Endovascular management of failure of maturation of natural vascular access
Mina Gamil Zekri Basta;
Abstract
Permanent vascular access in the patient with ESRD on hemodialysis is provided through a central venous catheter (CVC), arteriovenous graft (AVG), or AVF.
AVFs are associated with decreased morbidity and mortality and superior primary patency rates, the lowest rates of thrombosis, require the fewest secondary interventions, provide longer hemodialysis access survival rates and have lower rates of infection, lower hospitalization rates than patients with AV grafts or catheters.
Vascular access dysfunction is a major cause of morbidity and mortality in dialysis patients.
The “failing to mature” arteriovenous fistula (AVF) can be defined as a surgically created AVF that failed to properly grow to become usable for the purpose of hemodialysis (HD) in 8 to 12 weeks after its creation.
Fistula maturation is a complex vascular remodeling process that requires vessel dilation, marked increases in blood flow rates in the feeding artery and draining vein, and structural changes in the vessel walls.
Fistula maturation occurs through serial changes that occur at a hemodynamic, anatomic, molecular, and functional level after the creation of an arteriovenous anastomosis. The single most important determinant of all is the response of both the feeding artery and the draining vein to the increase in shear stress that occurs after the creation of an arteriovenous anastomosis.
Principles to achieve maturation is to have an adequate cardiac output and Arterial inflow and Draining vein must be adequate size. asingle large vein is preferable than multible small veins for dialysis. the juxtaanastomosis part must be free from any stenosis and no significant stenosis at the entire access circuit to empede flow.
The most common cause of early malfunction is a technical problem during the surgical procedure when the AV fistula is built. Early causes of low flow malfunction include technical problems at the site of anastomosis, kinking of the vein or artery that has been mobilized, choice of too small a vein for the anastomosis (often due to the unavailability of suitable veins), inflow obstruction due to proximal arterial stenosis, outflow obstruction due to distal venous stenosis or thrombosis or central venous occlusdion or premature use of the AV fistula for dialysis before it has matured.
Risk factors for failure of maturation include inadequate anatomy, obesity, advancing age, female gender, medical conditions such as heart failure, and diabetes mellitus. Many patients have more than one risk factor. It would be of value to be able to make some type of prediction of their overall risk of failure before an AVF is attempted.
AVFs are associated with decreased morbidity and mortality and superior primary patency rates, the lowest rates of thrombosis, require the fewest secondary interventions, provide longer hemodialysis access survival rates and have lower rates of infection, lower hospitalization rates than patients with AV grafts or catheters.
Vascular access dysfunction is a major cause of morbidity and mortality in dialysis patients.
The “failing to mature” arteriovenous fistula (AVF) can be defined as a surgically created AVF that failed to properly grow to become usable for the purpose of hemodialysis (HD) in 8 to 12 weeks after its creation.
Fistula maturation is a complex vascular remodeling process that requires vessel dilation, marked increases in blood flow rates in the feeding artery and draining vein, and structural changes in the vessel walls.
Fistula maturation occurs through serial changes that occur at a hemodynamic, anatomic, molecular, and functional level after the creation of an arteriovenous anastomosis. The single most important determinant of all is the response of both the feeding artery and the draining vein to the increase in shear stress that occurs after the creation of an arteriovenous anastomosis.
Principles to achieve maturation is to have an adequate cardiac output and Arterial inflow and Draining vein must be adequate size. asingle large vein is preferable than multible small veins for dialysis. the juxtaanastomosis part must be free from any stenosis and no significant stenosis at the entire access circuit to empede flow.
The most common cause of early malfunction is a technical problem during the surgical procedure when the AV fistula is built. Early causes of low flow malfunction include technical problems at the site of anastomosis, kinking of the vein or artery that has been mobilized, choice of too small a vein for the anastomosis (often due to the unavailability of suitable veins), inflow obstruction due to proximal arterial stenosis, outflow obstruction due to distal venous stenosis or thrombosis or central venous occlusdion or premature use of the AV fistula for dialysis before it has matured.
Risk factors for failure of maturation include inadequate anatomy, obesity, advancing age, female gender, medical conditions such as heart failure, and diabetes mellitus. Many patients have more than one risk factor. It would be of value to be able to make some type of prediction of their overall risk of failure before an AVF is attempted.
Other data
| Title | Endovascular management of failure of maturation of natural vascular access | Other Titles | علاج فشل نضوج الوصله الشريانيه الوريديه الطبيعيه باستخدام القسطره التداخليه | Authors | Mina Gamil Zekri Basta | Issue Date | 2015 |
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