Proximal forearm fistula for maintenance hemodialysis

Gracz, Kenneth C.; Ing, Todd S.; Soung, Lian-Sen; Armbruster, Kent; Seim, Sandra K.; Merkel, Frederick K.

doi:10.1038/ki.1977.9

Cited by 149 publications

(100 citation statements)

References 4 publications

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“…Atherosclerosis is the major cause of obstructive disease in the upper limbs and it is necessary to control their risk factors in these patients. It is estimated that bypasses of the upper limb due to ischemia account for only 4% of all vascular surgical procedures (6)(7)(8). Due to the shortage of surgical access opportunities for dialysis in this patient, having held several previous accesses and the absence of distal pulse, the denial of patient fabricate AVF in thigh, enabled the author to rethink a way of obtaining good access.…”

Section: Discussionmentioning

confidence: 99%

The construction of arteriovenous fistula for hemodialysis in patients with chronic obstructive arterial disease in the upper limb

et al. 2016

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Techniques in Vascular accesseral limb. However, there are occasions when the contralateral limb is also unable to perform the AVF due to venous or arterial deficiency (4, 5). case reportWe report a 53-year-old male patient with renal disease secondary grade V chronic glomerulonephritis. He began hemodialysis on 07/10/85 and underwent kidney transplant on 03/12/86. He returned to dialysis treatment on 15/03/94 for graft loss due to chronic rejection. Regarding vascular access, the patient had undergone five previous surgeries, two of which had not immediately functioned and the other three had a patency of 20 months, 57 months and 69 months, respectively.The last AVF performed was on 03/03/2000 and it evolved into a major aneurysm and presented thrombosis with consequent loss of its function on 15/09/2006. Dialysis treatment was maintained through a long-term catheter. The patient was referred for evaluation into the possibility of a new AVF. During clinical examination of the right upper limb, the absence of pulses in the brachial, radial and ulnar was noted. A requested angiographic study showed occlusion of the brachial artery in its proximal third with refilling of the distal portion of the brachial artery before the bifurcation (Figs. 1 and 2).Through venous clinical examination it was noted the presence of the vein basilica of good size and good length.

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Section: Discussionmentioning

confidence: 99%

The construction of arteriovenous fistula for hemodialysis in patients with chronic obstructive arterial disease in the upper limb

et al. 2016

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“…The perforating vein is sometimes utilized for proximal forearm fistula for maintenance dialysis [4,5]. In spite of its usefulness in maintaining a patent forearm fistula in the case of poor upper arm superficial veins [6], ligation of the perforating vein is recommended when it is not used for anastomosis in the case of an antecubital fistula [7,8].…”

Section: Discussionmentioning

confidence: 99%

An unusual case of arteriovenous fistula-related venous hypertension: sonographic detection of a culprit perforating vein with movie and compact review

Kamata

Yamamoto

Okamura³

et al. 2016

Ren Replace Ther

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Background: Venous hypertension is one of the critical complications of arteriovenous fistula (AV fistula). Here, we report an unusual variation of venous hypertension which was caused by retrograde outflow through a perforating vein of the elbow. Case presentation: A 79-year-old man with diabetic nephropathy had an AV fistula created at his left proximal forearm 2 years before referral. Shortly after the creation of the AV fistula, he developed swelling of the left hand and forearm. Six months prior to the referral, persistent pain of the left hand developed, and he visited the nephrology unit. An anastomosis of the AV fistula was located 5 cm distal to the elbow. Inspection, palpation, and auscultation did not suggest outflow stenosis. Ultrasound showed mature upper arm venous outflow without stenosis. His proximal radial artery had been anastomosed side-to-end to a nearby proximal forearm superficial vein. Color Doppler analysis revealed a retrograde outflow through an antecubital perforating vein, which drained into the deep portion of the forearm and then disappeared. Superficial veins of the left forearm had been exhausted due to a previous attempt to create a wrist AV fistula. Given the above, it was suspected that the unusual retrograde outflow through the perforating vein caused venous hypertension by interfering with the venous return of the forearm, which had been dependent on deep veins. The patient subsequently underwent ligation of the perforating vein. The day after the operation, the pain disappeared and swelling improved. The dialysis treatments were continued without problems. Conclusions: Retrograde outflow through a perforating vein can be a cause of venous hypertension in a patient with an AV fistula created using the proximal radial artery. Close sonographic examination of antecubital vessels should be done if a practitioner encounters unilateral whole forearm edema without apparent proximal outflow stenosis.

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“…The first angioplasty described by Dotter CT et al who introduced a type of balloon, was immensely conducive to the resolution of one of the most significant predicaments in vascular surgery and vascular access surgery [35]. In 1977, Gracz KC et al created the "proximal forearm fistula for maintenance hemodialysis", a variant of an AV anastomosis [36]. An adjustment of this AVF became quite significant in the old, hypertensive and diabetic patients on the grounds that it allows a proximal anastomosis with a low risk of hypercirculation [37].…”

Section: History Of Vascular Accessmentioning

confidence: 99%