Laura Pettorini

Preventive hemostasis for hemodialysis vascular access surgical reinterventions

Surgical reinterventions for treatment of complications or ligation of haemodialysis vascular access (VA), when performed in or below the mid/lower part of the upper arm, could benefit from the use of preventive haemostasis with an inflatable tourniquet. This technique offers several advantages, such as the reduced risk of bleeding and the increased accuracy of dissection allowing for a minimally invasive approach. The use of preventive haemostasis is safe, economical and time-saving. All the secondary procedures on VA that could benefit from its use are reviewed.

Preoperative duplex examination in patients with dialysis access-related hand ischemia: indication for distal radial artery ligation

Purpose To demonstrate that treatment with distal radial artery ligation (DRAL), based on preoperative evaluation with duplex ultrasound, is effective for correction of hand ischemia related to distal radiocephalic arteriovenous fistula (AVF). Methods Two patients with symptoms of hemodialysis access-induced distal ischemia (HAIDI) related to radiocephalic AVF at wrist (necrotic lesion of fingers, pain at rest and loss of sensory function) were studied with preoperative duplex examination. Color Doppler ultrasound (CDU) showed low-normal flux (700 and 500 mL/min respectively), retrograde flow in the DRA and increased digital perfusion after manual occlusion of DRA. They were both treated by ligation of the DRA. Results Both patients had immediate improvement of ischemic symptoms. Reversed DRA flow disappeared and peripheral flow ameliorated. Postoperative AVF flow was 500 and 350 mL/min, stable at 16 and 8 months of follow-up, respectively. Conclusions Preoperative CDU examination, simulating reversed DRA flow interruption, seems to be an effective tool to predict the success of DRAL procedure.

Echographic landmark of cephalic and collateral accessory vein at forearm in preoperative evaluation for hemodialysis angioaccess

Introduction Superficial veins in the upper arm differ according to their relationship to the superficial fascia. We investigated the echographic landmark of the cephalic vein (CV) to correctly distinguish it from the collateral accessory vein (CAV) before hemodialysis angioaccess creation. Materials and Method Twenty consecutive patients were evaluated by ultrasonographic scan. The echographic features of CV and CAV together with their relationship were described. Results Ninety-five percent of patients presented both CV and CAV (75% CAV laterally located, 25% medially located). CV and CAV diameters were 2.9 (±0.65) and 2.0 (±0.70), respectively. Conclusions CV differs from CAV for its anatomic location at forearm. Such a difference is clearly evident under ultrasound examination, despite any recommendation in ultrasound guidelines. Whether the exclusive use of CV for angioaccess creation can lead to a better outcome will be ascertained by further studies.