The Middle Arm Arteriovenous Fistula is an Additional Option to Expand Autogenous Hemodialysis Access

Abstract

A middle-arm fistula is as safe as a distal fistula among dialyzed patients, even diabetic and elderly. This could be considered a reliable option to expand native accesses.

Improved outcomes with proximal radial-cephalic arteriovenous fistulas compared with brachial-cephalic arteriovenous fistulas

“…Albeit relatively small, a growing body of literature exists that advocates for the use of prRCFs, given their functional success and low complication rates. [7][8][9][10][11][12][13] This study provides direct evidence that reaffirms this notion and provides details about complications often attributable to high-flow volume accesses with the ultimate goal of having prRCF become the second-line HD access option as opposed to a BCF. Changing practice patterns can be difficult; however, it is certainly realistic, especially when driven by clinical outcomes.…”

“…Despite multiple series reporting successful outcomes with midarm AVFs based off the proximal radial artery, the NKF KDOQI guidelines neglect to mention this configuration. [7][8][9][10][11][12][13] A proximal radial artery-cephalic vein AVF (prRCF) could be beneficial for multiple reasons. First, this configuration can increase opportunities for creating a functional autogenous AVF while preserving future upper arm options.…”

Two-year cumulative patency of endovascular arteriovenous fistula

“…Although viewed as a new type of AVF, it is in reality a PRA-AVF in which the anastomosis is created in a unique manner using a novel endovascular device. 15 As such, the enAVF has the beneficial attributes of the PRA-AVF 10,11,[16][17][18][19][20] while adding the advantages of avoiding the trauma of surgery by allowing a percutaneous approach performed under local/regional anesthesia. In addition, the location of the anastomosis and lack of an incision significantly expands the cannulation zone of the access in many patients.…”

Comparison of the mid-term results of proximal and distal radiocephalic arteriovenous fistulas created for hemodialysis

“…[4] Bu şekilde aynı arter ve ven hattı üzerinde ön kolda birden fazla girişim şansı oluşturulmuş ve üst kol bölgesi ilerleyen zamanlarda kullanılmak üzere korunmuş olur. [5,6] Biz de merkezimizde dRSF girişimi için uygun damar yapısı olmayan veya başarısız distal girişimi olan hastaları, kolda brakiyal seviyeye geçmeden fizik muayene ve Doppler ultrasonografi (USG) ile detaylı olarak değerlendirmekte ve uygun bulunan hastalara pRSF girişimi yapmaktayız.…”