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End-stage vascular access failure: can we define and can we classify?

BACKGROUND: Renal replacement therapy using dialysis has evolved dramatically over recent years with an improvement in patient survival. With this increased longevity, a cohort of patients are in the precarious position of having exhausted the standard routes of vascular access. The extent of this p...

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Autores principales: Al Shakarchi, Julien, Nath, Jay, McGrogan, Damian, Khawaja, Aurangzaib, Field, Melanie, Jones, Robert G., Inston, Nicholas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4581375/
https://www.ncbi.nlm.nih.gov/pubmed/26413286
http://dx.doi.org/10.1093/ckj/sfv055
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author Al Shakarchi, Julien
Nath, Jay
McGrogan, Damian
Khawaja, Aurangzaib
Field, Melanie
Jones, Robert G.
Inston, Nicholas
author_facet Al Shakarchi, Julien
Nath, Jay
McGrogan, Damian
Khawaja, Aurangzaib
Field, Melanie
Jones, Robert G.
Inston, Nicholas
author_sort Al Shakarchi, Julien
collection PubMed
description BACKGROUND: Renal replacement therapy using dialysis has evolved dramatically over recent years with an improvement in patient survival. With this increased longevity, a cohort of patients are in the precarious position of having exhausted the standard routes of vascular access. The extent of this problem of failed access or ‘desperate measures’ access is difficult to determine, as there are no uniform definitions or classification allowing standardization and few studies have been performed. The aim of this study is to propose a classification of end-stage vascular access (VA) failure and subsequently test its applicability in a dialysis population. METHODS: Using anatomical stratification, a simple hierarchical classification is proposed. This has been applied to a large dialysis population and in particular to patients referred to the complex access clinic dedicated to patients identified as having exhausted standard VA options and also those dialysing on permanent central venous catheters (CVC). RESULTS: A simple classification is proposed based on a progressive anatomical grading of (I) standard upper arm options exhausted, (II) femoral options exhausted and (III) other options exhausted. These are further subdivided anatomically to allow ease of classification. When applied to a complex group of patients (n = 145) referred to a dedicated complex access clinic, 21 patients were Class I, 26 Class II and 2 Class III. Ninety-six patients did not fall into the classification despite being referred as permanent CVC. CONCLUSIONS: The numbers of patients who have exhausted definitive access options will continue to increase. This simple classification allows the scope of the problem and proposed solutions to be identified. Furthermore, these solutions can be studied and treatments compared in a standardized fashion. The classification may also be applied if patients have the option of transplantation where iliac vessel preservation is desirable and prioritization policies may be instituted.
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spelling pubmed-45813752015-09-25 End-stage vascular access failure: can we define and can we classify? Al Shakarchi, Julien Nath, Jay McGrogan, Damian Khawaja, Aurangzaib Field, Melanie Jones, Robert G. Inston, Nicholas Clin Kidney J Contents BACKGROUND: Renal replacement therapy using dialysis has evolved dramatically over recent years with an improvement in patient survival. With this increased longevity, a cohort of patients are in the precarious position of having exhausted the standard routes of vascular access. The extent of this problem of failed access or ‘desperate measures’ access is difficult to determine, as there are no uniform definitions or classification allowing standardization and few studies have been performed. The aim of this study is to propose a classification of end-stage vascular access (VA) failure and subsequently test its applicability in a dialysis population. METHODS: Using anatomical stratification, a simple hierarchical classification is proposed. This has been applied to a large dialysis population and in particular to patients referred to the complex access clinic dedicated to patients identified as having exhausted standard VA options and also those dialysing on permanent central venous catheters (CVC). RESULTS: A simple classification is proposed based on a progressive anatomical grading of (I) standard upper arm options exhausted, (II) femoral options exhausted and (III) other options exhausted. These are further subdivided anatomically to allow ease of classification. When applied to a complex group of patients (n = 145) referred to a dedicated complex access clinic, 21 patients were Class I, 26 Class II and 2 Class III. Ninety-six patients did not fall into the classification despite being referred as permanent CVC. CONCLUSIONS: The numbers of patients who have exhausted definitive access options will continue to increase. This simple classification allows the scope of the problem and proposed solutions to be identified. Furthermore, these solutions can be studied and treatments compared in a standardized fashion. The classification may also be applied if patients have the option of transplantation where iliac vessel preservation is desirable and prioritization policies may be instituted. Oxford University Press 2015-10 2015-07-05 /pmc/articles/PMC4581375/ /pubmed/26413286 http://dx.doi.org/10.1093/ckj/sfv055 Text en © The Author 2015. Published by Oxford University Press on behalf of ERA-EDTA. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Contents
Al Shakarchi, Julien
Nath, Jay
McGrogan, Damian
Khawaja, Aurangzaib
Field, Melanie
Jones, Robert G.
Inston, Nicholas
End-stage vascular access failure: can we define and can we classify?
title End-stage vascular access failure: can we define and can we classify?
title_full End-stage vascular access failure: can we define and can we classify?
title_fullStr End-stage vascular access failure: can we define and can we classify?
title_full_unstemmed End-stage vascular access failure: can we define and can we classify?
title_short End-stage vascular access failure: can we define and can we classify?
title_sort end-stage vascular access failure: can we define and can we classify?
topic Contents
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4581375/
https://www.ncbi.nlm.nih.gov/pubmed/26413286
http://dx.doi.org/10.1093/ckj/sfv055
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