The gracz arteriovenous fistula evaluated. Results of the brachiocephalic elbow fistula in haemodialysis angio-access

Abstract

The elbow fistula has a long patency with few complications and performs as well as wrist fistulas and better than the graft fistulas reported in the literature. The Gracz elbow fistula has results as good as the side-to-side elbow fistula. Graft fistulas should be reserved for tertiary procedures only.

ASDIN: Banding of Hemodialysis Access to Treat Hand Ischemia or Cardiac Overload

“…The number of direct elbow access is rising at the expense of wrist access because of an increased percentage of patients suffering from obesity and diabetes mellitus. The down side of superior patency rates (13) and a longer lifespan of a direct elbow access is the occurrence of long‐term complications such as CO following prolonged high access flows (>2 l/minute) (2). Cardiac failure may ensue possibly contributing to relatively high mortality rates in a dialysis population.…”

Basilic vein transposition for unsuitable upper arm hemodialysis needle access segment may attenuate concurrent hand ischemia

“…This type of AVF entails mobilizing of the median cubital vein or a deep perforating venous branch that is subsequently connected to the brachial artery some 2 cm distal to the elbow fold. Using this technique, outflow is usually via upper arm cephalic and basilic veins and their SBs …”

“…Using this technique, outflow is usually via upper arm cephalic and basilic veins and their SBs. 10,11 Inadequate NAS and HAIDI Access flow of our HD population is standardly measured in duplicate every two months as suggested by KDOQI 12 using a standard two-needle dilution technique (HD03, Transonic Systems Inc, NY, USA). Each patient with structurally complicated HD sessions is discussed in a weekly multidisciplinary meeting attended by a nephrologist, vascular surgeon, interventional radiologist, vascular laboratory technician, and nurses of the shunt team.…”

Vascular Access for Hemodialysis - Overview and Emphasis on Complications

“…If the basilic vein is found to be inadequate, one of the brachial veins may be used instead [34]. Other access options like Gracz fistula, or bidirectional (reverse) fistulas offer no additional advantages over other conventional fistulas [38].…”