Cardiovascular Journal of Africa: Vol 26 No 1 (January/February 2015)

46 / 68

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 26, No 1, January/February 2015 44 AFRICA
segment.7 In our technique, U-vein compressors were occluding
side branches and proximal segments of the cephalic vein
externally. The cephalic vein was dilated in the approximately
10–12-cm segment and its compliance was increased.
In most succesful AVFs, these flow and size parameters are
generally met within the first few weeks of construction.10 In our
technique, these parameters (diameter and flow) are met in the
first few minutes postoperatively because the superficial fistula
tract is dilated enough during the operation by intra-operative
use of the U-vein compressor.
We believe that this technique canmaximise flow andminimise
failure in AVFs using small, superficial veins. Postoperative hand
exercises were not needed to accelerate maturation. This study
needs long-term follow up but the technique we have described
could be an alternative in patients with poor venous networks in
the forearm.
Conclusion
In this article, we present a technique to dilate veins of between
1.5 and 2 mm in diameter, which are normally accepted as poor
vessels to create RCAVF. With this technique, we can create good
functioning arterio-venous fistulae in the early postoperative
period, even if the superficial veins are not suitable for the
standard technique. Our preliminary experience has shown
satisfactory outcomes compared to the standard technique.
References
1. Silva MB Jr, Hobson RW 2nd, Pappas PJ, et al. A strategy for increasing
use of autogenous hemodialysis. Access procedure: impact of preopera-
tive noninvasive evaluation. J Vasc Surg 1998; 27(2): 302–308
2. Brescia MJ, Cimino JE, Appel K, Hurwich BJ. Chronic hemodialysis
using venapuncture and surgically created arteriovenous fistula. N Engl
J Med 1966; 275: 1089–1092.
3. Beathard GA, Settle SM, Shield MW. Salvage of poorly developed arte-
riovenous fistulae. Am J Kidney Dis 1999; 33: 910–916.
4. Beatherd GA, Arnold P, Jackson J, et al. Aggressive treatment of early
fistula failure. Kidney Int 2003; 64: 1487–1494.
5. Nassar GM, Nguyen B, Rhee E, et al. Endovascular treatment of the
‘‘failling to mature’’ arteriovenous fistula. Clin J Am Soc Nephrol 2006;
1: 275–280.
6. Turmel-Rodriques L, Mouton A, Birmele B, et al. Salvage of immature
forearm fistulas for haemodialysis by interventional radiology. Nephrol
Dial Transplant 2001; 16: 2365–2371.
7. Lauvao LS, Ihnat DM, Goshima KR, et al. Vein diameter is the major
predictor of fistula maturation. J Vasc Surg 2009; 49(6): 1499–1504.
8. Johnson CP, Zhu YR, Matt C, et al. Prognostic value of intraoperative
blood flow measurements in vascular access surgery. Surgery 1998; 124:
729–737; discussion 37–38.
9. Lin CH, Chua CH, Chiang SS, et al. Correlation of intraoperative blood
flow measurement with autogenous arteriovenous fistula outcome. J
Vasc Surg 2008; 48: 167–172.
10. Robbin ML, Chamberlain NE, Lockhart ME, et al . Hemodialysis arteri-
ovenous fistula maturity: US evaluation. Radiology 2002; 225(1): 59–64.
The potential of low-carbohydrate diets to reduce cardiovascular risk
Consuming low-carbohydrate diets can reduce inflammation
in patients with type 2 diabetes, which may decrease the risk of
patients developing cardiovascular disease (CVD). According
to a Swedish study [Diabetologia 2012; 55(8): 2118–2127],
eating a low-carbohydrate diet can reduce inflammation in
patients with type 2 diabetes.
People with type 2 diabetes have a higher level of
inflammation than those without diabetes, and this may play
a role in the increased risk of CVD associated with diabetes.
The Linkoping University study included 61 participants
with type 2 diabetes. The participants were randomly divided
up and given either a low-carbohydrate or low-fat diet. The
study method was a retrospective follow-up study.
The low-carbohydrate and the low-fat diet participants
were compared over the course of two years. Additionally, the
researchers studied how the diets impacted on inflammation
by checking the inflammation levels in the blood of each
patient.
The results showed that both the low-carbohydrate and
low-fat diets helped participants lose weight, roughly around
nine pounds (four kg), but when it came to which diet
produced reduced inflammatory markers in the blood, the
low-carbohydrate diet succeeded. Additionally, glucose-levels
dropped more in the low-carbohydrate diet groups.
In respect of cardiovascular risk, the researchers
recommended aiming for a carbohydrate energy intake of
20% as a treatment alternative for at-risk patients.
Source
potential-of-low-carbohydrate-diets-to-reduce-cvd-risk.