The importance of preoperative evaluation of the subclavian vein in dialysis access planning.

Surratt, R S; Picus, Daniel; Hicks, Marshall E.; Darcy, Michael D.; Kleinhoffer, Michael A.; Jendrisak, Martin D.

doi:10.2214/ajr.156.3.1781814

Cited by 139 publications

(61 citation statements)

References 10 publications

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“…O uso da ultrasonografia Doppler colorida pode identificar algum tipo de anormalidade em aproximadamente 40% dos casos 23 . Surratt et al 24 enfatizaram a importância de exames mais aprofundados naqueles casos suspeitos, como a venografia pré-operatória. Em um estudo recente realizado por esses autores, 40% de todos os pacientes com histórico de cateter venoso central apresentavam estenoses significativas na origem das veias subclávia e/ou jugular.…”

Section: Discussionunclassified

Avaliação da maturação das fístulas arteriovenosas para hemodiálise pelo eco-Doppler colorido

et al. 2008

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ResumoContexto: Quando se confecciona uma fístula arteriovenosa para hemodiálise (FAVH) autógena, é necessário que se aguarde a dilatação da veia em questão e o desenvolvimento de volume de fluxo mínimo, fenômeno chamado de maturação. Ainda hoje se discute qual o tempo necessário para ocorrer essa maturação.Objetivo: Avaliar a maturação de FAVH utilizando-se critérios ecográficos. MHz para a avaliação no pré-operatório e nos 7º, 14º, 21º e 28º dias de pós-operatório. Os critérios para a maturação após a cirurgia foram: veia com diâmetro médio maior que 4 mm e volume de fluxo maior que 400 mL/min. Método Resultados:O diâmetro médio pré-operatório foi de 3,24±1,43 e 3,71±1,37 mm para fístulas de punho e de cotovelo, respectivamente. O diâmetro final foi de 5,01±0,87 mm para as FAVH de punho (p = 0,006) e de 6,15±1,16 mm para as FAVH de cotovelo (p = 0,95). O volume de fluxo no 7º dia pós-operatório foi de 493,63±257,49 mL/min e 976,33±332,90 mL/min para as FAVH de punho e cotovelo, respectivamente. Ao final do estudo, foi calculado o valor de 556,81±288,42 mL/min nas FAVH de punho (p < 0,05) e de 1031,62±614,812 mL/min nas FAVH de cotovelo. Baseados nos dois critérios, a maturação ocorreu em 57,1% das fístulas de punho e em 100% das fístulas de cotovelo após a 1ª semana. Após 4 semanas, 67,9% das fístulas de punho e 100% das fístulas de cotovelo apresentaram maturação. Conclusão:A maioria das FAVH de cotovelo apresentou diâmetro e fluxo adequados para punção logo após a 1ª semana de pós-operatório. Para as FAVH de punho, houve melhora progressiva dos padrões de maturação com o passar das semanas, sugerindo que essas FAVH devem ser puncionadas preferencialmente após a 4ª semana de pós-operatório.Palavras-chave: Fístula, arteriovenosa, hemodiálise, eco-Doppler colorido. AbstractBackground: When a hemodialysis arteriovenous fistula (HAVF) is created, it is important to wait for venous dilatation and volume flow increase through the HAVF, a phenomenon called maturation. There is still some controversy as to the exact time required for this maturation to occur.

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Section: Discussionunclassified

Avaliação da maturação das fístulas arteriovenosas para hemodiálise pelo eco-Doppler colorido

et al. 2008

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“…Until time, three common methods have evolved for this purpose such as autogenous arteriovenous fistulas (AVFs), prosthetic arteriovenous grafts (AVG) and venous catheters. [1] AVFs are considered the most reliable long-term vascular access for maintenance of hemodialysis (HD) in patients with CRF due to their good long-term patency and low complication rate. [2] AVFs require fewer interventions, are less susceptible to failure due to infection and thrombosis, and have been shown to improve patient survival Therefore, for this commonly preferred surgery, its complications are in our main consideration.…”

mentioning

confidence: 99%

Complications of Arteriovenous Fistula Created for Hemodialysis Access and Treatment Approaches

Demiral

Turkoglu

Türkoğlu

2017

EJMO

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Objectives:Patients with chronic renal failure who are treated with hemodialysis need a patent arteriovenous fistula (AVF). This study was an analysis to determine the best approach to prevent complications and provide treatment. Methods: In this retrospective study, a total of 437 AVF patients' medical records and postoperative epicrisis with 4 years of clinical follow-up were evaluated. The preferred method of anastomosis surgery was the end-to-side technique. Complications were divided into categories of early (seen within 48 hours), and late (after 48 hours). Results: Of 437 patients, 288 (65.9%) were men, and the remaining 149 (34.1%) were women. The mean age was 46 years (range: 20-72 years). The locations of fistulas were snuffbox (n=42; 8.5%), radiocephalic (n=298; 60.9%), brachiocephalic (n=126; 25.6%), and brachiobasilic (n=25; 5%). Early complications were thrombosis (n=57; 69.5%), bleeding (n=14; 17%), and hematoma (n=11; 13.4%). Late complications observed were thrombosis/stenosis (n=25; 39.6%), venous hypertension (n=4; 6.3%), aneurysmatic dilatation (n=12; 19%), infection (n=6; 9.5%), bleeding/hematoma (n=7; 11.1%), arterial steal syndrome (n=4; 6.3%), congestive heart failure (n=1; 1.5%), seroma (n=2; 3.1%), and neuropathy (n=2; 3.1%). The most frequent of 145 total complications observed during the follow-up period was thrombosis (n=82; 16.7%). Conclusion:The benefits of ultrasound assistance in both the control and treatment of bleeding was also a supportive measure for the management of complications, such as steal syndrome, as it can be used to develop the best treatment strategy by considering flow velocities, or in the case of venous hypertension, to detect central stenosis. Embelectomy with re-operation may be preferred in a case of thrombosis, rather than embelectomy alone, as it is a time-consuming procedure and was reported in our clinic to be less effective when a standalone procedure.

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“…It is estimated that approximately 70 % may be treated endovascularly, the rest by surgical procedure or with av fi stula cessation. The cause of subclavian vein impairment is mostly its central venous access catheterization which presents in 14-40 % of patients, who later need dialysis access 4,5 . Complications occur in patients who are in the dialysis program for a long time and who undergo repeated dialysis access salvage and prior outfl ow tract examination 5 .…”

Section: Discussionmentioning

confidence: 99%

“…The cause of subclavian vein impairment is mostly its central venous access catheterization which presents in 14-40 % of patients, who later need dialysis access 4,5 . Complications occur in patients who are in the dialysis program for a long time and who undergo repeated dialysis access salvage and prior outfl ow tract examination 5 . Stenosis is not confi rmed, or there is no better outfl ow tract accessible and complication is assumed.…”

Section: Discussionmentioning

confidence: 99%

Operating Management of Central Venous Hypertension Complicating Upper Extremity Dialysis Access

Bachleda¹,

Utíkal²,

Kalinová³

et al. 2008

BIOMED PAP

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Aim:To evaluate the importance of surgical bypass between the terminal part of functional arteriovenous shunt (av) for hemodialysis on upper extremity and inner jugular vein in axillosubclavian venous segment obstruction associated with central venous hypertension.Method: Retrospective assessment of surgical bypass between central segments of av fi stula and ipsilateral/contralateral inner jugular vein using ePTFE graft in 17 patients over a 20 year period (1987)(1988)(1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006).Results: The surgical procedure was not associated with intra-or post-operative complications. Primary cumulative bypass and av fi stula function persisted for 26 months on average.Conclusion: An accurate bypass to salvage the functional dialysis access associated with central venous hypertension requires careful decision based on clinical and radiological examination. The bypass procedure is benefi cial where endovascular treatment is not indicated. Clinical and radiological bypass monitoring is crucial.

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The importance of preoperative evaluation of the subclavian vein in dialysis access planning.

Cited by 139 publications

References 10 publications

Avaliação da maturação das fístulas arteriovenosas para hemodiálise pelo eco-Doppler colorido

Avaliação da maturação das fístulas arteriovenosas para hemodiálise pelo eco-Doppler colorido

Complications of Arteriovenous Fistula Created for Hemodialysis Access and Treatment Approaches

Operating Management of Central Venous Hypertension Complicating Upper Extremity Dialysis Access

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