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July 2010

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Subject:
From:
Joe Swenson <[log in to unmask]>
Reply To:
UVM Flownet <[log in to unmask]>
Date:
Thu, 8 Jul 2010 16:02:43 -0400
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Thank you for your information. I have a few questions also: Was vasospasm 
an explanation for vein going from adequate to too small? What was the 
definition/criteria for a successful fistula? Also it would seem, from your data, 
that the application tourniquet will almost certainly result in an adequate vein 
diameter--with the exception of the tourniquet causing a adequate vein 
change to too small. I have been through those sites on several occasions but 
have yet to locate a fistula use torniquet policy that addresses the extended 
tourniquet times. You mentioned Robbin, who is that? Once agian thank you--
it was helpful info.
On Thu, 8 Jul 2010 13:53:04 -0400, Courtney Crawford 
<[log in to unmask]> wrote:

>I presented the SVU paper...here's a brief summary:
>
>We reviewed about two years of vein mappings with and without tourniquet.  
>At our site, the surgeons have established 0.30cm as the minimum for 
>adequate vein diameter.  Looking at 665 veins, we found some veins went 
>from being too small to adequate (9%) and some veins went from adequate 
to 
>too small (4%). 
>
>On average, tourniquet applied to the upper arm with patient supine only 
>makes a difference of 1mm (.01cm) in the forearm and 2mm (.02cm) in the 
>upper arm.  
>
>We were able to follow up on 111 patients.  Those with fistulas created with 
>dilation of vein to adequate diameter with tourniquet had a success rate of 
>35%, while patients who had veins big enough without tourniquet had a 
>success rate of 65%.  
>
>We concluded that tourniquet may lead to more autogenous fistula creation, 
>however those fistulas have higher failure rates than patients with veins of 
>similar diameter without tourniquet.  
>
>Joe, I believe you were looking for references regarding tourniquet use:  
>Robbin has written a couple papers on the topic, but other than that I had 
>trouble finding hardcore data other than a generic statement that tourniquet 
>should be used.  I think we've done it because that's the way it's always 
been 
>done.  
>For protocol, try svunet http://www.svunet.org/files/positions/0809-upper-
>extrem-vein-map.pdf 
>Here's a launching point for papers regarding vein maps:
>http://www.fistulafirst.org/Archives/ArchiveCC3.aspx
>Good luck!
>
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