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Vascular access: long-term results, new techniques.

J L Giacchino, W P Geis, J M Buckingham

    Archives of Surgery (Chicago, Ill. : 1960)
    |April 1, 1979
    PubMed
    Summary
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    This study reviews 840 vascular access procedures for renal failure patients over five years. Innovations improved access longevity and reduced procedures per patient, enhancing treatment effectiveness.

    Area of Science:

    • Vascular Surgery
    • Nephrology
    • Dialysis Access

    Background:

    • Vascular access is critical for hemodialysis in renal failure patients.
    • Traditional methods face challenges like vessel limitations and access failure.
    • A five-year experience with 840 procedures informs current best practices.

    Purpose of the Study:

    • To evaluate the effectiveness of various vascular access techniques in renal failure.
    • To analyze procedural outcomes and access longevity.
    • To refine surgical approaches for challenging vascular access cases.

    Main Methods:

    • Review of 840 angioaccess procedures over five years.
    • Analysis of standard and innovative techniques including external arteriovenous (AV) cannulas, internal AV fistulas, reverse fistulas, and expanded polytetrafluoroethylene (E-PTFE) grafts.

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  • Evaluation of secondary procedures for complex cases.

    • Main Results:

    • An average of 0.62 operations per patient per year was required.
    • Average access longevity was 1.6 years.
    • Complex procedures were needed for 61 patients due to primary access failure or anatomical challenges.

    Conclusions:

    • Standard forearm radiocephalic AV fistulas are the preferred initial approach for new renal failure patients.
    • Cannulas are reserved for emergency or short-term use.
    • A stepwise approach using reverse fistulas before E-PTFE grafts optimizes upper extremity vascular access construction.