Brachial vein transposition is a promising ultimate upper limb autologous arteriovenous angioaccess despite its many pitfalls

Karam, Lamisse; Rawa, Marek; Shoenfeld, Richard; Bourquelot, P

doi:10.1016/j.jvs.2017.05.120

Cited by 13 publications

(17 citation statements)

References 24 publications

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“…Surgical PRA to radial vein outflow AVF for staged brachial vein for staged brachial vein transposition is a successful surgical strategy. 22,23 A pAVF creation for brachial vein outflow and subsequent staged elevation represents a promising opportunity for an autogenous access which should be evaluated in future studies.…”

Section: Discussionmentioning

confidence: 99%

Feasibility for arteriovenous fistula creation with Ellipsys^®

Franco¹,

Mallios

Bourquelot

et al. 2020

J Vasc Access

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Objective: To investigate the feasibility of percutaneous arteriovenous fistula creation in consecutive patients screened for first access creation. Methods: Prospective study of ultrasound mapping based on the following minimal anatomic requirements: a patent proximal radial artery and adjacent elbow perforating vein with straight trajectory, each greater than or equal to 2 mm in diameter and within 1.5 mm of each other. In addition, the same population was evaluated for feasibility of a distal radiocephalic fistula established. Results: One hundred consecutive patients were examined between November 2018 and January 2019. Sixty-seven were male (67%) and mean age was 61 years. Sixty-three patients (63%) and a total of 100 limbs (50%) were found to be eligible for a percutaneous fistula creation with Ellipsys®. Thirty-seven percent of patients were ineligible because of the absence of both median cephalic and median cubital veins (15%), absence or inadequate elbow perforating vein and/or smaller than 2 mm proximal radial artery (14%), and/or distance greater than 1.5 mm (8%). We found suitable vessels for a surgical distal fistula creation in 91 extremities (45%), but this percentage dropped to 17% in patients over 70 years old. Among the 100 limbs eligible for percutaneous arteriovenous fistula, only 30 (30%) were eligible for radiocephalic arteriovenous fistula. Conclusion: More than 60% of patients were eligible for Ellipsys. The absence of veins at the elbow and a large distance between vessels were the most common limiting factors. Less than one half of the patients were candidates for surgical fistula and this percentage dropped significantly for older individuals.

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Section: Discussionmentioning

confidence: 99%

Feasibility for arteriovenous fistula creation with Ellipsys^®

Franco¹,

Mallios

Bourquelot

et al. 2020

J Vasc Access

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“…Some authors have reported similar results, with reduced use of grafts. 9,11,12,17,19 Other authors have compared the results of brachial vein transposition with those of arteriovenous grafts for hemodialysis. In 2017, Pham et al 1 compared 29 patients who underwent superficial displacement of the brachial vein and 36 patients who underwent construction of prosthetic arteriovenous access.…”

Section: Discussionmentioning

confidence: 99%

“…In both studies, reported brachial vein transposition patency was substantially lower than rates reported by other authors. 1,9,[11][12][13] The single intervention surgical technique was chosen, as described by Bazan and Schanzer. 8 Two-stage surgery for superficial transposition of the brachial vein has been described by several authors.…”

Section: Discussionmentioning

confidence: 99%

“…Other studies demonstrated increased patency and lower rates of complications of this type of access over the short and long terms, compared with arteriovenous grafts. 1,9 The objectives of the present study are to evaluate the patency and complications of brachial vein transposition compared with other autogenous accesses using the standard superficial veins and to present this method as an alternative to synthetic prostheses as access for hemodialysis.…”

Section: Introductionmentioning

confidence: 99%

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Transposição da veia braquial como acesso para hemodiálise: uma alternativa ao uso de prótese sintética

et al. 2019

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Resumo Contexto Atualmente, observa-se um esforço mundial para aumento do número de acessos autógenos para hemodiálise. Objetivos Avaliar a perviedade e as complicações da transposição da veia braquial em comparação aos outros acessos autógenos para hemodiálise. Métodos Avaliação retrospectiva de 43 pacientes, com 45 procedimentos. Os pacientes que não apresentaram veias do sistema venoso superficial adequadas ao Duplex Scan pré-operatório foram submetidos à transposição da veia braquial. Esses procedimentos foram divididos em dois grupos: A: uso da veia braquial, n = 10. B: demais acessos, n = 35. Resultados Não houve diferença estatística entre os grupos no que se refere à idade, diabetes, hipertensão arterial sistêmica, dislipidemias, arteriopatias, neoplasias, estágio da doença renal, diâmetro da artéria doadora e da veia receptora, pressão arterial sistólica no membro operado, isquemia pós-operatória, formação de hematoma e infecção. Não houve diferença quanto à perviedade aos 7 dias A: 80% vs. B: 90%, p = 0,6; aos 30 dias A: 80% vs. B: 86%, p = 0,6; e aos 60 dias A: 60% vs. B: 80%, p = 0,22. Houve diferença entre os grupos quanto ao número de fístulas prévias A: 1,0 ± 0,44 vs. B: 0,6 ± 0,3, p = 0,04; e quanto ao edema em membro superior A: 20% vs. B: 0%, p = 0,04. A veia doadora menor que 3 mm esteve associada ao maior risco de oclusão precoce (RR = 8, p = 0,0125). Nesse período, não houve nenhum procedimento com o uso de prótese sintética. Conclusões A veia braquial transposta é uma alternativa à prótese sintética.

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“…4 In patients where a long-term vascular access for hemodialysis rather than a catheter is indicated but have inadequate superficial and basilic veins, a choice can be made between a graft or an elevated brachial vein fistula. [5][6][7] A pAVF creation of a radial artery-radial vein anastomosis with the Ellipsys ® device combined with a secondary brachial vein elevation (BrVE) offers an attractive alternative, combining a minimally invasive first stage, a moderate flow radial artery pAVF, and added mid-arm mature brachial vein length for elevation and cannulation. In this report, we review our technique and experience in this subset of patients.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous creation of proximal radio-radial arteriovenous hemodialysis fistula before secondary brachial vein elevation

et al. 2020

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Objective: We evaluate the creation of a percutaneous proximal radial artery–radial vein arteriovenous fistula with Ellipsys® instead of the usual first-stage brachial artery fistula prior to a second-stage brachial vein elevation, in patients with inadequate cephalic and basilic veins. Methods: Single center study of eight patients (six males, mean = 54 years) who underwent a two-stage brachial vein elevation procedure between May 2017 and October 2019. Inclusion criteria were life expectancy > 6 months, patent brachial and proximal radial artery (>2 mm in diameter) absent/inadequate cephalic and basilic veins, existence of a brachial vein >3 mm in diameter, and in continuity with a proximal radial vein > 2 mm in diameter. Results: Technical success was 100%. Four patients required angioplasty of a juxta-anastomotic stenosis, accounting for a 6-month primary and secondary patency rates were 68% and 100%, respectively. Access flow averaged 982 mL/min (range 768–1586) at final follow-up evaluation. There were no significant adverse events related to the procedures. All fistulae were elevated at 4–12 (mean: 8) weeks post creation and were successfully cannulated with two needles after healing was completed (2–4 weeks after elevation). No patients developed hand ischemia or arm edema. Conclusions: Percutaneous creation of a proximal radial artery–radial vein fistula followed by brachial vein elevation is a safe and reliable option for autogenous access creation in patients with inadequate cephalic or basilic veins. Minimally invasive radial artery inflow and longer available length of the targeted brachial vein available for elevation are the main advantages in skilled hands.

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Brachial vein transposition is a promising ultimate upper limb autologous arteriovenous angioaccess despite its many pitfalls

Abstract: Despite many pitfalls for the surgeon, BrVT offers promising long-term patency.

Cited by 13 publications

References 24 publications

Feasibility for arteriovenous fistula creation with Ellipsys^®

Feasibility for arteriovenous fistula creation with Ellipsys^®

Transposição da veia braquial como acesso para hemodiálise: uma alternativa ao uso de prótese sintética

Percutaneous creation of proximal radio-radial arteriovenous hemodialysis fistula before secondary brachial vein elevation

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Brachial vein transposition is a promising ultimate upper limb autologous arteriovenous angioaccess despite its many pitfalls

Abstract: Despite many pitfalls for the surgeon, BrVT offers promising long-term patency.

Cited by 13 publications

References 24 publications

Feasibility for arteriovenous fistula creation with Ellipsys®

Feasibility for arteriovenous fistula creation with Ellipsys®

Transposição da veia braquial como acesso para hemodiálise: uma alternativa ao uso de prótese sintética

Percutaneous creation of proximal radio-radial arteriovenous hemodialysis fistula before secondary brachial vein elevation

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Feasibility for arteriovenous fistula creation with Ellipsys^®

Feasibility for arteriovenous fistula creation with Ellipsys^®