Seminars in dialysis
-
Seminars in dialysis · Sep 2005
Case ReportsCreation of secondary arteriovenous fistulas: maximizing fistulas in prevalent hemodialysis patients.
National Kidney Foundation Dialysis Outcomes Quality Initiative (NKF-DOQI) guideline 29 suggests that a patient should be evaluated for a secondary arteriovenous fistula (AVF) following each episode of dialysis access failure. Regretfully, it does not appear that this approach is used, even though recent data have emphasized that veins suitable for the creation of a secondary AVF can be identified in dialysis patients who are receiving dialysis via a synthetic arteriovenous graft (AVG) or other type of potentially dysfunctional vascular access. In this study nine patients (five with an AVG and four with an AVF) with vascular access dysfunction undergoing percutaneous interventions were evaluated for secondary AVF creation. ⋯ In addition, it was possible to continue uninterrupted dialysis without the use of a tunneled dialysis catheter in three of the patients with AVGs. This experience demonstrates the validity and success of this approach to the management of dialysis access dysfunction. In the ongoing effort to optimize vascular health status, we suggest that during percutaneous interventions, patients should routinely have identification of vessels suitable for creation of a secondary AVF.
-
Seminars in dialysis · Sep 2005
Comparative StudyConversion of temporary hemodialysis catheters to permanent hemodialysis catheters: a retrospective study of catheter exchange versus classic de novo placement.
Many clinicians believe that de novo access is required when converting temporary hemodialysis (HD) catheters to long-term or permanent catheters. However, since vascular access sites are at a premium in the dialysis patient, it is important to preserve existing central venous catheters and conserve future access sites. In this retrospective study, data from 94 patients referred to interventional radiology for placement of long-term, tunneled HD catheters between July 2001 and September 2002 were reviewed. ⋯ There was no incidence of exit site infection, tunnel infection, or florid sepsis in either group. Likewise, no stenosis or bleeding complication was noted. Thus conversion of a temporary HD catheter to a tunneled catheter using the same venous insertion site is safe, does not increase the risk of infection, and allows conservation of other central venous access sites.