Brachial vein transposition: an alternative to hemodialysis arteriovenous graft

Superficial femoral vein transposition as a solution for hemodialysis vascular access

The significant growth in the number of individuals dependent on hemodialysis for renal replacement therapy and unrestricted use of short and long-term catheters have challenged vascular surgeons in search of solutions for patients whose options for access via the upper limbs have been exhausted and for the increasing rates of central venous stenosis in these patients. When access via the upper limbs is impossible, exceptional techniques can be used and the lower limbs offer feasible alternative vascular access sites for hemodialysis. This article reports a case of superficial femoral vein transposition to make a loop arteriovenous fistula in a patient with no possibility of access via the upper limbs and presents a literature review on this technique that remains little used.

Superficial femoral vein transposition as a solution for hemodialysis vascular access

Abstract The significant growth in the number of individuals dependent on hemodialysis for renal replacement therapy and unrestricted use of short and long-term catheters have challenged vascular surgeons in search of solutions for patients whose options for access via the upper limbs have been exhausted and for the increasing rates of central venous stenosis in these patients. When access via the upper limbs is impossible, exceptional techniques can be used and the lower limbs offer feasible alternative vascular access sites for hemodialysis. This article reports a case of superficial femoral vein transposition to make a loop arteriovenous fistula in a patient with no possibility of access via the upper limbs and presents a literature review on this technique that remains little used.

Staged brachioradial artery to brachioradial vein arteriovenous fistula creation for hemodialysis access in three patients with a high origin of the radial artery

When patients lack suitable superficial veins in the upper extremity to create an arteriovenous fistula, surgeons are faced with a decision between a synthetic graft or autologous fistula using deep veins, such as a brachial artery to brachial vein arteriovenous fistula. In patients with a high radial artery origin (or brachioradial artery) and inadequate superficial veins, arteriovenous fistula creation will be even more challenging. In the present report, we describe a technique used in three such patients who underwent successful staged brachioradial artery to brachioradial vein arteriovenous fistula creation.

A systematic review of the brachial vein arteriovenous fistulas as a viable option for haemodialysis access

OBJECTIVES

International guidelines recommend the use of autogenous vascular access. Where suitable superficial veins are unavailable deeper veins may be used as an option. In most cases, basilic veins are used when cephalic veins are unavailable; arteriovenous fistulas using the brachial vein from the deep venous network are rare. Therefore, the purpose of the present study was to conduct a systematic review of the available literature evaluating the use of the brachial vein in arteriovenous fistulas.

METHODS

Systematic literature search of electronic databases in accordance with PRISMA was conducted. The primary outcomes of this study were primary and secondary patency rates for brachial vein arteriovenous fistulas; the secondary outcomes were the rates of access thrombosis, steal syndrome, pseudo-aneurysm and infection.

RESULTS

The 1-year primary, assisted, and secondary patency was recorded at (24%-77%), (45%-85%) and (45%-96%), respectively. The 2-year primary, assisted and secondary patency rate was recorded at (12%-46%), (19%-75%) and (19%-92%), respectively. However, the consistency regarding the reports and definitions used were highly variable. The incidence rate of infection, thrombosis and steal syndrome was 5% (0%-12%), 15.9% (9.5%-35%) and 3% (2%-6%), respectively.

CONCLUSION

Available studies support the use of brachial veins as a reliable access option in patients with non-accessible superficial veins where an autologous option is required.