Effect of Chinese Herbal Fomentation on Arteriovenous Fistula Maturation

Abstract

Objectives:

The study objectives were to examine the effects of Chinese herbal fomentation on radiocephalic arteriovenous fistula (AVF) maturation.

Methods:

All patients' preoperative evaluation, operative procedure, and follow-up information records were reviewed to identify patients undergoing radiocephalic AVF procedures for maintenance hemodialysis. All patients underwent preoperative vessel ultrasound. The ultrasound examinations were repeated every 2 months after the operative procedure. From the day after the operation, the forearm of the patient is fomented with a mixture of Dan Shen and Hong Hua in dry powdered form dissolved in fresh warm water. The fomentation lasted for 60 minutes, once a day for 28 consecutive days.

Results:

Sixty-four (64) specific access site operations were yielded in 62 patients for analysis. Forty-nine (49; 76.6%) of the 64 fistulas were considered sonographically mature and 15 (23.4%) were deemed sonographically immature. The sonographically mature fistulas (n=46) that were suitable for puncture had blood flow of 655±132 mL/minute, and venous diameter of 4.5±0.3 mm. The most frequent complication was thrombosis before first use, which accounted for 6 AVFs failures to mature (0.16 per patient-year). There were two hospitalizations for fistula-related bacteremia in the group (0.05 per patient-year).

Conclusions:

The Chinese herbal fomentation reduced the frequency of early thrombosis of new AVFs and was accompanied by an increase in the proportion of AVFs that were suitable for dialysis.

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References

NKF-DOQI clinical practice guidelines for vascular access. National Kidney Foundation-Dialysis Outcome Quality Initiative. Am J Kidney Dis, 1997; 30,4 suppl 3:S150–S191.

Lacson

Jr , Lazarus

, Himmelfarb

et al. Balancing fistula first with catheters last. Am J Kidney Dis, 2007; 50:379–395.

Newman

, Standreness

JDE

, van Breda

. Failing hemodialysis access sites: Angiographic findings and management with balloon angioplasty. 2. Philadelphia: Churchill Livingstone, 1994; 1077–1086.

Bao

, Lin

, Lu

et al. Therapeutic effect observation for the preservation of internal arteriovenous fistula with the recipe-steeping hands with Chinese medicine. J Liaoning Univ Trad Chin Med, 2008; 10:98–99.

Robbin

, Chamberlain

, Lockhart

et al. Hemodialysis arteriovenous fistula maturity: US evaluation. Radiology, 2002; 225:59–64.

Sidawy

, Gray

, Besarab

et al. Recommended standards for reports dealing with arteriovenous hemodialysis accesses. J Vasc Surg, 2002; 35:603–610.

Dhingra

, Young

, Hulbert-Shearon

et al. Type of vascular access and mortality in U.S. hemodialysis patients. Kidney Int, 2001; 60:1443–1451.

Allon

, Lockhart

, Lilly

et al. Effect of preoperative sonographic mapping on vascular access outcomes in hemodialysis patients. Kidney Int, 2001; 60:2013–2020.

Won

, Jang

, Lee

et al. Effects of intraoperative blood flow on the early patency of radiocephalic fistulas. Ann Vasc Surg, 2000; 14:468–472.

10.

Lazarides

, Iatrou

, Karanikas

et al. Factors affecting the lifespan of autologous and synthetic arteriovenous access routes for haemodialysis. Eur J Surg, 1996; 162:297–301.

11.

Brimble

, Rabbat

, Schiff

et al. The clinical utility of Doppler ultrasound prior to arteriovenous fistula creation. Semin Dial, 2001; 14:314–317.

12.

Miller

, Tolwani

, Luscy

et al. Predictors of adequacy of arteriovenous fistulas in hemodialysis patients. Kidney Int, 1999; 56:275–280.

13.

Beathard

. Strategy for maximizing the use of arteriovenous fistulae. Semin Dial, 2000; 13:291–296.

14.

Parmley

, Broughan

, Jennings

. Vascular ultrasonography prior to dialysis access surgery. Am J Surg, 2002; 184:568–572.

15.

Silva

, Hobson

, Pappas

et al. A strategy for increasing use of autogenous hemodialysis access procedures: Impact of preoperative noninvasive evaluation. J Vasc Surg, 1998; 27:302–308.

16.

Vassalotti

. How can the use of arteriovenous fistulas be increased? Semin Dial, 2003; 16:221–223.

17.

Malovrh

. The role of sonography in the planning of arteriovenous fistulas for hemodialysis. Semin Dial, 2003; 16:299–303.

18.

Silva

, Hobson

, Pappas

et al. Vein transposition in the forearm for autogenous hemodialysis access. J Vasc Surg, 1997; 26:981–988.

19.

Jennings

, Wood

. Role of vein patch angioplasty in isolated operations for profunda femoris stenosis and disabling claudication. Am J Surg, 1985; 150:263–265.

20.

Brescia

, Cimino

, Appel

et al. Chronic hemodialysis using venipuncture and a surgically created arteriovenous fistula. NEJM, 1966; 275:1089–1092.

21.

Goldstein

, Gupta

. Use of the radial artery for hemodialysis access. Arch Surg, 2003; 138:1130–1134.

22.

III. NKF-K/DOQI Clinical Practice Guidelines for Vascular Access: Update 2000. Am J Kidney Dis, 2001; 37:S137–S181.

23.

Bay

, Henry

, Lazarus

et al. Predicting hemodialysis access failure with color flow Doppler ultrasound. Am J Nephrol, 1998; 18:296–304.

24.

Lin

, Huang

, Chen

et al. Effects of age and diabetes on blood flow rate and primary outcome of newly created hemodialysis arteriovenous fistulas. Am J Nephrol, 1998; 18:96–100.

25.

Wong

, Ward

, Taylor

et al. Factors associated with early failure of arteriovenous fistulae for haemodialysis access. Eur J Vasc Endovasc Surg, 1996; 12:207–213.

26.

, Xu

. Effect of acetylsalvianolic acid A on platelet function. Acta Pharmaceut Sin, 1994; 29:412–416.

27.

, Xu

. Acetylsalvianolic acid A: a new thromboxane synthetase inhibitor. Acta Pharmaceut Sin, 1997; 32:467–469.

28.

Liu

, Li

et al. The effect of the extracting from Carthamus tinctorius L. on platelet aggregation and thrombosis. Pharmacol Clin Chin Materia Med, 2000; 16:20–21.

29.

NKF-K/DOQI clinical practice guidelines for vascular access. Am J Kidney Dis, 2006; 48,suppl 1:S248–S273.

30.

Fan

, Schwab

. Vascular access: Concepts for the 1990s [Editorial] J Am Soc Nephrol, 1992; 3:1–11.

31.

Twardowski

. Percutaneous blood access for hemodialysis. Semin Dial, 1995; 8:175–186.

32.

Feldman

, Held

, Hutchinson

et al. Hemodialysis vascular access morbidity in the United States. Kidney Int, 1993; 43:1091–1096.