Surgical Techniques to Improve Cannulation of Hemodialysis Vascular Access

Abstract Objective Successful access cannulation is of utmost importance for adequate hemodialysis treatment. Upper arm fistulae, obesity and deep or tortuous veins may impair needling and can cause significant complications and inconvenience for the patient. In the ultimate case, cannulation proble...

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Bibliographic Details
Published in:European journal of vascular and endovascular surgery 2010-03, Vol.39 (3), p.333-339
Main Authors: Tordoir, J.H.M, van Loon, M.M, Peppelenbosch, N, Bode, A.S, Poeze, M, van der Sande, F.M
Format: Article
Language:English
Subjects:
Arteriovenous Shunt, Surgical - adverse effects
Blood Vessel Prosthesis Implantation - adverse effects
Cannulation
Catheterization - adverse effects
Hemodialysis
Humans
Ligation
Lipectomy
Obesity - complications
Renal Dialysis
Reoperation
Risk Factors
Surgery
Surgical revision
Time Factors
Treatment Outcome
Upper Extremity - blood supply
Vascular access
Vascular Patency
Vascular Surgical Procedures
Veins - pathology
Veins - surgery
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Summary:Abstract Objective Successful access cannulation is of utmost importance for adequate hemodialysis treatment. Upper arm fistulae, obesity and deep or tortuous veins may impair needling and can cause significant complications and inconvenience for the patient. In the ultimate case, cannulation problems lead to temporary central vein catheter use for dialysis or even to irreversible access loss. Surgical access revision may enhance successful cannulation. Methods A systematic literature review of all publications related to hemodialysis vascular access, cannulation complications and treatment was performed. Results A total of 384 publications were identified, of which only 17 were related to treatment of cannulation complications in large patient populations. The clinical success rate of surgical intervention with vein elevation or transposition ranges from 85% to 91%. The 1-year primary and secondary patencies are 60% and 71%, respectively. Lipectomy results in an initial success rate of 100% with a primary and secondary patency of 71% and 98%, respectively, after 1 year of follow-up. Conclusion Surgical revision to improve hemodialysis vascular access cannulation has a high clinical success rate with good long-term patency.
ISSN:1078-5884
1532-2165
DOI:10.1016/j.ejvs.2009.11.033