The obtention of vascular access on the arm for hemodialysis

The chronic dialysis is the way of replacing the lost kidney function. Well functioning vascular access is the prerequisite for chronic hemodialysis treatment. The arteriovenous fistulas are the optimal form of vascular access. In patients, in whom the usual sites for fistula have been exhausted the vascular fistula on the arm was placed. 53 dialysis accesses were performed on the arm between 1989 and 1999. All subcutaneous fistulas were created by the junction of the cephalic vein with brachial artery, just above the cubital fossa on the anterior surface of the arm. All anastomoses were created in the operating room under local anesthesia. The preferred route for exposure of cephalic vein was making the single incision along the arm. When the distal part of cephalic vein has been ligated and divided, the adequate space for the graft in the tunnel was performed. End-to-end anastomosis between the distal end of vein and side of brachial artery was completed using the suture material. In 50 hemodialysed patients the regular flow through the arteriovenous fistula was observed. Fistula thrombosis occurred in 2 cases. In 4 examined patients we observed blood extravasation in the subcutaneous tissue, where the tunnel was created. In 5 patients the local cellulitis was noted. The late vascular complications were evaluated in 15 cases. Aneurysms were revealed clinically in 3 patients and false aneurysm occurred in 2 patients. The described late complications required no surgical correction. The anterior side of the arm is the best place for arteriovenous access used for hemodialysis, in patient without the possibilities of surgical creation of the forearm's fistula.