A dual-plane approach for surgical treatment of pseudoaneurysm with arteriovenous fistula in hemodialysis patients

Background We report the efficacy of a dual-plane approach using a Dufourmentel skin flap with a purse-string suture of the de-epithelized dermis to manage pseudoaneurysm at the vascular access site for hemodialysis.Methods A retrospective analysis was conducted of 61 patients from 2013 to 2018 with pseudoaneurysms at the arteriovenous fistula or graft who were treated with rhomboid excision, vessel repair with a purse-string suture, and a full-thickness Dufourmentel skin flap. The success rate was defined as the probability of complete wound closure and intact vascular access patency without infection or other complications.Results The success rate was 93.4% at 6 months postoperatively. Complications included newly occurring pseudoaneurysms (n=2), wound dehiscence (n=1) and bleeding (n=1). There were no complications such as stenosis or thrombosis from the procedure.Conclusions A dual-plane approach using a Dufourmentel skin flap with a purse-string suture for vessel repair was shown to be a favorable option for managing stable, small (diameter <2 cm) pseudoaneurysms without infection, rapid expansion, or patency issues of the vascular access.

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A novel technique of reimplantation of a radial artery that makes a hairpin turn to reduce the excessive vascular access flow in a dialysis patient

The Journal of Vascular Access ◽

10.1177/1129729820927910 ◽

2020 ◽

pp. 112972982092791

Author(s):

Sotaro Katsui ◽

Yoshinori Inoue ◽

Nishizawa Masato ◽

Kimihiro Igari ◽

Toshifumi Kudo

Keyword(s):

Arteriovenous Fistula ◽

Radial Artery ◽

Vascular Access ◽

Brachial Artery ◽

Chest Radiography ◽

Small Diameter ◽

Cardiac Preload ◽

A New Technique ◽

Artery Flow ◽

Distal Radial Artery

We report a new technique called “reimplantation of an artery with a hairpin turn (RAHT)” to reduce excessive vascular access flow. A 73-year-old woman on dialysis consulted us for vascular surgery because of an increased cardiac preload. Chest radiography and echocardiography revealed an excessive shunt flow in the brachial artery (flow rate, 2336 mL/min). Vascular echo-Doppler of the left upper limb showed that the radial artery made a hairpin turn at the arteriovenous fistula (diameter, 9 mm). Diameters of the radial artery proximal and distal to the arteriovenous fistula were 5.4 and 3.7 mm, respectively. We ligated and divided the juxta-anastomosis proximal radial artery and subsequently created an end-to-side anastomosis between the proximal radial artery and the distal radial artery. The anastomosis ostium in the distal radial artery (the recipient) was formed with a 4-mm longitudinal and gently curved incision. We performed RAHT so that the small anastomosis between both arteries and the small diameter of the distal radial artery juxta-anastomosis segment could reduce the vascular access flow. The flow rates in the brachial artery were 500 mL/min just after surgery and 560 mL/min at 2 months after surgery. Postoperative chest radiography and echocardiography confirmed a decrease in cardiac preload. We believe that this RAHT technique could be useful as one of the options to reduce the flow in patients who have excessive vascular access flow with a radial artery that makes a hairpin turn.

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Hemodynamic and Biologic Determinates of Arteriovenous Fistula Outcomes in Renal Failure Patients

BioMed Research International ◽

10.1155/2015/171674 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7 ◽

Cited By ~ 16

Author(s):

Mary Hammes

Keyword(s):

Renal Failure ◽

Renal Disease ◽

Arteriovenous Fistula ◽

Success Rate ◽

Vascular Access ◽

End Stage Renal Disease ◽

Neointimal Hyperplasia ◽

Venous Stenosis ◽

Stage Renal Disease ◽

End Stage

The outcome of patients with end-stage renal disease on hemodialysis depends on a functioning vascular access. Although a variety of access options are available, the arteriovenous fistula remains the best vascular access. Unfortunately the success rate of mature fistula use remains poor. The creation of an arteriovenous fistula is followed by altered hemodynamic and biological changes that may result in neointimal hyperplasia and eventual venous stenosis. This review provides an overview of these changes and the needed research to provide a long lasting vascular access and hence improve outcomes for patients with end-stage renal disease.

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Distal purse-string suture technique for TaTME

Techniques in Coloproctology ◽

10.1007/s10151-018-1917-8 ◽

2018 ◽

Vol 23 (1) ◽

pp. 67-68 ◽

Cited By ~ 1

Author(s):

R. Wu ◽

R. Benedict ◽

A. Caycedo-Marulanda

Keyword(s):

Suture Technique ◽

Purse String Suture ◽

Purse String

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Arteriovenous fistula cannulation in hemodialysis: A vascular access clinical practice guidelines narrative review

The Journal of Vascular Access ◽

10.1177/11297298211006972 ◽

2021 ◽

pp. 112972982110069

Author(s):

Rui Pinto ◽

Clemente Sousa ◽

Anabela Salgueiro ◽

Isabel Fernandes

Keyword(s):

Clinical Practice ◽

Arteriovenous Fistula ◽

Vascular Access ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Good Evidence ◽

Preparation Technique ◽

Patient Centered ◽

The Past ◽

Centered Care

The cannulation of an arteriovenous fistula (AVF) by the hemodialysis (HD) nurse is challenging. Despite it being the focus of extensive research, it is still one of the majors causes of damage making it prone to failure. A considerable number of Clinical Practice Guidelines (CPGs) for the management of vascular access (VA) have been published worldwide over the past two decades. This review aimed to assess all information available in the selected CPG regarding AVF cannulation for HD providing a comprehensive analysis in order to interpret possible future cannulation approaches. A total of seven CPGs were described in a coding table separated in seven subthemes: Initiation of cannulation, preparation, technique, needle selection, surveillance, pain, and education. Our analysis outlines current CPGs for HD VA cannulation with lack of good evidence support for the majority of the recommendations, showing that, there is an urgent need for international collaboration and coordination to ensure relevant and high-quality evidence. Future CPGs must consider recommendations with better grading of evidence aiming patient-centered care and nurse decision models that can potentially represent better AVF cannulation outcomes.

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Purse-string suture technique using a mini-Pfannenstiel incision to treat large dermoid cysts

Journal of Obstetrics and Gynaecology ◽

10.1080/01443615.2019.1706161 ◽

2020 ◽

Vol 40 (8) ◽

pp. 1160-1163

Author(s):

Remzi Atilgan ◽

Şehmus Pala ◽

Gülay Bulu

Keyword(s):

Suture Technique ◽

Purse String Suture ◽

Purse String ◽

Pfannenstiel Incision

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The usefulness and feasibility of placing a clinch knot with a guidewire to achieve temporary hemostasis in arteriovenous dialysis access interventions

The Journal of Vascular Access ◽

10.1177/1129729820954742 ◽

2020 ◽

pp. 112972982095474

Author(s):

Sung-Joon Park ◽

Hwan Hoon Chung ◽

Seung Hwa Lee ◽

Sung Beom Cho ◽

Tae-Seok Seo ◽

...

Keyword(s):

Clinical Success ◽

Primary Patency ◽

Interventional Treatment ◽

Secondary Patency ◽

Dialysis Access ◽

Hemodialysis Access ◽

Purse String Suture ◽

Purse String ◽

Arteriovenous Fistulas ◽

Arteriovenous Grafts

Purpose: To evaluate the usefulness and feasibility of using a reversible clinch knot with a guidewire in place rather than eliminating the access route during an arteriovenous hemodialysis access (AV access) intervention using the facing sheath technique. Material and methods: From July 2016 to June 2019, we retrospectively studied 78 sessions performed as interventional treatment for arteriovenous (AV) hemodialysis (HD) access using the “facing-sheath technique.” In all sessions, all antegrade sheaths were removed while a 0.035-inch guidewire remained in place with purse-string suture and the clinch knot. Seventy-two sessions were performed in patients with thrombosed AV accesses (69 arteriovenous grafts [AVGs] and three arteriovenous fistulas [AVFs]), and six sessions were carried out to treat non-thrombosed AV accesses (four AVGs and two AVFs). We evaluated whether proper hemostasis and successful reinsertion of the sheath over the wire into the clinch knot was achieved. Clinical success was defined as achieving prompt restoration of blood flow for AV access, and the postintervention primary and secondary patency were also evaluated. Result: In all 87 clinch knots created in 78 total sessions, proper hemostasis was achieved. All clinch knots that required reversal for additional procedures were successfully reopened (55 clinch knots in 50 sessions). The postintervention primary patency rates at 1, 3, and 6 months, and at 1 year were 77.8%, 68.9%, 55.6%, and 33.3%, respectively. The postintervention secondary patency rates at 1, 3, and 6 months, and also at 1 year were 93.3%, 91.1%, 86.7%, and 86.7%, respectively. Conclusion: Our AV access intervention which used a clinch knot with purse-string suture while the guidewire remained in place was both useful and feasible for maintaining temporary hemostasis.

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Arteriovenous fistula for haemodialysis: The role of surgical experience and vascular access education

Nefrología ◽

10.1016/j.nefro.2015.07.003 ◽

2016 ◽

Vol 36 (2) ◽

pp. 89-94 ◽

Cited By ~ 8

Author(s):

Branko Fila ◽

Jose Ibeas ◽

Ramon Roca Tey ◽

Vesna Lovčić ◽

Lada Zibar

Keyword(s):

Arteriovenous Fistula ◽

Vascular Access ◽

Surgical Experience

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Successful Management of Acute Liver Failure Patients Waiting for Liver Transplantation by On-Line Hemodiafiltration with an Arteriovenous Fistula

Case Reports in Gastroenterology ◽

10.1159/000445186 ◽

2016 ◽

Vol 10 (1) ◽

pp. 144-150 ◽

Cited By ~ 3

Author(s):

Yuki Haga ◽

Shin Yasui ◽

Tatsuo Kanda ◽

Noriyuki Hattori ◽

Toru Wakamatsu ◽

...

Keyword(s):

Liver Transplantation ◽

Prognostic Factors ◽

Infectious Diseases ◽

Liver Failure ◽

Acute Liver Failure ◽

Arteriovenous Fistula ◽

Vascular Access ◽

Treatment Options ◽

Successful Management ◽

On Line

On-line hemodiafiltration (OLHDF) is one of the treatment options in the management of acute liver failure (ALF) in Japan. It is essential to avoid infection in the management of ALF. In fact, infection is one of the prognostic factors in ALF. In this report, we present a middle-aged Japanese man with ALF associated with benzbromarone use. He was successfully managed without infection until liver transplantation by creating an arteriovenous fistula for OLHDF. Utilizing an arteriovenous fistula for OLHDF, rather than inserting a vascular access catheter, is a beneficial option to avoid infectious diseases in the management of ALF.

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