Proximal radial artery ligation (PRAL) for reduction of flow in autogenous radial cephalic accesses for haemodialysis.
نویسندگان
چکیده
OBJECTIVE Juxta-anastomosis proximal radial artery ligation (PRAL) is a new surgical technique for reduction of excessive blood flow of radial cephalic fistulas (RCFs). PATIENTS AND METHODS This prospective study included 37 consecutive patients (eight children and 29 adults) who underwent PRAL of high-flow RCFs causing ischaemia (n = 2), aneurysmal degeneration of the vein (n = 14), and cardiac insufficiency (n = 7) or for prevention of cardiac overload (n = 14). Mean fistula age was 2.6 years for children and 7.4 years for adults. None had diabetes. Anatomical prerequisites (side-to-end anastomosis fistula and retrograde flow in the distal radial artery) were checked by ultrasound or angiography. Division and ligation of the juxta-anastomosis proximal radial artery were performed under regional anaesthesia. Patency following ligation was estimated according to the life table method. RESULTS The success rate was 92% (34/37). The three failures included one excessive and two insufficient reductions of flow (<33%). Mean flow reduction rates were 50% in children and 53% in adults. Primary patency rates at 1 and 2 years were 88% +/- 6% and 74% +/- 9%, respectively. Secondary patency rates were 88% +/- 6% and 78% +/- 8%, respectively. CONCLUSION PRAL is a simple, safe, and effective technique for reduction of flow in RCFs.
منابع مشابه
Endovascular treatment of immature, dysfunctional and thrombosed forearm autogenous ulnar-basilic and radial-basilic fistulas for haemodialysis.
BACKGROUND Forearm basilic fistulas are rarely used as vascular accesses for haemodialysis but they represent a valuable option when autogenous radial-cephalic fistulas cannot be performed. There is no information in the literature to date about the outcome of direct ulnar-basilic or transposed radial-basilic forearm autogenous fistulas after endovascular treatment of stenosis or thrombosis. ...
متن کاملRadial artery approach for endovascular salvage of occluded autogenous radial-cephalic fistulae.
BACKGROUND The endovascular salvage of occluded autogenous radial-cephalic fistulae is a more challenging procedure than that for stenotic fistulae. To obtain an access to the fistula is one of the keys to success. Both retrograde venous approach and brachial artery approach have some disadvantages. The radial artery approach has been used in the endovascular therapy of fistula dysfunction, but...
متن کاملSalvage of a radiocephalic fistula by the palmar arch
We present a child with mild problems during haemodialysis due to stenosis of the proximal radial artery of his radiocephalic fistula. However, his problems spontaneously subsided. Follow-up sonography revealed arterial occlusion proximal to the fistula with retrograde flow in the distal segment. Kt/V and shunt flow were normal. Physical examination confirmed proximal radial artery occlusion wi...
متن کاملThe effect of reactive artery hyperaemia on the radial strain of the brachial artery: Definition of optimum cuff position
Instruction: Measurement of brachial artery diameter variation by ultrasound methods has commonly been used to test the endothelial function. It is known that the artery diameter is increased by flow stimulation. Therefore in the present study, the effect of external obstruction, as flow stimulation, on the radial strain of the brachial artery was assessed. Also the biomechanical behavior of...
متن کاملRare Multiple Variations in the Radial Anrtery of an Iranian Cadaver
Radial artery is a muscular artery that normally aroses from brachial artery in the elbow.The radial artery is increasingly being used as a coronary bypass graft. The aim of this paper is to report details of rare multiple variations in the radial artery of a male Iranian cadaver. In routine dissection, it was observed that the right side radial artery arose from brachial artery in the arm. It ...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
عنوان ژورنال:
- European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery
دوره 40 1 شماره
صفحات -
تاریخ انتشار 2010