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Rivista di Chirurgia Vascolare ed Endovascolare
Italian Journal of Vascular and Endovascular Surgery 2005 Dicembre;12(4):129-33
Strategies in vascular accesses for dialysis
Chiti E. 1, Conti P. 2, Mancini G. 2, Alessi Innocenti A. 1, Pulli R. 1, Bellandi S. 1, Pratesi C. 1
1 Unit of Vascular Surgery Careggi Polyclinic University of Florence, Florence, Italy
2 Unit of Nephrology and Dialysis Careggi Polyclinic University of Florence, Florence, Italy
Aim. The authors are herewith enclosing a data report related to the period between January 2000 and June 2005 in order to evaluate the results in terms of technical failure, cannulation practice and fistula survival.
Methods. Three-hundred and twenty-five arteriovenous fistulae (AVF) were carried out on 274 patients. Except in 5 cases of prosthetic AVF on superficial femoral vessels, all the other vascular accesses were carried out on upper limbs. Native vessels were used in about 84% of the cases and prosthetic AVF in the remaining 16%. The monitoring of the vascular access and the timing of initial cannulation was depending on a vascular nephrologist’s evaluation. In sospicious cases an eco-color-Doppler testing was required. The mean follow-up was 24 months ranging between 1 and 36 months. It was based on both AVF clinic evaluation, searching for the thrill and the assessment of Kt/V and QB. In case of problems in the dialytic performance, the access was rewieved by an eco-color-Doppler study. Ultrasonographic testings were, however, planned every 6 months.
Results. Technical failure consists of 18 cases (5%). All cases concerned upper limb AVF among which 3 proximal and 15 distal. Relevance was also given to the malfunctioning accesses. The cannulation was difficult because of tortuosity, small calibre or collaterals found in 4 cases. In the follow up thrombosis occurred in 8.6% of the cases.
Conclusion. This study suggest the importance of a qualified clinical practice of the medical-nursing staff in which nephrologist and surgeon keep on focus the improvement of long term patency results.