Creation of Arteriovenous Fistulas for Hemodialysis Using the End-to-side Anastomotic Technique vs. Piggyback.

Korábbi kezelés

• Arteriovenous prostheses (non-native fistulas), previous arteriovenous fistula repairs, arteriovenous accesses created in the lower extremities, and unusual (exotic) accesses.
• Repair of previous arteriovenous accesses (proximal reanastomoses).

Más betegség

• Any other condition that, in the investigator's judgment, prevents an adequate evaluation of the safety and efficacy of the study or poor compliance.

Laborértékek

• History or evidence of serious systemic illness, including:
  • Cardiac disease (New York Heart Association functional class III or IV, as evidenced by the inability to lie still), myocardial infarction within 6 weeks prior to randomization, ventricular tachyarrhythmia requiring ongoing treatment, or unstable angina.
  • Suspected or documented hypercoagulable or hypocoagulable state or Clinically significant active infection (White blood count > 15,000 cells/mm3) other than the use of a treated CVC.

Egyéb

• Pregnant women.
• Life expectancy <1 year.
• Known or suspected central venous stenosis/occlusion on the side of the planned access.
• Biological immunosuppression.
• Patient unwilling or unable to attend follow-up follow-ups.

• Age > 18 years
• Able to meet protocol requirements, including follow-up.
• Incident or prevalent patient with advanced chronic kidney disease in the hemodialysis stage (stage 5D).
• In predialysis patients (stage 5), if renal replacement therapy (hemodialysis) is anticipated to be required within the next 6 months (based on standard clinical criteria).
• Who, based on their associated pathology and according to medical criteria, can withstand the initial surgery and arteriovenous access maintenance procedures.
• Have a current ultrasound with preoperative venous and arterial mapping.
• Meet the anatomical requirements for AVF creation:
  • Wrist: artery >2 mm, vein >2 mm in diameter
  • Elbow: artery >3 mm, vein >3 mm in diameter
  • Absence of arterial calcification or occlusion, or other aberrant arterial anatomy.
  • Adequate arterial and venous patency.
  • Vein-to-skin distance <5 mm.
• Candidate for creation of a native arteriovenous fistula for hemodialysis, either distal (radiocephalic) or proximal (humerocephalic or humerobasilic).
• No immediate transplant scheduled within the next 60 days (inclusion on the kidney transplant waiting list is not a contraindication for entry into the study, nor for the creation of an arteriovenous fistula).
• No prior arteriovenous surgeries in the same or proximal location.
• Correct understanding of the study conditions and acceptance to participate.