Superior maturation and patency of primary brachiocephalic and transposed basilic vein arteriovenous fistulae in patients with diabetes

Hakaim, Albert G.; Nalbandian, Matthew; Scott, Thayer E.

doi:10.1016/s0741-5214(98)70302-7

Cited by 163 publications

(115 citation statements)

References 9 publications

(17 reference statements)

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“…These results indicate that patients with diabetes may encounter more complications during fistula life, but, if treated adequately, then functionality can be maintained as long as in patients without diabetes, regardless of the anatomic location of the anastomosis (19). Although a larger sample size may have resulted in a significantly increased risk for primary functional patency loss in aging or female hemodialysis patients, older patients and women were not at significantly increased risk for fistula abandonment in our population (20).…”

Section: Patency Ratesmentioning

confidence: 65%

Hemodialysis Arteriovenous Fistula Patency Revisited

Huijbregts

Bots²,

Wittens³

et al. 2008

Clinical Journal of the American Society of Nephrology

320

239

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Background and objectives: Vascular access standards are predominantly based on older, single-center reports; however, the hemodialysis population has changed dramatically and primary arteriovenous fistula failure is a huge problem. This prospective, multicenter study used standardized definitions to analyze patency rates and potential risk factors that affect functional patency and late arteriovenous fistula functionality.Design, setting, participants, & measurements: Eleven centers participated in a guidelines implementation program. All new permanent vascular accesses were included. Patency and functional patency, defined as access survival from creation and from first dialysis use, respectively, were calculated using Kaplan-Meier analysis. Risk factors for primary functional patency loss (intervention-free interval) and secondary failure (abandonment) were determined using regression models.Results: A total of 491 arteriovenous fistulas were placed in 395 patients. Six-, 12-, and 18-mo secondary patency and functional patency were 75 ؎ 2.0, 70 ؎ 2.3, and 67 ؎ 2.7% and 90 ؎ 1.9, 88 ؎ 2.2, and 86 ؎ 2.7%, respectively. Primary failure rate was 40%. Thrombosis rate was 0.14 per patient-year. Diabetes and arteriovenous fistula surveillance were significantly associated with primary functional patency loss. Preoperative duplex was inversely related to secondary failure. The secondary failure rate per hospital varied from 0 to 39%.Conclusions: This study showed a marked difference between patency and functional patency, likely to be explained by high primary failure rates. Hemodialysis patients with diabetes can be expected to have reduced primary functional patency rates, but if treated adequately, then arteriovenous fistula functionality can be maintained as long as in patients without diabetes.

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Section: Patency Ratesmentioning

confidence: 65%

Hemodialysis Arteriovenous Fistula Patency Revisited

Huijbregts

Bots²,

Wittens³

et al. 2008

Clinical Journal of the American Society of Nephrology

320

239

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“…In none of the studies, post-operative thrombosis was assessed at 24 hours (21)(22)(23). In this study, early postoperative thrombosis occurred in seven patients (28%) of the control group, who had not received heparin, and none of the patients that had received heparin.…”

Section: Discussionmentioning

confidence: 85%

Effect of Intra Operative Intravenous Injection of Heparin on Patency Rate of Radio Cephalic Autogenous Arteriovenous-Fistula in Chronic Renal Failure Patients

Ebrahimifard

2015

Arch Crit Care Med

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Background: Currently, there is no standard for the use of systemic heparin during creation of Arteriovenous (AV) fistula to decrease the incidence of postoperative thrombotic complications. Objectives: The goal of this study was to evaluate the effects of intra-operative IV heparin on patency rate and postoperative bleeding complications in patients undergoing surgery for AV fistula. Patients and Methods: A prospective, randomized controlled study was performed on 50 patients undergoing AV fistula creation, who were randomly divided in two groups. The control group received no systemic heparin and the heparin group received 5,000 units of intravenous heparin before clamping of theartery. Results: There was a significant difference in patency rate between the heparin and control groups (96% vs. 72%, P = 0.021), and there were no significant differences in operative time (P = 0.55). Perioperative bleeding was not significantly different between the two groups. Conclusions:The results suggest that intra operative administration of heparin has statistically significant effects on patency rates yet not on postoperative bleeding complications. Larger trials with longer follow-up durations and assessment of maturation rates are needed to determine this effect on fistula outcome.

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“…Its creation is technically easy but it is necessary to consider all possible complications which make it diffi cult or prevent its application and which require further surgical procedures. In terms of utility and complication occurrence, the results are very good [13][14][15][16][17] . This fi stula type involves well-known disadvantages and complications.…”

Section: Resultsmentioning

confidence: 96%

“…In advanced ischemic symptoms with fi nger gangrene, the basic factor is the atherosclerosis 26,27 . Since providing access for haemodialysis is a priority, the performance of the fi stula in the elbow is preferred in diabetic patients to the radiocephalic forearm fi stula, which is patent yet unsuitable for cannulation 17 . The actual occurrence of the steal syndrome demonstrations after elbow fistula performance between the brachial artery and the cephalic or basilic veins is diffi cult to assess because published reports usually do not specify the performance type with regard to fi stula complications 14,32,33 .…”

Section: Resultsmentioning

confidence: 99%

Autogenous Arteriovenous Elbow Fistula for Haemodialysis and Upper Extremity Ischemia

Bachleda¹,

Utíkal²,

Kojecký³

et al. 2007

BIOMED PAP

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Background:The autogenous brachiocefalic or brachiobasilic arteriovenous elbow fi stula is not considered to be only the secondary haemodialysis access. In patients with an unsuitable forearm vessel bundle, it is indicated as primary access and it is the method preferred to the fi stula creation using a vascular prosthesis. Its rather rare complication is the development of upper extremity ischemia.Aim: To summarise current knowledge of this fi stula type and its associated complications Methods: Review of the literature. Results:The creation and maturation of the fi stula and occurrence of the steal syndrome is infl uenced by a number of factors. The analysis and awareness of such factors will provide for creation of a suitable fi stula as well as for timely complication diagnostics and treatment.Conclusions: The autogenous elbow fi stula utilising the brachial artery and the cephalic or basilic vein in the upper extremity represents a high-quality haemodialysis access. Its potential complication is the occurrence of the steal syndrome. Its occurrence and manifestations do not constitute indications for ligation of the access. The gathered information shows that a suitable surgical procedure can help meet the basic rule for haemodialysis access -resolving the ischemia and maintaining the access.

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Superior maturation and patency of primary brachiocephalic and transposed basilic vein arteriovenous fistulae in patients with diabetes

Cited by 163 publications

References 9 publications

Hemodialysis Arteriovenous Fistula Patency Revisited

Hemodialysis Arteriovenous Fistula Patency Revisited

Effect of Intra Operative Intravenous Injection of Heparin on Patency Rate of Radio Cephalic Autogenous Arteriovenous-Fistula in Chronic Renal Failure Patients

Autogenous Arteriovenous Elbow Fistula for Haemodialysis and Upper Extremity Ischemia

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