The Pre-dilatation of vessels: A simple method to recruit small caliber veins for creating distal fistulas

Author:

Napoli Marcello1ORCID,Zito Anna2ORCID,Lefons Maria Luisa2,Ria Paolo2ORCID,Ferramosca Emiliana3,Martella Vilma3,Caterina Carbonara Maria3,Sozzo Efisio4,De Pascalis Antonio5

Affiliation:

1. Vito Fazzi Hospital, Lecce, Italy

2. ASL Lecce, Lecce, Italy

3. Ospedale Vito Fazzi, Lecce, Italy

4. Hospital Vito Fazzi, Lecce, Italy

5. Nephrology, Dialysis, Transplantation Unit, Vito Fazzi Hospital, Lecce, Italy

Abstract

Maturation failure remains a major clinical problem of distal arteriovenous fistula (AVF). Early failure (EF) is associated with the small size of the veins. For about 10 years we have used in more than 1000 fistulas, the Vessels Pre-Dilatation (VPD) to increase the recruitment of small veins for creating distal AVFs. The purpose of this study is to highlight if the VPD can reduce the incidence of EF or failure to mature (FTM) in AVFs created with small veins. Data of all the consecutive patients directly admitted to our Department for their first distal AVF from January to December 2019 were collected. The patients were divided in two groups, one with a vein diameter after the tourniquet ⩽2.0 mm (G1) and one >2 mm (G2). Both in G1 then in G2 the vessels had undergone VPD. Immediate failure (IF), EF, FTM, delayed or arrested maturation rate (DAM), unassisted AVFs and matured AFVs were evaluated. The patients recruited totalled 104, 37 in G1, and 67 in G2. The two groups were homogeneous in age, incidence of diabetes, obesity, heart disease, peripheral vasculopathy, and race. Female were more numerous in G1 (51% vs 12%, p < 0.001). In G1 and G2 occurred respectively 3 IF versus zero ( p < 0.05), 10 EF (29%) versus 6 (9%) ( p < 0.05), 6 DAM (16%) versus 6 (9%), 21 unassisted AVFs (57%) versus 57 (85%) ( p < 0.01). Dividing the patients into groups of unassisted and assisted AVFs, female and low vein diameter are more represented in the assisted group. There were 32 matured AVFs (86%) in G1 and 65 (97%) in G2. In order to increase the incidence of the distal AVF, the PDV allows to include small veins. However, more patients require further interventions to achieve maturation of the fistula.

Publisher

SAGE Publications

Subject

Nephrology,Surgery

Cited by 2 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. Zero upper arm hemodialysis fistulas: utopian or realistic goal?;The Journal of Vascular Access;2024-04-06

2. Outcomes of radiocephalic arteriovenous fistula in octogenarians;The Journal of Vascular Access;2021-07-28

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