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| Journal of Vascular Access 2000; 1: 15 - 18 |
| Vascular access for chronic haemodialysis in Lombardy |
A. Limido1, F. Galli2, P. Baiardi3, V. Piazza4, C. Cantů4, A. Salvadeo4
1Nephrology and Dialysis Unit, S. Antonio Abate Hospital - Gallarate, Varese - Italy
2Fondazione Maugeri, Pavia – Italy
3Computer Technology Medical Service, Statistic Unit, Fondazione Salvatore Maugeri, Pavia - Italy
4Department of Nephrology, Fondazione Salvatore Maugeri, Pavia - Italy
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Search Medline for articles by:
 A. Limido
F. Galli
P. Baiardi
V. Piazza
C. Cantů
A. Salvadeo
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ABSTRACT
To evaluate the organisation of vascular access surgery, the techniques used to monitor surgical access and the central catheters, a survey was conducted amongst dialysis Units of Lombardy. A questionnaire was sent out to the 43 dialysis centres in Lombardy, 96% of which replied. In almost 90% of dialysis units nephrologists perform vascular access albeit in close cooperation with vascular surgeons for the more complex cases. First choice access is by distal arteriovenous fistula (AVF): 36% end-to-end, 31.7% side-to-end, and 19.5% side-to-side with distal ligature of the vein. As second choice proximal AVF is more widely used than AV grafts, which are implanted only when all native vessels
and related surgical procedures are exhausted. Central venous catheters offer valid solutions not only as temporary access, but also as an alternative permanent one. In both cases the jugular vein is the most frequent site of insertion. Despite the documented incidence of related episodes of stenosis/obstruction, the subclavian vein is used as a temporary access in quite a high per-centage of cases. Only in selected cases are diagnostic procedures (mainly Venography and Doppler studies) performed prior to
permanent access choice. Similarly vascular access is monitored mainly using a recirculation test albeit not routinely. In case of vascular access thrombosis, surgical revision is the most common approach.
Key Words. Vascular access, Hemodialysis, Arteriovenous fistula, Central venous catheters
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