title: Vascular access in chronic dialysis: a plastic surgeon's approach.
abstract: Thirty-five years after Brescia et al. (N Engl J Med 275:1089-1092, 1966) realized the first peripheral autogenous arteriovenous fistula, the "Achilles' heel" of chronic dialysis is still the absence of a good-quality permanent vascular access. The number of patients depending on hemodialysis is increasing. Until 10 years ago, in Romania, there was a need to treat isolated critical cases. Nowadays, every dialysis center needs algorithms for a standardized approach, adaptable for each case. We reviewed 171 consecutive arteriovenous fistulas (132 patients) performed in adults in identical standard conditions: use of an inflatable tourniquet during the vascular dissection, microsurgical techniques, and use of only autogenous tissues. We analyzed our results, the technical difficulties encountered, and their management in long-term follow-up. The aim of this study was to set up the basic principles of our algorithms. Our approach, based on our education as plastic surgeons involved in hand surgery and microsurgery, might present the advantage of sparing renal patients vascular capital.
authors.affiliation: Department of Plastic and Reconstructive Surgery, University Accident Hospital, Gr T Popa University of Medicine, Iasi, Romania. dpieptu@iasi.mednet.ro
authors.forename: Dragos
authors.initials: D
authors.lastname: Pieptu
authors.forename: Stefan
authors.initials: S
authors.lastname: Luchian
authors.forename: Mihaela
authors.initials: M
authors.lastname: Hriscu
authors.forename: Irina
authors.initials: I
authors.lastname: Mititiuc
authors.forename: Manuela
authors.initials: M
authors.lastname: Florea
authors.forename: Simona
authors.initials: S
authors.lastname: Romete
authors.forename: Maria
authors.initials: M
authors.lastname: Popa
authors.forename: Angela
authors.initials: A
authors.lastname: Ungureanu
authors.forename: Loredana
authors.initials: L
authors.lastname: Chirita
mesh_terms: D000328:Adult; D000465:Algorithms; D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D006435:Renal Dialysis / Q000379:methods*; D012189:Retrospective Studies; D013518:Surgery, Plastic / Q000379:methods; D014656:Vascular Surgical Procedures / Q000379:methods*