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Complications of Renal Dialysis Access Procedures
John E. Connolly, MD;
Douglas A. Brownell, MD;
Edward F. Levine, MD;
P. Michael McCart, MD
Arch Surg. 1984;119(11):1325-1328.
Abstract
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• The complications of 2,179 dialysis access procedures of various types have been reviewed in an effort to determine their possible prevention and management. Scribner arteriovenous shunts or central venous catheters were preferred for temporary dialysis. Infection was a common complication of central venous catheters, but responded well to removal of the catheter. Brescia-Cimino fistulae were preferred for longterm dialysis, but were often not possible because of inadequate veins or the need for relatively urgent hemodialysis. The most useful secondary shunt was the straight forearm synthetic polytetrafluoroethylene (PTFE) graft whose most common complication was thrombosis due to intimal hyperplasia at the venous anastomosis. In most cases, this complication could be corrected by patch grafting or by extension bypass. Infection was infrequent with PTFE shunts and, when localized, was sometimes successfully treated by drainage, antibiotic therapy, and topical povidone-iodine. The principal complications of long-term peritoneal dialysis were peritonitis and tunnel infection that responded to antibitoic therapy and/or removal of the catheter. Compulsive care in access insertion and meticulous management during dialysis has permitted very satisfactory long-term hemodialysis and peritoneal dialysis.
(Arch Surg 1984;119:1325-1328)
Author Affiliations
From the Department of Surgery, University of California at Irvine.
Footnotes
Accepted for publication July 31, 1984.
Read before the Annual Meeting of the Southern California Chapter of the American College of Surgeons, Santa Barbara, Calif, Jan 27, 1984.
Reprint requests to Department of Surgery, University of California at Irvine, Irvine, CA 92717 (Dr Connolly).
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