| 1. USRDS. CKD in the General Population. Available at: https://adr.usrds.org/2020/chronic-kidney-disease/1-ckd-in-the-general-population. |
Review/Other-Dx |
N/A |
To present cross-sectional estimates of CKD prevalence in the United States using data from the National Health and Nutrition Examination Survey, which includes data derived from interviews, physical examinations, and laboratory testing. |
No abstract available |
4 |
| 2. Saran R, Robinson B, Abbott KC, et al. US Renal Data System 2018 Annual Data Report: Epidemiology of Kidney Disease in the United States. Am J Kidney Dis 2019;73:A7-A8. |
Review/Other-Tx |
N/A |
No abstract available. |
No abstract available. |
4 |
| 3. Vascular Access Work Group. Clinical practice guidelines for vascular access. Am J Kidney Dis 2006;48 Suppl 1:S248-73. |
Review/Other-Tx |
N/A |
No abstract available. |
No abstract available. |
4 |
| 4. KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for 2006 Updates: Hemodialysis Adequacy, Peritoneal Dialysis Adequacy and Vascular Access. Am J Kidney Dis 2006;48:S1-S322. |
Review/Other-Tx |
N/A |
No abstract available. |
No abstract available. |
4 |
| 5. Lok CE, Huber TS, Lee T, et al. KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update. Am J Kidney Dis 2020;75:S1-S164. |
Review/Other-Tx |
N/A |
To assist multidisciplinary practitioners care for chronic kidney disease patients and their vascular access. |
The National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (KDOQI) has provided evidencebasedguidelines for hemodialysis vascular access since 1996. Since the last update in 2006, there has been agreat accumulation of new evidence and sophistication in the guidelines process. The 2019 update to the KDOQIClinical Practice Guideline for Vascular Access is a comprehensive document intended to assist multidisciplinarypractitioners care for chronic kidney disease patients and their vascular access. New topics include the end-stagekidney disease “Life-Plan” and related concepts, guidance on vascular access choice, new targets for arteriovenousaccess (fistulas and grafts) and central venous catheters, management of specific complications, and renewedapproaches to some older topics. Appraisal of the quality of the evidence was independently conducted by using aGrading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, and interpretationand application followed the GRADE Evidence to Decision frameworks. As applicable, each guideline statement isaccompanied by rationale/background information, a detailed justification, monitoring and evaluation guidance,implementation considerations, special discussions, and recommendations for future research. |
4 |
| 6. Suttie SA, Ponnuvelu G, Henderson N, et al. Natural history of upper limb arterio-venous fistulae for chronic hemodialysis. J. vasc. access. 13(3):332-7, 2012 Jul-Sep. |
Observational-Tx |
398 native AVFs |
To determine the site and time to first stenosis and time to and factors influencing AVF failure for radio-cephalic (RC), brachio-cephalic (BC), and transposed brachio-basilic (BB) AVF. |
In total, 398 native AVF were included in the study (91 RC, 208 BC, and 99 BB), with a mean age of 66 years. A total of 215 (54%) AVF developed a flow limiting stenosis, and over time 151 (40%) AVF failed. Stenoses developed significantly earlier in RC AVF (median 113 days) compared to BC (median 277 days), compared to BB (median days 414), P=.029. There was no statistically significant difference in time to failure (RC median 1344 days; BC median 1576 days; BB median 1159 days), P=.673. The presence of stenosis was the only variable found to have a significant impact on AVF failure in multivariate analysis. |
3 |
| 7. Dariushnia SR, Walker TG, Silberzweig JE, et al. Quality Improvement Guidelines for Percutaneous Image-Guided Management of the Thrombosed or Dysfunctional Dialysis Circuit. J Vasc Interv Radiol 2016;27:1518-30. |
Review/Other-Tx |
N/A |
No abstract available. |
No abstract available. |
4 |
| 8. Beathard GA, Urbanes A, Litchfield T. Changes in the Profile of Endovascular Procedures Performed in Freestanding Dialysis Access Centers over 15 Years. Clin J Am Soc Nephrol. 12(5):779-786, 2017 May 08. |
Observational-Tx |
689,676 dialysis access procedures |
To evaluate how these changes have affected dialysis access maintenance and salvage procedures performed in freestandingdialysis access centers and to examine the effectiveness, efficiency, and safety of these procedures in this setting. |
The arteriovenous procedure profile changed from one characterized by approximately equal numbers of angioplasties and thrombectomies performed on arteriovenous grafts (AVGs) to one characterized primarily by angioplasties performed on arteriovenous fistulas. The percentage of angioplasties performed throughout the study was significantly greater than thrombectomies, with a mean of 67.9%versus 32.1%(P<0.001). Interventional procedures did not decrease with increasing arteriovenous fistula utilization in prevalent patients receiving dialysis. The incidence roughly paralleled the increasing prevalence of this type of access. A decreasing percentage of AVG utilization resulted in a progressive, roughly parallel, but disproportionately higher, decrease in the percentage of AVG procedures (P<0.001). A progressive improvement in procedure outcomes and a decrease in complication rates and procedure times were observed (P<0.001 for each). A progressive decrease in tunneled dialysis catheter placement was also observed. |
3 |
| 9. Leivaditis K, Panagoutsos S, Roumeliotis A, Liakopoulos V, Vargemezis V. Vascular access for hemodialysis: postoperative evaluation and function monitoring. Int Urol Nephrol 2014;46:403-9. |
Review/Other-Tx |
N/A |
To discuss methods that could provide vascular access (VA) surveillance. |
No results available. |
4 |
| 10. Leon C, Orozco-Vargas LC, Krishnamurthy G, et al. Accuracy of physical examination in the detection of arteriovenous graft stenosis. Semin Dial 2008;21:85-8. |
Review/Other-Tx |
N/A |
To present pathophysiology, clinical features, and differential diagnosis. It focuses on recently developed strategies to ameliorate DHIS in chronic HD patients. |
No results available |
4 |
| 11. Li B, Li Q, Chen C, Guan Y, Liu S. Diagnostic accuracy of computer tomography angiography and magnetic resonance angiography in the stenosis detection of autologuous hemodialysis access: a meta-analysis. PLoS One 2013;8:e78409. |
Meta-analysis |
16 studies (500 patients) |
To compare the diagnostic performances of computer tomography angiography (CTA) and magnetic resonance angiography (MRA) for detection and assessment of stenosis in patients with autologuous hemodialysis access. |
Sixteen eligible studies were included, with a total of 500 patients. Both CTA and MRA were accurate modality (sensitivity, 96.2% and 95.4%, respectively; specificity, 97.1 and 96.1%, respectively; DOR [diagnostic odds ratio], 393.69 and 211.47, respectively) for hemodialysis vascular access. No significant difference was detected between the diagnostic performance of CTA (AUC, 0.988) and MRA (AUC, 0.982). Meta-regression analyses and subgroup analyses revealed no statistical difference. The Deek's funnel plots suggested a publication bias. |
Good |
| 12. Duijm LE, Liem YS, van der Rijt RH, et al. Inflow stenoses in dysfunctional hemodialysis access fistulae and grafts. Am J Kidney Dis 2006;48:98-105. |
Observational-Tx |
66 dysfunctional AVFs and 35 AVGs in 56 men and 45 women |
To prospectively determine the incidence of inflow stenoses in dysfunctional hemodialysis access arteriovenous fistulae (AVFs) and grafts (AVGs). |
CE-MRA showed 19 arterial stenoses in 14 patients (14%). DSA confirmed 18 of these lesions in 13 patients and showed no additional inflow lesions. Of the 13 patients, 7 patients had arterial stenoses only and 6 patients had accompanying stenoses in the shunt region and/or outflow. Referral criteria for the 13 patients to undergo access evaluation had been decreased flow rates (9 patients), steal symptoms (2 patients), and insufficient access maturation (2 patients). Access flow of the 9 patients with a low-flow access improved from 477 +/- 74 mL/min to 825 +/- 199 mL/min after angioplasty. One patient with steal symptoms became symptom free after angioplasty. Endovascular intervention in 3 patients proved to be unsuccessful. |
2 |
| 13. Kamper L, Frahnert M, Grebe SO, Haage P. Radiological assessment of vascular access in haemodialysis patients. [Review]. J. vasc. access. 15 Suppl 7:S33-7, 2014. |
Review/Other-Dx |
N/A |
To review the radiological assessment of vascular access in haemodialysis patients. |
Clinical examination is still the most important diagnostic tool and duplex ultrasonography is the imaging method of first choice. Radiological assessment of vascular access for haemodialysis includes preoperative analysis of vessel anatomy and postoperative surveillance for access maturation as well as diagnosis in vascular access insufficiency. Compared to ultrasonography digital subtraction angiography is superior for the evaluation of the central veins and allows diagnosis and treatment in one session. Computed tomography should only be used in patients with inconclusive ultrasonography results, for example, for the assessment of the central veins and visualization of the vascular tree. Gadolinium-enhanced magnetic resonance imaging is no longer recommended in dialysis patients, because it may trigger nephrogenic systemic fibrosis. In patients with a history of previous central venous catheters additional preoperative imaging of the central veins should be performed. In this article we review the different radiological imaging methods for preoperative assessment and suspected vascular access dysfunction. |
4 |
| 14. Ehrman KO, Taber TE, Gaylord GM, Brown PB, Hage JP. Comparison of diagnostic accuracy with carbon dioxide versus iodinated contrast material in the imaging of hemodialysis access fistulas. J Vasc Interv Radiol 1994;5:771-5. |
Observational-Dx |
32 patients |
To assess the quality and accuracy of CO2 as a contrast agent. |
There was no significant difference in physician ratings of the degree of venous stenosis (P > .30). Estimation of the degree of stenosis was significantly higher with CO2 than with ionic contrast material (P = .0001). When iodinated contrast material is used as the gold standard, the sensitivity, specificity, and accuracy of CO2 were 94%, 58%, and 75%, respectively. |
1 |
| 15. Johnston WF, Zamora AJ, Upchurch GR, Jr. Transient paralysis from carbon dioxide angiography in a patient after four-vessel endovascular thoracoabdominal aortic aneurysm repair. J Vasc Surg 2012;56:1717-20. |
Review/Other-Tx |
1 patient |
To describe a case of suspected CO2 embolus to the iliolumbar artery after iliac artery stenting resulting in immediate loss of bilateral lower extremity motor and sensory function. |
No results available. |
4 |
| 16. Kariya S, Tanigawa N, Kojima H, et al. Efficacy of carbon dioxide for diagnosis and intervention in patients with failing hemodialysis access. Acta Radiol. 51(9):994-1001, 2010 Nov. |
Review/Other-Tx |
94 patients |
To evaluate the feasibility of fistulography using CO2 for diagnosis and intervention in patients with failing hemodialysis access. |
Interventional treatment was indicated in 141 accesses. In 115 of these 141 cases, intervention was performed using CO2 fistulography alone. When the access flow stopped or decreased very much due to an occlusion and severe stenosis, we could not visualize the access by CO2 fistulography, or could not perform CO2 fistulography. For those cases, iodinated contrast fistulography was performed. When the vascular rupture, dissection, or clot formation occurred during intervention, iodinated contrast fistulography was performed. In three patients with arteriovenous fistula, manual injection of CO2 into the brachial artery resulted in reflux of the gas into the thoracic aorta causing transient loss of consciousness. |
4 |
| 17. Wasinrat J, Siriapisith T, Thamtorawat S, Tongdee T. 64-slice MDCT angiography of upper extremity in assessment of native hemodialysis access. Vasc Endovascular Surg. 45(1):69-77, 2011 Jan. |
Observational-Dx |
21 patients |
To compare multidetector row computed tomographic (MDCT) angiography with conventional digital subtraction angiography (DSA) in the evaluation of vascular access stenoses in hemodialysis patients. |
The sensitivity and specificity of MDCT angiography for the detection of significant hemodialysis vascular access were 100% (95% CI, 89.3%-100%) and 94.8% (95% CI, 89.1%-97.6%), respectively. The positive and negative predictive values were 84.2% (95% CI, 68.1%-93.4%) and 100% (95% CI, 95.8%-100%), respectively. The accuracy of MDCT angiography for detection of significant stenoses was 95.9% (95% CI, 91.4%-97.0%). |
3 |
| 18. Heye S, Maleux G, Claes K, Kuypers D, Oyen R. Stenosis detection in native hemodialysis fistulas with MDCT angiography. AJR Am J Roentgenol. 2009;192(4):1079-1084. |
Experimental-Dx |
36 patients |
To assess the diagnostic value of 64-MDCT angiography in the evaluation of failing hemodialysis arteriovenous fistulas (AVFs) in comparison with conventional digital subtraction angiography (DSA). |
Interobserver agreement for detecting stenosis was excellent for both DSA (kappa = 0.86; 95% CI, 0.81-0.91) and MDCT angiography (kappa = 0.82; 95% CI, 0.77-0.87). Accuracy, sensitivity, specificity, PPV, and NPV of MDCT angiography for detecting >/= 50% stenosis or occlusion was 92.0% (95% CI, 86.8-95.3%), 90.2% (77.8-96.3%), 92.8% (85.9-96.6%), 85.2% (72.3-92.9%), and 95.4% (89.0-98.3%), respectively. No significant difference in image quality was seen between MDCT angiography and DSA (p = 0.3008) or between MDCT angiography with the patient's arm stretched overhead or alongside the body (p = 0.2912). |
2 |
| 19. Tordoir J, Canaud B, Haage P, et al. EBPG on Vascular Access. Nephrol Dial Transplant 2007;22 Suppl 2:ii88-117. |
Review/Other-Tx |
N/A |
No abstract available. |
No abstract available. |
4 |
| 20. Rajan DK, Bunston S, Misra S, Pinto R, Lok CE. Dysfunctional autogenous hemodialysis fistulas: outcomes after angioplasty--are there clinical predictors of patency? Radiology 2004;232:508-15. |
Observational-Tx |
151 dysfunctional fistulas |
To determine the primary and secondary patency rates for fistulas treated with angioplasty, as well as clinical predictors of fistula patency after angioplasty. |
One hundred fifty-one dysfunctional fistulas (94 radiocephalic and 57 brachiocephalic) were treated with angioplasty initially. Clinical success rate was 98.0% (297 of 303 interventions). At 3, 6, and 12 months, respectively, primary patency rates +/- standard errors of the estimate were 73% +/- 6, 51% +/- 7, and 39% +/- 7 for brachiocephalic fistulas and 85% +/- 4, 75% +/- 5, and 62% +/- 5 for radiocephalic fistulas; secondary patency rates were 96% +/- 2.4, 89% +/- 4, and 85% +/- 5 for brachiocephalic fistulas and 91% +/- 3, 88% +/- 3, and 86% +/- 4 for radiocephalic fistulas. For all time points, there was a significant difference in primary (P =.004) but not secondary (P =.45) patency between radiocephalic and brachiocephalic fistulas. Stenosis was most prevalent within 3 cm of the arteriovenous anastomosis in 74 (64%) of the 116 dysfunctional radiocephalic fistulas and at the cephalic arch in 22 (30%) of the 74 dysfunctional brachiocephalic fistulas. The clinical variables examined did not influence outcome. Complications occurred in seven (2.3%) of 303 interventions. |
2 |
| 21. Bautista AB, Suhocki PV, Pabon-Ramos WM, Miller MJ Jr, Smith TP, Kim CY. Postintervention Patency Rates and Predictors of Patency after Percutaneous Interventions on Intragraft Stenoses within Failing Prosthetic Arteriovenous Grafts. J Vasc Interv Radiol. 26(11):1673-9, 2015 Nov. |
Observational-Tx |
229 intragraft stenoses (183 patients) |
To determine postintervention patency rates after endovascular interventions on intragraft stenosis within failing prosthetic arteriovenous (AV) grafts, as well as predictors of patency. |
Two-hundred twenty-nine intragraft stenoses were identified in 183 grafts. Intragraft stenoses were treated at a median of 20.7 months (interquartile range, 12.0-33.9 mo) after graft creation. Graft thrombosis was present in 62%. The anatomic success rate of angioplasty was 85%. Fifteen percent required stent or stent-graft deployment because of inadequate response to angioplasty. A concurrent nonintragraft stenosis within the access circuit was identified in 76% of grafts. At 3, 6, and 12 months, postintervention primary patency rates were 56%, 40%, and 23%, respectively. Secondary patency rates were 84%, 77%, and 67%, respectively. The lesion-specific patency rates were 89, 75%, and 63%, respectively. Graft thrombosis (hazard ratio [HR], 1.43; P = .048) and concurrent nonintragraft lesion (HR, 1.51; P = .047) were independent negative predictors of primary patency. Graft thrombosis (HR, 1.81; P = .029) was a negative predictor of lesion patency, and stent or stent-graft deployment (HR, 0.42; P = .045) was a positive predictor of lesion patency. |
3 |
| 22. Beathard GA. Percutaneous transvenous angioplasty in the treatment of vascular access stenosis. Kidney Int 1992;42:1390-7. |
Observational-Tx |
536 PTVA procedures (285 patients) |
To evaluate percutaneous transvenous angioplasty (PTVA) for the treatment of all types of vascular access stenosis in a large population of dialysis patients. |
A total of 536 PTVA procedures was performed in 285 patients. This included 107 cases of long venous stenosis (> 6 cm) and 149 cases of mid-graft stenosis. In the total group, an initial success rate of 94% was obtained (80% or greater dilatation). A decrease in VPm (venous pressure measured on dialysis) of 35.9%, 32.4%, and 22.6% was seen at one week, one month, and three months, respectively. At 90 days, 180 days, and 360 days 90.6%, 61.3%, and 38.2%, respectively, of the treated grafts were continuing to be patent and functional with no need for repeat PTVA treatment. Repeat treatments for recurrent lesions were as successful as the initial treatment. |
2 |
| 23. Aoki J, Colombo A, Dudek D, et al. Peristent remodeling and neointimal suppression 2 years after polymer-based, paclitaxel-eluting stent implantation: insights from serial intravascular ultrasound analysis in the TAXUS II study. Circulation 2005;112:3876-83. |
Experimental-Tx |
77 BMS patients, 43 SR patients, 41 MR patients |
To evaluate long-term vascular responses as long as 2 years after implantation of polymer-based, paclitaxel-eluting stents in contrast to uncoated stents. |
TAXUS II is a randomized, double-blind trial comparing slow-release (SR) and moderate-release (MR) TAXUS stents with bare-metal control stents (BMSs). One hundred sixty-one event-free patients (SR, 43; MR, 41; and BMS, 77) underwent serial intravascular ultrasound (IVUS) analysis after the procedure and at 6 months and 2 years. At 2 years, neointimal responses continued to be significantly suppressed in the SR and MR groups when compared with the BMS group (BMS, 1.49+/-1.12 mm2; SR, 0.94+/-0.76 mm2 [P=0.004]; and MR, 1.06+/-0.90 mm2 [P=0.02]). Between 6 months and 2 years, the BMS group showed compaction of the neointima (Delta, -0.22+/-1.05 mm2 [P=0.08]). In contrast, both the SR and MR groups exhibited an increase (Delta SR, 0.30+/-0.76 mm2 (P=0.01); MR, 0.41+/-0.94 mm2 [P=0.009]). Between 6 months and 2 years, the initial increase in plaque outside the stent regressed in the BMS and SR groups to levels comparable to those after the procedure, whereas expansive remodeling partially regressed in the MR group (Delta between after the procedure and 2 years BMS, -0.34+/-1.28 mm2 [P=0.05]; SR, -0.02+/-1.40 mm2 [P=0.93]; MR, 0.32+/-1.56 mm2 [P=0.27]). |
1 |
| 24. Funaki B, Kim R, Lorenz J, et al. Using pullback pressure measurements to identify venous stenoses persisting after successful angioplasty in failing hemodialysis grafts. AJR Am J Roentgenol 2002;178:1161-5. |
Observational-Tx |
32 patients with elevated venous pressures at dialysis |
To identify hemodynamically significant venous stenoses in failing hemodialysis grafts that persist after successful angioplasty (as defined by digital subtraction angiography) and to determine whether these lesions could be successfully treated with repeated angioplasty using larger balloons. |
Hemodynamically significant stenoses with a gradient range of 10-27 mm Hg (mean, 16 mm Hg) were found in nine (18%) of 50 procedures. All gradients occurred at sites of previous angioplasty. Repeated angioplasty of these stenoses performed with larger angioplasty balloons reduced gradients to less than 3 mm Hg in six stenoses and to 5 mm Hg in three stenoses. In this subgroup, primary patency was eight (89%) of nine stenoses at 1 month and 2 months and five (56%) of nine stenoses at 6 months. Using life table analysis, we found that primary patency of the entire population was 84% at 1 month, 66% at 2 months, and 47% at 6 months. The mean time between interventions was 6 months, and the thrombosis rate was 0.32 per year. |
3 |
| 25. Vardza Raju A, Kyin May K, Htet Zaw M, et al. Reliability of ultrasound duplex for detection of hemodynamically significant stenosis in hemodialysis access. Ann Vasc Dis 2013;6:57-61. |
Observational-Tx |
35 hemodialysis patients with 51 vascular accesses having clinical feature or dialysis parameter suspicious of access problem |
To evaluate the accuracy of AVF and AVG duplex ultrasound (US) compared to angiographic findings in patients with suspected failing dialysis access. |
In 51 accesses (35 AVF, 16 AVG), US diagnosed significant stenosis in 45 accesses according to the criteria and angiogram confirmed 44 significant stenoses. In AVF lesions, Kappa was 0.533 with 93.3% sensitivity and 60% specificity for US whereas in AVG lesions, Kappa was 0.636 with 100% sensitivity and 50% specificity. Overall Kappa value of 0.56 meant fair to good agreement. ROC demonstrated area under the curve being 0.79 for all cases and was significant (p = 0.016). Using the =50% criteria for stenosis diagnosed by US yielded the best sensitivity (95.5%) and specificity (57.1%). |
3 |
| 26. Kudlicka J, Kavan J, Tuka V, Malik J. More precise diagnosis of access stenosis: ultrasonography versus angiography. J Vasc Access. 2012;13(3):310-314. |
Observational-Dx |
20 patients |
To compare ultrasonographic and angiographic measuring of residual diameter as the additional criterion of significant stenoses used in our center. |
The residual diameter was 1.69 +/- 0.05 mm by ultrasound and 1.65 +/- 0.59 mm measured by angiography. In the ultrasound repeatability study, CV was 3.17 +/- 2.76% and in the reproducibility study CV was 18.0 +/- 15.6%. All the stenoses found to be significant by ultrasound were above 65% by angiography and PTA was performed. |
2 |
| 27. Zamboli P, Calabria M, Camocardi A, et al. [Color-Doppler imaging and arteriovenous fistula: preoperative evaluation and surveillance]. G Ital Nefrol 2012;29 Suppl 57:S36-46. |
Review/Other-Tx |
N/A |
To present a survey of the applications of color-Doppler imaging (CDI) in the surgery and follow-up of arteriovenous fistula (AVF), with particular reference to preoperative mapping, AVF maturation and surveillance. |
No results provided |
4 |
| 28. Zamboli P, Fiorini F, D'Amelio A, Fatuzzo P, Granata A. Color Doppler ultrasound and arteriovenous fistulas for hemodialysis. [Review]. J. ultrasound. 17(4):253-63, 2014 Dec. |
Review/Other-Tx |
N/A |
To examine the numerous roles played by DUS in the construction and postoperative follow-up of AVFs, including preoperative vascular mapping, AVF maturation, and surveillance. |
No results available. |
4 |
| 29. Fox D, Amador F, Clarke D, et al. Duplex guided dialysis access interventions can be performed safely in the office setting: techniques and early results. Eur J Vasc Endovasc Surg. 42(6):833-41, 2011 Dec. |
Observational-Tx |
123 patients (223 procedures) |
To determine the utility of duplex guided angioplasty for hemodialysis access maturation and maintenance. |
Technical success was achieved in 219 cases (98.2%). Minor complications occurred in 21 cases (9.4%). Immature autogenous AV accesses had a median baseline VF of 210 mL/min. Median final VF for these autogenous AV accesses was 485 mL/min. The VF increased by 131%. Dysfunctional autogenous AV accesses and nonautogenous AV accesses had a median baseline VF of 472 mL/min. Median final VF was 950 mL/min. The VF increased by 101%. |
2 |
| 30. Kumar S, Mahajan N, Patil SS, et al. Ultrasound-guided angioplasty for treatment of peripheral stenosis of arteriovenous fistula - a single-center experience. J. vasc. access. 18(1):52-56, 2017 Jan 18. |
Observational-Tx |
78 angioplasties (53 patients with end-stage renal disease) |
To present single-center experience of 78 ultrasound-guided angioplasty procedures for treating peripheral stenoses of AVFs. |
In 49/53 patients (92.4%), 74 angioplasty procedures were successfully performed, whereas 4/53 patients (7.6%) had primary failure. A total of 35/49 patients (71.4%) underwent single angioplasty procedure whereas 14/49 patients (28.6%) underwent multiple angioplasty procedures. Post-intervention primary patency rates at 6, 12, 18 and 24 months were 78.6%, 60.2%, 53.8% and 48.9%, respectively. Post-intervention secondary patency rates at 6, 12, 18 and 24 months were 100%, 100%, 95.4% and 89%, respectively. Clinical success and anatomical success was 94.8% and 89.7%, respectively. |
2 |
| 31. Asif A, Leon C, Orozco-Vargas LC, et al. Accuracy of physical examination in the detection of arteriovenous fistula stenosis. Clin J Am Soc Nephrol 2007;2:1191-4. |
Observational-Dx |
142 consecutive patients |
To evaluate the accuracy of physical examination in the detection and location of stenosis when compared with standard angiography. |
There was strong agreement between physical examination and angiography in the diagnosis of outflow (agreement 89.4%, kappa = 0.78) and inflow stenosis (agreement 79.6%, kappa = 0.55). The sensitivity and specificity for the outflow and inflow stenosis were 92 and 86% and 85 and 71%, respectively. There was strong agreement beyond chance regarding the diagnosis of coexisting inflow-outflow lesions between physical examination and angiography (agreement 79%, kappa = 0.54). |
1 |
| 32. Shenoy S, Darcy M. Ultrasound as a tool for preoperative planning, monitoring, and interventions in dialysis arteriovenous access. AJR Am J Roentgenol 2013;201:W539-43. |
Review/Other-Tx |
N/A |
To review how ultrasound is currently used to evaluate patients pre-, intra-, and postoperatively for vascular access. |
No results available. |
4 |
| 33. Bacchini G, Cappello A, La Milia V, Andrulli S, Locatelli F. Color doppler ultrasonography imaging to guide transluminal angioplasty of venous stenosis. Kidney Int 2000;58:1810-3. |
Observational-Tx |
9 patients (12 PTAs) |
To investigate whether color Doppler imaging alone can be safely and effectively used to diagnose vascular graft access stenoses and guide subsequent PTA. |
Twelve PTAs (percutaneous transluminal angioplasty) were performed under CDU guidance in nine patients and led to the elimination of the stenosis or its reduction (two cases). The mean Qa was 809 +/- 263 mL/min at baseline, 468 +/- 153 before PTA, and 820 +/- 281 after PTA. The difference between the pre-PTA and post-PTA values was highly significant (P < 0.001), and the mean value after PTA was not different from baseline (P = 0.672). There were no relevant complications directly related to the procedure. |
2 |
| 34. Planken RN, Tordoir JH, Dammers R, et al. Stenosis detection in forearm hemodialysis arteriovenous fistulae by multiphase contrast-enhanced magnetic resonance angiography: preliminary experience. J Magn Reson Imaging 2003;17:54-64. |
Observational-Dx |
15 patients with dysfunctioning AVF |
To assess the feasibility and accuracy of multiphase contrast-enhanced magnetic resonance angiography (CE-MRA) in patients with dysfunctioning hemodialysis arteriovenous fistulae (AVF), using digital subtraction angiography (DSA) as the standard of reference. |
CE-MRA and DSA examinations were performed without side effects in all 15 patients. Image quality was scored significantly better on CE-MRA (observer 1: CE-MRA, 2.0; DSA, 1.3; P =.001; observer 2: CE-MRA, 2.0; DSA, 1.4; P =.002). Interobserver agreement for detection of >or=50% stenosis was 0.81 (95% confidence interval (CI) = 0.71-0.92) for CE-MRA and 0.69 (95% CI = 0.55-0.84) for DSA. ROC analysis revealed a mean area under the curve of 0.78. On the patient level, at the >or=50% threshold, mean sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 100% (95% CI = 69%-100%), 10% (95% CI = 0%-78%), 70% (95% CI = 38%-92%), and 100% (95% CI = 50%-100%), respectively. At the >or=75% threshold, mean sensitivity, specificity, PPV, and NPV were 75% (95% CI = 20%-99%), 78% (95% CI = 39%-98%), 55% (95% CI = 12%-96%), and 89% (95% CI = 52%-100%), respectively. |
1 |
| 35. Aktas A, Bozkurt A, Aktas B, Kirbas I. Percutaneous transluminal balloon angioplasty in stenosis of native hemodialysis arteriovenous fistulas: technical success and analysis of factors affecting postprocedural fistula patency. Diagn Interv Radiol 2015;21:160-6. |
Observational-Tx |
228 patients |
To determine the predictors of technical success and patency after percutaneous transluminal angioplasty (PTA) of de novo dysfunctional hemodialysis arteriovenous fistulas (AVF). |
A total of 330 stenoses were found in 228 patients. PTA was technically successful in 96.3% of the stenoses (n=319). Clinical success was achieved in 97.2% (n=321). Early dysfunction (within six months) was positively correlated with patient age (P < 0.001) and diabetes (P < 0.005). Older age (P < 0.001) and diabetes (P = 0.002) were associated with a lower primary patency rate. Patient age (P %lt; 0.001), presence of diabetes (P = 0.023), length of stenosis (P = 0.003), early recurrence (P = 0.003) and presence of residual stenosis (P = 0.014) were associated with a lower secondary patency rate. |
2 |
| 36. Tapping CR, Mallinson PI, Scott PM, Robinson GJ, Lakshminarayan R, Ettles DF. Clinical outcomes following endovascular treatment of the malfunctioning autologous dialysis fistula. J Med Imaging Radiat Oncol 2010;54:534-40. |
Observational-Tx |
angioplasty (n = 14); angioplasty & stent (n = 2); thrombolysis (n = 2); angioplasty, thrombolysis, stent (n = 2); angioplasty & thrombolysis (n = 5) |
To prospectively assess clinical outcomes following angioplasty with or without low-dose thrombolysis was undertaken in patients who presented with malfunctioning autologous haemodialysis fistulas. |
Technical success and initial clinical success rates were 88% and 76%, respectively. Primary and secondary clinical success rates at 6 months were 68% and 72%, at 12 months were 68% and 72%, at 18 months were 60% and 68% and at 24 months were 52% and 68%, respectively. There were no major complications following interventional procedures. There were four minor complications. After an initially successful procedure, five patients required subsequent intervention during the follow-up period. The overall fistula event rate was very low (five per 600 patient months or 0.0996 per access year) with a fistula loss rate of 0.14 per access year. |
2 |
| 37. Asif A, Lenz O, Merrill D, et al. Percutaneous management of perianastomotic stenosis in arteriovenous fistulae: results of a prospective study. Kidney Int 2006;69:1904-9. |
Observational-Tx |
73 consecutive patients (112 PTA procedures) |
To report the results of a prospective study using percutaneous balloon angioplasty (PTA) to treat fistulae with perianastomotic lesions. |
Seventy-three consecutive patients undergoing 112 PTA procedures for the treatment of perianastomotic lesions were studied. Primary and secondary patency rates were calculated. Procedure success, procedure-related complications, and conversion of fistulae to grafts were recorded. The initial success rate was 97%. The degree of stenosis before and after PTA was 81 +/- 9 and 11+/-11%, respectively. Primary patency rates at 6, 12, and 18 months were 75, 51, and 41%, respectively. Secondary patency rates at 6, 12, and 18 months were 94, 90, and 90%, respectively. Grade I hematoma occurred in three and vein rupture in two cases. No grafts were inserted. These outcomes are superior to those that have been reported for surgery. |
2 |
| 38. Dapunt O, Feurstein M, Rendl KH, Prenner K. Transluminal angioplasty versus conventional operation in the treatment of haemodialysis fistula stenosis: results from a 5-year study. Br J Surg 1987;74:1004-5. |
Observational-Tx |
37 transluminal angioplasties; 37 conventional operations |
To compare the results of 37 transluminal angioplasties with those of 37 conventional operations (thrombectomy, thrombendarterectomy with/without grafting, bypass) in the treatment of stenoses and occlusions of haemodialysis fistulae. |
There was no difference between the groups in terms of lesion morphology or the patients' age and sex. Cumulative patency rates for angioplasty and surgery, respectively, were 94.5 and 78.1 per cent after 1 week, 72.3 and 64.1 per cent after 1 month, 41.2 and 28.9 per cent after 5 months and 31.3 and 19.3 per cent after 1 year (X2 test, P less than 0.001). The difference is due mainly to a high percentage of early occlusions in the haemodialysis fistula stenoses is possible it achieves results which are at least as good as those of operation. |
3 |
| 39. Ayez N, Fioole B, Aarts RA, et al. Secondary interventions in patients with autologous arteriovenous fistulas strongly improve patency rates. J Vasc Surg. 54(4):1095-9, 2011 Oct. |
Observational-Tx |
294 patients (347 autologous AVFs) |
To evaluate the results after secondary interventions in patients with an upper extremity AVF. |
Between January 2000 and December 2008, 736 hemodialysis access procedures were performed. A total of 347 autologous arteriovenous fistulas (AVFs) were created in 294 patients. The mean age was 62.1 ± 14.7 years, and the majority (66%) of the patients was male. Mean follow-up of all 347 fistulas was 21.9 ± 21.6 months. During follow-up, failure occurred in 209 (60%) of the AVFs. A total of 133 of these failures were followed by a secondary intervention, of which 78 (59%) were endovascular interventions. Twenty-nine patients developed a third failure, and 25 of these patients underwent another intervention, of which 22 were percutaneous transluminal angioplasty for stenosis. Fifteen patients developed a fourth failure, and all of them underwent an intervention. One patient had 11 interventions. The 1- and 2-year primary patency rates were 46% and 36.8%, respectively. The 1- and 2-year primary assisted patency rates were 74.6% and 71.2%, respectively. The 1- and 2-year secondary patency rates were 79.2% and 77.8%, respectively. |
2 |
| 40. Cohen A, Korzets A, Neyman H, et al. Endovascular interventions of juxtaanastomotic stenoses and thromboses of hemodialysis arteriovenous fistulas. J Vasc Interv Radiol 2009;20:66-70. |
Observational-Tx |
43 patients |
To assess the primary and secondary patency rates for juxtaanastomotic stenoses, with or without superimposed thromboses, of arteriovenous hemodialysis fistulas treated with angioplasty.To compare it with National Kidney Foundation Dialysis Outcomes Quality Initiative treatment guidelines for stenosed and occluded arteriovenous fistulas (50% primary patency rate at 12 months). |
Immediate postprocedural angiography demonstrated an angiographic success rate of 98%. Clinical success, with at least one session of normal dialysis, occurred in 95% of interventions. Primary patency rates at 12 months for the stenosed and stenosed/thrombosed fistulas were 56% and 64%, respectively. Secondary patency rates at 12 months were 64% and 63%, respectively. Half of the stenosed fistulas were patent at 1.5 years, 28% were patent at 4 years, and 13% remained patent at 6 years. No major complications were documented. Four minor complications, which did not require therapy, were noted. |
3 |
| 41. Rajan DK, Clark TW, Patel NK, Stavropoulos SW, Simons ME. Prevalence and treatment of cephalic arch stenosis in dysfunctional autogenous hemodialysis fistulas. J Vasc Interv Radiol. 14(5):567-73, 2003 May. |
Observational-Tx |
177 dysfunctional autogenous fistulas |
To describe the prevalence of cephalic arch stenosis (CAS) among dysfunctional autogenous fistulas is described, as are outcomes after percutaneous therapy. |
The prevalence of CAS was 15% (26 of 177). There was a significant difference in the prevalence of CAS between brachiocephalic and radiocephalic fistulas (39% vs 2%; P <.001). High-pressure noncompliant balloon catheters were required in 29 of 50 dilations (58%) to efface the lesion. Primary patency rates (+/-SE) at 3, 6, and 12 months were 76% +/- 8, 42% +/- 10, and 23% +/- 9, respectively. Primary assisted patency rates (+/-SE) at 3, 6, and 12 months were 96% +/- 4, 83% +/- 8, and 75% +/- 10. Complications occurred in three cases (6%). A major complication with rupture of the cephalic arch resulted in thrombosis and fistula loss (n = 1); two minor complications of cephalic arch rupture were salvaged with placement of a Wallstent (n = 1) or prolonged balloon inflation (n = 1). |
2 |
| 42. Malka KT, Flahive J, Csizinscky A, et al. Results of repeated percutaneous interventions on failing arteriovenous fistulas and grafts and factors affecting outcomes. J Vasc Surg. 63(3):772-7, 2016 Mar. |
Observational-Tx |
91 patients |
To determine the results of the second percutaneous intervention on failing AVGs and AVFs and to identify factors associated with loss of patency. |
Among 91 patients, 96 second-time percutaneous interventions were performed on 52 AVFs and 44 AVGs. Patients included 56% men and 44% women with a mean age of 64 ± 17 years. The lesions intervened on were primarily located along the accessed portion of the outflow in AVFs and within the length of the graft and at the venous anastomosis in AVGs. Transluminal angioplasty alone was performed in 82 procedures (85%), and uncovered or covered stents were placed in 15 procedures (16%). Pharmacomechanical thrombectomy was performed in 32 patients (34%) and was more commonly performed in AVGs compared with AVFs (53% vs 17%; P = .0002). Technical success was achieved in 90 procedures (97%; n = 92). One-year primary patency, assisted primary patency, and secondary patency rates were 35%, 86%, and 86%, respectively. One-year primary patency did not differ between AVFs and AVGs, but secondary patency was lower for AVG in comparison to AVF (P = .04). On multivariable analysis, only the need for pharmacomechanical thrombectomy significantly predicted failure of primary patency (hazard ratio, 2.6; 95% confidence interval, 1.6-4.3). The presence of an AVG rather than an AVF independently predicted failure of secondary patency (hazard ratio, 2.9; 95% confidence interval, 1.0-8.2). |
2 |
| 43. Bountouris I, Kristmundsson T, Dias N, Zdanowski Z, Malina M. Is Repeat PTA of a Failing Hemodialysis Fistula Durable? Int J Vasc Med 2014;2014:369687. |
Observational-Tx |
159 stenoses (106 patients) |
To evaluate the outcome of percutaneous transluminal angioplasty (PTA) and particularly rePTA in a failing arteriovenous fistula (AV-fistula). |
Seventy-nine (50%) of the primary PTAs required no further reintervention. The primary patency was 61% at 6 months and 42% at 12 months. Eighty (50%) of the stenoses needed at least one reintervention. Primary assisted patency (defined as patency after subsequent reinterventions) was 89% at 6 months and 85% at 12 months. The durability of repeated PTAs was similar to the durability of the primary PTA. However, an early primary PTA carried a higher risk for subsequent reinterventions. Successful dialysis was achieved after 98% of treatments. Nine percent of the stenoses eventually required surgical revision and 13% of the fistulas failed permanently. |
2 |
| 44. Sidhu A, Tan KT, Noel-Lamy M, Simons ME, Rajan DK. Does Technical Success of Angioplasty in Dysfunctional Hemodialysis Accesses Correlate with Access Patency? Cardiovasc Intervent Radiol 2016;39:1400-6. |
Observational-Tx |
76 patients |
To study if <30 % residual stenosis post angioplasty (PTA) correlates with primary access circuit patency, and if any variables predict technical success. |
Technical success rates of PTA in AVFs and AVGs were 79.6 and 76.7 %, respectively. Technical failures of PTA were associated with an increased risk of patency loss among circuits with AVFs (p < 0.05), but not with AVGs (p = 0.7). In AVFs, primary access patency rates between technical successes and failures at three and 6 months were 74.4 versus 61.9 % (p = 0.3) and 53.8 versus 23.8 % (p < 0.05), respectively. In AVGs, primary access patency rates between technical successes and failures at three and six months were 72.1 versus 53.9 % (p = 0.5) and 33.6 versus 38.5 % (p = 0.8), respectively. Transonic flow rates did not significantly differ among technically successful or failed outcomes at one or three months. |
2 |
| 45. Aruny JE, Lewis CA, Cardella JF, et al. Quality improvement guidelines for percutaneous management of the thrombosed or dysfunctional dialysis access. J Vasc Interv Radiol 2003;14:S247-53. |
Review/Other-Tx |
N/A |
No abstract available |
No abstract available |
4 |
| 46. Saleh HM, Gabr AK, Tawfik MM, Abouellail H. Prospective, randomized study of cutting balloon angioplasty versus conventional balloon angioplasty for the treatment of hemodialysis access stenoses. J Vasc Surg. 60(3):735-40, 2014 Sep. |
Experimental-Tx |
316 patients (cutting balloon angioplasty), 307 patients (conventional balloon angioplasty) |
To compare the rates of patency achieved by cutting and conventional balloon angioplasty to treat hemodialysis access stenoses. |
The study randomized 623 patients into two groups, and the duration of follow-up was 15 ± 3 months. In the cutting balloon angioplasty group, the clinical success rate was 89% (282 of 316 stenoses). In the conventional balloon angioplasty group, the clinical success rate was 86% (265 of 307 stenoses; P = .637). Assisted primary patency for cutting PTA was statistically significantly higher at 6 months and 1 year (86% and 63%) than that for conventional PTA (56% and 37%, respectively; P = .037) in the treatment of stenosis of the graft-to-vein anastomosis. In the venous stenosis subgroup, equivalent primary assisted patency at 6 months and 1 year was observed for cutting PTA (84% and 55%) and conventional PTA (70% and 46%, respectively; P = .360). In the intragraft stenosis subgroup, primary assisted patency was equivalent at 6 months and 1 year for cutting PTA (67% and 39%) and conventional PTA (62% and 49%, respectively; P = .371). In the arterial anastomotic stenosis subgroup, assisted primary patency at 6 months and 1 year was equivalent for cutting PTA (70% and 30%) and conventional PTA (75% and 33%, respectively; P = .921). |
1 |
| 47. Rasuli P, Chennur VS, Connolly MJ, et al. Randomized Trial Comparing the Primary Patency following Cutting Versus High-Pressure Balloon Angioplasty for Treatment of de Novo Venous Stenoses in Hemodialysis Arteriovenous Fistulae. J Vasc Interv Radiol 2015;26:1840-6 e1. |
Experimental-Tx |
48 patients undergoing their first angioplasty |
To compare postinterventional primary patency rates achieved by cutting balloon angioplasty and high-pressure balloon angioplasty in the treatment of de novo stenoses within autogenous arteriovenous (AV) fistulae for hemodialysis. |
Forty-eight patients undergoing their first angioplasty were prospectively randomized to undergo angioplasty with a cutting balloon or high-pressure balloon 4-8 mm in diameter because cutting balloons larger than 8 mm are not available. Nine patients were excluded after angiography, with seven requiring balloons larger than 8 mm. In the remaining 39 patients, there were 42 stenoses in the following regions: juxtaanastomotic (38%), perianstomotic (38%), midcephalic (9%), and cephalic arch (14%). Patients in the cutting balloon group were younger (mean age difference, 9 y; P = .04), but other demographic variables were comparable (range, P = .08-.89). The mean follow-up period was 8.5 mo (range, 24 d to 32 mo). Kaplan-Meier analysis was used to compare duration of patency. Mann-Whitney rank-sum t test and ?2/Fisher exact tests were used to compare continuous and categoric variables, respectively. |
1 |
| 48. Aftab SA, Tay KH, Irani FG, et al. Randomized clinical trial of cutting balloon angioplasty versus high-pressure balloon angioplasty in hemodialysis arteriovenous fistula stenoses resistant to conventional balloon angioplasty. J Vasc Interv Radiol 2014;25:190-8. |
Experimental-Tx |
36 patients = CBA arm; 35 patients = HPBA arm |
To compare the efficacy and safety of cutting balloon angioplasty (CBA) versus high-pressure balloon angioplasty (HPBA) for the treatment of hemodialysis autogenous fistula stenoses resistant to conventional percutaneous transluminal angioplasty (PTA). |
Clinical success rates were 100% in both arms. Primary target lesion patency rates at 6 months were 66.4% and 39.9% for CBA and HPBA, respectively (P = .01). Secondary target lesion patency rates at 6 months were 96.5% for CBA and 80.0% for HPBA (P = .03). There was a single major complication of venous perforation following CBA. The 30-day mortality rate was 1.4%, with one non-procedure-related death in the HPBA group. |
1 |
| 49. Maleux G, Vander Mijnsbrugge W, Henroteaux D, et al. Multicenter, Randomized Trial of Conventional Balloon Angioplasty versus Paclitaxel-Coated Balloon Angioplasty for the Treatment of Dysfunctioning Autologous Dialysis Fistulae. J Vasc Interv Radiol 2018;29:470-75 e3. |
Experimental-Tx |
conventional percutaneous balloon angioplasty (n = 31) or PCB angioplasty (n = 33) |
To investigate the potential added value of paclitaxel-coated balloon (PCB) angioplasty to reduce fistula dysfunction related to recurrent stenoses in patients undergoing hemodialysis. |
There were no procedural or postprocedural complications. After 3, 6, and 12 months of follow-up, primary patency rates after PCB angioplasty and percutaneous transluminal angioplasty (PTA) were 88% and 80% (P = .43), 67% and 65% (P = .76), and 42% and 39% (P = .95), respectively. |
1 |
| 50. Irani FG, Teo TKB, Tay KH, et al. Hemodialysis Arteriovenous Fistula and Graft Stenoses: Randomized Trial Comparing Drug-eluting Balloon Angioplasty with Conventional Angioplasty. Radiology 2018;289:238-47. |
Experimental-Tx |
119 participants with failing AVFs or AVGs (DEB PTA = 59 and cPTA = 60) |
To compare lesion primary patency and restenosis rates between drug-eluting balloon (DEB) percutaneous transluminal angioplasty (PTA) and conventional balloon PTA (cPTA) in the treatment of arteriovenous fistula (AVF) and arteriovenous graft (AVG) stenosis. |
Estimated lesion primary patency in the DEB PTA and cPTA arms was 0.81 and 0.61, respectively, at 6 months (P = .03) and 0.51 and 0.34, respectively, at 1 year (P = .04). Estimated circuit primary patency in the DEB PTA and cPTA arms was 0.76 and 0.56, respectively, at 6 months (P = .048) and 0.45 and 0.32, respectively, at 1 year (P = .16). Restenosis rate was 34.0% (16 of 47) for DEB PTA and 62.9% (22 of 35) for cPTA at 6 months (P = .01). No major complications were noted. |
1 |
| 51. Lai CC, Fang HC, Tseng CJ, Liu CP, Mar GY. Percutaneous angioplasty using a paclitaxel-coated balloon improves target lesion restenosis on inflow lesions of autogenous radiocephalic fistulas: a pilot study. J Vasc Interv Radiol. 25(4):535-41, 2014 Apr. |
Experimental-Tx |
10 patients (included in both groups, PTA-PCB+PB Group 1
and PTA-PB Group 2) |
To determine whether the use of a paclitaxel-coated balloon (PCB) improves patency in patients undergoing percutaneous transluminal angioplasty (PTA) for recurrent juxtaanastomotic stenosis of radiocephalic arteriovenous fistulas (RCAVFs). |
The analysis of 20 lesions in 10 patients revealed that the TLR-free duration in group 1 was significantly longer than the TLR-free duration in group 2 (251.2 d vs 103.2 d; P < .01). The patency rate of the target lesion was significantly higher in group 1 than in group 2 at 6 months (70% vs 0%; P < .01) but not at 12 months (20% vs 0%; P > .05). |
1 |
| 52. Kitrou PM, Katsanos K, Spiliopoulos S, Karnabatidis D, Siablis D. Drug-eluting versus plain balloon angioplasty for the treatment of failing dialysis access: final results and cost-effectiveness analysis from a prospective randomized controlled trial (NCT01174472). Eur J Radiol 2015;84:418-23. |
Experimental-Tx |
40 patients (DEB = 20 or BA = 20) |
o report the final results and cost-effectiveness analysis of a prospective randomized controlled trial investigating drug-eluting balloon (DEB) versus plain balloon angioplasty (BA) for the treatment of failing dialysis access (NCT01174472). |
Baseline variables were equally distributed between the two groups. At 1 year, cumulative target lesion primary patency was significantly higher after DEB application (35% vs. 5% after BA, p<0.001). Overall, median primary patency was 0.64 years in case of DEB vs. 0.36 years in case of BA (p=0.0007; unadjusted HR=0.27 [95%CI: 0.13-0.58]; Cox adjusted HR=0.23 [95%CI: 0.10-0.50]). ICER was 2198 Euros (€) per primary patency year of dialysis access gained. INB was 1068€ (95%CI: 31-2105€) for a willingness-to-pay (WTP) threshold of 5000€ (corresponding acceptability probability >97%). |
1 |
| 53. Treatment of Peripheral Arterial Disease with Paclitaxel-Coated Balloons and Paclitaxel-Eluting Stents Potentially Associated with Increased Mortality - Letter to Health Care Providers. Available at: https://www.fda.gov/medical-devices/letters-health-care-providers/treatment-peripheral-arterial-disease-paclitaxel-coated-balloons-and-paclitaxel-eluting-stents. |
Review/Other-Tx |
N/A |
No abstract available. |
No abstract available. |
4 |
| 54. Quinn SF, Schuman ES, Demlow TA, et al. Percutaneous transluminal angioplasty versus endovascular stent placement in the treatment of venous stenoses in patients undergoing hemodialysis: intermediate results. J Vasc Interv Radiol 1995;6:851-5. |
Experimental-Tx |
47 patients (PTA alone) and 40 patients (PTA and stent placement) |
To describes intermediate findings from an ongoing prospective randomized trial comparing the results of percutaneous transluminal angioplasty (PTA) with results of endovascular stent placement in patients undergoing hemodialysis. |
For peripheral sites, the primary patency rates for PTA at 60, 180, and 360 days were 55%, 31%, and 10%, respectively, and for stents were 36%, 27%, and 11%, respectively (P = .6528). The secondary patency rates for PTA at 60, 180, and 360 days were 94%, 80%, and 71%, respectively, and for stents were 73%, 64%, and 64%, respectively (P = .1677). For central sites, the primary patency rates for PTA at 60, 180, and 360 days were 81%, 23%, and 12%, respectively, and for stents were 67%, 11%, and 11%, respectively (P = .4595). The secondary patency rates for PTA were 100% at each interval, and for stents were 100%, 89%, and 78%, respectively (P = .5408). |
1 |
| 55. Vogel PM, Parise C. Comparison of SMART stent placement for arteriovenous graft salvage versus successful graft PTA. J Vasc Interv Radiol 2005;16:1619-26. |
Observational-Tx |
60 patients (PTA group = 35 patients; Stent group = 25 patients) |
To compare the SMART (shape memory alloy recoverable technology) stent with percutaneous transluminal angioplasty (PTA) alone in hemodialysis access venous stenoses. |
The key venous stenosis was at the graft-to-vein anastomosis in all but two patients. Thirty-five patients showed a response to PTA alone. Sixteen patients received stents for stenoses greater than 30% after angioplasty, six for rapidly recurrent stenosis, and three for venous rupture. Nine patients received stents across the level of the elbow joint. Stenosis after intervention was significantly less frequent in the stent group (7% vs 16%; P = .001), but the midgraft systolic pressure ratios did not significantly differ. The clinical success rates were 100% after stent implantation and 97% after PTA alone. Except for venous rupture, there were no procedure-related complications, and, excluding early graft thrombosis, there were no complications at 30 days. A single stent fracture was found on follow-up. The mean primary graft patency times were 5.6 months after PTA and 8.2 months after stent treatment (P = .050). When stents were placed across the level of the elbow joint, the mean primary graft patency time was 8.9 months. |
2 |
| 56. Hoffer EK, Sultan S, Herskowitz MM, Daniels ID, Sclafani SJ. Prospective randomized trial of a metallic intravascular stent in hemodialysis graft maintenance. J Vasc Interv Radiol 1997;8:965-73. |
Experimental-Tx |
PTA alone (n = 20) or PTA with Wallstent (n = 17) |
To evaluate percutaneous transluminal angioplasty (PTA) alone versus PTA and flexible self-expanding stent placement for the management of hemodialysis access graft stenoses. |
Technical success was 100% (mean residual stenosis, 12%; range, 0%-30%). The primary patency of 128 days and secondary patency of 431 days were similar for both groups. Secondary patency required a mean of 1.8 and 1.6 additional interventions for the PTA and stent groups, respectively. The adjunctive stent placement increased the cost of the procedure by 90%. |
1 |
| 57. Chan MR, Bedi S, Sanchez RJ, et al. Stent placement versus angioplasty improves patency of arteriovenous grafts and blood flow of arteriovenous fistulae. Clin J Am Soc Nephrol 2008;3:699-705. |
Experimental-Tx |
211 patients (112 AVF, 99 AVG) |
To compare the effects of stent versus angioplasty on primary patency rates in the treatment of stenotic arteriovenous fistulae (AVF) and arteriovenous grafts (AVGs). To compare access flow (Qa) and urea reduction ratio (URR) between the two groups as a metric of the effect of stent placement versus angioplasty on dialysis delivery. |
Cox regression analysis revealed that the primary assisted AVG patency was significantly longer for the stent group compared with angioplasty, with a median survival of 138 versus 61 d, respectively (aHR = 0.17; 95% confidence interval, 0.07 to 0.39; P < 0.001). The primary AVG patency for stent versus angioplasty was 91% versus 80% at 30 d, 69% versus 24% at 90 d, and 25% versus 3% at 180 d, respectively. The primary assisted AVF patency did not differ significantly between the stent and angioplasty groups. In patients dialyzing via AVF, multiple regression analysis revealed that stent placement was associated with improved after intervention peak Qa, 1627.50 ml/min versus 911.00 ml/min (beta = 0.494; P = 0.008), change in Qa from before to after intervention, 643.54 ml/min versus 195.35 ml/min (beta = 0.464; P = 0.012), and change in URR from before to after intervention, 5.85% versus 0.733% (beta = 0.389; P = 0.039). |
2 |
| 58. Shemesh D, Goldin I, Zaghal I, Berlowitz D, Raveh D, Olsha O. Angioplasty with stent graft versus bare stent for recurrent cephalic arch stenosis in autogenous arteriovenous access for hemodialysis: a prospective randomized clinical trial. J Vasc Surg 2008;48:1524-31, 31 e1-2. |
Experimental-Tx |
12 patients (bare stent), 13 patients (stent graft) |
To compare the efficacy of stent grafts with bare stents in these patients. |
This report includes data on the outcome of 25 consecutive patients with recurrent cephalic arch stenosis who were treated from April to August 2006. At 3 months, three patients had died and one had undergone a renal transplant. The 21 patients who had angiography at 3 months had patent stents. Restenosis rates were seven of 10 (70%) in the bare stent group and two of 11 (18%) in the stent graft group (P = .024). Life-table analysis at 3 and 6 months showed that primary patency was 82% in the stent graft group and 39% in the bare stent group. One-year primary patency was 32% in the stent graft group and 0% in the bare stent group (P = .0023). During a mean follow-up of 13.7 months, nine patients died, four in the bare stent group and five in the stent graft group. Two patients in the stent graft group had received a renal transplant. The number of interventions per patient-year was 1.9 in the bare stent group and 0.9 in the stent graft group (P = .02). |
1 |
| 59. Rajan DK, Falk A. A Randomized Prospective Study Comparing Outcomes of Angioplasty versus VIABAHN Stent-Graft Placement for Cephalic Arch Stenosis in Dysfunctional Hemodialysis Accesses. J Vasc Interv Radiol. 26(9):1355-61, 2015 Sep. |
Experimental-Tx |
5 patients (percutaneous transluminal angioplasty); 9 patients (stent-graft placement) |
To determine if postintervention cephalic arch stenosis (CAS) primary patency and access circuit patency are superior with the VIABAHN stent graft compared with angioplasty at 3, 6, and 12 months. |
Anatomic and clinical success was obtained in all interventions. Mean patency intervals were 100 days in the PTA group and 300 days in the stent-graft group. Primary access circuit patency rates at 3, 6, and 12 months were significantly different: 20%, 0%, and 0% for PTA and 100%, 67%, and 22% for stent grafts (P < .01). Primacy target lesion patency rates at 3, 6, and 12 months were also significantly different: 60%, 0%, and 0% for PTA and 100%, 100%, and 29% for stent grafts (P < .01). No complications or adverse events were observed. |
1 |
| 60. Yang HT, Yu SY, Su TW, Kao TC, Hsieh HC, Ko PJ. A prospective randomized study of stent graft placement after balloon angioplasty versus balloon angioplasty alone for the treatment of hemodialysis patients with prosthetic graft outflow stenosis. J Vasc Surg. 68(2):546-553, 2018 08. |
Experimental-Tx |
49 patients (stent graft placement after balloon angioplasty), 49 patients (balloon angioplasty alone) |
To evaluate the efficacy and durability of stent graft placement after balloon angioplasty in comparison to balloon angioplasty alone for the treatment of graft outflow stenosis in hemodialysis patients. |
The postintervention restenosis rate of the stent graft placement group was superior to that seen in the balloon angioplasty alone group (9% vs 69% at 3 months [P < .0001] and 29% vs 72% at 6 months [P < .0001]). The mean postintervention primary patency duration was 380.22 ± 28.54 days for the stent graft placement group and 151.08 ± 16.79 days for the balloon angioplasty alone group (P < .0001). |
1 |
| 61. Vesely T, DaVanzo W, Behrend T, Dwyer A, Aruny J. Balloon angioplasty versus Viabahn stent graft for treatment of failing or thrombosed prosthetic hemodialysis grafts. J Vasc Surg. 64(5):1400-1410.e1, 2016 Nov. |
Experimental-Tx |
145 patients (stent graft); 148 patients (balloon angioplasty) |
To compare the results of stent graft placement to balloon angioplasty for the treatment of stenosis at the venous anastomosis of failing and thrombosed prosthetic hemodialysis grafts. |
The 6-month target lesion primary patency was statistically greater in the stent graft group than the balloon angioplasty group (intent-to-treat, 51.6% vs 34.2% [P = .006]; EPP, 52.9% vs 35.5% [P = .008]). Compared with the angioplasty group, the stent graft group increased the median time from the index procedure to the next intervention on the target lesion by 95 days (203 vs 108 days). Patients with dysfunctional (stenotic) grafts had higher target lesion primary patency compared with patients with thrombosed grafts regardless of treatment (EPP, stent graft, 64.6% vs 36.1% and balloon angioplasty, 45.8% vs 23.5%). When compared with angioplasty, using a stent graft for treatment of a venous anastomotic stenosis of a thrombosed graft increased the 6-month target lesion primary patency by 53.6% (EPP, 36.1% vs 23.5%). |
1 |
| 62. Falk A, Maya ID, Yevzlin AS, RESCUE Investigators. A Prospective, Randomized Study of an Expanded Polytetrafluoroethylene Stent Graft versus Balloon Angioplasty for In-Stent Restenosis in Arteriovenous Grafts and Fistulae: Two-Year Results of the RESCUE Study. J Vasc Interv Radiol. 27(10):1465-76, 2016 Oct. |
Experimental-Tx |
132 patients (stent-graft group), 143 patients (PTA group) |
To assess the safety and efficacy of an expanded polytetrafluoroethylene stent graft versus balloon angioplasty for the treatment of in-stent restenosis in the venous outflow of hemodialysis access grafts and fistulae. |
ACPP at 6 months was significantly higher in the stent-graft group (18.6%) versus the PTA group (4.5%; P < .001), and freedom from safety events (30 days) was comparable (stent graft, 96.9%; PTA, 96.4%; P = .003 for noninferiority). The separation in ACPP survival curves remained through 12 months (stent graft, 6.2%; PTA, 1.5%). Treatment area primary patency (TAPP) was superior for the stent-graft group (66.4%) versus the PTA group (12.3%) at 6 months (P < .001), with a survivorship difference in favor of stent-graft placement maintained through 24 months (stent graft, 15.6%; PTA, 2.2%). ACPP and TAPP for the stent-graft group were better than those for the PTA group when compared within central and peripheral vein subgroups (P < .001). In central veins, TAPP was 13.6% in the stent-graft group versus 4.3% in the PTA group at 24 months (P < .001). |
1 |
| 63. Haskal ZJ, Saad TF, Hoggard JG, et al. Prospective, Randomized, Concurrently-Controlled Study of a Stent Graft versus Balloon Angioplasty for Treatment of Arteriovenous Access Graft Stenosis: 2-Year Results of the RENOVA Study. J Vasc Interv Radiol. 27(8):1105-1114.e3, 2016 Aug. |
Experimental-Tx |
138 patients (SG); 132 patients (PTA) |
To present final, 2-year data from randomized comparison of an expanded polytetrafluoroethylene stent graft (SG) and percutaneous transluminal angioplasty (PTA) for treatment of arteriovenous graft (AVG) anastomotic stenoses. |
The study was completed by 191 patients (97 SG, 94 PTA). Five patients were lost to follow-up or withdrew; 74 patients died during the study (38 SG, 36 PTA). At 12 months, treatment area primary patency (TAPP) was SG 47.6% versus PTA 24.8% (P < .001), access circuit primary patency (ACPP) was SG 24% versus PTA 11% (P = .007), and index of patency function (IPF) was SG 5.2 months/intervention ± 4.1 versus PTA 4.4 months/intervention ± 3.5 (P = .009). At 24 months, TAPP was SG 26.9% versus PTA 13.5% (P < .001), ACPP was SG 9.5% versus PTA 5.5% (P = .01), and IPF was SG 7.1 months/intervention ± 7.0 versus PTA 5.3 months/intervention ± 5.2; estimated number of reinterventions before graft abandonment was 3.4 for SG patients versus 4.3 for PTA patients. There were no significant differences in adverse events (P > .05) except for restenosis requiring reintervention rates of 82.6% in PTA patients versus 63.0% in SG patients (P < .001). |
1 |
| 64. Santoro D, Benedetto F, Mondello P, et al. Vascular access for hemodialysis: current perspectives. Int J Nephrol Renovasc Dis 2014;7:281-94. |
Review/Other-Tx |
N/A |
To discuss types of vascular access: native arteriovenous fistula (AVF), arteriovenous graft, and central venous catheter (CVC). |
N/A |
4 |
| 65. Klamroth R, Orlovic M, Fritsche I, et al. The influence of thrombophilic risk factors on vascular access survival in chronic dialysis patients in a retrospective evaluation. Vasa 2013;42:32-9. |
Observational-Tx |
199 patients |
To determine if the presence of thrombophilic factors is associated with a reduced survival rate of vascular dialysis access. |
199 patients with a total of 499 vascular accesses in the past (311 native fistulas (62.3 %) and 188 PTFE grafts (33.7 %)) were included in this study. The type of vascular access played an important role, with mean survival times of 34.2 months for native fistulas versus 9.5 months for grafts. There was at least one thrombophilic risk factor present in 69.8 % of the patients. In the univariate analysis thrombophilia had a significant influence on vascular access survival. The effect persisted throughout the multivariate analysis. Multivariate Cox analysis showed that the presence of thrombophilic factors was associated with a 43 % (mild) to 105 % (severe thrombophilia) increased risk of occlusion of the vascular access, corresponding to a 45 % to 68 % reduction of native access survival time. The influence of thrombophilia was evident in fistulas as well as in PTFE grafts. |
3 |
| 66. De Rango P, Parente B, Cieri E, et al. Percutaneous approach in the maintenance and salvage of dysfunctional autologous vascular access for dialysis. J. vasc. access. 13(3):381-7, 2012 Jul-Sep. |
Observational-Tx |
199 procedures |
To assess the mid-term patency and complication rates of angioplasty procedures performed in a single center for treatment of stenosis compromising vascular accesses. |
There were 199 procedures for failing access: 135 were surgical and 64 angioplasties performed for anastomosis (n=27), venous (n=45) or arterial (n=7) stenosis. Immediate technical success of endovascular procedures was 95.3%(61/64); complication rate was 6.3% (4/64). Primary patency rates were 55% at six months, 49% at 12 months, and 21% at 24 months. In the concurrent group of 135 open procedures, primary patency rates were 80% at six months and 67% at 12 months (P=.002); nevertheless, at 24 months, patency was as low as 49%. Cost estimates for angioplasty revealed additional fees ranging from 411.34 to 446.34 Euro with respect to open surgical procedures. |
2 |
| 67. Fan SS, Chen CW, Lu KC, Mao HC, Chen MP, Chou CL. A comparison of efficacy of endovascular versus surgical repair for the treatment of arteriovenous fistula stenosis in Taiwan. J. vasc. access. 18(3):200-206, 2017 May 15. |
Review/Other-Tx |
544 hemodialysis patients |
(i) to understand the demographic characteristics, primary diseases, and other factors that affect fistula thrombosis in patients; (ii) to study the factors that affect the selection of revascularization surgery or PTA; and (iii) to compare the vascular access patency and medical expenses after the treatment of fistula thrombosis. |
The frequency of PTA in the patients undergoing long-term hemodialysis was not significantly associated with their demographic characteristics. The efficacy of PTA has declined with shorter maintenance duration with increasing PTA frequency. The cost profile of PTA was more expensive than that of fistula revascularization surgery. |
4 |
| 68. Fructuoso M, Ferreira J, Sousa P. Surgical Treatment of Cephalic Arch Problems in Arteriovenous Fistulas: A Center Experience. Ann Vasc Surg. 48:253.e11-253.e16, 2018 Apr. |
Observational-Tx |
7 patients |
To present the experience of their center with cephalic vein transposition in a group of patients with different problems involving the cephalic arch. |
Seven patients were treated by venovenostomy with transposition of the cephalic arch and anastomosis to the axillary vein. The average patient age was 72 years (59-81), and most patients were female (71%) and diabetic (71%). All accesses were brachiocephalic AVFs with a mean duration of 4 years (1-7). The underlying problems were intrinsic cephalic arch stenosis (n = 5), entrapment of the cephalic vein (n = 1), and clinically significant vein tortuosity at the cephalic arch (n = 1). These last 2 problems conducted to a surgical approach as first-line therapy instead of endovascular intervention, the initial treatment in the other 5 cases (all with high-pressure balloons, with cutting balloon in one case). Previous thrombotic episodes were reported in 57% of the patients. The mean access flow before surgical intervention was 425 mL/min (350-1,500). No complications related with the surgical procedure were reported. One patient underwent surgical thrombectomy after AVF thrombosis, followed by transposition of the vein. In another case, a simultaneous flow reduction was performed. Most of the patients on dialysis (5/6) used the AVF after surgery. After a mean follow-up period of 9 months (1-22), surgical treatment was associated with a reduction in endovascular intervention rate (1.9 interventions per patient-year presurgery versus 0.4 postsurgery; P < 0.05) and thrombosis rate (0.93 thrombotic episodes per patient-year presurgery versus 0.17 postsurgery; P < 0.05). The problems leading to endovascular reintervention were as follows: new venous anastomosis stenosis (57%), axillary vein stenosis (29%), and swing-point stenosis (14%). Primary and secondary patencies at 6 months were 57% and 71%, respectively. |
3 |
| 69. Iglesias RC, Cull DL, Carsten CG 3rd, Jones YR, Keahey GP, Johnson BL. The management of malfunctioning prosthetic arteriovenous accesses by interventional nephrologists and surgeons: a retrospective comparison of long-term outcomes. J. vasc. access. 14(2):120-5, 2013 Apr-Jun. |
Observational-Tx |
IN Group = 47 AVGs and VS Group = 49 AVGs |
To compare the outcomes of arteriovenous grafts (AVG) managed by interventional nephrologists (IN) to those managed by vascular surgeons (VS). |
The secondary patency rates at 6 and 18 months were 84% and 69% in the IN group and 79% and 68% in the VS group, respectively (P=.38). Twenty-five (53%) AVG in the IN required at least one surgical procedure to achieve a patency equivalent to that of the VS group. The mean number of AVG interventions to final failure was 4.8 in the IN group and 3.0 in the VS group (P=.03). Infection requiring AVG removal occurred in six patients in the IN group and one patient in the VS group (P=.07). |
3 |
| 70. Kim SM, Yoon KW, Woo SY, et al. Treatment Strategies for Cephalic Arch Stenosis in Patients with Brachiocephalic Arteriovenous Fistula. Ann Vasc Surg. 54:248-253, 2019 Jan. |
Observational-Tx |
462 patients |
To identify the incidence of cephalic arch stenosis (CAS) in BCAVF, to compare the patency of percutaneous transluminal balloon angioplasty (PTA) with that of cephalic vein transposition (CVT), and to establish the optimal treatment strategy for CAS. |
Seventy-seven (16.7%) patients had CAS and 42 of them (54.5%) were treated for clinically significant CAS. PTA was performed in 36 patients (85.7%), and CVT was done in 6 patients (14.3%) as the initial treatment. Nine patients underwent CVT after PTA, resulting in a total of 15 patients treated with CVT. Investigation of the patency of the 36 cases of PTA and 15 cases of CVT revealed that primary-assisted patency rates at 6 and 12 months were 68.2% and 57.3% for PTA and 100.0% and 87.5% for CVT, respectively (P = 0.038). Secondary patency rates at 6 and 12 months were 72.0% and 56.9% for PTA and 100% and 100% for CVT, respectively (P = 0.010). The median intervention rate was 2.5 interventions per access-year in the 36 cases treated with PTA and 1.5 interventions per access-year in the 15 cases treated with CVT. |
3 |
| 71. Kwon H, Choi JY, Ko HK, et al. Comparison of surgical and endovascular salvage procedures for juxta-anastomotic stenosis in autogenous wrist radiocephalic arteriovenous fistula. Ann Vasc Surg. 28(8):1840-6, 2014 Nov. |
Observational-Tx |
60 patients (surgical or endovascular salvage treatment), 35 patients (proximal neo-anastomosis), 25 (percutaneous transluminal angioplasty) |
To compare the cumulative patency rates following surgical and endovascular salvaging of dysfunctional RCAVFs, and to evaluate whether the maturity of vascular access sites at the time of treatment influenced the outcomes. |
Clinical and anatomical success rates were, respectively, 100% and 97.1% in the surgery group, and 100% and 96.0% in the angioplasty group (P = 0.81). The post-treatment restenosis rate was higher in the angioplasty group (n = 11, 46.0%) than in the surgery group (n = 8, 22.8%), without reaching statistical significance (P = 0.15). In a Kaplan-Meier analysis, the primary and assisted primary patency rates were significantly higher in the surgery group (P = 0.036 and P = 0.026, respectively), but there was no significant difference in secondary patency rates between the groups (P = 0.52). When stratified by RCAVF maturity at the time of treatment, no significant difference was noted in primary patency rates between the treatment groups. After adjusting for other variables, the relative risk of restenosis was significantly higher in the angioplasty group (hazard ratio 2.56; 95% confidence interval 1.02-6.46; P = 0.046). |
3 |
| 72. Romann A, Beaulieu MC, Rheaume P, Clement J, Sidhu R, Kiaii M. Risk factors associated with arteriovenous fistula failure after first radiologic intervention. J. vasc. access. 17(2):167-74, 2016 Mar-Apr. |
Observational-Tx |
155 consecutive AVFs in 155 patients |
To determine predictive factors for subsequent AVF failure post-PTA. |
Of the 155 patients, 52% required multiple subsequent PTAs; 32% of the AVFs were not in use prior to the first PTA. At first PTA, 83% had outflow vein stenosis (OVS), 26% had multiple stenoses and 43% of stenoses were longer than 2 cm. During follow-up, 1-, 2-, 3-year postintervention primary patency was 41%, 32%, 32% and secondary patency was 80%, 71% and 68%. AVFs with stenoses greater than 2 cm or OVS were at higher risk of requiring multiple PTAs (p = 0.04, 0.006). Factors associated with requiring a second PTA included stenosis greater than 2 cm (hazard ratio (HR) = 1.8, 95% confidence interval (CI) = 1.2-2.9), OVS (HR = 2.5, 95% CI = 1.1-5.4) and primary renal diagnosis of diabetes or renal vascular diseases (HR = 1.8, 95% CI = 1.1-2.9); after adjustments for competing risks, OVS and stenosis length remained associated with requiring subsequent PTAs. |
2 |
| 73. Sigala F, Sasen R, Kontis E, Kiefhaber LD, Forster R, Mickley V. Surgical treatment of cephalic arch stenosis by central transposition of the cephalic vein. J. vasc. access. 15(4):272-7, 2014 Jul-Aug. |
Observational-Tx |
25 patients |
To report our experience with cephalic vein transposition (CVT) for (cephalic arch stenosis, CAS). |
After CVT, two acute complications (8%) occurred: access thrombosis (one) and bleeding (one). During follow-up (1 to 54 months, median 13 months, 34.5 patient-years), six patients died with functioning AVF, three were successfully transplanted. Primary (secondary) 1-year patency was 79% (90%), with a reintervention rate of 0.1/patient/year. |
3 |
| 74. Davies MG, Hicks TD, Haidar GM, El-Sayed HF. Outcomes of intervention for cephalic arch stenosis in brachiocephalic arteriovenous fistulas. J Vasc Surg 2017;66:1504-10. |
Observational-Tx |
219 patients |
To evaluate the outcomes of endovascular and surgical interventions for cephalic arch stenosis. |
From January 2000 to December 2015, 219 patients (67% female; mean age, 58 ± 20 years) with a failing brachiocephalic AVF underwent intervention at the cephalic arch. These interventions included angioplasty, primary stent placement, transposition, and bypass. The average time to intervention for cephalic arch stenosis was 1.7 years after primary access placement. The average number of percutaneous interventions before the decision to intervene surgically on the cephalic arch was three (range, two to six). Technical success was superior in the surgical groups (70% and 80% compared with 96% and 100% for balloon angioplasty, stenting, transposition, and bypass, respectively; P = .02). Major adverse cardiovascular events were overall low but significantly higher in the surgical groups (1%, 1%, 0.3%, and 0.3% for transposition, bypass, balloon angioplasty, and stenting, respectively; P = .02). Both surgical options carried significantly superior patency rates at 2 years for transposition, bypass, balloon angioplasty, and stenting, respectively (63%, 59%, 90%, and 92%; P = .04). There was a lower rate of interventions per person-year of follow-up in the surgical groups compared with the endovascular groups (1.9, 1.4, 3.5, and 3.1 for transposition, bypass, balloon angioplasty, and stenting, respectively; P = .04). Functional dialysis durations were significantly superior in the surgical groups compared with the endovascular group (P = .03). |
2 |
| 75. Vasanthamohan L, Gopee-Ramanan P, Athreya S. The Management of Cephalic Arch Stenosis in Arteriovenous Fistulas for Hemodialysis: A Systematic Review. Cardiovasc Intervent Radiol 2015;38:1179-85. |
Review/Other-Tx |
9 studies |
To conduct a systematic review of management of current cephalic arch stenosis (CAS) and associated outcomes in the context of dysfunctional hemodialysis access. |
Nine papers satisfied the aforementioned criteria: five were retrospective studies and four were prospective studies. CAS management strategies have included percutaneous transluminal balloon angioplasty (PTA), peripheral cutting balloons, surgical cephalic vein transpositions, bare stents, and stent grafts. Reporting strategies varied between studies. Meta-analyses showed that results were variable even within studies using the same modality, particularly for PTA. |
4 |
| 76. Vesely TM, Gherardini D, Gleed RD, Kislukhin V, Krivitski NM. Use of a catheter-based system to measure blood flow in hemodialysis grafts during angioplasty procedures. J Vasc Interv Radiol 2002;13:371-8. |
Observational-Tx |
Stent graft group = 131 patients; Balloon angioplasty group = 138 patients |
To evaluate the accuracy and reliability of the Angioflow meter system with use of in vitro and in vivo methods and to compare it to the standard Transonics HD01 system in a clinical setting. |
Bench-top testing and animal studies demonstrated an excellent (r =.98) correlation between the measurements of the Angioflow meter and volumetric flow measurements. In the clinical trial, there was reasonable correlation (r =.72) between the blood flow measurements obtained with use of the Angioflow meter and Transonics HD01 system. The reproducibility of consecutive measurements with the Angioflow meter was excellent (r =.98). The mean increase in intragraft blood flow after angioplasty was 320 mL/min. |
1 |
| 77. Tessitore N, Bedogna V, Melilli E, et al. In search of an optimal bedside screening program for arteriovenous fistula stenosis. Clin J Am Soc Nephrol. 6(4):819-26, 2011 Apr. |
Observational-Dx |
199 patients (59 stenotic fistulas) |
To compare the performance of several bedside tests performed during dialysis in diagnosing angiographically proven >50% fistula stenosis. |
Angiography identified 59 stenotic fistulas: 43 stenoses were located upstream from the venous needle (inflow stenosis), 12 were located downstream (outflow stenosis), and 4 were located at both sites. The optimal tests for identifying an inflow stenosis were Qa < 650 ml/min and the combination of a positive PE "or" Qa < 650 ml/min (accuracy 80% and 81%, respectively), the latter being preferable because it was more sensitive (85% versus 65%, respectively) for a comparable specificity (79% versus 89%, respectively). The best tests for identifying outflow stenosis were PE and VAPR, with no difference between the two (accuracy 91% and 85%, sensitivity 75% and 81%, specificity 93% and 86%, respectively), the former being preferable because it was more reproducible, easier to perform, and applicable to all fistulas. |
1 |
| 78. Rajabi-Jaghargh E, Banerjee RK. Combined functional and anatomical diagnostic endpoints for assessing arteriovenous fistula dysfunction. [Review]. World j. nephrol.. 4(1):6-18, 2015 Feb 06. |
Review/Other-Dx |
N/A |
To discuss the advantages and limitations of current functional and anatomical diagnostic endpoints in AVFs. |
No results available. |
4 |
| 79. Frinak S, Zasuwa G, Dunfee T, Besarab A, Yee J. Dynamic venous access pressure ratio test for hemodialysis access monitoring. Am J Kidney Dis 2002;40:760-8. |
Observational-Tx |
120 hemodialysis patients with AVGs |
To develop a method prospectively monitor AVGs that uses an algorithm to calculate venous access pressure (VAP) during HD from the venous drip chamber pressure (VDP). |
During a 3-month interval, 120 HD patients with AVGs underwent 359 VAPRTs while access outcomes were monitored for 6 months. After 3 months, sensitivity and specificity for detection of a graft event were 70% +/- 8% and 88% +/- 2% and increased to 74% +/- 5% and 92% +/- 3% at 6 months, respectively. |
2 |
| 80. Wakabayashi M, Hanada S, Nakano H, Wakabayashi T. Ultrasound-guided endovascular treatment for vascular access malfunction: results in 4896 cases. J. vasc. access. 14(3):225-30, 2013 Jul-Sep. |
Observational-Tx |
4869 cases in 1011 patients |
To assess the usefulness of the treatment on the basis of early results: primary success, need for fluoroscopy, number of complications. |
In stenosis cases, early success (technical and clinical) was obtained in 4288 of 4414 cases (97.1%). In obstruction cases, early success was obtained in 443 cases and 91.9% for obstruction cases. Assistance by intra-operative fluoroscopy or radiography was required in 55 cases, and surgical reconstruction was required in 42 cases. Serious complications occurred in 12 of 4869 cases (0.2%). |
3 |
| 81. Leskovar B, Furlan T, Poznic S, Potisek M, Adamlje A, Kljucevsek T. Ultrasound-guided percutaneous endovascular treatment of arteriovenous fistula/graft. Clin Nephrol. 88(13):61-64, 2017 Supplement 1. |
Observational-Tx |
114 patients (228 US-guided angioplasties) |
To analyze the results of ultrasound-guided endovascular treatment of arteriovenous access failure. |
In the period from August 2012 until August 2016, 228 ultrasound-guided open or percutaneous transluminal angioplasties (PTA) were performed (61% men, mean age 66.6 ± 12.0 years), success rate was 93%. In 19 (8%) cases, ultrasound-guided PTA was used in conjunction with surgical reconstruction of arteriovenous fistula/graft and in 27 (12%) cases with thromboendarterectomy. Main complications were recoil, phlebitic vein rupture, and guidewire false route in thrombotic vessels. The main cause of access failure was perianastomotic stenosis (25%). 46% of patients required repeated PTA after the first one (after a mean time of 20.8 ± 22.8 weeks, mean number of repeated PTA 2.1 ± 1.7). Repeated PTA was done intentionally as stepped dilatation or because of rethrombosis/restenosis. Ultrasound-guided stent placement was done in 8% of PTA. |
2 |
| 82. Quencer KB, Friedman T. Declotting the Thrombosed Access. [Review]. Tech Vasc Interv Radiol. 20(1):38-47, 2017 Mar. |
Review/Other-Tx |
N/A |
To describe the methods to perform a percutaneous declot exist and to discuss how to avoid causing an arterial embolism and how to treat it if it does occur. |
No results available. |
4 |
| 83. Ishii T, Suzuki Y, Nakayama T, et al. Duplex ultrasound for the prediction of vascular events associated with arteriovenous fistulas in hemodialysis patients. J. vasc. access. 17(6):499-505, 2016 Nov 02. |
Observational-Dx |
2184 Duplex US patients |
To determine if duplex ultrasound (US) for arteriovenous fistulas (AVFs) can predict vascular events (VEs; thrombosis and stenosis). |
The mean Qa was 772.8 ± 441.4 mL/min; RI, 0.56 ± 0.1; and RD, 2.37 ± 1.0 mm. The optimal Qa cut-off point was calculated as 581.5 mL/min, RI cut-off as 0.56, and RD cut-off as 1.85 mm. VEs were more frequent in patients with a Qa <581.5 mL/min than in those with a Qa >581.5 mL/min (p<0.001). In multivariate analysis, Qa, ferritin, transferrin saturation, and warfarin use were significantly associated with VEs. |
4 |
| 84. Dimopoulou A, Raland H, Wikstrom B, Magnusson A. MDCT angiography with 3D image reconstructions in the evaluation of failing arteriovenous fistulas and grafts in hemodialysis patients. Acta Radiol. 52(9):935-42, 2011 Nov 01. |
Observational-Dx |
31 patients (24 AVF and seven AVG) |
To demonstrate the usefulness of 16-MDCTA with 3D image reconstructions, in long-term hemodialysis patients with dysfunctional arteriovenous fistulas and grafts (AVF and AVG). |
MDCTA illustrated the anatomy of the AVF/AVG and the entire vascular tree to the heart, in a detailed and comprehensive manner in 93.5% of the evaluated segments, and depicted pathology of AVF/AVG or pathology of the associated vasculature. MDCTA demonstrated a total of 38 significant stenoses in 25 patients. DSA verified 37 stenoses in 24 patients and demonstrated two additional stenoses. MDCTA had thus a sensitivity of 95%. All 24 patients were treated with percutaneous transluminal angioplasty (PTA) with good technical results. |
3 |
| 85. Meyer M, Geiger N, Benck U, et al. Imaging of Patients with Complex Hemodialysis Arterio-Venous Fistulas using Time-Resolved Dynamic CT Angiography: Comparison with Duplex Ultrasound. Sci. rep.. 7(1):12563, 2017 10 02. |
Observational-Dx |
35 patients |
To evaluate the feasibility and potential on therapy management of time-resolved dynamic computed tomography angiography (dCTA) in patients with forearm arterio-venous fistula (AVF)/arterio-venous grafts (AVG). |
Diagnosis and therapy management was evaluated versus duplex ultrasound (DUS) in three different readouts: 1. all dCTA datasets; 2. one arterial phase of the dCTA dataset; 3. one arterial and one venous dataset out of the dCTA dataset. All reads were performed >30 days apart from each other. Using all data of the dCTA examination, 20 patients were classified as having a stenosis >50%, 12 high-shunt flow, 11 partial thrombosis, 5 venous aneurysms and 5 complete thrombosis of their AVF/AVG grafts. This lead to 13 additional pathologic findings not visible on DUS and reclassification as normal in one patient with suspected AVF stenosis and complete thrombus on DUS. These additional findings lead to a direct change of therapeutic management in 8 patients. Compared to readout 1 (53 pathologies), readout number 2 and 3 revealed only 33 and 41 pathologies, respectively. |
1 |
| 86. Jin WT, Zhang GF, Liu HC, Zhang H, Li B, Zhu XQ. Non-contrast-enhanced MR angiography for detecting arteriovenous fistula dysfunction in haemodialysis patients. Clinical Radiology. 70(8):852-7, 2015 Aug.Clin Radiol. 70(8):852-7, 2015 Aug. |
Observational-Dx |
21 patients |
To assess the diagnostic value of non-contrast-enhanced magnetic resonance angiography (NCE-MRA), using time-of-flight and black-blood MRA, in the evaluation of arteriovenous fistulas in haemodialysis patients in comparison to multidetector computed tomography angiography (MDCTA). |
Sixty-three vascular segments in the 21 patients were clearly displayed. For the two observers of NCE-MRA, the accuracy was 98% and 95.4%; sensitivity 96.4% and 96.4%; specificity 97.1% and 94.3%; positive predictive value 96.4% and 93.1%; and, negative predictive value 97.1% and 97.1%. Inter-/intra-observer agreement for detecting stenosis was excellent for NCE-MRA, with a weighted kappa of 0.968 (95% confidence interval [CI], 0.874-1) and 0.936 (95% CI, 0.848-1). |
1 |
| 87. Okur A, Kantarci M, Karaca L, et al. Non-contrast-enhanced imaging of haemodialysis fistulas using quiescent-interval single-shot (QISS) MRA: a feasibility study. Clin Radiol 2016;71:244-9. |
Observational-Dx |
22 haemodialysis patients with end-stage renal disease (ESRD) |
To assess the efficiency of a novel quiescent-interval single-shot (QISS) technique for non-contrast-enhanced magnetic resonance angiography (MRA) of haemodialysis fistulas. |
One hundred vascular segments were analysed for QISS MRA. Two anastomosis segments were considered non-diagnostic. None of the arterial or venous segments were evaluated as non-diagnostic. The image quality was poorer for the anastomosis level compared to the other segments (p<0.001 for arterial segments, and p<0.05 for venous segments), while no significant difference was determined for other vascular segments. |
3 |
| 88. Vesely TM. Endovascular intervention for the failing vascular access. Adv Ren Replace Ther 2002;9:99-108. |
Review/Other-Tx |
N/A |
To describe endovascular interventions replacing surgical repair as the primary treatment of the failing or thrombosed vascular access. |
No results provided |
4 |
| 89. De Marchi S, Falleti E, Giacomello R, et al. Risk factors for vascular disease and arteriovenous fistula dysfunction in hemodialysis patients. J Am Soc Nephrol 1996;7:1169-77. |
Observational-Tx |
30 nondiabetic hemodialysis patients with primary arteriovenous fistula |
To explore the impact of serum levels of various risk factors for thrombosis and accelerated fibrointimal hyperplasia on progressive stenosis, and the subsequent thrombosis of hemodialysis fistula. |
Venous dialysis pressure, urea recirculation, color Doppler sonography, and angiography were used to monitor vascular access patency. Eleven patients (37%) developed a progressive stenosis in the venous circuit, which was complicated by thrombosis in three patients. Compared with the patients without fistula dysfunction, these patients had higher serum levels of monocyte chemoattractant protein-1 and interleukin-6, two cytokines that regulate the proliferation of vascular smooth muscle cells, which is the key mechanism in the pathogenesis of fistula stenosis. In addition, they had hyperinsulinemia, hyperlipidemia, and increased plasma levels of two hemostasis-derived risk factors for thrombosis: plasminogen activator inhibitor type 1 and factor VII. Monocyte chemoattractant protein-1, interleukin-6, plasminogen activator inhibitor type 1, factor VII, triglycerides, and the ratios for cholesterol/HDL-cholesterol, apolipoprotein (apo) A-I/ apo C-III, apo A-I/apo B, and glucose/insulin were independent predictors of fistula dysfunction. |
2 |
| 90. Cull DL, Washer JD, Carsten CG, Keahey G, Johnson B. Description and outcomes of a simple surgical technique to treat thrombosed autogenous accesses. J Vasc Surg. 56(3):861-5, 2012 Sep. |
Observational-Tx |
102 patients (146 surgical thrombectomies/interventions) |
To discuss the outcomes of a series of thrombosed autogenous accesses (AAs) treated by surgical thrombectomy/intervention using a technique for manual clot extraction. |
Complete extraction of thrombus from the AA was achieved in 140 of 146 cases (95%). The studied procedure itself was technically successful in 127 cases (87%). Reasons for failure were the inability to completely extract thrombus from the AA in six, failed angioplasty due to long segment vein stenosis or sclerosis in seven or vein rupture in two, and central vein occlusion in one. Three failures occurred for unknown causes = 3 days of successful thrombectomy. No single factor analyzed (age, sex, race, diabetes status, access type or location) was associated with technical failure. The estimated primary and secondary functional patency rates were 27% ± 5% and 61% ± 6% at 12 months. |
1 |
| 91. Aurshina A, Ascher E, Hingorani A, Marks N. A novel technique for duplex-guided office-based interventions for patients with acute arteriovenous fistula occlusion. J Vasc Surg. 67(3):857-859, 2018 03. |
Observational-Tx |
18 patients |
To aggressively salvage acutely occluded arteriovenous fistulas (AVFs) using duplex imaging as the sole imaging modality for percutaneous transluminal angioplasty of acutely thrombosed AVF. |
Of the 18 procedures, 13 (72%) were successful. Of the 14 patients, thrombus was located at the perianastomotic AVF in 6 (43%), proximal-mid AVF in 6 (43%), mid AVF in 1 (7%), and distal AVF in 1 (7%). From group A, six (60%) were successful. From group B, seven (88%) were successful. Among the unsuccessful procedures, one group B patient was hypercoagulable (polycythemia vera). Of the 18 procedures, 16 (89%) were treated within 2 weeks from when duplex revealed the presence of thrombus. Early rethrombosis (<1-month patency) occurred in three cases (17%), and these patients received new fistulas. Full restoration of the fistula flow was established in 14 cases (78%). Of these 14 patients, 8 (57%) are currently on hemodialysis via fistula, 3 patients (21%) had newly placed fistulas after failed interventions, 2 patients (14%) are not on dialysis yet, and 1 patient (7%) with polycythemia vera disorder is on dialysis via a Tesio catheter (MedComp, Harleysville, Pa). |
3 |
| 92. Lee T, Mokrzycki M, Moist L, Maya I, Vazquez M, Lok CE. Standardized definitions for hemodialysis vascular access. Semin Dial 2011;24:515-24. |
Review/Other-Tx |
N/A |
To provide working and standard vascular access definitions relating to (1) epidemiology, (2) vascular access function, (3) vascular access patency, and (4) complications in vascular accesses relating to each of the vascular access types. |
No results available. |
4 |
| 93. Allon M. Current management of vascular access. Clin J Am Soc Nephrol 2007;2:786-800. |
Review/Other-Tx |
N/A |
To provide an update on the current status of vascular access management. |
No results available. |
4 |
| 94. Yan Y, Soulen MC, Shlansky-Goldberg RD, et al. Evaluation of immature hemodialysis arteriovenous fistulas based on 3-French retrograde micropuncture of brachial artery. AJR Am J Roentgenol. 199(3):683-90, 2012 Sep. |
Observational-Tx |
123 outpatients with immature AVF |
The objective of our study was to assess outcomes after evaluation of immature hemodialysis arteriovenous fistulas (AVFs) via 3-French brachial artery access and to identify the incidence of arterial and venous puncture site spasm. |
The mean fistula age was 99 days (range, 21-639 days). There were 49 AVFs in the left forearm; 30 in the left upper arm; 26 in the right forearm; and 18 in the right upper arm. Twenty-eight AVFs were transposed. Angioplasty was technically successful in 81 of 95 patients (85%; mean diameter, 7 mm; range, 4-10 mm). Brachial artery puncture caused no major complication. Arterial spasm occurred in 19 patients (15%) and was severe in one patient. There were two hematomas (1.6%). Venous spasm, ranging from mild (four patients) to occlusive (8 patients), occurred in 38 patients (40%) at the site of venipuncture for intervention. Nitroglycerin (mean, 325 mcg; range, 100-600 mcg) was used in 26 procedures (21%). Venous spasm was more common with forearm (50%) than upper arm (24%) fistulas (p = 0.02) and with decreasing vein diameter (p = 0.02). |
3 |
| 95. Manninen HI, Kaukanen E, Makinen K, Karhapaa P. Endovascular salvage of nonmaturing autogenous hemodialysis fistulas: comparison with endovascular therapy of failing mature fistulas. J Vasc Interv Radiol 2008;19:870-6. |
Observational-Tx |
Nonmaturing Fistulas (n = 75) and Mature Fistulas (n = 45) |
To evaluate the utility of endovascular salvage of nonmaturing autogenous hemodialysis fistulas in a prospective trial of consecutive patients compared with a historical group of patients who underwent treatment of failing mature autogenous fistulas. |
A technical success rate of 88% (66 of 75) and a clinical success rate of 87% (65 of 75) were achieved for the nonmaturing fistulas. Including the secondary interventions, the rate of complications was 6.1% (eight of 131). By Kaplan-Meier analysis, the primary clinical patency rates were 43% +/- 6% (+/-SEM), 36% +/- 6%, and 23% +/- 6%, and the secondary patency rates were 76% +/- 5%, 68% +/- 6%, and 57% +/- 8% at 6, 12, and 36 months, respectively. A small inflow artery (<3 mm in diameter) predicted a poorer primary patency rate (28% +/- 10% vs 48% +/- 9% at 1 year; P = .01). The secondary patency rate of nonmaturing fistulas at 3 years was worse than that of mature fistulas, at 57% +/- 8% versus 79% +/- 8% (P = .02). |
1 |
| 96. Beathard GA, Settle SM, Shields MW. Salvage of the nonfunctioning arteriovenous fistula. Am J Kidney Dis 1999;33:910-6. |
Observational-Tx |
63 patients |
To investigate techniques for the salvage of AVFs that fail to mature. |
In this prospective observational series of 63 patients, failure of AVF development was the result of venous stenosis and/or the presence of accessory veins (venous side branches). The presence of these anomalies could be diagnosed by physical examination. After documentation by angiography, the patients were treated with angioplasty, venous ligation, or a combination of both. Three levels of venous ligation were performed depending on individual requirements: ligation of accessory veins (AVL), ligation of the median cubital vein, and temporary banding of the main fistula itself. The determining factor was the appearance of the fistula after each of the procedures was accomplished relative to potential for cannulation. Of these 63 patients with nonfunctional fistulae that ranged in age from 33 to 418 days, access was salvaged in 52 patients (82.5%). This included 9 of 12 patients who required repeat procedures. |
2 |
| 97. Turmel-Rodrigues L, Mouton A, Birmele B, et al. Salvage of immature forearm fistulas for haemodialysis by interventional radiology. Nephrol Dial Transplant 2001;16:2365-71. |
Observational-Tx |
52 dysfunctional and 17 thrombosed immature forearm fistulas (mean age 10 weeks) |
To assess the value of endovascular techniques for the salvage of fistulas that fail to mature. |
An underlying stenosis was diagnosed in 100% of cases. Half of them were located in the anastomotic area. The initial success rate of interventional radiology was 97%. Dilation-induced rupture occurred in nine cases (13%) but stents were necessary in only two cases. The rate of significant clinical complications was 2.8% (bacteraemia, pseudoaneurysm). Primary and secondary patency rates at 1 year were 39 and 79%, respectively. |
2 |
| 98. Beathard GA, Arnold P, Jackson J, Litchfield T. Aggressive treatment of early fistula failure. Kidney Int 2003;64:1487-94. |
Observational-Tx |
100 patients |
To report a prospective observational study in which early fistula failures were aggressively evaluated and treated in a salvage attempt. |
One hundred patients were identified that met the definition of early failure. Venous stenosis was present in 78% of these cases. In 43% of the cases, the lesion was in the JAS location. In 15%, this was the only lesion present. In 24%, it was associated with an accessory vein, in 6% with a proximal stenosis, and in 4% with both. A proximal stenosis lesion was present in the fistula in 36%. In 6%, it was associated with an accessory vein, in 6% with a JAS, and in 4% with both. The definition of arterial anastomosis stenosis was met in 38% of the cases. This was always in association with JAS. In four cases, a stenotic lesion was present in the artery above the anastomosis. An accessory vein was present in 46% of the cases. In 12% of the cases, this was the only lesion present. In 24% of the cases, this anomaly was associated with JAS, in 6% with proximal stenosis, and in 4% with both. Angioplasty was performed to treat venous stenosis in 72% of the cases with a 98% success rate. Angioplasty of the arterial anastomosis was performed in 38 cases with a 100% success rate. Accessory vein obliteration was performed in 46% of the patients with a 100% success rate. The overall complication rate in this series was 4%, of these 3% were minor and 1% were major. It was possible to initiate dialysis using the fistula in 92% of the cases. Actuarial life-table analysis showed that 84% were functional at 3 months, 72% at 6 months, and 68% at 12 months. |
2 |
| 99. Nassar GM, Nguyen B, Rhee E, Achkar K. Endovascular treatment of the "failing to mature" arteriovenous fistula. Clin J Am Soc Nephrol 2006;1:275-80. |
Observational-Tx |
119 patients |
To report our initial success rates as well as follow-up on a series of 119 consecutive patients who were referred for salvage of their “failing to mature” AVF. |
All patients underwent a fistulogram. Stenotic lesions underwent balloon angioplasty, and accessory veins underwent obliteration. Technical success was determined immediately after the procedure. AVF salvage was determined by successful use during HD. Patients were followed up for 1 yr, during which primary and secondary AVF patency rates were measured. The distribution of stenoses was as follows: Artery, 6 (5.1%); arterial anastomosis, 56 (47.1%); juxta-arterial anastomosis, 76 (63.9%); peripheral vein, 70 (58.8%); and central vein, 10 (8.4%). Significant accessory veins were present in 35 (29.4%). Mixed lesions were found in 85 (71.4%). The technique was successful in 107 (89.9%), and the AVF was salvaged in 99 (83.2%). Follow-up of salvaged fistulae showed a total event rate of 0.38/access-year, thrombosis rate of 0.12/access-year, and loss rate of 0.04/access-year. |
2 |
| 100. Ferring M, Henderson J, Wilmink T. Accuracy of early postoperative clinical and ultrasound examination of arteriovenous fistulae to predict dialysis use. J. vasc. access. 15(4):291-7, 2014 Jul-Aug. |
Observational-Dx |
119 AVF patients |
To assess the accuracy of early clinical and ultrasound (US) examination in terms of predicting arteriovenous fistula (AVF) dialysis use. |
Of 119 AVF patent at 4 weeks, 26 (22%) failed. Clinical examination was 96% sensitive for predicting successful dialysis, but only 21% specific for failure. Vein diameter above 5 mm and an arterial end-diastolic velocity above 110 cm/s were the best US predictors for dialysis use. Vein diameter was slightly better than arterial velocity in terms of predicting maturity (sensitivity: 83% vs 67%, specificity: 68% vs 65%). All assessments predicted AVF maturity (positive predictive value: clinical = 81%, US diameter = 90%, US velocity = 87%) much better than AVF failure (negative predictive value: clinical = 63%, US diameter = 53%, US velocity = 37%). |
1 |
| 101. Mufty H, Claes K, Heye S, Fourneau I. Proactive surveillance approach to guarantee a functional arteriovenous fistula at first dialysis is worth. J. vasc. access. 16(3):183-8, 2015 May-Jun. |
Observational-Tx |
164 patients |
To evaluate the impact of a proactive surveillance program on functional access rate at the time of first dialysis. |
One hundred sixty-four patients were included in the study. Patients were followed until first dialysis. Median follow-up time was 287 days (interquartile range, 108-551 days). During follow-up, 40 patients (24.4%) needed one or more additional interventions, resulting in 60 reinterventions. Ten patients needed dialysis within the minimal accepted maturation period of the AVF (4 weeks). Of the 154 patients who could await the maturation period of the AVF, 145 (94.2%) appeared ready for use at the time of dialysis or at the end of the study period. In 34 of them (22%), this was thanks to one or more interventions during follow-up. |
3 |
| 102. Kumbar L, Karim J, Besarab A. Surveillance and monitoring of dialysis access. Int J Nephrol 2012;2012:649735. |
Review/Other-Tx |
N/A |
To review the scientific evidence on different methodologies currently being used for surveillance and monitoring and their impact on the care of the dialysis access. |
The limited randomized studies especially involving fistulae and small sample size of the published studies with conflicting results highlight the need for a larger multicentered randomized study with hard clinical end points to evaluate the optimal surveillance strategy for both fistula and graft. |
4 |
| 103. Singh P, Robbin ML, Lockhart ME, Allon M. Clinically immature arteriovenous hemodialysis fistulas: effect of US on salvage. Radiology 2008;246:299-305. |
Observational-Tx |
95 patients with clinically immature fistulas |
To retrospectively determine whether postoperative ultrasonography (US) of clinically immature dialysis fistulas can be used to identify potential anatomic origins of immaturity and whether correction of immature fistulas promotes fistula maturation. |
Sixty-seven clinically immature fistulas were deemed sonographically immature. One or more remediable anatomic problems were detected with US in 60 subjects with sonographically immature fistulas; these problems included focal stenosis in 23, accessory veins in 34, and excessively deep veins in 19. Multiple abnormalities were present in 13 subjects. Of 58 subjects with sonographically immature fistulas and known clinical outcomes, 32 underwent an intervention. In those subjects who did not undergo a salvage procedure, only eight fistulas were usable for dialysis. Among those who underwent a salvage procedure, 25 fistulas were subsequently usable for dialysis (P < .001). |
3 |
| 104. Chen MC, Tsai WL, Tsai IC, et al. Arteriovenous fistula and graft evaluation in hemodialysis patients using MDCT: a primer. AJR Am J Roentgenol. 194(3):838-47, 2010 Mar. |
Review/Other-Dx |
N/A |
To introduce the scanning and interpretation techniques and to illustrate the conditions related to early and late fistula failures. |
MDCT is a fast, noninvasive, and accurate technique for diagnosing AVF complications. Radiologists familiar with these techniques can help to improve the prognosis and quality of life for hemodialysis patients. |
4 |
| 105. Trerotola SO, Ponce P, Stavropoulos SW, et al. Physical examination versus normalized pressure ratio for predicting outcomes of hemodialysis access interventions. J Vasc Interv Radiol 2003;14:1387-94. |
Observational-Tx |
97 patients (declotting = 51 and PTA = 46) |
To investigate whether physical examination of the access could be used with the ratio of venous limb pressure (VLP) to systemic pressure (S). To compare these techniques as predictors of outcome. |
Graft configuration, location, side, VLP, S(direct), and S(cuff) did not affect outcomes. An operator effect was noted for two physicians and was adjusted for in all analyses. Pressure ratios were weak predictors of outcome (VLP/S(direct), P =.07; VLP/S(cuff), P =.08) and suggested that patency increased with increasing pressure ratio, contrary to earlier studies. Procedure type predicted outcome (declotting, median patency of 50 days; PTA, median patency of 105 days; P =.01). Thrill at distal physical examination was predictive of outcome (P =.04) and even more so when thrill and TSP combined were compared with PST and pulse combined (P =.03). Similar but less-pronounced effects were seen at midportion and proximal physical examinations. |
3 |
| 106. Clark TW, Cohen RA, Kwak A, et al. Salvage of nonmaturing native fistulas by using angioplasty. Radiology 2007;242:286-92. |
Observational-Tx |
101 patients |
To retrospectively review outcomes following angioplasty of nonmaturing autogenous hemodialysis fistulas. |
Mean patient age was 58 years; 35% were women. Median time from fistula creation to fistulography was 2.5 months. Hemodynamically significant (>50%) stenoses were identified in 88% (89 of 101) of patients; angioplasty was attempted in 96% (85 of 89). Technical success was achieved in 92% (78 of 85) of fistulas following angioplasty; clinical success of normal hemodialysis with total access blood flow of more than 500 mL/min occurred following 88% (75 of 85) of angioplastic interventions. No major and two minor complications occurred. Mean primary unassisted patency at 3, 6, and 12 months was 60%+/-6% (95% confidence interval), 45%+/-6%, and 34%+/-6%, respectively. Additional angioplasty (n=12), stent placement (n=1), or thrombectomy (n=1) during subsequent interventions resulted in mean secondary patency at 3, 6, and 12 months of 82%+/-4%, 79%+/-5%, and 75%+/-6%, respectively. Patients without thrill following angioplasty were more than twice as likely to lose patency as patients with thrill (P=.035). No relationship was seen between primary patency and other predictors examined. |
3 |
| 107. Robbin ML, Greene T, Allon M, et al. Prediction of Arteriovenous Fistula Clinical Maturation from Postoperative Ultrasound Measurements: Findings from the Hemodialysis Fistula Maturation Study. J Am Soc Nephrol. 29(11):2735-2744, 2018 11. |
Observational-Tx |
602 participants |
To investigate the relationships of AVF blood flow, diameter, and depth, measured postoperatively at 1 day (0–3, targeting 1 day) and 2 and 6 weeks, with unassisted and overall (assisted and unassisted) AVF clinical maturation, and whether these ultrasound measurements could predict clinical maturation accurately enough for practical use. |
At each ultrasound measurement time, AVF blood flow, diameter, and depth each predicted in a statistically significant manner both unassisted and overall clinical maturation. Moreover, neither the remaining ultrasound parameters nor case-mix factors were associated with clinical AVF maturation after accounting for blood flow, diameter, and depth, although maturation probabilities differed among clinical centers before and after accounting for these parameters. The crossvalidated area under the receiver operating characteristic curve for models constructed using these three ultrasound parameters was 0.69, 0.74, and 0.79 at 1 day and 2 and 6 weeks, respectively, for unassisted AVF clinical maturation and 0.69, 0.71, and 0.76, respectively, for overall AVF maturation. |
2 |
| 108. Arhuidese IJ, Orandi BJ, Nejim B, Malas M. Utilization, patency, and complications associated with vascular access for hemodialysis in the United States. J Vasc Surg. 68(4):1166-1174, 2018 10. |
Observational-Tx |
476,926 patients initiating hemodialysis |
To evaluate the prevalence, patency, and associated patient survival for pre-emptively placed autogenous fistulas and prosthetic grafts; for autogenous fistulas and prosthetic grafts placed after a temporizing catheter; and for hemodialysis catheters that remained in use. |
There were 73,884 (16%) patients who initiated hemodialysis with autogenous fistula, 16,533 (3%) who initiated hemodialysis with prosthetic grafts, 106,797 (22%) who temporized with hemodialysis catheter prior to autogenous fistula use, 32,890 (7%) who temporized with catheter prior to prosthetic graft use, and 246,822 (52%) patients who remained on the catheter. Maturation rate and median time to maturation were 79% vs 84% and 47 days vs 29 days for pre-emptively placed autogenous fistulas vs prosthetic grafts. Primary patency (adjusted hazard ratio [aHR], 1.26; 95% confidence interval [CI], 1.25-1.28; P < .001) and primary assisted patency (aHR, 1.36; 95% CI, 1.35-1.38; P < .001) were significantly higher for autogenous fistula compared with prosthetic grafts. Secondary patency was higher for autogenous fistulas beyond 2 months (aHR, 1.36; 95% CI, 1.32-1.40; P < .001). Severe infection (aHR, 9.6; 95% CI, 8.86-10.36; P < .001) and mortality (aHR, 1.29; 95% CI, 1.27-1.31; P < .001) were higher for prosthetic grafts compared with autogenous fistulas. Temporizing with a catheter was associated with a 51% increase in mortality (aHR, 1.51; 95% CI, 1.48-1.53; P < .001), 69% decrease in primary patency (aHR, 0.31; 95% CI, 0.31-0.32; P < .001), and 130% increase in severe infection (aHR, 2.3; 95% CI, 2.2-2.5; P < .001) compared to initiation with autogenous fistulas or prosthetic grafts. Mortality was 2.2 times higher for patients who remained on catheters compared to those who initiated hemodialysis with autogenous fistulas (aHR, 2.25; 95% CI, 2.21-2.28; P < .001). |
2 |
| 109. Itoga NK, Ullery BW, Tran K, et al. Use of a proactive duplex ultrasound protocol for hemodialysis access. J Vasc Surg. 64(4):1042-1049.e1, 2016 Oct. |
Observational-Tx |
183 upper extremity AVFs (153 patients) |
To understand the clinical course of AVFs with early stenosis detected with DUS. |
During the study period, 183 upper extremity AVFs were created in 153 patients, including 82 radiocephalic, 63 brachiocephalic, and 38 brachiobasilic AVFs. A mortality rate of 43% (n = 66) was observed in a median follow-up period of 34.5 months (interquartile range, 19.6-46.9). A total of 164 early DUS were performed at a median of 6 weeks (interquartile range, 3.4-9.6 weeks) after the initial creation. Early DUS showed nine AVFs were occluded and were excluded from further analysis. Hemodynamically significant lesions were found in 62 AVFs (40%); however, only 17 (11%) were associated with an abnormal physical examination. Positive DUS finding prompted a secondary intervention in 81% of the patients. Among those with positive early DUS findings, AVF maturation was 70% in those undergoing a secondary intervention compared with 25% in those not undergoing a prophylactic intervention (P = .011). Primary-assisted patency for AVFs with early positive and negative DUS findings were 83% and 96% at 6 months, 64% and 89% at 1 year, and 52% and 82% at 2 years, respectively (P < .001). |
2 |
| 110. Renaud CJ, Francois M, Nony A, Fodil-Cherif M, Turmel-Rodrigues L. Comparative outcomes of treated symptomatic versus non-treated asymptomatic high-grade central vein stenoses in the outflow of predominantly dialysis fistulas. Nephrol Dial Transplant. 27(4):1631-8, 2012 Apr. |
Observational-Tx |
53 untreated asymptomatic/pauci-symptomatic and 50 symptomatic high-grade CVS |
To assess the short- and long-term benefits of such a strategy in mainly autogenous fistulas. |
Mean age, central catheter use and location of stenosis (brachiocephalic vein) in asymptomatic/pauci-symptomatic and symptomatic CVS were significantly different at 69 versus 75 years, 28 versus 48% and 74 versus 56%, respectively. Ninety percent of the cases had an autogenous fistula. The mean degree of stenosis was >80%. Fourty percent of asymptomatic/pauci-symptomatic CVS became severely symptomatic after 4 years. Primary central vein patency at 3, 12, 24 and 36 months in asymptomatic/pauci-symptomatic and symptomatic CVS were 87±5 versus 82±6, 77±6 versus 55±9, 71±7 versus 35±9 and 67±7 versus 18±9%, respectively (P=0.002). Primary access circuit patency rate was not significantly different between the two groups with 66±5 versus 50±4% at 1 year. Secondary central vein and access circuit patency rates at 1 and 3 years were 100 and 93±7 versus 89±5 and 84±7% (P=0.014). |
2 |
| 111. Agarwal AK. Central vein stenosis. Am J Kidney Dis 2013;61:1001-15. |
Review/Other-Tx |
N/A |
To discuss the management and treatment of central vein stenosis (CVS). |
No results provided |
4 |
| 112. Yan Y, Sudheendra D, Dagli MS, et al. Effect of central venous angioplasty on hemodialysis access circuit flow: prospective study of 25 symptomatic patients. J Vasc Interv Radiol 2015;26:984-91. |
Observational-Tx |
30 patients with symptoms attributable to CVS ipsilateral to their access |
To quantify the effect of central venous percutaneous transluminal angioplasty (PTA) on blood flow within hemodialysis access circuits in patients with symptomatic central venous stenosis (CVS). |
Eleven patients had only CVS, whereas 14 had at least 1 peripheral lesion in addition to CVS. All stenoses underwent PTA. Mean flow rates were 1,424 mL/min (range, 565-2,765 mL/min) before PTA and 1,535 mL/min (range, 598-2,545 mL/min) afterward, yielding a mean increase of 111 mL/min ± 456 or 15% ± 34 (range, -70% to +100%; 95% confidence interval, 1%-29%). Flow was decreased in 9 patients (36%). CVS symptoms were reduced in 24 patients (96%) and recurred in 14 (58%) within a mean of 110 days (range, 7-459 d) after initial PTA. Mean follow-up was 371 days (range, 17-592 d). |
2 |
| 113. Labropoulos N, Borge M, Pierce K, Pappas PJ. Criteria for defining significant central vein stenosis with duplex ultrasound. J Vasc Surg 2007;46:101-7. |
Observational-Tx |
37 patients |
To determine criteria for a clinically significant vein stenosis with duplex ultrasound (DU) in patients with signs and symptoms of central venous outflow obstruction. |
Thirty-seven patients, 20 males and 17 females, mean age 54 years, range 27 to 79, were evaluated. Forty-one stenotic venous sites were detected with DU; inferior vena cava 14, superior vena cava 2, portal 2, iliac 11, common femoral 3, brachiocephalic 3, subclavian 5, and axillary vein 1. Phlebography identified 37 of these stenoses and demonstrated two more not seen by DU. Pressure measurements confirmed 39 of those detected by DU. The best criterion by DU to detect a >50% stenosis was a poststenotic to pre-stenotic peak vein velocity ratio of 2.5. The presence of poststenotic turbulence and planimetric calculations of the diameter reduction increased the diagnostic confidence but not the accuracy. Using the pressure gradient of >/=3 mm Hg as a reference test, there were two false positive and two false negative exams with DU, while phlebography had two false negative exams. The overall agreement of DU alone was 90% of phlebography >95% and when combined 100%. Intravascular ultrasound identified correctly all 11 lesions in 11 patients. After angioplasty and stenting, there was a dramatic reduction in the edema in most patients particularly in those that had a caval stenosis. Restenosis was identified by DU in 5/29 (17%) patients at 6 months that were confirmed by phlebography and pressure measurements. Reintervention was performed in four and it was successful in three. |
2 |
| 114. Doelman C, Duijm LE, Liem YS, et al. Stenosis detection in failing hemodialysis access fistulas and grafts: comparison of color Doppler ultrasonography, contrast-enhanced magnetic resonance angiography, and digital subtraction angiography. J Vasc Surg 2005;42:739-46. |
Observational-Dx |
49 dysfunctional hemodialysis arteriovenous fistulas and 32 grafts |
To compare CDUS and CE-MRA with DSA for the detection of significant (> or = 50%) stenoses in failing dialysis accesses, and we determined whether the interventionalist would benefit from CDUS performed before DSA and endovascular intervention. |
DSA detected 111 significant (> or = 50%) stenoses in 433 vascular segments. Sensitivity and specificity of CDUS for the detection of significant stenosed vessel segments were 91% (95% CI, 84%-95%) and 97% (95% CI, 94%-98%), respectively. We found a positive predictive value of 91% (95% CI, 84%-95%) and a negative predictive value of 97% (95% CI, 94%-98%). The sensitivity, specificity, positive predictive value, and negative predictive value of MRA were 96% (95% CI, 90%-98%), 98% (95% CI, 96%-99%), 94% (95% CI, 88%-97%), and 98% (95% CI, 96%-99%), respectively. CDUS and CE-MRA depicted respectively three and four significant stenoses in six nondiagnostic DSA segments. The interventionalist would have chosen an alternative cannulation site in 38% of patients if the CDUS results had been available. |
1 |
| 115. Ko SF, Huang CC, Ng SH, et al. MDCT angiography for evaluation of the complete vascular tree of hemodialysis fistulas. AJR Am J Roentgenol 2005;185:1268-74. |
Observational-Dx |
36 failing AVFs or AVF-related complications |
To assess the clinical feasibility of MDCT angiography for evaluating hemodialysis arteriovenous fistulas (AVFs). |
Among the 14 AVFs examined with both MDCT angiography and DSA, no significant difference was seen in the detection and grading (p = 0.317 to > 0.999) of stenoses at various segments of the entire vascular tree. Among the 36 AVFs examined, MDCT angiography also showed no significant difference from DSA or surgery in revealing vascular stenoses, aneurysms, and thromboses from the supplying artery to central veins (p = 0.317 to > 0.999). Overall, the sensitivity, specificity, positive and negative predictive values, and accuracy of MDCT angiography in lesion detection were 98.7%, 97.5%, 98.8%, 97.2%, and 98.3%, respectively. High image quality with superb interobserver correlation (kappa = 0.809 to > 0.999) validated the clinical feasibility of MDCT angiography for assessing AVFs. |
3 |
| 116. Kundu S. Central venous obstruction management. Semin Intervent Radiol 2009;26:115-21. |
Review/Other-Tx |
N/A |
To identify the etiology and treatment options for central venous disease in hemodialysis patients, including percutaneous transluminal angioplasty, bare metal stents, and covered stents. |
No results available |
4 |
| 117. Levit RD, Cohen RM, Kwak A, et al. Asymptomatic central venous stenosis in hemodialysis patients. Radiology 2006;238:1051-6. |
Observational-Tx |
35 patients with 38 grafts |
To retrospectively evaluate the natural history of high-grade (>50%) asymptomatic central venous stenosis (CVS) in hemodialysis patients and the outcome of serial treatment of CVS with percutaneous transluminal angioplasty (PTA). |
Mean degree of CVS before intervention was 71% (range, 50%-100%). Sixty-two percent (53 of 86) of lesions had associated collateral vessels; 28% (24 of 86) of CVSs were not treated. Mean degree of stenosis in this group was 72% (range, 30%-100%); mean progression was -0.08 percentage point per day. No untreated CVS progressed to symptoms, stent placement, or additional CVS. Seventy-two percent (62 of 86) of CVSs were treated with PTA. Mean degree of stenosis in this group was 74% (range, 50%-100%) before and 40% (range, 0%-75%) after treatment; mean progression was 0.21 percentage point per day after treatment (P = .03). Six (8%) of 62 treatments were followed by CVS escalation; one patient developed arm swelling, four required stents, and four developed additional CVS. |
3 |
| 118. Bakken AM, Protack CD, Saad WE, Lee DE, Waldman DL, Davies MG. Long-term outcomes of primary angioplasty and primary stenting of central venous stenosis in hemodialysis patients. J Vasc Surg 2007;45:776-83. |
Observational-Tx |
26 patients with 26 central venous stenoses (PTS Group) and 47 patients with 49 central venous stenoses (PTA Group) |
To determine the outcomes of primary angioplasty (PTA) vs primary stenting (PTS) in a dialysis access population at a tertiary referral academic medical center. |
PTS was used to treat 26 patients (35% male; average age, 57 +/- 15 years) with 26 central venous stenoses, and 47 patients (45% male; average age, 57 +/- 18 years) with 49 central venous stenoses were treated with PTA. The PTS group underwent 71 percutaneous interventions per stenosis (average, 2.7 +/- 2.4 interventions), and the PTA group underwent 98 interventions per stenosis (average, 2.0 +/- 1.6 interventions). The PTS group hemodialysis access site was an average of 1.0 +/- 1.3 years old at the time of the initial intervention, and the hemodialysis access in the PTA group was an average of 1.1 +/- 1.2 years old. Primary patency was equivalent between groups by Kaplan-Meier analysis, with 30-day rates of 76% for both groups and 12-month rates of 29% for PTA and 21% for PTS (P = .48). Assisted primary patency was also equivalent (P = .08), with a 30-day patency rate of 81% and 12-month rate of 73% for the PTA group, vs PTS assisted patency rates of 84% at 30 days, and 46% at 12 months. Ipsilateral hemodialysis access survival was equivalent between groups. |
2 |
| 119. Ozyer U, Harman A, Yildirim E, Aytekin C, Karakayali F, Boyvat F. Long-term results of angioplasty and stent placement for treatment of central venous obstruction in 126 hemodialysis patients: a 10-year single-center experience. AJR Am J Roentgenol 2009;193:1672-9. |
Observational-Tx |
126 patients (94 patients in angioplasty group and 43 patients in stent group) |
To report and compare long-term results of percutaneous transluminal angioplasty and stenting of central venous obstruction in hemodialysis patients. |
One hundred forty-seven veins in 126 patients (63 males, 63 females) between 15 and 82 years old primarily underwent 101 angioplasties and 46 stent placements. The mean follow-up was 22.1 +/- 16.3 (SD) months. The average number of interventions per vein in the stent group (2.7 +/- 2.4 interventions) was significantly higher than that in the angioplasty group (1.5 +/- 1.0 interventions). Primary patency was significantly higher in the angioplasty group (mean, 24.5 +/- 1.7 months) than that in the stent group (mean, 13.4 +/- 2.0 months). Assisted primary patency of the angioplasty group (mean, 31.4 +/- 2.0 months) and that of the stent group (mean, 31.0 +/- 4.7 months) were equivalent. The overall mean primary patency was 21.1 +/- 1.4 months, and the overall mean assisted primary patency was 31.7 +/- 2.5 months. There were no significant differences in patency rates with regard to patient sex, the type of stent used, the vein or veins treated, or the type of lesions. |
2 |
| 120. Acri I, Carmignani A, Vazzana G, et al. Ipsilateral jugular to distal subclavian vein transposition to relieve central venous hypertension in rescue vascular access surgery: a surgical report of 3 cases. Ann Thorac Cardiovasc Surg. 19(1):55-9, 2013. |
Review/Other-Tx |
3 patients |
To report our experience on 3 patients on chronic hemodialysis treatment presenting with a patent AV fistula and ipsilateral subclavian vein chronic fibrotic obstruction. |
No results available. |
4 |
| 121. Grimm JC, Beaulieu RJ, Sultan IS, Malas MB, Reifsnyder T. Efficacy of axillary-to-femoral vein bypass in relieving venous hypertension in dialysis patients with symptomatic central vein occlusion. J Vasc Surg 2014;59:1651-6. |
Observational-Tx |
10 patients |
To present the initial results of a unique series of patients with a mature arteriovenous access and symptomatic upper extremity venous hypertension who were treated with axillary vein-to-femoral vein bypass after endovascular therapy failed. |
The 10 patients (seven men) were a median age of 58 years. All patients had documentation of prior central venous catheter placement and had undergone a previous endovascular procedure that was unsuccessful or technically unfeasible. The median hospital stay was 2 days (range, 1-3 days), and the median assisted-primary patency was 197 days (25th-75th percentile, 114-240 days). Three patients presented with recurrent arm swelling that was successfully managed in one patient with revision of the proximal anastomosis. Three additional patients presented with subsequent lower extremity swelling, with one patient benefitting from femoral vein angioplasty. Ultimately, six patients continued to use their original access, and two required placement of interval central venous catheters for hemodialysis. |
3 |
| 122. Allan BJ, Prescott AT, Tabbara M, Bornak A, Goldstein LJ. Modified use of the Hemodialysis Reliable Outflow (HeRO) graft for salvage of threatened dialysis access. J Vasc Surg 2012;56:1127-9. |
Review/Other-Tx |
2 patients |
To present two patients who underwent a modified implantation of the HeRO device for immediate salvage of a malfunctioning AV access. |
No results available. |
4 |
| 123. Patel MS, Street T, Davies MG, Peden EK, Naoum JJ. Evaluating and treating venous outflow stenoses is necessary for the successful open surgical treatment of arteriovenous fistula aneurysms. J Vasc Surg. 61(2):444-8, 2015 Feb. |
Observational-Tx |
48 patients |
To review our experience in treating patients with aneurysmal dilatation of their arteriovenous fistula (AVF). |
All patients underwent a fistulogram, and 90% required percutaneous angioplasty to improve outflow. Fifty-six percent of patients had one stenotic outflow lesion, and 44% had at least two tandem outflow stenoses that required treatment. Open repair with aneurysmorrhaphy was performed in one stage in 64% of patients and in two stages in 36%. A tunneled hemodialysis catheter was required in 11 patients (23%) until the surgically repaired AVF was ready for use again, comprising 10 patients treated with single-stage surgery and only one patient in the staged group. All AVFAs were effectively treated, and patients were able to maintain functional use of their access when healed. |
2 |
| 124. Shah AS, Valdes J, Charlton-Ouw KM, et al. Endovascular treatment of hemodialysis access pseudoaneurysms. J Vasc Surg. 55(4):1058-62, 2012 Apr. |
Observational-Tx |
PSA with symptoms (n = 11), PSA with skin erosion (n = 8), PSA with failed hemodialysis (n = 3), PSA after balloon angioplasty of a stenosis (n = 2) |
To determine the efficacy of stent grafts for repair of arteriovenous fistula and arteriovenous graft PSA. |
Twenty-seven self-expanding stent grafts (Viabahn, W. L. Gore, n = 25; Fluency, Bard, n = 2) were used to treat hemodialysis access (arteriovenous graft, n = 13; arteriovenous fistula, n = 11) PSA in 24 patients (16 females; mean age, 55.7 years; mean body mass index, 28.4; mean PSA diameter, 19.5 mm). Comorbidities included hypertension (n = 22; 91.7%), diabetes mellitus (n = 8; 33.3%), and coronary artery disease (n = 4; 16.67%). The median time from access creation to repair was 455 days. The technical success rate was 100%. Balloon angioplasty of an outflow stenosis was performed in 56% of stent grafts. The 30- and 180-day patency rate was 100% and 69.2%, respectively. Three secondary interventions were performed for treatment of unrelated stenosis. Treatment failure occurred in five (18.5%) stent grafts due to infection (n = 3) and thrombosis (n = 2). Treatment of PSA with skin erosion was associated with failure due to infection (odds ratio, 5.0; 95% confidence interval, .38, 66.01). The remaining 22 (81.5%) stent grafts remain patent. The mean follow-up time was 268.9 days (median, 97.5). |
2 |
| 125. Fotiadis N, Shawyer A, Namagondlu G, Iyer A, Matson M, Yaqoob MM. Endovascular repair of symptomatic hemodialysis access graft pseudoaneurysms. J. vasc. access. 15(1):5-11, 2014 Jan-Feb. |
Observational-Tx |
11 patients undergoing percutaneous endovascular repair of symptomatic hemodialysis access graft pseudoaneurysms |
To present our single-center experience using stent grafts in selected patients to exclude symptomatic hemodialysis graft pseudoaneurysms. |
Technical success across the 11 patients was 90.9%. The patient who presented with rupture required ligation of the access due to continuous bleeding after stent graft insertion. Balloon angioplasty of a separate hemodynamically significant stenosis at the time of stent graft insertion was performed in 7 of 11 (63.6%) patients. The primary access patency rates were 72.7% (95% CI of 0.390-0.939) at 3 months and 36.4% (95% CI 0.109-0.692) at 6 months. Secondary access patency rates were 72.7% at 6 months (95% CI 0.233-0.832). There were no procedure-related complications. Mean follow-up was 9 months (range 2-29 months). |
2 |
| 126. Kinning AJ, Becker RW, Fortin GJ, Molnar RG, Dall'Olmo CA. Endograft salvage of hemodialysis accesses threatened by pseudoaneurysms. J Vasc Surg. 57(1):137-43, 2013 Jan. |
Observational-Tx |
24 patients |
To evaluate the efficacy of percutaneous endograft placement for exclusion of hemodialysis access pseudoaneurysms. |
No procedural complications resulted from these interventions. An average of 1.8 endografts was placed per patient, with patients requiring between 1 and 3 endografts to exclude pseudoaneurysms. Primary-assisted patency was 83% at completed 2-month follow-up and 54% at 6-month follow-up. At 12 months, primary-assisted patency was 50%. Eleven patients left the study before 6-month follow-up: five (21%) required explantation secondary to infection between 1 and 4 months; three (13%) were lost to follow-up; two (8%) died of unrelated causes; and 1 requested explantation citing pain from the "stent poking the vein." Mean time to explantation secondary to infection was 2.4 months. Mean duration of patency was 17.6 months with a range from 0 to 76 months. Mean duration of patency for patients who completed 6-month follow-up was 28.7 months. The longest duration of patency is 6 years 4 months, after stent fracture and subsequent placement of a new stent at 6 years 2 months. One other incident of stent fracture occurred at 36 months. Dialysis patterns were not interrupted in either patient. |
2 |
| 127. Zink JN, Netzley R, Erzurum V, Wright D. Complications of endovascular grafts in the treatment of pseudoaneurysms and stenoses in arteriovenous access. J Vasc Surg. 57(1):144-8, 2013 Jan. |
Observational-Tx |
38 stent grafts |
To determine the incidence of these complications, the outcomes of the complications, and their implications related to graft longevity. |
Of 38 stent grafts placed, nine were for pseudoaneurysm (PS), 20 for stenosis (ST), and nine for a combination (PS/ST). The average length of follow-up was 218.6 days. Primary patency was 49%, with an assisted primary patency of 76%. Eleven patients (28.9%) presented with complications related to migration, fracture, erosion, or rupture. Six were in the PS, three in the PS/ST, and two in the ST treatment groups. In all cases, migration or fracture of the stent graft led to recurrent pseudoaneurysm formation or erosion. Rupture occurred after a herald bleed in four cases. Once complication occurred, 10 of the 11 access sites had to be abandoned. |
2 |
| 128. Gumus B.. Percutaneous embolization of hemodialysis fistulas by AMPLATZER vascular plug with midterm follow-up. J Vasc Interv Radiol. 22(11):1581-5, 2011 Nov. |
Review/Other-Tx |
21 patients |
To determine the midterm technical and clinical results of endovascular occlusion of native hemodialysis fistulas with the use of the AMPLATZER Vascular Plug (AVP) I and AVP II. |
All fistulas were embolized successfully by the end of the intervention. No procedure-related complications were observed after the intervention. The follow-up time ranged from 5 months to 24 months, with a mean of 13.5 months. |
4 |
| 129. Jaffers GJ, Fasola CG. Experience with ulcerated, bleeding autologous dialysis fistulas. J. vasc. access. 13(1):55-60, 2012 Jan-Mar. |
Review/Other-Tx |
24 patients |
To examine our experience with patients who presented with episodes of spontaneous bleeding in the presence of an ulcerated lesion over their autologous dialysis accesses. |
Two of 24 patients expired from major hemorrhagic events before obtaining surgical consultation (8.3%). Twenty-one patients (87.5%) underwent 28 surgical procedures for correction of the ulcers. One patient (4.1%) with simultaneous ulcers healed under antibiotic therapy during close observation in hospital. Simple suturing of the ulcer was found to be inconsistent in effectively maintaining hemostasis. Surgical excision of the ulcer with primary closure, vein patching of the fistula, or end-end anastomosis were equally effective in definitively correcting the problem. |
4 |
| 130. Akoh JA, Patel N. Infection of hemodialysis arteriovenous grafts. [Review]. J. vasc. access. 11(2):155-8, 2010 Apr-Jun. |
Observational-Tx |
58 patients |
To determine the infectious complications of prosthetic arteriovenous grafts (AVG) and review the relevant literature. |
There were 84 AVG inserted into 58 patients. Thigh AVG accounted for 55% of cases whereas upper arm AVG was inserted in 39%. Thirteen (17.3%) AVG were associated with one or more episodes of infection. The infection rate for SynerGraft (50%) was statistically significantly different from that of PTFE (12%) - Yates' x2=6.164; df=1; p=0.013. The rate of infection was higher for thigh grafts (9/37) compared to other sites (4/34), but the difference was not statistically significant (Yates' x2=1.123; df=1; p=0.289). Only one death was directly related to AVG infection in this series. |
3 |
| 131. Al-Thani H, El-Menyar A, Al-Thani N, et al. Characteristics, Management, and Outcomes of Surgically Treated Arteriovenous Fistula Aneurysm in Patients on Regular Hemodialysis. Ann Vasc Surg. 41:46-55, 2017 May. |
Observational-Tx |
129 patients with AV aneurysms |
To investigate the clinical characteristics, surgical interventions, and outcomes of arteriovenous fistula (AVF) aneurysms, we retrospectively analyzed patients on regular hemodialysis (HD). |
Of the 700 end-stage renal failure patients, 530 patients were maintained on HD (130 through PermCath and 400 through AV access in terms of AVF and arteriovenous graft). We identified 129 patients who developed AV aneurysms, and 40 of them required surgical interventions (24 men and 16 women) with a mean age of 58 ± 14.6 years. The 40 patients who developed AVF aneurysms underwent 43 surgical interventions. The majority of aneurysms were presented with thinning and ulceration (82.5%) of the overlying skin. Thirty-four patients had true aneurysms and 6 had pseudoaneurysms. The aneurysmal AVF comprised 26 brachiocephalic fistulas, 9 radiocephalic fistulas, 3 brachial artery grafts, 1 ulnar-basilic fistula, and 1 Fem-Fem graft at presentation. Patients were treated mainly with ligation (13; 32.5%), excision and repair with graft interposition (15; 37.5%) or vein interposition (11; 27.5%), and end-to-end AVF (1; 2.5%). The median follow-up postsurgery duration was 53 months (range 1-192) and the median duration from fistula creation to the surgical intervention was 52 months (range 4-182). On follow-up, 34 patients continued on HD, while 5 underwent renal transplantation and 1 shifted to peritoneal dialysis. The overall all-cause mortality rate was 37.5% and the leading causes of mortality were sepsis/pneumonia (60%), myocardial infarction, and heart failure (40%). |
2 |
| 132. Inui T, Boulom V, Bandyk D, Lane JS 3rd, Owens E, Barleben A. Dialysis Access Hemorrhage: Access Rescue from a Surgical Emergency. Ann Vasc Surg. 42:45-49, 2017 Jul. |
Observational-Tx |
26 patients |
To describe our experience using access rescue strategies, including in situ graft replacement, primary repair, or conversion to an autogenous fistula, coupled with treatment of central vein occlusion to maintain access usage in patients presenting with conduit hemorrhage. |
One-half of the patients were taken emergently to the operating room for hemorrhage control or impending rupture of an infected false aneurysm, the remaining repaired on an urgent basis. In 18 patients, emergency room personnel attempted control of access site bleeding by suturing (n = 14) or tourniquet (n = 4). Dialysis access salvage was achieved in 22 (85%) of 26 patients by in situ conduit replacement using a rifampin-soaked polytetrafluoroethylene conduit (n = 19) or primary repair (n = 3). Two patients with sepsis and ruptured, infected false aneurysm were treated by ligation, and 2 patients with nonsalvable access had conversion to an autogenous fistula. One-third of rescued accesses (n = 7) had staged endovascular treatment of central vein stenosis. One patient died within 30 days. All dialysis access revisions remained patent and used for immediate dialysis (n = 5), within 4-5 weeks (n = 19), or after vein maturation (n = 2). One replaced graft was revised for infection. Positive blood or bleeding site cultures were obtained from 9 (45%) of 20 patients tested. |
3 |
| 133. Leon C, Asif A. Arteriovenous access and hand pain: the distal hypoperfusion ischemic syndrome. Clin J Am Soc Nephrol 2007;2:175-83. |
Review/Other-Dx |
N/A |
To review the pathophysiology and present current strategies to ameliorate distal hypoperfusion ischemic syndrome. |
No results provided |
4 |
| 134. Tercan F, Kocyigit A, Guney B. Combined Endovascular Treatment with Distal Radial Artery Coil Embolization and Angioplasty in Steal Syndrome Associated with Forearm Dialysis Fistula. Cardiovasc Intervent Radiol. 39(9):1266-71, 2016 Sep. |
Observational-Tx |
589 patients |
To define the results of the endovascular treatment with angioplasty and distal radial artery embolization in ischemic steal syndrome associated with forearm arteriovenous accesses. |
Of 589 patients who underwent endovascular intervention for dialysis arteriovenous fistulae (AVF)-associated problems, 6 (1.01 %) (5 female, 1 males; mean age 62 (range 41-78) with forearm fistula underwent combined endovascular treatment for steal syndrome. In addition to steal phenomenon, there were stenosis and/or occlusion in proximal radial and/or ulnar artery in 6 patients concurrently. Embolization of distal radial artery and angioplasty to proximal arterial stenoses were performed in all patients. Ischemic symptoms were eliminated in all patients and the AVF were in use at the time of study. In one patient, ischemic symptoms recurring 6 months later were alleviated by repeat angioplasty of ulnar artery. |
3 |
| 135. Huber TS, Larive B, Imrey PB, et al. Access-related hand ischemia and the Hemodialysis Fistula Maturation Study. J Vasc Surg. 64(4):1050-1058.e1, 2016 Oct. |
Observational-Tx |
602 participants |
To prospectively describe its incidence, predictors, interventions, and associated access maturation. |
The study cohort included 602 participants with median follow-up of 2.1 years (10th-90th percentiles, 0.7-3.5 years). Mean age was 55.1 ± 13.4 (standard deviation) years; the majority were male (70%), white (47%), diabetic (59%), smokers (55%), and on dialysis (64%) and underwent an upper arm AVF (76%). Symptoms of ARHI occurred in 45 (7%) participants, and intervention was required in 26 (4%). Interventions included distal revascularization with interval ligation (13), ligation (7), banding (4), revision using distal inflow (1), and proximalization of arterial inflow (1). Interventions were performed =7 days after AVF creation in 4 participants (15%), between 8 and 30 days in 6 (23%), and >30 days in 16 (63%). Female gender (odds ratio, 3.17; 95% confidence interval, 1.27-7.91; P = .013), diabetes (13.62 [1.81-102.4]; P = .011), coronary artery disease (2.60 [1.03-6.58]; P = .044), higher preoperative venous capacitance (per %/10 mm Hg, 2.76 [1.07-6.52]; P = .021), and maximum venous outflow slope (per [mL/100 mL/min]/10 mm Hg, 1.13 [1.03-1.25]; P = .011) were significantly associated with interventions; a lower carotid-femoral pulse wave velocity and the outflow vein diameter in the early postoperative period (days 0-3) approached significance (P < .10). Intervention for ARHI was not associated with AVF maturation failure (unadjusted risk ratio, 1.18 [0.69-2.04], P = .56; adjusted odds ratio, 0.97 [0.41-2.31], P = .95). |
2 |
| 136. Valji K, Hye RJ, Roberts AC, Oglevie SB, Ziegler T, Bookstein JJ. Hand ischemia in patients with hemodialysis access grafts: angiographic diagnosis and treatment. Radiology 1995;196:697-701. |
Review/Other-Tx |
13 patients with 14 hemodialysis grafts |
To determine the cause of symptoms and efficacy of transcatheter therapy in a series of patients with dialysis grafts and hand pain referred for arteriography. |
The cause of symptoms was ischemia from obstructive arterial disease in seven cases (three with superimposed steal), graft steal alone in three, ischemic monomelic neuropathy in two, and carpal tunnel syndrome in two. Five arterial stenoses were treated with angioplasty, with improvement or resolution of symptoms in four patients. |
4 |
| 137. Tordoir JH, Dammers R, van der Sande FM. Upper extremity ischemia and hemodialysis vascular access. Eur J Vasc Endovasc Surg 2004;27:1-5. |
Review/Other-Tx |
N/A |
To review the pathophysiology, symptoms, diagnosis and treatment options of upper extremity ischemia and hemodialysis vascular access will be discussed. |
No results provided |
4 |
| 138. Lazarides MK, Staramos DN, Panagopoulos GN, Tzilalis VD, Eleftheriou GJ, Dayantas JN. Indications for surgical treatment of angioaccess-induced arterial "steal". J Am Coll Surg 1998;187:422-6. |
Observational-Tx |
111 retrospective patients (group A) and 69 prospective patients (group B) |
To determine the incidence of arterial steal after AV angioaccess at the antecubital level and to define clear indications for those patients who need surgical repair. |
Seven patients were operated on for steal-induced limb-threatening ischemia; in all seven patients, ischemia developed immediately after access construction. One additional patient with mild symptoms and deterioration in repeated NCS was considered a candidate for ischemic monomelic neuropathy and was successfully operated on 1 month later. The ligation-bypass technique was used in all patients, consisting of arterial ligature distal to the takeoff of the graft and short arterial bypass from a point proximal to the inflow of the access to a point just distal to ligation. In 94% of the patients, some degree of distal ischemia was detected (SPI < 0.8); patients with SPI < 0.5 were most likely to have impaired NCS. |
2 |
| 139. Beathard GA, Spergel LM. Hand ischemia associated with dialysis vascular access: an individualized access flow-based approach to therapy. [Review]. Semin Dial. 26(3):287-314, 2013 May-Jun. |
Review/Other-Tx |
N/A |
To present information that supports an individualized, physiologic approach to this condition. |
No results stated in abstract. |
4 |
| 140. Wang S, Asif A, Jennings WC. Dilator-assisted banding and beyond: proposing an algorithm for managing dialysis access-associated steal syndrome. J. vasc. access. 17(4):299-306, 2016 Jul 12. |
Observational-Tx |
30 patients underwent DAB for DASS |
To illustrate the expansion of dilator-assisted banding (DAB) and analyze the outcome of DAB in managing dialysis access-associated steal syndrome (DASS). |
Of the 30 patients, 23 had an arteriogram and 3 required angioplasty ± stent placement for inflow artery stenosis. Besides intraluminal DAB (12/30), this report also included extraluminal DAB (14/30) and open fistula reduction plus DAB (4/30). After DAB, the severity scores of DASS were reduced from 2.8 ± 0.4 to 0.2 ± 0.4 for the fistula group (n = 24, p<0.001) and from 3.0 ± 0.0 to 1.2 ± 1.2 for the graft group (n = 6, p = 0.041). DAB was effective in all but two graft patients who subsequently underwent proximalization of arterial inflow (PAI) that resulted in resolution of DASS. During follow-up of 18.7 ± 14.5 months (range 1-50), all accesses remained functional. At 24-months post-DAB, the primary patency, primary-assisted patency and secondary patency rates of the fistula group were 72%, 91% and 100%, respectively. |
2 |
| 141. Miller GA, Khariton K, Kardos SV, Koh E, Goel N, Khariton A. Flow interruption of the distal radial artery: treatment for finger ischemia in a matured radiocephalic AVF. J Vasc Access 2008;9:58-63. |
Review/Other-Tx |
150 end-stage renal disease patients |
To establish an effective approach for diagnosis and treatment of hand ischemia in matured radiocephalic arteriovenous fistulae (AVF). |
DRA flow interruption was effectively accomplished by either ligation or coil embolization in all cases. All patients had symptomatic improvement. Complete symptom resolution was experienced by 100% (10/10) of patients who received DRA embolization and by 3/5 patients who required ligation. The average follow-up period was 9 months. There were no complications during the procedure or during the follow-up period. |
4 |
| 142. Anaya-Ayala JE, Pettigrew CD, Ismail N, et al. Management of dialysis access-associated "steal" syndrome with DRIL procedure: challenges and clinical outcomes. J. vasc. access. 13(3):299-304, 2012 Jul-Sep. |
Observational-Tx |
33 patients with dialysis access-associated steal syndrome (DASS) |
To assess our experiences with the DRIL procedure for the management of DASS, regarding efficacy while preserving dialysis access. |
33 patients, (70% women, mean age of 56 ± 13) with DASS underwent a DRIL. Indications were ischemic pain alone in 12 (36%) patients, loss of neurologic function in 7 (21%), both ischemic pain and loss of neurologic function in 4 (12%) tissue loss in 7 (21%), pain during hemodialysis in one (3%), and "prophylactic" DRIL during a femoral vein transposition (FVt) fistula in two (6%). Technical success was 100%; Ischemic symptoms fully resolved by DRIL in 24 of the 31 symptomatic patients (77%) and during the follow up period DASS did not develop in the subjects we judged at high risk and underwent DRIL during FVt. One serious complication occurred because of early bypass thrombosis causing worsening hand gangrene requiring transmetacarpal amputation. The primary, assisted-primary, and secondary patency rates of the arterial bypass at 12 months were 65%, 75%, and 95% respectively. AV access primary, assisted-primary, and secondary patency were 29%, 85%, and 94% at 12 months. |
2 |
| 143. Bourquelot P.. Access flow reduction for cardiac failure. J. vasc. access. 17 Suppl 1:S60-3, 2016 Mar. |
Review/Other-Tx |
N/A |
To describe the following methods to reduce high flow AVFs: juxta-anastomosis Proximal Radial Artery Ligation (PRAL) for distal AVF, Distal Report of Arterial Inflow (RUDI-1) and more recently, Transposition of the Radial Artery (RUDI-2) for proximal AVF. |
No results provided |
4 |
| 144. Kanno T, Kamijo Y, Hashimoto K, Kanno Y. Outcomes of blood flow suppression methods of treating high flow access in hemodialysis patients with arteriovenous fistula. J. vasc. access. 16 Suppl 10:S28-33, 2015 Nov. |
Observational-Tx |
74 patients with HFA = A-ban with A-lig: 12 cases, Shunt vein banding (V-ban: 37 cases), Anastoplasty (Ana: 25 cases) |
To compare the various blood flow suppression techniques for treating HFA and the therapeutic outcomes. |
There were no differences in the sex or mean age or duration of HD between the treatment groups. The A-ban with A-lig method was mainly selected for patients with a distal AVF and the anastoplasty method was selected most often for patients with a cubital AVF. The techniques were equally effective in reducing flow volume (FV) and the FV/cardiac output ratio (Flow/CO) to target levels, and clinical symptoms improved in all patients. The rates of HFA recurrence and AVF occlusion were significantly higher in the V-ban group (18.9% and 24.3%, respectively). A small proportion of patients in each treatment group developed a postoperative infection. |
3 |
| 145. Leake AE, Winger DG, Leers SA, Gupta N, Dillavou ED. Management and outcomes of dialysis access-associated steal syndrome. J Vasc Surg. 61(3):754-60, 2015 Mar. |
Observational-Tx |
201 patients |
To describe a 10-year experience with the surgical management of dialysis access-associated steal syndrome (DASS). |
A total of 201 patients had 218 episodes of DASS. Mean age was 65 years, and 62% were women. DASS was caused by 175 arteriovenous fistulas (80%), 41 upper extremity prosthetic grafts (19%), and two thigh grafts (1%); 87% were brachial artery based. A portion (22%) were referred for DASS from outside practices. All patients had grade 2 (48%) or grade 3 (52%) DASS; 92% (185) were available for follow-up, with a median time to first follow-up of 23 days. Surgical procedures included ligation (73), distal revascularization with interval ligation (DRIL) (59), revision using distal inflow (RUDI) (21), banding (38), proximalization of arterial inflow (12), and distal radial artery ligation (13). There were no differences in preoperative comorbidities between treatment groups. The 30-day complications included continued steal, thrombosis, bleeding, infection, and mortality. Ligation and DRIL were performed most often for grade 3 steal. Ligation and banding were performed most acutely (median time to intervention after access creation of 39 and 24 days vs DRIL and RUDI at 97 and 100 days). Fistula preservation was 0% for ligation, 100% for DRIL, 95% for RUDI, and 89% for banding (P < .01). Improvement of symptoms ranged from 75% (banding) to 98% (DRIL) (P = .005). Women were less likely to have DRIL but more likely to have ligation (P = .001). Complications were highest in the banding (49%) and RUDI (37%) groups. Average mortality was 3.5%, with no significant differences among groups. During the study period, 3287 access procedures were performed, and access volume steadily increased (2003-2008, 1312 access creations; 2008-2013, 1975). Percentage of fistulas (79% vs 86%), incidence of steal (4% vs 6%), and percentage of DRILs (25% vs 28%) were consistent across the two study periods. |
2 |
| 146. Loh TM, Bennett ME, Peden EK. Revision using distal inflow is a safe and effective treatment for ischemic steal syndrome and pathologic high flow after access creation. J Vasc Surg. 63(2):441-4, 2016 Feb. |
Observational-Tx |
28 patients (29 RUDI procedures) |
To present our experience with revision using distal inflow (RUDI) for the treatment of ischemic steal syndrome (ISS) and pathologic high flow (HF). |
We performed 29 RUDI procedures in 28 patients (16 women, 12 men). Indications for surgery were pathologic HF in 13 and ISS in 19. Ten percent had previous banding for ISS or HF. Sixty-nine percent of patients had a history of diabetes. Fifty-two percent had a history of atherosclerotic disease. Mean time to intervention from creation was 40 months (range, 6-88 months). Accesses included 1 upper arm graft and 27 brachial artery-based fistulas. Outflow included 25 cephalic veins and 3 basilic veins. Distalization targets were 19 radial arteries and 10 ulnar arteries. Mean flow reduction was 1191 mL/min. Primary assisted patency at 1 year was 74%. Secondary patency at 1 year was 87%. A single access was ligated for continued heart failure after RUDI. ISS symptom resolution was reported as complete in 69% and partial in 31%. |
2 |
| 147. Gupta N, Yuo TH, Konig Gt, et al. Treatment strategies of arterial steal after arteriovenous access. J Vasc Surg 2011;54:162-7. |
Observational-Tx |
114 patients with ISS and 100 AV access patients (control group) |
To compare the management and success associated with techniques to treat Ischemic steal syndrome (ISS). |
A total of 114 patients with ISS had a mean age of 65 years (range, 20-90 years), were predominantly female (66%), diabetic (61%), and with a brachial origin fistula (69%). Risk factors for ISS included coronary artery disease (CAD; P < .001), hypertension (P < .001), and tobacco use (P = .048). Women were noted to have a brachial origin access more frequently than men (odds ratio [OR], 3.1; P = .009). Forty-four patients with mild steal were observed. Seventy patients underwent 87 procedures. Procedures performed included ligation (n = 27), banding (n = 22), distal revascularization and interval ligation (DRIL; n = 21), improvement of proximal inflow (n = 9), revision using distal inflow (RUDI; n = 4), and proximalization of arterial inflow (PAI; n = 3). Early procedures (<30 days from the index fistula) were mostly ligation (50%) or banding (38%), while DRIL was the most frequent choice for late interventions (41%). Banding had a high failure rate (62%) and was the most common reason for reintervention (8 of 11, 73%) and DRIL had a better success rate than banding (P = .05). In our current practice, 18% of patients had an AV fistula with the proximal radial artery (PRA) as the inflow source, while this type of fistula accounted for only 2% of all ISS patients. Ligation resolved symptoms in all patients, but the AV access was lost. |
2 |
