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[20 years' experience with "difficult" vascular access]

G Giorcelli1, A Tricerri, G Vacha

  • 1Divisione di Nefrologia e Dialisi, Ospedale Mauriziano Umberto I, Torino.

Minerva Urologica E Nefrologica = the Italian Journal of Urology and Nephrology
|May 14, 1998
PubMed
Summary
This summary is machine-generated.

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Vascular access for dialysis patients is challenging due to increased survival and age. Arteriovenous fistulas (AVF) in high-risk patients show lower survival, but alternative methods like grafts or catheters can resolve difficult cases.

Area of Science:

  • Nephrology
  • Vascular Surgery
  • Public Health

Context:

  • Increasing patient survival and age in chronic dialysis presents challenges for vascular access creation and maintenance.
  • Difficulties in establishing upper limb arteriovenous fistulas (AVF) necessitate alternative strategies.

Purpose:

  • To retrospectively analyze the incidence and outcomes of various vascular access methods in dialysis patients.
  • To evaluate the survival rates of different types of vascular access in relation to patient risk factors.

Summary:

  • A 277-month retrospective analysis of 1,037 arteriovenous fistula (AVF) implantations revealed lower AVF graft survival compared to natural vessels in low-risk patients.
  • High-risk patients (diabetics, vascular disease, systemic diseases, >70 years) showed distinctly lower AVF survival, with no significant difference between native vein AVF and grafts.

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  • Inability to achieve upper limb access was rare (4/1037), with alternatives like peritoneal dialysis or thigh AVF successfully employed.

    • Impact:

    • Highlights the effectiveness of natural vascular accesses but emphasizes the utility of alternative techniques like central venous catheters or thigh AVF for challenging cases.
    • Provides quantitative data on vascular access survival, informing clinical decision-making for complex dialysis patient populations.