Options for end stage vascular access: Translumbar catheter, arterial-arterial access or right atrial graft?

Background: Running out of vascular access for dialysis is thankfully rare, but despite this, most units will have a number of patients with few options and in a precarious state. The increasing longevity of dialysis patients portends more patients will reach minimal access options. End stage vascular access is poorly defined but classification may enable assessment and comparison of treatment options.

Aneurysms in vascular access: state of the art and future developments.

A master class was held at the Vascular Access at Charing Cross (VA@CX2017) conference in April 2017 with invited experts and active audience participation to discuss arteriovenous (AV) vascular access aneurysms, a serious and common complication of vascular access (VA). The natural history of aneurysms in VA is poorly defined, and although classifications exist they are not uniformly applied in studies or clinical practice. True and pseudo aneurysms of AV access occur.

Carotid bypass using the Gore Hybrid Vascular Graft as a rescue technique for on-table failed carotid endarterectomy.

Carotid endarterectomy (CEA) remains the "gold standard" for atherosclerotic lesions involving the carotid bifurcation. Carotid bypass grafting using either polytetrafluoroethylene or long saphenous vein is a suitable alternative technique, especially in challenging endarterectomy and on-table failed CEA. We report our initial experience of using the Gore Hybrid Vascular Graft (W.

A novel classification system for autogenous arteriovenous fistula aneurysms in renal access patients.

Introduction: Arteriovenous fistulae (AVFs) constructed for hemodialysis access are prone to aneurysmal degeneration. This can lead to life-threatening sequelae such as aneurysmal rupture. The literature includes various guidelines on the management of certain aspects of access-related aneurysm formation; however, no classification system exists to guide reporting or prognostication.

Diabetics are less likely to develop thoracic aortic dissection: a 10-year single-center analysis.

Background: Diabetes mellitus (DM) is an acknowledged risk factor for atherosclerosis, and diabetics are more likely to have hypertension. Atherosclerosis and hypertension are risk factors for aortic dissection. However, recent studies have shown that DM is associated with changes in aortic wall collagen.

Diabetes mellitus and aortic aneurysm rupture: a favorable association?

Introduction: Recent reports suggest that diabetic patients are relatively unlikely to have abdominal aortic aneurysms (AAAs). This retrospective study assesses the relationship between diabetes mellitus (DM) and aortic aneurysm rupture.

Methods: Patients with a diagnosis of any aortic aneurysm during a 10-year period were identified from our records.

Duplex ultrasound volumetric flow analysis before and after hemodialysis in patients with brachio-cephalic fistulae.

Purpose: The United Kingdom Renal Association recommends duplex ultrasound to monitor arteriovenous fistula (AVF) flow rates during surveillance. Significant flow rate changes should prompt further investigation or treatment to avoid a failing fistula. Hemodialysis is known to alter the hemorrheologic and physiologic factors with a potential impact on measured flow rates.

Early outcomes of the intraluminal flow guard device for secondary renal access.

Purpose: The Flixene Intraluminal Flow Guard (IFG) is a novel arteriovenous graft for use in complex renal access patients. The IFG is a PTFE graft with a covered nitinol stent at the venous end implanted into the axillary vein rather than anastomosed. The purported benefits are improved hemodynamic flow in the vein with reduced neointimal hyperplasia.

Axillary-axillary interarterial chest loop graft for successful early hemodialysis access.

Purpose: Obtaining adequate vascular access in patients undergoing chronic hemodialysis therapy can be demanding, particularly for those in whom all peripheral venous options have been exhausted.

Case: We present a case of a 46-year-old woman with a history of complex vascular access for end-stage renal failure for whom there was no remaining possibility of venous access and had reached a palliative stage. We implanted an emergency loop axillary-axillary interarterial early needling graft.

A large aneurysm in an arterio-venous fistula for renal access in a pregnant young woman.

Pregnancy is known to increase the risk of aneurysm formation, likely by a combination of histological changes in vessel walls associated with the hormones of pregnancy and the haemodynamic changes to the circulation. To our knowledge this is the first case of a pregnant woman with a brachial-cephalic arterio-venous fistula (AVF) that had never been needled for haemodialysis, yet became hugely aneurysmal during her pregnancy.

Vascular access outcomes in HIV-positive patients.

Purpose: There is a limited source of information about vascular access outcomes in HIV-positive patients in the literature. Previous studies have shown autogenous arteriovenous fistulae (AVF) to have similar cumulative survival rates in HIV-positive and negative patients but functional patency has not been assessed. The primary aim of this study was to investigate functional patency of AVFs in HIV-positive patients.

Comparison among transposed brachiobasilic, brachiobrachial arteriovenous fistulas and Flixene™ vascular graft.

Objective: To compare the outcomes of 3 upper arm access types: transposed brachiobasilic arteriovenous fistula (BBAVF), autogenous brachial vein-brachial artery access (ABBA), and a new type of ePTFE graft (Flixene™ graft) (AVG), in a consecutive series of patients treated in a tertiary centre.

Methods: A prospective, computerized access database was analysed retrospectively to identify all patients undergoing BBAVF, ABBA, or AVG between January 1, 2008, and December 31, 2009.

Results: A total of 108 patients were identified; of whom 45 had BBAVF, 15 ABBA, and 48 ePTFE brachioaxillary AVG.

High brachial artery bifurcation is associated with failure of brachio-cephalic autologous arteriovenous fistulae.

Objective: Although European Best Practice Guidelines on vascular access recommend universal pre-operative duplex scan in patients receiving brachio-cephalic (BC) arteriovenous fistulae (AVF), this is not widespread practice. Furthermore, cadaveric and angiographic studies suggest that variation in upper limb arterial anatomy is common. Our aim was to investigate the prevalence of high brachial artery bifurcation (HB) and its impact on BC AVF patency.

Recurrent refractory arterial thromboembolism associated with the Janus kinase 2 V617F mutation.

We report two patients with peripheral vascular disease requiring multiple bilateral radiologic and surgical interventions, and whose disease was unresponsive to conventional anticoagulation and antiplatelet therapy. Although thrombocytosis was only intermittent, analysis of the Janus kinase 2 (JAK2) gene revealed a V617F mutation, thus confirming the presence of an underlying occult myeloproliferative disorder. We propose that JAK2 mutation analysis be considered in patients with recurrent, unexplained arterial events to identify those with occult myeloproliferative disorders.