The Sleeve Method for Creation of Radiocephalic Arteriovenous Fistulas in Patients with Calcified Vessels

Abstract

In patients with calcified atherosclerotic plaques, which constitute a barrier or make it difficult to suture the vein to the side of the artery, the sleeve method may be considered as an alternative before abandoning the creation of a fistula on the forearm. The technique is much simpler than the standard end-to-side or side-to-side anastomosis.

Can We Create an Arteriovenous Fistula for Hemodialysis through 0.5–1.0 cm Incision without Using Vascular Clamps?

“…Handling this vessel is fraught with danger of further damaging the intima. 13 Intravenous heparin has very rarely been used in the postoperative period except when there is severe atherosclerosis and is followed by low-molecular-weight heparin and antiplatelet agents ( Table 1 ). It is the high flow across the fistula that saves the day.…”

Doppler ultrasound assessment of calcified radial arteries prior to radio-cephalic arterio-venous fistula placement: an observational study

“…Arterial wall was examined for presence of atherosclerotic changes. Based on clinical experience and other classifications in the literature, 8 , 10 , 12 , 13 atherosclerotic changes were classified as “mild” if the arterial wall was hyperechogenic but without distal shadowing (mild atherosclerosis), “moderate” if the arterial wall was hyperechogenic and had more intense white spots with distal shadowing present (patchy calcifications), and “severe” if calcifications were continuous and had severe distal shadowing (linear calcifications). Lumen of the artery was examined with color Doppler 13 , 14 and the signal was classified as “homogeneous” if the signal was present over the entire length of the artery, “partially homogeneous” if the signal was present along more than approximately two-thirds of the visible length of the artery, “very patchy” if less than two-thirds of the length of the artery had Doppler signal, or “absent” ( Figure 2 ).…”