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Donghua G, Zhen L, Xiaohe W, Guocun H, Lei S. Application of modified no-touch technique in rabbit arteriovenous fistula model and its effect on venous neointimal hyperplasia. J Vasc Access 2024:11297298241256172. [PMID: 38836593 DOI: 10.1177/11297298241256172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND To investigate the technical advantages of a modified no-touch technique (MNTT) in constructing arteriovenous fistulas (AVF) compared to the conventional technique (CT) and assess its potential to reduce neointimal hyperplasia in the outflow vein. METHODS Forty-seven New Zealand rabbits were randomly divided into three groups: control, CT, and MNTT. Rabbits in control group were observed using ultrasound and then euthanized to obtain external jugular vein (EJV) for Hematoxylin-eosin (H-E). We established common carotid artery (CCA)-EJV AVF using MNTT in the MNTT group and the CT in the CT group. AVF patency and complications were compared between the CT and MNTT groups. Rabbits with patent AVF in both groups were observed using ultrasound 2 weeks after surgery to evaluate changes in the vessel diameter and blood flow spectrum of the AVFs. H-E staining measured the intima thickness of EJV adjacent to the anastomosis and histologic characteristics of the AVF at 2 and 4 weeks after surgery. RESULTS Five rabbits died after surgery with common symptoms of sneezing, coughing, runny nose, anorexia, and diarrhea; two in the MNTT group and three in the CT group. There were significant differences in the diameter (p = 0.010) and peak systolic velocities (PSV) (p = 0.001) of EJV between the CT and MNTT groups 2 weeks after surgery. Spiral laminar flow (SLF) was observed in CCA and EJV adjacent to anastomosis in the MNTT group. Additionally, histological observations showed less venous neointimal hyperplasia in the MNTT group than in the CT group 4 weeks after surgery. CONCLUSION The rabbit model of CCA-EJV AVF established using MNTT demonstrated fewer complications, larger vein diameters, and reduced venous neointimal hyperplasia, indicating that this maybe an ideal animal model to further investigate the application of MNTT in AVF surgery.
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Affiliation(s)
- Gu Donghua
- Department of Pathology, Suzhou Hospital, Affiliated Hospital of Medical School, Nanjing University, Suzhou, China
| | - Liu Zhen
- Department of Nephrology, Suzhou Hospital, Affiliated Hospital of Medical School, Nanjing University, Suzhou, China
- Department of Nephrology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Wang Xiaohe
- Department of Nephrology, Suzhou Hospital, Affiliated Hospital of Medical School, Nanjing University, Suzhou, China
| | - Hou Guocun
- Department of Nephrology, Suzhou Hospital, Affiliated Hospital of Medical School, Nanjing University, Suzhou, China
- Department of Nephrology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Shen Lei
- Department of Nephrology, The First Affiliated Hospital of Soochow University, Suzhou, China
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Hou G, Fu M, Wang X, Liu Z, Zhang Y, Zhu D, Pang H, Li R, Shen L. Modified no-touch technique for radio-cephalic arteriovenous fistula increases primary patency and decreases juxta-anastomotic stenosis. J Vasc Access 2024; 25:904-913. [PMID: 36519744 DOI: 10.1177/11297298221139339] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
OBJECTIVE Low primary patency rate is a major problem of radio-cephalic arteriovenous fistula (RC-AVF) creation. Radial artery deviation and reimplantation (RADAR) is associated with low juxta-anastomotic stenosis rate. However, inflow artery stenosis is prominent with RADAR. To further reduce injury to veins and arteries during operation, a modified no-touch technique (MNTT) was used to create RC-AVF. METHODS We retrospectively reviewed our prospectively maintained database of patients with end-stage renal disease (ESRD)s undergoing RC-AVF creation for hemodialysis using either the MNTT between January 2021 and January 2022 (MNTT group) or conventional surgical procedure ( end-to-side vein-to-artery anastomosis) between October 2016 and October 2017 (Control group). Patients who chose to undergo RC-AVF surgery underwent standardized preoperative mapping and postoperative fistula evaluations using duplex ultrasound. Additionally, 4D flow MRI data were used to visualize and quantify the hemodynamics of one RC-AVF by MNTT. Outcomes included primary patency, juxta-anastomotic stenosis, and maturation rates. RESULTS Forty patients underwent RC-AVFs by MNTT, compared to 60 patients in the control group. The MNTT group had a higher primary unassisted patency rate than the control group (p = 0.038). Juxta-anastomotic stenosis (all on the cephalic vein) occurred in 4 (10%) patients who underwent MNTT. RC-AVF maturation rates after 3 months were not different between both groups (maturation rate: 90% and 81.7% in the MNTT and control groups, respectively, p = 0.253). COX regression showed that both conventional AVF surgery (p = 0.031) and smaller cephalic vein diameter (p = 0.034) were associated with higher odds of RC-AVF failure. The AVF flow within the proximal vein remained helical during cardiac cycle. The distribution of wall shear stress (WSS) and oscillatory shear index (OSI) differed from that of conventional surgical AVF. CONCLUSION RC-AVF by MNTT increases primary patency rate and decreases juxta-anastomotic stenosis rate. The improvement in hemodynamics may be one of the important reasons for the better patency rate of in the RC-AVF by MNTT group.
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Affiliation(s)
- Guocun Hou
- Department of Nephrology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Department of Nephrology, Suzhou Science & Technology Town Hospital, Gusu School, Nanjing Medical University, Suzhou, China
| | - Mingzhu Fu
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Xiaohe Wang
- Department of Nephrology, Suzhou Science & Technology Town Hospital, Gusu School, Nanjing Medical University, Suzhou, China
| | - Zhen Liu
- Department of Nephrology, Suzhou Science & Technology Town Hospital, Gusu School, Nanjing Medical University, Suzhou, China
| | - Yuanyuan Zhang
- Department of Nephrology, Suzhou Science & Technology Town Hospital, Gusu School, Nanjing Medical University, Suzhou, China
| | - Dongming Zhu
- Department of Medical Imaging, Suzhou Science & Technology Town Hospital, Gusu School, Nanjing Medical University, Suzhou, China
| | - Hongquan Pang
- Department of Medical Imaging, Suzhou Science & Technology Town Hospital, Gusu School, Nanjing Medical University, Suzhou, China
| | - Rui Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Lei Shen
- Department of Nephrology, The First Affiliated Hospital of Soochow University, Suzhou, China
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Xiaohe W, Jie L, Zhen L, Yuanyuan Z, Guocun H. A modified technique for arteriovenous fistula anastomosis: Preserving the surrounding tissue of the vein without the use of vascular clamps. J Vasc Access 2024:11297298241228932. [PMID: 38342969 DOI: 10.1177/11297298241228932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2024] Open
Abstract
BACKGROUND This pilot study describes a new technique for creating an arteriovenous fistula (AVF) and presents the preliminary outcomes after 1 year of follow-up. METHODS The study included 19 patients (10 males, 9 females) with a mean age of 62 years (range 26-88 years). All patients received an AVF using a modified technique in which the surrounding tissues were not removed from the veins and no elastic loops or vascular clamps were used. RESULTS Immediate patency was obtained for all patients. The proportion of patients experiencing primary patency at 30 days and 6 months was 89.5% and 83.1%, respectively, and cumulative patency at 30 days and 6 months was 100%. At 1 year of follow-up, primary patency was 83.1% and cumulative patency was 100%. CONCLUSIONS Complete preservation of the surrounding venous tissue in the absence of vascular clamps successfully established AVF, with a high surgical success rate.
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Affiliation(s)
- Wang Xiaohe
- Department of Nephrology, Suzhou Hospital, Affiliated Hospital of Medical School, Nanjing University, Suzhou, China
| | - Li Jie
- Department of Nephrology, Suzhou Hospital, Affiliated Hospital of Medical School, Nanjing University, Suzhou, China
| | - Liu Zhen
- Department of Nephrology, Suzhou Hospital, Affiliated Hospital of Medical School, Nanjing University, Suzhou, China
| | - Zhang Yuanyuan
- Department of Nephrology, Suzhou Hospital, Affiliated Hospital of Medical School, Nanjing University, Suzhou, China
| | - Hou Guocun
- Department of Nephrology, Suzhou Hospital, Affiliated Hospital of Medical School, Nanjing University, Suzhou, China
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Kordzadeh A, Mohaghegh V, Inston N. International survey of radiocephalic arteriovenous fistula: ISRAF survey. J Vasc Access 2024:11297298231222601. [PMID: 38253483 DOI: 10.1177/11297298231222601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024] Open
Abstract
AIMS The objective of this survey was to encompass the full scope of international practice, entailing all technical, non-technical, preoperative stratification and functional maturation (FM) of RCAVF. METHODS The survey contained n = 19 questionnaires with n = 46 variables completed by n = 85 providers from n = 21 nations across n = 5 continents. The numerical values were subjected to mean with standard error whereas the nominal data to a non-parametric (Kruskal-Wallis & Spearman correlation test) and analysis of variance (ANOVA). The test of homogeneity, & probability was reported 95% confidence intervals (CI) alongside error plots. Furthermore, a decision and higher attribute tree model was constructed based on current survey for higher FM in RCAVF. RESULTS FM is independently associated with volume of surgeon per year (procedures performed) (p < 0.01) [High Volume: 73% (95% CI, 68-77%) versus Average volume: 63% (95% CI, 59-66%) vs Low volume: 56% (95% CI, 51-61%)]. FM increased by 8% with every 20 more procedures per group of surgeons on end point of FM. Amongst continents: Australia, America, Asia and South America demonstrated higher FM to Africa & Europe (p < 0.05). UK possessed a lower FM 58% (95% CI, 48-68%) in comparison to the world & Europe respectively [65% (95% CI, 61-70%) vs 61% (95% CI, 58--65%)]. There was a positive causal link between angle of anastomosis at 30-76° (p < 0.01), longitudinal & S-shaped incision & arteriotomy length of 3 & 4 mm to higher FM (p < 0.05). CONCLUSION FM in RCAVF is independently & incrementally associated with the volume of surgeon per year. There is a diverse inclusion, exclusion and technical approach in RCAVF creation. This survey advocates the importance of international collaboration and/or registry in assimilation, consolidate and development of consensus.
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Affiliation(s)
- Ali Kordzadeh
- Department of Vascular, Endovascular Surgery and Renal Access, Mid and South Essex NHS Foundation Trust, Basildon Hospital, Nether Mayne, Basildon, Essex, UK
- Faculty of Science and Engineering, Anglia Ruskin University, Chelmsford, England, UK
| | - Vahaj Mohaghegh
- Faculty of Science and Engineering, Anglia Ruskin University, Chelmsford, England, UK
| | - Nicholas Inston
- Department of Renal Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, England, UK
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Xu S, Wang J, Tang L, Cao W, Liang L, Wei K, Wang Z, Kong X. The RADAR technique in reconstruction of failed autologous arteriovenous fistulas due to juxta-anastomotic stenosis is equivalent to that with traditional surgery in maintenance hemodialysis patients. J Vasc Access 2023:11297298231212225. [PMID: 37997036 DOI: 10.1177/11297298231212225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVE Autologous arteriovenous fistula (AVF) is recommended as superior vascular access for hemodialysis but has a high rate of failure, and juxta-anastomotic stenosis (JAS) is one of the predominant causes of fistula failure. The aim of this study was to compare the primary patency in reconstruction of failed AVFs due to JAS between the radial artery deviation and reimplantation (RADAR) technique and traditional surgery (end-vein to side-artery neo-anastomosis) in maintenance hemodialysis (MHD) patients. METHODS A total of 1215 MHD patients with failed AVF were enrolled in this retrospective cohort study, and 614 patients with failed AVF received surgical intervention. Among these surgical interventions, 417 patients experienced AVF failure due to JAS. Finally, 25 patients who received the RADAR technique were enrolled. Controls of 50 patients received traditional surgery were randomly selected matched by age and sex. Clinical data such as age, sex, comorbidities, and blood biochemical indices were collected. Kaplan-Meier survival curves and Cox proportional hazards analyses were used to explore the difference between the RADAR group and the traditional group in reconstruction of failed AVFs. RESULTS The RADAR group and the traditional group shared common baseline characteristics. The primary patencies of the reconstructed AVFs were 88.8%, 79.0%, 72.2%, 57.4%, and 38.3% at 12, 24, 36, 48, and 60 months among the 75 patients, respectively. Kaplan-Meier survival curve analysis demonstrated similar primary patencies in the two groups (log-rank test, p = 0.73). Compared with the traditional group, the RADAR group had no difference in predicting AVF failure after adjusting for potential confounders, with an HR of 0.92 (95% CI, 0.18-4.63). CONCLUSIONS The primary patency of the RADAR technique and the traditional surgery in the reconstruction of failed AVFs due to JAS is almost equal in 5 years.
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Affiliation(s)
- Shuqi Xu
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, PR China
| | - Jie Wang
- Department of Blood Purification Center, Qufu People's Hospital, Qufu, Shandong, PR China
| | - Lijun Tang
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, PR China
- Nephrology Research Institute of Shandong Province, Jinan, Shandong, PR China
| | - Wei Cao
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, PR China
- Nephrology Research Institute of Shandong Province, Jinan, Shandong, PR China
| | - Liming Liang
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, PR China
- Nephrology Research Institute of Shandong Province, Jinan, Shandong, PR China
| | - Kai Wei
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, PR China
- Nephrology Research Institute of Shandong Province, Jinan, Shandong, PR China
| | - Zunsong Wang
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, PR China
- Nephrology Research Institute of Shandong Province, Jinan, Shandong, PR China
| | - Xianglei Kong
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, PR China
- Nephrology Research Institute of Shandong Province, Jinan, Shandong, PR China
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Feng R, Wang S, Yu J, Zheng X, Chen W, Wang X, Chang G. The feasibility and efficiency for constructing arteriovenous fistula with <2 mm vein-a systematic review and meta-analysis. Front Cardiovasc Med 2023; 10:1226136. [PMID: 37808887 PMCID: PMC10552868 DOI: 10.3389/fcvm.2023.1226136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
Background Autogenous arteriovenous fistula (AVF) is an efficient hemodialysis access for patients with end-stage kidney disease (ESKD). The specific threshold of vein diameter still not reached a consensus. Method We conducted a comprehensive search in PubMed, Embase, and Web of Science databases for articles which comparing the treatment outcomes of AVF with 2 mm as vein diameter threshold. Fixed and random effect model were used for synthesis of results. Subgroup analysis was designed to assess the risk of bias. Result Eight high-quality articles were included finally. Among a total of 1,075 patients (675 males and 400 females), 227 and 809 patients possessed <2 mm and ≥2 mm vein respectively. Apart from gender and coronary artery disease (P < 0.05), there was no significant difference in age, diabetes, hypertension or radial artery between maturation and non-maturation groups. The functional maturation rate was lower in patients with <2 mm vein according to fixed effect model [OR = 0.19, 95% CI (0.12, 0.30), P < 0.01]. There was no significant difference in primary [OR = 0.63, 95% CI (0.12, 3.25), P = 0.58] or cumulative patency rates [OR = 0.40, 95% CI (0.13, 1.19), P = 0.10]. Conclusion Vein diameter less than 2 mm has a negative impact on the functional maturation rate of AVF, while it does not affect the primary and cumulative patency rates (12 months).
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Affiliation(s)
- Ruijia Feng
- Department of Vascular Surgery, National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Siwen Wang
- Department of Vascular Surgery, National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jianwen Yu
- Department of Nephrology, NHC Key Laboratory of Nephrology, Guangdong Provincial Key Laboratory of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xunhua Zheng
- Department of Nephrology, NHC Key Laboratory of Nephrology, Guangdong Provincial Key Laboratory of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wei Chen
- Department of Nephrology, NHC Key Laboratory of Nephrology, Guangdong Provincial Key Laboratory of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xin Wang
- Department of Nephrology, NHC Key Laboratory of Nephrology, Guangdong Provincial Key Laboratory of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Guangqi Chang
- Department of Vascular Surgery, National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Xiaohe W, Yuanyuan Z, Zhen L, Guocun H. A modified no-touch technique for anastomosis to create a radiocephalic arteriovenous fistula. J Vasc Surg Cases Innov Tech 2021; 7:686-690. [PMID: 34746531 PMCID: PMC8556484 DOI: 10.1016/j.jvscit.2021.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/31/2021] [Indexed: 11/19/2022] Open
Abstract
The application of a no-touch technique to create an autologous radiocephalic arteriovenous fistula might improve the patency rate. In the present report, we have expanded the concept of the no-touch technique by introducing a modified no-touch technique in which we preserve the perivenous vascular tissue, followed by a functional end-to-side anastomosis to create a radiocephalic arteriovenous fistula with early maturation for hemodialysis.
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8
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Lima ML, Silva HSM, Lougon LN, Barros FS, Gomes WJ. Remodeling of ipsilateral ulnar artery after radial artery harvesting for coronary artery bypass graft. Can J Physiol Pharmacol 2021; 99:231-236. [PMID: 33590782 DOI: 10.1139/cjpp-2020-0432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
There are controversies in the literature on the blood supply to the forearm after surgical removal of the radial artery in coronary artery bypass grafting (CABG). The objective was to investigate the arterial remodeling of the ulnar artery after the removal of the radial artery in myocardial revascularization by means of ultrasound examination with color Doppler in the pre- and post-operative periods. This paper describes an observational prospective study of the remodeling of the left brachial and ulnar arteries (donor arm) in 103 right-handed non-consecutive adult patients undergoing CABG with removal of the ipsilateral radial artery using the color Doppler ultrasound examination. In the ulnar artery, a significant increase (P < 0.05) was seen in the following measurements: lumen diameter by 13%, lumen area by 26%, peak systolic flow by 40%, and average flow by 46%. Intima-media thickness measured in the ulnar artery did not show a statistically significant difference (P = 0.22), except in diabetic patients (P = 0.007). We conclude that the ulnar artery undergoes positive physiological remodeling, adapting to the new requirements of chronic increase in flow after the ipsilateral removal of the radial artery to serve as a graft in CABG. There was no evidence of increased intima-media thickness, except in diabetic patients.
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Affiliation(s)
- Melchior L Lima
- Cardiovascular Surgery Center, Meridional Hospital, R. Meridional, 200 - Alto Lage, Cariacica, Espírito Santo, 29151-920, Brazil
| | - Héber S M Silva
- Cardiovascular Surgery Center, Meridional Hospital, R. Meridional, 200 - Alto Lage, Cariacica, Espírito Santo, 29151-920, Brazil
| | - Lourival N Lougon
- Cardiovascular Surgery Center, Meridional Hospital, R. Meridional, 200 - Alto Lage, Cariacica, Espírito Santo, 29151-920, Brazil
| | - Fanilda S Barros
- Cardiovascular Surgery Center, Meridional Hospital, R. Meridional, 200 - Alto Lage, Cariacica, Espírito Santo, 29151-920, Brazil
| | - Walter J Gomes
- Discipline of Cardiovascular Surgery, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, SP, Brazil
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Zhang H, Zhu G, Yan L, Lu Y, Shao F. Does ligation of the dorsal branch of the cephalic vein affect the patency of a distal forearm arteriovenous fistula? A randomised study. BMC Nephrol 2020; 21:155. [PMID: 32349711 PMCID: PMC7191813 DOI: 10.1186/s12882-020-01823-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 04/21/2020] [Indexed: 11/10/2022] Open
Abstract
Background Whether ligation of the dorsal branch of the cephalic vein during the surgical establishment of the radiocephalic arteriovenous fistula (RCAVF) favorably or adversely affects the patency rate of the RCAVF remains controversial. We performed a randomized controlled trial to evaluate the effect of dorsal branch ligation on the patency rate of RCAVF. Methods A total of 115 patients who underwent surgical establishment were randomized to two groups treated with or without ligation of the dorsal branch of the cephalic vein during the surgical process. The primary patency rates of the RCAVF at 90, 270, and 360 days after the surgery and the secondary patency rates during a follow-up up to 1 year were compared. Results The patency rate did not differ significantly between the two groups at 3, 9, or 12 months after the procedure (P > 0.05). The combined primary patency rates of the RCAVF in patients from both groups at 3, 9 and 12 months after the procedure were 87.6, 82, and 74.5% respectively, while the combined secondary patency rate was 92.2% at the 1-year follow-up. The Log-rank test indicated that the initial patency rate and secondary patency rate did not differ significantly between the two groups (P = 0.674 and 0.759, respectively). Conclusion This clinical study indicated that ligation of the dorsal branch of the cephalic vein does not significantly affect the patency of the arteriovenous fistula with a 1-year follow-up. Trial registration ISRCTN ISRCTN12288675, Registered 25 September 2019 in the ISRCTN registry. retrospectively registered.
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Affiliation(s)
- Hongtao Zhang
- Blood Purification Center, The People's Hospital of Zhengzhou University, Zhengzhou, China.,Blood Purification Center, Henan Provincial People's Hospital, Zhengzhou, China.,Institute of Nephrolog, Zhengzhou, Henan, China.,Department of Nephrology Henan Provincial People's Hospital, Zhengzhou, China
| | - Guizhen Zhu
- Blood Purification Center, The People's Hospital of Zhengzhou University, Zhengzhou, China.,Blood Purification Center, Henan Provincial People's Hospital, Zhengzhou, China.,Institute of Nephrolog, Zhengzhou, Henan, China.,Department of Nephrology Henan Provincial People's Hospital, Zhengzhou, China
| | - Lei Yan
- Blood Purification Center, The People's Hospital of Zhengzhou University, Zhengzhou, China.,Blood Purification Center, Henan Provincial People's Hospital, Zhengzhou, China.,Institute of Nephrolog, Zhengzhou, Henan, China.,Department of Nephrology Henan Provincial People's Hospital, Zhengzhou, China
| | - Yang Lu
- Blood Purification Center, The People's Hospital of Zhengzhou University, Zhengzhou, China.,Blood Purification Center, Henan Provincial People's Hospital, Zhengzhou, China.,Institute of Nephrolog, Zhengzhou, Henan, China.,Department of Nephrology Henan Provincial People's Hospital, Zhengzhou, China
| | - Fengmin Shao
- Blood Purification Center, The People's Hospital of Zhengzhou University, Zhengzhou, China. .,Blood Purification Center, Henan Provincial People's Hospital, Zhengzhou, China. .,Institute of Nephrolog, Zhengzhou, Henan, China. .,Department of Nephrology Henan Provincial People's Hospital, Zhengzhou, China.
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10
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Comparison of the one-year patency rates of radiocephalic arteriovenous fistulas created using no-touch versus conventional technique. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 27:43-48. [PMID: 32082826 DOI: 10.5606/tgkdc.dergisi.2019.16136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 09/21/2018] [Indexed: 11/21/2022]
Abstract
Background This study aims to compare the patency rates of radiocephalic arteriovenous fistulas prepared preserving the perivenous vascular tissues versus those prepared using the conventional technique. Methods A total of 169 patients (107 males, 62 females; mean age 59.5 years; range, 39 to 87 years) who underwent a radiocephalic arteriovenous fistula construction were included in this study. In 95 patients, the tissues surrounding the cephalic vein were stripped off as per the conventional method, while the no-touch technique preserving the perivenous vascular tissues was utilized for vein harvesting in 74 patients. Patients were followed-up to compare primary and secondary patency rates of the arteriovenous fistulas at one year. Results Fistula failure developed in 22 patients within the first year resulting in primary patency rates of 90.5% versus 84.2% for the no-touch and the conventional groups, respectively (p=0.225). Likewise, secondary patency rates were 94.6% versus 93.7% for the no-touch and the conventional groups, respectively (p=0.803). The two groups did not differ with regards to primary or secondary patency rates. Conclusion Findings of this study were not in favor of the no-touch technique compared to the conventional methods in terms of arteriovenous fistula patency at one year.
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Venkatesan VK, McHenry ZD, Ertel AE, Ahmad SA, Sussman JJ, Hanseman D, Shah SA, Abbott DE. Programmatic change leads to enhanced resource utilization and efficiency in port placement. J Surg Res 2018; 229:294-301. [PMID: 29937005 DOI: 10.1016/j.jss.2018.04.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 04/02/2018] [Accepted: 04/13/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Central venous port (CVP) placement is performed by a variety of surgeons in different subspecialties, and our previous work suggests that individual surgeons-regardless of training-are the strongest predictor of outcomes. We sought to prospectively evaluate a programmatic shift toward a resource-conscious, patient-focused algorithm for this common and simple surgical procedure. MATERIALS AND METHODS After implementation of a systems-level program for efficient CVP placement, 78 CVPs were placed by a single surgeon. Primary outcomes were procedure time, total operating room (OR) time, total facility time, and procedure-related complications. These prospective data were compared with retrospective cohorts of surgically placed and interventional radiology-placed CVP. Demographic data were analyzed by chi-square analysis, whereas time data were analyzed by the Wilcoxon rank-sum test. RESULTS The programmatic delivery (prospective) set showed significantly shorter procedural (median 16 min versus 26-40, P <0.05), OR times (median 36 min versus 46-70, P <0.05), and facility times (median 235 min versus 299-319, P <0.05) except for the interventional radiology facility time (median 187 versus 235, P <0.05). The range of OR time savings with the prospective versus comparison groups was 10-34 min, representing 22%-49% reductions in OR time (P <0.05). Complication rates were not significantly different (P = 0.13). CONCLUSIONS Through a programmatic change emphasizing efficiency and patient-centered outcomes, procedural/OR/facility time can be reduced greatly without changing complication rates. These data provide compelling evidence that common and ostensibly simple operative procedures can be substantially improved upon with thoughtful, data-driven systems-level enhancements.
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Affiliation(s)
- Vijay K Venkatesan
- Cincinnati Research on Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, Ohio; Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Zachary D McHenry
- Cincinnati Research on Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - Audrey E Ertel
- Cincinnati Research on Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - Syed A Ahmad
- Cincinnati Research on Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - Jeffrey J Sussman
- Cincinnati Research on Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - Dennis Hanseman
- Cincinnati Research on Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - Shimul A Shah
- Cincinnati Research on Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - Daniel E Abbott
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
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Sadaghianloo N, Declemy S, Jean-Baptiste E, Haudebourg P, Robino C, Islam MS, Hassen-Khodja R, Dardik A. Radial artery deviation and reimplantation inhibits venous juxta-anastomotic stenosis and increases primary patency of radial-cephalic fistulas for hemodialysis. J Vasc Surg 2016; 64:698-706.e1. [DOI: 10.1016/j.jvs.2016.04.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 04/03/2016] [Indexed: 12/17/2022]
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