Surgical Options in the Problematic Arteriovenous Haemodialysis Access

Accessory veins related hand ischemia: A case series

INTRODUCTION

Arteriovenous fistula is considered as a lifeline for chronic kidney patients undergoing maintenance hemodialysis.

OBJECTIVE

To study the outcome of ligation of the accessory vein causing hyperperfusion and ischemia of the ipsilateral limb.

METHOD

ology: A single institution, single surgeon, in-hospital, retrospective case series of patients presented with alarm symptoms in postoperative period following arteriovenous fistula.

RESULTS

A total of 800 AVF were created between 2016 and 2019, out of which 6/800 (0.75 %) patients presented with alarm symptoms related to venous hypertension and underwent accessory vein ligation. All showed normal recovery with complete resolution of symptoms postoperatively.

CONCLUSION

Timely ligation of the accessory vein in patients with arteriovenous fistula with accessory vein related alarm symptoms showed salvage of lifeline and limb with no residual complications during follow-up.

KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update

The National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (KDOQI) has provided evidence-based guidelines for hemodialysis vascular access since 1996. Since the last update in 2006, there has been a great accumulation of new evidence and sophistication in the guidelines process. The 2019 update to the KDOQI Clinical Practice Guideline for Vascular Access is a comprehensive document intended to assist multidisciplinary practitioners care for chronic kidney disease patients and their vascular access. New topics include the end-stage kidney disease "Life-Plan" and related concepts, guidance on vascular access choice, new targets for arteriovenous access (fistulas and grafts) and central venous catheters, management of specific complications, and renewed approaches to some older topics. Appraisal of the quality of the evidence was independently conducted by using a Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, and interpretation and application followed the GRADE Evidence to Decision frameworks. As applicable, each guideline statement is accompanied by rationale/background information, a detailed justification, monitoring and evaluation guidance, implementation considerations, special discussions, and recommendations for future research.

Úlceras de quirodáctilos e dorso de mão esquerda ocasionadas por hipertensão venosa após confecção de fístula arteriovenosa braquiocefálica: relato de caso

Venous ulcers caused by venous hypertension secondary to arteriovenous fistulae are rare. Their etiology can be confirmed by vascular Doppler ultrasonography, which can differentiate between stenosis of central vessels and hemodynamic overload caused by development of tributaries from the vein responsible for the arteriovenous fistula. We present a case caused by hemodynamic overload of a tributary, which diverted the primary flow from the fistula to the distal limb. We chose to ligate the fistula to treat the ulcers and create another arteriovenous fistula in the contralateral limb.