Effects of Intraoperative Blood Flow on the Early Patency of Radiocephalic Fistulas

Won, Taehee; Jang, Jin-Wook; Lee, Seok; Han, Jae Jin; Park, Young Sik; Ahn, Jae Ho

doi:10.1007/s100169910082

Cited by 78 publications

(60 citation statements)

References 15 publications

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“…1,4,27 Although the presence of a thrill has previously been used as evidence of technical success, clinical criteria are known to predict eventual maturation poorly. 13 In one study, Won and colleagues found that 93% of fistulas which failed to mature to be used for dialysis had a thrill present postoperatively. 13 To avoid presenting potentially misleading data, particularly in the group of patients who never proceeded to haemodialysis, we have not used this subjective clinical sign as a measure of success.…”

Section: Discussionmentioning

confidence: 99%

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The impact of training on outcomes in primary vascular access surgery

Weale

Barwell²,

Chant³

et al. 2004

Ann R Coll Surg Engl

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Background: There is evidence that the outcome of arteriovenous fistula surgery is dependent on the surgeon performing the operation. Vascular access surgery provides excellent technical training for surgical trainees. The effect of surgical trainees on the outcome of fistulas was evaluated. Methods: The grade of the main operator for all first attempted (primary) upper limb arteriovenous fistulas, between February 1998 and August 2001, was identified. Median follow-up was 18.0 months (IQR, 6.5-30.1 months). Successful use of fistula for dialysis, fistula patency and survival were assessed. Results: 441 primary fistulas were formed in the study period. Median age was 67.5 years (IQR, 54.0-75.2 years). 71% of all fistulas were formed at the wrist. Trainees performed 31.1% of all operations. The two groups (trainees and consultants) were well matched for age, sex, diabetes, and fistula type. Only 70.5% of patients proceeded to long-term haemodialysis. There were no significant differences in the successful use of AVF for dialysis or patency rates between the two groups. One and two year fistula survival in this group was 87.7% and 78.3% for trainees and 80.8% and 71.1% for consultants (P = 0.288 log rank). Conclusions: Surgical trainees can perform primary AVF surgery without significantly reducing fistula outcomes. Vascular access surgery can be utilised as a training operation.

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Section: Discussionmentioning

confidence: 99%

“…Presence or absence of a thrill was not used to define technical success, as the simple presence of a thrill does not determine whether a fistula will mature to become usable or can be used for dialysis. 13 Postoperative duplex assessment of fistulas was not performed routinely and, as such, flow measurements were not uniformly available.…”

Section: Outcomementioning

confidence: 99%

The impact of training on outcomes in primary vascular access surgery

Weale

Barwell²,

Chant³

et al. 2004

Ann R Coll Surg Engl

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“…Various studies have documented that the increments in blood flow begin to occur soon after the construction of an AVF in a great majority of cases (6,(12)(13)(14)(15)(16)(17)(18)(19) (Figure 2A). A recent report demonstrated changes in blood flow in an AVF after its construction (6).…”

Section: Timing Of Changes In Blood Flow and Diameter In A Newly Creamentioning

confidence: 99%

“…A recent report demonstrated changes in blood flow in an AVF after its construction (6). The authors investigated 50 radiocephalic fistulae.…”

Section: Timing Of Changes In Blood Flow and Diameter In A Newly Creamentioning

confidence: 99%

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Early Arteriovenous Fistula Failure

Asif

Roy‐Chaudhury²,

Beathard³

2006

Clinical Journal of the American Society of Nephrology

269

213

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A significant number of arteriovenous fistulae (28 to 53%) never mature to support dialysis. Often, renal physicians and surgeons wait for up to 6 months and even longer hoping that the arteriovenous fistula (AVF) will eventually grow to support dialysis before declaring that the AVF has failed. In the interim, if dialysis is needed, then a tunneled catheter is inserted, exposing the patient to the morbidity and mortality associated with the use of this device. In general, a blood flow of 500 ml/min and a diameter of at least 4 mm are needed for an AVF to be adequate to support dialysis therapy. In most successful fistulae, these parameters are met within 4 to 6 wk. Most important, commonly encountered problems (stenosis and accessory veins) that result in early AVF failure can be diagnosed easily with skillful physical examination. Recent studies have indicated that a great majority of fistulae that have failed to mature adequately can be salvaged by percutaneous interventions and become available for dialysis. Early intervention regarding identification and salvage of a nonmaturing AVF is critical for several reasons. First, an AVF is the best available type of access regarding complications, costs, morbidity, and mortality. Second, this approach minimizes catheter use and its associated complications. Finally, access stenosis is a progressive process and eventually culminates in complete occlusion, leading to access thrombosis. In this context, the opportunity to salvage the AVF that fails early may be lost. This report reviews the process of AVF maturation and suggests a strategy for when and how to intervene to identify and salvage AVF with early failure.

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AIUM Practice Parameter for the Performance of Vascular Ultrasound Examinations for Postoperative Assessment of Hemodialysis Access

2020

J of Ultrasound Medicine

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Effects of Intraoperative Blood Flow on the Early Patency of Radiocephalic Fistulas

Cited by 78 publications

References 15 publications

The impact of training on outcomes in primary vascular access surgery

The impact of training on outcomes in primary vascular access surgery

Early Arteriovenous Fistula Failure

AIUM Practice Parameter for the Performance of Vascular Ultrasound Examinations for Postoperative Assessment of Hemodialysis Access

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