Collateral Ligation in Failing Fistulas
| Status: | Recruiting |
|---|---|
| Conditions: | Hospital |
| Therapuetic Areas: | Other |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 12/15/2018 |
| Start Date: | May 14, 2018 |
| End Date: | March 31, 2020 |
| Contact: | Zubin Irani, MD |
| Email: | zirani@mgh.harvard.edu |
| Phone: | 617-643-0765 |
Prospective Randomized Evaluation of the Effect of Ligation of Venous Side Branches in Dialysis Arteriovenous Fistulas Presenting With Failure to Mature
Arteriovenous fistulas (AVFs) for hemodialysis often fail to become usable due to failure to
mature (FTM). The most common cause is narrowing of the artery or vein (stenosis). Another
potential cause is the presence of collateral or side branch veins that steal blood flow from
the main fistula channel. Some believe that occluding these veins might help maturation of
those failing AVFs. To evaluate if this actually works, patients with FTM will be randomly
assigned to side branch vein ligation (or not), and rates of AVF maturation of the two groups
will be compared.
mature (FTM). The most common cause is narrowing of the artery or vein (stenosis). Another
potential cause is the presence of collateral or side branch veins that steal blood flow from
the main fistula channel. Some believe that occluding these veins might help maturation of
those failing AVFs. To evaluate if this actually works, patients with FTM will be randomly
assigned to side branch vein ligation (or not), and rates of AVF maturation of the two groups
will be compared.
Arteriovenous fistulas (AVFs) for hemodialysis often fail to become usable due to failure to
mature (FTM). The most common cause is stenosis of the artery or vein. Another potential
cause is the presence of collateral or side branch veins that steal blood flow from the main
fistula channel. The utility of ligating these veins to improve maturation of those failing
AVFs is controversial. To evaluate this, 35 patients presenting for fistulograms for
evaluation of AVFs with FTM, found to have side branch veins will be prospectively enrolled.
After management of stenoses (if present), they will be randomly assigned to ligation of the
venous side branches or not. Maturation rates for each group will be prospectively assessed.
For patients assigned to the control group who have persistent failure to mature, a
cross-over intervention will be performed and side branch ligation will be offered.
mature (FTM). The most common cause is stenosis of the artery or vein. Another potential
cause is the presence of collateral or side branch veins that steal blood flow from the main
fistula channel. The utility of ligating these veins to improve maturation of those failing
AVFs is controversial. To evaluate this, 35 patients presenting for fistulograms for
evaluation of AVFs with FTM, found to have side branch veins will be prospectively enrolled.
After management of stenoses (if present), they will be randomly assigned to ligation of the
venous side branches or not. Maturation rates for each group will be prospectively assessed.
For patients assigned to the control group who have persistent failure to mature, a
cross-over intervention will be performed and side branch ligation will be offered.
Inclusion criteria:
- Patients with upper extremity autogenous AVF presenting with FTM with evidence of
collaterals on ultrasound and/or clinical exam.
Exclusion criteria:
- Age under 18 years
- Pregnant women
- Prior endovascular or surgical procedure in the fistula after its creation (with the
exception of surgical superficialization or mobilization)
- Clinical evidence of infection associated with the AVF
- Uncorrectable coagulopathy (International Normalized Radio >2.5, platelet count
<50.000/μL)
- Absence of significant venous side branches on angiogram (defined as those that arise
in the initial 10 cm, including the future cannulation zone, and have maximal diameter
greater than or equal to one third of the widest diameter of the fistula's main venous
channel in this segment).
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