A sterile elastic exsanguination tourniquet is effective in preventing blood loss during hemodialysis access surgery.

PURPOSE: We report the first use of a sterile elastic exsanguination tourniquet (SET) in performing hemodialysis vascular access procedures in 27 patients. The main advantages of this tourniquet are the reduction of blood loss and need for possible transfusions. Additional benefits are the near-perfect exsanguination and excellent exposure of the operative field. METHODS: This SET is a sterile elastic stockinet device that rolls up the arm starting from the hand by pulling on two handles. The elastic silicone ring provides sufficient pressure (220 ± 30 mmHg) to block arterial flow into the limb. The stockinet can be cut to provide access to the incision area while providing an additional sterile cover over the rest of the limb. RESULTS: No transfusions were required in any patients. Minor adverse effects occurred in four patients, including a twisted vessel, a bleeding vascular branch, a tear in atrophic arm skin, and pain, all of which had resolved on subsequent follow-up. Operational recommendations to avoid these adverse effects are outlined. CONCLUSIONS: We conclude that this sterile elastic exsanguination tourniquet is effective and safe in preventing bleeding during upper extremity hemodialysis vascular access procedures.

High incidence of perigraft seroma formation with gelatin-coated polytetrafluoroethylene grafts.

We reviewed the effectiveness of a gelatin-coated polytetrafluoroethylene (PTFE) graft designed to reduce suture line bleeding and graft weeping. Twenty-nine adults with end-stage renal disease underwent implantation the graft (n = 30) in the arm. All had preoperative ultrasound vascular mapping to assess their options for an autogenous arteriovenous fistula and patients with a history of prior central venous devices or sternotomy underwent contrast venography. A 4- to 7-mm tapered graft (n = 10) was used if the inflow artery was <4.0 mm in diameter, and a 6-mm straight graft (n = 20) was used if the artery was ≥4.0 mm. Intraoperative volume flows were measured by duplex methodology. Precautions to prevent ultrafiltration and seroma development were taken. Eleven clinically significant seromas were detected in 30 sealed PTFE grafts (36.7%), 10 in the 6-mm grafts (50%), and 1 in a 4- to 7-mm graft (10%), a significant difference between graft types. There were no significant differences in flow between the graft types and between grafts with seromas versus no seromas. Five grafts were explanted and one was ligated, resulting in cannulation delays from 2 to 4 months. We conclude that the gelatin-sealed PTFE vascular graft is not the ideal prosthesis for hemodialysis access.