Snuffbox fistula – a first-line approach to haemodialysis: A review

Idrees, Marwan; Suthananthan, Arul; Pathmarajah, Tishanthan; Sieunarine, Kishore

doi:10.1177/1129729819867817

Cited by 7 publications

(4 citation statements)

References 21 publications

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“…distal vascular access which is deemed feasible. The anatomic snuffbox fistulae seem to be a safe and reliable alternative for wrist and elbow AVF [35][36][37].…”

Section: Discussionmentioning

confidence: 99%

The impact of location and patency of the arteriovenous fistula on quality of life of kidney transplant recipients

et al. 2021

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“…distal vascular access which is deemed feasible. The anatomic snuffbox fistulae seem to be a safe and reliable alternative for wrist and elbow AVF [35][36][37].…”

Section: Discussionmentioning

confidence: 99%

The impact of location and patency of the arteriovenous fistula on quality of life of kidney transplant recipients

et al. 2021

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“…More attention should be given to avoid the creation of high flow AVFs. The shift toward the creation of AVFs at the snuffbox seems to be the right direction ( 37 , 38 ). We would also advise the routine evaluation of VA in KTx recipients at 1 year after transplantation to stratify the risk of a potential negative cardiovascular effect.…”

Section: Discussionmentioning

confidence: 99%

Vascular Access Perspectives in Patients After Kidney Transplantation

et al. 2021

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Introduction: More attention has been paid to the influence of arteriovenous fistula (AVF) on the cardiovascular system. In renal transplant recipients, some beneficial effect of an elective vascular access (VA) ligation was observed in patients with a high AVF flow. However, this strategy is not widely accepted and is in contradiction to the rule of vasculature preservation for possible future access. The aim of our study is to elucidate the vascular access function and VA perspective in the kidney transplantation (KTx) population.Materials and Methods: KTx patients with a stable graft function were recruited to participate in this single center observational study (NCT04478968). The measurement of VA flow and vessel mapping for future vascular access was performed by a color Doppler ultrasound. The study group included 99 (63%) males and 58 (37%) females; the median age was 57 (IQR 48–64) years. The median time from the transplantation to the baseline visit was 94 (IQR 61–149) months. Median serum creatinine concentration was 1.36 (IQR 1.13–1.67) mg/dl.Results: Functioning VA was found in 83 out of 157 (52.9%) patients. The sites were as follows: snuffbox in six (7.2%), wrist in 41 (49.4%), distal forearm in 18 (21.7%), middle or proximal forearm in eight (9.6%), upper-arm AV graft in one (1.2%), and upper-arm AVFs in nine (10.8%) patients, respectively. Blood flow ranged from 248 to 7,830 ml/min; the median was 1,134 ml/min. From the transplantation to the study visit, 66 (44.6%) patients experienced access loss. Spontaneous thrombosis was the most common, and it occurred in 60 (90.9%) patients. The surgical closure of VA was performed only in six (4%) patients of the study group with a functioning VA at the time of transplantation. Access loss occurred within the 1st year after KTx in 33 (50%) patients. Majority (50 out of 83, 60.2%) of the patients with an active VA had options to create a snuffbox or wrist AVF on the contralateral extremity. In a group of 74 patients without a functioning VA, the creation of a snuffbox or wrist AVF on the non-dominant and dominant extremity was possible in seven (9.2%) and 40 (52.6%) patients, respectively. In 10 (13.1%) patients, the possibilities were limited only to the upper-arm or proximal forearm VA on both sides. Access ligation was considered by 15 out of 83 (18.1%) patients with a patent VA.Conclusions: In the majority of the patients, vascular access blood flow was below the threshold of the negative cardiovascular effect of vascular access. Creation of a distal AVF is a protective measure to avoid a high flow and preserve the vessels for future access. The approach to VA should be individualized and adjusted to the patient's profile.

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“…However, creating AVF at the wrist level is the most common and preferred method to gain access. 3 It has been documented that thrombus formation and failure to mature (FTM) rates pose a barrier to the development of a functional AVF. In European and American hemodialysis patients FTM rates were reported to be 24% and 60% respectively.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of AV fistula formation for dialysis patients using interrupted sutures one-year single center study

Naz,

Javaid,

Noor

et al. 2024

Pak J Med Sci

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Objectives: To document the Outcomes of AV fistula formation for dialysis patients using interrupted sutures. Methods: In this Cross-sectional study conducted at PNS Shifa Karachi, from June 2022 to June 2023, patients above 18 years of age, male or female, with ESRD/CKD were included. After clinical screening and ultrasound doppler, the distal most part of wrist was considered as a site for radio cephalic AVF. Operation was performed under surgical loupe with 4.5x magnification. Standard incision of about 4-5 cm oblique proximal to the wrist crease was given at the volar surface on the radial side of Distal forearm, extending till the lateral side up to the snuffbox. Subcutaneous tissue was incised and dissection was done to identify the cephalic vein and radial artery. Distal most end of the cephalic vein was ligated using vicryl 4-0 suture and cephalic vein dissected free from the underling tissue to mobilize it up to the radial artery. Results: During the study N=35 patients who required AVF creation visited the department. The mean age of the study participants was 59.34±15.48. If thrill at the site of AVF and backflow at cut end of cephalic vein were present the surgeons were satisfied, higher satisfaction among the surgeon was achieved in the AVF created at brachiocephalic artery while the diameter of vessels didn’t contribute in surgeon satisfaction. Conclusion: Presence of thrill at the site of AVF and backflow at cut end of cephalic vein have strong association with good prognosis of AVF. doi: https://doi.org/10.12669/pjms.40.5.8990 How to cite this: Naz F, Javaid RH, Noor S, Katpar H. Outcomes of AV fistula formation for dialysis patients using interrupted sutures one-year single center study. Pak J Med Sci. 2024;40(5):---------. doi: https://doi.org/10.12669/pjms.40.5.8990 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Snuffbox fistula – a first-line approach to haemodialysis: A review

Cited by 7 publications

References 21 publications

The impact of location and patency of the arteriovenous fistula on quality of life of kidney transplant recipients

The impact of location and patency of the arteriovenous fistula on quality of life of kidney transplant recipients

Vascular Access Perspectives in Patients After Kidney Transplantation

Outcomes of AV fistula formation for dialysis patients using interrupted sutures one-year single center study

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