Vascular access for hemodialysis

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Presentation transcript:

Vascular access for hemodialysis Steve J. Schwab Kidney International Volume 55, Issue 5, Pages 2078-2090 (May 1999) DOI: 10.1046/j.1523-1755.1999.00409.x Copyright © 1999 International Society of Nephrology Terms and Conditions

Figure 1 Intravascular ultrasound of fibromuscular hyperplasia in brachial vein at the vein graft anastomosis. Sphere in center of vein is the head of the ultrasound catheter. Kidney International 1999 55, 2078-2090DOI: (10.1046/j.1523-1755.1999.00409.x) Copyright © 1999 International Society of Nephrology Terms and Conditions

Figure 2a Radiograph of outflow stenosis at vein graft anastomosis in an AV graft before (A) and after (B), opposite page, correction with angioplasty. A. White arrowhead represents location of occluding blood pressure cuff. White arrow shows stenosis at vein graft anastomosis. Black arrow represents AV graft. Curved white arrow indicates proximal native vein. Kidney International 1999 55, 2078-2090DOI: (10.1046/j.1523-1755.1999.00409.x) Copyright © 1999 International Society of Nephrology Terms and Conditions

Figure 2b White arrow shows stenosis post angioplasty demonstrating restored venous flow. (From Schwab SJ, Saeed M, Sussman SK, McCann RL, Stickel DL: Transluminal angioplasty of venous stenoses in polytetranfluoroethylene vascular access grafts. Kidney Int 32:395–398, 1987.) Kidney International 1999 55, 2078-2090DOI: (10.1046/j.1523-1755.1999.00409.x) Copyright © 1999 International Society of Nephrology Terms and Conditions

Figure 3 Primary unassisted patency of AV fistulas and AV grafts. Solid line represents AV fistula patency. Dashed line represents AV graft patency. AV fistula patency excludes fistulas that did not mature sufficiently to allow initial cannulation. Graph derived from summed data analysis from the Vascular Access DOQI7. Primary patency reflects patency from initial cannulation to first intervention. First intervention could reflect thrombosis, removal, angioplasty, or surgical revision. Kidney International 1999 55, 2078-2090DOI: (10.1046/j.1523-1755.1999.00409.x) Copyright © 1999 International Society of Nephrology Terms and Conditions

Figure 4 Cumulative patency of AV fistulas and AV grafts. Solid line represents AV fistula patency. Dashed line represents AV graft patency. AV fistula patency excludes AV fistulas that did not mature sufficiently to allow initial cannulation. Graph derived from summed data analysis from the Vascular Access DOQI7. Cumulative patency reflects patency from initial cannulation to abandonment or removal of access. AV graft intervention (procedure) rate > 3 × AV fistula intervention rate. Kidney International 1999 55, 2078-2090DOI: (10.1046/j.1523-1755.1999.00409.x) Copyright © 1999 International Society of Nephrology Terms and Conditions

Figure 5 Cumulative patency of AV fistulas and AV grafts with prospective monitoring and intervention. Solid line represents AV fistula patency. Dashed line represents AV graft patency. AV fistula patency excludes AV fistulas that did not mature sufficiently to allow initial cannulation. Cumulative patency reflects patency from initial cannulation to abandonment or removal of access. AV graft intervention (procedure) rate > 6 × AV fistula intervention rate. Kidney International 1999 55, 2078-2090DOI: (10.1046/j.1523-1755.1999.00409.x) Copyright © 1999 International Society of Nephrology Terms and Conditions

Figure 6 Central vein stenosis recurrence rate following angioplasty or angioplasty and use of a wall stent. (From Ref. 52.). Kidney International 1999 55, 2078-2090DOI: (10.1046/j.1523-1755.1999.00409.x) Copyright © 1999 International Society of Nephrology Terms and Conditions

Figure 7 Schematic drawing of pulse spray thrombolysis of an AV graft. (Reprinted with permission from AngioDynamics, Inc., Glens Falls, New York.) Kidney International 1999 55, 2078-2090DOI: (10.1046/j.1523-1755.1999.00409.x) Copyright © 1999 International Society of Nephrology Terms and Conditions