Complications of Renal Dialysis Access Procedures

Connolly, John E.; Brownell, Douglas A.; Levine, Edward; McCart, P. Michael

doi:10.1001/archsurg.1984.01390230091023

Cited by 59 publications

(14 citation statements)

References 8 publications

(2 reference statements)

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“…6,7 Based on the results of this study in terms of patency and complication rates, polyurethane grafts are unlikely to replace radiocephalic fistulas as the access of choice for hemodialysis.…”

Section: Discussionmentioning

confidence: 97%

Polyurethane Grafts: A Viable Alternative for Dialysis Arteriovenous Access?

Peng

Tan

2003

Asian Cardiovasc Thorac Ann

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Polyurethane grafts, promoted for their self-sealing properties and low complication rates, were recently introduced for hemodialysis access. We review our experience with this graft material to determine its complication and patency rates. Between January 1995 and December 1999, 118 patients, 75 female and 43 male, with a mean age of 51 years, had a total of 163 polyurethane arteriovenous grafts inserted. The grafts were mostly 6 mm in diameter (69.3%), placed in a loop configuration (91.4%) in the forearm (49.7%). The median follow-up period was 12 months. The grafts were first cannulated for hemodialysis at a median time of 19 days after implantation, with 12% used within 3 days. Thrombosis and infection were the most common complications at rates of 32.7% and 30.0%, respectively. Infection was the most common cause of graft loss (61.5%). These complications were amenable to salvage intervention. The 1-year primary and secondary patency rates were 73% and 86%, respectively; the 3-year secondary patency rate, 72%. The 1-year serviceability rate was 64%. With satisfactory patency rates and the advantage of its self-sealing properties permitting early cannulation, polyurethane grafts provide a viable alternative for hemodialysis access. Early recognition and appropriate management of complications can prolong graft survival.

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Section: Discussionmentioning

confidence: 97%

Polyurethane Grafts: A Viable Alternative for Dialysis Arteriovenous Access?

Peng

Tan

2003

Asian Cardiovasc Thorac Ann

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“…Initial experiences with enforcing the hemodialysis access to the lower extremity were discouraging because of high infection rate and associated major limb amputation [8,9]. Presently, lower extremity AVGs are created as a last resort, for patients who have failure of their upper extremity sites.…”

Section: Discussionmentioning

confidence: 99%

Long Term Outcomes of Arteriovenous Grafts for Hemodialysis in Lower Extremities

Han

Song

Yun

2016

VSI

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Purpose:The lower extremity has received its fair share of attention as a vascular access site in patients who have exhausted their upper arm vessels. However, experiences with lower extremity arteriovenous grafts (AVGs) have so far been disappointing because of high infection rates and severe limb ischemia. We report our experience with hemodialysis access from the lower extremity.Materials and Methods:A retrospective review of 60 lower extremity AVGs created between January 2003 and December 2011 was performed. Age, sex, etiology of end-stage renal disease and complications were tabulated. Primary and secondary patency rates were determined.Results:The average age of the study population was 56 years and 38 patients were female. Renal failure was associated with hypertension in 40 (66.7%) patients, diabetes in 28 (46.7%) patients and cardiovascular disease in 9 (15.0%) patients. The follow-up period was 8–108 months. Fifty-four patients had bilateral central vein stenosis. Seven (11.7%) patients had primary failure of their AVG. There was no operation-related death. Primary and secondary patency rates were: 66% and 90% at 1 year, 40% and 90% at 2 years, 27% and 87% at 3 years, and 18% and 87% at 5 years, respectively. There were 105 postoperative complications that developed in 67 patients. Postoperative complications were: thrombosis (30), proximal vein stenosis (56), infection (9), bleeding with hematoma (1), perigraft seroma (3), steal syndrome (2), and pseudoaneurysm (4).Conclusion:A lower extremity AVG seems to be a viable option in patients with unusable upper extremity veins.

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“…In the superior limb fistulas, some of the possible complications are: occlusion, infection, limb ischemia, venous hypertension in the limb, aneurysm formation, congestive heart failure and nerve complications (1)(2)(3)(4)(5)(6)(7). To our knowledge, there has been no description of jugular venous hypertension and glaucoma as a complication of an arteriovenous fistula.…”

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confidence: 99%