Conversion of tunneled hemodialysis catheter-consigned patients to arteriovenous fistula

Arif Asif, Gautam Cherla, Donna Merrill, Cristian D. Cipleu, Patricia Briones, Phillip Pennell

Research output: Contribution to journalArticle

85 Citations (Scopus)

Abstract

Objective. Despite their high incidence of complications, costs, morbidity, and mortality, nearly 27% of the chronic hemodialysis (HD) patients are receiving treatment via a tunneled hemodialysis catheter (TDC). Methods. In this prospective analysis, an interventional nephrology team employed an organized program consisting of vascular access (VA) education and vascular mapping (VM) to TDC-consigned patients. A full range of surgical approaches for arteriovenous fistula (AVF) creation, including vein transpositions, was exercised. Physical examination was performed every 1 to 2 weeks after surgery to assess the development of the AVF. Fistulas that failed to develop adequately to support HD (early failure) underwent salvage [percutaneous transluminal angioplasty (PTA), accessory vein obliteration (AVL)] procedures. Results. One hundred twenty-one TDC-consigned patients received VA education. Eighty-six (71%) agreed to undergo VM. Two groups were identified. Group I (N = 66; using TDC for 7.2 ± 1.8 SD months) had never had an arteriovenous access; group II (N = 20; using TDC for 12.3 ± 4.0 months) had a history of one or more previously failed arteriovenous accesses. Upon VM, 64/66 (97%) in group I and 18/20 (90%) in group II were found to have adequate veins for AVF creation. Seven patients (11%) in group I and 3 (17%) in group II refused surgery. In group I, 57 (89%) received an arteriovenous access (radiocephalic AVF = 15, brachiocephalic AVF = 35, transposed brachiobasilic AVF = 3, brachiobasilic AVG = 4). In group II, 15 (83%) received a transposed AVF (radiobasilic = 2, brachiobasilic = 13). Sixteen fistulas (30%) in group I and 8 (53%) in group II had early failure. All except for one fistula in each group were salvaged using PTA and/or AVL. All 70 accesses (AVF = 66, AVG = 4) remain functional, with a mean follow-up of 8.5 ± 3.6 months. Conclusion. These results demonstrate that an organized approach based upon a comprehensive program utilizing VA counseling, VM, application of full range of surgical techniques, and salvage procedures can be very successful in providing optimum vascular access to the catheter-dependent patient.

Original languageEnglish (US)
Pages (from-to)2399-2406
Number of pages8
JournalKidney International
Volume67
Issue number6
DOIs
StatePublished - Jan 1 2005

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Arteriovenous Fistula
Blood Vessels
Renal Dialysis
Catheters
Veins
Fistula
Angioplasty
Education
Nephrology
Physical Examination
Counseling
Morbidity
Costs and Cost Analysis
Mortality
Incidence

Keywords

  • Arteriovenous fistula
  • Fistula salvage
  • Immature fistula
  • Interventional nephrology
  • Tunneled dialysis catheter

ASJC Scopus subject areas

  • Nephrology

Cite this

Conversion of tunneled hemodialysis catheter-consigned patients to arteriovenous fistula. / Asif, Arif; Cherla, Gautam; Merrill, Donna; Cipleu, Cristian D.; Briones, Patricia; Pennell, Phillip.

In: Kidney International, Vol. 67, No. 6, 01.01.2005, p. 2399-2406.

Research output: Contribution to journalArticle

Asif, Arif ; Cherla, Gautam ; Merrill, Donna ; Cipleu, Cristian D. ; Briones, Patricia ; Pennell, Phillip. / Conversion of tunneled hemodialysis catheter-consigned patients to arteriovenous fistula. In: Kidney International. 2005 ; Vol. 67, No. 6. pp. 2399-2406.
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abstract = "Objective. Despite their high incidence of complications, costs, morbidity, and mortality, nearly 27{\%} of the chronic hemodialysis (HD) patients are receiving treatment via a tunneled hemodialysis catheter (TDC). Methods. In this prospective analysis, an interventional nephrology team employed an organized program consisting of vascular access (VA) education and vascular mapping (VM) to TDC-consigned patients. A full range of surgical approaches for arteriovenous fistula (AVF) creation, including vein transpositions, was exercised. Physical examination was performed every 1 to 2 weeks after surgery to assess the development of the AVF. Fistulas that failed to develop adequately to support HD (early failure) underwent salvage [percutaneous transluminal angioplasty (PTA), accessory vein obliteration (AVL)] procedures. Results. One hundred twenty-one TDC-consigned patients received VA education. Eighty-six (71{\%}) agreed to undergo VM. Two groups were identified. Group I (N = 66; using TDC for 7.2 ± 1.8 SD months) had never had an arteriovenous access; group II (N = 20; using TDC for 12.3 ± 4.0 months) had a history of one or more previously failed arteriovenous accesses. Upon VM, 64/66 (97{\%}) in group I and 18/20 (90{\%}) in group II were found to have adequate veins for AVF creation. Seven patients (11{\%}) in group I and 3 (17{\%}) in group II refused surgery. In group I, 57 (89{\%}) received an arteriovenous access (radiocephalic AVF = 15, brachiocephalic AVF = 35, transposed brachiobasilic AVF = 3, brachiobasilic AVG = 4). In group II, 15 (83{\%}) received a transposed AVF (radiobasilic = 2, brachiobasilic = 13). Sixteen fistulas (30{\%}) in group I and 8 (53{\%}) in group II had early failure. All except for one fistula in each group were salvaged using PTA and/or AVL. All 70 accesses (AVF = 66, AVG = 4) remain functional, with a mean follow-up of 8.5 ± 3.6 months. Conclusion. These results demonstrate that an organized approach based upon a comprehensive program utilizing VA counseling, VM, application of full range of surgical techniques, and salvage procedures can be very successful in providing optimum vascular access to the catheter-dependent patient.",
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T1 - Conversion of tunneled hemodialysis catheter-consigned patients to arteriovenous fistula

AU - Asif, Arif

AU - Cherla, Gautam

AU - Merrill, Donna

AU - Cipleu, Cristian D.

AU - Briones, Patricia

AU - Pennell, Phillip

PY - 2005/1/1

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N2 - Objective. Despite their high incidence of complications, costs, morbidity, and mortality, nearly 27% of the chronic hemodialysis (HD) patients are receiving treatment via a tunneled hemodialysis catheter (TDC). Methods. In this prospective analysis, an interventional nephrology team employed an organized program consisting of vascular access (VA) education and vascular mapping (VM) to TDC-consigned patients. A full range of surgical approaches for arteriovenous fistula (AVF) creation, including vein transpositions, was exercised. Physical examination was performed every 1 to 2 weeks after surgery to assess the development of the AVF. Fistulas that failed to develop adequately to support HD (early failure) underwent salvage [percutaneous transluminal angioplasty (PTA), accessory vein obliteration (AVL)] procedures. Results. One hundred twenty-one TDC-consigned patients received VA education. Eighty-six (71%) agreed to undergo VM. Two groups were identified. Group I (N = 66; using TDC for 7.2 ± 1.8 SD months) had never had an arteriovenous access; group II (N = 20; using TDC for 12.3 ± 4.0 months) had a history of one or more previously failed arteriovenous accesses. Upon VM, 64/66 (97%) in group I and 18/20 (90%) in group II were found to have adequate veins for AVF creation. Seven patients (11%) in group I and 3 (17%) in group II refused surgery. In group I, 57 (89%) received an arteriovenous access (radiocephalic AVF = 15, brachiocephalic AVF = 35, transposed brachiobasilic AVF = 3, brachiobasilic AVG = 4). In group II, 15 (83%) received a transposed AVF (radiobasilic = 2, brachiobasilic = 13). Sixteen fistulas (30%) in group I and 8 (53%) in group II had early failure. All except for one fistula in each group were salvaged using PTA and/or AVL. All 70 accesses (AVF = 66, AVG = 4) remain functional, with a mean follow-up of 8.5 ± 3.6 months. Conclusion. These results demonstrate that an organized approach based upon a comprehensive program utilizing VA counseling, VM, application of full range of surgical techniques, and salvage procedures can be very successful in providing optimum vascular access to the catheter-dependent patient.

AB - Objective. Despite their high incidence of complications, costs, morbidity, and mortality, nearly 27% of the chronic hemodialysis (HD) patients are receiving treatment via a tunneled hemodialysis catheter (TDC). Methods. In this prospective analysis, an interventional nephrology team employed an organized program consisting of vascular access (VA) education and vascular mapping (VM) to TDC-consigned patients. A full range of surgical approaches for arteriovenous fistula (AVF) creation, including vein transpositions, was exercised. Physical examination was performed every 1 to 2 weeks after surgery to assess the development of the AVF. Fistulas that failed to develop adequately to support HD (early failure) underwent salvage [percutaneous transluminal angioplasty (PTA), accessory vein obliteration (AVL)] procedures. Results. One hundred twenty-one TDC-consigned patients received VA education. Eighty-six (71%) agreed to undergo VM. Two groups were identified. Group I (N = 66; using TDC for 7.2 ± 1.8 SD months) had never had an arteriovenous access; group II (N = 20; using TDC for 12.3 ± 4.0 months) had a history of one or more previously failed arteriovenous accesses. Upon VM, 64/66 (97%) in group I and 18/20 (90%) in group II were found to have adequate veins for AVF creation. Seven patients (11%) in group I and 3 (17%) in group II refused surgery. In group I, 57 (89%) received an arteriovenous access (radiocephalic AVF = 15, brachiocephalic AVF = 35, transposed brachiobasilic AVF = 3, brachiobasilic AVG = 4). In group II, 15 (83%) received a transposed AVF (radiobasilic = 2, brachiobasilic = 13). Sixteen fistulas (30%) in group I and 8 (53%) in group II had early failure. All except for one fistula in each group were salvaged using PTA and/or AVL. All 70 accesses (AVF = 66, AVG = 4) remain functional, with a mean follow-up of 8.5 ± 3.6 months. Conclusion. These results demonstrate that an organized approach based upon a comprehensive program utilizing VA counseling, VM, application of full range of surgical techniques, and salvage procedures can be very successful in providing optimum vascular access to the catheter-dependent patient.

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KW - Immature fistula

KW - Interventional nephrology

KW - Tunneled dialysis catheter

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