scholarly journals P1356PACLITAXEL-COATED BALLOON ANGIOPLASTY FOR STENOSIS OF ARTERIOVENOUS FISTULA IN PATIENTS UNDER HEMODIALYSIS: 18TH MONTH FOLLOW-UP

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
IOANNIS GRIVEAS ◽  
GEORGIOS VOURLIOTAKIS ◽  
IOANNIS KANDOUNAKIS
Keyword(s):  
Clinical Course ◽  
Therapeutic Option ◽  
Minimal Invasive ◽  
Arteriovenous Fistulas ◽  
Day Clinic ◽  
Before And After ◽  
Vascular Stenosis ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background and Aims The recording of the experience of the use of paclitaxel-coated balloons in patients with End Stage Renal Disease under hemodialysis (HD) exhibiting narrowing in arteriovenous fistulas (AVF). Method 20 patients with ultrasonographically confirmed AVF dysfunction were subjected after angiographic screening to prosthesis with a simple angioplasty balloon, and then a balloon drug gradually released the drug paclitaxel. After the damage was restored (one-day clinic), arteriovenous communication was used immediately. The degree of vascular stenosis, blood flow to it and kt / V before and after recovery were assessed by ultrasound. At the same time, the clinical course of the patient and the vestibule of the vessel were monitored for 18 months. Results In the 20 patients of the study, since the damage was recovered, AVF was immediately treated without any problems. After angioplasty the degree of stenosis of the responsible vessel was statistically significantly reduced from 69.85% to 27.38% (p <0.05). Flow volume increased statistically significantly from 690.47 mils / min to 942.67 mils / min (p <0.05). The kt / v of patients improved from 1.25 to 1.6. During the 18th -month follow-up, the clinical course of the patients was stable, no problems related to vascular access appeared. Restenosis occurred to two patients, one of each received another successful angioplasty. Conclusion Drug-releasing balloons can be a useful therapeutic option for patients with AVF stenosis due to accelerated endothelial hyperplasia. The use of paclitaxel-coated balloons helps reduce the risk of restenosis of arteriovenous anastomoses and is a safe, time consuming, minimal invasive and immediate solution to AVF management.

scholarly journals Use of non-invasive intracranial pressure pulse waveform to monitor patients with End-Stage Renal Disease (ESRD)

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0240570
Author(s):  
Cristiane Rickli ◽  
Lais Daiene Cosmoski ◽  
Fábio André dos Santos ◽  
Gustavo Henrique Frigieri ◽  
Nicollas Nunes Rabelo ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Time To Peak ◽  
Hemodialysis Session ◽  
Before And After ◽  
Intracranial Pressure Waveform ◽  
Stage Renal Disease ◽  
End Stage

End-stage renal disease (ESRD) is treated mainly by hemodialysis, however, hemodialysis is associated with frequent complications, some of them involve the increased intracranial pressure. In this context, monitoring the intracranial pressure of these patients may lead to a better understanding of how intracranial pressure morphology varies with hemodialysis. This study aimed to follow-up patients with ESRD by monitoring intracranial pressure before and after hemodialysis sessions using a noninvasive method. We followed-up 42 patients with ESRD in hemodialysis, for six months. Noninvasive intracranial pressure monitoring data were obtained through analysis of intracranial pressure waveform morphology, this information was uploaded to Brain4care® cloud algorithm for analysis. The cloud automatically sends a report containing intracranial pressure parameters. In total, 4881 data points were collected during the six months of follow-up. The intracranial pressure parameters (time to peak and P2/P1 ratio) were significantly higher in predialysis when compared to postdialysis for the three weekly sessions and throughout the follow-up period (p<0.01) data showed general improvement in brain compliance after the hemodialysis session. Furthermore, intracranial pressure parameters were significantly higher in the first weekly hemodialysis session (p<0.05). In conclusion, there were significant differences between pre and postdialysis intracranial pressure in patients with ESRD on hemodialysis. Additionally, the pattern of the intracranial pressure alterations was consistent over time suggesting that hemodialysis can improve time to peak and P2/P1 ratio which may reflect in brain compliance.

scholarly journals MO857HEMOPERFUSION IN HEMODIALYSIS PATIENTS WITH COVID-19 INFECTION:  IMPACT ON CLINICAL COURSE

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Ioannis Griveas ◽  
Antonis Schinas ◽  
Anthoula Balitsari ◽  
Gerasimos Asimakopoulos ◽  
Evangelos Pratilas
Keyword(s):  
Clinical Course ◽  
Therapeutic Option ◽  
Alternative Therapy ◽  
Purification Method ◽  
Dialysis Unit ◽  
Extracorporeal Blood Purification ◽  
Group B ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Impact

Abstract Background and Aims Our Nephrology Department during spring period on the first wave of COVID-19 was the referral Dialysis Unit for Covid-19 positive hemodialysis (HD) patients in the district area of Athens, Greece. We used hemoperfusion (HP) as a therapeutic option in our patients. The aims of this study are to report characteristics, rates and outcomes of all patients affected by infection with SARS-CoV-2 undergoing HD and were treated under our care focusing on the impact of HP on them. Method This is an observational study. Our Dialysis Unit has been assigned as a referral unit for Covid-19 positive HD patients. Patients divided to 2 groups: first group of patients underwent HD sessions with Hemoperfusion (A) and the second one received HD sessions without any other extracorporeal blood purification method (B). We used resin-directed hemoadsorption cartridges (HA-330 and HA-130) manufactured by the Jafron Biomedical Company, China. We registered all the data regarding the clinical course of our patients population. Age, primary cause of end stage renal disease, weight, clinical presentation, HD history, outcome, days of hospitalization. Results Group A 13 patients (4 males) have been enrolled in this group with mean age of 74 years old. 5 of them were presented asymptomatic at admission and 7 of them admitted with or developed during their stay pleural effusions. 4 of them were asymptomatic without effusions during the whole hospital stay. 12 patients received HP for 3 hours in our Dialysis Unit during the planned HD session and one patient received Hemoperfusion in ICU during CRRT. 6 patients had one session of Hemoperfusion (with HA130, 4 patients and with HA 330, 2 patients). 6 patients had 2 sessions (7 days interval) either with HA 130 both sessions (3 patients) or with HA 330 followed 7 days after with HA 130 (3 patients). The patients that admitted in ICU started HP the third day of her admission. The pattern was as follows: We used HA330 in 3 consecutive days during CRRT. In Day 10 we used HA130 and in Day 13 HA330. HP was performed for 3 hours. 24 days was the average hospitalization stay before starting HP for the 12 patients in boards. 9 patients discharged from the hospital after 43 days of hospitalization (range: 35-56 days). 30 days were the mean hospitalization stay for the diceased ones. We did not observe any side effects with HP cartridges (hypotension, reduction of platelets, bleeding). Group B 9 patients (7 males) with mean age of 75 years old did not receive HP during their hospitalization. All of them were presented symptomatic. 8 out of 9 patients died after 6 days of hospitalization (range: 1-14 days), 2 of them in ICU. Conclusion To sum up, HP seems to be a helpful, safe an quite efficient tool in the battle against Covid-19 in HD patients. Despite the method is unspecific, our lack of strong evidence, our views are with the opinion that is an reliable alternative therapy. However, the real impact of HP on the patient’s clinical course (time of initiation, therapeutic protocols, tools to evaluate response) has yet to be determined. The above notice does not minimize the great interest for the method that renal community should give.

Impact of pulmonary hypertension on arteriovenous fistula failure of hemodialysis patients: A 10 years follow-up cohort study

2021 ◽  
pp. 112972982110274
Author(s):  
Li Song ◽  
Zi-Lin Quan ◽  
Li-Yan Zhao ◽  
Dong-Mei Cui ◽  
Mi Zhong ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Failure Rate ◽  
Maintenance Hemodialysis ◽  
Systolic Pulmonary Artery Pressure ◽  
Arteriovenous Fistulas ◽  
Significant Difference ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Impact

Background: Pulmonary hypertension (PH) is common in patients with end-stage renal disease (ESRD). Arteriovenous fistulas (AVF) creation may involve in the pathogenesis of PH. The aim of this study was to explore the impact of PH after AVF creation on the AVF failure rate in maintenance hemodialysis (MHD) patients. Methods: From January 1, 2009, to January 1, 2019, we retrospectively collected data of 578 MHD patients in Guangdong Provincial People’s Hospital Blood Purification Center, China. Patients were followed-up until AVF failure or death or May 25, 2020. According to the systolic pulmonary artery pressure (SPAP) within 1 year after the establishment of AVF, the MHD patients were divided into three groups: SPAP ⩽ 35 mmHg, 35 < SPAP < 45 mmHg, SPAP ⩾ 45 mmHg. The primary outcome was AVF failure defined as AVF cannot complete hemodialysis. The secondary outcomes were all-cause mortality. Results: A total of 578 patients were analyzed. The average age was 60.66 ± 15.34 years (58.1% men). Of these, 26.1% of patients were reported PH. The SPAP exhibited a left-skewed nonparametric distribution and the overall SPAP after the creation of AVF was 39.00 (29.00–52.00) mmHg. The median follow-up was 5.8 (5.5–6.3) years. Overall, 12.8% (74/578) patients were reported AVF failure events. There was no significant difference in AVF failure rate among three groups ( p = 0.070). A total of 111 (19.2%) died during the follow-up period. Compared with the SPAP ⩽35 mmHg group, only the all-cause death rate significantly increased in MHD patients with PH ( p < 0.001). Conclusions: The secondary pulmonary hypertension after AVF creation did not increase the risk of AVF failure in MHD patients, but significantly increased the risk of mortality for this portion of the patients. Future larger sample sizes, multi-center, and prospective trials are needed to make sure which type of access will benefit on their survival for MHD patients with SPAP ⩾35 mmHg.

scholarly journals Fibrillary glomerulonephritis with a favourable prognosis of 26 years

2020 ◽  
Vol 10 (4) ◽  
pp. e44-e44
Author(s):  
David Micarelli ◽  
Valentina Pistolesi ◽  
Emanuela Cristi ◽  
Anna Rita Taddei ◽  
Ilaria Serriello ◽  
...  
Keyword(s):  
Renal Function ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Kidney Biopsy ◽  
Clinical Course ◽  
Glomerular Sclerosis ◽  
Fibrillary Glomerulonephritis ◽  
Stage Renal Disease ◽  
End Stage

Fibrillary glomerulonephritis (FGN) is a rare glomerular disease. The prognosis is usually unfavorable with nearly half of patients progressing to end-stage renal disease within 4 years. We report a case of biopsy-proven FGN characterized by an unusual benign clinical course in which a kidney biopsy, repeated after an extended follow-up of 26 years, confirmed the presence of fibrils deposition. In 1993, a 32-year-old Caucasian man was admitted to our nephrology ward because of macroscopic hematuria. Renal function was normal. Kidney biopsy displayed an FGN with mesangial pattern. The patient was treated with lisinopril, titrated for blood pressure; the therapy was maintained during 26 years of follow-up. The yearly slope of estimated glomerular filtration rate was -3.17 mL/ min). Starting from March 2018, a rapid worsening of renal function was observed and proteinuria increased up to a nephrotic range. We planned a second renal biopsy to assess the cause of the rapid change of clinical course. The diagnosis of FGN on advanced sclerosis was made, and the severity of glomerular sclerosis. We report a case of FGN with an unusually benign clinical course, characterized by a slow progression to end-stage renal disease over a very extended follow-up time; thus, to better clarify the reason for renal function worsening, a second renal biopsy was performed. The persistence of fibrils deposition confirmed the initial diagnosis of FGN, and a histological pattern characterized by global glomerular sclerosis and interstitial fibrosis has been observed.

Corneal and Conjunctival Calcification in a Dialysis Patient Reversed by Parathyroidectomy

2020 ◽  
pp. 1-3
Author(s):  
Maria Beatriz C.N. Pessoa ◽  
Ruth Miyuki Santo ◽  
Aline A. De Deus ◽  
Eduardo Jorge Duque ◽  
Carlos Eduardo Rochitte ◽  
...  
Keyword(s):  
End Stage Renal Disease ◽  
Dialysis Patient ◽  
Anterior Segment ◽  
Maintenance Hemodialysis ◽  
Short Term ◽  
Before And After ◽  
Eye Examination ◽  
Stage Renal Disease ◽  
End Stage

Mineral and bone metabolism disorders are relatively common among patients with end-stage renal disease on maintenance hemodialysis. Corneal and conjunctival calcification is the main extravascular site for calcification. Recently, this form of calcification has been linked to vascular calcification. Secondary hyperparathyroidism can lead to high levels of calcium and phosphorus and increase the risk of calcification. Here, we report a case of a 38-year-old female with severe hyperparathyroidism who underwent eye examination before and after parathyroidectomy. Anterior segment optical coherence tomography showed an improvement in the number and size of ocular calcifications 6 months after surgery. This case calls attention to the importance of eye examination in patients on dialysis and brings the possibility of recovery of calcification in a short-term follow-up.

Use of non-invasive intracranial pressure pulse waveform to monitor patients with End-Stage Renal Disease (ESRD) Intracranial pressure in patients with ESRD

2020 ◽  
Author(s):  
Cristiane Rickli ◽  
Lais Daiene Cosmoski ◽  
Fábio André dos Santos ◽  
Gustavo Henrique Frigieri ◽  
Nicollas Nunes Rabelo ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Time To Peak ◽  
Hemodialysis Session ◽  
Before And After ◽  
Intracranial Pressure Waveform ◽  
Stage Renal Disease ◽  
End Stage

AbstractEnd-stage renal disease (ESRD) is treated mainly by hemodialysis, however, hemodialysis is associated with frequent complications, some of them involve the increased intracranial pressure. In this context, monitoring the intracranial pressure of these patients may lead to a better understanding of how intracranial pressure morphology varies with hemodialysis. This study aimed to follow-up patients with ESRD by monitoring intracranial pressure before and after hemodialysis sessions using a noninvasive method. We followed-up 42 patients with ESRD in hemodialysis, for six months. Noninvasive intracranial pressure monitoring data were obtained through analysis of intracranial pressure waveform morphology, this information was uploaded to Brain4care® cloud algorithm for analysis. The cloud automatically sends a report containing intracranial pressure parameters. In total, 4881 data points were collected during the six months of follow-up. The intracranial pressure parameters (time to peak and P2/P1 ratio) were significantly higher in predialysis when compared to postdialysis for the three weekly sessions and throughout the follow-up period (p<0.01) data showed general improvement in brain compliance after the hemodialysis session. Furthermore, intracranial pressure parameters were significantly higher in the first weekly hemodialysis session (p<0.05). In conclusion, there were significant differences between pre and postdialysis intracranial pressure in patients with ESRD on hemodialysis. Additionally, the pattern of the intracranial pressure alterations was consistent over time suggesting that hemodialysis can improve time to peak and P2/P1 ratio which may reflect in brain compliance.

scholarly journals P1840EVOLUTION OF FACTORS ASSOCIATED WITH THE DEVELOPMENT OF CALCIPHYLAXIS AFTER KIDNEY TRANSPLANTATION

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Elena Guillen Olmos ◽  
Jose-Vicente Torregrosa ◽  
Fritz Diekmann ◽  
David Cucchiari
Keyword(s):  
Kidney Transplantation ◽  
Therapeutic Option ◽  
Calcineurin Inhibitors ◽  
Mtor Inhibitors ◽  
Exact Test ◽  
Factors Associated ◽  
Before And After ◽  
Student’S T ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background and Aims Calciphylaxis, also known as calcific uremic arteriolopathy (CUA), is a rare and underdiagnosed condition usually associated with end-stage renal disease (ESRD), with a poor prognosis once established. Although typically related with ESRD vintage, there are some reports of CUA after kidney transplantation (KT). The development of CUA in patients with KT is uncommon, and the underlying factors for its development remain unclear. Method Revision of the factors associated with the development of CUA after KT in 37 cases, of which 8 cases were extrapolated from our local registry and 29 cases reported by the literature from 1969 to 2019. Differences between groups were analyzed with Student’s T-test and Fisher’s exact test, according to the studied variable (continuous/dichotomous). Results Demographic and baseline characteristics are displayed in Table 1. In the whole population, 52.8% of patients were men and mean age was of 46.95 ± 18.72 years. Diabetes mellitus was present in 36.4% of patients while only 5.3% were reported to be obese. Vitamin K inhibitors were used in almost half of the population (45.5%). Creatinine at diagnosis was 3.14 ± 3.63 mg/dl. Dialysis and transplant vintage were respectively 76.97 ± 141.90 and 29.54 ± 56.11 months. Mean PTH was 631.15 ± 502.64 and previous parathyroidectomy was performed in 21.6% of patients. It has to be highlighted that 28.0% of total population had PTH levels &lt; 100 pg/ml at diagnosis. Total calcium was 9.69 ± 1.04 mg/dl and phosphorus 4.16 ± 1.51 mg/dl. Many of these factors differed greatly depending on the time period of the diagnosis (before or after 1990). Patients diagnosed before 1990 were younger than those diagnosed after 1990 (31.57 ± 10.19 years vs. 56.30 ± 16.44 years; p &lt; 0.001). Creatinine at diagnosis was much lower in patients diagnosed before 1990 (1.44 ± 0.58 vs. 3.68 ± 4.03). Dialysis and transplant vintage were greater in cases diagnosed after 1990 (dialysis plus transplant vintage 19.87 ± 12.65 vs. 115.04 ± 174.14, p=0.02). Patients diagnosed after 1990 had higher phosphorus and lower calcium compared to the other group. The employed immunosuppression changed considerably during time, being based on azathioprine (90.9%) and prednisone (100.0%) before 1990 and on calcineurin inhibitors (76.5%), mycophenolic acid (41.2%) and/or mTOR inhibitors (41.2%) and steroids (82.4%) after 1990. The CUA treatment demonstrated great variability too. Before 1990, 76.9% of patients were submitted to therapeutic parathyroidectomy, while after 1990 it was only performed in 10.5% of patients (P&lt;0.01). Tiosulphate was administered in 31.6% and biphosphonates in 36.8% of cases. Mortality was similar in both groups (57.1% and 52.2% for patients diagnosed before and after 1990 respectively). Conclusion Factors associated with the development of CUA after KT varied greatly during time. Patients diagnosed before 1990 were younger, with better renal function, shorter dialysis and transplant vintage, higher calcium and lower phosphorus. Parathyroidectomy was the main therapeutic option before 1990 while after 1990 treatment was multimodal.

scholarly journals Comparative analysis of radiocephalic versus brachiocephalic native arteriovenous fistula for hemodialysis in end stage renal disease

2016 ◽  
Vol 5 (1) ◽  
pp. 171
Author(s):  
Aniket Khadatkar ◽  
Chandrashekhar Mahakalkar ◽  
Tanu Pradhan ◽  
Akshay Bora
Keyword(s):  
Arteriovenous Fistula ◽  
Cephalic Vein ◽  
Maturation Time ◽  
Arteriovenous Fistulas ◽  
Before And After ◽  
Arteriovenous Grafts ◽  
Stage Renal Disease ◽  
End Stage ◽  
Work Up

Background: Chronic kidney disease (CKD) is a long term condition caused by damage to both kidneys. The benefits of arteriovenous fistulas over other forms of chronic access are: Arteriovenous fistulas are associated with decreased morbidity and mortality among hemodialysis patients compared with arteriovenous grafts and central venous catheters. Objectives of the study were o choose the proper sites for formation of arteriovenous fistula, to find out the success rate at various sites and to study the complications of arteriovenous fistula.Methods: This prospective study was carried out on total 150 patients over the duration of two years. The fistulae were created using radial artery and cephalic vein side to side (Radiocephalic AVF) and brachial artery and cephalic vein side to side anastomosis (Brachiocephalic AVF). Doppler studies were done before and after every procedure to demonstrate the velocity, volume of blood flow, depth from the skin, diameter of vessels and to access the time of maturation of AVF. Patients were followed up to first dialysis by AVF to assess the overall outcomes and various complications.Results: Brachiocephalic AVF matured earlier than Radiocephalic AVF (mean maturation time Brachiocephalic 38.02 days and Radiocephalic 43.26 days) which was statistically significant. Brachiocephalic AVF matured earlier than Radiocephalic AVF with more flow rate. Complication rate was more at wrist (Radiocephalic AVF with 66.67% of overall complication) than at elbow (Brachiocephalic AVF with 33.33% of overall complication).Conclusions: We concluded that the Brachiocephalic AVF maturation time was significantly less than the maturation time of Radiocephalic AVF and rate of complication was less in Brachiocephalic AVF. The utility of pre-operative colour Doppler to select the vessels for AVF creation was found to be as an essential parameter of pre-operative work up.

scholarly journals Needle Directed Pulse Spray Pharmacomechanical Thrombolysis for Acute Thrombosis of Dialysis Fistulas – Technique, Efficacy and Short Term Follow UP

2020 ◽  
Vol 8 (1) ◽  
pp. 14-20
Author(s):  
Geda Anusha ◽  
Yugandhar Samireddypalle ◽  
Ranjith Kumar Vulchi ◽  
Sagar Dembla ◽  
Pavithira Annamalai ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Short Term ◽  
Tertiary Care Centre ◽  
Portable Ultrasound ◽  
Acute Thrombosis ◽  
Medical College ◽  
Arteriovenous Fistulas ◽  
Stage Renal Disease ◽  
End Stage

Background: The incidence of end stage renal disease is on the rise and most of these patients are undergoing dialysis either through tunnelled/non tunnelled dialysis catheters or through arteriovenous fistulas/grafts. The dialysis grafts and fistulas have limited durability of about 3 years and are more prone for thrombosis and stenosis. Catheter directed interventions are successful in establishing flow in most of the thrombosed fistulas, but require dedicated Cath lab and tertiary care centre. Needle directed thrombolysis is a novel economical, safe technique for thrombolysis of dialysis fistulas and grafts. The aim of the studt is to review the technique, safety, efficacy of needle directed pulse spray pharmacomechanical thrombolysis of dialysis fistulas and grafts with short term follow up. Subjects and Methods: This was a prospective observational study done in department of Radio diagnosis, Narayana medical college, Nellore. Selectively 25 patients with thrombosed AV fistulas were referred from nephrology OPD for needle directed thrombolysis to our department from December 2018 to May 2019. The procedure was performed on OPD basis in ultrasound procedure room. Regular Doppler follow up of patients is done up to 6 months. Results: Out of twenty five cases about seventeen cases (68%) were successful in achieving adequate recanalization in single session. four cases (16%) required repeat sessions of thrombolysis and were successful in second attempt. In four cases (16%) there was failure in attaining adequate recanalization due to marked multisegment attenuation/flow limiting stenosis of the draining vein. Conclusion: Needle directed Pulse spray pharmacomechanical thrombolysis is a novel technique, which can be done bedside, under portable ultrasound guidance and is an economical procedure as no intervention hardware is required. Continuous monitoring allows procedure to be stopped at the earliest once there is optimal recanalization, minimizing the systemic side effects of thrombolytic agents.

scholarly journals Assessment of arteriovenous fistulas made with the oval-shaped anastomosis technique in the end-stage renal disease patients

2019 ◽  
Vol 10 (4) ◽  
pp. 3669-3673
Author(s):  
Samer Makki Mohamed Al-Hakkak ◽  
Firas Shaker Mahmoud Al-Faham ◽  
Alaa Abood Al-Wadees ◽  
Mehmet Besir Akpinar
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Hemodialysis Patients ◽  
Arteriovenous Fistulas ◽  
Surgical Methods ◽  
Stage Renal Disease ◽  
End Stage ◽  
Significant Health

The end-stage renal disease still holds significant health problems, getting, good, long term functioning vascular access for hemodialysis is our utmost value. Autogenous techniques are generally used for access. There are many surgical methods for getting autogenous access in hemodialysis patients. We aimed to assess the outcomes of the “oval-shaped anastomosis” technique used during the creation of arteriovenous fistulas in patients with advanced renal impairments. We randomly selected and retrospectively examined 52 patients on whom the “oval-shaped anastomosis” technique had been performed. Forty-nine (94%) patency rate in the 52 randomly selected patients on whom we used this mechanism in the first 6 months follow up. The patency and good functioning fistula created for hemodialysis is our priority in advance renal impairment. This technique has been particularly useful in stiff arteriosclerotic arteries, and it provides a more comfortable and clear anastomosis.

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