Publications by authors named "Evamaria Anvari"

3 Publications

  • Page 1 of 1

New Devices and Technologies for Hemodialysis Vascular Access: A Review.

Am J Kidney Dis 2021 07 6;78(1):116-124. Epub 2021 May 6.

Department of Nephrology and Hypertension, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH; Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.

In the United States, hemodialysis remains the most common treatment modality for kidney failure, chosen by almost 90% of incident patients. A functioning vascular access is key to providing adequate hemodialysis therapy. Recently, major innovations in devices and technology for hemodialysis vascular access care have rapidly changed the landscape. Novel endovascular devices for creation of arteriovenous fistulas may offer a solution to the barriers encountered in initiating maintenance hemodialysis with a permanent vascular access rather than a central venous catheter (CVC). Furthermore, in the prevalent hemodialysis population, the minimally invasive endovascular arteriovenous fistula procedure should help improve long wait times for vascular access creation, which remains a major barrier to reducing CVC dependence. Bioengineered grafts are being developed and may offer another option to polytetrafluoroethylene grafts. Early studies with these biocompatible grafts are promising, as additional studies continue to evaluate their clinical outcomes in comparison to cryopreserved or synthetic options. Prolonging the vascular access patency with appropriate use of devices such as drug-coated balloons and stent grafts may complement the novel techniques of creating arteriovenous access. Finally, innovative solutions to treat stenosed and occluded thoracic central veins can provide an approach to creating a vascular access and allow patients with exhausted vasculature to remain on hemodialysis. The robust developments in hemodialysis vascular access are likely to change practice patterns in the near future.
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http://dx.doi.org/10.1053/j.ajkd.2020.11.027DOI Listing
July 2021

The Hemodialysis Access Surveillance Controversy Continues.

Kidney Int Rep 2020 Nov 2;5(11):1848-1850. Epub 2020 Oct 2.

Department of Hypertension and Nephrology, Glickman Urological and Kidney Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA.

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http://dx.doi.org/10.1016/j.ekir.2020.09.037DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7529591PMC
November 2020

Monitoring and Surveillance of Hemodialysis Access.

Semin Intervent Radiol 2016 Mar;33(1):25-30

Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio.

Access surveillance using invasive or noninvasive methods with an objective to improve access patency and decrease hospital admissions for access dysfunction in dialysis population has been promoted, but its success to predict incipient thrombosis and subsequent access failure is a controversial topic. Some studies have shown improvement in access outcomes, while others have failed to demonstrate an ideal method to diagnose access problems. Furthermore, the use of endovascular interventions such as percutaneous transluminal angioplasty to timely correct access problem might itself be a promoter of neointimal hyperplasia and restenosis during balloon angioplasty. There are significant costs and efforts associated with routine dialysis surveillance; therefore, it is necessary to understand whether such programs will help improve access-related problems and guarantee adequate dialysis care. It is generally agreed upon that despite the lack of guaranteed success of surveillance, such strategies have helped improve dialysis management, resulted in decreased costs and hospitalizations, and represented clinically relevant indications of failure prior to planning any radiological or surgical intervention. In this study, the authors review monitoring and surveillance measures in place, and their associated merits and limitations to detect stenosis and prevent incidences of vascular access thrombosis.
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http://dx.doi.org/10.1055/s-0036-1572548DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4806702PMC
March 2016