to Give up on Nonmaturing Fistulas

Beathard, Gerald A.

doi:10.1111/sdi.12511

Cited by 3 publications

(4 citation statements)

References 16 publications

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“…Multiple reports have emphasized that percutaneous transluminal balloon angioplasty has assumed a central role in the management of arteriovenous dialysis access (graft and fistula) stenosis. [5][6][7][8][9][10][11][12][13][14][15][16][17] Over the years, this treatment has proven to be safe as well as effective. [4][5][6][7][8][9][10][11] This procedure is usually performed on an outpatient basis and the dialysis access can be used immediately following the angioplasty.…”

Section: Stenosis Of Vascular Accessmentioning

confidence: 99%

“…Mechanical as well as pharmacomechanical thrombolysis procedures can be successfully performed. 6,9,10,16 It is worth mentioning that the primary patency rates after declotting of a clotted vascular access are markedly reduced when compared with the primary patency following angioplasty of access stenosis. 10,16 Declotting of a thrombosed access should be performed quickly for multiple reasons.…”

Section: Thrombosis Of Hemodialysis Accessmentioning

confidence: 99%

“…[6][7][8][9][10] In recent years, major advances have been made in our understanding of dialysis access complications as well as the management of these complications. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Three most common complications continue to surround hemodialysis access. 16 These include vascular access stenosis, vascular access thrombosis, and catheter-related fibroepithelial sheath formation.…”

mentioning

confidence: 99%

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The Complications of Vascular Access in Hemodialysis

Masud

Costanzo

Zuckerman

et al. 2017

Semin Thromb Hemost

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Complications related to hemodialysis vascular access continue to have a major impact on morbidity and mortality. Vascular access dysfunction is the single most important factor that determines the quality of dialysis treatment. Vascular access stenosis is a common complication that develops in a great majority of patients with an arteriovenous access and leads to access dysfunction. By restricting luminal diameter, this complication leads to a reduction in blood flow and places the access at risk for thrombosis. Similarly, the development of catheter-related fibroepithelial sheath also causes catheter dysfunction with its detrimental effects on blood flow. In this article, we discuss the most common complications associated with dialysis access and provide therapeutic options to manage these problems.

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Section: Stenosis Of Vascular Accessmentioning

confidence: 99%

Section: Thrombosis Of Hemodialysis Accessmentioning

confidence: 99%

mentioning

confidence: 99%

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The Complications of Vascular Access in Hemodialysis

Masud

Costanzo

Zuckerman

et al. 2017

Semin Thromb Hemost

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“…For example, Dember et al showed that approximately 60% of new fistulas fail to attain suitability for dialysis and Lok et al demonstrated that patients at highest risk for primary failure have an overall risk of 70% . Those with primary failure undergo an average of 3.3 procedures to assist maturation and typically require an additional 3 months before the fistula is deemed suitable for cannulation …”

Section: Establishing Vascular Access Should Be Easymentioning

confidence: 99%

Central venous catheters for chronic hemodialysis: Is “last choice” never the “right choice”?

Dumaine

Brown

MacRae

et al. 2017

Seminars in Dialysis

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Since the publication of the first vascular access clinical practice guidelines in 1997, the global nephrology community has dedicated significant time and resources toward increasing the prevalence of arteriovenous fistulas and decreasing the prevalence of central venous catheters for hemodialysis. These efforts have been bolstered by observational studies showing an association between catheter use and increased patient morbidity and mortality. To date, however, no randomized comparisons of the outcomes of different forms of vascular access have been conducted. There is mounting evidence that much of the difference in patient outcomes may be explained by patient factors, rather than choice of vascular access.Some have called into question the appropriateness of fistula creation for certain patient populations, such as those with limited life expectancy and those at high risk of fistula-related complications. In this review, we explore the extent to which catheters and fistulas exhibit the characteristics of the "ideal" vascular access and highlight the significant knowledge gaps that exist in the current literature.Further studies, ideally randomized comparisons of different forms of vascular access, are required to better inform shared decision making.Twenty years ago, fistulas were first promoted as the vascular access of choice by the Kidney Disease Outcomes Quality Initiative.1 Since then, the nephrology community has worked to increase fistula prevalence and reduce the use of central venous catheters. These efforts have been supported by initiatives such as Fistula First, 2 clinical practice guidelines from around the world, [3][4][5][6] and in some jurisdictions, by financial incentives which reward dialysis centers with high fistula prevalence and penalize those with high catheter prevalence. 7 In 2007, a modification of the Fistula First Initiative to "Fistula First, Catheter Last" was proposed, re-emphasizing the perceived importance of minimizing catheter use. 8 However, critics of "Fistula First, Catheter Last" have expressed concern that all comparisons between access types have been observational, subject to high degrees of bias, 9,10 and unable to account for other patient factors which likely contribute to poor outcomes seen in patients treated with catheters. 11,12 Others have questioned the utility of fistula creation in elderly patients and in patients at high risk for fistula failure or complications, arguing that such patients may be better served by catheters. 13 Surveys of the nephrology community suggest that many clinicians feel that a catheter is often appropriate and that there is equipoise regarding the ideal form of vascular access in many situations. 14,15 In fact, enrollment recently began for a pilot randomized trial comparing outcomes in incident hemodialysis patients, over the age of 65, who start dialysis with a catheter. Patients will be randomized to creation of a fistula vs continued use of a catheter (clinicaltrials.gov NCT02675569). 16The ideal vascular access has...

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