Abstract
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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 2399-2406 |
| Number of pages | 8 |
| Journal | Kidney International |
| Volume | 67 |
| Issue number | 6 |
| DOIs | |
| State | Published - Jan 1 2005 |
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Keywords
- Arteriovenous fistula
- Fistula salvage
- Immature fistula
- Interventional nephrology
- Tunneled dialysis catheter
ASJC Scopus subject areas
- Nephrology
Cite this
Conversion of tunneled hemodialysis catheter-consigned patients to arteriovenous fistula. / Asif, Arif; Cherla, Gautam; Merrill, Donna; Cipleu, Cristian D.; Briones, Patricia; Pennell, Phillip.
In: Kidney International, Vol. 67, No. 6, 01.01.2005, p. 2399-2406.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Conversion of tunneled hemodialysis catheter-consigned patients to arteriovenous fistula
AU - Asif, Arif
AU - Cherla, Gautam
AU - Merrill, Donna
AU - Cipleu, Cristian D.
AU - Briones, Patricia
AU - Pennell, Phillip
PY - 2005/1/1
Y1 - 2005/1/1
N2 - 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.
AB - 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.
KW - Arteriovenous fistula
KW - Fistula salvage
KW - Immature fistula
KW - Interventional nephrology
KW - Tunneled dialysis catheter
UR - http://www.scopus.com/inward/record.url?scp=23044481008&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=23044481008&partnerID=8YFLogxK
U2 - 10.1111/j.1523-1755.2005.00347.x
DO - 10.1111/j.1523-1755.2005.00347.x
M3 - Article
C2 - 15882285
AN - SCOPUS:23044481008
VL - 67
SP - 2399
EP - 2406
JO - Kidney International
JF - Kidney International
SN - 0085-2538
IS - 6
ER -