Un garrot étroit est utile pour le 2ème temps de superficialisation...
Transcript of Un garrot étroit est utile pour le 2ème temps de superficialisation...
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Un garrot étroit est utile pour le 2ème temps de
superficialisation des veines basiliques ou brachiales
Nicola Pirozzi
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Disclosure
Speaker name: Nicola Pirozzi
I do not have any potential conflict of interest
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Humero-basilic AVF + vein superficialisationDagher F, Gelbert R, Ramos E, Sadler J.
The use of basilic vein and brachial artery as an A-V fistula for long term
hemodialysis.
J Surg Res 1976;20:373–6.
The Brachial Artery-basilic Vein Arterio-venous Fistula in Vascular Access for Haemodialysis—
A Review Paper
F.P. Dix, Y. Khan, H. Al-Khaffaf
European Journal of Vascular and Endovascular Surgery
Volume 31, Issue 1, Pages 70-79 (January 2006)
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Humero-basilic AVF
+ vein superficialisation
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A Comparison of Two Surgical Techniques for the Second Stage of Brachiobasilic Arteriovenous
Fistula Creation
Mauro R et al Artif Organs. 2016
« elevation » VS « transposition »
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J Vasc Surg. 2015 Mar;61(3):809-16.
Similar failure and patency rates when comparing one- and two-
stage basilic vein transposition.Cooper J1, Power AH1, DeRose G1, Forbes TL1, Dubois L2.
CONCLUSIONS:
Meta-analysis of the existing literature comparing one-stage and two-
stage basilic vein transposition suggests no difference in failure and patency
rates, despite the two-stage procedure's being used in patients with
smaller basilic veins. These findings are limited by the small size, observational
design, and inconsistent quality of included studies. Reserving a two-stage
procedure for patients with smaller basilic veins appears justified, although
the strength of the evidence is limited.
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Front Surg. 2015 Apr 29;2:14.
Randomized controlled trial
comparing primary and staged
basilic vein transposition.
Kakkos SK, Tsolakis IA, Papadoulas SI,
Lampropoulos GC, Papachristou EE,
Christeas NC, Goumenos D, Lazarides MK.
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J Vasc Access. 2008
Brachial vein transposition arteriovenous fistula: is it an acceptable
option for chronic dialysis vascular access?Torina PJ, Westheimer EF, Schanzer HR.
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Jour Vasc Surg 2009
Brachial vein transposition arteriovenous fistulas for hemodialysis accessWilliam C. Jennings, MD, Matthew J. Sideman, MD, Kevin E. Taubman, MD, Thomas A. Broughan, MD
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Courtesy of Dr. M Rawa
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Procedures requiring incision up to the axilla
Impossible to use preventive haemostasis
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Preventive Haemostasis
Bourquelot PD.
Preventive haemostasis with an inflatable tourniquet for microsurgical distal arteriovenous fistulas
for haemodialysis.
Microsurgery. 1993;14(7):462-463.
Pirozzi N et al
Preventive hemostasis for hemodialysis vascular access surgical reinterventions.
J Vasc Access. 2013;14(2):193-195.
Bloodless operative field
- Sharp and minimally invasive procedure
- Reduced risk (bleeding, nerve injury etc)
- Reduced operative time
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Hemaclear®
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Ladenheim E et al
A sterile elastic exsanguination tourniquet is effective in
preventing blood loss during hemodialysis access surgery.
J Vasc Access. 2013;14(2):116-119.
Bourquelot P, Levy BI.
Narrow elastic disposable tourniquet (Hemaclear®) vs. traditional wide
pneumatic tourniquet for creation or revision of hemodialysis
angioaccesses.
J Vasc Access. 2016 May 7;17(3):205-9
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CONCLUSIONS
Preventive haemostasis is safe and effective for AVF surgery
The new device (Hemaclear®) allow the use of this technique
even for arm deep vein superficialisation surgery
Favorable personal experience
An extended use and collection of data would provide interesting
evidence ([email protected])
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CONCLUSIONS#2
- Better operative field visualization
- Reduced operative time
- Sharpness of the procedure
- Reduced risk of bleeding and nerve injury