Revision Arteriovenous Access

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SAMPLE EXCERPT
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PRE-PROCEDURE
INDICATIONS

Early or late arteriovenous fistula failure

CONTRAINDICATIONS
  • Hyperkalemia
  • Volume overload
  • Uremia
  • Metabolic acidosis
  • Contrast allergy
  • Infected fistula
EQUIPMENT
  • Intraoperative fluoroscopy
  • Sterile field, local anesthetic, and conscious sedation
  • Standard endovascular wires, catheters, and balloons.
ANATOMY
  • In the upper extremity, the radial and brachial arteries provide the inflow for forearm and upper arm fistulae, respectively.
  • The basilic, cephalic, and antecubital veins provide venous outflow for upper arm fistulae. The basilic vein needs to be translocated to a suprafascial location to permit percutaneous dialysis access.

PROCEDURE
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The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

POST-PROCEDURE
CARE
  • Bandages are removed and the patient may shower 24 hours after the procedure.
  • The patient should not lift anything heavier than 10 pounds with the affected extremity for at least one week.
  • Bleeding, signs of access site infection, or fistula nonfunction should be rapidly evaluated in the periprocedural period.
COMPLICATIONS
  • Bleeding
  • Infection
  • Fistula thrombosis
  • Fistula rupture
  • Recurrence of venous outflow pathology
RESULT ANALYSIS
  • Postintervention angiography and physical exam permit immediate outcome evaluation. Flow monitoring during dialysis and subsequent duplex ultrasound will diagnose recurrent venous pathology.
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