Surgical Techniques for Haemodialysis Access-Induced Distal                     Ischaemia

Shakarchi, Julien Al; Stolba, Jan; Houston, J. Graeme; Inston, Nicholas

doi:10.5301/jva.5000467

Cited by 13 publications

(11 citation statements)

References 33 publications

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“…In line with the current survey, patients identified that care could be improved by encouraging collaborative decision-making between the clinician and the patient. Similarly, Larsen et al [ 32 ] found, in a cohort of 10 medical/surgical patients, that these patients reported communication breakdowns between the inserter and themselves and that this was a cause for concern. These patients were keen to suggest areas for improvement, including insertion techniques, insertion site choice and ways to increase comfort and reduce anxiety, which suggests that they are keen to be more active participants in their care.…”

Section: Discussionmentioning

confidence: 94%

Not "just" an intravenous line: Consumer perspectives on peripheral intravenous cannulation (PIVC). An international cross-sectional survey of 25 countries

et al. 2018

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Peripheral intravascular cannula/catheter (PIVC) insertion is a common invasive procedure, but PIVC failure before the end of therapy is unacceptably high. As PIVC failure disrupts treatment and reinsertion can be distressing for the patient, prevention of PIVC failure is an important patient outcome. Consumer participation in PIVC care to prevent failure is an untapped resource. This study aimed to understand consumers’ PIVC experience; establish aspects of PIVC insertion and care relevant to them; and to compare experiences of adult consumers to adult carers of a child. An international, web-based, cross-sectional survey was distributed via social media inviting adult consumers and adult carers of a child under 18 years who had experienced having a PIVC in the last five years (one survey each for adults and adult carers) to complete a 10-item survey. As such, sampling bias is a limitation and results should be carefully considered in light of this. There were 712 respondents from 25 countries, mainly female (87.1%) and adults (80%). A little over 50% of adults described insertion as moderately painful or worse, with level of insertion difficulty (0–10 scale) identified as moderate (median 4, IQR 1, 7). Adult carers reported significantly more pain during insertion and insertion difficulty (both p < 0.001). Rates of first insertion attempt failure were higher in children compared with adults (89/139 [64%] vs 221/554 [40%]; p < 0.001), and 23% of children required ≥ 4 attempts, compared with 9% of adults (p < 0.0001). Three themes from open-ended question emerged: Significance of safe and consistent PIVC care; Importance of staff training and competence; and Value of communication. The PIVC experience can be painful, stressful and frustrating for consumers. Priorities for clinicians and policy makers should include use of pain relief as standard practice to reduce the pain associated with PIVC insertion and developing strategies to increase first PIVC insertion attempt success particularly for children and older consumers.

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Section: Discussionmentioning

confidence: 94%

Not "just" an intravenous line: Consumer perspectives on peripheral intravenous cannulation (PIVC). An international cross-sectional survey of 25 countries

et al. 2018

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“…7d). 602 The proximal bypass anastomosis should be placed at least 10 cm above the VA anastomosis to ensure adequate deviation of sufficient flow to the distal extremity. In RCAVFs with ischaemia, ligation of the distal limb of the radial artery may be an alternative (Fig.…”

Section: Recommendation 64mentioning

confidence: 99%

“…7f). 602,603 HD patients with VA flow > 1500 ml/min should be monitored regularly by flow measurements, echocardiography and for clinical signs of congestive heart failure (CHF). Patients with progression of symptoms, progressive increase in VA flow or objective signs of heart failure should be considered for the surgical procedures described above.…”

Section: Recommendation 64mentioning

confidence: 99%

Editor's Choice – Vascular Access: 2018 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS)

Schmidli¹,

Widmer²,

Basile³

et al. 2018

European Journal of Vascular and Endovascular Surgery

623

622

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“…In that case, superficialization on a deep brachial vein is possible, but the primary and secondary flow of such vascular access is insufficient. In addition, an aneurysm at the puncture site for hemodialysis, axillary vein thrombosis, "steal syndrome, " and other complications are frequent [13]. It is well known that implantation of the vascular graft requires appropriate diameter and quality of arterial and venous blood vessels, which may be a major obstacle for this type of surgery [14].…”

Section: Discussionmentioning

confidence: 99%

Two-stage forearm brachio-basilic loop arteriovenous graft for hemodialysis

et al. 2018

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Introduction The autologous radio-cephalic arteriovenous fistula (AVF) is the best vascular access for patients on chronic hemodialysis. In some patients with inadequate blood vessels, it is necessary to create proximal AVF, or arteriovenous grafts. High percentage of primary graft failure is noted in cases where diameters of the brachial artery and the basilic vein are insufficient. The aim of this work was to introduce a new surgical technique for arteriovenous creation in patients with inadequate blood diameter. Case outline The authors have proposed implantation of brachio-basilic polytetrafluoroethylene AV forearm loop graft in two acts. In the first act, the native brachio-basilic AVF was created in the distal region of the arm by side-to-end anastomosis. Three to four weeks after the first act, significant dilatation of brachial artery and basilic vein was noted (confirmed by the use of color duplex sonography technique). During the second act, polytetrafluourethylene graft was implanted by end-to-end anastomosis on the dilated basilica vein. Conclusion AV graft that was created in two acts has sufficient blood flow without early or late complications. Primary patency was 30 months and secondary patency was 50 months. As an original method in the current literature, we recommend it in different clinical settings when there are no better alternatives for vascular access.

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Surgical Techniques for Haemodialysis Access-Induced Distal Ischaemia

Abstract: All four procedures have high success rate in relieving ischaemic symptoms with the DRIL procedure having a significantly better vascular access patency rate than other techniques, although further well designed studies are required to compare all four surgical techniques.

Cited by 13 publications

References 33 publications

Not "just" an intravenous line: Consumer perspectives on peripheral intravenous cannulation (PIVC). An international cross-sectional survey of 25 countries

Not "just" an intravenous line: Consumer perspectives on peripheral intravenous cannulation (PIVC). An international cross-sectional survey of 25 countries

Editor's Choice – Vascular Access: 2018 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS)

Two-stage forearm brachio-basilic loop arteriovenous graft for hemodialysis

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