Transposition of radial artery for reduction of excessive high-flow in autogenous arm accesses for hemodialysis

Abstract

Transposition of the radial artery, a safe and effective technique, might now be considered in the surgical armamentarium of flow reduction techniques.

Radial artery deviation and reimplantation inhibits venous juxta-anastomotic stenosis and increases primary patency of radial-cephalic fistulas for hemodialysis

“…Indeed, radial artery ligation was performed in all patients for AVF access in its original description by Röhl at al, 2 resulting in the exact hemodynamic configuration of RADAR. Ligation and radial artery transposition are mainly performed to reduce high flow (>1500 mL/min) and steal syndrome, even in pediatric patients, [29][30][31] and are safe in the presence of a patent ulnar artery and a palmar arch free from major calcification. These criteria were retained as prerequisites for RADAR.…”

Effectiveness of surgical banding for high flow in brachial artery-based hemodialysis vascular access

“…Conversely, alternative procedures, such as RUDI, proximal radial artery ligation, or radial artery transposition, may be more appropriate for an elbow artery-based HFA in these young patients. 3,[23][24][25] Long-term data after these alternative approaches must be awaited. However, banding may still be considered in elderly comorbid patients who are poor candidates for a flow-reducing technique that requires general anesthesia.…”

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

“…One high-flow fistula was reduced by transposition of the radial artery. 17 Six patients required percutaneous transluminal angioplasty (PTA) to maintain patency; four patients had one PTA and two patients had three.…”