The role of surgery for assisted maturation after endovascular and percutaneous arteriovenous fistula creation.

The role of surgery for assisted maturation after endovascular and percutaneous arteriovenous fistula creation.
J Vasc Access. 2020 Sep 11;:1129729820954724
Authors: Illig KA, Lok C, Rajan DK, Aruny J, Peden E, Nelson P, London MJ, Ross JR
Abstract
Even in the best of circumstances, a significant number of patients will require adjunctive endovascular and/or surgical revision prior to achieving functional patency after endovascular or percutaneous AVF creation, at least within the United States. This rate appears to be higher after percutaneous AVF than after endovascular AVF, although because published reports of the former are mostly derived from American experience and those of the latter derived from experience outside the United States, it is unclear whether these differences are due to the technique itself or cultural and/or anatomic differences in dialysis access practices and patient populations. If arterial inflow is poor, this should be corrected first. When flow is adequate (perhaps 900 cc/min) but no single vein is cannulatable, a dominant suitable vein can be superficialized or transposed. If no suitable vein is dominant (most accurately assessed by using an intraoperative flowmeter), the best vein can be used, with or without occlusion of the other veins or reimplantation into the brachial artery. Finally, if the original anastomosis remains the sole supply to the cannulated vein, the original fistula has achieved ass...

Source: The Journal of Vascular Access - September 13, 2020 Category: Surgery Tags: J Vasc Access Source Type: research