CIR - Comunicações e Conferências
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Browsing CIR - Comunicações e Conferências by Subject "Arteriovenous fistula"
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- Brachiobasilic AV fistula transposition without reanastomosis: preliminary resultsPublication . Rocha, R; Gomes, A; Sousa, M; Germano, A; Marinho, R; Pignatelli, N; Nunes, VBackground: When the venous territory is poor the brachiobasilic arteriovenous fistulae (BBAVF) could be the only option for native vascular access. Several techniques have been proposed. Our aim is to evaluate the efficiency of the brachiobasilic AV fistula with two stage elevation and transposition without reanastomosis. Materials and Methods: Observational, descriptive and prospective study. Patients submitted to BBAVF elevation and transposition throughout 2012 and 2013 were included. A two stage procedure was done. The basilic vein was isolated, a subcutaneous flap was made and it was subsequently transposed without being transected. The subcutaneous flap is then sutured keeping the transposed vein in the anterior surface of the arm. Length of superficialized segment, distance from the skin, arterial flow, sistolic velocity, resistance index and vein diameter was measured by color doppler ultrasound. Results: From 160 patients admitted for creation of first AV access in 2012 and 2013, 22 BBAVF were performed. Average age was 65,59±12,96, 10 female patients. 18 were pre-dialysis patients. Mean follow up was 12,74 months with 13 functional access. Length of superficialized segment was always higher than 6cm (89±2,1 mm); mean distance from skin was 3,82±2,3 mm; mean arterial flow was 1,401±0,570 l/min with a max velocity of 223,16±84,02 and a resistance index of 0,48±0,17, mean vein diameter was 9,96±5,1 mm. 20 were functional as an AV access for HD at 2nd week postoperative. 3 complications were reported, 2 hematomas and 1 wound infection overcome with medical treatment. Conclusions:. This technique is safe, simpler, and efficient and allows for early use of the access. Although our follow-up is short, we are optimistic about these preliminary results and hope to compare this technique with others in the long term.
- Unrecognized vascular variation leading to failure of arteriovenous fistula creation: case report and impact of vascular planningPublication . Marinho, R; Germano, A; Gomes, A; Sousa, M; Rocha, R; Fragoso, M; Pignatelli, N; Nunes, VAIMS OF THE STUDY: To describe the importance of preoperative venous and arterial mapping before choosing the best arteriovenous fistula (AVF) according to the National Kidney Foundation Dialysis Outcomes Quality Initiative (NKF-DOQI) guidelines. METHODS: We describe a case of a successful arteriovenous graft (AVG) creation after the failure of two AVF and a AVG without vascular mapping conducted before the successful surgery. This case was selected among 239 patients between February 2011-January 2014. RESULTS: 52 y woman with postpartum complications that evolved with chronic renal disease was referred from another hospital where a right upper arm brachial-cephalic and a brachial-basilic AVF and a left forearm radial-cephalic AVG were performed but failed due to thrombosis. Then a radial-cephalic AVG also failed in the left forearm. Venous and arterial imaging showed a right sinuous brachial artery with a 4mm diameter and a 0,13l/min flow. The right basilic and cephalic veins couldn´t be characterized due to the extensive thrombosis. The left radial artery had a 2mm diameter and a 0,01l/min flow and the cephalic vein was also thrombosed. Left brachial artery showed a 4mm diameter and a 0,14l/min flow and the basilic vein presented with a good permeability in the upper arm with a 7mm diameter. A left brachial-basilic AVG was successfully performed at our hospital and still being used for hemodialysis. CONCLUSIONS: According to the KDOQI guidelines, the radial-cephalic AVF at the wrist and brachial-cephalic AVF at the antecubital fossa are the first and second access choices being the brachio basilic the third choice. AVG is indicated in absence of no suitable vein for AVF. This case underscores the importance of vascular mapping before surgery to avoid AVF failure and preservation of future access.
- Upper limb arterial hemodynamics in high brachial artery bifurcation by color doppler ultrasoundPublication . Fragoso, M; Germano, M; Gomes, A; Sousa, M; Rocha, R; Marinho, R; Pignatelli, N; Nunes, VBackground: High bifurcation of the brachial artery is a common anatomic variant, with a prevalence of 12-20% and a challenging Doppler identification. This variant may have hemodynamic implications and compromise the success of a native arteriovenous fistula (AVF). The aim of this study is to compare the hemodynamic characteristics of the upper limb arterial axis based on the location of the brachial bifurcation in patients in need of a vascular access for hemodialysis. Methods: Cross sectional observational study with retrospective data collection. The studied variables were arterial diameter, flow, peak systolic velocity and resistance index of the brachial, radial and ulnar arteries in patients proposed for first vascular access construction between February 2011 and January 2014. Results: Of 153 patients studied, 6,53% had high brachial artery bifurcation. In these patients, the diameter of the brachial artery was smaller (3,77mm±0,64 vs. 4,38mm±1,2; p<0,05) and the resistance index was higher (0,97±0,68 vs. 2,18±0,58; p<0,05). The remaining variables were not statistically different. Conclusions: The brachial, radial and ulnar arteries flow and peak systolic velocity, as well as the diameter and resistance index of the radial and ulnar arteries were independent of the location of the brachial artery bifurcation. The lack of differences in hemodynamic distal arteries characteristics suggests that the success of distal vascular access is not compromised. The smaller diameter and higher resistance index found in the high brachial artery bifurcation patients may recommend an exhaustive research of this anatomical variant in preoperative mapping, since it might influence the proximal vascular access success.
- Value of color doppler ultrasound: parameters for proximal vascular access patencyPublication . Sousa, M; Germano, A; Gomes, A; Rocha, R; Marinho, R; Fragoso, M; Pignatelli, N; Nunes, VBackground: Color Doppler Ultrasound (CDU) is essential for vascular mapping in vascular access planning/creation. The aims of this study was to evaluate which anatomical and physiological variables of the artery and the vein, measured by CDU, were associated with higher patency at one year follow-up in brachiocephalic (BC) and brachiobasilic (BB) primary AV fistula (AVF). Materials and Methods: Retrospective observational analysis of patients admitted at our institution between January 2011 and June 2013 for native proximal AVF creation after CDU vascular mapping. Results: We analyzed 61 patients, mean age of 66,1±6,8; 26 female; 43 BC and 18 BB access, mean follow up 37,9 months, 69% of patency at one year follow up. Brachial artery and venous diameter, Resistance Index and venous distensibility show no differences between groups. Brachial Artery flow was higher in the 1 year patency group (0,160l/min±0,11 vs 0,19l/min± 0,06; t=2,37;df=59; p<0,05) as well as the peak systolic velocity (78,77m/s±23,2 vs 65,47m/s±18,47; t=2,09;df=59; p<0,05) and distance between the artery and the vein (a-v distance) (31,73mm ±11,9 vs 17,75mm ±8,61; t=3,70;df=59; p<0,001). The presence of comorbidities as diabetes and arterial hypertension were higher in the non-patency group (p<0,05). Logistic regression performed confirmed positive association between brachial artery flow, peak systolic velocity and a-v distance and AVF patency (p<0,001; Exp(B)꞊0,265). Conclusions: Of the CDU variables measured, in our population, higher brachial artery flow, higher peak systolic velocity of brachial artery and higher distance between artery and vein influenced the one year patency.