Transition to all-autogenous hemodialysis access: the role of preoperative vein mapping.
Safe, reliable, and efficient hemodialysis access (DA) remains an unrealized ideal. Autogenous dialysis access (ADA) may improve outcome for renal failure patients. We now place ADA in 9 out of 10 new patients in an effort to maximize primary patency and minimize access-related complications. We reviewed our recent DA experience to determine whether our increased reliance on autogenous access (ADA) has improved outcomes, and to evaluate the impact of preoperative duplex venous imaging (vein mapping) on early and intermediate results. We conducted a retrospective database review of 108 consecutive patients undergoing initial permanent DA between 10/97 and 8/01. Mean follow-up was 13.1 months. Our results showed that increased ADA utilization decreases the need for secondary access procedures. The functional superiority of ADA vs. prosthetic dialysis access (PDA) in this series may be due to optimal autogenous conduit selection facilitated by preoperative vein mapping.
Department of Surgery, Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA, USA. rld@stanford.edu
Ronald L
RL
Dalman
E John
EJ
Harris
Braden J
BJ
Victor
Sheila M
SM
Coogan
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene / Q000627:therapeutic use; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D011300:Preoperative Care; D006435:Renal Dialysis / Q000639:trends; D012086:Reoperation; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency / Q000187:drug effects / Q000502:physiology
D011138:Polytetrafluoroethylene