The difficult hemodialysis access extremity: Proximal radial arteriovenous fistulas and the role of angioscopy and valvulotomes

Justin K. Roberts, Matthew J Sideman, William C. Jennings

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background: Native arteriovenous (AV) fistulas (NAVF) offer significantly lower risks than grafts or catheters. Individuals with a difficult access extremity (DAE) are often viewed as unsuitable for NAVFs. The proximal radial artery (PRA) NAVF offers a safe and reliable opportunity for a direct fistula in most patients, and we find it an important surgical option in the DAE. Methods: Consecutive vascular access operations were reviewed to find individuals with DAE. We defined the DAE patient group as those individuals where a wrist (Cimino) or upper arm brachiocephalic NAVF was not possible or was predicted to fail. Results: Preoperative physical and ultrasound examinations identified 58 individuals with DAE. Mean age was 56 years (range 11 to 87), 34 were female, 29 were diabetic, and 27 had previous access surgery. NAVFs were constructed in all patients. No grafts were utilized. Forty-six patients had a PRA NAVF constructed. NAVF patency was 91%. Twenty-three patients required retrograde angioscopy or passage of a valvulotome to gain forearm access. Twenty-one of these 23 individuals maintained an open NAVF segment in the forearm. Conclusion: NAVFs were constructed in all patients. PRA NAVFs play an important role in extending hemodialysis by NAVF for this difficult patient group. Forearm access is often possible in these patients and may be successfully augmented by angioscopy or valvulotomes.

Original languageEnglish (US)
Pages (from-to)869-873
Number of pages5
JournalAmerican Journal of Surgery
Volume190
Issue number6
DOIs
StatePublished - Dec 2005
Externally publishedYes

Fingerprint

Angioscopy
Arteriovenous Fistula
Renal Dialysis
Extremities
Radial Artery
Forearm
Transplants
Wrist
Physical Examination
Fistula
Blood Vessels
Arm
Catheters

Keywords

  • Angioscopy
  • Arteriovenous fistula
  • Hemodialysis
  • Radial artery
  • Valvulotome
  • Vascular access

ASJC Scopus subject areas

  • Surgery

Cite this

The difficult hemodialysis access extremity : Proximal radial arteriovenous fistulas and the role of angioscopy and valvulotomes. / Roberts, Justin K.; Sideman, Matthew J; Jennings, William C.

In: American Journal of Surgery, Vol. 190, No. 6, 12.2005, p. 869-873.

Research output: Contribution to journalArticle

Roberts, Justin K. ; Sideman, Matthew J ; Jennings, William C. / The difficult hemodialysis access extremity : Proximal radial arteriovenous fistulas and the role of angioscopy and valvulotomes. In: American Journal of Surgery. 2005 ; Vol. 190, No. 6. pp. 869-873.
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abstract = "Background: Native arteriovenous (AV) fistulas (NAVF) offer significantly lower risks than grafts or catheters. Individuals with a difficult access extremity (DAE) are often viewed as unsuitable for NAVFs. The proximal radial artery (PRA) NAVF offers a safe and reliable opportunity for a direct fistula in most patients, and we find it an important surgical option in the DAE. Methods: Consecutive vascular access operations were reviewed to find individuals with DAE. We defined the DAE patient group as those individuals where a wrist (Cimino) or upper arm brachiocephalic NAVF was not possible or was predicted to fail. Results: Preoperative physical and ultrasound examinations identified 58 individuals with DAE. Mean age was 56 years (range 11 to 87), 34 were female, 29 were diabetic, and 27 had previous access surgery. NAVFs were constructed in all patients. No grafts were utilized. Forty-six patients had a PRA NAVF constructed. NAVF patency was 91{\%}. Twenty-three patients required retrograde angioscopy or passage of a valvulotome to gain forearm access. Twenty-one of these 23 individuals maintained an open NAVF segment in the forearm. Conclusion: NAVFs were constructed in all patients. PRA NAVFs play an important role in extending hemodialysis by NAVF for this difficult patient group. Forearm access is often possible in these patients and may be successfully augmented by angioscopy or valvulotomes.",
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