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- Title
Conversion of tunneled hemodialysis catheter–consigned patients to arteriovenous fistula.
- Authors
Asif, Arif; Cherla, Gautam; Merrill, Donna; Cipleu, Cristian D.; Briones, Patricia; Pennell, Phillip
- Abstract
Conversion of tunneled hemodialysis catheter–consigned patients to arteriovenous fistula.Objective.Despite their high incidence of complications, costs, morbidity, and mortality, nearly 27% of the chronic hemodialysis (HD) patients are receiving treatment via a tunneled hemodialysis catheter (TDC).Methods.In this prospective analysis, an interventional nephrology team employed an organized program consisting of vascular access (VA) education and vascular mapping (VM) to TDC-consigned patients. A full range of surgical approaches for arteriovenous fistula (AVF) creation, including vein transpositions, was exercised. Physical examination was performed every 1 to 2 weeks after surgery to assess the development of the AVF. Fistulas that failed to develop adequately to support HD (early failure) underwent salvage[percutaneous transluminal angioplasty (PTA), accessory vein obliteration (AVL)] procedures.Results.One hundred twenty-one TDC-consigned patients received VA education. Eighty-six (71%) agreed to undergo VM. Two groups were identified. Group I (N= 66; using TDC for 7.2± 1.8 SD months) had never had an arteriovenous access; group II (N= 20; using TDC for 12.3± 4.0 months) had a history of one or more previously failed arteriovenous accesses. Upon VM, 64/66 (97%) in group I and 18/20 (90%) in group II were found to have adequate veins for AVF creation. Seven patients (11%) in group I and 3 (17%) in group II refused surgery. In group I, 57 (89%) received an arteriovenous access (radiocephalic AVF= 15, brachiocephalic AVF= 35, transposed brachiobasilic AVF= 3, brachiobasilic AVG= 4). In group II, 15 (83%) received a transposed AVF (radiobasilic= 2, brachiobasilic= 13). Sixteen fistulas (30%) in group I and 8 (53%) in group II had early failure. All except for one fistula in each group were salvaged using PTA and/or AVL. All 70 accesses (AVF= 66, AVG= 4) remain functional, with a mean follow-up of 8.5± 3.6 months.Conclusion.These results demonstrate that an organized approach based upon a comprehensive program utilizing VA counseling, VM, application of full range of surgical techniques, and salvage procedures can be very successful in providing optimum vascular access to the catheter-dependent patient.
- Subjects
FLORIDA; CATHETERS; HEMODIALYSIS; ARTERIOVENOUS fistula; NEPHROLOGY; MEDICAL research; ARTERIAL catheterization; PHYSICAL diagnosis; BLOOD vessels; TRANSLUMINAL angioplasty; DIALYSIS catheters; INFORMED consent (Medical law); DESCRIPTIVE statistics; HEMODIALYSIS facilities; CATHETERIZATION; ENDOVASCULAR surgery; SALVAGE therapy; MEDICAL equipment; EDUCATIONAL outcomes; LONGITUDINAL method
- Publication
Kidney International, 2005, Vol 67, Issue 6, p2399
- ISSN
0085-2538
- Publication type
Article
- DOI
10.1111/j.1523-1755.2005.00347.x