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Technical Aspects of the Mouse Aortocaval Fistula
Published on: July 11, 2013
Primary and staged transposition arteriovenous fistulas
Michael R Arroyo1, Matthew J Sideman, Lawrence Spergel
1Department of Surgery, University of Oklahoma College of Medicine, Tulsa, OK 74135, USA.
Journal of Vascular Surgery
|June 3, 2008
Summary
Transposition arteriovenous fistulas (AVF-T) offer a durable solution for patients with difficult vascular access. Both primary and staged AVF-T procedures, including those using the brachial vein, demonstrate high patency rates, avoiding risky catheters and grafts.
Area of Science:
- Vascular Surgery
- Nephrology
- Dialysis Access
Background:
- Arteriovenous fistulas (AVF) are preferred for vascular access over catheters or prosthetic grafts due to lower risks and costs.
- Patients with challenging access extremities often have complex medical histories, necessitating alternative surgical approaches.
- Transposition AVFs (AVF-T) are utilized to circumvent the need for grafts or catheters in high-risk patients.
Purpose of the Study:
- To evaluate the efficacy and outcomes of primary and staged basilic vein and brachial vein transposition arteriovenous fistulas (AVF-T).
- To assess the durability and patency rates of AVF-T in patients with difficult vascular access.
- To determine the suitability of the brachial vein as an alternative for AVF-T when the basilic vein is inadequate.
Main Methods:
- A retrospective review of 78 upper extremity AVF-T procedures performed between May 2003 and September 2006.
- Primary AVF-T utilized basilic veins ≥4 mm; staged procedures were employed for basilic veins measuring 2.5-4 mm or when unsuitable.
- Brachial vein AVF-T was performed as a staged procedure when the basilic vein was not viable, with preoperative ultrasound assessment.
Main Results:
- Of 78 AVF-T procedures, 57 patients (73.1%) were female, 44 (56.4%) were diabetic, and 46 (59.0%) had prior access surgery.
- Sixty-eight procedures used the basilic vein, six used the brachial vein, and four used the cephalic vein, with inflow from the proximal radial artery in 60 cases.
- Twelve-month primary, assisted primary, and cumulative patency rates were 45.7%, 93.5%, and 96.0%, respectively; 24-month rates were 27.6%, 86.5%, and 88.9%.
Conclusions:
- Primary and staged AVF-T are effective in patients with difficult access extremities, offering durable vascular access.
- AVF-T procedures demonstrated high cumulative patency rates (96.0% at 12 months, 88.9% at 24 months), though some required interventions.
- The brachial vein serves as a viable alternative for staged AVF-T when the basilic vein is not suitable, expanding treatment options.
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