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Vascular access for chronic haemodialysis in Lombardy
1Nephrology and Dialysis Unit, S. Antonio Abate Hospital - Gallarate, Varese - Italy.
Insights
Nephrologists in Lombardy primarily perform vascular access surgery, favoring distal arteriovenous fistulas. Monitoring and intervention for vascular access thrombosis mainly involve surgical revision.
Area of Science:
- Nephrology
- Vascular Surgery
- Dialysis Access
Background:
- Vascular access is crucial for hemodialysis.
- Optimizing vascular access surgery organization and monitoring is essential for patient outcomes.
- Current practices in dialysis units require evaluation.
Purpose of the Study:
- To assess the organization of vascular access surgery.
- To evaluate monitoring techniques for surgical access and central catheters.
- To understand current practices in Lombardy dialysis units.
Main Methods:
- A survey was conducted among 43 dialysis centers in Lombardy.
- A questionnaire was distributed, achieving a 96% response rate.
- Data on surgical procedures, monitoring, and catheter use were collected.
Main Results:
- Nephrologists perform vascular access in nearly 90% of units, often with vascular surgeon collaboration.
- Distal arteriovenous fistula is the preferred initial access.
- Central venous catheters are used for temporary and permanent access, with the jugular vein being the most common insertion site.
Conclusions:
- Distal arteriovenous fistulas are the primary choice for vascular access.
- Central venous catheters provide a viable alternative for both temporary and permanent access.
- Vascular access monitoring and thrombosis management primarily rely on recirculation tests and surgical revision, respectively.
Abstract:
To evaluate the organisation of vascular access surgery, the techniques used to monitor surgical access and the central catheters, a survey was conducted amongst dialysis Units of Lombardy. A questionnaire was sent out to the 43 dialysis centres in Lombardy, 96% of which replied. In almost 90% of dialysis units nephrologists perform vascular access albeit in close cooperation with vascular surgeons for the more complex cases. First choice access is by distal arteriovenous fistula (AVF): 36% end-to-end, 31.7% side-to-end, and 19.5% side-to-side with distal ligature of the vein. As second choice proximal AVF is more widely used than AV grafts, which are implanted only when all native vessels and related surgical procedures are exhausted. Central venous catheters offer valid solutions not only as temporary access, but also as an alternative permanent one. In both cases the jugular vein is the most frequent site of insertion. Despite the documented incidence of related episodes of stenosis/obstruction, the subclavian vein is used as a temporary access in quite a high per-centage of cases. Only in selected cases are diagnostic procedures (mainly Venography and Doppler studies) performed prior to permanent access choice. Similarly vascular access is monitored mainly using a recirculation test albeit not routinely. In case of vascular access thrombosis, surgical revision is the most common approach.
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