Vascular Access for Dialysis

Schanzer, Harry; Schanzer, Andres

doi:10.1002/9780470755815.ch84

Cited by 11 publications

(16 citation statements)

References 62 publications

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“…We observed chronic thrombotic changes, such as contour irregularities and relative wall thickening, in a CV segment varying between 8 and 16 cm (mean, 10 cm) in length (Figs. [2][3][4]. Spontaneity and phasicity in the flow were not altered.…”

Section: Resultsmentioning

confidence: 87%

“…In the literature, the preferred site of AVF construction is considered to be at the wrist, but in patients with poor CVs at the forearm and good antecubital veins at the elbow, a higher AVF may provide more satisfactory access. 2 Interposing an autologous or synthetic tube graft between an artery and vein, known as a bridge arteriovenous fistula, seems to be a good solution; however, it causes more complications, such as thrombosis, swelling, infection, and allergy, than the AVF. Both types of fistula require a 1-to 4-week period of maturation, during which they cannot be safely used.…”

Section: Discussionmentioning

confidence: 99%

“…1 The most common complications of fistulas are lack of patency, failure of maturation, and insufficient flow through dialysis. 1,2 The factors affecting the success of fistula surgery and adequate fistula flow are adequate arterial volume flow (which must be >200 mL/min) and patency as well as adequate distention capacity of the vein. 2 Color Doppler ultrasonography (CDUS) proves to be a very suitable noninvasive method for both qualitative and quantitative analysis of vessels, in contrast to venography, which is comparatively invasive and requires the use of contrast material and radiography for assessment of the venous bed.…”

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confidence: 99%

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Cephalic vein and hemodialysis fistula: surgeon's observation versus color Doppler ultrasonographic findings.

Mihmanlı

Beşirli

Kuruğoğlu

et al. 2001

J of Ultrasound Medicine

102

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The aim of this study was to evaluate whether preoperative color Doppler ultrasonography improves immediate success rates of arteriovenous fistulas for dialysis. One hundred twenty-four patients with chronic renal failure underwent color Doppler ultrasonographic examination of both arms, including the cephalic vein, before arteriovenous fistula construction. Patients were randomly divided into 2 groups: A and B. In group A, there were 52 patients, and the surgeon planned to construct arteriovenous fistulas depending only on physical examination. In group B, which comprised 72 patients, surgeons performed arteriovenous fistula construction on sites labeled by color Doppler ultrasonography. In group A, of 52 patients who had surgery for arteriovenous fistula construction, 13 had fistulas that did not function. Among these 13 patients, 8 were found to have chronic thrombotic changes in the cephalic vein on color Doppler ultrasonography, and 5 had none of these changes. When we checked the color Doppler ultrasonographic findings, we noted that these 5 patients had decreased volume flow in the radial artery. On the whole, the arteriovenous fistulas worked in 39 patients (75%) and did not function in 13 patients (25%). In group B, surgeons followed the color Doppler ultrasonographic results. Of 72 patients who underwent the procedure, 68 patients (94.4%) had functioning fistulas, whereas 4 (5.6%) had fistulas that did not work. These 4 patients were found to have low volume flow in the radial artery. When both groups were compared by chi2 analysis, the difference was statistically significant (P = .002). Group B, in which patients were preoperatively evaluated by color Doppler ultrasonography, had a high success rate. We found that color Doppler ultrasonography is very helpful as a noninvasive procedure for this evaluation. Although many surgical clinics still perform arteriovenous fistula construction without the aid of color Doppler ultrasonographic findings, we think that the use of color Doppler ultrasonography should be emphasized before surgeons proceed with arteriovenous fistula construction.

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Section: Resultsmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Cephalic vein and hemodialysis fistula: surgeon's observation versus color Doppler ultrasonographic findings.

Mihmanlı

Beşirli

Kuruğoğlu

et al. 2001

J of Ultrasound Medicine

102

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“…The indications for intervention were signs of impending rupture such as rapid increase in size of the aneurysm, poor eschar formation over the puncture site, spontaneous bleeding or difficulty in achieving hemostasis at the conclusion of the hemodialysis session, and various other indications such as questionable viability of the skin over the aneurysm due to thinning, symptomatic aneurysms (pain), local infection, or limitation of cannulation sites by the size or number of the aneurysms. 1,4,5 Revisions were not done for esthetic reasons for access aneurysms that did not fulfill the recommended criteria for revision.…”

Section: Methodsmentioning

confidence: 99%

Stent graft treatment for hemodialysis access aneurysms

Shemesh

Goldin

Zaghal

et al. 2011

Journal of Vascular Surgery

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“…Native arteriovenous (AV) fistulas, which are the most commonly used access line, enable sufficient and repeated hemodialysis applications and improves the rate of survival and quality of life in patients with end-stage renal disease (ESRD) when performed timely in an appropriate anatomic location using a fine technique (2,3). The most-preferred sites for AV fistulas are the wrist (radial-cephalic) as the first choice and the elbow (brachial-cephalic) as the second choice.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Risk Factors for Arteriovenous Fistula Failure in Patients Undergoing Hemodialysis

Sarı¹,

Taşkapan²,

Sigirci³

et al. 2016

Erciyes Med J

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Objective: The aim of the present study is to evaluate the relationship between demographic characteristics, hematological and biochemical parameters, and elements of the coagulation system that may predispose a person to thrombosis or to anatomical and functional parameters in Doppler ultrasonography scanning and the maturation and adequacy of arteriovenous fistulas. Materials and Methods:Overall, 36 patients who underwent a native arteriovenous fistula operation were included. Biochemical parameters, hematological parameters, the coagulation system, and a Doppler ultrasonography evaluation were performed before an arteriovenous fistula operation on day 1 after the fistula operation and at the time point when the arteriovenous fistula became dysfunctional.Results: A thrombus occurred between 1 and 73 days (mean: 28.4±26.1) in 10 patients. It was found that the female gender (p<0.001), presence of thrill (p=0.014), quality of vein (p<0.001), peak systolic velocity and end-diastolic velocity of the radial artery at the snuffbox region on day 1 after the operation (p=0.035 and p=0.049, respectively), and the cephalic vein diameter in the Brescia-Cimino region (p=0.011) were associated with thrombosis formation. No relation was found among blood pressure, fistula region, quality of artery, spasm of artery and vein, hematologic and biochemical parameters, coagulation parameters, active protein C resistance, anti-cardiolipin antibody, D-dimer, C-reactive protein, or erythrocyte sedimentation rate and thrombosis formation (p>0.05).Conclusion: Thrombosis occurs at a relatively early period in approximately a quarter of arteriovenous fistulas. Female gender, quality of vein, and the absence of thrill in the post-operative period are important factors in thrombosis formation.

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Vascular Access for Dialysis

Cited by 11 publications

References 62 publications

Cephalic vein and hemodialysis fistula: surgeon's observation versus color Doppler ultrasonographic findings.

Cephalic vein and hemodialysis fistula: surgeon's observation versus color Doppler ultrasonographic findings.

Stent graft treatment for hemodialysis access aneurysms

Evaluation of Risk Factors for Arteriovenous Fistula Failure in Patients Undergoing Hemodialysis

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