TH4.2 To do or not to do, Branch ligation of a non-maturing arterio-venous fistula for haemodialysis
| Autor: | Abdallah Abdelwahed, Fatima de Figueiredo, Raghvinder Pal Singh Gambhir |
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| Rok vydání: | 2022 |
| Předmět: | |
| Zdroj: | British Journal of Surgery. 109 |
| ISSN: | 1365-2168 0007-1323 |
| DOI: | 10.1093/bjs/znac248.219 |
| Popis: | Aim Up to 20% of arterio-venous fistulas (AVFs) may fail to mature to become usable for renal access in patients on Haemodialysis (HD). There is no consensus on benefit of branch ligation. This study aimed to assess the outcomes of branch ligation on maturation of these AVFs. Methods Electronic patient records and Renalware were accessed to obtain data of branch ligation procedures done at secondary care centre from 2016 till 2021. Results With a prevalent dialysis population of over 771 patients and incident dialysis population of 147 in 2021, we as a centre perform 250–300 access procedures annually. A total of 23 ligation procedure were done in the above-mentioned period. Less than 50% of patients had a large branch documented on Duplex scan report to be draining a significant and measurable flow away from the AVF. The other procedures were done based on clinical judgement. All procedures were done under Duplex guidance and under Local or Regional anaesthesia. About two thirds of the fistulas that required branch ligation were Radio-Cephalic AVFs, the rest Brachio-Cephalic AVFs. No complications were reported though one patient needed a fistuloplasty due to vein pinch. In 16 out of the 23(69.5%) patients there was clinical and sonological improvement in flow, and or vein diameter after the branch ligation making them usable for HD. Conclusion Branch ligation of non- maturing fistula in selected cases can help maturation and make these arteriovenous fistulas usable. |
| Databáze: | OpenAIRE |
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