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Thu, 8 Jul 2010 13:53:04 -0400 |
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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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