One of our specific goals has been a concerted effort to increase the construction of an A-V fistula in preference to a graft, whenever suitable vessels could be found.
An alternative strategy would be to construct preferentially forearm A-V grafts or an upper arm A-V fistula. We believe that only in selected subpopulations (nondiabetic men under age 65) is the adequacy rate of a forearm fistula sufficiently high (56%) to justify attempting the first fistula at that site.
Causes of chronic kidney disease in patients who underwent A-V Fistula surgery (n=110) Causes of Chronic kidney disease Frequency Percentage Diabetes Mellitus 45 41% Hypertension 32 29% Both DM & hypertension 16 14.5% Obstructive nephropathy 5 4.5% Chronic interstitial nephritis 5 3.6% Chronic glomerulonephritis 5 4.5% Renovascular disease (ischemic nephropathy) 1 0.9% Polycystic disease 1 0.9% Table- 2.
The most effective way to reduce the need for repeated dialysis access procedures is to place native A-V fistulas as often and as soon as possible.
(34) Clearly, a more aggressive approach to the creation of A-V fistulas may result in an increased number of failures in patients with marginal vascular anatomy.
Acceptable choice when an A-V fistula is not possible or viable is AV graft of synthetic or biological material.
Vessel mapping is also indicated when a vascular access failure or impending failure occurs to determine if the patient is a candidate for an A-V fistula.
The purpose of this article is to describe the formation and assessment of a pseudoaneurysm versus an A-V fistula, discuss the nurse's role in recognizing femoral pseudoaneurysms, and to describe a new treatment option called ultrasound-guided compression and the recommended nursing care.
Assessment should include differentiation of a psuedoaneurysm from an A-V fistula (see Table 1).
Ultrasound will also be able to identify the presence of an A-V fistula.
Table 1 International Comparison of Vascular Access Placement Country A-V Fistula
A-V Graft Incident Prevalent Incident Prevalent United States 15% 24% 23% 58% United Kingdom 48% 67% 2% 9% Spain 69% 82% 5% 12% Italy 60% 90% 0% 4% Germany 83% 84% 1% 12% France 62% 77% 2% 15% Country Catheter Incident Prevalent United States 61% 17% United Kingdom 50% 22% Spain 26% 7% Italy 39% 5% Germany 15% 4% France 35% 6% Note: From Pisoni et al., 2002; Rayner et al., 2003.