Vascular Access News

When it comes to selecting a vascular access type for a patient with late-stage CKD or ESKD, the arteriovenous fistula, once labelled the ‘gold standard’ for creating permanent access, may not always be the ideal one, according to a viewpoint published in the Clinical Journal of the American Society of Nephrology.

DALLAS — The long-term outcomes and complications of tunneled hemodialysis access in children with ESRD depend on a variety of factors, with infection rarely being an indication of replacement, according to findings presented at the Annual Dialysis Conference.

Israeli company Laminate Medical Technologies has secured $12 million to support development of its vascular support device. The investment round included Asahi Kasei, a Japanese company that makes hemodialyzers.

CMS has approved a separate reimbursement code for the Ellipsys Vascular Access System, which is made by Avenu Medical Inc.

SAN DIEGO — At ASN Kidney Week 2018, Annamaria T. Kausz, MD, MS, discussed two phase III trials that evaluated the safety and efficacy of ALLN-177 in patients with enteric hyperoxaluria.

According to recently published results, insurance-related disparities in the use of arteriovenous fistulas and grafts in patients who underwent dialysis continued through the fourth month of dialysis and may not fully correct after patients obtain Medicare coverage. In addition, these disparities were linked to greater risk of vascular access infections.

Improvement of the clinical practice guidelines for chronic hemodialysis patients has become a priority for CMS.1,2 The use of an arteriovenous fistula has become widely endorsed as the optimal vascular access device. The other two commonly used access modalities include an arteriovenous graft and a central venous catheter.

Fifteen years ago, CMS launched the Fistula First Breakthrough Initiative to encourage greater use of the arteriovenous fistula among patients with end-stage renal disease. The natural anastomosis created by using the vein and the artery was considered the “gold standard” in nephrology care – both in the United States and abroad – for its longevity, superior delivery of high blood flows and fewer infections compared to the use of the synthetic arteriovenous graft and the central venous catheter.

The use of 3-D images to survey the progress of a maturing arteriovenous fistula can help clinicians determine whether the access will need modifications or be useable over time, a recently published study shows.

Given a limited time on dialysis and poor vasculature, elderly patients initiating hemodialysis therapy may face more access-related complications with an arteriovenous fistula than with an arteriovenous graft, a study shows.