Surgical Revision and Early Cannulation of the Arteriovenous Fistula in Hemodialysis Patients: An Effective Technique
Bibliographic record
Abstract
Arteriovenous fistula (AVF) dysfunction is a common problem in hemodialysis patients. After surgical revision for malfunction, we used AVFs early to avoid complications associated with central venous catheters. In this study, we report experience with surgical revisions of native AVFs with suspected arterial dysfunction as the cause of inadequate arterial inflow for dialysis. Exclusion criteria were presence of a central venous catheter as a hemodialysis access, and clinical or radiologic evidence of stenosis or thrombosis of the distal venous segment of the AVF. We prospectively studied 50 patients (mean age 60.2 ± 10.5 years, 25 men and 25 women) with 59 revisions. The patients were followed until change in the modality of dialysis, transplant, or death. The types of AVFs revised were left wrist radiocephalic in 27 patients (54%), left forearm radiocephalic in 10 (20%), right wrist radiocephalic in 6 (12%), left antecubital brachiocephalic in 3 (6%), right antecubital brachiocephalic in 2 (4%), and right forearm radiocephalic in 2 (4%). The causes of inadequate arterial flow were juxta-anastomotic thrombosis in 20 patients (40%), inadequate arterial anastomotic flow in 16 (32%), inadequate anastomosis in 7 (14%), and juxta-anastomotic venous stenosis in 7 (14%). The primary surgical revision techniques were proximal neo-anastomosis using the semiarterialized vein in 43 patients (86%), thrombectomy and re-anastomosis in 5 (10%), and resection and repair in 2 (4%). Technical success, defined as successful cannulation of the revised AVF for hemodialysis and avoidance of central venous catheter, was achieved in 44 of 50 patients (88%). Technical failure occurred 6 cases, the causes being inadequate arterial flow in 3 patients, failure to cannulate the veins in 2 patients, and steal syndrome in 1 patient. After primary revisions failed, 9 re-revisions were done in 6 patients. The 1-year, 2-year, and 3-year primary and overall patency rates were 76.2%, 67.6%, 65.0%, and 85.7%, 75.7%, 65.0%, respectively. In conclusion, surgical salvage of the AVF with inadequate arterial flow is an effective approach that can be performed as an outpatient procedure and allows early cannulation of the semi-arterialized veins, thus avoiding the use of central venous catheters.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".