Radio‐cephalic arteriovenous fistula recovered with drainage through the brachial vein

Abstract

Dysfunction of arteriovenous access for hemodialysis is a challenge for the vascular surgeon. Some patients have complex vascular access with problems that are difficult to solve. Careful analysis of the vascular network with ultrasound and dissection of the veins during surgery can help to identify the best option for each access. We introduce and discuss the case of creation of a radio-cephalic fistula with outflow into the brachial vein in 64-year-old hemodialysis male patient. This technique enables extending fistula patency, arterializing the brachial vein, and improves cost efficiency.

Radio‐cephalic fistula recovered with drainage to median basilic vein by straightening of the forearm cephalic vein: A case report

“…We have found no reference in the literature on straightening the cephalic vein of the forearm to solve flow problems. This technique can be used when the vein segment is long enough to be rotated into the median basilic vein 4–6 . Such procedure enables increasing the diameter of the basilic vein and the subsequent basilic transposition in the first stage 8 .…”

“…Several interventions for the recovery of a distal AVF with outflow problems are described in the literature 4 . Rotation of the basilic vein in the forearm 5 or of the brachial vein in the elbow may be solutions for the recovery of a distal AVF with outflow problems 6 . Such solutions have good post‐procedure patency 4 .…”

Radiocephalic Fistula Recovery Using the Brachial Vein and Forearm Basilic Vein: A Case Series and Literature Review

“…In patients with dysfunctional AVF, it is very important to analyze the vascular network with ultrasound in order to identify whether there are veins that can be used as a solution to solve the access dysfunction (6). However, it is very important during surgery to confirm if the solution proposed in the preoperative phase is adequate for the clinical situation of the patient.…”

“…Sometimes, solutions to RC-AVF problems can be challenging for the vascular surgeon in order to keep the fistula working. The superficial veins or the deep veins may be a good solution to solve the problem in order to maintain RC-AVF permeability (6).…”

“…© 2018 International Society for Apheresis, Japanese Society for Apheresis, and Japanese Society for Dialysis Therapy Ther Apher Dial, Vol. 22, No 6,. 2018 RC-AVF Recovery Using Different Veins…”