Nephrology Dialysis Transplantation, Vol 14, Issue 1 118-120, Copyright © 1999 by Oxford University Press
S Sivanesan, T How and A Bakran
Background: A large proportion of late failures of
radiocephalic arteriovenous fistulae are related to the progression of
intimal hyperplasia. The aetiology of this process is still unknown but the
fistula configuration and resultant haemodynamics have been implicated.
This clinical study was devised to identify sites of stenosis in patients
with fistulae and relate the findings to various clinical and geometrical
parameters. Methods: Measurement of anastomotic length
and angle was made intraoperatively in 25 consecutive fistulae.
Post-operative assessment was carried out at regular intervals using duplex
and colour-flow ultrasonography. Results: Stenoses
were present in all 25 of the fistulae studied at 3 months. The stenoses
could be classified to three specific sites: at the anastomosis (Type 1),
on the inner wall of the curved region of the cephalic vein (Type 2) and
just proximal to this curved segment where the vein straightens out (Type
3). Most of Type 1 and Type 2 stenoses were not progressive while type 3
stenoses were generally progressive. Conclusions:
These finding emphasize the need for an effective surveillance programme of
AV fistulae. Key words: arteriovenous fistula;
anastomosis geometry; duplex ultrasound
ORIGINAL ARTICLES
Sites of stenosis in AV fistulae for haemodialysis access
Renal Transplant Unit, Royal Liverpool University Hospital, and Department of Clinical Engineering, University of Liverpool, Liverpool L7 8XP, UK; Corresponding author
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