RT Journal
A1 Giacchino JL, Geis W, Buckingham JM, Vertuno LL, Bansal VK
T1 Vascular access: Long-term results, new techniques
JF Archives of Surgery
JO Archives of Surgery
YR 1979
FD April 1
VO 114
IS 4
SP 403
OP 409
DO 10.1001/archsurg.1979.01370280057008
UL http://dx.doi.org/10.1001/archsurg.1979.01370280057008
AB • Effective approaches to unique problems of vascular access in renal failure have evolved from a five-year experience with 840 angioaccess procedures. Standard techniques plus innovations have required only 0.62 operations per year per patient with an average access life of 1.6 years. Classical forearm external arteriovenous (AV) cannulas and internal AV fistulas provided vascular access in 392 patients, while 61 required more complex procedures due to failure of primary cannulas and fistulas, inherently small forearm vessels, and iatrogenic vessel loss. Secondary techniques include reverse fistula, vascular graft AV fistulas using expanded polytetrafluoroethylene (E-PTFE), and arterioarterial (AA) jump graft. Presently, the new renal failure patient receives a forearm radiocephalic AV fistula; the cannula is restricted to emergency or short-term hemodialysis and may later be converted to a subcutaneous fistula. The reverse fistula is attempted before using E-PTFE grafts. Upper extremity AV and AA loops can then be constructed de novo or from the reverse fistula.(Arch Surg 114:403-409, 1979)