{"title":"Creation of arteriovenous fistula by forearm endoscopic basilic vein transposition.","authors":"Mustafa Baris Kemahli, Cuneyt Narin","doi":"10.1177/11297298251358561","DOIUrl":"https://doi.org/10.1177/11297298251358561","url":null,"abstract":"<p><p>The basilic vein is one of the two primary veins used for creating an autogenous arteriovenous fistula in the upper extremity. In the creation of an arteriovenous fistula with basilic vein transposition in the forearm, an incision along the forearm is typically required to prepare the basilic vein. This extensive surgical incision can lead to wound healing issues. In this case, we reported that the basilic vein in the forearm could be prepared endoscopically. This method allowed for avoiding the surgical incision along the vein to be transposed. Endoscopic vein preparation allows for less surgical dissection in basilic vein transposition, and thus may be beneficial in avoiding postoperative wound complications.</p>","PeriodicalId":56113,"journal":{"name":"Journal of Vascular Access","volume":" ","pages":"11297298251358561"},"PeriodicalIF":1.7,"publicationDate":"2025-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144805357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Biochemical and radiological factors affecting arterio-venous fistula maturation and its comparative outcome between adult and elderly chronic kidney disease patients.","authors":"Abhishek Jha, Himansu Sekhar Mahapatra, Lalit Pursnani, Muthukumar Balakrishna, Renju Binoy, Chandra Krishnan, Beauty Suman, Tanvi Thakker, Md Mahboob Alam","doi":"10.1177/11297298251359358","DOIUrl":"https://doi.org/10.1177/11297298251359358","url":null,"abstract":"<p><strong>Background: </strong>Changing vascular integrity with aging may be a crucial factor presuming Arterio-Venous fistula (AVF) maturation. Present study compared outcome of AVF maturation and associated factors responsible between adult and elderly population.</p><p><strong>Methodology: </strong>In this prospective observational study, CKD 4/5 patients of age ⩾18 years in whom AVF was planned were included. All were divided as adult (18-59 years) and elderly (⩾60 years) groups. Various clinical, biochemical, and radiological parameters including doppler assisted vascular mapping were recorded. AVF was created by side to side anastomosis. Clinical and doppler assessment like blood flow and wall shear stress (WSS) were done at 4th, 6th, and 12th weeks. Radiological maturation of AVF was defined as combination of blood flow of ⩾500 mL/min and vessel diameter of 5 mm. At 12 weeks, maturation of both group and association of biochemical factors with primary AVF failure were compared.</p><p><strong>Results: </strong>A total of 120 patients (60 in each age group) were included. Overall AVF maturation rate was 75% (<i>n</i> = 90). Among elderly 70% (<i>n</i> = 42) and adult 80% (<i>n</i> = 48); <i>p</i> < 0.02. Early clinical and radiological maturation were seen in adult as compared to elderly (<i>p</i> = 0.022). Hyperphosphatemia, and higher c-reactive protein (CRP) levels were associated with AVF primary failure (<i>p</i> = 0.033) and (<i>p</i> = 0.005) respectively which are more in elderly group. Elderly patients had more arterial calcification (<i>p</i> = 0.034). Radio cephalic AVF (RCAVF) was common in both group, adult (85%) and elderly (76.5%), however elderly have more brachiocephalic AVF (BCAVF) (14.8% vs 23.3%). Blood flow, fistula diameter, and WSS had significant differences between the matured and non-matured groups (<i>p</i> < 0.001) in both adult and elderly.</p><p><strong>Conclusion: </strong>Higher serum phosphate level, CRP, arterial calcification, and higher WSS were likely cause of reduced AVF maturation rate in elderly. Meticulous clinical, biochemical, and radiological evaluation, site of AVF creation selection are essential to reduce AVF failure rate.</p>","PeriodicalId":56113,"journal":{"name":"Journal of Vascular Access","volume":" ","pages":"11297298251359358"},"PeriodicalIF":1.7,"publicationDate":"2025-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144805356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The use of experimental preclinical models in evaluating endovascular interventions for vascular access stenosis: A review.","authors":"Linda B Liu, Shahriar Moossavi, Saami K Yazdani","doi":"10.1177/11297298251362928","DOIUrl":"https://doi.org/10.1177/11297298251362928","url":null,"abstract":"<p><p>Stenosis of vascular accesses, particularly in arteriovenous fistulas and grafts, remains a significant challenge in hemodialysis patients, often leading to access dysfunction and failure. Endovascular interventions, including stent grafts and drug-coated balloons (DCBs), have emerged as key treatment modalities to mitigate restenosis and prolong access patency beyond simple balloon angioplasty. Preclinical evaluation of these devices relies on large animal models to assess safety, effectiveness, and biological responses before clinical application. This review provides a comprehensive analysis of the large animal models used for evaluating endovascular devices in vascular access stenosis, highlighting their advantages, limitations, and translational relevance. Additionally, we summarize premarket approval (PMA) animal studies for seven endovascular devices currently indicated for use in vascular accesses, examining their study designs, key findings, and regulatory considerations. By synthesizing preclinical data, this review aims to inform future research and regulatory strategies for optimizing endovascular therapies in vascular access management.</p>","PeriodicalId":56113,"journal":{"name":"Journal of Vascular Access","volume":" ","pages":"11297298251362928"},"PeriodicalIF":1.7,"publicationDate":"2025-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144805359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Using ultrasound magnetic needle navigation technique for vascular cannulation: Systematic review and meta-analysis.","authors":"Tarasova Natalia, Khapov Ivan, Hu Yirui, Hsiung Benjamin, Zhang Xiaopeng, Husain Kamran","doi":"10.1177/11297298251362912","DOIUrl":"https://doi.org/10.1177/11297298251362912","url":null,"abstract":"<p><strong>Introduction: </strong>Recently developed ultrasound magnetic field navigation technology allows to visualize the needle and project needle trajectory. The aim of this review was to assess performance with ultrasound magnetic needle navigation technique for vascular cannulation compared to the conventional ultrasound technique.</p><p><strong>Methods: </strong>The systematic review was conducted according to the guideline for reporting systematic reviews (PRISMA). Ovid Medline, Embase, and Cochrane Central databases were searched for eligible studies. Meta-analysis was performed to compare the outcomes between two techniques.</p><p><strong>Results: </strong>A total of eight randomized controlled studies with 495 participants were included. For central venous cannulation, the ultrasound magnetic navigation technique was associated with significantly higher out of plane success rate (RR = 1.17, 95% CI = [1.07, 1.29]), significantly lower rate of posterior wall puncture (RR = 0.30, 95% CI = [0.11, 0.80]), and lower rate of artery puncture (RR = 0.14, 95% CI = [0.04, 0.45]).</p><p><strong>Conclusion: </strong>For ultrasound-guided central venous cannulation the magnetic needle positioning technique is associated with higher success rate for out of plane cannulation approach and less complications in comparison to conventional ultrasound.</p>","PeriodicalId":56113,"journal":{"name":"Journal of Vascular Access","volume":" ","pages":"11297298251362912"},"PeriodicalIF":1.7,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144796256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Risk prediction for hemodialysis initiation: The role of Kidney Failure Risk Equation and personalized timely vascular access referral.","authors":"Andreia Henriques, João Venda, Emanuel Ferreira, Joana Costa, Nuno Oliveira, Rui Alves","doi":"10.1177/11297298251362913","DOIUrl":"https://doi.org/10.1177/11297298251362913","url":null,"abstract":"<p><strong>Introduction: </strong>Optimal timing for arteriovenous fistula creation in chronic kidney disease is challenging. Late referral results in hemodialysis (HD) initiation via a central venous catheter (CVC), whereas early referral may lead to unnecessary procedures. We evaluate the predictive value of estimated glomerular filtration rate (eGFR) and the 2-Year Kidney Failure Risk Equation (KFRE) in forecasting HD initiation.</p><p><strong>Methods: </strong>Included adults referred for vascular mapping with ⩾3 months of nephrology follow-up who selected HD as their preferred modality. The index date was the date of modality selection. We assessed HD initiation timing, vascular access (VA) type, mortality, and the predictive performance of eGFR and KFRE.</p><p><strong>Results: </strong>Included 179 patients, of whom 43.6% (<i>n</i> = 78) and 58.7% (<i>n</i> = 105) initiated HD within 12 and 24 months, respectively, with most (59.9%) starting via a CVC (59.9%). Within 24 months, 6.7% (<i>n</i> = 12) died before HD initiation. Higher urinary protein-to-creatinine ratio, higher KFRE, lower eGFR, male sex, and heart failure with reduced ejection fraction were associated with increased HD risk. Predictive thresholds for HD initiation within 12 months were eGFR <17.1 mL/min/1.73 m<sup>2</sup> (sensitivity: 77.9%, specificity: 54.1%, <i>p</i> < 0.001), and KFRE >32.8% (sensitivity: 75.6%, specificity: 68.3%, <i>p</i> ⩽ 0.001). For 24 months, thresholds were eGFR <15.5 mL/min/1.73 m<sup>2</sup> (sensitivity: 56.7%, specificity: 73.2%, <i>p</i> < 0.001), and KFRE >31.0% (sensitivity: 71.4%, specificity: 71.6%, <i>p</i> ⩽ 0.001). Patients exceeding the KFRE threshold had a higher risk of HD initiation than those below the eGFR threshold. A KFRE >40.0% increased specificity, while lower thresholds (>30%) improved sensitivity. Combining eGFR with KFRE enhance specificity but reduced sensitivity.</p><p><strong>Conclusion: </strong>KFRE demonstrates superior predictive performance compared to eGFR for VA planning. Balancing different thresholds values and integrating KFRE with eGFR, can refine HD initiation risk assessment and VA referral, preventing unnecessary surgery and minimizing HD initiation via CVC.</p>","PeriodicalId":56113,"journal":{"name":"Journal of Vascular Access","volume":" ","pages":"11297298251362913"},"PeriodicalIF":1.7,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144796255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Esther D Wilschut, Eduard P de Winter, Ernst J Bos, Margreet R de Vries, Hein Putter, Timothy J van der Steenhoven, Daniël Eefting, Jaap F Hamming, Joris I Rotmans, Koen E A van der Bogt
{"title":"Cephalic vein dilatation at the elbow by preoperative supervised forearm exercise depends on adherence to therapy: Results from the randomized controlled single-blind PINCH trial.","authors":"Esther D Wilschut, Eduard P de Winter, Ernst J Bos, Margreet R de Vries, Hein Putter, Timothy J van der Steenhoven, Daniël Eefting, Jaap F Hamming, Joris I Rotmans, Koen E A van der Bogt","doi":"10.1177/11297298251350745","DOIUrl":"https://doi.org/10.1177/11297298251350745","url":null,"abstract":"<p><strong>Background: </strong>Maturation failure may be as high as 30%-60% of arteriovenous fistulas (AVF). Forearm exercise postoperatively has shown potential in increasing blood vessel size in patients with end-stage renal disease and may promote maturation of AVFs. Little evidence exists on the impact of pre-operative forearm exercises on the increase of vascular diameters. Aim of this study was to evaluate the effect of supervised forearm exercises on vascular diameters and AVF maturation.</p><p><strong>Methods: </strong>The PINCH trial is a single-blinded, randomized controlled trial on supervised forearm exercises compared to no exercise 6 weeks before AVF creation. Forty-eight patients were included.</p><p><strong>Primary endpoint: </strong>vascular diameters after 6 weeks of exercise. Secondary endpoints: cephalic vein diameters and blood flow 6 weeks after surgery and change in vascular diameters between baseline and after exercise after tourniquet application (vascular compliance).</p><p><strong>Results: </strong>A non-significant increase of cephalic vein diameters at the elbow after exercise was found. Subgroup analysis of patients that showed increased forearm force after 6 weeks of training, revealed an increased diameter of the cephalic vein at the elbow with tourniquet inflation (+0.73 vs -0.25 mm, <i>p</i> = 0.037) and a greater increase in compliance of the cephalic vein at the elbow (+0.61 vs -0.34 mm, <i>p</i> = 0.045), when compared to patients without exercises. No difference in cephalic vein diameters at the level of the wrist, or in AVF maturation was found (50% <i>p</i> > 0.999).</p><p><strong>Conclusion: </strong>The PINCH study was a randomized trial to evaluate the effect of pre-operative, supervised forearm exercises on vein diameters in patients with end stage kidney disease, and the first to evaluate supervised forearm exercises in this population. This trial shows that response to forearm exercise relies on adherence to the training program, with a positive effect on cephalic vein diameters at the elbow and a positive effect on the cephalic vein compliance without change in maturation rates.</p>","PeriodicalId":56113,"journal":{"name":"Journal of Vascular Access","volume":" ","pages":"11297298251350745"},"PeriodicalIF":1.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Parth S Patel, Ashley Battenberg, Emma Wetmore, Mauricio F Jin, Aditya Devalapalli
{"title":"Ischemic monomelic neuropathy as a consequence of intraoperative in-sheath thrombosis.","authors":"Parth S Patel, Ashley Battenberg, Emma Wetmore, Mauricio F Jin, Aditya Devalapalli","doi":"10.1177/11297298251360931","DOIUrl":"https://doi.org/10.1177/11297298251360931","url":null,"abstract":"<p><p>Ischemic monomelic neuropathy (IMN) is a rare peripheral neuropathy caused by limb ischemia and subsequent nerve degeneration, typically manifesting with unilateral pain, paresthesia, and numbness without overt signs of limb ischemia. This case report describes a 59-year-old female with extensive peripheral artery disease who developed IMN in her right lower extremity following an acute, intraoperative in-sheath thrombosis during a right femoral endarterectomy and external iliac artery stent placement, a rare etiology distinct from the more commonly reported associations with bypass surgery or hemodialysis access. Despite successful intraoperative revascularization, the patient developed diminished motor and sensory function with unremitting pain, and subsequent electromyography confirmed a length-dependent neuropathy with features of denervation, consistent with IMN. This case underscores the critical need for clinicians to consider IMN in the differential diagnosis of post-procedural neuropathic pain, even in the absence of classic ischemic signs and following seemingly successful vascular interventions, as acute thrombotic events during vascular procedures can precipitate this debilitating condition.</p>","PeriodicalId":56113,"journal":{"name":"Journal of Vascular Access","volume":" ","pages":"11297298251360931"},"PeriodicalIF":1.7,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Cephalic vein reimplantation for treating cephalic arch stenosis: A novel surgical approach.","authors":"Jithin Jagan Sebastian, Bricilla Gnana Preethe, Sairam Subramanian","doi":"10.1177/11297298251359033","DOIUrl":"https://doi.org/10.1177/11297298251359033","url":null,"abstract":"<p><p>Cephalic arch stenosis (CAS) is a well-recognized complication associated with brachiocephalic arteriovenous fistulas (BCAVFs), often necessitating intervention when symptomatic due to elevated venous pressures. We report the case of a 58-year-old lady with end-stage renal disease undergoing long-term hemodialysis via a left-sided BCAVF. She presented with progressively increased bleeding from puncture sites following dialysis sessions attributed to cephalic arch stenosis .A fistulography revealed a tortuous, zigzag-shaped stenosis at the terminal segment of the cephalic vein near the cephalo-axillary junction. The patient underwent a surgical resection of the stenotic segment and end-to-side reimplantation of the cephalic vein onto the axillary vein, through a single infraclavicular incision. The procedure was well tolerated. Postoperative outcomes included a marked reduction in venous pressures and resolution of symptoms, with stable fistula function over a 9-month follow-up period. This report highlights a novel surgical approach to cephalic arch stenosis, detailing its indications and potential advantages.</p>","PeriodicalId":56113,"journal":{"name":"Journal of Vascular Access","volume":" ","pages":"11297298251359033"},"PeriodicalIF":1.7,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marco Simone, Cristiana Reverberi, Silvia Cavalli, Stefano Elli
{"title":"Use of oblique-axis view with in-plane venipuncture in PICC insertion: A case report.","authors":"Marco Simone, Cristiana Reverberi, Silvia Cavalli, Stefano Elli","doi":"10.1177/11297298251356771","DOIUrl":"https://doi.org/10.1177/11297298251356771","url":null,"abstract":"<p><p>Peripherally inserted central catheters are increasingly utilized, but placement can be challenging due to anatomical constraints and the need for an adequate catheter-to-vein ratio and optimal exit site positioning. This paper presents a novel approach combining in-plane oblique axis ultrasound guidance with pseudotunneling for catheter insertion in a complex anatomical scenario. A patient requiring long-term venous access presented with a target vein located near the axillary cavity, positioned beneath the axillary artery and musculocutaneous nerve, precluding the standard short axis out-of-plane puncture. Therefore, an in-plane oblique axis technique was employed, enabling continuous real-time visualization of surrounding structures and the needle's trajectory. This approach facilitated safe vein cannulation while creating a subcutaneous pseudotunnel to relocate the exit site to the desired green zone. The technique, described through a clinical case, involved oblique probe angulation, in-plane needle insertion, and pseudotunnel creation. This method demonstrates the feasibility and safety of in-plane oblique-axis ultrasound guidance combined with pseudotunneling for catheter insertion in challenging anatomical conditions, ensuring an optimal catheter-to-vein ratio and appropriate exit site placement.</p>","PeriodicalId":56113,"journal":{"name":"Journal of Vascular Access","volume":" ","pages":"11297298251356771"},"PeriodicalIF":1.7,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shen Chen, Chang Sheng, Xianwei Wang, Wei Wang, Zhou Cai
{"title":"Internal jugular vein bypass for central venous obstruction with associated visual impairment.","authors":"Shen Chen, Chang Sheng, Xianwei Wang, Wei Wang, Zhou Cai","doi":"10.1177/11297298251335828","DOIUrl":"https://doi.org/10.1177/11297298251335828","url":null,"abstract":"<p><p>Central venous obstruction (CVO) is a common complication in hemodialysis (HD) patients that can lead to rare but potentially reversible visual impairment (VI). We report the case of a 50-year-old female with end-stage renal disease and uremic cardiomyopathy, who had received HD through a left radiocephalic arteriovenous fistula (AVF) for 6 years. She presented with progressive swelling in her left arm, chest wall, and face over the past year, along with vision loss and diplopia in the last 6 months. Angiography revealed occlusion of the left brachiocephalic vein. After unsuccessful percutaneous transluminal angioplasty attempts, she underwent a left-to-right internal jugular vein (IJV) bypass to maintain AVF function. The vascular graft was placed between the trachea and neck skin. Postoperatively, significant swelling reduction and partial vision restoration were noted. At a 2-year follow-up, the graft remained patent, allowing normal HD procedures. This surgical method may be a viable alternative after failed endovascular treatment for CVO, effectively preserving venous access, prolonging HD sustainability, and potentially reversing CVO-related VI.</p>","PeriodicalId":56113,"journal":{"name":"Journal of Vascular Access","volume":" ","pages":"11297298251335828"},"PeriodicalIF":1.7,"publicationDate":"2025-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144735582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}