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Arteriovenous fistula (AVF) is the preferred access for hemodialysis. Percutaneous transluminal angioplasty (PTA) has become a choice for AVF stenosis, and ultrasound has been used in PTA more frequently.This single-center retrospective cohort study analyzed 129 patients who underwent PTA in the First Affiliated Hospital of Chongqing Medical University from January 2016 to December 2016. Angioplasty was performed using a noncompliant high-pressure balloon. The process was visualized by duplex scan. Our inclusion criteria were as follows: (1) stenoses or occlusions were located at the juxta-anastomosis site: the first 5 cm of the vein distal to the anastomosis; (2) stenosis was confirmed with the following conditions: (a) flow rates are 500 mL/min in the brachial artery and 200 mL/min in the fistula during dialysis, and (b) the stenosis diameter is 1.7 mm. We used the Kaplan-Meier curve to show the postintervention primary and secondary patency rates of patients with stenosis and occlusion.Altogether, 129 patients with 76 males were analyzed. Moreover, 104 have AVFs on the left arm, and only one patient had an ulnar-basilic AVF, whereas others had a radial-cephalic AVF. The postintervention primary patency rates are better in occlusion cases (P .05), whereas secondary patency rates have no difference. The postintervention primary patency rates are better in patients without diabetes mellitus (P .05), whereas the secondary patency rates had no difference.For juxta-anastomosis site stenosis or occlusion, PTA can be used to obtain satisfactory results.

Background: The creation of dialysis shunt affects hemodynamic and cardiac function. High-output cardiac failure may occur if dialysis access volume flow is greater than 1500 to 2000 mls/min. To resolve symptoms of cardiac failure due to high flow dialysis shunt requires flow reduction procedure. We describe successful resolution of symptoms of heart failure due to excessive flow dialysis access by adopting precision banding, totally under vascular ultrasound guidance without angiography. Case: Hemodialysis adult patient uses the right arm radiocephalic fistula for 4 years. Recently, the patient presented with symptoms of high-output cardiac failure, including dyspnea, palpitations, fatigue, and orthopnea. The cardiac unit excluded all other causes of cardiac failure and referred the patient to our center for further evaluation. Ultrasonography revealed high blood volume flow measuring 3100 mls/min at brachial artery, marking high flow fistula and the underlying cause of cardiac failure. Juxta-anastomotic segment of fistula vein was identified; 3 mm diameter balloon was advanced to the juxta-anastomotic segment and maximally inflated. Two precision bandings were made on this segment, 1 to 2 cm apart with flow reduction to 691 mls/min. All steps of the procedure were done under ultrasound guidance without angiography. All symptoms were significantly alleviated immediately following the procedure. The patient was discharged after 48 h of monitoring. At 6 months, the patient was stable, no recurrence of high flow access, no signs or symptoms of cardiac failure, and the flow was 1119 mls/min. Conclusion: This case demonstrates that the precision banding procedure is feasible under ultrasound guidance, and the procedure is safe and effective in resolution of cardiac failure due to high flow radiocephalic fistula.

There is no optimal treatment for central vein occlusive disease that remains a major contributor to vascular access impairment. This study aimed to review the outcomes of percutaneous treatment with a mother-child technique in the treatment of symptomatic central venous stenosis (CVS) and central venous occlusion (CVO) in patients on hemodialysis.Data were collected retrospectively and included all consecutive patients with CVS or CVO who were treated with percutaneous angioplasty and stenting. The occlusive lesions were crossed using the mother-child technique with an angiographic catheter-in-guiding catheter system.A total of 36 patients with symptomatic CVS and 45 patients with total CVO were included. The average age and gender composition were similar between the two groups. Patients with CVO had higher prevalence of diabetic nephropathy than CVS (24.4% vs 5.6%; P .05). Lesion success, device success, and procedural success were achieved in 36 (100%), 1 (100%), and 36 (100%) patients in the CVS group and in 43 (95.6%), 11 (100%), and 43 (95.6%) patients in the CVO group, respectively. There were no severe complications or procedure-related deaths in either group. During follow-up (median, 6 months), the primary patency rates were 89.7% (CVS) and 81.0% (CVO) at 6 months and were 54.2% (CVS) and 47.1% (CVO) at 12 months. The assisted primary patency rates were 100% (CVS) and 91.2% (CVO) at 6 and 12 months.With extra backup support of the mother-child technique, percutaneous treatment provides an effective and safe method for recanalization of chronic venous occlusion in patients on hemodialysis.

Xi Zhang,1 Ziming Wan,1 Si Cheng,2 Hua Gan1 1Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China; 2Department of Orthopaedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of ChinaCorrespondence: Hua GanDepartment of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of ChinaEmail correspondzx@126.comIntroduction: ENPP1 and ENTPD1 are two main enzymes involved in ATP-AMP-ADP-adenosine axis, which is associated with lipid metabolism, diabetes mellitus (DM) and renal fibrosis. The single nucleotide polymorphisms (SNPs) of ENPP1 and ENTPD1, rs1044498 and rs6584026, are associated with these factors. This retrospective study aimed to address the two SNPs variants in hemodialysis (HD) patients and analyzes their relations with clinical characteristics.Methods: This study included 543 regular HD patients over 3 months at our center. Overnight fasting peripheral blood sample was taken from each subject to extract the DNA. The genotypes of rs1044498 and rs6584026 were detected by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. The basic clinical data were noted such as sex, age, and HD-age, and the main causes of chronic kidney disease (CKD) and the clinical characteristics were collected on average at least three times in half a year. T-test and Chi-test were performed for the statistical analyses. Binary logistic regression was applied for the significant parameters by excluding the confounders, gender, age and HD-age. All statistical tests were considered significant for P< 0.05.Results: The rs1044498 genotypes showed in two types, A/A and A/C without C/C. The rs6584026 genotypes were C/C and C/T without T/T. The genotype frequency of rs1044498 (A/C) was 0.238, and the genotype frequency of rs6584026 (C/T) was 0.328. The age and the level of lipoprotein α showed statistical significance with rs1044498 variant (A/C, P< 0.05). The rs6584026 variant (C/T) was frequently found in patients with nephritis (P< 0.05). The albumin, alkaline phosphatase (ALP), lipoprotein α, cholesterol, apolipoprotein B (Apo B), Apo B/A1 and nephritis were independently associated with rs6584026 variant (C/T, P< 0.05) in binary logistic regression model by controlling the confounders of gender, age and HD-age. High level of triglyceride and low level of urine nitrogen were related to rs6584026 variant (C/T, P< 0.05).Conclusion: The rs1044498 and rs6584026 SNPs were related to several high levels of lipids, and rs6584026 variant was related to nephritis and autoimmune disease. The rs6584026 SNP may contribute to the increased risks of cholesterol and ApoB/A1 in HD patients.Keywords: chronic kidney disease, CKD, single nucleotide polymorphisms, SNPs, ectonucleotide pyrophosphatase/phosphodiesterase 1, ENPP1, ectonucleoside triphosphate diphosphohydrolase 1, ENTPD1, rs1044498, rs6584026

The purpose of this study was to evaluate the outcome and the factors associated with stenosis after treatment using partial aneurysmectomy for aneurysm in autologous arteriovenous fistulas.This retrospective cohort study was conducted from July 2007 to June 2016 and included patients with complicated aneurysms in upper extremity autologous arteriovenous fistulas were treated by partial aneurysmectomy. Vascular ultrasound examination was performed every 6 months after the surgery.Forty-one patients (median age, 37 years; 70.7% males) were included. Of the patients, 95.1% had a radial-cephalic fistula in the forearm and nearly 88% had 1 or 2 aneurysms in arteriovenous fistulas that had been created for 10 to 84 months. Technical success of partial aneurysmectomy was achieved in all patients. The access diameter (44.0 ± 5.1 mm vs 10.4 ± 1.8 mm; P .01) and brachial artery blood flow (1618.2 ± 277.0 mL/min vs 772.1 ± 127.4 mL/min; P .01) were significantly decreased after the surgery. The median follow-up time was 27 months (range, 12-43 months). The primary patency rates at 6 and 12 months were 100% and 95%, respectively. Loss of patency was due to stenosis of the remodeled fistulas, which occurred in seven patients (17%). Multivariate COX regression analysis revealed that diabetes (hazard ratio, 114.28; 95% confidence interval, 2.85-4583.94; P = .01) was a risk factor for the impaired primary patency rates. A larger postprocedure residual diameter trended to favor fistula patency (hazard ratio, 0.46; P = .07). Stenosis was successfully treated with percutaneous transluminal angioplasty.Partial aneurysmectomy is an effective and safe method for treating aneurysm of upper extremity autologous arteriovenous fistulas, leading to good 12-month primary patency and no aneurysm recurrence. Using a larger catheter to size the revised fistula during aneurysmectomy may increase access patency.

Background Previous studies have not described the relationship between reducing radial artery diameter as well as increasing age and functional maturation of the radio-cephalic arteriovenous fistula (RCAVF) and no data identify these as linear relationship. The objective of this study was to perform trend analysis to assess these aspects. Methods Our retrospective cohort study enrolled and analyzed 353 follow-up cases that underwent first AVF creation. The artery and vein sizes were measured by ultrasound. We performed follow-up, a minimum of 3 months after surgery. Multivariable logistic regression analysis was used to identify independent risk factors inmaturation. Participant age was categorized into four groups (age ≤ 29, 30–49, 50–69, and 70–90 years). Radial artery diameter was categorized into four groups (≤ 1.9, >1.9 and ≤ 2.1, >2.1 and ≤ 2.4, >2.4 mm) according to median and interquartile ranges. We adjusted for confounders in four logistic models, and primary analyses were based on building ordered category models and tested P values for trends to estimate the relationship of radial artery diameter and each 20-year increase in age with risk of maturation. Results The mature RCAVF group included 301 cases, and the immature group included 52 cases. Radial artery diameter, age, and diabetes were independent risk factors of maturation. Odds ratios (ORs) associated with maturation reduced with increasing age, while ORs increased with increasing radial artery diameter. P values for trends() were observed in all four models. A reduction in radial artery diameter and higher age were significantly associated with a higher incidence of immaturity after adjusting the multivariate models. The risks of immaturation were increased by more than 1.54 fold for each 20-year increase and increased by more than 1.34 fold for the smaller radial artery diameter group. Conclusion Our findings suggest that a significantly higher immaturity risk of RCAVF was associated with increasing age and a reduction in radial artery diameter. Our study identified a linear exposure-response relationship of age and radial artery diameter with immaturity incident. A careful selection of patients will be helpful in improving AVF functional maturation.

Objective This study aimed to evaluate the efficacy of beraprost sodium (BPS) or clopidogrel (CL) using vascular thromboembolic events (VTEs) of arteriovenous fistula as a primary endpoint in patients with end-stage renal disease (ESRD) undergoing arteriovenous fistula surgery. Methods We performed a multicentre, retrospective cohort study from August 2012 to August 2016. We studied patients with ESRD who underwent arteriovenous fistula surgery and received peroral administration of 40 µg BPS, three times per day, for 1 month, or 75 mg CL (initial dose of 300 mg), one time per day, for 1 month. The time to first on-study VTE was the primary endpoint. Results The BPS-treated cohort had a significantly delayed time to first VTE compared with the CL-treated cohort (hazard ratio 0.33, 95% confidence interval 0.18–0.56). An increased incidence of VTEs was detected in the 1-month follow-up, with rates of 2.4% and 8.7% for BPS and CL, respectively. This difference persisted over time, with rates of 8.0% and 18.1% at the final follow-up, respectively. Conclusion CL-treated patients with ESRD have a greater risk of VTEs compared with BPS-treated patients. CL-treated patients also tend to experience a VTE within the first month after cessation of oral administration.

Background The purse-string suture has been widely used for bleeding control after percutaneous interventions through arteriovenous fistula (AVF) and graft (AVG), and it requires suture removal the next day. This study aimed to introduce a simple method using a tourniquet to facilitate hemostasis following AVF or AVG sheath removal after percutaneous procedures. Methods Data were retrospectively collected and included all the consecutive patients who received bleeding control with a tourniquet after percutaneous AVF or AVG interventions. Hemostasis was facilitated using the tourniquet technique after sheath removal. Results A total of 1966 patients who received the tourniquet technique for bleeding control after percutaneous AVF or AVG interventions were included. Bleeding control was successfully achieved in all patients. Regarding complications, hematoma, thrombosis, and rebleeding occurred in 57 (2.9%), 11 (0.6%), and 8 (0.4%) patients, respectively. Neither pseudoaneurysm nor infection occurred in the patients. Age, gender, pre-existing diseases (including diabetes and hypertension), procedure count, sheath size, hemodialysis access type, and canalization route were similar between patients with and without complications. The primary patency rates at 6,12, 24, and 36 months were 85.0, 64.6, 53.8, and 41.6%, respectively. Conclusions The tourniquet technique is an effective and safe approach for facilitating hemostasis after catheter-based percutaneous interventions of hemodialysis accesses.

Arteriovenous fistula (AVF) thrombosis is a common complication in patients undergoing hemodialysis, and early intervention is required. Urokinase has been used as a thrombolytic agent for declotting the thrombosed access. However, the optimal route for infusing urokinase remains to be determined. In the present retrospective observational study, 49 patients who underwent local venous infusion and 57 patients with peripheral venous infusion of urokinase were included. A urokinase dosage of 300,000 U was administered until successful thrombolysis, which was a maximum of three times. Age, sex, period of dialysis, time of AVF placement, systolic and diastolic blood pressure and thrombus age were similar between the two groups. The efficacy of urokinase infusion via the two routes in resolving thrombosed AVFs, defined as successful fibrinolysis, and the safety, defined as the number of bleeding events, was compared. The cumulative thrombolysis success rate following three sessions of thrombolytic therapy in the local venous thrombolysis group was higher compared with that in the peripheral venous thrombolysis group (85.7 vs. 68.4%; P=0.04). The local thrombolysis group exhibited less ecchymosis (4.1 vs. 14.0%; P=0.07), epistaxis (2.0 vs. 10.5%; P=0.08) and gingival bleeding (4.1 vs. 19.3%; P=0.02) events compared with the peripheral thrombolysis group. Further analyses demonstrated that systolic [odds ratio (OR)=1.10; 95% confidence interval (CI), 1.03-1.17; P

Background Kidney allograft loss becomes an important cause of end-stage kidney disease and requires dialysis reinitiation. We report a case of a patient who restarted hemodialysis after his second kidney graft failure using a long-discarded autologous arteriovenous fistula. Case presentation A 62-year-old man was diagnosed with end-stage renal disease 20 year ago, and a native arteriovenous fistula was created for hemodialysis. After the patient received his first kidney transplantation, the hemodialysis fistula was discarded and chronically thrombosed for 13 years. When the patient experienced his second kidney graft loss and presented with uremia again, dialysis restart was needed. Under vascular ultrasound, but not x-ray, guidance, we successfully revascularized the patient’s chronically occluded, long-discarded arteriovenous fistula access and used it for hemodialysis. The resurrected fistula remained patent and clinically useable for hemodialysis up to 18 months. Conclusions This report provides the feasibility of ultrasound-guided transluminal angioplasty for the treatment of a mummy hemodialysis fistula, which could be considered when managing patients who need dialysis reinitiation. Electronic supplementary material The online version of this article (10.1186/s12882-018-1089-9) contains supplementary material, which is available to authorized users.

Background To assess the time to first on-study vascular thromboembolic events (VTEs) of clopidogrel (CL) or beraprost sodium (BPS) in Chinese population with end-stage renal disease (ESRD) treated with arteriovenous fistula (AVF) surgery. Methods From Jan 2009 to May 2015, 346 ESRD cases suffering an AVF surgery and undergoing oral administration of 75 mg CL (initial dose of 300 mg), 1 time/day, for 4 weeks or 40 μg BPS, 3 times/day, for 4 weeks were retrospectively assessed. The primary outcome was time to first on-study VTE. Results In total, 222 ESRD cases (CL, n = 112; BPS, n = 110) were assessed, with a median follow-up time of 38.1 months (range, 37–40 months). The mean time to first on-study VTE was 1.2 weeks (0.5–2.3) and 1.8 weeks (1.2–3.8) for CL and BPS, respectively (HR 0.27, 95% CI 0.16–1.45; P = 0.00). An increased incidence of VTEs was found during the 1th-month follow-up, with rates of 14.2 and 5.5% for CL and BPS, respectively (P = 0.03). The difference persisted over time, with rates of 24.1 and 11.8% at final follow-up, respectively (P = 0.02). Conclusion CL with an increased risk of VTEs tended to have a VTE within the 1st month after cessation compared with BPS.