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The Fistula Elevation Procedure: A Valuable Technique for Maximizing Arteriovenous Fistula Utilization

The Fistula Elevation Procedure: A Valuable Technique for Maximizing Arteriovenous Fistula... Many patients are not considered candidates for radiocephalic fistula (RCF) or brachiocephalic fistula (BCF) creation or have fistulas that do not mature because the cephalic vein is too deep or tortuous to be accessed. Other patients have not been candidates for the basilic vein transposition (BVT) because limited length of adequate caliber vein precludes subcutaneous tunneling of the vein. In an effort to maximize arteriovenous fistula (AVF) utilization, we developed an adjunctive procedure designed to make the deep or tortuous fistula accessible to needle cannulation. The fistula elevation procedure (FEP) involves mobilization of the fistula, approximation of the subcutaneous tissue beneath the fistula, and subcuticular skin closure over the fistula. The procedure enhances the accessibility of the fistula by placing it in a more superficial position. The overlying cicatrix also acts as a guide for dialysis needle insertion. Between June 1998 and January 2001, 45 patients underwent a natural AVF that could not be accessed secondary to venous depth, tortuosity, or length. In each case, a FEP was performed to salvage the fistula.The FEP was performed as an adjunct to a BCF in 20 patients, a RCF in 7 patients, and a BVT in 8 patients. The FEP is a simple procedure that enhances AVF utilization by making the fistula more accessible to dialysis needle cannulation. The procedure is particularly helpful in obese patients who would not traditionally be considered candidates for natural AVF creation. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Annals of Vascular Surgery Springer Journals

The Fistula Elevation Procedure: A Valuable Technique for Maximizing Arteriovenous Fistula Utilization

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Publisher
Springer Journals
Copyright
Copyright © Inc by 2002 Annals of Vascular Surgery
Subject
Medicine & Public Health; Abdominal Surgery
ISSN
0890-5096
eISSN
1615-5947
DOI
10.1007/s10016-001-0140-6
pmid
11904810
Publisher site
See Article on Publisher Site

Abstract

Many patients are not considered candidates for radiocephalic fistula (RCF) or brachiocephalic fistula (BCF) creation or have fistulas that do not mature because the cephalic vein is too deep or tortuous to be accessed. Other patients have not been candidates for the basilic vein transposition (BVT) because limited length of adequate caliber vein precludes subcutaneous tunneling of the vein. In an effort to maximize arteriovenous fistula (AVF) utilization, we developed an adjunctive procedure designed to make the deep or tortuous fistula accessible to needle cannulation. The fistula elevation procedure (FEP) involves mobilization of the fistula, approximation of the subcutaneous tissue beneath the fistula, and subcuticular skin closure over the fistula. The procedure enhances the accessibility of the fistula by placing it in a more superficial position. The overlying cicatrix also acts as a guide for dialysis needle insertion. Between June 1998 and January 2001, 45 patients underwent a natural AVF that could not be accessed secondary to venous depth, tortuosity, or length. In each case, a FEP was performed to salvage the fistula.The FEP was performed as an adjunct to a BCF in 20 patients, a RCF in 7 patients, and a BVT in 8 patients. The FEP is a simple procedure that enhances AVF utilization by making the fistula more accessible to dialysis needle cannulation. The procedure is particularly helpful in obese patients who would not traditionally be considered candidates for natural AVF creation.

Journal

Annals of Vascular SurgerySpringer Journals

Published: Jan 16, 2002

References