Journal of Vascular Access最新文献

Background: The maturation and patency of arteriovenous fistula (AVF) are crucial in patients requiring hemodialysis (HD). Although several trials have been conducted to evaluate the impact of various medications on AVF maturation, little has been observed. Apixaban, a direct oral anticoagulant, has been shown to have a protective effect against intimal hyperplasia (IH). We therefore aimed to determine the effect of Apixaban on the patency, maturation, and anastomotic size of AVF after creation.

Methods: This two-center randomized study included all patients who underwent AVF creation between July 2023 and November 2024. The primary outcome was AVF maturation. Secondary outcomes were complications and mortality. Patients were divided randomly into two groups. The first group (treatment group, N = 44) received Apixaban 2.5 mg twice daily, while the second group (control group, N = 48) received no treatment. A Doppler ultrasound was performed for measurement of anastomotic size, vein diameter, and flow volume based on subsequent fistula adequacy. Autogenous AVFs were constructed with end to side anchor technique anastomosis as distally as possible in all patients. Both groups were followed‑up for 6 months.

Results: Ninety two patients underwent AVF creation during the study period. After 6 months follow up, the primary patency in the Apixaban group was 90.9%, while it was 79.2% in the control group (p = 0.117). The incidence of anastomotic stenosis was significantly lower in the Apixaban group compared to the control group (9.1% vs 29.2%, p = 0.015). A thrombosis event was reported in three cases (6.8%) and nine cases (18.8%), in Apixaban and control groups respectively (p = 0.09). Patients who received Apixaban encountered a total of ten bleeding episodes (one major and nine minor incidents), accounting for 22.7% of the group (p = 0.11). It is important to highlight that none of these incidents led to fatalities.

Conclusion: Apixaban might be beneficial for decreasing early AVF maturation failure in patients requiring HD.

Distal limb ischemia and venous hypertension are rare but serious complications of arteriovenous fistula (AVF) used for hemodialysis. Managing such combined arterial-venous pathology while preserving vascular access remains challenging. A 62-year-old man on long-term hemodialysis presented with swelling, pain, and dark discoloration of the left hand fingers. Duplex ultrasonography revealed cephalic vein occlusion, venous hypertension, and retrograde flow from the distal radial artery, consistent with AVF-associated venous hypertension. The patient underwent venous flow reconstruction and AVF outflow rerouting. The postoperative course was uneventful, with rapid improvement in hand perfusion, resolution of swelling, and sustained AVF patency suitable for dialysis use.

Background: Subcutaneous Anchor Securement System (SASS) are increasingly used for stabilization of vascular access devices. For many hemodialysis (HD) patients tunneled central venous catheters (t-CVC) are the last vascular access option and their unplanned replacement results in complex procedures and increased costs. Nevertheless, accidental dislodgment of hemodialysis t-CVC is a frequent occurrence in clinical practice. We here describe our first experience with SASS utilization in this unexplored setting.

Methods: Between July 2022 and September 2023, we applied a SASS (SecurAcath^®) to newly placed Tesio t-CVC in two HD centers. Patients were routinely monitored as per center standard protocol for accidental t-CVC dislodgment, tip migration, t-CVC dysfunction, early and late SASS-related complications, until a censoring event or the end of follow-up (December 2023) occurred. Data were retrospectively collected by two Authors per center, cross-checked, and analyzed with descriptive statistics in a case series.

Results: Twenty-four Tesio t-CVC were included in the analysis. Among the entire cohort, the SASS (each with the corresponding t-CVC) were maintained for a total of 5.324 CVC-days. Median single device length of follow-up was 188 (144-276) days. Complete accidental dislodgment with cuff exposure and need for t-CVC replacement was never observed. One bleeding episode was reported among early complications. Infection incidence rate was 0.56 per 1.000 CVC-days and 71% of Tesio t-CVC with their SASS were still in use at the end of follow-up.

Conclusions: This is the first report of the use of SASS in HD t-CVC. In our experience, SecurAcath^® was safe and effective for stabilization of Tesio t-CVC.

Self-administered capillary blood collection devices are increasingly used in both clinical research and patient care. The Tasso+ device, a CE-certified system designed to collect 500 µL of whole blood, is generally regarded as safe and user-friendly. However, complications related to its use remain insufficiently documented. We describe the case of a female study participant who developed an unexpected wound complication after using the self-blood collection device. Although the blood collection itself was successful, the participant later required surgical treatment for a gaping lesion at the application site, which ultimately left a small permanent scar. To our knowledge, this represents a previously unreported adverse effect of the device. The case raises concerns about the interaction between device application and skin tension lines and underscores the need for further evaluation of safety aspects in self-administered blood collection systems.

Percutaneous peritoneal dialysis access procedures (PPAP) are commonly employed for peritoneal dialysis (PD) catheter placement in patients with end-stage renal disease (ESRD). However, traditional techniques such as the blind Seldinger method can lead to complications, particularly bowel perforation and catheter malposition. We report a safe and effective technique for PD catheter placement utilized in a 73-year-old male with ESRD. This novel approach involves lifting the abdominal wall and directly visualizing the puncture site with ultrasound, thereby minimizing the risk of bowel injury. Additionally, the combined use of transversus abdominis plane (TAP) and rectus sheath (RS) block provides effective postoperative analgesia. This technique is particularly beneficial in resource-limited settings, offering a safer, adaptable, and analgesia-optimized alternative for PD catheter placement.

Background: Hemodialysis Reliable Outflow (HeRO) graft is vital for complex hemodialysis patients who have exhausted all other access options. Hemodialysis access-induced distal ischemia (HAIDI) is a serious complication, however, risk factors for HAIDI after HeRO graft operation are unknown.

Methods: Institutional records were retrospectively reviewed for all index HeRO graft implantations performed between 2014 and 2023. Re-do HeRO grafts were excluded. Patient demographics, operative details, and postoperative outcomes were collected. Primary outcome was symptomatic HAIDI following HeRO surgery. Statistical analysis was performed using univariate tests, logistic regression analysis, and Kaplan-Meier estimates for patency.

Results: Over the 10-year study period, 232 index HeRO surgeries were performed of which 23 (9.9%) developed symptomatic HAIDI. Patients with HAIDI were older than their counterparts (64.0 ± 13.7 vs 57.0 ± 13.3 y, p = 0.008). All other demographic factors and comorbidities were similar between groups (p = NS each). For inflow, patients with HAIDI more frequently underwent brachial artery anastomosis (78.3% vs 65.1%, p = 0.04), and less frequently utilized a prior arteriovenous graft or fistula (8.7% vs 25.8%, p = 0.04). The use of a tapered graft was similar between groups (47.8% vs 31.1%, p = 0.10). On multivariable analysis, only patient age (hazard ratio (HR) 1.06 per year, 95% confidence interval [CI], 1.02-1.10, p = 0.003) was independently associated with symptomatic HAIDI. Tapered graft utilization was not associated with reduced risk of HAIDI (HR 0.75, 95% CI, 0.23-2.38, p = 0.61). Patients with HAIDI had significantly higher 30-day hospital readmission rates (34.8% vs 17.7%, p = 0.0049) and reduced secondary graft patency rates (1-year, 46.0 ± 11.4% vs 71.3 ± 3.6%; 3-year, 23.7 ± 11.1% vs 44.0 ± 4.8%, p = 0.01).

Conclusion: Symptomatic HAIDI is fairly common after HeRO graft implantation and portends inferior long-term outcomes with older age being the only associated risk factor. Tapered conduits were not associated with reduced risk of HAIDI. These data are valuable for informed consent and shared decision-making among patients undergoing HeRO graft surgery.

Importance: Venipuncture is among the most common neonatal painful procedures. While several analgesic interventions (non-pharmacologic and pharmacologic) have been studied in the last two decades, their comparative efficacy is unknown.

Objective: To compare the efficacy and safety of different interventions for analgesia during venipuncture in neonates by a systematic review and network meta-analysis (NMA).

Data sources: Medline, the Cochrane Central Register of Controlled Trials, Embase, and CIHAHL were searched from inception until March 2023.

Study selection: Randomized and quasi-randomized clinical trials that evaluated different pharmacological and non-pharmacological interventions for analgesia during venipuncture were included.

Data extraction and synthesis: Data from the included trials were extracted in duplicate. An NMA with frequentist random-effects model was used for data synthesis. Certainty of evidence (CoE) was assessed using GRADE.

Main outcomes and measures: Pain scores during and 30 s after the venipuncture.

Results: Of 95 full texts, 37 trials comparing 18 different analgesic measures were included. Three trials had a low risk of overall bias, 21 had some concerns and 13 had a high risk of overall bias. Among the 18 interventions for pain during the venipuncture, breastfeeding (including breastmilk; SMD -1.9 (-0.83, -3)) followed by non-nutritive sucking (SMD -1.69 (-0.27, -3.1)) had a high certainty of evidence (CoE) to reduce pain scores when compared to no intervention. Glucose and swaddling had low certainty of evidence to reduce pain scores.

Conclusions and relevance: Among various non-pharmacological and pharmacological analgesics to reduce pain during and after the venipuncture in neonate, breastfeeding (including breast milk) was the best intervention to reduce pain during venipuncture, followed by NNS. Both these are feasible interventions in all settings.

Background: Central venous stenosis (CVS) is a clinically significant complication in patients who depend on long-term hemodialysis access. While digital subtraction angiography remains the diagnostic gold standard, it is invasive, costly, and exposes patients to contrast and radiation. This study examined the diagnostic value of a simple, non-invasive, radiation-free alternative-the ultrasound-guided "sniff test," which assesses dynamic changes in subclavian vein diameter during a forceful sniff to screen for CVS. Despite its potential advantages, the diagnostic performance of this method has not been well established.

Method: A prospective study was conducted among 71 end-stage kidney disease (ESKD) patients scheduled for angiography. Each participant underwent a sniff test before the procedure. A reduction of more than 40% in subclavian vein diameter during sniffing was considered normal, indicating absence of stenosis. Angiographic findings were used as the reference standard. Clinical signs-specifically ipsilateral arm swelling and visible chest wall veins-were also evaluated for diagnostic utility.

Results: Angiography confirmed CVS in 32 patients (45.1%). The sniff test showed a strong association with stenosis (OR 20.9) and demonstrated solid diagnostic performance, with sensitivity of 84.4%, specificity of 79.5%, and an AUC of 0.82. A normal sniff test accurately excluded stenosis in the majority of patients without CVS (86.1%), whereas an abnormal result was predominantly seen among those with stenosis (77.1%). Arm swelling was also significantly associated with stenosis (OR 20.40) and showed good standalone diagnostic accuracy (sensitivity 75.0%, specificity 87.2%, AUC 0.81). Importantly, combining the sniff test with clinical assessment enhanced overall performance, achieving higher specificity (94.9%) and excellent discriminative ability (AUC 0.90).

Conclusion: In conclusion, the ultrasound sniff test is a promising, accessible, and accurate screening tool for CVS. Used alone or alongside clinical findings, it offers a practical method to identify patients who may benefit from confirmatory angiography-particularly valuable in resource-limited or radiation-averse settings.

Background: Peripherally Inserted Central Catheters-Related Thrombosis (PICC-RT) is a challenging complication associated with PICC in cancer patients. Risk assessment models (RAMs) help identify patients at high risk of PICC-RT. This study compares the predictive performance of the Michigan RAM, the Caprini RAM, and the Maneval RAM in cancer patients with PICCs. The results could help recommend an optimal RAM for PICC-RT risk assessment in practice.

Methods: A prospective observational study was conducted in a large cancer center in Guangzhou, China. 281 patients with cancer who underwent PICC insertions were enrolled from April 2023 to January 2024. The extracted data included basic information on patients and catheters, the scores of the Michigan, Caprini, and Maneval RAMs, and the occurrence of PICC-RT. The sensitivity, specificity, and area under the receiver operating characteristics (AUC) values were used to compare the predictive performance of these three RAMs.

Results: 275 participants were finally included for data analysis. Eighteen patients (6.5%) developed symptomatic PICC-RT. The average time between catheter insertion and PICC-RT diagnosis was 83.40 ± 34.63 days (range 28-143 days). The sensitivity/specificity of the Michigan, Caprini, and Maneval RAM were 0.06/0.97, 0.44/0.78, and 0.89/0.68, respectively. The AUC of the Maneval RAM (0.85, 95% CI: 0.78-0.91) was higher than that of Michigan (0.50, 95% CI: 0.37-0.64) and Caprini RAM (0.62, 95% CI: 0.47-0.76).

Conclusions: Maneval RAM has a better predictive value for PICC-RT than Michigan and Caprini RAM. Maneval RAM is recommended for predicting the risk of PICC-RT in patients with cancer.

Background: Percutaneous transluminal angioplasty (PTA) of brachiocephalic arteriovenous fistulas (BC AVF) can be painful, particularly during balloon dilatation of cephalic arch or outflow vein. This study evaluated the effectiveness and safety of interscalene nerve block (ISB) for analgesia during endovascular treatment of BC AVFs.

Materials and methods: We retrospectively reviewed 22 endovascular procedures in 21 patients with dysfunctional BC AVFs (March-September 2025) at our institution. All procedures were performed under ISB, with 13 (59%) also receiving supplementary supraclavicular cutaneous nerve block (SCNB). Pain during balloon inflation of the culprit stenosis was assessed using the visual analogue scale (VAS), serving as the primary endpoint of the study. Secondary endpoints included sedative requirements and factors associated with lower pain scores.

Results: The mean patient age was 72 years, and 14 patients (67%) were female. The median VAS score was 2 (0-3) with most procedures resulting in no pain (32%) or mild pain (59%). Sedative use was significantly reduced compared with patients' prior procedures without nerve blocks (midazolam reduction: 1.2 ± 0.8 mg, 95% CI [0.8, 1.6], p < 0.001; fentanyl reduction: 28 ± 16 µg, 95% CI [20, 36], p < 0.001). Combined ISB and SCNB provided superior analgesia compared with ISB alone (median VAS: 1.5 (0-2) vs 3 (2-5), 95% CI of the difference [0.2, 3.2], p < 0.05) when the culprit stenotic lesion was in the shoulder/clavicular region. Higher local anaesthetic volumes correlated with lower pain scores (p < 0.001). No block-related complications occurred, and all patients had full recovery of sensory and motor function within 4 hours.

Conclusion: ISB, with or without SCNB, offers safe and effective analgesia for endovascular treatment of BC AVFs, significantly reducing pain and sedative needs. It may be a useful alternative to systemic sedation, particularly for patients at higher risk from sedative medications.