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Alnahhal KI, Rowse J, Kirksey L. The challenging surgical vascular access creation. Cardiovasc Diagn Ther 2023; 13:162-172. [PMID: 36864962 PMCID: PMC9971302 DOI: 10.21037/cdt-22-560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/06/2023] [Indexed: 02/16/2023]
Abstract
With the increasing life expectancy of patients with end-stage kidney disease, the creation and maintenance of hemodialysis vascular access are becoming more challenging. A comprehensive patient evaluation including a complete history, physical examination, and ultrasonographic vessel assessment is the foundation of the clinical evaluation. A patient-centered approach acknowledges the myriad of factors that impact the selection of optimal access for the distinct clinical and social circumstance of each patient. An interdisciplinary team approach involving various healthcare providers in all stages of hemodialysis access creation is important and associated with better outcomes. While patency is considered the most important parameter in most vascular reconstructive scenarios, the ultimate determinant of success in vascular access for hemodialysis is a circuit that allows consistent and uninterrupted delivery of the prescribed hemodialysis. The best conduit is one that is superficial, easily identified, straight, and of a large caliber. Individual patient factors and skill level of the cannulating technician also play a crucial role in the initial success and maintenance of vascular access. Special attention should be considered in dealing with more challenging groups such as the elderly population where the newest vascular access guidance from The National Kidney Foundation's Kidney Disease Outcomes Quality Initiative will be transformative. The current guidelines recommend monitoring the vascular access by regular physical and clinical assessments, however, inadequate evidence is available to support routine ultrasonographic surveillance for improving access patency.
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Affiliation(s)
- Khaled I Alnahhal
- Department of Vascular Surgery, Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jarrad Rowse
- Department of Vascular Surgery, Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lee Kirksey
- Department of Vascular Surgery, Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
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Gołębiowski T, Jerzak P, Letachowicz K, Konieczny A, Kusztal M, Gołębiowski M, Banasik M, Sznajder K, Krajewska M. Prone Position Facilitates Creation of Ulnar-Basilic Arteriovenous Fistula. J Clin Med 2022; 11:jcm11092610. [PMID: 35566736 PMCID: PMC9100111 DOI: 10.3390/jcm11092610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/27/2022] [Accepted: 05/04/2022] [Indexed: 02/04/2023] Open
Abstract
Background: The distal ulnar-basilic arteriovenous fistula (UBAVF) is a rarely used alternative type of vascular access for haemodialysis. The location of the vein on the back aspect of the forearm forces an extremely uncomfortable external rotation of the upper limb during surgery when the patient is in a supine position. Methods: We present a new approach towards creating UBAVF, which involves placing the patient in the prone position, thus eliminating the aforementioned inconvenience. The procedure was performed and described in a 46-year-old patient with chronic kidney disease (CKD) due to diabetic nephropathy. In the period from September 2021 to December 2021, we created an additional three UBAVFs with such modifications. Results: All fistulas were patent both immediately after the procedure and 2 weeks after surgery. Conclusions: The prone position may improve the comfort of both the operator and the patient during the procedure. On top of this, it may have a positive impact on the quality of the arteriovenous anastomosis.
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Affiliation(s)
- Tomasz Gołębiowski
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (P.J.); (K.L.); (A.K.); (M.K.); (M.G.); (M.B.); (M.K.)
- Correspondence:
| | - Patryk Jerzak
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (P.J.); (K.L.); (A.K.); (M.K.); (M.G.); (M.B.); (M.K.)
| | - Krzysztof Letachowicz
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (P.J.); (K.L.); (A.K.); (M.K.); (M.G.); (M.B.); (M.K.)
| | - Andrzej Konieczny
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (P.J.); (K.L.); (A.K.); (M.K.); (M.G.); (M.B.); (M.K.)
| | - Mariusz Kusztal
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (P.J.); (K.L.); (A.K.); (M.K.); (M.G.); (M.B.); (M.K.)
| | - Maciej Gołębiowski
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (P.J.); (K.L.); (A.K.); (M.K.); (M.G.); (M.B.); (M.K.)
| | - Mirosław Banasik
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (P.J.); (K.L.); (A.K.); (M.K.); (M.G.); (M.B.); (M.K.)
| | | | - Magdalena Krajewska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (P.J.); (K.L.); (A.K.); (M.K.); (M.G.); (M.B.); (M.K.)
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