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Etkin Y, Woo K, Guidry L. Options for Dialysis and Vascular Access Creation. Surg Clin North Am 2023; 103:673-684. [PMID: 37455031 DOI: 10.1016/j.suc.2023.05.006] [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: 07/18/2023]
Abstract
End-stage kidney disease (ESKD) affects nearly 800,000 patients in the United States. The choice of peritoneal dialysis (PD) versus hemodialysis (HD) should be patient centric. An ESKD Life-Plan is crucial with the goal of creating the right access, for the right patient, at the right time, for the right reason. Complex access should be considered when straightforward access options have been exhausted. Evolving techniques such as percutaneous access for HD and PD should be further investigated. Shared decision-making and palliative care is an essential part of the care of patients with CKD and ESKD..
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Affiliation(s)
- Yana Etkin
- Division of Vascular and Endovascular Surgery, Department of Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Karen Woo
- Division of Vascular Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, 200 UCLA Medical Plaza Suite 526, Los Angeles, CA 90095, USA.
| | - London Guidry
- Division of Vascular and Endovascular Surgery, Department of Surgery, Louisiana State University Health and Science Center, New Orleans, LA, USA
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Płoński A, Płoński AF, Głowiński J. Surgical Management, Prevention and Outcomes for Aneurysms of Arteriovenous Dialysis Fistulas: A Case Series Study and Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6256. [PMID: 37444103 PMCID: PMC10341233 DOI: 10.3390/ijerph20136256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023]
Abstract
The escalating population of individuals afflicted with end-stage renal disease necessitates the provision of secure and efficacious vascular access for hemodialysis, with arteriovenous fistulas representing a preferred option. Nonetheless, the creation of dialysis fistulas may entail complications, including the occurrence of fistula aneurysms that may require surgical intervention. This study included eight patients with large aneurysms of dialysis fistulas and aimed to evaluate the safety and effectiveness of classic, endovascular, or hybrid methods for fistula reconstruction or ligation, depending on the indications. Vascular interventions were performed on patients on chronic hemodialysis and on those in whom hemodialysis was discontinued due to the proper functioning of the transplanted kidney. Performed procedures were considered safe and effective. The reconstructed fistulas provided the patients with patent vascular access, allowing for continued hemodialysis. No re-aneurysmal dilatation of the reconstructed or ligated fistulas was observed. Regular monitoring of dialysis fistulas is crucial to detect complications in time. Guidelines should be established to specify the dimensions at which fistula aneurysm should be excised and whether to remove asymptomatic aneurysms at all. For patients who have undergone kidney transplantation, outlines should indicate when the fistula should be preserved and when it should be ligated.
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Affiliation(s)
- Adam Płoński
- Department of Vascular Surgery and Transplantation, Medical University of Bialystok, 15-276 Bialystok, Poland; (A.F.P.); (J.G.)
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Khan UA, Kareem T, Uneeb M, Ehsan O, Wyne H. Forearm Basilic Vein Transposition: A Single-Centre Experience. Cureus 2023; 15:e40129. [PMID: 37425617 PMCID: PMC10329455 DOI: 10.7759/cureus.40129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2023] [Indexed: 07/11/2023] Open
Abstract
INTRODUCTION Forearm basilic vein transposition (FBVT) is a viable alternative for arteriovenous grafts (AVGs) and can be used as secondary vascular access as well, as it allows for the use of veins that are remote from the arterial source of inflow. FBVT involves two main steps: first, the basilic vein is dissected from its original location; and second, the basilic vein is transposed to a subcutaneous tunnel on the volar aspect of the forearm and anastomosed to a suitable artery, usually the radial or ulnar artery. OBJECTIVE This paper aims to present a series of FBVT cases performed at our hospital and present it as a viable option for secondary vascular access. We also aim to review the available literature relating to FBVT fistula in terms of surgical technique, patency rates, maturation time, and one-year outcome, and to establish a comparison with our clinical experience. MATERIALS AND METHODS This is a retrospective descriptive case series. The data were collected from online medical records, and patients were contacted by telephone to make a follow-up visit. For a review of the literature, a search was done on PubMed for articles containing the following keywords in either the title or the abstract: basilic, transposition, fistula, and forearm. Similarly, a search was done on Google Scholar for articles with the following words in the title: basilic, transposition, and forearm. The data are expressed as mean and standard deviation. Statistical analysis was done using SPSS 26.0 software (IBM Corp., Armonk, NY). CONCLUSION The primary patency rate of FBVT in our study makes it a suitable solution to opt for before moving to AVGs. FBVT should be considered before moving more proximally in patients with inadequate forearm cephalic veins.
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Affiliation(s)
- Umair A Khan
- Vascular Surgery, Shifa International Hospital, Islamabad, PAK
| | - Talha Kareem
- Vascular Surgery, Shifa International Hospital, Islamabad, PAK
| | - Muhammad Uneeb
- General Surgery, Shifa International Hospital, Islamabad, PAK
| | - Omer Ehsan
- Vascular Surgery, Shifa International Hospital, Islamabad, PAK
| | - Hassan Wyne
- Urology, Multan Institute of Kidney Diseases, Multan, PAK
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Goyal VD, Pahare A, Sharma S, Misra G. Early and midterm patency of arteriovenous fistula for hemodialysis access using different techniques and their advantages and disadvantages. Indian J Thorac Cardiovasc Surg 2022; 38:481-486. [PMID: 36050972 PMCID: PMC9424408 DOI: 10.1007/s12055-022-01390-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/18/2022] [Accepted: 06/21/2022] [Indexed: 10/15/2022] Open
Abstract
This descriptive retrospective study was done to observe the different techniques of arteriovenous fistula creation for advantages and disadvantages, complications, and early and midterm patency. Fifty-three arteriovenous fistulas were created from September 2018 to August 2020 using four different techniques. Radio-cephalic arteriovenous fistula was usually the first option. Other techniques like brachio-cephalic arteriovenous fistula, radio-basilic arteriovenous fistula, and brachio-basilic arteriovenous fistula were used when the radio-cephalic fistula had thrombosed or could not be constructed due to small-sized cephalic vein in the forearm. The majority of patients (41 (77.35%)) underwent radio-cephalic fistula creation. Early patency was 38 (92.7%) in the radio-cephalic technique whereas it was 12 (100%) in the radio-basilic, brachio-cephalic, and brachio-basilic techniques combined. The midterm patency was 32 (78%) in the radio-cephalic technique, 5 (83%) in the brachio-cephalic technique, 3 (75%) in the radio-basilic technique, and 1 (50%) in the brachio-basilic technique. Radio-basilic and brachio-cephalic are alternative techniques for fistula creation after radio-cephalic depending upon the size of the basilic vein in the forearm or cephalic vein in the cubital fossa or arm. The radio-basilic technique may have advantages over the brachio-cephalic technique which need to be further evaluated. Proximal fistulas like brachio-basilic and brachio-cephalic are more commonly associated with limb edema.
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Affiliation(s)
- Vikas Deep Goyal
- Department of Surgery, Shri Ram Murti Samarak Institute of Medical Sciences, Bareilly, (UP) 243202 India
| | - Akhilesh Pahare
- Department of Anesthesia, Shri Ram Murti Samarak Institute of Medical Sciences, Bareilly, (UP) 243202 India
| | - Shobhit Sharma
- Department of Surgery, Shri Ram Murti Samarak Institute of Medical Sciences, Bareilly, (UP) 243202 India
| | - Gaurav Misra
- Department of Anesthesia, Shri Ram Murti Samarak Institute of Medical Sciences, Bareilly, (UP) 243202 India
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Pirozzi N, De Alexandris L, Fazzari L, Scrivano J, Pirozzi R, Menè P. Cubital vein transposition for a distal radiocephalic fistula complicated by outflow obstruction. J Vasc Access 2019; 21:520-523. [DOI: 10.1177/1129729819890472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction: Outflow stenosis is a frequent complication of vascular access for hemodialysis. It may cause increased pressure within the angioaccess along with reduced blood flow. Elective treatment is percutaneous transluminal angioplasty; however, when a long occlusion (>2 cm) occurs, success and mid-term patency of endovascular treatment are uncertain. We describe a case series of patients with long occlusion of elbow outflow complicating an otherwise excellent forearm arteriovenous fistula, treated by a bypass across the elbow through cubital vein transposition. Patients and methods: Six consecutive patients have been treated between 2015 and 2017; all were referred because of either low flow, increased venous pressure, excessive bleeding time, or recirculation and were examined by duplex ultrasound. A total of 83% of patients showed associated thrombosis within the access. All procedures were performed under loco-regional anesthesia and preventive hemostasis. Surgical thrombectomy was also performed when needed. Results: Immediate success was obtained in all but two patients converted in veno-venous polytetrafluoroethylene bypass. Post-operative blood flow increased from 316 to 878 mL/min. All patients were dialyzed through the forearm access immediately the day after surgery, without the need for central vein catheter. Overall, 75% of patients needed a percutaneous transluminal angioplasty of the veno-venous anastomosis within 6 months. Primary and secondary patency at 12 and 24 months were 25%–0% and 100%–100%, respectively. Conclusion: Outflow reconstruction through the elbow bypass by cubital vein transposition is a valuable resource to rescue radiocephalic arteriovenous fistula complicated by outflow obstruction, avoiding the use of an interim central vein catheter. Endovascular treatment is vital to maintain functional patency in the mid- and long term.
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Affiliation(s)
- Nicola Pirozzi
- Nephrology Unit, Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Lorenzo De Alexandris
- Nephrology Unit, Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | | | | | | | - Paolo Menè
- Nephrology Unit, Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
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Transposition of basilic vein in forearm for arteriovenous fistula creation: Our mid-term results. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 27:508-511. [PMID: 32082917 DOI: 10.5606/tgkdc.dergisi.2019.17600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 07/31/2019] [Indexed: 11/21/2022]
Abstract
Background In this study, we aimed to present our mid-term results of basilic vein transposition in the forearm to create an arteriovenous fistula. Methods Between January 2015 and October 2017, a total of 21 patients (13 males, 8 females; mean age 54.2±11.3 years; range, 32 to 74 years) with an adequate basilic vein and radial arterial systems who underwent basilic vein transposition in the forearm were retrospectively analyzed. All operations were performed under local anesthesia and mild sedation. The basilic vein was harvested using a single incision from elbow joint to wrist as an in situ vein graft. If the harvested basilic vein did not extend easily to the radial artery in the wrist region, the saphenous vein was harvested to extend arteriovenous fistula tract. Results The mean follow-up was 25.3±9.8 (range, 2 to 32) months. All patients underwent arteriovenous access surgery using transposed basilic vein in the forearm. In all patients, except for two, transposed basilic vein in the forearm stayed patent during follow-up with a patency rate of 90.5%. The mean fistula maturation time was 45.2±10.7 (range, 28 to 59) days. Conclusion If cephalic vein diameters are too small for arteriovenous fistula creation, basilic vein system in the medial surface of the forearm may be considered a favorable option.
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Comparison of forearm versus upper arm basilic transposition arteriovenous fistulas demonstrates equivalent satisfactory patency. J Vasc Surg 2019; 70:1247-1252. [DOI: 10.1016/j.jvs.2019.01.093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 01/11/2019] [Indexed: 11/19/2022]
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Zielinski M, Inston N, Krasinski Z, Gabriel M, Oszkinis G. The forearm basilic vein looped transposition fistula as a tertiary option for upper limb vascular access. J Vasc Access 2018; 19:596-601. [DOI: 10.1177/1129729818764137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: The forearm basilic vein can serve as an option for haemodialysis access but may not be possible in cases where the wrist arteries are unsuitable. In this setting, the forearm basilic vein can be used in a looped transposition with a brachial artery anastomosis. Aims: The aims of this study were to assess the outcome of forearm basilic vein looped transposition as an option for vascular access. Material and methods: Data from January 2007 to December 2010 were prospectively collected and analysed. Outcome measures were operative success, complications, maturation and primary and secondary patency following 5 years of follow-up. Results: From a total of 583 patients receiving autologous vascular access for haemodialysis, 24 (4.1%) underwent a forearm basilic vein looped transposition. The median age was 60 years (range, 27–80 years), with a slight male predominance (13 male:11 female). Mean follow-up was 34 months (1–60 months). Two patients died and other three were transplanted with subsequent fistula closure. All procedures were successful (100%); however, maturation failure occurred in one case (4.2%). No serious perioperative complications were observed. In two cases, we observed late false aneurysm formation requiring intervention. Primary patency at 1, 2, 3 and 5 years was the following: 77%, 62%, 21% and 10%, whereas secondary patency was the following: 81%, 71%, 61% and 32%, respectively. Conclusion: Autologous forearm basilic vein looped transposition is an effective surgical procedure for the creation of access for haemodialysis. This may be a useful option in patients with compromised peripheral arterial diameter or flow and should be considered in patients with a suitable forearm basilic vein.
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Affiliation(s)
- Maciej Zielinski
- Department of General and Vascular Surgery, Poznan University of Medical Sciences, Poznań, Poland
| | - Nicholas Inston
- Department of Renal Surgery, Queen Elizabeth Hospital, University Hospital Birmingham, Birmingham, UK
| | - Zbigniew Krasinski
- Department of General and Vascular Surgery, Poznan University of Medical Sciences, Poznań, Poland
| | - Marcin Gabriel
- Department of General and Vascular Surgery, Poznan University of Medical Sciences, Poznań, Poland
| | - Grzegorz Oszkinis
- Department of General and Vascular Surgery, Poznan University of Medical Sciences, Poznań, Poland
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