Materiały źródłowe

• #1 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

  VAF impairs the quality of life in patients undergoing HD while imposing high medical costs. […] 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. […] The prevention of VAF is crucial for all healthcare providers involved in RRT.

• #1

  https://www.actamedindones.org/index.php/ijim/article/view/2208

  Clopidogrel is an anti-platelet aggregation that has been reported to reduce the incidence of primary failure in FAV compared to other anti-platelet aggregation agents. […] All of the three studies involved indicated the benefit of clopidogrel for the prevention of AVF primary failure. […] Clopidogrel can reduce the incidence of primary FAV failure without significant increase of bleeding events.

• #1 Antiplatelet agents maintain arteriovenous fistula and graft function in patients receiving hemodialysis: A nationwide case–control study | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0206011

  Antiplatelet therapy increased the AVF and AVG patency times with adjusted odds ratios of 0.748 (95% confidence interval [CI]: 0.7030.796, p 0.0001) and 0.810 (95% CI: 0.728

• #1 Prevention of thrombosis in arteriovenous fistulas – PubMed

  https://pubmed.ncbi.nlm.nih.gov/4096837/

  To prevent thrombosis in arteriovenous fistulas it is necessary to obtain the knowledgeable cooperation not only of the whole health care team, but also of the patient. The first step is preservation of forearm veins by avoiding unnecessary venipunctures in patients with chronic renal failure. Fistulas should be constructed well in advance of need and use natural rather than prosthetic veins whenever possible. Major surgery elsewhere is a potential cause of fistula thrombosis. Fistula construction is often best delayed till major surgery is over and until the veins have recovered from the effects of systemic steroid therapy. Avoidance of premature fistula cannulation and correct needling techniques help to prevent vein wall damage. Alertness to the presence of high venous pressures on dialysis and observation of inefficient dialysis due to recirculation should lead to detection of narrowed segments which can be surgically corrected before thrombosis occurs. Antiplatelet drugs are of proven value in the prevention of recurrent thrombotic episodes.

• #1 Take a look at the Recent articles

  https://www.oatext.com/does-systemic-heparin-reduces-thrombosis-rate-of-radiocephalic-fistula-a-double-blinded-randomized-study.php

  Background/Objective: The National Kidney Foundation Kidney disease outcomes quality initiative guidelines suggest that the creation of more native arteriovenous fistulas (AVFs) would improve the quality of life of end stage renal failure patients. […] Heparin is a well-accepted treatment to prevent thrombosis in general but has not been suggested in arteriovenous fistula. […] This study revealed the beneficial outcomes, and no adverse effects, associated with intraoperative administration of heparin in radio cephalic fistula. Better maturation was demonstrated in the heparin group at the six-week follow-up. These beneficial outcomes should be taken into consideration in the future to change the practice of AVF creation. […] Based on the literature, thrombosis can be effectively prevented by heparin.

• #1 Take a look at the Recent articles

  https://www.oatext.com/does-systemic-heparin-reduces-thrombosis-rate-of-radiocephalic-fistula-a-double-blinded-randomized-study.php

  In this study, we aim to compare the effect of systemic heparin on the early thrombosis rate of radiocephalic fistulas. We hope that the use of systemic heparin intraoperatively will reduce the thrombosis rate among radiocephalic fistula patients. […] Our study has shown that heparin does reduce early and late thrombus formation, three times more than the placebo group. This highlights the importance of heparin in native AVF creation. […] Our analysis showed better maturation rate in the group given intraoperative heparin. By reducing the early thrombosis rate, heparin indirectly improved the maturation rate in our study. […] This study has demonstrated that the use of heparin efficiently reduces the thrombosis rate in small caliber native AVFs (radiocephalic), with no statistically significant adverse effects.

• #1 Nitric Oxide Resistance Reduces Arteriovenous Fistula Maturation in Chronic Kidney Disease in Rats | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0146212

  CKD induces oxidative stress resulting in NO resistance that can hamper AV fistula maturation. […] sGC activators like BAY 602770 could offer therapeutic potential to increase AV fistula maturation. […] The key requirement for AV fistula maturation is dilation of the arterial and venous vessel segments, to generate a sufficient flow required for hemodialysis and to prevent thrombosis. […] It has been hypothesized that one of the key events in AV fistula maturation failure is endothelial dysfunction as a result of uremia-induced oxidative stress. […] The syndrome of NO resistance can be targeted by a new group of pharmacologic agents including BAY 602770, that are possible to either stimulate sGC in a NO-dependent way, or activate sGC in an NO-independent manner. […] To investigate a potential beneficial effect of BAY 602770 on AV fistula maturation in vivo, this compound was administered to CKD animals after creation of the AV fistula.

• #1 Nitric Oxide Resistance Reduces Arteriovenous Fistula Maturation in Chronic Kidney Disease in Rats | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0146212

  CKD is associated with decreased AV fistula maturation and NO resistance of sGC in vascular smooth muscle. The sGC-activator BAY 602770 can induce vasodilation in CKD that could prevent non-maturation in uremic patients by increasing vessel diameter, although a direct effect on fistula flow was not found in this study.

• #1 27 Prevention of Arteriovenous Fistula Failure Due to Thromosis: Is there a Role for Thromboprophylaxis? | Pediatric Research

  https://www.nature.com/articles/pr2006303

  Background: Development of thrombosis is the commonest cause of arteriovenous fistula (AVF) failure in children with end stage renal disease (ESRD) requiring hemodialysis. We report our experience of using primary thromboprophylaxis (PTP) for prevention of thrombosis at AVF. […] Conclusion: Our experience of LMWH thromboprophylaxis appears encouraging for prevention of AVF failure due to thrombosis. Close clinical and laboratory monitoring is required to prevent bleeding complications related to LMWH. More prospective data to expand our sample size will be required to clarify our observation.

• #1 Fistula Occlusion – Prevention and Treatment | Laminate Medical

  https://www.laminatemedical.com/2016/10/31/fistula-occlusion-prevention-treatment/

  While prevention is not always possible, there are several things that can be done in order to reduce the risk of occlusion, thrombosis and stenosis. […] Prior to surgery Patient should discuss use of VasQ, with physician. VasQ is a device, implanted during the fistula creation procedure, designed to improve maturation and patency rates of AV fistulas by providing external support and regulating blood flow while reinforcing the perianastomic vein. The potential result of using VasQ is a reduced rate of complications and an improved fistula outcome. […] Post-surgery it is important that patient optimize fistula maturation by doing daily hand exercise, and adhere to strict hygiene and cleanliness instructions. Also, patient should avoid wearing restrictive clothing or jewelry, carrying heavy weights with fistula arm, use of bag straps around arm, and should make sure that no pressure is placed on fistula.

• #1

  https://journals.lww.com/ijvs/fulltext/2023/10020/the_importance_of_perioperative_flow_evaluation.6.aspx

  Our aim is to evaluate the relationship between the survival time of arteriovenous (AV) fistula whose flows are measured with flow meter in patients with chronic renal failure who were operated for AV fistula (AVF) and present the results. […] By evaluating the fistula flows with the flow meter and make an intraoperative revision if necessary we ensure to extend the lifespan of a fistula. […] Perioperative AVF flow failure incidence is estimated to be between 5% and 11%. […] Therefore, it is important for surgeons to directly assess the quality of the anastomosis. […] Several methods have been introduced over the last decade to increase the reliability of anastomotic quality of AVF. Transit-time flow measurement (TTFM) has been reported to be an appropriate method for easy and fast intraoperative functional evaluation of grafts, regardless of vessel size and shape.

• #1

  https://journals.lww.com/ijvs/fulltext/2023/10020/the_importance_of_perioperative_flow_evaluation.6.aspx

  Intraoperative blood flow measurement immediately after fistula formation is useful for predicting early AVF failure. […] Our main purpose in opening AVF is to provide a good graft opening and an intervention path for long-term hemodialysis for the patient. Therefore, we use intraoperative TTFM in questionable situations to achieve high-quality AVF surgery and improve the outcome for patients. […] TTFM, which provides important and accurate intraoperative information about the status and patency of the AVF, enables accurate diagnosis of technical problems such as torsioned or stenotic conditions, and thus rapid revision of AVFs made before the patient leaves the operating room.

• #1 Effects of an arteriovenous fistula stenosis prevention program in patients receiving hemodialysis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10493700/

  To prevent AVF stenosis and occlusion, exercise therapy to improve upper extremity muscle strength and maintain the patency of blood vessels and a diet that helps prevent blood clots are crucial. […] Education combined with exercise and diet increases the size and blood flow of AVFs and prevents hyperphosphatemia. […] Therefore, patients should understand AVF management, treatment procedures, and their role in treatment procedures, and programs should be conducted to enhance their perceived self-efficacy. […] The AVF stenosis prevention program in this study resulted in an increase in upper extremity muscle strength through grip strength exercises and was effective in preventing AVF stenosis by increasing the blood flow rate. […] Consequently, the AVF stenosis prevention program for patients receiving hemodialysis applied in this study was found to be effective in enhancing upper extremity muscle strength through gripping exercises and preventing AVF stenosis by reducing blood phosphorus levels and improving the blood flow rate. […] The program in this study effectively prevented arteriovenous fistula (AVF) stenosis in hemodialysis patients, and it is expected to be useful for continuous vascular management and as part of nursing interventions for the effective self-management of AVFs.

• #1 Effects of an arteriovenous fistula stenosis prevention program in patients receiving hemodialysis

  https://ophrp.org/journal/view.php?number=731

  Objectives: To increase the efficiency of hemodialysis, an appropriate vascular pathway must be created, and its function must be maintained. This study aimed to identify the effects of an arteriovenous fistula (AVF) stenosis prevention program on upper muscular strength, blood flow, physiological indexes, and self-efficacy among patients receiving hemodialysis. […] To prevent AVF stenosis and occlusion, exercise therapy to improve upper extremity muscle strength and maintain the patency of blood vessels and a diet that helps prevent blood clots are crucial. […] Education combined with exercise and diet increases the size and blood flow of AVFs and prevents hyperphosphatemia. […] Therefore, patients should understand AVF management, treatment procedures, and their role in treatment procedures, and programs should be conducted to enhance their perceived self-efficacy.

• #1 Effects of an arteriovenous fistula stenosis prevention program in patients receiving hemodialysis

  https://ophrp.org/journal/view.php?number=731

  The AVF stenosis prevention program featured exercise therapy, a phosphorus-restricted diet, and AVF self-care; these have been used in previous studies to prevent vascular maturation failure and vascular calcification, which are factors that correspond to AVF stenosis. […] Therefore, in this study, upper extremity muscle strength and blood flow velocity (as clinical indicators of AVF stenosis), serum calcium and phosphorus (as risk indicators of vascular calcification), and self-efficacy were utilized as variables to understand the effects of the AVF program. […] Consequently, the AVF stenosis prevention program for patients receiving hemodialysis applied in this study was found to be effective in enhancing upper extremity muscle strength through gripping exercises and preventing AVF stenosis by reducing blood phosphorus levels and improving the blood flow rate. […] The program in this study effectively prevented arteriovenous fistula (AVF) stenosis in hemodialysis patients, and it is expected to be useful for continuous vascular management and as part of nursing interventions for the effective self-management of AVFs.

• #1 Effects of an arteriovenous fistula stenosis prevention program in patients receiving hemodialysis

  https://ophrp.org/journal/view.php?doi=10.24171/j.phrp.2023.0101

  The AVF stenosis prevention program featured exercise therapy, a phosphorus-restricted diet, and AVF self-care; these have been used in previous studies to prevent vascular maturation failure and vascular calcification, which are factors that correspond to AVF stenosis. […] Consequently, the AVF stenosis prevention program for patients receiving hemodialysis applied in this study was found to be effective in enhancing upper extremity muscle strength through gripping exercises and preventing AVF stenosis by reducing blood phosphorus levels and improving the blood flow rate. […] The program in this study effectively prevented arteriovenous fistula (AVF) stenosis in hemodialysis patients, and it is expected to be useful for continuous vascular management and as part of nursing interventions for the effective self-management of AVFs.

• #1 Cited

  https://koreamed.org/SearchBasic.php?RID=2545876

  Objectives To increase the efficiency of hemodialysis, an appropriate vascular pathway must be created, and its function must be maintained. This study aimed to identify the effects of an arteriovenous fistula (AVF) stenosis prevention program on upper muscular strength, blood flow, physiological indexes, and self-efficacy among patients receiving hemodialysis. […] The AVF stenosis prevention program was effective in improving upper extremity muscle strength (F = 15.23, p p p Conclusion The AVF stenosis prevention program in this study resulted in an increase in upper extremity muscle strength through grip strength exercises and was effective in preventing AVF stenosis by increasing the blood flow rate.

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

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

  The most effective method of AVF thrombectomy is to avoid thrombosis altogether. […] Patients should be taught to examine their fistula to understand the feel of a healthy thrill and look for any redness or swelling that indicates an infection to expedite treatment interventions to save the fistula and avoid the morbidity of surgery and potential loss of a valuable access site. […] Endovascular interventionalists should be aware of when not to intervene on thrombosed AVFs. Contraindications include recent access creation ( 30 days), severe ipsilateral steal syndrome, right-to-left shunt, access infection, moderate to severe pulmonary hypertension, or efforts in futile salvage. […] One of the most important factors for success in AVF thrombectomy is the length of duration of the access occlusion. Longer duration of stenosis and thrombosis allows further organization and integration of the clot into the intima, making it more difficult to pass a wire and more difficult to remove thrombus; in fact, prolonged thrombosis of AVFs can lead to irreversible ischemic changes to the autologous vein. […] The time that has passed since AVF creation additionally determines success and safety of intervention.

• #1 Assessment of Nurses Performance regarding Arteriovenous Fistula Cannulation and Suggested Guidelines for Prevention of its Failure

  https://jnsbu.journals.ekb.eg/article_244317.html

  Background: Dialysis center nurses play a central role in preventing arteriovenous fistula complications. […] Recommendations: In-service training programs should frequently be established in the unit for continuous updating and regeneration of nurses’ knowledge and skills to maintain and improve level of awareness and practice.

• #1

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

  There are a number of things you should do to protect your fistula. […] Keep your fistula clean although infections are less likely with a fistula they can still happen. […] Check your fistula daily the nurse will show you how to check for a pulse or vibration through your fistula (called a thrill) or a sound (called a bruit). […] Do not let anything obstruct the blood flow in your arm do not allow your blood pressure to be taken on your fistula arm and do not wear constricting clothes or jewellery. […] Generally you should avoid allowing anyone to take blood from your fistula arm when you are not on dialysis. […] Never allow a cannula to be inserted into your fistula for administration of drugs or IV fluids. […] Try not to scratch your fistula or do anything which can cause an injury to it.

• #1

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

  If you suffer from itching, let your doctor know so that medication can be considered to relieve the itching. […] A fistula is the best vascular access for dialysis because it tends to have fewer problems and last longer than other types of dialysis access. […] If you notice any of these signs please let your nurses and doctor know so they can investigate. Most problems of this nature can be resolved to ensure your fistula keeps healthy. […] 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.

• #1 Complications of Arteriovenous Fistulas for Hemodialysis | Laminate Medical

  https://www.laminatemedical.com/2016/11/07/complications-arteriovenous-fistulas-hemodialysis/

  The quality of vascular access for HD should be suitable for repeated puncture and allow a high blood flow rate for high-efficiency dialysis with minimal complications. […] It is important to gain information about early clinical symptoms of AVF dysfunction in order to prevent and adequately treat potential complications. […] In order to reduce the risk of turbulence and endothelium injury which minimizes the potential for stenosis, surgeons should avoid the following: performing an acute angle, longitudinally rotating the veins, or changing their anatomical position. […] As the treatment of this condition is difficult, attention must be focused on prevention. […] Therefore, AVF care should be a priority not only for patients but also for the entire professional team involved in the treatment of dialysis patients.

• #1 Aneurysmal Dilatation of Dialysis Arteriovenous Access

  https://openurologyandnephrologyjournal.com/VOLUME/6/PAGE/1/

  A thorough physical examination of dialysis arteriovenous access is critical in allowing early diagnosis and timely referral for treatment before complications ensue. […] Although, NKF-KDOQI guidelines recommend avoiding cannulation of aneurysmal area, a significant number of ESRD patients are being cannulated in the aneurysmal area for a variety of reasons, including lack of knowledge of the dialysis staff, lack of awareness amongst practicing nephrologists, poor communication to the dialysis staff and barriers preventing timely referral to name a few. […] An immediate surgical referral is required in patients demonstrating these warning signs indicative of impending catastrophic rupture. […] It is crucial to identify patients with unstable aneurysms in a timely fashion, allowing for an appropriate surgical intervention that would not only prevent aneurysm rupture but also increase the chance of salvaging the existing AV access.

• #1 Aneurysmal Dilatation of Dialysis Arteriovenous Access

  https://openurologyandnephrologyjournal.com/VOLUME/6/PAGE/1/

  If an aneurysm has normal overlying skin and does not compromise cannulation, management consists of avoiding cannulating the aneurysm and continued observation. […] A careful assessment is mandated to identify the cannulation site, away from the aneurysmal area and educating the dialysis staff. […] The authors concluded that problematic fistulae with large aneurysmal dilatations with a small area available for cannulation can be salvaged by using SMH modified buttonhole technique. […] Although, complete ligation and resection of AVF is often curative, the access is invariably sacrificed. […] In addition, these patients invariably require a tunneled dialysis catheter insertion for continuation of maintenance dialysis while a new AV access is created at another site. […] Aneurysmal dilatation of AV access represents a unique challenge in ESRD patients and requires a multidisciplinary team work amongst nephrologist, interventionalist, dialysis staff and surgeons, to achieve a timely diagnosis and effective treatment.

• #1 Controlling bleeds from a fistula or graft | Kidney Care UK

  https://kidneycareuk.org/kidney-disease-information/treatments/vascular-access-for-dialysis/controlling-bleeds-from-a-fistula-or-graft/

  Fistulas and grafts are essential in maintaining a kidney patients life. However, it can often be challenging to maintain the function of a fistula or graft, and they frequently require regular intervention and/or surgery to ensure their survival. […] Following several reported cases of LTBs, in 2018 the British Renal Societys (BRS) Vascular Access Special Interest Group and the Vascular Access Society of Britain Ireland (VASBI) have complied recommendations for the prevention of an LTB from dialysis vascular access and guidance on how to manage LTBs effectively when they do occur. […] You should not just rely on your dialysis team to detect a problem with your access. YOU should remain alert and highlight any concerns you may have about your access with your dialysis team. […] The priority with a life-threatening bleed is to get help; do not delay whilst trying to stop the bleed, as loss of consciousness through blood loss can occur quickly.

• #1

  https://haematologica.org/article/view/5247

  Arteriovenous fistula (AVF) has been evaluated as an alternative to central venous access devices in hemophilic children since 1999. […] This study confirms the feasibility of arteriovenous fistula with an acceptable rate of complications and suggests that its use is particularly favorable in children with inhibitors in whom it should be considered as first-choice venous access. […] AVF is still in use in 7 children (64%) on regular prophylaxis. […] Aneurysmatic dilatation was more frequent in children on a daily treatment regimen (4/17, 24% vs. 0/18 in children not treated daily; p<0.05) who underwent a greater cumulative number of AVF accesses (median 1,594, range: 1,054-2,036 vs. 1,020, range: 166-1,965 in children without aneurysm; p<0.05), while no statistically significant difference was found according to the inhibitor status.

• #1

  https://haematologica.org/article/view/5247

  Overall, complications with some impact on AVF use or duration (i.e. excluding hematomas and distal steal syndrome) occurred in 14/43 procedures (32%) in 13/38 patients (34%), including AVF overflow (AVF flow rate up to 2,200 mL/min) without US signs of cardiac involvement observed in one child after 6.9 years of AVF use. […] Regular follow-up and continuous surveillance on long-term outcome and complications is ongoing in our series and is recommended to centers that choose AVF as venous access in hemophiliacs.

• #1 Use of arteriovenous fistula in children with bleeding…

  https://sciendo.com/article/10.17225/jhp00087

  Haemophilia and associated bleeding disorders are chronic conditions that require easy, accessible, and reliable venous access for treatment. […] Our experience suggests AVF is a viable option of venous access in patients with haemophilia and other bleeding disorders, especially so for children with repeated CVC infections or poor peripheral venous access. […] However, this is not a straightforward option and further evidence on long-term use based on multicentre research will be beneficial in managing AVF in this group of patients.

• #1 Hemodialysis Access | Fistula, Graft, & Catheter National Kidney Foundation

  https://www.kidney.org/kidney-topics/hemodialysis-access

  A fistula should be considered the first choice for your access because it generally lasts longer and has fewer problems such as infections and clotting. […] A graft is considered the second choice for an access. […] Your dialysis care team will teach you the steps of good access care. […] The chart below gives you some general tips about everyday access care and how to prevent problems. […] If an infection occurs, your doctor will order antibiotics for you. […] If your access develops a clot, you may need to go to the hospital for treatment.

• #1 Arteriovenous fistula – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/arteriovenous-fistula/symptoms-causes/syc-20369567

  If you have signs and symptoms of an arteriovenous fistula, make an appointment to see your health care provider. Early detection of an arteriovenous fistula may make the condition easier to treat. It may also reduce the risk of developing complications, including blood clots or heart failure. […] Treatment for arteriovenous fistulas includes monitoring, compression, catheter-based procedures and, sometimes, surgery.

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

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

  Arteriovenous fistulas arent preventable because the most common causes are injuries (which are almost always unpredictable), or they form before youre born. When they happen in connection with dialysis, theyre intentional, and your medical provider will create one to help make your dialysis care more effective.

• #1 Understanding Arteriovenous Fistula: Types, Causes, Symptoms, Treatment, and Prevention

  https://www.doctorshubnepal.com/diseases-conditions/arteriovenous-fistula-avf

  Preventions of Arteriovenous Fistula (AVF) While some risk factors for AVF are beyond your control, there are steps you can take to reduce your risk: […] Safety Measures: Practice safety in sports and activities to minimize the risk of trauma. […] Regular Check-ups: Routine medical check-ups can help identify and address vascular conditions early. […] Blood Pressure Management: Keep your blood pressure in a healthy range through lifestyle changes or medications as advised by your healthcare provider. […] Family History: If AVF runs in your family, inform your doctor, and monitor your health closely.

• #1 Arteriovenous Fistula (AV Fistula) – MD Searchlight

  https://mdsearchlight.com/heart-health/arteriovenous-fistula-av-fistula/

  For people with severe kidney disease, the creation of an arteriovenous fistula (AVF) may be necessary. However, if you want to prevent the formation of AVFs, the best way is to avoid unnecessary injuries or procedures that could lead to their development. The origin of congenital AVFs, which you are born with, isnt well understood, so theres not much we can do in terms of prevention. […] If youre diagnosed with an AVF, or suspect you might have one, you should first visit your primary doctor. After an in-depth assessment, you might be recommended to a specialist for possible AVF treatment. It is crucial to note any symptoms, changes in the body part in question, or significant history, like injuries or procedures in the same area, before any appointment. Even an old injury can cause an AVF later on in your life.

• #1 Pulmonary arteriovenous fistula Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/pulmonary-arteriovenous-fistula

  Because HHT is often genetic, prevention is not usually possible. Genetic counseling may help in some cases.

• #2 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

  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. […] Although there have been no reports of prophylactic drugs with strong efficacy for preventing VAF, such drugs could be effective in any phase. […] Therefore, further large, randomized placebo-controlled studies are warranted to support the development of effective strategies for preventing VAF.

• #2 Take a look at the Recent articles

  https://www.oatext.com/does-systemic-heparin-reduces-thrombosis-rate-of-radiocephalic-fistula-a-double-blinded-randomized-study.php

  In this study, we aim to compare the effect of systemic heparin on the early thrombosis rate of radiocephalic fistulas. We hope that the use of systemic heparin intraoperatively will reduce the thrombosis rate among radiocephalic fistula patients. […] Our study has shown that heparin does reduce early and late thrombus formation, three times more than the placebo group. This highlights the importance of heparin in native AVF creation. […] Our analysis showed better maturation rate in the group given intraoperative heparin. By reducing the early thrombosis rate, heparin indirectly improved the maturation rate in our study. […] This study has demonstrated that the use of heparin efficiently reduces the thrombosis rate in small caliber native AVFs (radiocephalic), with no statistically significant adverse effects.

• #2

  https://journals.lww.com/ijvs/fulltext/2023/10020/the_importance_of_perioperative_flow_evaluation.6.aspx

  Intraoperative blood flow measurement immediately after fistula formation is useful for predicting early AVF failure. […] Our main purpose in opening AVF is to provide a good graft opening and an intervention path for long-term hemodialysis for the patient. Therefore, we use intraoperative TTFM in questionable situations to achieve high-quality AVF surgery and improve the outcome for patients. […] TTFM, which provides important and accurate intraoperative information about the status and patency of the AVF, enables accurate diagnosis of technical problems such as torsioned or stenotic conditions, and thus rapid revision of AVFs made before the patient leaves the operating room.

• #2 Effects of an arteriovenous fistula stenosis prevention program in patients receiving hemodialysis

  https://ophrp.org/journal/view.php?number=731

  The AVF stenosis prevention program featured exercise therapy, a phosphorus-restricted diet, and AVF self-care; these have been used in previous studies to prevent vascular maturation failure and vascular calcification, which are factors that correspond to AVF stenosis. […] Therefore, in this study, upper extremity muscle strength and blood flow velocity (as clinical indicators of AVF stenosis), serum calcium and phosphorus (as risk indicators of vascular calcification), and self-efficacy were utilized as variables to understand the effects of the AVF program. […] Consequently, the AVF stenosis prevention program for patients receiving hemodialysis applied in this study was found to be effective in enhancing upper extremity muscle strength through gripping exercises and preventing AVF stenosis by reducing blood phosphorus levels and improving the blood flow rate. […] The program in this study effectively prevented arteriovenous fistula (AVF) stenosis in hemodialysis patients, and it is expected to be useful for continuous vascular management and as part of nursing interventions for the effective self-management of AVFs.

• #2 Effects of an arteriovenous fistula stenosis prevention program in patients receiving hemodialysis

  https://ophrp.org/journal/view.php?doi=10.24171/j.phrp.2023.0101

  The AVF stenosis prevention program featured exercise therapy, a phosphorus-restricted diet, and AVF self-care; these have been used in previous studies to prevent vascular maturation failure and vascular calcification, which are factors that correspond to AVF stenosis. […] Consequently, the AVF stenosis prevention program for patients receiving hemodialysis applied in this study was found to be effective in enhancing upper extremity muscle strength through gripping exercises and preventing AVF stenosis by reducing blood phosphorus levels and improving the blood flow rate. […] The program in this study effectively prevented arteriovenous fistula (AVF) stenosis in hemodialysis patients, and it is expected to be useful for continuous vascular management and as part of nursing interventions for the effective self-management of AVFs.

• #2

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

  If you suffer from itching, let your doctor know so that medication can be considered to relieve the itching. […] A fistula is the best vascular access for dialysis because it tends to have fewer problems and last longer than other types of dialysis access. […] If you notice any of these signs please let your nurses and doctor know so they can investigate. Most problems of this nature can be resolved to ensure your fistula keeps healthy. […] 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.

• #2 Aneurysmal Dilatation of Dialysis Arteriovenous Access

  https://openurologyandnephrologyjournal.com/VOLUME/6/PAGE/1/

  If an aneurysm has normal overlying skin and does not compromise cannulation, management consists of avoiding cannulating the aneurysm and continued observation. […] A careful assessment is mandated to identify the cannulation site, away from the aneurysmal area and educating the dialysis staff. […] The authors concluded that problematic fistulae with large aneurysmal dilatations with a small area available for cannulation can be salvaged by using SMH modified buttonhole technique. […] Although, complete ligation and resection of AVF is often curative, the access is invariably sacrificed. […] In addition, these patients invariably require a tunneled dialysis catheter insertion for continuation of maintenance dialysis while a new AV access is created at another site. […] Aneurysmal dilatation of AV access represents a unique challenge in ESRD patients and requires a multidisciplinary team work amongst nephrologist, interventionalist, dialysis staff and surgeons, to achieve a timely diagnosis and effective treatment.

• #2

  https://haematologica.org/article/view/5247

  Overall, complications with some impact on AVF use or duration (i.e. excluding hematomas and distal steal syndrome) occurred in 14/43 procedures (32%) in 13/38 patients (34%), including AVF overflow (AVF flow rate up to 2,200 mL/min) without US signs of cardiac involvement observed in one child after 6.9 years of AVF use. […] Regular follow-up and continuous surveillance on long-term outcome and complications is ongoing in our series and is recommended to centers that choose AVF as venous access in hemophiliacs.

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