Pierre Bourquelot, Paris Gracz (Kidney Int 1977 1977) ) Gracz - - PowerPoint PPT Presentation

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Jan 23, 2023 43 likes •270 views

Pierre Bourquelot, Paris Gracz (Kidney Int 1977 1977) ) Gracz (Kidney Int Gracz (Kidney Int 1977 1977) ) Gracz (Kidney Int Elbow Perforating V. to Brachial / Pr. Radial A.AVF Major Risk was High Flow : due to the anastomosis of

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Pierre Bourquelot, Paris

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Gracz (Kidney Int Gracz (Kidney Int 1977 1977) )

Major Risk was High Flow :

due to the anastomosis of multiple

veins to the large brachial artery (or the proximal radial artery prone to secondary dilatation)

responsible for:

 Distal ischemia  High-flow and cardiac issues  Venous hypertension

Gracz (Kidney Int Gracz (Kidney Int 1977 1977) ) Elbow Perforating V. to Brachial / Pr. Radial A.AVF

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Gracz AVF was rapidly abandoned by many surgeons who preferred one vein to brachial artery anastomosis

Cephalic Vein Basilic Vein Brachial Vein

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In 1977, Toledo-Pereyra

promoted PRA as an alternative inflow site for AVF creation in 20 patients
half of them were diagnosed with diabetes
Outflow was upper arm cephalic vein
Reported primary patency rate was 90%

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In 2003 , you Dr Jennings

Reintroduced PRA AVF created in 71 patients. The overall assisted

primary patency approached 100% at 1 year

In 2006 you published an additional report of 105 PRAs. Again

assisted primary patency was excellent at 97%

In each of these reports, patency was defined as the percentage of

fistulas that had flow at some post operative time, not necessarily the percent of PRAs being successfully accessed for hemodialysis treatments

Was the inflow from brachial artery in 20 % of cases ?
Outflow vein was described as basilic, cephalic, median

antecubital, lateral antecubital or perforating deep vein

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Actually, one of your current drawings is of course not very different from Gracz’s 40 years ago

Gracz (Kidney Int) 1977) Perforating Vein Cephalic Vein Comitans Radial Vein Radial Artery Basilic Vein Jennings (J Vasc Surg 2017)

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In 2015, Amendola

…reported 284 male pts, 571

access procedures including 144 PRA (25%) :

 87 P-PRA : no previous forearm AA  57 S-PRA : previous failed AVF/graft

By one single senior surgeon

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Amendola – Discussion, Results

PRA has been established as an early viable surgical option for

arteriovenous fistula creation. The overall assisted primary patency reported in the literature approaches 100% at 1 year.

Amendola hypothesize that this excellent patency does not

represent a functional result when seen in light of successful cannulation and fistula utilization.

Actually, his overall cannulation rate was an abysmal 43%

his overall cannulation rate was an abysmal 43% (S- PRA= 55%, P-PRA= 33%); however, he believes this analysis of his patient population is a real-world true functional outcome as it relates to successful use of this fistula type.

The mean functional patency (successful cannulation to

abandonment) was 645 ± 592 days

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