Efficacy of blood flow measurement using intraoperative color flow Doppler ultrasound as a predictor of autologous arteriovenous fistula maturation.

INTRODUCTION: Hemodialysis vascular access parameters of intraoperative Color flow Doppler ultrasound remain controversial. This study aimed to evaluate the optimal cut-off value and efficacy of intraoperative arteriovenous fistula parameters identified by Color flow Doppler ultrasound for arteriovenous fistula maturation success. METHODS: This retrospective study consisted of a review of the medical records of 137 consecutive patients who underwent their first autologous arteriovenous fistula formation under local anesthesia for end-stage renal disease from April 9, 2020 to March 19, 2021. RESULTS: The receiver operating characteristic curve analysis revealed that the optimal cut-off for intraoperative cephalic vein flow volume for brachiocephalic arteriovenous fistula maturation at the 4-week follow-up was 349.53 ml/min (area under the curve, 0.792; p, 0.036; Youden index, 0.514). CONCLUSION: Intraoperative color Doppler ultrasound outflow cephalic vein flow volume is a useful factor in predicting arteriovenous fistula maturation. Intraoperative Color flow Doppler ultrasound should be performed.

Efficacy of Lymphatic Sealing Using the LigaSure in Kidney Transplantation: A Pilot Study.

BACKGROUND: Iliac vessel lymphatic ligation is critical in kidney transplantation, because it is associated with the occurrence of lymphocele. Lymphocele can also affect the renal graft. This study aimed to evaluate the efficacy of lymphatic sealing using LigaSure (an electrothermal bipolar sealing device) in kidney transplantation as compared with conventional silk-tie ligation. METHODS: This retrospective study included 100 consecutive patients from a prospectively registered database who underwent kidney transplantation at Seoul St. Mary's Hospital, South Korea, between December 1, 2019 and November 12, 2020. Comorbidities, primary renal disease, transplantation variables, surgical variables, and posttransplantation outcomes were compared between conventional and LigaSure lymphatic ligations. Subgroup analyses were performed by anastomosis pattern. RESULTS: The mean age of patients was 47.4 ± 12.40 (range, 24-73) years. The LigaSure and conventional groups comprised 50 (50%) patients. Hypertension history, number of anastomosed renal arteries, and anastomosis patterns differed significantly between groups (P < .05). No significant difference was found in postoperative outcomes. In the subgroup analysis, greater drain volume was found at postoperative day 1 in the end-to-end internal iliac artery-renal artery anastomosis group (P = .001) because the internal iliac artery dissection results in longer lymphatic ligation. Nevertheless, no differences in drain removal time (P = .528) or lymphocele incidence were found between subgroups. CONCLUSION: LigaSure is expected to benefit from surgery time and will be identified in subsequent studies. LigaSure can be safely and comfortably used for iliac lymphatic ligation in kidney transplantation. In conclusion, LigaSure lymphatic ligation is superior to conventional lymphatic ligation in kidney transplantation.