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Lima A, Carrilho P, Germano A. Clinical and ultrasound evaluation for hemodialysis access creation. Nefrologia 2022; 42:1-7. [PMID: 36153888 DOI: 10.1016/j.nefroe.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 10/17/2020] [Indexed: 06/16/2023] Open
Abstract
Chronic kidney disease (CKD) is an emerging global burden with an increasing number of patient's requiring renal replacement therapy (RRT), with hemodialysis being the most prevalent dialysis modality. A functioning vascular access remains the main constrain for an adequate treatment. Clinical and, in some patients, ultrasound evaluation are fundamental for better access planning. Access planning is dependent not only on patient clinical characteristics and preference but also in vascular patrimony. As such, ultrasound evaluation aids in characterizing patient arterial and venous upper arm anatomy and provides information for which access would better suit each patient. Doctors dealing with CKD patients should be familiar with the role of ultrasound and Doppler use in access planning.
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Affiliation(s)
- Anna Lima
- Nephrology Department - Hospital Prof Fernando Fonseca, Lisbon, Portugal.
| | - Patrícia Carrilho
- Nephrology Department - Hospital Prof Fernando Fonseca, Lisbon, Portugal
| | - Ana Germano
- Radiology Department - Hospital Prof Fernando Fonseca, Lisbon, Portugal
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Kim H, Ahn S, Kim M, Chung CTY, Choi KW, Ko H, Han A, Min S, Min SK, Ha J. Comparison between autogenous brachial-brachial upper-arm elevated direct arteriovenous fistulas and prosthetic brachial-antecubital indirect forearm arteriovenous grafts. J Vasc Access 2021; 23:936-945. [PMID: 34058911 DOI: 10.1177/11297298211018020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) guidelines recommend forearm arteriovenous grafts (AVGs) as an alternative procedure to transposed basilic vein fistulas for providing secondary access during hemodialysis. Recently, autogenous elevated brachial-brachial vein fistulas (BVE) have become increasingly popular. The aim of this study was to compare the outcomes of BVE and forearm loop AVG (AVG) for secondary access in hemodialysis. METHODS We retrospectively reviewed the medical records of patients who had received a BVE or forearm AVG at a single center from January 2015 to April 2019. In total, 19 BVE were created via two-stage operations and two via a one-stage operation; 53 forearm AVG's were performed. RESULTS The AVG group was twice as likely to suffer loss of primary patency compared with the BVE group (odds ratio [OR], 2.666; 95% confidence interval [CI], 1.108-6.412; p = 0.029) per the multivariate analysis. The primary patency and primary assisted patency of the BVE group were superior those of the AVG group, except for secondary patency (p = 0.02, p = 0.07, p = 0.879, respectively). In subgroup analysis, there were no significant differences in primary, primary assisted, or secondary patency between AVG and BVE when brachial vein was used for AVG outflow. In addition, no significant differences were noted regarding the infection rate (12.5% vs 12.3%, p = 0.331, severity >0), postoperative bleeding rate (14.5% vs 3.5%, p = 0.191, severity >1), early thrombus rate (0.0% vs 10.5%, p = 0.122), and early failure rate (7% vs 4.8%, p = 0.591). CONCLUSIONS The primary patency and primary assisted patency rates of BVE were significantly better than those observed in AVGs, but the complication rates were similar. The appropriate procedure to provide vascular access should be determined by the individual patient's condition and the surgical skill of the operating surgeon.
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Affiliation(s)
- Hyokee Kim
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Sanghyun Ahn
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Minseob Kim
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | | | - Kwang Woo Choi
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Hyunmin Ko
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Ahram Han
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Sangil Min
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Seung-Kee Min
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Jongwon Ha
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
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Lima A, Carrilho P, Germano A. Clinical and ultrasound evaluation for hemodialysis access creation. Nefrologia 2021; 42:S0211-6995(21)00028-X. [PMID: 33707099 DOI: 10.1016/j.nefro.2020.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 08/22/2020] [Accepted: 10/17/2020] [Indexed: 11/22/2022] Open
Abstract
Chronic kidney disease (CKD) is an emerging global burden with an increasing number of patient's requiring renal replacement therapy (RRT), with hemodialysis being the most prevalent dialysis modality. A functioning vascular access remains the main constrain for an adequate treatment. Clinical and, in some patients, ultrasound evaluation are fundamental for better access planning. Access planning is dependent not only on patient clinical characteristics and preference but also in vascular patrimony. As such, ultrasound evaluation aids in characterizing patient arterial and venous upper arm anatomy and provides information for which access would better suit each patient. Doctors dealing with CKD patients should be familiar with the role of ultrasound and Doppler use in access planning.
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Affiliation(s)
- Anna Lima
- Nephrology Department - Hospital Prof Fernando Fonseca, Lisbon, Portugal.
| | - Patrícia Carrilho
- Nephrology Department - Hospital Prof Fernando Fonseca, Lisbon, Portugal
| | - Ana Germano
- Radiology Department - Hospital Prof Fernando Fonseca, Lisbon, Portugal
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Norton de Matos A, Sousa CN, Almeida P, Teles P, Rego D, Teixeira G, Loureiro L, Teixeira S, Antunes I. Radiocephalic Fistula Recovery Using the Brachial Vein and Forearm Basilic Vein: A Case Series and Literature Review. Ther Apher Dial 2018; 22:570-574. [PMID: 30047255 DOI: 10.1111/1744-9987.12719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 04/15/2018] [Accepted: 05/29/2018] [Indexed: 11/30/2022]
Abstract
Vascular access dysfunction is a serious problem in dialysis units. Some patients have complex dysfunctions that are difficult to resolve. In this article, we report the case a of two patients with radiocephalic arteriovenous fistulae (RC-AVF) who had stenosis/occlusion of the forearm median vein and where we used the basilic vein of the forearm as a solution. We reviewed the use of this surgical solution in RC-AVF. Two male patients on hemodialysis exhibited stenosis/occlusion of the forearm median vein. The forearm basilic vein was isolated and rotated toward the forearm median vein in order to solve RC-AVF problems. One patient had fistula thrombosis 5 months after the procedure, while for the other patient, the fistula continues to work without problems. Literature describes only a few cases using the forearm basilic vein or the brachial vein for fistula recovery. This procedure increased the patency of fistulas. This approach has been proven to be a good solution for solving outflow problems using the superficial or deep veins, increasing fistula patency and avoiding the need to place a central venous catheter and all the related complications.
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Affiliation(s)
- António Norton de Matos
- Vascular Access Center (Grupo de Estudos Vasculares), Porto, Portugal.,Angiology and Vascular Surgery Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Clemente N Sousa
- Vascular Access Center (Grupo de Estudos Vasculares), Porto, Portugal.,Nursing School of Porto, Porto, Portugal.,CINTESIS-Center for Health Technology and Services Research Faculty of Medicine, Porto University, Porto, Portugal
| | - Paulo Almeida
- Vascular Access Center (Grupo de Estudos Vasculares), Porto, Portugal.,Angiology and Vascular Surgery Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Paulo Teles
- School of Economics and LIAAD-INESC Porto LA, University of Porto, Porto, Portugal
| | - Duarte Rego
- Vascular Access Center (Grupo de Estudos Vasculares), Porto, Portugal.,Angiology and Vascular Surgery Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Gabriela Teixeira
- Vascular Access Center (Grupo de Estudos Vasculares), Porto, Portugal.,Angiology and Vascular Surgery Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Luís Loureiro
- Vascular Access Center (Grupo de Estudos Vasculares), Porto, Portugal.,Angiology and Vascular Surgery Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Sérgio Teixeira
- Vascular Access Center (Grupo de Estudos Vasculares), Porto, Portugal.,Angiology and Vascular Surgery Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Inês Antunes
- Vascular Access Center (Grupo de Estudos Vasculares), Porto, Portugal.,Angiology and Vascular Surgery Department, Centro Hospitalar do Porto, Porto, Portugal
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Norton de Matos A, Sousa CN, Almeida P, Teles P, Rego D, Teixeira G, Loureiro L, Teixeira S. Radio-cephalic arteriovenous fistula recovered with drainage through the brachial vein. Hemodial Int 2018; 22:E53-E56. [PMID: 29461007 DOI: 10.1111/hdi.12641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Indexed: 11/27/2022]
Abstract
Dysfunction of arteriovenous access for hemodialysis is a challenge for the vascular surgeon. Some patients have complex vascular access with problems that are difficult to solve. Careful analysis of the vascular network with ultrasound and dissection of the veins during surgery can help to identify the best option for each access. We introduce and discuss the case of creation of a radio-cephalic fistula with outflow into the brachial vein in 64-year-old hemodialysis male patient. This technique enables extending fistula patency, arterializing the brachial vein, and improves cost efficiency.
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Affiliation(s)
- António Norton de Matos
- Vascular Access Center (Grupo de Estudos Vasculares), Porto, Portugal.,Angiology and Vascular Surgery Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Clemente Neves Sousa
- Vascular Access Center (Grupo de Estudos Vasculares), Porto, Portugal.,Nursing School of Porto, Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research Faculty of Medicine, Porto, Portugal
| | - Paulo Almeida
- Vascular Access Center (Grupo de Estudos Vasculares), Porto, Portugal.,Angiology and Vascular Surgery Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Paulo Teles
- School of Economics and LIAAD-INESC Porto LA, Porto University, Porto, Portugal
| | - Duarte Rego
- Vascular Access Center (Grupo de Estudos Vasculares), Porto, Portugal.,Angiology and Vascular Surgery Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Gabriela Teixeira
- Vascular Access Center (Grupo de Estudos Vasculares), Porto, Portugal.,Angiology and Vascular Surgery Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Luís Loureiro
- Vascular Access Center (Grupo de Estudos Vasculares), Porto, Portugal.,Angiology and Vascular Surgery Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Sérgio Teixeira
- Vascular Access Center (Grupo de Estudos Vasculares), Porto, Portugal.,Angiology and Vascular Surgery Department, Centro Hospitalar do Porto, Porto, Portugal
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