The Advantages of Using Vascular Dilators in Angioaccess Surgery

Abstract

The creation of a functional angioaccess is the cornerstone in treatment of chronic hemodialysis patients. The aim of this article is to review the use of vascular probes as a simple and cheap tool that could help surgeons in preparation of vessels and with creation of an anastomosis. Autogenous arteriovenous fistula is the best angioaccess available but is hampered by its relatively high non-maturation rate. Guidelines recommend preoperative duplex ultrasonography (USG) and use of vessels with a diameter that is able to maintain sufficient flow and fistula maturation to avoid unsuccessful attempts. Despite recommendations, preoperative duplex USG is not performed in many centers. In such circumstances, the use of vascular probes could help surgeons to create a fistula with a high chance of successful maturation. Vessel probes and dilators could be used to assess vessel diameter and patency, the ability to dilate and resolve a spasm, to stop retrograde blood flow in the vein (to avoid the use of vascular clamps), to avoid torsion of vein, to open and check vessel lumen with each stitch (to avoid using the forceps and possible wall injury), for tightening of continuous suture over the probe (to avoid excessive tightening and possible anastomotic stenosis). To my knowledge, this is the first review article which summaries the experience of using vascular dilators in angioaccess surgery. This information can be very helpful especially when there is the lack of valid preoperative USG of the vessels.