Venous Distensibility as a Key Factor in the Success of Arteriovenous Fistulas at the Wrist

Kim, Jung Tae; Chang, Woon Ha; Oh, Tae Yun; Jeong, Young Kyun

doi:10.1016/j.avsg.2011.05.014

Cited by 27 publications

(38 citation statements)

References 14 publications

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“…19 By promoting sustained arterial and venous dilation, vascular spasm is minimized and an adequate flow of arterialized blood is allowed into the nascent AVF, an effect far superior than what can be acheived with the traditional tourniquet. 9,12,20 While general anesthesia can also promote intraoperative vasodilation, it has several limitations. 17 Induction is required, making it unsuitable in an ambulatory setting.…”

Section: Discussionmentioning

confidence: 99%

Effect of brachial plexus block-driven vascular access planning on primary distal arteriovenous fistula recruitment and outcomes

Renaud

Leong

Bin

et al. 2015

Journal of Vascular Surgery

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Section: Discussionmentioning

confidence: 99%

Effect of brachial plexus block-driven vascular access planning on primary distal arteriovenous fistula recruitment and outcomes

Renaud

Leong

Bin

et al. 2015

Journal of Vascular Surgery

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“…Many of the previous studies measured vein distensibility preoperatively using DUS or venography. They dilated the cephalic vein indirectly using a tourniquet, applying a heating pad, immersing in warm water, sitting and lying the arm in a lower position, or a composite of several of these methods (13,17,(19)(20)(21)(22)(23). These studies showed vein dilation to have a statistical significance.…”

Section: Discussionmentioning

confidence: 99%

“…Neither of these are the true vein diameter. According to van Bemmelen (20). Therefore, a 0.3-0.7-mm change in DUS is too small to accept it as an indicator of maturation success.…”

Section: Discussionmentioning

confidence: 99%

“…The female gender, the presence of diabetes mellitus (DM), and an insufficient diameter or poor compliance of the candidate vessels are recognized as possible causes of maturation failure (10)(11)(12)(13)(14)(15)(16)(17)(18). Several studies have reported the effects of vein distensibility (VD) on AVF maturation (16,19,20) and various methods to get vein distensibility (13,17,(21)(22)(23). Most studies have measured the vein diameter twice-the initial status and again after dilation, using a duplex ultrasound scan (DUS) or venography preopera-tively.…”

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confidence: 99%

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Clinical Importance of Intraoperative Cephalic Vein Distensibility as a Predictor of Radiocephalic Arteriovenous Fistula Maturation

Kim

Koyama

et al. 2015

Seminars in Dialysis

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Radiocephalic arteriovenous fistula (RCAVF) is the preferred vascular access, but the maturation failure rate is high. Poor vein distensibility is the main cause of maturation failure. There have been several studies regarding vein distensibility, but vein dilation protocol and the cut-off value predicting maturation failure were inconsistent. We were doubtful that the vein distensibility had been appropriately evaluated, and sought to determine a more clinically applicable parameter. The cephalic vein was dilated via intraluminal hydrostatic pressure during the surgery and the vein size was measured. Maturation failure occurred in 30 patients (22.4%) and was more common in females and in patients who had a previous history of arteriovenous access formation (p = 0.0095 and p = 0.014). The intraoperative postdilation diameter, and the difference between pre and postdilation diameters differed between the two groups (p = 0.0004 and p = 0.0004). The cut-off value of the postdilation diameter, which indicated a high probability of maturation success, was >4 mm, and the cut-off value which indicated a higher probability of maturation failure; that is, the difference between the pre and postdilation diameter, was ≤2.2 mm. The degree of distensibility of the cephalic vein may be an important determinant of RCAVF maturation.

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“…Regarding veins, a clinical study demonstrated that a venous luminal diameter of ≥ 2.5 mm and of ≥ 4.0 mm is essential for AVF and AVG, respectively; additionally, the continuity of distal superficial veins in the forearm is essential [59]. Furthermore, several reports have emphasized the importance of evaluating vein distensibility before AVF construction [59][60][61]. Evaluating venous dilatation involves the inflation of the blood pressure cuff or the use of a tourniquet above the vein so that the vein can dilate at least 50% of the remaining inner diameter [61].…”

Section: Differential Blood Pressuresmentioning

confidence: 99%

Pharmaceutical prevention strategy for arteriovenous fistula and arteriovenous graft failure

et al. 2019

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Vascular access failure (VAF) is a critical problem in patients undergoing hemodialysis (HD). Importantly, VAF impairs the quality of life in patients undergoing HD while imposing high medical costs. A variety of strategies (e.g., endovascular therapy and surgical reconstruction) for treating VAF have been established. However, strategies for preventing VAF are scarce. In this review, we summarized the available literatures regarding the prevention of VAF in patients undergoing HD with a focus on arteriovenous fistulas and arteriovenous grafts. This review proposes the following three aspects for developing strategies for preventing VAF: (i) early identification of risk factors of VAF (e.g., preoperative vascular conditions, age, sex, ethnicity, and clinical backgrounds), (ii) prophylactic drugs to reduce the risk of VAF, and (iii) early VAF detection through monitoring and surveillance of vascular access, particularly at frequent stenotic sites. A few prophylactic drugs may effectively prevent VAF based on the patient's clinical background. A few prophylactic drugs may effectively prevent VAF based on the patient's clinical background; however, currently, there is no strong evidence on the efficacy of these drugs in reducing the incidence of VAF. Thus, additional large, randomized controlled studies are warranted to establish effective strategies for preventing VAF.

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Venous Distensibility as a Key Factor in the Success of Arteriovenous Fistulas at the Wrist

Cited by 27 publications

References 14 publications

Effect of brachial plexus block-driven vascular access planning on primary distal arteriovenous fistula recruitment and outcomes

Effect of brachial plexus block-driven vascular access planning on primary distal arteriovenous fistula recruitment and outcomes

Clinical Importance of Intraoperative Cephalic Vein Distensibility as a Predictor of Radiocephalic Arteriovenous Fistula Maturation

Pharmaceutical prevention strategy for arteriovenous fistula and arteriovenous graft failure

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