scholarly journals The influence of cephalic vein diameter and diabetes on primary maturation and patency of autogenous radiocephalic arteriovenous fistulas

2015 ◽  
Vol 62 (4) ◽  
pp. 1003-1009 ◽  
Author(s):  
Yang Jin Park ◽  
Peter Gloviczki ◽  
Young-wook Kim ◽  
Junhyuk David Kwon ◽  
Dong-Ik Kim ◽  
...  
Keyword(s):  
Cephalic Vein ◽  
Arteriovenous Fistulas ◽  
Vein Diameter

Preoperative cephalic vein diameter and diabetes do not limit the choice of wrist radio-cephalic arteriovenous fistula

2019 ◽  
Vol 21 (3) ◽  
pp. 366-371 ◽  
Author(s):  
Guocun Hou ◽  
Yonghong Yan ◽  
Guangyi Li ◽  
Yi Hou ◽  
Xiuli Sun ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Confidence Interval ◽  
Arteriovenous Fistula ◽  
Odds Ratio ◽  
Diabetic Kidney Disease ◽  
Cephalic Vein ◽  
Clinical Effects ◽  
Diabetic Kidney ◽  
Arteriovenous Fistulas ◽  
Vein Diameter

Aim: To identify predictors that affect initial maturation of new wrist radio-cephalic arteriovenous fistula and evaluate the clinical effects of the ipsilateral mid-forearm radio-cephalic arteriovenous fistulas creation in the event of first wrist radio-cephalic arteriovenous fistula failure. Methods: We performed a retrospective review of all patients who underwent first wrist radio-cephalic arteriovenous fistula creation between September 2016 and May 2018. Currently, we prefer to re-create an ipsilateral mid-forearm radio-cephalic arteriovenous fistula when the first wrist radio-cephalic arteriovenous fistula fails. Predictors of successful radio-cephalic arteriovenous fistulas were identified using univariate and multivariate analyses. Kaplan–Meier survival analysis and log-rank test were used to calculate successful radio-cephalic arteriovenous fistula rates. Results: Univariate analysis showed that predictive factors for successful wrist radio-cephalic arteriovenous fistula include larger preoperative cephalic vein diameter ( p = 0.001) and non-diabetic kidney disease ( p = 0.007). Multivariate binary logistic regression analysis revealed cephalic vein diameter ⩾2 mm (odds ratio = 4.55, 95% confidence interval = (1.49–13.92), p = 0.008) and non-diabetic kidney disease (odds ratio = 4.22, 95% confidence interval = (1.38–12.88), p = 0.011) to be independent predictors for successful radio-cephalic arteriovenous fistula. We re-created ipsilateral mid-forearm radio-cephalic arteriovenous fistulas in 15 patients among the 21 failed wrist radio-cephalic arteriovenous fistulas; all these arteriovenous fistulas maintained clinical maturation following up for 1–2 years. Conclusion: Small cephalic vein diameter (<2 mm) and diabetes were independent risk factors for failed wrist radio-cephalic arteriovenous fistulas, but this risk could be overcome by aggressive ipsilateral mid-forearm radio-cephalic arteriovenous fistula to address a failed first attempt. Cephalic vein diameter is more important during the maturation stage, and once maturation has occurred, diabetes has an additive role in determining the patency of wrist radio-cephalic arteriovenous fistula. The “wrist RCAVF first, ipsilateral mid-forearm RCAVF second” strategy is the most clinically significant message of our study.

Improvement of radiocephalic fistula maturation: rationale and design of the Liposomal Prednisolone to Improve Hemodialysis Fistula Maturation (LIPMAT) study – a randomized controlled trial

2017 ◽  
Vol 18 (1_suppl) ◽  
pp. S114-S117 ◽  
Author(s):  
Bram M. Voorzaat ◽  
Jan van Schaik ◽  
Koen E.A. van der Bogt ◽  
Liffert Vogt ◽  
Laurens Huisman ◽  
...  
Keyword(s):  
Animal Model ◽  
Randomized Controlled Trial ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Arteriovenous Fistulas ◽  
Randomized Controlled ◽  
Hemodialysis Fistula ◽  
Vein Diameter ◽  
Double Blinded ◽  
Fistula Maturation

Background Non-maturation is a frequent complication of radiocephalic arteriovenous fistulas (RCAVF). In an animal model, liposomal prednisolone improved maturation of experimental fistulas. The Liposomal Prednisolone to Improve Hemodialysis Fistula Maturation (LIPMAT) study investigates if liposomal prednisolone improves RCAVF maturation. Methods and results The LIPMAT study is an investigator-initiated, multicenter, double-blinded, placebo-controlled randomized controlled trial with 1:1 randomization to liposomal prednisolone or placebo. Eighty patients receiving an RCAVF will be included. The primary outcome is the cephalic vein diameter six weeks after surgery, measured by ultrasound. The LIPMAT study started in May 2016. Enrollment is expected to be completed by the end of 2017. Conclusions The LIPMAT study is the first to evaluate the efficacy of liposomal prednisolone to enhance RCAVF maturation.

The relation between tourniquet pressure and cephalic vein diameter and pressure

2000 ◽  
Vol 17 (Supplement 19) ◽  
pp. 24
Author(s):  
Y. Risin ◽  
A. Breitgand ◽  
A. Ben-Or ◽  
N. Leiberman
Keyword(s):  
Cephalic Vein ◽  
Vein Diameter

scholarly journals Creating percutaneous radiocephalic arteriovenous fistulas at the wrist

2020 ◽  
pp. 112972982093373
Author(s):  
Alexandros Mallios ◽  
Peter R Nelson ◽  
Gilbert Franco ◽  
William C Jennings
Keyword(s):  
Arteriovenous Fistula ◽  
Late Complications ◽  
Dialysis Therapy ◽  
Arteriovenous Fistulas ◽  
Post Procedure ◽  
Construction Techniques ◽  
Vein Diameter ◽  
Fistula Maturation ◽  
Arteriovenous Fistula Maturation

Background: The first arteriovenous fistulas were created at the wrist more than 60 years ago. Basic surgical construction techniques remain unchanged with mobilization and repositioning of the vessels followed by a sutured anastomosis. We used the Ellipsys device to construct percutaneous radiocephalic–arteriovenous fistulas at the wrist and report the results. Methods: Data were reviewed retrospectively for all patients who had a percutaneous radiocephalic–arteriovenous fistula created during a 6-month period. Each individual underwent ultrasound vessel mapping in addition to physical examination. When a radiocephalic–arteriovenous fistula was feasible and a communicating vein ⩾ 2 mm in diameter was noted in the distal forearm along with a radial artery ⩾ 2 mm, a percutaneous radiocephalic–arteriovenous fistula was considered and reviewed with the patient. Results: Four individuals met the criteria to consider a percutaneous radiocephalic–arteriovenous fistula and all elected to have the procedure performed. Ages were 54–85 years. Three were diabetic and one was female. All percutaneous radiocephalic–arteriovenous fistulas were technically successful. Two individuals had not yet started dialysis therapy. Successful and repetitive cannulation for the two individuals with catheters was initiated at 4 and 8 weeks post procedure. The two pre-dialysis patients had physiologic arteriovenous fistula maturation (6 mm vein diameter and >500 mL/min flow) at 4 and 12 weeks. There were no procedural or late complications and none required intervention. Follow-up was 8–23 months (mean 16 months). Conclusion: The success of these percutaneous radiocephalic–arteriovenous fistulas suggests that use of the Ellipsys device will be applicable at the wrist in selected patients where appropriate vessel sizes and configurations are found.

FACTORS PREDICTING OUTCOMES OF UPPER LIMB RADIO-CEPHALIC ARTERIO-VENOUS FISTULA- A PROSPECTIVE OBSERVATIONAL STUDY

2021 ◽  
pp. 74-76
Author(s):  
Ershad Hussain Galeti ◽  
Ifrah Ahmad ◽  
Veda Murthy Reddy Pogula
Keyword(s):  
Upper Limb ◽  
Vascular Anatomy ◽  
Cephalic Vein ◽  
Successful Outcome ◽  
Av Fistula ◽  
Doppler Study ◽  
Study Results ◽  
Vein Diameter ◽  
Venous Fistula ◽  
Minimum Criteria

AIMS AND OBJECTIVES: To study the factors predicting outcomes of upper limb radio-cephalic arterio-venous stula. MATERIALAND METHODS: This was an observational prospective study that included all chronic renal failure patients requiring AV Fistula surgery between June 2018 to December 2019. All patients whose vascular anatomy does not permit the construction of a native AV stula, as detected on preoperative doppler study, were excluded from the study. RESULTS: Out of 120 cases studied, 88 were male, and 32 were females. In males out of 88 cases, 61 cases had successful outcome (69%) and in 27 cases, stula failed (31%). No signicance on the outcome of the AV stula noted related to comorbidities. Mean preoperative radial artery diameter of 2.8 and 1.9 mm was associated with successful and failed stula, respectively. Mean preoperative cephalic vein diameter of 2.2 and 1.9 mm were associated with successful and failed stulae, respectively. Results suggested a threshold PSV of at least 50cm/sec for stula success. A stula diameter of > 0.4 cm and a minimum ow rate of > 58mL/min resulted in a 93% chance that the stula would be adequate versus 28 % if neither of the minimum criteria were met. Mean post-operative cephalic vein diameter 4.24 and 3.28 mm were associated with successful and failed stula, respectively. CONCLUSION: In our study the cephalic vein size, arterial size and ow rate is the predominant factor determining the success of the radio cephalic stula. There is increasing evidence that routine preoperative duplex USG reduces the rate of primary stula failure and unnecessary surgical exploration. Aminimum arterial diameter of 2mm is associated with successful stula formation. Below this diameter, the success of the stula depends on the ability of the artery to dilate. Athreshold for the minimal venous diameter is difcult to establish. But most clinical studies use a value of 2.5mm for AFV.

The Effect Of Hand Exercise On Grip Strength, Forearm Circumference, Diameter Of Vein, Blood Flow Volume And Velocity In Patient Who Underwent Arteriovenous Fistula Surgery And On Routine Haemodialysis

2019 ◽  
Vol 1 (1) ◽  
pp. 14
Author(s):  
Jufri Febriyanto Poetra ◽  
Andriati Andriati ◽  
Dewi Poerwandari
Keyword(s):  
Blood Flow ◽  
Flow Velocity ◽  
Grip Strength ◽  
Blood Flow Velocity ◽  
Intervention Group ◽  
Cephalic Vein ◽  
Flow Volume ◽  
Blood Flow Volume ◽  
Before And After ◽  
Vein Diameter

Background: The arteriovenous fistula (AVF) is considered the gold standard for haemodialysis access. The fistula needs time to be mature and functional. Maturation process respond to increases in blood flow. Exercise stimulates vascular response as such an increase of blood flow. Aims: The purpose of this study is to determine the effectiveness of hand exercise in increasing grip muscle performance, and its effectiveness in supporting maturation process of fistula.Methods: This experimental study done on 14 patients underwent AVF procedure and on routine haemodialysis. Randomly, 7 subjects allocated on intervention group by doing hand exercise using hand gripper (HG) for 5 weeks, and 7 subjects allocated as control group without introduction to hand gripper. Grip strength and forearm circumference were measured before and after 5 weeks of intervention. Cephalic vein diameter, blood flow volume and velocity were measured using Doppler USG on AVF arm. The comparison of intervention effects between groups treatment were analyzed based on effect size (ES).Results: Grip strength and forearm circumference increased significantly on intervention group before and after exercise intervention (p<.001, p=.001). Cephalic vein diameter and blood flow were increased significantly in this group (p=.027, p=.033). Blood flow velocity showed no difference before and after exercise intervention. Significant results were found on increased grip strength, forearm circumference, cephalic vein diameter and blood flow volume in comparison between treated group (p<.001; ES=.94, p<.001; ES=.4, p=.046; ES=.84, p=.035; ES=.53). There were no differences on cephalic vein blood flow velocity between these two groups.Conclusion: Five weeks hand exercise were effective to increase grip strength, forearm circumference, cephalic vein diameter and blood flow volume, nonetheless ineffective to increase cephalic vein blood flow velocity in post AVF procedure patients with routine haemodialysis.

Accessory Veins and Radial-Cephalic Arteriovenous Fistula Non-Maturation: A Prospective Analysis Using Contrast-Enhanced Magnetic Resonance Angiography

2007 ◽  
Vol 8 (4) ◽  
pp. 281-286 ◽  
Author(s):  
R.N. Planken ◽  
L.E. Duijm ◽  
A.G. Kessels ◽  
T. Leiner ◽  
J.P. Kooman ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Arteriovenous Fistula ◽  
Predictive Value ◽  
Preoperative Assessment ◽  
Cephalic Vein ◽  
Salvage Procedure ◽  
Venous Stenosis ◽  
Contrast Enhanced ◽  
Vein Diameter

Purpose To determine if large caliber accessory veins are associated with radial-cephalic arteriovenous fistula (RC-AVF) non-maturation. Methods RC-AVFs were created in 15 consecutive patients (radial artery and cephalic vein diameter >2 mm, in the absence of arterial inflow or venous outflow stenoses or occlusions). Contrast-enhanced magnetic resonance angiography (CE-MRA) was performed preoperatively for the determination of vessel diameters, stenoses and occlusions. The location and caliber of accessory veins was determined. Vascular access (VA) function was monitored and all interventions required to obtain a functioning VA were recorded. Non-maturation was defined as a nonfunctional VA at 2 months after creation. The predictive value of accessory vein caliber for prediction of RC-AVF non-maturation was evaluated using receiver operating characteristic (ROC) analysis. Results Non-maturation occurred in 10 (67%) out of 15 RC-AVFs. Large caliber accessory veins (n=4), venous stenosis (n=3) or both (n=2) were associated with RC-AVF non-maturation. The presence of large caliber accessory veins was the only significant predictor for RC-AVF non-maturation (p=0.01). Preoperatively detected accessory veins with a diameter >70% of the cephalic vein diameter, had a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 80, 100, 100 and 91% for prediction of RC-AVF non-maturation on patient level. Accessory vein ligation and dilatation of venous stenosis resulted in an overall salvage success rate of 89% (8/9). Conclusion Large caliber accessory veins are associated with RC-AVF non-maturation. Ligation of large caliber accessory veins is a successful salvage procedure in a substantial group of patients. Furthermore, ligation of these accessory veins during initial RC-AVF creation can potentially reduce non-maturation rates; and therefore, preoperative assessment of accessory veins is recommended.

Venous distensibility is more important than venous diameter in primary survival of autogenous radiocephalic arteriovenous fistulas

2020 ◽  
Vol 21 (6) ◽  
pp. 963-968
Author(s):  
Guocun Hou ◽  
Yi Hou ◽  
Xiuli Sun ◽  
Na Yin ◽  
Guozhen Feng ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Confidence Interval ◽  
Arteriovenous Fistula ◽  
Radial Artery ◽  
Odds Ratio ◽  
Diabetic Kidney Disease ◽  
Peak Systolic Velocity ◽  
Cephalic Vein ◽  
Venous Distensibility ◽  
Vein Diameter

Background: Many studies suggested that the optimal cephalic vein diameter for wrist radio-cephalic arteriovenous fistula construction should be at least 2 mm to predict successful maturation and primary patency. However, our experience has shown that many patients with smaller cephalic vein diameter (≤2 mm) in the neutral state (without a tourniquet) also have good clinical outcomes. The aim of this study was to identify predictors that affect primary survival of new wrist radio-cephalic arteriovenous fistula in patients with cephalic vein diameter ≤2 mm. Methods: We performed a retrospective review of 50 patients with preoperative cephalic vein diameters ≤2 mm in the neutral state who underwent wrist radio-cephalic arteriovenous fistula construction between September 2016 and October 2019. Internal diameters of the cephalic vein and radial artery, venous distensibility, peak systolic velocity, and resistance index of the radial artery were determined by ultrasound examination before wrist radio-cephalic arteriovenous fistula placement. Patients were divided into two groups: failure and survival. Results: The radio-cephalic arteriovenous fistula survival rate was 68% from the time of radio-cephalic arteriovenous fistula creation until the end of the study. Univariate analysis showed that larger venous distensibility (p < 0.001), non-diabetic kidney disease (p = 0.009), and slower peak systolic velocity of the radial artery (p = 0.033) were predictive factors for primary radio-cephalic arteriovenous fistula survival. Multivariate regression analysis revealed good venous distensibility (odds ratio = 9.637, 95% confidence interval = 1.893–49.050, p = 0.006) and non-diabetic kidney disease (odds ratio = 0.148, 95% confidence interval = 0.033–0.660, p = 0.012) to be independent predictors for primary radio-cephalic arteriovenous fistula survival. Receiver operating characteristic analysis showed that venous distensibility >0.52 mm (sensitivity: 70.6%, specificity: 68.8%) was the best cut-off value to predict primary radio-cephalic arteriovenous fistula survival. Conclusion: When cephalic veins with diameter ≤2 mm are found, venous distensibility should be used to aid in the surgery decision-making process. The outcome of wrist radio-cephalic arteriovenous fistula survival would be significantly improved through the use of cephalic vein with venous distensibility >0.52 mm.

Radial‐cephalic fistula recovered with graft interposition from the brachial artery into the cephalic vein—Patient with two arteriovenous fistulas

2020 ◽  
Vol 24 (6) ◽  
pp. 731-735
Author(s):  
Clemente Neves Sousa ◽  
Filipa Cabrita ◽  
Sara Rodrigues ◽  
Ana Ventura ◽  
António Norton de Matos ◽  
...  
Keyword(s):  
Brachial Artery ◽  
Cephalic Vein ◽  
Arteriovenous Fistulas ◽  
Graft Interposition

Impact of Isometric Handgrip Exercises on Cephalic Vein Diameter in Non-AVF Candidates, a Pilot Study

2012 ◽  
Vol 14 (2) ◽  
pp. 157-163 ◽  
Author(s):  
Alice L. Uy ◽  
Rahul M. Jindal ◽  
Travis W. Herndon ◽  
Christina M. Yuan ◽  
Kevin C. Abbott ◽  
...  
Keyword(s):  
Pilot Study ◽  
Cephalic Vein ◽  
Isometric Handgrip ◽  
Vein Diameter
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