Novel external stenting for reconstruction of high flow arteriovenous fistula
| Autor: | E.L. Kalmykov, Vladimir Matoussevitch, Robert Shahverdyan |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Male
Adult Chromium medicine.medical_specialty Time Factors medicine.medical_treatment Arteriovenous fistula Young Adult Arteriovenous Shunt Surgical Renal Dialysis medicine Humans cardiovascular diseases Vascular Patency Aged Retrospective Studies Aged 80 and over Ventricular Remodeling business.industry Stent Cobalt Middle Aged medicine.disease Surgery Treatment Outcome Nephrology Arteriovenous Fistula Female Stents Hemodialysis High flow business |
| Zdroj: | The Journal of Vascular Access. 23:864-870 |
| ISSN: | 1724-6032 1129-7298 |
| DOI: | 10.1177/11297298211015508 |
| Popis: | Background: High-flow arteriovenous fistulae (HF-AVF) may lead to adverse cardiac remodeling in hemodialysis patients. We have investigated whether a novel external stent is safe and effective in reducing and stabilizing flow rates during a 1-year follow-up after HF-AVF reconstruction. Methods: All patients with HF-AVF (access flow rate ⩾ 1500 ml/min), who underwent HF-AVF reconstruction with external stenting in two centers between June 2018 and May 2020, were included in this retrospective analysis. During HF-AVF reconstruction, the dilated vein segment was resected, underwent volume reduction, and was externally stabilized using a braided cobalt-chromium external stent. AVF flow rates were assessed preoperatively, intraoperatively, and at follow up visits using duplex ultrasound. Results: Forty-three HF-AVFs in 42 patients were reconstructed and supported with an external stent (mean age 49 years, range 20–86 years; 74% men). Fifty-one percent were forearm AVFs, 49% were upper arm. The mean preoperative flow rate was 2622 ± 893 ml/min (range: 1500–6000 ml/min) and was decreased to 710 ± 221 ml/min (range: 300–1300 ml/min) intra-operatively after HF-AVF reconstruction. At 6 and 12-months follow-up, the mean flow rates were 1132 ± 320 ml/min (range: 470–1700 ml/min) and 1453 ± 888 ml/min (range: 300–3800 ml/min), respectively. Recurrence of high flow (>1500 ml/min) occurred in 16% and 25% of the patients at 6 and 12 months and primary patency rates were 86% and 70%, respectively. Conclusions: This early experience with novel external stenting for HF-AVF reconstruction demonstrates that it is a safe and effective method for reducing and stabilizing flow rates up to 1-year post procedure. Additional studies are required to evaluate the durability of this procedure over the longer term and assess its effect on cardiac remodeling. |
| Databáze: | OpenAIRE |
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