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Algorithmic salvage techniques in non-maturing radiocephalic arteriovenous fistulae with their long-term patency

Abstract

Introduction

The aim of this study is to examine the role of five different operative salvage techniques with their long-term primary patency (PP) in an algorithmic manner in gaining primary functional maturation (FM) in radio cephalic arteriovenous fistulae (RCAVF) formation following their impairment.

Methods

A prospective consecutive data collection on 195 patients undergoing only autogenous RCAVF formation from July 2013 to December 2015 was conducted. Each non-maturing fistula was then exposed to a salvage technique by an algorithmic methodology and their FM and PP was prospectively recorded.

Results

Forty-two patients were exposed to five different salvages techniques, with a median age of 67 years (IQR, 27-90), cephalic vein diameter of 2 mm (IQR, 1.5-4 mm) and radial artery diameter of 1.8 mm (IQR,1.2-2.1 mm), demonstrated 63.1% FM and cumulative primary patency of 15.2 months (95% CI, 12.5-17.9) over a 21-month follow-up period.

Conclusions

Operative salvage techniques play an important role in achieving assisted functional maturation and long-term patency in RCAVF as an alternative and/or in conjunction with other minimally invasive procedures. These procedures can maximize access outcome, minimize bridging procedures, decrease complications and optimize patient anatomical resources for longer access provisions in an era of aging population.

J Vasc Access 2017; 18(5): 443 - 449

Article Type: TECHNIQUES IN VASCULAR ACCESS

DOI:10.5301/jva.5000745

Authors

Ali Kordzadeh, Yiannis P. Panayiotopolous

Article History

Disclosures

Financial support: No grants or funding have been received for this study.
Conflict of interest: None of the authors has financial interest related to this study to disclose.

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Authors

Affiliations

  • Department of Vascular, Endovascular and Renal Access, Mid-Essex Hospital Services NHS Trust Broomfield Hospital, Chelmsford, Essex - UK
  • Medical Sciences, Anglia Ruskin University, Cambridge - UK

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