Inaccessibilitagrave vascolare e ricorso alla dialisi peritoneale

DOTT A STURNIOLO NEFROLOGIA E DIALISI

C I COLUMBUS ndash UNIVERSITAgrave CATTOLICA DEL SACRO CUORE - ROMA

VI Corso teorico-pratico

Nefrologia Interventistica Roma 6-8 Maggio 2013

The reasons for transfer from haemodialysis to peritoneal were vascular access problems (1325) cardiovascular problems (725) and patients choice (525)

In conclusion

bull In our study patients transferred from haemodialysis to peritoneal dialysis have had a poor outcome on peritoneal dialysis

bull However these patients presented numerous comorbid conditions at peritoneal dialysis initiation which could explain the poor outcome on peritoneal dialysis

Nephrol Ther 2005 mar1(1)38-43 Transfer from chronic haemodialysis to peritoneal dialysis Lobbedez T Crand A Le Roy F Landru I Queacutereacute C Ryckelynck JP Service De Neacutephrologie CHU Clemenceau 14033 Caen Cedex France

The reasons for transfer from haemodialysis to peritoneal were vascular access problems (1325) cardiovascular problems (725) and patients choice (525)

In conclusion

bull In our study patients transferred from haemodialysis to peritoneal dialysis have had a poor outcome on peritoneal dialysis

bull However these patients presented numerous comorbid conditions at peritoneal dialysis initiation which could explain the poor outcome on peritoneal dialysis

Nephrol Ther 2005 mar1(1)38-43 Transfer from chronic haemodialysis to peritoneal dialysis Lobbedez T Crand A Le Roy F Landru I Queacutereacute C Ryckelynck JP Service De Neacutephrologie CHU Clemenceau 14033 Caen Cedex France

Perit Dial Int 2008 may-jun28(3)313-4 Outcomes and risk factors for mortality after transfer from hemodialysis to peritoneal dialysis in uremic patients Zhang X han F he Q huang H yin X ge J chen J Kidney Disease Center The First Affiliated Hospital College of Medicine Zhejiang University Hangzhou Zhejiang Province PR China

bull Our study found that patients that transferred from HD to PD had a

worse outcome than patients that had initiated dialysis with PD which

has been confirmed in non-Chinese patients

bull The causes for transfer consisted of cardiovascular problems (1628)

vascular access problems (628) patient choice (328) and

hemorrhage

Nefrologia 2012 may 1432(3)335-42 Is there impact of mortality prior hemodialysis therapy in peritoneal dialysis patients Koc Y Unsal A Basturk T Sakaci T Ahbap-dal E Sinangil-Arar A Kose-Budak S Kayabasi H Department Of Nephrology Sisli Etfal Research And Educational Hospital Istanbul Turkey

bull Group 1 and group 2 consisted of patients with (n=48) and without (n=251) a history of prior HD respectively

bull 35 (70) and 25 patients (93) have been transferred to PD due to vascular problems in group 1 and 2 respectively (plt0001)

CONCLUSION

bull Our data show that mortality in patients transferred to PD from HD was higher than in patients undergoing PD as first-line therapy Compulsory choice such as vascular access problems and social factors were the most important causes of increasing mortality in patients transferred to PD from HD

Perit Dial Int 199111(2)118-27

A multicenter selection-adjusted

comparison of patient and

technique survivals on CAPD and

hemodialysis

Maiorca R Vonesh EF Cavalli P De

Vecchi A Giangrande A La Greca G

Scarpioni LL Bragantini L Cancarini

GC Cantaluppi A Et Al

Division Of Nephrology University

And Civic Hospital Brescia Italy

Nephrol Dial Transplant 2009 sep24(9)2889-94 Therapy outcome in peritoneal dialysis patients transferred from haemodialysis Liberek T Renke M Skonieczny B Kotewicz K Kowalewska J Chmielewski M Kot J Lichodziejewska-niemierko M Rutkowski B Department Of Nephrology Transplantology And Internal Medicine Medical University Of Gdańsk Poland

bull However in many PD programmes a significant percentage of patients ranging from 15 to 25 has been transferred from HD due to problems experienced during this therapy or patient choice

bull Surprisingly little is known about causes of these transfers and therapy outcome in this group of patients and often the idea of transferring HD patients to PD due to complications appears to be controversial especially among nephrologists who are less experienced with PD

bull In majority of them (43 patients 64) therapy was changed because of vascular access problems in 14 (21) due to heart failure or severe intradialytic hypotension and in 10 (15) due to patient preference

Lazio tipo di accesso vascolare Anni 2001-2011 Prevalenti

J Vasc Interv Radiol 2007 feb18(2)227-35 The natural history of tunneled hemodialysis catheters removed or exchanged a single-institution experience Alomari AI Falk A Department Of Radiology Mount Sinai Medical Center USA

bull Over a 2-year period tunneled hemodialysis catheters that presented to interventional radiology for

removal or exchange were entered into this retrospective study Patient demographics catheter location

dwell time and indication for removal were recorded Pull-back contrast venography was performed with

imaging over the chest Catheters were then removed or exchanged

RESULTS

bull 334 tunneled dialysis catheters were removed or exchanged in 207 patients 108 male median age 53

years Dwell time available from 296 catheters ranged from 1 to 114 days (median 66 days) for a total of

32847 catheter days One hundred three catheters were removed for infection yielding a rate of infection

requiring catheter removal of 30 per 1000 catheter days One hundred catheters were removed for other

working access and 96 catheters were exchanged for poor function Two hundred sixty-five were removed

or exchanged from the internal jugular vein 22 from the subclavian vein and 24 from the femoral vein

One hundred seventy-two (76) of the 226 catheters studied with contrast had fibrin sheaths of which 42

had thrombus identified along the catheter tract One hundred ninety-three catheters were removed and

141 catheters were exchanged for new catheters with 82 catheters receiving balloon disruption of the

fibrin sheath

CONCLUSIONS

bull Fibrin sheaths associated with hemodialysis

catheters are very common

bull Thrombus formation around the sheath is frequent

J Vasc Interv Radiol 2007 feb18(2)227-35 The natural history of tunneled hemodialysis catheters removed or exchanged a single-institution experience Alomari AI Falk A Department Of Radiology Mount Sinai Medical Center USA

bull Over a 2-year period tunneled hemodialysis catheters that presented to interventional radiology for

removal or exchange were entered into this retrospective study Patient demographics catheter location

dwell time and indication for removal were recorded Pull-back contrast venography was performed with

imaging over the chest Catheters were then removed or exchanged

RESULTS

bull 334 tunneled dialysis catheters were removed or exchanged in 207 patients 108 male median age 53

years Dwell time available from 296 catheters ranged from 1 to 114 days (median 66 days) for a total of

32847 catheter days One hundred three catheters were removed for infection yielding a rate of infection

requiring catheter removal of 30 per 1000 catheter days One hundred catheters were removed for other

working access and 96 catheters were exchanged for poor function Two hundred sixty-five were removed

or exchanged from the internal jugular vein 22 from the subclavian vein and 24 from the femoral vein

One hundred seventy-two (76) of the 226 catheters studied with contrast had fibrin sheaths of which 42

had thrombus identified along the catheter tract One hundred ninety-three catheters were removed and

141 catheters were exchanged for new catheters with 82 catheters receiving balloon disruption of the

fibrin sheath

CONCLUSIONS

bull Fibrin sheaths associated with hemodialysis

catheters are very common

bull Thrombus formation around the sheath is frequent

Am J Kidney Dis 1995 may25(5)732-7 Percutaneous translumbar inferior vena cava cannulation for hemodialysis Lund GB Trerotola SO Scheel PJ Jr Russell Morgan Department Of Radiology And Radiologic Sciences Johns Hopkins Medical Institutions Baltimore MD USA

bull Seventeen double-lumen hemodialysis catheters were placed percutaneously from the right flank to the inferior vena cava in 12 patients Catheter placement was successful in all patients Adequate flow rates were obtained Seven episodes of thrombosis-related access failure occurred (033 episodes100 days at risk) Two catheters were removed and five catheters were managed with urokinase infusion Six episodes of infection occurred (028 episodes100 days at risk) Four required catheter removal Two catheters were removed after defects developed in the catheter Five catheters were removed electively because catheter hemodialysis was discontinued Four catheters remained in place Cumulative patency was 52 at 6 months and 17 at 12 months Translumbar inferior vena cava hemodialysis catheters represent a valuable alternative in cases in which traditional catheter sites have failed

J Vasc Surg 2005 aug42(2)286-9 Transthoracic cuffed hemodialysis catheters a method for difficult hemodialysis access Wellons ED Matsuura J Lai KM Levitt A Rosenthal D Atlanta Medical Center GA 30312 USA

bull Recurrent vascular access failure is a major cause of morbidity in patients receiving long-term hemodialysis Central venous catheters are often necessary for dialysis and easily accessed vessels (ie the internal jugular vein and subclavian vein) frequently occlude because of repeated cannulation When standard access sites occlude unconventional access methods become necessary We report a technique of placing hemodialysis catheters directly into the superior vena cava (SVC)

RESULTS

bull In a 24-month period 22 patients underwent transthoracic permanent catheter placement All patients had the permanent catheters successfully inserted Two major complications occurred One patient experienced a pneumothorax and another patient experienced a hemothorax Both patients were successfully treated with chest tube decompression All permanent catheters functioned immediately with a range of 1 to 7 months

CONCLUSIONS

bull Transthoracic permanent catheter placement is an appropriate alternative for patients in whom traditional venous access sites are no longer available

bull We report three patients with

chronic renal failure in

hemodialysis therapy which had

exhausted conventional venous

access in the upper hemitoacuterax

(internal jugular subclavian

axillary) for hemodialysis primarily

due to thrombosis of these veins

by previous catheterization

J Vasc Interv Radiol 2012 aug23(8)1016-21 Radiofrequency wire for the recanalization of central vein occlusions that have failed conventional endovascular techniques Guimaraes M Schonholz C Hannegan C Anderson MB Shi J Selby B Jr Division Of Vascular And Interventional Radiology Medical University Of South Carolina 96 Jonathan Lucas St Charleston SC 29425 USA

bull To report the technique and acute technical results associated with the PowerWire Radiofrequency (RF) Guidewire used to recanalize central vein occlusions (CVOs) after the failure of conventional endovascular techniques

bull A retrospective study was conducted from January 2008 to December 2011 which identified all patients with CVOs who underwent treatment with a novel RF guide wire Forty-two symptomatic patients (with swollen arm or superior vena cava [SVC] syndrome) underwent RF wire recanalization of 43 CVOs which were then implanted with stents The distribution of CVOs in central veins was as follows six subclavian 29 brachiocephalic and eight SVC All patients had a history of central venous catheter placement Patients were monitored with regular clinical evaluations and central venography after treatment

RESULTS

bull All 42 patients had successful recanalization of CVOs facilitated by the RF wire technique There was one complication which was not directly related to the RF wire one case of cardiac tamponade attributed to balloon angioplasty after stent placement Forty of 42 patients (952) had patent stents and were asymptomatic at 6 and 9 months after treatment

CONCLUSIONS

bull The present results suggest that the RF wire technique is a safe and efficient alternative in the recanalization of symptomatic and chronic CVOs when conventional endovascular techniques have failed

J Vasc Interv Radiol 2012 aug23(8)1016-21 Radiofrequency wire for the recanalization of central vein occlusions that have failed conventional endovascular techniques Guimaraes M Schonholz C Hannegan C Anderson MB Shi J Selby B Jr Division Of Vascular And Interventional Radiology Medical University Of South Carolina 96 Jonathan Lucas St Charleston SC 29425 USA

bull To report the technique and acute technical results associated with the PowerWire Radiofrequency (RF) Guidewire used to recanalize central vein occlusions (CVOs) after the failure of conventional endovascular techniques

bull A retrospective study was conducted from January 2008 to December 2011 which identified all patients with CVOs who underwent treatment with a novel RF guide wire Forty-two symptomatic patients (with swollen arm or superior vena cava [SVC] syndrome) underwent RF wire recanalization of 43 CVOs which were then implanted with stents The distribution of CVOs in central veins was as follows six subclavian 29 brachiocephalic and eight SVC All patients had a history of central venous catheter placement Patients were monitored with regular clinical evaluations and central venography after treatment

RESULTS

bull All 42 patients had successful recanalization of CVOs facilitated by the RF wire technique There was one complication which was not directly related to the RF wire one case of cardiac tamponade attributed to balloon angioplasty after stent placement Forty of 42 patients (952) had patent stents and were asymptomatic at 6 and 9 months after treatment

CONCLUSIONS

bull The present results suggest that the RF wire technique is a safe and efficient alternative in the recanalization of symptomatic and chronic CVOs when conventional endovascular techniques have failed

J Vasc Surg 2012 feb55(2)603-6 Radiofrequency thermal wire is a useful adjunct to treat chronic central venous occlusions Iafrati M Maloney S Halin N Department Of Vascular Surgery Tufts Medical Center Boston MA 02111 USA

bull Conventional techniques for central venous recanalization are successful in crossing most lesions but still fail in many patients We used a radiofrequency wire in these failed cases

bull We report three patients with complicated central venous occlusions in whom conventional catheter and guidewire techniques were not successful and who were successfully treated using the PowerWire Radiofrequency Guidewire (Baylis Medical Company Inc Montreal QC Canada)

bull Occlusions were traversed using the radiofrequency wire followed by angioplasty and stenting The average length recanalized was 82 plusmn 36 cm One patient required repeat angioplasty at 4 months

bull All stents were patent at 12 to 15 months

bull The radiofrequency wire is valuable in the management of patients with refractory central venous occlusions

Esperienza personale

Negli ultimi 3 anni

bull 11 casi di stenosi eo ostruzione della vena cava superiore

bull Nellrsquoultimo anno 3 casi di impianto di protesi vascolari

allrsquoarto superiore dopo angioplastica e stent della Vena

Cava Superiore

bull 3 casi di passaggio obbligato alla dialisi peritoneale

Trapianto per condizioni di urgenza il sistema di allocazione dei reni

Conclusioni

bull Iniziare la terapia sostitutiva con la DP per poi passare alla HD al bisogno aumenta la sopravvivenza

bull Con lrsquoesaurimento dei vasi dellrsquoavambraccio per il confezionamento di FAV native utilizzare lrsquoimpianto di protesi vascolari invece dei cateteri cuffiati quando possibile ritarda le complicanze dei vasi venosi centrali

bull La Dialisi Peritoneale va assolutamente considerata nei pazienti con inaccessibilitagrave vascolare

Solo ED

DP -gt ED

J Am Soc Nephrol 2000 11 116-25

Iniziare la terapia sostitutiva con la DP

per poi passare alla HD al bisogno

aumenta la sopravvivenza

Conclusioni

bull Iniziare la terapia sostitutiva con la DP per poi passare alla HD al bisogno aumenta la sopravvivenza

bull Con lrsquoesaurimento dei vasi dellrsquoavambraccio per il confezionamento di FAV native utilizzare lrsquoimpianto di protesi vascolari invece dei cateteri cuffiati quando possibile ritarda le complicanze dei vasi venosi centrali

bull La Dialisi Peritoneale va assolutamente considerata nei pazienti con inaccessibilitagrave vascolare

Conclusioni

bull Iniziare la terapia sostitutiva con la DP per poi passare alla HD al bisogno aumenta la sopravvivenza

bull Con lrsquoesaurimento dei vasi dellrsquoavambraccio per il confezionamento di FAV native utilizzare lrsquoimpianto di protesi vascolari invece dei cateteri cuffiati quando possibile ritarda le complicanze dei vasi venosi centrali

bull La Dialisi Peritoneale va assolutamente considerata nei pazienti con inaccessibilitagrave vascolare

Grazie per lrsquoattenzione

Trapianto per condizioni di urgenza il sistema di allocazione dei reni

Conclusioni

bull Iniziare la terapia sostitutiva con la DP per poi passare alla HD al bisogno aumenta la sopravvivenza

bull Con lrsquoesaurimento dei vasi dellrsquoavambraccio per il confezionamento di FAV native utilizzare lrsquoimpianto di protesi vascolari invece dei cateteri cuffiati quando possibile ritarda le complicanze dei vasi venosi centrali

bull La Dialisi Peritoneale va assolutamente considerata nei pazienti con inaccessibilitagrave vascolare

Solo ED

DP -gt ED

J Am Soc Nephrol 2000 11 116-25

Iniziare la terapia sostitutiva con la DP

per poi passare alla HD al bisogno

aumenta la sopravvivenza

Conclusioni

bull Iniziare la terapia sostitutiva con la DP per poi passare alla HD al bisogno aumenta la sopravvivenza

bull Con lrsquoesaurimento dei vasi dellrsquoavambraccio per il confezionamento di FAV native utilizzare lrsquoimpianto di protesi vascolari invece dei cateteri cuffiati quando possibile ritarda le complicanze dei vasi venosi centrali

bull La Dialisi Peritoneale va assolutamente considerata nei pazienti con inaccessibilitagrave vascolare

Conclusioni

bull Iniziare la terapia sostitutiva con la DP per poi passare alla HD al bisogno aumenta la sopravvivenza

bull Con lrsquoesaurimento dei vasi dellrsquoavambraccio per il confezionamento di FAV native utilizzare lrsquoimpianto di protesi vascolari invece dei cateteri cuffiati quando possibile ritarda le complicanze dei vasi venosi centrali

bull La Dialisi Peritoneale va assolutamente considerata nei pazienti con inaccessibilitagrave vascolare

Grazie per lrsquoattenzione

Conclusioni

bull Iniziare la terapia sostitutiva con la DP per poi passare alla HD al bisogno aumenta la sopravvivenza

bull Con lrsquoesaurimento dei vasi dellrsquoavambraccio per il confezionamento di FAV native utilizzare lrsquoimpianto di protesi vascolari invece dei cateteri cuffiati quando possibile ritarda le complicanze dei vasi venosi centrali

bull La Dialisi Peritoneale va assolutamente considerata nei pazienti con inaccessibilitagrave vascolare

Solo ED

DP -gt ED

J Am Soc Nephrol 2000 11 116-25

Iniziare la terapia sostitutiva con la DP

per poi passare alla HD al bisogno

aumenta la sopravvivenza

Conclusioni

bull Iniziare la terapia sostitutiva con la DP per poi passare alla HD al bisogno aumenta la sopravvivenza

bull Con lrsquoesaurimento dei vasi dellrsquoavambraccio per il confezionamento di FAV native utilizzare lrsquoimpianto di protesi vascolari invece dei cateteri cuffiati quando possibile ritarda le complicanze dei vasi venosi centrali

bull La Dialisi Peritoneale va assolutamente considerata nei pazienti con inaccessibilitagrave vascolare

Conclusioni

bull Iniziare la terapia sostitutiva con la DP per poi passare alla HD al bisogno aumenta la sopravvivenza

bull Con lrsquoesaurimento dei vasi dellrsquoavambraccio per il confezionamento di FAV native utilizzare lrsquoimpianto di protesi vascolari invece dei cateteri cuffiati quando possibile ritarda le complicanze dei vasi venosi centrali

bull La Dialisi Peritoneale va assolutamente considerata nei pazienti con inaccessibilitagrave vascolare

Grazie per lrsquoattenzione

Solo ED

DP -gt ED

J Am Soc Nephrol 2000 11 116-25

Iniziare la terapia sostitutiva con la DP

per poi passare alla HD al bisogno

aumenta la sopravvivenza

Conclusioni

bull Iniziare la terapia sostitutiva con la DP per poi passare alla HD al bisogno aumenta la sopravvivenza

bull Con lrsquoesaurimento dei vasi dellrsquoavambraccio per il confezionamento di FAV native utilizzare lrsquoimpianto di protesi vascolari invece dei cateteri cuffiati quando possibile ritarda le complicanze dei vasi venosi centrali

bull La Dialisi Peritoneale va assolutamente considerata nei pazienti con inaccessibilitagrave vascolare

Conclusioni

bull Iniziare la terapia sostitutiva con la DP per poi passare alla HD al bisogno aumenta la sopravvivenza

bull Con lrsquoesaurimento dei vasi dellrsquoavambraccio per il confezionamento di FAV native utilizzare lrsquoimpianto di protesi vascolari invece dei cateteri cuffiati quando possibile ritarda le complicanze dei vasi venosi centrali

bull La Dialisi Peritoneale va assolutamente considerata nei pazienti con inaccessibilitagrave vascolare

Grazie per lrsquoattenzione

Conclusioni

bull Iniziare la terapia sostitutiva con la DP per poi passare alla HD al bisogno aumenta la sopravvivenza

bull Con lrsquoesaurimento dei vasi dellrsquoavambraccio per il confezionamento di FAV native utilizzare lrsquoimpianto di protesi vascolari invece dei cateteri cuffiati quando possibile ritarda le complicanze dei vasi venosi centrali

bull La Dialisi Peritoneale va assolutamente considerata nei pazienti con inaccessibilitagrave vascolare

Conclusioni

bull Iniziare la terapia sostitutiva con la DP per poi passare alla HD al bisogno aumenta la sopravvivenza

bull Con lrsquoesaurimento dei vasi dellrsquoavambraccio per il confezionamento di FAV native utilizzare lrsquoimpianto di protesi vascolari invece dei cateteri cuffiati quando possibile ritarda le complicanze dei vasi venosi centrali

bull La Dialisi Peritoneale va assolutamente considerata nei pazienti con inaccessibilitagrave vascolare

Grazie per lrsquoattenzione

Conclusioni

bull Iniziare la terapia sostitutiva con la DP per poi passare alla HD al bisogno aumenta la sopravvivenza

bull Con lrsquoesaurimento dei vasi dellrsquoavambraccio per il confezionamento di FAV native utilizzare lrsquoimpianto di protesi vascolari invece dei cateteri cuffiati quando possibile ritarda le complicanze dei vasi venosi centrali

bull La Dialisi Peritoneale va assolutamente considerata nei pazienti con inaccessibilitagrave vascolare

Grazie per lrsquoattenzione

Grazie per lrsquoattenzione