Materiały źródłowe

• #1 Arteriovenous fistula – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/arteriovenous-fistula/diagnosis-treatment/drc-20369571

  If an arteriovenous fistula is small and doesn’t cause any other health problems, close monitoring by a health care provider may be the only treatment needed. Some small arteriovenous fistulas close by themselves without treatment. […] If an arteriovenous fistula requires treatment, your provider may recommend: […] Ultrasound-guided compression. This may be an option for an arteriovenous fistula in the legs that’s easily seen on ultrasound. In this treatment, an ultrasound probe is push down on the fistula for about 10 minutes. The compression destroys blood flow to the damaged blood vessels. […] Catheter embolization. In this procedure, a thin, flexible tube (catheter) is inserted in an artery near the arteriovenous fistula. Then, a small coil or stent is placed at the site of the fistula to reroute blood flow. Many people who have catheter embolization stay in the hospital for less than a day and can resume daily activities within a week. […] Surgery. Large arteriovenous fistulas that can’t be treated with catheter embolization may require surgery. The type of surgery needed depends on the size and location of the arteriovenous fistula.

• #2 Arteriovenous (AV) Fistula: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/23450-arteriovenous-fistula

  An arteriovenous fistula is when an artery and vein connect directly, allowing blood to flow incorrectly. These can be surgically created for people who need dialysis care. […] While theyre sometimes dangerous, theyre usually treatable and often curable. […] Most arteriovenous fistulas are often curable, depending on the cause, size and where they are. […] Many people with this condition may not need treatment as a first option. The main reasons why treatment becomes necessary include: […] The most common means of treating or curing an arteriovenous fistula include: […] Catheter-based procedures. These involve a long, tube-like device that your healthcare provider will insert into a major blood vessel (usually one near your upper thigh). […] Surgery. In instances where your provider cant reach the fistula through blood vessels from the inside, or if the fistula is very large, a surgeon can often directly access it and repair it.

• #3 Arteriovenous Fistula – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK559213/

  Arteriovenous fistulas (AVFs) are abnormal connections between arteries and veins. […] This activity reviews the role of the interprofessional team in evaluating and managing arteriovenous fistulas. […] Compare the options available for the management of arteriovenous fistula. […] AVF treatment aims to isolate and close the fistula while attempting to maintain essential blood flow. Repair may be completed by direct primary repair, reconstruction (autogenous or prosthetic graft or bypass), or endovascular. […] Indications for Treatment include hemodynamic instability, availability of a surgical team, injury to adjacent tissue, and unsuccessful endovascular repair. […] It is the preferred method of management for AVFs. […] The advantages of endovascular repair include rapid recovery, less post-operative pain, and less disability compared with the open approach. […] Open Surgery is an option for repair when endovascular management fails.

• #4 Arteriovenous Fistulas: Etiology and Treatment – Endovascular Today

  https://evtoday.com/articles/2012-apr/arteriovenous-fistulas-etiology-and-treatment

  An arteriovenous fistula (AVF) is an anomalous direct communication between an artery and a vein that results in shunting of blood between the two. […] Surgical AVFs may be constructed for the purpose of hemodialysis (usually in the upper limb) to provide a superficial arterialized vein that can be easily punctured with flow that is high enough to allow efficient hemodialysis in patients with end-stage renal failure. […] Patients with distal arterial ischemia (steal), venous hypertension causing symptoms or end-organ dysfunction, as well as patients with high-output cardiac failure, require treatment. […] The goal of treatment is to isolate and close the site of arteriovenous communication. […] Surgical treatment may be possible and appropriate in superficial lesions with simple arteriovenous communications such as superficial traumatic AVFs in the extremities with a single afferent artery and few draining vessels.

• #5 Arteriovenous fistula: Symptoms, outlook, and more

  https://www.medicalnewstoday.com/articles/arteriovenous-fistula

  An AVF is an abnormal connection between an artery and a vein. […] If an AVF is not causing any symptoms or complications, or if the AVF is likely to resolve by itself, people may not need any treatment. […] A person may need treatment for an AVF if it is causing problems, such as: abnormal or unstable blood pressure, bleeding from a blood vessel, ischemia, congestive heart failure, difference in limb sizes, sores or ulcers that do not heal, impaired function. […] If an AVF is congenital, doctors may treat it as soon as they are aware, as it can cause problems later in life. […] Treating an AVF early may help to prevent complications. […] Doctors can use endovascular surgery to treat an AVF, or if this fails, open surgery. […] Endovascular surgery is a minimally invasive surgery within the blood vessels.

• #6 Arteriovenous (AV) Fistula: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/23450-arteriovenous-fistula

  Radiation therapy. In some cases, a way to repair an existing fistula is to destroy the connection. […] Treating an arteriovenous fistula often involves medication as well. […] Dialysis-related fistulas arent usually the focus of treatment unless something goes wrong with them. […] The complications or side effects from treatments depend on the specific treatments and the location and size of the fistula. […] Quick diagnosis and treatment are essential, especially with larger fistulas. […] While repairing a fistula often allows your heart to return to normal even after heart failure starts, this doesnt always happen. […] An arteriovenous fistula is a condition that can have little to no effect on your life, or it can cause significant problems. […] However, they can cause serious complications or even death in rare cases. […] Fortunately, advances in modern imaging and medical care mean this condition is often treatable or even curable.

• #7 Arteriovenous Fistula – Taylor Family Department of Neurosurgery

  https://neurosurgery.wustl.edu/items/arteriovenous-fistula/

  Washington University cerebrovascular surgeons work as part of a multidisciplinary team to offer treatment for arteriovenous fistulas at the Barnes-Jewish Hospital Stroke and Cerebrovascular Center. […] Because of our expertise, minimally invasive techniques are often used for the treatment of AVFs. […] The type of treatment depends on the AVFs location, presence or absence of cortical venous drainage (CVD), severity and nature of symptoms, the patients age and health status, and the risk involved in treatment. AVFs are treated on a case-by-case basis. Treatment options include: […] When a patient has an AVF without cortical venous drainage (CVD), observation is often the appropriate choice. […] This inpatient procedure entails passing a small catheter (tube) from a blood vessel in the groin (or arm) up into the AVF, where glue or other material is injected. […] Open surgery is an inpatient procedure designed to remove the CVD (the dangerous part of an AVF) or cure the entire AVF. […] A one-day, less-invasive outpatient procedure that involves precisely focusing radiation beams onto the AVF, Gamma Knife radiosurgery causes the AVF to shrink over time.

• #8 Arteriovenous fistula // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/arteriovenous-fistula

  Arteriovenous fistulas usually occur in the legs but can develop anywhere in the body. An arteriovenous fistula may be surgically created for use in dialysis in people with severe kidney disease. […] Treatment for arteriovenous fistulas includes monitoring, compression, catheter-based procedures and, sometimes, surgery. […] If an arteriovenous fistula requires treatment, your provider may recommend: […] Ultrasound-guided compression. This may be an option for an arteriovenous fistula in the legs that’s easily seen on ultrasound. In this treatment, an ultrasound probe is push down on the fistula for about 10 minutes. The compression destroys blood flow to the damaged blood vessels. […] Catheter embolization. In this procedure, a thin, flexible tube (catheter) is inserted in an artery near the arteriovenous fistula. Then, a small coil or stent is placed at the site of the fistula to reroute blood flow. Many people who have catheter embolization stay in the hospital for less than a day and can resume daily activities within a week. […] Surgery. Large arteriovenous fistulas that can’t be treated with catheter embolization may require surgery. The type of surgery needed depends on the size and location of the arteriovenous fistula.

• #9 Arteriovenous (AV) Fistula Causes, Symptoms and Treatments

  https://www.upmc.com/services/heart-vascular/conditions/av-fistula

  Ultrasound-guided compression […] This 10-minute nonsurgical procedure compresses the fistula under ultrasound guidance and blocks blood flow to the damaged blood vessels. […] Minimally invasive catheter embolization […] During a catheter embolization, your doctor will insert a catheter into a blood vessel and use x-ray or other imaging techniques to guide it to the site of your AV fistula. […] AV fistula treatment is effective for managing symptoms and preventing complications.

• #10 Arteriovenous Fistulas – Types & Treatment | Mount Sinai – New York

  https://www.mountsinai.org/locations/cerebrovascular-center/conditions/vascular-malformations/arteriovenous-fistulas

  An arteriovenous fistula (AVF) is an abnormal connection between an artery and a vein. […] Like arteriovenous malformations, we can treat arteriovenous fistulas with endovascular embolization, microsurgery, or stereotactic radiosurgery. Our multidisciplinary team, which evaluates every complex case, will determine the best approach for you. […] Endovascular embolization is the most common form of treatment for an AVF. […] Occasionally, when the fistula happens between the side of an important artery and the vein next to it, we insert a covered stent into either the artery or the vein. […] Microsurgery is the most appropriate treatment for a dural, brain, or spinal AVF, either alone or in combination with endovascular embolization. […] Stereotactic radiosurgery is appropriate if an AVF is located too close to important brain structures for us to safely perform embolization or microsurgery.

• #11 Arteriovenous Fistulas: Etiology and Treatment – Endovascular Today

  https://evtoday.com/articles/2012-apr/arteriovenous-fistulas-etiology-and-treatment

  In the treatment of complex AVFs with many feeding and draining vessels, embolization is indicated and surgery is specifically contraindicated. […] Access is usually arterial and is gained via a site best placed with respect to the individual anatomy and location of the AVF. […] The most appropriate embolic agent is determined by the anatomy of the AVF, particularly with regard to the type and size of arteriovenous communication and vessels, the flow velocity, whether the involved vessels can be sacrificed or require preservation, and the risks and consequences of nontarget distal embolization, either arterially or via the venous communication. […] Successful initial treatment with exclusion of the AVF and minimal risk of persistence or complex recurrence requires intricate planning and execution. […] AVFs can be safely treated endovascularly, either by embolization or stent grafting. The aim of treatment is to definitively close the direct communication between the artery and vein.

• #12 Dural Arteriovenous Fistula Diagnosis & Treatment – NYC | Columbia Neurosurgery in New York City

  https://www.neurosurgery.columbia.edu/patient-care/conditions/dural-arteriovenous-fistula

  A dural arteriovenous fistula (DAVF), also called a dural arteriovenous malformation (dural AVM), is an atypical connection between blood vessels in the dura. When necessary, surgical treatment for DAVF most commonly takes the form of endovascular embolization, microsurgical resection, or stereotactic radiosurgery. […] Dural arteriovenous fistulas are complex lesions and should be managed at major centers with specialists highly trained in their treatment. […] The current treatment of choice for other DAVFs is endovascular embolization. To perform this procedure, a specialist inserts a catheter through an artery in the groin and then guides the catheter through the circulatory system to the site of the DAVF. Once in position, the catheter delivers a kind of glue. The glue embolizes the abnormal passageway, blocking the abnormal connection often permanently curing the fistula.

• #13 Spinal Dural Arteriovenous Fistula Diagnosis & Treatment – NYC | Columbia Neurosurgery in New York City

  https://www.neurosurgery.columbia.edu/patient-care/conditions/spinal-dural-arteriovenous-fistula

  A spinal dural arteriovenous fistula (SDAVF) is an abnormal connection between arteries and veins in the dura, the outer lining of the spinal cord. […] For information about abnormal tangles of blood vessels inside the spinal cord, see our page on spinal arteriovenous malformations (spinal AVMs). […] Most patients do quite well with treatment. Left untreated, however, patients may experience progressive spinal cord dysfunction and ultimately paralysis. Therefore, in the overwhelming majority of cases, treatment is recommended. […] SDAVFs are often treated with a procedure called endovascular embolization. This technique does not require surgery and involves passing a tiny catheter, or tube, into the vessels feeding into the fistula. Once in place, the catheter releases a glue-like material or tiny particles that can seal off the fistula. However, for reasons that have to do with blood flow and vessel anatomy, this procedure may not be effective in every case.

• #14 Arteriovenous Fistula (AVF) Doctor | NJ, NYC

  https://www.neurosurgeonsofnewjersey.com/arteriovenous-fistula-avf/

  Your neurosurgeon probably wants to close your AVF before it results in permanent damage. He or she will discuss treatment options with you. They include catheter embolization and/or microsurgical resection. […] Catheter embolization uses a procedure similar to the angiogram. The doctor guides a catheter through your arteries or veins to the site of the AVF. At the site, the doctor uses medical glue or a specialized device to close the fistula. This treatment option is effective for most people. […] Microsurgical resection involves the surgical closure of the AVF. If you have an AVF near your brain, the surgeon may perform a craniotomy as part of this procedure. A craniotomy is the removal of part of the skull to expose the brain in order to access the appropriate tissues for repair. […] As a patient, you should always feel comfortable asking questions of your care team about the various treatment options and which one may be right for you.

• #15 Arteriovenous fistula: Symptoms, outlook, and more

  https://www.medicalnewstoday.com/articles/arteriovenous-fistula

  Open surgery involves large incisions to access the blood vessels. […] Endovascular surgery has fewer risks and less pain postsurgery and may result in quicker recovery with better outcomes than open surgery. […] To treat an AVF, doctors may use endovascular surgery to close the fistula. Early treatment means the outlook for an AVF can be positive and it may prevent complications.

• #16 Dural arteriovenous fistulas – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/dural-arteriovenous-fistulas/diagnosis-treatment/drc-20364281

  Mayo Clinic neurosurgeons review surgical options for a dural arteriovenous fistula. […] Treatment for a dural arteriovenous fistula (dAVF) involves a procedure to block or disconnect the fistula. […] Procedures that can treat dAVF include: […] In an endovascular procedure, a long, thin tube called a catheter is inserted into a blood vessel in your leg or groin. It is threaded through blood vessels to the dural arteriovenous fistula using X-ray imaging. Coils or a glue-like substance is released to block the connection in the blood vessels. […] In stereotactic radiosurgery, precisely focused radiation blocks the irregular connection in the blood vessels. This causes blood vessels in the fistula to close off, destroying the dAVF. […] If an endovascular procedure or stereotactic radiosurgery aren’t options for you, you may need dAVF surgery. Surgery may be performed to disconnect the dAVF or cut off the blood supply and remove the fistula.

• #17 Arteriovenous Fistula (DAVF) Treatment Options | UNC Rex

  https://www.ncneurospine.com/neuroscience-medical-services/neuroendovascular/arteriovenous-fistula-davf/

  Stereotactic Radiosurgery: Stereotactic radiosurgery is a technique that employs precisely focused radiation to disrupt the abnormal connection within the blood vessels. High doses of radiation are directed at the fistula, prompting the closure of blood vessels and ultimately eradicating the dAVF. Various technologies can be utilized for dAVF stereotactic radiosurgery, including the linear accelerator (LINAC), Gamma Knife, and proton beam therapy. […] If endovascular procedures or stereotactic radiosurgery are not feasible or suitable for your condition, dAVF surgery may be necessary. During this surgical intervention, the dAVF can either be disconnected or its blood supply severed and the fistula removed. […] The choice of treatment modality depends on the specific characteristics of the dAVF and your individual medical circumstances, with the goal of eliminating the abnormal connection and preventing associated complications.

• #18 Updates in the management of cranial dural arteriovenous fistula | Stroke and Vascular Neurology

  https://svn.bmj.com/content/5/1/50

  While endovascular techniques are often considered first-line therapy for treatment of dAVFs, surgery remains an alternate effective and safe option. […] Stereotactic radiosurgery (SRS) is usually reserved as a last salvage option for treatment of dAVF. […] Endovascular treatment is generally the first-line treatment for dAVF.

• #18 Updates in the management of cranial dural arteriovenous fistula | Stroke and Vascular Neurology

  https://svn.bmj.com/content/5/1/50

  Dural arteriovenous fistula (dAVF) accounts for approximately 10% of all intracranial vascular malformations. […] Endovascular treatment is often the first line of treatment for dAVF. Both transarterial and transvenous approaches are used to cure dAVF. […] Surgery and, to a lesser extent, stereotactic radiosurgery are used when endovascular approaches are impossible or unsuccessful. […] For diagnosis, CT and MRI are usually unremarkable in dAVF. […] Because of the benign nature, dAVFs without CVR (grades I and II) are often managed conservatively. Treatment can be palliative for patients who suffer from incapacitant tinnitus, ocular symptoms or severe headache. […] Various treatment modalities are used to manage aggressive dAVFs, including endovascular techniques, surgery, radiosurgery or a combination of these treatments.

• #18 Updates in the management of cranial dural arteriovenous fistula | Stroke and Vascular Neurology

  https://svn.bmj.com/content/5/1/50

  Endovascular approach is the first-line treatment for most dAVFs. […] Transarterial approaches are often done under general anaesthesia with motor paralysis to decrease patient motion. […] In transarterial approaches, microcatheters are tracked over microwires to distal locations in feeding arteries, with the goal of getting the microcatheter as close to the fistula connection as possible. […] While flow-diverting stents have been used to treat direct CCFs, there is limited efficacy for treatment of the most common dAVF because of lesion complexity including multiple arterial feeders origins. […] Before the Onyx era, transvenous approach was the mainstay of endovascular treatment for cure of dAVF given that transarterial embolisation was successful only in about 50% of cases. […] Major complications of a transvenous approach include vessel perforation, cerebral haemorrhage and venous infarction.

• #19 Dural Arteriovenous Fistula | Barrow Neurological InstituteSecond Opinion IconGroup 49Group 49

  https://www.barrowneuro.org/condition/dural-arteriovenous-fistula-davf/

  A dural arteriovenous fistula (DAVF) is a vascular anomaly formed by an abnormal connection between an artery within the tough covering of the brain (dura mater) and a vein that carries blood from the brain back to the heart. […] Treatment depends on the drainage pattern of the dural arteriovenous fistula and your symptoms. Most DAVFs can be cured with endovascular embolization, a minimally invasive procedure in which a catheter is threaded through the arteries and veins of either your wrist or leg to the site of the fistula. The fistula is then plugged with a material such as glue, a metal coil, or a balloon to correct the abnormal pattern of blood flow. […] Yes, the most common means of treating—and curing—a DAVF is through endovascular embolization. Open brain surgery rarely is required to treat a DAVF.

• #20 Dural Arteriovenous Fistula Diagnosis & Treatment – NYC | Columbia Neurosurgery in New York City

  https://www.neurosurgery.columbia.edu/patient-care/conditions/dural-arteriovenous-fistula

  Sometimes microsurgical resection, in which a surgeon completely removes the abnormal vessels, is necessary. When possible, the DAVF lesion is embolized before it is removed. But in cases in which the risk of hemorrhage is high, or in which the catheter cannot reach the DAVF, microsurgical resection may be used alone. […] Stereotactic radiosurgery also may be used in specific cases.

• #21 Treatment strategy to maximize the treatment outcome of spinal dural arteriovenous fistula after initial endovascular embolization attempt at diagnostic angiography | Scientific Reports

  https://www.nature.com/articles/s41598-021-89407-w

  Initial attempt of endovascular treatment (EVT) for spinal dural arteriovenous fistula (SDAVF) is preferred because of concurrent diagnosis and treatment. […] We retrospectively reviewed 71 patients with SDAVF to evaluate treatment outcomes of SDAVF after an initial EVT attempt. […] Complete occlusion was achieved by initial EVT in 37 of 56 patients (66.1%). […] Among 19 patients with incomplete occlusion upon initial EVT, 14 underwent additional surgery, 13 of whom (92.9%) obtained improved or stationary functional outcomes. […] Additional surgery achieved improved functional outcomes in cases of incomplete occlusion of SDAVF after the initial EVT attempt or recurrence rather than repeated EVT or follow-up. […] Although the surgical outcome of spinal dural arteriovenous fistula (SDAVF) is excellent, with a success rate over 95%, initial attempt of endovascular treatment (EVT) at the same session of diagnostic spinal angiography for spinal dural arteriovenous fistula (SDAVF) has become a preferred approach because of the benefit from concurrent diagnosis and treatment with a 70-90% rate of complete obliteration.

• #22 Treatment strategy to maximize the treatment outcome of spinal dural arteriovenous fistula after initial endovascular embolization attempt at diagnostic angiography | Scientific Reports

  https://www.nature.com/articles/s41598-021-89407-w

  In the case of complete occlusion by either initial EVT or surgery, patient evaluation and follow-up spine MRI were performed 6 months after initial treatment. […] Therefore, in cases of incomplete occlusion of the SDAVF after initial EVT, the present study showed that functional outcomes were dependent upon complete occlusion of the SDAVF by additional treatment and procedure-related complications. […] In the treatment of SDAVFs, improved or stationary functional outcomes can be achieved after complete occlusion of the SDAVF by a trial of initial EVT at the same session of diagnostic spinal angiography. […] Additionally, in cases of incomplete occlusion by initial EVT, surgical treatment should be considered rather than additional EVT or a wait-and-see approach with the expectation of spontaneous thrombosis to achieve complete obliteration of the SDAVF and improved functional outcomes.

• #23 Spinal Dural Arteriovenous Fistula Diagnosis & Treatment – NYC | Columbia Neurosurgery in New York City

  https://www.neurosurgery.columbia.edu/patient-care/conditions/spinal-dural-arteriovenous-fistula

  In some cases, surgery may be necessary. Using a surgical microscope and extremely fine instruments, neurosurgeons can microsurgically remove the malformation and restore the normal blood flow to the spinal cord. […] Spinal dural arteriovenous malformations are complex problems. They should be addressed at major medical centers by professionals like those at the Spine Hospital at the Neurological Institute of New York who are experienced in their treatment.

• #24 Preparing for Dialysis (AV Fistula) > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/preparing-dialysis-av-fistula

  A procedure that connects an artery to a vein in preparation for dialysis […] An AV fistula is a good long-term solution for dialysis, but some alternatives exist […] The longest-lasting and best type of dialysis access is an arteriovenous fistula, or AV fistula. […] AV fistula surgery takes a few hours and is generally an outpatient procedure. […] An AV fistula is how patients are connected to a dialysis machine. […] AV fistula is the best way to receive dialysis because its a long term solution for dialysis patients and carries a low risk of infection. […] If you do not have a vein of sufficient size for an AV fistula, an artificial vein may be installed via AV bypass graft surgery. […] Our vascular surgeons are internationally recognized for their development of new techniques for dialysis access.

• #25 Arteriovenous Fistulae | Cooper University Health Care

  https://www.cooperhealth.org/services/arteriovenous-fistulae

  Arteriovenous fistulas usually occur in the legs, but can develop anywhere in the body. Arteriovenous fistulas are often surgically created for use in dialysis in people with severe kidney disease. […] People who have late-stage kidney failure may also have an arteriovenous fistula surgically created to make it easier to perform dialysis. […] Creating an arteriovenous fistula widens the vein by connecting it to a nearby artery, making it easier to insert a needle for dialysis and causing blood to flow faster. This AV fistula is usually created in the forearm. […] If you have an arteriovenous fistula in your legs and it’s easily visible on ultrasound, treatment with ultrasound-guided compression may be an option for you. […] In this treatment, an ultrasound probe is used to compress the fistula and block blood flow to the damaged blood vessels.

• #26 Having an arteriovenous fistula formed – Overview | Guy’s and St Thomas’ NHS Foundation Trust

  https://www.guysandstthomas.nhs.uk/health-information/having-arteriovenous-fistula-formed

  An arteriovenous fistula (AVF) is a type of vascular access. Its a connection that is made by joining a vein onto an artery. […] An AVF is usually the best form of vascular access for haemodialysis. An AVF is likely to last longer, and you are likely to have less complications (such as infections) than with other types of vascular access. […] Once the fistula is formed it usually takes around 6 weeks for it to become big enough to be used for haemodialysis. […] For most people, a fistula is the best option for haemodialysis access, but this is not suitable for everyone. […] An AVG is similar to a fistula, but instead of the artery being directly connected to a vein, a synthetic tube is used to join them together. […] A piece of synthetic tubing is inserted into one of the large veins, usually in the neck.

• #27 Having an arteriovenous fistula formed – Overview | Guy’s and St Thomas’ NHS Foundation Trust

  https://www.guysandstthomas.nhs.uk/health-information/having-arteriovenous-fistula-formed

  To form the fistula, you will need to have surgery. […] The surgeon will join an artery (a blood vessel transporting blood from the heart around the body), directly to a vein (a blood vessel taking blood back to the heart). This is usually done at the wrist or the arm. […] When you leave hospital, you will need to check your fistula each day for a buzzing sensation known as a thrill. […] You can help your fistula to develop by squeezing a rubber ball in your hand. […] It usually takes about 6 weeks for the vein to get big enough for the haemodialysis needles to be inserted. […] We will contact you to arrange a follow-up appointment to have your fistula reviewed within 4 to 6 weeks.

• #28

  https://www.kidney.org.uk/fistula-care

  A fistula can clot because of a narrowing by slowing the blood flow rate through the fistula. The clot can be removed and this is carried out by a radiologist who inserts a catheter along a small guide wire to the clot which delivers medication into the clot to break it up or a mechanical device is used to break the clot down. Alternatively, if radiological methods fail, the clot can occasionally be removed by surgery. […] If your fistula begins bleeding profusely, as if your needles have just been removed, when you are not at the dialysis unit this is a MEDICAL EMERGENCY. […] Always tell nurses and dialysis doctor of any bleeds from your fistula of any size/description as acting on this may prevent a large fistula bleed occurring.

• #29 Tips, Tricks, and Pitfalls for Thrombosed AVFs – Endovascular Today

  https://evtoday.com/articles/2023-june/tips-tricks-and-pitfalls-for-thrombosed-avfs

  The decision of when to perform thrombectomy for a clotted AVF can be confusing for physicians, particularly in the setting of repeated episodes of fistula occlusion. […] The lyse-and-wait technique involves injecting thrombolytic directly into the thrombosed AVF. […] A variety of devices may be employed as a solution for rapid clearance of thrombus from AVFs. […] If thrombosis is too extensive for balloon maceration or the AVF is completely occluded, the push-pull thrombectomy technique can be used. […] Studies have shown that push-pull thrombectomy can be an effective method for restoring blood flow in thrombosed AVFs. […] Mechanical thrombectomy for AVF thrombosis may involve the use of one of many devices currently on the market to remove thrombus. […] All manipulation of thrombus poses risks of intra-arterial emboli to the hand or larger, clinically significant PE.

• #30 Tips, Tricks, and Pitfalls for Thrombosed AVFs – Endovascular Today

  https://evtoday.com/articles/2023-june/tips-tricks-and-pitfalls-for-thrombosed-avfs

  Endovascular interventionalists should be aware of when not to intervene on thrombosed AVFs. […] One of the most important factors for success in AVF thrombectomy is the length of duration of the access occlusion. […] The management of AVF thrombosis can be challenging, requiring careful consideration of the options and indications for treatments. […] A variety of endovascular treatment options are available that have been shown to have good outcomes.

• #31 Care of your arteriovenous fistula (AVF) after surgery | CUH

  https://www.cuh.nhs.uk/patient-information/care-of-your-arteriovenous-fistula-avf-after-surgery/

  The majority of fistulas work immediately following surgery. […] A successful fistula is less likely to form clots or become infected than other types of access. […] Fistulas tend to last years longer than any other kind of access. […] However, a small number of fistulas never work and you might return from the theatre with a failed fistula. […] If you are on haemodialysis, your named nurse will give you a bleeding pack with instructions. […] If your fistula bleeds after you get home, sit down and apply pressure with clean gauze for 10 minutes. If the bleeding does not stop after this time, please contact your renal unit or the Cambridge Dialysis Centre.

• #32 Pharmaceutical prevention strategy for arteriovenous fistula and arteriovenous graft failure | Renal Replacement Therapy | Full Text

  https://rrtjournal.biomedcentral.com/articles/10.1186/s41100-019-0210-2

  Vascular access failure (VAF) is a critical problem in patients undergoing hemodialysis (HD). […] A variety of strategies (e.g., endovascular therapy and surgical reconstruction) for treating VAF have been established. However, strategies for preventing VAF are scarce. […] This review proposes the following three aspects for developing strategies for preventing VAF: (i) early identification of risk factors of VAF (e.g., preoperative vascular conditions, age, sex, ethnicity, and clinical backgrounds), (ii) prophylactic drugs to reduce the risk of VAF, and (iii) early VAF detection through monitoring and surveillance of vascular access, particularly at frequent stenotic sites. […] A few prophylactic drugs may effectively prevent VAF based on the patients clinical background; however, currently, there is no strong evidence on the efficacy of these drugs in reducing the incidence of VAF.

• #33 Pharmaceutical prevention strategy for arteriovenous fistula and arteriovenous graft failure | Renal Replacement Therapy | Full Text

  https://rrtjournal.biomedcentral.com/articles/10.1186/s41100-019-0210-2

  Thus, additional large, randomized controlled studies are warranted to establish effective strategies for preventing VAF. […] The prevention of VAF is crucial for all healthcare providers involved in RRT. This review proposed the prevention of VAF based on the following criteria: (i) preoperative examination, (ii) prophylactic drugs for VAF, and (iii) maintenance of VA by monitoring and surveillance. […] Several studies have investigated the effectiveness of drugs for VAF prophylaxis during the perioperative period; the drugs studies mainly include cardiovascular drugs such as antiplatelet drugs, anticoagulant drugs, statins, fish oil, and antihypertensive drugs. […] The effect of antiplatelet drugs on VAF has been controversial. […] Several studies have reported that VA coordinators could significantly increase the proportion of AVF in newly constructed VA.

• #34 Pharmacological approaches to reducing arteriovenous fistula failure rates

  https://renalinterventions.net/pharmacological-approaches-to-reducing-arteriovenous-fistula-failure-rates/

  There are new, exciting novel local therapies on the horizon that have been tested in preclinical animal models, including the rodent and the pig. […] One of these is 1alpha,25-dihydroxyvitamin D3 (1α,25[OH]2D3)—which is active Vitamin D3—used in patients with chronic kidney disease (CKD) for calcium homeostasis. […] Moreover, periadventitial delivery of 1,25 NPs to the stenotic vein after PTA in an experimental model of rodents reduces venous stenosis/neointimal hyperplasia too. […] Another one of these technologies is local delivery of nitric oxide-releasing gel aimed at reducing venous stenosis formation. […] First-in-human studies are being planned with these technologies.

• #35 Arteriovenous Fistula | Expert Surgeon | Aaron Cohen-Gadol, MD

  https://www.aaroncohen-gadol.com/en/patients/arteriovenous-fistula/overview

  An arteriovenous fistula (AVF) is an abnormal connection between an artery and a vein. […] Treatment options include observation, endovascular embolization, surgery, or radiosurgery or a combination of these treatments. […] dAVF treatment options include observation, embolization, and surgery. […] Embolization is the primary mode of treatment for dAVFs. […] For cases in which endovascular embolization has failed or is not possible, surgical resection might be performed. […] Radiosurgery aims hundreds of low-dose beams of radiation at the abnormal vessels of the dAVF using technologies such as the Gamma Knife or Novalis. […] Complete cure involves occluding the fistula by closing the fistula through embolization or surgery.

• #36 Spinal dural arteriovenous fistula: a comprehensive review of the history, classification systems, management, and prognosis | Chinese Neurosurgical Journal | Full Text

  https://cnjournal.biomedcentral.com/articles/10.1186/s41016-023-00355-y

  If embolization fails or is not possible due to anatomy-related issues, surgical therapy can be considered as a standby and is often successful in curing patients with low morbidity. […] Based on the largest and most recently reported multicenter cohort study, which was published in 2020, surgery is superior to endovascular treatment for the complete obliteration of spinal dural arteriovenous fistulas. […] Although surgery is often associated with a complete cure, there has been a shift towards endovascular embolization of spinal dural arteriovenous fistulas which is currently considered to be the first-line treatment. […] The treatment goal of spinal dural arteriovenous fistula is to halt the progression of the disease, and the prognosis depends on both the duration of symptoms as well as the clinical condition prior to therapy.

• #37 Tips, Tricks, and Pitfalls for Thrombosed AVFs – Endovascular Today

  https://evtoday.com/articles/2023-june/tips-tricks-and-pitfalls-for-thrombosed-avfs

  There are limited data comparing surgical to endovascular treatments of thrombosed AVFs, but a recent meta-analysis reviewing outcomes of surgical and endovascular repair of arteriovenous grafts showed no significant differences in primary nonpatency rates for endovascular and surgical therapy at 1, 2, and 3 months, but did show significantly higher 1- and 2-year primary nonpatency rates for endovascular therapy. […] The decision of whether to perform endovascular salvage or surgical intervention for thrombosed AVF relies on the expertise of the center, but if percutaneous options are available, the surgical approach should be reserved for failed or high-risk percutaneous treatments. […] Success rates for surgical management have been reported from 70% to 90%, with primary patency rates ranging from 51% to 84% at 6 months and 75% at 1 year, showing no significant difference compared to endovascular interventions.

• #38 Dural Arteriovenous Fistula (DAVF) | Boston Medical Center

  https://www.bmc.org/patient-care/conditions-we-treat/db/dural-arteriovenous-fistula-davf

  It is important to tailor management of DAVF to each patient. Specific goals should be put forward taking into account the natural history of the lesion (which mainly depends on its venous drainage pattern), its specific anatomical features and the patient’s symptoms. Most dural fistulas can be managed by endovascular means but some are more appropriately approached by surgery. Some difficult lesions need the judicious combination of endovascular techniques and surgery. […] Endovascular treatment was recommended to prevent recurrent hemorrhage. He underwent embolization and disconnection of the fistula. […] After an embolization treatment procedure, Dr. Abdalkader and Dr. Nguyen successfully and completely disconnected the fistula.

• #39 Arteriovenous Fistula (AVF) – Cerebrovascular Disease | UCLA Health

  https://www.uclahealth.org/medical-services/neurosurgery/cerebrovascular/conditions/arteriovenous-fistula-avf

  Our expert team is skilled at treating complex cerebrovascular conditions and providing the finest and most comprehensive patient care. […] After your diagnosis, a multidisciplinary team of neurovascular experts will meet to review your case and create a customized treatment plan. At UCLA, we typically treat AVFs using strategies that include some combination of: […] Endovascular liquid embolization: This minimally invasive technique is performed by inserting a catheter through the groin, then injecting a liquid that solidifies in the blood vessel and cuts off blood flow to the AVF. […] Micro-coiling: Micro-coils made of platinum are placed into the artery, vein or venous sinus to seal off the AVF and prevent blood flow through it. […] Microsurgical obliteration: During this open surgery procedure, the neurosurgeon disrupts or disconnects the AVF from the brain or spinal cord.

• #40 Arteriovenous Fistula Treatment | Expert Surgeon | Aaron Cohen-Gadol, MD

  https://www.aaroncohen-gadol.com/en/patients/arteriovenous-fistula/treatment/overview

  Surgical intervention is a common treatment for dAVFs, particularly when other methods have failed or are not feasible. Surgery may involve: […] Microsurgical Resection: A precise procedure where abnormal blood vessels are removed to restore normal blood flow. Real-time angiography may be used during surgery to ensure complete treatment. […] Endovascular Embolization: A minimally invasive procedure often done before surgery to reduce blood loss by blocking the fistulas blood supply. […] For some dAVFs, endovascular embolization is an effective treatment option that involves the use of a catheter to deliver materials like glue or coils to block the abnormal blood flow. This approach can be: […] Radiation therapy, specifically Stereotactic Radiosurgery (SRS) like Gamma Knife, offers another option for treating dAVFs. This method delivers high doses of focused radiation to the abnormal vessels, leading to gradual closure over time.

• #41 Dural arteriovenous fistula – Wikipedia

  https://en.wikipedia.org/wiki/Dural_arteriovenous_fistula

  Treatment Arteriovenous fistula obliteration, including: embolization, surgery, radiosurgery. […] Type II fistulas need to be treated to prevent hemorrhage. The treatment may involve embolization of the draining sinus as well as clipping or embolization of the draining veins. […] Type III dural fistulas need to be treated to prevent hemorrhage. Treatment can be as simple as clipping the draining vein at the site of the dural sinus. […] Treatment decisions are more complicated and require a consultation with a multidisciplinary team consisting of at least a interventional neuroradiologist, neurosurgeon and radiotherapist familiar with these lesions. […] One approach used for treatment is embolization. […] DAVFs are also managed surgically. The operative approach varies depending on the location of the lesion. […] Stereotactic radiosurgery is used for obliterating DAVFs sometimes in conjunction with embolization or surgery, and is considered an important adjunct and sometimes a primary treatment method for non-aggressive DAVFs.

• #42 Arteriovenous Fistula – London Neurosurgery Partnership

  https://lnpuk.com/arteriovenous-fistula/

  An arteriovenous fistula can occur both in and around the brain, as well as the spine. […] Early detection of an arteriovenous fistula may make your condition easier to treat. It also may reduce your risk of developing complications, including blood clots or heart failure. […] Currently, we aim whenever possible to close the AV fistula before the increased pressure in the venous system causes irreversible damage to the brain or spinal cord. […] Minimally invasive endovascular embolization usually this sufficient to cure the AV fistula. During this procedure, a catheter is fed through the groin up into the arteries in the brain that supply the AV fistula and inject liquid embolic agents into these arteries. This injection shuts off that artery and reduces the flow of blood to the fistula. […] Microsurgical resection this is used solely for AV fistulae which cannot be treated with endovascular embolization. During microsurgical resection, we perform a craniotomy and using the microscope, isolate and remove the AV fistula from the tissues around the brain or spinal cord.

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