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Factors affecting the physical characteristics of arterio-venous fistula in patients with renal failure
Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences.
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background and Purpose

A patent access is vital for a dialysis patient. The arterio-venous fistula (AVF), the most important access for haemodialysis (HD), is frequently affected by extensive complications such as stenosis and occlusions.

Study I: To investigate whether the dimensions of AVFs used for performing haemodialysis were affected by the original disease.

Study II: To investigate if the diameter of the distal radiocephalic fistula could influence left ventricular variables in stable haemodialysis patients.

Study III: To investigate whether a single Far Infrared (FIR) light treatment could alter blood velocity, AVF diameter or inflammatory markers.

Study IV: To evaluate in what extent the renal diagnosis and radiological interventions affected the dysfunction of AVF and results of percutaneous transluminal angioplasty (PTA).

Materials and methods

Study I: The lumen diameter of the AVF was studied by ultrasound in 19 patients with autosomal dominant polycystic kidney disease (ADPKD) and in 19 control patients. The monitoring was performed along the forearm part of the vein, the maximal diameter was measured. The diameters of the two needle insertion sites were also measured.

Study II: Nineteen patients were investigated with echocardiography, using M-mode recordings and measurements in the 2D image. Ultrasound and doppler ultrasound were performed. Transsonic measurements were performed after the ultrasound investigation. Measurements of the diameter of the AVF were performed in four locations. Heart variables were analysed regarding left ventricular (LV) criteria.

Study III: Thirty patients with native AVF in the forearm were included. Each patient was his/her own control. Ultrasound examinations of the AVF diameter and blood flow velocity were performed before and after a single Far Infrared light (FIR) treatment.

Study IV: 522 radiological investigations and endovascular treatments between January 1, 2006 and December 31, 2014 were analysed in 174 patients, retrospectively. All investigations had been performed due to clinical suspicion of impaired AVF function. All stenoses were evaluated and the number, degree, length, location and relation to anastomosis were recorded. After PTA the remaining stenoses were evaluated again and complications were recorded.

Results

Study I: The diameter of the AVF at the maximal site in patients with ADPKD was significantly wider than that for the control patients.

Study II: A larger AVF mean and maximal diameter worsened left ventricular characteristics.

Study III: A single FIR treatment resulted in a significant increase in blood velocity over the AV fistula from a mean of 2.1±1.0 m/s to 2.3±1.0 m/s. The diameter of the arterialized vein became wider, i.e. 0.72±0.02 to 0.80±0.02 cm. The increase in fistula blood velocity correlated positively with baseline serum-urate and the increase in venous diameter correlated positively with the baseline plasma orosomucoid concentration.

Study IV: The degree of AVF stenosis before PTA correlated significantly with the degree of remaining stenosis after intervention. Arterial stenosis was significantly more frequent among patients with diabetic nephropathy and interstitial nephritis. A shorter life span between PTAs was related to diabetic nephropathy.

Conclusions

Study I: The receiving veins of AVF in patients with ADPKD have an abnormality that causes a greater than normal dilatation in response to the arterialization.

Study II: The maximal diameter of the distal AVF seems to be a sensitive marker of LV impairment in stable haemodialysis patients.

Study III: A single FIR treatment increased AVF blood velocity and vein diameter. Thus, one FIR treatment can help maturation of AVF in the early postoperative course.

Study IV: Repeated PTA was performed significantly more often in patients with diabetic nephropathy. Clinically significant stenosis should be dilated as soon as possible. Occlusion of the AVF should be thrombolyzed and/or dilated when diagnosed.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2019. , p. 50
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1656
National Category
Cardiac and Cardiovascular Systems Surgery Gastroenterology and Hepatology Radiology, Nuclear Medicine and Medical Imaging
Identifiers
URN: urn:nbn:se:liu:diva-154623ISBN: 9789176851593 (print)OAI: oai:DiVA.org:liu-154623DiVA, id: diva2:1291053
Public defence
2019-03-07, Hugo Theorell, Campus US, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2019-02-22 Created: 2019-02-22 Last updated: 2019-02-22Bibliographically approved
List of papers
1. Dimensions of Arteriovenous Fistulas in Patients with Autosomal Dominant Polycystic Kidney Disease
Open this publication in new window or tab >>Dimensions of Arteriovenous Fistulas in Patients with Autosomal Dominant Polycystic Kidney Disease
2000 (English)In: Nephron. Clinical practice, ISSN 1660-8151, E-ISSN 2235-3186, Vol. 85, no 1, p. 50-53Article in journal (Refereed) Published
Abstract [en]

Background/Aim: Aneurysms are known manifestations of autosomal dominant polycystic kidney disease (ADPKD). We investigated whether the dimensions of arteriovenous fistulas created for performance of haemodialysis were affected by the original disease.

Methods: The lumen diameter of the fistula was studied by ultrasound in 19 patients with ADPKD and in 19 control patients. The patients’ sex, age, the duration of their fistulas, haemoglobin values and blood pressure levels were similar in both groups. The monitoring was performed along the forearm part of the vein, and the maximal diameter was measured. The diameters at the two needle insertion sites were also measured.

Results: The ADPKD patients had a significantly higher fistula diameter than the control patients: 12 (range 8–19) mm versus 8 (range 6–24) mm at the widest level (p = 0.003). There were no significant differences in the diameters at the needle insertion sites.

Conclusion: The receiving veins of arteriovenous fistulas in patients with ADPKD have an abnormality that causes a greater than normal dilatation in response to the arterialization. We postulate that this phenomenon is linked with the increased prevalence of aneurysms in ADPKD.

Place, publisher, year, edition, pages
Basel: S. Karger, 2000
National Category
Rheumatology and Autoimmunity Surgery Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-154621 (URN)10.1159/000045629 (DOI)
Available from: 2019-02-22 Created: 2019-02-22 Last updated: 2019-02-22Bibliographically approved
2. Fistula diameter correlates with echocardiographic characteristics in stable hemodialysis patients
Open this publication in new window or tab >>Fistula diameter correlates with echocardiographic characteristics in stable hemodialysis patients
Show others...
2015 (English)In: Nephrology @ Point of Care, ISSN 2059-3007, Vol. 1, no 1, p. e44-e48Article in journal (Refereed) Published
Abstract [en]

Left ventricular hypertrophy (LVH) is a common finding in hemodialysis patients. The aim of the present study was to investigate if the diameter of the distal radiocephalic fistula could influence left ventricular variables in stable hemodialysis patients.

Methods

Nineteen patients were investigated. Measurements of the diameter of the arteriovenous (AV) fistula were performed in 4 different locations. The patients were investigated using M-mode recordings and measurements in the 2D image. Doppler ultrasound was also performed. Transonic measurements were performed after ultrasound investigation.

Results

Fistula mean and maximal diameter correlated with left ventricular characteristics. Fistula flow correlated neither with the left ventricular characteristics nor with fistula diameters.

Conclusions

The maximal diameter of the distal AV fistula seems to be a sensitive marker of LVH in stable hemodialysis patients.

Place, publisher, year, edition, pages
Wichtig Publishing, 2015
National Category
Cardiac and Cardiovascular Systems Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:liu:diva-130611 (URN)
Note

DOI does not work: 10.5301/pocj.5000193

Available from: 2016-08-18 Created: 2016-08-18 Last updated: 2019-02-22
3. A single treatment, using Far Infrared light improves blood flow conditions in arteriovenous fistula
Open this publication in new window or tab >>A single treatment, using Far Infrared light improves blood flow conditions in arteriovenous fistula
2017 (English)In: Clinical hemorheology and microcirculation, ISSN 1386-0291, E-ISSN 1875-8622, Vol. 66, no 3, p. 211-217Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: A native arteriovenous fistula (AVF) is recommended for angio access in patients on chronic hemodialysis (HD). Fistula patency has been improved by exposure to Far Infrared light (FIR). OBJECTIVE: To investigate whether a single FIR treatment could alter blood velocity, AVF diameter or inflammatory markers. METHODS: Thirty patients with a native AVF in the forearm were included. Each patient was his/her own control. Ultrasound (US) examinations were performed before and after a single FIR treatment. RESULTS: A single FIR treatment resulted in a significant increase in blood velocity over the AV fistula from a mean of 2.1 +/- 1.0 m/s to 2.3 +/- 1.0 m/s (p = 0.02). The diameter of the arterialized vein became wider; 0,72 cm +/- 0.02 to 0,80 cm +/- 0.02, (p = 0.006). The increase in fistula blood velocity correlated positively with base line serum-urate p = 0.004) and the increase in venous diameter with the base line plasma orosomucoid concentration (p = 0.005). CONCLUSIONS: This study shows that a single FIR treatment significantly increased AVF blood velocity and vein diameter. Thus, one FIR treatment can help maturation of AVF in the early postoperative course.

Place, publisher, year, edition, pages
IOS PRESS, 2017
Keywords
Ultrasound; vascular access; Far Infrared therapy; hemodialysis
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-139673 (URN)10.3233/CH-170254 (DOI)000404475300004 ()28527196 (PubMedID)
Available from: 2017-08-16 Created: 2017-08-16 Last updated: 2019-02-22

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