Vascular access in chronic dialysis: a plastic surgeon's approach

Area of Science:

• Nephrology
• Vascular Surgery
• Microsurgery

Background:

• The creation of durable vascular access for hemodialysis remains a significant challenge, impacting patient outcomes.
• The increasing prevalence of end-stage renal disease necessitates standardized and effective surgical techniques for permanent vascular access.

Purpose of the Study:

• To establish foundational principles for standardized arteriovenous fistula (AVF) creation algorithms.
• To present a microsurgical approach aimed at preserving vascular capital in renal patients.

Main Methods:

• Review of 171 consecutive autogenous arteriovenous fistulas performed in adults.
• Standardized surgical conditions included the use of an inflatable tourniquet during dissection and microsurgical techniques.
• Emphasis on the exclusive use of autogenous tissues for fistula construction.

Main Results:

• Analysis of surgical outcomes, technical difficulties, and long-term follow-up of AVFs.
• Demonstration of a microsurgical approach potentially preserving vascular capital.
• Identification of key principles for developing standardized AVF algorithms.

Conclusions:

• A standardized, microsurgical approach using autogenous tissues can improve the quality of permanent vascular access for chronic dialysis.
• This technique, rooted in plastic surgery and microsurgery expertise, offers a method to conserve valuable vascular resources in patients requiring long-term hemodialysis.
• The study provides a basis for developing institutional algorithms for AVF creation, adaptable to individual patient needs.