The timely construction of arteriovenous fistulae: a key to reducing morbidity and mortality and to improving cost management

Ortega, Teresa; Ortega, Francisco; Díaz‐Corte, Carmen; Rebollo, Pablo; Baltar, José M.; Alvarez-Grande, J

doi:10.1093/ndt/gfh644

Cited by 74 publications

(48 citation statements)

References 15 publications

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“…O paciente em seu primeiro ano de hemodiálise em uso de cateter venoso custa, em média, 19.000 dólares a mais que um paciente com FAV, devido às maiores taxas de complicações 6 . Ortega et al 17 relatam maiores taxas de hospitalização e mortalidade nos pacientes em uso de cateteres em relação ao uso de FAV. Para O'Hare et al 18 , a adequação do serviço e a experiência do cirurgião têm impacto positivo na escolha e confecção do acesso vascular.…”

Section: Discussionunclassified

Avaliação da perviedade precoce das fístulas arteriovenosas para hemodiálise

et al. 2011

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ResumoContexto: A insuficiência renal crônica é uma doença de alta prevalência e morbidade, o que determina queda da qualidade de vida. Pacientes em hemodiálise necessitam de um acesso vascular que permita a conexão da circulação do paciente ao circuito externo de hemodiálise. Dentre os acessos disponíveis, as fístulas arteriovenosas (FAV) são as que mais se aproximam do acesso ideal. Objetivo: Avaliar a perviedade precoce das FAV, identificando os fatores relacionados ao insucesso destas. Métodos: Foram acompanhados todos os pacientes submetidos à confecção das FAV no Hospital do Servidor Público Municipal de São Paulo, no período de agosto de 2008 a janeiro de 2009, avaliando-se a perviedade destas no 1º, 10º e 30º pós-operatório. Foram realizadas 31 FAV no período, apresentando-se média de idade de 63,06 anos, sendo 18 pacientes do sexo masculino e 13 do feminino. Resultados: Vinte e seis FAV foram distais, todas radiocefálicas; quatro foram proximais, das quais duas braquiocefálicas e duas braquiobasílicas superficializadas; uma FAV confeccionada com alça de politetrafluoretileno (PTFE) fêmoro-femoral esquerda. A taxa de perviedade no primeiro mês foi de 71% dos casos. O uso de cateteres venosos centrais apresentou-se como fator de risco para oclusão da FAV (p=0,01). As FAV continuam sendo o acesso vascular para hemodiálise mais aceito e mais seguro. A indicação precoce para confecção das FAV é de fundamental importância, evitando-se, assim, o uso de cateteres e suas complicações. Conclusões: A perviedade precoce encontrada neste estudo é semelhante à da literatura, e o uso prévio de cateteres é o fator de risco mais significativo para oclusão precoce desta. Palavras-chave: Fístula arteriovenosa, diálise renal, desobstrução vascular AbstractBackground: Chronic renal failure is a disease of high prevalence and high morbidity, which impairs the patients' quality of life. Patients on hemodialysis need a vascular access for connection with the hemodialysis equipment. Arteriovenous fistulas (AVF) are the best option for this purpose. Objective: To evaluate the early patency of AVFs and to identify the causes of their failure. Methods: All patients AVF underwent operations for dialysis from August, 2008 to January, 2009. The AVF patency was evaluated on the 1 st , 10 th and 30 th postoperative days. Thirty-one operations for AVF were performed in our hospital in the period; 18 patients were males and the mean age was 63.03 years. Results: Twenty-six AVF were distal, all radial-cephalic; four were proximal, out of which two were brachiocephalic and two were brachiobasilic; one AVF was a femoral-femoral loop PTFE graft. The patency rate in the first month was of 71%. The use of central venous catheters was a risk factor for AVF occlusion (p=0.01). AVF remains the most accepted and safe vascular access. Early performance of the AVF is very important to avoid the complications resulting from long-term use of central venous catheters. Conclusions: Data regarding early patency found in this study were similar to those f...

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Section: Discussionunclassified

Avaliação da perviedade precoce das fístulas arteriovenosas para hemodiálise

et al. 2011

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“…In dialysis patients they are linked with higher rates of infection, hospitalization, morbidity and mortality 16 .…”

Section: Central Venous Cathetersmentioning

confidence: 99%

Acesso vascular para hemodialise: o que ha de novo?

et al. 2013

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The increasing life expectancy of patients with chronic diseases, including chronic renal failure, means that treatment methods are constantly being updated and improved. Long term hemodialysis has created the need to provide and maintain long lasting vascular access. Arteriovenous fistula is the first-choice option for hemodialysis and research has been conducted to attempt to increase the useful life of both fistula and catheter access methods. This article reviews the vascular access options and solutions currently available for hemodialysis.Keywords: renal dialysis; catheters; arteriovenous fistula. ResumoO aumento da expectativa de vida dos portadores de doenças crônicas, entre as quais a insuficiência renal crônica, faz com que métodos de tratamentos estejam em constante aperfeiçoamento. O uso em longo prazo da hemodiálise torna necessário confeccionar e manter acessos vasculares de utilização duradoura. Tanto as fístulas arteriovenosas -primeira opção de acesso para os pacientes hemodialíticos -como os cateteres vêm sendo objeto de estudos na literatura, na tentativa de prolongar sua vida útil. Esta revisão tem como objetivo relatar as alternativas e soluções atuais para os acessos vasculares para hemodiálise.Palavras-chave: diálise renal; cateteres; fístula arteriovenosa.

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“…(1,2,3,4) The improvement in AVF prevalence is a welcome trend however older patients could be disadvantaged by repeated unsuccessful attempts at surgical AVF creation and resulting overdependence on central venous catheters (CVCs). (5) The age structure of the end-stage renal disease (ESRD) population has changed considerably over the past 20 years with an increasing proportion of older patients (>75 years) receiving dialysis.…”

Section: Introductionmentioning

confidence: 99%

Patient Survival following Arteriovenous Fistula Formation

et al. 2015

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Type of article for submission Original manuscript ABSTRACT Purpose:Efforts to promote arteriovenous fistulas (AVFs) have been successful in increasing the prevalence of AVF use as the primary vascular access for haemodialysis HD.Sustained preference for AVF use may not be the most appropriate vascular access choice for all patient groups. Arteriovenous grafts (AVGs) offer advantages of earlier use and lower primary failure rates compared to AVFs so may be preferable for patients where short term vascular access is needed. This study was designed to assess comparative mortality in different age groups following AVF formation. Methods:A prospective cohort of patients having AVF creation was recruited. Patients were subdivided into three age groups; Group A: < 50 years; Group B: 50-74 years and Group C: 75 years. Survival curves and Cox regression analysis was performed on each of these groups. Results:One hundred and thirty-four patients (n=134) were recruited into the study. The prevalence of diabetes increased significantly with age. As expected, mortality was higher in older age groups (log rank (mantel cox) 19.227; p = 0.0001). Mortality rates at one year were 0% in group A, 12.5% in group B and 29.1% in group C. Medium term mortality at four years was 7.9% in group A, 39.1% in group B and 54.8%% in group C. Conclusions:We found a significantly higher mortality rate in patients ≥75 years in comparison to those <75 years. The choice of vascular access modality should be tailored to the individual with particular reference to the patient's expected survival.

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The timely construction of arteriovenous fistulae: a key to reducing morbidity and mortality and to improving cost management

Abstract: The lack of an adequate AVF at the start of haemodialysis decreases survival significantly-even if patients are not diabetic, are referred to a nephrologist early and planned haemodialysis is initiated. It also increases the cost of each prevented death.

Cited by 74 publications

References 15 publications

Avaliação da perviedade precoce das fístulas arteriovenosas para hemodiálise

Avaliação da perviedade precoce das fístulas arteriovenosas para hemodiálise

Acesso vascular para hemodialise: o que ha de novo?

Patient Survival following Arteriovenous Fistula Formation

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