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Other venous disorders
Published in Ken Myers, Paul Hannah, Marcus Cremonese, Lourens Bester, Phil Bekhor, Attilio Cavezzi, Marianne de Maeseneer, Greg Goodman, David Jenkins, Herman Lee, Adrian Lim, David Mitchell, Nick Morrison, Andrew Nicolaides, Hugo Partsch, Tony Penington, Neil Piller, Stefania Roberts, Greg Seeley, Paul Thibault, Steve Yelland, Manual of Venous and Lymphatic Diseases, 2017
Ken Myers, Paul Hannah, Marcus Cremonese, Lourens Bester, Phil Bekhor, Attilio Cavezzi, Marianne de Maeseneer, Greg Goodman, David Jenkins, Herman Lee, Adrian Lim, David Mitchell, Nick Morrison, Andrew Nicolaides, Hugo Partsch, Tony Penington, Neil Piller, Stefania Roberts, Greg Seeley, Paul Thibault, Steve Yelland
A haemodialysis fistula is formed either by direct anastomosis between artery and vein in an extremity, termed a native arteriovenous fistula, or by a synthetic or vein graft between the two, termed a prosthetic haemodialysis access arteriovenous graft. Adjacent vessels used are the radial artery and cephalic vein at the wrist (Brescia–Cimino fistula) or brachial artery and cephalic or basilic vein at the cubital fossa.
Endovascular arteriovenous fistulas— are they the answer we haven’t been looking for?
Published in Expert Review of Medical Devices, 2021
Bynvant Sandhu, Charlie Hill, Mohammad Ayaz Hossain
The global prevalence of Chronic Kidney Disease (CKD) is estimated at 9%. There is a significant disease mortality (41.5%) in these patients[1]. CKD patients who progress to End-Stage Kidney Disease (ESKD) may opt for hemodialysis (HD) as their modality of renal replacement therapy. The Brescia-Cimino fistula has been the preferred method for the provision of vascular access for hemodialysis since its original description over half a century ago [2]. The National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (KDOQI) provides evidence-based guidelines for HD vascular access. The KDOI suggests that arteriovenous access is preferred to a central venous catheter (CVC) in most incident and prevalent HD patients due to the lower infection rates compared with arteriovenous access use [3]. These guidelines, along with initiatives, such as the Fistula First Breakthrough Initiative, have resulted in an estimated 65% arteriovenous fistula (AVF) use in prevalent hemodialysis patients in the US [4]. AVF creation, however, is not without its challenges (Figure 1). Maturation (the development of an adequate size and flow of the cannulation segment of the fistula), can be suboptimal, requiring further procedures. Maturation failures, requirement for re-intervention and patient refusal also limits their utility. Patient refusal may in part be related to the potential requirement for re-interventions to establish and maintain AVF access [5].